Lead Researchers:
Professor Mark Brown, Associate Professor George Mangos, Dr Greg Davis
Significance
Hypertension affects 10% of pregnancies; while severe complicated hypertension (pre-eclampsia) affects 4% of pregnancies.
(The breakdown of hypertension includes: gestational hypertension in 4% (generally mild, but can transform into pre-eclampsia); chronic hypertension in 2% (usually essential hypertension which can be readily managed, but 1/4 of these transform into pre-eclampsia AND they have recently been shown to carry life long vascular risks).
Pre-eclampsia in pregnancy, in the short term, doubles the risk of perinatal mortality in the mother. While only a small number of mothers die from it; 10-20% will have potentially life-threatening liver, kidney or bleeding problems; 30% will get severe hypertension with risk of stroke if not treated. In less developed countries the morbidity and mortality is even higher. Pre-eclampsia is the commonest cause of death in women under age 50 in such countries.
Long term consequences: It is now recognised that having pre-eclampsia puts a woman at increased risk of death due to myocardial infarction or stroke by age 50 compared with those who had a normal pregnancy; that it carries an increased risk of life long chronic hypertension. Hence, pre-eclampsia has important health implications that go well beyond pregnancy.
Most significant advances or findings in past 10yrs
Internationally recognised research into blood pressure problems in pregnancy involving obstetricians, midwives and renal physicians has been a feature of St George for the past 20 years.
This research has been led by Professor Mark Brown, Dr George Mangos & Dr Greg Davis and has led to important and fundamental changes in the way these problems are handled in pregnancy; not only here but around the world. Based on the recommendation from studies done at St George the sounds used when measuring blood pressure in pregnancy has been standardised worldwide.
A rapid test of a urine sample to detect protein in the urine of pregnant women with preeclampsia has been adopted as a worldwide approach, acknowledged in the British Medical Journal this week. Previously women were made to collect all their urine for 24 hours to get the same answer.
Most important aspects of current work
Current research work in this area is focussing on trying to predict, in women who had preeclampsia in a previous pregnancy, which ones will have similar problems in their next pregnancy. This is relevant because not all women have problems second time around. By identifying these women at high risk we hope to be able to watch them more intensively in pregnancy so they can have healthier babies.
Saudan PJ, Brown MA, Farrell T, Shaw L. Improved methods of assessing proteinuria in hypertensive pregnancy. British Journal of Obstetrics and Gynaecology. 1997; 104: 1159-64.
Brown MA, Buddle ML, Farrell TJ, Davis G, Jones M. Randomised trial of management of hypertensive pregnancies by Korotkoff phase IV or phase V. Lancet. 1998; 352: 777-81
Brown MA, Buddle ML, Farrell T, Davis GK.Efficacy and safety of nifedipine tablets for the acute treatment of severe hypertension in pregnancy. American Journal of Obstetrics and Gynaecology. 2002; 187: 446-50
Brown MA, Mangos G, Davis G, Homer C. The natural history of white-coat hypertension during pregnancy. BJOG. 2005; 112: 601-6.
