Doctors want to reduce maternal deaths
Initiative aims to detect preeclampsia earlier
A leading cause of maternal mortality often goes unnoticed. By the time it’s diagnosed, it’s sometimes too late to stem the damage.
Doctors typically do not identify preeclampsia, a serious form of high blood pressure developed during pregnancy, until blood pressure and urine checks are so pronounced that the condition has likely progressed, causing organ damage. When cases are detected this late, women often end up going into preterm labor, resulting in consequences for babies and mothers.
Women of color, particularly Black and Native women, because of existing health issues, are at much greater risk of having the condition.
An initiative announced last week aims to detect and treat preeclampsia earlier. If preeclampsia can be curbed, more women will be able to bring their babies to term. Treatment can be as simple as prescribing aspirin to reduce or prevent the condition. Researchers also hope the initiative can spur new treatments.
Tania Kamphaus, director of metabolic disorders at the nonprofit Foundation for the National Institutes of Health, noted that even with small preventative steps, “You can make a dramatic difference to (a) person’s life and the life of the baby.” If allowed to run its course well, she said, preeclampsia “impacts both mother and child – and not just during pregnancy or in the first year after, for life.”
The Centers for Disease Control and Prevention found 1,205 women died of maternal causes in 2021, up from 861 in 2020. Black women died at more than twice the rate of white women. The CDC has determined that more than 80% of pregnancy-related deaths are preventable.
Nearly a third of pregnant people who died during delivery had a hypertensive disorder, a category that includes preeclampsia. Globally, between 10 and 15% of maternal deaths are caused by preeclampsia and related complications, according to the nonprofit March of Dimes. Preeclampsia can also occur postpartum.
The condition typically kicks in after the first 20 weeks of pregnancy, about midway through the second trimester, the Mayo Clinic said. Preeclampsia is often discovered through blood pressure checks. It often is detected through urine checks that show a patient has high protein levels. Other symptoms include decreased blood platelet levels, increased liver enzymes, headaches, changes in vision, and shortness of breath caused by fluid in the lungs, upper belly pain and nausea or vomiting.
However, doctors have been limited in detecting the condition in patients, often only finding it when it’s too late.
“In the U.S., the way to detect somebody’s risk of developing preeclampsia is purely clinical,” said Dr. Garima Sharma, director of cardiovascular women’s health and cardio-obstetrics at Inova Health System, who has studied preeclampsia risks in Black American populations. “We don’t have any validated tests that we can use very early in pregnancy, or maybe even early in the second trimester, to understand somebody’s higher risk.”
Risk factors include having preeclampsia in a previous pregnancy, as well as chronic hypertension, diabetes, kidney disease, obesity and older maternal age, Sharma said. Black women are at greater risk, in addition to Indigenous women. Women of color in the U.S. may have a higher incidence of chronic illnesses that are considered risk factors for the disease.
Preeclampsia, when untreated, can result in organ damage and lead to preterm birth. Later, women are at greater risk of heart failure and heart disease, Sharma said.
Detecting markers for preeclampsia
The three-year project, by the nonprofit that promotes NIH’s work, seeks to evaluate data on two biomarkers, molecules indicating placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), that can help tell if someone has preeclampsia.
The project will draw from Eunice Kennedy Shriver National Institute of Child Health and Human Development data on more than 25,000 pregnancies in the U.S. and Canada that researchers say allows for an ethnically and racially diverse study group.
The presence of PlGF and PAPP-A doesn’t mean a patient had preeclampsia, but it would help researchers identify patients at higher risk, Pawlyk said.
Once markers are detected, doctors could more closely monitor these women for changes in blood pressure, prioritizing ultrasound tests to look at blood flow, and blood work to look at liver enzyme levels. That way, Pawlyk said, aspirin can be used earlier.
The goal is to get the Food and Drug Administration to allow this type of detection. If approved it, the data would be publicly available, allowing development of diagnostic testing.