What is the only cure for preeclampsia?
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As an expert in vascular biology, Karumanchi became fascinated years ago with growing evidence that preeclampsia damages the cells that form the lining of blood vessels. He figured the cause had to be one or more of the proteins released into the mother’s blood vessel system by the placenta. But which one? Show
Finding the culprit could have been a daunting, needle-in-a-haystack undertaking. But he got lucky. He was able to use new technology to examine the entire genome of the placenta in a single snapshot, rather than looking at one protein at a time to determine whether it was elevated in preeclampsia patients. “I was asking the right question at the right time,” he says. “This technology had just come out. Without it, I might have spent 50 years trying to do this.” The “brightest signal” came from a “bad” protein called soluble fms-like tyrosine kinase 1 (sFlt-1). Also significant was a “good” protein essential to healthy blood vessels: placental growth factor (PIGF). Karumanchi had a hunch that preeclampsia was triggered when the “bad guys” outnumbered the “good guys,” causing blood vessels to constrict instead of relaxing and opening up to support blood flow for a healthy pregnancy. While Karumanchi was working on this basic biological science, Thadhani was studying high blood pressure in women and caring for preeclampsia patients in the clinic. He found it frustrating not to be able to do more for them. When he heard about Karumanchi’s results, he knocked on his door. The two launched a study using 10,000 tissue samples Thadhani had collected from pregnant women in Boston to validate Karumanchi’s theory. This led them to the diagnostic tool that is now the focus of a clinical trial at Cedars-Sinai. The study seeks to identify a ratio between the “bad” and “good” proteins that would help identify patients most likely to develop severe symptoms of preeclampsia. Once they confirmed the role of the “bad” sFlt-1 protein in preeclampsia, they knew they had a critical building block for a treatment as well as a diagnostic test. Anyone who observed them on that stormy day in the bookstore in Boston might have thought they were arguing. “We sat there for hours trying to figure out the best approach. It was a cognitive wrestling match,” Thadhani says. Their expertise as kidney specialists led them to an answer. “Our predecessors in nephrology realized that, rather than taking out whole blood, we can tinker with it to take out what’s bad and leave in what’s good,” Thadhani says. “Nephrologists have been pioneers in selective removal strategies.” A light bulb went on: Instead of developing a drug targeting sFLt-1 that might cross the placenta and damage the fetus, why not remove the offending protein from the mother’s bloodstream? Three years later, Thadhani and Karumanchi launched their first treatment study in Europe. Using a process similar to kidney dialysis, they modified existing technology to develop a device that removes blood through a catheter, runs it through a machine that eliminates sFLt-1 and then returns the blood to the mother. Thadhani says they’ve been able to extend pregnancy for about two weeks, a significant period for development of the fetus. The findings of their first pilot study on this potential treatment method were published in 2011 in Circulation. A follow-up study published in 2016 by the Journal of the American Society of Nephrology confirmed the initial findings and set the stage for the next step—validating these results in larger U.S. studies. Pre-eclampsia is a serious medical condition that can occur after 20 weeks of pregnancy. It typically causes high blood pressure and can affect several of your body organs, including the liver, kidney and brain. If left untreated, it can lead to serious problems for you or your baby. Pre-eclampsia is the most common serious medical disorder that can occur during pregnancy. Mild pre-eclampsia can occur in up to 1 in 10 pregnancies, and severe pre-eclampsia in up to 1 in 100 pregnancies. Early detection and treatment are important to prevent life-threatening complications. What risk factors may increase my chances of pre-eclampsia?You might be at a higher risk of pre-eclampsia if you have had any of the following: Pre-eclampsia may also be more common if you are:
What are the symptoms of pre-eclampsia?Most women with pre-eclampsia do not have any symptoms. It is usually diagnosed during a routine antenatal appointment. Women who have severe pre-eclampsia with high blood pressure may also experience kidney problems leading protein in the urine. Women with pre-eclampsia can also have the following symptoms:
