Blood-pressure condition puts new moms increasingly at risk
Conventional wisdom might have predicted the early hours of July 21, 2010, would be hectic for 43-year-old Joan Donnelly.
She and her husband, Todd Heiden, had just added a newborn — and round-the-clock feedings — to the Ocoee household they shared with their two other children.
Donnelly was recovering from a pregnancy plagued by doctor changes, diabetes and a lesserknown hypertensive disease for which delivery is widely considered the cure: severe preeclampsia. Baby Max had arrived days earlier, weighing 9 pounds and 9 ounces a month before his due date.
Physicians, researchers, activists and legislators across the U.S. are working to understand why preeclampsia is rising faster than other chronic conditions and how to prevent it.
That night, at 12:15 a.m., Don-
nelly woke up Heiden for a different reason.
“I need your help. I need your help,” she told him.
Within minutes, Donnelly began shaking and gasping for breath.
In the seven minutes it took emergency responders to arrive, she passed out. After 25 minutes of medical intervention, her heart began beating again. But Donnelly’s brain — the organ that drove her love of Disney, animals and kids — had been without oxygen too long. About two days after her family withdrew life support, she died Aug. 6.
“The happiest time in a woman’s life is not her family planning her funeral. It’s planning a baptism; it’s planning a birthday party,” said Donnelly’s sister, Kerry Donnelly, 55, of Orlando. “In this modern age, she shouldn’t have died.”
Donnelly’s autopsy said she died of postpartum eclampsia, a violent progression of preeclampsia.
According to Dr. Anupam B. Jena, internal medicine physician and professor at Harvard Medical School, and his colleagues, preeclampisia increased “from 2.4 percent of pregnancies in 1980 to 3.8 percent of pregnancies in 2010.”
“We don’t really know much about how preeclampsia impacts both the short-term and longterm health of mothers and their infants on a national scale,” said Jena, the co-author of a recent study that will appear in the American Journal of Obstetrics & Gynecology’s September issue.
Jena’s study said preeclampsia increases the rate of medical complications for women and their infants by 5.5 and 7.6 percent, respectively. Care for preeclamptic mothers and infants in the year after delivery “cost the U.S. health care system an additional $2.18 billion” in 2012.
About 4.6 percent of the pregnant women that Orlando Health treats have diagnosed preeclampsia, spokeswoman Alayna Curry said. Orlando Health reported 14,317 deliveries in 2016. Dr. Christine Greves, an ob-gyn at Winnie Palmer Hospital for Women & Babies, says she sees the condition “pretty much every time I’m on call.”
Meanwhile, Florida Hospital providers in Central Florida had 593 cases in 2016.
Symptoms include headaches, nausea and vomiting, according to the Mayo Clinic. However, women may routinely experience such reactions during pregnancy, which can make the condition challenging to diagnose.
Other soon-to-be moms might not have any symptoms, according to Dr. Ashley Hill, Obstetrics Medical Director at Florida Hospital for Women in Orlando.
“Preeclampsia is one of those diseases that has a lot of variation. It’s not onesize-fits-all,” Hill said.
Donnelly was just excited to have her baby. The eighth of nine children in a tightknit blue-collar West Virginia family, she “had always wanted kids,” according to Heiden, now 51, who already had a daughter. The couple underwent in vitro fertilization and welcomed Sofie, 9, in 2008. In 2009, Donnelly suffered a miscarriage. Max, 7, was born the following year.
During his 23 years of practicing in Central Florida, Hill has seen an increase in the number of women who develop preeclampsia. He thinks several trends may be to blame.
One trend is that women are waiting longer to have children. Those older than 40 are more likely to develop preeclampsia, as are extremely young mothers, the Mayo Clinic says.
Being overweight, also a rising condition, is another preeclampsia risk factor, Hill said.
Finally, couples are increasingly turning to in vitro fertilization to get pregnant, according to Hill. IVF inflates a woman’s likelihood of having multiple babies at once, making her pregnancy more liable to preeclampsia.
At 32 weeks, Donnelly developed a potassium deficiency, sparking weeks of worrying symptoms, doctor’s visits and hospital transfers. On July 14, 2010, she was diagnosed with severe preeclampsia and admitted to Winnie Palmer Hospital in Orlando. Two days later, a cesarean section prompted by the beginnings of eclampsia brought Max into the world.
Both Winnie Palmer and Florida hospitals have protocols designed to help detect patient hypertension and preeclampsia, Greves and Hill said.
Still, Donnelly’s family said they think the resources she received were insufficient.
Through telling her story, they hope to prevent other deaths. At Donnelly’s funeral, they met Eleni Tsigas, a preeclampsia survivor and executive director of the Melbourne-based Preeclampsia Foundation. She said Donnelly’s story was heartbreaking.
“You don’t often hear about a mother dying of preeclampsia, and then when it happens in your own backyard. … I couldn’t not go,” Tsigas said.
In 2016, about half the states had boards in place to scrutinize maternal deaths, according to The Pew Charitable Trusts. Tsigas’ foundation is calling for federal legislation that would help other states implement similar programs, as well as strengthen existing boards in places such as Florida.
“It’s enabling all states in the country to follow these same steps, analyzing cases and taking action to prevent future death,” Tsigas said.
U.S. Rep. Stephanie Murphy, D-Orlando, is co-sponsoring the House version of the legislation, titled the Preventing Maternal Deaths Act of 2017.
“I strongly believe that childbirth should be a beautiful moment for a family and shouldn’t end in tragedy,” said Murphy, who faced life-threatening complications while pregnant with her first child. To her, maternal mortality is not a partisan talking point; instead, it’s a “human issue.”