Improving pre-eclampsia diagnosis
Pre-eclampsia affects up to 6% of pregnancies in the UK and can cause serious problems for mothers and babies, but the exact cause is unknown so identifying and supporting women at risk can be a challenge. Doctors can use a blood test that measures levels of a hormone called placental growth factor (PlGF), which usually increases in the first and second trimester so low levels can be a warning sign. Although high PlGF levels can rule out suspected pre-eclampsia, it’s harder to say exactly how low they can safely fall, which can mean women don’t always get the right treatment at the right time.
Tommy’s researchers are looking at ways to ‘rule in’ pre-eclampsia instead of ruling it out when PlGF levels pass a certain point. Our scientists analysed plasma samples from over 300 pregnant women with suspected pre-eclampsia and were able to predict their diagnosis about half the time. The team published their latest results in the journal Pregnancy Hypertension and while they strive to develop an even more accurate test, their findings suggest this could be used to identify those in need of extra support and make better use of precious NHS resources.
Meanwhile, one of Tommy’s experts on this is unpicking the problem of diagnosing pre-eclampsia specifically for women with kidney problems, who are 10x more likely to develop the condition. Raised blood pressure and protein in urine during pregnancy are signs of pre-eclampsia, but chronic kidney disease has similar symptoms, so women living with the condition may not realise these symptoms could indicate another issue. Prof Lucy Chappell from our London Research Centre has published her work on this in the Clinical Journal of the American Society of Nephrology.
Prof Chappell has also been investigating whether magnetic resonance imaging (MRI) could be used to check the health of the placenta during pregnancy and potentially spot pre-eclampsia developing. MRI scanning isn’t always available so doctors often have to rely on less precise tools, like measuring the baby’s size or using an ultrasound to measure the blood flow in the umbilical cord. The Tommy’s team continue to explore the possibilities but Hypertension recently published their early findings, which show that MRI can be an effective tool for predicting and managing pre-eclampsia.
Understanding premature birth
In the UK around 60,000 babies are born prematurely every year, leaving them vulnerable to serious complications outside the womb and lifelong effects; this is the leading cause of neonatal death (death in the first few weeks after birth) and so we desperately need to find ways to predict it in order to prevent it.
Prof Andrew Shennan, who runs Tommy’s Preterm Birth Surveillance Clinic, is looking at whether detailed scans of unborn babies’ lungs could be used to tell if they will be ‘very preterm’ (between 28 and 32 weeks). The journal Nature has just printed his small but exciting study which found that the lungs of babies who were born very preterm couldn’t hold as much air as they should, regardless of whether the mother’s waters had broken – suggesting that something happens in pregnancy to cause this, which could become a focus of pre-emptive therapies in the future.
Last month we announced that our Preterm Birth Surveillance Clinic has updated its QUIPP app so that it can now accurately predict the risk of premature birth for twins as well as single pregnancies. Prof Shennan and the team behind the app looked at data from more than 1800 pregnant women to make sure the latest version is even more precise and reliable than the original. Their evaluation has now been printed in Ultrasound in Obstetrics and Gynecology, and we’re calling for the test to be standard practice across the NHS so that everyone can benefit from it.