Pre-eclampsia is a global problem—it affects 2-8% of pregnancies, and an estimated 8.3 million women develop the disease each year. For developing countries, the priority is preventing maternal deaths from multiorgan complications of the disease. The difference in case fatality rates from eclampsia between developing countries and developed countries (5.2% v 0.72%) suggests that mortality is easily avoidable.1 In developed countries where death is rarer, research is directed towards improving prediction and prevention of pre-eclampsia and minimising morbidity. Accurate diagnosis is needed to accomplish this. In the accompanying systematic review, Côté and colleagues assess urinary spot protein:creatinine and albumin:creatinine ratios as diagnostic tests for significant proteinuria in women with hypertension in pregnancy.2

Pre-eclampsia is a multiorgan syndrome, the clinical characteristics of which may include kidney, liver, and cerebral damage, an altered coagulant state, and fetal growth restriction.3 It is defined by two imperfect measures of end organ involvement—hypertension and proteinuria.4 Early blood markers of the disease can now be identified many weeks before these clinical manifestations,5 but antenatal diagnosis still relies on measuring blood pressure and urine …