The diagnostic device that could SAVE THE LIVES OF MOTHERS AND BABIES
Irish scientists are leading the way in improving pre-eclampsia outcomes
IT IS the world’s most dangerous pregnancy complication, killing over 70,000 mothers and half a million babies worldwide each year. Preeclampsia can affect almost one in ten Irish pregnancies but warning signs often go unnoticed until serious complications develop for mothers and babies.
With World Preeclampsia Day taking place this Friday, a team of Irish scientists and doctors is now developing a diagnostic tool to predict the severity of the disease and help save lives.
Their project, AI PREMie, has been shortlisted in Science Foundation Ireland’s Artificial Intelligence for Societal Good Challenge — dubbed Dragon’s Den for Scientists.
SFI is the national foundation for investment in science, technology, engineering, and mathematics (STEM) research. The AI for Societal Good Challenge supports interdisciplinary teams to develop inventive AI-based solutions that address significant national and global societal challenges.
‘AI PREMie is a risk stratification tool that identifies women with preeclampsia and also how they will progress,’ explains Professor Patricia Maguire, Director of UCD Institute for Discovery, who is leading the UCD Conway SPHERE team.
“At present delivery of the pre-term baby is the only treatment and the safest option for the mother. But early delivery can lead to long-term neurodevelopmental problems and death.
‘Our AI PREMie tool assesses the preeclampsia risk based on what are called biomarkers in the mother’s blood. After a simple blood test carried out in the hospital, caregivers will know if they need to plan for a swift birth or if the baby can stay in utero and have that precious opportunity to develop more. Every day in utero counts.’
FINDING these PET biomarkers in a mother’s blood is, according to Professor Maguire, ‘like finding a needle in a haystack. Basically we have developed an algorithm to pull out that needle from the haystack.’
And as the SFI challenge supports interdisciplinary teams to develop ‘novel, potentially disruptive AI-based solutions that address significant national and global societal challenges,’ AI PREMie is the right fit.
Professor Maguire co-directs the research group with Professor Fionnuala Ní Áinle, clinical lead in the Department of Haematology at Dublin’s Rotunda and Mater Misericordiae hospitals.
Completing the all-women AI PREMie team are biochemist Dr Paulina Szklanna and Professor Mary Higgins, consultant obstetrician at the National Maternity Hospital, Holles Street.
‘I was asked to participate because I provide care to women who have been affected by early onset preeclampsia. This includes women whose babies have died and women who have been very sick,’ says Professor Higgins.
‘They’ve gone from a perfectly normal pregnancy to a life-changing experience which will affect their families for the rest of their lives.
‘And also in a personal capacity I had preeclampsia myself so that’s why it’s something that’s really meaningful to me,’ she adds.
‘My daughter was born at 31 weeks, a week after Christmas, in 2004. We had no idea what to call her because she was nine weeks early. She was born on New Year’s
Eve so we called her Eve.
‘She spent seven weeks in the intensive care unit. You kind of think as a doctor you’re going to be immune to preeclampsia which is ridiculous because it can affect anybody.
‘But I can still remember having a pregnancy that was normal — and suddenly, not normal. Having to be admitted over Christmas, staying in hospital. You feel it as a failure.
You feel like your body has let you down.
‘And one of those fundamental tasks as a parent is to protect your child but then you’ve failed in that, your body has failed in it, and it sets you up for the question of whether you will be able to be a parent for the rest of the time? There’s a lot of psychology in it too.’
Former midwife Libby O’Sullivan knows only too well what Professor
Higgins means. The 46-year-old farmer’s wife from Kenmare, Co. Kerry — and mother to Grace, 12 and three-year-old Caoimhe — had preeclampsia on both pregnancies.
‘A lot more research and support needs to be done around the postnatal period because women who have been through preeclampsia deliveries can suffer from PostTraumatic Stress Disorder. At the time you just get through it but it leaves a really big scar,’ Libby says.
While Libby’s eldest Grace was born at 39 weeks, Caoimhe was born at 28 weeks weighing just 850 grams (1lb 9oz).
‘I’ve experienced preeclampsia from both a midwifery point of view and a mum’s perspective on my first and especially my second child. I knew all the symptoms to look for — not that I was terribly symptomatic.
‘I didn’t have the proteins in my urine, I didn’t have loads of swelling, I had no vision disturbance or headaches. The reduced rate of Grace’s growth was the major symptom on my first pregnancy.’
Because of her history with Grace, Libby was put on blood pressure tablets immediately when she became pregnant for a second time. But it wasn’t enough.
‘When my consultant in University
Hospital Kerry scanned me at 27 weeks and five days she saw there was no flow from the placenta to the baby,’ Libby says. ‘I was immediately taken up to Cork University Hospital and they sectioned me the next day.
‘I had to have a magnesium sulphate infusion and steroids. It was a very fraught time. Horrible,’ she says. General anesthetics are avoided in preeclampsia deliveries because of concerns about bleeding. Libby had a spinal anesthesia instead.
‘I was just thinking, “Get on with it. I want her out now.” I knew from my experience as a midwife that she wasn’t safe where she was. Caoimhe weighed just 850 grams. It was really awful because I had experience of delivering premature babies and knew the complications that Caoimhe could face.
‘I thought, “She’s not going to make it, there’s too many things that can go wrong — breathing problems, problems with the bowel”.’
Little Caoimhe was in hospital for four months and slowly but surely she rallied. ‘She had a lot of feeding problems. She had laryngomalacia, or a floppy airway,’ Libby says.
‘She had a cyst on her vocal chords. She found feeding and breathing and swallowing very difficult.’ Caoimhe is still an outpatient at Crumlin Children’s Hospital almost four years on.
‘She had a lot of help,’ Libby says. ‘Neurologically speaking she is doing well and her sight and hearing are pretty good. We are very lucky. She still is very small — underneath the ninth centile on the growth chart — and we’re still monitored by a paediatric consultant and speech and language feeding specialists. We don’t have physio any more. The preemie babies need physio because they’re in hospital so long. You also get occupational therapy,’ she adds.
‘Caoimhe’s upper airway has always been her issue. Lots of children born prematurely develop what is called an oral aversion— reluctance, avoidance or fear of eating and drinking — because they have so much done to their mouths with breathing equipment and feeding equipment.
‘Even as a midwife I didn’t do neonates so I hadn’t a clue they could get this oral aversion.
CAOIMHE does eat but it’s sporadic and she has sensory and textural sensitivities. We are still on our journey. We have spent a lot of time in Crumlin for various appointments and it is a five-hour drive from our home in Kerry. I don’t think there’s enough said about preeclampsia and there’s definitely far more research needed,’ says Libby, praising the UCD Conway SPHERE team for their diagnostic breakthrough.
‘It is great to see more research being done on the early detection and treatment of preeclampsia. If you can predict who is at risk you can treat it earlier. And the earlier you can identify people at risk the better.’
Prof Maguire agrees that even a minor improvement in gestation at delivery would improve outcomes for the baby and potentially save lives. ‘AI PREMie is an affordable test and we believe it will become part of the standard blood testing for preeclampsia within five years,’ she says.
‘Preeclampsia diagnosis can be difficult but it is even harder to predict the disease severity and progression. Clinicians must constantly monitor their patients and they have to rely on their experience to determine the best time for preterm delivery of the baby, which is the only treatment option.
‘By predicting preeclampsia severity, AI PREMie will allow clinicians to delay delivery in some cases, significantly improving the baby’s survival and future health.’