Improving diagnosis of Pre-eclampsia among women in Uganda

Sheila Nabweyambo is a female laboratory scientist with a passion for laboratory diagnostics and investigations, currently enrolled for a PhD in Immunology and Molecular Biology at Makerere University, Uganda. For her first degree, she pursued education and training in biomedical laboratory technology so as to secure an ideal position that would enable her achieve a career in laboratory research. She further pursued a Master of Science degree in Immunology and Clinical Microbiology.

From 2013 to 2017, Sheila worked as a Laboratory technologist at the Infectious Diseases Institute (IDI) – a centre of excellence that supports various research investigations in Uganda. Her work experience at IDI exposed her both to field and laboratory research from which she gained vast experience in disease investigations. “Laboratory research is key in disease surveillance, prevention, diagnosis, treatment and monitoring, and outbreak investigations. Through my obtained skills and expertise, I would like to contribute towards the ease of disease burden in Uganda,” said Sheila. Her research interests include maternal health, non-communicable diseases and HIV.

In 2017, she was privileged to be granted a fellowship by MUII Plus (Makerere University / UVRI Centre of Excellence in Infection and Immunity), under a Maternal and New-born Health group leader award to Prof. Annettee Nakimuli, an esteemed lead woman researcher in preeclampsia; a hypertensive pregnancy disorder, and other obstetric complications among women in Uganda. Under Prof. Nakimuli’s supervision and mentorship, Sheila’s PhD research involves investigation of blood proteins that play a role in the development and function of blood vessels (angiogenic biomarkers), and their association to preeclampsia among women in Uganda.

Why should people care about your research?

People should care about this research because preeclampsia is a major threat to pregnant women globally, with more cases concentrated in developing countries especially in Africa. Severe forms of preeclampsia are reported to be common in Africa, ranging from as low as 4% of all deliveries to as high as 18%. This calls for undivided effort towards alleviating the observed burden of preeclampsia among women of African ancestry. Preeclampsia (PE) usually occurs at any time after 20 weeks of pregnancy, and is characterized by high blood pressure, and proteinuria (the presence of excess proteins in urine) or significant end organ dysfunction. Preeclampsia may cause serious consequences including brain, liver and kidney complications, and death to the mother. Preeclampsia is also linked to birth of premature babies.

Angiogenic biomarkers are involved in the formation of placental blood vessels during early pregnancy so as to enable supply of blood to the growing fetus during the entire pregnancy period. Abnormalities in the circulating levels of the angiogenic biomarkers may therefore lead to improper formation of the blood vessels in the placenta. Three major angiogenic biomarkers have been implicated in the pathophysiology of preeclampsia, including; Vascular Endothelial Growth Factor (VEGF), Placental Growth Factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt1). There is a need to investigate how these may contribute to the observed burden of preeclampsia among women of African ancestry, and how these can be utilised to improve management of preeclampsia patients.

In this research, we set out to determine the association of Vascular Endothelial Growth Factor (VEGF), Placental Growth Factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt1) with preeclampsia among women in Uganda, a sub-Saharan African country; looking at their circulating levels, diagnostic performance and the genetic variations of the VEGF gene. This research will provide more insights on the pathophysiology of preeclampsia among African women, and improving diagnosis and prognosis of preeclampsia which remains elusive due to its heterogeneous clinical presentation. And currently, there is no single established laboratory test tool for preeclampsia.

What are the big challenges in your research area?

A major challenge I have faced during this research is related to enrollment of study participants especially healthy pregnant women as controls, who do not realize the need to participate in research investigating preeclampsia.

Another challenge with investigating the genetic variations and the circulating levels of the angiogenic biomarkers is the high cost of required kits to perform the assays.

How will this research help you achieve your long-term career plans?

This research has given me a platform to advance my knowledge and skills that I hope to apply to future research as well as mentor other scientists.

What are some of the findings you are seeing from your research? We have so far obtained results on the circulating levels of VEGF, PlGF and sFlt1, their association with preeclampsia, and diagnostic performance among pregnant women attending Mulago National Referral Hospital in Uganda.

Similar to previous studies by other researchers, our results indicated that women with preeclampsia have abnormal levels of circulating angiogenic biomarkers compared to healthy pregnant women. Specifically, women with preeclampsia have lower blood levels of VEGF and PlGF and higher levels of sFlt1. We also found that sFlt1 and PlGF had a good performance for the diagnosis of preeclampsia among Ugandan women.

How has the work taking place changed or improved your understanding of your research? 

Through this work, I have obtained wider knowledge about preeclampsia and angiogenic biomakers. I have obtained advanced laboratory skills through various trainings both in the country and externally – these have enabled me improve my research methods and articulate the research problem for better understanding.

What are some of the outputs of your research and of what benefit is it to your stakeholders?

I have had one community engagement activity during the Uganda Virus Research Institute Science open day.  During the event, secondary school going students from various schools in Uganda were invited to the exhibition of scientific research activities. I got the opportunity to show case some of the laboratory methods used in my PhD research; such as DNA sequencing. I have also had the opportunity to present my research findings in international conferences including the Infectious Disease Institute (IDI) Science Fair, 2021.

The results obtained from this research will present a platform to develop algorithms, using angiogenic biomarkers for both prediction and diagnosis of preeclampsia. These will hopefully improve the management of preeclampsia.