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, are at much greater risk of having the condition due to existing health issues.
An initiative announced this 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.”
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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 also 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’s also often detected through urine checks that show a patient has high protein levels. Other symptoms include decreased platelet levels in the blood, increased liver enzymes, severe headaches, changes in vision, as well as 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. Garita 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 on, 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 (NICHD) 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.
Aaron Pawlyk, chief of NICHD’s obstetric and pediatric pharmacology and therapeutics branch, said this was important, since existing data on how well the biomarkers work have been generated in other countries. The data would measure PlGF and PAPP-A in blood collected from patients in cohort studies.
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 these markers are detected, doctors could more closely monitor these women for changes in blood pressure, prioritizing Doppler ultrasound tests to look at blood flow, and blood work to look at liver enzyme levels. That way, Pawlyk explained, aspirin can be used earlier.
The ultimate goal of the project is to get the Food and Drug Administration to allow this type of detection. If the FDA approved it, the data would be publicly available, allowing companies to develop diagnostic testing. Companies could then offer tests for pregnant patients during their regular bloodwork.
This could also help develop treatments in addition to detection. Clinical trials have strict limits on using pregnant women in testing, said Kamphaus, of the foundation. Earlier testing could potentially develop better treatments for preeclampsia.
Eduardo Cuevas covers health and breaking news for USA TODAY. He can be reached at EMCuevas1@usatoday.com.
