Pregnancy and childbirth are among the most cherished experiences of a lifetime. While most women can count on having a pleasant, healthy pregnancy and delivery, sometimes complications do arise — and Black moms are more likely than white moms to experience them.
In fact, Black women are three times more likely to die of pregnancy-related complications than white women, according to the Centers for Disease Control and Prevention (CDC).[1]
Why? Well, it's complicated. For one, Black women are more likely to be uninsured and face greater financial barriers to health care. But even Black women who are relatively well-off are more likely to face complications due to systemic racism in the health care system.
One 2016 analysis of data from New York City hospitals found that Black, college-educated moms were more likely to face life-threatening pregnancy or childbirth complications than white moms with only a high school diploma.[2]
The good news is that many pregnancy complications are preventable, or at least manageable. If you're a Black mom-to-be, there are concrete steps you can take to cut your risk of complications. And being in tune with your body and understanding warning signs that something might be wrong can help you protect yourself.
Here are 10 common pregnancy complications that disproportionately affect Black moms.
1. Gestational diabetes
Gestational diabetes (GD) is one of the most common pregnancy complications, affecting up to 9% of expectant moms. But with careful monitoring and proper care, it can be managed without compromising the health of your pregnancy.
Risk factors
GD is a bit of an enigma in terms of understanding why some women get it and others don't. Still, specific factors increase the risk of GD, some of which may explain why Black expectant moms are more likely to be diagnosed with the condition. They include:
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- Being overweight, or having a body mass index (BMI) of 30 or more going into pregnancy
- Family history of type 2 diabetes
- Previous pregnancy with gestational diabetes
- Having pre-diabetes
- Excessive weight gain, including that associated with bed rest
Because members of the Black community have the highest prevalence of obesity compared to other racial groups, according to the CDC, Black expectant moms tend to be more at risk for gestational diabetes.[3] Black women are also more likely to have high blood pressure than white women and are more susceptible to having a family or prior history of GD.
Socioeconomic status, poverty and housing situations also play a role in some Black women not having the means to afford or access nutrient-rich foods like fresh fruits and vegetables. That, in turn, can impact their ability to maintain a healthy diet and pregnancy weight. Lack of awareness and knowledge about GD, as well as a lack of access to quality medical care, are also to blame.
How to protect yourself
Most women with gestational diabetes don't experience any symptoms. The best way to confirm whether you have GD is by getting the glucose screening test around weeks 24 to 28 of pregnancy.
How it's treated
Once diagnosed, GD is generally treated with a special diet (modified for carbs and refined sugars) and regular exercise to prevent further excessive weight gain and better regulate blood sugar. Although most cases resolve after delivery, insulin is sometimes prescribed to control blood sugar levels for more serious cases.
Unmanaged gestational diabetes can result in other pregnancy complications, including preeclampsia and macrosomia, which may affect delivery.
2. Preeclampsia
Preeclampsia typically develops after 20 weeks of pregnancy and is characterized by sudden-onset high blood pressure, severe swelling of hands and face, and protein in the urine. Left untreated, it can lead to serious complications for both mom and baby.
Risk factors
Several preexisting conditions associated with preeclampsia raise the risk of diagnosis, including:
- History of hypertension
- Obesity
- Sickle cell disease
- Diabetes
- Vitamin D deficiency in the first 26 weeks of pregnancy
- Autoimmune disease such as lupus
Given that Black women have higher rates of high blood pressure, hypertension, sickle cell disease, obesity and diabetes, and the Black community overall has higher rates of vitamin D deficiency, pregnant Black moms are more likely to be diagnosed with preeclampsia and experience more severe outcomes than white women.
Black women also tend to exhibit signs of preeclampsia earlier in pregnancy than white women, and it has been found that preeclampsia is more prevalent among expectant American mothers from low-income areas in the South.
How to protect yourself
The most important thing you can do is pay attention to your body and watch for these common preeclampsia symptoms:
- A spike in blood pressure
- Sudden excessive weight gain that can't be explained
- Severe swelling in the hands and face
- Edema, or severe swelling of the ankles, that doesn't subside
- Severe headaches that aren't relieved by acetaminophen (Tylenol)
- Abdominal pain, especially in the upper abdomen
- Double or blurred vision
- Accelerated heartbeat
- Trouble breathing or pronounced shortness of breath
- Dark or small amounts of urine
Some doctors also prescribe low-dose aspirin, often from the end of the first trimester through the end of pregnancy, because it may reduce the risk of developing preeclampsia by up to 24 percent. It can also help stave off blood clots that can factor into other complications. Be sure to talk to your doctor before taking aspirin or any other medications during pregnancy, however.
