Women in labor can now be tested more specifically for risk of preeclampsia— a leading but preventable cause of maternal death. The ratio of two blood proteins, fibrinogen and albumin (FAR), can be measured in routine blood tests to indicate risk of the condition. But there has been no universally recognized normal value for FAR in preeclampsia. Now, researchers at the Icahn School of Medicine at Mount Sinai may have found one.
Their work showed that the likelihood of developing preeclampsia was 24% for patients with a FAR of at least 0.1 on admission to the hospital, and it rose to more than 41% when that value was above 0.3.
“While FAR has been associated with other inflammatory conditions, its specific application to preeclampsia and preeclampsia with severe symptoms has not been reported in a group this large and racially diverse,” said Lucy Shang, lead author of the study and a medical student at the Icahn School of Medicine at Mount Sinai, New York. “Our study shows that FAR can be a predictive tool that gives anesthesiologists and obstetricians a new method for assessing a laboring mom’s risk of developing preeclampsia when they are admitted to the hospital.”
The research was 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. Black women are 60% more likely to develop the condition than white women, and more likely to die or have serious outcomes, such as kidney damage.
While preeclampsia can develop as early as the 20th week of pregnancy, this study focused on women who were at risk for preeclampsia when they were admitted to the hospital in labor.
In the study, researchers analyzed the records of 2,629 women who gave birth between 2018 and 2024: 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, including severe headaches, high liver enzymes, visual disturbances, low platelet count or kidney impairment).
The researchers determined those who had a higher FAR were more likely to develop preeclampsia than those with a lower FAR. 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— fibrinogen may be elevated, albumin may be reduced, or both can occur.
If a woman in labor is found to be at increased risk for preeclampsia based on the FAR and other clinical indicators, doctors can take extra precautions to reduce the risk and ensure the patient’s blood pressure and fluid levels remain stable and controlled.
Shang noted that while the FAR ratio should be assessed for all pregnant women, it is especially important for women who are at higher risk for preeclampsia, such as Black women and those with high blood pressure and obesity.
