A simple blood test could help doctors identify women in labor who are at risk for preeclampsia—a leading cause of maternal death—and take precautions to prevent it, according to research presented at the ANESTHESIOLOGY® 2024 annual meeting.
Between 5% and 10% of pregnant women develop preeclampsia (sudden high blood pressure and protein in the urine), according to the Centers for Disease Control and Prevention (CDC). Black women are 60% more likely to develop preeclampsia than white women and are more likely to experience serious outcomes, such as kidney damage. While preeclampsia can develop as early as the 20th week of pregnancy, this study focused on identifying women at risk upon their admission to the hospital in labor.
Researchers found that doctors could predict a woman’s risk of developing preeclampsia by calculating the ratio of two blood proteins—fibrinogen and albumin—measured in routine blood tests performed when women in labor enter the hospital. Fibrinogen is involved in blood clotting and inflammation, while albumin helps maintain fluid balance and carries hormones, vitamins, and enzymes throughout the body. Both proteins can be disrupted in preeclampsia, with fibrinogen potentially elevated, albumin reduced, or both occurring simultaneously.
Currently, there is no universally established normal value for the fibrinogen-to-albumin ratio (FAR), which can range from 0.05 to 1 or higher. Higher FAR values are often associated with increased inflammation, infection, or serious health conditions, with greater values indicating a greater concern. This trend has been consistently observed when FAR is used to evaluate other inflammatory conditions, such as rheumatoid arthritis, cardiovascular diseases, and inflammatory bowel disease.
In the study, researchers analyzed the records of 2,629 women who gave birth between 2018 and 2024. Of these, 1,819 did not have preeclampsia, 584 had preeclampsia with mild features or symptoms (including blood pressure of 140/90 mm Hg or higher but no significant signs of organ damage), and 226 had preeclampsia with severe features or symptoms (including blood pressure of 160/110 mm Hg or higher and signs of organ damage, such as severe headaches, elevated liver enzymes, visual disturbances, low platelet count, or kidney impairment).
The researchers determined that women with a higher FAR were more likely to develop preeclampsia than those with a lower FAR. They found that the predicted likelihood of developing any degree of preeclampsia was 24% for patients with a FAR of at least 0.1 upon admission to the hospital, rising to more than 41% when that value exceeded 0.3.
If a woman in labor is found to be at increased risk for preeclampsia based on the FAR and other clinical indicators—such as being older than 35, having chronic high blood pressure, or being obese—obstetricians and anesthesiologists can take extra precautions to mitigate risk and ensure the patient’s blood pressure and fluid levels remain stable and controlled. For example, they may order more frequent blood pressure checks or lab tests. If the FAR indicates a woman is at risk for preeclampsia with severe symptoms, an epidural for pain management can be placed early to minimize risks.
The study emphasized that while this ratio should be assessed for all pregnant women, calculating the FAR is particularly crucial for those at higher risk for preeclampsia, such as Black women and those with high blood pressure or obesity. “Additional research is needed to determine the exact range of the FAR that would be considered concerning and would be helpful to incorporate into routine prenatal care as a predictive tool for early identification of preeclampsia,” the researcher stated.
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