May is preeclampsia awareness month so I thought it would be important to write our blog on a topic that is crucial to address the Black maternal health crisis. Black women have some of the worst birth outcomes in the nation, but this doesn’t have to be. 84% of all of these complications. Cardiovascular vascular disease is the leading cause of these complications. 

But what is the connection between cardiovascular disease and preeclampsia? It’s probably best to start with a clear breakdown of what preeclampsia is.  Preeclampsia is a serious complication of pregnancy that not only causes high blood pressure but can also affect the function of important organs like the kidneys, lungs, liver, and even the brain. Untreated preeclampsia can also lead to a condition called eclampsia, which is a seizure condition. While the cause of preeclampsia is not fully understood, it is thought to have a connection to the blood vessels in the placenta which constrict or tighten resulting in high blood pressure.

High blood pressure is anything 140/90 or higher.  The top number is your systolic number and the bottom is your diastolic number.  Both of these numbers matter. If just one of them is out of range, screening for preeclampsia should begin, and possibly blood pressure medications.  Only one of these numbers needs to be out of range to be considered high, not both.

Symptoms of preeclampsia include:

  • Severe headaches
  • Shortness of breath
  • Swelling in the hands and face
  • Blurred vision

These are signs that are often dismissed as normal pregnancy symptoms. Know that these symptoms can be warning signs of preeclampsia and should be evaluated.  A protein urine test is the most common but isn’t required for a diagnosis if other symptoms are present. Black women are more likely to not be listened to and have their concerns dismissed.  If you feel this is happening to you, push for an evaluation of your symptoms to make sure.  An advocate like a community health worker or doula can help you speak up. If you don’t have one available, connecting to a community-based organization like ours can help hold the medical team accountable. 

Preeclampsia increases the risk of developing chronic hypertension within five years after giving birth and also strains the heart, increasing the risk of future heart disease. Black women are most likely to experience preeclampsia due to their experiences with racism and sexism, rather than their race. Other risk factors include a previous history of preeclampsia, being age 35 or older, being pregnant with your first child, and being overweight. It’s important for Black women with these risk factors to have a conversation with their provider about starting low dose aspirin to help prevent the development of preeclampsia.

Given the serious risk of preeclampsia, why isn’t more being done to prevent it?  Baby or low-dose aspirin which is a dose of 81 mg is one of the only tools we have to prevent preeclampsia. Yet only 10% of Black women who meet the criteria for baby aspirin are actually given a prescription.  To have the best chance of prevention, the aspirin should be started between 13-28 weeks, with 16 weeks being the most optimal time. 

Aspirin is commonly known to thin the blood so I completely understand folks’ hesitancy in taking the medication during their pregnancy. Baby aspirin however does not have that impact during the pregnancy. Baby aspirin works by helping the placenta function better and increases the blood supply to the placenta.  This action helps to reduce the development of high blood pressure and also increases the odds of a full-term birth.

Here are 5 tips for moms to manage preeclampsia

  1. Get a validated blood pressure cuff and check your blood pressure daily. Our team can help you get a validated cuff and show you how to use it. You can also check your cuff on this website https://www.validatebp.org/
    • Record your blood pressure in a log or app 
    • Any blood pressure of 140/90 or higher should be reported to your health care provider
  2. Ask your doctor about starting baby (low dose) aspirin.  The earlier you start this conversation the better.  Remember the best time to start baby aspirin is between 13 and 28 weeks, with 16 weeks being the best time to start.
  3. Know your protein levels.  In not all cases of preeclampsia but in many of them, the kidneys begin to spill protein into the urine. The presence of protein can be a sign of worsening kidney function and should be monitored closely
  4. Get connected to a cardiologist.  Anyone with high blood pressure during pregnancy should have regular care by a cardiologist during the pregnancy and for years after.  This will help to quickly identify and manage signs of heart disease
  5. Get a primary care doctor.  After your care has been completed by your Midwife or OB you want to continue to have annual checkups with your primary care doctor.  A family medicine doctor is a great option. 

Our care team has a program called “Cuff It” to help families who experience preeclampsia during their pregnancy or after giving birth manage their condition and connect to education and resources.  If you have been diagnosed with preeclampsia and live in NJ, be sure to reach out to our team to help.  A diagnosis of preeclampsia can be scary but with support, we can manage the condition together. 

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