**7. Outlook**

All biophysical and biochemical markers shown are used for prediction of preeclampsia. Meanwhile it has been obvious that a single diagnostic marker is not strong enough to accurately assume subsequent preeclampsia. Based on this reason, seemingly it is convincing to use historical, biophysical, and several biochemical parameters to ascertain the best possible detection rate is achieved.

Finally, one must distinguish between early- and late-onset preeclampsia in order to classify the present results correctly. The early-onset preeclampsia is defined as the onset before 34 weeks of pregnancy, the intermediate-onset preeclampsia between the 34 and 37 weeks, and the late-onset preeclampsia after 37 weeks. The late-onset PE seems to follow a different pathogenetic mechanism, since the serum parameters differ significantly as a marker of disturbed placentation in terms of predictive power [34]. The placentation disorder, according to previous published data, is a feature of early preeclampsia. The addition of biochemical markers in the first trimester is therefore particularly suitable for detection of early preeclampsia.

Poon et al. pioneered the evaluation of a few serum parameters and maternal factors in order to achieve a good predictive power of early preeclampsia. The detection rate of early-onset PE is 93.1% in the first trimester by algorithms from maternal risk factors, mean arterial blood pressure, pulsatility index of the uterine arteries, PAPP-A, and PlGF. The detection rate for the late-onset PE with an appropriate algorithm is 44.9% [34].

These named parameters can now be purchased commercially and combined with appropriate software. Akolekar et al. found that the detection rate of preeclampsia in the first trimester by a combination of several markers (PIGF, PAPP-A, PP13, inhibin A, activin A, sEndoglin, PTX3, P-selectin, blood pressure, Doppler sonography, and history) is increased significantly to a detection rate of 91% at a fixed 5% false-positive rate for early-onset PE, 79.4% for intermediate-onset PE (34–37th weeks of gestation), and 60% for late-onset PE [60]. The addition of these parameters allows a better predictive power of all forms of preeclampsia compared to the above-described relatively simple algorithm, having particular effect on a high detection rate for early-onset preeclampsia.

Further studies are expected that show which of the biochemical markers are really useful in clinical practice. The relation of costs and benefit must be explored.

Finally, the question arises that how far it may succeed in establishing the firsttrimester screening tests with the consecutive possible prevention by aspirin and/or low-molecular-weight heparin, as a screening in a large, unselected collective. Since

**29**

**8. Conclusion**

*Risk Factor and Biomarker of Preeclampsia DOI: http://dx.doi.org/10.5772/intechopen.85173*

prevention is simple and inexpensive, the obstacle is much more on a personal and cost-intensive screening tool. The investigation regarding chromosome abnormalities will depend on the basis of the consequences of abnormal test results of many factors and is always carried out only in a preselected group. Examining on preeclampsia should be for a much larger group of pregnant women, not at least because of the higher risk to get preeclampsia as a chromosomal abnormal baby and the simplicity of prophylaxis. The other essential reason for early preeclampsia risk estimation is the fact that preeclamptic pregnant women have a bigger lifetime risk for suffering heart and blood vessel disease. Better observation of this collective of patients, changing of lifestyle factors, and health education could be an important step to reduce morbidity

Currently, the aspect of fetal programming is in the main focus of research. Not only the mother also the offspring bears the consequences of preeclamptic pregnancy with mostly intrauterine growth restriction like elevated risk for cardio-

It would be desirable in the future to integrate preeclampsia risk calculation to the regular prenatal care in the first trimester. Further studies on large collectives have to determine to what extent the false-positive and false-negative findings can lead in relation to health and economic disadvantages. Even an early screening

Finally, pregnancy is not only a short time in a woman's life with the aim to deliver a baby but it is also an important time giving insights in women's health status. As we already know, pregnancy may positively influence women's health future as could be shown by studies which detected a reduced risk of developing breast cancer after pregnancy. As an indicator of risk factors, pregnancy is not only

To conclude, the best possible detection rate of preeclampsia seems to be convincing to apply historical, biophysical, and several biochemical parameters. A detailed medical history such as diabetes mellitus, assisted reproductive techniques, increase body mass index, family background, multiple pregnancy, pregnancy over 40 years, previous renal problem, and clotting disorder. The collection of biophysical parameters such as blood pressure, arterial stiffness, and Doppler examination of maternal blood vessels. The determination of biochemical parameter such as angiogenic factors PIGF, sFlt-1, PAPP-A, inhibin A, activin A, PP13, PTX3, P-selectin, IGFBP-1

the beginning of taking care for a family but also for a better self-care [77].

and IGFBP-3, adiponectin, resistin, l-arginine, ADMA, and homoarginine.

and mortality according to cardiovascular problems worldwide.

vascular diseases and behavioral disorders, for example.

should not replace careful pregnancy monitoring.

