Pre-eclampsia is a multisystem disorder that arises in at least 2–4% of pregnancies and is characterised by hypertension and new-onset organ dysfunction. The pathophysiology of pre-eclampsia is diverse but mostly involves a mismatch between fetoplacental demands and uteroplacental supply, combined with a maternal predisposition to cardiometabolic disease. While our understanding of the mechanisms underlying pre-eclampsia has advanced in recent years, maternal and perinatal mortality remains high in low-income and middle-income countries (LMICs), where pre-eclampsia incidence is higher. Risk factors include maternal chronic hypertension, diabetes, obesity, and previous pre-eclampsia. Preventive strategies include structured behavioural changes focused on diet quality and moderate-intensity physical activity for women with metabolic risk factors, low-dose aspirin for women at high risk, and risk-stratified timed birth at term. To date, the only recourse for pre-eclampsia is delivery of the placenta, and many discrepancies in care remain between high-income countries and LMICs. Current efforts primarily focus on the prediction, accurate diagnosis, and prevention of pre-eclampsia.
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