Grant: CIHR Fellowship

Background: Pre-eclampsia (PE) is a serious condition of high blood pressure in the second half of pregnancy alongside signs of organ damage, associated with over 46,000 maternal deaths each year. Most research has focused on early-onset disease before 34 weeks of pregnancy, though a majority of women experience late-onset. Maternal nutrition is a promising approach to preventing PE, but current research has rarely examined timing of disease onset, which different forms of malnutrition may impact. Rates of pregnancy hypertension and associated deaths are increasing in sub-Saharan Africa where there is also an increasing concern about overnutrition, undernutrition and nutritional deficiencies. Objective: The purpose of this research is to understand early, late and post-delivery PE rates in sub-Saharan Africa and how they are linked with different forms of malnutrition, explore biological pathways between maternal nutrition and risk of developing pre-eclampsia, and develop policy recommendations. Methods: This study will employ mixed-methods research within the PRECISE Network, a prospective cohort of over 6900 pregnant women in Kenya, The Gambia and Mozambique. Rates of PE by disease onset (early, late, post-delivery) and form of malnutrition (overnutrition, undernutrition, nutritional deficiencies) will be compiled and a systematic review conducted to evaluate nutritional biomarkers associated with risk of developing pre-eclampsia. Relevant biomarkers will be analyzed from PRECISE biological samples and findings interpreted alongside qualitative community perspectives on maternal diets. Experts and African partners will be engaged to identify feasible and culturally appropriate recommendations. Significance: Enhanced understandings of the intersections between multiple forms of malnutrition and PE, supported by findings on biomarker pathways, can improve the precision of nutritional interventions in resource-limited settings in sub-Saharan Africa and globally.