Preeclampsia is a common but poorly understood pregnancy complication characterized by dangerously high blood pressure and elevated levels of protein in the urine. It affects up to 8% of pregnancies worldwide, with a particularly damaging impact in developing nations. In the United States preeclampsia is the root cause of 18% of maternal deaths. For babies born prematurely because of maternal preeclampsia, it is an important precursor of developmental abnormalities. The identification of a diagnostic test for preeclampsia has been termed the "Holy Grail of obstetrics." If preeclampsia could be recognized early in pregnancy, it might be possible to ward off some of its potentially serious consequences through vigilant surveillance of mother and baby. And identification of early changes that precede preeclampsia might boost research efforts into finding more effective treatments.
Costs are not mentioned in this story. This is partially excusable because the diagnostic test is still under development, but, given the possibility of applying this test in low-resource settings, it would have been important for the reporter to ask the researchers for a cost range to show whether it is going to make any sense for most of the world. Many tests like this are too expensive to be applied widely, and there would be comparable tests that could be mentioned as a cost comparison.
The story says that the study "identified 40 organic molecules to be significantly elevated and 5 that were reduced in plasma at 14 to 16 weeks’ gestation," quoting the study. It would have been nice to have some context for those numbers. Is elevation bad? Is reduction good? The numbers just float and don’t add to our understanding. The story goes on to say, "From this series of compounds they narrowed down a list of 14 sugars, fats and amino acids that were different in the women who developed the condition. It detected around 90 percent of the cases, with a false positive rate of about 24 percent, meaning 24 percent of the women flagged in the test as having a risk of pre-eclampsia would never actually develop it." Given that the sample size is so small, the story should have provided the numbers both in percentages and in absolute terms. That 90 percent figure sounds huge, but we are still only talking about 71 women. And, of those, 17 were false positives. Those numbers would have been good context for helping readers understand the findings. The study itself is actually fairly easy to understand.
The preliminary nature of the research makes it difficult to accurately assess potential risks associated with the diagnostic test. At the same time, high in the story the lead author touts the huge potential benefits of the research. "Such a "metabolic fingerprint" test could save the lives of thousands of women, Philip Baker of the University of Alberta in Canada, who helped lead the study, said in a statement." With all screenings and "early warning sign" tests there are opportunities for overtreatment and potentially harmful treatment, this should have been addressed in some fashion. For example, the main treatment right now for preeclampsia is magnesium sulfate. As the Preeclampsia Foundation, which is quoted in this story, points out on its website, "Nevertheless, magnesium sulfate, is not a benign drug and must be used by a skilled health care provider with appropriate support facilities. Overdoses can and do occur."
The author did not convey clearly the preliminary nature of the evidence on this diagnostic test and did not present the study in an accurate context.
There is little evidence of disease mongering in the article. Preeclampsia is a serious and potentially lethal condition for both mother and child, and that is made clear.
The article did include a comment from Eleni Tsigas, executive director of the Preeclampsia Foundation. A better source would have been another researcher, perhaps one of the many cited in the article. The article did not mention whether any of the researchers had conflicts of interest regarding the development of the diagnostic test. The study itself says the authors had no disclosures and reports the study to be entirely government funded. Given that at least one outside source was contacted and that there were no obvious conflicts to disclose, we give this one a pass.
The article made it clear there are no validated diagnostic tests for preeclampsia early in pregnancy.
This is an experimental diagnostic test and not available beyond research settings. The story makes that clear.
The article makes it clear that this is a novel diagnostic test.
The article appeared to draw from the journal’s press release and on the press release from the University of Alberta. But there is enough original reporting here to make it squeak by.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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