Abstract Background: Preeclampsia (PE) remains a major cause of maternal and perinatal morbidity, and reliable early prediction is essential for timely prevention. Numerous noninvasive biomarkers have been proposed, but their comparative performance in early pregnancy is not consistently established. Objective: To evaluate the diagnostic accuracy of noninvasive biomarkers measured before 20 weeks’ gestation for the prediction of PE and to identify core markers with the strongest and most consistent predictive contribution. Materials and Methods: A systematic review of studies assessing biochemical, molecular, and biophysical biomarkers in early pregnancy was conducted. Data on study characteristics and predictive performance were extracted. Pooled estimates and subgroup analyses were performed where appropriate. Results: Multimarker models integrating clinical and biochemical measures demonstrated higher accuracy than single biomarkers (pooled area under the receiver operating characteristic curve: 0.89; sensitivity: 0.86; and specificity: 0.89). Placental growth factor (PlGF) showed the strongest independent association with subsequent PE (pooled adjusted odds ratio aOR: 3.5 and 95% confidence interval CI: 2.8–4.4), followed by mean arterial pressure (MAP) (aOR: 2.8, 95% CI: 2.2–3.6). Uterine artery pulsatility index contributed additional but more modest predictive value (aOR 2.1, 95% CI 1.7–2.6). Molecular biomarkers demonstrated variable performance across studies. Conclusion: Early prediction of PE is achievable using a streamlined panel centered on PlGF and MAP, with uterine artery Doppler pulsatility index providing supplemental refinement where feasible. Further validation in diverse populations is needed to support routine clinical implementation.
Bassi et al. (Wed,) studied this question.