Joint Associations of Maternal-Fetal APOL1 Genotypes and Maternal Country of Origin With Preeclampsia Risk

Xiumei Hong, Avi Z. Rosenberg, Boyang Zhang, Elizabeth Binns-Roemer, Victor David, Yiming Lv, Rebecca C. Hjorten, Kimberly J. Reidy, Teresa K. Chen, Guoying Wang, Yuelong Ji, Claire L. Simpson, Robert L. Davis, Jeffrey B. Kopp, Xiaobin Wang, Cheryl A. Winkler

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Rationale & Objectives: Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia. Study Design: Nested case-control study. Setting & Participants: 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort. Exposure: Maternal and fetal APOL1 risk alleles. Outcomes: Preeclampsia. Analytical Approach: Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin. Results: Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P < 0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P = 0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P = 0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P < 0.001) in African Americans. Limitations: Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study. Conclusions: This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia.

Original languageEnglish (US)
Pages (from-to)879-888.e1
JournalAmerican Journal of Kidney Diseases
Issue number6
StatePublished - Jun 2021


  • APOL1
  • African Americans
  • Haitian
  • US-born
  • ancestry
  • apolipoprotein L1 gene
  • country of origin
  • ethnic disparities
  • fetal genetics
  • kidney risk allele
  • maternal-fetal genotype discordance
  • non–US-born
  • preeclampsia
  • pregnancy complication
  • risk allele

ASJC Scopus subject areas

  • Nephrology


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