Pursuing safer pregnancies

Pregnancy-related deaths have risen dramatically in recent years, especially in California. Cardiovascular disease accounts for about 15 percent of deaths.

As national leaders in maternal-fetal medicine, UCI Health researchers are spearheading projects in cardiovascular disease and preeclampsia that promise to make pregnancy and childbirth healthier and safer for both mother and baby.

A soon-to-be released toolkit aims to help expectant women and their doctors identify previously undiagnosed heart conditions during pregnancy and following childbirth.

The toolkit is the result of work by the California Maternal Quality Care Collaborative cardiovascular committee chaired by Dr. Afshan Hameed, a UC Irvine Health professor of cardiology and maternal-fetal medicine, that seeks to understand and address a three-fold rise in pregnancy-related deaths statewide recorded from 1996 to 2007.

The 20-member California Pregnancy Associated Mortality Review Committee identified heart disease as the No. 1 cause of death in pregnancy after reviewing pregnancy-related deaths from the years 2002 through 2006. More than 95 percent of the women who died were unaware they had heart conditions.

The toolkit algorithm alerts physicians to undiagnosed heart disease—symptoms that often mimic the normal symptoms of pregnancy, particularly in the last trimester, such as shortness of breath, fatigue and lower extremity swelling.

“Almost nine out of 10 mothers who died would have been alerted as having a high-risk heart condition if their healthcare providers had applied the knowledge that our team has put together in this toolkit,” says Hameed, who also serves as UCI Health director of obstetrical services and of quality and safety.

The toolkit will be available to all obstetrics providers in California and across the nation who care for pregnant women. Patient education materials to raise awareness among pregnant women are also part of the toolkit.

UCI Health physicians have been involved with the broader California Maternal Quality Care Collaborative since its formation in 2007. The organization is developing toolkits to improve care for other conditions that can increase the risk of maternal death, including hemorrhaging.

UCI Health maternal-fetal health experts are also focused on preeclampsia, a complication of pregnancy characterized by high blood pressure, protein in the urine and swelling. It’s usually diagnosed in the last trimester of pregnancy and affects 6 to 7 percent of women.

The condition can be life-threatening to both mother and baby. Its causes remain unknown, and the only known way to halt the illness is to deliver the baby—frequently prematurely.

“Because of this, obstetricians are often faced with a dilemma in balancing the mother’s health against the baby’s health,” says Dr. Deborah Wing, a UCI Health professor of obstetrics and gynecology. “The complications of prematurity are many and include chronic lung disease, blindness, deafness and neurodevelopmental delay. About 15 years ago the nationwide cost of prematurity was estimated at $26 billion a year. Adjusted for inflation, it’s certainly much higher today.”

Wing is the lead investigator of the nationwide PRESERVE-1 clinical trial to assess the safety, efficacy and pharmacokinetics of an anticoagulant drug called antithrombin in treating early-onset preeclampsia. Researchers recently enrolled 120 women at trial sites nationwide, including UC Irvine Medical Center.

“In my 20-year-plus career in high-risk obstetrics, this trial offers the best promise for prolonging the pregnancies of women with preterm preeclampsia of anything I’ve seen,” Wing says. “UCI Health patients enrolled in the trial will play an important role in advancing much-needed research that may help determine whether this drug is a potential treatment.”

UC Irvine Medical Center has one of California’s few combined regional perinatal/neonatal programs to treat high-risk pregnancies, deliveries and newborns.

Learn more about maternal-fetal health at ucirvinehealth.org/highriskob.

— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Summer 2016