Background Pre-eclampsia (PE) continues to be a major risk to maternal and fetal health, complicating up to 5% of all pregnancies, with no proven pharmacological intervention to reduce its incidence at term. Screening for pre-eclampsia risk at 35–36 weeks' gestation has been associated with a 30% reduction in the incidence of the primary outcome of PE, in The PREVENT-PE Trial. Methods We aimed to understand women's maternity and birth experiences in The PREVENT-PE Trial. Semi-structured interviews were conducted with women (N = 80) from The PREVENT-PE Trial including those who were screened and had a timed birth (n = 37); those who were randomised to usual care (n = 31); and those who declined randomisation (n = 12). Data were subjected to a Template Analysis, based on findings from previous studies on maternity care experiences. Findings We report on four key themes: Achieving Efficiencies with Research-embedded Clinical Care; Communicating Trial Information; Building Relationships with Care Providers; and Agency and Shared Decision-making. Maternity service delivery was deemed to be efficient as was the care they received during the trial. Volume of complex medical information caused concern; however, regular, consistent contact between women and their healthcare providers, helped women feel valued and understood; especially when they were provided with the opportunity to ask questions and have them answered. Conclusion Participation in an intervention trial within maternity care should embed principles of effective communication, relational care, shared decision-making, and efficient service delivery. Addressing these with not only enhance maternal experience but may also further promote greater participation in research.
Preeclampsia (PE) is a major hypertensive disorder characterized by systemic endothelial dysfunction and renal involvement. Although traditionally linked to glomerular endotheliosis, evidence suggests that podocyte injury is central to its pathophysiology. This systematic review and meta-analysis compares urinary levels of nephrin (NEP) and podocalyxin (PDC) between patients with PE and normotensive controls during the second half of gestation. Following PRISMA guidelines, 12 observational studies (421 PE cases and 415 controls) were included. A random-effects meta-analysis using Standardized Mean Differences (SMD) was performed to aggregate the heterogeneous biomarker metrics. Both urinary NEP and PDC were significantly elevated in patients with PE compared to normotensive controls during the second half of gestation, displaying robust pooled effect sizes (NEP: SMD = 2.38; 95% CI: 1.62–3.14; p < 0.00001; PDC: SMD = 3.07; 95% CI: 1.66–4.47; p < 0.0001). However, extreme statistical heterogeneity was observed (I2 = 93% and I2 = 95% for NEP and PDC, respectively), reflecting substantial pre-analytical and analytical diversity across commercial assays. Furthermore, diagnostic performance data remain scarce and controversial. While some studies report an Area Under the Curve (AUC) above 0.95, others report a specificity as low as 32%. This inconsistency, coupled with a lack of standardized cut-off points and Receiver Operating Characteristic (ROC) curves in most reports, makes it impossible to establish a universal diagnostic threshold. In conclusion, while urinary NEP and PDC confirm that PE involves significant podocytopathy, the current evidence is insufficient to support their use as reliable clinical tools. These findings underscore the urgent need for standardized laboratory protocols to determine their true diagnostic value.
Objective To evaluate the risk of hypertensive disorders of pregnancy (HDP) according to the 2017 American Heart Association (AHA) blood pressure (BP) categories based on preconception and early pregnancy measurements. Study design This retrospective cohort study included nulliparous singleton pregnancies (2010−2023) with at least one BP measurement from one year before conception through 13 weeks' gestation. Women with chronic hypertension were excluded. Participants were classified as normotensive, elevated BP (systolic BP 120–129 mmHg and diastolic BP <80 mmHg), or stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg). The primary outcome was composite HDP, including preeclampsia, eclampsia, or HELLP syndrome. Logistic regression adjusted for maternal age, aspirin use, BMI, and pregestational diabetes mellitus (PGDM). Subgroup analyses were performed for obesity (BMI ≥30) and PGDM. Results Among 57,524 women, 81.6% were normotensive, 11.5% had elevated BP, and 6.9% had stage 1 hypertension. Composite HDP rates increased in a dose–response manner (2.8%, 6.4%, and 8.2%, respectively; p < 0.001). Both elevated BP and stage 1 hypertension were independently associated with HDP (adjusted odds ratios [aOR] 2.22, 95% CI 1.94–2.55, and 2.75, 95% CI 2.34–3.24). Similar associations were observed in women with obesity and PGDM, with particularly high risk among those with elevated BP and PGDM (aOR 2.88, 95% CI 1.89–4.20). Conclusion Preconception and first-trimester elevated BP and stage 1 hypertension are associated with substantially increased HDP risk, supporting early BP-based risk stratification, especially in high-risk populations.
In this cross-sectional study of 18,969,287 hospital deliveries identified in Healthcare Cost and Utilization Project's National Inpatient Sample from 2016 to 2022, Black pregnant people had higher incidence rates of developing pre-eclampsia with severe features compared to White pregnant people across all the socioeconomic strata. The effect sizes for Black pregnant people comparing to White pregnant people were similar and consistent across census-level household income and insurance status. These data suggest that the development of pre-eclampsia with severe features may be driven by a combination of social determinants of health, environmental, and biologic factors, calling for corroboration in a prospective assessment.
