Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide, with the heaviest burden falling on low- and middle-income countries. This narrative review synthesizes literature published largely between 2023 and 2026 on the risk factors, prevention strategies, diagnostic advances, and management approaches relevant to pre-eclampsia. Established clinical risk factors, including prior pre-eclampsia, chronic hypertension, pregestational diabetes, obesity, and antiphospholipid syndrome, continue to anchor risk stratification, while emerging evidence points to the independent contribution of social determinants such as socioeconomic deprivation, limited healthcare access, and psychosocial stress. Low-dose aspirin initiated before 16 weeks' gestation remains the cornerstone of pharmacological prevention, with recent network meta-analyses helping to clarify optimal dosing, while calcium supplementation, including newer low-dose regimens, offers a complementary strategy where dietary calcium intake is limited. The soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio has matured into a clinically validated tool for ruling out short-term progression to severe disease and recently received expanded regulatory approval. Management continues to balance maternal safety against fetal maturity, with trial evidence supporting planned delivery for late preterm disease and tighter postpartum blood pressure targets. Persistent barriers, including workforce shortages, inconsistent guideline adoption, supply chain gaps, and patient-level adherence challenges, constrain the translation of proven interventions into practice, particularly in under-resourced settings. The review concludes that further progress depends substantially on the equitable implementation of existing evidence rather than solely on the discovery of new interventions.