PRE-EMPT (PRE-eclampsia-Eclampsia Monitoring, Prevention and Treatment): A low and middle income country initiative to reduce the global burden of maternal, fetal and infant death and disease related to pre-eclampsia

Pre-eclampsia is associated with an unacceptable burden of death (maternal, fetal and neonatal), disability and health crises throughout the world [1]. However, it is in low and middle income countries (LMICs) that women, their families and their communities bear a disproportionate risk for developing the life-ending, life-threatening, and life-altering complications of pre-eclampsia; it is believed that over 99% of the estimated 70–80,000 annual maternal and 500,000 annual perinatal pre-eclampsia-related deaths occur in LMICs [1]. Many of these complications arise in women who never reach the formal health care system, or who arrive too late to be saved. This disparity in outcomes between women in high income countries and those in LMICs represents a social equity issue [2]. Why are the actuarial risks faced by women with preeclampsia in high income countries dramatically lower when compared with women in LMICs? Along with others, we believe that the answer lies, in large part, in (i) the provision of effective routine antenatal care in high income countries, with accelerated visits near and at term (leading to pre-eclampsia detection), (ii) increased awareness of, and responsiveness to, symptoms by women in high income countries (leading to self-referral for assessment), (iii) diagnostic and surveillance capacity in high income countries, (iv) the control of severe pregnancy hypertension (because blood pressure is measured and severe hypertension is diagnosed), (v) the prevention and treatment of eclampsia with MgSO4 (which is available in all institutions), (vi) timely delivery (given excellent neonatal supportive care), and (vii) maternal organ support (including intensive care and blood transfusion, if necessary) during the recovery phase. The possibility of biological risk factors in LMICs such as dietary deficiencies remains to be proven. Can key elements of this high income country care be introduced into LMICs in a cost-effective manner and while