PRECLAMPSIA

Preeclampsia is a multisystem disorder of pregnancy characterized by the presence of hypertension and proteinuria after 20 weeks gestation. While estimated to affect only 3%–5% of all pregnancies in the U.S., the disorder is responsible for 15% of premature deliveries and up to 18% of maternal deaths. In fact, complications from hypertension in pregnancy are the third leading cause of maternal death, surpassed only by embolism and hemorrhage. Other risks associated with preeclampsia include placental abruption, liver or renal failure, disseminated intravascular coagulopathy, cardiovascular complications, and seizures or other neurological manifestations (eclampsia).

The incidence of preterm birth is also higher in preeclamptic women, primarily because obstetricians attempt to minimize the risks to both the mother and fetus by delivering the fetus early. However, preterm infants are at risk of complications as well. They have a greater probability of developing respiratory distress syndrome, intraventricular hemorrhage, cerebral palsy, and other neurological and developmental delays. In women whose preeclampsia is caused by placental anomalies, severe intrauterine fetal growth restriction may occur, leading to higher prevalence of intrauterine asphyxia and placental abruption.

Despite being well recognized as a complication of pregnancy, many unknowns still surround prediction, diagnosis, and pathophysiology of preeclampsia, earning it the common name, “disease of theories.” Efforts to lessen the risks associated with preeclampsia have been focused on accurate and earlier diagnosis of the disorder. New biomarkers for predicting and possibly preventing preeclampsia promise to give the laboratory a major role in the care of at-risk pregnant women. Here we describe the current understanding of the etiology of preeclampsia, the lab’s current role in monitoring at-risk women, as well as how new biomarkers on the horizon may lead to greater involvement of the lab in earlier prediction of the condition.