Skip to main content
Top
Published in:

26-12-2023 | Pre-Eclampsia | Preeclampsia (A Kattah, Section Editor)

Cell-Free Nucleic Acids for Early Prediction of Preeclampsia

Authors: Mira N. Moufarrej, Virginia D. Winn, Stephen R. Quake

Published in: Current Hypertension Reports | Issue 4/2024

Login to get access

Abstract

Purpose of Review

This review summarizes the potential of cell-free nucleic acids for predicting preeclampsia, contrasts them with other methods, and discusses these findings’ relevance to preeclampsia’s pathogenesis and care.

Recent Findings

Recent studies have demonstrated the utility of cell-free nucleic acids in early preeclampsia risk prediction. Encouragingly, nucleic acid measurement exhibits similar or better sensitivity as compared to standard screening assays and furthermore sheds light on preeclampsia’s underlying placental biology.

Summary

Over the past decade, liquid biopsies measuring cell-free nucleic acids have found diverse applications, including in prenatal care. Recent advances have extended their utility to predict preeclampsia, a major cause of maternal mortality. These assays assess methylation patterns in cell-free DNA (cfDNA) or gene levels in cell-free RNA (cfRNA). Currently, preeclampsia care focuses on blood pressure control, seizure prevention, and delivery. If validated, early prediction of preeclampsia through liquid biopsies can improve maternal health and deepen our understanding of its causes.
Literature
1.
go back to reference Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.CrossRefPubMed Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–33.CrossRefPubMed
2.
3.
go back to reference Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019;15(366):l2381.CrossRef Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019;15(366):l2381.CrossRef
4.
go back to reference Dimitriadis E, Rolnik DL, Zhou W, Estrada-Gutierrez G, Koga K, Francisco RPV, et al. Pre-eclampsia Nat Rev Dis Primers. 2023;9(1):8.CrossRefPubMed Dimitriadis E, Rolnik DL, Zhou W, Estrada-Gutierrez G, Koga K, Francisco RPV, et al. Pre-eclampsia Nat Rev Dis Primers. 2023;9(1):8.CrossRefPubMed
5.
go back to reference Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2017;10(2). Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular health: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2017;10(2).
6.
go back to reference Hackshaw A, Morris JK, Boniface S, Tang J-L, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;24(360):j5855.CrossRef Hackshaw A, Morris JK, Boniface S, Tang J-L, Milenković D. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018;24(360):j5855.CrossRef
7.
go back to reference •Moufarrej MN, Bianchi DW, Shaw GM, Stevenson DK, Quake SR. Noninvasive prenatal testing using circulating DNA and RNA: advances, challenges, and possibilities. Annu Rev Biomed Data Sci. 2023;6:397–418. This review details the advances in noninvasive prenatal testing in the past decade and provides a lens to assess the impact of liquid biopsy testing on prenatal care more generally. •Moufarrej MN, Bianchi DW, Shaw GM, Stevenson DK, Quake SR. Noninvasive prenatal testing using circulating DNA and RNA: advances, challenges, and possibilities. Annu Rev Biomed Data Sci. 2023;6:397–418. This review details the advances in noninvasive prenatal testing in the past decade and provides a lens to assess the impact of liquid biopsy testing on prenatal care more generally.
8.
go back to reference •Rasmussen M, Reddy M, Nolan R, Camunas-Soler J, Khodursky A, Scheller NM, et al. RNA profiles reveal signatures of future health and disease in pregnancy. Nature. 2022;601(7893):422–7. This study along with Moufarrej et al. (2022) demonstrates the utility of cell-free RNA to predict risk of preeclampsia. This work focused on cell-free RNA’s utility as a predictor in the early second trimester. •Rasmussen M, Reddy M, Nolan R, Camunas-Soler J, Khodursky A, Scheller NM, et al. RNA profiles reveal signatures of future health and disease in pregnancy. Nature. 2022;601(7893):422–7. This study along with Moufarrej et al. (2022) demonstrates the utility of cell-free RNA to predict risk of preeclampsia. This work focused on cell-free RNA’s utility as a predictor in the early second trimester.
9.
