A comprehensive review on hypertensive disorders of pregnancy: risk stratification, predictors and preventive strategies

Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia, are important causes of maternal and perinatal morbidity and mortality. Because effective prevention must begin before clinical disease is established, antenatal care should include early risk assessment and timely initiation of evidence-based prophylaxis. Pre-eclampsia is a heterogeneous, multisystem disorder in which abnormal placentation and placental stress contribute to an imbalance between pro-angiogenic and anti-angiogenic factors, systemic endothelial dysfunction, and end-organ injury. This review summarises the pathophysiology of pre-eclampsia; examines clinical risk assessment, the HDP-Gestosis Score, mean arterial pressure (MAP), uterine artery Doppler and angiogenic biomarkers; and compares key recommendations from the World Health Organization (WHO) and the NICE/RCOG clinical framework. Low-dose aspirin is recommended for pregnant women at increased risk, with dose and timing determined by the applicable guideline and local protocol. Calcium supplementation is recommended by WHO in populations with low dietary calcium intake. Combined clinical and first-trimester multimarker screening can improve identification of pregnancies at risk of preterm pre-eclampsia, but no screening test replaces ongoing blood-pressure assessment and clinical surveillance. Implementation should prioritise validated tools, clear referral pathways, equitable access to antenatal care and accurate counselling.