Preeclampsia: what angiogenic markers and lipid profiles reveal during pregnancy
The RECLAMA pilot study examines biochemical and vascular signals associated with the development of preeclampsia and explores the potential role of lipoprotein(a) in risk assessment.
Preeclampsia is a pregnancy complication that goes far beyond high blood pressure. Its links with placental function, the vascular endothelium and lipid metabolism raise an important question: which biomarkers could help us better understand risk before clinical manifestations emerge?
This is one of the questions addressed by the RECLAMA study (Lipid profile and angiogenic markers in the Detection of Preeclampsia: The RECLAMA Study), a collaborative investigation involving Núria Amigó of Biosfer Teslab and researchers from clinical and academic institutions in Reus.
Why investigate preeclampsia from a cardiovascular perspective?
Preeclampsia affects approximately 2–8% of pregnancies worldwide. It is characterized by new-onset hypertension, usually after 20 weeks of gestation, accompanied by proteinuria or other signs of organ dysfunction. Its pathophysiology involves placental abnormalities and an imbalance in factors regulating blood-vessel development and maintenance.
These include sFlt-1, an antiangiogenic factor, and PlGF, which supports placental angiogenesis. Their ratio, sFlt-1/PlGF, is a biomarker used in the clinical assessment of suspected preeclampsia in specific settings.
RECLAMA investigates an additional dimension: lipid metabolism, including lipoprotein(a), or Lp(a), a particle of interest because of its association with cardiovascular risk.
How was the RECLAMA study designed?
This prospective pilot case–control study recruited 98 pregnant women between 2023 and 2025. Participants were grouped according to initial risk and subsequent pregnancy outcomes:
At gestational week 14, clinical data and vascular measurements were collected, including carotid intima–media thickness (cIMT), pulse wave velocity (PWV) and augmentation index (AIx). At week 24, researchers measured conventional lipids, apolipoprotein B, Lp(a), and the angiogenic factors sFlt-1 and PlGF.
An important distinction: although the wider RECLAMA project includes advanced lipidomics using proton nuclear magnetic resonance (1H-NMR), this article reports preliminary findings on conventional lipids, Lp(a), vascular measurements and angiogenic markers. It does not yet present definitive NMR lipidomics results.
What did the researchers find?
Angiogenic imbalance
At week 24, women who subsequently developed preeclampsia had higher sFlt-1 and lower PlGF levels. Their sFlt-1/PlGF ratio was significantly higher than in the other groups.
Conventional lipid profile
No statistically significant differences were found in total cholesterol, LDL-C, HDL-C, triglycerides or apoB. However, there was a trend toward higher triglycerides and lower HDL-C in women who developed preeclampsia.
Lipoprotein(a)
Median Lp(a) levels were approximately 37% higher in women who developed preeclampsia than in at-risk women who did not. This difference was not statistically significant and should be interpreted as exploratory.
Early vascular markers
At week 14, no significant between-group differences were observed in cIMT, PWV or AIx. No participants had carotid plaques.
The scientific takeaway: angiogenic markers distinguished the groups, while lipid-related signals—particularly Lp(a)—raise questions that require confirmation in larger studies.
What might be the role of Lp(a)?
Lipoprotein(a) is a lipoprotein particle with proinflammatory and prothrombotic properties that has been extensively investigated in cardiovascular research. The trend observed in RECLAMA is an important research hypothesis, but it does not establish that Lp(a) independently predicts preeclampsia or should be used as a stand-alone diagnostic test.
The authors also report that the lipid variables examined were not clearly correlated with angiogenic factors in this cohort, highlighting the need to investigate whether these measurements provide complementary information.
Next steps: integrating advanced lipidomics
The project aims to extend its analyses through proton NMR (1H-NMR) lipidomics and metabolomics and multivariable models integrating metabolic signals, glycoproteins, angiogenic markers and clinical characteristics.
The aim is to explore more comprehensive risk-stratification approaches. Their predictive performance must still be demonstrated and validated before any clinical application can be considered.
How should these findings be interpreted?
These findings come from a pilot study with a relatively small group of women who developed preeclampsia (13 participants). Some biomarker measurements were unavailable for certain participants, and the reported analyses were mainly unadjusted univariate comparisons, without full control for potential confounders.
Accordingly, the results contribute to understanding mechanisms associated with preeclampsia; they do not establish a validated new clinical test or demonstrate causality.
Collaborative research involving Biosfer Teslab
The study was authored by Daiana Ibarretxe, Sara Tameish, Ana González-Lleó, Èrica Cunillera, Natalia Andreychuk, Jara Ballestin, Alba Cabello, Lydia Cabau, Núria Amigó and Carme Grifoll.
Scientific reference: Ibarretxe D, Tameish S, González-Lleó A, Cunillera E, Andreychuk N, Ballestin J, et al. Lipid profile and angiogenic markers in the Detection of Preeclampsia: The RECLAMA Study.
Published in: Clínica e Investigación en Arteriosclerosis. Read the published article on Elsevier. This post is for scientific communication purposes and does not replace obstetric medical advice.
Funding reported by the authors: FEA/SEA 2022 grant from the Spanish Atherosclerosis Society.