GCRF: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network: a sub-Saharan network for placental disorders

The PRECISE Network is a new and broadly-based group of research scientists and health advocates mainly based in the UK and Africa, but also including the World Health Organization. We will establish this network through a shared project that will investigate three important complications of pregnancy, namely high blood pressure (hypertension), babies who are smaller than they should be before birth (fetal growth restriction) and babies who die before birth (stillbirth). We think that about 46,000 women and two-and-a-half million babies (both before and after birth) die due to these problems every year, and half of them die in Africa. In addition, about 50 million women and babies will have their short and long term health altered because of these complications. These numbers represent one of the great global inequalities of our time. In 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. 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 power to make decisions for themselves, life in communities that are prone to either flooding or drought and are remote from health facilities. Therefore, the way that pregnancy complications arise 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. We need to address this area of neglected global health research. In PRECISE, we will train and mentor junior investigators in how to do pregnancy research, and we will establish new databases related to pregnant and some non-pregnant women, the context of their lives, their pregnancy complications and what happens at the end of their pregnancies. We will save samples of blood, urine and placental tissue, and test them to increase our knowledge about how women's bodies cope with both normal and complicated pregnancies. All the samples and the data will remain in Africa for use primarily by Africans in collaboration with UK-based and other scientists. To have a sample of pregnancies that are typical of women in sub-Saharan Africa, we will invite about 12,000 women in The Gambia and Senegal (West Africa), Kenya (East Africa) and Mozambique (Southern Africa) to share their stories, the data related to their pregnancy and babies, and their blood, urine and placental samples with their regional team and the wider global research community, especially the PRECISE scientists. This large number of women will allow us to gain new and important insights into how and why women in sub-Saharan Africa develop these pregnancy complications, and how and why may of them and their babies die from these complications. Through these activities, we hope to improve the health and well-being of women and their families in Africa, to build resilience to environmental events such as flooding or infectious disease outbreaks, to advise about where infrastructure such as roads will improve pregnancy outcomes, and to reduce the inequality of maternal and child deaths that is visited on families in sub-Saharan Africa.