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RESEARCH NEWS

EMPOWER Improves Maternal Health Research in Low Resource Settings

The International Society for the Study of Hypertension in Pregnancy (ISSHP) and the Preeclampsia Foundation announced a collaborative program at the 2014 ISSHP World Congress to advance research in the field of hypertension in pregnancy.

EMpowering Progress in Obstetric and Women's hEalth Research (EMPOWER) creates and supports partnerships between seasoned investigators and young investigators in low resource settings to improve research capacity, primarily in the area of high blood pressure in pregnancy. Preeclampsia, the most dangerous form of pregnancy hypertension, is estimated to contribute to at least 120 maternal and 1,300 fetal or newborn deaths every day throughout the world, primarily in regions such as the Indian subcontinent, Africa and Latin America. Most of these cases are considered preventable.

"Our focus is on building research operational infrastructure and competency in low resource settings," said ISSHP President Mark Brown. "As part of our commitment to the program, we are supporting travel and other living expense needs for seasoned investigators to serve as mentors to young, motivated investigators in low-resource settings. This partnership will focus on pilot projects that have the potential to improve health outcomes from preeclampsia in the local population. Secondarily, we want to disseminate those results and advocate for required resources to the broader maternal health communit

y, other funders, professional societies and governments."

Preeclampsia Foundation Executive Director Eleni Tsigas added, "With ISSHP facilitating the mentorship aspect of EMPOWER, our Foundation is pleased to provide the financial seed money to enable execution of the research. In low-resource countries, developing a research program has the potential to positively impact the broader community, as well as directly impact the clinical care and lessen the threat of preeclampsia to those mothers and babies."

EMPOWER Welcomes New Zealand Action on Pre-eclampsia

As the founding sponsors of EMPOWER, the Preeclampsia Foundation and ISSHP are pleased to welcome New Zealand Action on Pre-eclampsia (NZ APEC) as a contributing partner. Additional partners are being invited to contribute financial and in-kind resources.

The first recipient of the EMPOWER grant is principal investigator
Dr. Shuchita Mundle who will investigate the ecology of eclampsia in Nagpur, India, where she is an associate professor of obstetrics and gynecology, and where the research project is now underway. The two-year grant provides $10,000 USD per year for 2014 and 2015 and the collaboration with ISSHP will support the ongoing mentorship role by Drs. Gerda Zeeman, Secretary, ISSHP from the Netherlands, and Thomas Easterling, professor of obstetrics and gynecology at the University of Washington.

Mentors Drs. Tom Easterling and Gerda Zeeman meet with first EMPOWER program recipient Dr. Shuchita Mundle from Nagpur, India.

EMPOWER is seeking program "champions" to serve as mentors to local investigators, evaluate site feasibility and help refine project proposals. In addition, research sites interested in applying to this program should contact info@preeclampsia.org.

RESEARCH NEWS

ISSHP World Congress Attracts Best and Brightest Researchers

Almost 500 delegates from 36 countries convened in New Orleans late last month for the bi-ennial meeting of the International Society for the Study of Hypertension in Pregnancy (ISSHP). The world's best and brightest researchers in preeclampsia and related hypertensive disorders of pregnancy brought their latest findings and hot topics for discussion. But we also had some fun!

The Preeclampsia Foundation's executive director, Eleni Tsigas, and research coordinator, Alina Brewer, were heavily involved. We collaborated closely with ISSHP leaders to expand research capacity in low and middle income countries, awarded three travel grants to promising young investigators, showcased The Preeclampsia Registry [link] as a valuable resource for investigators, and demonstrated results from two Foundation-sponsored research studies during Poster sessions. Dr. Mahesh Jariwala, who received one of the travel grants, graciously donated his $1,000 award to benefit preeclampsia survivors in his homeland, India. Check out the Twitter handle #isshp14 for photos and brief takeaways from Tsigas and others at the meeting.

Dr. Kyu-Ho Lee (r), member of The Preeclampsia Registry's Scientific Advisory Council, discusses findings highlighted on our poster presentation at ISSHP with Research Coordinator Alina Brewer (l) and Executive Director Eleni Tsigas (c).

