How do social factors affect preeclampsia in Black and African American women?

Black and African American women in the U.S. face higher rates of preeclampsia and worse outcomes than other groups. This disparity is not due to race itself but to social factors — such as poverty, limited access to care, and the lifelong effects of racism — that combine with biological vulnerabilities. Research shows that these social conditions can alter placental function and increase risk through stress, inflammation, and other pathways ⁶⁹.

What the research says

Social determinants of health — including low income, lack of insurance, and neighborhood disadvantage — are strongly linked to higher preeclampsia rates in Black women. These factors contribute to higher rates of conditions like hypertension and obesity, which themselves raise preeclampsia risk ⁹. Chronic stress from racism and discrimination can also dysregulate immune and vascular systems, affecting the placenta ⁶.

Genetic factors may play a role, but they interact with social context. For example, APOL1 kidney risk alleles, common in people of African ancestry, are associated with preeclampsia risk, but this association is modified by maternal country of origin — suggesting that environmental and social exposures matter ¹⁰. Similarly, studies show that placental pathology differs by race, with Black women more likely to have placental lesions linked to poor blood flow, which can lead to preeclampsia and preterm birth ⁷.

Qualitative research highlights how structural racism — including discrimination in healthcare and lack of continuity of care — creates barriers to timely prenatal and postpartum care, increasing the risk of complications like preeclampsia ¹¹. These social factors are not just background; they directly affect biological pathways, such as inflammation and oxidative stress, that are central to preeclampsia ⁵⁶.

What to ask your doctor

• Given my personal and family history, what is my specific risk for preeclampsia?
• Are there any social or community resources that can help me access prenatal care more easily?
• How can I monitor my blood pressure at home and when should I call you?
• What signs of preeclampsia should I watch for, and how do I reach you after hours?
• Can you help me understand how my stress levels or living situation might affect my pregnancy and what support is available?