The global preclinical research and development landscape for pre-eclampsia and eclampsia therapies

BACKGROUND: Surprisingly few medicines are available to prevent or manage pre-eclampsia, all of which are repurposed from non-pregnant populations and conditions. Analyses of clinical research and development pipelines for pre-eclampsia medicines have identified high-potential candidates; however, the preclinical pipeline has not been interrogated. To address this gap, we developed an approach to analyse and rank preclinical candidates and applied it to the preclinical pipeline for pre‑eclampsia and eclampsia. METHODS: We analysed and ranked the potential of 83 preclinical candidates for pre-eclampsia and eclampsia identified in the Maternal Health Pipeline spanning 2000 to 2025. Candidates were assessed across three domains - quality of preclinical evidence, product development stage and implementability. Each question in the prioritisation matrix was assigned a numerical value based on importance. The sum of these values was used to rank the potential of each candidate for future research. RESULTS: There is a total of 106 candidates in the preclinical pipeline. Twenty-three candidates are excluded from our analysis. Among the 83 candidates analysed, 11 high-potential candidates are identified, and the remaining candidates are ranked as medium (63 candidates) and low potential (nine candidates). Of the candidates analysed, 49.4% are new chemical or biological entities, 37 different binding targets are identified and the proposed mechanism of action for 32 candidates is a reduction in angiogenic factor sFlt-1. CONCLUSIONS: High potential candidates should be prioritised for further development, but progress is restricted by current mechanisms of action and animal models. Increased investment is essential to advance pre-eclampsia therapies into clinical trials.