Preeclampsia, a complex pregnancy disorder, is marked by the onset of hypertension after 20 weeks of gestation. This condition manifests through various symptoms such as proteinuria, severe headaches, and visual disturbances. In severe cases, preeclampsia can be life-threatening for the mother and poses significant risks to the fetus, including growth retardation, hypoxia, and preterm birth.

The precise cause of preeclampsia remains elusive. However, it is believed that abnormal placental development and immune response play crucial roles. Additional risk factors include heredity, maternal age, obesity, and pre-existing medical conditions such as diabetes and hypertension. The early detection and management of preeclampsia are critical, highlighting the importance of regular prenatal care. Routine prenatal examinations typically include blood pressure measurements, urinalysis, and fetal health assessments. but these are not sufficient and more means of identifying preeclampsia are needed.

One promising avenue for early detection of preeclampsia is the use of biomarkers. Given that preeclampsia is associated with impaired angiogenesis, several angiogenic factors are considered significant in its early diagnosis. Studies have indicated a decrease in pro-angiogenic factors such as placental growth factor (PlGF) and vascular endothelial growth factor (VEGF), coupled with an increase in anti-angiogenic factors like soluble fms-like tyrosine kinase (sFlt-1) and soluble endoglin (sEng).

sFlt-1 is known to cause endothelial dysfunction [1], and its primary source is the placenta, with elevated levels observed in women with preeclampsia [2]. PlGF, crucial for placental development in early pregnancy [3], typically increases as pregnancy progresses; however, it decreases in women with suspected preeclampsia [4]. sEng, an anti-angiogenic factor, is elevated in preeclampsia and facilitates early prediction of the condition [5]. Glycoprotein pregnancy-associated plasma protein-A (PAPP-A) [6] and Placental protein 13 (PP-13) [7]are reported to predict early-onset preeclampsia. While promising as preeclampsia predictors, these factors have not been established in all patients.

Notably, the sFlt-1/PlGF ratio has been found to be a reliable predictor among women with suspected preeclampsia. Specifically, an sFlt-1/PlGF ratio of less than 38 can effectively rule out preeclampsia, a ratio between 38 and 84 indicates a high risk for preeclampsia, and a ratio of 85 and above can predict the development of preeclampsia and its associated complications [8, 9].

To explore the role of angiogenic factors in predicting preeclampsia, a longitudinal study was conducted involving 1154 singleton pregnant women recruited from two hospitals [10]. Blood and plasma samples were collected at four key points during pregnancy: 11–14 weeks, 18–22 weeks, 26–28 weeks, and at delivery. The study included 108 women diagnosed with preeclampsia and 216 matched controls. The potential diagnostic value of these biomarkers was assessed using ROC curves, which demonstrated that sEng levels and the sEng/PlGF ratio were significantly correlated with the odds of developing preeclampsia at all measured time points.

The study’s findings revealed specific cut-off values for predicting early-onset preeclampsia: 33.5 for the sFlt-1/PlGF ratio and 25.9 for the sEng/PlGF ratio. Additionally, the sEng/PlGF ratio emerged as a new biomarker capable of predicting preeclampsia in early pregnancy. This multi-time-point analysis from early pregnancy stages provides a more comprehensive understanding of these biomarkers’ predictive capabilities, suggesting their potential greater clinical value in real-world practice.

The implications of these findings are significant. By identifying and validating reliable biomarkers for early prediction, healthcare providers can better monitor and manage at-risk pregnancies, potentially improving outcomes for both mothers and infants. Future research should focus on integrating these biomarkers into clinical practice, refining the predictive models, and evaluating their effectiveness in diverse populations. Such advancements could lead to more personalized and timely interventions, ultimately reducing the incidence and severity of preeclampsia and its associated complications.