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One of the main causes of maternal mortality often goes unnoticed. When diagnosed, sometimes it is too late to stop the damage.
Doctors generally do not identify preeclampsia, a severe form of high blood pressure that develops during pregnancy, until the blood pressure and urine controls are so pronounced that the condition is likely to have progressed and caused damage to the kidneys. organs. When cases are detected so late, women often end up giving birth prematurely, which has consequences for babies and mothers.
Women of color, particularly Black and Native women, are at much higher risk for this condition due to existing health problems.
An initiative announced this week aims to detect and treat preeclampsia earlier. If preeclampsia can be stopped, more women will be able to carry their babies to term. Treatment may be as simple as prescribing aspirin to reduce or prevent the condition. Researchers also hope the initiative could spur new treatments.
Tania Kamphaus, director of metabolic disorders at the nonprofit. Foundation for the National Institutes of Health, noted that even small preventative measures, “can make a dramatic difference in (a) person’s life and the life of the baby.” If allowed to run its course properly, she said, preeclampsia “affects both mother and child, and not just during pregnancy or in the first year afterward, for life.”
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He The Centers for Disease Control and Prevention found that 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 avoidable.
Nearly a third of pregnant women who died during childbirth 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 organization. Dime March. Preeclampsia can also occur after childbirth.
The condition usually appears after the first 20 weeks of pregnancy, about the middle of the second trimester, the Mayo Clinic said. Preeclampsia is often discovered through blood pressure checks. It is also usually detected through urine tests that show that the patient has high levels of protein. Other symptoms include decreased blood platelet levels, increased liver enzymes, severe headaches, vision changes, as well as difficulty breathing caused by fluid in the lungs, pain in the upper abdomen and nausea or vomiting.
However, doctors have been limited in detecting the condition in patients, often only detecting it when it is too late.
“In the United States, the way to detect a person’s risk of developing preeclampsia is purely clinical,” said Dr. Garita Sharma, director of women’s cardiovascular health and cardioobstetrics at Inova Health Systemwho has studied risks of preeclampsia in African American populations. “We don’t have any validated tests that we can use in the early stages of pregnancy, or perhaps even in the early stages of the second trimester, to understand a person’s increased risk.”
Risk factors include having had preeclampsia in a previous pregnancy, as well as chronic hypertension, diabetes, kidney disease, obesity and advanced maternal age, Sharma said. Black women are most at risk, as well as Indigenous women. Women of color in the US may have a higher incidence of chronic diseases that are considered risk factors for the disease.
Preeclampsia, when left untreated, can cause organ damage and lead to premature birth. Later in life, women are at greater risk for heart failure and heart disease, Sharma said.
Detection of preeclampsia markers
The three-year project, conducted by the nonprofit organization that promotes the work of the NIH, seeks to evaluate data on two biomarkers, molecules signaling placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP). -A), which can help determine if someone has preeclampsia.
The project will be based on 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.
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Aaron Pawlyk, chief of the branch of obstetric and pediatric pharmacology and therapeutics at the NICHD, said this was important, since existing data on how well biomarkers work have been generated in other countries. The data would measure PlGF and PAPP-A in blood drawn from patients in cohort studies.
The presence of PlGF and PAPP-A does not mean that a patient had preeclampsia, but it would help researchers identify patients at higher risk, Pawlyk said.
Once these markers are detected, doctors could monitor these women more closely for changes in blood pressure, prioritizing Doppler ultrasound tests to look at blood flow and blood tests to look at liver enzyme levels. That way, Pawlyk explained, aspirin can be used sooner.
The ultimate goal of the project is to get the Food and Drug Administration to allow this type of screening. If approved by the FDA, the data would be publicly available, allowing companies to develop diagnostic tests. Companies could then offer tests to pregnant patients during their regular blood tests.
This could also help develop treatments in addition to screening. Clinical trials have strict limits on the use of pregnant women in testing, said the foundation’s Kamphaus. Earlier testing could potentially develop better treatments for preeclampsia.
Eduardo Cuevas covers health and breaking news for USA TODAY. He can be contacted at EMCuevas1@usatoday.com.