Download PDF
Am J Perinatol 2024; 41(S 01): e1291-e1300
DOI: 10.1055/a-2008-7167
Review Article

Understanding Health Disparities in Preeclampsia: A Literature Review

Mary B. Conklin
1   School of Medicine, Creighton University, Omaha, Nebraska
2   Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
,
Brittney M. Wells
1   School of Medicine, Creighton University, Omaha, Nebraska
,
Emily M. Doe
1   School of Medicine, Creighton University, Omaha, Nebraska
,
Athena M. Strother
1   School of Medicine, Creighton University, Omaha, Nebraska
,
Megan E. Burnett Tarasiewicz
1   School of Medicine, Creighton University, Omaha, Nebraska
,
Emily R. Via
1   School of Medicine, Creighton University, Omaha, Nebraska
3   Department of Obstetrics and Gynecology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
,
Lesley B. Conrad
1   School of Medicine, Creighton University, Omaha, Nebraska
4   Department of Obstetrics and Gynecology, School of Medicine, Creighton University, Omaha, Nebraska
5   Lynch Comprehensive Cancer Research Center, School of Medicine, Creighton University, Omaha, Nebraska
,
Robin Farias-Eisner
1   School of Medicine, Creighton University, Omaha, Nebraska
4   Department of Obstetrics and Gynecology, School of Medicine, Creighton University, Omaha, Nebraska
5   Lynch Comprehensive Cancer Research Center, School of Medicine, Creighton University, Omaha, Nebraska
6   College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Pomona, California
7   Department of Obstetrics and Gynecology, David Geffen School of Medicine, the University of California at Los Angeles, Los Angeles, California
› Author Affiliations Funding This investigation was made possible through the guidance of the Lynch Comprehensive Cancer Research Center at Creighton University School of Medicine and with support from the NCI U54 grant, LB595 Nebraska Cancer and Smoking Disease Research Program, Kelly Day Foundation, and Kicks for Cure.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Preeclampsia is a multifactorial pathology with negative outcomes in affected patients in both the peripartum and postpartum period. Black patients in the United States, when compared to their White and Hispanic counterparts, have higher rates of preeclampsia. This article aims to review the current literature to investigate how race, social determinants of health, and genetic profiles influence the prevalence and outcomes of patients with preeclampsia. Published studies utilized in this review were identified through PubMed using authors' topic knowledge and a focused search through a Medline search strategy. These articles were thoroughly reviewed to explore the contributing biosocial factors, genes/biomarkers, as well as negative outcomes associated with disparate rates of preeclampsia. Increased rates of contributing comorbidities, including hypertension and obesity, which are largely associated with low access to care in Black patient populations lead to disparate rates of preeclampsia in this population. Limited research shows an association between increased rate of preeclampsia in Black patients and specific APOL1, HLA-G, and PP13 gene polymorphisms as well as factor V Leiden mutations. Further research is required to understand the use of certain biomarkers in predicting preeclampsia within racial populations. Understanding contributing biosocial factors and identifying genes that may predispose high-risk populations may help to address the disparate rates of preeclampsia in Black patients as described in this review. Further research is required to understand if serum, placental, or urine biomarkers may be used to predict individuals at risk of developing preeclampsia in pregnancy.

Key Points

  • Prevalence of preeclampsia in the U.S. is higher in Black patients compared to other racial groups.

  • Patients with preeclampsia are at risk for poorer health outcomes both during and after delivery.

  • Limited research suggests specific biomarkers or gene polymorphisms contribute to this difference; however, explanations for this disparity are multifactorial and further investigation is necessary.

