New FDA-Approved Preeclampsia Blood Test Could Reduce Black Maternal Deaths

Early detection for preeclampsia allows for early intervention–for Black birthing people, this could be lifesaving.

The FDA has recently approved a blood test for screening preeclampsia—a deadly form of high blood pressure that could be fatal if left untreated.

Preeclampsia impacts approximately one in every 25 pregnancies annually in the U.S., according to the CDC. Black birthing people, however, are disproportionately at risk.Considering a staggering 60% of preeclampsia-related deaths are deemed to be preventable, this blood test is a welcome and necessary development.

Doctorate-prepared board-certified nurse midwife Dr. Chanelle Nsangou Njoya explains that preeclampsia is characterized by high blood pressure that may result in multiorgan damage. Most commonly, the liver and kidneys are impacted. “It usually occurs after 20 weeks of pregnancy but it can also begin in the postpartum period. It can be fatal, if not properly managed. Similar to high blood pressure in a non-pregnant person, preeclampsia can be a silent condition. The earlier preeclampsia is diagnosed, the better.”

Birthing people with preeclampsia tend to experience symptoms such as a persistent headache, changes in vision, stomach pain, swollen hands or face, sudden weight gain, or trouble breathing. It's possible to not experience any of these symptoms, hence why this newly approved blood test is vital, along with regular checkups with clinicians. Making the test a routine part of prenatal medical care may help to alleviate some of the systemic discrimination that is at the root of the Black maternal mortality crisis.

Dr. Njoya says that according to a large innovative multi-site study, the blood test measures eight different markers that are likely the causative factors of preeclampsia. “Researchers established that this test resulted in a high negative predictive value, implying that 95% of those who tested negative for preeclampsia due to this new test, would not develop preeclampsia for the 7 days following testing. The test can be utilized between 23 and 35 weeks of pregnancy to help determine the possible progression to severe preeclampsia in symptomatic pregnant people.” Importantly, 31% of the study’s participants were Black.

Although the exact cause of preeclampsia is not fully understood, Dr. Njoya says that it is believed to be related to problems with the blood vessels that supply the placenta. Risk factors for developing preeclampsia include first-time mothers, a history of high blood pressure, obesity, carrying multiple babies, in-vitro fertilization, and certain medical conditions such as diabetes or kidney disease.

“If a healthcare provider suspects that a woman may have preeclampsia, they will monitor her blood pressure and may order additional tests such as blood and urine tests that check for organ damage,” she explains. “Treatment for preeclampsia may involve medications to lower blood pressure and prevent seizures, bed rest, dietary changes, and close monitoring of the mother and baby. In some cases, delivery of the baby may be necessary to prevent further complications.” This may involve labor induction or performing a c-section.

Dr. Njoya notes that “the delivery of the baby typically results in normalization of the blood pressure for most mothers, within a few weeks. It is still vital that healthcare providers continue to monitor for any lingering effects even after blood pressure stabilization even beyond those few weeks.”

Racism Trumps All

In April, three-time Olympic medalist Tori Bowie died due to childbirth complications shedding fresh light on the sorrowful state of maternal care and maternal mortality rates in the country. Her autopsy lists respiratory distress and eclampsia as possible complications. Fellow athlete Allyson Felix had an emergency c-section also because of severe preeclampsia. Tennis icon Serena Williams shared her near-death birth story, again evidencing that pregnancy and childbirth are deadlier for Black birthing people, regardless of income.

According to 2021 data, Black birthing people are three times more likely to die due to pregnancy-related complications than their white counterparts. One of the leading causes of this is preeclampsia. Black birthing people are less likely than white birthing people to receive proper care for this condition as well as other serious conditions, which significantly contributes to racial disparities in maternal mortality. It’s all too common to hear stories of doctors not believing our pain, years spent being misdiagnosed and struggles accessing necessary care.

Black women’s healthcare experiences are not merely anecdotal. Research has shown that doctors are less likely to give pain medication to Black patients and are also less likely to diagnose Black women correctly. A 2022 study found that Black birthing people with high incomes were more likely to have serious childbirth complications than their white peers with low incomes. Another study from 2008 to 2012 found that the rate of severe maternal morbidity among Black birthing people remained higher than non-Black birthing people regardless of educational attainment, neighborhood poverty level, and pre-pregnancy obesity.

Research suggests these adverse statistics are inextricably linked to structural racism and racial bias in medicine. Racial negligence and racial oppression–which heavily devalue Black voices–account for the reasons why there are profound health disparities between Black Americans and other groups. Black people are chronically under-cared for and wrongly fictionalized with attributes such as thicker skin or less sensitive nerve endings.

While Dr. Njoya stresses that race alone doesn’t account for the Black maternal health crisis, she agrees that it plays a big part. “I believe that implicit bias, also known as implicit prejudice, is a major key player. Implicit bias is the act of displaying a negative attitude, of which one is not consciously aware, against a specific group.”

She emphasizes that studies also show biological, cultural, structural, and social determinants may also contribute to the progression of a disorder like preeclampsia.

“Healthcare providers have to be diligent about practicing cultural humility that focuses on patient-centered engagement. Simply put, they have to check their biases and listen more than they speak to the patient. They should lead with understanding, recognizing the patient as a person with an intricate identity. They should understand that the health concern may not be the only issue. Healthcare providers should recognize their power and use that to empower the patient.”

Black birthing people shouldn't have to put their life on the line to bring life into the world. With the overall state of U.S. maternal healthcare worsening, this new preeclampsia blood test—which is already available in Europe—could be a big step toward improving the trajectory of maternal health outcomes.

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