It was the fall of 2024 when Abigail Hendricks learned she was pregnant with her fifth child. She was glowing with excitement.
"For me, a baby is a blessing," says Hendricks. "They are cute. They are precious. And they are a gift from God."
But Hendricks, who was 33 at the time and living in Cape Town, South Africa, would later learn that her growing baby was also a grave health risk to her. Hendricks already had high blood pressure. Soon, the headaches began. From time to time, her vision would blur. Then protein started showing up in her urine.
"I kept on fighting," she recalls. "I did go to church. I pray in the morning. I pray at night for my baby to be safe and for me to be safe."
Her doctors put her on a different blood pressure medication and told her to rest. By this time, all of Hendricks' appointments had shifted to Tygerberg hospital, a facility in Cape Town equipped to handle more complex cases.
But a month before she was due to give birth, she was losing blood pressure control. A normal reading is 120 over 80, but hers climbed to 163 over 101.
Hendricks had developed preeclampsia, a potentially fatal complication of pregnancy involving damage to the blood vessels and high amounts of fluid loss. It can lead to dangerous swelling of the lungs, brain, and heart and massive hemorrhaging.
"They told me I can have a seizure because the blood pressure is too high," she says. "It made me feel scared and worried. Like, what is going to happen now?" (Eclampsia refers to the seizures that occur in pregnant women with preeclampsia.)
The medical team believed Hendricks' life was in danger — and so was her baby's.
An anxious beginning
On a recent morning, Cathy Cluver glides through the bustling maternity ward of Tygerberg Hospital. Supply carts are wheeled down the hallway. Nurses and doctors move between their many patients. A newborn baby's first cry pierces the air. Cluver is a professor of obstetrics and gynecology at nearby Stellenbosch University, and she's been searching for a treatment for preeclampsia for a decade.
"We do about eight to 9,000 deliveries here a year of only high-risk women," explains Cluver, including those with preeclampsia who do their best to delay delivery. It's important for a baby to stay inside the womb as long as possible but this can jeopardize the health of the mother.
Cluver points to a room containing mothers with preeclampsia. "You can see they're not looking well," she says. "Their feet and their legs are swollen, and their hands are swollen. These mums are putting their own lives at risk for the sake of the baby."
Preeclampsia occurs when the placenta sends out a kind of molecular distress call that it's not getting enough oxygen. "It's saying, 'I need more blood supply, so I'll push the blood pressure up,'" says Cluver, who had preeclampsia herself when she was pregnant with her first child.
Conventional medications to treat high blood pressure are risky because even though they might lower the mother's blood pressure, they may also reduce blood flow to the baby — right when the placenta is demanding more oxygen.
"It really is one of the most serious complications of pregnancy," says Cluver, making it one of the leading causes of maternal mortality worldwide — with at least 42,000 maternal deaths each year.
Cluver has been searching for a treatment that lowers blood pressure and heals the damaged blood vessels to help both mother and baby. Then, about two years ago, she got an email from DiaMedica Therapeutics, a U.S.-based pharmaceutical company.
They were testing a drug for certain types of stroke called DM199 that functioned in a way they thought might also work for preeclampsia. Cluver was skeptical at first, but on closer inspection, she and her colleagues thought maybe it was worth trying out. "It could potentially work because it's ticking all the boxes of what we would want," she says.
So they began a trial at the hospital for mothers with dangerously high blood pressure and who were scheduled to deliver their babies early.
"I was so nervous that first day," says Cluver. "We started the infusion and you never quite know what's going to happen."
The team enrolled small groups of women with each group receiving a slightly higher amount of the drug. Fifteen patients in, there was no sign that it was having any effect.
"I thought, 'this drug is not real,'" says Jacqui Thake, a research nurse at Stellenbosch University who is overseeing the trial. "There was really no difference in the blood pressure — maybe slightly here and there but nothing major."
Lucky number 16
When the 16th patient received the next highest dose, however, "we literally just opened up this IV infusion and then her blood pressure stabilized," recalls Cluver. "We suddenly saw these sky-high blood pressures coming down and we were like, 'We don't believe this. This is impossible!'"
"That's actually when the real excitement started," says Thake. "Like jumping up and down. I [sent] a gazillion emojis celebrating the blood pressure going down."
And it stayed down. The same was true for subsequent patients with the same or incrementally higher doses.
"The drug stabilizes the lining of the blood vessels so it makes the blood vessels happier," says Cluver.
Tests show the drug doesn't appear to cross into the placenta or the breastmilk either, which means it's likely not reaching the baby.
Cluver and her colleagues are hopeful that this might be the first pharmaceutical treatment for preeclampsia.
"It would mean a healthy mom and a healthy baby," says Thake, who talks about what it might be like to lose a mother or child. "It would mean less broken homes and possibly a better life for the little ones growing up. That's what it would mean to me — a mom and a kid growing up with love."
Still, she says there is more to learn about how the drug works and whether it can keep mothers pregnant for longer.
Corneila Graves is the medical director of Tennessee Maternal Fetal Medicine, a facility where she says up to 10% of pregnant women have preeclampsia.
"This is a small study — it has great potential but we need a bigger data set on a broader population," says Graves, who is not involved in the trial.
"But what is really promising about this particular study is that it also increases placental blood flow," she adds. That is, this new drug lowers the mother's blood pressure while also improving blood flow to the womb at a time when the baby appears to need it.
Kara Rood, a maternal fetal medicine physician at the Ohio State University who isn't contributing to the trial, feels similarly encouraged by the early results. But she's eager to see how the drug impacts women earlier in their pregnancies and not in the urgent moments right before their delivery.
"I think the real test will be whether this medication can safely prolong the pregnancy to decrease those risks and ultimately improve neonatal outcomes," says Rood.
As for Abigail Hendricks, she was patient number 24 in the trial at Tygerberg hospital. Her baby son is almost 9 months now. "Hayden is a sweet little boy. He's very playful."
Back when her blood pressure kept going up last year several weeks before her due date, she enrolled in the trial and received the new drug just before the medical team induced her. Hendricks' blood pressure slowly dropped.
And then, "he was delivered screaming," she says. "When I held my baby for the first time, I cried. I had so much joy in my heart to know that he is alright. And I was alright."
This story was supported by a grant from the Pulitzer Center.
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