5 Questions with Stanford's Transdisciplinary Preeclampsia Research Team

Thursday, August 22, 2019

By: Roxanna Van Norman

1. The research team, lead by Co-PIs Drs. Virginia Winn, MD, PhD & Mark Hlatky, MD along with members from 12 Stanford Departments, recently received a $6 million grant from the NHLBI to study the connections between preeclampsia in pregnant women and heart diseases in later life. What is the purpose of the study and why this specific approach?
It has only been recently recognized that a woman’s pregnancy history may alter her risk of developing heart disease later in life. Adverse pregnancy outcomes, especially preeclampsia, appear to have long-term effects on cardiovascular health. We designed the EPOCH (Effect of Preeclampsia On Cardiovascular Health) study to look at potential pathways that might link preeclampsia during pregnancy to an increased risk of heart disease and stroke decades later. We are focusing on identifying biomarker signatures across the life-course, starting with pregnancy, through mid-life, and years later when heart disease typically develops.

This study could improve identification of women at elevated risk of heart disease, suggest new interventions to reduce that risk, and advance personalized care of women with a history of preeclampsia. EPOCH will enroll 400 women at Stanford in two different cohorts. The first study group includes women who are currently pregnant (with or without preeclampsia). The second study group will enroll women who were pregnant two or more years ago, pre-menopausal, and either had preeclampsia or are willing to serve as a normal control.

2. The EPOCH Study enrolled its first patient this summer, a huge milestone for any research study. Can the invesitgators comment on this? How and why did the participant become involved?
We are excited to have enrolled five patients as of end of July 2019. All of the participants are patients at Stanford LPCH OB clinic. Our team reaches out to the OB care team daily to let interested patients know about this study opportunity here at Stanford. Our first patients have had uncomplicated pregnancies, and have been generous to volunteer for the study simply to improve knowledge about women’s cardiovascular health. We are grateful for their support.

3. For others who are thinking about participating in the study, what are the benefits (and risks) of enrolling in this study? What was criteria to participate in the study?
Study participants will receive the results of a lipid and cardiovascular blood panel test during and after pregnancy, as well as a gift cards upon completion of their study visits. The study does not involve any interventions, and is very low risk. The main benefits of this study will be to future patients by increasing understanding of the link between preeclampsia and cardiovascular disease in women.

Women may be eligible if they are:

1.  Between 18 and 45 years of age AND currently pregnant

   OR

2. Between 21 and 55 years of age and at least two years after their last pregnancy

4. This is a large 4-year grant that will support a multi-disciplinary research team and aims to enroll three cohorts of women at distinct points. Can the team talk about this approach and, if relevant, why this might be informative to participants? How can participants learn more about this study and how their participation contributes to research in this area?
We are not able to follow the same woman for 40 years to see how her cardiovascular system may be affected by preeclampsia, so instead we have adopted a life-course approach. Our strategy is to enroll one group of women who are pregnant now, a second group of women who are several years after pregnancy, and a third group who are several decades after pregnancy. In each of these three groups, we will do the exact same blood tests in the same labs, which will allow us to look for changes at different points in the life-course, and piece together the life-course effects of preeclampsia by looking at data from these three groups.

We are doing many sophisticated assays on all the samples, and have engaged a large number of faculty here at Stanford to participate.

5. Earlier efforts for this project received funding from MCHRI through the Arline & Pete Harman Faculty Scholar award that contributed to the preliminary data in the application to the NIH. How did that funding support the early development of this study, leading up to where you are now?
The Pete & Arline Harman Faculty Scholar award laid a formidable foundation for this current work. We are very fortunate to have had this support from MCHRI which enabled the research team of Dr. Winn, Dr. Valerie Baker, MD and Dr. Frauke Von Versen-Hoynck MD, PhD to use a similar approach of studying the blood and blood vessels in pregnancy to understanding the impact of how one conceives, spontaneous or in vitro fertilization, related to preeclampsia and vascular health in pregnancy. 

For more information about the study visit our website: https://epoch.sites.stanford.edu/ or through the Stanford Medicine News Center.

Women can also determine their eligibility by going to: https://epoch.sites.stanford.edu/are-you-eligible-study.