Hypertensive disorders of pregnancy (HDP) are a group of medical conditions that involve high blood pressure during pregnancy. High blood pressure, also known as hypertension, is a condition where the force of the blood against the walls of the arteries 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 a 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 gestation, or that persists longer than 12 weeks after delivery.
• Gestational hypertension: High blood pressure that develops after 20 weeks of gestation, without signs of organ damage or protein in the urine.
• Preeclampsia: High blood pressure that develops after 20 weeks of gestation, with signs of organ damage or protein in the urine.
• Preeclampsia superimposed on chronic hypertension: Chronic hypertension that worsens or causes organ damage or protein in the urine during pregnancy. This means that 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 people diagnosed with HDP is increasing and more maternal deaths are occurring due to complications from these conditions in pregnancy. On top of that, the rates between white people and other racial groups are widening, especially among black pregnant people during pregnancy.  According to a Centers for Disease Control and Prevention (CDC) report, HDP affected at least 1 in 7 delivery hospitalizations in the United States from 2017 to 2019, and about a third of those who died during hospital delivery had some form of HDP.  Some of the other key findings of the report were that:

• HDP affected more than 1 in 5 delivery hospitalizations of Black women and about 1 in 6 delivery hospitalizations of American Indian and Alaska Native women, compared to 1 in 8 delivery hospitalizations of White women.
• Black women had higher odds of entering pregnancy with chronic hypertension and developing severe preeclampsia.
• Black women 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 age 35) and the rates are higher among communities of color compared to white people. In general, more than 50% of black women have hypertension, compared to 39% of non-Hispanic white women and 38% of Hispanic women.  The symptoms of hypertensive disorders of pregnancy may vary depending on the type and severity, but some common ones are headaches, swelling, blurred vision, stomach pain, and reduced amounts of urine than usual.

There are many factors that can affect the health of pregnant people, such as access to health care, quality of health care, stress, and discrimination. The solutions require a coordinated and comprehensive approach from the federal, state, and local governments, as well as from healthcare 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 people and those planning for pregnancy can take the following steps:

• Get early and regular prenatal care. They can check your blood pressure and screen for any signs of HDP¹.
• Take your blood pressure medication to lower your blood pressure and prevent complications. They may also advise you to take a low-dose daily aspirin after 12 weeks of pregnancy to reduce the risk of preeclampsia².
• Maintain a healthy weight and lifestyle. Try to lose weight before you conceive and gain weight gradually during pregnancy according to your doctor’s guidelines. Exercise regularly, eat a balanced diet, avoid smoking, limit alcohol and salt intake, and manage stress²³.
• Monitor your blood pressure at home. Your doctor may suggest that you use a home blood pressure monitor to keep track of your blood pressure between visits.

Racial disparities of HDP are a serious public health issue that affects the health and well-being of many women and babies in the U.S. It is important to address the factors that cause these disparities and to improve the prevention, recognition, and treatment of HDP for all groups.

MotherToBaby has helpful factsheets on smoking, alcohol, stress and exercise, and low-dose aspirin.  You can also contact us for information on medications that may be recommended by your healthcare provider for treatment. We are a free service that is available for everyone.  The heart of the matter is that you do what is best for you and your baby and we are here to help you through all stages of pregnancy from the time you hear a heartbeat on a monitor and until the time your baby captures your heart.

Resources:

American Heart Association. (2023, February 27. Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks. Accessed February 7, 2024 Read More

Ford, N. D., et al., (2022). Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-2019. MMWR. Morbidity and mortality weekly report, 71(17), 585–591.

Hoover, C., (2023, August 30). Addressing Hypertension Is Critical for Lowering the Black Maternal Mortality Rate. The Century Foundation . Read More

Kalinowski, J., et al., (2021). Stress interventions and hypertension in Black women. Women’s health (London, England), 17, 17455065211009751.

Leonard, S. A., et al., (2023). Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications. Obstetrics and gynecology, 142(4), 862–871.

Margerison, C. E., et al., (2019). Pregnancy as a Window to 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.

The post Getting to the Heart of the Matter: Hypertension and Pregnancy among the Black Community appeared first on MotherToBaby.

The United States has the highest maternal mortality rate out of all industrialized countries and Black pregnant individuals are three times more likely to die during or after childbirth compared to white pregnant people. As a matter of fact, from the time I received my graduate degree over 40 years ago until now, the maternal mortality rate has not changed for Black people and they still trail behind white people in the majority of health outcomes.  As a public health official, it was not surprising to learn that Black people have been disproportionately affected by the COVID-19 pandemic compared to white people.  Therefore, we need to consider the impact this could have for pregnant Black individuals who are already behind in the majority of health outcomes.

This issue is made worse by the state of vaccine hesitancy that exists across the nation, especially among the Black community. Therefore, the issue of being Black and pregnant poses its own set of challenges.  The question remains, is there a role that MotherToBaby can play in addressing vaccine hesitancy?

The State of COVID-19 in the Black and Pregnant Population

COVID-19 has proven to be a formidable opponent. As of January 30, 2022, there have been more than 372 million cases worldwide and over 5.6 million deaths. The United States has the highest death toll of over 906,000 compared to other nations.  Data shows that people of color are disproportionately affected by COVID-19 compared to white individuals. Black people are 10% more likely to get coronavirus compared to white people, three times more likely to be hospitalized and twice as likely to die from the disease.

