Preeclampsia, a serious pregnancy complication involving high blood pressure and potential organ damage, affects about 8% of pregnancies nationally, but rates climb dramatically in low-income communities of color. New research from El Paso, Texas reveals that social stressors like poverty, immigration concerns, and discrimination may trigger the condition at rates far exceeding national averages, offering crucial insights into why maternal health disparities persist.

What Is Preeclampsia and Why Does It Matter?

Preeclampsia is a pregnancy complication characterized by high blood pressure and often protein in the urine. If left untreated, it can escalate rapidly into life-threatening complications including brain hemorrhages, cardiac events, organ damage, and seizures. Preeclampsia is a leading cause of maternal death worldwide.

The condition likely develops when the placenta doesn't attach to the uterine wall properly, but not everyone with this irregularity develops preeclampsia. Researchers believe environmental, social, and individual factors determine whether the condition progresses. Delivery of the baby and placenta typically stops the condition's progression, and labor induction and symptom management can be lifesaving.

How Do Social Stressors Trigger Preeclampsia?

Medical anthropologists and human biologists studying El Paso documented a nearly 25% preeclampsia prevalence rate among 176 Latinas using publicly funded prenatal care during the first two years of the COVID-19 pandemic. For comparison, the national prevalence rate was around 8% in 2021. El Paso, where over 80% of the nearly 700,000 residents identify as Latino and 35% of households reported food insecurity in 2023, serves as a window into how social inequities become biological risk.

The researchers identified multiple converging factors that likely contributed to the elevated preeclampsia rates:

• Economic Insecurity: Socioeconomic hardship and lack of stable income increase preeclampsia risk among pregnant people.
• Immigration-Related Stress: About 21% of study participants reported having an immediate family member who had been deported or detained by immigration officials, creating ongoing emotional distress.
• Trauma and Mental Health: Past exposure to stressful and traumatic life events, severe mental health symptoms, and depression during pregnancy elevate risk.
• Discrimination: Racism and discrimination activate physiological responses that may contribute to preeclampsia development.
• Environmental Hazards: Exposure to environmental toxins, extreme heat, and COVID-19 infection during pregnancy can trigger chains of physiological responses leading to preeclampsia.

The research took place in the aftermath of the 2019 racially motivated mass shooting in El Paso, during a period when immigration was becoming increasingly polarizing. The timing overlapped with the region's disproportionate burden of economic, social, and public health crises created by the COVID-19 pandemic.

How Does Emotional Distress Become a Physical Symptom?

Study participants who developed preeclampsia often emphasized how their emotions contributed directly to their pregnancy complications. One participant, Brisa, an undocumented immigrant from rural Mexico, spent most of her pregnancy living in view of the U.S.-Mexico border wall, with constant Border Patrol vehicles and helicopters in her neighborhood. She described her pregnancy as plagued by anguish stemming from her immigration status and economic concerns from losing steady work during the pandemic. While still pregnant, Brisa described the swelling in her hands and feet as a result of her emotional state, saying in Spanish, "If I go outside, I feel that despair. It's like this worry and an anxiety. I feel this despair in my hands and feet." Swelling is also a common symptom of preeclampsia, which she later developed.

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Another participant, Janeth, a U.S.-born citizen with undocumented family members, developed preeclampsia complicated by gestational diabetes, a blood sugar condition during pregnancy. She attributed these complications to her mental health during pregnancy, explaining, "I did get very, very depressed during the pregnancy. My husband became unemployed and it was just a very stressful pregnancy. I was having suicidal thoughts." Research shows a potential link between mental health status and gestational diabetes risk. Janeth's stress stemmed from economic concerns and isolation caused by the pandemic, along with the recent deportation of three family members after their asylum claims were denied.

One participant, Lupe, experienced a dramatic shift in her blood pressure during the final weeks of pregnancy. Dark spots began distorting her vision, prompting her to visit the emergency room. Her blood pressure registered 167 over 98, a sharp contrast to her ideal reading of 115 over 70 documented at her first prenatal visit. She was quickly diagnosed with preeclampsia. Timely medical support prevented her symptoms from worsening.

Why Are Preeclampsia Rates Higher in Some Regions Than Others?

Preeclampsia rates vary dramatically across the world and within the United States. While an estimated 4.4% of pregnancies result in preeclampsia globally, rates are typically higher in low- and middle-income countries compared to wealthier nations. Sub-Saharan Africa has the highest regional prevalence rate, at 13%. In the U.S., the preeclampsia rate rose from 4.5% in 2008 to 8% in 2021, during the height of the COVID-19 pandemic.

However, racial and ethnic minorities in the U.S. experience higher prevalence rates than the national average. The El Paso study focused specifically on women with incomes low enough to qualify for public benefits, recruited from the prenatal clinic serving the county public hospital, which is heavily utilized by immigrants. Therefore, the 25% prevalence rate in the study sample was likely higher than would be found in a broader cross-section of the region. Nevertheless, the findings demonstrate the risks faced by populations experiencing multiple, compounded hardships.

Steps to Support Pregnant People at Higher Risk of Preeclampsia

• Comprehensive Prenatal Screening: Regular blood pressure monitoring and screening for proteinuria (protein in urine) at every prenatal visit can catch early signs of preeclampsia before symptoms become severe.
• Mental Health Support: Integrated mental health services during pregnancy, including counseling and depression screening, may help reduce stress-related physiological responses that trigger preeclampsia.
• Social Support Services: Addressing underlying social determinants of health, such as food insecurity, economic instability, and immigration-related stress, through community resources and case management can reduce overall pregnancy risk.
• Culturally Sensitive Care: Healthcare providers should acknowledge and validate the specific stressors faced by immigrant and low-income communities, creating safe spaces for patients to discuss immigration concerns and discrimination.
• Rapid Intervention Protocols: Clear pathways for emergency evaluation when symptoms like vision changes, severe headaches, or swelling occur can prevent preeclampsia from escalating into life-threatening complications.

The medical establishment has historically focused on individual risk factors for preeclampsia, such as age, obesity, or previous hypertension. However, the El Paso research highlights that understanding the social roots of preeclampsia is equally critical. When pregnant people face simultaneous challenges like poverty, immigration uncertainty, discrimination, and pandemic-related isolation, their bodies respond with physiological stress that increases preeclampsia risk.

This research suggests that reducing maternal health disparities requires more than clinical interventions alone. Addressing the social inequities that create chronic stress in vulnerable communities may be essential to preventing preeclampsia and improving maternal outcomes for all pregnant people.

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