Abstract
Abstract
Objectives
This study assessed the knowledge, attitude and practice (KAP) of pregnant women in Chongqing, China, regarding pre-eclampsia and examined their inter-relationships.
Design
A cross-sectional survey was conducted using validated questionnaires.
Setting
The study was conducted between May 2023 and August 2023 in Chongqing, China.
Participants
A total of 427 pregnant women were included, with 68.15% aged ≤30 years and a mean pregnancy duration of 238.18±45.01 days.
Interventions
This was an observational study, and interventions were applied.
Primary and secondary outcome measures
The primary outcomes were the KAP scores (knowledge: 0–40; attitude: 12–60 and practice: 10–50). The correlations and structural equation modelling (SEM) analyses were conducted to explore the relationships among KAP.
Results
Mean scores were 22.19±12.17 (knowledge), 46.38±6.14 (attitude) and 41.96±5.96 (practice). Knowledge positively correlated with attitude (r=0.586, p<0.001) and practice (r=0.387, p<0.001). Attitude correlated with practice (r=0.593, p<0.001). SEM showed knowledge directly influenced attitude (β=0.716, p<0.001), while attitude directly affected practice (β=0.444, p<0.001). Knowledge indirectly impacted practice via attitude (β=0.151, p=0.001).
Conclusions
Pregnant women exhibited inadequate knowledge and a suboptimal attitude but a proactive practice. Targeted interventions to improve knowledge and attitudes are recommended for better clinical outcomes, particularly in regions where few such studies have been conducted.
Keywords: Pregnant Women, Knowledge, Attitude
STRENGTHS AND LIMITATIONS OF THIS STUDY
Large sample size: the study included 427 pregnant women, enhancing the generalisability of the findings.
Comprehensive analysis: structural equation modelling was used to explore direct and indirect relationships among knowledge, attitude and practice (KAP), providing deeper insights.
Cross-sectional design: the study only assessed KAP at a single time point, limiting causal inferences about how knowledge and attitudes influence practice over time.
Self-reporting bias: data relied on participant-reported questionnaires, which may introduce inaccuracies due to recall or social desirability bias.
Introduction
Pre-eclampsia, a specific form of pregnancy-induced hypertension, affects 3–5% of pregnancies in first-time mothers globally.1 Pregnancy-induced hypertension encompasses a broader category of hypertensive disorders during pregnancy, including gestational hypertension, chronic hypertension and chronic hypertension complicated by pre-eclampsia.2
The reported prevalence of pregnancy-induced hypertension varies globally. It affects approximately 6–10% of pregnancies and is a common complication in late pregnancy, posing a significant risk for maternal mortality.3,5 Specifically, the prevalence of pre-eclampsia has been reported as 5.6–9.4% in China, 10–14% in Mexico and 4–12% in Ethiopia, reflecting regional differences in geography, climate, diet and healthcare quality.12 6,8
Pre-eclampsia presents a serious threat to maternal health, contributing to substantial complications for both mothers and newborns. It is associated with increased risks of fetal prematurity and long-term cardiovascular problems in mothers.8 9 Given its global prevalence and adverse outcomes, pre-eclampsia represents an urgent public health concern.
The knowledge, attitude and practice (KAP) survey is widely used to assess a group’s understanding, beliefs and behaviours, particularly in the area of health literacy.2 7 10 In the context of pregnancy-induced hypertension and pre-eclampsia, delayed recognition often leads to late diagnosis and severe complications for pregnant women. Insufficient dissemination of medical information further contributes to pregnant women’s inadequate understanding of the risks, management options and preventive measures. This lack of awareness results in suboptimal adherence to medical guidelines, hampering early prevention and timely detection, thereby diminishing the effectiveness of prompt diagnosis and intervention.
Given that not all pregnant women with pre-eclampsia exhibit established risk factors, and a significant proportion of pre-eclampsia cases arise in apparently ‘healthy’ pregnant women without overt risk factors,1 6 11 12 it is imperative to explore the KAP towards pre-eclampsia in pregnant women. Implementing KAP surveys on pre-eclampsia among pregnant individuals can serve as a foundation for targeted health education efforts. This, in turn, can improve public health, strengthen pregnant women’s adherence to medical interventions for pre-eclampsia and facilitate early diagnosis, timely intervention and effective treatment of pregnancy-induced hypertension, thereby mitigating adverse pregnancy outcomes. Furthermore, early detection and intervention can help reduce iatrogenic prematurity associated with pre-eclampsia, thus alleviating the familial and socio-economic burden linked with premature births.
