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By Dr. Linda Burke-Galloway
When we think about maternal deaths, visions of thin, malnourished women lying on cots in thatched-roof cots immediately come to mind, when in fact they occur right in our backyard. In the U.S., preeclampsia is one of the four most common reasons for maternal death. On an average, there is approximately 1 maternal death for every 100,000 births, but for African American women, this number triples. African American women are three times more likely to die from preeclampsia and other childbirth-related issues and no one knows why.
As our society becomes more culturally diverse, this problem will indirectly affect all of us. Our daughters and granddaughters may no longer look like us ethnically but carry genes that places them at risks for complications associated with a particular race. While we attempt to unravel the mystery of what causes preeclampsia, an equally mystifying dilemma is to determine why are African American women more at risk for developing and then dying from preeclampsia than anyone else? Older schools of thought attempted to use socioeconomic status as a reason to explain the problem, but it doesn't hold up under statistical analysis. Let's take my sorority sister, Dawn, as an example.
Dawn did not live in the ghetto. She didn't use drugs. She didn't have high blood pressure and she wasn't morbidly obese. She was the oldest of four children who grew up in my hometown of Queens, New York, graduated from college and became an urban radio host, first in Buffalo and then in Orlando. While in Buffalo, she became extremely popular and had listeners as far away as Toronto.
Dawn was 31 years old when she married and became pregnant. Because of her notoriety as a DJ, her pregnancy and death made the local news. She was 32 weeks and had been on bedrest. Her blood pressure became extremely high and the baby was delivered. The day after her delivery, she called her pastor with a request for prayer. But by the time he arrived that evening, she had had a stroke, lapsed into a coma, and died. Her baby lived, but her young husband became an instant widower. Her story, while uncommon, is not unheard of.
The actress and singer, Vanessa Williams and her mother, Helen, describe the death of her paternal grandmother from preeclampsia in their book, If You Only Knew.
Another African American woman suffered a "near miss" with her preeclampsia, but lived to tell her story on her popular blog. Angela Burgin Logan is a former Kraft Foods marketer and an editor for Lifetime TV. When she became pregnant with her first child, her complaints of weight gain, fainting spells and headaches went unheeded by her obstetrician. Angela ultimately had preeclampsia and cardiomyopathy that almost killed her. She never saw it coming but was so grateful to ultimately be alive that she and her husband produced a movie entitled Breathe.
When African American women have preeclampsia, its effects are severe and it presents earlier than in women of other races. We don't know why. More research is certainly needed in this area but in the meantime, African American women should be screened for potential high-risk conditions and be managed as if they will develop preeclampsia, especially if it's their first pregnancy. If that had happened, my sorority sister Dawn, might be alive today.
Linda Burke-Galloway, MD, MS, FACOG is the author of "The Smart Mother's Guide to a Better Pregnancy: How to minimize risks, avoid complications, and have a healthy baby." She is an author, speaker, Ob-Gyn patient safety and risk management expert.
International Society for the study of Hypertension in Pregnancy
October 23, 2016
San Paulo, Brazil