Keywords

preeclampsia - hypertensive disorders of pregnancy - maternal morbidity and mortality - health disparities


Publication History

Received: 16 June 2022

Accepted: 16 December 2022

Accepted Manuscript online:
05 January 2023

Article published online:
24 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol 2020; 135 (06) e237-e260
    CrossrefPubMedGoogle Scholar
  • 2 Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25 (04) 391-403
    CrossrefPubMedGoogle Scholar
  • 3 Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 4 Wang W, Xie X, Yuan T. et al. Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population-based study. BMC Pregnancy Childbirth 2021; 21 (01) 364
    CrossrefPubMedGoogle Scholar
  • 5 Ford ND, Cox S, Ko JY. et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalizations – United States 2017–2019. MMWR Morb Mortal Wkly Rep 2022; 71 (17) 585-591
    CrossrefPubMedGoogle Scholar
  • 6 Ying W, Catov JM, Ouyang P. Hypertensive disorders of pregnancy and future maternal cardiovascular risk. J Am Heart Assoc 2018; 7 (17) e009382
    CrossrefPubMedGoogle Scholar
  • 7 Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012; 36 (01) 56-59
    CrossrefPubMedGoogle Scholar
  • 8 Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33 (03) 130-137
    CrossrefPubMedGoogle Scholar
  • 9 Shih T, Peneva D, Xu X. et al. The rising burden of preeclampsia in the United States impacts both maternal and child health. Am J Perinatol 2016; 33 (04) 329-338
    PubMedGoogle Scholar
  • 10 Brouwers L, van der Meiden-van Roest AJ, Savelkoul C. et al. Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG 2018; 125 (13) 1642-1654
    CrossrefPubMedGoogle Scholar
  • 11 Zhang N, Tan J, Yang H, Khalil RA. Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world. Biochem Pharmacol 2020; 182: 114247
    CrossrefPubMedGoogle Scholar
  • 12 Sircar M, Thadhani R, Karumanchi SA. Pathogenesis of preeclampsia. Curr Opin Nephrol Hypertens 2015; 24 (02) 131-138
    CrossrefPubMedGoogle Scholar
  • 13 Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol 2020; 222 (06) 532-541
    CrossrefPubMedGoogle Scholar
  • 14 Ghosh G, Grewal J, Männistö T. et al. Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women. Ethn Dis 2014; 24 (03) 283-289
    PubMedGoogle Scholar
  • 15 Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol 2022; 226 (2S): S876-S885
    CrossrefPubMedGoogle Scholar
  • 16 Doyle SK, Chang AM, Levy P, Rising KL. Achieving health equity in hypertension management through addressing the social determinants of health. Curr Hypertens Rep 2019; 21 (08) 58
    CrossrefPubMedGoogle Scholar
  • 17 Tanaka M, Jaamaa G, Kaiser M. et al. Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study. Am J Public Health 2007; 97 (01) 163-170
    CrossrefPubMedGoogle Scholar
  • 18 Wagner JL, White RS, Tangel V, Gupta S, Pick JS. Socioeconomic, racial, and ethnic disparities in postpartum readmissions in patients with preeclampsia: a multi-state analysis, 2007–2014. J Racial Ethn Health Disparities 2019; 6 (04) 806-820
    CrossrefPubMedGoogle Scholar
  • 19 Ross KM, Dunkel Schetter C, McLemore MR. et al. Socioeconomic status, preeclampsia risk and gestational length in Black and White women. J Racial Ethn Health Disparities 2019; 6 (06) 1182-1191
    CrossrefPubMedGoogle Scholar
  • 20 Carr A, Small M, Kershaw T, Brown H. 743: hypertensive disease in pregnancy: an examination of ethnic differences and the Hispanic paradox. Am J Obstet Gynecol 2012; 206 (01) S329-S330
    CrossrefPubMedGoogle Scholar
