The number of women and babies dying from pre-eclampsia in low- and middle-income countries (LMICs) compared to the UK is one of the starkest and most avoidable health injustices in the world.

Globally, pre-eclampsia claims the lives of around 30,000 women and 500,000 babies every year, with 70% of maternal deaths occurring in sub-Saharan Africa and 16% in South Asia. A woman in Sierra Leone is over 2,000 times more likely to die from pre-eclampsia than a woman in the UK. Despite its inclusion in the Sustainable Development Goals as a priority for action, progress in reducing these deaths has been far too slow.

Understanding Pre-eclampsia

Pre-eclampsia is a serious pregnancy complication characterized by high blood pressure (hypertension) and signs of organ dysfunction in the mother, such as:

• Protein in the urine (proteinuria)
• Problems with the liver, kidneys, or blood clotting
• Seizures (eclampsia)
• Poor growth or stillbirth of the baby

The disease affects 3–5% of pregnancies worldwide, with suspected pre-eclampsia in up to 10% of women. In the UK, maternal deaths from pre-eclampsia are now extremely rare (fewer than one per million pregnancies), but in LMICs, it remains one of the leading causes of maternal and newborn mortality.

Why is Pre-eclampsia So Dangerous?

Pre-eclampsia is difficult to diagnose and predict, especially in resource-limited settings where access to the following is often limited:

• Blood pressure monitors
• Blood and urine tests
• Ultrasound scans

The only definitive treatment for pre-eclampsia is to deliver the baby, as this stops the progression of the disease in the mother. However, early delivery carries serious risks for newborns, especially in settings without advanced neonatal care. Premature babies may face breathing difficulties, infections, and long-term health challenges.

This is why it’s critical that only women who urgently need early delivery receive it. Timely and accurate diagnosis helps to strike this delicate balance of saving mothers’ lives without exposing babies unnecessarily to the risks of prematurity.

PAPAGAIO’s call for action

The PAPAGAIO Project is advancing research and innovative solutions to address this injustice. By strengthening early detection and care pathways in Sierra Leone, Zambia, India, and Brazil, our goal is to save lives and ensure that both mothers and babies receive the right interventions at the right time.

How? Placental Growth Factor (PlGF) Testing

A breakthrough innovation ‘Placental Growth Factor (PlGF)’ testing is transforming how clinicians identify women at risk of pre-eclampsia.

Abnormally low PlGF levels and elevated sFlt-1 can be detected up to 10 weeks before the clinical onset of pre-eclampsia. These biomarkers are more closely linked to the underlying causes of the condition than traditional measures like blood pressure or proteinuria.

Why PlGF Matters

• High diagnostic performance: Outperforms current standard tests.
• Reassures low-risk women: Normal PlGF levels can rule out pre-eclampsia requiring delivery within 14 days with a 98% negative predictive value.
• Focuses resources: Enables intensive monitoring of high-risk women.

PlGF in Low-Resource Settings

In high resource settings like the UK, PlGF testing has already demonstrated: faster diagnosis (1.9 vs. 4.1 days), reduced severe maternal complications (3.8% vs. 5.4%) and more accurate decision-making. PlGF testing is now recommended by NICE for suspected pre-eclampsia in the UK.

Point-of-care capillary blood PlGF testing is now available, offering immediate results without costly lab infrastructure. This innovation is especially promising for remote and resource-limited areas, where access to diagnostics is limited. Recent studies in Mozambique and pilot work in Sierra Leone confirm the strong link between very low PlGF levels and adverse outcomes like stillbirth and maternal complications.