Racial Disparities in Maternal Health: Exploring Preeclampsia in Black Women

By: Maame Brako (Mommy Monitor's Youth Subcommittee)

On April 17, 2019, Beyoncé released her Coachella documentary, “Homecoming” on Netflix, giving viewers an intimate look into the months leading up to her iconic performance as the first Black Woman headliner of the renowned festival. In this documentary, she describes her “extremely difficult” pregnancy with twins, Rumi and Sir. In the film she says:

"I got pregnant unexpectedly and it ended up being twins, which was even more of a surprise. My body went through more than I knew it could… I was 218lbs the day I gave birth. I had an extremely difficult pregnancy. I had high blood pressure. I developed toxemia, preeclampsia, and in the womb, one of my babies’ heartbeat paused a few times, so I needed to get an emergency C-section."

During her pregnancy, Beyoncé developed a condition known as preeclampsia. According to The American College of Obstetricians and Gynecologists (ACOG), preeclampsia is “a serious blood pressure disorder that can affect all of the organs in a woman’s body” (ACOG, 2018). This condition is marked by high blood pressure and proteinuria (the presence of protein in the urine), and usually occurs late in pregnancy (after 20 weeks, typically in the third trimester). It is a leading cause of preterm birth, and maternal and infant illness and mortality.

Who is at (increased) risk & why?

Among the most significant risk factors for preeclampsia, which include family history of the condition, obesity, and chronic hypertension, is being a Black woman. Studies conducted in the United States, Canada, and the UK, have shown that across the board, Black women are more likely than white women and other ethnic groups to develop preeclampsia, as well as eclampsia. The exact reasons why are not entirely known. Some medical professionals suspect that it may be related to the higher rates of hypertension (high blood pressure) in Black women. However, in an article for Healthline, Dr. Elizabeth Howell, director of the Blavatnik Family Women’s Health Research Institute at the Icahn School of Medicine at Mount Sinai said:

I wish I could tell you that if we just controlled women’s high blood pressure, we wouldn’t have these issues, but it’s much more complex. Patient-level factors, community neighbourhood factors, provider factors, and system factors — they all seem to contribute to these [racial and ethnic] disparities [in maternal health outcomes]. (Cruickshank, 2019, para. 3).

These factors can not only negatively impact the health and outcomes of Black women on an individual level, but can also impede their ability to access appropriate health information, and proper prenatal and antenatal care. However, this still might not be the full picture because interestingly, even when controlling for socioeconomic factors, these disparities continue to exist. After all, if Beyoncé and Serena Williams, two of the richest Black women in the world, can still endure complications surrounding pregnancy and childbirth, then how much more so the average Black woman?

There is a growing body of work that is pointing to the fact that systemic racism has a role to play in why Black women in particular, have worse outcomes. Ranging from racial biases that go unchecked in healthcare providers, impacting the quality of care they provide Black women, to a concept called “weathering”, coined by Arline Geronimus, a public health researcher and professor at the University of Michigan’s Population Studies Center. Taken directly from an edited version of an interview she held with the Code Switch podcast, she says:

"[…] What I’ve seen over the years of my research and lifetime is that the stressors that impact people of colour are chronic and repeated through their whole life course, and in fact may even be at their height in the young adult-through-middle-adult ages rather than in early life. And that increases a general health vulnerability — which is what weathering is."

Conversations about systemic racism and how they impact health need to be had, no matter how uncomfortable.

For now, women should arm themselves with knowledge regarding signs and symptoms, and consult with their physician to identify and address risk factors early, in order to lower the chances of adverse long-term effects for both mom and baby.

Links for further reading, if interested:

https://www.acog.org/Womens-Health/Preeclampsia-and-Hypertension-in-Pregnancy

https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy

https://www.preeclampsia.org/health-information/faqs#eclampsia

https://preeclampsiacanada.ca/

https://www.mdedge.com/obgyn/article/136887/obstetrics/preeclampsia/eclampsia-rate-highest-black-women

https://www.mdedge.com/obgyn/article/136518/womens-health/uspstf-says-check-bp-each-visit-screen-preeclampsia

http://www.nbcnews.com/id/4781703/ns/health-womens_health/t/understanding-pre-eclampsia-black-women/#.XOxGVtNKigR

https://www.healthline.com/health-news/beyonces-dangerous-pregnancy-highlights-issues-for-women-of-color#Framework-for-change

https://nortonhealthcare.com/news/pregnant-african-american-women-pre-eclampsia

https://www.ncbi.nlm.nih.gov/pubmed/25211000

https://www.ahajournals.org/doi/10.1161/circ.127.suppl_12.AP192

https://www.ncbi.nlm.nih.gov/pubmed/25211000

https://home.liebertpub.com/publications/journal-of-womens-health/42

https://www.preeclampsia.org/health-information/sign-symptoms

https://www.webmd.com/baby/guide/preeclampsia-eclampsia#1

https://www.jogc.com/article/S1701-2163(16)35215-X/pdf

http://iosrphr.org/papers/v6i10V2/G0610026273.pdf

https://www.canada.ca/en/public-health/services/publications/healthy-living/maternal-hypertension-canada.html

https://www.preeclampsia.org/act2savemoms/149-advocacy-awareness/332-preeclampsia-and-maternal-mortality-a-global-burden

https://www.utoronto.ca/news/eclampsia-and-preeclampsia-higher-female-immigrants-sub-saharan-africa

https://www.cbc.ca/news/health/maternal-death-rates-rose-in-canada-u-s-over-20-years-1.2633940

https://www.bbc.co.uk/news/uk-england-47115305

https://www.babycenter.com/0_black-women-and-pregnancy-high-blood-pressure_10326262.bc#articlesection3

https://www.npr.org/sections/codeswitch/2018/01/14/577664626/making-the-case-that-discrimination-is-bad-for-your-health

https://theresponsibleconsumer.wordpress.com/systemic-implicit-microaggression-racism/

https://www.wellesleyinstitute.com/health/rethinking-the-definition-of-institutional-racism/