This study evaluated whether, in pregnancies with extreme angiogenic imbalance, defined by a soluble fms-like tyrosine kinase-1 to placental growth factor ratio greater than 600, the absolute ratio provides additional prognostic value for perinatal death or severe morbidity beyond gestational age and estimated fetal weight. A secondary objective was to assess the contribution of ratio kinetics and placental growth factor levels in fetal growth restriction.We conducted a retrospective observational cohort study including 132 singleton pregnancies managed at a tertiary referral hospital between June 2015 and September 2024. Outcomes were intrauterine fetal death, death within the first week, death within the first year, severe morbidity with major sequelae, and a composite adverse outcome. Baseline models including gestational age and estimated fetal weight at the time of ratio greater than 600 were compared with models additionally including the logarithm of the ratio.Event rates were 8.3%, 15.9% week, 20.6%, 29.5%, and 43.9%, respectively. Adding the ratio did not improve discrimination for any endpoint. A ratio greater than 600 was, however, associated with shorter time to delivery. In the serial subset, the rate of increase of the ratio improved prediction of death within the first week. In fetuses with growth restriction, lower placental growth factor levels were associated with severe morbidity.In this extreme range, the ratio mainly reflects disease imminence rather than outcome severity. Ratio kinetics may identify acute deterioration, whereas placental growth factor may better reflect residual placental reserve and fetal viability, especially in growth-restricted fetuses.
Hypertensive disorders of pregnancy affect 13-16% of U.S. pregnancies and remain a leading cause of maternal and neonatal morbidity. Management is complicated by diagnostic uncertainty, as most markers rise only after end-organ injury. The sFlt-1/PlGF ratio has shown strong prognostic value, but its effect, on U.S. clinical management decisions, is unknown. We conducted a case-based webinar with obstetric and maternal-fetal medicine providers (n = 68) to assess changes in management intent after a low ratio result. Expectant management intent rose from 20.9% to 87.8%, while delivery intent decreased. These findings suggest sFlt-1/PlGF biomarker data may influence intended patient management.
Hypertensive disorders of pregnancy (HDP) affect the incidence of preterm birth. The sFlt-1/PlGF ratio test predicts preeclampsia progression, but its effect on neonatal outcomes is understudied. This study estimated reductions in neonatal mortality and morbidity through sFlt-1/PlGF-guided management for hospitalized patients with HDP. Using a decision-analytic model with PRAECIS and BEACON data and neonatal outcomes from a U.S. cohort of 760,000 infants, outcomes were estimated for patients with HDP at 24-35 weeks' gestation. Results indicated biomarker-guided management was associated with averting 1 death and 75 morbidity cases per 1000 preterm deliveries. sFlt-1/PlGF-guided management could reduce preterm neonatal mortality and morbidity.
OBJECTIVE:To estimate the prevalence of undiagnosed hypertension among pregnant women in Peru, assess socioeconomic inequities, and characterize departmental geographic variability during 2014-2024. METHODS:We conducted an analytical cross-sectional study using the Demographic and Family Health Survey (ENDES) 2014-2024. The sample included 5243 pregnant women aged 15-49 years with valid blood pressure measurements and no prior hypertension diagnosis. Undiagnosed hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg among women without self-reported diagnosis. Weighted prevalences and 95% confidence intervals (95% CI) were estimated. Socioeconomic inequities were assessed using the Slope Index of Inequality (SII), Relative Index of Inequality (RII), and Erreygers concentration index. Spatial autocorrelation was assessed using Moran's I. RESULTS:The prevalence of undiagnosed hypertension was 5.6% (95% CI: 4.4-6.7). Prevalence was higher in urban than rural areas (6.1% vs 4.2%) and in the richest versus poorest quintile (6.4% vs 3.8%), although these contrasts were imprecise. The SII was 3.36 percentage points (95% CI: -0.72 to 7.44), the RII was 1.83 (95% CI: 0.92-3.64), and the Erreygers index was 0.021 (95% CI: 0.007-0.035; p = 0.003), indicating a small pro-rich concentration. Moran's I was positive and statistically significant after correction to 25 ENDES spatial units (I = 0.294; p = 0.013). CONCLUSIONS:Undiagnosed hypertension affected approximately one in eighteen pregnant women in Peru. Findings suggest modest pro-rich concentration and significant departmental spatial autocorrelation.
