Niclas Carlberg: The importance of blood pressure treatment in preeclampsia

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NICLAS CARLBERG
Dissertation defense: 11 December 2025 (click for details)
Doctoral thesis: Dynamic cerebral autoregulation and endothelial dysfunction in preeclampsia
Research area: Obstetrics and Gynecology
Sahlgrenska Academy, The Institute of Clinical Sciences

Preeclampsia, also known as pregnancy-induced hypertension, is a condition that can affect pregnant women. In many cases it causes no symptoms and is discovered during a routine check-up* with a midwife. In some instances, the condition can worsen and become life-threatening. Globally, more than 40,000 women die each year due to preeclampsia.

How the body’s organs are affected in preeclampsia is still largely unclear. Eclampsia is a severe form of preeclampsia involving the brain and causing seizures.

“Today, we lack tools that can predict which women will develop severe disease. Reliable methods are needed to prevent complications and provide the best possible care for individuals with preeclampsia,” says Niclas Carlberg, senior consultant in anesthesia and intensive care at Sahlgrenska University hospital Östra, and a doctoral student at the Institute of Clinical Sciences.

In his clinical work, Niclas Carlberg meets pregnant patients admitted to the hospital with preeclampsia, both in the women’s surgery units and in labor ward.

The brain’s ability to regulate blood pressure

“We examined the pregnant women using a type of ultrasound called transcranial doppler, which measures the speed and direction of blood flow in the brain’s major arteries. This method is used to assess cerebral autoregulation, meaning the brain’s ability to maintain stable blood flow despite fluctuations in blood pressure.”

Illustration from thesis:  Dynamic cerebral autoregulation in normotensive pregnant control and women with preeclampsia. Example of good (A) and impaired (B) cerebral autoregulation.

Blood samples were also collected to analyze how proteins and sugar molecules on the inside of blood vessels are affected by the disease, and to investigate whether their concentrations in the blood could predict which women would develop severe illness.

The women included in the research were examined both during pregnancy and again one year after giving birth. They had either normal blood pressure during pregnancy or had developed preeclampsia or eclampsia.
 

Illustration from thesis:  Schematic drawing of a part of the wall of an arteriole. The endothelial cells and the luminal glycocalyx can be seen on the luminal surface of the endothelial cells .The drawing was made by Lisa Vukovic Karlsson 

Difficult to predict complications

“None of the blood samples we collected were reliable enough to predict which women diagnosed with preeclampsia would go on to develop severe disease.”

The transcranial doppler assessments showed that cerebral autoregulation is impaired by preeclampsia - and even more so in eclampsia. This strongly emphasizes the importance of careful blood pressure management in both preeclampsia and eclampsia.

“One year after delivery, we found that the impairment in cerebral autoregulation had returned to normal. Therefore, brain-related conditions that women with a history of preeclampsia may develop later in life are not caused by a lasting impairment of cerebral autoregulation.”

Rewarding to meet curiosity about the research

What has been most rewarding and challenging about the doctoral project?
“I have met and collaborated with many interesting researchers and built several international connections. It has been exciting to deepen my knowledge in such a complex field, and it feels reassuring when treating patients with preeclampsia. It has also been fun to meet colleagues curious about what I’m working on. Bringing a large project to the finish line always involves unexpected challenges that can feel frustrating.”

Text: Susanne Lj Westergren