If your physician believes that you might have preeclampsia, you'll need to take a urine and blood test to check for protein in your urine (proteinuria), excessively high liver enzymes or a low blood platelet count.
How it's treated
Preeclampsia is typically treated with blood pressure medication and rest. Although the condition is manageable, the cure begins with delivering the baby and the placenta, which might result in an early delivery in more severe cases. Fortunately, 75% of cases are mild.
Although preeclampsia is manageable with early detection and proper treatment, in rare cases additional complications can arise, including preterm birth, HELLP syndrome, eclampsia and others.
Rarely, preeclampsia symptoms can arise after delivery. Postpartum preeclampsia affects an estimated 4 to 6% of women who had preeclampsia during pregnancy. It's essential to let your doctor know if you experience any preeclampsia symptoms up to six weeks after your baby's birth.
3. Preterm labor
Preterm labor is classified as a baby's birth before 37 weeks of pregnancy. Most research suggests that preterm labor affects about 1 in every 10 infants in the U.S., but the rate of preterm birth among Black women is 14 percent, almost 50 percent higher than the rate for white women (9 percent).
There are ways for Black expectant moms to reduce their risk of preterm birth — and there are plenty of babies born prematurely who go on to live healthy and happy lives.
Risk factors
There are no specific causes for preterm birth, but several factors can play a significant role in triggering preterm labor:
- Chronic emotional stress or extreme (work-related) physical stress
- Smoking, drug and alcohol use
- Abnormalities of the cervix or uterus
- Getting pregnant when you're younger than 17 or older than 35
- Previous preterm birth
- Pregnancies spaced fewer than 18 months apart
- Periodontal disease
- Mothers born prematurely themselves
- Uterine and vaginal infections such as bacterial vaginosis and trichomoniasis
- Untreated urinary tract infections
- Carrying twins or other multiples
- Pregnancy complications like gestational diabetes, preeclampsia and others
How to protect yourself
Focus on caring for yourself and your baby-to-be. Pick up these healthy habits, if you haven't already:
- Don't drink, smoke or take drugs that weren't prescribed by your physician
- Maintain a healthy diet and weight
- Regularly take your prenatal vitamins
- Maintain good oral health
- Consult with your doctor regularly and educate yourself about your risk
- Drink plenty of water
How it's treated
If you or your doctor suspect that you may be at risk for preterm labor, your physician might run a couple of tests to predict if you're at risk. Depending on the outcome, steps might be taken to prevent preterm labor (or stave labor off as long as possible), or if you're far enough along, your doctor might recommend inducing labor.
4. Eclampsia
In rare cases when preeclampsia is not properly managed, an expectant mother might develop eclampsia. Eclampsia is the onset of seizures during pregnancy, and it affects about 1 in every 1,500 pregnancies. Like preeclampsia, it's characterized by severe swelling, high blood pressure and protein in your urine.
Risk factors
Pregnant women who have not received proper care for preeclampsia are at a higher risk of developing eclampsia. This, unfortunately, places some Black women at an increased risk due to not having access to medical insurance and quality medical care. Racial bias and discrimination can also play a significant role in Black women not receiving proper medical treatment.
How to protect yourself
Advocating for yourself is the best thing that a Black expectant mom can do if diagnosed with eclampsia or if you suspect that you might have it. If you have preeclampsia, your provider should monitor you and your blood pressure very closely to ensure that your condition doesn't become more severe.
If you feel that you're not receiving adequate care or if your condition begins to worsen, contact your physician immediately, or seek emergency medical treatment.
How it's treated
Seizures are typically the most common symptom associated with eclampsia, and because the condition can be life-threatening for both mother and baby, a doctor might recommend immediate delivery depending on how far along the pregnancy is. Like preeclampsia, delivery is the only treatment for the condition. However, maternal death as a result of eclampsia is very rare in the U.S., and with proper medical care and follow-up treatment, women with eclampsia return to normal health after delivery.
5. HELLP syndrome
Eclampsia is not the only rare complication that can crop up for women with preeclampsia. HELLP syndrome is a condition that typically happens in conjunction with preeclampsia during the third trimester. This liver and blood-clotting disorder occurs in only about 1 to 2 in 1,000 pregnancies.
Risk factors
While it's not known what exactly causes HELLP syndrome, an estimated 70 to 80% of the women who have it also have preeclampsia, which is why it can be thought of as a possible complication of preeclampsia.
