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The Food and Drug Administration has approved a blood test that can identify pregnant women who are at imminent risk of developing a severe form of high blood pressure called pre-eclampsia, a leading cause of disability and death in women of age. to procreate.
The condition disproportionately affects black women in the United States and may have contributed to the recent death of Tori Bowie, a track and field star who won gold at the 2016 Olympics. Two black teammates of Ms Bowie – Allyson Felix and Tianna Bartoletta – also developed pre-eclampsia during their pregnancy.
The new test may offer an early warning, identifying which of the many pregnant women who show suggestive symptoms will develop the life-threatening disease within the next two weeks.
“It’s revolutionary. It’s groundbreaking,” Dr. Doug Woelkers, professor of maternal-fetal medicine at the University of California, San Diego, said of the test. “This is the first step forward in diagnosing pre-eclampsia since 1900, when the condition was first defined.”
How much the test will improve outcomes and save lives is unclear, as there is no effective treatment for pre-eclampsia, which usually improves after birth.
“We don’t have a therapy that reverses or cures pre-eclampsia other than delivering the baby, which feels more like a last resort,” Dr. Woelkers said.
The new blood test, manufactured by Thermo Fisher Scientific, has been available in Europe for several years. It is intended for pregnant women hospitalized for a blood pressure disorder between the 23rd and 35th week of gestation.
The test can tell, with up to 96% accuracy, who will not develop pre-eclampsia within the next two weeks and can therefore be safely discharged from hospital. In contrast, two-thirds of women who test positive will progress to severe pre-eclampsia during this time, and their babies may need to deliver early.
Distinguishing between the two groups of women is a challenge that has long vexed doctors.
“The warning signs of pre-eclampsia aren’t very specific,” said Dr. Sarosh Rana, a professor of obstetrics and gynecology at the University of Chicago who studied the test. “Many women will have edema and headaches.” (Edema means swelling.)
“But we don’t really know who among these patients is most at risk for really undesirable outcomes,” she said.
Pre-eclampsia affects approximately one in 25 pregnancies, and the incidence has increased in recent years in the United States. The problem usually begins midway through a pregnancy, although it can also occur after childbirth. This can lead to a condition called eclampsia, which can lead to seizures and death.
Black women in the United States have much higher rates of pre-eclampsia than white women, and they are three times more likely than white women to suffer kidney damage or die from pre-eclampsia. Black women are also more likely to lose their babies.
The blood test measures the ratio of two proteins that are produced by the placenta. A study published in NEJM Evidence in November followed 1,014 pregnant women hospitalized with hypertensive disorder of pregnancy at 18 medical centers in the United States from 2019 to 2021. Just under a third were black and 16% were Hispanic.
Researchers found that the two proteins were severely unbalanced in the blood women who have developed severe pre-eclampsia. Those with the widest ratios had a 65% chance of progressing to severe pre-eclampsia and delivering within two weeks, either spontaneously or by induction.
“If your levels are among the highest, you’ll deliver within days,” said study author Dr. Ravi Thadhani.
Women who have symptoms suggesting pre-eclampsia but test negative can be reassured and sent home, but they may need to repeat the test every two weeks, Dr Rana said.
Pre-eclampsia develops precipitously and without a blood test the warning signs can be vague.
“A woman can feel fine and be completely healthy and have normal kidney and liver function, and within 24 to 48 hours these organs can fail and develop brain swelling and seizures,” Dr. Thadhani. “That’s the scary part of the disease.”
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