African women possess a special gene that prevents onset of high blood pressure during pregnancy, a medical conditional called preeclampsia, according to findings of research by British and Ugandan scientists led by a Makerere University lecturer, Dr Annettee Nakimuli.
Dr Nakimuli, a senior lecturer at the department of obstetrics and gynaecology, School of Medicine, Makerere University discovered a KIR B centromeric gene, a version of the KIR2DS5 gene present among Africans but not the Europeans which protects pregnant women from pre-eclampsia.
The research also published last year in the peer reviewed journal of the National Academy of Sciences in the US, was done at Mulago hospital by a team of 19 Ugandan and British researchers.
The case- control of pre-eclampsia involved a total of 738 pregnant women at Mulago National Referral Hospital where 90 per cent of the sample were Bantu, the largest ethnic group, with small numbers of Luo, Nilo-Hamites, and other ethnic groups.
It was discovered from the research that the preventive gene did not exist among most women who have suffered from the condition. Those who have not suffered from the same condition were, however, found with the same gene.
“The findings, therefore, mean that those women without this type of gene are at higher risk of catching the condition compared to those mothers with the gene and therefore, the former can be given special attention when pregnant,” Dr Nakimuli says.
Dr Nakimuli, however, notes that the research did not guarantee that women without the gene necessarily suffer from pr-eclampsia but said very few with the preventive gene would suffer from the same condition.
Dr Nakimuli adds that despite the high mortality rate caused by preeclampsia in sub-Saharan Africa, this is the first remarkable research on the cause of the condition throughout Africa due to the high costs involved in the genetic research.
“I spent about Shs500m on the whole research project which included transporting the women DNA samples to the University of Cambridge laboratories in the United Kingdom, eligible to carry out the tests,” Dr Nakimuli says.
She adds that the research carried out between 2010 and 2014 was inspired by the high number of maternal death caused by pre-eclampsia at Mulago hospital where she also doubles as a staff.
“Ten per cent of our admissions at the gynaecology department at Mulago hospital are due to pre-eclempsia. This means one in every four admissions is preeclampsia related, “She adds.
It’s upon the discovery that Dr Nakimuli says, “It is easier at this moment to do another research on the drugs that can cure the ailment having had a clue on the prevention of preeclampsia.”
Florence Nassali, 28, has so far had two consecutive pregnancies terminated due to preeclampsia. Although she is seven months pregnant, Nassali is uncertain about her fate.
Lying on one of the beds at Mulago hospital’s preeclampsia unit, she weeps as she ponders about the pain of carrying pregnancies for months only to lose them prematurely.
“I usually lose my babies when the pregnancy is approaching six and half months,” she says “I was diagnosed with the condition eight years ago during my first pregnancy, although the doctors were able to save that one baby.”
She says her condition usually worsens when the pregnancy reaches around the fifth month. “I don’t feel any pain apart from swelling the whole body and weak joints.” Nassali says, “This last pregnancy had been the worst when I fainted abruptly and spent 12 hours in comma.”
Joy Achen, the Nursing officer in charge of preeclampsia unit at Mulago hospital reveals that on average 50 admissions are registered at the unit every month. Of these, at least one mother is lost.
“But these are only figures for those mothers who are brought at this unit but there are those whose hypertension is worse and they have to be taken straight to the special care unit for operation. So we do not usually follow up on how many mothers and their babies lost there, “she notes.
Achen, however, says most deaths accrue from late referrals.
Steps towards cure
The research has been received with optimism from other local experts, marking it as a remarkable step towards the discovery of the cure of the killer disorder.
Dr Peter Waiswa, a lecturer at Makerere University School of Public Health, says issues to do with genetic research are powerful and will go a long way in ensuring that drugs manufactured match with the genes of the population.
“Africans have the most original and rich genes, but most of the time we use medicine that is a result of research elsewhere and not specifically for us, yet there is a lot of genetic variations,” Dr Waiswa says.
Dr Margret Mungherera, the former president of the World Medical Association, said any research that seeks to reduce maternal mortality is very welcome and a big contribution to the fight.
“We encourage more of that research and studies done there should be more encouraged especially when both government and donors allocate funds to boost local research,”notes Dr Mungherera.
Prevalence rate in Uganda
Dr Anthony Mbonye, the commissioner for community health services at ministry of Health, confirms that preeclampsia is among the top five causes of maternal deaths in Uganda.
“Preeclampsia is a very serious condition killing a number of women in the country,” Dr Mbonye says. He says the other maternal death causes include unsafe abortion and obstetric complications such as severe bleeding, infection, and obstructed labour.
Although the exact cause of preeclampsia is not known and the exact number of women who develop preeclampsia is also unknown, statistics from the World Health Organisation indicate that, among women who have had preeclampsia, about 20 per cent to 40 per cent of their daughters and 11 per cent to 37 per cent of their sisters also will get the disorder.
