„Women's health is not only of utmost importance to me, it is also essential to ensure equal opportunities in health care.”
Complications during pregnancy, such as hypertensive disorders of pregnancy or gestational diabetes, significantly increase the risk of being diagnosed with chronic kidney disease, cardiovascular disease, hypertension, and Type 2 diabetes mellitus (T2DM). In the nephrology outpatient clinic, I repeatedly treat women with chronic kidney disease of uncertain aetiology. It often turns out that they were diagnosed with preeclampsia during their pregnancy without any further follow-up care. Pregnancy offers a crucial time window for identifying high-risk patients and, thus, the potential for primary and secondary prevention of chronic kidney and cardiovascular disease in women. “This interface allows us to interlink clinical care with research in women's lives like no other. Implementing treatment approaches tailored for pregnancy-associated complications improves long-term women's health. Researching new and better risk markers and innovative treatment methods may have immediate clinical relevance,” Dr Birgit Pfaller-Eiwegger emphasises. In addition to her clinical work in the nephrology and peritoneal dialysis outpatient clinics of the 1st Clinical Division of Internal Medicine at the University Hospital of St Pölten, she runs a special outpatient clinic that provides medical care for high-risk pregnant women with chronic kidney disease, hypertensive disorders of pregnancy and obesity.
A Research Time Out (RTO), which is part of the Karl Landsteiner University of Health Sciences, initiated the “Go! Research” programme provides 50 per cent protected time to advance her outpatient clinic further and to conduct research for the continued care of women at increased risk for cardiovascular and kidney disease. To succeed in improving follow-up care, creating public awareness, and developing new treatment approaches, clinical research, financial support, and media coverage are required.
After completing her studies at the Medical University of Vienna, Dr Birgit Pfaller-Eiwegger works as an intern at the University Hospital of St Pölten. During her internal medicine residency in St Pölten, she takes an educational leave to spend a year in Switzerland. After completing her residency, she starts her nephrology fellowship at the Clinical Division of Internal Medicine 1, University Hospital of St Pölten. At the same time, she completes her Master of Science with honours at the University for Continuing Education Krems. Well-prepared with these skills, a fellowship in 2016 at the Division of Clinical Pharmacology and Toxicology at the Hospital for Sick Children in Toronto/Canada, offers her the opportunity to be part of the renowned Mother Risk Programme, a research and consultation programme on medication during pregnancy and breastfeeding. The SickKids Research Institute linked to the hospital is regarded as one of the world's largest hospital-based research institutes for children's health, with almost 400 research groups. This gives Dr Pfaller-Eiwegger access to clinical research and amplifies her ambitions to deal with the subject of perinatal women's health on a scientific basis. She publishes an important resource on monoclonal antibody treatments during pregnancy (“Biologicals in atopic disease in pregnancy”), a systematic review and position paper of the European Academy of Allergy and Clinical Immunology on the use of biologicals during pregnancy. In 2017, Dr Birgit Pfaller-Eiwegger went on to do a clinical fellowship in Obstetric Medicine, a subspecialty of internal medicine in managing medical problems in pregnant women (Mount Sinai Hospital in Toronto). This is followed by a research fellowship at the Department of Cardiology at the Toronto General Hospital headed by Prof Candice K. Silversides, who directs one of the world's largest prospective registries for pregnant women with heart diseases (Cardiac Disease in Pregnancy Study; CARPREG). The knowledge gained from CARPREG has profoundly changed clinical practice in high-risk cardiac pregnancy care and risk assessment. Dr Birgit Pfaller-Eiwegger's participation in this study resulted in three manuscripts in the Journal of the American College of Cardiology, one of the top 3 journals of cardiology (impact factor 27.2), as the first author. Her publications “Preventing Complications in Pregnant Women with Cardiac Disease” and “Impact of Obesity on Outcomes of Pregnancy in Women With Heart Disease” reflect her special interest in preventing cardiovascular disease and complications in pregnant women. “Translating the knowledge gained from research into the clinical practice is key,” Dr Pfaller-Eiwegger says.
Following the Canadian model of Postpartum Cardiometabolic Clinics, the PRECARE-FEM clinic is implemented at the Clinical Division of Internal Medicine 1 at the University Hospital of St Pölten in a successful collaboration between the Karl Landsteiner University for Health Sciences and the Lower Austrian Health Agency (LGA NÖ). The clinician's objective is the long-term collection of female data to improve women's health continuously. “We know that cardiovascular disease, in particular, is diagnosed later in women than in men, so we lose valuable time for prevention. If we use the stress test in pregnancy to identify women at increased risk, we can treat them better. Gestational diabetes and its associated health risks are now well known. However, preeclampsia, hypertensive pregnancy disorders, premature birth and other complications during pregnancy are much less recognised.” The hospitals in Melk, Lilienfeld and St Pölten already refer patients to the follow-up care clinic at the University Hospital of St Pölten. In the future, the physician plans to expand her project in Lower Austria with translational projects to identify biomarkers that enable early detection of high-risk patients so they can receive the best possible care.
Interdisciplinary collaboration with the Department of General Health Studies, Division of Biostatistics and Data Science (Prof. Dr Sacha Klee), Clinical Department of Gynecology and Obstetrics has already been established, as with the dietetics department of the University Hospital of St Pölten, and with the Institute of Health Sciences at the St Pölten College as lifestyle (nutrition, physical activity and mental health) is a key factor in prevention. In close cooperation with the Department of Pediatrics and Adolescent Medicine at the University Hospital St. Pölten, we will also study the offspring of women with adverse pregnancy outcomes to better understand the associated risks to the children.
Dr Birgit Pfaller-Eiwegger is passionate about women's health and the risk factors for chronic kidney disease and cardiovascular disease in women. “Pregnancy does not end with birth. Pregnancy and its outcome are often critical to a woman's future health. With my work, I would like to contribute to equal health opportunities for women,” explains Dr Pfaller-Eiwegger.
Link: Division of Internal Medicine 1, University Hospital St. Pölten
Text: Research Management