PEARLS
Preeclampsia Research Laboratories

PEARLS newsletter June 2002

Volume 1 Issue 2

The big news this edition is feedback from the recent Canadian meeting for the International Society for the Study of Hypertension in Pregnancy (ISSHP), and the meeting beforehand of the Society of Obstetric Medicine of North America, in which PEARLS director Associate Professor Annemarie Hennessy participated.

Summary of ISSHP - Toronto 2002

Bells palsy and preeclampsia

Several cases were presented which suggest an association between Bells Palsy and Preeclampsia. It was felt that there was compression of the nerve in the same way that women experience "carpal tunnel" wrist pain when they are pregnant due to with nerve compression form swelling in the tissues. The good news was that although these women have a drooping smile and eyelid, many recovered after the delivery of the baby.

Anaesthetics

There was some good discussion at both meetings about the importance of anaesthetics in preeclampsia. Whether epidurals and spinals are equally safe is yet to be fully determined, but the importance of good pain relief in controlling blood pressure around the time of delivery was emphasized. Epidurals and spinals can reduce blood pressure dramatically and therefore there needs to be very careful monitoring of mother and baby in women with preeclampsia if these procedures are to be used.

Focus on placental changes

The key talks at this year's international meetings were on placental changes in preeclampsia. This supports the focus on placental function in PEARLS research. There is an increasing sophistication in understanding of the way that the placental and mother's nearby uterus cells behave in early pregnancy, and thus in preeclampsia.

Preeclampsia and clotting diseases

The relationship between preeclampsia and clotting diseases was initially thought to be quite strong. There may be a group of women in whom this is relevant, but overall there are many groups of women where there is no greater risk of preeclampsia whether the clotting disorders are present of not. No clear guidelines were provided about the usefulness of treatment with blood thinners in this group of women.

Mildly increased blood pressure: to treat or not to treat

There was a Great Debate about the benefit of treating mildly increased blood pressure in pregnancy (at 140/90).

Some groups of physicians would require the blood pressure to be 160/ 100 or even 170/110 before blood pressure tablets were to be used. There is some evidence that treating these "Lower" levels of blood pressure make it less likely that the mother will have an episode of extremely elevated blood pressure - which of course are the events that are associated eventually with fitting (Seizures) and even unfortunately strokes. The risk of an emergency caesarean section is reduced by these treatments and less time for the baby in the neonatal intensive care unit. However, disappointingly, there may be a disadvantage by treating mildly elevated blood pressure with babies possibly born slightly smaller after a course of blood pressure treatment with tablets. Ultimately if the condition is getting worse and involves the liver or the kidneys, then delivery is the only option.

MAGPIE study

The MAGPIE (magnesium salts, Epsom salt ) study was revealed. This study used magnesium salt to treat women with preeclampsia (not to prevent preeclampsia as has been reported in the media) to prevent seizure.

The majority of these women were in Africa and South America and several thousand in the USA, UK, Canada and Australia. Remember that magnesium is widely used in the USA. Across the board, the magnesium showed a decrease in the rate of maternal death and seizure in the women treated (compared with placebo).

The Oxford Group are to be congratulated for conducting the large and gruelling study of 10,000 women around the world. The women involved in this study have provided a great service to future women with preeclampsia.

The question of Antioxidants and Preeclampsia for prevention remains unanswered. Several large trials are planned to see whether taking vitamin C and E are helpful in preventing the development of preeclampsia. Many studies in laboratories around the world are attempting to identify abnormalities in the placenta and mother's blood in preeclampsia and some of these are looking promising - but are a long way from real use at this stage. Anyway - it's back to the lab with a few new ideas…

Local Innovations in Preeclampsia Research

The Australian presence at the meeting was impressive with around 10% of the oral presentations overall being from novel research in Australia. Support for the local research effort and of course greater collaboration here will go a long way to improving our chances of finding a cure.

Website Exposure for Preeclampsia

You are invited to submit websites of interest that you have found, to help women and families who have contact with preeclampsia. Preeclampsia information abounds on the internet. We are interested in identifying the sites of greatest value. So, if you find a site that you think will benefit other people who have contact with someone with preeclampsia, please let us know and we will link it to the preeclampsia.org.au website.