Social determinants of pre-eclampsia: a scoping review and evidence map

Background: Existing reviews of pre-eclampsia determinants have focused on clinical and genetic risk factors. Objective: To evaluate social determinants for pre-eclampsia prevention. Search strategy: Systematic searches were conducted on relevant electronic databases to 31 st July 2023. Selection criteria: Reviews and large cohort studies (≥1,000 participants), published within the last 10 years, reporting quantitative associations between social determinant exposures and pre-eclampsia outcomes. Data collection and analysis: Titles and abstracts and then relevant full-texts were reviewed by two reviewers, independently. Strength of association was evaluated as ‘definite’ (odds ratios [OR] or relative risk [RR] ≥3.00 or <0.33), ‘probable’ (OR or RR 1.50-2.99 or 0.33-0.67), ‘possible’ (OR or RR 1.10-1.49 or 0.68-0.89), or ‘unlikely’ (OR or RR 0.90 - 1.09). Quality of the evidence was high, moderate, low, or very-low, using GRADE. Main results: Twenty-six publications found 22 associations of pre-eclampsia with socioeconomic status, social support/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low-quality evidence). Probable associations included: work stress and lack of antenatal care (high-quality evidence); prolonged occupational exposure to whole body vibrations or bending, elevated temperatures beyond seasonal norms, and UV-B radiation exposure (protective factor), all based on moderate-quality evidence; and Asian/Oceanian origins (protective, low-quality evidence). There were 11 possible associations, which did not include education. Conclusion: Our findings support recommendations to address climate change, strengthen occupational protection, and promote early ANC attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre-eclampsia incidence and severity.