New tool predicts severe risks in mothers with pregnancy complications
A new tool developed by researchers from Queen Mary University of London (QMUL) could save mothers’ and babies’ lives by predicting whether women with early onset pre-eclampsia are safe to prolong their pregnancy.
The study provides the most robust evidence yet to help clinicians decide on the management of mothers-to-be with early onset pre-eclampsia – a condition which affects one per cent of pregnant women and can lead to fatal complications including seizures, liver and kidney failure, bleeding disorders and heart and lung problems. An estimated 1,000 babies a year die from complications caused by pre-eclampsia.
The PREP study, funded by the National Institute for Health Research (NIHR) and published in BMC Medicine, found two successful methods to predict the risk of complications which were accurate in up to 84 per cent of mothers.
Project lead Professor Shakila Thangaratinam from QMUL’s Blizard Institute said: “Often babies are delivered prematurely to ensure the mother is safe from complications. But this decision depends on the individual clinician, with no robust test to guide whether early birth is needed or not.
“Given the scarcity of neonatal intensive care beds and high-dependency hospital wards for mothers and the high costs of these facilities, an accurate estimation of the health risks at various time points after diagnosis of early onset pre-eclampsia is needed to prioritise and plan care.”
The researchers studied 946 women with early onset pre-eclampsia recruited from 53 NHS Trusts. By using routinely gathered data including mother’s age, gestation at which pre-eclampsia was diagnosed, blood pressure, urine protein level, liver and kidney function and oxygen levels in blood, the team developed mathematical models that were able to predict the risk of complications in the pregnant mothers.
Professor Thangaratinam added: “The PREP models could play a role in helping clinicians decide whether mothers need to be transferred to hospital for intensive maternal and neonatal care. Women categorised to be low risk could be followed-up in an outpatient setting, with high- and very high-risk women monitored as inpatients with regular intensive monitoring.
“The next stage is to evaluate the impact of using PREP models in clinical practice for doctors to use – this requires well-planned, robust clinical trials.”
Professor Hywel Williams, director of the NIHR Health Technology Assessment (HTA) Programme, said: “The NIHR is proud to have supported this independent research which should make a difference to the health of mothers and babies in the NHS.”
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- Research paper: ‘Prediction of complications in early-onset pre-eclampsia (PREP): development and external multinational validation of prognostic models’. Shakila Thangaratinam, John Allotey, Nadine Marlin, Julie Dodds, Fiona Cheong-See, Peter von Dadelszen, Wessel Ganzevoort, Joost Akkermans, Sally Kerry, Ben W. Mol, Karl G. M. Moons, Richard D. Riley, Khalid S. Khan and for the PREP Collaborative Network. BMC Medicine 2017 15:68. DOI: 10.1186/s12916-017-0827-3.