Revolutionary preeclampsia screening test could be available within a year

4 minute read


It’s a simple blood test which detects both early-onset and term preeclampsia months before the conditions develop.


Early-onset preeclampsia can be detected up to 18 weeks earlier than clinical diagnosis, and late-onset nearly 15 weeks earlier, according to a study recently presented at the annual European Society of Human Reproduction and Embryology conference.

The research not only has the potential to revolutionise preeclampsia screening but may also hint at the molecular mechanisms underpinning preeclampsia, which could open new avenues for treatment and research.

“With validation and regulatory efforts already underway, we anticipate that cfRNA-based screening could become available in clinical practice within the next year, offering an unprecedented opportunity for early, non-invasive identification of high-risk pregnancies and timely intervention,” Dr Tamara Garrido, molecular biologist and senior principal investigator at the Carlos Simon Foundation, told press.

Researchers enrolled more than 9000 pregnant women across Spain between September 2021 and June 2024. More than 500 plasma samples were collected at various timepoints during pregnancy (9–14 weeks, 18–28 weeks, and >28 weeks or at diagnosis) from a nested case-control group of over 200 participants.

From this, cfRNA “signatures” were identified. These were subtle molecular signals from various maternal tissues such as the uterus and placenta found months before preeclampsia developed.

As current standard first-trimester screening relied on maternal risk factors or placental biomarkers, more than half of impending cases were missed and risk was often only detected after preeclampsia was already developing, the researchers said.

The cfRNA model predicted early-onset preeclampsia in the first trimester with an 83% sensitivity, 90% specificity, and an AUC of 0.88, on average 18 weeks before diagnosis.

“Identifying high-risk pregnancies this early opens a crucial window for preventive treatment and closer monitoring to protect mothers and babies,” postdoctoral researcher at iPremom and study author, Dr Nerea Castillo Marco, said to media.

Associate Professor Scott White, RANZCOG Women’s Health Committee Chair, told TMR that this test could more accurately detect preeclampsia risk than standard pregnancy screening methods.

“The current testing that we do is good, but it sounds like this one is probably going to have a lower false positive rate,” he said.

He said the simple blood test would be part of routine early pregnancy screening and a positive result for early-onset preeclampsia would be an indication to start low dose aspirin, which was very effective at preventing preeclampsia but had to be started by about 15 weeks’ gestation.

“The challenge with term preeclampsia is that even if we know who’s at risk, we don’t have any treatment,” Professor White said.

But the benefit of the test was that it could funnel those likely to develop late-onset preeclampsia into a high-risk model of care, he said.

Professor White said that thanks to the high level of sensitivity and specificity of the test, it could also fairly definitively rule out people who won’t have the condition.

This was particularly important for women in rural areas. Knowing they’re likely to need more care and intervention than they have geographical access to would give them the opportunity to make alternate arrangements ahead of time, he said. 

The Spanish research supports the theory that uterine dysfunction plays a key role in early-onset preeclampsia.

Nearly half of the predictive transcripts were linked to genes associated with decidualisation resistance of the maternal endometrium, which is where uterine lining fails to adapt to early pregnancy.

The late-onset preeclampsia signature had very few decidualisation-related transcripts, confirming that early-onset and late-onset are biologically and temporally distinct conditions with unique cfRNA signatures, the researchers said.

Dr Marco explained that early-onset preeclampsia appeared to involve widespread molecular changes across multiple organs, including liver, kidney, placenta, brain and lungs, while late-onset displayed more localised patterns, specifically in immune and hepatic pathways.

Professor White highlighted the importance of clinician education in preeclampsia management and pointed to the RANZCOG guidelines for doctors who wanted to familiarise themselves with the latest advice.

The study abstract is set to be published in Human Reproduction.

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