Understanding the Dangers of Preeclampsia and Why Black Mothers Are at Such High Risk

Preeclampsia is a common condition that affects 1 in 25 pregnancies in the U.S. It’s the most serious form of high blood pressure in pregnancy and can have severe complications. In many cases, preeclampsia is mild. But it can be life-threatening. In fact, preeclampsia is a leading cause of death for pregnant mothers — especially Black women.

While there’s no way to prevent preeclampsia, early detection and treatment can help save lives. Let’s take a closer look at preeclampsia, what makes it so dangerous, and ways your provider can screen for it.

What is preeclampsia?

Preeclampsia is a high blood pressure condition that develops in pregnancy. Preeclampsia usually occurs in the latter stages of pregnancy. But it can occur as early as week 20 of pregnancy. In rare cases, it can develop up to 48 hours after delivery. 

There’s no known cause for preeclampsia, though many theories exist. Experts believe that it may be the result of a problem with the placenta that develops over time. 

Along with high blood pressure, there are often signs of organ damage in preeclampsia. Preeclampsia will commonly affect the liver, kidney, or brain. It can also cause problems with the placenta.

If untreated, preeclampsia can progress to eclampsia — the most severe form of the condition. Eclampsia involves the brain, and seizures and coma can occur. 

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The only cure for severe symptoms of preeclampsia is to deliver the baby. This can also lead to a premature birth if preeclampsia develops before the pregnancy is full-term.

How do you diagnose preeclampsia?

Preeclampsia is a diagnosis based on multiple new high blood pressure readings: 

• Systolic pressure (top number): 140 or higher and 

• Diastolic pressure (bottom number): 90 or higher

Your provider will also perform a physical exam with ultrasound and check your urine and blood tests. This is to look for protein in the urine, evidence of major organ damage in the blood, and blood flow issues to the growing baby. 

The diagnosis of preeclampsia is confirmed if there’s evidence of high blood pressure along with at least one of the following:

• Protein in the urine

• Organ damage (evidenced by symptoms or abnormal kidney, liver, brain tests)

• Thrombocytopenia (low platelet count)

• Placenta problems or growth problems with the developing baby

Why are Black women more likely to experience preeclampsia?

Rates of preeclampsia are 60% higher in Black women than white women. It’s not entirely clear why there’s a huge difference in the rates for this condition. Experts believe there may be several factors linked to the disparity. Let’s take a closer look.

Social and environmental factors

Many social factors appear to affect the high rates of preeclampsia in Black women. These include issues like:

• Lack of healthcare access: A lack of proper prenatal care prevents preeclampsia being diagnosed at early stages.

• Unconscious bias: Biases about pregnant Black women can affect decision-making by healthcare providers.

• High rates of stress: Stress from systemic racism and discrimination may play a role.

• Lack of social support: Black women are less likely to have support systems in place.

Biological factors

Black women also have higher rates of other conditions that are risk factors for developing preeclampsia. Dr. Kimberly Moran Turner, an OB-GYN physician at Johns Hopkins Community Physicians, says “Black women are at especially high risk of preeclampsia because many have underlying high blood pressure.” 

And some people have health conditions before pregnancy that can increase the risk of preeclampsia. Examples include:

• Diabetes 

• Obesity

• Genetic predisposition (APOL1 variant)

Why is preeclampsia so dangerous?

Preeclampsia is dangerous because it can have immediate and long-term health effects for both mother and baby. Let’s start by reviewing short-term effects from preeclampsia. 

Short-term fetal effects (for baby)

Short-term fetal effects can include:

• Preterm birth

• Stillbirth (pregnancy loss after week 20 of gestation)

• Poor fetal growth or low birth weight

• Low amniotic fluid

Short-term maternal effects (for mom) 

Short-term maternal effects can include:

• Increased risk of postpartum heart failure

• Kidney failure

• Seizures

• Abnormal heart rhythm

Long-term fetal effects

Most of the long-term fetal effects are a direct result of preterm delivery, and many will improve with time. These effects can include:

• Increased risk of impaired cognitive function or attention deficit disorder

• Chronic lung disease

• Feeding difficulties leading to uncoordinated suck and swallow

Long-term maternal effects

Long-term maternal effects can include:

• Increased risk of cardiovascular disease 

• Increased risk of chronic high blood pressure

• Increased risk of chronic kidney disease

How do you reduce the risk of preeclampsia?

There are no known ways to prevent preeclampsia. But there are some measures that might help lower the risk of preeclampsia in some people.

Prenatal care

Women without prenatal care are seven times more likely to die from preeclampsia. Prenatal care visits improve the likelihood of earlier diagnosis. And it allows for regular monitoring of mom and the growing baby. 

Blood pressure screening and urine testing is a routine part of prenatal care. Subtle changes could be detected when a pregnant mother has access to proper care.

Screening blood test

There is now an FDA-approved screening test for preeclampsia. It is based on research of two proteins that are linked to women with severe preeclampsia. 

The screening test looks at the ratio of these proteins in women who are in the hospital for high blood pressure in weeks 23 to 25 of pregnancy. With 96% accuracy, it can help to identify mothers most likely to develop severe preeclampsia within a 2-week timeframe.  

Aspirin

Aspirin started at 12 weeks gestation for some groups at high risk of preeclampsia may help to prevent preeclampsia. Mothers at high risk have almost 25% lower rates of preeclampsia when taking aspirin during pregnancy. 

Despite being at high risk, studies show that Black women are less likely to be offered aspirin.  Dr. Turner says it’s important to speak up. “Self-advocacy is so important for pregnant women.” Make sure you feel heard at your medical visits. Talk with your healthcare provider about your risk for preeclampsia and if you need to consider aspirin during pregnancy.

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Written by:

Alicia Stevens, MD

Alicia Stevens, MD, is a board-certified physician in the fields of internal medicine and pediatrics with over 15 years of experience. She graduated from the University of Cincinnati College of Medicine and completed her training at Tulane University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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