Anthem Blue Cross Connecticut LAB.00040 Serum Biomarker Tests for Risk of Preeclampsia Form

This document addresses serum biomarker testing to identify individuals at increased risk of preeclampsia during pregnancy. Serum biomarkers that can be used to predict preeclampsia include placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), levels of which tend to drop during pregnancy in asymptomatic individuals who later develop preeclampsia. Moreover, the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1), which tends to increase in preeclampsia and PlGF may be calculated to test for the presence or absence of preeclampsia. In addition, there are other potential serum protein biomarkers, such as retinol-binding protein 4 (RBP4) and endoglin (ENG), the concentrations of which can be assessed and results combined into a risk-score to identify individuals at high risk of preeclampsia.

Note: This document does not apply to routine tests performed during pregnancy such as urine protein analysis, blood pressure, renal function labs, liver function labs and complete blood count (CBC).

Please see the following related document for additional information:

• ADMIN.00002 Preventive Health Guidelines

Position Statement

Investigational and Not Medically Necessary:

Serum biomarker tests to diagnosis, screen for, or assess risk of preeclampsia are considered investigational and not medically necessary.