Biomarkers of Preeclampsia

Preeclampsia is a multifaceted disorder related to pregnancy. In order to assess the predictive value of different biomarkers related to it; and finally proposing the best marker for routine use in clinical settings for its screening; this study has been undertaken. Screening, the deliberate examination of substantial segments of the population in search for disease at its earliest stages, is a logical extension of the role of preventive medicine and one that is becoming...
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Preeclampsia is a multifaceted disorder related to pregnancy. In order to assess the predictive value of different biomarkers related to it; and finally proposing the best marker for routine use in clinical settings for its screening; this study has been undertaken.
Screening, the deliberate examination of substantial segments of the population in search for disease at its earliest stages, is a logical extension of the role of preventive medicine and one that is becoming increasingly popular. Ideally a screening test should be inexpensive, easy to perform, readily interpretable and readily available to the entire population at risk. Also a screening test for the entire population must be acceptable to the population.
Ongoing research shows abundant evidence that the pathophysiological changes of Preeclampsia were present long before the clinical presentation of the disorder, which probably explains why all the management of Preeclampsia are only palliative till delivery. This indicates that for an effective therapy to be successful, the therapy has to be instituted before clinically evident disease.
The study can be concluded as follows:

• In the present study the Urinary Calcium/Creatinine Ratio in asymptomatic normotensive pregnant women in second trimester had been measured and followed them up to the delivery. The statistical analysis of the results showed that there lies a very significant relationship between low Urinary Calcium/Creatinine Ratio and the development of Preeclampsia later in pregnancy.
• In the present study the Serum levels of Calcium, Magnesium and Uric acid in preeclamptic women had been measured and compared those with normal pregnant women in third trimester. Based on the results of the present study and data available from literature, it is clear that in Preeclampsia, the Serum levels of Calcium and Magnesium were found lower than normal while Serum Uric acid levels were higher indicating the possible role of these biomarkers in the pathophysiological of Preeclampsia.

• We have developed a predictive model for screening Preeclampsia and subgroups at increased risk in which prior therapy might be indicated to prevent maternal and perinatal morbidity and mortality.

Thus predictors of Preeclampsia with high sensitivity and moderate specificity will be useful initially in the conduct of clinical trials and perhaps eventually for therapy in future.
Spot Urinary Calcium/Creatinine Ratio is simple, cheap and easy to perform, noninvasive, specific and sensitive; which could also add up the diagnostic predictability of Preeclampsia. The role of Calcium/ Creatinine Ratio appears to be significant & it may be used as additional marker for Preeclampsia in Antenatal care (ANC) profile. Therefore, we recommend that analysis of spot Urinary Calcium/Creatinine Ratio may be an effective screening method for impending Preeclampsia and useful to identify population at greater risk. So, it could be included in primary prevention programs.

Serum Calcium, Magnesium and Uric acid levels should also be estimated as a part of Secondary prevention programs in diagnosed cases of Preeclampsia to prevent further complications.
Laboratory facilities should be developed at Primary health centre level for Spot urine examination for above mentioned markers to prevent disease and its comorbidities.