While there have been some KAP surveys regarding pre-eclampsia among healthcare professionals and pregnant women,13,15 few have focused on pregnant women in the Chinese context. Therefore, this study aimed to comprehensively assess the KAP of pregnant women in Chongqing, China, regarding pre-eclampsia and provide evidence to support future health education strategies.
Methods
Patient and public involvement
Pregnant women participated in this study as survey respondents, but they were not involved in the design, conduct, reporting or dissemination plans of our research.
Study design and participants
The cross-sectional survey was conducted between May and August 2023 at the Banan Hospital of Chongqing Medical University among pregnant women. The inclusion criteria for this study encompassed individuals (1) with a singleton pregnancy, (2) without intellectual disabilities, as assessed by the researchers during the recruitment process and (3) having no history of pregnancy-induced hypertension or chronic hypertension. Conversely, individuals residing outside the southwestern region and those unwilling to participate in the questionnaire survey were excluded from the study.
Questionnaire introduction
The self-designed questionnaire was initially developed by drawing on existing literature16 17 and subsequently refined based on feedback received from three senior experts in obstetrics and gynaecology, with working experience of over 20 years, and a pilot study was conducted among 32 participants, resulting in a Cronbach’s α of 0.934, which indicated good internal consistency.
The final questionnaire was developed in Chinese and consisted of four distinct dimensions: demographic characteristics, knowledge, attitudes and practice (online supplemental material 1). The knowledge dimension comprised 11 questions, encompassing a total of 21 items. Questions 1–10 were scored with two points for correct answers and 0 points for incorrect or unclear responses, resulting in a score range of 0–40 points. Question 11 was used to assess the data collection quality. The attitudes dimension consisted of 6 questions with a total of 12 items, employing a 5-point Likert scale, ranging from ‘strongly agree’ (5 points) to ‘strongly disagree’ (1 point), yielding a score range of 12–60. The practice dimension featured 8 questions with 10 items, also employing a 5-point Likert scale, from ‘always/very willing’ (5 points) to ‘never/very unwilling’ (1 point), and had a score range of 10–50. Participants achieving scores exceeding 80% of the total were categorised as possessing adequate knowledge, positive attitudes and proactive practices.18
Trained research assistants employed a convenience sampling method to collect questionnaires from pregnant women registered at our outpatient clinic who met the predetermined inclusion and exclusion criteria. The pregnant women were classified into first trimester (<14 weeks), second trimester (14–27+6 weeks) and third trimester (≥ 28 weeks) according to their gestational weeks. To ensure participation, respondents were required to have the capacity for autonomous decision-making, which was assessed subjectively by the researchers during recruitment without the use of standardised tools. They accessed the questionnaire by scanning the QR code on Wenjuanxing, a survey platform integrated with WeChat, and voluntarily decided whether to participate after reviewing the instructions on the questionnaire’s home page. Declining to participate would end the survey process for that individual, and no data will be collected. Trained research assistants were responsible for supervising the process and providing unbiased clarification and support to individuals who encountered difficulties in comprehending the questionnaire’s content.
The sample size was estimated using Cochran’s formula, assuming a 95% confidence level, a 5% margin of error and a 50% response proportion. The minimum required sample was 384.
Statistical analysis
Statistical analysis was conducted using SPSS V.26.0 (IBM, Armonk, New York, USA). Continuous variables were described using mean± standard deviation (SD) and compared using t-tests or analysis of variance. Categorical variables were presented as n (%). Spearman’s correlation analysis was used to analyse the correlation among KAP scores. The hypotheses were confirmed through structural equation modelling (SEM). These SEM hypotheses encompassed (1) a positive influence of participants’ knowledge on their attitude, (2) a positive impact of participants’ attitude on their practice and (3) a positive influence of participants’ knowledge on their practice. Two-sided p<0.05 was considered statistically significant.
