Preeclampsia (PE) is a major cause of maternal–fetal morbidity and mortality worldwide, affecting approximately 2–8% of pregnancies and contributing substantially to maternal deaths, particularly in low- and middle-income countries (LMICs) [1–3]. In LMICs, late access to antenatal care, diagnostic delays, and structural constraints within health systems exacerbate the disease burden and account for a large share of severe complications observed [4–6].

Clinically, PE is defined by the onset after 20 weeks’ gestation of hypertension, proteinuria, and maternal and/or utero-placental organ involvement, according to updated criteria from the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, which also frame management and postpartum follow-up [2, 7–9]. Severe forms are associated with eclampsia, hemorrhage, placental abruption, and prematurity, while women with a history of PE face an increased long-term risk of cardiovascular disease and hypertension [1, 10]. Primary prevention with low-dose aspirin in high-risk women is recommended and supported by a growing body of literature, although implementation remains incomplete in many settings [8, 11, 12].

In sub-Saharan Africa, and in Cameroon in particular, multiple studies highlight the substantial contribution of hypertensive disorders of pregnancy (HDP) to mortality and admissions to intensive care, with often late diagnosis and unfavorable perinatal outcomes [6, 13–15]. Concurrently, Cameroonian studies describe the persistence of hypertension after PE and identify local risk factors and clinical profiles that should guide risk stratification and the organization of care [16–18]. In this context, estimating hospital incidence, documenting maternal–fetal complications, and identifying predictive factors for PE in Yaoundé, Cameroon, is essential to strengthen early screening, the use of aspirin in eligible women, and the optimization of delivery timing.

Preeclampsia remains a major cause of maternal–fetal morbidity and mortality in resource-limited settings, where diagnosis may be delayed and access to specialized care is uneven, resulting in a high hospital burden and adverse perinatal outcomes. At HGOPY and HCY—referral centers that receive many complicated pregnancies—up-to-date local data were needed to inform screening, prevention, and the timing of delivery. In this context, our study aimed to estimate the hospital incidence of preeclampsia, to characterize associated maternal–fetal complications, and to identify independent predictive factors for its occurrence, in order to guide clinical and organizational strategies within the managing services.

The hospital incidence of preeclampsia (31.5%) (Fig. 1) observed in a sample of 146 women is among the highest compared with global average estimates (2–8%) and several syntheses on the topic in sub-Saharan Africa (4–5%). This incidence can be explained by the nature of recruitment across two referral centers that typically receive referred and more severe cases. In addition, potential differences in diagnostic definitions and the limited 6-month observation period may contribute to this figure. Guidelines from the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists emphasize that extending criteria beyond proteinuria (to include organ involvement) increases diagnostic sensitivity and may raise rates in specialized settings such as ours [2, 19]. Global analyses and meta-analyses place the burden of hypertensive disorders of pregnancy (HDP) at substantial levels, with marked regional heterogeneity [1, 20, 21]. In the Cameroonian context, hospital series such as those by Priso et al. (2015), Kaze et al. (2014), and Nganou-Gnindjio et al. (2021) have confirmed the heavy HDP load in intensive care and postpartum, which may partly explain our results [6, 16, 18].

The age distribution (mean ≈ 31 years, most participants aged 20–34) is typical of urban obstetric cohorts in Africa. Interpreting the baseline characteristics (Table 1), a personal history of preeclampsia showed a trend toward association with current preeclampsia. This aligns with findings by Meazaw et al. (2020) and Fox et al. (2019), which identify prior preeclampsia as a major risk factor [22, 23]. Gestational age is strongly linked to preeclampsia status: clustering at 34–36 weeks reflects obstetric decision-making for late-onset severe forms, whereas early-onset forms (< 34 weeks) are known for high perinatal morbidity [2, 24]. The absence of significant associations with marital status, education, occupation, or parity does not negate their contextual importance; it may reflect limited power, coarse categorization, or unadjusted confounding [23].

Cesarean delivery (42%) and prematurity (25%) were the main maternal–fetal complications in our cohort, with a slightly lower trend for low birth weight among participants with preeclampsia (15/34) compared with those without (19/34) (Table 2). These profiles are consistent with the literature linking preeclampsia to iatrogenic or spontaneous prematurity, low birth weight, and adverse perinatal outcomes [25–27]. Eclampsia and placental abruption were uncommon in our sample but remain particularly feared in sub-Saharan Africa [14, 15]. The lack of statistical significance in our comparisons (p ≥ 0.05), despite clinically plausible differences, is likely due to the small sample size and wide confidence intervals—a well-documented phenomenon in single-setting series [19]. Finally, long-term consequences for mother and child justify postpartum surveillance: preeclampsia approximately doubles subsequent maternal cardiovascular risk [10, 28] and is associated with cardiometabolic vulnerabilities in offspring [29, 30].

Independent predictors reinforced the central role of the cardiometabolic background: personal history of hypertension (aOR = 3.55) supports the contribution of chronic hypertension, endothelial dysfunction, and atherogenic load to preeclampsia risk and related morbidity [23, 31]. WHO class I obesity (aOR = 4.19) fits a robust dose–response relationship between BMI and preeclampsia; multiple cohorts and meta-analyses show risk rising from overweight, with a gradient across obesity classes I to III [32–36]. History of preeclampsia (aOR = 4.31) is a major determinant, consistent with syntheses on recurrence and risk stratification [22, 37]. Finally, gestational age < 34 weeks (aOR = 6.08) likely reflects the early-onset (placental) phenotype—more severe and rich in perinatal complications—which often prompts delivery before 34–37 weeks [2, 23]. These findings support low-dose aspirin prophylaxis in high-risk women [11] and close surveillance, particularly in our setting.

Strengths include explicit diagnostic criteria, a prospective design, and multivariable analysis. Limitations include a modest sample size (wide 95% CIs), two-center recruitment, and limited power for rare outcomes (eclampsia, placental abruption). Practical implications include: targeting high-risk women (history of hypertension, prior preeclampsia, obesity), initiating low-dose aspirin at 12–16 weeks, optimizing follow-up (proteinuria/BP screening), and planning delivery timing according to disease severity and fetoplacental assessment.

In conclusion, among pregnant women followed at HCY and HGOPY, preeclampsia showed a high hospital incidence, with cesarean delivery and prematurity as the predominant maternal–fetal complications. It was independently associated with a personal history of hypertension, WHO class I obesity, a history of preeclampsia, and gestational age < 34 weeks. These findings support reinforced antenatal screening, low-dose aspirin in eligible women, rigorous weight and blood-pressure management, and appropriately timed delivery. Larger, longer-duration, and ideally multicenter studies are recommended to refine these estimates and guide resource allocation.