My Baby Died So That I Could Live - Twenty years ago, Isabel Walker lost her baby boy when she developed pre-eclampsia. She asks if new research brings us any closer to curing this deadly condition.
Nicola Bandy and I have something in common. Over 20 years ago, I lost my first baby, Benji, when he had to be delivered three months early to save my life. I had developed pre-eclampsia, a potentially dangerous complication of pregnancy. Benji died two days after his birth.
I recall not only the grief, but my bewilderment that, with all the advances of modern medicine, there was no way to control this condition other than by delivering my baby early and effectively ending his life, to save mine. Pre-eclampsia happens when the placenta, the organ that transports food and oxygen from the mother’s blood supply to the baby, fails to grow as it should. At present, the only “cure” remains delivery. Later, when contemplating a second pregnancy, I was dismayed to learn that there was no way to predict whether I would get pre-eclampsia again and no way to stop it happening.
Isabel Walker, who has suffered from pre-eclampsia and lost a baby 20 years ago and is now campaigning to raise awareness of the condition
Nicola has had pre-eclampsia too, but more recently. Six months into her first pregnancy, the first sign was when her feet and then her hands and face, swelled up to spectacular proportions: her feet, she says, were “like balloons”. She also she started to put on weight alarmingly fast. At 38 weeks, with her blood pressure rising, she underwent an emergency Caesarean. Her baby, Seth survived and is now 16 months.
But Nicola, who is 37, remains traumatised by what happened. Like me more than two decades ago, she finds the idea of another pregnancy frightening. 'I’m still struggling with the idea that I or my baby could have died,’ she says. 'I would love to give Seth a little brother or sister but the way I feel now I would be much too scared to try again.’
Why Nicola’s pregnancy had a happier outcome than mine is a mystery. In all likelihood I had a more severe, fast-moving form of the disease that left no room for the standard policy with pre-eclampsia – to watch, wait and deliver the baby when essential but as late as possible. Certainly, the difference has nothing to do with any progress in the treatment of pre-eclampsia: in the years between our two experiences, little has changed in this respect.
I was fortunate to go on to have two successful pregnancies and my children (Joe, 22, a father himself, and Mimi, 21, currently doing an MA in music ) are now adults. But my experience left me with a lasting interest in pre-eclampsia and a passion to support research into the prevention and treatment of this mystery condition, which still kills about 6 women in the UK every year. I’ve watched as research has produced numerous false dawns, with one potential panacea after another – including aspirin, calcium, vitamins C and E, magnesium and fish oils – showing initial promise but ultimately shown to be useless or (in the case of low-dose aspirin) of limited benefit.
But now it seems that progress in being made on several fronts. Experts are confident that within a decade it will be possible to accurately identify women at risk of this frightening condition, with screening available in early pregnancy. At the same time scientists are moving closer to understanding the causes of pre-eclampsia, which could open the door to more effective treatment - and even to prevention.
At the moment the underlying cause of pre-eclampsia is unknown. Most common in the last few weeks of pregnancy, it is thought to start with a defect in the placenta. As a result, the baby may suffer growth problems and the mother high blood pressure. As it gets worse, pre-eclampsia can cause kidney and other organ damage in the mother and starvation and oxygen deprivation in the baby.
Many women don’t realise they have it until it reaches a late and dangerous stage – which is why ante-natal clinics routinely carry out checks on blood pressure and urine, aimed to pick up early signs. It cannot be prevented and the only medical response is delivery – sometimes at the expense of babies, like Benji, who are too premature to survive. In the UK alone, pre-eclampsia leads to 5-600 deaths of babies every year.
Until now, it’s been hard to predict which women are at risk of pre-eclampsia. But new research offers hope that a blood test could become available within a few years. The study, involving 2,000 women, published in the journal Hypertension, found that high levels of a combination of 14 chemicals (called metabolites) in the blood of women tested at around 15 weeks of pregnancy could accurately predict the development of pre-eclampsia later.
The discovery of this particular 'metabolic signature’ opens the door for a screening test for pre-eclampsia that would be more accurate than current screening for Down’s syndrome, according to researchers. This will mean closer monitoring, earlier intervention and safer outcomes for mothers and babies.