Results
During the study period, a total of 11 288 pregnant women sought medical attention at the hospital. From this cohort, 622 individuals were selected for inclusion in the study. Subsequently, 622 questionnaires were collected for the research. After excluding 195 questionnaires with insufficient responses (n=6), refusals to participate (n=7) or with logical errors (n=182), 427 valid questionnaires were analysed, which met the requirements for sample size calculation. Among the participants, 291 (68.15%) were aged 30 years or younger, 310 (72.60%) had completed junior college or undergraduate education and the mean pregnancy duration was 238.18±45.01 days. Additionally, 206 (48.24%) were experiencing pregnancy for the first time, 211 (49.41%) had no prior childbirth experience, 41 (9.60%) were employed in medical-related occupations and 387 (90.64%) were in the third trimester.
The mean scores for KAP were 22.19±12.17 (range: 0–40), 46.38±6.14 (range: 12–60) and 41.96±5.96 (range: 10–50), respectively. Knowledge scores varied among pregnant women with different education levels (p<0.001), medical-related occupations (p=0.006), residences (p=0.001), monthly incomes (p=0.011), pregnancy experiences (p=0.014), delivery histories (p=0.002) and ethnicities (p=0.011).
Attitude scores differed by education (p<0.001) and medical-related occupation (p=0.022).
Practice scores varied by education (p<0.001), residence (p<0.001) and monthly income (p=0.002) (table 1).
Table 1. Baseline characteristics and KAP scores.
| Characteristics | N (%) | Knowledge, mean±SD | P value | Attitudes, mean±SD | P value | Practice, mean±SD | P value |
|---|---|---|---|---|---|---|---|
| n=427 | |||||||
| Total | 22.19±12.17 | 46.38±6.14 | 41.96±5.96 | ||||
| Age, years | 0.423 | 0.950 | 0.057 | ||||
| ≤30 | 291 (68.15) | 22.52±11.96 | 46.36±6.06 | 42.33±6.00 | |||
| >30 | 136 (31.85) | 21.50±12.63 | 46.40±6.33 | 41.15±5.80 | |||
| Gestational weeks | 0.550 | 0.421 | 0.691 | ||||
| First trimester | 8 (1.87) | 24.25±8.45 | 48.38±5.40 | 43.63±5.10 | |||
| Second trimester | 32 (7.49) | 24.19±11.94 | 47.31±5.77 | 42.25±5.12 | |||
| Third trimester | 387 (90.64) | 21.98±12.26 | 46.26±6.18 | 41.90±6.04 | |||
| Times of pregnancy | 0.014 | 0.520 | 0.546 | ||||
| 1 time | 206 (48.24) | 23.09±12.23 | 46.66±6.03 | 42.16±5.96 | |||
| 2–3 times | 171 (40.05) | 22.47±11.90 | 46.27±6.13 | 41.96±5.87 | |||
| ≥4 times | 50 (11.71) | 17.56±12.06 | 45.58±6.64 | 41.12±6.30 | |||
| Times of delivery | 0.002 | 0.187 | 0.255 | ||||
| 0 times | 211 (49.41) | 23.79±12.10 | 46.62±6.15 | 42.11±5.84 | |||
| 1 time | 176 (41.22) | 21.50±11.90 | 46.47±5.85 | 42.11±5.74 | |||
| ≥2 times | 40 (9.37) | 16.80±12.22 | 44.70±7.16 | 40.48±7.32 | |||
| Residence | 0.001 | 0.069 | <0.001 | ||||
| Urban | 338 (79.16) | 23.22±11.70 | 46.65±6.02 | 42.48±5.56 | |||
| Rural or suburban | 89 (20.84) | 18.27±13.16 | 45.33±6.49 | 39.99±6.96 | |||
| Ethnicity | 0.011 | 0.562 | 0.805 | ||||
| Han Chinese | 403 (94.38) | 21.83±12.27 | 46.33±6.16 | 41.94±5.96 | |||
| Minority | 24 (5.62) | 28.33±8.54 | 47.08±5.85 | 42.25±5.97 | |||
| Education | <0.001 | <0.001 | <0.001 | ||||
| High school and below | 104 (24.36) | 15.77±12.43 | 43.96±6.39 | 39.42±6.29 | |||
| Junior college/undergraduate | 310 (72.60) | 24.10±11.28 | 47.08±5.91 | 42.77±5.66 | |||
| Postgraduate and above | 13 (3.04) | 28.00±12.96 | 48.92±4.15 | 42.85±4.54 | |||
| Medical-related occupation | 0.006 | 0.022 | 0.325 | ||||
| Yes | 41 (9.60) | 27.17±10.97 | 48.46±5.19 | 42.83±5.71 | |||
| No | 386 (90.40) | 21.66±12.19 | 46.16±6.20 | 41.87±5.98 | |||
| Monthly income, ¥ | 0.011 | 0.550 | 0.002 | ||||
| <5000 | 141 (33.02) | 19.72±12.48 | 45.92±6.41 | 40.81±6.10 | |||
| 5000–10 000 | 182 (42.62) | 23.13±12.05 | 46.54±6.20 | 41.98±6.08 | |||
| >10 000 | 104 (24.36) | 23.90±11.54 | 46.70±5.65 | 43.47±5.20 | |||
| Type of medical insurance | 0.281 | 0.254 | 0.111 | ||||
| 1 | 373 (87.35) | 22.06±12.34 | 46.24±6.19 | 41.75±5.94 | |||
| 2 | 49 (11.48) | 22.29±11.20 | 47.06±5.77 | 43.12±6.11 | |||
| No medical insurance | 5 (1.17) | 30.80±3.35 | 50.20±5.07 | 45.80±2.95 | |||
KAP, knowledge, attitude and practice; n, number.
