For patients who have experienced seizures, liver failure, premature delivery, the loss of their baby, or a sudden turn of bad health caused by hypertension during pregnancy, it might seem obvious that women are left feeling depressed, scared and lonely. In the words of one patient, "I tried [unsuccessfully] to psych myself into believing that because I survived and our son survived, I should be happy."

The Foundation has learned from patient stories that women were suffering more than just poor physical health because of preeclampsia, but research has thus far been scant on the specifics of how women are suffering emotionally and cognitively. And without that peer-reviewed research, health care practices to help patients with their psychological needs will not change.

Two teams of researchers from the Netherlands and the University of Southern California set out to do just that. With collaboration from Preeclampsia Foundation supporters, the Brain Study utilized a combination of tools (including pregnancy history, the Cognitive Failures Questionnaire (CFQ), the abbreviated WHO Quality Of Life questionnaire (WHOQOL-BREF), Social Functioning Questionnaire (SFQ) and the Breslau Short Screening Scale for DSM-IV Posttraumatic Stress Disorder) to evaluate what impact preeclampsia had on a woman's cognitive, social and psychological health.

The main Brain Study, led by Ineke Postma and Dr. Gerda Zeeman of the Department of Obstetrics and Gynaecology, University Medical Center Groningen in The Netherlands, looked at 966 cases (women who had some type of hypertension during pregnancy) and 342 controls (women who had not had any type of hypertension during pregnancy). The cases scored significantly worse on all of the evaluation tools, especially women who reported an eclamptic seizure or migraines. The Groningen team has also conducted research

One part of the Brain Study specifically evaluated for post-traumatic stress disorder (PTSD). For PTSD to be diagnosed, all of the following symptoms must be present:

(1) Persistent re-experiencing of traumatic event through images, thoughts or flashbacks,

(2) Avoidance of stimuli associated with the event, and

(3) Persistent symptoms of increased arousal, such as difficulty sleeping or concentrating, outbursts of anger.

Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The Breslau Short Screening Scale specifically looks for symptoms of avoidance and arousal in patients.

Women with a traumatic pregnancy had almost 4 times the risk of screening positive for PTSD compared to the control population. Interestingly, the study found a clear and dramatic increasing risk of PTSD with the increased risk of severe effects. Women who reported having had an eclamptic seizure were at nearly 10 times the risk of screening positive for PTSD; women with HELLP syndrome almost 6 times more likely. All numbers were adjusted for age, previous history of mental illness and number of pregnancies.

So what does that mean for patients with preeclampsia? First of all, patients should watch for signs of psychological difficulties and talk to their healthcare providers. Health care providers should also be aware and discuss this with their high-risk patients.

As promising as both studies are, more research is needed before these findings on long-term cognitive and psychological impacts will change health care practices. The Foundation continues to collaborate on research through our Vision Grant funding, Study Recruitment Services, and through the patient-led Preeclampsia Registry. These two studies are the beginning of a continuing process to look at the long-term effects of preeclampsia as more than "just" a disease of pregnancy.

This week Chemical & Engineering News featured an article about the early detection of preeclampsia. Preeclampsia Foundation Executive Director Eleni Tsigas was interviewed, and the leading tests to identify and predict the life-threatening pregnancy complication were reviewed. The Preeclampsia Foundation eagerly observes and applauds the advances being made in molecular tests (biomarkers) to confirm diagnosis of preeclampsia and to predict early in pregnancy a woman's likelihood of developing preeclampsia.

"Biomarkers are leading tests to identify the life-threatening pregnancy complication before it becomes deadly," reports Celia Henry Arnaud, author of "Early Detection of Preeclampsia" in the December 2, 2013 issue of Chemical & Engineering News.

Noted among the innovators working in this area were:

• Alere, a multinational corporation of several diagnostic and health management companies, working on a diagnosis confirmation test based on placental growth factor (PlGF). (See GUEST BLOG in this newsletter, below.) 
• Screening for Pregnancy Endpoints (SCOPE) Consortium, which has established a biobank of samples from approximately 6,000 pregnant women in the U.K., Australia, New Zealand, and Ireland. The consortium has focused on healthy, low-risk women in their first pregnancy. Samples from this study are being used to help develop predictive tests.   
• Thermo Fisher Scientific and PerkinElmer, both of which use biomarkers to calculate a risk score that the mother will develop preeclampsia before 34 weeks. These screening tests are meant to be used at the end of the first trimester, approximately between weeks 10 and 14.
• Pronota, a company in Ghent, Belgium, which is working on a predictive test, using four biomarkers, that will be administered halfway through a pregnancy, at week 20.  
• Carmenta Bioscience, based in Palo Alto, California, which is also working on a predictive test and a diagnosis confirmation test.
• Metabolomic Diagnostics, a company based in Cork, Ireland, which has used samples from the SCOPE study to identify metabolites for development of a predictive test that can be used early in pregnancy.