AHN's Advanced Biomarker Test for Enhanced Preeclampsia Diagnosis and Management

Preeclampsia remains a major contributor to maternal and fetal morbidity and mortality, and its diagnosis is often challenging when symptoms overlap with other conditions in pregnancy. Conventional markers, such as proteinuria, often appear late or lack specificity, limiting their value for early risk stratification.

To support more precise evaluation, maternal-fetal medicine specialists at AHN Women’s Institute are among the first in the region to offer a soluble fms-like tyrosine kinase 1 and placental growth factor (sFlt-1:PlGF) ratio — a blood-based biomarker that helps predict the risk and timing of preeclampsia development.

Understanding preeclampsia's pathogenesis and the sFlt-1:PlGF ratio

Preeclampsia’s etiology remains uncertain but current research suggests that abnormal placentation leads to placental ischemia and maternal endothelial dysfunction. Imbalance between angiogenic (PIGF) and anti-angiogenic (sFlt-1) factors is a central feature of this process.

Elevated sFlt-1 and reduced PlGF result in a high sFlt-1:PlGF ratio, correlating strongly with placental dysfunction and increased likelihood of preeclampsia. This makes the ratio a useful adjunct for evaluating disease trajectory in patients with suspected early or evolving disease.

Guiding patient management and reducing diagnostic uncertainty

Following FDA approval in 2023, the sFlt-1:PlGF ratio has emerged as a novel tool for evaluating preeclampsia risk and supporting real-time clinical decision-making.

Studies demonstrate:

• Low ratios are highly predictive of absence of progression to severe preeclampsia within 14 days.
• Elevated ratios correlate with increased likelihood of disease progression during the same interval.

AHN’s maternal-fetal medicine specialists use the test in inpatient settings to clarify diagnostic uncertainty, particularly in patients with chronic or gestational hypertension. However, the ratio is not a stand-alone diagnostic test, nor does it replace established clinical criteria in accordance with American College of Obstetrician and Gynecologists (ACOG) guidelines.

“Where this screening is most impactful is in patients with chronic or gestational hypertension who present with evolving symptoms but don’t meet criteria for [preeclampsia with] severe features,” said Carmen Proctor, MD, maternal-fetal medicine specialist at AHN. “The ratio helps us clarify whether we can safely monitor or need to escalate care.”

High-risk maternal care with AHN's Maternal-Fetal Medicine Program

Through AHN’s Maternal-Fetal Medicine Program, high-risk patients also have access to evidence-based treatments and comprehensive obstetrics care including:

• 24/7 availability of AHN physicians for consultation or emergency support.
• Behavioral health services to assist women in managing stress associated with high-risk pregnancies or neonatal health complications.
• Preconception and prenatal counseling to evaluate maternal and fetal risk factors for inherited or congenital conditions.
• Level II and Level III NICUs for newborns requiring specialized care.
• Advanced diagnostic and procedural capabilities, including first trimester anatomic surveys, fetal echocardiograms, amniocentesis, chorionic villus sampling (CVS), and more.

How to refer

To refer patients for advanced obstetrics care and access to novel testing like the sFlt-1:PlGF ratio screening, contact the maternal-fetal medicine team at AHN Women’s Institute by calling 412-578-3951 to speak with a nurse navigator.