Improving Pregnancy Outcomes through Early Detection of Preeclampsia
Molecular biomarker-based detection methods developed using real-world data could help assess preeclampsia risk early
Tiffany Payne, MS, is the global clinical market director at Agilent Technologies. Payne received her master’s in chemistry and pharmaceutical sciences from the University of the Pacific, where she studied the use of mass spectrometry for rhenium-based anticancer agents.
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Tiffany Payne, MS, is the global clinical market director at Agilent Technologies. Payne received her master’s in chemistry and pharmaceutical sciences from the University of the Pacific, where she studied the use of mass spectrometry for rhenium-based anticancer agents.
Adverse pregnancy outcomes (APOs) in the US are the highest of any high-income nation and are on the rise. Maternal health initiatives seek to identify and monitor high-risk patients to reverse these trends, but better tests are needed. The standard of care needs to be improved to prevent the onset of hypertensive syndromes like preeclampsia before they occur, not just monitor for their symptoms when it already may be too late to save patients and their newborns.
While worldwide maternal health appears to be improving, the US trends indicate that better healthcare services and support are needed to identify at-risk patients and provide early intervention. The current standard of care for detecting preeclampsia is to check patients’ blood pressure to monitor for symptom onset and test later into pregnancy to confirm preeclampsia if symptoms are present. However, new test methods in development may make it possible to detect high-risk pregnancies before onset.
Trends in maternal health and pregnancy outcomes
Between 2000 and 2020, worldwide maternal deaths dropped by about 34 percent. Within that same period (2007 to 2019), the American Heart Association reported that adverse pregnancy outcomes in the United States more than doubled and exceeded every other high-income country in the world.
In June 2022, the Biden administration issued an action plan to address the US. maternal health crisis. In addition to outlining goals for improving access to and quality of maternal healthcare services, the plan calls out the need for high-risk or hypertensive patients to self-monitor blood pressure to detect the onset of symptoms of preeclampsia.
Monitoring blood pressure is the standard approach for detecting the onset of preeclampsia. However, the problem with the current standard of care is that by the time a patient shows preeclampsia symptoms, the opportunity to prevent adverse health outcomes may have already passed. Patients are often classified as high risk for preeclampsia based on factors like a high BMI or advanced maternal age, but the most accurate way is to find out whether they have experienced preeclampsia in one or more previous pregnancies. Therefore, patients who are pregnant for the first time may unknowingly be at risk for developing preeclampsia.
In July 2023, the U.S. FDA approved a test that can assess preeclampsia risk in pregnant women, but is for use only in patients in their 23rd to 35th week of pregnancy showing the symptoms.
Reducing cases of preeclampsia
Early detection is critical to reducing the occurrence of preeclampsia. Studies have shown that low-dose aspirin can reduce the risk of developing preeclampsia when taken from 12 weeks of gestation and continued until the birth of the newborn. However, low-dose aspirin cannot be prescribed to all patients because it could introduce complications like bleeding in otherwise healthy pregnancies. So how can at-risk patients be identified earlier to reduce the occurrence of preeclampsia before symptoms appear?
According to Robin Tuytten, PhD, CEO of Metabolomic Diagnostics, preeclampsia is a syndrome involving multiple biological systems; screening for a single biomarker will not be informative enough for early diagnosis. The panel of biomarkers that can achieve this goal is diverse and may differ from one patient population to another.
Using liquid chromatography/mass spectrometry (LC/MS) and sophisticated data algorithms to analyze patient samples between 11 weeks and 13 weeks, six days gestation, Tuytten’s team’s studies have shown that they can identify high-risk patients, even if they are pregnant for the first time and/or can’t be identified by any other accepted risk factors.
Predicting preterm preeclampsia-associated risks
Another important factor to consider is whether patients are at risk of developing preeclampsia before 37 weeks gestation (preterm preeclampsia), or after birth (postpartum preeclampsia). The only way to treat preeclampsia once it has developed is to deliver the baby. Therefore, identifying preterm preeclampsia is crucial to reduce pregnancy complications in the mother and infant.
When asked about the effect of preterm preeclampsia on maternal health, Tuytten says, “Preterm preeclampsia accounts for about 30 percent of all preeclampsia cases and is easier to predict. This might be because there is a placental component to the disease, and if the placenta is impaired early in pregnancy, it might lead to earlier presentation [of symptoms]. It is also found that women with earlier forms of preeclampsia will have a higher morbidity and bigger degree of complications.”
Researchers and companies must invest in early detection methods to unleash a new era in maternal health. These could be the silver bullet in combating hypertensive disorders and adverse maternal health outcomes, offering a beacon of hope for a healthier future for mothers worldwide.