An important new treatment that could potentially save the lives of 60 000 pregnant women every year, is currently being tested at the Faculty of Medicine and Health Sciences (FMHS), Stellenbosch University and Tygerberg Hospital.
Dr Cathy Cluver with the Department of Obstetrics and Gynaecology at the FMHS is leading an international study which is testing whether a common drug used to treat gastric reflux, called esomeprazole, can treat pre-eclampsia.
Pre-eclampsia is a potentially deadly pregnancy complication where the placenta releases toxins in the body that can damage blood vessels and lead to organ failure in pregnant women. In South Africa, pre-eclampsia is one of the most common causes of maternal death.
"Currently the only treatment for pre-eclampsia is to deliver the baby and to get the placenta out. Late in a pregnancy it is fairly safe to deliver a baby, but when it is early in the pregnancy – before the baby is fully developed – delivery could be dangerous, or even fatal, to the baby," says Cluver.
The Pre-eclampsia Intervention with Esomeprazole (PIE) Trial is currently underway. It is a double-blind, randomised control trial designed to test whether esomeprazole treatment can help pregnant women who develop pre-eclampsia early in pregnancy (between 26 and 32 weeks of gestation) to safely carry the pregnancy up to 34 weeks when the baby has an increased chance of survival. A pregnancy is full term at 40 weeks.
"We know that if we deliver babies at 34 weeks they do pretty well, and that's why we try and get the pregnancy to 34 weeks. We deliver the babies even if the moms are doing well, because of the risk to the mom," says Cluver. Side-effects of pre-eclampsia include high blood pressure and it could cause a mom to have a stroke or fit. Other complications include kidney damage, fluid on the lungs and heart failure.
Esomeprazole is a proton pump inhibitor which trades under the brand name Nexium. It is used to treat gastric reflux and is commonly used in pregnancy.
Cluver is conducting the trial in collaboration with researchers from the Translational Obstetrics Group (TOG) at the University of Melbourne in Australia, who originally discovered the potential treatment benefits of esomeprazole for pre-eclampsia. The pre-clinical results were recently published in the prestigious journal Hypertension.
Cluver and her research midwife, Sister Erika van Papendorp, have already recruited over one hundred participants and hope to complete the trial in the next few months.
"If this trial shows a difference it may be the first successful treatment for this devastating condition. This would be a breakthrough in medical practice," says Cluver.