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Diagnosing preeclampsia

NBC News medical correspondent Robert Bazell reports on a very common and potentially life-threatening condition in pregnant women.
/ Source: TODAY

Preeclampsia is a syndrome marked mostly by high blood pressure and protein in the urine and it can threaten the life of both the mother and the baby. It is responsible for 15 percent of the premature births in this country and is a leading cause of maternal death. NBC medical correspondent Robert Bazell reports on how this life-threatening condition affected one family.

REBECCA JOHNSON IS 8-months pregnant. But for her and her husband Andrew Smith, it has been a period of enormous anxiety. That is because 26 weeks into her first pregnancy she was struck with intense nausea and high blood pressure. The diagnosis: severe preeclampsia. The only hope to save the child is a caesarian section at a very premature stage.

Rebecca says, “I very clearly remember asking my doctor, ‘What’s his best chance?’” And she said his best chance is to come out. So I said ‘yes.’”

The baby, named Luke, was born weighing only 1.1 pounds. Despite heroic efforts in a neonatal intensive care unit, he died after four days.

Preeclampsia only strikes women during pregnancy. Once the pregnancy ends the problem goes away. But Rebecca, a writer and editor, was determined to find out more.

“It was just crucial for me to understand what had happened.”

Her efforts ended up as a cover story in the New York Times Magazine. Her research started with origins of the word itself.

“It’s derived from the Greek for “eclampsia” which is — a sudden — bolt of lightning. And that’s what it was like. It was like this sudden bolt of lightning had come out and knocked me down.”

Dr. James Roberts of the University of Pittsburgh and Magee Women’s Research Institute, an expert on the condition, says doctors still do not know the cause but they do know the severity of the condition can vary enormously.

“Some women within 24 hours will be deathly ill and some women, the disease will sort of linger, very slowly progressing over several weeks. And it’s one of the real challenges of caring for women with the disease is deciding, you know, when’s the time to quit.”

Deciding when to quit — that is delivering the baby — remains the primary treatment.

Some would think Roberts is practicing an almost 19th century medicine to treat this disease.

“It’s a little embarrassing to admit that. I mean, basically how we manage women right now is the same general approach we had previously, which is we do our best to decide whether the baby is safest delivered or undelivered.”

In their labs, Dr. Roberts and his team are searching for possible new treatments. A big obstacle is that neither doctors nor drug companies are eager to give medicines to pregnant women for fear of harming the child.

The National Institute of Health IS now beginning a study of 10,000 women to find out if very large doses of vitamin E and C might safely cut the risk of preeclampsia. It will take years to know the results. Meanwhile scientists are looking for any clues to diagnose the condition at its earliest stages.

Doctors emphasize that preeclampsia can strike any pregnant woman — but there are certain conditions that put them at greater risk.

A history of high blood pressure, kidney disease or diabetes — the biggest factor of all though is a previous pregnancy with the condition — giving women a 50 percent chance it will strike again.

Still, Rebecca Johnson wanted to try again to have a healthy child.

“Those are not good odds. And I remember looking at this one doctor and she said many women in your position choose not to do it or to find a surrogate.”

Eventually Rebecca found Dr. Mary D’Alton, an expert on high risk pregnancy at Columbia — Presbyterian Medical Center in New York.

D’Alton says, “I was reasonably optimistic that with careful monitoring she could get to a gestational age where it would be safe to deliver her baby although I certainly couldn’t promise that. And then Rebecca was aware of that.”

Rebecca and Andrew decided to take the chance. Weekly tests to monitor Rebecca’s blood pressure and measure the baby’s growth helped doctors watch for a possible return of preeclampsia.

Fortunately, in Rebecca’s case, it did not return. Baby Simon was born last month, weighing 6 pounds 3 ounces.

“He just looked so different from Luke — from how Luke had looked. And you know, I just felt this wash of relief and happiness,” says Rebecca.

Andrew Smith: “I think in our case we were very lucky. Despite all of the things in the last two years — we have a beautiful baby boy.”