She was only 32 years old and about to become a mother. American sprinter Tori Bowie, Olympic vice-champion in the 100 meters in 2016 in Rio then world champion in 2017, died in early May at eight months pregnant, when labor had already begun. According to the autopsy report released a few days ago by several American media, the young woman died of eclampsia, which results in potentially fatal seizures associated with high blood pressure.
Extremely rare, eclampsia is a complication occurring in the event of preeclampsia, a much more frequent condition which manifests itself by a set of symptoms and must be taken care of as early as possible. But how ?
What are the risk factors for preeclampsia?
“The pregnant women most at risk of preeclampsia are those who have a multiple pregnancy or medically assisted procreation with sperm donation”, details the Health Insurance. There are other factors, such as “a history of preeclampsia, chronic hypertension, kidney disease or diabetes, family history of preeclampsia (mother, grandmother…), polycystic ovary syndrome (PCOS) , an autoimmune disease, a change of sexual partner or an insufficiency in the exposure of the sperm of one’s partner (prolonged wearing of a condom)”, adds Inserm.
And “nulliparous women [n’ayant pas d’enfant] are more at risk than others, they represent 70 to 75% of cases of preeclampsia, adds Dr. Odile Bagot, gynecologist and author of the Mam gyneco blog. Age – being over 40 or under 18, as well as obesity with a BMI over 30, are high risk factors for preeclampsia”.
If the precise causes of this condition have not yet been identified, other social factors could favor its occurrence. In the United States, country of athlete Tori Bowie, a study published in 2021 in the Journal of the American Medical Association (JAMA) shows that across the Atlantic, black women born in the country have a higher risk of suffering from preeclampsia than black women from other countries who have emigrated to the United States. “Social determinants of health also play a role in maternal health, and recent studies have implicated housing instability and food insecurity in blood pressure disorders and other pregnancy complications,” THE New York Times. Disparities in access to health care services [dont sont statistiquement plus victimes les femmes noires aux Etats-Unis] can also play a role.
What are the symptoms of the illness ?
“Preeclampsia, or severe dysgravidism, is pregnancy hypertension, which occurs in women who have never had it before, which generally begins at the beginning of the third trimester of pregnancy”, explains Dr. Bagot. It is manifested “by metabolic problems: severe headaches, signs of high blood pressure, significant edema with the impression of swelling suddenly and very sudden weight gain. And, more seriously, abdominal pain under the ribs, an imminent sign of complication, ”lists Professor Françoise Coux, obstetrician-gynecologist.
In this case, “there is also a presence of proteins – albumin – in the urine, continues Dr. Bagot, which can be measured with urine strips. And the patients frequently testify to phosphenes, small luminous points in front of the eyes”.
How to prevent and manage preeclampsia?
“To date, preeclampsia is well diagnosed in France, so it is extremely rare for it to develop into eclampsia. The disappearance of this athlete is therefore all the more surprising. However, there is no treatment, says Dr. Bagot. Thus, the prevention of the disease and its complications requires screening for dysgravidism as soon as possible, with a monthly examination throughout pregnancy with blood pressure measurement and control of proteinuria in the urine”.
When the diagnosis is made, “the future mother is hospitalized and watched like milk on fire. The care must be extremely fast and requires terminating the pregnancy, recalls the obstetrician-gynecologist. The only treatment is to induce labor or, in the event of severe preeclampsia, to carry out an emergency caesarean section”.
In France, “1 to 2% of pregnancies are accompanied by preeclampsia, specifies the Health Insurance. In 10% of cases, it progresses to a severe form”.