By Stephen Beech via SWNS
Personalized screening early in pregnancy may improve detection of a potentially deadly complication, suggests a new study.
The more extensive screening method in the first trimester of pregnancy may help spot warning signs of pre-eclampsia, say scientists.
The condition is characterized by severe high blood pressure and liver or kidney damage, and it is a leading cause of deaths during pregnancy worldwide.
Pre-eclampsia is a major cause of complications and death for the mother and her unborn child, and also doubles a woman’s risk of heart diseases – such as high blood pressure, heart attack, stroke or heart failure – later in life.
The condition affects up to one in 14 pregnant women – including celebrity moms Kim Kardashian, Mariah Carey and Sophie Ellis Bextor.
Found in around 42,000 pregnancies a year in the UK (six per cent), it reduces the flow of blood through the placenta, and can lead to stillbirth or even the death of the mother.
Children born to mothers with pre-eclampsia are also at higher risk of developing high blood pressure and heart disease.
While in many women the symptoms are mild, in some cases the condition becomes so severe the baby needs to be delivered prematurely.
In the latest study, involving more than 7,000 women, the new screening method – which combined maternal history, biomarker tests and ultrasound scans – was better at identifying pre-eclampsia risk than current risk factor-based guidelines.
Senior study author Professor Emmanuel Bujold, of Laval University, Canada, said: “Pre-eclampsia is one of the most severe illnesses of pregnancy and may lead to preterm birth and/or maternal death.”
He explained that the biological mechanisms that lead to pre-eclampsia usually start in the first trimester of pregnancy, but the initial symptoms most often do not appear before week 20.
Current risk factor-based guidelines recommend pregnant women take aspirin if they have a major risk factor such as chronic high blood pressure, Type 2 diabetes, chronic kidney disease, lupus or pre-eclampsia in a previous pregnancy.
Aspirin is also recommended for pregnant women with two moderate risk factors such as being a black woman, having a sister or mother with history of pre-eclampsia, having a first pregnancy, obesity or an IVF pregnancy.
Prof Bujold said: “Following those guidelines, almost all black women should take aspirin during pregnancy, as should about one-third of all women of other races and ethnicities.”
Previous studies have found that preterm pre-eclampsia, defined as developing the condition before 37 weeks of gestation, can be predicted in the first trimester using a combination of ultrasound and blood biomarker tests.
In the new study, researchers recruited more than 7,000 Canadian women, average age 29, who were between 11 and 14 weeks pregnant with their first child to evaluate the screening model consisting of maternal history, ultrasound data and several tests for blood markers.
The findings, published in the journal Hypertension, showed that for participants between 11 and 13 weeks of pregnancy, the pre-eclampsia detection rate was 63.1 percent.
Prof Bujold said: “Using this new screening model, treatment decisions were based on each individual’s personal risk.
“With their personal risk calculated, it’s much easier for a woman to make the right decision, for example, if she chooses to take daily low-dose aspirin, she is much more likely to follow through because it’s based on personalized screening test.
“It’s reasonable to believe that the inclusion of the entire population and immediate analysis of blood samples may both have improved the screening process.
“If we implemented a screening program in big cities across North America, the screening would be expected to be even better and more accurate.”
He added: “The good news is that we now have a more precise screening approach using existing tests that can predict pre-eclampsia early in pregnancy.
“The next step is to make this screening available to all pregnant women so that more women could receive a diagnosis early in pregnancy and begin preventative aspirin treatment, potentially preventing complications of severe preeclampsia.”
Professor Sadiya Khan, of the American Heart Association, welcomed the findings.
She said: “Since the risks for pre-eclampsia may be largely influenced by health before pregnancy, the ability of a screening model to be applied in early pregnancy is very helpful and can initiate conversations between the clinician and patient about strategies to optimize heart health.
“However, challenges remain with implementation of models such as this one that integrate biomarkers that are not routinely assessed and may not be widely available, especially among people in vulnerable populations who are most likely to have the highest risk for preterm pre-eclampsia.”
