Global prevalence of hypertensive disorders of pregnancy: a scoping review and global perspective by country and region

Introduction: Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal morbidity and mortality worldwide and an increasing global concern. This review aimed to estimate the global prevalence of HDP by country and World Health Organization (WHO) region using nationally representative, population-based studies. Methods: We searched PubMed and Embase for articles published between January 2004 and December 2023 and included population-based, observational studies with nationally or internationally representative samples reporting primary data on HDP prevalence. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. Results: A total of 143 studies from 31 countries across six WHO regions met the inclusion criteria. The African Region reported the highest prevalence of chronic hypertension (4.80%), gestational hypertension (17.50%), and composite HDP (22.20%), although nationally representative prevalence estimates for preeclampsia and eclampsia were not available for this region. In contrast, the Eastern Mediterranean Region reported the lowest rates of chronic hypertension (1.10%), gestational hypertension (1.70%), preeclampsia (1.45%), and HDP (5.10%). The European Region had intermediate rates of chronic hypertension (1.70%), gestational hypertension (2.90%), preeclampsia (2.50%), eclampsia (0.02%) and HDP (5.90%). The Americas Region and the Western Pacific Region had varying rates across the HDP spectrum: chronic hypertension (2.35%, 3.15%), gestational hypertension (5.10%, 1.98%), preeclampsia (5.35%, 2.45%), eclampsia (0.08%, 0.06%), and HDP (8.04%, 5.60%, respectively). High-income countries had more studies of higher methodological quality than low- and middle-income countries. Discussion: We observed considerable variability in HDP prevalence and study quality across countries and regions. This may stem from variations in screening methods, diagnostic criteria, and data availability, highlighting critical gaps in standardized protocols particularly in resource-limited settings.