Pre-eclampsia is a dangerous complication during pregnancy, characterized by high blood pressure and organ damage. It typically occurs in the second half of pregnancy, during labor, or within the first week after delivery. Pre-eclampsia is responsible for about 16% of maternal deaths in sub-Saharan Africa and is becoming increasingly prevalent. Between 2010 and 2018, the incidence of pre-eclampsia in Africa rose by approximately 20%.
The condition disproportionately affects young women, particularly those having their first pregnancies. Teenage girls under 18 are at especially high risk, with the probability of a 15-year-old girl dying from pregnancy complications in developing countries estimated at one in 150, compared to one in 3,800 in developed nations.
Pre-eclampsia not only endangers the mother’s life but also harms the baby, contributing to stillbirth, preterm birth, and low birth weight. Despite the severity of the condition, there is still a lack of understanding regarding its underlying causes and mechanisms. A decade ago, a study on pre-eclampsia among African and European women uncovered significant genetic factors that contribute to the condition. Both populations carry a gene, the KIR AA genotype, which increases susceptibility to pre-eclampsia. However, African women face a higher risk because they are more likely to carry a fetus with the C2-type HLA-C gene from the father, which is more prevalent in African populations.
Interestingly, African populations also possess unique genetic protections that can reduce the likelihood of pre-eclampsia. However, these protective factors are not enough to overcome the heightened risks, particularly when factors like limited access to healthcare and socio-economic constraints come into play. The condition’s prevalence is linked not only to genetic factors but also to inequalities in healthcare, with wealthier, better-educated African women typically receiving timely diagnosis and treatment, while poorer and less-educated women often do not.
The situation is exacerbated in countries like Uganda, where high maternal mortality rates persist. In 2023, Uganda recorded 1,276 maternal deaths, 16% of which were related to high blood pressure during pregnancy. Hospitals in the country, such as the Kawempe National Referral Hospital in Kampala, are overwhelmed by the increasing number of pre-eclampsia cases, with around 150 patients being treated each month. Uganda’s maternal mortality rate is significantly higher than that of developed countries, such as Australia, highlighting the stark contrast in care received by pregnant women in different regions of the world. This disparity is primarily attributed to challenges within Uganda’s healthcare system, including shortages of healthcare workers, medical supplies, and facilities, especially in rural areas.
Research into pre-eclampsia, particularly in Africa, remains underfunded, despite the urgent need for more information and effective interventions. Early detection of pre-eclampsia is crucial, as the condition can be treated and managed if caught early. Predictive biomarkers, identified through data analysis and artificial intelligence, have the potential to help categorize women based on their risk levels and guide the delivery of targeted treatments.
While the exact causes of pre-eclampsia remain unclear, contributing factors such as immune system dysfunction and inadequate placenta development are suspected. Most existing research comes from high-income countries, and findings from these studies may not be applicable to African women. To address this knowledge gap, ongoing research is focusing on the unique genetic and environmental factors influencing pre-eclampsia in African populations.
Efforts are being made to bridge the gap between research and practical healthcare solutions. Many Ugandan women are unaware of the warning signs of pre-eclampsia, such as headaches, visual disturbances, and swelling in the legs, which leads to missed opportunities for early intervention. Screening algorithms and educational campaigns are essential to empower women with the knowledge to seek medical help early.
Ultimately, increasing investment in pre-eclampsia research is crucial to improving prevention, early detection, and treatment. This could lead to the development of novel therapies and reduce the burden on healthcare systems. Improved maternal health care and the application of genetic research will not only help save lives but also enhance the quality of life for both mothers and their children.