Stephen Robson, Professor of Fetal Medicine at Newcastle University, who is planning a larger study, is enthusiastic about the prospects for screening, although he also warns it is at least five years away. “People tend to think there is no point in screening unless you also have a magic bullet that can prevent the disease” he says. “But what we can do here is transform the whole pattern of antenatal care to separate high risk from low risk women and streamline care accordingly.”
This year also saw a breakthrough in understanding the causes of maternal high blood pressure, which is usually the first sign of pre-eclampsia. Scientists from Cambridge University reported in the journal Nature that women with pre-eclampsia have high blood levels of a certain protein called angiotensinogen. This protein triggers the release of hormones called angiotensins, which cause blood vessels to constrict, so raising pressure. Understanding this process offers “real hope for developing strategies to prevent or treat this dangerous condition” according to Professor Peter Weissberg, Medical Director of the British Heart Foundation, which funded the study.
It’s important, though, to sound a note of caution about the Cambridge findings on blood pressure – although important, these have been talked up in the media as scientists finding the cause of pre-eclampsia. But, in fact, high blood pressure is simply one of a number of outward signs of pre-eclampsia, not the cause. Preventing or treating this outward sign may not halt progression of the underlying disease.
So although things all looks promising, specialists are still wary about talk of immediate “breakthroughs”. Professor Chris Redman, formerly of the Nuffield Department of Obstetrics and Gynaecology at Oxford University and an international authority on pre-eclampsia, describes the prospect of screening as 'only half a step forward – the other half being something that could stop pre-eclampsia in its tracks’. He also believes pre-eclampsia will never be totally preventable since he regards it as 'a hotch-potch of different kinds of problems that come together with the same appearance’.
The fundamental research question about pre-eclampsia remains: what happens inside a woman’s body to transform a healthy pregnancy into a time bomb that can threaten her own life and that of her unborn child?
Until this question is answered, ideas about prevention will be based to a considerable extent on guesswork. And women like me and Nicola Bandy, nurtured on the modern mantra that 'pregnancy is not an illness’, will continue to find, to their cost, that it can be just that. ( telegraph.co.uk )
Nicola Bandy and I have something in common. Over 20 years ago, I lost my first baby, Benji, when he had to be delivered three months early to save my life. I had developed pre-eclampsia, a potentially dangerous complication of pregnancy. Benji died two days after his birth.
I recall not only the grief, but my bewilderment that, with all the advances of modern medicine, there was no way to control this condition other than by delivering my baby early and effectively ending his life, to save mine. Pre-eclampsia happens when the placenta, the organ that transports food and oxygen from the mother’s blood supply to the baby, fails to grow as it should. At present, the only “cure” remains delivery. Later, when contemplating a second pregnancy, I was dismayed to learn that there was no way to predict whether I would get pre-eclampsia again and no way to stop it happening.
Isabel Walker, who has suffered from pre-eclampsia and lost a baby 20 years ago and is now campaigning to raise awareness of the condition
Nicola has had pre-eclampsia too, but more recently. Six months into her first pregnancy, the first sign was when her feet and then her hands and face, swelled up to spectacular proportions: her feet, she says, were “like balloons”. She also she started to put on weight alarmingly fast. At 38 weeks, with her blood pressure rising, she underwent an emergency Caesarean. Her baby, Seth survived and is now 16 months.
But Nicola, who is 37, remains traumatised by what happened. Like me more than two decades ago, she finds the idea of another pregnancy frightening. 'I’m still struggling with the idea that I or my baby could have died,’ she says. 'I would love to give Seth a little brother or sister but the way I feel now I would be much too scared to try again.’
Why Nicola’s pregnancy had a happier outcome than mine is a mystery. In all likelihood I had a more severe, fast-moving form of the disease that left no room for the standard policy with pre-eclampsia – to watch, wait and deliver the baby when essential but as late as possible. Certainly, the difference has nothing to do with any progress in the treatment of pre-eclampsia: in the years between our two experiences, little has changed in this respect.
