Study reveals early molecular signs of pregnancy

There has been a lot of research in identifying the markers and developing tests that could predict pregnancy related complications.

June 09, 2019 Inga Louisa Stevens

A recent study published April 8, 2019, in the Journal of Experimental Medicine has revealed that women who have healthy pregnancies tend to show distinct changes in the activities of immune genes starting early in pregnancy, while women who have complicated pregnancies tend to show clear departures from that pattern.

The study, led by researchers at Weill Cornell Medicine and Hospital for Special Surgery (HSS), was designed to find early molecular predictors of the hypertension syndrome preeclampsia, miscarriage and other adverse pregnancy outcomes in women with the autoimmune disorder lupus, who face a relatively high risk of such outcomes. Over half of the more than 200 women studied were lupus patients. But the results suggest that modulation of the immune system during pregnancy is very similar in women with and without lupus.

Highlights from the study

Commenting on the results of the study, Dr. Amit Majumdar, Consultant Obstetrician and Gynaecologist, and his colleague Dr. Geetanjali Sharma, Specialist Obstetrician and Gynaecologist at King’s College Hospital London in Dubai told Arab Health Magazine: “Understanding early molecular signs, as highlighted within this study, in high-risk pregnancies is very interesting and useful for doctors within our field. We are able to use this study to understand similar risks to low-risk women, the importance of early diagnosis tests and ultimately increase positive outcomes for women.”

In the last decade, there has been a lot of research on the severe complications in pregnancy, including preeclampsia (high blood pressure during pregnancy with protein found in urine), still-births and miscarriages, and it has been well established that alterations and imbalances in immunity during pregnancy can lead to these placental complications. “These issues are routinely faced in practice and with the increased use of the Internet, pregnant women often come with some knowledge of such complications. For us, as healthcare professionals, studies like these are vital to make sure that we have the most up-to-date information on healthcare both in the region and across the world,” says Dr. Majumdar.

The results suggest that modulation of the immune system during pregnancy is very similar in women with and without lupus.

In-depth research

There has been a lot of research in identifying the markers and developing tests that could predict pregnancy related complications, specifically tests related to placental problems such as preeclampsia, foetal growth problems and pre-term still-births. These tests help doctors and patients create an extensive management plan to reduce any complications.

“One test we recommend for high-risk pregnant women, is the ‘Uterine Artery Doppler’, which looks specifically at the blood flow between mother and baby,” Dr. Majumdar explains. “This test is particularly important for women with restricted foetal growth and severe preeclampsia. Other useful tests include ‘Maternal Serum Analytes’ which are an important component of Down’s Syndrome screening. These serum markers are routinely used to identify women who may be at increased risk of having a child with an abnormal chromosomal count, or chromosomal aneuploidy, such as, trisomy 21, 18 and 13. These are also useful in identifying children with structural malformations such as birth defects of the brain, spine or spinal cord.”

“One test we recommend for high-risk pregnant women, is the ‘Uterine Artery Doppler’, which looks specifically at the blood flow between mother and baby,” Dr. Majumdar explains.

"Within the industry there has been a shift towards predicting the development of these potential complications in the first trimester, as opposed to later in the pregnancy," says Dr. Sharma.

Dr. Amit Majumdar

Dr. Geetanjali Sharma

Current approach

To make sure that they provide the very best outcomes for patients, Dr. Sharma describes their current approach is to perform a risk assessment in early pregnancy for all women. “We look at the clinical history, demographic profile and examination findings, and high-risk women are then offered various investigations, such as uterine artery doppler with increased surveillance and possible interventions to reduce the risk. However, within the industry there has been a shift towards predicting the development of these potential complications in the first trimester, as opposed to later in the pregnancy. This allows for the appropriate treatment and focus to be provided, ultimately leading to better outcomes for both mother and child.”