Body fat link to pre-eclampsia

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Chemicals in fat tissue may trigger pre-eclampsia in some pregnant women, a study suggests.

Researchers in the United States studied over 1,000 pregnant women. About 6% went on to develop pre-eclampsia.

The condition causes a woman's blood pressure to rise sharply, putting both mother and baby at risk.

The researchers found a direct link between the women's weight before they became pregnant and their risks of developing pre-eclampsia.

Higher risk

For instance, women who were obese before they were pregnant were three times more likely to develop pre-eclampsia compared to those of normal weight.

Women who were overweight were twice as likely to suffer problems. Those who were underweight were half as likely to experience difficulties compared to those of normal weight.

Action on Pre-Eclampsia

In fact, the risks increased steadily depending on how much body fat the women had before they were pregnant.

The researchers, who are based at the Magee Women's Research Institute in Pittsburgh, said this suggested that body fat played a role in determining who was at risk.

While further studies are needed, they suggested that chemicals produced by fat tissue may be responsible.

Speaking at the American Society for Nutritional Sciences annual meeting in Washington, they said the findings could lead to new treatments to protect against the condition.

However, they said the findings also highlighted the importance for women of being normal weight when they become pregnant.

Researchers at the University of Glasgow were recently awarded has almost £129,000 by the British Heart Foundation to carry out work in this area.

They will compare blood plasma from women who have had pre-eclampsia with healthy women.

They believe that in some women plasma can stimulate fat cells and cause them to release excessive amounts of fatty acids and other toxic products triggering pre-eclampsia.

Mike Rich, chief executive of Action on Pre-Eclampsia, said women planning to become pregnant can take action to reduce their risks of developing the condition.

"The Magee research confirms what we have known about increased BMI being linked to a greater risk of pre-eclampsia.

"However, it goes further and shows that even small increases in BMI can be significant.

"There is a clear health message. We would advise all women, pregnant and considering becoming pregnant to eat a sensible and healthy diet in order to help reduce the risk of pregnancy complications such as pre-eclampsia.

"Women should also ensure that they attend all of their antenatal appointments for blood pressure monitoring and urine testing."

Pregnancy disorder link to cancer

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Women with a history of the pregnancy disorder pre-eclampsia are at greater risk of cancer, research suggests.

The chance of developing breast cancer is "significantly" increased, the study shows.

Research by the Hadassah-Hebrew University in Jerusalem also indicates a greater risk of stomach, ovary, lung and larynx cancer.

A report in the BMJ also suggests environmental and genetic factors may influence pre-eclampsia and cancer.

The study, which found a link to specific cancers, looked at 37,000 women delivering babies in three large hospitals in Jerusalem between 1964 and 1976.

They compared the risk of cancer in those who had experienced pre-eclampsia, with those who had not.

They also looked at the link between social class and other factors including ethnic origin, religion and diabetes on pre-eclampsia - a life-threatening condition which affects about 5-8% of all pregnancies.

It is characterised by a sharp rise in blood pressure and the presence of protein in the urine and occurs in the last three months of pregnancy.

The study revealed that nearly 2,300 women developed cancer for the first time, including 978 (42.6%) of the breast.

'Significant' risk

Pre-eclampsia was recorded in 1,070 women from the study and of these, 40 or 3.7% developed breast cancer.

This compares to 938 or 2.6% of women who got breast cancer among the 36,000 women who did not have pre-eclampsia.

The research team in Israel concluded the risk of breast cancer was "significantly" increased for pre-eclamptic women.

Only a third of the Jerusalem study group originated in Europe - the others were from the Middle East, north Africa, other Western countries and the Americas.

It is believed that in general breast cancer rates are higher among Western women.

The Israeli study also found the risk of cancers of the stomach, ovary, lung and larynx were increased.

The women were followed-up for an average of 29 years.

Genetic link

The study also discovered that West Asian women were more likely to have pre-eclampsia as were those from a lower social class and those with gestational diabetes - the type which occurs during pregnancy.

