Beyoncé is famously reluctant to speak with members of the press.
But in an article published in Vogue this week, she broke her silence to discuss some of the challenges she experienced while pregnant with twins last year.
“I was 218 pounds the day I gave birth to Rumi and Sir. I was swollen from toxemia and had been on bed rest for over a month. My health and my babies’ health were in danger, so I had an emergency C-section,” the award-winning musician revealed in the magazine.
Toxemia is more commonly known as preeclampsia.
It’s a complication that can develop in later stages of pregnancy, causing high blood pressure and other problems.
In severe cases, it can lead to organ damage, problems with fetal development, and a potentially life-threatening condition called eclampsia.
How many women are affected?
Preeclampsia and related disorders affect 5 to 8 percent of births in the United States, estimates the Preeclampsia Foundation.
Studies suggest that black women are more likely than white women to be affected.
“There’s increased risk of developing preeclampsia among women of color, particularly among African-American women,” Dr. Allison S. Bryant Mantha, vice chair of quality, equity, and safety in the department of obstetrics and gynecology at Massachusetts General Hospital, told Healthline.
“There’s also some evidence that they may be more likely to get more severe forms of preeclampsia than others,” she added.
In fact, the Agency for Healthcare Research and Quality found that in 2014, the rate of preeclampsia/eclampsia was 60 percent higher for black women than white women.
Another study published this year in the International Journal of Hypertension found that eclampsia most commonly develops among Samoan, Hawaiian, and black women.
“The rate of eclampsia in our study was 4 per 1,000 live births for black women, compared with 2.3 per 1,000 live births for non-Hispanic white women,” Gopal Singh, PhD, lead author of the 2018 study, and senior health equity advisor at the Health Resources and Services Administration, told Healthline.
“The rate of eclampsia was highest among Samoans and Hawaiians,” he continued, “and lowest among Chinese, Vietnamese, and Koreans.”
Part of a larger pattern
Racial disparities in preeclampsia are part of a much larger pattern, in which black women are more likely than white women to develop many complications of pregnancy.
Black women are also three to four times more likely than white women to die from pregnancy-related problems, reports the .
Their babies are at heightened risk, too, of both and .
It might be tempting to chalk these differences up to socioeconomic inequalities, but income and education disparities alone can’t account for the gaps between black and white mothers.
Even when researchers control for income, education, and other socioeconomic factors, they find that white mothers tend to come out ahead.
“There’s something to be said for accumulated wealth, family dynamics, and other things that aren’t easily measured and put in a model,” Bryant Mantha said, “but I also think there’s something about being black in this society that probably contributes, above and beyond how much money you actually have at this very moment.”
For example, she suggests that differences in healthcare access and experiences may play a role — not only during pregnancy, but also before it.
“It may be that women of color who have poor access to primary care, preventive care, and even birth control methods and reproductive planning, enter pregnancy less healthy,” she explained.
“If women are not able to be as intentional as they would like to be and get themselves in as good shape as possible before pregnancy,” she continued, “that may increase their likelihood of having a poor pregnancy outcome.”
Racial bias in the healthcare system may also contribute to poorer healthcare and health outcomes among black women.
“We do think that people are treated differently in the healthcare system,” she said. “Whether it’s the overt or unconscious ways that women get different care once they enter healthcare, it probably also has something to do with how they exit.”
Leveling the playing field
To help address disparities in maternal and infant health outcomes, Bryant Mantha emphasizes the importance of raising awareness about them.
“What we’re trying to do is improve everyone’s awareness of disparities, both in the lay public so women can advocate for themselves, but also among providers so providers can be aware that perhaps despite their best intentions, there are differences and they should be keeping an eye out for women when they’re taking care of them,” she explained.
“Then on a bigger health system level,” she added, “it’s trying to make sure that we’re looking out for women before pregnancy, or between pregnancies, to make sure they have the access they need to get blood sugars under control, get high blood pressure under control, and make sure they have healthy eating habits and healthy behaviors.”
Women who have chronic high blood pressure, diabetes, kidney disease, or a history of blood clots are at increased risk of developing preeclampsia during pregnancy.
Singh and colleagues also found that women who are obese, those who smoke, and those who get pregnant under the age of 20 or over the age of 35 are more likely to experience eclampsia.
Many of those risk factors can be modified through lifestyle changes and interventions.
“It is important for women who are planning to become pregnant to seek and receive healthcare before pregnancy and during pregnancy to reduce their risk of pregnancy complications, such as gestational diabetes, prepregnancy obesity, excess weight gain during pregnancy, and preeclampsia,” Singh said.
“There are many community-based federal programs aimed at reducing rates of obesity, physical inactivity, smoking, and chronic hypertension,” he continued, “and promoting healthy eating and weight management.”
Singh cites the CDC’s program as one example.
Bryant Mantha also encourages black women and others to develop strategies for advocating for themselves during healthcare appointments.
“Whether that’s bringing a partner into the room, bringing a doula, bringing a grandmother, bringing a friend, reading up on your conditions ahead of time, going in with questions — all of those things are helpful to advocate for your own care,” she said.