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The American College of Obstetricians and Gynecologists (The College) Task Force on Hypertension in Pregnancy published its reportHypertension in Pregnancy, on November 2013. This report on the diagnosis and management of preeclampsia is the culmination of two years of hard work by the 16-member College task force, on which the Preeclampsia Foundation represented the patient's point of view.


"This Task Force report changes the paradigm that we use in diagnosing preeclampsia from one that is dependent on new onset hypertension and proteinuria," said James N. Martin, Jr., MD, who is on the medical advisory board of the Preeclampsia Foundation and past president of The College. "The problem is that many patients with preeclampsia don't have enough proteinuria to meet the former criteria, so their diagnosis and treatment is delayed."


The revised definition of preeclampsia is just one of many improvements made to the College's guidelines based on scientific evidence. 


The new guidelines are presented in a 99-page report written for the College's professional members. The Preeclampsia Foundation is in the process of developing a patient guide to the new College guidelines for publication this coming winter. The patient overview will be a PDF available online to help patients understand the changes and what to expect if they experience hypertension in pregnancy. A planned second edition is to include notes about international guidelines, such as those coming from the World Health Organization (WHO) and the soon-to-be-published guidelines from the Society of Obstetricians and Gynecologists of Canada (SOGC).


The Revised Definition of Preeclampsia


According to the new College guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Evidence shows organ problems with the kidneys and liver can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress. Prior to this time, most healthcare providers traditionally adhered to a rigid diagnosis of preeclampsia based on blood pressure and protein in the urine(proteinuria).


Preeclampsia is now to be diagnosed by persistent high blood pressure that develops during pregnancy or during the postpartum period that is associated with a lot of protein in the urine OR the new development of decreased blood platelets, trouble with the kidney or liver, fluid in the lungs, or signs of brain trouble such as seizures and/or visual disturbances.


Other Big Changes in Diagnosis and Management


Evidence tells us that preeclampsia is a dynamic process. Diagnosing a woman's condition as "mild preeclampsia" is not helpful because it is a progressive disease, progressing at different rates in different women. Appropriate care requires frequent re-evaluation for severe features of the disease and appropriate actions outlined in the new guidelines.


Mild to moderate high blood pressure (140-159 mm Hg systolic or 90-159 mm Hg diastolic measured on two occasions at least four hours apart) warrants close evaluation and monitoring. High blood pressure greater than or equal to 160 mm Hg systolic or greater than or equal to 110 mm Hg diastolic is a feature of severe preeclampsia.


To prevent eclampsia (seizures), magnesium sulfate should be given if your blood pressure is 160/110 or higher. If your blood pressure is less than 160/110 and you have other severe symptoms that usually precede seizures, you should be given magnesium sulfate. Severe hypertension can be confirmed within a short interval (minutes) to facilitate timely anti-hypertensive therapy.


Guidelines for the timing of delivery have been modified based on data indicating best outcomes for mother and baby. One of the biggest changes in preeclampsia management relates to the timing of delivery in women with preeclampsia without severe features. Studies suggest that the best time of delivery is at 37 weeks of gestation. It has been known for many years that preeclampsia can worsen or become apparent for the first time after delivery. The new guidelines include specific recommendations to improve outcomes for women who have postpartum preeclampsia.


Evidence firmly tells us that preeclampsia is associated with later life cardiovascular disease (CVD), and the College's report calls for research to learn how to use this information to help patients.


A new recommendation is to educate all pregnant and postpartum patients about the signs and symptoms of preeclampsia. The Preeclampsia Foundation advocated for this addition based on the evidence of its own research study that has just been published.


Survivors Applaud


Comments on the Preeclampsia Foundation's Facebook page indicate the new diagnostic guidelines are perceived as a cause for celebration among survivors of preeclampsia. Here is a sample of your thoughts:


Great news - but bittersweet for so many of us who did not have all the classic symptoms of PE and/or HELLP and who struggled trying to get people to listen to us that something was not right.

~ Amanda G.


I too didn't spill protein until I was in dire straits and nearly dead from Preeclampsia and HELLP! So glad to see this change to the guidelines! ~Brenda S.


