Ten warning signs linked to severe seizures in preeclampsia

Ten previously unknown symptoms may indicate an increased risk of severe seizures in pregnant women with preeclampsia - enabling timely preventive treatment for the right patients. The findings come from an international research collaboration.

The condition in question is eclampsia, in which a pregnant woman develops seizures. It can be life-threatening. In many parts of the world, it remains a major cause of severe illness and death among pregnant women. At the same time, it is difficult to predict in advance who is at greatest risk, and in some cases seizures can occur suddenly without clear warning signs.

Stronger clinical indicators

The researchers identified ten symptoms strongly associated with eclampsia, including twitching in the arms or legs, impaired speech, confusion, impaired hearing, severe vertigo, and difficulty concentrating. These symptoms were rare among women without seizures but frequently occurred before an episode. Nearly all women with eclampsia experienced at least one symptom beforehand, and the risk increased markedly with the number of symptoms present.

Lina Bergman, researcher at the University of Gothenburg, Sweden:
"Currently, it is difficult to determine who should receive preventive treatment with magnesium sulfate. Using the clinical signs available today, we miss many women who later develop eclampsia. The symptoms we have now identified could make it possible to detect more cases in time," says Lina Bergman.

Magnesium sulfate is used to reduce the risk of seizures but requires monitoring and is therefore not administered to all patients. The newly identified symptoms may support more accurate clinical decision-making about who should be treated.

Women interviewed

The study included 2,142 women in Pakistan and South Africa: 341 had eclampsia, 1,355 had preeclampsia without seizures, and 389 had normotensive pregnancies. The researchers assessed symptoms in the days preceding a seizure or, for the other groups, before the interview, and compared responses across groups. The study is published in the journal PLOS Medicine.

The results show a clear association between the symptoms and eclampsia, but do not establish causation. Because participants were asked retrospectively, the findings may be subject to some uncertainty.

Stephen Tong, Professor, University of Melbourne, Australia:
"The symptoms currently used, such as headache and visual disturbances, show relatively weak associations with eclampsia. Here, we see symptoms with substantially stronger links, which could better inform clinical decision-making," says Stephen Tong.

Catherine Cluver, Professor, Stellenbosch University, South Africa:
"Eclampsia is rare in some parts of the world but remains a major global problem. Being able to identify women at risk earlier could have a significant impact, particularly in settings with limited access to advanced care," says Catherine Cluver.

Lina Bergman, Stephen Tong, and Catherine Cluver contributed equally to the work underlying the scientific article.