  • 21 Silva LM, Coolman M, Steegers EA. et al. Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study. J Hypertens 2008; 26 (06) 1200-1208
    CrossrefPubMedGoogle Scholar
  • 22 Assari S. Protective effects of maternal education against low birth weight deliveries: Blacks' diminished returns. Res Health Sci 2020; 5 (04) 1-17
    CrossrefPubMedGoogle Scholar
  • 23 Hajizadeh S, Ramezani Tehrani F, Simbar M, Farzadfar F. Factors influencing the use of prenatal care: a systematic review. Journal of Midwifery and Reproductive Health 2016; 4 (01) 544-557
    PubMedGoogle Scholar
  • 24 Liu CM, Chang SD, Cheng PJ. Relationship between prenatal care and maternal complications in women with preeclampsia: implications for continuity and discontinuity of prenatal care. Taiwan J Obstet Gynecol 2012; 51 (04) 576-582
    CrossrefPubMedGoogle Scholar
  • 25 Giurgescu C, Sanguanklin N, Engeland CG. et al. Relationships among psychosocial factors, biomarkers, preeclampsia, and preterm birth in African American women: a pilot. Appl Nurs Res 2015; 28 (01) e1-e6
    CrossrefPubMedGoogle Scholar
  • 26 Zozzaro-Smith PE, Bacak S, Conway C, Park J, Glantz JC, Thornburg LL. Association between obesity during pregnancy and the adequacy of prenatal care. Matern Child Health J 2016; 20 (01) 158-163
    CrossrefPubMedGoogle Scholar
  • 27 Mostello D, Catlin TK, Roman L, Holcomb Jr WL, Leet T. Preeclampsia in the parous woman: who is at risk?. Am J Obstet Gynecol 2002; 187 (02) 425-429
    CrossrefPubMedGoogle Scholar
  • 28 DeJoy SB, Bittner K. Obesity stigma as a determinant of poor birth outcomes in women with high BMI: a conceptual framework. Matern Child Health J 2015; 19 (04) 693-699
    CrossrefPubMedGoogle Scholar
  • 29 Drife J. Risk factors for maternal death revisited. BJOG 2016; 123 (10) 1663
    CrossrefPubMedGoogle Scholar
  • 30 Lister RL, Drake W, Scott BH, Graves C. Black maternal mortality-the elephant in the room. World J Gynecol Womens Health 2019;3(01):
    PubMedGoogle Scholar
  • 31 Shah LM, Varma B, Nasir K. et al. Reducing disparities in adverse pregnancy outcomes in the United States. Am Heart J 2021; 242 (242) 92-102
    CrossrefPubMedGoogle Scholar
  • 32 Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight - reconsidering the use of race correction in clinical algorithms. N Engl J Med 2020; 383 (09) 874-882
    CrossrefPubMedGoogle Scholar
  • 33 Jenkins KA, Keddem S, Bekele SB, Augustine KE, Long JA. Perspectives on racism in health care among black veterans with chronic kidney disease. JAMA Netw Open 2022; 5 (05) e2211900
    CrossrefPubMedGoogle Scholar
  • 34 Rosen EM, Muñoz MI, McElrath T, Cantonwine DE, Ferguson KK. Environmental contaminants and preeclampsia: a systematic literature review. J Toxicol Environ Health B Crit Rev 2018; 21 (05) 291-319
    CrossrefPubMedGoogle Scholar
  • 35 Poropat AE, Laidlaw MAS, Lanphear B, Ball A, Mielke HW. Blood lead and preeclampsia: a meta-analysis and review of implications. Environ Res 2018; 160: 12-19
    CrossrefPubMedGoogle Scholar
  • 36 Cassidy-Bushrow AE, Sitarik AR, Havstad S. et al. Burden of higher lead exposure in African-Americans starts in utero and persists into childhood. Environ Int 2017; 108: 221-227
    CrossrefPubMedGoogle Scholar
  • 37 Beltran AJ, Wu J, Laurent O. Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight. Int J Environ Res Public Health 2013; 11 (01) 91-172
    CrossrefPubMedGoogle Scholar
  • 38 Haelterman E, Marcoux S, Croteau A, Dramaix M. Population-based study on occupational risk factors for preeclampsia and gestational hypertension. Scand J Work Environ Health 2007; 33 (04) 304-317
    CrossrefPubMedGoogle Scholar