Dr Simon Vincent of Cancer Research UK said the results of the study were interesting.

"There are likely to be many factors to do with our environment and our health that might increase our risk of developing cancer," he said.

"We already know of some of these factors thanks to research projects, like this one, that look at large numbers of people over a long period of time.

"There are several very large studies, following women over several years, which are currently running in the UK and elsewhere.

"It will be interesting to see if these researchers see the same effects of pre-eclampsia as this study has demonstrated in Israel."

Some, but not all, previous studies have shown a protective effect of pre-eclampsia on breast cancer, although such research has been carried out mainly in northern Europe and North American populations.

The research team suggests there may be a genetic link to both pre-eclampsia and cancer.

They also claim that diet, insulin resistance, smoking or patterns of infection may affect the development of both cancer and pre-eclampsia and their effects may differ between populations.

Birth weight pre-eclampsia 'link'

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Women who were underweight when they were born are at greater risk of severe pre-eclampsia in pregnancy, a Swedish study involving 6,000 women suggests.

The risk is particularly pronounced if their mothers had pre-eclampsia when pregnant with them, researchers say.

Pre-eclampsia is a common condition which causes high blood pressure and can put the mother's life at risk.

UK experts said doctors should use the findings, reported in BJOG, to identify women who need more careful monitoring.

The researchers looked at more than 6,000 women under the age of 30 years who had been unusually small when they were born and who had given birth themselves.

Women who were underweight when born had a "markedly increased" risk for severe pre-eclampsia during their pregnancy, they said.

If their mothers had also had pre-eclampsia, the risk was doubled.

The research supports previous work suggesting that pre-eclampsia may run in families.

Low birth weight is also believed to be related to other conditions associated with high blood pressure, such as heart disease.

Prevention

Spotting pre-eclampsia early on can be difficult, despite routine monitoring of blood pressure, and knowing who might be more at risk would be useful.

Dr Karin Zetterstrom, study leader and gynaecologist and obstetrician at Orebro University Hospital in Sweden, said pre-eclampsia could be dangerous to a mother and baby in many ways.

"Those who are born underweight also have high risk of heart disease and the severe form of pre-eclampsia might be part of that pathway.

"It might be of value to ask a woman if she was born underweight or if her mother had pre-eclampsia because we know she is at high risk that her pre-eclampsia will turn out to be the severe form."

Professor Andrew Shennan, professor of Obstetrics and Gynaecology at King's College London and spokesperson for the baby charity Tommy's, agreed with the researchers recommendations for identifying and monitoring those at increased risk.

He said finding women at risk of the severe form of the condition was key.

"One of the really important things is distinguishing between early (commonly severe) and late onset pre-eclampsia because early onset is where the problems lie.

"But paradoxically we don't see people very often at that crucial time and that's the time we need increased surveillance."

"This is quite new stuff and a lot of obstetricians may not even be thinking about it," he added.

Professor Phil Steer, BJOG editor-in-chief, said: "What this research demonstrates is the need for careful and detailed history taking when a woman is first seen in pregnancy.

"If we know that the likelihood of a woman developing severe pre-eclampsia is high, increased surveillance during pregnancy and early appropriate management will help to safeguard the health of both mother and baby."

Preeclampsia genetic basis

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A gene associated with susceptibility to preeclampsia is identified in the May issue of Nature Genetics, explaining why this condition runs in families. Preeclampsia is a common and serious complication of pregnancy, involving elevated blood pressure and impaired kidney function.

Cees Oudejans and colleagues found that the majority of individuals with preeclampsia had received variants of a particular gene from their mother, and suggest that this variant functions less well than most other forms of the gene.

Intriguingly, only the maternal copy of this gene is expressed in the placenta during the critical stage in which it invades the lining of the uterus, explaining why the process is so sensitive to loss of this gene's function.

The loss of appropriate function of this gene in the placenta is suggested as a cause of preeclampsia. The study included 67 cases of preeclampsia amongst families with two or more affected sisters, identified from databases within 22 hospitals in the Netherlands.

