For example, during pregnancy African Americans are said to have a higher chance of getting preeclampsia or gestational diabetes. Genetically, what’s happening here?
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The last 2-3 thousand years are a bit of an exception in terms of how easily humans of different races could mix whether it be due to movement, military, or cultural reasons.
For the tens to hundreds of thousands of years before that, humans typically reproduced with people of similar race. Because of that, there are selective pressures to favor certain traits.
Low nutrition diet but your culture values large, physically strong warriors? Then the people who can convert food into physical bulk would have reproductive advantage and spread their genes more than those who don’t have the trait. The American Samoans are 40 times more likely to play in the NFL compared to their percentage of US population. However, American Samoans have one of the highest obesity rates in the world and their airlines charge tickets based on weight! One trait can provide positive and negative benefits.
For your African American pregnancy risk example, it’s possible some traits in the past were favorable and common for the race in the past for that sort of lifestyle. But now with a modern diet and/or lack of the same types of physical movement/labor, the trait provides disadvantages.
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