I was fortunate to go on to have two successful pregnancies and my children (Joe, 22, a father himself, and Mimi, 21, currently doing an MA in music ) are now adults. But my experience left me with a lasting interest in pre-eclampsia and a passion to support research into the prevention and treatment of this mystery condition, which still kills about 6 women in the UK every year. I’ve watched as research has produced numerous false dawns, with one potential panacea after another – including aspirin, calcium, vitamins C and E, magnesium and fish oils – showing initial promise but ultimately shown to be useless or (in the case of low-dose aspirin) of limited benefit.
But now it seems that progress in being made on several fronts. Experts are confident that within a decade it will be possible to accurately identify women at risk of this frightening condition, with screening available in early pregnancy. At the same time scientists are moving closer to understanding the causes of pre-eclampsia, which could open the door to more effective treatment - and even to prevention.
At the moment the underlying cause of pre-eclampsia is unknown. Most common in the last few weeks of pregnancy, it is thought to start with a defect in the placenta. As a result, the baby may suffer growth problems and the mother high blood pressure. As it gets worse, pre-eclampsia can cause kidney and other organ damage in the mother and starvation and oxygen deprivation in the baby.
Many women don’t realise they have it until it reaches a late and dangerous stage – which is why ante-natal clinics routinely carry out checks on blood pressure and urine, aimed to pick up early signs. It cannot be prevented and the only medical response is delivery – sometimes at the expense of babies, like Benji, who are too premature to survive. In the UK alone, pre-eclampsia leads to 5-600 deaths of babies every year.
Until now, it’s been hard to predict which women are at risk of pre-eclampsia. But new research offers hope that a blood test could become available within a few years. The study, involving 2,000 women, published in the journal Hypertension, found that high levels of a combination of 14 chemicals (called metabolites) in the blood of women tested at around 15 weeks of pregnancy could accurately predict the development of pre-eclampsia later.
The discovery of this particular 'metabolic signature’ opens the door for a screening test for pre-eclampsia that would be more accurate than current screening for Down’s syndrome, according to researchers. This will mean closer monitoring, earlier intervention and safer outcomes for mothers and babies.
Stephen Robson, Professor of Fetal Medicine at Newcastle University, who is planning a larger study, is enthusiastic about the prospects for screening, although he also warns it is at least five years away. “People tend to think there is no point in screening unless you also have a magic bullet that can prevent the disease” he says. “But what we can do here is transform the whole pattern of antenatal care to separate high risk from low risk women and streamline care accordingly.”
This year also saw a breakthrough in understanding the causes of maternal high blood pressure, which is usually the first sign of pre-eclampsia. Scientists from Cambridge University reported in the journal Nature that women with pre-eclampsia have high blood levels of a certain protein called angiotensinogen. This protein triggers the release of hormones called angiotensins, which cause blood vessels to constrict, so raising pressure. Understanding this process offers “real hope for developing strategies to prevent or treat this dangerous condition” according to Professor Peter Weissberg, Medical Director of the British Heart Foundation, which funded the study.
It’s important, though, to sound a note of caution about the Cambridge findings on blood pressure – although important, these have been talked up in the media as scientists finding the cause of pre-eclampsia. But, in fact, high blood pressure is simply one of a number of outward signs of pre-eclampsia, not the cause. Preventing or treating this outward sign may not halt progression of the underlying disease.
So although things all looks promising, specialists are still wary about talk of immediate “breakthroughs”. Professor Chris Redman, formerly of the Nuffield Department of Obstetrics and Gynaecology at Oxford University and an international authority on pre-eclampsia, describes the prospect of screening as 'only half a step forward – the other half being something that could stop pre-eclampsia in its tracks’. He also believes pre-eclampsia will never be totally preventable since he regards it as 'a hotch-potch of different kinds of problems that come together with the same appearance’.
The fundamental research question about pre-eclampsia remains: what happens inside a woman’s body to transform a healthy pregnancy into a time bomb that can threaten her own life and that of her unborn child?
Until this question is answered, ideas about prevention will be based to a considerable extent on guesswork. And women like me and Nicola Bandy, nurtured on the modern mantra that 'pregnancy is not an illness’, will continue to find, to their cost, that it can be just that. ( telegraph.co.uk )
No comments:
Post a Comment