Pregnancy and childbirth are among the most cherished experiences of a lifetime. While most pregnancies go smoothly, sometimes complications arise. Many personal, systemic, and historical realities leave Black mothers vulnerable to pregnancy-related complications like preeclampsia and gestational diabetes. The weight of these concerns leaves many Black mothers in a state of anticipation and hypervigilance during what should be a joyful time.
It’s widely known that Black women are three to four times more likely to die of pregnancy-related complications than white women.[1] Many of those disparities are the result of systemic racism in health care, unequal access to quality care, and the physiological toll that chronic stress from racism takes on the body, which presents regardless of educational or financial mobility.[2]
Fortunately, awareness of the risk, selecting a high-quality, culturally competent medical team, and establishing a plan of action can be empowering for Black mothers.
The better news is that many pregnancy complications are preventable, or at least manageable. If you’re a Black mom-to-be, there are concrete steps you can take to cut your risk of complications. Being in tune with your body and understanding warning signs that something might be wrong can help you advocate for yourself, if needed.
Here are 11 common pregnancy complications that disproportionately affect Black moms — and what you can do about each one.
Hypertension
Hypertension and high blood pressure are two different terms for the same condition. It’s important to distinguish gestational hypertension (the kind that crops up during the second half of pregnancy) from chronic hypertension (when a pregnant woman has preexisting hypertension).
Gestational hypertension is typically diagnosed during pregnancy, and it usually subsides after delivery. Still, your doctor will monitor you closely because gestational hypertension may progress to preeclampsia.
Chronic hypertension puts you and your baby at higher risk for preterm delivery, low birth weight, and preeclampsia. You may be diagnosed with chronic hypertension if you have two blood pressure readings of 140/90 mm Hg before you reach 20 weeks of pregnancy.
How to protect yourself
Hypertension is manageable. If diagnosed, you can likely go on to have a safe pregnancy and a healthy baby. The most important things you can do are to keep all your prenatal appointments and get any tests your doctor prescribes.
Your doctor may also suggest that you take low-dose aspirin from the end of your first trimester throughout the rest of your pregnancy, as it can lower the risk of developing blood clots and other complications like preeclampsia. But always ask your practitioner before taking any medications during pregnancy.
Feeling like you have a lot to keep track of? You're not alone. Download the What to Expect app to stay on top of appointments, track your pregnancy week by week, and learn about symptoms and warning signs as they come up — so you can feel a little more informed and a little less overwhelmed.
Risk factors
Nearly 60% of Black women have hypertension. The risk factors for chronic hypertension include:
- Being overweight or obese
- Having diabetes
- Family history of high blood pressure
- Lack of physical activity
- Having sleep apnea
- Drinking too much alcohol
- High cholesterol
- Smoking
- Stress
How it’s treated
You’ll work with your doctor to develop a treatment plan customized to your needs. If you had chronic hypertension before pregnancy, you may need to continue taking any blood pressure meds you were on before you got pregnant, or you may need to switch to something safer. You may also be advised to take baby aspirin.
Gestational diabetes
Gestational diabetes (GD) is one of the most common pregnancy complications, affecting up to 9% of expectant moms. Most women with GD go on to have healthy deliveries through careful monitoring, lifestyle adjustments, and proper care.
How to protect yourself
Most women with gestational diabetes don't experience any symptoms. The best way to confirm whether you have GD is by getting the glucose screening test around weeks 24 to 28 of pregnancy.
Risk factors
GD is a bit of an enigma in terms of understanding why some women get it and others don’t. Still, specific factors increase the risk of GD, some of which may explain why Black expectant moms are more likely to be diagnosed with the condition. They include:
- Being overweight, or having a body mass index (BMI) of 30 or more, going into pregnancy
- Family history of type 2 diabetes
- Previous pregnancy with gestational diabetes
- Having pre-diabetes
- Excessive weight gain, including that associated with bed rest
Black women are also more likely to have high blood pressure than white women and are more susceptible to having a family or prior history of GD.
