The Scan by 2 Minute Medicine®: Pre-Eclampsia Prevention, BMI No More, Madonna’s Sepsis Scare, Presidential Controversy, and Injuries of the Tour de France
7-24-2023
The Scan by 2 Minute Medicine® is a pop-culture medical newsletter and exclusive benefit for 2 Minute Medicine Plus subscribers.
Pre-Eclampsia Prevention
The Story: The Federal Drug Administration (FDA) recently approved a new blood test that can accurately identify pregnant individuals at a greater risk of pre-eclampsia. The approval comes just months after Olympic gold medalist Tori Bowie tragically passed away due to pregnancy complications, including eclampsia. Many hope that the new blood test will reduce the number of fatalities attributable to pre-eclampsia and aid in reducing racial disparities seen in birth complications.
What is pre-eclampsia?
Pre-eclampsia is a pregnancy complication involving high blood pressure, increased urine protein content, and sometimes kidney damage. Eclampsia results from pre-eclampsia and is a more severe form of the condition that is accompanied by seizures or coma. The exact cause of pre-eclampsia is unknown, but it is suspected to be associated with abnormalities of the placenta. Medications to lower blood pressure and reduce seizures can help manage these conditions. However, the only way to cure the spike in blood pressure is to deliver the baby; as a result, pre-eclampsia can result in preterm delivery. The condition can also result in several other complications, including organ failure, fetal growth restriction, and death in severe cases. Early detection of pre-eclampsia and those at risk can allow for preventative therapy, such as daily aspirin, to minimize the risk of devastating complications.
The burden of pre-eclampsia
The good news is that pre-eclampsia is not very common — only about 4% of pregnancies in the United States are affected by the condition, and the more severe form, eclampsia, is even less common. Some well-known risk factors for the condition include having higher blood pressure at baseline, type 1 or 2 diabetes, kidney disease, and autoimmune disorders. Certain pregnancy characteristics can also place people at higher risk, including having advanced maternal age, being pregnant with more than one child, or having experienced pre-eclampsia in a previous pregnancy. The bad news is that despite its relatively low prevalence, pre-eclampsia is the leading cause of many poor outcomes in childbirth, including maternal death, intensive care admissions, and prematurity. The burden of disease is not distributed evenly, as the rate of pre-eclampsia is around 60% higher in black women than in white women. This is just one pregnancy complication among many that black women are disproportionately affected by. Beyoncé and Serena Williams are two prominent figures who have brought attention to this issue by discussing their experiences with birthing complications. Addressing the social determinants of health, early detection, and recognizing those at greater risk are ways to reduce the racial disparities seen in pre-eclampsia rates and outcomes. Many hope the new FDA-approved blood test will play a role in this.
BMI No More
Body mass index (BMI) has long been used as a measure of health in medicine. BMI is determined through a calculation of a person’s height and weight. As a result of the metric, BMI classifies a patient’s weight as underweight, healthy weight, overweight, obese, or severely obese. However, the American Medical Association (AMA) recently adopted a new policy indicating that BMI should no longer be used in isolation to determine whether a patient is at a healthy weight due to limitations of the measurement.
The longstanding use of BMI in medicine has not been without its controversies. For starters, the weight measurement does not distinguish between fat and muscle. As a result, elite athletes with very muscular builds, such as LeBron James, Tom Brady, and Lionel Messi, are classified as overweight based on BMI measurements, despite being extremely fit and having a low body fat percentage. BMI is also a poor predictor of health, as previous studies have shown that the measurement does not correlate well with other markers of metabolic health, such as blood pressure and cholesterol levels. Celebrities such as Lizzo have brought attention to the fact that weight is not a perfect predictor of health outcomes and that exercising and eating well can have health benefits, even if it doesn’t result in a significant drop in BMI.