The distribution of knowledge dimensions revealed that the two knowledge items with the highest correctness rates were as follows: ‘pre-eclampsia is a form of pregnancy-induced hypertension, an idiopathic condition that occurs during pregnancy. Once it develops, it can lead to adverse outcomes for both the mother and the child, such as preterm birth, placental abruption and an increased risk of chronic hypertension in the distant future in pregnant women’ (Knowledge question 1) with 79.6%, and ‘hypertension increases the risk of pre-eclampsia’ (Knowledge question 3.5) with 72.13%. The two items with the lowest correctness rates were ‘excessive weight gain during pregnancy increases the risk of pre-eclampsia’ (Knowledge question 3.9) with 31.38%, and ‘primiparity increases the risk of pre-eclampsia’ (Knowledge question 3.1) with 30.21% (online supplemental table 1).
Regarding key questions in the knowledge dimension, different pregnancy numbers (p=0.007) and childbirth numbers (p=0.003) may influence whether pregnant women are aware that first pregnancies increase the risk of pre-eclampsia. Different ethnicities (p=0.013) and education levels (p=0.023) may affect whether pregnant women are aware that an interpregnancy interval greater than 10 years increases the risk of pre-eclampsia. Different pregnancy numbers (p=0.001), childbirth numbers (p<0.001), place of residence (p=0.044) and education levels (p=0.022) may influence whether pregnant women are aware that irregular or inadequate prenatal checks increase the risk of pre-eclampsia (online supplemental table 2).
The survey revealed strong consensus among respondents regarding their views on pre-eclampsia. An overwhelming majority (90.87%) recognised pre-eclampsia as a severe pregnancy complication with detrimental effects on both the mother and the fetus (Attitude question 1). Likewise, a substantial portion (89.93%) believed that the risk of pre-eclampsia could be mitigated through appropriate preventive measures (Attitude question 2). Respondents expressed a high level of agreement (93.91%) with the importance of pregnant women following their doctors’ advice and actively engaging in the management of pre-eclampsia (Attitude question 3) (online supplemental table 3).
In terms of dietary habits, 54.8% and 61.36% of the respondents reported that their daily diet always contains an adequate amount of calcium (Practice question 1) and vitamins (Practice question 2). Healthcare practices also received positive feedback, with a resounding 92.27% of participants confirming their regular attendance at prenatal check-ups (Practice question 3) and 82.44% reporting consistent monitoring of their blood pressure (Practice question 4). In terms of proactive health engagement, 48.48% of respondents expressed a willingness to participate in prenatal health courses (Practice question 5). For scenarios related to a high risk of pre-eclampsia, a substantial 76.35% of individuals mentioned their willingness to accept medication for prevention (Practice question 8.1). Additionally, 81.96% stated their readiness to increase the frequency of prenatal check-ups (Practice question 8.2), and 82.44% expressed their willingness to monitor daily changes in blood pressure and weight (Practice question 8.3) (online supplemental table 4).
For the key questions related to attitude and practice, age (p=0.014), education level (p=0.027) and whether the respondent’s profession is related to the medical field (p=0.019) may influence whether pregnant women agree with treating high-risk individuals for pre-eclampsia with high-dose calcium therapy for prevention. Different education levels (p=0.005) and whether their profession is related to the medical field (p=0.002) may affect whether they agree with low-dose aspirin treatment for prevention. Additionally, different education levels (p=0.008) may also influence whether they include sufficient vitamins in their daily diet (online supplemental table 5).
