Why Preeclampsia, a Life-Threatening Pregnancy Complication, Is on the Rise

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Original Article: Why Preeclampsia, a Life-Threatening Pregnancy Complication, Is on the Rise Convert your long form article to podcast? Visit SendToPod Follow me on Twitter to find out more. ---- It’s impossible to pinpoint when ob-gyns sensed that preeclampsia—a surge in blood pressure in the later stages of pregnancy that endangers both mother and baby—was increasing among their patients during the COVID pandemic. Preeclampsia affects some two hundred thousand pregnant people in the U.S. per year, and case numbers had been ticking steadily upward for a couple of decades (although some of this increase was attributable to improvements in how doctors diagnose the disease). But this seemed to be more than an uptick; this felt like a jump. Physicians describe not a eureka moment but a creeping realization, a longitudinal hunch. Group texts and Facebook forums lit up with talk of more patients whose labor had to be induced early owing to blood-pressure spikes; doctors told one another that they were seeing more preterm births and more stillbirths. “Right away, there was chatter about more hypertension and preeclampsia being noticed in the COVID hot spots,” Jennifer Jury McIntosh, a maternal-fetal-medicine specialist in Milwaukee, said.The coronavirus attacks endothelial cells, which form the cellophane-like lining of blood vessels. Ob-gyns began to suspect that the virus affects the vessels of the placenta, which ferries oxygen and nutrients to the fetus. Inflammation, clotting, and other vascular damage in the placenta put the baby at risk for not getting enough oxygen; the baby’s growth may slow, or stop. The same damage is also believed to trigger preeclampsia and other hypertensive disorders in the mother, which can impair the liver and kidneys, trigger strokes, and even result in death. The closest thing to a surefire remedy is to deliver the placenta, which means inducing labor. In the earliest and most severe cases, which occur before or at the threshold of fetal viability, the treatment for preeclampsia is termination of the pregnancy.“We were seeing an increase not only in preeclamptic patients but the severity of preeclampsia,” Alison Petraske, an ob-gyn in Princeton, New Jersey, said. These outcomes, Petraske went on, appeared to have a common denominator. “It’s a general feeling: preeclampsia, intrauterine-growth restriction, later miscarriages, stillbirths—all of it is placental.”More than two years into the pandemic, the general feeling is solidifying into data. A study of more than three hundred thousand women in England, conducted in 2020 and 2021, showed that patients who were infected with COVID when they gave birth had higher rates of preeclampsia, emergency C-sections, preterm birth, and stillbirths. Similar findings were reported in a National Institutes of Health study of pregnant people in the U.S. who experienced severe COVID symptoms and also by the INTERCOVID study, which involved more than two thousand pregnant women in eighteen countries, and which showed a strong correlation between COVID infection and preeclampsia and preterm birth, especially for first-time mothers. That study also indicated that COVID infection nearly doubled a pregnant person’s chances of developing HELLP syndrome, an extreme variant of preeclampsia that ravages the liver. Perhaps the most startling study examined sixty-four stillbirths and four neonatal deaths—all of which involved unvaccinated mothers—across twelve countries, and found that COVID could lead to a novel inflammatory disorder, SARS-CoV-2 placentitis, which causes “widespread and severe placental destruction.”Brigham and Women’s Hospital, in Boston, has maintained a biobank of blood and urine samples from pregnant volunteers, collected at various stages of gestation, since 2006. The specimens, kept in deep-freeze storage, serve as a research platform for studying all manner of pregnancy complications. Thomas McElrath, a maternal-fetal-medicine physician at the h...