World Pre-eclampsia Day: are we moving in the right direction?

INTRODUCTION In 2026, the greatest challenge in pre-eclampsia is no longer making the diagnosis or managing the condition. It is whether Asia can deliver screening and prevention equitably across its nations. This year’s World Pre-eclampsia Day highlights an uncomfortable paradox in our region. We now possess in our armamentarium the tools to predict and to prevent preterm pre-eclampsia. Yet, in many underserved populations, we continue to see women who present late, convulse and die from this ancient malady. Our ability to save lives is divided not by knowledge, but by access to it. Although we are all aware that modern medicine often deepens the divide between health and healthcare, saving mothers’ lives by reducing the incidence of preterm pre-eclampsia may yet be that singular goal where Asian nations unite to bring novel and frugal innovation into the capillaries of society, in which women give birth to the future itself. Hypertensive disorders account for approximately 16% of maternal deaths globally, corresponding to about 42,000 deaths in 2023.[1,2] The World Health Organization (WHO) estimates that pre-eclampsia affects around 2.8% of live births in developing countries—approximately seven times higher than in developed countries, where the incidence is about 0.4%.[3] Maternal mortality from eclampsia is also substantially higher in developing settings, reaching up to 15% compared with up to 1.8% in developed countries.[4] Pre-eclampsia thus remains a leading cause of maternal and perinatal mortality and morbidity, with short- and long-term morbidity being most significant when the disease arises preterm.[2] It is associated with eclampsia, HELLP syndrome, pulmonary oedema, renal failure and subsequently cardiovascular disease. Neonates require prolonged intensive care and endure the long-term consequences of preterm birth. The tools to mitigate this impact already exist; structured screening, timely initiation of aspirin prophylaxis and increased antenatal surveillance can yield substantial benefit, as every additional week gained in utero enhances neonatal survival and long-term neurodevelopmental outcomes. FROM RISK-BASED SCREENING TO PRECISION PREVENTION Screening strategies have evolved considerably, shifting from traditional risk factor-based approaches to multivariable first-trimester models incorporating biomarkers such as placental growth factor (PlGF) and uterine artery Doppler indices. The ASPRE trial demonstrated that a Bayesian-based screening approach combined with aspirin prophylaxis significantly reduced the occurrence of preterm pre-eclampsia. This model can predict 90% of early pre-eclampsia cases at