Global Inequities in Preeclampsia Research: A Scoping Review and Landscape Analysis of Drug Repurposing Clinical Trials (2000–2025)

Background: Preeclampsia (PE) remains a leading cause of maternal mortality globally. Yet data on trial representation across regions and populations are limited, raising concerns about equity and inclusivity in research. Methods: We performed a scoping review and landscape analysis of ClinicalTrials.gov and WHO ICTRP registries (January 1, 2000–December 31, 2025). Interventional trials testing non-standard pharmacological agents for PE were included. Data were stratified by country, income level, and Maternal Mortality Ratio (MMR). Spearman's rank correlations were used to assess associations among research activity, national wealth (GDP), and clinical burden (MMR). Results: From 1,765 records, 47 trials met the inclusion criteria. Metformin was most studied (n=15; 31.9%), followed by statins (n=11; 23.4%) and esomeprazole (n=9; 19.1%). High-income countries (HICs) hosted 51.1% of trials (n=24) despite the lowest MMRs. Iran (n=9; 19.1%) and Egypt (n=7; 14.9%) led globally, outpacing the United States (n=5). No significant correlations emerged between trial numbers and GDP (rₛ=0.40; p=0.06) or MMR (rₛ=0.21; p=0.33). Public/academic funding dominated (93.6%; n=44), with minimal industry involvement (6.38%; n=3).