his study investigates the effectiveness of three specific biological markers (biomarkers) in the blood-the sFlt-1/PlGF ratio, soluble endoglin (sEng), and osteoprotegerin (OPG)-to better diagnose and monitor preeclampsia. Preeclampsia is a serious pregnancy complication characterized by high blood pressure and potential organ damage that affects 2-8% of pregnancies worldwide

Preeclampsia is a pregnancy-specific hypertensive disorder characterized by newonset hypertension and proteinuria or other maternal organ dysfunction after 20 weeks of gestation. It affects 2-8% of pregnancies globally and remains a major contributor to maternal and perinatal morbidity and mortality The etiology is multifactorial, but placental dysfunction and abnormal angiogenesis are central to its pathogenesis. Given the limitations of current clinical indicators (e.g., blood pressure, proteinuria), there is growing interest in identifying predictive and diagnostic biomarkers to improve early detection, prognosis, and monitoring of therapeutic response. This study proposes to investigate three biomarkers: the sFlt-1/PlGF ratio, soluble endoglin (sEng), and osteoprotegerin (OPG), based on their roles in angiogenesis and endothelial dysfunction, which are hallmarks of preeclampsia

sFlt-1/PlGF Ratio Soluble fms-like tyrosine kinase-1 (sFlt-1) is an anti-angiogenic protein that binds to vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), preventing their interaction with endothelial receptors. The imbalance, especially elevated sFlt-1 and decreased PlGF, is characteristic of preeclampsia. Numerous studies, including the multicenter PROGNOSIS trial, have validated the sFlt-1/PlGF ratio as a strong predictor of preeclampsia. A ratio ≥85 is associated with a high risk of developing preeclampsia within two weeks, while ≤38 effectively rules it out .

Soluble Endoglin (sEng) Endoglin is a co-receptor for transforming growth factor-beta (TGF-β), involved in vascular development. Its soluble form (sEng) acts as a decoy receptor, inhibiting TGF-β signaling, contributing to endothelial dysfunction, a key feature of preeclampsia. sEng levels are elevated in the maternal circulation prior to clinical onset and correlate with disease severity.

Osteoprotegerin (OPG) OPG, a member of the TNF receptor superfamily, is primarily involved in bone metabolism but also plays a role in vascular biology. Some studies have reported altered OPG levels in preeclampsia, potentially reflecting vascular damage or endothelial activation . Its role remains less defined, but it may complement other angiogenic markers in profiling disease status.

IInclusion Criteria:

• Pregnant women between 20 and 36 weeks of gestation
• Age between 18 and 45 years
• Attending the antenatal clinic at the study site

Exclusion Criteria:

• Chronic hypertension
• Renal disease
• Diabetes mellitus
• Multiple gestations
• Autoimmune disorders

he study population will include pregnant women aged 18-45 years, between 20 and 36 weeks of gestation, attending the antenatal clinic at the study site. Participants will be divided into three groups:

Pregnant women diagnosed with preeclampsia who have not yet received antihypertensive treatment.

Pregnant women diagnosed with preeclampsia who are receiving antihypertensive treatment.

Healthy pregnant women serving as control subjects.

Exclusion criteria include pre-existing chronic hypertension, renal disease, diabetes mellitus, multiple gestations, or autoimmune disorders.

All participants will provide informed consent before enrollment. Blood samples will be collected for biomarker analysis (sFlt-1, PlGF, soluble endoglin, and osteoprotegerin). This population has been selected to allow comparison of biomarker levels in different clinical scenarios and to evaluate their

Yes - De-identified individual participant data (IPD) will be available upon reasonable request to qualified researchers. Data will include biomarker measurements (sFlt-1, PlGF, sEng, OPG) and relevant clinical parameters. Requests will be reviewed by the principal investigator, and shared under a data use agreement ensuring confidentiality. Data will be available 12 months after publication of the study results.

De-identified individual participant data (IPD) will be made available to qualified researchers upon reasonable request. Supporting information to be shared includes the study protocol, statistical analysis plan (SAP), and analytic code. Data will be provided in an anonymized format, with requests reviewed by the principal investigator and shared under a data use agreement ensuring confidentiality. Data will be available 12 months after publication of the study results.