  • 39 Kinshella MW, Omar S, Scherbinsky K. et al. Maternal dietary patterns and pregnancy hypertension in low- and middle-income countries: a systematic review and meta-analysis. Adv Nutr 2021; 12 (06) 2387-2400
    CrossrefPubMedGoogle Scholar
  • 40 Allen R, Rogozinska E, Sivarajasingam P, Khan KS, Thangaratinam S. Effect of diet- and lifestyle-based metabolic risk-modifying interventions on preeclampsia: a meta-analysis. Acta Obstet Gynecol Scand 2014; 93 (10) 973-985
    CrossrefPubMedGoogle Scholar
  • 41 Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr 2006; 136 (01) 177-182
    CrossrefPubMedGoogle Scholar
  • 42 Borders AEB, Wolfe K, Qadir S, Kim KY, Holl J, Grobman W. Racial/ethnic differences in self-reported and biologic measures of chronic stress in pregnancy. J Perinatol 2015; 35 (08) 580-584
    CrossrefPubMedGoogle Scholar
  • 43 Sibai BM, Lindheimer M, Hauth J. et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. N Engl J Med 1998; 339 (10) 667-671
    CrossrefPubMedGoogle Scholar
  • 44 Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci 2014; 348 (02) 135-138
    CrossrefPubMedGoogle Scholar
  • 45 Flint S. Obesity stigma: prevalence and impact in healthcare. Brit J Obesity 2015; 1: 14-18
    PubMedGoogle Scholar
  • 46 Stamilio DM, Beckham AJ, Boggess KA, Jelovsek JE, Venkatesh KK. Risk factors for postpartum readmission for preeclampsia or hypertension before delivery discharge among low-risk women: a case-control study. Am J Obstet Gynecol MFM 2021; 3 (03) 100317
    CrossrefPubMedGoogle Scholar
  • 47 Mosca L, Benjamin EJ, Berra K. et al; American Heart Association. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: a guideline from the American Heart Association. J Am Coll Cardiol 2011; 57 (12) 1404-1423
    CrossrefPubMedGoogle Scholar
  • 48 Shahul S, Tung A, Minhaj M. et al. Racial disparities in comorbidities, complications, and maternal and fetal outcomes in women with preeclampsia/eclampsia. Hypertens Pregnancy 2015; 34 (04) 506-515
    CrossrefPubMedGoogle Scholar
  • 49 Gyamfi-Bannerman C, Pandita A, Miller EC. et al. Preeclampsia outcomes at delivery and race. J Matern Fetal Neonatal Med 2020; 33 (21) 3619-3626
    CrossrefPubMedGoogle Scholar
  • 50 Zhang M, Wan P, Ng K. et al. Preeclampsia among African American pregnant women: an update on prevalence, complications, etiology, and biomarkers. Obstet Gynecol Surv 2020; 75 (02) 111-120
    CrossrefPubMedGoogle Scholar
  • 51 Yang J, Pearl M, DeLorenze GN. et al. Racial-ethnic differences in midtrimester maternal serum levels of angiogenic and antiangiogenic factors. Am J Obstet Gynecol 2016; 215 (03) 359.e1-359.e9
    CrossrefPubMedGoogle Scholar
  • 52 Rivers ER, Horton AJ, Hawk AF. et al. Placental Nkx2-5 and target gene expression in early-onset and severe preeclampsia. Hypertens Pregnancy 2014; 33 (04) 412-426
    CrossrefPubMedGoogle Scholar
  • 53 Park MJ, Lee DH, Joo BS. et al. Leptin, leptin receptors and hypoxia-induced factor-1α expression in the placental bed of patients with and without preeclampsia during pregnancy. Mol Med Rep 2018; 17 (04) 5292-5299
    PubMedGoogle Scholar
  • 54 Iwagaki S, Yokoyama Y, Tang L, Takahashi Y, Nakagawa Y, Tamaya T. Augmentation of leptin and hypoxia-inducible factor 1alpha mRNAs in the pre-eclamptic placenta. Gynecol Endocrinol 2004; 18 (05) 263-268
    CrossrefPubMedGoogle Scholar
  • 55 Mise H, Sagawa N, Matsumoto T. et al. Augmented placental production of leptin in preeclampsia: possible involvement of placental hypoxia. J Clin Endocrinol Metab 1998; 83 (09) 3225-3229
    PubMedGoogle Scholar
