The broad objectives for The PRECISE Network cover all strategic areas of the programme; research capacity building, global maternal and child health research, partnership building and advocacy.

  1. Build individual and institutional research capacity across Africa and the UK through a shared pregnancy research programme of work.

  2. Develop a unique cohort of biologically and contextually characterised pregnant and non-pregnant women of reproductive age in East (Kenya), West (The Gambia) and Southern (Mozambique) sub Saharan Africa to support research into placental disorders (hypertension, fetal growth restriction and stillbirth) in the region.

  3. Build sustainable, equitable partnerships across the individuals and institutions in The PRECISE Network, ensuring leadership and autonomy in research strategy and delivery across the collaborators.

  4. Embed PRECISE in the global maternal and child health landscape across the areas of research, health service providers, NGO’s, industry and national and international policy to maximise the contribution of PRECISE to the attainment of SDG 3 through broad advocacy and engagement.

The research outcomes planned within objective 2 (as above) are detailed as follows:

2.a.     To develop a unique cohort of pregnancies affected by placental disease and assess the prevalence of these disorders in women attending antenatal care in centres representative of urban and rural communities in three sub-Saharan African countries.

2.b.     To develop cohorts of women with unselected pregnancies, and non-pregnant women of reproductive age, for comparison.  These cohorts will provide appropriate data with which to compare the context of women and their biology as they have pregnancies complicated by placental disorders, or not.  Sufficient culturally- and geographically- relevant data do not exist to identify pathways to pregnancy resilience or vulnerability, considering women’s burden of infectious, mental, and/or non-communicable disease.  Existing control data have been almost uniformly from more-developed countries in Europe, North America and Australasia.

2.c.     To investigate environmental, biological, epidemiological, clinical, social/cultural and health system factors affecting the ability to understand, prevent and manage the effects of placental diseases for African women and their families.

2.d.    To investigate the potential for introduction of novel methods to assist the prevention, diagnosis and management of placental disorders in sub-Saharan Africa.  Such methods could be new diagnostics based on the agnostic proteomic screening of samples from women with or without pregnancy complications.  New pathways to disease may be identified that could be circumvented with novel therapeutics.  In addition, the role of culturally- and geographically-relevant interventions (e.g., faith-based discussions, or roads and bridges) may be emphasised as critical health interventions.

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 1.  Over 99% of these deaths occur in low- and middle-income countries (LMICs) and over half in sub-Saharan Africa 1.  Major morbidities complicate about 20-fold more pregnancies and infancies than lives lost, resulting in 50 million lives that are threatened and altered by these disorders.  This disparity in outcomes between LMICs and high-income countries (HICs) represents a human rights issue and provides the opportunity to intervene to enhance development through improved survival and ‘thrival’ of each community’s greatest resource, their people.

In more-developed countries like the UK, we know that these three pregnancy complications are caused by problems with the afterbirth (placenta), and we know quite a lot about how they develop and complicate pregnancies 2.  In contrast, in sub-Saharan Africa, we know very little about how and why these placental conditions occur.  This is especially complex as women in Africa often have many other challenges: limited diets that change with the seasons, chronic infections such as HIV or malaria, acute infections like Ebola, limited autonomy of decision-making, and life in communities that are prone to either flooding or drought and are remote from health facilities.

Therefore, the pathways to pregnancy complications are probably very different for these women in sub-Saharan Africa, compared with women living in the UK.  Yet, these women and their babies bear most of the burden of death and illness related to pregnancy complications.  PRECISE is designed to address this area of neglected global health research.

The widely-cited failure within the Millennium Development Goals to adequately reduce infant deaths and reverse maternal health inequalities, prompted incorporation of new goals in the 2016 UN Sustainable Development Goal 3 to ‘ensure healthy lives and promote well-being for all at all ages’:

  • By 2030, reduce the global mortality ratio to less than 70 per 100,000 live births

  • By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

This is underpinned by WHO Global Strategy for Women’s, Children’s and Adolescents’ Health. In the maternal-fetal-newborn research field, PRECISE has been funded to develop a network of sub-Saharan-, North American-, European, and UK-based scientists that will capacity-build through the investigation of pathways to disease that result in the placental complications of pregnancy.  Designed to strengthen research capacity in Africa through a shared research project, PRECISE will learn about women in a 360ᵒ manner (Figure 2), including their socio-geographical, environmental and physical and mental health contexts, and will create a biorepository that complements replete clinical and epidemiological data.

Biological samples and associated phenotypic information will be collected from a prospective cohort of up to 10,000 pregnant women across three countries in Africa: The Gambia, Mozambique, and Kenya.  In addition, we anticipate 20% of these pregnant women will present at clinic or hospital with pregnancy complications.  Samples will be collected at booking and at subsequent visits, including delivery and post-delivery.  An additional 1,800 non-pregnant women of reproductive age will also be enrolled as control subjects and samples collected at one timepoint.

The samples will be used to test for biomarkers as predictors of important maternal and fetal outcomes and will include genomic, proteomic, nutritional, hormonal and inflammatory markers.  All samples remaining after planned analyses for the initial project are done will be used to establish a biorepository (PRECISE biorepository) to facilitate and accelerate future discoveries on maternal, fetal and neonatal health. The biorepository will be managed, governed and owned by each country.