Preeclampsia is a condition that develops during pregnancy, characterized by hypertension and protein in the urine. Being the most common complication of pregnancy, its consequences can be fatal for the mother and the baby. Until now, the only cure was to deliver the baby, but a new study published in the Journal of the American Society of Nephrology (JASN) describes novel therapeutic interventions that will allow the pregnancy to continue safely.

Developing The Novel Treatment

Lead author Ravi Thadhani, MD, MPH (Massachusetts General Hospital) explained that recent advances in understanding preeclampsia have led to the development of treatments that facilitate pregnancy to continue safely even if preterm complications start to develop. Prolonging the pregnancy allows the growing baby to mature and reduces future problems.

One proposed treatment involves removing a protein that alters the growth of blood vessels – the soluble Fms-like tyrosine kinase-1 (sFlt-1) – and is believed to play a significant role in development of preeclampsia.

Results Of The Pilot Study

Dr. Thadhani, along with his colleagues, conducted an open pilot study to assess the safety and efficacy of removing the soluble Fms-like tyrosine kinase-1 (sFlt-1) from blood via a process known as apheresis. The latter involves removing blood and passing it through a column lined with a substance that binds and retains sFlt-1 while the rest of the blood returns to the body.

The research team performed this procedure on 11 pregnant women who were suffering from very preterm preeclampsia (23-32 weeks gestation).

Results potentially reduced the amount of sFlt-1 excreted in the woman’s urine and briefly reduced their blood pressure as well. Moreover, pregnancy was able to continue for an average of eight and 15 days for women treated once and multiple times respectively. This was in comparison to the 3 days of prolonged pregnancy in the 22 untreated women. Most importantly, no adverse effects of apheresis were seen on the infants born or on their mothers.

“Our pilot study suggests that we can safely prolong pregnancy by targeting the removal of sFlt-1 in women with severe preterm preeclampsia. We hope this is confirmed through randomized trials”, said Dr. Thadhani.

Editorial

Thomas Easterling, MD (University of Washington, Seattle) commented on the biological significance of reducing sFlt-1 concentrations in pregnant women suffering from preeclampsia.

“Achieving an additional week of gestational age in a premature infant is very important, given the cost of neonatal intensive care”, he stated.

According to him, apheresis might prove to be a significant component of a broader intervention of synergistic agents. However, a randomized trial – something that will be challenging to design and employ – is needed.