WHO estimates the incidence of preeclampsia to be seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%).
What you need to know about preeclampsia
Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or failing to stay active, are major risk factors for high blood pressure.
Women that are experiencing first pregnancy are also more likely to have high blood pressure. Fortunately, the following pregnancies with the same partner will have a lower chance of this condition.
Women carrying more than one child are more likely to develop hypertension, as their body is under additional stress from the pregnancy. Maternal age is also a factor, with pregnant women over the age of 40 being more at risk.
According to the American Society for Reproductive Medicine, using assistive technologies (such as IVF) during the conception process can increase chances of high blood pressure in a pregnant woman.
Women who have had pre-existing high blood pressure are at higher risk for related complications during pregnancy than those with normal blood pressure.
What are the complications?
If high blood pressure continues after 20 weeks of pregnancy, there can be complications. Preeclampsia can develop. This condition can cause serious damage to your organs, including your brain and kidneys. Preeclampsia is also known as toxemia and pregnancy-induced hypertension. Preeclampsia with seizures may become eclampsia. This can be fatal.
Thorough prenatal care, including regular doctor’s visits, should be able to spot some of the symptoms of preeclampsia.
Symptoms of preeclampsia include:
• Protein in a urine sample
• Abnormal swelling in hands and feet.
• Persistent headaches
High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in a low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:
• Placental abruption (a medical emergency during which the placenta detaches from the uterus prematurely)
• Preterm delivery (defined as delivery prior to 38 weeks of pregnancy)
• Caesarean sections
How will i know if i have high blood pressure?
During pregnancy, your doctor or midwife should be monitoring your blood pressure during regular checkups. A reading higher than 140/90 mm Hg will indicate that there’s a problem with your blood pressure.
Preeclampsia is harder to diagnose than hypertension. Your doctor will check for signs of protein in your urine along with high blood pressure if preeclampsia is suspected. Your doctor may also want to perform a “nonstress test” to ensure the baby is moving and has a normal heart rate. An ultrasound may also be done to check fluid levels and the health of the developing infant.
How can i prevent high blood pressure during pregnancy?
Common risk factors, such as obesity and a history of high blood pressure, can be minimized through diet and exercise.
Of course, during pregnancy, it is inevitable that you will gain some weight. It is recommended that pregnant women consult with their doctors to identify a weight gain target that is healthy for them.
The best dietary guidelines for pregnant women vary from person to person. Speak with a nutritionist that will keep your specific height and weight in mind when creating a nutrition plan for you.
Doctors emphasize that it’s important to take preventive measures to help lessen your risk of high blood pressure. You should steer clear of smoking and drinking alcohol, both of which have been known to raise blood pressure.
Some traditional blood pressure medications can cause problems in pregnant women.
According to Mayo Clinic, medications for lowering blood pressure should be avoided when you are pregnant:
These drugs in particular will be passed through the bloodstream to the developing baby. This can negatively impact the infant’s health. These medications may also cause blood to thin. This can compromise the mother’s ability to carry the baby to term.
Methyldopa and labetalol are both drugs that have been deemed safe for use to manage blood pressure during pregnancy.
Talk to your doctor about how to control your blood pressure if you develop hypertension during pregnancy.
Pregnancy can cause hormone shifts, as well as psychological and physical changes. This can cause stress in a pregnant woman. Stress can make the issue of high blood pressure harder to manage. However, when pregnant women find ways to manage their stress levels, blood pressure is less of an issue.
Prenatal yoga can be a great tool to manage stress during pregnancy. If yoga poses are too uncomfortable, simply listening to relaxing music while taking the time to meditate is helpful for the body and for the mind.
High impact or extensive aerobic exercise is not typically recommended during pregnancy, especially if your body is not used to it. However, taking walks is a great way to relieve stress and stay active.
There are a variety of herbal remedies and supplements that promise to relieve stress. As with any supplement, be very cautious and consult your medical professional before ingesting these products. If your doctor gives the OK, decaffeinated teas can be an option for easing stress. Oolong, ginger, and blueberry can supply you with antioxidants to help you de-stress. Though it isn’t easy, getting enough sleep during pregnancy is crucial, so aim for six to eight hours a night.
In most cases, high blood pressure during pregnancy will subside almost immediately after the baby is delivered. Sometimes the blood pressure will remain elevated, in which case your doctor may prescribe medication to get it back to normal.
High blood pressure during pregnancy doesn’t commonly lead to serious problems. However, if it goes untreated, hypertension can become life-threatening for both mother and baby.
Take the time to understand the risk factors and possible causes of high blood pressure before you get pregnant — and practice preventive measures to keep your blood pressure down during pregnancy.