Heart disease and stroke cause the majority of pregnancy-related deaths in the United States, according to the Centers for Disease Control and Prevention (CDC), and decades of research has shown that these killers disproportionately affect Black women. Black women are 3 times as likely to die from pregnancy than white women, CDC data shows. New research found that the rate of heart conditions and heart-related deaths during or soon after pregnancy have declined significantly among Black women in recent years, while staying about the same in white women. But despite these improvements, Black women still have the highest rates of pregnancy-related heart risks. A study published on December 16, 2020, in The Journal of the American Heart Association reviewed 10 years of National Inpatient Sample (NIS) data which included almost 47 million American women who were hospitalized for conditions related to pregnancy. The researchers found that while Black mothers were much more likely to be younger than white mothers, they had significantly higher rates of cardiovascular risk factors, including high blood pressure, diabetes, obesity, heart failure, cardiomyopathy, and atrial fibrillation. Black women also had a higher risk of bleeding, cardiac tamponade, cardiac arrest, acute kidney injury, and sepsis compared with other races. And while the majority of Black women in the study were insured by Medicaid — compared with the majority of white women, who had private health insurance — the researchers found that socioeconomic status did not improve a Black woman’s cardiovascular-related pregnancy outcomes. A trove of research has illustrated how systemic racism, the stress of living in a racist society, and implicit bias among healthcare workers greatly contributes to Black Americans having many of the worst health outcomes in the nation, with maternal mortality being among the starkest. “This study absolutely demonstrates that there is a problem. We talk quite often about this problem, but I think what this new research can do is open up is the dialogue about how we can fix this problem,” says Rachel Bond, MD, system director of women’s heart health at Dignity Health in Arizona. According to the CDC, 60 percent of pregnancy-related deaths are preventable: “Which means that if we listen to mothers, monitor them closely, and intervene early, we can stop a lot of these deaths from happening,” she says.
Expanding Cardio-Obstetrics and Bolstering Black-Led Outreach Are Key to Improving Outcomes
Both the American Heart Association (AHA) and the American College of Cardiology (ACC) are working to grow the field of cardio-obstetrics so women have access to cardiovascular experts that are keenly aware of how the cardiovascular system is impacted during and after pregnancy. According to Dr. Kapadia, expanding this specialization is crucial for early intervention that could manage risk factors and halt complications. “We need to closely monitor the highest risk women, specifically Black women, who should be seen by a cardio-obstetrics specialist, not just a cardiologist,” says Kapadia. “Pregnancy tests the cardiovascular systems and even women without existing risk factors may develop heart disease during pregnancy.” According to Dr. Bond, healthcare changes need to happen at the community level, too. The best way to intervene is to invest in Black-led community-level outreach that specifically targets Black women, who are at a higher risk for cardiovascular complications during pregnancy, says Bond. “Systemic racism is going to take time to fix. The first step is making sure we are giving Black women better access to care providers and community activists such as midwives and doulas. They can advocate for these patients who may feel that their voices aren’t being heard,” she says, noting that getting cardiologists involved early on in a woman’s pregnancy and reaching out to high-risk women before they conceive are also key strategies that would help improve maternal health outcomes for Black women. According to Bond, acute scenarios such as cardiac arrest or tamponade — fluid buildup in the heart — occur suddenly and often without warning, but the conditions are triggered by treatable risk factors, such as obesity, high cholesterol, high blood pressure. “These are the preventable factors that we in the medical field have to do a better job of educating our patients before the thought of having a baby even comes to mind,” says Bond. Improving maternal health would have a ripple effect that could simultaneously improve other glaring health disparities, especially heart health, explains Bond. “Pregnancy is a stress test that gives us an overview of what future health complications might be. Complications during pregnancy put women at higher risk for premature stroke, high blood pressure, and blockages in the arteries of the legs,” says Bond. “Preventing complications during pregnancy will improve a woman’s health later on in life."
