Wednesday 26 June 2019

'I'm lucky I carried both girls to term': Why early detection of pre-eclampsia saves lives

Pre-eclampsia causes 76,000 maternal deaths a year, but early detection is the key to saving mothers’ lives

Lynn O’Connell and her daughters Lily and Gracie, who were born by C-section due to Lynn’s pre-eclampsia
Lynn O’Connell and her daughters Lily and Gracie, who were born by C-section due to Lynn’s pre-eclampsia
Bill Liao

Ailin Quinlan

Lynn O'Connell should have been enjoying a relaxing sun holiday in Portugal - but she couldn't, because her hands and feet had suddenly started to swell.

Twelve-weeks pregnant with her eldest daughter Lily, now aged six, the swelling became so extreme she couldn't see her own ankles.

"I didn't know what to do, so I elevated my feet as much as possible," recalls the 42-year-old mum-of-two of that holiday in May 2007.

A few weeks later, a routine check-up showed Lynn's blood pressure had started to rise. The swelling and high blood pressure continued throughout the pregnancy.

The week before her due date of November 21, tests showed the presence of protein in her urine. This was another symptom of a potentially dangerous condition that affects up to 8pc of pregnant women - pre-eclampsia.

The condition can cause fits in the mother. For the baby, it can herald growth problems and a premature birth, and when the condition is severe, it can be potentially fatal for both mother and baby.

In Lynn's case, the protein level in her urine did not become worryingly high until later on, but the mum, who lives in Mallow, Co Cork, had been warned early on in the pregnancy that she was showing symptoms of the condition.

She was getting twice-daily check-ups from her GP but pre-eclampsia was not confirmed until the day before her due date.

"I was very worried, but I was very closely monitored by my GP, who was brilliant," she says. "On November 20, I had my blood pressure monitored at Cork University Hospital and my urine was tested - the protein level was very high."

Her doctors decided to induce her, and 26 hours later she had an emergency C-section. "My blood pressure remained very high in the weeks after Lily was born," she recalls.

The swelling took a long time to go down, and, in fact, it led to another condition, carpal tunnel syndrome.

"It causes damage to the nerves in the wrist. You get tingling and numbness in the fingers and severe pins and needles," says Lynn, who is due to have surgery for the condition.

Two years after Lily's birth, Lynn became pregnant with Gracie, now aged four. As with Lily, the swelling started about 12 weeks into the pregnancy. This time, Lynn was 32-weeks pregnant when her blood pressure started to rise.

Gracie, too, was born by C-section. Lynn's blood pressure was extremely high, but this time the protein showed up in her urine the day after she was born.

"The doctors were very reluctant to let me home because my blood pressure was so high," she recalls, adding that, once again, she was closely monitored after leaving hospital with Gracie.

"It was a very stressful time, but I was very lucky that I carried both of them to term," she says, adding that she still suffers from high blood pressure.

One of the most frightening things about pre-eclampsia is its suddenness - the name actually comes from Latin, meaning "lightning". It can strike with no warning and is one of the most significant causes of maternal death, clocking up 76,000 maternal deaths and 500,000 infant deaths annually.

The only cure for it is for the baby to be born.

For the mother, it can lead to acute problems of the liver, kidneys, brain and clotting system, and survivors of pre-eclampsia have an increased risk of cardiovascular and metabolic diseases later in life.

One quarter of all babies born to mothers with pre-eclampsia experience growth restrictions, which predisposes them to high blood pressure, diabetes and heart conditions in adulthood, while a third are born prematurely.

Awareness of this condition during pregnancy is vital to ensure that expectant mothers seek medical attention immediately if their blood pressure increases or they experience other symptoms

Earlier this year, entrepreneur Bill Liao - co-founder Coder Dojo - invested in Irish firm Metabolomic Diagnostics, which has produced a blood test that detects pre-eclampsia early in a pregnancy.

Liao, a dad-of-three who lives near Clonakilty, Co Cork, experienced the terror of pre-eclampsia in 1994 when his wife Kerrie was pregnant with their eldest son Liam.

"Liam was not due for another five weeks. She'd had no problems up to then, but they told her that her blood pressure was spiking and they had to induce her," he says.

It was shocking, he says, how quickly Kerrie's condition deteriorated.

"At the start of the labour, they said they had to get her blood pressure down and they told me to try to calm her - they said if I didn't calm her down she would die."

The experience stayed with him, and when he heard a Cork company had come up with a test that diagnosed pre-eclampsia early on, he was immediately interested.

"If you catch it super-early, your chances are very good - you can monitor yourself and everyone is prepared," says Liao, who invested earlier this year.

"There is currently no predictive early screening test for pre-eclampsia, which can be a fatal condition. Our PrePsia solution could potentially become a standard part of prenatal care, globally," says Metabolomic Diagnostics founder and CEO, Charles Garvey.

The tests could be rolled out over the next two years.

Eleni Tsigas, executive director of the Pre-eclampsia Foundation in the US, says that education, awareness "and a biochemical test which tells us yes or no" are what is needed.

Tsigas, who visited Ireland to mark National Pre-eclampsia Awareness Day in July, lost her first child to the condition 16 years ago. She believes education is an important element of coping with the condition, for both providers and patients.

"There also needs to be a greater awareness of the symptoms so that when women have symptoms of pre-eclampsia it is understood."

Symptoms can vary and include, among other things, severe headaches not relieved by painkillers, blurred vision, abdominal pain, shortness of breath and sudden swelling of hands face or feet.

The problem is, Tsigas points out, symptoms are not always specific.

She says: "When you have symptoms that are worrying, they should be followed up and taken seriously by health providers - but sometimes they are not."

Problems arise, she warns, when women don't recognise the symptoms or get medical care quickly; and when the condition is either not diagnosed or acted upon quickly enough.

"My message to the women and families of Ireland is of hope and empowerment - and empowerment comes through education and awareness."

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