Preeclampsia — a pregnancy complication characterized by high blood pressure and signs of organ damage — affects between 5% and 8% of pregnancies in the United States and is a leading cause of both maternal and preterm birth mortality worldwide. It is also, in a significant proportion of cases, preventable or mitigatable with early identification and appropriate intervention. We are not doing enough of either.
What We Know and Are Not Using
Low-dose aspirin, initiated in the first trimester, reduces preeclampsia risk by approximately 15% in high-risk pregnancies. The U.S. Preventive Services Task Force recommends it. Evidence supports it. And yet uptake remains inconsistent, particularly among the populations at highest risk: Black women, women with prior preeclampsia, women with chronic hypertension or diabetes, and women with multiple gestation pregnancies.
The barriers are not scientific. They are systemic. First-trimester care — when aspirin prophylaxis is most effective — requires early access to prenatal care that millions of women, particularly those on Medicaid or in rural areas, do not have. By the time many high-risk women enter the prenatal care system, the window for primary prevention has closed.
The Diagnostic Gap
The diagnosis of preeclampsia is made based on blood pressure and protein in the urine — measures that identify established disease rather than predict or prevent it. Emerging biomarker-based tools, including placental growth factor and soluble fms-like tyrosine kinase-1 testing, can identify women at elevated risk earlier and more precisely than current standard-of-care screening. These tools are available and validated. They are not standard practice.
SWHR has highlighted preeclampsia diagnostics as a priority area, noting that the gap between available innovation and clinical adoption is particularly damaging in a condition where time-to-intervention directly affects outcomes.
Who Bears the Burden
Black women in the United States experience preeclampsia at significantly higher rates than white women and face worse outcomes when they do. This disparity reflects the convergence of higher baseline cardiovascular risk, differential access to early prenatal care, and clinical bias that affects the intensity and quality of monitoring received during pregnancy.
A condition that disproportionately kills Black mothers and their infants, in the presence of tools that could reduce that toll, is not simply a clinical problem. It is a political one.