Correlation analysis revealed significant and positive associations among KAP. Knowledge correlated positively with attitude (r=0.586, p<0.001) and practice (r=0.387, p<0.001). Additionally, attitude and practice exhibited a positive correlation (r=0.593, p<0.001) (table 2).
Table 2. Pearson correlation analysis.
| Knowledge | Attitudes | Practices | |
|---|---|---|---|
| Knowledge | 1 | ||
| Attitudes | 0.586 (p<0.001) | 1 | |
| Practice | 0.387 (p<0.001) | 0.593 (p<0.001) | 1 |
In the SEM results, it was evident that knowledge had a direct impact on attitude (β=0.716, p<0.001), and attitude, in turn, had a direct impact on practice (β=0.444, p<0.001). While knowledge didn’t have a direct effect on practice, it was linked indirectly through its influence on attitudes (β=0.151, p=0.001) (tables3 4).
Table 3. SEM.
| Estimate | SE | CR | P value | |
|---|---|---|---|---|
| Attitude←knowledge | 0.716 | 0.085 | 8.455 | <0.001 |
| Practice←knowledge | 0.056 | 0.048 | 1.171 | 0.242 |
| Practice←attitude | 0.444 | 0.061 | 7.220 | <0.001 |
CR, Critical Ratio; SE, standard error; SEM, structural equation modelling.
Table 4. Direct and indirect effects.
| Total effects | Direct effects | Indirect effects | ||||
|---|---|---|---|---|---|---|
| Effect | P value | Effect | P value | Effect | P value | |
| Knowledge→attitude | 0.288 | 0.288 | <0.001 | |||
| Knowledge→practice | 0.190 | 0.003 | 0.039 | 0.099 | 0.151 | 0.001 |
| Attitude→practice | 0.525 | 0.525 | <0.001 | |||
Discussion
The study revealed that pregnant women exhibited inadequate knowledge, suboptimal attitude and limited preventive behaviours towards pre-eclampsia. Recognising the interdependence between KAP, healthcare providers should prioritise enhancing pregnant women’s understanding through education, cultivating positive attitudes via structured educational initiatives and offering comprehensive antenatal counselling to promote better outcomes.
Taken together, these findings underscore the urgent need for targeted educational interventions to improve clinical practices related to pre-eclampsia in this population. To address these deficiencies in knowledge and attitude, educational initiatives should be implemented, offering comprehensive information about pre-eclampsia and its implications, aiming to cultivate a more positive attitude towards proactive practices, such as regular prenatal check-ups and adhering to recommended guidelines.19 20 The transition from knowledge to attitude is a critical step in this process, emphasising the significance of educational interventions in nurturing positive perceptions and practices.21
This study provides valuable insights into the relationship between occupation and healthcare, indicating statistically significant disparities in knowledge and attitude scores, but not in practice. This suggests that obstetric medical professionals may encounter challenges in achieving optimal patient compliance in clinical practice. Additionally, individuals with multiple pregnancies had higher knowledge scores but no significant differences in attitudes or practices. This implies that clinical exposure may improve disease understanding without necessarily changing attitudes or behaviours. This may be due to a lack of adverse outcomes in previous pregnancies, leading to the mistaken belief that positive practices have little effect. Clinicians should be reminded to strengthen educational interventions targeting the attitudes and practices of those women, emphasising that pre-eclampsia can occur even in those with seemingly ‘normal’ pregnancies. These findings emphasise the need to intensify educational efforts in clinical practice. Furthermore, higher education levels, urban residence and higher incomes were associated with statistically significant differences in KAP, aligning with prior studies that link pre-eclampsia with lower educational levels, rural backgrounds and lower incomes.22 23 In light of these results, tailored educational interventions and targeted support should be developed to address the specific needs of different patient groups, with a focus on improving their KAP related to pre-eclampsia, thereby contributing to enhanced clinical practice and better maternal and fetal outcomes.24
The findings from the knowledge dimension highlight certain notable deficiencies in pregnant women’s awareness of specific risk factors associated with pre-eclampsia, namely, primiparity, a pregnancy interval of ≥10 years and irregular prenatal check-ups. The accuracy of responses to these knowledge points was significantly lower compared with other aspects of pre-eclampsia knowledge. These results suggest that there is a substantial gap in knowledge regarding specific risk factors that contribute to the development of pre-eclampsia. The findings underscore the importance of tailoring educational efforts to address specific knowledge deficiencies, thereby contributing to a more informed and proactive patient population and ultimately improving clinical practice in the context of pre-eclampsia.25
