Prasad: Rethink Pre-Eclampsia Phenotypes

A 2026 commentary in BJOG: An International Journal of Obstetrics & Gynaecology calls for a fundamental shift in how pre-eclampsia is categorized. Authors S. Prasad, R. P. Jokhi, and D. O. C. Anumba argue that the traditional binary classification of 'early-onset' and 'late-onset' disease is insufficient for modern clinical practice.

They propose that the condition should instead be understood through distinct clinical phenotypes. This new framework aims to better guide treatment decisions and target future research, which could be tracked in our detailed stats section.

The Limits of the Current System

The commentary, titled "Pre-Eclampsia Beyond the Binary: Rethinking Phenotypes for Clinical Use," critiques the long-standing model. The authors state that grouping pre-eclampsia simply by the timing of onset-before or after a specific number of weeks of gestation-fails to capture the disease's complexity. This binary approach, they contend, masks significant heterogeneity in symptoms, underlying causes, and patient outcomes.

A more nuanced system is needed. The one-size-fits-all classification can lead to suboptimal management strategies for a condition that remains a leading cause of maternal and fetal morbidity and mortality worldwide.

A Proposed Phenotype-Based Model

Prasad, Jokhi, and Anumba suggest replacing the binary model with one focused on identifiable clinical phenotypes. These phenotypes would be defined by specific clusters of signs, symptoms, and biomarker profiles observed in patients, much like analyzing a team's squad composition reveals different strengths and roles.

The goal is to create categories that more accurately reflect the different biological pathways involved. The authors write that such a system could "transform clinical management by aligning therapeutic strategies with the underlying pathophysiology." This could mean more personalized care plans and more efficient use of resources.

Potential Impact on Care and Research

Adopting a phenotype-based classification system would have significant implications. For clinicians, it could provide a clearer roadmap for monitoring and intervention based on a patient's specific disease presentation.

For researchers, it would allow for the design of more targeted clinical trials. Studies could enroll patients with a specific phenotype, making it easier to determine if a new therapy is effective for that particular disease variant. This precision could accelerate the development of new treatments.

The commentary concludes by urging the obstetric community to collaborate on defining these phenotypes. Establishing clear, consensus-driven criteria is presented as a critical next step. The authors believe this shift is essential for advancing the field and improving outcomes for all affected by pre-eclampsia.