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

to look for the presence of white matter lesions in patients who have experienced eclamptic seizures, which may provide a glimpse of long-term effects on patient's brain.


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.
Are You Eligible for this Research Study?

You may be eligible for this study if you have experienced preeclampsia and delivery at or before 34 weeks in either of your 2 most recent pregnancies, and you are currently pregnant. This is a study of a medication that may be useful in preventing recurrence of preeclampsia in women at high risk for recurrence. This is an FDA-approved medication for the treatment of high cholesterol, as well as for decreasing the risk of heart attack and stroke. In this study, the medication is experimental because it has not been approved for the prevention of preeclampsia in pregnant women. This study will evaluate the effects of this medication on chemicals in the blood that are associated with preeclampsia, the safety of the medication, and how the body handles and responds to the medication.

Participation in this study will involve collecting information from you and your medical records, physical exams, blood and urine collections, monitoring for side effects, and taking the study medication.


Seattle-area: For more information about participation, please contact the University of Washington Medical Center study coordinator Navi Gill, at 206-616-9902 or by e-mail at


Indiana-area: If you are interested in learning more about this study, please contact the study coordinator Amy McCormick at  317-630-8816 or


Pittsburgh-area: If you are interested in participating or learning more, please contact the study coordinator, Dawn Fischer, RN, at either 412- 641-5194 or


Investigators interested in our Study Participant Recruitment Services should contact the Preeclampsia Foundation at


Related articles shed light on why we need clinical trials for preeclampsia research and provide a thoughtful safety analysis of a potential treatment for severe preeclampsiaIn addition, is a registry of most federally and privately supported clinical trials conducted in the United States and around the world. gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. 

DECEMBER 5, 2013

During our "When I Wish" Annual Giving Campaign, we are sending weekly messages featuring real families just like you, who have been deeply and lastingly affected by preeclampsia. Our first message "A Husband's Dream" was sent to you two days ago.

This season, please
make a donation
to the Foundation so that we can carry on our mission of supporting families like yours, raising awareness, educating patients, improving healthcare practices, and accelerating research to find the causes and a cure.

Thank you! 
Mission Moment  
"When I Wish: I wish for awareness, awareness, awareness! I lost my daughter at 25 weeks in 2006 to class 3 HELLP, preeclampsia and growth restriction... the preeclampsia experts on the forums suggested I get blood test done and I did. I have two blood clotting disorders and an antibody disorder, and with that information and with the help of my wonderful doctors I now have two beautiful sons. Bless you, Preeclampsia Foundation, bless you! Let's make wishes, wishes, wishes!!!"  


~Elaine H., "When I Wish" Facebook event post 

Remember, December 15 is the CFC deadline if you are a Federal employee. Please consider giving to the Preeclampsia Foundation via the Combined Federal Campaign (CFC)  by December 15. The Preeclampsia Foundation's CFC number is 99819.
Give to the Foundation by Sharing Our Giving Library Video 

Giving Library, an online video archive that connects donors to nonprofits, is kicked off a $100,000 "Share to Give" campaign on #GivingTuesday, December 3.

This is a way for you to support the Preeclampsia Foundation by simply raising awareness. All you have to do is share our Giving Library video, and the Giving Library will donate $5 to us. It's that simple! Participants can share up to five organizations per month, and the Giving Library will donate up to $100,000 during the campaign.

How to Share:
1. Sign up at the Giving Library. (All you need is an email address!)

2. Visit the Preeclampsia Foundation Giving Library page.

4. Click "Share Now" and share the video on Facebook or Twitter. (Share either the default message or a message of your choice.)

6. The organization will receive $5 per share.

7. Individuals may share up to five organizations per month.

Upcoming Activities

When I Wish Annual Giving Campaign
December 1-31, 2013
New Orleans, LA
February 2-8, 2014
Florence, Italy
March 26-29, 2014
Chicago, IL
April 26-30, 2014

Improving Healthcare Practices Depends on Evidence
The evidence to support changes in healthcare practices to improve diagnosis and management is derived from data. To move data collection forward, the Preeclampsia Foundation launched The Preeclampsia Registry on September 9, 2013. To date over 400 have enrolled in the registry and begun entering their pregnancy history and other data in response to easy-to-use online questionnaires.
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