August 27, 2013 |

Rectal delivery. There. We said it.

Could a novel approach to delivering medicine for preeclampsia and eclampsia save more women's lives?
A smiling mother holds a newborn wrapped in a red blanket.
For women with high blood pressure disorders, getting magnesium sulfate rectally rather than via a needle might make childbirth safer. Photo: PATH/Amy MacIver.

PATH researcher Dr. David McAdams knows you’ll likely squirm when you hear the name of his project, so let’s get that out of the way first: rectal delivery of magnesium sulfate in a mucoadhesive gel.

To define our terms, magnesium sulfate, also known as Epsom salts, is the most effective low-cost medication for treating preeclampsia and eclampsia, high blood pressure disorders that together are the second leading cause of maternal death worldwide. A mucoadhesive gel could deliver magnesium sulfate in a form that’s quickly absorbed through the moist tissues of the lower digestive tract.

The rectal delivery part we bet you understand.

“It makes people uncomfortable,” David admits. “But preeclampsia and eclampsia are life-threatening conditions, and if this is going to save a woman’s life, I think we can get past it.”

Saving lives at birth

The magnesium sulfate project is one of four with PATH involvement recently awarded grants by Saving Lives at Birth, a coalition that supports work with the potential to help mothers and newborns during their most vulnerable hours—during and shortly after childbirth. For details on Saving Lives at Birth and our other award winners, please see our announcement.

That magnesium sulfate is an effective treatment for preeclampsia and eclampsia is not news. But it’s a treatment that can be difficult to administer, David explains, especially for women who give birth without the help of a skilled attendant or outside of well-equipped health facilities.

Right now, magnesium sulfate is delivered either intravenously or through repeated, often painful, injections. Getting the concentration of the solution right is complex and can be confusing.

A new, improved route

At PATH, David most often works on finding better ways to deliver effective vaccines, including as gels. This time, he began looking for different ways to give women magnesium sulfate—ways that didn’t involve a complex regimen, sophisticated equipment, needles and syringes, or advanced training for birth attendants.

While investigating this new approach, David and his team consulted with maternal health experts at the University of Washington School of Medicine, who encouraged the idea of using the rectal route of delivery. The team began working in PATH’s laboratory to determine the viability of using a magnesium sulfate gel delivered rectally.

Effective, simple to use

“So our idea is to design a product that would be effective and simple to deliver,” says David. “And it could complement other delivery methods.”

But that’s in the future. The project is in early stages now. David and his colleagues at PATH will be conducting preclinical research in 2014, including a cultural study in western Kenya to help determine whether the rectal route of delivery will be acceptable to women and health care providers.

When qualified, capable personnel aren’t available to administer magnesium sulfate, David points out, preeclampsia and eclampsia can’t be treated. That may go a long way toward encouraging women and health care providers to try another route.

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