What you need to know about eclampsia

On Tuesday, an autopsy report shared with The New York Times found Olympic sprinter Tori Bowie, who was found dead in May, was eight months pregnant and in labor at the time of her death. She was 32 years old. The report identified complications of childbirth as the cause of death, citing eclampsia and respiratory distress as possible factors.

“Eclampsia occurs in 1 to 10 in 10,000 pregnancies,” says Dr. Joanne Stone, chief of the division of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai. Research has suggested that the number of gestational hypertensive conditions – including preeclampsia, eclampsia and gestational hypertension – is rising and increasing during the Covid-19 pandemic.

What is Eclampsia?

Eclampsia is when a pregnant woman has seizures due to severe hypertension, said Dr. Monica Longo, a medical officer in the pregnancy and perinatal division of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which is associated with the National Institutes of Health.

It can be diagnosed before, during and up to six weeks after birth. Some researchers think the seizures may be caused by the blood vessels in the brain no longer being able to automatically regulate blood flow, said Dr. Stone, but that’s not well established. There may be other causes of seizures during pregnancy, but it’s considered eclampsia “until proven otherwise” through lab tests, including neurological tests, said Dr. Longo.

Preeclampsia can be a precursor to eclampsia, but not always, Dr. Stone said.

Preeclampsia consists of severe hypertension during pregnancy, with elevated blood pressure (a top number of 140 or higher, or a bottom number of 90 or higher) and is usually accompanied by protein in the urine. While the cause remains unclear, preeclampsia is believed to be caused by dysfunction in the blood vessels of the placenta, which can cause hypertension in the mother. It usually develops after 20 weeks of pregnancy, according to the American College of Obstetricians and Gynecologists.

Both preeclampsia and eclampsia can be fatal, accounting for about 8 percent of all pregnancy-related deaths between 2008 and 2017, and 11 percent of black mothers’ pregnancy-related deaths during that period, according to the Centers for Disease Control and Prevention. The conditions can also lead to it health complications later in lifeincluding an increased risk of stroke, heart attacks and kidney disease.

What are the risk factors for developing eclampsia?

Several risk factors are associated with preeclampsia and eclampsia, including getting pregnant over age 35 and having a family history of preeclampsia, as well as diabetes and obesity, said Dr. Stone.

But being black is one of the strongest predictors of developing these conditions, she said, anyway social economical status and even overall fitness level. Studies have shown that higher incomes don’t protect black mothers of developing preeclampsia in the way they protect white women, and in fact still high-income black women have a higher risk of developing complications related to preeclampsia than low-income white women.

One reason for the disparity is that having chronic hypertension – a condition that is more common in black women — before pregnancy increases the risk of developing related complications during pregnancy, said Dr. Stone.

What are the symptoms?

While there are several warning signs of preeclampsia — including headaches that don’t subside and seeing spots or blurred vision — eclampsia is more difficult to watch for. According to the American College of Obstetricians and Gynecologists, between 20 and 38 percent of patients with eclampsia do not develop the classic signs of preeclampsia before the onset of attacks. When a pregnant woman has seizures, she needs immediate medical attention.

Can You Control Eclampsia?

Medication can control seizures in a woman with eclampsia. But ultimately, in severe cases of preeclampsia and eclampsia, the only solution is to deliver the fetus or terminate the pregnancy, Dr. Longo said. “The moment she starts having seizures, there’s no looking anymore,” she said.

“This is a disease of the placenta and unfortunately — no matter how many scientists have looked at it — we don’t have a clear understanding of what’s going on,” she said. “So delivery of that placenta is fundamental.”