The death of Olympic sprinter Tori Bowie in May 2023 has focused attention on eclampsia, a rare and serious pregnancy-related complication. Ms. Bowie was eight months pregnant and in labor when she died. An autopsy of the 32-year-old track star identified eclampsia as a possible factor in her death.
Eclampsia is when a pregnant or postpartum patient develops seizures as a result of high blood pressure. It is an escalation of preeclampsia, which is characterized by high blood pressure associated with pregnancy and is usually accompanied by protein in the urine. While most women who develop eclampsia have been diagnosed with preeclampsia, that is not always the case. It can strike suddenly.
Preeclampsia occurs in about 1 in 25 U.S. pregnancies, and eclampsia affects less than 3% of people with preeclampsia. Both are medical emergencies, and for most patients, risk factors can be identified and managed through regular prenatal care.
Along with seizures, eclampsia can lead to confusion, disorientation, loss of consciousness, stroke, severe hypoxia, aspiration pneumonia, or coma. While most patients can recover with swift treatment, eclampsia can be fatal.
Understanding the personal and societal risk factors for developing eclampsia is key, and recognizing signs that you need to seek medical care quickly can be lifesaving.
Risk factors for developing eclampsia
The biggest risk factor for eclampsia is having preeclampsia, which can be managed through close monitoring during pregnancy, labor, and delivery. Other risk factors include:
- A first pregnancy.
- Being younger than 25 or older than 35.
- Getting limited or inadequate prenatal care.
- Having a family history of preeclampsia or eclampsia.
- Having pre-existing high blood pressure, obesity, diabetes, lupus, or other autoimmune conditions.
Race and socioeconomic status also influence pregnancy-related hypertension and potential negative outcomes. Black women are 60% more likely to develop preeclampsia than white women. And data from the Maternal Mortality and Morbidity Task Force and Department of State Health Services Joint Biennial Report revealed that Black women in Texas were more than twice as likely to die from pregnancy-related causes than non-Hispanic White women and more than four times as likely as Hispanic women.
These racial discrepancies are multifactorial, complex, and not simply a result of “biological differences.” Research has shown that Black women born in the U.S. have a higher risk of developing preeclampsia compared with Black women who immigrated here, which suggests that a combination of social and biological factors likely account for increased preeclampsia prevalence and associated risk amongst U.S.-born Black women. For example, Black women are more likely to face financial and geographical barriers to health care, limiting access to prenatal care and increasing their risk of having unmanaged conditions such as high blood pressure, which increases the risk of pregnancy complications.
Related reading: Standing against racial bias in obstetric care
Warning signs and treatment for eclampsia
When blood pressure spikes, you may not feel any different, so it’s possible not to notice the warning signs of seizures due to eclampsia. Such is the case for 20% to 38% of patients with eclampsia, according to the American College of Obstetricians and Gynecologists.
While eclampsia symptoms can be vague – the condition can strike suddenly – many women will have symptoms before having a seizure caused by eclampsia. Seek emergency medical care if you suddenly develop any of these symptoms in pregnancy:
- Severe headaches
- Vision changes, such as blurriness or seeing double
- Swelling of the hands, ankles, or face
- Difficulty breathing
- Nausea or vomiting
- Abdominal pain on the upper right side
- Mental confusion or altered behavior
Like with preeclampsia, only delivery can start the healing process in women diagnosed with eclampsia. Following a diagnosis of preeclampsia, your doctor may prescribe a magnesium sulfate infusion to prevent the development of seizures during the labor and delivery process. Magnesium sulfate infusions are typically also continued for 24 hours after delivery, since this encompasses the most at-risk time frame for eclampsia development.
Related reading: Who should consider low-dose aspirin to prevent preeclampsia?
Prenatal and postpartum care for eclampsia
Tragedies like Ms. Bowie’s death can be reduced with active, concerted work within the medical community to listen to and communicate with patients about their health and risk factors during and after pregnancy.
One of the best outlets for these conversations – and the best way to prevent eclampsia – is through regular prenatal care appointments and postpartum follow-up care. Prioritize going to these appointments. Talk with your doctor if you have barriers such as transportation or child-care needs, and we can help connect you with community resources to ease the burden.
If you develop symptoms of eclampsia, don’t dismiss them. Seek help immediately. And don’t let anyone – even a health care provider – dismiss your concerns. You know your body and you know when something isn’t right.
If you go to an emergency department, make sure they know you are pregnant or recently gave birth. Postpartum eclampsia typically happens within a few days after delivery but can occur up to six weeks later. If your blood pressure is above 140/90 and they say it’s fine, push back. That blood pressure reading may not be cause for immediate concern for most patients, but it should be investigated for pregnant and postpartum women.
Although eclampsia is scary to think about, we have a long history of caring for women with this and other high-risk pregnancy complications. We will help support and manage your pregnancy to keep you healthy and give your baby the best possible start in life.