"Investing in research is an investment in the clinical care that expectant mothers receive," explained Tsigas. The Hawthorne Effect means that patients often have better outcomes when they're in a research environment, even if they are not receiving special care as part of a study. Thus, building out the research capacities in settings where the maternal and infant death rate is the highest will not only contribute to our scientific knowledge, but improve outcomes in those settings.

The EMPOWER program, announced at the opening ceremony, hopes to do just that.

Revolutionary Science?

One of the most talked about plenaries showcased "Novel therapies for preeclampsia." While none are ready for clinical use today, many studies showed promise for helping women diagnosed with preeclampsia delay delivery of their premature baby, reversing or slowing down preeclampsia's damaging effects. Biologics and recombinant treatments are advancing into Phase III clinical trials and may become available within the next two to three years.

High Blood Pressure Management in Preeclampsia

Attendees got a sneak peak at the results of the CHIPS Trial - a five year study to evaluate the effectiveness and potential harms - on both mother and baby - of controlling blood pressure during pregnancy. The final paper will be published in the coming month, but lead investigator Dr. Laura Magee explains in this interview why these results should inform how we manage preeclampsia and other forms of high blood pressure in pregnancy today.

Dr. Kent Thornburg, a leading thinker about fetal origins of disease, presented a compelling theory about why the 100 year effect and 1000 day effect can contribute to the programming of our adult diseases. But according to Dr. Thornburg, even with a less than optimal beginning, there's still something we can do to enjoy healthy lives.

Expectations readers may recall answering survey questions two years ago about their views on preeclampsia diagnosis, screening/prediction and clinical trials. After careful data analysis with our scientific collaborators, we reported some of those results in a poster at the ISSHP meeting. The feedback we received from our poster presentations helped us identify areas for improvement and encouraged us to seek publication in a peer-reviewed journal. Scientists we spoke with acknowledged a significant void in patient perspectives needed in research and clinical priority-setting.

Some Meaningful Fun, Too

At the opening ceremony, ISSHP President Mark Brown (Australia), who had to take the reins when President Andrea Tranquilli (Italy) died unexpectedly in January 2014, paid tribute to the man we called "a patient's advocate". The crowd engaged in a traditional New Orleans Second Line - local musicians led us in a dirge followed by a joyful celebration of Tranquilli's life.

The next World Congress will be in Sao Paulo, Brazil in October 2016. The Preeclampsia Foundation will be there, pushing forward awareness, education, scientific investment and clinical improvements on a continent where preeclampsia is the #1 killer of pregnant mothers. If you would like to support our global agenda, please let us know here.

GETTING INVOLVED

Expanded Volunteer Recognition Program Introduced

We recently announced the recipients of our newly expanded volunteer recognition awards. Building upon the historical significance of their annual Hope Award for Volunteer of the Year, we created three new award categories to reflect the growing nature of their volunteer program, which now includes over 800 active volunteers across the country.

"The addition of new volunteer recognition categories allows us to truly celebrate the breadth of volunteer experience across the Preeclampsia Foundation's mission," said Director of Community Relations Laney Poye. "We couldn't have made the strides we've made in awareness, education and research without the dedication of many talented individuals."

New award categories beginning this year include "Promise Walk Coordinator of the Year," "Promise Walk Team of the Year," and the "Angela Little Spirit of Giving Award," as well as the traditional "Hope Award for Volunteer of the Year."

The 2014 recipients are:
Hope Award for Volunteer of the Year - Denise Lang:

A two-time preeclampsia survivor, Denise began volunteering with the Foundation in 2004. What started as a need to give back to the community that supported her evolved into several volunteer roles within the Preeclampsia Foundation over the last 10 years, as a forum moderator and the leader of the Wisconsin preeclampsia survivor group. Denise was instrumental in the 2010 process of rebranding the Promise Walk for Preeclampsia and launching promisewalk.org, helping the event grow to the national presence it has today. She also coordinates her own successful event in Wausau, Wisconsin, and is the 2015 Central Regional Promise Walk Coach, motivating and supporting dozens of volunteers in her region.

