Highlighting Black Maternal Health Week: The Risks of Chronic Hypertension during Pregnancy
By Dr. Lea Porche, Maternal Fetal Medicine Specialist at CHRISTUS Children’s
Black Maternal Health Week, which is recognized annually between April 11 and April 17, is an opportunity to build awareness, amplify voices, and promote public health efforts surrounding Black maternal health. Originally founded by the Black Mamas Matter Alliance, the week-long campaign is held during National Minority Health Month and begins each year on April 11, which is recognized as the International Day for Maternal Health and Rights. To promote these efforts, Dr. Lea Porche, Maternal Fetal Medicine Specialist at CHRISTUS Children's, has penned a series of three articles to highlight disparities that exist and share educational information for both providers and patients. This is the first article in that series.
Monitoring blood pressure is an important part of any pregnancy, but high blood pressure—known as hypertension—can have adverse effects for both a mother and her baby. According to a recent article published in the Journal of Women’s Health, Black women in the United States have rates of hypertension that are 50% higher than white women, and they are 40% more likely to develop cardiovascular disease—for which hypertension is a risk factor.
Hypertension is defined as high blood pressure, and chronic hypertension is the sustained presence of high blood pressure. Chronic hypertension can increase a person’s risk for heart attack, stroke, heart failure, vision problems and kidney disease. If a person has a blood pressure reading of 140/90 or higher on two separate occasions, then we would diagnose her with hypertension.
Chronic hypertension can be especially dangerous to women who are pregnant, and it can lead to potential complications for both a mother and her baby. Adverse effects of chronic hypertension in pregnancy include an increased risk of preeclampsia, elevated blood pressure, organ damage, seizures, heart attack, stroke, cardiomyopathy and fetal growth restriction. Severe and uncontrolled hypertension can also lead to placental abruption in pregnant mothers, which is the early separation of the placenta before delivery and can result in hemorrhaging and intrauterine fetal death.
We take hypertension in pregnancy very seriously and recommend that women get checked for hypertension before getting pregnant. However, many women are not diagnosed until after they are pregnant, and for some women, hypertension arises for the first time during a pregnancy. There are safe medications available for controlling hypertension during pregnancy, and these interventions can and do improve outcomes for both moms and their babies.
Existing hypertension can often get worse during pregnancy, since a woman’s blood volume increases significantly when pregnant, especially during the latter part of the second trimester and in the third trimester; that increased blood volume can put a strain on the heart and blood vessels, and increase a woman’s risk for the complications listed above.
It is especially important for providers to routinely evaluate expecting Black mothers for hypertension, since Black individuals with hypertension are at higher risk of end organ damage, stroke, and congestive heart failure, among other conditions.
As a physician who cares for pregnant mothers, I am also continually evaluating my patients to see how their bodies respond to pregnancy—even after they give birth. Pregnancy is like a physiologic stress test; in the same way a cardiologist will put a patient on a treadmill to see if her heart muscle is working well, pregnancy acts like a 40-week stress test and can show us potential issues your body may not have revealed until later in life. For example, women who have preeclampsia have an increased risk of having cardiovascular disease later in life, and pre-term labor or pre-term delivery is also associated with cardiovascular disease later in life. Pregnancy is an incredible opportunity for us to learn about our bodies, and I encourage both providers and patients to respect the wisdom of bodies and what they are trying to tell us.
In the three months after delivery, often known as the “fourth trimester” a woman’s body is recovering and going through a series of physiologic changes. This is a critical opportunity for providers to look back on their patients’ pregnancies and evaluate them for any potential complications or future conditions. Especially in cases of women with hypertension, which can lead to long-term and severe health issues, providers can use this time to ensure that their patients have access to primary care and that any barriers to being seen on a regular basis are addressed.
Remember, undiagnosed means untreated—so be sure to see your provider today to ensure your blood pressure is within a healthy range so that we can help optimize your health before, during and after a pregnancy.