Preeclampsia: problems and possibilities of early diagnosis

Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality. According to the World Health Organization reports, hypertensive disorders, including preeclampsia and eclampsia, rank as the third leading cause of maternal deaths. Despite significant progress in understanding the pathophysiology of the disease, early diagnosis of preeclampsia retains high clinical relevance. This is due to the pronounced heterogeneity of the pathological process, the lack of unified screening algorithms, and the late manifestation of initial clinical symptoms, which limits the possibilities for preventive intervention. The present review systematizes current data on the key pathogenetic mechanisms of preeclampsia development: endothelial dysfunction, angiogenic imbalance with elevated vascular endothelial growth factor receptor-1 and reduced placental growth factor levels, oxidative stress, systemic inflammation, and immune dysregulation with a predominant shift toward the Th1 phenotype. Promising serum biomarkers (soluble endoglin, PP-13, afamin, ADAMTS-13) and urinary markers (PlGF, KIM-1, netrin-1, polyamines) are discussed in detail, as well as the potential of omics technologies (genomic studies, non-coding ribonucleic acids), inflammatory hematological indices (NLR, SIII), ultrasound Doppler, and artificial intelligence methods. Special attention is paid to combined first-trimester screening based on the FMF methodology, which has been introduced into clinical practice in the Russian Federation since 2021. Key challenges remain the lack of international standardization, insufficient large scale validation studies, and the mismatch between the time windows for diagnostic detection and effective prevention. The integration of multicomponent biomarker panels considering individual patient characteristics and gestational age is recognized as a promising direction.