While people of color are disproportionately affected by COVID-19, data has emerged about the effects to pregnant individuals.  COVID-19 infection has not been associated with an increased chance of birth defects or miscarriage. In addition, while pregnant individuals are not more vulnerable to infection than the general public; they tend to suffer more severe symptoms of the disease than non-pregnant individuals if they get infected.  The pregnant population was twice as likely to be admitted to the ICU or require life support and 70% more likely to die than individuals who were not pregnant.  In addition to the risks of severe illness and death for pregnant people, there is an increased risk of pregnancy complications and poor pregnancy outcomes, particularly an increased chance of preterm birth (birth before 37 weeks of pregnancy) and admission of the newborn to the neonatal intensive care unit (NICU), according to the Centers for Disease Control and Prevention (CDC). Data indicates that approximately 97% of pregnant people hospitalized (either for illness or for labor and delivery) with confirmed COVID-19 infection were unvaccinated.

The Complexities of the COVID-19 Vaccination among the Black Community

The state of the pandemic continues to fluctuate because the virus keeps changing. Currently we have different variants circulating around in the United States that are more contagious and are causing infection rates to rise. Vaccine hesitancy has proven to be another obstacle in the fight to combat the COVID-19 pandemic.

Despite the number of deaths and risks of COVID-19, only 40% of pregnant individuals are vaccinated, according to the CDC. Among people of color, the lowest vaccination rates are among Black pregnant people (38%% among Hispanics and only 26% among African Americans).This is particularly concerning for pregnant Black people since COVID-19 impacts communities of color disproportionately and the risk of infection increases the chance of preterm birth that was already 50% higher in the black community compared to the white population even before the pandemic began.

What are the Reasons Behind COVID-19 Vaccine Hesitancy?

Racism and its subsequent effects on social and economic factors have resulted in the virus disproportionally affecting Black people and maternal mortality rates.  The historical treatment of the Black community in this country has promoted a level of distrust in the government and medical profession that have been noted in many studies. When asked, Black people mention the history of racism in medical research (Tuskegee experiment) and care as the key reasons for not being vaccinated. Black people also express that they feel dismissed or ignored by medical professionals; that they do not have a voice and are not heard.  There has also been the issue of availability due to supply, location and transportation that has been an obstacle for Black and underserved communities to get vaccinated.

In one study among pregnant individuals, additional reasons for not getting vaccinated included the speed in which the vaccine was produced, the safety of the vaccine for themselves and their pregnancies and its effectiveness. This study reflected the same trend that the lowest vaccination rates were among Black individuals compared to white people and other people of color.

Future Steps to Reduce Vaccine Hesitancy

Among pregnant individuals that were vaccinated, they mentioned their healthcare provider, primarily their OBGYN, as being a trusted resource.  Some studies stress the need for having more people of color in medicine to promote a level of trust in all fields of medicine. While Black people make up 13% of the US population, they only make up 4% of US doctors and less than 7% of medical students.²

MotherToBaby can continue to be the resource that providers can trust to give them the information they need to advise their patients. We can continue to use social media and other outlets to provide evidence-based information on the safety of the COVID-19 vaccine.  The advantage of MotherToBaby is that it is an independent non-profit organization with a mission to provide evidence-based information to serve all. Since MotherToBaby is a free service there are no restrictions in access for anyone.  We can expand our partnerships and collaborations with community-based organizations that serve people of color including churches, mosques, barber shops, hair salons, schools and other groups and businesses that play a role in promoting health education and combatting COVID-19 vaccine misinformation. We need to make sure that our materials speak to the communities that we are trying to reach by being culturally and ethnically appropriate.

Our own Dr. Richard Miller led us in a discussion during our monthly seminar about how we, as MothertoBaby, can help with vaccine hesitancy. Many good points were made including the following: “Be a good listener, and meet people where they are. People want to be heard and once we understand where they are, we can provide them the information they need.  Not all will be receptive but we can help as many as we can.”

Dr. Martin Luther King Jr, said it best, “Education must enable one to sift and weigh evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction.”   Our goal at MotherToBaby is to do exactly that for all. We would not lie to you-Let’s all be well.

Get the facts by visiting our online Resource Hub on common exposures during pregnancy including COVID-19 and the COVID-19 vaccines. If you have a question that is not addressed, our confidential experts are available at no-cost (and health insurance is never asked about or required). Contact an expert for personalized COVID-19 information today!

    References

• Battarbee AN, et al.  2022.  Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August-December 2020. Am J Perinatol. 2 Jan;39(1):75-83. 2021 Oct 1.

• Cato TL. 2021. Addressing Justified Vaccine Hesitancy in the Black Community. J Racial Ethn Health Disparities. Mar 30 : 1–4.

• Gillispie-Bell V. 2021. The Contrast of Color: Why the Black Community Continues to Suffer Health Disparities. Obstet Gynecol.  Feb 1; 137(2):220-224

• Holness NA. et al.  2020. Pregnancy and Postpartum Challenges During COVID-19 for African-African Women. J Natl Black Nurses Assoc.  Dec;31(2):15-24.

• Njoku A, Joseph M, Felix R. 2021. Changing the Narrative: Structural Barriers and Racial and Ethnic Inequities in COVID-19 Vaccination.  Int J Environ Res Public Health. Sep 20;18 (18):9904

• ina-Odunsi AJ. 2021.  Commentary:COVID-19 vaccines inequity and hesitancy among African Americans. Clin Epidemiol Glob Health. Oct-Dec;12:100876.

• Priya Kr. 2021.  CNN ’ Visualizing the stark maternal health inequities in the United States’ CNN.

• Centers for Disease Control and Prevention. 2021. Emergency Preparedness and Response. COVID-19 Vaccination for Pregnant People to Prevent Serious Illness, Deaths, and Adverse Pregnancy Outcomes from COVID-19. Retrieved from https://emergency.cdc.gov/han/2021/han00453.asp

The post Would I Lie to You? The Issue of COVID-19 Vaccine Hesitancy among the Black Community during Pregnancy appeared first on MotherToBaby.