From first-trimester screening to risk stratification of evolving pre-eclampsia in second and third trimesters of pregnancy : comprehensive approach

Pre-eclampsia and associated hypertensive disorders of pregnancy are leading causes of maternal and perinatal morbidity and mortality worldwide and, currently, the only treatment is delivery. However, the ability to identify those women at high risk of developing preterm pre-eclampsia in early pregnancy, who would benefit from administration of low-dose aspirin, has the potential to reduce significantly the rate of preterm pre-eclampsia. In addition, follow-up of these women in the second and third trimesters of pregnancy, and effective risk stratification to identify women who require more intensive surveillance, will aid with early detection of pre-eclampsia, enabling referral to specialist centers and timely delivery and liaison with the neonatal team, if necessary. This is expected to improve clinical maternal and neonatal outcomes. Angiogenesis-related biomarkers – sFlt-1 and PlGF – have been shown to have clinical value, aiding in the prediction, diagnosis and risk stratification of pre-eclampsia. In this Opinion paper, we have outlined the evidence demonstrating the clinical value of sFlt-1 and PlGF, in combination with maternal factors and/or other biomarkers, throughout the duration of pregnancy. Based on the available evidence, we have outlined a potential model to link first-trimester screening for preterm pre-eclampsia with appropriate pre-eclampsia management strategies in the second and third trimesters of pregnancy. Further clinical trials are needed to demonstrate the benefits of such a strategy, in terms of perinatal and maternal risk reduction and resource optimization.