Thirty-two weeks into her first pregnancy, Katie Love began to notice some startling changes that she couldn’t explain.
Suddenly, her shoes no longer fit. She had difficulty walking, and she noticed increased swelling in her ankles and face. Her fingers were numb, making work difficult.
It was April 2020, and UPMC Magee-Womens Hospital had transitioned patients to telemedicine visits as a precaution amid the COVID-19 pandemic. As part of the transition, expectant mothers were given blood pressure cuffs for home monitoring.
While on a televisit with her doctor, Katie reported her new symptoms, and her doctor asked her to take her blood pressure while they were on the call. Her systolic pressure jumped from a normal reading of 110, which it had been throughout her pregnancy, to a startling 160. (Normal systolic pressure ranges between 90 and 120.)
“I don’t want to alarm you, but I think we need to end this visit, and you need to come get checked in,” her doctor said, adding that Katie should pack a bag in case she needed to deliver.
When Katie arrived at the hospital, the staff monitored her blood pressure every 15 minutes for about six hours and kept her calm. Finally, she had a diagnosis: preeclampsia, a serious condition affecting about 8 in every 100 pregnant women. Characterized by high blood pressure and protein in the mother’s urine, it is also a leading cause of premature birth, according to Dr. Janet Catov, an associate professor at Magee-Womens Research Institute, who has been studying preeclampsia for about 15 years.
“About a quarter of all premature births are really due to preeclampsia, so it’s a very strong predictor,” Dr. Catov says, adding that around the U.S. and worldwide, preeclampsia is the single largest contributor to maternal mortality: “The really scary thing about preeclampsia is that it can go very bad, get very serious, very quickly.”
Managing the condition then becomes a delicate balance between the health of the mother and the health of her baby.
“It was stressful to hear two months out,” says Katie, a former television news reporter who now owns a social media business. After her diagnosis, she went to the hospital twice a week for blood pressure measurement and an ultrasound.
“I know as a mother you don’t really have any control when you go into labor, but to constantly feel that it might be too dangerous for the baby to stay inside … I wasn’t sleeping,” Katie recalls.
Finally, at 37 weeks, doctors induced her. Her daughter, Adley, was born May 8, 2020. When the staff placed her on Katie’s chest, Adley grabbed the sensor on her mother’s finger: “It was the most amazing feeling,” Katie says.
But the journey wasn’t over; Adley’s glucose levels were low, and she was jaundiced, which can lead to potential complications if left untreated. She spent a week in the hospital’s neonatal intensive care unit. Today, mother and baby are healthy, though no cause for Katie’s preeclampsia was ever found.
Dr. Catov says Katie’s experience reflects much of the uncertainty that surrounds preeclampsia, despite how common a condition it is. While there are known risk factors such as high blood pressure prior to pregnancy, not all women who have that risk factor develop preeclampsia. It also plays a significant role in health disparities; Black women are about two to three times more likely to develop the condition and also more likely to have a severe form. Because preeclampsia is a strong contributor to prematurity, it is also linked to infant mortality disparities; preterm birth rates were 50 percent higher among Black women (14.4 percent) in 2019 than among white or Hispanic women, according to the U.S. Centers for Disease Control.
“It is really a syndrome where a lot of systems are compromised. And yet we actually don’t yet know all the causes or have a preventive strategy,” she says.
But there are some known aftereffects: women who had preeclampsia are three to four times more likely to have high blood pressure after pregnancy as soon as five years after delivery, and two to three times more likely to have a heart attack later in life than women who have not been affected, Dr. Catov says.
Her group is exploring the link between preeclampsia and later cardiac disease to see whether it yields new insights that could lead to possible preventive efforts.
Dr. Catov also oversees the Steve N. Caritis Magee Obstetric Maternal & Infant (MOMI) Database & Biobank, which collect biosamples and information about pregnant women, including those with preeclampsia. Dr. Catov hopes the samples will help researchers both within and external to Magee to identify biomarkers that might help predict preeclampsia.
“As we study what goes wrong, we believe there will be clues, very early in pregnancy — subtle, but important. What would be ideal would be if we had a screening test early in pregnancy,” she says. “I’m hopeful that we’re getting closer.”
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