PUFFIN: using MRI scans to detect complications of pregnancy hypertension

We want to be able to identify the women and babies who are most at risk of complications associated with hypertension. To do this, we have been using MRI scans to detect abnormalities.
  • Authors list

    Professor Lucy Chappell, Dr Kate Duhig, Dr Alison Ho, Dr Carolyn Gill, Paul Seed, Professor Mary Rutherford

    Start date: 2017
    End date: 2020

  • Research centre

  • Research status

    Completed projects

Why do we need this research?

About 5% of women have hypertension – or high blood pressure – during pregnancy, which can lead to problems for both mother and baby. Mothers are at risk of stroke and damage to their kidneys, while their babies may be born early or underweight. In some cases, this can lead to stillbirth

If we can identify the women with hypertension that are at high risk of complications, this would help us to ensure they receive the right level of care. On the other hand, if we can find out which babies will remain well, we will be able to normalise their care as much as possible with the aim of avoiding early delivery.

What happened in this project?

Researchers supported by Tommy’s have developed a safe way of taking pictures of the baby and placenta using Magnetic Resonance Imaging (MRI) scans. They hope that studying the placenta in this way will make it easier to detect problems linked to high blood pressure. It is also possible to use an MRI scan to see how well the baby’s brain is developing, which could help healthcare professionals spot the babies who are struggling the most.

Our researchers carried out the PUFFIN study in 43 women with chronic hypertension and 14 with pre-eclampsia. The women had MRI scans at different points during pregnancy and donated samples of their placenta. Alongside the MRI investigations, the team looked at substances in the mother’s blood. They were particularly interested in molecules that are involved in placental blood vessel development, and those that are linked to placental stress.

After analysing all the MRI scans and samples taken during the study, the team noticed that the placentas from women with pre-eclampsia showed signs that they may not have been getting enough oxygen. The placentas were also overly mature compared to the placentas of women who had uncomplicated pregnancies, and there were signs that placental blood vessel development was impaired and that blood flow to the placenta was poor. Some women with chronic hypertension had features that were similar to those with pre-eclampsia, while others had features that were similar to those with uncomplicated pregnancies. In the women with chronic hypertension who had placental changes, the abnormalities were visible before they developed complications such as pre-eclampsia.

The team are now carrying out a follow-up study, PUFFIN-2, which is looking at the placenta in women with diabetes. As well as receiving MRI scans and blood tests, the women will have their blood sugar levels monitored continuously using a special device that sits just under the skin. It is hoped that this study will help us understand more about which women with diabetes are most at risk of giving birth to small babies or having a stillbirth.

What difference will this project make?

By looking at the baby and placenta during pregnancy in this new way, doctors may be able to decide whether or not a mother with health conditions such as high blood pressure or diabetes is likely to suffer complications during pregnancy. This will help to make sure that mothers get the care they need to reduce the chances of health problems for both themselves and their baby.

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