Socioeconomic status, poverty, and housing situations also play a role in some Black women not having the means to afford or access nutrient-rich foods like fresh fruits and vegetables. That, in turn, can impact their ability to maintain a healthy diet and pregnancy weight. Lack of awareness and knowledge about GD, as well as a lack of access to quality medical care, are also to blame.
How it’s treated
Once diagnosed, GD is generally treated with a special diet (modified for carbs and refined sugars) and regular exercise to prevent excess weight gain and better regulate blood sugar.
Although most cases resolve after delivery, insulin may be prescribed to control blood sugar levels in more serious cases. In 2025, the American Diabetes Association updated its Standards of Care in Diabetes to recognize continuous glucose monitoring (CGM) as appropriate for the management of GD. Ask your provider if a CGM device is right for your care plan.
Unmanaged gestational diabetes can result in other pregnancy complications, including preeclampsia and macrosomia, which may affect delivery.
Preeclampsia
Preeclampsia typically develops after 20 weeks of pregnancy and is characterized by sudden-onset high blood pressure, severe swelling of the hands and face, and protein in the urine. Left untreated, it can lead to serious complications for both mom and baby — thankfully, the overwhelming majority of cases are mild, and early detection improves outcomes drastically.[3]
How to protect yourself
The most important thing you can do is pay attention to your body and watch for these common preeclampsia symptoms:
- A spike in blood pressure
- Sudden excessive weight gain that can’t be explained
- Severe swelling in the hands and face
- Edema, or severe swelling of the ankles, that doesn’t subside
- Severe headaches that aren’t relieved by acetaminophen (Tylenol)
- Abdominal pain, especially in the upper abdomen
- Double or blurred vision
- Accelerated heartbeat
- Trouble breathing or pronounced shortness of breath
- Dark or small amounts of urine
The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) now categorize being Black or low income as a moderate risk factor for preeclampsia — both due to social, rather than biological, factors — even if no other risk factors are present.
The medically backed preventive intervention is simple: Add a low-dose aspirin to your routine under your doctor's guidance.[4]
If your physician believes that you might have preeclampsia, you’ll need to take a urine and blood test to check for protein in your urine (proteinuria), excessively high liver enzymes, or a low blood platelet count.
Risk factors
Several preexisting conditions are associated with preeclampsia, including:
- Being Black or African American
- Being lower income
- History of hypertension
- Conceiving through in vitro fertilization (IVF)
- Obesity
- Sickle cell disease
- Diabetes
- Vitamin D deficiency in the first 26 weeks of pregnancy
- Autoimmune disease such as lupus
Given that Black women have higher rates of high blood pressure, sickle cell disease, obesity, and diabetes, and the Black community overall has higher rates of vitamin D deficiency, pregnant Black moms are more likely to be diagnosed with preeclampsia and experience more severe outcomes than white women.
Black women also tend to exhibit signs of preeclampsia earlier in pregnancy than white women, and it has been found that preeclampsia is more prevalent among expectant American mothers from low-income areas in the South.
How it’s treated
Preeclampsia is typically treated with blood pressure medication and rest. Recovery begins with delivering the baby and the placenta, which might result in an early delivery in more severe cases.
Although preeclampsia is manageable with early detection and proper treatment, in rare cases additional complications can arise, including preterm birth, HELLP syndrome, eclampsia, and others.
Rarely, preeclampsia symptoms can arise after delivery. Postpartum preeclampsia affects an estimated 4 to 6% of women who had preeclampsia during pregnancy. It’s essential to let your doctor know if you experience any preeclampsia symptoms up to six weeks after your baby’s birth.
Preterm labor
Preterm labor is classified as a baby's birth before 37 weeks of pregnancy. Most research suggests that preterm labor affects about 1 in every 10 infants in the U.S., but the rate of preterm birth among Black women is 14%, almost 50% higher than the rate for white women (9%).
