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A year after we reported that the University of British Columbia (UBC) had received a $7 million grant from the Bill & Melinda Gates Foundation to address the problem of preeclampsia in low- and middle-income countries (LMIC), the team issued their first progress report and convened their first update meeting in Vancouver, Canada, Nov. 2-4. The Preeclampsia Foundation received a small stipend from that grant to support some of our international initiatives and contribute to the “knowledge translation” component of the grant. As a member of the Technical Advisory Group and the Knowledge Translation sub-committee, executive director Eleni Tsigas attended the Vancouver meeting and shared the group’s enthusiasm at the progress already realized.
“It was clear that the Gates Foundation is very pleased with the progress the grant team has achieved through the development of the international research and community-level intervention project called PRE-eclampsia-Eclampsia Monitoring, Prevention and Treatment (PRE-EMPT),” explained Tsigas.
Specifically, the PRE-EMPT initiative consists of five interrelated projects to be conducted over a four year period: studies include testing the impact of calcium supplementation, and a package of interventions with magnesium sulfate, oral antihypertensives, and a non-laboratory based diagnostic system – all that could be implemented in very low resource settings; development of a multi-faceted international research collaboration (the Global Preeclampsia CoLaboratory); and LMIC-oriented preeclampsia Knowledge Translation (KT) activities.
The PRE-EMPT team is lead by chief investigator, Dr. Peter von Dadelszen, an associate professor of Obstetrics and Gynecology in UBC’s Faculty of Medicine and includes researchers, physicians and community health professionals from Canada, the U.S., Africa, Asia, Oceania, the U.K. and the World Health Organization (WHO).
The overarching theme of all this work is to reduce adverse outcomes, not just the diagnosis of preeclampsia, in low resource settings. “It remains our conjecture that it is not necessarily pre-eclampsia, per se, that matters, but rather those adverse maternal and perinatal outcomes that cluster around the diagnosis,” said von Dadelszen in the group’s annual report.
One project already completed is the development of WHO Recommendations for Pre-Eclampsia and Eclampsia, a key focus of the KT subgroup. New guidelines were drafted following an April meeting in Geneva, were subsequently approved by WHO’s Guidelines Review Committee, published in September and have now been distributed to countries through the WHO, United Nations Population Fund, UNICEF and World Bank offices. They are also posted on our website.
Tsigas commented, “These are the most recent evidence-based guidelines that used a quality of evidence scoring system to develop recommendations; they’ve set the standard which the American College of Ob-Gyns is using for new US guidelines, currently in development.” Members of the Preeclampsia Foundation’s medical board as well as a strong contingent of other experts from the United States, contributed to the proceedings. The guidelines will be updated in view of new evidence within 3-4 years.
According to von Dadelszen, Tsigas’ involvement has been representing the patient perspective and “keeping us honest and reminding us why we do what we do.”
“As a non-scientist, my biggest contribution was challenging the ‘real world’ implications on women and their families of some recommendations, as well as the lay perspectives on interventions such as diet and bedrest,” said Tsigas.
At the recent meeting in Vancouver, one of the most interesting presentations was a Phone Oximeter, a portable, low-cost device that will rapidly and reliably identify women and babies at increased risk of adverse outcomes from preeclampsia. The prediction of adverse maternal outcomes is based on symptoms and clinical signs, and one of the indicators that the PRE-EMPT research is suggesting is low levels of blood oxygen saturation. By combining a mobile phone application with the PIERS predictive probability, women in rural, low-resource communities will now have access to this useful innovation.
Look for upcoming reports on the other research initiatives coming out of PRE-EMPT including a collaborative pooling of biospecimens, and a diagnostic and triage protocol that relies almost solely on a woman’s symptoms, when laboratory facilities are not available to test urine or take sophisticated blood pressure readings.