OBJECTIVES:This study investigated whether necroptosis-associated proteins are elevated in urinary extracellular vesicles (uEVs) from women with preeclampsia (PE) compared with normotensive pregnancies (NP), and explored uEV origin. STUDY DESIGN:Urine was collected from 22 women with PE and 22 gestation-matched NP controls (Cohort A). A separate cohort of four PE samples with heavy proteinuria, gestation-matched to NP controls, was examined (Cohort B). uEVs were isolated using differential ultracentrifugation. MAIN OUTCOME MEASURES:Western blot determined presence of necroptotic markers, total mixed lineage kinase domain-like protein (MLKL) and phosphorylated MLKL (pMLKL), together with small EV markers CD9 and TSG101. Placental alkaline phosphatase (PALP) and the renal cotransporter NKCC2 were used to assess EV organ origin. Nanoparticle tracking analysis (NTA) characterised uEVs. RESULTS:uEV pMLKL was detected more frequently in the PE group than NP controls (6/22 versus 0/22, P = 0.021). There was a non-significant increase in total MLKL in PE (10/22 versus 5/22, P = 0.203). PALP was detected in 2/12 PE and 1/12 NP samples, suggesting a placental contribution to uEVs in some participants. NTA confirmed uEVs in a subset of samples, with no significant differences in size or concentration between groups. In heavily proteinuric PE subjects (Cohort B), pMLKL was detected in 3/4 samples. CONCLUSIONS:pMLKL was detected more frequently in uEVs from women with PE. Detection of PALP in a subset of uEVs suggests possible placental contribution to the uEV pool. These findings are consistent with increased necroptosis-related signalling in the urinary tract/kidney in women with PE.
Gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), preterm birth, and intrauterine growth restriction represent major contributors to maternal and neonatal morbidity worldwide. Traditional screening methods relying on single biomarkers or linear models often demonstrate limited predictive accuracy. This review examines the transformative role of machine learning (ML) in shifting obstetric care toward predictive, preventive, and personalized approaches. Advanced computational models integrating multimodal data sources clinical records, biochemical markers, multi-omics profiles, medical imaging, and lifestyle factors show promising performance. Ensemble methods such as Random Forest and XGBoost, alongside deep learning architectures, frequently outperform conventional logistic regression, achieving AUC values above 0.90 in selected cohorts. Emphasis is placed on preprocessing techniques for class imbalance (e.g., SMOTE), model interpretability via Explainable AI (SHAP), and privacy-preserving strategies like federated learning. While technical and ethical challenges including bias, external validation, and data heterogeneity remain, robust ML frameworks offer substantial potential for early risk stratification and timely intervention in precision obstetrics. Prospective, multicenter validation is essential for clinical translation.
Pre-Eclampsia (PE) is characterized by an imbalance of angiogenic and inflammatory modulators, with clinical symptoms emerging after 20 weeks of gestation. Fibroblast Growth Factor-2 (FGF2) promotes angiogenesis, whereas the acute-phase protein Pentraxin-3 (PTX3) binds FGF2 and blocks its interaction with receptors. In this cross-sectional case-control study, we compared plasma levels of PTX3 and FGF2 in normotensive (NT) and PE pregnancies and evaluated their ability to discriminate early-onset (<34 weeks) from late-onset PE (≥ 34 weeks). PTX3 and FGF2 concentrations were quantified by sandwich ELISA in non-pregnant women (NP, n = 19) and in third-trimester samples from NT women (n = 29) and women with PE (n = 30; early-onset PE = 11, late-onset PE = 19). Both PTX3 and FGF2 levels were significantly higher (p < 0.05) in PE compared to NT pregnancies. Moreover, their concentrations in early-onset PE were, on average, twice as high as those observed in NT and late-onset PE groups. Pearson's correlation analysis revealed a negative association between PTX3 and FGF2 levels in PE (r = -0.5160; p = 0.0167). In conclusion, PTX3 and FGF2 are both elevated in PE, particularly in early-onset cases. Their inverse correlation suggests a disrupted PTX3-FGF2 axis that may contribute to the angiogenic deficit found in PE. These findings suggest that PTX3 and FGF2 are candidate biomarkers associated with disease severity and may contribute to a molecular signature related to early-onset PE. Further prospective studies are required to establish their predictive value and clinical applicability.
