Comparison of the Predictive Value of Blood and Urine Biomarkers During Pregnancy for the Risk of Preterm and Term Pre-Eclampsia.

Background and Objectives: Pre-eclampsia (PE) is an obstetric complication defined by placental insufficiency, including intrauterine growth restriction and placental abruption. Timely and accurate detection and treatment of pre-eclampsia are difficult because its diagnostic criteria are still based on nonspecific signs and symptoms and because the association between common severity criteria, and unfavorable outcomes for mother and fetus remain unclear. Therefore, the aim of this study was to evaluate the potential use of blood and urine PE risk markers-soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), sFlt-1/PlGF ratio, and albumin/creatin ratio-in predicting and managing PE in groups at risk for preterm and term PE (gestational weeks 24-37) and to correlate the levels of blood and urine PE markers with pregnancy outcome indicators. Materials and Methods: This study was conducted at the Department of Obstetrics and Gynecology and at the Center of Laboratory Diagnostics and Nuclear Medicine, University Clinical Center of Vojvodina. This study included 166 pregnant women (GW 24-37) divided into two groups: study group P (n = 52), consisting of pregnant women who were identified as a high-risk group for PE according to clinical signs and medical history and who subsequently developed PE; control group C (n = 114), consisting of pregnant women who had risk factors in their medical history but did not eventually develop PE symptoms. The evaluated parameters included two groups: blood and urine PE risk indicators-biochemical markers such as PlGF, sFlt-1, and sFlt-1/PlGF ratio; urine risk indicators such as albumin/creatine ratio; and pregnancy outcome indicators-gestational age of delivery (GW) and neonatal birth weight (NW). Results: The results of the analysis support that the PE risk biochemical indicators (PlGF, sFlt-1, sFlt-1/PlGF ratio, and albumin/creatine ratio) show statistically significant differences between the analyzed groups, that they correlate with PE occurrence, and that they have good predictive value. As expected, sFlt-1/PlGF ratio and albumin/creatine ratio, as the most valuable PE risk indicators, show good predictive value. However, our results also demonstrate that pro- and antiangiogenic indicators alone, especially sFlt-1 (high values), may play roles in risk evaluation and prediction of preterm and term PE (GW 24-37). Conclusions: In our study, all evaluated blood and urine indicators (PlGF, sFlt-1, sFlt-1/PlGF ratio, and albumin/creatine ratio) show high predictive value for PE in a PE risk group of pregnancies between GW 24 and 37. The results suggest that sFlt-1 alone has equal predictive value to sFlt-1/PlGF ratio and outperformed PlGF in predicting PE onset. The combined use of pro- and antiangiogenic biochemical markers, indices, and urine markers in blood, together with patient history and clinical parameters, shows potential as a more effective means of predicting PE than a single biochemical parameter such as sFlt-1/PlGF ratio.