Understanding Health Disparities in Cardiovascular Diseases in Pregnancy Among Black Women: Prevalence, Preventive Care, and Peripartum Support Networks

Abstract

Black women have higher morbidity and mortality in pregnancy and postpartum, as compared with women of other races/ethnicities, including white and Hispanic women. Pregnancy-associated deaths are rising in the USA and are higher than in other developed nations. Pregnancy-associated mortality rates are disproportionately higher among non-Hispanic black women. The purpose of this paper is to (1) review the current literature regarding pregnancy-associated cardiovascular disease prevalence in black women compared with women of other races/ethnicities, (2) review proposed factors contributing to these health disparities, and (3) discuss potential avenues to address these disparities in the name of reproductive justice. There is a paucity of data regarding factors contributing to disparities in health among black pregnant women, but it is clear that these cannot be fully explained by differences in socioeconomic backgrounds, access to health insurance, or healthcare literacy. Additionally, although some cardiovascular-related pregnancy mortality etiologies such as hemorrhage, pulmonary embolism, and hypertensive disorders of pregnancy are decreasing in incidence, other pregnancy-associated cardiovascular diseases and cardiomyopathy rates are increasing. Although the pathophysiology behind peripartum cardiomyopathy is still unclear, its prevalence is high among black women. Studies are lacking probing the influence of psychosocial factors on patient-provider relationships and patient-centered decision-making among black women during pregnancy and postpartum. Black women disproportionately experience higher pregnancy-related cardiovascular morbidity and mortality compared with white women. More studies are needed to fill the gap in the literature data regarding the causes of this significant health disparity. A better understanding of the various factors driving these maternal health disparities could inform the development of holistic, multifaceted approaches to caring for black women in pregnancy and postpartum. Continued dialog—among healthcare professionals, patients, and their allies—is important to promote advocacy and to improve patient-provider relationships.