PERSONALIZED APPROACHES TO PREDICTION, PREVENTION, AND TREATMENT OF PREECLAMPSIA: A MULTICENTER PROSPECTIVE STUDY

Klassov Alibek Murzabekovich, Nemtseva L., Vesnina Olesya Vyacheslavovna, Genina Veronika Aleksandrovna, Ivashchenko Viktoriia Vladimirovna, Popova Ekaterina Alekseevna

In a multicenter prospective cohort study conducted from 2021 to 2023 at 12 obstetric centers in Russia, a personalized algorithm for predicting and preventing preeclampsia was developed and validated. The study included 2,242 pregnant women who underwent comprehensive first-trimester screening with assessment of clinical, biochemical (PAPP-A, PlGF, sFlt-1, sEng), ultrasound (uterine artery PI) and genetic markers. The integrated predictive model demonstrated high accuracy (AUC 0.94; sensitivity 87.4%, specificity 92.1%), enabling stratification of patients by risk. High-risk patients (n = 289) were randomized into three prevention groups: standard care, low-dose acetylsalicylic acid (ASA, 150 mg/day) and a personalized strategy tailored to the pathogenetic variant of preeclampsia. Five main variants were identified: placental (30.1%), endothelial (23.5%), metabolic (18.7%), immunological (14.5%) and mixed (13.1%). Personalized prevention showed significant superiority: a 70% reduction in preeclampsia incidence (27.1% vs 89.7% in controls; RR 0.30), whereas ASA monotherapy achieved only a 29% reduction (incidence 63.5%; RR 0.71). The personalized approach substantially improved clinical outcomes. In the personalized management group, the rate of severe maternal complications fell from 41.4% to 11.5% (p < 0.001), and hospital stay shortened from 12.7 to 8.5 days. Perinatal outcomes also improved: preterm birth before 34 weeks decreased from 33.3% to 17.2% (p = 0.014), intrauterine growth restriction from 31.0% to 18.4% (p = 0.050), and neonatal asphyxia from 26.4% to 13.8% (p = 0.034). The study confirms the clinical value of differentiated management based on pathogenetic subtypes of preeclampsia, allowing optimization of healthcare resources and reduction of maternal and perinatal morbidity..

Keywords:preeclampsia, personalization, prediction, prevention, multicenter study.