Comparing Severity of Different Subtypes of Preeclampsia Using Different Diagnostic Criteria - A Retrospective Cohort Study. BACKGROUND:New diagnostic criteria introduced by ISSHP in 2018 and ACOG in 2020 lowered diagnostic thresholds to create distinct subtypes. OBJECTIVES:We assess changes in prevalence and compare biochemical profiles and outcomes of patients diagnosed by different criteria. We evaluated associations of each diagnostic component with adverse outcomes. STUDY DESIGN:Singleton pregnancies with any hypertensive disorder in pregnancy diagnosed between 1/1/2011 and 31/12/2019 had demographics and outcomes retrieved from an electronic records system. Patients were reclassified by ISSHP 2001, ACOG 2020, and ISSHP 2018 criteria. Additional patients identified were analysed separately. MAIN OUTCOME MEASURES:Prevalence and associations between categorical variables and adverse outcomes were calculated. Multivariate logistic regression between components of each criteria and adverse outcomes was performed. RESULTS:Prevalence increased by 4.0-21.6% from 1.99% to 2.07-2.42% (ACOG 2020, ISSHP 2018 respectively). Additional patients diagnosed by ISSHP 2018 and ACOG 2020 had less severe hypertension (0.7% and 0.0% vs 15.6%, p < 0.001), MgSO4 use (0.0% vs 8.6%, p < 0.05), preterm birth <37 weeks (8.5% and 4.0% vs 35.7%, p < 0.001), Caesarean section (36.2% and 12.0% vs 56%, p < 0.001) and NICU admission >24 h (2.8 and 8.0% vs 10.1%, p < 0.001 and not significant) than patients diagnosed by ISSHP 2001. Proteinuria, thrombocytopenia, elevated creatinine and transaminases were significantly associated with adverse outcomes across most groups. CONCLUSION:Using newer diagnostic criteria increases incidence. Additional patients had milder disease and better outcomes despite management as gestational hypertension.
OBJECTIVES:Previous studies demonstrated that preeclampsia (PE) with proteinuria is associated with concurrent renal injury. However, it is unclear how renal damage that occurs during pregnancy changes after delivery. This study was conducted to assess postpartum renal impairment in women with PE and to examine its possible link to the subsequent development of chronic kidney disease (CKD). STUDY DESIGN:We conducted a retrospective cohort study analyzing a group of women with PE and proteinuria (PE-UP (+)) (N = 30). Control data were obtained from normotensive participants at 35 weeks of gestation (N = 20) and 12 weeks postpartum (N = 15). MAIN OUTCOME MEASURES:Serum hyaluronan (glycocalyx injury), urinary podocalyxin (podocyte injury), urinary liver-type fatty acid-binding protein (L-FABP) and N-acetyl-β-D-glucosaminidase (NAG) (tubular injury) were measured at PE diagnosis and at 12 weeks postpartum. RESULTS:Based on the urinary protein/creatinine ratio (UPCR) at 12 weeks postpartum, the PE-UP (+) group was stratified into the PE-UP improved group (UPCR <0.15 g/g Cr; N = 20) and PE-UP persistent group (UPCR ≥0.15 g/g Cr; N = 10). The urinary L-FABP and NAG levels in the PE-UP improved group were significantly lower than those in the PE-UP persistent group. In contrast, the levels of hyaluronan and podocalyxin remained significantly elevated in both PE subgroups compared to those in the postpartum controls. CONCLUSIONS:Postpartum women with PE and prolonged proteinuria exhibit residual tubular dysfunction. Women with PE in whom proteinuria has resolved may still have residual glomerular damage at 12 weeks postpartum. The clinical trial described in this paper was registered at the UMIN Clinical Trials Registry under registration number UMIN000058351. URL of registration: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000066708.
We thank Liu et al. for their constructive comments on our article reporting the internal and external validation of a reduced-feature machine learning model for the prediction of preeclampsia-related adverse outcomes. The letter raises four points, which we address in turn. Regarding calibration and clinical utility, we generated calibration curves for the gradient-boosted tree model in both cohorts. Neither cohort shows a systematic, clinically concerning miscalibration pattern; deviations are concentrated at the extremes of the risk distribution, where observations are fewest. Brier scores were 0.010 (German cohort) and 0.068 (North American cohort), indicating good overall probabilistic accuracy. We agree that a formal clinical utility analysis, such as net benefit across threshold probabilities, represents an important next step. Regarding incremental value over the sFlt-1/PlGF ratio, we note that while the ratio offers strong short-term rule-out performance, its positive predictive value for ruling in preeclampsia related adverse outcomes remains limited. Our model, which incorporates the sFlt 1/PlGF ratio alongside ten additional routine clinical features, achieved AUCs of 92% and 87% in the German and North American cohorts, respectively. A formal head-to head comparison remains an important direction for future work. Regarding dataset heterogeneity, we acknowledge the structural differences between cohorts as a relevant limitation, while noting that discriminative performance remained statistically indistinguishable across cohorts despite significant differences in baseline characteristics. Regarding longer-term outcomes, we agree this is a valuable direction and intend to pursue it as follow-up data become available.
