Understanding Hypertensive Disorders of Pregnancy: Risks, Disparities, and Solutions

My baby sister was 35 years old and pregnant with her first child. As a family, we were ecstatic. She was in her third trimester and very pregnant, yet she was up there in the choir singing and dancing her heart out at a memorial concert. Her energy was impressive, but afterward, I noticed her feet were very swollen. Concerned, I urged her to consult her doctor immediately.

Three days later, she was called to check into the hospital, six days before her due date. Unbeknownst to me, she had dropped off a urine sample the day before the concert. The results revealed she had preeclampsia, a type of high blood pressure specific to pregnancy. This condition necessitated the early delivery of her baby. Thankfully, my sister, a strong and educated African American woman, had a positive outcome, but this is not always the case.

What Are Hypertensive Disorders of Pregnancy?

Hypertensive disorders of pregnancy (HDP) are a group of conditions involving high blood pressure during pregnancy. High blood pressure, or hypertension, exerts excessive force against artery walls, increasing the risk of heart attack, stroke, and other severe health problems. HDP is a leading cause of maternal death and poses serious risks to both mother and baby.

Types and Risk Factors

There are four main types of hypertensive disorders during pregnancy. Chronic hypertension affects approximately 85,000 births (2.3%) in the United States annually. Risk factors include obesity, diabetes, kidney disease, family history, multiple pregnancies, and advanced maternal age. Alarmingly, the number of pregnant individuals diagnosed with HDP is rising, with racial disparities particularly pronounced among Black women.

Racial Disparities in HDP

According to the Centers for Disease Control and Prevention (CDC), HDP affected at least 1 in 7 delivery hospitalizations in the U.S. from 2017 to 2019. The report highlighted stark racial disparities, with Black women disproportionately affected. More than 50% of Black women have hypertension, compared to 39% of non-Hispanic white women and 38% of Hispanic women.

Symptoms and Prevention

Symptoms of HDP vary but commonly include headaches, swelling, blurred vision, stomach pain, and reduced urine output. Prevention and treatment require a coordinated effort from governments, healthcare organizations, and communities. Pregnant individuals can reduce their risk by maintaining a healthy lifestyle and seeking regular medical care.

Addressing Disparities

Racial disparities in HDP are a critical public health issue. It’s essential to address the underlying causes and improve prevention, recognition, and treatment for all groups. Organizations like MotherToBaby offer valuable resources, including factsheets on managing stress, exercise, and the use of low-dose aspirin during pregnancy.

Ultimately, ensuring the best outcomes for mothers and babies involves a comprehensive approach, emphasizing health equity and access to quality care at every stage of pregnancy.

Resources

• American Heart Association (2023). Black women of childbearing age more likely to have high blood pressure, raising pregnancy risks.
• Ford, N. D., et al. (2022). Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization – United States, 2017-2019.
• Hoover, C. (2023). Addressing Hypertension Is Critical for Lowering the Black Maternal Mortality Rate.
• Kalinowski, J., et al. (2021). Stress interventions and hypertension in Black women.
• Leonard, S. A., et al. (2023). Chronic Hypertension in Pregnancy and Racial-Ethnic Disparities in Complications.
• Margerison, C. E., et al. (2019). Pregnancy as a Window to Racial Disparities in Hypertension.
• Sharma, G., et al. (2022). Social Determinants of Suboptimal Cardiovascular Health Among Pregnant Women in the United States.