What Is Gestational Hypertension and Why Does It Disproportionately Affect Black Mothers?
Gestational hypertension is a condition characterized by high blood pressure that develops after the 20th week of pregnancy in women who had normal blood pressure before becoming pregnant. Unlike chronic hypertension, which is present before pregnancy or diagnosed before 20 weeks, gestational hypertension occurs during pregnancy and usually goes away after delivery. However, it can lead to serious complications without good care and observation.
Why Gestational Hypertension Matters
High blood pressure in pregnancy isn’t just a number on a chart—it’s a critical warning sign. If left untreated, gestational hypertension can become preeclampsia, a life-threatening condition that can damage organs , particularly the liver and kidneys. It also increases the risk of placental abruption (where the placenta separates from the uterus), preterm birth, low birth weight, and in severe cases, maternal or infant death.
Gestational hypertension affects about 6–8% of pregnancies in the U.S., but some moms are more likely to experience the condition than others [1].
Why Black Mothers Are Disproportionately Affected
Black women in the United States are 60% more likely to develop gestational hypertension compared to white women [2]. They are also three times more likely to die from pregnancy-related complications, including hypertensive disorders [3].
Several factors contribute to this disparity:
1. Implicit Bias and Delayed Diagnoses
Research has shown that Black women’s symptoms are more likely to be dismissed or minimized by healthcare providers. This leads to delays in diagnosis and treatment, which can turn manageable conditions like gestational hypertension into life-threatening emergencies [4].
2. Structural Racism in Healthcare
Historic and systemic racism has created inequities in access to quality prenatal care, insurance coverage, and culturally competent providers. These barriers can lead to under-treatment, missed follow-up appointments, and a lack of careful and proactive management of symptoms.
3. Chronic Stress
The daily stress of navigating racism, discrimination, and economic inequities can lead to chronic high levels of cortisol, a hormone that raises blood pressure and inflammation in the body [5]. This physiological stress response is believed to play a role in the higher rates of hypertension and preterm labor seen in Black pregnant women.
4. Lack of Trust in the Medical System
Many Black mothers report feeling unheard or unsafe in medical settings. This lack of trust which comes from lived experiences and history of communities not being well cared for, can lead to reluctance to seek care or adhere to treatment plans.
What You Can Do: Steps Toward Safer Pregnancies
While change from hospital administration and medical school are needed, there are critical actions individuals can take to protect their health and advocate for better care:
Monitor your blood pressure regularly. Blood pressure cuffs that can be used at home are available and can help you detect early warning signs.
Know the symptoms of gestational hypertension: persistent headaches, swelling in the hands or face, vision changes, and upper abdominal pain.
Ask questions. You have the right to understand your care plan and receive answers.
Bring a support person to appointments who can help advocate for you.
Seek culturally competent care. Whenever possible, work with providers who understand the unique needs of Black mothers and who take your concerns seriously.
Together, We Can Change the Outcomes
Gestational hypertension is common but it doesn’t have to be deadly. By raising awareness, improving care, and working with hospital care systems and medical schools, we can create a safer path to motherhood for Black women. No mother should have to fight for her life while bringing life into the world.
Sources:
American College of Obstetricians and Gynecologists (ACOG). Gestational Hypertension and Preeclampsia
Centers for Disease Control and Prevention (CDC). Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths
Petersen, E.E., et al. (2019). Vital Signs: Pregnancy-Related Deaths — United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR. Morbidity and Mortality Weekly Report.
Taylor, J. (2020). Structural Racism and Maternal Health Among Black Women. Journal of Law, Medicine & Ethics.
Christian, L.M. (2012). Psychoneuroimmunology in pregnancy: Immune pathways linking stress with maternal health, adverse birth outcomes, and fetal development. Neuroscience & Biobehavioral Reviews.
