10 Pregnancy-Related Complications Black Women Should Know About

This story was originally published on the Everyday Health Group website What to Expect.

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.

Why? Well, it's complicated. For one, Black women are more likely to be uninsured and face greater financial barriers to healthcare. But even Black women who are relatively well-off are more likely to face complications due to systemic racism in the healthcare system.

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

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:

• 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 prediabetes
• Excessive weight gain, including that associated with bed rest

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 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 percent 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 (hemolysis, elevated liver enzymes, and low platelets) syndrome, eclampsia, and others.

Rarely, preeclampsia symptoms can arise after delivery. Postpartum preeclampsia affects an estimated 4 to 6 percent 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

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 United States, and with proper medical care and follow-up treatment, women with eclampsia return to normal health after delivery.

5. HELLP Syndrome

Risk Factors

While it's not known what exactly causes HELLP syndrome, an estimated 70 to 80 percent of the women who have it also have preeclampsia, which is why it can be thought of as a possible complication of preeclampsia.

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 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 preexisting 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 mmHg 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

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 United States.

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 percent of PPCM cases show up during the last month of pregnancy and 80 percent 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 United States.

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 thirties and forties)
• 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

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.