PREgnancy Care Integrating translational Science, Everywhere (PRECISE): a prospective cohort study of African pregnant and non-pregnant women to investigate placental disorders - cohort profile

Abstract

Purpose: The PREgnancy Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study visits were conducted in the third trimester, delivery and 6 weeks to 6 months postpartum. To elucidate the difference between pregnancy and non-pregnancy biology in these settings, non-pregnant nulliparous and parous women, aged 16-49 years, were recruited opportunistically primarily from family planning clinics in Kenya and Mozambique, and randomly through the Health and Demographic Surveillance System in The Gambia. Non-pregnant participants only had one study visit. Biological samples were processed rapidly and locally, stored initially in liquid nitrogen and then at -80°C, and details entered into an OpenSpecimen database linked to their social determinants and clinical research data.

Findings to date: A total of 6932 pregnant and 1825 non-pregnant women were recruited to the study, providing a repository of clinical and social data and a biorepository of 482 448 samples. To date, baseline descriptive analysis of the cohort has been undertaken, as well as a substudy on the prevalence of COVID-19 in the cohort.

Future plans: Analysis of data and samples will include an analysis of biomarker and social and physical determinants of health and how these interact in a systemic approach to understanding the origins of common placental disorders. The data from non-pregnant women will provide control data for comparison with the data from normal and complicated pregnancies. Findings will be disseminated to local stakeholders and communities through meetings and ongoing community engagement and globally by publication and presentations at scientific meetings.

Keywords: PUBLIC HEALTH; Pregnant Women; REPRODUCTIVE MEDICINE.

Figure 1. Flow diagram of participants in the PRECISE cohort. Some of the postpartum follow-up visits in Kenya and The Gambia were conducted as part of the PRECISE-DYAD study. All the data collected in the PRECISE postpartum visit were collected at the DYAD visit. ANC, antenatal care; mo, months; NND, neonatal death; PRECISE, PREgnancy Care Integrating translational Science, Everywhere; TOD, time of disease; UNS, unselected pregnancy; wk, weeks; WRA, women of reproductive age. *Eighteen pregnancy outcome could not be classified.