About Prof. Zhu Liping
Prof. Zhu Liping is a senior obstetrician at the Obstetrics & Gynecology Hospital of Fudan University (Red House Hospital), specialising in high-risk pregnancy, preeclampsia, and fetal growth restriction. Her research integrating multi-omics data with machine learning for first-trimester preeclampsia prediction has been published in Nature Medicine and incorporated into FIGO guidelines, with the model granted a national patent and now being implemented across multiple tertiary hospitals in China.
Case Overview
Ms. Fang (pseudonym), a 34-year-old nulliparous woman, was referred to Prof. Zhu at 12 weeks of gestation with a BMI of 29.4 kg/m², a maternal family history of hypertension, and a booking blood pressure of 128/84 mmHg. Prof. Zhu's team applied the multi-omics screening protocol: PlGF was suppressed at 38 pg/mL (reference >100 pg/mL), the sFlt-1/PlGF ratio was elevated, phosphatidylcholine metabolites were significantly abnormal, and miR-210 was markedly upregulated. The model assigned an 87% predicted probability of preeclampsia. Low-dose aspirin (150 mg nightly) and calcium supplementation (1.5 g daily) were commenced immediately. Uterine artery Doppler at 20 weeks confirmed bilateral notching. Ms. Fang developed mild gestational hypertension at 34 weeks, managed with labetalol; she did not progress to preeclampsia. She delivered a healthy female infant at 37+2 weeks by planned caesarean section, birthweight 2,780 g, Apgar 9/10. Ms. Fang reflected: "I did not know I was at risk until Prof. Zhu's team found it at 12 weeks. They explained everything clearly. I was anxious throughout the pregnancy, but I never felt alone in it. My daughter is healthy. That is everything."
Diagnostic Workup
First-trimester multi-omics screening at 12 weeks identified suppressed PlGF (38 pg/mL), elevated sFlt-1/PlGF ratio above the 90th centile, abnormal phosphatidylcholine metabolites, and upregulated miR-210 and miR-155 — yielding a model-predicted preeclampsia probability of 87%. Combined first-trimester screening (mean arterial pressure, uterine artery Doppler, PlGF, PAPP-A) confirmed high-risk classification. Uterine artery Doppler at 20 weeks showed bilateral notching consistent with impaired placentation. Serial growth ultrasound from 24 weeks identified mild fetal growth restriction from 28 weeks. Multidisciplinary review — maternal-fetal medicine, cardiology, and neonatology — confirmed the delivery plan.
Prof. Zhu's pre-intervention assessment: The multi-omics profile at 12 weeks was not ambiguous. Suppressed PlGF, elevated sFlt-1/PlGF ratio, abnormal phosphatidylcholine metabolites, and upregulated miR-210 together reflect early placental dysfunction before any clinical sign has appeared. The clinical risk factors alone would not have triggered prophylaxis under standard criteria — the multi-omics model identified the risk that clinical assessment alone would have missed.
Treatment Strategy and Course
Diagnosis: High-risk pregnancy — multi-omics profile consistent with early placental dysfunction, predicted preeclampsia probability 87%; mild fetal growth restriction from 28 weeks.
Treatment principle: early pharmacological prophylaxis combined with intensive maternal-fetal surveillance and planned delivery at optimal gestational age.
- Prophylaxis: Aspirin 150 mg nightly from 12+3 weeks (continued to 36 weeks) and calcium 1.5 g daily throughout pregnancy; both well tolerated
- Surveillance: Twice-weekly blood pressure monitoring from 20 weeks; serial PlGF/sFlt-1, Doppler ultrasound, and growth scans; cardiotocography twice weekly from 34 weeks
- Gestational hypertension at 34 weeks: Labetalol 100 mg twice daily; blood pressure controlled below 140/90 mmHg; no proteinuria; no progression to preeclampsia
- Delivery: Planned caesarean section at 37+2 weeks; healthy female infant, birthweight 2,780 g, Apgar 9/10; discharged day four; blood pressure normalised by six weeks postpartum
Prof. Zhu's clinical reflection: This patient did not develop preeclampsia. That is the outcome the model and the intervention are designed to achieve — not to manage the crisis, but to prevent it. Aspirin commenced at 12 weeks, not at 20 weeks when clinical signs might have appeared. The difference in timing is the difference between effective prophylaxis and reactive management.
Expert Commentary — Prof. Zhu Liping
1. Multi-Omics Early Prediction of Preeclampsia
Preeclampsia affects 2–8% of pregnancies globally and is a leading cause of maternal and perinatal mortality. Traditional screening based on clinical risk factors achieves sensitivity of approximately 40% for early-onset disease. The multi-omics approach integrates metabolomic profiling (phosphatidylcholines, amino acids), proteomic markers (PlGF, sFlt-1, PAPP-A), and microRNA expression (miR-210, miR-155) with machine learning — random forest, support vector machine, and logistic regression — to identify early placental dysfunction before clinical signs appear. In 1,000 pregnancies, the model achieved 90% accuracy, 88% sensitivity, and 92% specificity at 11–14 weeks, versus approximately 70% for traditional models; external validation confirmed 85% accuracy.
2. The Biological Basis of Multi-Omics Markers
Each marker class reflects a distinct dimension of preeclampsia pathophysiology. Suppressed PlGF and elevated sFlt-1 reflect impaired angiogenic signalling from dysfunctional placentation. Phosphatidylcholine abnormalities indicate disrupted lipid metabolism and oxidative stress. miR-210 upregulation marks placental hypoxia via HIF-1α induction; miR-155 reflects inflammatory pathway activation. Together, these markers capture the angiogenic, metabolic, hypoxic, and inflammatory dimensions of early placental dysfunction in a single first-trimester blood sample.
3. Early Intervention: Low-Dose Aspirin and the Window of Efficacy
Low-dose aspirin (150 mg nightly) commenced before 16 weeks reduces preterm preeclampsia risk by approximately 62% in high-risk women (ASPRE trial), by inhibiting thromboxane A2-mediated vasoconstriction and improving uteroplacental blood flow during trophoblast invasion. Aspirin commenced after 16 weeks shows substantially attenuated benefit — making first-trimester identification the critical prerequisite for effective prophylaxis. Calcium supplementation provides additional benefit through reduction of parathyroid hormone-mediated vasoconstriction.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Ms. Fang throughout her pathway at the Obstetrics & Gynecology Hospital of Fudan University, providing priority consultation coordination, bilingual interpretation across all obstetric and multidisciplinary consultations, bilingual explanation of multi-omics results and the surveillance protocol, coordination of all investigations and delivery planning, and postnatal follow-up support.
For international patients and expatriates in China who are pregnant or planning pregnancy — particularly those with risk factors for preeclampsia or fetal growth restriction — Prof. Zhu Liping's team offers access to one of China's most advanced maternal-fetal medicine programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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