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November 2021

Two women with baby jpeg
Shannon Boland with her baby Hudson and her mum.

International trial clamps down on preeclampsia

A joint team of researchers has found the diabetes drug metformin may slow preeclampsia.

Worldwide, preeclampsia claims the lives of 500,000 unborn babies and 70,000 pregnant mothers each year.

No drug – until now – has been discovered that slows the pregnancy condition from progressing to cause life-threatening injuries to major organs in the mother – kidneys, liver, lungs and brain.

The idea of testing metformin as a treatment for preeclampsia came from laboratory studies conducted by a research team at Mercy Hospital for Women and the University of Melbourne.

The team took the concept to colleagues in Cape Town, South Africa, where the disease is far more severe and common, and clinical trials were conducted.

‘Preeclampsia that sets in at an early gestation, called preterm preeclampsia, is a highly-dangerous variant of the disease where the risks to baby and mother are particularly high,’ said Mercy perinatal researcher and joint senior investigator of the trial Stephen Tong.

‘When preterm preeclampsia sets in, we are often forced to deliver the baby prematurely as this is the only way to reverse the disease process and cure preeclampsia,’ said Mercy perinatal researcher and joint senior trial investigator Susan Walker.

‘Early delivery saves the mum from becoming gravely sick.

‘But, by doing this, we birth babies that are not fully developed and not ready to leave the womb.

‘Babies born too early are at risk of developing permanent disability or even death,’ Professor Walker said.

Finding a drug that can curb the disease’s severity could enable pregnancies affected by preeclampsia to safely continue for longer.

The babies can be delivered at a less premature gestation, which may mean fewer disabilities and better lifelong health outcomes.

Previous efforts to find drugs to treat the condition have not succeeded.

‘Laboratory studies by our research teams at Mercy Hospital for Women and University of Melbourne identified metformin as a promising treatment for preeclampsia.

‘This led us to test the idea in humans,’ said Professor Tong.

In this trial, conducted at Tygerberg Hospital in South Africa, the researchers recruited 180 women with preterm preeclampsia between 26 and 31 weeks of pregnancy.

Half the women received metformin tablets while the other half were given a placebo.

The participants were not told whether they were taking the active drug or the placebo.

‘What is really exciting is that the women who took metformin stayed pregnant for seven to eight days longer compared to those who took a placebo,’ said lead investigator working in South Africa Cathy Cluver, of the University of Stellenbosch.

‘Furthermore, their babies spent 12 days less in hospital.

‘When we are dealing with this level of prematurity, an extra week in the mother’s womb is likely to be a really important gain that could translate into lifelong health benefits for the baby,’ Associate Professor Cluver said.

‘It is the first time that a treatment given to mums with preterm preeclampsia to keep them pregnant for a week longer might have worked.

‘It could mean that preterm preeclampsia can now be treated and that we can slow disease progression right down.’

Shannon Boland, 27, of Werribee lost her daughter, Mia, at 24 weeks a year ago after developing preeclampsia at 17 weeks gestation.

This put her at higher risk of the complication when carrying son Hudson, but he arrived safely last month at 37 weeks.

‘I would do anything to have my daughter here and I feel some pain every day.

‘I think it’s amazing that the team from Mercy Health has achieved such great success.

‘If it meant taking a tablet every day to change the outcome, I would do it 1,000 times over,’ Ms Boland said.

The Mercy Hospital for Women/Cape Town collaboration is now gearing up to start a larger trial involving 500 participants to confirm its discovery.

‘If our findings are confirmed, it may mean that metformin could be used to save the lives of thousands of mothers and their infants,’ said Professor Tong.

The work was funded by the Mercy Health Foundation, and the National Health and Medical Research Council of Australia, which provided salary support.

International funders were the Preeclampsia Foundation, Peter Joseph Pappas research grant program and the South African Medical Research Council.

The trial findings were published in the British Medical Journal.