The burden of cardiovascular disease in the United States remains high, and the risk of cardiovascular disease (CVD) is disproportionately prominent among Black individuals. Fifty-nine percent of Black women over the age of 19 have CVD. The death toll each year for Black women with CVD is over 50,000, surpassing deaths due to breast cancer, lung disease, and stroke combined.
“Less than half of Black women are aware that heart disease is their number one cause of death.” -Dr. LaPrincess Brewer, Cardiologist and Assistant Professor of Medicine within the Mayo Clinic
CVD and Prenatal Health Statistics
CVD, or cardiomyopathy, contributes to 1 in 4 maternal deaths in the United States. A pregnant woman’s heart exerts twice as much force to circulate the increase in blood volume. It has to adjust to changes in heart rate and blood pressure which further challenges the cardiovascular system. For example, preeclampsia, a condition characterized by high blood pressure, organ damage, and pre-term birth, can occur and pose a risk to both the mother and fetus.
Black women are more likely to have pre-existing cardiovascular morbidities, which increases the risk of preeclampsia, gestational diabetes, pre-term birth, and maternal mortality. Non-Hispanic Black women in the United States are almost 4 times more likely to die from preventable pregnancy-related deaths than the general population.
March of Dimes examined data from 2018-2020 among women ages 15-44 years old. They reported that Black women had the second highest fertility rate at 62.6 per 1,000 yet had the third highest birth rate (15.2 percent) compared to the 52.1 percent of live births from white women. This stark discrepancy suggests that Black mothers and their babies are not receiving equitable access to prenatal care, maternal health services, and other essential resources for a healthy and successful pregnancy which puts both lives at risk.
Contributions to CVD and Maternal Health Inequities
Structural and systemic inequalities such as disparities in access to quality and affordable healthcare, employment, income, housing, transportation, and food insecurity promote the development of cardiovascular disease and prevent access to proper pre- and post-natal healthcare.
Implicit biases: Biases held by healthcare providers can negatively impact the care received by Black women. These biases can lead to undertreatment, delayed diagnosis, or inadequate management of complications, contributing to adverse outcomes, including maternal death.
Limited access to quality care: Systemic racism has led to healthcare deserts, where predominately Black communities have limited access to quality healthcare facilities and services. This lack of proximity to healthcare providers can lead to delays in fundamental pre- and post-natal care, increasing maternal risk.
Socioeconomic disparities: Black women experience higher rates of poverty, limited access to education, and employment opportunities with livable wages. These factors increase stress, endorse poor nutrition, limit healthcare insurance access, and further heighten maternal health risk.
Discrimination in healthcare: Black women often report experiences of discrimination within healthcare systems, including dismissal of their concerns, lack of cultural competence, and even disrespectful treatment. These experiences effectively deter Black women from seeking care, delaying necessary interventions, and destroying trust in healthcare providers.
Pregnant women with known heart conditions must receive specialized care from a multidisciplinary team of obstetricians, cardiologists, and other healthcare professionals. To ensure a healthy pregnancy and baby, preconception healthcare and counseling are essential for women with pre-existing cardiovascular conditions. For women with cardiovascular disease, preconception care can include assessing overall heart health, determining procedures that must be performed before pregnancy, and discussing the safety of procedures or medication. The American Heart Association has recommended healthcare plans for women with pre-existing heart conditions, yet 1 in 5 women do not receive or know about this care. Implementing programs catered to educating and counseling women on the importance of their heart health before pregnancy can aid in minimizing disproportionate rates of maternal mortality in the Black community.
Recommendations and Conclusions
Pregnant women must prioritize prenatal care and communicate clearly and openly with their healthcare providers about pre-existing health conditions. Timely intervention, regular monitoring, and a collaborative approach among healthcare professionals can help manage complications and ensure the best possible outcomes for the mother and the baby.
Addressing these disparities requires a comprehensive approach. It involves increasing
awareness among healthcare providers about the unique risks that Black women face, addressing racial inequality, promoting culturally sensitive care, and improving access to prenatal care and specialized services. Implementing policies that address social determinants of health, such as equitable access to education, employment opportunities, and healthcare resources, is also crucial.
Efforts to reduce cardiovascular complications in Black women during pregnancy must also be intersectional, addressing both racial and gender disparities. By addressing systemic inequities, providing comprehensive prenatal care, and promoting health education, we can improve maternal outcomes and ensure that all women, regardless of race, receive the care they deserve.