In Wake of Tori Bowie's Death, Doctor Warns Preeclampsia 'Spares No One'

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U.S. Olympic champion sprinter Tori Bowie died last month due to complications of childbirth, according to a report from the medical examiner in Orlando, Florida.

The medical examiner's report said 32-year-old Bowie was estimated to be 8 months pregnant and had shown signs of undergoing labor when she was discovered dead on May 2. Bowie had been found in bed in a "secured residence" with possible complications including respiratory distress and eclampsia, according to the report.

MedPage Today spoke with cardiologist Evelina Grayver, MD, who heads the Women's Heart Program at Northwell Health's Katz Institute for Women's Health, as well as the health system's cardiovascular obstetrics program. Grayver weighed in on how such tragic outcomes of pregnancy can occur, including in individuals who appear to be in remarkable physical condition, and what efforts can help in terms of early detection and treatment.

"This is an insanely unfortunate case," Grayver said. "It's really frightening."

The U.S. continues to lose more women due to maternal and pregnancy-related deaths -- including those in the first year following pregnancy -- than other developed countries, Grayver said.

Additionally, racial disparities have persisted, with Black women comprising a disproportionate number of maternal deaths nationwide, as MedPage Today previously reported.

Cardiovascular complications are driving the alarming maternal mortality rate, Grayver said. Preeclampsia, in particular, is a hypertensive condition that can occur during and after pregnancy. It affects about 1 in 25 pregnancies in the U.S.

Some women can go on to develop the related condition, eclampsia, which is often characterized as a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure, and even death of the mother and/or baby.

While there are certain risk factors for developing preeclampsia, "it actually spares no one," Grayver said. African American women have been found to be at higher risk, she noted, as have women with a history of high blood pressure, kidney disease, or an autoimmune disorder.

People think, "if you're thin, you're fit, and there's no family history ... that spares you," Grayver said. But that's not necessarily the case, she noted.

In the case of Bowie, the public doesn't know of any potential underlying conditions or family history, but as an elite athlete, she is perceived as active and fit -- someone who might consider themselves risk-free, she said.

For Grayver, it all comes back to increasing awareness.

When she launched the cardiovascular obstetrics program at Northwell in September 2020, one of her first efforts focused on educating other colleagues on the specific risks for women during and after pregnancy and on the need for specialized care.

During visits, she informs patients of all of the symptoms to watch for, including how to appropriately take and monitor blood pressure at home and how to gauge the appropriate weight gain during pregnancy.

If a patient suddenly becomes very swollen and has gained 5 pounds overnight, that's not normal, she said. Additional warning signs of preeclampsia can include shortness of breath, headache, blurred vision, and sensitivity to light.

"They're vague, and because of the fact that they are vague, people [may] feel this is just pregnancy-related," she said.

"My greatest pet peeve," Grayver said, "is to hear someone say [that a symptom] is pregnancy-related."

Shortness of breath or swelling of the hands, feet, or face should never be downplayed until the pregnant person has seen an expert to rule out cardiovascular issues, she added.

"The most important thing is to make sure that women are aware," Grayver said, "that women do not dismiss their own symptoms."

Grayver noted that after a complicated delivery, she sees her patients "aggressively" for 6 months. There can be risk for seizures and stroke during this time, she said. Following that period, she continues baseline cardiovascular testing on an annual basis and makes sure patients fully understand their risk and lifestyle modifications that may help to mitigate that risk.

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