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Hypertension is the second most prevalent maternal complication worldwide after anaemia in pregnancy, and it is associated with a significant morbidity and mortality of the mother and foetus. An important focus for improving the antenatal management of pre-eclampsia is to develop accurate prediction models that identify women at high risk of disease. This would enable more appropriate targeting of prophylaxis from the first trimester as well as increased surveillance of those at high risk of disease. Lack of recognition of risk contributes to substandard care associated with maternal deaths.5 Altered angiogenic biomarkers indicate placental dysfunction, and their implementation into clinical practice will help reduce the considerable burden of morbidity and mortality associated with adverse pregnancy outcomes as a consequence of angiogenic-placental syndrome.