There is currently just one drug – aspirin - that clearly prevents preeclampsia (relative risk reduction for all preeclampsia of 18%). And no disease modifying drugs available to treat preeclampsia. My research has a strong focus on identifying and evaluating treatments for preeclampsia.
There appears to be a trend for increasingly liberal administration of aspirin to prevent preeclampsia and other placental disorders. There has even been commentary proposing it is universally administered to all pregnancies. The likely reason that aspirin is so freely recommended is because the drug is considered really safe. Collaborating with Swedish colleagues, our team has been revisiting the safety and efficacy of aspirin in large population epidemiological studies. In the first part of the Priscilla Kincaid Smith Lecture, I will discuss our research revisiting the safety and efficacy of aspirin.
In the second part of this lecture, I will present our program of research to discover drugs that slow disease progression of preeclampsia ie drugs with disease modifying effects. Our research is a pipeline of drug testing that starts in the laboratory and takes the most promising candidate to randomised clinical trials.
In the laboratory, research teams lead by senior scientists among the translational obstetrics group screens drugs for their potential to counter the endothelial and placental disease of preeclampsia. Drugs that appear promising are then evaluated in randomised clinical trials in South Africa, to see whether they can prolong gestation in preterm preeclampsia and possibly improve neonatal outcomes. We have completed two randomised clinical trials, with further ones planned. Our second trial (PI2 trial n=180) found that metformin may prolong pregnancies complicated by preterm preeclampsia by just over a week and reduce the length of neonatal admission post birth. If validated, metformin may be the first disease modifying drug (that is safe in pregnancy) identified for preeclampsia.