As a mother of two children and a Houston-area labor and delivery nurse, Bre’Ana Warner could only imagine what her first pregnancy in 2018 would have been like if she hadn’t educated herself about the disparities Black women face during pregnancy.
“My awareness was more heightened and aware of the situations in my body,” she said. “When I started to notice symptoms around 34 weeks into my pregnancy, there were two factors to confirm my preeclampsia diagnosis. The first was the high blood pressure, and the second was the protein in my urine.”
She recalls telling her patients the importance of being mindful of the physicians they choose to be part of their care. Picking a provider that knew her name and personalized her care made a difference.
Warner’s mother and father had hypertension, which was crucial information needed for early detection. Eventually, she was medically induced at 37 weeks. However, she said that with the right team in place, the support of her family, and her eagerness to self-educate, it was a successful delivery.
What is preeclampsia?
Preeclampsia is a pregnancy complication involving the factors Warner mentioned, including signs of damage to the kidneys or other organs. The first signs of preeclampsia are often detected during routine prenatal visits with a healthcare provider, and it usually begins after 20 weeks of pregnancy or after giving birth. Other symptoms include nausea or vomiting, shortness of breath, severe headaches, pain in the upper belly, blurred vision and/or swelling in your hands and face.
High blood pressure is a common chronic health condition that is treatable. However, if undetected and uncontrolled, hypertension could lead to a stroke or heart attack and even be fatal, especially during pregnancy.
Racial maternal health disparities apparent in hypertension
Warner’s experience underscores the complexities of maternal mortality.
A new study published by the American Heart Association states that Black women between the ages of 20 and 50 face significantly higher risks of developing high blood pressure in their childbearing years than white women.
Hypertension affects 17.6% of women of childbearing age in the United States and has since increased in the past decade, according to the 2019 National Center for Health Statistics.
Similar stories like Warner’s are familiar. Grammy Award-winning recording artist Beyoncé, tennis icon Serena Williams, and track and field star Allyson Felix have been vocal about their experiences with preeclampsia during pregnancy. All were fortunate to live to tell their stories.
Then, there are stories like Dr. Chaniece Wallace, a chief pediatric resident at Indiana University School of Medicine, whose death due to preeclampsia complications two days after delivering her premature daughter via C-section that made national news.
“If high blood pressure isn’t stabilized during pregnancy, that goes into what we call eclampsia, so you’ll start having seizures. And with that, unfortunately, the only way to treat it is to deliver the baby,” said Dr. George Adesina, cardiologist at Kelsey-Seybold Clinic. “There are several factors that contribute to this problem.”
What are the factors?
Several factors contribute to the racial and ethnic disparities in maternal health outcomes. Some examples are socioeconomic status, racial bias in the medical system and lack of access to healthy food options, prenatal treatment and healthcare.
“I see first-hand how Black moms and Hispanic moms don’t get the chance to pick their providers due to insurance reasons,” Warner said. “In this day and age, we can research and find the information we need online. When picking our physicians, everything is easy and at our fingertips because they play a big part in your outcome.”
Adesina says having those early-stage conversations with your healthcare provider will help you get into optimal shape before you get pregnant.
“One of the biggest problems is the foods we digest, for example. Unfortunately, if you don’t have as much money, you’re probably budgeting for cheaper food items processed with a lot of salt, which increases your blood pressure,” Adesina said. “It helps to get a head start with a balanced diet, regular exercise and eliminating factors that cause stress to have better health outcomes.”
What should expecting mothers consider?
One piece of advice Warner suggests for expecting mothers is to strongly advocate for themselves when communicating with medical professionals about their issues.
“Many moms don’t (monitor) their blood pressure at home and wait until they get to the doctor’s office to advocate for themselves. Keep track of your process so you can better advocate for yourself when you feel a doctor doesn’t understand your concerns,” Warner said. “My provider had me do a blood pressure log throughout my pregnancy to look at the trends.”
The role medical professionals should play
Researchers say more study is needed, including examining structural racism and discrimination, to understand better why Black women of childbearing age face challenges in food security and heart health.
Experts also say that providing patient-centered care that is responsive to the needs of Black women can improve their maternal health. They should receive culturally competent, safe, respectful and high-quality care.
“The first step is recognizing that there is a problem and making sure we’re paying extra attention to those communities that are going to be at the highest risk,” Adesina said. “Also, we need to not only educate our patients on what they can do to prevent high blood pressure but need more studies on what is truly causing this. We need equitable participation, so if certain things impact our communities, we have the data for treatment going forward.”