go back to reference •Moufarrej MN, Vorperian SK, Wong RJ, Campos AA, Quaintance CC, Sit RV, et al. Early prediction of preeclampsia in pregnancy with cell-free RNA. Nature. 2022;602(7898):689–94. This study along with Rasmussen et al. (2022) demonstrates the utility of cell-free RNA to predict risk of preeclampsia. This work focused on cell-free RNA’s utility as a predictor in across gestation and especially in the first trimester. •Moufarrej MN, Vorperian SK, Wong RJ, Campos AA, Quaintance CC, Sit RV, et al. Early prediction of preeclampsia in pregnancy with cell-free RNA. Nature. 2022;602(7898):689–94. This study along with Rasmussen et al. (2022) demonstrates the utility of cell-free RNA to predict risk of preeclampsia. This work focused on cell-free RNA’s utility as a predictor in across gestation and especially in the first trimester.
10.
go back to reference •De Borre M, Che H, Yu Q, Lannoo L, De Ridder K, Vancoillie L, et al. Cell-free DNA methylome analysis for early preeclampsia prediction. Nat Med. 2023;28. This study demonstrates the utility of cell-free DNA to predict risk of early-onset preeclampsia. •De Borre M, Che H, Yu Q, Lannoo L, De Ridder K, Vancoillie L, et al. Cell-free DNA methylome analysis for early preeclampsia prediction. Nat Med. 2023;28. This study demonstrates the utility of cell-free DNA to predict risk of early-onset preeclampsia.
11.
go back to reference Ngo TTM, Moufarrej MN, Rasmussen M-LH, Camunas-Soler J, Pan W, Okamoto J, et al. Noninvasive blood tests for fetal development predict gestational age and preterm delivery. Science. 2018;360(6393):1133–6.ADSCrossRefPubMedPubMedCentral Ngo TTM, Moufarrej MN, Rasmussen M-LH, Camunas-Soler J, Pan W, Okamoto J, et al. Noninvasive blood tests for fetal development predict gestational age and preterm delivery. Science. 2018;360(6393):1133–6.ADSCrossRefPubMedPubMedCentral
12.
go back to reference Pan W, Ngo TTM, Camunas-Soler J, Song C-X, Kowarsky M, Blumenfeld YJ, et al. Simultaneously monitoring immune response and microbial infections during pregnancy through plasma cfRNA sequencing. Clin Chem. 2017;63(11):1695–704.CrossRefPubMed Pan W, Ngo TTM, Camunas-Soler J, Song C-X, Kowarsky M, Blumenfeld YJ, et al. Simultaneously monitoring immune response and microbial infections during pregnancy through plasma cfRNA sequencing. Clin Chem. 2017;63(11):1695–704.CrossRefPubMed
13.
go back to reference Linthorst J, Welkers MRA, Sistermans EA. Clinically relevant DNA viruses in pregnancy. Prenat Diagn. 2022;15. Linthorst J, Welkers MRA, Sistermans EA. Clinically relevant DNA viruses in pregnancy. Prenat Diagn. 2022;15.
14.
go back to reference Linthorst J, Baksi MMM, Welkers MRA, Sistermans EA. The cell-free DNA virome of 108,349 Dutch pregnant women. Prenat Diagn. 2022;11. Linthorst J, Baksi MMM, Welkers MRA, Sistermans EA. The cell-free DNA virome of 108,349 Dutch pregnant women. Prenat Diagn. 2022;11.
15.
go back to reference Chesnais V, Ott A, Chaplais E, Gabillard S, Pallares D, Vauloup-Fellous C, et al. Using massively parallel shotgun sequencing of maternal plasmatic cell-free DNA for cytomegalovirus DNA detection during pregnancy: a proof of concept study. Sci Rep. 2018;8(1):4321.ADSCrossRefPubMedPubMedCentral Chesnais V, Ott A, Chaplais E, Gabillard S, Pallares D, Vauloup-Fellous C, et al. Using massively parallel shotgun sequencing of maternal plasmatic cell-free DNA for cytomegalovirus DNA detection during pregnancy: a proof of concept study. Sci Rep. 2018;8(1):4321.ADSCrossRefPubMedPubMedCentral
16.
go back to reference Liu S, Huang S, Chen F, Zhao L, Yuan Y, Francis SS, et al. Genomic analyses from non-invasive prenatal testing reveal genetic associations, patterns of viral infections, and chinese population history. Cell. 2018;175(2):347-359.e14.CrossRefPubMed Liu S, Huang S, Chen F, Zhao L, Yuan Y, Francis SS, et al. Genomic analyses from non-invasive prenatal testing reveal genetic associations, patterns of viral infections, and chinese population history. Cell. 2018;175(2):347-359.e14.CrossRefPubMed
17.
go back to reference Camunas-Soler J, Gee EPS, Reddy M, Mi JD, Thao M, Brundage T, et al. Predictive RNA profiles for early and very early spontaneous preterm birth. Am J Obstet Gynecol. 2022;227(1):72.e1-72.e16.CrossRefPubMed Camunas-Soler J, Gee EPS, Reddy M, Mi JD, Thao M, Brundage T, et al. Predictive RNA profiles for early and very early spontaneous preterm birth. Am J Obstet Gynecol. 2022;227(1):72.e1-72.e16.CrossRefPubMed
18.
go back to reference Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31(3):141–6.CrossRefPubMed Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A, et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther. 2012;31(3):141–6.CrossRefPubMed
19.