OBJECTIVES:SIGLEC6, a human-specific transmembrane receptor, is highly expressed in placenta. SIGLEC6 is elevated in maternal circulation preceding preeclampsia and in women with preeclampsia, correlating with disease severity. This study aimed to investigate the regulatory mechanisms of placental SIGLEC6 and its involvement in processes associated with preeclampsia pathogenesis. STUDY DESIGN:To determine cell source, SIGLEC6 was measured in (cyto)trophoblasts, syncytiotrophoblasts, and extravillous trophoblasts. We then assessed the impact of hypoxia (1% vs 8% Oxygen), inflammatory cytokines (Interleukin 6 (IL-6) or Tumour Necrosis Factor alpha (TNFα)), or Brefeldin A (impairs protein trafficking) on SIGLEC6 production/secretion. We also assessed whether treatment with recombinant SIGLEC6 induced endothelial dysfunction in human umbilical vein endothelial cells (HUVECs). MAIN OUTCOMES MEASURES:SIGLEC6 expression across trophoblast subpopulations; its regulation under hypoxia, inflammation and Brefeldin A treatment; and its effect on endothelial dysfunction markers. RESULTS:SIGLEC6 was expressed in all cell types and upregulated during differentiation of human trophoblast stem cells into syncytiotrophoblasts and extravillous trophoblasts. Exposure of syncytiotrophoblasts to hypoxia elevated SIGLEC6 expression (p = 0.0079), and protein secretion (p = 0.0079). Similarly, pro-inflammatory cytokines increased SIGLEC6 expression (IL-6: p = 0.0016, and TNFα: p = 0.0015) and protein secretion (IL-6: p = 0.002, and TNFα: p = 0.01) from syncytiotrophoblasts. Treatment with Brefeldin A reduced SIGLEC6 secretion in cell lysates (p = 0.001) and conditioned media (p = 0.02). Recombinant SIGLEC6 had no effect on pro- and anti-angiogenic factors and endothelial dysfunction markers in HUVECs. CONCLUSION:SIGLEC6 expression is induced by hypoxia and inflammation in syncytialised hTSCs, but recombinant SIGLEC6 did not induce endothelial dysfunction in HUVECs.
OBJECTIVES:To identify latent trajectories of blood pressure throughout pregnancy and evaluate their associations with body mass index (BMI), physical fitness (estimated via oxygen uptake), and serum relaxin levels in a cohort of healthy pregnant women. STUDY DESIGN:Prospective inception cohort study. Group-based trajectory modelling was used to characterize systolic and diastolic blood pressure patterns across gestation. Multiple logistic regression analyses were conducted to identify predictors of trajectory group membership. MAIN OUTCOME MEASURES:Longitudinal trajectories of systolic and diastolic blood pressure during pregnancy. RESULTS:A total of 492 women were included in early pregnancy. Three distinct and stable trajectories were identified for both systolic and diastolic blood pressure. Nulliparous women and those with BMI >25 kg/m2 had significantly increased odds of belonging to the highest blood pressure trajectory group (adjusted odds ratio [aOR] 2.47; 95% CI: 1.58-3.86 and aOR 1.61: 95% CI 1.04-2.49), respectively). No significant associations were observed between trajectory group membership and maternal age, physical fitness, or early-pregnancy serum relaxin concentrations. CONCLUSIONS:Early pregnancy blood pressure may serve as a clinically relevant marker for gestational hypertension risk. Women with lower baseline readings may require less frequent antenatal monitoring, whereas those with elevated initial values could benefit from closer surveillance. Nulliparity and overweight status were associated with higher blood pressure trajectories, highlighting their relevance in antenatal risk stratification. Physical fitness and relaxin levels did not demonstrate predictive value in this context.
