May: Postpartum Preeclampsia
Written by Paityn Edwards and Alka Dev
Point of View:
RACE AS A SOCIAL CONSTRUCT SHOULD NOT BE CITED AS A RISK FACTOR FOR PREECLAMPSIA
In a letter to the editor, Camille A. Clare, MD, MPH, takes issue with the inclusion of “Black race” under risk factors, stating how race is a sociologic construct, not based on genetics or biology, and declares that the perpetuation of race as a biological construct leads to the disregard of strategies to address racism and mitigate health disparities, worsening maternal morbidity and mortality. She ends her letter with a call to action, “The inclusion of racially and ethnically diverse members of editorial boards, journals, and scientific study sections can note these race-based views in medicine and eliminate them before publication, thereby preventing the furtherance of racially based notions of biological differences.” See ‘Scientific Publication’ for a summary of the original article.
Resource:
PREECLAMPSIA FOUNDATION
The Preeclampsia Foundation aims to improve the outcomes of hypertensive disorders of pregnancy by educating pregnant and birthing people, supporting and engaging the community, and improving healthcare practices and research to find a cure. They have trained 100,00 healthcare providers in best practices for hypertensive patients, distributed 3 million patient-focused educational materials, and invested 1.5 million dollars in preeclampsia research. As of 2021, the Preeclampsia Foundation’s research goals are: to fund novel research and move promising research forward; to actively engage the patient perspective and experience in research studies, to catalyze the research field through funding, advocacy, and awareness; to communicate research results to our community.
News Story:
“Knowing Her Story Saved My Life:” Twins Suffer Postpartum Preeclampsia
Samantha began her first pregnancy with an understanding of her increased risk of preeclampsia due to her twin sister, Ilana’s experience 37 weeks post-partum, and their older sister Gabby’s history of preeclampsia. When Samantha discovered she was pregnant, Ilana was six months along in her own pregnancy. She made sure to reiterate the importance of advocating for herself throughout her pregnancy, especially due to their family history. Samantha shares, “I went into my first Ob/Gyn appointment with the details of Ilana’s experience and her provider’s advice for me at the ready… My obstetrician decided that we’d monitor it as we went, but not to put me on aspirin.” Samantha continued her pregnancy focused on self-monitoring her blood pressure (BP) and staying active. Unfortunately, due to her own OB going on maternity leave, the various other doctors she met with throughout pregnancy did not make an effort to acknowledge her concerns.
Ilana delivered a healthy baby, then spent six days in the hospital due to high BP, and was given the same medications as her previous pregnancy. By Samantha’s 37-week appointment, her blood pressure was elevated enough for her care team to do a 24-hour urine collection test for protein. Her provider decided to induce Samantha who delivered a healthy baby, and the care team assumed they caught her preeclampsia in time to prevent any postpartum complications. Samantha wasn’t so sure. She had to advocate for herself many times, asking for her BP to be checked before they tried to discharge her. Her fears were correct, her BP was still high, and her provider put her on magnesium. In reflection of her induced delivery Samantha shares, “ I was induced on the day I was because when I went to get the jug for my 24-hour urine test, I insisted I wasn’t feeling well and that I needed to be seen by the OB. Looking back, I feel aghast that my provider was willing to wait over the weekend to do the test, even after he’d urgently called me back to the office to do a second blood pressure check… So, when your body is insisting that you are not well, you insist, insist, insist at the nurses and doctors. Stand your ground.” While this story sounds unique because of twins expecting at the same time, the difficulty of going through post-partum preeclampsia is not. Scenarios like this are why these sisters and other women with similar experiences hesitate to plan future pregnancies.
Scientific Publication:
Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy
The authors call for improving the terminology surrounding postpartum preeclampsia (PE) onset within the first 48 hours after delivery as well as delayed-onset postpartum PE, which has traditionally been defined as new-onset PE between 48 hours to 6 weeks after delivery. Postpartum PE can develop after a pregnancy with no prior hypertensive disorder or after a pregnancy complicated by gestational hypertension or in women with underlying chronic hypertension. The prevalence varies considerably (between 0.3% and 27.5%), perhaps due to milder symptoms that get treated by providers who are unfamiliar with the disease. The authors propose that further study is needed to determine if new-onset postpartum PE or eclampsia is a distinct entity from PE with antepartum onset. The presence of any severe features (including severely elevated BP in women with no history of hypertension) should be referred to as postpartum PE after the exclusion of other etiologies. They suggest removing the term “mild preeclampsia” from current guidelines to capture the considerable maternal morbidity associated with pregnancy-related hypertension, and only using postpartum hypertension for women with nonsevere hypertension, and no other end-organ involvement. Among risk factors, the authors list demographics (older age, Black race, and maternal obesity) and intrapartum factors (cesarean delivery, higher rates of intravenous (IV) fluid infusion on labor and delivery). It is the designation of Black race as a risk factor that is disputed by Dr. Clare (see ‘Point of View’).
