Pre-eclampsia

David Linden Excerpts

Thursday 9th May 2019 Westminster Hall

[David Linden (Glasgow East) (SNP)]

It is, as always, an immense pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) for securing and opening the debate. Ahead of World Pre-Eclampsia Day later this month, the debate timeously highlights a hugely important issue surrounding prenatal health. She spoke with a personal understanding that sadly will resonate with many other families right across the UK. The fact that she can stand up and talk about something so deeply personal should be valued. That is not easy. She did so when many others would sit back and say, “I’m not willing to put myself in that space.” I am sure I speak on behalf of the Chamber in saying that we should be hugely appreciative of that.

This is not an easy subject to talk about, but my hon. Friend did so in a considered and sensitive manner. I very much commend her for putting pre-eclampsia on the parliamentary agenda for the first time. I heard her say earlier in the week that this was the first time it was to be debated, and I confess that I doubted that, but she confirmed today that it is the first time that it has been debated in the House of Commons. I hope that this will be not just one set-piece event to mark World Pre-Eclampsia Day, but the beginning of a conversation in this place.

I am also grateful to my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands), who stood up and contributed without notes, again referring to his personal experience and that of his wife, Lynn, with the birth of Emma and Eilidh. It is no secret that he is a genuine friend of mine and somebody I spend personal time with—not just time with here as a Member of Parliament. He is a real ally in the campaign to extend paid parental leave for parents of premature and sick babies. I am all the richer for having him at my side as together we battle the UK Government.

Pre-eclampsia has been at the forefront of my mind recently. Some in the Chamber will know that my wife Roslyn had a baby late last year and that her type 1 diabetes complicated the pregnancy. In addition to the complications we experienced during her first pregnancy with our son Isaac, we were acutely aware that diabetes increases the risk of pre-eclampsia by a factor of between two and four. I know from that experience that it is a real source of stress for expectant parents, particularly those with multiple risk factors for pre-eclampsia.

Pre-eclampsia is traditionally difficult to diagnose. Women with pre-eclampsia are often asymptomatic, and conventional diagnosis methods that look at hypertension and urinary protein levels can be subject to observer error. Therefore, the recently published findings of the Parrot trial into placental growth factor testing are a game-changer, showing that the time it takes for clinicians to diagnose the condition can be significantly reduced. Alongside clinical assessment, the testing can also be used to rule out pre-eclampsia, which would bring peace of mind to parents-to-be as well as cost-saving benefits to health services. Jane Brewin, the chief executive of Tommy’s, the charity behind the Parrot trial, said:

“For other women with raised blood pressure this ‘rule out’ test will give women peace of mind and enable doctors to treat their condition more appropriately.”

The reduction in diagnosis time brought about by placental growth factor testing is hugely important in determining the care pathway for mum and baby.

I have recently held stakeholder meetings in my role as chair of the APPG on premature and sick babies, one of which was with Professor Andrew Shennan, a professor of obstetrics at King’s College London, and Marcus Green, the chief executive of Action on Pre-Eclampsia. Professor Shennan truly is a leading expert on pre-eclampsia, with a working knowledge spanning decades of clinical practice. What really came across was the importance of individualised, tailored care pathways for patients with pre-eclampsia. A multi-disciplinary and systematic approach is required to ensure that each patient receives the appropriate care in order to reduce risk and increase the likelihood of a positive outcome.

Placental growth factor testing will play a vital role in the future, allowing for much greater management of the condition. At an estimated cost of only £70 for a simple blood test, there is clearly a massive cost-benefit in making the testing widely available. Research published by Action on Pre-Eclampsia shows that the cost reduction per patient compared to standard clinical assessment could be almost £3,000.

The recent announcement that NHS England will be rolling out this testing is a hugely welcome step forward. It would be churlish of me not to place on the record my admiration of Her Majesty’s Government for taking that step forward. I understand that the Scottish Government are looking at adopting this north of the border, and I am keen to see that. I am happy to support the lobbying efforts of my hon. Friend the Member for North Ayrshire and Arran to ensure that progress is made. Given the Scottish Government’s recent announcement of a new model for neonatal and maternity care, backed with £12 million of investment, I strongly expect that Edinburgh will be fairly receptive.

The other big takeaway from my meeting with Professor Shennan and Marcus Green was that there are training issues with some clinicians. To an extent there is a postcode lottery when it comes to the assessment and knowledge of risk factors for pre-eclampsia. Globally, the UK has the lowest level of maternal deaths caused by pre-eclampsia, but if we are ever to change the stubbornly high level of adverse outcomes for babies, educating clinicians must be prioritised.

The work being done at centres of excellence, such as the clinic at St Thomas’ Hospital just across the river, deserves to become the gold standard of care, regardless of location. It is really promising that there will be some replication of the approach taken at the unit, and in the next 12 months we will start to see more clinics set up in other places. That is welcome. That approach, building on the strong foundations of the preterm birth network, could see the UK become a true world leader in dealing with pre-eclampsia. We should all get behind that.

As my hon. Friend the Member for North Ayrshire and Arran said, we know that the greatest burden of the condition is on low-income countries, and there is a role for us to play in improving outcomes around the world as well as at home. In order to do that we need to have a best-practice model, and it needs to be in place and operational across all our health services.

Maternal deaths as a result of pre-eclampsia are now rare in the UK, with a risk of just one in a million, as my hon. Friend explained. Although that is good news, regrettably there are hundreds of stillbirths in the UK each year as a result of the condition, and we have heard personal testimony of that today. There is more research to be done and more support that can be given. It might seem like a big ask of the Minister, but one small step that the Government can take now is to recognise World Pre-Eclampsia Day, which takes place on 22 May. I sincerely hope that she will join me in doing that.

I will wrap up by noting that there is clearly a great deal of expertise and willingness within the health services to improve outcomes, but that perhaps we need to see some sharper focus on this issue from the top, including from the House of Commons. I congratulate the Government on being so quick to act on making placental growth factor testing available throughout NHS England and hope that this is followed with greater resourcing to help predict and prevent adverse outcomes in future.