BJOG : an international journal of obstetrics and gynaecology · 2026
Integrating Social and Clinical Determinants of Pre-Eclampsia: A Hierarchical Systematic Review and Conceptual Framework for Prevention.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Kinshella Mai-Lei Woo, Bone Jeffrey N, Elawad Terteel, Mistry Hiten D, Poye Laney, Tsigas Eleni, Devadas Deepika, Mateljan Violet, Volvert Marie-Laure, Vidler Marianne, Blencowe Hannah, Filippi Véronique, Magee Laura A, von Dadelszen Peter, PRECISE Network
Аннотация
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.
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.