Pre-eclampsia affects around 1 in 25 pregnancies in the UK and remains one of the leading causes of maternal and perinatal mortality. Yet for decades, standard of care testing has failed to reliably identify at-risk patients.
Placental growth factor (PlGF) testing gives clinicians a direct biological signal of placental health, flagging pregnancies at risk for pre-eclampsia weeks before symptoms appear. Research has found that PlGF-guided care significantly reduced the time to diagnosis of pre-eclampsia and improved clinical decision making in triage settings.
Here, Rea Castro, Director of Medical Affairs at QuidelOrtho, shares how PlGF-based diagnostics are reshaping pre-eclampsia care in the UK, and why adoption remains uneven.
What is the current standard of care for pre-eclampsia testing, and what are the gaps that need to be addressed in that model?
The current standard relies primarily on clinical science, namely elevated blood pressure and proteinuria testing. The fundamental limitation is that by the time these signs are present, the disease has already progressed to a stage of maternal involvement.
Another significant gap is in risk stratification. When pre-eclampsia is suspected, clinicians still face uncertainty about its trajectory. The clinical data can't reliably predict whether a patient might deteriorate quickly or if they can be safely monitored at home.
That uncertainty drives costly outcomes: unnecessary hospital admissions for some patients, and delayed escalation for others at high risk. The field needs tools that speak directly to near-term risk, not just whether the disease is present.
How might blood biomarker testing help to address those gaps?
PlGF is a protein produced by the placenta. Its levels fall significantly in women who go on to develop pre-eclampsia, often weeks before any clinical signs appear. Testing PlGF directly measures placental dysfunction, giving clinicians a stronger biological foundation for decision making.
First, in women presenting with symptoms or risk factors, it helps identify those who are unlikely to develop pre-eclampsia in the near term. A low-risk result supports safe discharge or outpatient monitoring rather than unnecessary admission, which is enormously valuable for triage.
Second, it helps identify women at higher short-term risk who need closer surveillance, earlier intervention, and more intensive support. PlGF-guided care has been shown to reduce time to diagnosis of pre-eclampsia and to improve clinical decision making.
What are the recommendations for PlGF testing in the UK?
The UK is ahead of much of the world in this. The National Institute for Health and Care Excellence (NICE) first recommended PlGF-based testing for suspected pre-eclampsia in 2016, and that guidance was updated in 2022. At a policy level, the UK has made a clear evidence-based commitment to PlGF testing.
What does adoption of the test look like in reality?
While many NHS trusts and maternity units have integrated PlGF testing into their triage pathways, implementation is really not uniform. There are significant regional variations in routine availability, who it is offered to, and how results are used to guide care decisions.
The gap between what NICE recommends and what consistently happens in practice is where the opportunity lies. The work now is ensuring the infrastructure, training, and clinical workflow support consistent coverage.
What are the factors that influence implementation of PlGF testing?
The UK has a significant structural advantage over many healthcare systems. Its centralized procurement and national guidelines make it much easier to adopt a new diagnostic once it receives formal endorsement. NICE guidance carries real weight in that respect.
The barriers tend to be more operational and cultural. Some relate to workflow integration. For example, how does a PlGF test fit into an already stretched maternity triage pathway, and how quickly can results be turned around? Others relate to awareness and training. Settings that could benefit from PlGF testing are dependent on physicians being confident in interpreting and acting on them.
There's also a broader question about clinical inertia. When a diagnostic paradigm has been built around observing symptoms, introducing decision making before symptoms appear requires a genuine shift in approach. That kind of change takes time, education, and consistent reinforcement from clinical leadership. It reflects the normal challenge of embedding any meaningful innovation into our complex clinical systems.
How can health systems remove some of those barriers and move towards more reactive maternal care?
The most important step is implementing PlGF testing into standard triage protocols. When a test is a part of the pathway, and automatically triggered for women presenting with suspected pre-eclampsia, it is used consistently rather than selectively.
That consistency also addresses an equity issue. Populations at elevated risk of severe pre-eclampsia outcomes – those with limited access to specialist care and more fragmented prenatal follow-up – are also most likely to benefit from a reliable, early risk stratification tool.
Alongside that, clinicians need to understand both what PlGF measures, and what to do with the result – how it influences decisions about admission, monitoring intensity, or the timing of intervention. That requires investment in training. Feedback loops should also be supported, to monitor the impact of PlGF-guided decisions on patient outcomes.
What is your message to NHS leaders on the future of pre-eclampsia care?
While there is evidence that PlGF-guided care improves clinical decision making and patient outcomes, there remain bottlenecks to its implementation, which NHS leaders can directly influence. There are several key questions: Are the women in your maternity units receiving the level of risk assessment that the evidence supports? Are triage pathways consistently using PlGF testing? If not, what is preventing that, and what would it take to change it?
Pre-eclampsia remains a leading cause of maternal mortality in the UK – but it does not have to be. The future of maternal care is proactive, biologically informed, equity conscious, and built around anticipating risk rather than reacting to it. Let's bring that future into the present.
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