Hypertensive Disorders of Pregnancy: A Data-Driven Roadmap Informed by Global Burden and Knowledge Networks
Description
Background Hypertensive disorders of pregnancy (HDP) remain a leading threat to maternal and perinatal health. Despite sustained declines in overall burden, reductions are uneven across settings and a persistent evidence-to-practice gap limits impact. Methods Using GBD 2021, we analysed females HDP DALY rates (per 100 000) across 204 countries and territories, 1990–2021, and estimated AAPC via log-linear models. Web of Science Core Collection records informed a burst-detected knowledge network (CiteSpace) of paradigms and research fronts, integrated with burden patterns along a need–maturity–feasibility axis. Findings Globally, DALY rates fell from 131·4 to 62·8 per 100 000 (−52·2%) with an AAPC of approximately −2·3% per year (1990–2021). Low-SDI regions carried higher absolute burden and exhibited relatively slower declines; inequality narrowed over time yet remained marked in 2021. The knowledge network converged on four mature intervention lines: first-trimester integrated risk screening; ≤16-week targeted aspirin; mid/late-pregnancy triage informed by sFlt-1/PlGF ratio; and postpartum cardiovascular follow-up. Interpretation Aligning burden maps with evidence maturity and implementability yields a deployable Where–What–When–How–KPI sequence. We recommend an equity-first, closed-loop package for high-burden clusters, tracked with minimal KPIs (eg, coverage, on-time initiation, early-onset pre-eclampsia, perinatal outcomes); adoption requires external validation, context-specific adaptation, and adherence support. Funding Military Key Discipline Construction Projects of China (HL21JD1206) and China Medical Board (CMB21-428); funders had no role, and the corresponding author had full data access and final responsibility for submission. Keywords: hypertensive disorders of pregnancy; pre-eclampsia; Global Burden of Disease; CiteSpace; aspirin; placenta growth factor; sociodemographic index; implementation science; equity.