Pre‐eclampsia in low and middle‐income settings: What are the barriers to improving perinatal outcomes and evidence‐based recommendations?

Abstract

ObjectiveTo discuss the points that still challenge low‐ and middle‐income countries (LMICs) and strategies that have been studied to help them overcome these issues.MethodsNarrative review addressing 20 years of articles concerning pre‐eclampsia morbidity and mortality in LMICs. We summarized evidence‐based strategies to overcome the challenges in order to reduce the pre‐eclampsia impact on perinatal outcomes.ResultsPre‐eclampsia is the first or second leading cause in the ranking of avoidable causes of maternal death, and approximately 16% of all maternal deaths are attributable to eclampsia and pre‐eclampsia. Considering the social and economic contexts, it represents a major public health concern, and prevention and early detection of pre‐eclampsia seem to be a major challenge. Reducing maternal mortality related to hypertensive disturbances depends on public policies to manage these preventable conditions. Early and continuous recognition of signs of severity related to hypertensive disorders during pregnancy and childbirth, self‐monitoring of symptoms and blood pressure, as well as preventive approaches such as aspirin and calcium, and magnesium sulfate, are lifesaving procedures that have not yet reached a universal scale.ConclusionThis review provides a vision of relevant points to support pregnant women in overcoming the constraints to healthcare access in LMICs, and strategies that can be applied in primary prenatal care units.

Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps

“…Preventing preeclampsia and eclampsia is even more urgent in LMICs, where antenatal care is not always available, access to emergency obstetric services might be limited, and magnesium sulfate is often unavailable or underused. 53 In addition, survival rates for preterm infants are significantly lower in LMIC than in HIC. 54 …”

“… 61 The use of mobile phone applications has shown potential to facilitate data collection in LMIC. 53 These applications could serve as valuable tools for self-reporting pregnancy outcomes and complications, such as bleeding during aspirin therapy, and for collecting data on predictors of preeclampsia. In addition, they can play a significant role in educating women about the importance of antenatal care, improving communication with healthcare providers, and collecting data on barriers and facilitators to attending antenatal care.…”

AI-based preeclampsia detection and prediction with electrocardiogram data

“…Preeclampsia affects 3%–5% of pregnancies in the US. In addition about 16% of maternal deaths occurring in low- and middle-income countries are related to preeclampsia and eclampsia and are mostly attributed to limited medical care ( 6 ). Furthermore, late or delayed diagnosis or management of preeclampsia is associated with worse outcomes for the mother and infant ( 2 , 7 ).…”