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Preeclampsia among us...
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26th-May-2008 10:27 pm - call for papers

The ISSHP 2008 Program Committee invites you to submit abstracts of original investigations for consideration at the International Society for the Study of Hypertension in Pregnancy (ISSHP) 2008 Conference to be held September 21-24, 2008 at the Omni Shoreham Hotel in Washington, DC. Accepted abstracts will be published in the Journal of Hypertension in Pregnancy.

Abstracts should constitute original research (clinical studies, basic investigation and animal studies are equally encouraged) in the field of hypertension in pregnancy and intervention. The content may include portions of prior abstracts and/or manuscripts submitted or presented elsewhere...
3rd-Oct-2007 11:03 pm - please vote for Anne
A co-founder of the Preeclampsia Foundation, Anne Garrett Addison, has been nominated for a L'Oreal Women Of Worth award. In addition to lots of PR for the Foundation, if she wins the full award we'll be able to throw more money at research grants next year. (Last year the vast majority of the budget went for research -- the Foundation has two paid employees IIRC, and I'm not one of them.)

28th-Jul-2007 10:12 am - for quaintpassion
quaintpassion, I noticed yesterday that about a month ago, you'd been asked for some information on another group. I happen to have all of that to hand, so I'm posting it here for you (and anyone else) to use as you see fit.

People who ask for peer-reviewed rebuttals of Brewer's research are missing the point by hitting it. As I understand it, Brewer's research was never published nor peer-reviewed. All I can find from him on Pubmed are letters to the editor.

Asking for recent rebuttals of 40-year old unpublished data -- well, that's just not how science works; it would be nice to see midwives who have been working with clients publish a study showing a statistically significant outcome from the Brewer diet, though. I know PhD nutritionists who work specifically in pregnancy nutrition who are willing to be involved and I have spoken with people at the NICHD who are interested in coordinating interested researchers and funding... so I don't think money is likely to be an issue -- I think we just need the population.

Diet in pregnancy has been constantly studied.

Cochrane review of protein and energy supplementation in pregnancy

Tellingly, considering Brewer's proposed mechanism (insufficient dietary protein intake lowers albumin production, leading to leaky blood vessels, swelling, and hypertension), *reducing* women's protein intake does not lead to an uptick in preeclampsia cases. Neither increasing nor decreasing dietary protein intake has been shown to affect the rate at which women develop preeclampsia.

The most recent review of vitamin C & E supplementation

The most recent review of oral magnesium supplementation (has no mention of an effect, either positive or negative, on PE rates)

and more anecdotes from women who ate the Brewer diet throughout their pregnancies and yet developed preeclampsia anyway.

The current understanding of preeclampsia is that it's a conflict between the maternal immune system, and the foreign (and demanding) placenta. We know that the placenta releases soluble factors which create the symptoms of de novo hypertension, proteinuria, swelling, hyperreflexia, elevated liver enzymes, and so forth. We also know that one of the factors is released in response to hypoxia and that the other is released in response to a protein produced by the maternal immune system. I will quickly explain it below and provide the names and university affiliations of the researchers working on it right now.

The idea now is that the mother and baby negotiate to grow a big enough baby to survive, but not so big that it won't fit out the mother's pelvis. This also provides an explanation for why preeclampsia only occurs in higher primates; we're the only ones who went through the upright posture therefore smaller pelvis + bigger brains therefore bigger heads bottleneck. David Haig at Harvard does some work in this area.

Research on the hypoxic placenta and the protein it dumps in response

Ananth Karumanchi is at Beth Israel Deaconness in Boston. I believe he is working with Richard Levine and Roberto Romero (both top docs at the NICHD.)

Research on the maternal-fetal conflict and the proteins produced by the maternal immune cells and the placenta

For the research on the shallowly implanted placenta, see Susan Fisher at UCSF.

90% of severe cases of preeclampsia can be detected by Doppler in the first trimester.

Assessing the soluble factors in conjunction with Doppler will allow us to diagnose women who will develop preeclampsia about six weeks before symptoms appear. All of these researchers I've mentioned are working together to develop a practical screening test.

Here's a link to the most recent NICHD conference.

I attended this conference as an observer, if anyone has any further questions.