OBJECTIVES:Children of mothers with early-onset preeclampsia (EOPE) are at increased risk of respiratory morbidity due to factors including fetal growth restriction, prematurity, and impaired pulmonary vascular development. While animal studies suggest compromised fetal pulmonary vasculature in preeclampsia, human data remain limited. This study aimed to compare fetal pulmonary vascular volume in EOPE pregnancies with healthy controls as a proof of concept. STUDY DESIGN AND MAIN OUTCOME MEASURES:Pregnant women with EOPE and healthy controls were prospectively recruited. Ultrasound assessments were performed at three gestational intervals: 19 + 0-24 + 0 weeks (US1), 24 + 1-29 + 6 weeks (US2), and 30 + 0-32 + 0 weeks (US3). Using 3D Power Doppler ultrasound, fetal right pulmonary vascular volume (R-PVV), right lung volume (R-LV), and the R-PVV/LV ratio were measured. Perinatal parameters were also evaluated. RESULTS:Seventy-two controls and 36 EOPE fetuses were included. EOPE fetuses showed significantly reduced R-PVV at US2 and US3 compared to controls. The R-PVV/LV ratio remained significantly lower at both time points, suggesting impaired vascular development independent of lung size. Maternal BMI, gestational age at birth, and neonatal outcomes differed significantly between groups. CONCLUSIONS:This is the first human study to demonstrate impaired fetal pulmonary vascular development in EOPE. These findings offer insight into the pathophysiological effects of EOPE on fetal lung health.
We evaluated an antenatal telemonitoring program for pregnant women at increased risk of preeclampsia, fully integrated in the hospital electronic health record (EHR). In this retrospective case-control study, 20 women receiving telemonitoring were compared with 20 women receiving usual care. Primary outcomes were hypertension-related outpatient visits and hospital admissions; secondary outcomes included other contacts, diagnostics, and patient experience. Outpatient visits were similar, but hospital admissions were significantly lower in the telemonitoring group. Asynchronous patient messages increased, while other process outcomes were comparable. Patient satisfaction and willingness to reuse telemonitoring were high, supporting feasibility and acceptability of EHR-embedded telemonitoring.
OBJECTIVE:To compare echocardiographic hemodynamic parameters between pregnant women with and without preeclampsia evaluated at high altitude. STUDY DESIGN:We conducted an observational cross-sectional study including pregnant women evaluated at a tertiary referral center located at 2640 m above sea level. Participants were classified according to the presence or absence of preeclampsia, diagnosed using International Society for the Study of Hypertension in Pregnancy criteria. All participants underwent standardized transthoracic echocardiography following international guidelines. Conditions known to significantly affect maternal hemodynamics were excluded. RESULTS:A total of 105 pregnant women were included (35 with preeclampsia and 70 controls). Women with preeclampsia had higher cardiac output (median 5.18 L/min (IQR 3.90-6.04) vs. 4.52 L/min (IQR 3.67-5.15); p = 0.045) and higher left ventricular stroke volume (median 62.80 mL (IQR 53.04-71.41) vs. 55.65 mL (IQR 50.24-62.80); p = 0.019) compared with controls. Systemic vascular resistance was lower in the preeclampsia group, although the difference was not statistically significant (median 1243.36 dyn·s·cm-5 (IQR 1057.32-1594.65) vs. 1418.58 dyn·s·cm-5 (IQR 1234.44-1717.41); p = 0.06). Left ventricular systolic function and indexed chamber volumes were similar between groups. CONCLUSIONS:Among pregnant women evaluated at high altitude, preeclampsia was associated with higher cardiac output and stroke volume, accompanied by mild alterations in diastolic filling, without significant differences in ventricular structure or systolic function. These findings underscore the heterogeneity of maternal hemodynamic presentation in preeclampsia and support further investigation of maternal cardiovascular adaptation in high-altitude settings.
