The National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) held a workshop to examine the topic of Predicting, Preventing, and Treating Preeclampsia on May 21-22nd, 2018, in Bethesda, MD. The workshop, which was open to the public, gathered leading experts in the field to discuss the current knowledge and identify scientific gaps and challenges related to research on preeclampsia. The workshop is responsive to NHLBI Strategic Vision Objectives 1-5.
Preeclampsia is a pregnancy-specific, multisystemic disorder that occurs in roughly 5% of pregnancies in the United States. The rates of preeclampsia in the United States have been steadily rising over the past 30 years. But even more importantly, women with preeclampsia, as well as their offspring, are at greater risk for chronic disease, including heart disease later in life. Despite being the leading cause of maternal death and major contributor to maternal and perinatal morbidity, there is no effective drug treatment to prevent preeclampsia, and current management therapies have significant limitations. In fact, at present, delivery is considered the only effective intervention toward treating preeclampsia. The lack of progress in identifying new therapeutic targets for the treatment of preeclampsia is due in part to a paucity of animal models that address the heterogeneity of human preeclampsia as well as lack of understanding of basic mechanisms. Developing novel animal models to mimic human preeclampsia, developing biomarkers to predict preeclampsia, conducting basic studies to better understand disease mechanisms, and ultimately, developing novel therapeutic strategies are clearly needed.
The workshop brought together 16 invited experts in the field who discussed the gaps and barriers related to the prediction, prevention, and treatment of preeclampsia. Specific topics discussed on the first day of the workshop were: i) pathophysiology of preeclampsia; ii) immunological origins of preeclampsia; iii) how to define subsets of preeclampsia; iv) biomarkers; v) genetics and epigenetics; vi) animal models; vii) collaboration, harmonization, sharing large data and sample sets in the study of preeclampsia; viii) periconceptional contributors to pathophysiology; ix) clinical risk factors for preeclampsia; x) novel therapies for the prevention and treatment of preeclampsia; xi) long-term cardiovascular consequences of preeclampsia and xii) patient perspectives.
The second day of the workshop all attendees participated in one of four breakout sessions:
The following are the main recommendations that arose from group discussions during the breakout sessions:
Pathophysiology of preeclampsia
Impact of preeclampsia on long-term health outcomes
Biomarkers and diagnostic tools
Translational research and novel treatment strategies
A white paper outlining the recommendations that arose from the deliberations of the workshop is in preparation.