What is eclampsia, the condition that may have contributed to Olympian Tori Bowie’s death?

By Sandee LaMotte, CNN

(CNN) — American track and field champion Tori Bowie, who won gold, silver and bronze medals in the 2016 Olympic Games, died of pregnancy complications that may have included eclampsia, according to an autopsy report. Bowie was found dead in her bed May 2 while approximately eight months pregnant.

Eclampsia, which is characterized by one or more seizures during pregnancy or in the postpartum period, develops from preeclampsia, according to the US Centers for Disease Control and Prevention.

Preeclampsia occurs when pregnant women with normal blood pressure suddenly develop high blood pressure, protein in their urine and other complications after 20 weeks of pregnancy, the CDC said.

“You are at an increased risk if you’re Black, if you are overweight, or if you have underlying health conditions. But it can develop in anyone, including someone who’s thin and super healthy,” said Dr. Nicole Calloway Rankins, a maternal health advocate and obstetrician-gynecologist in Richmond, Virginia.

Treatment is critical

Preeclampsia stresses the heart and can cause fluid to build up in the lungs, according to the Cleveland Clinic. The stress on circulation can affect blood supply to the placenta and impair the liver and kidneys — high protein levels in the urine indicate kidney dysfunction.

Left untreated, eclampsia seizures can occur, which can result in brain damage, coma and possible death for the mother and fetus, the CDC said.

“Eclampsia is rare — it may occur in about 1% of pregnancies compared to the 3% to 5% risk of preeclampsia and hypertensive disease,” said maternal-fetal medicine specialist Dr. Antonia Oladipo, assistant professor of obstetrics and gynecology at Hackensack Meridian School of Medicine in New Jersey.

Eclampsia comes from the Greek word for lightning, as it can strike as quickly as lightning, said Eleni Tsigas, CEO of the Preeclampsia Foundation, an advocacy and research organization based in Melbourne, Florida.

“But we know that in most cases, there is a lead-up that may just not be recognized, such as a severe headache from blood pressure climbing to dangerous levels, or extreme swelling in the lower extremities and visual disturbances,” she said.

Much is not known about the circumstance of Bowie’s pregnancy and death. However, it is “theoretically possible that she had an eclamptic seizure, and just didn’t recover from that,” said Rankins, who also hosts the podcast “All About Pregnancy & Birth.”

The autopsy report from the office of the medical examiner in Orlando, Florida, ruled Bowie’s manner of death was natural, with possible complications from pregnancy including “respiratory distress and eclampsia.”

Eclampsia “is not a death sentence. The problem with this story is that Tori obviously wasn’t in the hospital,” Tsigas said.

“We’ve learned how to treat eclampsia and preeclampsia with antihypertensive medications and with magnesium sulfate to prevent seizures,” Tsigas added. “There absolutely are interventions that can and should be used to prevent the mother dying and it’s unconscionable that did not happen in this case.”

Preeclampsia risk and symptoms

One of the most common complications of the latter half of pregnancy, preeclampsia is most likely to occur during a first pregnancy, according to the National Institutes of Health. Existing medical conditions such as diabetes, hypertension, kidney disease, lupus and obesity can also raise risk, as does being older than age 35, carrying multiple fetuses or having preeclampsia in a former pregnancy. A family history of preeclampsia and having a child via in vitro fertilization is another risk factor.

Signs of preeclampsia include headaches, abdominal pain on the right side of the body, swelling in the ankles, feet, hands and face due to water retention, shortness of breath, and dark spots or blurry vision and sensitivity to light, the Cleveland Clinic notes on its website.

However, high blood pressure, often called the “silent killer,” does not always show signs, so the best prevention is regular checkups and blood pressure readings throughout pregnancy, experts say. The only cure for preeclampsia is giving birth, according to the Cleveland Clinic.

More dangerous during pregnancy

Preeclampsia is defined as blood pressure readings starting at 140 mm Hg (systolic) over 90 mm Hg (diastolic), Tsigas said: “From there, it continues to go up and when you’re 150/90 or 160/100, you’re in severe range levels for pregnancy. That’s literally a hypertensive crisis.”

For people worried about heart disease, blood pressure at those levels would be concerning, but not a crisis. What is it about pregnancy that makes high blood pressure so dangerous?

“It has to do with the physiology of the pregnant body — it cannot handle high blood pressures without risk for seizures and stroke,” Tsigas explained. “Blood volume goes up, small blood vessels and capillaries thin — one of the reasons pregnant women look bloated.

“Capillaries become much more vulnerable in pregnancy and less able to withstand high blood pressures,” she continued. “And what is happening to the capillaries and fluid volume also affects the brain — now you’re talking about leaky vessels in the brain.”

The body does not go back to normal immediately after birth, meaning that a 140/90 blood pressure during that period can be just as dangerous as during pregnancy, Tsigas said.

“We really have to be vigilant and understand that blood pressure in pregnancy is different than outside of pregnancy. We all know about women going to the emergency room where physicians are not familiar with pregnancy-related blood pressure and then don’t get the right treatment,” Rankins said.

Women and their loved ones should advocate for adequate care, “especially if you’re from a marginalized community,” Rankins said. “Speak up and say, ‘Hey, I feel like something’s not right. Could I be at risk for preeclampsia? Are these things that I need to be worried about?’”

US leads in maternal deaths

The United States has the highest maternal death rate of any developed nation, according to a 2022 report from The Commonwealth Fund, a US foundation that says it advocates for a high-functioning, equitable health care system.

“Black women are three times more likely to die from a pregnancy-related cause than White women,” according to the CDC, due to variations in the quality of health care a woman receives due to structural racism and bias. In the United States, about 6.9 million women have little or no access to maternal health care, according to the March of Dimes.

“A high rate of cesarean sections, inadequate prenatal care, and elevated rates of chronic illnesses like obesity, diabetes, and heart disease may be factors contributing to the high U.S. maternal mortality rate. Many maternal deaths result from missed or delayed opportunities for treatment,” Commonwealth Fund researchers wrote in the report.

President Joe Biden has signed one of 13 bills that are part of the Black Maternal “Momnibus” Act of 2021, designed to provide pre- and post-natal support for Black mothers, including extending eligibility for certain benefits postpartum. The Century Foundation, a progressive, independent think tank, is tracking progress on the other bills

However, the Covid-19 pandemic has only made the maternal mortality crisis worse in the US, according new federal data released in March. Data showed that 1,205 women died of maternal causes in 2021 — a significant jump from 861 in 2020.

The racial disparity remains evident: In 2021 alone, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.

“The new data from the NCHS (National Center for Health Statistics) also show a nearly 60% percent increase in maternal mortality rates in 2021 from 2019, just before the start of the pandemic,” Dr. Iffath Abbasi Hoskins, president of the American College of Obstetricians and Gynecologists said in a statement in March.

“The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was — and still is — already a maternal mortality crisis,” Hoskins said.

“Just as concerning are worsening racial health inequities and the fact that pregnant and postpartum Black people continue to make up a disproportionate number of maternal deaths at growing and alarming rates. This trend must be stopped.”

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