Narrowing risk of preeclampsia to a specific phenotype

August 28, 2019

The force of blood traveling through your arteries and veins determines much of your heart health. High blood pressure can lead to heart disease, heart failure, heart attack, stroke and chronic kidney disease, and when it's coupled with type 1 diabetes and pregnancy, it can put both the mother and the baby at risk.

In a recent paper in The Journal of Clinical Endocrinology & Metabolism, researchers at the Medical University of South Carolina look at preeclampsia, a combination of high blood pressure and pregnancy, when it coincides with type 1 diabetes.

The general female population has a 5% chance of developing preeclampsia during pregnancy, but that chance increases to 20% for diabetic women. "By studying these patients, we have identified different markers that could help predict the complication before its onset," said Clare Kelly, an endocrine researcher who worked with MUSC endocrinologist Timothy Lyons on the paper.

According to the Centers for Disease Control and Prevention, preeclampsia can lead to a baby being born early and can put the mother at risk of a seizure or stroke during delivery. It can also lead to damage in the kidneys, liver, lungs, heart or eyes and can increase a patient's risk for cardiovascular disease in the future.

Some current treatments for preeclampsia include taking aspirin or remaining on bedrest, and the only cure is delivering the baby. But by monitoring someone at high risk for preeclampsia, physicians can work closely with these patients and take proactive measures to keep their blood pressure down.

Each patient in the study could be categorized as having one of three phenotypes: 1-1, 1-2 and 2-2. Phenotypes describe the way a person expresses their genetic makeup and can be determined using a simple, one-time blood test. By looking at the three groups and their lipoproteins, the compounds that transport fat throughout their bodies, the researchers were able to determine that the diabetic patients with a 2-2 phenotype who also had elevated lipoproteins were at greater risk for preeclampsia.

Previous studies have examined lipoprotein levels and diabetes, but this one concluded that these markers were indicative of risk only for patients with the specific phenotype. Otherwise, looking at the biomarkers was not useful. "Currently, we're taking the more reactive approach when it comes to preeclampsia," said Kelly. "But if we know a patient is diabetic and has the 2-2 phenotype, we can monitor her more closely throughout her pregnancy and treat it proactively."

While high lipoprotein levels in conjunction with the 2-2 phenotype were associated with an increased risk of preeclampsia, this scenario is not yet proven to be causative. Currently, there are various hypotheses about what contributes to preeclampsia, like insufficient blood flow to the uterus or poor nutrition, but the root cause of the disease is not known. By looking at the genetics and conditions associated with preeclampsia, researchers are moving one step closer to understanding what causes it and potentially how to prevent it.

"While we were looking at pregnant women with type 1 diabetes specifically," said Kelly, "we're hoping to extend some of our findings to women with type 2 diabetes and gestational diabetes as well as the general population of diabetics when identifying people at risk for hypertension."
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About MUSC

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state's only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and 700 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state's leader in obtaining biomedical research funds, in fiscal year 2018, MUSC set a new high, bringing in more than $276.5 million. For information on academic programs, visit http://musc.edu.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available, while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians' practice plan, and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2019, for the fifth consecutive year, U.S. News & World Report named MUSC Health the number one hospital in South Carolina. To learn more about clinical patient services, visit http://muschealth.org.

MUSC and its affiliates have collective annual budgets of $3 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.

Medical University of South Carolina

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