Annually, pregnancy hypertension, fetal growth restriction (FGR), and stillbirth unrelated to intrapartum events are associated with 46,000 maternal and 2.5 million fetal, neonatal and infant deaths. Over 99% of these deaths occur in low and middle-income countries (LMICs), and over half in sub-Saharan Africa.
The PRECISE consortium was established in 2018 to address this area of neglected global health research, with an overall aim to develop a unique cohort of biologically and contextually characterized pregnant and non-pregnant women of reproductive age, to support research into placental disorders (namely hypertension, fetal growth restriction and stillbirth) in sub-Saharan Africa.
The primary objective of the observation study is to develop a unique cohort of pregnant women, to describe the extent of placental disorders in women attending antenatal care in centres representative of urban and rural African communities. Other poor delivery outcomes will also be described as part of the study. Additional objectives include to investigate socio-cultural and health system barriers preventing access, effective management and care pathways; and to investigate the potential for the introduction of novel methods to assist with the diagnosis and management of placental disorders in sub-Saharan Africa. A prospective cohort of up to 10,000 pregnant women from across three countries representative of sub-Saharan Africa: The Gambia (West Africa), Mozambique (Southern Africa), and Kenya (Eastern Africa), will be set up.
The MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM) is one of the three recruiting sites of the PRECISE consortium. In The Gambia, 2,000 pregnant women (1,000 in rural Farafenni and 1,000 in Farafenni town) will be recruited during their antenatal care (ANC) visits, and followed-up until 6 weeks post-delivery to determine the prevalence of placental disorders and associated risk factors.
Clinical, epidemiological and demographical information are collected during antenatal visits, labour, and post-labour. Different biological samples are also collected at these time points to create a bio-repository. The Gambian bio-repository is managed, governed and owned by the MRCG at the LSHTM. An additional 600 non-pregnant women of reproductive age will be enrolled in the study and samples will be collected at one time-point.