White-coat hypertension (WCH) during pregnancy has been linked to adverse maternal and fetal outcomes, although available evidence is inconsistent, particularly during the second half of gestation. This variability may be partly explained by heterogeneity in blood pressure (BP) phenotype definitions, especially regarding the inclusion of different ambulatory BP monitoring (ABPM) periods. We conducted a retrospective cohort study including pregnant women evaluated between 20 and 34 weeks of gestation within a high-risk pregnancy setting. Office BP and 24-h ABPM were obtained using a standardized protocol. BP phenotypes were classified as normotension, white-coat hypertension, masked hypertension, or sustained hypertension based on office BP and all ABPM periods (24-h, daytime, and nighttime). The primary outcome was a composite maternal endpoint including preeclampsia, eclampsia, or HELLP syndrome, while adverse fetal outcomes were also assessed. Logistic regression models were used to estimate adjusted odds ratios. Among 1415 women included, 56%(793) were normotensive, 2%(28) had WCH, 14.3%(203) masked hypertension, and 27.6% (391) sustained hypertension. The overall incidence of composite maternal outcome was 21.5%(304), with rates of 10.2%(81) in normotensive women, 7.1%(2) in those with WCH, 30.5%(62) in masked hypertension, and 40.7%(159) in sustained hypertension (p < 0.001). After adjustment, WCH was not associated with an increased risk of composite maternal outcome compared with normotension (OR 0.81; 95% CI 0.19-3.52). Adverse fetal outcomes were significantly more frequent in masked and sustained hypertension, but not in WCH. These findings suggest that when white-coat hypertension is defined using all ABPM periods, including nighttime BP, it may not be associated with a significantly increased maternal or fetal risk during the second half of pregnancy among women in a high-risk cohort. Accurate BP phenotype classification, particularly including nocturnal BP assessment, remains essential for appropriate risk stratification in pregnant women.
OBJECTIVE:To compare neurodevelopmental (ND) outcomes in children of mothers who experienced hypertensive disorders of pregnancy (HDP) compared to normotensive mothers using data from a prospective cohort study. STUDY DESIGN:Secondary analysis of ND outcomes in children (aged 4-8 years) born to women who received serial fetal growth ultrasounds in the National Fetal Growth Study. The primary and secondary outcomes were executive and motor functioning scores, respectively (NIH toolbox measures and parent reported scales from Ages and Stages Questionnaire, Behavior, and Autism Scores). The primary exposure was HDP, defined as preeclampsia (PE) or gestational hypertension (GHTN), compared to normotensive. Additionally, PE and GHTN subgroups were compared to normotensive. Linear regression models with significant covariates yielded adjusted mean differences (95% CI). RESULTS:Of 675 children, 63 (9.3%) had HDP, of whom 28 (4.1%) had PE and 35 (5.2%) had GHTN. Those with HDP had lower gestational age at delivery (38.4 vs. 39.5 wks.), higher pre-pregnancy BMI (26.4 vs. 24.2 kg/m2), and higher prevalence of nulliparity (62.0% vs. 44.0%; all p < 0.01). After adjustments, mean scores for all ND outcomes were lower for those with in-utero exposure to HDP compared to normotensive women, but the only significant difference was in executive functioning for children between 3 and 7 years old (mean difference = -3.02, 95% CI -5.70, -0.33). CONCLUSION:In-utero exposure to HDP is associated with increased risks for poor executive functioning, with PE potentially having a stronger association with these long-term ND outcomes than GHTN. CLINICALTRIALS:gov Identifiers: NCT00912132.
BACKGROUND:Climate exhibits substantial variation based on geographic location and latitude. Evidence of its effects on maternal health largely comes from temperate regions, while studies in tropical areas remain scarce, necessitating region-specific research to address these gaps effectively. This study assessed the association between climatic factors, such as temperature, precipitation, humidity, and solar radiation, and eclampsia and preeclampsia. METHODS:This study used health insurance data from Indonesia's National Health Insurance registry, covering 342,432 pregnancies across 514 districts in 34 provinces from 2015 to 2022. Associations between climatic factors and pregnancy complications were analyzed using multilevel Poisson regression models, adjusting for individual and district characteristics. The relative risk (RR) and 95% confidence intervals (CI) were used to assess these relationships. RESULTS:A 5 °C increase in temperature was associated with a decreased risk of pregnancy complications (RR = 0.86, 95% CI: 0.83-0.89), and a 100 mm increase in precipitation also lowered the risk (RR = 0.97, 95% CI: 0.95-0.98). Conversely, higher solar radiation (per 50 W/m2) and humidity (per 10 g/m3) were linked to an increased risk, with RRs of 1.02 (95% CI: 1.01-1.04) and 1.12 (95% CI: 1.05-1.19), respectively. Adjusting for district characteristics did not alter these relationships significantly. CONCLUSION:This study highlights the impact of climatic factors on the incidence of eclampsia and preeclampsia. A coordinated effort among multi stakeholders is crucial, with policymakers prioritizing the inclusion of localized climate variables in health programs, ensuring effective policy implementation, and preparing healthcare providers for climate-related challenges.
