What Is Preeclampsia
Latest research shows that from 70,000 to 80,000 women die each year as a direct cause of preeclampsia.
Preeclampsia is a life-threatening condition characterised by high blood pressure (hypertension) and elevated protein in the urine leading to restricted blood supply to the foetus. The condition begins in early pregnancy with defective development of the placenta but most often does not manifest itself until the second half of pregnancy. Once diagnosed, the only treatment option is the delivery of the baby prematurely. It affects 5% of first time mothers but may reach 10% in the developing world and can severely impact their health and that of their unborn child. The condition has been the most important cause of maternal death over recent decades (associated globally with 70,000 – 80,000 deaths annually) and is responsible for occupancy of approximately 20% of neonatal intensive care unit cots. For the mother it can lead to acute problems in the liver, kidneys, brain and the clotting system. Additionally, epidemiological studies have demonstrated that pre-eclampsia is associated with an increased risk of cardiovascular and metabolic diseases later in the mother’s life. A quarter of the babies born to mothers with pre-eclampsia are growth restricted and a third are premature. The child may have problems with neurocognitive development that can result in mild learning difficulties through to severe disabilities. Being born growth restricted also predisposes the child to high blood pressure, heart attacks and diabetes as an adult. The social consequences and lifelong economic costs resulting from these conditions are enormous. Prevention of these health problems is of paramount importance to future mothers, fathers and children.
“Everything we know about this condition suggests women do not become sick and present with preeclampsia until late in pregnancy, but the condition originates in early pregnancy. To develop effective treatment and prevention strategies — our ultimate goal — we need to be able to start treatment in early pregnancy. We need to be able tell who is at risk and who is not.” – Louise C Kenny, MD, PhD, the study lead and professor of obstetrics and gynecology at the Anú Research Centre, University College Cork.
Identification of first time mothers at risk for these conditions is the first step to effective intervention and prevention. Prenatal care currently consists of a series of consultations during pregnancy with a doctor or midwife. The main reason for these checks is to detect early signs of hypertension and proteinuria. The standard intervals between prenatal visits may result in delays in diagnosis with an increased chance of severe complications. If at risk first time mothers could be identified in early pregnancy, known and emerging therapies could potentially prevent almost a third of cases. In the US alone the cost of prenatal care associated with pre-eclampsia is over £7Billion.
Widespread plasma alterations precede the clinical onset of pre-eclampsia and there is intense interest in the identification of predictive biomarkers. Numerous candidate biomarkers have been proposed for prediction of disease, including placental hormones, angiogenic factors and lipids. However, none (nor any combination) has emerged with the requisite specificity and sensitivity to be of clinical use; the World Health Organization recently concluded that there is currently no cost effective or reliable screening test for pre-eclampsia. As a consequence, clinicians are unable to offer either targeted surveillance or potential preventative therapies to those at greatest risk.