Headaches and swelling during pregnancy could be fairly harmless — or the telltale signs of preeclampsia, a dangerous condition that can lead to fatal complications for mother and baby.
With many of its nonspecific symptoms commonly experienced in healthy pregnancies, preeclampsia can be challenging to diagnose. Further still, the diagnosis can be complicated for those with pre-existing hypertension (high blood pressure) or chronic kidney disease.
In February 2020, Sunnybrook made an important step forward when it became the first hospital in North America to use a new blood test in clinical care to diagnose preeclampsia in a pregnant woman with chronic kidney disease.
By looking at the imbalance between proteins secreted by the placenta, the blood test can be used as a triage tool, separating patients who are very likely to have preeclampsia or to develop it within the week, from those at lower risk.
Dr. Nir Melamed, a maternal fetal medicine specialist at Sunnybrook, worked together with physician-in-chief Dr. Michelle Hladunewich, to develop the test as part of a year-long Roche-Diagnostics-funded study.
They have since witnessed the incredible value of the new test in patients, including one woman with severe kidney disease who went on to develop worsening hypertension during her pregnancy.
“Because her test came back normal, it gave us some assurance that it was unlikely to be preeclampsia,” says Dr. Melamed. The patient was given blood pressure medication and induced at 37 weeks — a full-term delivery.
Since then, the blood test has helped identify another patient with borderline blood pressure, who was at very high risk of preeclampsia. The patient was admitted — and developed severe preeclampsia 48 hours later. The baby was delivered quickly and safely in hospital.
Several other medical centres have contacted the team to learn from their experience. “The introduction of this blood test really puts Sunnybrook at the forefront of individualized medicine,” Dr. Melamed says.
