THE IMPACT OF PREECLAMPSIA ON MATERNAL MORTALITY IN ASIA: A COMPREHENSIVE EVIDENCE SYNTHESIS
DOI:
10.54443/morfai.v5i2.2771Published:
2025-04-16Downloads
Abstract
Preeclampsia remains one of the leading causes of maternal mortality globally, particularly in developing countries with limited access to antenatal care and emergency obstetric services. This study aims to synthesize scientific evidence regarding the relationship between preeclampsia and maternal mortality in Asia through a Systematic Literature Review (SLR). Using reputable databases such as Scopus, PubMed, and Web of Science, the study analyzed relevant articles published between 2020 and 2024. The results indicate that preeclampsia significantly contributes to maternal death through complications such as eclampsia, HELLP syndrome, and multi-organ failure. The trend of publications shows fluctuating research interest, with a peak in 2023, reflecting increased attention to maternal health post-pandemic. The majority of studies originate from the health sciences and biomedical fields, focusing on clinical interventions and pathophysiology. However, contributions from social, cultural, and policy-oriented research remain minimal, indicating a need for interdisciplinary integration. This review highlights critical risk factors such as chronic hypertension, limited prenatal care, and socio-economic disparities that exacerbate the impact of preeclampsia. It also emphasizes the importance of early detection, risk communication, and context-specific interventions in reducing maternal mortality. Ultimately, this synthesis provides a foundation for improving health policies, clinical practices, and future research directions related to preeclampsia and maternal mortality in Asia.
Keywords:
eclampsia; health policy; maternal mortality rate; preeclampsia; risk factorsReferences
Adepoju, A. A., Vidler, M., Akadri, A. A., Jaiyesimi, E., Nwankpa, C. C., Odubena, O. O., Sharma, S., Li, L., Tu, D., Drebit, S., Payne, B., Akeju, D. O., Bhutta, Z., Magee, L. A., Nathan, H. L., Shennan, A. H., Sotunsa, J., Adetoro, O. O., von Dadelszen, P., … Group, T. C. N. W. (2021). The ability and safety of community-based health workers to safely initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 260 community treatments with MgSO4 and/or methyldopa. Pregnancy Hypertension, 25, 179–184. https://doi.org/10.1016/j.preghy.2021.05.005
Angelina, J. A., Kibusi, S. M., Mwampagatwa, I., & Ernest, A. (2020). Knowledge on Prevention and Management of Preeclampsia and Eclampsia among Nurses in Primary Health Settings: Baseline Findings from an Interventional Study in Dodoma Region, Tanzania. The East African Health Research Journal, 4(1), 33–40. https://doi.org/10.24248/eahrj.v4i1.619
Arshad, N., Skjærven, R., Klungsøyr, K., Sørbye, L. M., Kvalvik, L. G., & Morken, N. (2024). Pregnancy‐Associated Maternal Mortality Within One Year After Childbirth: Population‐Based Cohort Study. BJOG: An International Journal of Obstetrics & Gynaecology, 132(3), 365–374. https://doi.org/10.1111/1471-0528.17985
Awoyemi, T., Zhang, W., Rahbar, M., Cribbs, A., Logenthiran, P., Jiang, S., Collett, G., Cerdeira, A. S., & Vatish, M. (2023). A cross-sectional analysis of syncytiotrophoblast membrane extracellular vesicles–derived transcriptomic biomarkers in early-onset preeclampsia. Frontiers in Cardiovascular Medicine, 10, 1291642. https://doi.org/10.3389/fcvm.2023.1291642
Berhe, E., Teka, H., Abraha, H. E., Abera, B. T., Gebru, M. A., Gebremariam, T., Yahya, M., Amare, B., Tadesse, H., Gidey, H., Tesfay, F., Ebrahim, M. M., Kidanemariam, R., & Legesse, A. Y. (2024). Characteristics and outcome of pregnancy-related acute kidney injury in a teaching hospital in a low-resource setting: a five-year retrospective review. BMC Nephrology, 25(1), 182. https://doi.org/10.1186/s12882-024-03616-9
