My sister was 35 and pregnant with her first child. As a family, we were ecstatic. The family was expanding and I was about to become an aunt for the third time. She was 3 years oldrd three months and heavily pregnant, but she was up there in the choir singing and dancing her heart out at a memorial concert. I, along with many others, was shocked at how energetic and agile she was this far into the pregnancy. However, when the concert was over, I looked at her feet and they were very, very swollen. I was concerned and told her to talk to her doctor right away. Three days later, she received a call from her doctor to go to the hospital, 6 days before her actual due date. Unbeknownst to me, he had left a urine sample the day before the concert. Test results revealed she had pre-eclampsia (a type of high blood pressure specific to pregnancy) and they had to deliver the baby. If left untreated, preeclampsia can be very dangerous for mom and baby. My sister struggled to get it all together and rushed to the hospital and baby Jordan, my nephew, was born. My sister is a strong, educated, physically fit African-American woman, and thank God her story ended well. However, this is not always the case. It could have gone very differently.
Hypertensive disorders of pregnancy (HDP) is a group of medical conditions that include high blood pressure during pregnancy. High blood pressure, also known as hypertension, is a condition where the force of the blood on the artery walls is too high. This can damage the arteries and increase the risk of heart attack, stroke and other serious health problems. Hypertensive disorders of pregnancy are the leading cause of maternal death and can put both mother and baby at risk for serious complications during pregnancy.
There are four main types of hypertensive disorders of pregnancy:
- Chronic hypertension: High blood pressure that occurs before pregnancy or before 20 weeks of pregnancy or that persists for more than 12 weeks after delivery.
- Gestational hypertension: High blood pressure that develops after 20 weeks of pregnancy, without signs of organ damage or protein in the urine.
- Pre-eclampsia: High blood pressure that develops after 20 weeks of pregnancy, with signs of organ damage or protein in the urine.
- Pre-eclampsia attacks chronic hypertension: Chronic hypertension that worsens or causes organ damage or protein in the urine during pregnancy. This means you have two problems with your blood pressure.
Chronic hypertension affects approximately 85,000 births (2.3%) in the United States each year. Unfortunately, the number of pregnant women diagnosed with HDP is increasing and more maternal deaths are occurring due to complications from these conditions in pregnancy. In addition, rates among whites and other racial groups are widening, especially among black pregnant women during pregnancy. According to a report by the Centers for Disease Control and Prevention (CDC), HDP affected at least 1 in 7 deliveries in the United States from 2017 to 2019, and about a third of those who died during hospital births had some form of HDP. Some of the other key findings of the report were that:
- HDP affected more than 1 in 5 hospitalizations for black women and about 1 in 6 hospitalizations for American Indian and Alaska Native women, compared with 1 in 8 hospitalizations for white women.
- Black women were more likely to enter pregnancy with chronic hypertension and develop severe preeclampsia.
- Black and American Indian and Alaska Native women had higher rates of maternal death due to HDP than white women.
The causes of hypertensive disorders of pregnancy are not fully understood, but some risk factors include obesity, diabetes, kidney disease, family history, multiple pregnancies, and advanced maternal age (over 35 years), and rates are higher among communities of color in compared to white people. Overall, more than 50% of black women have hypertension, compared to 39% of non-Hispanic white women and 38% of Hispanic women. Symptoms of hypertensive disorders of pregnancy can vary depending on the type and severity, but some common ones are headaches, swelling, blurred vision, stomach pain and less urine than usual.
There are many factors that can affect the health of pregnant women, including access to health care, quality of health care, stress and discrimination. Solutions require a coordinated and integrated approach by federal, state, and local governments, as well as health care organizations, providers, researchers, advocates, and communities.
HDP can be dangerous for both you and your baby, but it can be prevented and treated with proper care and attention. To reduce the chance of HDP, pregnant women and those planning to become pregnant can take the following steps:
HDP racial disparities are a serious public health issue affecting the health and well-being of many women and infants in the US It is important to address the drivers of these disparities and to improve the prevention, recognition and treatment of HDP for all groups.
MotherToBaby has helpful fact sheets on smoking, alcohol, stress and exercise, and low-dose aspirin. You can also contact us for information about medications that your healthcare provider may recommend for treatment. We are a free service that is available to everyone. The heart of the matter is that you’re doing what’s best for you and your baby, and we’re here to help you through all stages of pregnancy from the moment you hear a heartbeat on the monitor to the moment your baby takes hold your heart.
Resources:
American Heart Association. (2023 Feb 27. Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks. Accessed 7 Feb 2024 read more
Ford, ND, et al., (2022). Hypertensive Disorders in Pregnancy and Hospital Delivery Mortality – United States, 2017-2019. MMWR. Morbidity and Mortality Weekly Report, 71(17), 585–591.
Hoover, C., (2023, August 30). Treating hypertension is critical to reducing the black maternal mortality rate. The Century Foundation. read more
Kalinowski, J., et al., (2021). Stress and hypertension interventions in black women. Women’s Health (London, England), 1717455065211009751.
Leonard, SA, et al., (2023). Chronic hypertension in pregnancy and racial-ethnic disparities in complications. Obstetrics and Gynecology, 142(4), 862–871.
Margerison, CE, et al., (2019). Pregnancy as a window on racial disparities in hypertension. Journal of Women’s Health (2002), 28(2), 152–161.
Sharma, G., et al., (2022). Social determinants of suboptimal cardiovascular health among pregnant women in the United States. Journal of the American Heart Association, 11(2), e022837.
