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June 13, 2002


Every six minutes, a woman dies of a pregnancy complication called preeclampsia, according to the Preeclampsia Foundation. Worldwide, the disorder, which is linked to hypertension, leads to an estimated 76,000 deaths — 30,000 in Africa alone.

Women who have experienced the condition, also known as toxemia, have an even greater chance of developing the disorder in subsequent pregnancies.

The results of several clinical and basic science research studies of preeclampsia were presented by Magee-Womens Research Institute faculty at the 13th World Congress of the International Society for the Study of Hypertension in Pregnancy, which was held here recently.

Highlights of the findings include:

Condition leads to increased levels of sialic acid in blood Blood concentrations of a metabolic sugar called sialic acid are increased in women who develop preeclampsia with preterm delivery but not term delivery, Carl A. Hubel, assistant professor of obstetrics, gynecology and reproductive sciences at Pitt's School of Medicine, and his colleagues found. Preeclampsia that takes place in preterm is generally more severe than that which develops later, and is more likely to be associated with fetal growth restriction. Elevated levels of sialic acid indicate inflammation and are associated with an increased risk of atherosclerosis.

Blood samples were studied from pregnant women who had experienced preeclampsia in a previous pregnancy. Women were randomized into two groups, receiving either 60 milligrams of aspirin, an anti-inflammatory drug, or a placebo daily. Early results also indicate that the low-dose aspirin may lessen this inflammatory response.

Preeclampsia heightens risk for high blood pressure Women who have had preeclampsia appear to be at greater risk for high blood pressure and cardiovascular disease later in life, Roberta Ness, associate professor of epidemiology and obstetrics, gynecology and reproductive sciences, graduate student Patricia Agatisa and their colleagues found.

By studying heart rate, blood pressure and forearm blood flow in pregnant women who had a prior preeclampsia, women with normal pregnancies, and never-pregnant women when under stress, investigators found that having had a normal pregnancy was associated with a positive long-term effect on blood vessel behavior that was not present in women who had previous preeclamptic pregnancies or those who had never been pregnant.

Smoking found to decrease risk of preeclampsia While smoking during pregnancy has many adverse health effects on mother and fetus, it appears to decrease the risk of preeclampsia, Kristine Yoder Lain, assistant professor of obstetrics, gynecology and reproductive sciences at the School of Medicine, and her colleagues found.

Uric acid concentrations in the blood were compared among women with normal pregnancies, including smokers, nonsmokers and smokers who had quit smoking during pregnancy. Elevated levels of uric acid are observed during normal pregnancy among smokers. Higher uric acid levels also are observed in preeclampsia. Uric acid concentrations increased for all pregnant women, but the rate of increase was greatest among those who had quit smoking at the onset of pregnancy.

Other blood studies of pregnant smokers found that certain cellular components associated with blood-vessel activation called fibronectin, vascular cellular adhesion molecule-1 and intracellular adhesion molecule-1 were either reduced or increased. Reasons for a decreased risk of preeclampsia among smokers remain elusive, researchers said.

Vitamin C levels lowered in women with condition Even a mild deficiency in vitamin C appears to negatively affect vascular elasticity and function, Carl A. Hubel, assistant professor of obstetrics, gynecology and reproductive sciences at Pitt's School of Medicine, and his colleagues found. By comparing arterial pressure and elasticity in pregnant and non-pregnant rats that, like humans, are unable to synthesize vitamin C, the scientists learned that vessel stiffness increased in pregnant rats when vitamin C concentrations were restricted. Non-pregnant rats were not similarly affected by vitamin C restriction, however.

These results were observed in spite of a natural physiologic change initiated by pregnancy that typically increases blood vessel elasticity, which in turn affects blood pressure. While researchers have long known that vitamin C concentrations are decreased in women with preeclampsia, the specific effect on vascular function remains unclear.


New radiation technique promising in reducing treatment for breast cancer

A new tumor site-specific radiation therapy, MammoSite Radiation Therapy System, is now an option for breast cancer patients with early and small breast tumors treated at Magee-Womens Hospital.

The new treatment, recently approved by the U.S. Food and Drug Administration, can significantly reduce the amount of time patients spend receiving radiation therapy because it allows radiation oncologists to specifically treat the tumor site instead of the entire breast.

"MammoSite internally delivers radiation therapy directly to the tumor site where cancer cells are most likely to reside," said Dwight Heron, assistant professor of radiation oncology, Magee-Womens Hospital. "It allows for the safe delivery of radiation to the breast in a very short period of time and, as a result, reduces the time, inconvenience and side effects that are associated with traditional external radiation therapy."

MammoSite is a type of breast brachytherapy that uses a single catheter inserted into the breast following lumpectomy, or surgical removal of the tumor. Brachytherapy is a radiation delivery technique that internally targets radiation to a tumor site. With MammoSite, once the catheter is inserted, a tiny balloon is inflated and filled with radioactive seeds that deliver prescribed levels of radiation to the targeted tissue surrounding the tumor site. Because it is targeted directly to the tumor site, MammoSite limits the dose of radiation to nearby normal tissues.

"MammoSite is an option for some women with breast tumors that are small enough to be removed via lumpectomy," said Kristina Gerszten, professor and director of radiation oncology, Magee-Womens Hospital. "While not appropriate for all breast cancer patients, it is an easier and less invasive way to deliver radiation directly to the breast tissue."

Gerszten added that before MammoSite became a treatment option, some women may have opted for mastectomy (complete removal of the breast) to avoid standard postoperative radiation treatment that requires at least a six-week course of daily therapy.

Proper use of MammoSite requires a substantial amount of expertise and training for staff and surgeons alike. A special team of experts has been assembled at Magee-Womens Hospital that includes Jeffery Falk, William Poller, Gwen King, Raj Selvaraj and Andrew Wu.


Grant funds study to stop children's head & spinal cord injuries

Researchers at Pitt's Center for Injury Research and Control (CIRCL) have received a one-year, $68,000 grant from Pittsburgh's FISA Foundation to study the prevention of head and spinal cord injuries in children.

This grant supports CIRCL's Think First for Kids Program, a school-based curriculum for first, second and third graders that is focused on helping them develop safety habits that minimize their risks of sustaining brain, spinal cord and other traumatic injuries. Think First for Kids provides enjoyable, age appropriate activities that are designed to be integrated into school curricula.

According to statistics from the National Center for Injury Prevention and Control, more than 20 children die each year from playground-related injuries in the United States, and at least 25 percent of all children sustain an injury severe enough to require medical attention, missed school or bed rest.

Additionally, more than 200,000 preschool and elementary school children visit emergency departments for care of injuries sustained on playground equipment.

"Our hope is to empower children to think before they participate in playground activity that might result in a traumatic injury," said Donald W. Marion, professor and vice-chairman of neurosurgery at the School of Medicine and director of CIRCL.

In addition to providing head and spinal cord injury prevention classes for children, CIRCL also provides lessons on vehicular, bike, water, sports, weapon and playground safety.

CIRCL's Think First for Kids program is a collaboration of the Benedum Pediatric Trauma Program at Children's Hospital of Pittsburgh and Allegheny General Hospital's Department of Neurosurgery.

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