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ASH position paper: Research needed for tests, treatments of preeclampsia
Cardiologists should question older women about their history of preeclampsia.
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A new position paper from the American Society of Hypertension addresses the classifications, diagnosis and management of preeclampsia, and calls for new research for tests that can predict the disease.
“We are asked by obstetricians often about how to manage [preeclampsia] and I’m not sure many of us are up to speed,” Henry Black, MD, president of the American Society of Hypertension and clinical professor of medicine at New York University School of Medicine, said during a society-sponsored press briefing. Black said that at the society’s annual meeting, only about an hour is devoted to preeclampsia, which he said is not enough. “We have to devote much more attention to this as a problem in the United States and increasingly, worldwide.”
Marshall D. Lindheimer, MD, professor emeritus, medicine and obstetrics and gynecology at the University of Chicago Pritzker School of Medicine, said that the paper suggests using the classifications of hypertension in pregnancy that the National High BP Education Program Working Group recommends, and that is in line with what the American College of Obstetricians and Gynecologists suggests: preeclampsia-eclampsia, chronic hypertension of any cause, preeclampsia superimposed on chronic hypertension and gestational hypertension. Hypertension in pregnancy is defined as BP >140 mm Hg/90 mm Hg and proteinuria >300 mg/24h, spot CRP=0.3.
The position paper suggests that at the first sign of preeclampsia, women should be hospitalized. Also, the paper suggests that near term, inducing labor should also be the therapy of choice with attempts to postpone labor if pregnancy is at an earlier stage.
Although there is no reliable test to predict preeclampsia, the paper discusses new research exploring the measurement of a group of proteins (combinations of sFlt-1, sEng and PIGF) produced by the placenta that may have predictive value.
For the cardiologist, the biggest message of the paper is that preeclampsia needs to be part of a patient history.
“Cardiologists should be looking at an older woman and finding out what her pregnancies were [like], and be much more vigilant about looking for [her] risk factors,” Black said. – by Judith Rusk
For more information:
- Lindheimer MD, Taler SJ, Cunningham FG. Hypertension in Pregnancy. J Am Soc Hypertens. 2008;2:484-494.