Understanding the Elevated Risk of Pre-eclampsia Among African Women

Pre-eclampsia is a severe maternal health condition marked by the abrupt onset of hypertension and potential organ damage, often emerging after the 20th week of pregnancy. It remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Epidemiological evidence highlights that African women—particularly those in sub-Saharan regions—are disproportionately affected, with both genetic and systemic factors driving these disparities.

Overview and Clinical Relevance

Current research confirms that African women, especially those in sub-Saharan Africa, face a substantially higher risk of pre-eclampsia. A systematic review of 49 studies across the region reported an incidence rate of approximately 13%, significantly higher than the global average. This elevated burden underscores the need for enhanced early detection strategies, context-specific prenatal care, and improved maternal health infrastructure.

For healthcare providers, recognizing this elevated risk is critical. Clinical awareness facilitates earlier diagnosis and supports tailored interventions—from individualized prenatal screening to strategic allocation of resources for high-risk populations.

Epidemiology and Risk Factors

Pre-eclampsia presents as high blood pressure and, in severe cases, damage to the kidneys, liver, or other organs. It can occur during pregnancy, labor, or even in the postpartum period. Numerous studies indicate that women of African descent have a higher prevalence of this condition compared to other ethnic groups. This heightened vulnerability is driven by an intricate interplay of genetic, environmental, and socio-economic determinants.

Among the genetic contributors, variants of the apolipoprotein L1 (APOL1) gene—which are more prevalent in individuals of African ancestry—have drawn particular attention. A recent study found that fetal APOL1 kidney risk alleles are associated with a 3.6-fold increased risk of pre-eclampsia, highlighting the importance of exploring genetic screening in prenatal care strategies (ScienceDirect, 2025).

African Ancestry and the 60% Differential

Globally, Black women are shown to have a 60% higher risk of developing pre-eclampsia than their white counterparts. This disparity has been well documented in the United States, where data from Rochester Regional Health revealed significantly elevated rates among African American women.

Importantly, this differential risk persists even after accounting for income and education levels, suggesting that racial disparities in healthcare access, implicit bias, and environmental stressors contribute to these outcomes. A study from Johns Hopkins Medicine further emphasized that U.S.-born Black women are at greater risk than foreign-born Black women, indicating that structural racism and chronic stress may play as significant a role as genetics.

Clinical Implications and the Path Forward

The findings from sub-Saharan Africa and diaspora populations emphasize the need for holistic, multifactorial interventions. Improved screening and clinical risk assessment tools that include ancestry-informed data can enable earlier detection. In parallel, expanding equitable access to quality prenatal care and embedding genetic counseling into obstetric practices are key steps toward narrowing disparities.

To be effective, these measures must also consider socio-economic barriers, such as limited transportation, reduced healthcare literacy, and under-resourced healthcare systems. Interventions rooted in community-based education, culturally responsive care models, and strengthened public health infrastructure offer the greatest promise.

Ultimately, addressing the disproportionate burden of pre-eclampsia in African women demands a global and intersectional approach—one that integrates the best available science with practical, equitable solutions.