Black History & Heart Awareness Month and Black Maternal Deaths

by Kenny Anderson

A major medical group the American College of Obstetricians and Gynecologists (ACOG) has issued new guidance on detecting and treating the leading cause of death in pregnant women and new mothers in the United States.

In the U.S. Black women are 3 to 4 times more likely to die of pregnancy related causes than white women regardless of education and socioeconomic status. 

According to the Center of Disease Control Black mothers die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health.

To put maternal deaths in perspective a Black woman is 22 percent more likely to die from heart disease than a white woman, 71 percent more likely to perish from cervical cancer, but 243 percent more likely to die from pregnancy or childbirth related causes. 

The maternal mortality crisis is rooted in racism; the marginalization of Black women and the institutional barriers to quality health care. For most Black women this means being exposed to multiple forms of discrimination disparities.

Thus Black maternal health outcomes are largely tied to social determinants including health and systems services, location, employment, education, race, and income.

Black women are more likely to:

*Be uninsured before becoming pregnant

*Be poorer and experience more hardships

*Be more distressed and anxious

*Be exposed to environmental risks

*Receive subpar medical care based on their location

*Experience racial bias from health care providers 

Heart Disease and Black Maternal Deaths

Heart disease accounts for 26.5% of pregnancy-related deaths, and rates are highest among Black women and those with low incomes. The risk of death from heart disease is 3.4 times higher among Black women than white women.

A heart muscle disease called peripartum cardiomyopathy is the leading cause of death in expectant mothers, accounting for 23% of deaths late in pregnancy. 

Cardiomyopathy, along with thrombotic pulmonary embolism, and hypertensive disorders of pregnancy contributed more to pregnancy-related deaths among Black women than among white women.

During pregnancy the cardiovascular system undergoes major changes to sustain tremendous increases in blood volume. Dr. James Martin, chairman of ACOG's pregnancy and heart disease task force says "pregnancy is a natural stress test."

While pre-existing conditions play a part in the death toll, acquired heart conditions can develop silently during or after pregnancy. Common risk factors for maternal death due to heart disease include age, high blood pressure during pregnancy, and obesity.

Curbing Black Maternal Deaths

The American College of Obstetricians and Gynecologists (ACOG) has set new guidelines on screening, diagnosis and management of heart disease.

ACOG President Dr. Lisa Hollier said: "Most maternal deaths are preventable, but we are missing opportunities to identify risk factors prior to pregnancy and there are often delays in recognizing symptoms during pregnancy and postpartum, particularly for Black women."

The American College of Obstetricians and Gynecologists recommends:

*Women with known heart disease should see a cardiologist before getting pregnant and receive pre-pregnancy counseling, the practice guidelines advise.

*A follow-up visit with a primary care doctor or cardiologist should occur within 10 days for women with high blood pressure disorders and within seven to 14 days for women with heart disease and related disorders.

*Patients with moderate and high-risk heart disease should be managed during pregnancy, delivery, and postpartum in a medical center that can provide a higher level of care.

*Collaboration between health care providers particularly ob-gyns and cardiologists is crucial.

*Develop a long-term comprehensive care plan; a cardiovascular postpartum visit at the three-month mark, at which time the clinician and patient can discuss collaborative plans for yearly follow-up and future pregnancy intentions. The increased risk of death from heart disease can last up to a year after a woman gives birth. 

Community Intervention

Curbing maternal mortality requires investment specifically in Black maternal health care and solutions that engage inequities undermining health outcomes for Black mothers and their babies.

From my perspective to reduce the high rates of maternal deaths of Black women begins at the community level by exposing, educating, advocating, promoting, and investing in community led prevention strategies.