It is very important to see your doctor, midwife or pregnancy care provider if any of these symptoms occur. How do I know if I have pre-eclampsia?Your doctor or midwife will routinely check your blood pressure at every visit during your pregnancy to check that it is within the normal range. If your blood pressure is too high, your doctor may order a number of other tests to check for pre-eclampsia. This may include a urine test to check for protein, blood tests to check your kidney and liver function, and routine physical examinations to check your leg reflexes. Your baby will also be checked using an ultrasound to assess their growth and wellbeing, and heart rate monitoring using a cardiotocograph (CTG). How is pre-eclampsia treated?If your pre-eclampsia is mild or moderate, your doctor may recommend that you go to hospital for monitoring and start taking blood pressure medicines. You may also be prescribed treatment to prevent blood clots. The only complete cure for pre-eclampsia is the birth of your baby. Your doctor may recommend inducing labour early to help manage your pre-eclampsia. Every pregnancy is unique, and your doctor will discuss with you what is best for you and your baby. You may be able to delay inducing labour for a while, or you may need to have your baby before the due date — the exact timing will depend on your particular situation, including how many weeks pregnant you are, your baby’s size and how severe your pre-eclampsia is. The majority of pregnant women with pre-eclampsia will not have any complications once they are on blood pressure medicines and give birth to their baby. However, some pregnant women may experience serious complications such as seizures, a stroke, kidney failure, liver failure or bleeding due to clotting problem. Women who have had pre-eclampsia may be at an increased risk of high blood pressure, heart disease, diabetes, or ongoing clotting disorders later in life. Your doctor may ask you to have more regular check-ups so you can receive treatment as early as possible if any of these disorders occur. Many women feel overwhelmed or distressed after a diagnosis of pre-eclampsia. If this has been your experience, let your doctor or midwife know you need some support. You can also call Pregnancy, Birth and Baby, 7 days a week on 1800 882 436 to speak with a maternal child health nurse. Does pre-eclampsia affect my baby?Pre-eclampsia can cause your placenta to not function as well. This can affect your baby and may cause abnormal growth or trigger a premature birth. If your baby is born early or smaller than expected, they may need to be cared for in a special care nursery. How long will my pre-eclampsia last?After your baby is born, many of your symptoms of pre-eclampsia will improve, but it can take several days, and sometimes longer, until everything returns to normal. Some of your blood tests may get worse for a day or two before they get better. High blood pressure can continue up to 3 months after your baby is born. Do I still need treatment for pre-eclampsia after my baby is born?After your baby is born, you are still at an increased risk of complications for the first few days. You will usually stay in hospital and may need to continue taking medicine for your blood pressure. It is important that you attend your 6-week postnatal check-up to make sure your blood pressure has returned to normal and there is no more protein in your urine. Will I have pre-eclampsia with other pregnancies?If you have had pre-eclampsia, you are at a risk of having pre-eclampsia again with any future pregnancies. Before planning any future pregnancies, meet with an obstetrician who can help manage blood pressure conditions during your pregnancy and will help reduce the chance of any complications.  Speak to a maternal child health nurseCall Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week. Why is delivery the only cure for preeclampsia?Removing the placenta is the only way to begin reversing the disease process, so when the mother or baby is too unwell to continue the pregnancy, delivery is indicated. The nuance here, though, is the definition of “cure.”
What is the first line treatment for preeclampsia?Hydralazine and labetalol are the two “first line” agents used for hypertension in preeclampsia. Hydralazine is an arteriolar dilator that reduces blood pressure but may cause tachycardia.
Can preeclampsia just go away?Preeclampsia usually resolves within 6 weeks after the baby is born and the placenta is delivered. However, it may persist longer or even begin after delivery. Most often, at 37 weeks, your baby is developed enough to be healthy outside of the womb.
What is the main cause of preeclampsia?Pre-eclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it.
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