It’s difficult to imagine someone in better physical condition than an Olympic athlete, which is why it came as a shock last year when three-time medalist Tori Bowie died from complications in childbirth at the age of 32. Bowie’s death may have been caused by eclampsia, a life-threatening condition that can develop from preeclampsia, which is a disease of pregnancy marked by high blood pressure and impaired kidney function.
Dr. Christine Greves, an OB-GYN at Orlando Health Women’s Institute in Florida, explained to HuffPost: “Eclampsia means seizure. So [preeclampsia is] what you experience before you have a seizure. Obviously, we do not want anybody to have a seizure.” This kind of seizure can be fatal.
Preeclampsia affects approximately 5% of pregnant people, with a disproportionate number of Black people impacted. (Overall, Black women and birthing people in the U.S. are three times more likely than white people to die of pregnancy complications.) The reasons for this racial disparity are poorly understood.
“Research is needed to explore why biological and psychological [and] social determinants of health [are] contributing to pregnancy-related disparities in preeclampsia,” Greves said.
The disparities are clear, she continued, but “we need to understand the
why in order to try to help more.”
She added, “Some centers like ours recognize the disparities and are incorporating strategies with more access to help.”
Preeclampsia is also a leading cause of maternal mortality worldwide.
If you’ve been pregnant, you know that prenatal visits always involve taking your blood pressure and testing a urine sample. These procedures detect those two major markers of preeclampsia: high blood pressure and protein in the urine. Because preeclampsia can become life-threatening, health care providers are eager to catch it early so that they can monitor patients closely.
Now, researchers have discovered a new screening method that is able to detect signs of preeclampsia more effectively and even earlier in pregnancy, giving doctors a chance to prevent the condition from developing — and potentially saving lives. Here’s what you need to know.
What preeclampsia screening and treatment currently look like.
Providers monitor patients’ blood pressure and check their urine throughout pregnancy, and with greater frequency towards the end of pregnancy, when preeclampsia is most likely to develop. Preeclampsia can even occur postpartum, after delivery.
In addition, patients with risk factors for developing preeclampsia are given a daily dose of aspirin, starting by the 16th week of their pregnancy, as previous research has shown that it effectively reduces the rate of preeclampsia in people who are at risk.
“Aspirin prevents the majority of preeclampsias when started in the first trimester of pregnancy,” Dr. Emmanuel Bujold, one of the study’s authors, told HuffPost.
For this reason, currently, pregnant people who meet one or more of the following severe risk factors, or two or more of the following moderate risk factors are advised to start taking aspirin by 16 weeks, Bujold said.
Moderate risk factors:
- It is your first pregnancy
- You are Black
- You have obesity
- You became pregnant through IVF
- You are over 40 or under 18 years old
- There is a family history of preeclampsia
Severe risk factors:
- You have a personal history of preeclampsia (a previous pregnancy with preeclampsia)
- You have chronic hypertension
- You have diabetes
- You have Lupus
Other diseases and conditions can also increase risk. Greves noted that even a mental health condition, post-traumatic stress disorder, has been correlated with an increased risk of preeclampsia.
Bujold explained that by these criteria, about 35% of non-Black pregnant people, and over 50% of Black pregnant people, are advised to take aspirin.
The aspirin treatment is “relatively safe and highly effective,” Bujold said.
You might wonder, if aspirin is so safe, why all pregnant people aren’t simply told to take it starting at 16 weeks. Bujold says this has been proposed in some places, such as Brazil, but has met with little success.
“In the absence of screening, compliance with treatment is much poorer, follow-up is absent, and the risk of incorrect dosage and errors is high,” he said. In other words, people are less likely to follow through on a blanket recommendation than they are on one that is based on their own, personal risk. Greves also mentioned that while small, there is a risk of bleeding from taking aspirin.
If preeclampsia does develop, doctors will monitor a patient closely and treat their symptoms, but, unfortunately the only cure is delivery. This can leave doctors and patients in an impossible bind. You want to deliver the baby before the pregnant person becomes seriously ill, but you also want to delay delivery as long as possible for the health of the baby. Babies born at 28 weeks of gestation or later have 80-90% odds of survival, whereas babies born before 24 weeks have odds below 50%, in addition to a 40% chance of developing long-term health problems.
How the newly-proposed screening method would work.
Bujold and his co-authors conducted a study of over 7,000 Canadian women. Some were screened for preeclampsia using only a tally of the risk factors, as explained above. Others were also given a blood test which identified biomarkers associated with preeclampsia.
The results of this blood test, along with those from an ultrasound, a blood pressure reading, and the patient’s health history were then “integrated into a computer algorithm that indicates whether or not the woman is at risk,” Bujold said.
Using the new screening method, Bujold said, researchers were able to detect about two-thirds of the cases of severe (before 37 weeks) cases of preeclampsia and about three-quarters of very severe (before 34 weeks) cases. This represents a significant improvement over the current screening method based on risk factors alone, which identifies about half of cases.
The rate of false positives — a person is labeled at risk but does not go on to develop preeclampsia — is also lower using the new screening method. Its rate of false positives is around 16%, meaning “one woman in six is worried when she won’t develop preeclampsia,” explained Bujold, while the rate of false positives for the current method is twice as high: 34%, or 1 in 3.
What patients need to know.
While the ability to test for these biomarkers and calculate a person’s individual risk of developing preeclampsia is promising, these tests are not widely available yet. For now, Greves said, if you are pregnant, the most important things are to listen to your health care provider and to your body. If you are having headaches that don’t go away with Tylenol, or other symptoms, let your provider know. And if your provider asks you to take aspirin or check your blood pressure, it’s important that you follow through.
Screening can prevent some, but not all, cases of preeclampsia.
“Recognize that it doesn’t mean you did anything wrong if you have it,” Greves said. “Some people are just more predisposed than others.”
Engaging in regular physical activity, going to all of your prenatal appointments, following your provider’s recommendations and reporting any worrisome symptoms to them are things you can do to increase your chances of a healthy pregnancy, whether or not you happen to have any risk factors.