Most babies born prematurely go on to live healthy and happy lives. There are meaningful steps Black expectant moms can take to reduce their risk.
How to protect yourself
Focus on caring for yourself and your baby-to-be. Pick up these healthy habits if you haven’t already:
- Don’t drink, smoke, or take drugs that your physician didn’t prescribe
- Maintain a healthy diet and weight
- Regularly take your prenatal vitamins
- Maintain good oral health
- Drink plenty of water
- Consult with your doctor regularly and educate yourself about your risk
Risk factors
There are no specific causes for preterm birth, but several factors can play a significant role in triggering preterm labor:
- Chronic emotional stress or extreme (work-related) physical stress
- Smoking, drug, and alcohol use
- Abnormalities of the cervix or uterus
- Getting pregnant when you’re younger than 17 or older than 35
- Previous preterm birth
- Pregnancies spaced fewer than 18 months apart
- Periodontal disease
- Mothers who were born prematurely themselves
- Uterine and vaginal infections such as bacterial vaginosis and trichomoniasis
- Untreated urinary tract infections
- Carrying twins or other multiples
- Pregnancy complications like gestational diabetes, preeclampsia, and others
How it’s treated
If you or your doctor suspects that you may be at risk for preterm labor, your physician might run a couple of tests to predict your risk. Depending on the outcome, steps might be taken to prevent preterm labor (or stave labor off as long as possible), or if you’re far enough along, your doctor might recommend inducing labor.
Eclampsia
In rare cases, when preeclampsia is not properly managed, an expectant mother might develop eclampsia. Eclampsia is the onset of seizures during pregnancy, and it affects about 1 in every 1,500 pregnancies. Like preeclampsia, it's characterized by severe swelling, high blood pressure, and protein in your urine.
The good news: With proper medical care, women with eclampsia return to normal health after delivery, and death as a result of eclampsia is very rare in the U.S.
How to protect yourself
Advocating for yourself is the best thing that a Black expectant mom can do if diagnosed with eclampsia or if you suspect that you might have it. If you have preeclampsia, your provider should monitor you and your blood pressure very closely to ensure that your condition doesn't become more severe.
Remember: You’re not being “too much,” even if you need a second or third option. If you have preeclampsia, your provider should monitor you and your blood pressure very closely to ensure that your condition doesn’t worsen.
If you feel that you’re not receiving adequate care or if your condition begins to worsen, contact your physician immediately or seek emergency medical treatment.
Risk factors
Pregnant women who have not received proper care for preeclampsia are at a higher risk of developing eclampsia. This, unfortunately, places some Black women at an increased risk due to not having access to medical insurance and quality medical care. Racial bias and discrimination can also play a significant role in Black women not receiving proper medical treatment.
How it’s treated
Because eclampsia can be life-threatening for both mother and baby, a doctor might recommend immediate delivery depending on how far along the pregnancy is. Like preeclampsia, delivery is the only treatment for the condition.
With proper medical care and follow-up treatment, women with eclampsia return to normal health after delivery.
HELLP syndrome
HELLP syndrome (which stands for hemolysis, elevated liver enzymes, and low platelets) is a condition that typically happens in conjunction with preeclampsia during the third trimester. This liver and blood-clotting disorder occurs in only about 1 to 2 in 1,000 pregnancies.
How to protect yourself
Although HELLP typically occurs between 27 and 37 weeks of pregnancy, some cases can develop within 48 hours after delivery. Recognizing the symptoms is key to early detection and treatment.
If you notice any of the following, contact your provider right away, especially if you’ve been diagnosed with preeclampsia:
- Headaches that will not go away
- Excessive weight gain
- Excessive and consistent edema or water retention and swelling
- Pain and tenderness in the upper right side of the abdomen
- Nausea and/or vomiting
- Blurred vision
- Nosebleeds
- Generally not feeling well
- Seizures (in rare cases)
Risk factors
While it’s not known what exactly causes HELLP syndrome, an estimated 70 to 80% of the women who have it also have preeclampsia. And women who developed HELLP during one pregnancy are more likely to get it again in subsequent pregnancies.
