Preeclampsia – A Modern View to the Problem, Methods of Prognosis and Early Diagnosis Based on Clinic?-Genetic Predictors

Abstract

Preeclampsia (PE) is a disease that continues to be the main cause of maternal and fetal mortality and complications in 5-8% of pregnancies, Preeclampsia develops after 20 weeks of pregnancy and is characterized by hypertension and proteinuria. According to WHO, hypertension during pregnancy is the cause of 9 to 25 per cent of all maternal mortality, but accurate data are difficult to determine. In addition to the fact that PH is one of the leading causes of maternal and perinatal mortality, this disease and its complications cause a range of medical problems. Placental growth factor (PIGF) is relevant for healthy pregnancy, and abnormalities in PIGF functions have been associated with hypertensive disorders of pregnancy. Our group recently demonstrated that PIGF genetic polymorphisms affect the susceptibility to preeclampsia (PE).

Research objectives: To improve the prognosis and early diagnosis of preeclampsia based on clinico-genetic and endothelial predictors for the purpose of rational management of patients with preeclampsia, reducing maternal and perinatal mortality.

Methods: We examined 165 pregnant women aged 18 to 40 years with a physiological course of pregnancy observed in the 2,3,4 maternity complexes of Samarkand (11-40 weeks). The concentration of PIGF and sFlt-1 in the blood serum of pregnant women was determined using Elecsys PIGF and Elecsys sFlt-1 electrochemiluminescent diagnostic test systems of the Hoffmann La Roche concern (Switzerland) on a Cobas e411 automatic analyzer of the same company. Total genomic DNA was isolated from 100 l of whole venous blood by the sorbent method using the set "Proba-GS Genetics", NP-480-100 (AGTR1_1166 rs5186), NP-476-100 (AGTR2 G1675A rs1403543); for endothelial nitric oxide synthetase, 3 sets were used: NP-554-100 (eNOS_786 rs 2070744), NP-555-100 (eNOS_774 rs 1549758), NP-419-100 (eNOS_298 1799983); single-nucleoid polymorphisms were detected by real-time polymerase chain reaction using the above sets.

Results: Thus, based on the performed study, it was found that concentrations of PIGF, sFlt-1 and their ratio values are highly informative indicators of preeclampsia, and the reference intervals of PIGF, sFlt-1 concentrations and their ratio values can be used as "standards". In addition, the determination of the concentration of these markers and the calculation of their ratio should be carried out in the first and second trimesters of pregnancy as part of screening programs for the diagnosis of intrauterine fetal pathology. The determination of preeclampsia markers at the end of the second and third trimester of pregnancy can serve as a basis for the final diagnosis of preeclampsia and the development of tactics for prolonging pregnancy.