Promise Walk Coordinator of the Year Award: Sarah Hughes: After surviving a harrowing case of postpartum preeclampsia after the birth of her daughter, this mom of two dedicated herself to helping other moms by starting the Philadelphia, Penn. Promise Walk for Preeclampsia in 2012 and raising over $70,000 over the past three years. In 2014 Sarah was named a Johnson & Johnson Social Influencer for Social Good for her use of her blog

Finnegan and the Hughes to support the work of the Preeclampsia Foundation and other maternal health causes.

Angela Little Spirit of Giving Award: Rosemary Jorden: This award, named after the Foundation's former Director of Operations, is given to a volunteer who exhibits selfless devotion to the Foundation's mission of education and support. As a preeclampsia survivor and often working quietly in the background, Rosemary has created eight separate Preeclampsia Memorial and Survivor Quilts to honor the experience of survivors from across the globe. She is an active member of the Foundation's Patient Support Network, providing grief support to families who have experienced infant or maternal loss.

Promise Walk Team of the Year:

Chicago, Illinois Promise Walk (Jasmine Mago, Melanie DalPonte, Nikki Mather, Elizabeth Pebelske, Jill Siegel and Johanna Aiken): In 2014, the Chicago Promise Walk and 5K Run was the top event in the nation, raising over $65,000 with over 500 participants. The success of the event was due in no small part to the three lead walk coordinators, Mago, DalPonte and Mather, building off of the hard work of their predecessors Pebelske, Siegel and Aiken. In addition, the Chicago volunteer team puts in many hours of mission work in Chicago through patient education and improving health care practices in their local community.

ADVOCACY

Postpartum Depression Research Needs Your Support

Roughly 10 percent of women suffer from postpartum depression following their pregnancies, and between five percent and eight percent of pregnancies are affected by preeclampsia. It is critical that women and their physicians are aware of the risks of both of these conditions, and specifically the connection between them. More research is required to better understand postpartum depression and to help develop methods to prevent, detect, and treat the disorder. The health reform law (Affordable Care Act or ACA) passed in 2010 included provisions to increase efforts in this area, and the community continues to await action.

The link between preeclampsia and postpartum depression - sometimes manifested as post-traumatic stress disorder (PTSD) - has been established; numerous peer reviewed publications have shown the connection and advised that physicians should be aware of the risks to their patients. A 2010 study published in the

International Journal of Obstetrics and Gynecology showed that women with complications during pregnancy, including preeclampsia, were more likely to develop postpartum depression. The risk was even greater for women with multiple complications; for example, women with preeclampsia who delivered via C-section had a higher chance of developing depressive symptoms than those who experienced one or the other. A second study showed that women with preeclampsia whose babies were admitted to the NICU after birth were at particular risk for postpartum depression.

The health reform law encourages the U.S. Secretary of Health and Human Services (HHS) to expand postpartum depression research and activities in five areas: basic research, epidemiological studies, screening and diagnostics, clinical treatments, and public education campaigns. These efforts, taken together, would drastically improve the ability of obstetricians, midwives, physicians, and nurses to provide high quality care for women at risk for postpartum depression, including those who have had preeclampsia.

Over four years have passed since the landmark health care law became law, and little action has been taken to address gaps in postpartum depression research. The U.S. Agency for Healthcare Research and Quality released a systematic review of the efficacy and safety of screening for postpartum depression on March 9, 2012. The report to Congress was required by the health reform law, but so far, it is the only activity called for in law that has been completed. In a 2012 report released by HHS's Assistant Secretary for Planning and Evaluation titled, The Affordable Care Act and Women, postpartum depression was not mentioned at all.

The Obama Administration often touts the ACA as especially important for women's healthcare. Preventive services including mammograms, cervical cancer screenings, and well-care visits are covered, and the law requires maternity coverage as an essential health benefit within healthcare exchange marketplaces.

