Photo Credit: AndreyPopov
Recent preeclampsia studies have investigated predictors such as placenta location and PAPP-A, in addition to comparing the P/C ratio with 24-hour proteinuria.
Various studies and analyses have been published in the last several months regarding preeclampsia screening and management. This round-up includes the latest insights across three journals.
Placenta Location Predicts Preeclampsia
In a case-control study published in BMC Pregnancy and Childbirth,1 researchers performed ultrasounds on 206 women and identified several factors predicting preeclampsia.
“This study identified anterior placental location, increased maternal age, and BMI above 25 kg/m² as significant predictors of preeclampsia. These findings suggest that healthcare professionals should closely monitor pregnant women with anteriorly located placentas, advanced age, or elevated BMI. Regular BP monitoring and urine protein screening for patients with anterior placental location could facilitate early diagnosis and management of preeclampsia. While posterior placental location showed a potential association, it was less consistent, and further research is needed to confirm its role.” –Mahsa Geravandi, of the Isfahan University of Medical Sciences, and colleagues.
PAPP-A for Preeclampsia Screening
In a systematic review and meta-analysis published in The Journal of Maternal-Fetal & Neonatal Medicine,2 researchers evaluated 22 studies of pregnant women and concluded that pregnancy-associated plasma protein A (PAPP-A) was significantly lower in women with preeclampsia.
“First-trimester screening using biomarkers like PAPP-A, combined with other clinical factors such as maternal characteristics and uterine artery Doppler results, can help identify high-risk women early in pregnancy. Once at-risk individuals are identified, timely interventions, such as the administration of low-dose aspirin before 16 weeks of gestation, can significantly reduce the incidence of preeclampsia, particularly in women with low PAPP-A levels. Additionally, close monitoring of high-risk pregnancies throughout gestation is essential to detect signs of preeclampsia early and implement appropriate management strategies, including BP control and the use of antihypertensive medications. Protocols should also include educating patients on lifestyle modifications and regular prenatal care, with an emphasis on monitoring for early signs of preeclampsia, to further mitigate risks and improve maternal and fetal outcomes.”—Ismini Tzanaki, MD, of the European University Cyprus, and colleagues.
P/C Ratio vs 24-Hour Proteinuria
A retrospective study published in the Journal of Gynecology Obstetrics and Reproduction3 determined that a proteinuria/creatininuria (P/C) ratio of at least 300 mg/mmol showed strong agreement with 24-hour proteinuria of at least 3 g for preeclampsia prognostication.
“Clinically, the strong agreement between the P/C ratio and the 24-hour proteinuria measurement suggests that the P/C ratio can be a reliable and faster alternative for assessing the severity of preeclampsia. This could lead to more timely and effective management of preeclampsia, reducing the need for prolonged urine collection and the associated delays in treatment. Additionally, 24-hour urine collection can be particularly uncomfortable and burdensome for pregnant women, especially in the third trimester, as it requires them to collect and store urine in a container over a full day. Altogether, incorporating the P/C ratio into clinical practice could improve patient care, particularly in settings where rapid decision-making is crucial.”—Victoire de Logivière, of the Paris Cité University, and colleagues.
