Objectives: To assess the value of sequential estimation of biomarkers for prediction of gestation hypertension (GHTN) and preeclampsia (PE) and to stratify PE according to time of development and severity.   
Patients & Methods: 80 normotensive (NT) newly pregnant women who continued pregnancy and were free of hypertensive manifestation (NT group), and the GHTN group included 80 newly pregnant NT women who developed high blood pressure (BP) measures without proteinuria after the 20th gestational week (GW). Early-onset PE (EO-PE) was diagnosed if a GHTN woman developed proteinuria before the 34th GW, but after the 34th GW, it is Late-onset PE (LO-PE). PE was diagnosed as mild if BP was <160/110 with +1 proteinuria on the dipstick, otherwise it is severe PE. Blood samples were obtained at the 12th, 24th, 32nd, and 36th GW for ELISA estimation of serum levels of placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFlt-1), pregnancy protein 13 (PP13), and pregnancy-associated plasma protein-A (PAPP-A) levels. The outcome is the ability of the estimated biomarkers' levels to distinguish women liable to develop GHTN or PE among NT pregnant women.  
Results: 9 women developed EO-PE and 25 had LO-PE. 20 women had mild and 14 women had severe PE. Statistical analyses defined a high sFlt-1/PLGF ratio as specific, and low PAPP-A level as a screening predictor for GHTN at the 12th GW, and at the 24th GW low serum levels of PP13 were defined as the highly significant screening, and high sFlt-1/PLGF as a highly significant specific predictor for EO-PE. In the 32nd GW sample, low PP13 levels were defined as the most significant screening predictor, and high sFlt-1/PLGF ratio was the specific predictor for LO-PE.   
Conclusion: Sequential estimation of multiple serum biomarkers for screening of pregnant women to distinguish women vulnerable to developing HPD is required for early detection of these women, especially the high-risk women. The best policy is an estimation of serum PP13 at the 12th GW and an estimation of PP13, sFlt-1, and PLGF to calculate the sFlt-1/PLGF ratio at the 24th and 32nd GW to define women vulnerable to develop PE and to stratify them according to time and severity of PE.