Mom Elaine Cruise Smith and Dad Cameron Smith play with 8 year old son Austin Smith and one year old daughter Lauren Smith in their home in Ajax, Ontario, Canada. Elaine had eclampsia in both her pregnancies.Deborah Baic/The Globe and Mail
About 32 weeks into her first pregnancy, Elaine Cruise Smith began to feel "funny."
At first, she shrugged off lower back pain as the effect of a long car ride. But within a day, her symptoms worsened. She began suffering from excruciating abdominal pain, headaches and vomiting.
"It basically feels like someone is just squeezing the life out of you," she recalls.
She had preeclampsia, a potentially fatal condition that affects four million pregnant woman a year worldwide. The expectant mother was taken to hospital, and underwent a caesarean.
Both she and son Austin, delivered seven weeks early, survived. When she had her second child, her pregnancy was closely monitored and she had few complications.
"Had I known about it the first time, the outcomes might have been a little bit different," said Ms. Cruise Smith, now 41. "You can make plans and be aware that you may not make it to 40 weeks, and have contingencies in place."
In a study published on Monday, a team led by a pair of University of Alberta researchers announced it has discovered a way to test pregnant women for preeclampsia at 15 weeks. Women such as Ms. Cruise Smith - and an estimated 13,000 others who get the disease each year in Canada - could then receive targeted care, reducing complications.
A test is also expected to help pave the way to a cure.
"It's a significant finding," said lead author and obstetrician Philip Baker, dean of the University of Alberta's Faculty of Medicine and Dentistry. He called preeclampsia "our biggest pregnancy problem. It's the biggest clinical issue we have."
The researchers found what they call a "metabolic fingerprint" in pregnant women who developed preeclampsia. The fingerprint can indicate who will get the illness. The test can identify 90 per cent of cases, but also gives false positives.
What's next is finding a cheap and easy way to perform the test that's not confined to high-tech labs in North America, because preeclampsia deaths disproportionately occur in the developing world.
"I think we've robustly got that predictive model," said Dr. Baker. "What we need to do is translate that with a commercial model."
Peter von Dadelszen, a Vancouver-based preeclampsia researcher not involved with the report, praised the discovery as "a true international success story" because "now we know which women to target" with treatment.
However, while the study's lead investigator, University of Alberta adjunct professor Louise Kenny, describes a viable preeclampsia test as "obstetrics' Holy Grail," it's expected to take three to five years to develop a commercial test. Further research may also be needed, as the study sample included only 60 women.
"I'm not going to be breaking out the champagne yet, but we're optimistic," said Eleni Tsigas, the executive director of the U.S.-based Preeclampsia Foundation.
About 75,000 mothers and 500,000 babies are estimated to die from preeclampsia (once known as toxemia) each year, researchers say. The world's developed countries spend $45-billion a year treating preeclampsia, Ms. Tsigas's organization says.
In Canada, Dr. Baker estimates between three and five per cent of pregnant women develop preeclampsia - or, applying that to birth rates, about 13,000 mothers per year. Ms. Tsigas's organization figures it's twice as high. (No official national data are kept.) It's tied with blood clots as Canada's leading cause of maternal mortality, Dr. von Dadelszen said.
Most Canadian cases aren't fatal, but still have a serious impact on the physical and mental health of those affected. For Ms. Cruise Smith, preeclampsia was a strain on the household as she and her husband debated whether to have a second child.
"He was highly resistant. 'You know what, we're not doing this. We're not going to lose you,' " she recalls.
Four women interviewed on Monday who have had preeclampsia all had the benefit of paid leave for maternity and other short-term absences from work - those who don't would be put under an increased financial strain, as they're forced to leave work earlier in the pregnancy.
While fatalities happen most frequently in Asia and sub-Saharan Africa, they do occur in Canada.
Owen Salava and Cheryl Walker had waited years for their son, Gabriel. After fertility treatments, the couple conceived in 2007. Ms. Walker began feeling ill in her 24th week, and a day later was in hospital fighting preeclampsia.
"I had virtually no warning," the 31-year-old recalls. Doctors told Mr. Salava that his wife and unborn son would both die. They induced delivery, and Gabriel was born on Dec. 10. He lived 30 minutes. Ms. Walker survived.
"I love my son. I love him now. I miss him desperately, and I would give anything to have five more minutes with him," she said, praising Monday's discovery.
"Predictive testing gets the right resource to the right woman, hopefully at the right time. It also means we know more about the disease. And for every little bit more we know, we're closer to a cure."