Improving Risk Prediction in Pregnancy-related Hypertensive Disorders

Proteomic analysis of blood samples from pregnant individuals did not improve risk prediction of hypertensive disorders of pregnancy compared to current methods, according to findings published in JAMA Cardiology.

The findings underscore the demand for more accurate tools that predict before the possibility of disease onset, according to Philip Greenland, MD, the Harry W. Dingman Professor of Cardiology and a co-author of the study.

“The purpose of identifying such high-risk patients early is to be able to follow them more closely and to use appropriate medications that could help prevent the eventual onset of a hypertensive disorder,” said Greenland, who is also a professor of Medicine and of Preventive Medicine in the Division of Epidemiology.

Hypertensive pregnancy disorders, including gestational hypertension and preeclampsia, occur in about 10 to 15 percent of first-time pregnancies. There is no consensus regarding how physicians can predict such disorders, and instead must rely on a patient’s age, body weight, previous history of hypertension or previous hypertensive pregnancy.

In the current study, Greenland and his collaborators aimed to determine if hypertensive disorders of pregnancy can be predicted using large-scale proteomic analysis of blood samples from pregnant individuals collected during their first trimester.  

Blood samples from 753 individuals who developed hypertensive disorders of pregnancy and 1,097 healthy controls were included in the analysis and were previously collected through the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) study, of which Northwestern Medicine was one of eight participating U.S. academic medical centers.

Proteomics analysis of the blood samples included more than 6,000 unique human proteins. However, the investigators found that the proteomics panel did not improve prediction rates alone or when added to clinical features.

The findings underscore the need for other approaches that might better predict hypertensive disorders of pregnancy, Greenland said.

“It is possible that other clinical and blood markers, like genomic markers or metabolomic markers, could be better than this protein panel. This needs to be explored in other studies,” said Greenland, who is also a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

This study was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, by cooperative agreement funding from the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Sciences, the Barbra Streisand Women’s Cardiovascular Research and Education Program and the Erika J. Glazer Women’s Heart Research Initiative, Cedars-Sinai Medical Center, Los Angeles.