Pre-eclampsia was discussed in parliament for the first time on 9th May, coinciding with world pre-eclampsia awareness month. Pre-eclampsia inhibits the blood supply to the fetus via the placenta, seriously impacting fetal growth and causing pregnancy complications for both mother and baby. Preterm delivery is typically prescribed, in the absence of other options, even though premature birth risks a range of problems for infant health and development.
In the debate, the Parliamentary Under-Secretary of State for Health and Social Care, Jackie Doyle-Price, remarked that in recent years there has been a significant decrease in maternal mortality from the condition which affects pregnant women with high blood pressure. In fact, the UK has the world’s lowest rate of maternal mortality from pre-eclampsia. However, Sharon Hodgson MP cited findings that 63% of these deaths were avoidable, leaving significant potential for improvement. In the global picture, pre-eclampsia accounts for ca. 40,000 maternal deaths. Pre-eclampsia puts babies at greater risk, causing the death of ca. 500,000 per year worldwide. Such data are not recorded for the UK, but research by Imperial College London puts the figure at around 1,000 babies each year. Less tangible are the ill effects caused by premature birth; pre-eclampsia’s only “cure”. 14,352 pregnancies were coded for pre-eclampsia in 2017-18 in England. That’s 2.29% of deliveries, and 39 women per day.1
Working to improve these figures is at the core of our charity’s mission: to reduce preventable baby loss. We – Genesis Research Trust – fund research into the causes of preterm birth, among other problems around fertility and the health of women and babies. We’re pleased that the debate raised government policy makers’ awareness of pre-eclampsia, to increase the will to translate future research findings into real results. Currently, medical diagnosis is a particular challenge for pre-eclampsia, since its symptoms are so similar to the general symptoms of pregnancy. This means pre-eclampsia may not be diagnosed. Therefore broad awareness of the condition is important to avoid missed diagnoses. Such cases were recounted in the debate.
How can the government implement improvements? Doyle-Price promotes a holistic approach in a “life-course focus” for the NHS, rather than a pregnancy disease focus. This seems appropriate given that pre-eclampsia is so strongly linked to heart function, blood circulation and obesity. If the NHS successfully helps women control these factors, it would be effective – not only in preventing pre-eclampsia, but fetal growth restriction, as well as conditions beyond pregnancy. Ridding the population of hypertension would bring myriad benefits, but is somewhat ambitious. 26% of women have high blood pressure2 and 30% of women were obese in 2017, up from 27% in 20163. These rates are much higher than those of pre-eclampsia, highlighting that, while pre-eclampsia is caused by hypertension, we are yet to understand the reason that pre-eclampsia precipitates in a particular subset; a small proportion. “We’re still largely in the dark about [pre-eclampsia’s] root cause”, commented Professor Christoph Lees, Imperial College London, author of a study linking women’s heart function and blood circulation with pre-eclampsia4. Further, as Patricia Gibson MP noted in the parliamentary debate, black and Asian women are far more likely than white women to develop pre-eclampsia. Research has some way to go to ascertain its reasons for occurring, beyond high blood pressure.
Contrasting with the “life-course” approach to pre-eclampsia, David Linden MP reported that in meetings for the all-party parliamentary group on premature and sick babies, which he chairs, Action on Pre-Eclampsia’s Chief Executive, Marcus Green, and chairman, Professor Andrew Shennan, had stressed the need for individualised, tailored care pathways for pre-eclampsia patients, as well as a need to ensure all clinicians are sufficiently trained.
Doyle-Price promoted routine antenatal tests for risk of pre-eclampsia (urine and blood pressure) based findings by MBRRACE-UK (Mothers and babies: Reducing Risk through Audits and Confidential Enquiries across the UK) that such checks were not undertaken on most women who died from pre-eclampsia.
She, Patricia Gibson and David Linden all expressed their support to make the placental growth factor (PlGF) test available across the UK. NHS England will soon start offering this simple blood test, which costs an estimated £70. The recently published findings from PARROT (Placental growth factor to Assess and diagnose hypeRtensive pRegnant wOmen: a stepped-wedge Trial) show that this ‘rule out’ test reduces time to diagnose pre-eclampsia and enables doctors to treat it more appropriately.
This is an encouraging example of research-based progress. The PHOENIX study (Pre-eclampsia in Hospital: Early Induction or Expectant Management) is set to conclude next year. It compares maternal complications following delivery at 34-36 weeks and after 37 weeks.
We hope to see the further development of scientific and political understanding of pre-eclampsia, and continued support for clearly vital research.
1. Full transcript of the debate: Pre-Eclampsia, 09 May 2019, Hansard
2. Health matters: combating high blood pressure, 2017, UK Govt.
3. Health Survey for England 2016, and 2017, NHS
4. High blood pressure in pregnancy linked to mother’s heart function, 2018, Imperial College London