Carbon Monoxide May Help Prevent Debilitating Pregnancy Condition

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New findings by Queen's University researchers suggest that administering low doses of carbon monoxide to pregnant women may help prevent the potentially damaging effects to mother and baby of pre-eclampsia.

The study was precipitated by the fact that mothers who smoke cigarettes during pregnancy have a 33 per cent decreased risk of developing pre-eclampsia compared to nonsmokers.

A debilitating condition that affects five to seven per cent of pregnancies, pre-eclampsia is characterized by high blood pressure in pregnant women and is one of the leading causes of baby and maternal deaths. "At present there is no cure or effective treatment for this condition, other than delivery of the baby," says research team leader Dr.Graeme Smith (Obstetrics and Gynecology), an expert in high-risk obstetrics.

In the Queen's study, published in the September issue of the American Journal of Pathology, tissue from the placentas of nonsmoking women who had delivered babies by caesarian section was exposed to the same kind of oxidative stress -- not enough oxygen being supplied through the blood -- experienced by women with pre-eclampsia. When the tissues were treated with carbon monoxide, at levels similar to those found in the blood of smoking mothers, cell death in the placenta was significantly reduced.

"We believe that carbon monoxide found in cigarette smoke, and subsequently carried in a smoking mother's blood, may be the cause of their lower risk of developing pre-eclampsia," says Dr. Smith. He stresses however that any perceived benefit of smoking during pregnancy is outweighed by the many risks: premature membrane rupture, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome.

Produced naturally by the body at low levels, carbon monoxide relaxes blood vessels and may prevent the death of placental cells, which can cause injury to fetus and mother. Future studies will determine whether carbon monoxide can prevent placental cell death in animal models and whether other approaches similar to carbon monoxide may provide protection.

Also on the research team, from Queen's Department of Anatomy and Cell Biology, are: Shannon Bainbridge, Louiza Belkacemi, Michelle Dickinson, and Charles Graham.

The work was supported by the Strategic Training Initiative in Research in Reproductive Health Sciences, the Heart and Stroke Foundation of Ontario, and the Canadian Institutes of Health Research.

Adapted from materials provided by Queen's University.

Old Drug Being Tested As Possible Pre-eclampsia Cure

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Researchers at the University of Texas Medical Branch at Galveston are trying to determine whether a drug already available to heart patients can also be used to delay delivery in expectant mothers with severe preeclampsia. If so, this groundbreaking study would give hope to hundreds of thousands of women who experience this life-threatening disorder each year.

The drug, Digibind, has been prescribed for over 20 years to patients who overdose on a certain heart medication, but is not yet approved for preeclampsia, the most common and dangerous pregnancy complication affecting as many as eight in every 100 pregnant women. The disorder is characterized by high blood pressure, protein in the urine and multi-organ dysfunction, all of which can seriously harm both mother and fetus.

"Preeclampsia is the No. 1 killer of pregnant women in the world, and there is no cure except delivery," said Dr. George Saade, chief of maternal--fetal medicine at UTMB. "When it is severe and occurs early in the pregnancy, delivery in order to protect the mother results in a premature baby. That's why this study is important, because if the medication works, then we can protect the mom while allowing the baby to grow and develop without delivering early."

The clinical trial will test whether Digibind reverses or prevents the abnormalities that occur with preeclampsia and allows the fetus to remain in the womb longer. This would give doctors more time to administer steroids to prevent respiratory complications in premature births and reduce the need for costly and lengthy neonatal intensive care.

"Right now, there is no treatment for preeclampsia, so this is truly groundbreaking," said Dr. Nicole Ruddock, the study's principal investigator and an instructor in UTMB's Department of Obstetrics and Gynecology.

UTMB will continue enrolling participants at least through the end of this year. The study is sponsored by Protherics and is taking place in eight states around the country.

Adapted from materials provided by University of Texas Medical Branch at Galveston.