Conklin Mary B, Wells Brittney M, Doe Emily M, Strother Athena M, Tarasiewicz Megan E Burnett, Via Emily R, Conrad Lesley B, Farias-Eisner Robin
School of Medicine, Creighton University, Omaha, Nebraska.
Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Am J Perinatol. 2024 May;41(S 01):e1291-e1300. doi: 10.1055/a-2008-7167. Epub 2023 Jan 5.
Preeclampsia is a multifactorial pathology with negative outcomes in affected patients in both the peripartum and postpartum period. Black patients in the United States, when compared to their White and Hispanic counterparts, have higher rates of preeclampsia. This article aims to review the current literature to investigate how race, social determinants of health, and genetic profiles influence the prevalence and outcomes of patients with preeclampsia. Published studies utilized in this review were identified through PubMed using authors' topic knowledge and a focused search through a Medline search strategy. These articles were thoroughly reviewed to explore the contributing biosocial factors, genes/biomarkers, as well as negative outcomes associated with disparate rates of preeclampsia. Increased rates of contributing comorbidities, including hypertension and obesity, which are largely associated with low access to care in Black patient populations lead to disparate rates of preeclampsia in this population. Limited research shows an association between increased rate of preeclampsia in Black patients and specific APOL1, HLA-G, and PP13 gene polymorphisms as well as factor V Leiden mutations. Further research is required to understand the use of certain biomarkers in predicting preeclampsia within racial populations. Understanding contributing biosocial factors and identifying genes that may predispose high-risk populations may help to address the disparate rates of preeclampsia in Black patients as described in this review. Further research is required to understand if serum, placental, or urine biomarkers may be used to predict individuals at risk of developing preeclampsia in pregnancy. KEY POINTS: · Prevalence of preeclampsia in the U.S. is higher in Black patients compared to other racial groups.. · Patients with preeclampsia are at risk for poorer health outcomes both during and after delivery.. · Limited research suggests specific biomarkers or gene polymorphisms contribute to this difference; however, explanations for this disparity are multifactorial and further investigation is necessary..
子痫前期是一种多因素疾病，对受影响患者的围产期和产后均会产生不良后果。与白人和西班牙裔患者相比，美国黑人患者患子痫前期的几率更高。本文旨在回顾当前文献，以研究种族、健康的社会决定因素和基因谱如何影响子痫前期患者的患病率和预后。本综述中使用的已发表研究是通过作者的主题知识在PubMed上识别的，并通过Medline搜索策略进行了重点搜索。对这些文章进行了全面审查，以探讨促成子痫前期发病率差异的生物社会因素、基因/生物标志物以及不良后果。包括高血压和肥胖在内的共病发生率增加，这在很大程度上与黑人患者获得医疗服务的机会有限有关，导致该人群子痫前期的发病率存在差异。有限的研究表明，黑人患者子痫前期发病率增加与特定的载脂蛋白L1（APOL1）、人类白细胞抗原G（HLA-G）和妊娠相关血浆蛋白A（PP13）基因多态性以及凝血因子V莱顿突变之间存在关联。需要进一步研究以了解某些生物标志物在预测不同种族人群子痫前期方面的应用。了解促成子痫前期的生物社会因素并识别可能使高危人群易患该病的基因，可能有助于解决本综述中所述的黑人患者子痫前期发病率差异问题。需要进一步研究以了解血清、胎盘或尿液生物标志物是否可用于预测妊娠期有发展为子痫前期风险的个体。要点：· 在美国，黑人患者子痫前期的患病率高于其他种族群体。· 子痫前期患者在分娩期间和分娩后均有健康状况较差的风险。· 有限的研究表明特定的生物标志物或基因多态性导致了这种差异；然而，这种差异的解释是多因素的，需要进一步调查。
