Phil Baker
Liggins Institute, . Auckland
Pre-eclampsia is a major pregnancy complication characterised by multi-systemic maternal disease. Although the precise etiology of pre-eclampsia is unclear – research over recent decades has led to increased understanding regarding the etiology; inadequate adaptation of the maternal blood supply to the placenta causes placental hypoperfusion and the release of factors or ‘toxins’ into the maternal circulation – causing widespread endothelial activation. This increased understanding has not yet translated to altered clinical management. Although therapies are directed to preventing complications of pre-eclampsia, the only current clinical cure involves delivery of the placenta, with the potential for iatrogenic premature delivery if this is necessary at early gestations.
One of the current clinical challenges is how to identify which pregnant women will suffer preeclampsia. Strategies for screening and prediction will be discussed, with particular focus on arguably one of the most promising technologies – the use of metabolomics. Metabolomics involves the study of small molecules that may have the potential to identify women at risk of the disease in early pregnancy.
Successful screening strategies will aid the development of novel therapies. A research programme focussed on the investigation of treatments which increase blood supply to the uterus and placenta, and largely utilising murine pregnancies, will be discussed. Results of novel treatments such as sildenafi l citrate and resveratrol will be discussed – with the potential for these to translate to clinical practice.