The distribution of results within the attitude and practice dimensions reveals essential insights that warrant further examination. In both dimensions, it becomes evident that varying levels of agreement and adherence exist among pregnant women regarding the management and prevention of pre-eclampsia. These variations, when examined in detail, can offer valuable opportunities for enhancing clinical practice. To address these deficiencies, there is a need to develop initiatives that target specific aspects of patient attitudes and behaviours. Initiatives could focus on increasing the awareness of the severity of pre-eclampsia, promoting the importance of preventive measures and fostering a commitment to following medical advice and recommendations. In terms of practice, interventions should encourage regular prenatal check-ups, blood pressure monitoring and other preventive measures.26 Overall, it is essential to create a holistic and patient-centred approach that addresses the multifaceted aspects of patient attitude and practice to enhance clinical care and improve maternal and fetal outcomes.27
The findings from both the correlation analysis and SEM provide valuable insights into the inter-relationships among KAP concerning pre-eclampsia. The strong positive associations identified in the correlation analysis indicate that as knowledge about pre-eclampsia increases, so do positive attitudes and proactive practices. This implies that improving patient knowledge can serve as a catalyst for fostering better attitudes and practices.10 28 Furthermore, the SEM results validate this concept, demonstrating that knowledge exerts a direct influence on attitude, and attitude, in turn, directly impacts practice. While knowledge does not directly impact practice, it still plays an indirect role by shaping attitudes, highlighting the importance of cultivating informed and positive perceptions about pre-eclampsia to drive improved clinical practices. These findings underscore the need for comprehensive patient education initiatives that target knowledge enhancement as a cornerstone for promoting desirable attitudes and practices.29
The study is subject to several limitations that should be acknowledged. First, the cross-sectional survey design employed in this study offers a snapshot of the participants’ KAP at a specific point in time. Longitudinal studies or interventions conducted over an extended period could provide valuable insights into the dynamic nature of KAP and the effectiveness of educational initiatives. Second, the data collection relied on self-administered questionnaires, which are susceptible to response bias, potentially leading to an inaccurate reflection of participants’ actual behaviours. The presence of social desirability bias might have influenced participants to provide more socially acceptable responses.30 Additionally, the assessment of participants’ intellectual ability was based on the subjective judgement of researchers during recruitment without the use of standardised scales, which may have introduced selection bias. Moreover, the study focuses solely on pregnant women, which limits the exploration of perspectives from healthcare providers, partners or family members, who also play crucial roles in the management of pre-eclampsia. Finally, the participants were mainly in the third trimester who experienced more prenatal examination and education. Therefore, this study may overestimate the KAP among pregnant women. Incorporating a more diverse range of participants could provide a more comprehensive understanding of the issue.
In conclusion, this study highlights that pregnant women had inadequate knowledge, suboptimal attitudes and limited preventive behaviours towards pre-eclampsia. The findings underscore the urgent need to implement targeted interventions to improve the clinical approach to managing pre-eclampsia. Considering the notable and positive correlations between KAP, healthcare providers should prioritise comprehensive educational programmes and awareness campaigns to enhance pregnant women’s understanding of pre-eclampsia. Moreover, fostering a positive attitude is crucial, as it directly influences the adoption of better clinical practices. These findings may also inform future community-based education policies and maternal health strategies.
Supplementary material
Acknowledgements
Thanks for guidance and advice from Professor Qi Hongbo, Director Li Xinlin, Director Zhang
Xiaoqin.
Footnotes
Funding: This study was supported by the National Natural Science Foundation of China, 82001580, Mechanism of miRNA-21 regulation of Hippo signalling pathway in extravillous trophoblastic cells via PP2A in pre-eclampsia.
Prepublication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online (https://doi.org/10.1136/bmjopen-2025-106259).
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Consent obtained directly from patient(s).
Ethics approval: This study involves human participants and was approved by the medical ethics committee of Banan Hospital of Chongqing Medical University (approval number: BNLL-KY-2023–035). Participants gave informed consent to participate in the study before taking part.
Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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