Preeclampsia is a disease that occurs during pregnancy and affects upwards of 10% of pregnancies around the world (Osungbade & Ige, 2011). African American pregnant women are particularly vulnerable and die at a disproportionate rate compared to other races. In this literature review, three research studies were analyzed to determine if African American pregnant women were included in preeclampsia Studies. Only one of the studies included in this review met all criteria by including African American pregnant women. One research study met half of the criteria; however, the authors noted that there was not enough evidence for Black Americans. The third research article also only met half of the criteria. We conclude that further studies are needed that include African American women in studies on preeclampsia.

This research highlights the experiences of mothers diagnosed with preeclampsia and HELLP syndrome through qualitative data analysis of social media comments. I collected 300 comments from the Instagram accounts @preeclampsia.foundation and @HELLPsyndrome. The two overarching themes found were: (1) Experiences with maternal healthcare and (2) Virtual Healing Spaces. These Instagram accounts represented unique communities that provide support and information that cannot be found elsewhere. These findings address gaps in the literature on maternal experience with preeclampsia and HELLP syndrome and identify directions for further research. The conclusions drawn add to current research that points to the need for reform in maternal healthcare.

In the 1950s and 1960s, researchers Leon Chesley, John Annitto, and Robert Cosgrove investigated the possible familial factor for the conditions of preeclampsia and eclampsia in pregnant women. Preeclampsia and eclampsia, which are related to high blood pressure, have unknown causes and affect at least five percent of all pregnancies. The researchers, who worked at Margaret Hague Maternity Hospital in Jersey City, New Jersey, used hospital patient records to find and reexamine women who had eclampsia at the hospital, as well as their daughters, sisters, daughters-in-law, and granddaughters. Chesley and colleagues found that the daughters and granddaughters of eclamptic women were more likely than the female offspring of non-eclamptic women to have preeclampsia and eclampsia in their own pregnancies, and especially in their first pregnancies. The study provided evidence that the disorders are inherited, enabling physicians to better monitor pregnancies in women who have a known family history for preeclampsia and eclampsia.

Leon Chesley studied hypertension, or high blood pressure, in pregnant women during the mid-twentieth century. Chesley studied preeclampsia and eclampsia, two hypertensive disorders found in approximately five percent of all US pregnancies. In New Jersey and New York, Chesley devoted over forty years to researching preeclampsia and eclampsia. Chesley conducted several long-term studies using the same group of women beginning from their pregnancies. Chesley’s multi-decade research led to more accurate diagnosis of preeclampsia and eclampsia in pregnant women and significantly reduced the mortality of pregnant women due to hypertensive diseases.

In 1916 Edwin B. Cragin in the United States published Conservatism in Obstetrics in which he discussed medical practices and techniques to preserve the vitality of pregnant women and their fetuses. Cragin argued that women who give birth via cesarean section, the surgical act of making an incision through both the abdomen and uterus to remove the fetus from a pregnant woman's womb, must rely on that method for future births. That claim was later coined the Dictum of Cragin. In Conservatism in Obstetrics, Cragin described obstetric techniques to maintain healthy births for women and fetuses. Cragin's article outlined the best practices for obstetricians in the early twentieth century, and publicized the claim that if a woman delivers a newborn via cesarean section, she should deliver any future newborn via the same method, a theory that persisted throughout the century.

Leon Chesley published Hypertensive Disorders in Pregnancy in 1978 to outline major and common complications that occur during pregnancy and manifest in abnormally high blood pressures in pregnant women. The book was published by Appleton-Century-Crofts in New York, New York. Chesley compiled his book as a tool for practicing obstetricians and teachers. The book focuses on preeclampsia and eclampsia, but it also describes other common and rare hypertensive diseases and disorders of pregnancy and discusses their histories, diagnoses, management plans, pathologies, and immediate and remote prognoses for mothers and fetuses. Doctors used the book and all subsequent editions to help diagnose and manage complications during pregnancy and to avoid deaths for pregnant women and fetuses.

Gordon Watkins Douglas researched cervical cancer, breach delivery, and treatment of high blood pressure during pregnancy in the US during the twentieth century. He worked primarily at Bellevue Hospital Center in New York, New York. While at Bellevue, he worked with William E. Studdiford to develop treatments for women who contracted infections as a result of illegal abortions performed throughout the US in unsterile environments. Douglas also established the first contraception and pregnancy termination clinic at Bellevue Hospital shortly after the legalization of abortion as a result of the 1973 US Supreme Court ruling in Roe v. Wade. Furthermore, Douglas showed that fetal and maternal cells exchange between the pregnant woman and fetus during pregnancy, which led to the later development of non-invasive prenatal testing in the early twenty-first century.

For most women, pregnancy is the period in which they will have more interaction with the healthcare field than any other period in their lives. The quality and accessibility of obstetric care varies greatly throughout the United States, and health disparities in this field have the largest impact on African American women. Black mothers in the U.S. are three to four times more likely than white mothers to die as a result of pregnancy related complications. The increased risk of maternal morbidity and mortality seen in the African American population is largely due to preventable causes. This thesis project includes three case studies which analyze the most prevalent and preventable sources of health disparity affecting Black mothers: preeclampsia, hemorrhage, and cesarean section. Possible solutions to each of these disparities are explored on an individual, institutional, and societal scale.