Understanding Health Disparities in Preeclampsia: A Literature Review

Mary B. Conklin; Brittney M. Wells; Emily M. Doe; Athena M. Strother; Megan E. Burnett Tarasiewicz; Emily R. Via; Lesley B. Conrad; Robin Farias-Eisner

doi:10.1055/a-2008-7167

American Journal of Perinatology, Table of Contents

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

¹School of Medicine, Creighton University, Omaha, Nebraska

²Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey

,

Brittney M. Wells

¹School of Medicine, Creighton University, Omaha, Nebraska

,

Emily M. Doe

¹School of Medicine, Creighton University, Omaha, Nebraska

,

Athena M. Strother

¹School of Medicine, Creighton University, Omaha, Nebraska

,

Megan E. Burnett Tarasiewicz

¹School of Medicine, Creighton University, Omaha, Nebraska

,

Emily R. Via

¹School of Medicine, Creighton University, Omaha, Nebraska

³Department of Obstetrics and Gynecology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York

,

Lesley B. Conrad

¹School of Medicine, Creighton University, Omaha, Nebraska

⁴Department of Obstetrics and Gynecology, School of Medicine, Creighton University, Omaha, Nebraska

⁵Lynch Comprehensive Cancer Research Center, School of Medicine, Creighton University, Omaha, Nebraska

,

Robin Farias-Eisner

¹School of Medicine, Creighton University, Omaha, Nebraska

⁴Department of Obstetrics and Gynecology, School of Medicine, Creighton University, Omaha, Nebraska

⁵Lynch Comprehensive Cancer Research Center, School of Medicine, Creighton University, Omaha, Nebraska

⁶College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Pomona, California

⁷Department of Obstetrics and Gynecology, David Geffen School of Medicine, the University of California at Los Angeles, Los Angeles, California

› Author Affiliations

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

Full Text

References

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