Hypertensive disorders of pregnancy (HDP) can affect different groups of women in different ways, and even though we know this happening, we don't fully understand why. There are many factors, like biology, the environment, culture, and access to healthcare, that could play a role. This article discusses what we currently know about these differences and suggests ways to improve both research and medical care to help women from minority backgrounds have better health during pregnancy.

In this review article, the authors discuss the disparities of the prevalence of HDP in women of different ethnicities. First, they address the concept of ethnicity, as it is now recognized that what we refer to as "race" or "ethnicity" is primarily a social construct. This is clear when one considers that one race/ethnicity (Black) is assigned based on skin color, another (Hispanic) by primary language, and a third (Asian) by a broad, multicultural geographic location.  None the less, multiple studies show higher rates of HDPs among Black women in the US compared to other ethnic and racial groups.

The authors share potential causes of these differences which include:

• Social and environmental determinants of health – global geographic location, socio-economic status (SES), education level, employment and housing stability, food quality and availability, and environmental pollution. However, studies have shown that higher SES and education does not alter the discrepancies between US Black and White women. Future studies could look further into food insecurity and the impact of diet on HDP.
• Preexisting chronic diseases – chronic hypertension, obesity, diabetes, lupus and renal disease. Once again, however, differences still exist after accounting for these risk factors.
• Disparities in epidemiology - the paper notes that risks of HDP are very high in Filipino women, but low in East Asian women - yet both are usually classified as "Asian." There is a higher risk among South Asians and Pacific Islanders, especially women of Filipino and Samoan backgrounds.
• Racism – leading theories suggest that increased stress due to navigating racist systems can lead to increases in inflammatory processes involved in cardiovascular disease.
• Quality of and access to prenatal care including previous poor healthcare experiences by Blacks leading to distrust of the healthcare system.
• Biological and molecular mechanisms that differ among populations such as higher baseline levels of angiogenic factors (PlGF and s-Flt) involved in the etiology of preeclampsia in Black women.

More research needs to be done into the etiology of these differences before they can be adequately addressed. Preventative measures may also differ among ethnic and racial groups - research shows that Black women are less likely to be prescribed low-dose aspirin for preeclampsia prevention, even when screening as at-risk. They may also experience less tight blood pressure control (less than 135/85) than White women. Innovative strategies that directly involve the Black community are needed to empower patients with education on prevention, monitoring, and treatment.

Take home:  Despite difficulties with the concept of ethnicity, worldwide, Black women suffer HDP more often and have worse outcomes than White women.  South Asian, Pacific Islander, and American Indian women also have a higher risk of preeclampsia than White women. The reasons for this are unclear, but involve complex interactions among biological, behavioral, environmental, socio-cultural and healthcare system factors that need more research.  Short term goals, such as aspirin prophylaxis for women at high risk of HDP and adequate blood pressure control, can be implemented now.

Healthcare systems should focus on helping women from minority backgrounds manage their blood pressure during pregnancy and after giving birth. It's important that women who have experienced these challenges are involved in creating and planning research and programs to help reduce disparities in care. Preeclampsia research studies need to include a mix of different ethnic groups in their studies, so that new treatments can help all women. Involving diverse women with lived experiences in the research process is key to making sure the solutions work for everyone.

The Preeclampsia Foundation’s Racial Disparities Task Force action plan to tackle ethnic disparities in HDP, published in 2024, was mentioned in this study. It includes recommendations across research, healthcare practices and community domains.

Citation: Conti-Ramsden, F, de Marvao, A, and Chappell, LC. Reproduction.  2025;169:e250049. (https://doi.org/10.1530/REP-25-0049).

About Research Roundup

Each quarter, our team of science writers reviews the most current research studies related to hypertensive disorders of pregnancy and summarizes those studies of greatest interest and potential impact to our community, including research studies related to risk assessment, diagnosis, prevention, and treatment. Special thanks to our volunteer research team including Dr. Sig-Linda Jacobson, Dr. Jennifer Mitchell, Dr. Julie Reynolds, Amanda Yang, and Simren Gupta who make Research Roundup possible, and to our Patient Advisory Council, who reviews these materials from the patient perspective.