Beyonce

On Monday, Beyoncé graced the cover of a historic September issue of Vogue. In her essay, she reveals details of her experience with “toxemia”, a dangerous condition that can befall between two and eight percent of pregnant women and has also made an appearance on Downton Abbey.

In the essay, Beyoncé recounted that “I was swollen from toxemia and had been on bed rest for over a month.” Her use of the word toxemia is perhaps a bit outdated, according to the NIH. Most caregivers now refer to toxemia as preeclampsia. That condition is the forerunner of eclampsia, which is the condition that actually kills Sibyl Crawley in season three of Downton Abbey. While you can’t draw perfect comparisons between a real 21st-century music icon and a fictional character in a TV series set in the late 19th century, the shared experience indicates this is a condition that women have been facing for a long time.

While doctors aren’t exactly sure what causes preeclampsia, they do know that it’s a hypertensive condition that causes such high blood pressure, which can threaten other systems in the body. High blood pressure, which can progress to preeclampsia, is one of the top six causes of maternal deaths, according to a 2016 paper released by the NIH. The authors of that paper noted that preeclampsia diagnosis has risen 69% between 1990 and 2010 in the United States.

Small raises in blood pressure during pregnancies are not uncommon and are diagnosed as “gestational hypertension.” But if blood pressure consistently rises above 140/90 (normal blood pressure is around 120/80), it can start to cause even more problems, like swelling. Even more dangerous is that it can cause an increased amount of protein in a mother’s urine, according to the American College of Obstetricians and Gynecologists, as it can be a sign that her kidneys aren’t working properly.

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This is where things get tricky when it comes to treating preeclampsia. Speaking to Livescience in 2017, Dr. Arun Jeyabalan, a maternal and fetal medicine specialist at Magee-Womens Hospital at the University of Pittsburgh Medical Center, noted that “delivery is the beginning of the cure for preeclampsia.” It’s possible that this is the reason that Beyoncé’s twins were delivered premature and by C-section. Protracted high blood pressure caused by the condition can cause organ damage, particularly to the kidneys. To relieve this pressure, blood pressure medications are sometimes administered, but other times mothers opt for early deliveries, depending on the severity of the preeclampsia:

high blood pressure pregnancy
Incident of high blood pressure during pregnancy 

“My health and my babies’ health were in danger,” Beyoncé says in the essay, “so I had an emergency C-section.”

Deciding whether to wait it out and deliver the child on time or to have a pre-term C-section is the same difficult choice Sibyl Crawley had to make in Downton Abbey. While the country doctor argues that she should be taken to a hospital for an emergency C-section, her private doctor advocates for waiting it out — a dangerous choice that would exposed her kidneys to protracted hypertensive effects and eventually kills her.

While neither choice is ideal, life seem to have worked out well for Beyoncé, who, after a harrowing experience in the Neonative Intensive Care Unit, now has two healthy twins and her own health to show for it. But her brave acknowledgment of her own struggle can hopefully help bring some more resources to research on this issue.