Black Mothers'
Childbirth Complications

INTRODUCTION:

According to the Centers for Disease Control, Black women are three times more likely
to die from a pregnancy-related cause than White women.i As damaging as racism and lack of
access to healthcare is to Black health in general, it is also true that several years ago, two of the
wealthiest women in the Black community, tennis star Serena Williams and entertainer Beyoncé
Knowles almost died of blood clots, toxemia and preeclampsia after giving birth. As an
evolutionary historian, I began my academic career decades ago translating Arabic manuscripts
from Timbuktu and the empires of ancient Ghana, Mali and Songhay. Never once during those
early years could I have imagined that this proprietary knowledge might have medical value.
But, in fact, these geographical details had been unavailable to Transatlantic slave traders from
Europe and America, who never ventured past the malarial coast of West Africa, nor to later
western scholars. And yet, the ecological homeland of America’s slave labor force represented
the missing piece of a biological jigsaw puzzle, which could contribute to saving the lives of
contemporary Black women in childbirth.
 

My ancestors and those of 37 million other African-Americans emanated from the lowsodium
interior of the West African tsetse belt. Not even coastal West Africans, let alone
Europeans, could survive this harsh ecological niche to which interior West Africans had over
the millennia become genetically adapted. But these vital geographical details of their origins
Manuscript meant nothing to the indigenous slavers who marched them 500 to 1,000 miles in chains to such
coastal ports as Lagos, Goree and Ouidah. Nor did the slave ship captains care about such
trivalities. And yet genomic confirmation of the ecological niche to which enslaved African—
Americans were adapted has been sitting in our scientific databases for at least a decade –
unstudied. Why? . America’s unspoken one-size-fits-all medical paradigm lacks the taxonomic
precision required to differentiate the sodium and calcium needs of Americans whose ancestors
may have evolved variants that allowed them to live in ecologically challenging niches around
the world. Ironically, the use of race in medicine is the biggest obstacle. This is not because
human differences should be ignored, but rather because “racial” categories are unscientific and
cumbersomely misleading.

Interior West Africans, who farmed in the sweltering heat of the tropics, lived on a
sodium intake of 200 mg/day, which even today U.S. medical texts would describe as being
incompatible with human survival. But as, an evolutionary historian, how can I be so sure of
these facts, since clearly no one was collecting nutritional data on enslaved West Africans in the
17th and 18th centuries? It is because recent genomic research has corroborated the historical
narrative. The G1 and G2 variants of the APOL1 gene carried by Black Americans of slave
descent (but not immigrants to America from coastal regions of Africa), cause 75% of Black
women to be at high risk of salt-sensitive hypertension, with a 4 times higher mortality rate from
kidney failure.ii Whatever unique role sodium saturation might play in the health of pregnant
Black women has yet to be examined by obstetric researchers. But whatever the case, this factor
is compounded by an even more striking difference between the descendants of West Africa and
American immigrants from either East Africa, Europe, as well as most of Latin America and
Asia, which might have a bearing on childbirth.

Several years ago I began investigating the fact that West Africans inhabiting the tsetse
belt lacked dairy in their diets on account of infestations of the tsetse fly glossina, which
prevented cattle breeding. Their children were not exposed to large calcium intakes after the age
of breast feeding and yet these populations suffered unusually low rates of osteoporosis.iii I
scoured the medical literature and came across articles in several prominent scientific journals
explaining that the African variant of the TRPV6 calcium ion channel gene was 25% more
absorbent of dietary calcium than the European and other variants. But what stopped me in my
tracks was learning that the same TRPV6a variant was present in the placenta. In addition, this
calcium retentive feature was compounded by ethnic-specific variants in the TRPV5 renal-associated
gene.iv

We may even have been given a hint of population differences during pregnancy
regarding calcium and sodium metabolism by the research of Lawrence Malcolm Resnick, MD.
However, his premature death from pancreatic cancer in 2004 at the age of 55 halted a line of
research that recognized metabolic differences, especially during pregnancy, in the delicate
dance between sodium and calcium in diverse genetic populations. In fact, during a seven year
stint at Wayne State University Medical Center in Detroit, Dr. Resnick conducted clinical
research on the pregnancy complications of African-American women. He noted:
“This analysis suggests that although increasing oral calcium intake to achieve at least
current nutritional standards is entirely appropriate, uniform recommendations for all
hypertensives to further increase or decrease dietary calcium or salt may be inappropriate
and will obscure those for whom these maneuvers are particularly relevant.”v,vi

A further clue emerged in a 1993 study of pre-eclampsia in African-American women, in
which researchers observed ‘: . . an abnormal intracellular free calcium (Ca2+ i) metabolism as
early as the second trimester of pregnancy.’vii There is no evidence that follow-up studies were
made to clarify these findings.
Pregnancy further complicates the delicate dance of metabolic systems in the human
body. And yet our current obstetric protocols are by default Northern European, rather than
universal. Until the medical community adjusts its one-size-fits-all paradigm to reflect ancestral
DNA, the demographic groups with the furthest genetic distance from the Northern European
genotype will bear the ugliest bruises from this medical myopia.

 

ENDNOTES
i https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
ii Centers for Disease Control and Prevention: VITAL SIGNS. African American Health: Creating equal
opportunities for health. (Page last reviewed: July 3, 2017). Content source: National Center for Chronic Disease
Prevention and Health Promotion https://www.cdc.gov/vitalsigns/aahealth/ (Accessed December 2022)
iii CB Hilliard High osteoporosis risk among East Africans linked to lactase persistence genotype. Bonekey
Rep. (2016 Jun 29);5:803.
iv T Na, W Zhang, Y Jiang, Y Liang, HP Ma, DG Warnock. The A563T variation of the renal epithelial
calcium channel TRPV5 among African Americans enhances calcium influx. American Journal of Physiology -
Renal Physiology (Published 24 April 2009) Vol. 296 no. 5, F1042-F1051
v Am J Hypertens 1999;12:99–112 © 1999 American Journal of Hypertension, Ltd.
vi Lawrence M. Resnick, The role of dietary calcium in hypertension: A hierarchal overview, American
Journal of Hypertension, Volume 12, Issue 1, January 1999, Pages 99–112
vii JR Sowers, PR Standley, S Jacober, T Niyogi, L Simpson Postpartum abnormalities of carbohydrate and
cellular calcium metabolism in pregnancy induced hypertension. Am J Hypertens. (1993 Apr);6.4:302-7.
 

Declaration of interests
☒ The authors declare that they have no known competing financial interests or personal relationships
that could have appeared to influence the work reported in this paper.
☐ The authors declare the following financial interests/personal relationships which may be considered
as potential competing interests:       

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