The New Yorker:

The rate of preeclampsia had been climbing steadily for years. Then COVID-19 arrived, and the numbers spiked.

By Jessica Winter

It’s impossible to pinpoint when ob-gyns sensed that preeclampsia—a surge in blood pressure in the later stages of pregnancy that endangers both mother and baby—was increasing among their patients during the covid pandemic. Preeclampsia affects some two hundred thousand pregnant people in the U.S. per year, and case numbers had been ticking steadily upward for a couple of decades (although some of this increase was attributable to improvements in how doctors diagnose the disease). But this seemed to be more than an uptick; this felt like a jump. Physicians describe not a eureka moment but a creeping realization, a longitudinal hunch. Group texts and Facebook forums lit up with talk of more patients whose labor had to be induced early owing to blood-pressure spikes; doctors told one another that they were seeing more preterm births and more stillbirths. “Right away, there was chatter about more hypertension and preeclampsia being noticed in the covid hot spots,” Jennifer Jury McIntosh, a maternal-fetal-medicine specialist in Milwaukee, said.

The coronavirus attacks endothelial cells, which form the cellophane-like lining of blood vessels. Ob-gyns began to suspect that the virus affects the vessels of the placenta, which ferries oxygen and nutrients to the fetus. Inflammation, clotting, and other vascular damage in the placenta put the baby at risk for not getting enough oxygen; the baby’s growth may slow, or stop. The same damage is also believed to trigger preeclampsia and other hypertensive disorders in the mother, which can impair the liver and kidneys, trigger strokes, and even result in death. The closest thing to a surefire remedy is to deliver the placenta, which means inducing labor. In the earliest and most severe cases, which occur before or at the threshold of fetal viability, the treatment for preeclampsia is termination of the pregnancy.

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