go back to reference Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110-120.e6.CrossRefPubMed Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110-120.e6.CrossRefPubMed
20.
go back to reference Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, et al. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol. 2023;229(3):193–213.CrossRefPubMed Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, et al. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol. 2023;229(3):193–213.CrossRefPubMed
21.
go back to reference Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;20(5):307.CrossRef Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;20(5):307.CrossRef
22.
go back to reference Organization WH. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. 2019. Organization WH. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. 2019.
23.
go back to reference Fink DA, Kilday D, Cao Z, Larson K, Smith A, Lipkin C, et al. Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. 2023;6(6):e2317641.CrossRefPubMedPubMedCentral Fink DA, Kilday D, Cao Z, Larson K, Smith A, Lipkin C, et al. Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021. JAMA Netw Open. 2023;6(6):e2317641.CrossRefPubMedPubMedCentral
24.
go back to reference Levine RJ, Maynard SE, Qian C, Lim K-H, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672–83.CrossRefPubMed Levine RJ, Maynard SE, Qian C, Lim K-H, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350(7):672–83.CrossRefPubMed
25.
go back to reference Thadhani R, Lemoine E, Rana S, Costantine MM, Calsavara VF, Boggess K, et al. Circulating angiogenic factor levels in hypertensive disorders of pregnancy. NEJM evid. 2022;9. Thadhani R, Lemoine E, Rana S, Costantine MM, Calsavara VF, Boggess K, et al. Circulating angiogenic factor levels in hypertensive disorders of pregnancy. NEJM evid. 2022;9.
26.
go back to reference Akolekar R, Zaragoza E, Poon LCY, Pepes S, Nicolaides KH. Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008;32(6):732–9.CrossRefPubMed Akolekar R, Zaragoza E, Poon LCY, Pepes S, Nicolaides KH. Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol. 2008;32(6):732–9.CrossRefPubMed
27.
go back to reference Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol. 2022;226(2S):S1071–S1097.e2. Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol. 2022;226(2S):S1071–S1097.e2.
28.
go back to reference Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides KH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther. 2013;33(1):8–15.CrossRefPubMed Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides KH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther. 2013;33(1):8–15.CrossRefPubMed
29.
go back to reference O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017;49(6):756–60.CrossRefPubMed O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M, et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017;49(6):756–60.CrossRefPubMed
30.
go back to reference Poon LCY, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11–13 weeks’ gestation. Fetal Diagn Ther. 2012;31(1):42–8.CrossRefPubMed Poon LCY, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11–13 weeks’ gestation. Fetal Diagn Ther. 2012;31(1):42–8.CrossRefPubMed
31.
go back to reference Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol. 2014;43(5):500–7.CrossRefPubMed Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55,974 women. Ultrasound Obstet Gynecol. 2014;43(5):500–7.CrossRefPubMed
32.
go back to reference Oliveira N, Magder LS, Blitzer MG, Baschat AA. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort. Ultrasound Obstet Gynecol. 2014;44(3):279–85.CrossRefPubMed Oliveira N, Magder LS, Blitzer MG, Baschat AA. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort. Ultrasound Obstet Gynecol. 2014;44(3):279–85.CrossRefPubMed
33.
go back to reference Chaemsaithong P, Pooh RK, Zheng M, Ma R, Chaiyasit N, Tokunaka M, et al. Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population. Am J Obstet Gynecol. 2019;221(6):650.e1-650.e16.CrossRefPubMed Chaemsaithong P, Pooh RK, Zheng M, Ma R, Chaiyasit N, Tokunaka M, et al. Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population. Am J Obstet Gynecol. 2019;221(6):650.e1-650.e16.CrossRefPubMed
Metadata
Title
Cell-Free Nucleic Acids for Early Prediction of Preeclampsia
Authors
Mira N. Moufarrej
Virginia D. Winn
Stephen R. Quake
Publication date
26-12-2023
Publisher
Springer US
Keyword
Pre-Eclampsia
Published in
Current Hypertension Reports / Issue 4/2024
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-023-01291-z

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more