Breakthroughs Blog

Preeclampsia affects millions of pregnancies around the world, claiming the lives of 42,000 women each year and contributing significantly to fetal and newborn mortality and complications. Early detection and management are crucial to prevent progression to eclampsia, which is characterized by seizures and can be life-threatening.  The burden of preeclampsia is greatest in low- and middle-income countries (LMICs), where workforce shortages, limited laboratory capacity, and procurement challenges undermine the implementation of recommended tools and protocols.  Despite its global impact, preeclampsia remains under-researched and under-represented in the health innovation pipeline compared to conditions with similar prevalence that are not specific to women. These challenges have created critical gaps in screening, diagnosis, and treatment, but new tools in the pipeline could help transform care, particularly in low-resource settings worldwide. Rethinking preeclampsia screening and diagnosis Preeclampsia screening aims to identify high-risk pregnant women before symptoms appear and before they can be formally diagnosed, enabling closer monitoring and preventive care. Screening has traditionally relied on a checklist to evaluate patient history and risk factors. While simple, this approach has shown limited effectiveness and depends heavily on the accuracy of assessment.Newer recommended approaches that combine risk-factor screening with biomarker testing offer improved predictive performance. However, they require medical and laboratory imaging infrastructure that is not widely available in LMICs, limiting their uptake.  Preventive therapies, including low-dose aspirin, calcium supplements, and antihypertensive medications, are recommended for women identified as high risk, but they are not consistently offered to women in LMICs. As a result, many women are diagnosed later in pregnancy, when risks are greater.  The Accelerating Innovation for Mothers project identified 89 preeclampsia risk screening tools in the R&D pipeline but concluded current approaches are unlikely to adequately address the needs of women in LMICs, underscoring the need for greater investment in tools explicitly designed to address their realities.  Artificial intelligence (AI) is emerging as a promising tool to bridge screening and diagnosis gaps. With support from the Gates Foundation, Siemens Healthineers is developing an AI-driven tool that leverages data from blood tests already routinely performed as part of prenatal care to screen for both preeclampsia and anemia. By using existing samples and integrating screening for multiple conditions, this tool could enable more efficient and scalable screening in resource-limited settings. Confirmatory preeclampsia diagnosis relies on detecting elevated blood pressure and the presence of protein in urine, alongside the potential presence of severe symptoms. This requires trained health care workers and access to laboratory equipment, which can hinder accurate, timely diagnosis in resource-challenged environments. Monod Bio, with Gates Foundation support, is developing a rapid, point-of-care diagnostic test that can deliver results in less than 15 minutes. Using an AI-derived algorithm to analyze results, this tool could significantly reduce workforce and equipment needs. Together, these innovations reflect a promising shift toward designing tools specifically to address the needs of low-resource environments, rather than adapting tools used in high-income contexts, a shift essential to closing global gaps in care. Expanding the treatment pipeline There is currently no specific cure for preeclampsia other than early delivery, which can be dangerous for both mother and baby, especially in low-resource settings. Existing treatments focus on managing symptoms, including preventing seizures with magnesium sulfate and controlling blood pressure with antihypertensive medications. A new generation of therapies aims to go further by addressing underlying disease causal pathways, rather than managing symptoms alone.  A research team at the University of Nebraska Medical Center, supported by a Gates Foundation grant, is advancing an innovative treatment based on a naturally occurring compound that reduces the levels of a protein that plays a key role in the development of preeclampsia. In preclinical studies, the compound has improved vascular function, reduced inflammation, and lowered blood pressure. Importantly, it is also stable at room temperature and inexpensive to produce, making it well-suited for settings with limited resources. Another Gates-supported team at the Medical College of Wisconsin has launched a clinical trial evaluating a promising supplement for preeclampsia. The compound, which occurs naturally in foods, has been shown to improve vascular functions in animal models and early human studies. It is also shelf-stable and inexpensive. These novel therapeutics could help transform preeclampsia care by slowing or halting the progression of the condition, rather than simply responding to the presence of symptoms. Their affordability and suitability for austere settings could also help expand access for women who currently lack effective treatment options. Looking ahead Preeclampsia mortality rates remain far too high, reflecting long-standing gaps in research advancing women’s health and a lack of tools suited to low-resource settings. Innovations that leverage emerging technologies like AI and respond to the needs of pregnant women everywhere could help save more mothers and babies worldwide. Solutions designed for LMIC health systems could also strengthen care in underserved or overstretched settings in high-income countries like the United States, where rising health care costs, workforce shortages, and even conflict-related supply chain disruptions are straining health care service delivery.  Turning this potential into impact will require sustained investment to ensure innovations are not only developed but designed for and delivered to the women who need them most.