CamFest Speaker Spotlight

Dr Carmel McEniery is a Senior Research Associate in the Division of Experimental Medicine and Immunotherapeutics at the University of Cambridge and principal investigator on the Cambridge POPPY study into pre-eclampsia. She will be taking part in an event which will explore the puzzling relationship between pregnancy, pre-eclampsia and women’s long-term cardiovascular health. Pre-eclampsia and its lasting impact on women’s health: Not just a villain of pregnancy? takes places on 28th March, 6.30-7.30pm.  

How common is pre-eclampsia and what are the main symptoms?
Pre-eclampsia affects approximately 6-8% of pregnancies and is thought to be a problem with the placenta that usually causes blood pressure to rise. If left untreated, pre-eclampsia can be very dangerous for both the Mother and her baby. 

The main symptoms are: 
Headache that doesn’t go away with simple painkillers 
Visual disturbances – blurring or flashing in eyesight 
Swelling of face, hands or feet 
Persistent heartburn 
Pain below the ribs 
Nausea or vomiting 
Feeling very unwell 

What is currently known about why some women get it and others don't? 

The exact causes of pre-eclampsia are unknown. However, pre-eclampsia occurs more commonly in women who have one of the following risk factors: 

• high blood pressure in a previous pregnancy 
• chronic high blood pressure (e.g outside of pregnancy) 
• chronic kidney disease 
• type I or type II diabetes 
• an autoimmune disease (eg Lupus) 

In addition, pre-eclampsia also occurs more commonly in women who have at least two of the following risk actors: 

• First pregnancy 
• Older than 40 years of age 
• More than 10 years since previous pregnancy 
• Body mass index (BMI) of 35kg/m² or greater 
• Family history of pre-eclampsia e.g mother or sister had pre-eclampsia 
• Multiple pregnancy (e.g twins, triplets etc) 

What are the possible long-term effects? 

Pre-eclampsia and other placental syndromes such as gestational hypertension (high blood pressure in pregnancy) and foetal growth restriction (small baby) are thought to be “cured” by delivery of the baby and the placenta. However, women who have experienced these conditions remain at significantly increased long-term health risk.

In the case of pre-eclampsia, women are at four times the risk of developing life-long high blood pressure, which is the leading risk factor for cardiovascular disease, and have a 2-4 fold increased risk of having a heart attack or stroke later in life compared with women who have a healthy pregnancy. 

What is POPPY trying to achieve? 

POPPY is trying to understand why placental syndromes such as pre-eclampsia are associated with increased risk of cardiovascular disease in women post-pregnancy. By understanding this risk, it is hoped that better strategies can be developed to improve long-term cardiovascular health in women who develop pre-eclampsia or other placental syndromes. 

What is new about this? 

Many pregnancy-related studies start from the first trimester of pregnancy, but the POPPY study is recruiting women who are planning to become pregnant for the first time. This will allow us to examine women’s cardiovascular health before they become pregnant, which will provide important and novel insights about whether a woman might have “pre-pregnancy factors” which affect her risk of developing a placental syndrome and future cardiovascular disease. 

Why do you think so little attention has been paid to the long-term impact on women's health? 

There seems to be a worrying inertia surrounding postpartum follow-up of women who have experienced a placental syndrome. I think this is related to a lack of clear guidance and clinical care pathways available for women.

For example, in the UK, NICE guidelines recognise that women who have experienced placental syndromes are at increased risk in the long term, but there are no specific recommendations for following up those women ie how often they should be monitored, what measurements should be taken or what treatments should be given.

Indeed, previous studies have shown that only a quarter to a third of women suffering high blood pressure in pregnancy are told about their increased long-term health risk, so there is a problem of inadequate counselling of women regarding their longer-term health risk and an important missed opportunity to empower women in their own long-term healthcare. 

What do you hope to achieve with the event at the Festival? 

Our principal aim is to raise awareness about the increased long-term health risks faced by women who experience pre-eclampsia and other pregnancy syndromes. We need to ‘continue the conversation’ around pregnancy, pre-eclampsia and women’s long-term health and the Festival will be an ideal forum for this. We also wish to highlight the POPPY study, which will address fundamental questions around the links between pre-eclampsia and women’s long-term cardiovascular health.