San Diego, CA -- Understanding how best to anticipate, diagnose, and treat preeclampsia—a leading cause of maternal and infant illness and death in the US—was the focus of today's opening ceremonies of The American College of Obstetricians and Gynecologists' (The College) 60th Annual Clinical Meeting (ACM). Preeclampsia is a serious pregnancy-related condition that affects the placenta, liver, kidneys, blood, brain, and other organs. Up to 7 percent of pregnant women develop preeclampsia, which can foreshadow future health problems in the mother.
“I consider preeclampsia to be the most important medical complication of pregnancy. It can be life-threatening to mother and baby. Its treatment—which can include emergency early delivery—can be a frightening ordeal for women and their families,” said James N. Martin, Jr, MD, president of The College. “I am honored to have leaders in the field of preeclampsia research, management, and advocacy speaking to ob-gyns about a condition that affects so many of our patients.”
The cause of preeclampsia is unknown, but high blood pressure is a main contributing factor. Women may have chronic high blood pressure before becoming pregnant or may develop it during pregnancy, usually after the 20th week of gestation. High blood pressure in pregnant women can restrict the flow of blood, oxygen, and nutrients to the fetus. Women who have chronic hypertension, are pregnant for the first time, have had preeclampsia in a previous pregnancy, are 35 or older, are carrying more than one fetus, have certain medical conditions such as diabetes or kidney disease, are obese, are African American, or have certain immune disorders such as lupus or blood diseases are at increased risk of developing preeclampsia. Additionally, some women with preeclampsia have no risk factors at all.
Today’s three lectures covered the entire spectrum of preeclampsia—from diagnosis to treatment and management—and aimed to educate and reduce its myriad effects on pregnancy.
“A scientist friend once asked me ‘If we’ve learned so much about preeclampsia, how come we haven’t treated it or prevented it yet?’” said James M. Roberts, MD, professor in the department of obstetrics, gynecology, and reproductive sciences at the Magee-Womens Research Institute, University of Pittsburgh. Dr. Roberts reviewed the progress that has occurred during the last several decades, our understanding and treatment of preeclampsia today, and what’s next, during the Samuel Cosgrove Memorial Lecture, “Preeclampsia: Past, Present, and Future.”
“Preeclampsia may not actually be what we understand it to be,” Dr. Roberts said. “What we call ‘preeclampsia’ may be several diseases, and subtypes may exist similar to type 1 and type 2 diabetes. It’s unlikely you can cure several diseases by a single, preventive treatment, nor can you predict several diseases with a single predictive test.”
According to Dr. Roberts, significant recent advances have emerged in the management of preeclampsia and more developments are on the horizon. “I believe there’s hope for a preventive tool or predictive tool once we begin to stop trying to determine that everybody has the same disease,” he said. “In the future, the idea would be to examine subtypes and present some obvious candidate subtypes, such as early onset or recurrent. There may also be strategies, such as laboratory predictors, to suggest.”
John R. Barton, MD, a maternal-fetal medicine specialist at Central Baptist Hospital in Lexington, KY, delivered the Anna Marie D’Amico Lecture, “The Management of Preeclampsia: Summary of the Hypertension in Pregnancy Task Force.” Dr. Barton addressed atypical preeclampsia, changing targets of blood pressure control, the timing of delivery based on the severity of disease, the increasing rates of postpartum preeclampsia and eclampsia, and how patients should be monitored.
Dr. Barton likened preeclampsia to a screening test for future health issues. “Women with preeclampsia clearly carry a higher long-term risk for chronic hypertension, stroke, venous thromboembolism, ischemic heart disease, and even a slightly higher risk for mortality,” he said. “Physicians should be aware of this and have a plan in place to provide long-term health surveillance.”
Dr. Barton discussed the work of The College’s Hypertension in Pregnancy Task Force. Established by Dr. Martin, the task force’s findings will be incorporated into future guidance on best practices for the management of preeclampsia and chronic hypertension. “Our goal is to provide outpatient instructions for antepartum preeclampsia and postpartum preeclampsia, as well as long-term follow-up health risk assessments in women with preeclampsia,” he added.
“We’ve known about preeclampsia for 2,000 years or so, and yet it has lived as a footnote, like it’s ‘just a pregnancy thing.’ Today, I’d like to focus on sharing preeclampsia’s effects on patients that go beyond just the physical,” said Eleni Z. Tsigas, executive director of the Preeclampsia Foundation in Melbourne, FL. Ms. Tsigas presented the Jim and Midge Breeden Lecture, “Patient Perspectives on Preeclampsia,” where she discussed the emotional, psychological, social, and physiological effects that preeclampsia and its related hypertensive disorders have on patients and their family members.
Ms. Tsigas highlighted the power of patient education on health outcomes and how it can be incorporated into ob-gyn practices. “Research has shown that less than half of women are actually getting preeclampsia education during their prenatal care. It is important for women to know the signs and symptoms of preeclampsia and that it is urgent to report them,” she said.
“It’s just coincidental that the Annual Clinical Meeting is in May, coinciding with Preeclampsia Awareness Month,” Ms. Tsigas said. “It is fortuitous that we’re able to focus national attention on this issue and educate ob-gyns at the same time.”
Hear more with Dr. Martin and Ms. Tsigas.