Beza, Z., Tadesse, R., Teshome, H., Tadele, G., & Siferih, M. (2024). Admission indications, initial diagnoses, Interventions, and patient outcomes within the sole obstetric high-dependency unit in Ethiopia. BMC Women’s Health, 24(1), 329. https://doi.org/10.1186/s12905-024-03175-z
Bhattacharya, R., Chaudhary, M., Bhattacharjee, S., kukadiya, R., Shahu, S., Shah, D., & Patel, M. R. (2024). Clinical Profile of Patients Presenting With Eclampsia at a Semi-urban Tertiary Care Center. Cureus, 16(7), e65651. https://doi.org/10.7759/cureus.65651
Bosquet Enlow, M., Petty, C. R., Hacker, M. R., & Burris, H. H. (2020). Maternal psychosocial functioning, obstetric health history, and newborn telomere length. Psychoneuroendocrinology, 123, 105043. https://doi.org/10.1016/j.psyneuen.2020.105043
Brandt, A. J., Pedroza, J., de Bortoli Cassiani, S. H., Brown, S., & da Silva, F. A. M. (2020). Maternal health training priorities for nursing and allied professions in Haiti. Rev Panam Salud Publica;44, Jul. 2020, 44, 1. https://doi.org/10.26633/rpsp.2020.67
Cao, J., Jiang, W., Yin, Z., Li, N., Tong, C., & Qi, H. (2024). Mechanistic study of pre-eclampsia and macrophage-associated molecular networks: bioinformatics insights from multiple datasets. Frontiers in Genetics, 15, 1376971. https://doi.org/10.3389/fgene.2024.1376971
Cardona-Pérez, J. A., Villegas-Mota, I., Helguera-Repetto, A. C., Acevedo-Gallegos, S., Rodríguez-Bosch, M., Aguinaga-Ríos, M., Coronado-Zarco, I., León-Juárez, M., Aguilar-Ayala, D., Valdespino-Vázquez, M. Y., Moreno-Verduzco, E. R., Rivera, M. A., Valencia-Contreras, C., de Lourdes Gómez-Sousa, M., Solis-Paredes, M., Frías-Madrid, B., Velasco-Téllez, C., Rodriguez-Aldama, J. C., Avila-Sosa, V., … Irles, C. (2021). Prevalence, clinical features, and outcomes of SARS-CoV-2 infection in pregnant women with or without mild/moderate symptoms: Results from universal screening in a tertiary care center in Mexico City, Mexico. PLOS ONE, 16(4), e0249584. https://doi.org/10.1371/journal.pone.0249584
Coates, D., Makris, A., Catling, C., Henry, A., Scarf, V., Watts, N., Fox, D., Thirukumar, P., Wong, V., Russell, H., & Homer, C. (2020). A systematic scoping review of clinical indications for induction of labour. PLOS ONE, 15(1), e0228196. https://doi.org/10.1371/journal.pone.0228196
Dol, J., Hughes, B., Bonet, M., Dorey, R., Dorling, J., Grant, A., Langlois, E. V, Monaghan, J., Ollivier, R., Parker, R., Roos, N., Scott, H., Shin, H. D., & Curran, J. (2022). Timing of maternal mortality and severe morbidity during the postpartum period: a systematic review. Jbi Evidence Synthesis, 20(9), 2119–2194. https://doi.org/10.11124/jbies-20-00578
Escobar, M. F., Echavarria, M. P., Vasquez, H., Nasner, D., Ramos, I., Hincapié, M. A., Pabon, S., Kusanovic, J. P., Martínez-Ruíz, D. M., & Carvajal, J. A. (2022). Experience of a telehealth and education program with maternal and perinatal outcomes in a low-resource region in Colombia. BMC Pregnancy and Childbirth, 22(1), 604. https://doi.org/10.1186/s12884-022-04935-1
Falconi, A. M., Bromfield, S. G., Tang, T., Malloy, D., Blanco, D., Disciglio, R. S., & Chi, R. W. (2022). Doula care across the maternity care continuum and impact on maternal health: Evaluation of doula programs across three states using propensity score matching. EClinicalMedicine, 50, 101531. https://doi.org/10.1016/j.eclinm.2022.101531
Fishel Bartal, M., & Sibai, B. M. (2020). Eclampsia in the 21st century. American Journal of Obstetrics and Gynecology, 226(2), s1237–s1253. https://doi.org/10.1016/j.ajog.2020.09.037
Flávio-Reis, V. H. P., Pessoa-Gonçalves, Y. M., de Castro Barbosa, A., Desidério, C. S., Rodrigues, W. F., & Oliveira, C. J. F. (2024). Maternal deaths caused by eclampsia in Brazil: a descriptive study from 2000 to 2021. Revista Brasileira de Ginecologia e Obstetrícia, 46, e-rbgo65. https://doi.org/10.61622/rbgo/2024rbgo65
Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., Baird, S. M., Magee, L. A., Rana, S., Vermunt, J. V, August, P., & Arteriosclerosis, T. and V. B. C. on L. and C. H. C. on P. V. D. and S. C. on behalf of the A. H. A. C. on H. C. on the K. in C. D. (2021). Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension, 79(2), e21–e41. https://doi.org/10.1161/hyp.0000000000000208
Gemechu, K. S., Assefa, N., & Mengistie, B. (2020). Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis. Women’s Health, 16, 1745506520973105. https://doi.org/10.1177/1745506520973105
Harris, M. L., Loxton, D., Hassen, T. A., Shifti, D. M., & Chojenta, C. (2024). Worldwide Wellness of Mothers and Babies (WWOMB): program overview and lessons learned from Ethiopia. Archives of Public Health, 82(1), 190. https://doi.org/10.1186/s13690-024-01419-w
Hilowle, N. M., Ahmed, S. A., Ali, K. Y., Altinel, E., Waberi, M. M., Hassan, M. S., Köprülü, D., Ali, A. A., & Hassan, M. O. (2023). Outcomes of Women with Preeclampsia and Eclampsia Admitted in the Intensive Care Unit at a Tertiary Care Hospital in Mogadishu, Somalia. Anesthesiology Research and Practice, 2023(1), 6641434. https://doi.org/10.1155/2023/6641434
Hussein, A. I., Kurtay, S., Omar, A. A., Yusuf, A. A., & Mohamud, R. Y. H. (2023). An Analysis of the Rate, Indications, and Associated Maternal Mortality for Cesarean Sections at a Tertiary Care Hospital, First Report from Somalia. International Journal of Women’s Health, 15, 225–233. https://doi.org/10.2147/ijwh.s383122
Kassie, B., Bazezew, Y., Sharew, Y., Yismaw, L., Desta, M., & Alene, M. (2021). Time to recovery from Eclampsia and its determinants in east Gojjam zone hospitals, Amhara, Ethiopia, 2017/18. BMC Pregnancy and Childbirth, 21(1), 301. https://doi.org/10.1186/s12884-021-03769-7
Kavi, A., Kinshella, M.-L. W., Ramadurg, U. Y., Charantimath, U., Katageri, G. M., Karadiguddi, C. C., Honnungar, N. V, Bannale, S. G., Mungarwadi, G. I., Bone, J. N., Vidler, M., Magee, L., Mallapur, A., Goudar, S. S., Bellad, M., Derman, R., von Dadelszen, P., & Group, T. C. I. W. (2022). Community engagement for birth preparedness and complication readiness in the Community Level Interventions for Pre-eclampsia (CLIP) Trial in India: a mixed-method evaluation. BMJ Open, 12(12), e060593. https://doi.org/10.1136/bmjopen-2021-060593
Kea, A. Z., Lindtjorn, B., Gebretsadik, A., & Hinderaker, S. G. (2023). Variation in maternal mortality in Sidama National Regional State, southern Ethiopia: A population based cross sectional household survey. PLOS ONE, 18(3), e0272110. https://doi.org/10.1371/journal.pone.0272110
Khan, S., Siddique, A. B., Jabeen, S., Hossain, A. T., Haider, M. M., Zohora, F. T., Rahman, M., Arifeen, S. El, Rahman, A. E., & Jamil, K. (2023). Preeclampsia and eclampsia-specific maternal mortality in Bangladesh: Levels, trends, timing, and care-seeking practices. Journal of Global Health, 13, 7003. https://doi.org/10.7189/jogh.13.07003
Kumari, U., Sharma, R. K., Keshari, J. R., & Sinha, A. (2023). Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health. Cureus, 15(5), e38548. https://doi.org/10.7759/cureus.38548
Kurjak, A., Medjedovic, E., & Stanojević, M. (2022). Use and misuse of ultrasound in obstetrics with reference to developing countries. Journal of Perinatal Medicine, 51(2), 240–252. https://doi.org/10.1515/jpm-2022-0438
Luo, S., Wang, L., Li, S., Wang, H., Huang, S., Zhang, Z., Wang, R., Guan, H., & Huang, Y. (2021). Identification of Key Molecules and lncRNA-miRNA-mRNA ceRNA Network in Preeclampsia. International Journal of General Medicine, 14, 7579–7590. https://doi.org/10.2147/ijgm.s305337
