Researchers at Hospital for Special Surgery (HSS) have released a second set of results from the PROMISSE study showing that proteins measured in the mother’s blood successfully predict whether or not a woman with lupus is likely to experience serious complications during pregnancy – complications that could negatively affect her health or that of her baby.
The new findings from PROMISSE ("Predictors of pRegnacy Outcome: BioMarkers in antiphospholipid antibody Syndrome and System lupus Erthematosus") were published in The American Journal of Obstetrics and Gynecology.
In this study, researchers measured proteins made by the placenta that circulate in the mother's blood, which also regulate growth and development of the placenta, called angiogenic factors. As early as 12 -15 weeks into a pregnancy, alterations in their levels identified pregnancies associated with a high risk for serious problems. Most importantly, normal levels predicted normal pregnancies.
"The findings of the study allow physicians to stratify risk early in pregnancy to optimize patient care and allocation of healthcare resources,” said Jane E. Salmon, MD, Director of the Lupus and APS Center of Excellence and Collette Kean Research Chair at Hospital for Special Surgery and principal investigator of the PROMISSE study. "When these biomarker tests are available clinically, they will guide prenatal care in women living with lupus."
The new study revealed that only 12 percent of patients with inactive SLE and/or APL have severe adverse pregnancy outcomes, showing that most patients with these conditions go to term without difficulties. Those pregnancies defined as high risk, based on levels of angiogenic factors and clinical features, like high blood pressure and certain autoantibodies, had a 94 percent risk of preeclampsia before 34 weeks, delivery before 30 weeks or fetal death, compared to 4.6 percent with these serious complications in women with normal angiogenic factor levels and no clinical risk factors.
"The goal of our research efforts is to provide early identification of risk in expectant mothers with lupus and to develop treatments to prevent serious pregnancy complications," said Dr. Salmon. "We are halfway there, and now we are planning a trial with a drug that targets the mediators of placental injury in high risk women with SLE and APL."