  • 56 Laml T, Preyer O, Hartmann BW, Ruecklinger E, Soeregi G, Wagenbichler P. Decreased maternal serum leptin in pregnancies complicated by preeclampsia. J Soc Gynecol Investig 2001; 8 (02) 89-93
    CrossrefPubMedGoogle Scholar
  • 57 Martínez-Abundis E, González-Ortiz M, Pascoe-González S. Serum leptin levels and the severity of preeclampsia. Arch Gynecol Obstet 2000; 264 (02) 71-73
    CrossrefPubMedGoogle Scholar
  • 58 Reidy KJ, Hjorten RC, Simpson CL. et al. Fetal—Not Maternal—APOL1 genotype associated with risk for preeclampsia in those with African ancestry. Am J Hum Genet 2018; 103 (03) 367-376
    CrossrefPubMedGoogle Scholar
  • 59 Thakoordeen-Reddy S, Winkler C, Moodley J. et al. Maternal variants within the apolipoprotein L1 gene are associated with preeclampsia in a South African cohort of African ancestry. Eur J Obstet Gynecol Reprod Biol 2020; 246: 129-133
    CrossrefPubMedGoogle Scholar
  • 60 Ni S, Zhang Y, Deng Y. et al. AGT M235T polymorphism contributes to risk of preeclampsia: evidence from a meta-analysis. J Renin Angiotensin Aldosterone Syst 2012; 13 (03) 379-386
    CrossrefPubMedGoogle Scholar
  • 61 Dizon-Townson D, Miller C, Sibai B. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol 2005; 106 (03) 517-524
    CrossrefPubMedGoogle Scholar
  • 62 Loisel DA, Billstrand C, Murray K. et al. The maternal HLA-G 1597ΔC null mutation is associated with increased risk of pre-eclampsia and reduced HLA-G expression during pregnancy in African-American women. Mol Hum Reprod 2013; 19 (03) 144-152
    CrossrefPubMedGoogle Scholar
  • 63 Madar-Shapiro L, Karady I, Trahtenherts A. et al. Predicting the risk to develop preeclampsia in the first trimester combining promoter variant -98A/C of LGALS13 (placental protein 13), black ethnicity, previous preeclampsia, obesity, and maternal age. Fetal Diagn Ther 2018; 43 (04) 250-265
    CrossrefPubMedGoogle Scholar
  • 64 Bhatti S, Cordina M, Penna L, Sherwood R, Dew T, Kametas NA. The effect of ethnicity on the performance of protein-creatinine ratio in the prediction of significant proteinuria in pregnancies at risk of or with established hypertension: an implementation audit and cost implications. Acta Obstet Gynecol Scand 2018; 97 (05) 598-607
    CrossrefPubMedGoogle Scholar
  • 65 Hill LD, Hilliard DD, York TP. et al. Fetal ERAP2 variation is associated with preeclampsia in African Americans in a case-control study. BMC Med Genet 2011; 12 (01) 64
    CrossrefPubMedGoogle Scholar
  • 66 Nevalainen J, Skarp S, Savolainen ER, Ryynänen M, Järvenpää J. Intrauterine growth restriction and placental gene expression in severe preeclampsia, comparing early-onset and late-onset forms. J Perinat Med 2017; 45 (07) 869-877
    CrossrefPubMedGoogle Scholar
  • 67 Phoswa WN, Ramsuran V, Naicker T, Singh R, Moodley J. HLA-G polymorphisms associated with HIV infection and preeclampsia in South Africans of African ancestry. BioMed Res Int 2020; 2020: 1697657-14
    CrossrefPubMedGoogle Scholar
  • 68 Ackerman CM, Platner MH, Spatz ES. et al. Severe cardiovascular morbidity in women with hypertensive diseases during delivery hospitalization. Am J Obstet Gynecol 2019; 220 (06) 582.e1-582.e11
    CrossrefPubMedGoogle Scholar
  • 69 Tolcher MC, Chu DM, Hollier LM. et al. Impact of USPSTF recommendations for aspirin for prevention of recurrent preeclampsia. Am J Obstet Gynecol 2017; 217 (03) 365.e1-365.e8
    CrossrefPubMedGoogle Scholar
  • 70 Declercq E, Zephyrin L. Maternal mortality in the United States: a primer. The Commonwealth Fund; December 16, 2020. Accessed January 19, 2022, at: https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer
    PubMedGoogle Scholar