The three major areas of research which are supported by PEARLS are set out below:
This basic laboratory work has been designed to show how mothers' blood vessel walls respond to the cells of the placenta. A healthy interaction equals a healthy placenta. We have now been able to show that some of the suspected 'toxins" in "Toxaemia" (the old name for preeclampsia) attack the placetal cells. This follows on from work we have done to describe the effect of blood pressure medications on the formation and function of the placenta. Some types of medications are better than others, at least in terms of how they stimulate the placental cells. A new collaboration with Kerry-Anne Rye at the Heart Research Institute and Prof Ralph Nanan at Nepean Hospital has allowed us to examine why some women and some couples are more prone to preeclampsia than others. This will include looking at how high cholesterol can be detrimental to the development of a normal placenta and how some parents (interaction between mother and father's immune systems) can promote a healthy placenta,and others lead to the type of shallow placenta we see in preeclampsia.
Our group has been instrumental in defining improved outcomes for mothers after preeclampsia. Work done with hospitals here in NSW and overseas, has determined that there are aspects of clinical care (e.g how much fluid a mother is given in labour) that determine whether they develop heart failure or not. Heart failure is one of the very dangerous consequences of preeclampsia. Our ongoing work will examine not only the immediate impact of preeclampsia on the heart, but whether this effect is still present 20 years later. We will address the question about whether pregnancy events in and of themselves are risk factors for heart disease in the same way that we know longer term high blood pressure is a risk factor. We will also examine whether future weight, diabetes and cholesterol levels have been influenced by events in pregnancy.
We and others have identified some blood and urine tests which can identify patients with preeclampsia. This is a very new area of research and the usefulness of these tests is currently being considered. The current rounds of tests has arisen from work we have done to show that a placenta with reduced blood flow is a toxic placenta and thus these tests are very specific to the placental insult. This is very different from prior tests which do not actually examine the mechanism of disease but are non-specific tests of mothers wellness or otherwise. We will continue to determine how these tests predict high blood pressure, whether controlling the blood pressure, controls the blood results and whether we can reverse the toxic response at the same time as reversing the high blood pressure. We have the capacity in some of our laboratory work to very directly examine blood flow to the placenta for the first time.
We are proud to have been able to support an amazing number of PhD and postdoctoral students involved in preeclampsia research. The doctors we support in their specialisation are future clinicians with a vested interest in preeclampsia and womens’ health. By providing this type of funding we make a 3 year investment into what ultimately becomes a lifetime of work dedicated to preventing preeclampsia.