Hypertensive disorders of pregnancy in low- and middle-income countries: a review of antenatal interventions to improve maternal outcomes.

INTRODUCTION

Hypertensive disorders of pregnancy remain a major contributor to maternal mortality worldwide, responsible for an estimated 16% of maternal deaths with the majority in low- and middle-income countries (LMICs). This review synthesizes interventions for HDP tailored to LMICs to improve their widespread implementation and in turn, improve maternal outcomes.

METHODS

This review synthesizes literature published between 2010 and 2024 on interventions addressing hypertensive disorders of pregnancy in LMICs using MEDLINE, Cochrane, EMBASE, and WHO Global Index Medicus. Interventions are described using a novel conceptual framework establishing three key steps of the hypertension disorders of pregnancy care continuum: prevention, screening, and treatment.

RESULTS

A total of 212 studies were identified with interventions across multiple domains: 21 involved (10%) screening, 51 (24%) prevention and 119 (56%) treatment, and 21 (10%) including more than one step. The majority of studies were from lower-middle- and middle-income countries, with less than 10% including only low-income countries. Interventions range from educational programs, clinical trials evaluating medication type and dosing algorithms, and development of novel screening tools with comparably little implementation science studies.

DISCUSSION: The majority of studies on interventions for hypertensive disorders of pregnancy in LMICs were randomized trials focused on efficacy. While there were several feasibility and acceptability studies, there was a lack of research translating trials to real-world community and clinical settings. Further, interventions were lacking in countries with the highest rates of maternal mortality. Additional research should focus on the implementation of integrated strategies that improve care across all stages of the care continuum, particularly in LMICs with the greatest burden.

SYSTEMATIC REVIEW REGISTRATION: https://osf.io/7sz5w/overview.