These are certainly all positive steps in maternal health and well-being, but the Foundation is also hopeful that there will be greater investment in research that generates more knowledge about preeclampsia and its connection to conditions like postpartum depression.

We want to know what you are doing in your local community to continue the advocacy fight for increased postpartum care. Follow us on Twitter and retweet with your thoughts, post and discuss on our Community Forum or send us comments on Facebook. History has proven that everyone has a voice and we want to hear yours.

NOVEMBER 2014

To Rest or Not to Rest? That's the Question

Four separate studies from the past year found no scientific evidence supporting bed rest in pregnancy and several actually reported harmful effects from placing an expectant mom on prolonged bed rest. In a recent issue of

Obstetrics & Gynecology, Dr. Robert Lorenz summarizes current research findings:

* Activity restriction among women with a short cervix may actually increase preterm birth;

* Therapeutic bed rest in pregnancy is unethical and unsupported by data, and if used, should be limited to investigational trials with informed consent so the woman fully knows the risks;

* It may cause both mental and physical harm; and finally,

* "Bed Rest in Pregnancy: Time to Put the Issue to Rest" states that while physicians may prescribe activity restriction, most still believe it does not work. It also costs $2-7 billion and affects almost 1 million families annually.

This begs the question:

Why do so many women at risk for preeclampsia get put on bed rest?

Members of the Preeclampsia Foundation's Medical Advisory Board suggest that in certain individuals, reduced activity - rather than strict bed rest - may be beneficial. For instance, your job or lifestyle may include strenuous physical activity that should be curtailed. Doctors would discourage high intensity cardiovascular training in an "at risk pregnancy."

Your individual situation may include other factors, not related to preeclampsia, that warrant reduced activity or bed rest. This may include:

* Vaginal bleeding or problems with the placenta

* An incompetent cervix - a condition in which the cervix is likely to open (dilate) prematurely

* Contractions and other advanced signs or symptoms of preterm labor

* A twin or multiple pregnancy

In any case, be aware that bed rest increases your chances of deep vein thrombosis (DVT), otherwise known as blood clots. Discuss with your healthcare provider steps you should take to minimize your chances of developing blood clots, as well as the specific details of how strictly you should adhere to this instruction. Bed rest, like any medical intervention, should always be evaluated against its Benefits, Risks and Alternatives. Mentally and emotionally, if you are cautioned to reduce your activity or spend a lot of time in bed, we have compiled some great tips so it doesn't feel like solitary confinement.

Were you put on bed rest in your pregnancy? What did that experience do for you? Talk about it here.

NEWS FROM THE FOUNDATION

New Partners for Success-

Healthy Start Coalition and Preeclampsia Foundation

Healthy Start Coalition of Brevard County and the Preeclampsia Foundation are partnering to create a countywide Preeclampsia Education Program. As part of this new program, Healthy Start care coordinators will provide preeclampsia education materials to expectant mothers during their home visits and to obstetricians' offices throughout the county. Education materials include an easy-to-understand illustrated tear pad that describes the signs and symptoms of preeclampsia and when to seek medical attention.

The Preeclampsia Foundation will provide training and education to Healthy Start care coordinators.

To learn more about this program, contact Healthy Start's Jennifer Schwalb Floyd , or Preeclampsia Foundation's Eleni Tsigas.

RESEARCH NEWS

New Discovery Links Pregnancy-related Substances to Preeclampsia

2011 Vision Grant recipient Dr. Nihar Nayak has published his work

with sFLT-1, a protein related to blood vessel development in the early part of pregnancy and strongly implicated in the vascular dysfunction associated with preeclampsia. Published in the well-respected

Journal of Clinical Investigation, Nayak's team discovers that another pregnancy related substance, VEGF, is responsible for triggering the overproduction of the much-discussed sFLT-1. However, the findings

show that sFlt1 can actually help to protect the fetus by "sequestering" excess VEGF, even though this is dangerous for the mother.

You can read about his original Vision Grant research on our website.

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