Medjedovic, E., Kurjak, A., Stanojević, M., & Begic, E. (2022). Pre-eclampsia and maternal health through the prism of low-income countries. Journal of Perinatal Medicine, 51(2), 261–268. https://doi.org/10.1515/jpm-2022-0437
Olivier, S. E., de Waard, L., Muller, C. J. B., & Gebhardt, G. S. (2021). Delivery outcomes of patients with pre-eclampsia at 27 - 34 weeks’ gestation at Tygerberg Hospital, Cape Town, South Africa: A retrospective observational study. South African Medical Journal, 111(5), 437–443. https://doi.org/10.7196/samj.2021.v111i5.15201
Omar, N. M. S., Osman, M. M., Hilowle, I. A., Erismis, B., Osman, A. A., Fiidow, O. A., & Bashir, A. M. (2022). Demographic Characteristics and Risk Factors Affecting the Development of Postpartum Acute Kidney Injury in Somalia: Single-Center Experience. International Journal of Women’s Health, 14, 881–888. https://doi.org/10.2147/ijwh.s372453
Padhan, S. C., Pradhan, P., Panda, B., Pradhan, S. K., & Mishra, S. K. (2023). Risk Factors of Pre-eclampsia: A Hospital-Based Case-Control Study. Cureus, 15(7), e42543. https://doi.org/10.7759/cureus.42543
Pallangyo, A. S., & Seif, S. A. (2023). Knowledge and Attitude of Healthcare Providers on Managing Pre-Eclampsia and Eclampsia During Antenatal Care in Mwanza Region-Tanzania. SAGE Open Nursing, 9, 23779608231193744. https://doi.org/10.1177/23779608231193745
Pfeiffer, M., Gelsinger, C., Palmsten, K., Lipkind, H. S., Ackerman-Banks, C., & Ahrens, K. A. (2023). Rural-urban residence and sequelae of hypertensive disorders of pregnancy in the first year postpartum, 2007 – 2019. Pregnancy Hypertension, 32, 10–17. https://doi.org/10.1016/j.preghy.2023.02.002
Pribadi, A., Hidayat, D., Sasotya, R. M. S., Aziz, M. A., Nurdiawan, W., Pramatirta, A. Y., Siddiq, A., Mose, J. C., Hidayat, Y. M., Nugrahani, A. D., Santoso, D. P. J., & Permadi, W. (2023). Assessing the Impact of the Zero Mother Mortality Preeclampsia Program on Maternal Mortality Rates at a Single Center in Bandung, West Java (2015-2022): A Retrospective Study. Medical Science Monitor, 29, e941097-1. https://doi.org/10.12659/msm.941097
Robbins, T., Shennan, A., Sandall, J., Guangul, T. E., Demissew, R., Abdella, A., Mayston, R., & Hanlon, C. (2023). Understanding challenges as they impact on hospital-level care for pre-eclampsia in rural Ethiopia: a qualitative study. BMJ Open, 13(4), e061500. https://doi.org/10.1136/bmjopen-2022-061500
Sevene, E., Sharma, S., Munguambe, K., Sacoor, C., Vala, A., Macuacua, S., Boene, H., Ansermino, J. M., Augusto, O., Bique, C., Bone, J., Dunsmuir, D. T., Lee, T., Li, J., Macete, E., Singer, J., Wong, H., Nathan, H. L., Payne, B. A., … Group, the C. M. W. (2020). Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertension, 21, 96–105. https://doi.org/10.1016/j.preghy.2020.05.006
Sk, I. K. (2022). Socioeconomic and epidemiological milieu of maternal death due to eclampsia in West Bengal, India: A mixed methods study. Health Care Science, 2(1), 45–59. https://doi.org/10.1002/hcs2.28
Sola, I. M., Karin-Kujundzic, V., Paic, F., Lijovic, L., Glibo, M., Serman, N., Duic, T., Skrtic, A., Kuna, K., Vranic, S., & Serman, L. (2022). WNT5A, β-catenin and SUFU expression patterns, and the significance of microRNA deregulation in placentas with intrauterine growth restriction. Molecular Medicine Reports, 27(2), 28. https://doi.org/10.3892/mmr.2022.12914
Soto, A. S. M., Piña, M. D. R., Benhumea, A. M. S., & Zerón, H. M. (2023). Use of Renal Replacement Therapy in Pregnant Women with Acute Kidney Injury or Chronic Kidney Disease: A Systematic Review. Acta Medica Philippina, 58(19), 101–108. https://doi.org/10.47895/amp.vi0.7369