Another critical limitation of BMI is that it does not account for differences across races, sexes, and ages, making it an even worse predictor of health for specific groups. This is because the “average” values used for BMI classifications were based on predominantly white populations. In some instances, BMI cut-offs are used to determine insurance reimbursement for certain medications and surgeries, leading to unfair exclusion of those whose health is not accurately represented by the measurement. The AMA’s BMI policy encourages physicians and insurance companies to no longer consider BMI in isolation but instead include other indicators of health, including visceral fat, waist circumference, and various metabolic factors, when making determinations about peoples’ health.
Madonna’s Sepsis Scare
Madonna is back on the mend after a stay in the intensive care unit. Earlier this year, the singer postponed the dates of her “Celebration Tour” due to a bacterial infection that led to sepsis. The pop star has provided an update on her current situation, indicating that she is doing better and focusing on her health before resuming the tour.
Sepsis is an inappropriate and life-threatening immune response to an infection. Typically, an infection spurs the immune system into action, targeting and clearing the offending pathogen. In sepsis, this process goes into overdrive, triggering a full-body inflammatory response that damages your own tissues and can have severe consequences. In some instances, sepsis can progress to septic shock, when a person’s blood pressure drops dangerously low due to the dysregulated immune response. The management of sepsis includes the administration of antibiotics, intravenous fluids, and medications to increase blood pressure back to a normal level. Sepsis affects around 1.7 million Americans yearly. Some people are at an increased risk of developing the condition, including those over 65 or under the age of 1 and those with a weakened immune system or chronic medical conditions. Sepsis can also result from a viral infection and following extended hospital stays, so there has been a strong link between COVID-19 hospitalizations and sepsis cases.
Even with treatment, many sepsis survivors experience long-term symptoms such as fatigue, swelling, repeat infections, memory loss, and more — largely considered “post-sepsis syndrome.” As in Madonna’s case, quick treatment is the best way to prevent long-term complications of the condition.
Presidential Controversy
The American College of Cardiology (ACC), the governing body that oversees cardiologists in the country, recently sparked controversy by selecting a nurse as their newest president. Cathleen Dalton Biga will become president after serving as the ACC’s vice president in 2023-2024. Biga serves as the president and CEO of Cardiovascular Management of Illinois and has more than 40 years of experience in the healthcare sector. Despite her vast experience, the move has sparked debate amongst medical professionals, with many questioning the move to select a registered nurse rather than a trained cardiologist. Others are suggesting that the ACC select its governing board through an election rather than the current selection process that leaves members of the society out of the decision-making process. Despite the controversy, Biga is set to become president in April 2024.
Injuries of the Tour de France
The Tour de France recently came to a close, and although this year’s 110th edition of the cycling event was full of heroic performances, it wasn’t without its disappointments. On the 8th day of the 21-stage event, one of the event’s most winningest athletes, Mark Cavendish, had to drop out of his last Tour after suffering a broken collar bone following a crash. Unfortunately, Tour-ending injuries are relatively common.
A broken clavicle, often called the collarbone, is the most common injury in Tour de France athletes. The clavicle is the bone that connects the sternum to the shoulder, so these fractures often occur in riders after falling on a shoulder or outstretched hand. Treatment usually requires wearing a sling and occasionally can require surgery, including placing a plate or screw in the bone. In fact, Mark Cavendish previously had surgery for a broken collarbone back in the 2017 Tour de France. Other common fractures experienced by cyclists include those in the wrist, hand, femur, upper arm, and ribs.
In addition to fractures, head injuries are another common complication seen following cycling crashes. Fabio Jakobsen was another athlete forced to leave this year’s event, which comes just three years after the prolific sprinter experienced a life-threatening crash that left him in a medically-induced coma and kept him from cycling for eight months. The crash left him with a brain contusion, a fractured skull, and several other injuries. Fortunately, wearing a helmet can reduce the risk of head injury by over 50%. Each year the Tour is a reminder of the importance of safe cycling practices and helmet use.
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