The Preeclampsia Registry

Preeclampsia is a life-threatening complication of pregnancy, diagnosed by the development of
high blood pressure and protein in the urine in the latter half of pregnancy. Preeclampsia
affects approximately 5 percent of pregnancies, up to 300,000 pregnant women in the U.S.
annually. Approximately 75,000 of these women suffer severe maternal outcomes: organ failure,
massive blood loss, permanent disability or death; and severe fetal outcomes: prematurity,
abnormal fetal growth, and long-term disability or death of their babies.

Despite years of research along multiple investigational lines, the cause and mechanisms
underlying preeclampsia remain unclear. At this point in time, the only "cure" for
preeclampsia remains delivery of the placenta. Given the onset of preeclampsia at sometimes
very preterm gestational ages, delivery can be associated with substantial risks of
prematurity. In addition, delays in diagnosis and treatment of preeclampsia can put
pregnancies at significant risk. An improved understanding of this condition is essential for
the development of novel screening, diagnostic, and therapeutic approaches for mothers and
their babies.

To further our scientific understanding of preeclampsia, large, longitudinal studies of women
and their families are needed. The Preeclampsia Registry will provide a large-scale data
registry and sample repository resource with unique attributes to address these important
questions, including long-term longitudinal follow up of participants and engagement of
families.

Specific Procedures

Participants will log on to The Preeclampsia Registry website to enter their name, address,
phone number, and email. An email will be sent to participants containing a unique login ID,
which is the participant's email address, and a password. Participants will return to the
registry website to login and will be asked to change their password. Participants will
review the informed consent documents, and provide informed consent. Participants will have
the opportunity to contact the Research Coordinator with questions regarding the consent
and/or registry.

Once informed consent is obtained, participants will complete the registry questionnaire on
The Preeclampsia Registry website (www.preeclampsiaregistry.org). The participants will have
the ability to return to the website to complete or update information as often as necessary.
Participants will have the option of scanning and uploading their own medical records to The
Preeclampsia Registry website using their unique login and password. The registry will also
ask participants to complete and sign a medical records release form to provide permission
for a member of the registry staff to request the participant's medical records from the
doctor and/or hospital where they were treated. The registry will send out notifications by
email periodically to remind participants to return to the registry website to update their
information and their children's information, make changes to their medical history, and add
new pregnancies if applicable.

Saliva samples for DNA extraction are being collected on some participants. All participants
will be asked to provide their permission to be contacted in the future about donating a
sample of blood, tissue, or other biospecimen for future research. Participants will not be
required to submit biological specimens in order to participate in the Registry and will need
to sign a separate consent to donate a sample.

Self reported data collected from participants includes Personal History, Maternal Outcomes,
Brief Reproductive History, Medical History, Family Medical History, Biological Father
Information, Demographic Information, Prenatal Care, Medications/Drug use During Pregnancy,
Metabolic Questions, Pregnancy Symptoms, Hypertension, Delivery and Baby Information, and
Postpartum data.

Medical records will be used primarily to confirm a diagnosis of PE or other hypertensive
disorder of pregnancy; however, they will also be used to validate any self-reported data as
available.

Participant medical information will be stored electronically within the Registry. The names
of the Registry participants will be deleted from their stored medical information and
replaced with a linkage code, making the record de-identified. Access to participant medical
information contained within the Registry will be restricted to the Principal Investigator
and her designees.

Participants will be asked to provide their permission to share their de-identified (coded)
information with other registries and databases. This information may be used for
retrospective research or to plan for clinical trials. Participants will be asked to allow
the Foundation investigators to review this information to determine if the participants may
be eligible for participation in future research studies being conducted by secondary
investigators (not affiliated with the Foundation). Interested Registry participants
contacted for possible participation in future research studies being conducted by secondary
investigators will undergo a separate informed consent process for each such research study.

The Registry's Steering Committee will conduct a formal review of proposals of
investigator-driven research projects and will provide recommendations to the PI. The PI,
under the Registry's current protocol, must grant final approval for all studies conducted
using medical information contained within the Registry. Such approvals shall be obtained
prior to providing investigator information from the Registry; shall be based upon
considerations of scientific quality and validity; shall be granted only for research studies
related to PE or related hypertensive disorders of pregnancy; and shall be documented. Prior
to provision of data to any investigator, the information shall be de-identified. The
Registry shall require investigators to obtain IRB approval prior to its provision of
de-identified information to the investigator.