Because Black women are more likely to develop preeclampsia and eclampsia, they face a higher risk of HELLP syndrome as well.
How it’s treated
The only treatment for HELLP syndrome is delivery. If you are experiencing symptoms, call your doctor or head to the emergency room immediately.
Heart disease
Heart disease refers to several conditions that affect the heart, including coronary artery disease, arrhythmias, and congenital heart defects. It’s the leading cause of maternal death in the U.S.
How to protect yourself
If you know you have heart disease, it’s best to talk to a doctor before you start trying to conceive because pregnancy will put added stress on your circulatory system. You may be referred to a maternal-fetal medicine specialist, an obstetrician who specializes in high-risk pregnancies.
Heart disease is often called a “silent killer” because many women don’t realize they have it. All pregnant and postpartum women should watch for these heart-related warning signs — and head to the emergency room if any appear:
- Sudden, extreme swelling or weight gain
- Extreme fatigue
- Fainting
- Persistent cough
- Chest pain
- Shortness of breath
Risk factors
There are many medical conditions and lifestyle habits that raise the risk of heart disease, including:
- High blood pressure
- High cholesterol
- Smoking
- Diabetes
- Unhealthy diet
- Lack of exercise
- Excessive alcohol use
Heart disease is more prevalent among Black women than white women. Conditions like hypertension, obesity, and diabetes — which Black women face at higher rates — also increase the risk of heart disease.
How it’s treated
The best treatment for heart disease depends on your individual situation and may include:
- Counseling for stress and mental health
- Treatment for related conditions like high blood pressure and diabetes
- Cardiac rehabilitation, if you’ve experienced heart problems in the past
Peripartum cardiomyopathy
Peripartum cardiomyopathy (PPCM) is a rare but serious heart condition that can develop late in pregnancy or in the postpartum period and occurs when the heart's chambers enlarge and its muscles weaken. This prevents the heart from effectively pumping oxygen-rich blood to the rest of the body.
About 10% of PPCM cases show up during the last month of pregnancy, and 80% occur within the first three months of giving birth. PPCM isn’t common — it affects 1 out of every 1,000 women in the U.S. — and most women who receive care recover.
How to protect yourself
Knowing the signs can save your life. Symptoms of PPCM can be easy to miss because they mirror regular pregnancy symptoms — but it’s worth flagging any of the following with your provider:
- Extreme swelling in the hands and feet
- Pronounced fatigue
- Chest pains
- Erratic heartbeat
Experts say that if you were diagnosed with PPCM during one pregnancy, it’s likely you’ll develop it again during a subsequent pregnancy. Doctors highly recommend consulting with your provider before trying to conceive again if you have a previous PPCM diagnosis.
Risk factors
Studies show that Black women are at a higher risk of being diagnosed with PPCM and at a younger age. However, researchers are still working to understand why, beyond the connection to other heart conditions, diabetes, and hypertension.
Other factors often associated with PPCM include:
- Poor diet
- Obesity
- Heavy alcohol use
- Smoking
- Previous heart issues
- Being pregnant with twins
- Being over 30 years old
How it’s treated
If you’re diagnosed with PPCM, your doctor will likely focus on stabilizing your symptoms and relieving discomfort. You may receive heart medication.
In more serious cases, your doctor might recommend inducing labor, depending on how far along you are in the pregnancy. Expectant mothers with milder cases will be monitored closely and induced only if their condition worsens.
Fibroids
Uterine fibroid tumors are noncancerous masses of muscle tissue that grow on the wall of your uterus. Black women should know about fibroids because they're up to three times more likely to have them than white women, and the tumors are more likely to grow larger and cause severe pain.
Most women who have fibroids go on to have completely normal pregnancies, and many women don't even realize they have them until they undergo their first ultrasound.
However, there are some pregnancy risks associated with fibroids, including placental abruption (when the placenta separates from the uterine wall before delivery), preterm labor, and C-section.
