The first ever World Pre-eclampsia Day takes place today, highlighting a condition that kills 100,000 pregnant women and 500,000 babies every year globally, writes Ailin Quinlan
IT is described in the hieroglyphics of the ancient Egyptians, and mentioned in the writings of Hippocrates, yet there’s still neither a screening test nor a cure for one of the most frightening medical conditions for pregnant women.
Pre-eclampsia can cause seizures and even death. Readers may remember Lady Sybil, in the hit TV series, Downtown Abbey, who had convulsions and tragically died of eclampsia.
Globally, up to 100,000 women and half a million babies, mostly in disadvantaged countries, die each year of the condition, which only occurs in pregnancy and which affects between 3% and 5% of first-time pregnant mothers.
Despite the fact that pre-eclampsia is a leading cause of maternal death, it’s a “very mysterious condition,” says Louise Kenny, professor of obstetrics and gynaecology at UCC, and consultant obstetrician and gynaecologist at Cork University Maternity Hospital.
“We have a very poor understanding of what causes it. It tends to occur in the second half of pregnancy, and affected mothers tend to have very high blood pressure, among other conditions. It’s very variable,” she says.
Pre-eclampsia can occur any time after the 20th week of pregnancy, and is marked by elevated blood pressure and, usually, protein in the urine.
Symptoms include a severe headache that medication can’t ease, swelling of the face and hands, gasping or panting, difficulty breathing, nausea after mid-pregnancy, changes in vision (for example, spots, light flashes, or vision loss) and pain in the upper-right belly, which is often mistaken for indigestion or flu.
Patricia Hetherington (43), from White’s Cross, Cork, had pre-eclampsia while pregnant with each of her daughters, Abby, aged seven, and Cara, who was born in late April.
At 34 weeks pregnant with Abby, on St Patrick’s Day, 2010, Patricia experienced a severe pain in her abdomen, was diagnosed with pre-eclampsia, and was hospitalised. Two days later, Abby was born by caesarean section.
“It took the best part of a year for me to get back to normal,” she says. When she became pregnant with Cara, she was warned that, because she’d already had it, there was now a 30% chance of pre-eclampsia reoccurring.
She was prescribed aspirin, which had to be stopped at 34 weeks. “The plan was to deliver Cara by a caesarean section, at 38 weeks, but this happened at 37 weeks, because the signs of pre-eclampsia were beginning again. My blood pressure was high and the level of protein in my urine was high.
“Pre-eclampsia is a very deceptive condition, because you don’t necessarily know you have protein in the urine or high blood pressure.
“It’s a condition which kind of creeps up on you, so you really need to ensure that you are attending your medical check-ups.
“This is very important, because things can change so quickly,” Patricia says. Despite records that an ancient Egyptian queen died agonisingly from pre-eclampsia, we still don’t have a screening test or a cure for it cure.
The only cure is the delivery of the baby.
Yet, says Professor Kenny, if a baby is born small or premature, or both, because its mother had pre-eclampsia, it will be up to five times more likely to die of a heart attack, up to five times more likely to develop diabetes, and much more likely to have high blood pressure or a stroke later in life.
However, as director of the Irish Centre for Fetal and Neonatal Translational Research, at UCC, Professor Kenny is coordinating the international IMPROVED study, and trialling a blood test that will screen for the risk of pre-eclampsia in pregnant women at 15 weeks.
“We developed the test at UCC in the laboratory and it seems to work well, but it needs to be trialled. This is a Europe-wide study,” she says. 5,000 women in Ireland, the UK, the Netherlands, and Sweden are participating.
Recruitment is complete in the other countries, and 1,500 women have signed up at Cork University Maternity Hospital, but Prof Kenny is hoping to add another 300 women to the trial. Hopefully, this test will prove accurate in identifying women prone to pre-eclampsia in early pregnancy.
Once the test is approved, it will be administered to every pregnant woman at 15 weeks, and it will predict their risk of pre-eclampsia later in the pregnancy. Meanwhile, public awareness of this potentially fatal condition is growing. The first-ever World Preeclampsia Day takes place today, Monday, May 22, and buildings throughout Cork and Dublin are being lit up to mark the occasion.
In Cork, the list of buildings includes City Hall, UCC’s Quad and the Blackrock Castle Observatory, while, in Dublin, the buildings include The Mansion House, the Rotunda Hospital, the National Maternity Hospital, the RCSI, and Trinity College Dublin.
The PARROT study, which trials a diagnostic test for women who have presented with symptoms of pre-eclampsia, is also about to be launched.
PARROT uses an extra blood test to help doctors both diagnose pre-eclampsia in women pregnant for more than 24 weeks and to determine the severity of their condition.
Professor Kenny says: “The PARROT test identifies a blood-marker or protein in the blood, which indicates both the presence and severity of the condition”.
The study is being rolled out across Ireland in seven maternity hospitals in Cork, Belfast, Limerick, Galway, and Dublin, from the beginning of June, when researchers hope to recruit 4,000 women to take part in the study. The test will begin in the Coombe and be rolled out over 18 months across the country.
From June 1, all women who are pregnant for more than 24 weeks, and who are showing signs of pre-eclampsia, will be offered the test. This will happen one hospital at a time. “If the test shows the women have a significant risk, it will help to guide the management of the condition.
The test provides additional information and helps doctors to manage patients better,” Prof Kenny says.
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