The United States has the highest maternal mortality rate among high-income nations. It is not close.
More than 80 percent of the deaths that occur during or after pregnancy are preventable, according to the Centers for Disease Control and Prevention. Black women die from pregnancy-related causes at two to three times the rate of white women. These are not new statistics. They have been cited, flagged, studied, and re-cited for years. What has been slower to materialize is a serious, systemic response at the intersection of diagnostics, clinical practice, and policy.
Why Diagnostics Matter
Two conditions — gestational diabetes and preeclampsia — account for a significant share of preventable maternal deaths and complications. Both are conditions where early, accurate detection changes outcomes dramatically. Both are conditions where the current diagnostic landscape falls short.
Preeclampsia — a serious pregnancy complication characterized by high blood pressure and signs of damage to organ systems — affects 5 to 8 percent of pregnancies in the United States. It is a leading cause of maternal and perinatal morbidity and mortality. Current screening relies heavily on blood pressure monitoring and urine protein testing, approaches that are imprecise and miss a significant proportion of cases before symptoms escalate. Biomarker-based screening tools that show promise in identifying high-risk women earlier exist — but their adoption has been slow and their availability uneven.
Gestational diabetes mellitus (GDM) affects an estimated 6 to 9 percent of pregnancies, and rates are rising. The current standard screening approach — a glucose challenge test followed by a diagnostic oral glucose tolerance test — has significant limitations in sensitivity and specificity, and access to appropriate follow-up care after a positive screen varies enormously by geography and insurance status.
The Equity Dimension
Any honest analysis of maternal health diagnostics has to confront race.
Black women with preeclampsia are more likely to present at later stages, receive delayed diagnoses, and experience worse outcomes. This is not primarily a biological phenomenon. It is the predictable result of a health system that has consistently undertreated Black women’s pain, dismissed their concerns, and failed to provide the follow-up care that early diagnosis requires.
Better diagnostic tools deployed in a system that does not treat all patients equitably will not close the maternal mortality gap. They are necessary but not sufficient. What is also required is clinical culture change — provider training on implicit bias, accountability mechanisms for disparate outcomes, and structural investment in the communities where maternal mortality rates are highest.
What Policy Can Do
The 2025 SWHR Value of Diagnostics within Women’s Health series, which examined preeclampsia and gestational diabetes, produced a clear set of policy recommendations. They warrant attention:
Require sex-disaggregated and race-disaggregated outcome data from health systems and insurance plans as a condition of federal funding. What gets measured gets managed.
Expand coverage for evidence-based maternal screening tools, including newer biomarker approaches for preeclampsia risk stratification, under Medicaid and Medicare.
Invest in maternal health workforce capacity in rural and underserved areas — including midwives, doulas, and community health workers who have demonstrated effectiveness in improving outcomes among Black mothers.
Protect and expand Medicaid postpartum coverage extensions. A significant share of pregnancy-related deaths occur in the weeks and months after delivery — a period when millions of women previously lost coverage. Extending postpartum coverage to 12 months is one of the most evidence-based interventions available.
The diagnostic gap in maternal health is real and addressable. The will to address it — consistently, equitably, and at scale — is what has been missing.