How to protect yourself
As noted above, the vast majority of pregnant women who have fibroids experience no complications. That said, if you experience vaginal bleeding, belly pain, or severe back pain, call your doctor right away — those are signs of placental abruption, which requires prompt attention.
Risk factors
Researchers still aren’t sure why fibroids are so much more common in Black women, but they believe a link may exist to chronic stress associated with a lifetime of exposure to racism.
In addition to being Black, risk factors include:
- Age (most common in the 30s and 40s)
- Family history
- Obesity
- Eating a lot of red meat
How it’s treated
There isn’t much that can be done for fibroids during pregnancy — and chances are, you can leave them alone even after you give birth. If they bother you, though, your doctor might suggest you take acetaminophen (Tylenol).
Postpartum hemorrhage
Up to 5% of women experience postpartum hemorrhage (PPH), or excessive bleeding after giving birth. Usually, PPH happens immediately after the baby is delivered, but it can occur later too. Non-Hispanic Black women are more likely to experience severe complications from PPH than women of any other race.
How to protect yourself
While most cases of PPH happen within an hour of having a baby, postpartum hemorrhage can occur up to 12 weeks after delivery. Call your doctor immediately if you experience any of these symptoms:
- Soaking through more than one pad in an hour
- Bright red vaginal bleeding beyond the third day after birth
- Blood clots larger than a plum
- Blurred vision
- Clammy skin
- Dizziness
- Weakness
- Chills
- Nausea
- Feeling faint
Risk factors
Several conditions contribute to a higher risk of postpartum hemorrhage. They include:
- Preeclampsia
- Obesity
- Blood and liver conditions
- Having a C-section
- Medications to induce labor or stop preterm contractions
- Vaginal or cervical tearing
- Fast labor, or being in labor for a long time
- Carrying twins or multiples
There’s also a small increased risk of PPH if you have fibroids, which may help explain why Black women are more likely to experience PPH complications.
How it’s treated
There are many treatments for PPH, and your doctor will choose one based on the reasons behind your bleeding. In 2025, the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics, and the International Confederation of Midwives highlighted tranexamic acid (TXA) as an essential part of first-response treatment alongside standard uterotonic medications.[5]
Pregnancy and postpartum depression
Mental health is finally getting the recognition it deserves as a life-threatening pregnancy complication. Black women face increased risk for pregnancy and postpartum depression, along with significant underdiagnosis and undertreatment.[6]
How to protect yourself
Most providers follow ACOG’s recommendation to administer at least one standardized screening during the perinatal period (which encompasses your pregnancy and the first year after giving birth). But you can ask, “Can we do a depression screening today?” if they don’t.
Depression symptoms often present differently in Black women. In addition to mood changes, watch for unexplained physical symptoms like high blood pressure, body aches, pain, or nausea — these can also be signs of depression.
Risk factors
Any pregnant or postpartum woman can experience perinatal depression, but factors that raise the risk include:
- A previous history of depression
- Lack of financial or social support
- Complications during pregnancy
- Chronic stress, including the cumulative stress of navigating racism in health care settings
- Lack of access to mental health screenings and culturally competent care
How it’s treated
Black women experiencing pregnancy-related depression and other mental health concerns will find that treatment often includes a mix of therapy, support groups, and identifying the best medication with their doctor.
A relatively new prescription option, Zurzuvae, is specifically approved for postpartum depression and is covered by Medicaid for eligible patients, but results vary, as with all medications.
For peer support, the Shades of Blue Project offers free virtual support groups specifically for Black and brown mothers navigating pregnancy and postpartum mental health.
Though these pregnancy complications disproportionately affect Black moms, knowledge is protective. By attending your prenatal appointments regularly, advocating for yourself, asking plenty of questions, and staying as healthy as possible, you can meaningfully reduce your risk — and manage these conditions effectively if they do arise. That puts you in a strong position for a healthy pregnancy and a healthy baby.
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