Unfortunately, this places Black women at a higher risk of HELLP syndrome because they're more likely to develop preeclampsia and eclampsia. The National Institutes of Health (NIH) reports that an estimated 1 in 4 women who had HELLP during a previous pregnancy are also at a greater risk of getting it again during a subsequent pregnancy.
How to protect yourself
Although HELLP typically occurs between 27 and 37 weeks of pregnancy, some cases can develop within 48 hours after delivery. Recognizing the symptoms is instrumental for early detection and treatment.
Symptoms include:
- Headaches that will not go away
- Excessive weight gain
- Excessive and consistent edema or water retention and swelling
- Pain and tenderness in the upper right side of the abdomen
- Nausea and/or vomiting
- Blurred vision
- Nosebleeds
- Generally not feeling well
- Seizures (in rare cases)
HELLP signs can resemble those of preeclampsia or even typical pregnancy symptoms, so talk to your doctor if you notice any of them. This is especially important if you're at risk of preeclampsia or have already been diagnosed with preeclampsia and your symptoms have worsened.
How it's treated
The only treatment for HELLP syndrome is delivery. If you are experiencing symptoms, call your doctor or head to the emergency room immediately.
6. Hypertension
First, it's important to distinguish between gestational hypertension (the kind that crops up during the second half of pregnancy) and chronic hypertension (when a pregnant woman has pre-existing hypertension).
Gestational hypertension is typically diagnosed during pregnancy, and it usually subsides after delivery. Still, your doctor will monitor you closely because gestational hypertension may progress to preeclampsia.
Chronic hypertension, on the other hand, puts you and baby at higher risk for preterm delivery and low birth weight, as well as preeclampsia. You may be diagnosed with chronic hypertension if you have two blood pressure readings of 140/90 mm Hg before you reach 20 weeks of pregnancy.
Risk factors
The risk factors for chronic hypertension are the same as the risk factors for high blood pressure. They include:
Being overweight or obese
- Having diabetes
- Family history of high blood pressure
- Lack of physical activity
- Having sleep apnea
- Drinking too much alcohol
- High cholesterol
- Smoking
- Stress
More than 50% of non-hispanic Black people have high blood pressure.[4] Researchers believe rates are so high because Black people are more likely to be obese or have diabetes.
How to protect yourself
Chronic hypertension is manageable, and if diagnosed, you will likely go on to have a safe pregnancy and a healthy baby. The most important things you can do are keep all your prenatal appointments and go for any tests your doctor prescribes.
Your doctor may also suggest that you take low-dose aspirin from the end of your first trimester throughout the rest of your pregnancy, as it can lower the risk of developing blood clots and other complications like preeclampsia. But always ask your practitioner before taking any medications during pregnancy.
How it's treated
You'll work with your doctor to develop a treatment plan customized to your needs. You may need to continue taking the blood pressure meds you were on before you got pregnant, or you may need to switch to something safer. You may also be advised to take baby aspirin.
7. Heart disease
"Heart disease" refers to several conditions that affect the heart, including coronary artery disease, arrhythmias and congenital heart defects. It's the leading cause of maternal death in the U.S.
Risk factors
There are many medical conditions and lifestyle choices that put you at greater risk of heart disease, including:
- High blood pressure
- High cholesterol
- Smoking
- Diabetes
- Unhealthy diet
- Lack of exercise
- Excessive alcohol use
Heart disease is more prevalent among Black women in general than it is among white women. Some of the conditions Black women are at a higher risk of — including hypertension, obesity and diabetes — increase the risk of heart disease, which makes Black women more susceptible.
How to protect yourself
If you know you have heart disease, it's best to talk to a doctor before you start trying to conceive because pregnancy will put added stress on your circulatory system. You may be referred to a maternal-fetal medicine specialist, a type of obstetrician who specializes in high-risk pregnancies.
That said, heart disease is often called a "silent killer" for a reason. Plenty of women have heart disease and don't even realize it. All pregnant and postpartum women should watch out for these heart-related warning signs:
- Sudden, extreme swelling or weight gain
- Extreme fatigue
- Fainting
- Persistent cough
- Chest pain
- Shortness of breath
- If you experience any of the above symptoms, head to the emergency room right away.
How it's treated
Heart disease treatment depends on your individual situation. Your doctor may advise counseling for stress and mental health issues or treating related conditions like high blood pressure and diabetes. You may also be prescribed cardiac rehabilitation (rehab) if you've experienced heart problems in the past.
8. Peripartum cardiomyopathy
Peripartum cardiomyopathy (PPCM) is a rare but serious heart condition that can develop later in pregnancy or postpartum and occurs when the chambers of the heart become enlarged and the muscles of the heart begin to weaken. This prevents the heart from effectively pumping oxygen-rich blood to the rest of the body. About 10% of PPCM cases show up during the last month of pregnancy and 80% occur within the first three months of giving birth.