#### *Risk Factor and Biomarker of Preeclampsia DOI: http://dx.doi.org/10.5772/intechopen.85173*

*Prediction of Maternal and Fetal Syndrome of Preeclampsia*

**6.10 Resistin**

**7. Outlook**

priate algorithm is 44.9% [34].

high detection rate for early-onset preeclampsia.

is no relationship between adiponectin and PAPP-A levels and Doppler values. In addition, there is no advantage in prediction by the addition of adiponectin [75].

sia than controls. There is no relationship to impaired placental perfusion [75].

**6.11 l-Arginine, asymmetric dimethylarginine (ADMA), and homoarginine**

All biophysical and biochemical markers shown are used for prediction of preeclampsia. Meanwhile it has been obvious that a single diagnostic marker is not strong enough to accurately assume subsequent preeclampsia. Based on this reason, seemingly it is convincing to use historical, biophysical, and several biochemical

to classify the present results correctly. The early-onset preeclampsia is defined as the onset before 34 weeks of pregnancy, the intermediate-onset preeclampsia between the 34 and 37 weeks, and the late-onset preeclampsia after 37 weeks. The late-onset PE seems to follow a different pathogenetic mechanism, since the serum parameters differ significantly as a marker of disturbed placentation in terms of predictive power [34]. The placentation disorder, according to previous published data, is a feature of early preeclampsia. The addition of biochemical markers in the first trimester is therefore particularly suitable for detection of early preeclampsia. Poon et al. pioneered the evaluation of a few serum parameters and maternal factors in order to achieve a good predictive power of early preeclampsia. The detection rate of early-onset PE is 93.1% in the first trimester by algorithms from maternal risk factors, mean arterial blood pressure, pulsatility index of the uterine arteries, PAPP-A, and PlGF. The detection rate for the late-onset PE with an appro-

Finally, one must distinguish between early- and late-onset preeclampsia in order

These named parameters can now be purchased commercially and combined with appropriate software. Akolekar et al. found that the detection rate of preeclampsia in the first trimester by a combination of several markers (PIGF, PAPP-A, PP13, inhibin A, activin A, sEndoglin, PTX3, P-selectin, blood pressure, Doppler sonography, and history) is increased significantly to a detection rate of 91% at a fixed 5% false-positive rate for early-onset PE, 79.4% for intermediate-onset PE (34–37th weeks of gestation), and 60% for late-onset PE [60]. The addition of these parameters allows a better predictive power of all forms of preeclampsia compared to the above-described relatively simple algorithm, having particular effect on a

Further studies are expected that show which of the biochemical markers are really useful in clinical practice. The relation of costs and benefit must be explored. Finally, the question arises that how far it may succeed in establishing the firsttrimester screening tests with the consecutive possible prevention by aspirin and/or low-molecular-weight heparin, as a screening in a large, unselected collective. Since

parameters to ascertain the best possible detection rate is achieved.

Resistin levels in the first trimester are higher in patients who develop preeclamp-

All three substances are part of NO metabolism. l-Arginine and l-homoarginine are increased in the first trimester at later-developing early-onset preeclampsia, as well as the ratio of ADMA/l-arginine and ADMA/L-homoarginine. This is not the case for late-onset preeclampsia and for the isolated analysis of ADMA [76].

**28**

prevention is simple and inexpensive, the obstacle is much more on a personal and cost-intensive screening tool. The investigation regarding chromosome abnormalities will depend on the basis of the consequences of abnormal test results of many factors and is always carried out only in a preselected group. Examining on preeclampsia should be for a much larger group of pregnant women, not at least because of the higher risk to get preeclampsia as a chromosomal abnormal baby and the simplicity of prophylaxis. The other essential reason for early preeclampsia risk estimation is the fact that preeclamptic pregnant women have a bigger lifetime risk for suffering heart and blood vessel disease. Better observation of this collective of patients, changing of lifestyle factors, and health education could be an important step to reduce morbidity and mortality according to cardiovascular problems worldwide.

Currently, the aspect of fetal programming is in the main focus of research. Not only the mother also the offspring bears the consequences of preeclamptic pregnancy with mostly intrauterine growth restriction like elevated risk for cardiovascular diseases and behavioral disorders, for example.

It would be desirable in the future to integrate preeclampsia risk calculation to the regular prenatal care in the first trimester. Further studies on large collectives have to determine to what extent the false-positive and false-negative findings can lead in relation to health and economic disadvantages. Even an early screening should not replace careful pregnancy monitoring.

Finally, pregnancy is not only a short time in a woman's life with the aim to deliver a baby but it is also an important time giving insights in women's health status. As we already know, pregnancy may positively influence women's health future as could be shown by studies which detected a reduced risk of developing breast cancer after pregnancy. As an indicator of risk factors, pregnancy is not only the beginning of taking care for a family but also for a better self-care [77].
