Prevention of Preeclampsia: Modern Strategies and the Role of Early Screening

A BSTRACT Preeclampsia (PE) is a multisystem hypertensive disorder of pregnancy that remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Despite advances in obstetric care, PE continues to contribute substantially to preterm birth, fetal growth restriction, and long-term cardiovascular risk in affected women. Increasing evidence indicates that PE originates from abnormal placentation in early pregnancy, followed by placental ischemia, angiogenic imbalance, and widespread maternal endothelial dysfunction. These insights have driven the development of preventive strategies focused on early risk identification and timely intervention. Traditional screening based on maternal history and clinical risk factors alone has limited predictive performance. Consequently, modern approaches integrate maternal characteristics with biophysical and biochemical markers, including mean arterial pressure, uterine artery Doppler indices, and angiogenic biomarkers such as placental growth factor and soluble fms-like tyrosine kinase-1, to improve first-trimester risk stratification. Robust clinical evidence supports the use of low-dose aspirin initiated before 16 weeks’ gestation in women at increased risk, significantly reducing the incidence of preterm preeclampsia. Calcium supplementation has also demonstrated preventive benefits, particularly in populations with low dietary calcium intake. In addition to pharmacological measures, lifestyle interventions – such as weight optimization, appropriate gestational weight gain, and regular physical activity – play supportive roles in risk reduction. Current international guidelines consistently emphasize early screening combined with targeted prophylaxis as the cornerstone of PE prevention. Continued research into novel biomarkers, predictive algorithms, and personalized prevention strategies is expected to further refine risk assessment and enhance maternal–fetal outcomes.