Risk factors
Studies show that Black women are at a higher risk of being diagnosed with PPCM and at a younger age, but there is limited information on what makes Black women more vulnerable, other than having an increased risk of other heart conditions, diabetes and hypertension. Fortunately, PPCM isn't common and affects 1 out of every 1,000 women in the U.S.
It remains unclear what causes PPCM, but studies suggest that there are several factors often associated with the diagnosis, like:
- Poor diet
- Obesity
- Heavy alcohol use
- Smoking
- Previous heart issues
- Being pregnant with twins
- Being over 30
How to protect yourself
Experts say that if you were diagnosed with PPCM during one pregnancy, it's likely you'll develop it again during a subsequent pregnancy. Consequently, doctors highly recommended that women with a previous PPCM diagnosis consult with their doctor before trying to conceive again.
It's important to know the signs and symptoms of PPCM — including extreme swelling in the hands and feet, pronounced fatigue, chest pains and erratic heartbeat, among others — to detect the condition early and treat it as soon as possible. But it can be tricky since many PPCM symptoms mirror regular pregnancy symptoms. The best thing to do is not to panic and check in with your doctor.
How it's treated
If you're diagnosed with PPCM, your doctor will likely focus on stabilizing your symptoms and relieving discomfort associated with them. You may receive heart medication too.
In more serious cases, your doctor might recommend inducing labor, depending on how far along you are in the pregnancy. Expectant mothers with milder cases will be monitored closely and induced only if their condition worsens.
9. Fibroids
Uterine fibroid tumors are noncancerous masses of muscle tissue that grow on the wall of your uterus. Most women who have fibroids go on to have completely normal pregnancies, and many women don't even realize they have them until they undergo their first ultrasound.
However, there are some pregnancy risks associated with fibroids, including placental abruption (when the placenta breaks from the uterine wall before delivery), preterm labor and C-section. Black women should know about fibroids because they're up to three times more likely to have them than white women, and the tumors are more likely to grow larger and cause severe pain.
Risk factors
Researchers still aren't sure why fibroids are so much more common in Black women, but they believe they may be linked to chronic stress associated with a lifetime of exposure to racism.
In addition to being Black, risk factors include:
- Age (most common in the 30s and 40s)
- Family history
- Obesity
- Eating a lot of red meat
How to protect yourself
The vast majority of pregnant women who have fibroids experience no complications. That said, if you experience vaginal bleeding, belly pain or severe back pain, call your doctor right away — those are signs of placental abruption, which is serious.
How it's treated
There isn't much that can be done for fibroids during pregnancy (and chances are, you can just leave them alone even after you give birth). If they bother you, though, your doctor might suggest you take acetaminophen (Tylenol).
10. Postpartum hemorrhage
Up to 5% of women experience postpartum hemorrhage (PPH), or excessive bleeding after giving birth. Usually, PPH happens immediately after the baby is delivered, but it can occur later too. Non-hispanic Black women are more likely to experience severe complications than women of any other race.
Risk factors
Several conditions contribute to a higher risk for postpartum hemorrhage. They include:
- Preeclampsia
- Obesity
- Blood and liver conditions
- Having a C-section
- Medications to induce labor or stop preterm contractions
- Vaginal or cervical tearing
- Fast labor, or being in labor for a long time
- Having multiple gestation like twins, triplets or more
There's also a small increased risk of PPH if you have fibroids, which may explain why Black women are more likely to experience PPH complications.
How to protect yourself
While most cases of PPH happen within an hour of having a baby, postpartum hemorrhage can occur up to 12 weeks after delivery. Call your doctor immediately if you experience any of these symptoms:
- Soaking through more than one pad in an hour
- Bright red vaginal bleeding beyond the third day after birth
- Blood clots larger than a plum
- Blurred vision
- Clammy skin
- Dizziness
- Weakness
- Chills
- Nausea
- Feeling faint
How it's treated
There are many treatments for PPH, and your doctor will choose one based on the reasons behind your bleeding.
Rest assured that though these pregnancy complications affect Black expectant moms more than white women (and those of other races and ethnicities in some cases), by attending your prenatal appointments regularly, advocating for yourself, asking plenty of questions and staying as healthy as possible, you can reduce your chances of developing these conditions during pregnancy.
You can also manage them properly if they do crop up. That, in turn, means you'll up your chances considerably of having a happy, healthy pregnancy and baby.
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