Austdal M, Silva GB, Bowe S, et al. - Using metabolic profiling, researchers intended to classify placental dysfunction in preeclampsia and fetal growth restriction at delivery. They also sought to validate the biomarker Flt-1 (FMS-like tyrosine kinase receptor 1) for placental dysfunction. In this study, they examined 143 pregnancies with or without preeclampsia and/or fetal growth restriction delivered by cesarean section. Based on 21 metabolites and diagnostic outcome parameters, 3 distinct placenta groups were discovered: normal placentas, moderate placental dysfunction, and severe placental dysfunction. A link was identified between increased placental Flt-1 and severe placental dysfunction. Also, moderate and severe placental dysfunction was observed in correlation with increased serum Flt-1. Five metabolites and placental Flt-1 enabled the discrimination between preeclamptic pregnancies with and without placental dysfunction. Normal pregnancies with and without placental dysfunction could be separated by placental Flt-1 alone. Overall, classification of placental dysfunction was allowed by metabolomics, which also offered information that traditional diagnostics fail to provide. Metabolites with biomarker potential were recognized. Findings corroborated Flt-1 as precision biomarker for placental dysfunction. Its utility for the detection of high-risk pregnancies for preeclampsia and fetal growth restriction with placental involvement was verified.