Pregnant women finally have a test to predict preeclampsia, one of the top six causes of maternal death in Georgia, after the Food and Drug Administration recently approved the first of its kind.
Preeclampsia is a potentially life-threatening form of high blood pressure that can develop suddenly during pregnancy or following childbirth and quickly turn deadly. It has been known about for 100 years, but seen as wildly unpredictable.
The new test may offer an early warning, identifying which of the many pregnant women who have suggestive symptoms will go on to develop the life-threatening disease within the next two weeks.
Dr. Ravi Thadhani, an author of the study, is now executive vice president for health affairs at Emory, starting this new role last October. He oversees all components of Emory’s academic medical center, including the School of Medicine, School of Nursing, School of Public Health, and Emory Healthcare.
Credit: handout
Credit: handout
Thadhani worked on this research for several years in his previous position as chief academic officer at Harvard University’s flagship teaching hospital Mass General Brigham. He is a renowned researcher on preeclampsia.
Preeclampsia develops precipitously, and without the blood test, the warning signs can be vague.
“A woman can go from feeling fine and being completely healthy and having normal kidney and liver function, and within 24 to 48 hours those organs can fail and she develops brain swelling and seizures,” Dr. Thadhani said. “That is the scary part of the disease.”
Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.
The condition disproportionately affects Black women in the United States and was linked to the recent death of Tori Bowie, a track star who won gold at the 2016 Olympics. Two Black teammates of Bowie — Allyson Felix and Tianna Bartoletta — also developed preeclampsia during their pregnancies.
In a recently released investigation of maternal deaths for the years 2018 through 2020, the Georgia Department of Public Health identified preeclampsia as a leading cause of maternal deaths. The report also found almost all the deaths in the report, 89%, “had at least some chance of being prevented” if only the right steps were taken.
Dr. Doug Woelkers, a professor of maternal fetal medicine at the University of California, San Diego, called the test: “groundbreaking” and “revolutionary.”
“It’s the first step forward in preeclampsia diagnostics since 1900 when the condition was first defined,” he said.
After the pandemic began in 2020, COVID-19 posed an additional danger for the health of pregnant women. The pandemic also worsened existing gaps in maternity care.
The new blood test, made by Thermo Fisher Scientific, has been available in Europe for several years. It is intended for pregnant women who are hospitalized for a blood pressure disorder in the 23rd to 35th weeks of gestation.
Treatment for preeclampsia generally depends on how severe the preeclampsia is and how far along a woman is in her pregnancy. Some medications can help treat preeclampsia including drugs to lower blood pressure and to prevent seizures. Sometimes it is safer to deliver the baby early than to risk prolonging the pregnancy. But women who have severe preeclampsia need to be hospitalized and monitored to avoid potential complications.
Credit: TNS
Credit: TNS
The test can tell, with up to 96 percent accuracy, who will not develop preeclampsia within the next two weeks and so can safely be discharged from the hospital. Two-thirds of the women who get a positive result, on the other hand, will progress to severe preeclampsia in that time, and their babies may need to be delivered early.
Preeclampsia affects about one in 25 pregnancies, and the incidence has been on the rise in recent years in the United States. The problem usually starts about halfway through a pregnancy, though it can also occur after childbirth. It can lead to a condition called eclampsia, which can lead to seizures and death.
The blood test measures the ratio of two proteins that are produced by the placenta. A study published in NEJM Evidence in November tracked 1,014 pregnant women hospitalized with a hypertensive disorder of pregnancy at 18 medical centers in the United States from 2019 through 2021. Just under one-third were Black, and 16 percent were Hispanic.
The researchers found that the two proteins were greatly unbalanced in the blood of women who developed severe preeclampsia. Those with the widest ratios had a 65 percent chance of progressing to severe preeclampsia and of delivering their baby within two weeks, either spontaneously or through induction.
—Staff reporter Helena Oliviero contributed to this article.
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