Black Health
EMERGENT — Call 911 now Maternal For Black women

Preeclampsia symptoms in Black women

Black women have a 60 percent higher rate of preeclampsia than white women and a 3-times higher rate of preeclampsia-related death, per the CDC Pregnancy Mortality Surveillance System.

Source: https://www.cdc.gov/maternal-mortality/php/data-research/index.html

How it shows up differently in Black women

The textbook description leads with high blood pressure, proteinuria, and edema, and assumes routine prenatal monitoring will catch it. Black women face two specific pattern-mismatch issues. First, the Bryant 2010 Obstetrics & Gynecology paper (PMID 20567176) documented that Black women report symptoms — headache, swelling, vision changes — that are dismissed at significantly higher rates before objective signs of preeclampsia are caught. Second, preeclampsia in Black women more often progresses to eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) with less warning — by the time the diagnosis is made, the case is already severe. Postpartum preeclampsia, which can present up to six weeks after delivery, is also more common in Black women and is frequently dismissed in the ED as a postpartum headache or anxiety.

Key symptoms to watch for

Preeclampsia can develop after 20 weeks of pregnancy and up to six weeks postpartum. The diagnosis combines new-onset high blood pressure with signs of organ stress. Symptoms a Black patient should act on:

  • Severe headache that does not respond to acetaminophen, especially throbbing or behind the eyes.
  • Vision changes — blurred vision, light flashes, floating spots, brief vision loss.
  • Right-upper-quadrant or upper-stomach pain, sometimes mistaken for heartburn or gallbladder pain.
  • Sudden swelling of the face, hands, or feet — particularly if it appears overnight.
  • Sudden weight gain of more than 2 to 3 pounds in a week.
  • Shortness of breath at rest or when lying flat.
  • Nausea or vomiting in the second half of pregnancy that is new (morning sickness should have ended).
  • Decreased urination or dark, tea-colored urine.
  • Reduced fetal movement — fewer than 10 kicks in two hours after 28 weeks.

Emergency

When to call 911

Call 911 or go to the obstetric ED immediately for any of:

  • Blood pressure 160/110 or higher (severe-range hypertension).
  • Severe headache that won't go away with acetaminophen.
  • Vision changes — flashes, blurred vision, vision loss.
  • Severe right-upper-quadrant or upper-abdominal pain.
  • Shortness of breath at rest.
  • Decreased fetal movement after 28 weeks.
  • Seizure (eclampsia is preeclampsia plus seizure — life-threatening).

If you are postpartum, do not assume your symptoms are unrelated to pregnancy. Postpartum preeclampsia can develop weeks after delivery.

If anything on this list applies to you or someone with you, call 911 now. Do not drive yourself.

Advocacy script

What to say to your clinician

Black patients are documented to receive less aggressive workups and longer waits for the same symptoms. The sentences below give you a script when a clinician seems ready to send you home.

  1. "I'm [X weeks pregnant / X weeks postpartum]. I am here because I'm concerned about preeclampsia."
  2. "I would like my blood pressure measured in both arms, with the correct cuff size, and rechecked after I've sat quietly for five minutes."
  3. "I would like a urine protein measurement, a CBC, a comprehensive metabolic panel, and a liver-enzyme panel."
  4. "What is my blood pressure trend across this visit and the prior two visits? Has it gone up?"
  5. "What else could explain [headache / swelling / RUQ pain / vision changes]? Please document the differential before discharging me."
  6. "I am aware that Black women are more likely to die of preeclampsia and that symptom dismissal is a documented contributor. I would like every symptom I've reported documented in the chart."
  7. "Who is my OB on call? I want them looped in before any discharge decision."

Risk factors and prevalence in Black women

Chronic hypertension, obesity, type 2 diabetes, and pre-existing kidney disease all raise preeclampsia risk and all run higher in Black women. The Aspirin for the Prevention of Preeclampsia evidence (USPSTF 2021, based on multiple RCTs) supports low-dose aspirin starting at 12 weeks for women at high risk, including by race and prior pregnancy history. First pregnancy, age over 35, multiple gestation, and prior preeclampsia are independent risk factors. Black women with prior preeclampsia have a meaningfully higher recurrence rate in subsequent pregnancies than white women with the same history.

More maternal guides

EMERGENT — Call 911 now

Postpartum hemorrhage in Black women

{# Affiliate placement: telehealth partner — but ONLY for non-emergent guides. Symptom guides at the EMERGENT or URGENT urgency tier are crisis-adjacent ("call 911 if..."); commerce content there is exploitative. Render only when urgency_tier is 'see-soon' or 'track-and-monitor'. #}

References

  • Bryant AS et al. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology. 2010. PMID 20567176.
  • ACOG Practice Bulletin 222 — Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology. 2020. acog.org.
  • U.S. Preventive Services Task Force. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality. JAMA. 2021. PMID 29036508.
  • CDC Pregnancy Mortality Surveillance System. cdc.gov/maternal-mortality.

Medically reviewed: