Biomarker testing for preeclampsia with Lisa A. Bukovac, DO, FACOG

Placental biomarker testing can help clinicians distinguish which patients with suspected preeclampsia require hospitalization and which can be safely monitored, according to Lisa A. Bukovac, DO, FACOG, chief clinical officer, Ob Hospitalist Group.

The discussion follows the Preeclampsia Foundation's February 2026 launch of an educational resource for obstetricians and gynecologists covering the clinical background, pathophysiology, and use case for ratio tests on 2 key placental protein markers: placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 receptor (sFlt-1). Hypertensive disorders of pregnancy affect approximately 5% to 8% of all pregnancies.¹

What the biomarkers add

Bukovac said the value of these markers lies in identifying underlying placental pathology that conventional testing can miss.

“There are women who begin pregnancy that are already hypertensive, and it makes it very difficult to determine when they have crossed from their chronic hypertension into a preeclamptic episode. These biomarkers help, with better certainty, determine that because the traditional lab work that we do, in concert with blood pressure and proteinuria that we use, has not always been as reliable as it should be,” Bukovac said.

RELATED: ACOG releases new practice update on biomarker testing for hypertensive disorders in pregnancy

“These biomarkers help us to identify the women who we know already have placental damage from very early in the pregnancy when the placenta was establishing itself. So, long story short, they have damage to the blood vessels. Those blood vessels are leaking these proteins, and to date, we have not been able to measure those proteins, but now we can, and the other tests can be abnormal for a lot of reasons, not just because of preeclampsia,” she said.

Timing and clinical impact

Bukovac identified 24 to 34 weeks as the current target window, noting that fetal survival considerations limit intervention value outside that range. She emphasized the negative predictive value as clinically actionable.

“If they test negative, then you know that probably for the next 4 weeks they are in a safe zone, where if they test positive, you know that in the next 1 to 2 weeks, they are more likely to develop the disease and need to be more closely followed,” she said.

She projected the greatest downstream effect on resource use and iatrogenic prematurity.

“It is going to help control some of the costs, so we can start to weed out unnecessary, lengthy hospitalizations that are a strain on the healthcare system, and we can actually hospitalize and focus on the ones that test positive, so we know they are most at risk. And it will help to prevent babies being born early unnecessarily,” Bukovac said.

Tests from Thermo Fisher Scientific and Roche Diagnostics are FDA-cleared for use in hospitalized pregnant patients.¹

Reference:

1. Preeclampsia Foundation launches resource for understanding predictive and diagnostic biomarker testing for preeclampsia. Preeclampsia Foundation. Press release. Published February 17, 2026. Accessed July 22, 2026. https://www.preeclampsia.org/the-news/news-from-the-foundation/preeclampsia-foundation-launches-resource-for-understanding-predictive-and-diagnostic-biomarker-testing-for-preeclampsia