PRECISE Network Maps Pre-Eclampsia Risk

A new research series has developed a unified conceptual framework for pre-eclampsia prevention. The work, led by the PRECISE Network, integrates 35 evidence-based determinants of the condition.

Pre-eclampsia is a hypertensive disorder of pregnancy. It is a leading global cause of maternal mortality, linked to over 46,000 maternal deaths annually. The condition also contributes to severe fetal outcomes like growth restriction and stillbirth. The burden is disproportionately high in low- and middle-income countries, where placental disorders may complicate up to a third of pregnancies.

A Broader View of Risk

Traditional clinical guidelines have focused heavily on clinical risk factors assessable early in pregnancy. However, a prior review found these guidelines often listed risk factors based on variable evidence. For instance, obesity is a strong evidence-informed risk factor but was rarely listed as a major one. Other factors emerging later in pregnancy, like gestational diabetes or severe anaemia, were poorly represented. This highlights gaps, especially for settings where infections and anaemia are more common.

The new framework moves beyond clinical factors alone. It systematically maps social determinants like socioeconomic status, healthcare access, and physical environment. It also evaluates biomarker evidence, identifying 18 robust biomarkers linked to pre-eclampsia development.

An Integrated Framework for Action

The research series synthesises social and clinical evidence into a single model. This integrated framework maps the interwoven relationships between 35 different determinants. It highlights indirect pathways, such as how elevated BMI, Type 2 diabetes, and hypertension contribute to pre-eclampsia risk. Strengthening antenatal care attendance is also noted as a key intervention point.

Beyond clinical care, the framework offers a tool for analysing existing data and planning future studies. It will inform the PRECISE Network's ongoing prospective pregnancy cohort study across The Gambia, Kenya, and Mozambique. The goal is to elucidate pathways to both optimal and complicated pregnancy outcomes in sub-Saharan Africa.

The work, published in a scientific supplement, marks a step toward a more comprehensive understanding of pre-eclampsia risk. It reflects the full complexity of the condition affecting women worldwide, particularly in resource-limited settings. The research was funded by the UK Research and Innovation Global Challenges Research Fund.