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Erica Morales of Phoenix is among the thousands of women who die each year during pregnancy or within a year of giving birth from pregnancy-related complications. (Courtesy photo)

The nation mourned the loss of Erica Morales, a Phoenix woman who died just moments after delivering quadruplets earlier this year.  Morales, who had undergone fertility treatment in order to conceive, began to experience signs of preeclampsia, a condition that causes blood pressure to rise, 31 weeks into her pregnancy.  While the actual cause of death is still under investigation, Morales’ blood pressure was documented as 190/90 and she posted a message on social media explaining her doctor’s concern about a potential stroke.  Following her death, several research bodies, including the Centers for Disease Control and Prevention, began efforts to reassert the connection between high blood pressure and other chronic conditions and maternal deaths.

High rates of obesity, high blood pressure, and inadequate prenatal care cause death from childbirth more often for African-Americans in the United States than for Whites and other ethnic groups. Worsening this trend are the increasing numbers of Cesarean sections that result in deadly complications for overweight women or those suffering from hypertension or other ailments.

Nationally, Blacks have a four times greater risk of pregnancy-related death than Whites –  a rate of 36.1 per 100,000 live births compared with 9.6 for whites and 8.5 for Hispanics, according to the CDC report.

Caryl Mussenden, a Lanham, Md.-based obstetrician and gynecologist said that the overall health of Black women before pregnancy plays a vital role in maternal mortality rates.  “Health conditions that are not being managed well before pregnancy often become chronic diseases during pregnancy, especially obesity, which increases rates of diabetes and high blood pressure,” Mussenden said.  “Something like uncontrolled hypertension becomes particularly problematic because it can easily develop into preeclampsia, edema and swelling, all of which compromise the body’s organs, especially the kidneys.”

A recent California study supports Mussenden’s observations, finding that of 386 women who died in the state during childbirth in 2002 and 2003 in cases of Black maternal deaths, the women were more likely to have been overweight or obese and to have risk factors identified in the prenatal period, including hypertension.  High rates of obesity or excessive gestational weight gain were contributing factors in one of four deaths.

Further, cardiomyopathy, or heart disease, was assessed as the leading cause of pregnancy-related death for African-American women and accounts for 36 percent of deaths in that group. Another 65 had undergone emergency C-sections in order to save the life of the mother or child and died from related complications. In most cases, the study concluded, maternal mortality was preventable.

Southeast resident Steve Shorter’s girlfriend, N’Zinga Bridgeman suffered a stroke shortly after giving birth to their son, Trey, after trying unsuccessfully to manage her hypertension.  Shorter said she endured debilitating headaches during the last three months of her pregnancy and was induced nearly five weeks prematurely.

“The pregnancy was rough on her because she couldn’t get her pressure right,” Shorter said.  “She kept saying she was craving certain foods, but it was like everything she ate gave her headaches – lots of take out and stuff.  Then her feet and legs began swelling and then her fingers and face.”

Bridgeman’s poor health and 270 pound girth (50 of which she gained during the pregnancy) made the pregnancy dangerous and a C-section necessary.  Shorter believes had Bridgeman’s weight and hypertension been managed before the pregnancy, the stroke would not have occurred.  Bridgeman and their son now reside in South Carolina with her parents.

Mussenden said that the old adage, you are what you eat was most apropos for Black women – even before conception begins.  Obesity among Black women may not only be a major risk factor in maternal mortality, but also a juggernaut for reproducing obesity-related conditions in unborn children.

“If we eat sugar, we gain weight and get fat.  In pregnant women, the sugar not only impacts the mother’s glucose levels and contributes to weight gain, but also causes rapid overgrowth of tissue in the baby, who develops conditions like heart defects and clef pallets,” Mussenden said.   “Out of control sugar habits can also cause these big babies – fat babies that are at increased risk of fetal distress and contribute to the rapid rise in deliveries by C-section.”

Similarly, with high blood pressure the fetus is not getting enough blood supply through the placenta and does not grow enough, according to Mussenden.

“It’s like starving a baby or putting the embryo on a diet so they are born weighing only 5 or 6 pounds.  If the nutrition is compromised, the babies are forced to be delivered early because they begin to show signs of fetal distress,” she said.

Dr. Kerry M. Lewis, chairman of the Department of Obstetrics and Gynecology at Howard University’s College of Medicine and chief of the Division of Maternal-Fetal Medicine, said, “I deal with a gamut of high-risk problems, but complications from obesity are an underlying problem in all of them.  Even young patients when they come in for prenatal visits have very elevated rates of high blood pressure. It really starts with obesity, so when they become pregnant, it places them at a higher risk for infections and other complications,” Lewis said.

As pregnancy-related mortality rates in some states begin to rival those in under-developed nations, researchers have begun to insist solutions focus on access to proper health care information and resources, rather than on technological advances.  Said Michael Lu, an associate professor of obstetrics and genecology and public health at UCLA, the U.S. spends more money on health care for mothers and babies than any other country in the world, but without the associated health outcomes.

“If you look at mortality as an indicator of community health, we’re doing pretty poorly.We’re not producing maternal and child health to the extent that we need to and it is not a problem of technology. It’s a systems problem. It’s an access problem,” Lu said.

Under Affordable Care Act addendums, beginning in 2014, all maternity care will be covered by new individual, small business, and government exchange plans. “This will provide an extraordinary opportunity to improve women’s health not only during pregnancy but before, between, and beyond pregnancy, and across the life course,” said Lu.