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New pre-eclampsia test could spot mothers at risk

Author: Neil Fearn  Bullet  Dated: 29/05/2013

A new way of assessing whether pregnant women are at risk from pre-eclampsia is in development at King's College London.

Researchers are working on a new method of establishing, early in pregnancy, whether a healthy first-time mother could develop the hypertensive condition that can cause serious kidney or liver damage and blood clotting.

Pre-eclampsia is characterised by high blood pressure and excess protein in urine during pregnancy. If untreated, it can develop into a potentially life-threatening series of seizures.

In the first prototype of its kind, the King's test is designed to show how various permutations of risk factors could predict the development of pre-eclampsia, which complicates 1 in 20 first-time pregnancies.

Scientists hope the test will increase pre-eclampsia detection rates and enable healthy first-time mothers not normally considered high-risk to benefit from the right preventative care.

Each year some 70,000 women worldwide die from pre-eclampsia, with infants born to women with the condition between 3 and 10 times more likely to die than those born to unaffected mothers. Around 25% are born premature.

Although basic NICE guidelines can spot high-risk mothers-to-be according to age or high body mass index (BMI), there is currently no way of precisely identifying which healthy women are prone to developing pre-eclampsia in their first pregnancy.

Under Prof Robyn North, from the Division of Women's Health at King's, researchers studied more than 3,500 healthy first-time mothers for medical and family histories, lifestyles and clinical examination findings.

They found that 5% of women developed pre-eclampsia and of these subjects up to 66% showed themselves as high-risk using a variety of clinical risk factors. These included high blood pressure, high BMI, a family history of pre-eclampsia or coronary heart disease, their own weight at birth and bleeding in early pregnancy.

Factors proved to be related to lower risk included a previous single miscarriage with the same partner, a wait to conceive of at least 1 year, high fruit consumption, smoking tobacco and alcohol use in the 1st trimester.

The scientists noted that the reason these factors should be associated with a lower risk is not yet known, and that expectant mothers should stick to Department of Health advice on healthy pregnancies.

They also suggested a framework for specialist referral using these factors, together with an ultrasound scan, that could identify 50% of the women who developed pre-eclampsia and subsequently gave birth prematurely.

Prof North noted that antenatal care could be tailored according to who might be affected. "We have developed a model which, for the first time, allows us to predict increased risk of pre-eclampsia for otherwise healthy first-time mums," Prof North said, adding that the test needs to be validated by further studies.

"This is the first stage towards creating a robust test which uses clinical information alongside blood tests to build a clearer picture of a woman's risk of developing the condition. "

"If it's known that a mother is at high-risk of developing pre-eclampsia, then she can be offered the specialist care she needs right from the start. This will mean warning signs are picked up earlier, and any complications managed more effectively to prevent her health, and her baby's health, from deteriorating."

Experts in medical mistakes and the law point out that failure by obstetricians to properly treat pre-eclampsia could leave them liable to negligence claims.

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