A full search for medical literature examining the association between endometriosis, preeclampsia, and eclampsia specifically among Black women yielded zero results, according to an abstract presented at the 2026 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting. The scoping review, which aimed to connect these conditions within a specific demographic, instead exposed a significant blind spot in existing research.
Researchers involved in the project dug through 9 databases and PROSPERO from inception through March 2024. They were looking for studies involving reproductive-age Black women aged 15 to 49 who had laparoscopically diagnosed endometriosis and outcomes of preeclampsia or eclampsia. While the team identified 5 relevant articles, none of them met the necessary inclusion criteria for the review.
Calbeth C. Alaribe, an OB-GYN hospitalist physician associate and maternal health equity consultant, outlined the reasoning behind pursuing this specific line of inquiry. She pointed out a stark contrast in how these conditions affect different populations.
“Endometriosis affects approximately 10% of reproductive-age women, yet Black women are 50% less likely to be diagnosed. On the other hand, preeclampsia and eclampsia are notorious for having 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,” she said.
A Gap in The Data
The rationale for the review rests on emerging biological evidence. Alaribe noted that recent studies suggest hypertensive disorders in pregnancy and endometriosis share overlapping immunologic and vascular pathways. Despite these biological links, the intersection of these conditions in Black patients remains largely unexamined.
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This absence of data reflects a broader, persistent issue in medical research where aggregated findings often obscure the specific risks faced by minority groups. Historically, clinical studies centered on male physiology, leaving gaps in understanding how conditions present in women. Similarly, without separating data by race, the medical field risks overlooking how conditions like endometriosis uniquely impact Black patients.
Alaribe explained that the issue is not necessarily a lack of data collection, but rather how that data is processed. She stated that studies conducted in the United States often collect information on race but fail to break down the results based on it.
“Studies that were conducted in the United States actually collected race data but did not stratify results. So, the data were absolutely meaningless to us in terms of determining if endometriosis has an impact in the development of preeclampsia and how that impacts Black women,” she said.
She framed the null result of the scoping review as a significant finding in itself. The inability to draw conclusions highlights a failure in the research infrastructure rather than a lack of medical relevance.
“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,” Alaribe said, adding that without representation in data sets, Black patients are “completely invisible in our data sets.”
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Clinical Implications
Despite the lack of statistical evidence linking the two conditions, Alaribe emphasized that clinicians should not ignore the potential risk. She noted that no current guideline supports treating endometriosis as a preeclampsia risk factor, largely because biological plausibility has not yet established causation.
However, she suggested that a proactive approach to care is necessary. Providers are encouraged to look beyond the missing data and treat the patient based on observed symptoms and potential risks.
“If a patient comes in with severe chronic pelvic pain, bad menstrual pain as well, we 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,” she said.
This approach could involve earlier blood pressure monitoring and referrals to maternal-fetal medicine specialists for patients planning pregnancy. 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 concluded that the findings highlight an urgent need for inclusive, race-conscious research. She noted that such studies are essential to inform clinical care and effectively reduce maternal health disparities.
