Preeclampsia: building a tool to identify women with a high risk

By Todd Neff from the University of Colorado Insider

Preeclampsia: building a tool to identify women with a high risk is a goal for Lorraine Dugoff. Those whose circadian rhythms demand uninterrupted sleep don’t go into obstetrics and gynecology in the first place, but Lorraine Dugoff’s energy is uncommon, especially for research on preeclampsia.

That much was evident on a recent morning. The University of Colorado School of Medicine associate professor of Obstetrics & Gynecology was at the Platte River Perinatal Center near downtown Denver, where she sees mothers-to-be (as well as those intending to become mothers) once a week.

Dugoff was still in her hospital greens. A few hours earlier, she was at University of Colorado Hospital after she’d been paged to help out with a tough delivery.

Things weren’t going to slow down anytime soon. She was flying to Bethesda, Md., the next day for meetings about the National Institute of Child Health and Human Development’s prestigious Maternal-Fetal Medicine Units Network, to which the University of Colorado School of Medicine’s Maternal Fetal Medicine Division had just been accepted.

Despite all this, Dugoff somehow looked well rested. That’s not a surprise to her colleague and mentor, John Hobbins, MD.

“She’s a bulldog. She grabs onto something and takes the ball and runs with it,” Hobbins said. “She’s an excellent clinician, a dynamic researcher, and a good person to work with.”

Dugoff maintains board certifications in three specialties (obstetrics, maternal fetal medicine and genetics), as well as a vigorous commitment to research in first-trimester diagnosis of fetal and pregnancy-related problems. The aim is to catch them before they become serious, or even prevent them outright.

Now she is focused on creating a tool to help caregivers identify mothers with a high risk of preeclampsia, or pregnancy-induced high blood pressure. A side benefit: a preeclampsia screen shows promise in also spotting low-growth babies early in pregnancy.

Dugoff recently won a National Institutes of Health grant to continue her work in this area. She has already recruited approximately 1,200 women over the past three years, she said, each of whom has had ultrasounds and donated blood. “Almost every single woman wants to participate,” Dugoff said. “They all want to help advance this field of obstetric research and improve outcomes for women and their babies.”

Preeclampsia affects about 10 percent of pregnancies and causes 18 percent of maternal deaths in the United States, according to the Preeclampsia Foundation. The disorder is also responsible for roughly 15 percent of premature births and costs the health care system $7 billion a year in the United States alone, the foundation says.

The preeclampsia prediction model, as Dugoff calls the screening tool in development, aims to establish a patient’s risk profile based on a combination of demographic data (such as age, race and body mass index), the amount of blood flow to the uterus, and the presence and volume of certain bloodstream chemicals.

She’s collaborating with scientists in the United Kingdom and New York to develop the prediction model, and with a lab in Finland to identify the markers. The goal, Dugoff said, is to find three or four of the dozens of marker candidates that might combine to signal preeclampsia in the making.

There is precedent for her work. Dugoff was an investigator on a major national trial called FASTER. The trial, whose results were published in the New England Journal of Medicine in 2005, led to standardized testing for Downs syndrome based on a small number of markers. The American College of Obstetrics and Gynecology now recommends the screen as part of the standard of prenatal care.

“It led to an improvement in prenatal screening for pregnant women in the U.S. and worldwide, really,” Dugoff said.
It’s this kind of impact that attracts Dugoff to the Maternal-Fetal Medicine Units Network, an NIH-funded collaboration of 14 top maternal-fetal medicine units (Stanford and Duke were just invited to join, along with CU).

“It’s exciting to be part of a national group with really bright people,” she said. “The kinds of projects that come out of this really shape the standard of care.”