Asian Journal of Medicine and Health

Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal and perinatal morbidity and mortality in low- and middle-income countries (LMICs). While clinical risk factors are well-described, non-biological determinants including environmental, psychosocial, and health-system factors play a critical but underexplored role. This systematic review synthesizes evidence on these determinants, with particular focus on Kano State Northern Nigeria and sub-Saharan Africa. A systematic review was conducted following PRISMA 2020 guidelines. Key electronic databases were searched, including PubMed, Scopus, and Web of Science, along with grey literature sources such as WHO, ACOG, and the Nigerian Federal Ministry of Health, for studies published between 2000 and 2025. Observational and mixed-methods studies reporting on hypertensive disorders of pregnancy (HDP) and non-biological determinants in low- and middle-income countries (LMICs) were included. Data on study characteristics, HDP prevalence, maternal and neonatal outcomes, and environmental, psychosocial, and health-system exposures were extracted. Study quality was assessed using standardized checklists appropriate for observational studies, and findings were synthesized narratively and, where feasible, quantitatively. Forty-eight studies involving over 138 women met the inclusion criteria. In Nigeria, HDP prevalence ranged from 6% to 17%, with preeclampsia at 4–8% and eclampsia at 1–2%. Key non-biological determinants included psychosocial stressors (chronic stress, domestic violence, low social support), socioeconomic disadvantage (low education, poverty), environmental exposures (ambient heat, household air pollution), and health-system constraints (limited antenatal care, delayed booking, inadequate monitoring, insufficient referral systems). These factors were linked to delayed diagnosis, severe maternal complications (eclampsia, HELLP syndrome, renal impairment). This study highlights a critical and underexplored dimension of hypertensive disorders of pregnancy (HDP) by examining non-biological determinants in low- and middle-income countries (LMICs). By synthesizing evidence on psychosocial, environmental, and health-system factors, it broadens the understanding of HDP beyond traditional clinical risk factors. The focus on Kano State Northern Nigeria and sub-Saharan Africa provides context-specific insights for regions with high maternal morbidity and mortality. These findings are valuable for researchers, clinicians, and policymakers, informing the design of targeted interventions, the strengthening of antenatal care services, and the implementation of community-based strategies. Ultimately, this work contributes to improving maternal and neonatal health outcomes and advancing Sustainable Development Goal 3 by 2030.