Tuesday, February 13, 2007

A Worldwide Hope -- More on Preeclampsia

In my October 24, 2006 posting below, entitled "How Magic Happens", I cite an article by Dr. Jerome Groopman about research concerning preeclampsia that was conducted by scientists at BIDMC. This is a serious disease, a major cause of maternal and perinatal death and morbidity worldwide, but especially in developing countries. Because of the importance of the disease, public health officials around the world hope for rapid clinical applications of the recent discoveries.

In that vein, I learned this week of a clinical trial being undertaken by the World Health Organization as part of a collaborative effort with several institutions around the world. The trials derive directly from the research described in Jerry's article. The idea is to determine whether simple urine and blood tests can be used to identify women at risk for this disease. The trial is being carried out in several countries, and the hope is to evaluate this procedure in over 12,000 women who have risk factors for the disease.

The idea is straightforward. If simple tests during early pregnancy can indicate which women are more likely to get the disease, their pregnancy can be closely monitored and their symptoms alleviated rapidly when they occur -- reducing the chance of death or injury to the mother and the baby. As noted in the summary:

If as we hypothesize, this large prospective study convincingly demonstrates that urinary ... and serum ... bio-markers predict preeclampsia, with a high degree of sensitivity and specificity, and weeks prior to overt disease, we will focus on the best way to implement the use of these easily performed and affordable tests in developing nations.

Read through the minutes of the cooperative group to get a sense of how these scientists are designing the trial and the considerations they must examine to make sure it is scientifically valid and useful. The minutes give you a feeling for the enthusiasm with which these doctors approach the trial and also for their underlying wish that it will be successful.

It is always tempting to have great hopes for clinical trials, and we shouldn't permit ourselves to get ahead of the results. That being said, if this trial is conclusive, this is a big deal for the entire world. We all wish them great success.


Ileana said...

4 years ago I had no idea what this disease is... until 4 hours later. I was just at the beginning of my 6th month of pregnancy and it was Valentine's Day.

Everything looked like another hospital nightmare until I got into hands that knew about preeclampsia: then we started to realize the gravity of the situation: within 15 minutes I got catheterized, an IV put in and briefed on the fact that I will not leave the hospital until the baby is born... and that should happen within the next few days.

It felt like hitting a wall in a car going 100 miles/hour. I was feeling just fine. I was in the hospital for 10 days after that dealing with crisis after crisis. Angel, my baby boy, did not survive that experience. But I am healthy. Other women don't get to.

In this disease it is essential to have the patient aware of the signs and symptoms. Lots of tragedies can be resolved if women recognize the symptoms and seek medical help on time. Having this simple urine test to determine a women's risk of getting this disease is a huge step forward.

On the Preeclampsia Foundation's website , under Share your Story there are hundreds of stories just like mine. Heartbreaking proofs that something needs to be done.

And as long as you are there, look at the About Preeclampsia page for signs and symptoms and FAQ.

Thank you, Paul.

Anonymous said...

Preeclampsia is a very scary and difficult disease to treat. With growing numbers of women having babies later and the correlation of greater complications the older the mother is, including pregnancy induced hypertension, we will continue to see a rise in the numbers of pregnancies that are affected by Preeclampsia. It strikes like lightening and many women and practitioners aren't always aware that edema, fast weight gain and creeping pressures are the warning signs. I had preelcampsia and delivered at BIDMC last year. In retrospect, the professionals on staff gave me the option to have a c-section, or to be induced. I knew nothing about this disease, felt trapped against a wall without the help I needed to understand the disease or its consequences. I was unaware that a baby's heartbeat can start to decelerate during an induction, and later with anesthetics. Looking back I wish that the professionals on staff insisted I c-section, before even attempting to induce. For me, it became an emergency situtation that following morning. Thankfully I made it through and so did our baby -- she was born early but has developed well. We desperately need greater national attention to this disease, and not only just diagnostics to determine who will or who won't get it. In lieu of having a cure, we need major resources, education and training to get to the OBs and nurses, so that once symptoms hit there are teams of people who know exactly how to treat, and how to make the best decisions, with minimal trauma to mother and baby.