Approved scientists, researchers, and clinicians, will be given only the de-identified
information and may search the de-identified data for patients for their studies. If an
affected individual looks like a good match for a specific study, the researcher will contact
the Registry. A Registry staff member will then contact the participant or the participant's
family. Researchers will not directly contact participants or their families as they will
only see de-identified data. It will be the choice of the Registry participant or their
family to decide to initiate direct contact with the interested researcher.

Data Management and Statistical Analysis

The information collected through this registry is maintained by MedSciNet, a company based
in Sweden that specializes in the development of online database systems for registries,
clinical trials, and medical bio banks. The data and safety monitoring plan for the registry
will involve routine monitoring by the Principal Investigator or her designees of 1) removal
of direct identifiers from information contained within the registry; 2) the documentation of
provision of de-identified registry information to investigators; 3) the security of the
database linking the registry linkage codes with participant identifiers and the
documentation of access to this database for the purpose of gathering data for investigators;
and 4) any conditions that may negatively impact the confidentiality of information contained
within the registry.

High data quality is achieved using standard data entry fields (numeric, date, time,
dropdown, radio, checkbox fields, open text, etc.) as well as applying standard validation
rules (mandatory, ranges for dates/numeric fields, data type, etc.) Predefined code lists are
used to ensure that only standardized values are chosen. Clinical data is entered via forms
comprised mainly of checkboxes, drop down menus and specified value fields. A few open text
box fields capture natural history and individual participant experiences. Built-in data
checks prevent most errors during data entry, further contributing to the ease of use for a
non-technical user.

All history of changes of individual data values is kept in the database. The information
that is kept about each change of the data value includes user performing the change, date
and time of change, old and new value. Reviewing of audit trail is available at individual
data point level or at the form level.

For the collection of outcomes data, standard, well-validated outcomes instruments have been
used such as the data harmonization criteria established by Co-Lab, the reVITALize data
definitions validated by the American Congress of Obstetricians and Gynecologists, and the
common data points suggested by the Women's Health Registries Alliance. Using these
instruments helps ensure that all basic data captured by the Registry will be compatible and
interoperable across all registries and biobanks that may share research data. Beyond those
instruments, the remaining questions have been formulated based on the input of the
Registry's volunteer Scientific Advisory Council with input from patients and a review of the
Foundation's Community Forum and social media networks where patients' research questions are
typically expressed. These validation efforts, already voluntarily undertaken, demonstrate
the Foundation's intention to maximize the use of its Registry and its willingness and
commitment to participate in networks that will amplify the Registry's research potential.

Recruitment Procedures

Recruitment will involve an IRB approved email that will be sent to Preeclampsia Foundation
volunteers and mailing list subscribers. Advertisements will be placed online (social media
sites and webpages) and newspapers or other media sources after IRB approval. Other IRB
approved forms of advertisement will include printed materials such as brochures, posters,
pass along cards, and flyers placed in physician offices, public health clinics, and
community health education events.

Safety Considerations

There are no risks of physical harm associated with participation in The Preeclampsia
Registry. As the registry includes questions that can be sensitive and uncomfortable for an
individual to answer, participants will be encouraged to skip questions they do not wish to
answer.

Benefits

There are no direct benefits associated with participation in The Preeclampsia Registry. The
use of information contained within The Preeclampsia Registry for retrospective research
analysis may be of benefit to future patients with preeclampsia or related hypertensive
disorders of pregnancy. Participants in the registry will be informed of future research
studies involving preeclampsia and related hypertensive disorders of pregnancy, for which a
separate informed consent will be obtained, and may offer direct benefit to The Preeclampsia
Registry participants.

Cost and Payments

All costs associated with the implementation and maintenance of the registry shall be
supported by the Preeclampsia Foundation. Participants will not be compensated for their time
and participation in this registry.

Withdrawal From Study

Participation in all aspects of this study is voluntary. The consent form states this
clearly. Should a participant change his/her mind and wish to withdraw participant
information from the registry, the individual may do so by writing a letter or email to The
Preeclampsia Foundation to notify them he/she no longer wants to participate. No explanation
will be required. If withdrawal is requested, the participant's information will be removed
from the registry. However, information accessed prior to the request for removal cannot be
retrieved from researchers that have already accessed it.

Inclusion Criteria:

- Women who were medically diagnosed with preeclampsia or a related hypertensive
disorder of pregnancy (HDP) such as eclampsia or HELLP syndrome.

- Female relatives of affected women

- Women who have never had preeclampsia or hypertensive disorders of pregnancy, but who
would like to serve as "controls" in research studies of preeclampsia.

- An authorized representative may complete the questionnaire and provide consent for a
woman who had preeclampsia, but has died or is disabled as a result.

Exclusion Criteria:

- Those unable to provide consent

- Prisoners

- Individuals unable to speak English