A scoping review of literature on the association between preeclampsia, eclampsia, and endometriosis in Black women found no qualifying studies, according to an abstract presented at the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting.
The review searched 9 databases and PROSPERO from inception through March 2024, including studies of reproductive-age Black women aged 15 to 49 years with laparoscopically diagnosed endometriosis and outcomes of preeclampsia or eclampsia.
Calbeth C. Alaribe, DMSc, MPH, PA-C, CPCHE, OB-GYN hospitalist physician associate and maternal health equity consultant, described the rationale for pursuing the question, noting that endometriosis affects approximately 10% of reproductive-age women, yet Black women are 50% less likely to be diagnosed.
Endometriosis affects a significant portion of reproductive-age women. Black women are less likely to be diagnosed. On the other hand, preeclampsia and eclampsia have the highest rates in Black women in the United States, with Black women having the highest maternal mortality rates from it in comparison to any other ethnic group, Alaribe said.
Alaribe noted that emerging evidence suggests hypertensive disorders of pregnancy and endometriosis share overlapping immunologic and vascular pathways, but the intersection with Black patients remains unexamined.
Studies conducted in the United States collected race data but did not stratify results. The data were meaningless in terms of determining if endometriosis has an impact on the development of preeclampsia and how that impacts Black women, she said.
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She framed the null result as a finding in itself, stating that it basically tells us that just because there is no evidence does not mean that there are no risk factors. It just means that there is more presence of neglect, and that without representation in data sets, Black patients are completely invisible in our data sets.
The review’s principal limitation is inherent to its result: With no studies meeting the inclusion criteria, no conclusions can be drawn about the association itself.
Alaribe emphasized that no guideline currently supports treating endometriosis as a preeclampsia risk factor, given that biological plausibility has not established causation, but suggested clinicians nonetheless approach care proactively.
If a patient comes in with severe chronic pelvic pain, bad menstrual pain as well, they should start clinically diagnosing them with endometriosis, and then potentially looking at ways that this could further implicate the risk of developing preeclampsia in the future, Alaribe said, citing earlier blood pressure monitoring and maternal-fetal medicine involvement for patients planning pregnancy.
Alaribe concluded that the findings highlight the urgent need for inclusive, race-conscious research to inform clinical care and reduce maternal health disparities.
For more information on maternal health disparities, visit the obstetrics study findings to learn about the importance of addressing these disparities.
