FDA approves blood test for preeclampsia as fans mourn death of Olympian. What is this condition and what should you watch for?

The Food and Drug Administration has approved a blood test for preeclampsia, a condition that may have played a role in the recent death of Olympian Tori Bowie. She died while she was in labor. Her autopsy report included eclampsia as a possible factor in her death.

Preeclampsia and eclampsia are terms that a lot of pregnant women have heard of because the consequences can be so severe. But many aren’t sure exactly what they mean and what symptoms they should look for. 

Sarah Shea, M.D., a maternal fetal medicine specialist at MUSC Women’s Health and an assistant professor in the Department of Obstetrics and Gynecology in the College of Medicine at the Medical University of South Carolina, provides some answers in this Q&A.

What are preeclampsia and eclampsia?

Preeclampsia is a disorder of pregnancy that is most commonly seen in the third trimester of pregnancy and is associated with new-onset high blood pressure along with possible protein in the urine, as well as liver and kidney lab abnormalities , and/or patient symptoms. In many instances, it is the precursor to eclampsia. Eclampsia is the presence of a seizure in someone who has preeclampsia, and it is considered one of the most severe manifestations of the disease.

What causes it?

Despite the disease being prevalent since the beginning of time and many years of research being dedicated to the topic, it is still not entirely clear what causes preeclampsia and eclampsia to develop. Many mechanisms have been proposed, and they are similar in the idea that the root of the problem is improper development of the placenta due to abnormalities in the blood vessels that supply it. 

What effects can it have?

From a maternal standpoint, eclampsia and preeclampsia are significant causes of maternal morbidity and death, specifically in low-resource settings. Preeclampsia can lead to kidney and liver dysfunction or failure, strokes and respiratory distress from fluid buildup in the lungs.

 

Eclamptic seizures can lead to severe lack of oxygen due to respiratory depression as well as trauma. In cases of recurrent seizures, some women may experience short-term or long-term impaired memory and cognitive function. From a fetal standpoint, eclampsia and preeclampsia have an increased risk of growth issues, preterm birth and stillbirth.

From a long-term standpoint, women with a history of preeclampsia/eclampsia have an increased risk of cardiovascular disease, including high blood pressure, heart attacks and congestive heart failure.

How is it diagnosed?

Eclampsia is diagnosed when a new-onset seizure occurs in a pregnant individual that cannot be explained by an alternative condition, such as epilepsy, brain injury or drug use. It usually (approximately 80% of the time), though not always, is preceded by patient symptoms and accompanied by elevated blood pressures and/or protein in the urine, the classical findings of preeclampsia.

How common is it?

Thankfully, eclampsia is rather rare. Globally, there is an incidence of approximately 0.3%, with high-resource countries having the lowest incidence. That is partially due to our ability to detect preeclampsia and hopefully prevent progression to eclampsia, though many cases of eclampsia are not preceded by the classic signs of preeclampsia. Preeclampsia’s incidence is slightly higher, affecting approximately 2% to 8% of pregnancies globally.

Is it preventable or treatable?

Strategies to prevent preeclampsia and eclampsia have been studied extensively for over 30 years and unfortunately, to date, no intervention has been proven to be unequivocally effective at eliminating the risk of the disease. There is, however, some data to suggest that low-dose aspirin (81 milligrams daily), initiated ideally prior to 16 weeks gestation, is associated with a modest reduction in the risk of the development of preeclampsia and eclampsia.

As preeclampsia and eclampsia are thought to derive from the placenta, the only definitive cure for the disease is delivery with removal of both the fetus and the placenta. Once preeclampsia is diagnosed, whether or not delivery is recommended at the time of diagnosis or whether it is deemed safe to prolong pregnancy for the sake of an extremely preterm fetus, depends on a multitude of factors, including lab abnormalities, patient symptoms, ability to control blood pressure and fetal well-being. 

In cases of severe preeclampsia, administration of IV magnesium sulfate has been shown to be beneficial in preventing eclampsia. Eclampsia precludes the patient from expectant management and warrants initiation of magnesium sulfate and proceeding toward delivery at the time of diagnosis.

Who is most likely to develop it?

There are many risk factors for the development of preeclampsia and eclampsia. Some of the most common factors associated with the highest risk include a prior history of preeclampsia, carrying more than one fetus (twins, triplets or more), chronic hypertension (elevated blood pressures outside of pregnancy), kidney disease, diabetes mellitus and various autoimmune conditions. 

What are the symptoms to watch for?

The most common symptoms for preeclampsia and eclampsia are a headache that does not improve with the usual measures (i.e., Tylenol, snack, sleep, water), visual disturbances (mainly seeing spots or bright lights in your vision), pain in the right upper part of your abdomen and altered mental status.

Are there any new treatments on the horizon?

As the cause of preeclampsia and eclampsia is thought to stem from the placenta, there is likely never going to be a cure for the disease other than delivery. That being said, there are ongoing clinical trials that continue to look at novel pharmacological options that may help safely prolong pregnancies affected by preeclampsia.

How often do you see it in your practice?

MUSC is considered a tertiary care center with a Level IV neonatal intensive care unit, the highest level of NICU capabilities available. Due to this fact, patients who are diagnosed with preeclampsia extremely early in the third trimester are often transferred to MUSC, due to their local hospitals’ inability to care for extremely preterm infants should delivery be required. 

As a result of this, here at MUSC, the numbers of pregnancies and deliveries affected by eclampsia and preeclampsia are higher than in outlying hospitals. Of the 3,200 deliveries that we perform annually, approximately 0.1% to 0.2% are complicated by eclampsia and approximately 10% are complicated by preeclampsia.

If you’re concerned that you might have symptoms of preeclampsia, you should immediately contact your doctor.