Discovery; Your Pregnancy Matters

Improving preeclampsia care with new research and prevention strategies

Ongoing research at UT Southwestern aims to prevent preeclampsia, or high blood pressure from developing during pregnancy, and provide better treatment options for when it does occur.

UT Southwestern scientists recently created a preeclampsia study in the lab that allowed them to investigate this condition and potentially transform future treatment.

Preeclampsia, which causes high blood pressure to develop during pregnancy, occurs in 1 in 25 U.S. pregnancies and is a leading cause of maternal death in Texas. Along with high blood pressure, preeclampsia also can cause:

  • Protein to develop in the urine
  • Damage to the kidneys, lungs, or liver
  • Low blood platelet counts
  • Fatal seizures, stroke, or brain damage

Currently, delivering the baby early is the only way to treat preeclampsia. But in the future, doctors might be able to intervene with safer, less invasive treatment options.

As an academic medical center, UT Southwestern recognizes our responsibility to practice leading-edge care with our patients. Our recent research on preeclampsia is particularly timely because our Ob/Gyn team is working to decrease the number of preeclampsia cases that occur and improve the care we provide when it does develop.

These images show how APS antibodies inhibit trophoblast migration in the mouse placenta, protecting them from preeclampsia without harming them or their babies.

Targeting a specific enzyme

Antiphospholipid syndrome (APS) is an autoimmune disease that causes certain antibodies to attack healthy cells. The condition is rare, but APS antibodies have been found in almost 30% of pregnant patients who have preeclampsia.

In a healthy pregnancy, placental cells called trophoblasts grow into the uterus. This promotes normal fetal growth and survival. In the study, led by UTSW’s Philip W. Shaul, M.D., when pregnant mice were given APS antibodies their placentas were underdeveloped and the mice exhibited signs of preeclampsia.

This appeared to be modulated by a receptor on trophoblasts called ApoER2. Scientists confirmed this by giving APS antibodies to pregnant mice that were genetically engineered not to have ApoER2 receptors on their placentas – those mice did not develop signs of preeclampsia.

Giving mice a drug that blocked the effects of APS antibodies protected the mice from preeclampsia without harming them or their babies.

Researchers also discovered that these processes occur in the placentas of women with preeclampsia, even if the women did not have APS. This opens the door to developing treatments to potentially reduce maternal and fetal harm from preeclampsia.

Preventing preeclampsia at UT Southwestern

While we are excited about this recent discovery in the lab, we are several years away from applying this new research in the clinic. For safety’s sake, the scientific process is meticulous.

In the meantime, UT Southwestern providers are reducing cases of preeclampsia by identifying patients at risk of developing it and intervening before their condition becomes dangerous.

Risk factors for preeclampsia include:

  • First pregnancy
  • Preeclampsia in earlier pregnancies
  • Family history of preeclampsia
  • Age – over 35 or under 20
  • Obesity
  • High blood pressure before pregnancy
  • Diabetes
  • Kidney disease
  • Autoimmune disorders
  • Multiple pregnancy (pregnant with more than one baby at the same time)

I’ve invited my colleague, Jamie Morgan, M.D., to discuss how she is working with UT Southwestern medical residents to prevent preeclampsia and educating more providers on the value of quality improvement in health care.

Jamie Morgan, M.D.

Putting research into practice

Innovative research can only improve patient outcomes when findings are safely applied to standards of care.

Quality improvement is so important that the Accreditation Council for Graduate Medical Education (ACGME) recently required medical training programs to include quality improvement education and training. At UT Southwestern, I’m one of three faculty members running the curriculum for our second-year Obstetrics and Gynecology residents. We collaborate with specialists across several disciplines to plan quality improvement projects for our residents, and preeclampsia care is one of our current areas of focus.

Optimizing aspirin therapy

In 2018 the American Congress of Obstetrics and Gynecologists (ACOG) made a research-based recommendation that pregnant women at risk for preeclampsia take daily low-dose aspirin from week 12 of pregnancy through delivery.

Although most Obstetrics providers are aware of the recommendation to use low-dose aspirin in women at risk for preeclampsia, patients who qualify for preventative therapy may be overlooked. Therefore, our Ob/Gyn resident team is working on a quality improvement project to ensure that all pregnant women who qualify for low-dose aspirin treatment are identified and offered therapy early in pregnancy.

This intervention might sound simple, but it can be challenging to apply in practice. First and foremost, it is often difficult for providers to recall all the important risk factors that may increase preeclampsia risk. Furthermore, patients may not know to disclose potentially relevant information that might increase their risk, such as a family history of preeclampsia or history of high blood pressure in a prior pregnancy.

In addition to improving use of low-dose aspirin in at-risk women, we are doing quality improvement work to:

  • Develop more provider education tools around preeclampsia risk identification
  • Supply and administer high blood pressure medications more quickly in hospitalized patients with severely elevated blood pressure
  • Standardize blood pressure guidelines for patients who are leaving the hospital after having preeclampsia

Related reading: Postpartum hemorrhage – how much bleeding after delivery is normal?

Plan, do, study, act

Quality improvement projects focus on a small number of patients for a shorter time – and then scale up. We follow the PDSA cycle: plan, do, study, act.

We’re still in the planning phase for our low-dose aspirin project. Once our plans are finalized, we’ll start by evaluating a small number of patients for a few days. From there, we’ll update our processes with larger and larger groups until we’re ready to roll out the new standard of care across the hospital system.

The best way to learn quality improvement is to do it. This project is not only improving patient outcomes but also developing more providers who understand and will carry the importance of quality improvement into their future practice.

Patient-centered progress

Your well-being drives us to do better every day. Whether we’re treating common conditions or high-risk complications, there’s always room for improvement – and we’re determined to make it happen with every new discovery.

For high-quality care personalized to your pregnancy, call 214-645-8300 or request an appointment online.