TY - JOUR
T1 - Integrating Social and Clinical Determinants of Pre-Eclampsia A Hierarchical Systematic Review and Conceptual Framework for Prevention
AU - The PRECISE Network
AU - Woo Kinshella, Mai Lei
AU - Bone, Jeffrey N.
AU - Elawad, Terteel
AU - Mistry, Hiten D.
AU - Poye, Laney
AU - Tsigas, Eleni
AU - Devadas, Deepika
AU - Mateljan, Violet
AU - Volvert, Marie Laure
AU - Vidler, Marianne
AU - Blencowe, Hannah
AU - Filippi, Véronique
AU - Magee, Laura A.
AU - von Dadelszen, Peter
AU - D’Alessandro, Umberto
AU - Roca, Anna
AU - Jah, Hawanatu
AU - Prentice, Andrew
AU - Martinez-Alvarez, Melisa
AU - Diallo, Brahima
AU - Sesay, Abdul
AU - Suso, Sambou
AU - Njie, Baboucarr
AU - Touray, Fatima
AU - Idris, Yahaya
AU - Kongira, Fatoumata
AU - Ndure, Modou F.S.
AU - Gibba, Lawrence
AU - Bah, Abdoulie
AU - Bah, Yorro
AU - Temmerman, Marleen
AU - Koech, Angela
AU - Okiro, Patricia
AU - Omuse, Geoffrey
AU - Mwashigadi, Grace
AU - Amondi, Mary Goretti
AU - Juma, Consolata
AU - Mutunga, Joseph
AU - Mukhanya, Moses
AU - Okello, Robin
AU - Wanje, Onesmus
AU - Mwaniki, Isaac
AU - Ochieng, Marvin
AU - Mwadime, Emily
AU - Sevene, Esperança
AU - Tchavana, Corssino
AU - Macuacua, Salesio
AU - Vala, Anifa
AU - Boene, Helena
AU - Makanga, Prestige Tatenda
PY - 2026/4/14
Y1 - 2026/4/14
N2 - Background: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality, with risk factors reported across a vast literature base fragmented between social and clinical factors. Objective: To develop a comprehensive conceptual framework of the strongest risk factors and their relationships contributing to pre-eclampsia incidence. Search Strategy: Medline, Embase, Health Technology Assessments and Database of Abstracts of Reviews of Effects, Cochrane Library were searched. Selection Criteria: Reviews, randomized controlled trials and cohort studies (> 1000 participants), reporting social and clinical factors associated with pre-eclampsia were included. Data Collection and Analysis: The strongest factors, defined as those with at least moderate strength of association and quality of evidence using GRADE, were compiled from our previously published individual frameworks to create a combined conceptual framework. Indirect associations were searched and the strongest indirect factors were added. Main Results: The conceptual framework integrated 35 social and clinical determinants of pre-eclampsia. Key modifiable factors included BMI, interlinked with chronic hypertension/elevated blood pressure in early pregnancy, type 2 diabetes mellitus, and obstructive sleep apnoea, as well as antenatal care attendance, interconnected with maternal/work stress and prenatal micronutrient supplementation. Other modifiable factors included smoking, antiphospholipid syndrome, infection, exposure to occupational hazards, distance to health facility, maternal heat exposure in early gestation, and UV-B exposure. Conclusion: There are strong social factors alongside clinical factors associated with pre-eclampsia incidence. Interwoven relationships between factors highlight the multifactorial aetiology of pre-eclampsia. Many determinants were potentially modifiable, which provides actionable intervention points for clinical care and public health strategies.
AB - Background: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality, with risk factors reported across a vast literature base fragmented between social and clinical factors. Objective: To develop a comprehensive conceptual framework of the strongest risk factors and their relationships contributing to pre-eclampsia incidence. Search Strategy: Medline, Embase, Health Technology Assessments and Database of Abstracts of Reviews of Effects, Cochrane Library were searched. Selection Criteria: Reviews, randomized controlled trials and cohort studies (> 1000 participants), reporting social and clinical factors associated with pre-eclampsia were included. Data Collection and Analysis: The strongest factors, defined as those with at least moderate strength of association and quality of evidence using GRADE, were compiled from our previously published individual frameworks to create a combined conceptual framework. Indirect associations were searched and the strongest indirect factors were added. Main Results: The conceptual framework integrated 35 social and clinical determinants of pre-eclampsia. Key modifiable factors included BMI, interlinked with chronic hypertension/elevated blood pressure in early pregnancy, type 2 diabetes mellitus, and obstructive sleep apnoea, as well as antenatal care attendance, interconnected with maternal/work stress and prenatal micronutrient supplementation. Other modifiable factors included smoking, antiphospholipid syndrome, infection, exposure to occupational hazards, distance to health facility, maternal heat exposure in early gestation, and UV-B exposure. Conclusion: There are strong social factors alongside clinical factors associated with pre-eclampsia incidence. Interwoven relationships between factors highlight the multifactorial aetiology of pre-eclampsia. Many determinants were potentially modifiable, which provides actionable intervention points for clinical care and public health strategies.
KW - conceptual framework
KW - determinants of health
KW - pre-eclampsia
KW - social and clinical
U2 - 10.1111/1471-0528.70240
DO - 10.1111/1471-0528.70240
M3 - Article
C2 - 41982049
AN - SCOPUS:105036709695
SN - 1470-0328
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
ER -
SDG 3 Good Health and Well-being