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Strength of association was evaluated as \u2018definite\u2019 (odds ratios [OR] or relative risk [RR] \u2265\u20093.00 or &lt;\u20090.33), \u2018probable\u2019 (OR or RR 1.50\u20132.99 or 0.33\u20130.67), \u2018possible\u2019 (OR or RR 1.10\u20131.49 or 0.68\u20130.89), or \u2018unlikely\u2019 (OR or RR 0.90\u20131.09). Quality of the evidence was high, moderate, low, or very\u2010low, using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Results<\/jats:title>\n                    <jats:p>Twenty\u2010seven publications found 24 associations of pre\u2010eclampsia with socioeconomic status, social support\/exclusion, healthcare access, and occupational and physical environmental factors. One association (polygamy) was definite (low\u2010quality evidence). Probable associations included: work stress, lack of antenatal care and heat exposure in early pregnancy (high\u2010quality evidence); prolonged occupational exposure to whole body vibrations or bending, distance to health facility, and UV\u2010B radiation exposure (protective factor), all based on moderate\u2010quality evidence; and neighbourhood deprivation, rotating work shifts, and Asian\/Oceanian origins (protective factor), all based on low\u2010quality evidence. There were 13 possible associations, which did not include education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings support recommendations to address climate change, strengthen occupational protection, and promote early antenatal attendance. Social determinants may be indicative of upstream factors (e.g., obesity) that increase likelihood of clinical risk factors for pre\u2010eclampsia incidence and severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.18082","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T01:38:31Z","timestamp":1740015511000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Towards the Development of a Conceptual Framework of the Determinants of Pre\u2010Eclampsia: A Hierarchical Systematic Review of Social Determinants"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5846-3014","authenticated-orcid":false,"given":"Mai\u2010Lei Woo","family":"Kinshella","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology BC Children's and Women's Hospital and University of British Columbia  Vancouver British Columbia 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