The preeclampsia is a pregnancy complication which can cause significant damage to both mother and baby. pregnant women who suffer from it have a high blood pressurewhich reduces the blood supply to the placenta and, consequently, the amount of oxygen and nutrients that the fetus receives, which can affect its development.
So much so that preeclampsia “It is one of the main causes of maternal morbidity and mortality and prematurity and its consequences for newborns, including in utero death”, as shown by Dr. Belén Santacruz, head of the Gynecology and Obstetrics service at the Torrejón University Hospital, president of the iMaterna Foundation and associate professor at the Francisco de Vitoria University of Madrid.
It is considered that it is preterm preeclampsia when it appears before the 37th week of gestation and, within it, early onset preeclampsia if it occurs before week 32. “Although preeclampsia is more common at the end of pregnancy, the consequences, especially for the baby, are much more important the earlier preeclampsia occurs,” points out the doctor.
Fortunately, there are research projects that seek to find an effective remedy for this serious complication that can appear during pregnancy. One of these research projects is the DECREASE study, led by the Fetal Medicine Foundation (FMF)in which the Torrejón University Hospital, belonging to the public network of the Community of Madrid, has also participated, with the active involvement of Dr. Belén Santacruz, which is why we have contacted her.
The DECREASE study shows that It is possible to reduce the appearance of preterm preeclampsia by 50% and early onset preeclampsia by up to 70%.. These are not insignificant and encouraging percentages, even more so taking into account that the treatment used is not complex or difficult to obtain, since it is acetylsalicylic acidthat is, of aspirin.
Of course, what the study reveals is the need to carry out prior screening to effectively detect those pregnant women who are at greater risk of suffering from preeclampsia and thus be able to administer the treatment preventively.
The consequences, especially for the baby, are much more important the earlier preeclampsia occurs.
Detecting pregnant women at risk of suffering from preeclampsia, the key to prevention
“In order to establish which group of pregnant women we have to treat, we need to do a screening test in the first trimester of pregnancy (week 11-13) to inform us individually about the risk that each pregnant woman has in each pregnancy of having preterm preeclampsia,” explains Dr. Santacruz. The question is what this screening is or should be like.
The head of the Gynecology and Obstetrics service at the Torrejón Hospital informs us that it consists of a very complex mathematical calculation that combines factors of the mother, such as age, weight, race, history of certain diseases and history of previous pregnancies; a good blood pressure measurement and a blood test for the pregnant woman in which it is measured a protein produced in the placenta, PLGF. “And finally we do an ultrasound to assess the condition of the arteries of the uterus using Doppler”, he details. “With all this, we determine the risk and classify it as high or low risk, with a view to starting treatment only when the expected benefit is greater than the risk.”
Fortunately, many Spanish centers are already carrying out this test, according to what the specialist tells us. However, it is not being carried out in a general way in all centers, “which is generating great inequalities depending on where a surrogate mother lives,” he warns. “It is a situation that should not happen. We need it to be included as soon as possible within the screening programs to provide hospitals with the necessary means to carry it out, as well as to assume the quality control of the screening to ensure that it is carried out correctly.”
© Getty ImagesIs it safe to take aspirin during pregnancy?
Taking into account that the acetylsalicylic acid is the drug that, according to the study, should be prescribed to pregnant women at risk of suffering from preeclampsia, we have asked Dr. Santacruz about the safety and possible adverse effects of taking this medication during pregnancy. “Aspirin given at low doses (150 mg) and in short periods of time (less than 6 months to prevent preeclampsia) is a safe drug in pregnancy, but not without risks,” he answers.
“Therefore, always A specialist must assess that the increased risk that may occur (especially at the gastrointestinal level or bleeding) are less than the expected benefit (preventing preeclampsia and, therefore, prematurity due to it). And some women, due to their pathologies, should not take it. In other cases, such as twin pregnancies, its effectiveness has not yet been proven, studies are still ongoing.”
The gynecologist and obstetrician warns that one of the main dangers that it can pose taking aspirin during pregnancy is to do it indiscriminately, without medical indication: “small risks can increase without achieving the desired effect.” That is why it is so important that aspirin is not taken without indication and control by the obstetrics specialist.
Many Spanish centers are already carrying out this test, but others are not, which is generating great inequalities depending on where a surrogate mother lives. It is a situation that should not happen
How was the study carried out?
The study in which it was developed preeclampsia screening It was carried out at the European level, as we noted previously, by the Fetal Medicine Foundation (FMF). “We needed to know if it was also useful in the Spanish population and if our health system was capable of carrying out this type of test in its hospitals,” says the head of Gynecology and Obstetrics at the Torrejón Hospital.
The Torrejón University Hospital led the study together with the iMaterna Foundation and, as the researcher tells us, had the collaboration of the Alcorcón Foundation University Hospital, the Vall d’Hebron Hospital, the A Coruña University Complex, the Virgen de la Arrixaca University Hospital, the Quirón University Hospital in Madrid, the Clinical University Hospital of San Cecilio y de las Nieves in Granada. “20,000 pregnant women from Galicia, Barcelona, Granada, Murcia and Madrid participated in the study.”
In the first part of it, called PREVAL10,000 pregnant women were monitored. Already in this first phase, the researchers demonstrated that the three screening test models used in Spain had good results. In the second phase, called DECREASE, with another 10,000 pregnant women, a clinical implementation study was carried out; That is, screening was launched as it would be done outside of a clinical trial to assess whether it was feasible to do so and whether the expected result was achieved, which was none other than reducing the rate of preterm preeclampsia.
“Our study has shown that, indeed, It is feasible to carry out screening with the means of our health system and that preeclampsia that appears before week 34 of gestation has been reduced by 76% and that which appears before week 37 of gestation has been reduced by 46%, which is all the power we could expect,” concludes Dr. Belén. Santacruz. “I can’t help but say that if any woman has had preeclampsia during pregnancy, of any type, It is essential that your tension is controlled also in the postpartum to avoid complications, especially in its cardiovascular system in the long term.