Management of Preeclampsia in Low-and Middle-Income Countries:Lessons to Date,and Questions Arising,from the PRE-EMPT and Related Initiatives

作     者：Peter von Dadelszen Marianne Vidler Eleni Tsigas Laura A.Magee 

作者机构：Department of Women and Children’s HealthSchool of Life Course SciencesKing’s College LondonLondon SE17EUUK Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouver BC V5Z 4H4Canada Preeclampsia FoundationMelbourneFL 32934USA 

出 版 物：《Maternal-Fetal Medicine》 (母胎医学杂志（英文）)

年 卷 期：2021年第3卷第2期

页      面：136-150页

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

基　　金：funded by the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation The PRECISE Network is funded through a UK Research & Innovation Grand Challenges Research Fund Grow Award the PRECISE-DYAD Study by a NIHR-Wellcome Partnership for Global Health Research Collaborative Award funded by the Canadian Institutes of Health Research 

主　　题：Pre-eclampsia Global health Low-and middle-income countries 

摘      要：Preeclampsia remains associated with an increased risk of maternal and perinatal morbidity and mortality,and the burden of that excess risk is largely borne by pregnant women and their families in low-and middle-income countries(LMICs).Therefore,the Bill&Melinda Gates Foundation funded the PREeclampsia–Eclampsia Monitoring,Prevention,and Treatment(PRE-EMPT)initiative to accelerate *** PRE-EMPT,and related activity,have come a number of impactful ***,there is increasing global support for broadening the definition of preeclampsia to include women with hypertension and either significant proteinuria or evidence of target organ damage or fetoplacental compromise(including evidence angiogenic imbalance).Second,using blood pressure(BP)data from the Community-Level Interventions for Preeclampsia trials in India,Mozambique,and Pakistan,acquired on validated-for-pregnancy,semi-automated,low-cost BP devices,there are now population-level,rather than facility-based,estimates for the burden of pregnancy hypertension(sub-categorized into preeclampsia(4%–6%),gestational hypertension(7%–12%),and chronic hypertension(0.3%–0.6%)).Third,there is an identified need to understand biological pathways that underlie the causation of preeclampsia in ***,the Community-Level Interventions for Preeclampsia trials have shown that providing at least eight antenatal contacts,in this case using digital health-supported community health workers,cost-effectively reduces the burden of maternal(by 60%),fetal(60%),and neonatal(40%)***,what is the utility and cost-effectiveness of routine proteinuria screening of normotensive pregnant women?Sixth,clinical risk factor-based prediction of preeclampsia remains most relevant for most women in LMICs;calcium replacement(≥1 g/day)and low-dose aspirin(100–175 mg/day)are the most useful directly preventative ***,achieving sustainable development goals(SDGs)not directly related to health are more likel