Cell-free DNA fragmentomics for preeclampsia risk assessment

W Wenqiu Xu S Songchang Chen J Jia Li S Si Zhou (Guangdong Basic Research Center of Excellence for Structure and Fundamental Interactions of Matter, Guangdong Provincial Key Laboratory of Quantum Engineering and Quantum Materials, School of Physics) Y Yanning Yin Z Zhixu Qiu J Jianguo Zhang C Cong Liu Q Qiang Zhao G Gefei Xiao Y Yan Zhou Z Zhiguang Zhao X Xiao Zhang W Wenzhi Yang Y Yunfang Wang H Huiqin Li Z Zhen Yang S Suihua Feng Q Qun Zhang W Weiping Chen H Huahua Li X Xiaohong Ruan H Hua Li S Sufen Zhang L Liqing Hu J Jie Qin W Wuyan Huang Z Zhongzhe Li X Xianling Cao X Xuanyou Zhou N Naixin Xu D Dongxia Hou H Hong Dong J Jie Wang (State Key Laboratory of Molecular Oncology, Beijing Key Laboratory, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences Beijing China) Y Yaxian Liu (Department of Chemistry, Molecular Science Research Hub) Q Quanfu Zhang X Xiaohua Wang L Lijian Zhao H Hefeng Huang C Chenming Xu

Abstract

Abstract Preeclampsia (PE) is a pregnancy-specific hypertensive disorder that could lead to serious maternal and fetal complications, yet early identification of women at risk remains challenging because reliable biomarkers are limited. Here we show that generating relatively stable cell-free DNA (cfDNA) fragmentomic metrics, including transcription start site (TSS) coverage, TSS score, and Gini coefficient, required 600 million whole-genome sequencing reads of plasma cfDNA. These metrics exhibited observable differences among genes with varying expression levels in blood cells and placental tissues. In a cohort of 1,058 pregnant women, cfDNA fragmentomics could distinguish pregnancies that subsequently developed PE. When integrated with maternal risk factors, predictive models in two independent test sets achieved mean area under the curves of 0.903 and 0.850 for early-onset and late-onset PE, respectively, with sensitivities of 0.731 and 0.607 at a 10% false positive rate. Importantly, these models also performed well in samples collected before or at 16 weeks of gestation, supporting the potential of cfDNA fragmentomics in early PE risk assessment.

Article Details

Volume / Issue Vol. 17, Issue 1
Published May 02, 2026
ISSN 2041-1723
Publisher Nature Portfolio

Journal Info

Nature Communications

Nature Portfolio

ISSN: 2041-1723 Open Access Life Sciences

Authors (40)

W

Wenqiu Xu

S

Songchang Chen

J

Jia Li

S

Si Zhou

Guangdong Basic Research Center of Excellence for Structure and Fundamental Interactions of Matter, Guangdong Provincial Key Laboratory of Quantum Engineering and Quantum Materials, School of Physics

Y

Yanning Yin

Z

Zhixu Qiu

J

Jianguo Zhang

C

Cong Liu

Q

Qiang Zhao

G

Gefei Xiao

Y

Yan Zhou

Z

Zhiguang Zhao

X

Xiao Zhang

W

Wenzhi Yang

Y

Yunfang Wang

H

Huiqin Li

Z

Zhen Yang

S

Suihua Feng

Q

Qun Zhang

W

Weiping Chen

H

Huahua Li

X

Xiaohong Ruan

H

Hua Li

S

Sufen Zhang

L

Liqing Hu

J

Jie Qin

W

Wuyan Huang

Z

Zhongzhe Li

X

Xianling Cao

X

Xuanyou Zhou

N

Naixin Xu

D

Dongxia Hou

H

Hong Dong

J

Jie Wang

State Key Laboratory of Molecular Oncology, Beijing Key Laboratory, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology Cancer Hospital, Chinese Academy of Medical Sciences Beijing China

Y

Yaxian Liu

Department of Chemistry, Molecular Science Research Hub

Q

Quanfu Zhang

X

Xiaohua Wang

L

Lijian Zhao

H

Hefeng Huang

C

Chenming Xu