Racial Maternal Health Disparities Apparent in Hypertension, Preeclampsia

Hypertension during pregnancy is a growing problem in the United States, with Black and American Indian/Alaska Native (AI/AN) pregnant people being the most at-risk for hypertension, according to recent Centers for Disease Control & Prevention figures. These data are another in a long list of Black maternal health disparities, the CDC said.

Hypertensive disorders during pregnancy (HDPs) are critical conditions that can lead to adverse maternal health outcomes, like heart attack and stroke. HDPs are a leading cause of pregnancy-related death in the US, and that problem is only getting worse, the CDC Morbidity & Mortality Weekly Report revealed.

Between 2017 and 2019, the rate of HDP in pregnancy hospitalizations increased from 13.3 percent to 15.9 percent. Additionally, the prevalence of pregnancy-related hypertension increased from 10.8 percent to 13 percent, and the prevalence of chronic hypertension rose from 2 percent to 2.3 percent during that same time period.

Those increases were seen in some groups more than others, emblematic of persistent Black maternal health disparities in the US, the researchers said. For Black birthing people, the rate of HDP in pregnancy hospitalizations was 20.9 percent, and for AI/AN birthing people, it was 16.4 percent.

Black birthing people also saw a higher risk of developing preeclampsia, a severe medical condition only impacting pregnant people and which significantly drives the maternal mortality problem in the US.

“Factors that contribute to racial and ethnic inequities in chronic and pregnancy-induced hypertension include higher prevalences of HDP risk factors, as well as differences in access to health care and the quality of health care delivered,” the researchers explained. “Racial bias within the U.S. health care system can affect HDP care from screening and diagnosis to treatment.”

The CDC researchers also acknowledged that weathering, or the demands of experiencing everyday interpersonal and institutional explicit and implicit racism, is linked to chronic hypertension.

The researchers also observed age-related health disparities, with HDPs documented in 18 percent of pregnancy hospitalizations among those ages 35 to 44. For birthing individuals ages 45 to 55, HDPs were documented in about a third of pregnancy hospitalizations.

This finding was not entirely surprising, considering the more significant risks seen during advanced pregnancy, the researchers said.

Other factors like obesity, diabetes diagnosis, and history of pregnancy-related hypertension or cardiovascular disease were likewise linked to HDP hospitalization.

The researchers recommended that healthcare organizations adopt more equitable and comprehensive screening and intervention efforts. Early detection of HDP or HDP risk is essential, as is strict adherence to prevention and monitoring protocols.

“Recommendations for identifying and monitoring pregnant persons with hypertension include measuring blood pressure throughout pregnancy, including self-monitoring,” the researchers advised.

In managing HDPs, healthcare providers should be monitoring for associated illnesses, like preeclampsia, a condition that disproportionately impacts pregnant people of color and contributes significantly to maternal mortality in the US.

“Recommendations for preventing preeclampsia include low-dose aspirin for persons at risk and exercise programs,” the researchers wrote. Once a diagnosis of an HDP is received, management strategies include blood pressure–lowering medication, prevention of eclamptic seizures (e.g., administration of magnesium sulfate), and close maternal and fetal monitoring and coordination and continuity of care during the postpartum period.”

Organizations may consider institutional changes, like creating perinatal quality collaboratives and maternal mortality review committees (MMRCs) to assess their detection and prevention strategies. CDC also advised that organizations consider their cultural responsiveness and health equity efforts to ensure that HDP prevention and detection programming reaches all patients.

“Health communication campaigns increase awareness of urgent warning signs of HDP that indicate need for immediate care,” the researchers concluded. “Strategies to address health inequities in HDP include addressing implicit, institutional, and structural racism, disparate access to clinical care, social determinants of health, and engagement of community partners.”