(edited to repair hyperlinks)
10th-Jul-2007 12:08 am - Hello everyone
Hello. My name is Jessica. I go by the nick name Hope. About 5years ago I was raped. I don't want to go in to details about that but I got pregant. I don't believe in abortions unless its a life or death situation. Five months in to the pregancy the doctors told me that I had pre-eclampsia. They also told me that I have to rest and to be careful. A few weeks after that I start feeling really funny. My mother takes me to the navy hospital. They did a few tests and kept me in there for a week. Well I got out of the hospital and got stuck on bedrest. A week later I started to feel bad. Went back to the hospital and I was there for three weeks. They let me out on Christmas eve because they wanted me to have Christmas with my family. But before they let me out they gave me two steriods shots just in case something happened. Christmas I really don't remember much. But the next day, I didn't feel good. I felt like I was outside of my body. So my mother started to take me to the hospital. Well we stopped at a local gas station to pick up something to snack on. Well I remember getting out of the van and walking in the door. But then I started to turn around in circles. After that everything went black and I could hear my mother yelling at me. I wake up five days later with a baby girl. The doctor told me that I had three seizures and he had to bring me back a few times. But my daughter came out healthy. I was so happy.

I have been in a relationship for a while now and we have been thinking about having another child. But the one thing that keeps us for actually having one is the fact of eclampsia. I have one daughter that I almost killed me. I had three seizures. It hurts knowing that I can have another child but reallynb not sure what would happen to me or the unborn child. Has there been anyone who has had eclampsia and had another child?

I am really scared. I don't want to die. I know that if I do get pregant again that I want the child to live. But my husband doesn't want to stand there and chose between the woman he loves and his child. Its like I"m stuck in between a rock and a hard place. If anyone has any stories or advice I would love to hear it. Because I am so very confused about this whole subject. One doctor will tell me that yes it will be fine and then another will tell me that it only gets worse. I hope someone can help me.

Thank you for your time.
28th-Apr-2007 11:28 pm - urine screening test
"Urine testing for kidney cells can help detect preeclampsia, a potentially serious condition involving high blood pressure and fluid retention during pregnancy, according to findings published in the American Journal of Obstetrics and Gynecology..."


Here's the Pubmed abstract:

"Urinary podocyte excretion occurred in all patients with preeclampsia. The positive predictive value for the diagnosis of preeclampsia was greater for podocyturia than for any of the measured angiogenic factors..."


This is excellent news, especially as urine screening tests are vastly easier to administer than bloodwork in rural areas of the world. They're more stable, don't have to be refrigerated, etc.

Did y'all know that India has eclampsia wards? They tie the women down and try to keep them from aspirating, and start an induction.
5th-Apr-2007 11:23 am(no subject)
"Preeclamptic villous explants secreted high levels of sFlt-1 and sEng. Adenoviral overexpression of HO-1 in endothelial cells inhibited VEGF-mediated sFlt-1 release and interferon-gamma- and tumor necrosis factor-alpha-induced sEng release, whereas HO-1 inhibition potentiated sFlt-1 and sEng production from endothelial cells and placental villous explants..."


Okay all, this is very, very big news. They have identified something that blocks the action of both the proteins implicated in PE.

CAUTION: this is not necessarily going to turn out to help the *baby*, just the mother. Lowering levels of these may turn out to compromise blood flow to the baby.

That's because the placenta is mucking with the levels of all of these factors in order to send more blood to the baby -- it's just that when it does so, it damages the mother's systems. There may be no benefit to prolonging pregnancy further if the placenta is so compromised that the baby can't grow any more. (Though I suppose it *would* help the baby if you could buy a few days for lung maturity with a large enough baby.)

Regardless it means the research is going forwards at a lightning pace, which in the long run is good news.
Sorry, but I see posts in naturalbirth *all the time* asking "will I get PE again", and replies recommending 30-year-old therapies, and I just wanted to respond here.

I ate the Brewer diet and developed severe PE at 34 weeks, so I don't buy a word of it. My home waterbirth went right out the window, replaced by an emergent c-section -- and boy, did I need that section, with bp of 220/116 while laying down on my left side on the maximum IV meds and hyperreflexia with a beat of clonus and +4 protein and a baby having decels even though I wasn't in labor.

The current understanding of PE is that it's an immune system response to the foreign placenta -- there's a recent New Yorker article on it available here: http://www.newyorker.com/fact/content/articles/060724fa_fact

Having had PE is the largest single risk factor for developing it again; that said, the vast majority don't get it again.

My best advice for women with a history of preeclampsia would be a preconception consult with a perinatologist.
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