The Use of Maternal Race in Antenatal Screening Tests: A Narrative Review

The historical legacy of white supremacy in the United States has been institutionalized in ways that contribute to maternal health care inequities, including the treatment of race as a biological risk factor in health care. Race is a social construct with neither a genetic nor biological basis, and racism is the major contributor to adverse outcomes. Recently, medical specialties have identified and reduced the use of race in clinical tests and decision-making. Identifying the use of race in antenatal care is essential to dismantling institutional racism and improving perinatal outcomes. We conducted a narrative review to describe the role of race in currently recommended antenatal care tests. We identified tests considered routine and gold standard for antenatal care in the United States based on the 2025 American College of Obstetricians and Gynecologists Clinical Consensus for Tailored Prenatal Care Delivery. We searched bibliographic databases and reference lists. Of the 18 tests found in routine antenatal care, 3 currently use race, 3 previously used race, and 12 do not and have not used race. Currently, Black race is considered a moderate risk factor for preeclampsia, and race-specific adjustment factors remain embedded in the first-trimester combined and second-trimester quadruple aneuploidy screening for the interpretation of maternal serum markers. Historically, anemia diagnosis definitions included race-specific thresholds, and race and ethnicity were considered alongside other risk factors when recommending screening for hemoglobinopathies and gestational diabetes. Although the inclusion of race was likely an attempt to address maternal health care inequities, it can perpetuate racist rhetoric that an individual's increased risk is attributable to inherent biological differences. These findings reinforce the need to review antenatal care practices and eliminate race-based clinical guidelines to provide evidence-based health care and advance perinatal health equity.