April 11-17 is Black Maternal Health Week. These stories regarding the health of women during pregnancy, childbirth, and the postpartum period are to commemorate the work being done to improve the birthing experiences of Black mothers in this country.
According to a recent report from the Centers for Disease Control (CDC), from 2020 to 2021, there was a 40 percent increase in death, particularly impacting Black women, during pregnancy or shortly after women had given birth. Fourty percent.
Cardiologist Rachel Bond, M.D., system director of women’s heart health at Dignity Health says those numbers are partly because of social factors. “Where people are born and where they grow up, where they live, where they work, and where they pray and play, it matters,” Bond tells ESSENCE. And social factors, amid the early days of the COVID-19 pandemic, were greatly impacted due to psychosocial stress and the isolation required at that time. “If they have access to care, if they have a safe environment where they can maybe exercise it, do they have access to healthy eating? Do they even have a healthy location where they can go to the physician or the clinician? It’s really those social aspects that are driving these rates that we’re seeing and the data that the CDC is highlighting,” she tells ESSENCE.
In addition to that, cardiovascular health issues are also a huge contributor to the rising numbers. Heart disease is still the number one killer of men and women in the United States, and pregnancy is particularly tough on even the healthiest of hearts, pumping a greater volume of blood than usual. Cardiovascular disease is a leading cause of complications during pregnancy and of maternal death.
“Cardiac disease doesn’t discriminate during pregnancy. Sometimes pregnancy, we like to call it its own cardiac stress test,” Bond says. “And what that means is that it could unmask things that maybe had already been there, things that we were born with, such as congenital heart disease, or things that we acquired throughout our lifetime because of those risk factors of the diabetes, the high blood pressure, the high cholesterol. And it unmasks it during the pregnancy, making the mom more at risk of having complications.”
She adds, “Sometimes, also during the pregnancy, you may not necessarily have an unmasking of heart disease, but you could be more at risk of having some of the adverse pregnancy outcomes. That’s the term that we use for complications that occur during pregnancy, such as preeclampsia, high blood pressure of pregnancy or diabetes of pregnancy. All of which are issues that could occur during pregnancy, but also are independent risk factors for heart disease in the future.”
So how can women look out for their heart health in an effort to curb these numbers as they journey into pregnancy? Bond says preconception counseling is a good place to start. That is when women of reproductive age go every year for a well woman visit, getting their blood pressure, cholesterol, and blood sugar checked to know what their risk factors are.
“You even talk to your family members about whether or not they had any issues with their pregnancy, particularly, your mother. But also, asking your family members about their cardiac history is such an amazing way for us to hopefully optimize a person’s health before they decide to have a family if they decide to have a family,” she says.
She also notes that it’s important to not assume once you exit the hospital after having your child that you’re all clear. An alarming number of deaths happen after delivery. In fact, 53 percent of the maternal deaths occur seven to 365 days postpartum.
“I can’t emphasize the importance of having that close follow-up with the clinician,” she says. “Any patient that had some of those complications that I mentioned, the preeclampsia, the gestational diabetes or hypertension, or even having a premature labor, those are women who absolutely need to have a close follow-up because as I noted, they do place them at a higher risk in the future of having a cardiac event.”
She notes that if women have prolonged swelling in their legs past a couple of weeks, or it gets worse, that’s a red flag. Also troubling is swelling in the face or hands, pain or pressure in the chest, shortness of breath, especially when lying flat, and belly discomfort.
“These are usually red flags of a condition called preeclampsia. Many people think that once you deliver, you’re in the clear of preeclampsia. And we actually know that preeclampsia, which is a condition that affects the blood pressure and can also affect other organs, including the heart, it can actually occur up to six weeks after delivery,” she says. “And this is why it’s so, so important that these mothers are going for their postpartum checkup.”
During pregnancy, it’s suggested that you know the recommended weight gain from your provider and not go overboard with your diet, especially if you’re at risk for the aforementioned complications. And once cleared after you give birth, it’s important for high-risk patients to get moving to get the weight off not for cosmetic purposes, but to fend off future heart disease.
“So much data demonstrates that when mothers don’t lose the baby weight within three to six months post-delivery, they are at a higher risk of having insulin resistance, elevated cholesterol and high blood pressure, all risk factors for cardiovascular disease in the future,” says Bond. “We do recommend, once the obstetrician has cleared them to start a routine exercise regimen, to start exercising. Many of these risk factors can largely be controlled with the use of lifestyle measures. And that does include a heart healthy, well-balanced diet, which usually is high in greens, whole food, and very low in saturated fat.”
While there are definitely efforts that can be made by mothers to handle heart health issues before, during and after pregnancy, these numbers still beg the question of what medical providers and institutions are doing to address this alarming increase in deaths. Bond’s institution has already begun taking special steps in the effort to save lives.
“Dignity Health is just one of many hospital systems that are focusing on these maternal heart councils. One thing that’s unique within our council is the fact that we acknowledge that many of the poor outcomes that we see have a lot to do with the fact that women, particularly Black women, are not being listened to and they’re not being heard,” she says. “Even though Black women are saying, ‘Something doesn’t feel right. I know my body and it just doesn’t seem appropriate to me,’ they’re still not being listened to. And as such, we’re going days, weeks, and sometimes even months without a diagnosis.”
“As such, what we really are aiming for is focused clinician education. That’s not just at the level of the nursing staff that are taking care of these patients, more so within the hospital system, but also that’s at the level of the clinicians that are caring for them also in the outpatient setting,” Bond adds. “We really have had targeted education that has allowed us the opportunity to talk about the risk factors, talk about the implicit biases that we know exist within the healthcare structure as a whole. And I really do think at the end of the day, it’s going to make a large difference in at least giving us the opportunity to start listening to these women to prevent these poor outcomes from happening.”