Souza, J. P., Day, L. T., Rezende-Gomes, A. C., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J. P., Campbell, O., Mugerwa, K. Y., Lumbiganon, P., Tunçalp, Ö., Cresswell, J., Say, L., Moran, A. C., & Oladapo, O. T. (2023). A global analysis of the determinants of maternal health and transitions in maternal mortality. The Lancet Global Health, 12(2), e306–e316. https://doi.org/10.1016/s2214-109x(23)00468-0
Stitterich, N., Shepherd, J., Koroma, M. M., & Theuring, S. (2021). Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC Pregnancy and Childbirth, 21(1), 413. https://doi.org/10.1186/s12884-021-03874-7
Susanu, C., Vasilache, I.-A., Harabor, A., Vicoveanu, P., & Călin, A.-M. (2024). Factors Associated with Maternal Morbidity in Patients with Eclampsia in Three Obstetric Intensive Care Units: A Retrospective Study. Journal of Clinical Medicine, 13(21), 6384. https://doi.org/10.3390/jcm13216384
Tavarna, T., Phillips, P. L., Wu, X., & Reyes, L. (2020). Fetal growth restriction is a host specific response to infection with an impaired spiral artery remodeling-inducing strain of Porphyromonas gingivalis. Scientific Reports, 10(1), 14606. https://doi.org/10.1038/s41598-020-71762-9
Vasconcelos, A., Bandeira, N., Sousa, S., Machado, M. C., & Pereira, F. (2022). Adolescent pregnancy in Sao Tome and Principe: are there different obstetric and perinatal outcomes? BMC Pregnancy and Childbirth, 22(1), 453. https://doi.org/10.1186/s12884-022-04779-9
Verschueren, K. J. C., Paidin, R. R., Broekhuis, A., Ramkhelawan, O. S. S., Kodan, L. R., Kanhai, H. H. H., Browne, J. L., Bloemenkamp, K. W. M., & Rijken, M. J. (2020). Why magnesium sulfate ‘coverage’ only is not enough to reduce eclampsia: Lessons learned in a middle-income country. Pregnancy Hypertension, 22, 136–143. https://doi.org/10.1016/j.preghy.2020.09.006
Wang, W., Zhang, W., Chen, L., Wu, X., Gu, J., Yang, F., Wang, B., Qin, S., & Tang, P. (2024). Identification of differentially expressed miRNAs in plasma exosomes from patients with early-onset pre-eclampsia using next generation sequencing. Heliyon, 10(3), e24543. https://doi.org/10.1016/j.heliyon.2024.e24543
Wang, X., Liu, X., Song, Z., Shen, X., Lu, S., Ling, Y., & Kuang, H. (2020). Emerging roles of APLN and APELA in the physiology and pathology of the female reproductive system. PeerJ, 8, e10245. https://doi.org/10.7717/peerj.10245
Ward, Z. J., Atun, R., King, G., Dmello, B. S., & Goldie, S. J. (2024). Global maternal mortality projections by urban/rural location and education level: a simulation-based analysis. EClinicalMedicine, 72, 102653. https://doi.org/10.1016/j.eclinm.2024.102653
Wulandari, R. D., Laksono, A. D., Rohmah, N., Matahari, R., & Antonio, C. A. (2024). Factors related to intrapartum/delivery care in Southeast Asia: A cross-sectional study in the Philippines and Indonesia. Heliyon, 10(6), e27718. https://doi.org/10.1016/j.heliyon.2024.e27718
Yadav, A., Prakash, A., Sharma, C., Saha, M. K., Yadav, S., Baghel, J., & Kamath, A. (2022). Maternal Mortality in the Remote Islands of India—Unraveling the Conundrum. Journal of Family Medicine and Primary Care, 11(2), 733–738. https://doi.org/10.4103/jfmpc.jfmpc_1365_21
Yang, D., Dai, F., Yuan, M., Zheng, Y., Liu, S., Deng, Z., Tan, W., Chen, L., Zhang, Q., Zhao, X., & Cheng, Y. (2021). Role of Transforming Growth Factor-β1 in Regulating Fetal-Maternal Immune Tolerance in Normal and Pathological Pregnancy. Frontiers in Immunology, 12, 689181. https://doi.org/10.3389/fimmu.2021.689181
Zhang, X., & Wei, H. (2021). Role of Decidual Natural Killer Cells in Human Pregnancy and Related Pregnancy Complications. Frontiers in Immunology, 12, 728291. https://doi.org/10.3389/fimmu.2021.728291
License
Copyright (c) 2025 Pratiwi Ramlan , Sunandar Said, Zulkarnain Sulaiman, Khaeriyah Adri, Mardhatillah, Devy Febrianti, Ruslang
This work is licensed under a Creative Commons Attribution 4.0 International License.
Downloads
How to Cite
