Ethnicity, Expectant Moms and the Cardiovascular Connection
by Natalie GutierrezHeart disease is the No. 1 killer of American women.
Source: American Heart Association
According to the Agency for Healthcare Research and Quality, the death rates from cardiovascular disease are about two-thirds higher among African-American women than among white women. This startling statistic played a significant role in a study conducted by a researcher in the School of Nursing at the Health Science Center.
"We discovered another disturbing trend among African-American women that is related to their cardiovascular well-being," said Teresa James, Ph.D., R.N., C.N.M., clinical instructor in the department of family nursing care. "We found that African-American women are at a higher risk for delivering, low-birth-weight babies than white women, and their cardiovascular reactivity, or the way their cardiovascular systems react to stress, may be the culprit."
Dr. James, along with colleagues at Mount Sinai School of Medicine and Columbia University School of Medicine in New York, conducted a four-year study of 500 African-American and white pregnant active-duty military patients at Wilford Hall Medical Center. The study was funded by a $4 million U.S. Department of Defense grant. Their findings were published in the March 2006 issue of Epidemiology.
Dr. James, who retired from active duty in the U.S. Air Force this year, has more than 30 years of experience in perinatal nursing and was the senior nurse executive for maternal and child nursing at Wilford Hall Medical Center prior to joining the Health Science Center faculty.
Previous studies indicated an alarming rate of preterm deliveries among African-American women nationwide. But none had looked at why this was occurring. "We chose to study active-duty military women because we felt this group provided a homogenous population with similar socioeconomic and educational status," Dr. James said. "They share similar life challenges but also have unique stressors in their lives. Many have husbands who are also active-duty military who are stationed overseas and in dangerous situations, have young children at home, full-time jobs, and a long-term commitment to military life. The military makes many decisions for them about where they’ll live and what kind of jobs they’ll hold. We wanted to learn how these pregnant women’s cardiovascular systems handled stress, and whether or not we could see a direct correlation to preterm delivery."
Study participants were interviewed at the time of enrollment early in pregnancy (six to 12 weeks of gestation) and were asked to return at 28 weeks of gestation to fill out a second questionnaire and to complete psychophysiological testing to determine cardiovascular reactivity. Blood pressure and heart rate responses were measured during and immediately after the testing.
"What we found was that when exposed to even minor stressors, a significant number of the African-American women had faster heart rates and higher blood pressures than the white women in the study," Dr. James said. "We also found that these same African-American women were delivering earlier. The risk of preterm delivery among the African-American women in the study was approximately double what it was for the white women (13.9 percent versus 6.2 percent)."
Dr. James said the findings emphasize the importance for women, especially African-American women, to closely monitor their cardiovascular health, not only for their own well-being, but for their children’s health as well.
"Too many women don’t pay attention to how stress negatively affects their health until it’s too late. It’s important for African-American women in particular to be aware because of their susceptibility to heart disease and preterm delivery."
Dr. James hopes her research will lead to the creation of a center dedicated solely to the research of high-risk pregnancies and preterm delivery. According to the March of Dimes, more than 9,500 babies are born preterm each week. "We still have much work to do. The more we know about the underlying causes of preterm delivery, the better able we’ll be to intervene and prevent it from happening."
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