An Innovative Way To Predict Preeclampsia
Dr Yi-Ning Su, the Chairman and CEO of Sofvifa Genomics Ltd. and Founder of the Taiwan-based Dianthus MFM Clinic, is the leading obstetrician and a specialist clinical geneticist in prenatal diagnosis and genetic testing. He was the first person in Taiwan to publish a paper on the correlation between preeclampsia and a protein called the Placental Growth Factor, or PlGF1. This led to a new era in Taiwan’s preeclampsia screening, safeguarding millions of women through accurate risk diagnoses. He also explored an innovative new approach to the triage of women who are suspected of having this condition related to pregnancy.[1]
The interest of Dr Yi-Ning Su in maternal health goes back to his days as a Ph.D. student at the National University of Taiwan. One of his studies was on preeclampsia and it left the young student with a lasting impression. Back then preeclampsia was seen as a condition that, in Dr. Su’s words, “remained unsolved”. Not much was understood about its causes or screening methods. Although PIGF was known to the medical community, not many knew about the soluble FMS-like tyrosine kinase-1 (sFlt-1), which meant that doctors were not looking for altered sFlt-1 levels.
There was no national program for screening pregnant women for preeclampsia in the absence of any clinical evidence. Yet Dr Su’s clinical paper showed that the early trimester uses of PAPP-A, PlGF, and Uterine Artery Resistance could detect preeclampsia. This became a defining moment in Dr Su’s life. “There was a lot of guesswork ahead of this. We had no sure shot way to identify if an expectant mother showed signs of preeclampsia.” He explained
A Condition That Risks Lives Of Millions of Women
The onset of hypertension and proteinuria (protein in the urine) is a serious complication of pregnancy, preeclampsia. But it’s not easy to detect. Nicknamed “the great imitator,” preeclampsia often mimics symptoms of many normal pregnancies, such as nausea, lower back pain, weight gain, and limb swelling.
The disease, if left undetected or untreated, can lead to serious complications for both mother and baby. Women can suffer from stroke, epilepsy, organ failure and it may lead to death in some cases. Complications for babies include slower growth within the uterus and low birth weight.
Preeclampsia accounts for about 15% of all premature births and 42% of maternal deaths.[5] People with a history of preeclampsia also have an increased risk of dyslipidemia, high blood pressure, and cardiovascular and renal disease.
In Taiwan’s background, he says, “The pattern of preeclampsia among women is growing. The risk of preeclampsia increases with age and later in life, we’re seeing more women having babies. So, I’d say overall about 5% have a high risk of developing preeclampsia and this will be very serious for 2% of women.
Even though preeclampsia’s specific pathophysiology remains unknown, according to Dr Su, the sFlt-1 and PlGF biomarkers have the potential to offer significant advances in the diagnosis and management of this serious and potentially life-threatening disorder.
The combination of high blood pressure and proteinuria is the worldwide medical gold standard for diagnosing preeclampsia. Both are considered unreliable predictors for which women develop preeclampsia and how the disease progresses. Many patients with preeclampsia have almost no symptoms. As a result, health care providers spend an additional USD 120 billion each year on preeclampsia treatment.
Predictive Diagnosis A Boon
Discussing the difficulties of diagnosing preeclampsia, Dr Su said, “The clinical appearance of preeclampsia and the subsequent clinical course of the disease will vary enormously, making it difficult to diagnose and determine the progression of the disease. But now, precise diagnostic tools will help us determine whether pregnant women with suspected preeclampsia will and will not experience the disorder with greater certainty than a standard diagnosis. [3],[4]
Dr Su supports the use of advanced screening tests to reliably diagnose the risk of preeclampsia in a woman by calculating the ratio of two proteins found in the blood of the mother–sFlt-1 and PlGF. [2] “These tests allow us to rule in or out the probability of preeclampsia. We can be confident that expectant mothers are unlikely to develop preeclampsia if they do not show abnormal levels. And we can take appropriate action for those who do, to track and manage the disease. A UK study showed that using the sFlt-1/PlGF preeclampsia test could reduce hospitalization by 50% and save about £28 million annually from the National Health Service (NHS). Dr Su finishes with this, “What’s important now is deepening scientific understanding among healthcare professionals so that the expectant mother can focus on what matters – her health and that of her unborn child.”
References:
- Su YN, et al. (2001). Obstet Gynecol. Jun;97(6):898-904.: https://pubmed.ncbi.nlm.nih.gov/11384693/
- Verlohren, S., et al. (2010). Am J Obstet Gynecol 202 (161): e1-11.: https://pubmed.ncbi.nlm.nih.gov/19850276/
- Verlohren, S., Stepan, H., & Dechend, R. (2012). Clin Sci
122(2): 43-52.: https://pubmed.ncbi.nlm.nih.gov/21929511/ - Meads, C.A., Cnossen, J.S., Meher, S., et al. (2008). Health Technol Assess. 12(6), iii-iv. Methods of prediction and prevention of preeclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling.: https://pubmed.ncbi.nlm.nih.gov/18331705/
- Strunz-McKendry et al (2014). 20th COGI World Congress 2014.: https://www.ogpnews.com/2016/02/new-study-shows-how-pregnant-women-can-rule-out-pre-eclampsia-with-one-simple-blood-test/13813