TOPLINE:

Despite the low incidence of eclampsia in high-income European countries, critical gaps in prevention and management remained; fewer than half of women were diagnosed with preeclampsia before the onset of seizures, approximately one third had seizures postpartum, and some did not receive magnesium sulphate treatment.

METHODOLOGY:

• Researchers conducted an individual participant data meta-analysis to assess the incidence of eclampsia, characterise maternal and perinatal profiles, investigate seizure and clinical features, and document outcomes.
• The analysis included 2,611,553 women who delivered liveborn or stillborn infants beyond 22 weeks of gestation using population-based cohort data from six high-income countries in Europe and one upper-middle-income country between 2012 and 2019.
• Eclampsia was defined as seizures during pregnancy or postpartum not attributable to other causes, with cases prospectively identified through enhanced obstetric surveillance systems in most countries using standardised case report forms and verified using national hospital discharge databases.

TAKEAWAY:

• The pooled incidence of eclampsia was 2.2 per 10,000 deliveries across the six high-income countries vs 36.6 per 10,000 deliveries in the upper-middle-income country.
• Preeclampsia was diagnosed in about 42% of women prior to the onset of seizures. Approximately two thirds of seizures occurred antepartum or intrapartum, and one third of seizures occurred postpartum; hypertension with seizures was the most reported clinical sign in 91.1% of cases.
• Magnesium sulphate treatment was administered in 91.1% of women, and antihypertensive medications were used in 89.8%; however, substantial variation in practice was observed between countries.
• Caesarean delivery was performed in about 73% of cases, with urgent/emergency caesarean deliveries varied by country and seizure timing; 52.6% of women delivered preterm, which was mostly linked to antepartum cases. Maternal and neonatal deaths were rare overall and occurred more frequently in the upper-middle-income country than in high-income European countries.

IN PRACTICE:

"[The study] findings emphasise the need for renewed global attention to eclampsia. Declining incidence in HICs [high-income countries] may reduce clinical awareness, while eclampsia remains a major challenge in MICs [middle-income countries]," the authors wrote.

"International consensus on best practices, strengthened surveillance systems and sustained multinational collaborations/networks such as INOSS [International Network of Obstetric Survey Systems], supported by governmental investment, are crucial to improving prevention, management and outcomes worldwide," they added.

SOURCE:

This study was led by Silvia Salvi and Donatella Mandolini, Istituto Superiore di Sanità — Italian National Institute of Health, Rome, Italy. It was published online on March 26, 2026, in BJOG: An International Journal of Obstetrics & Gynaecology.

LIMITATIONS:

Definitions of national cases varied across participating countries. A significant heterogeneity was observed for some outcomes across participating countries, and missing data for several outcomes exceeded 25% in some high-income countries. Data-sharing regulations across different countries restricted access to individual-level data.

DISCLOSURES:

This study did not receive any funding from any sources. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.