Preeclampsia – Prediction and Monitoring Factors

Abstract

Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality, usually characterized by hypertension and proteinuria. Despite high incidence of preeclampsia the pathophysiological basis of preeclampsia is still not clear and there are a number of mechanisms and signaling pathways that intertwine. It is very important to develop specific and reliable predictive algorithms in order to enable early initiation of therapy due to facts that incidence of preeclampsia has upward trend and that cause adverse maternal and fetal outcome. Some of the most commonly used methods for prediction of preeclampsia include uterine artery Doppler velocimetry, determination of some microRNA, such as miR-210, and assessment of various pro-angiogenic and anti-angiogenic factors from blood. Angiogenic factors that possibly have most important role in pathogenesis of preeclampsia are vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), which promote angiogenesis, and soluble fms-like tyrosine kinase-1 (sFlt1) and soluble form of endoglin (s-Eng), which exhibit anti-angiogenic properties. Aggravating circumstance is that preeclampsia has heterogeneous origin, and due to this fact, the value of individual markers can vary significantly. There is a constant tendency for creating comprehensive algorithm for prediction of preeclampsia which would be sufficiently specific and sensitive, and in the same time cheap and available. In that sense, new clinical studies are needed to show the most effective combination of parameters in the predeclampsia prediction.

Alternate abstract:

Preeklampsija je jedan od vodećih uzroka materinskog i perinatalnog morbiditeta i mortaliteta, koju najčešće karakterišu hipertenzija i proteinurija. Uprkos visokoj incidenciji patofiziloška osnova preeklampsije nije dovoljno jasna i postoji veliki broj mehanizama i signalnih puteva koji se međusobno prepliću. Vrlo je važno razviti specifične i pouzdane algoritme za predviđanje preeklampsije kako bi se omogućilo rano započinjanje terapije u skladu sa činjenicom da incidencija preeklampsije ima uzlazni trend i uzrokuje neželjeni maternalni i fetalni ishod porođaja. Neki od najčešćih metoda koje se koriste za predviđanje nastajanja preeklampsije podrazumevaju Dopler uterine arterije, određivanje pojedinih mikroRNK, poput miR-210, kao i određivanje različitih proangigenih i antiangiogenih faktora iz periferne krvi. Angiogeni faktori koji možda imaju najznačajniju ulogu u patogenezi preeklampsije su vaskularni endotelni factor rasta (VEGF) i placentalni factor rasta (PlGF), koji pospešuju angiogenezu, i solubilna fms-slična tirozin kinaza-1 (sFlt1) i solubilni oblik endoglina (s-Eng), koji ispoljavaju antiangiogena svojstva. Otežavajuća okolnost je činjenica da preeklampsija ima heterogeno poreklo, i u skladu sa tim vrednosti pojedinih markera mogu znatno da variraju. Postoji konstantna težnja za stvaranje sveobuhvatnog algoritma za predviđanje nastajanja preeklampsije koji bi bio dovoljno specifičan i senzitivan, a u isto vreme jeftin i dostupan. U tom smislu, potrebne su nove kliničke studije kako bi se obrazovala najefikasnija kombinacija parametara za predviđanje nastajanja preeklampsije.