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Tadese M, Damesa WA, Solomon GS, Wakie GE, Tessema SD, Endale A. Maternal outcomes of pre-eclampsia with severe features and its determinants at Abebech Gobena Mothers and Childrens Health and Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e081901. [PMID: 38553084 PMCID: PMC10982730 DOI: 10.1136/bmjopen-2023-081901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE The main objective of this study was to determine the prevalence and factors associated with unfavourable maternal outcomes among pregnant women with pre-eclampsia with severity features (PEWSF) at Abebech Gobena Maternal and Children's Health and St. Peter's Hospital, Addis Ababa, Ethiopia, 2023. DESIGN A hospital-based cross-sectional study was conducted from 1 January 2023 to July 2023. The data was collected using a structured and pre-tested questionnaire through face-to-face interviews and a review clinical chart. Data was entered using EpiData V.4.6 and analysed using SPSS V.26.0 statistical software. Binary logistic regression analysis was run to identify predictors of maternal outcome. SETTING Two hospitals in Addis Ababa, Ethiopia. PARTICIPANTS 348 pregnant women with PEWSF were included. OUTCOME MEASURES Unfavourable maternal outcome was defined as mothers with PEWSF that develop at least one complication, that is, eclampsia, abruption placenta, Haemolysis, Elevated Liver Enzymes and Low Platelet Count (HELLP) syndrome, acute renal failure, disseminated intravascular coagulation, cardiac failure, stroke, postpartum haemorrhage, pulmonary oedema and death. RESULTS The overall prevalence of unfavourable maternal outcomes was 33.9% (N=118) (95% CI=28.7 to 38.8). Abruptio placenta (17.2%), HELLP syndrome (15.5%) and postpartum haemorrhage (13.8%) were common complications that occurred among mothers with PEWSF. Age above 35 years (adjusted OR (AOR) (95% CI)=2.70 (1.31 to 5.59)), rural residence (AOR (95% CI)=1.94 (1.07 to 3.53)), unemployment (AOR (95% CI)=0.35 (0.20 to 0.62)), severe blood pressure on admission (AOR (95% CI)=2.32 (1.03 to 5.19)) and complain of severe headache (AOR (95% CI)=1.91 (1.16 to 3.16)) were significant associates of unfavourable maternal outcomes. CONCLUSIONS The prevalence of unfavourable maternal outcomes was high compared with other studies in Ethiopia. Maternal age, residence, occupation, blood pressure on admission and severe headache have shown a statistically significant association with unfavourable maternal outcomes. Socioeconomic development and early identification of severe signs and symptoms of pre-eclampsia are needed to reduce unfavourable outcomes.
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Affiliation(s)
- Mesfin Tadese
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Wogene Asefa Damesa
- Department of Medicine, Obstetrics and Gynecology, Abebech Gobena Mothers and Childrens Health Hospital, Addis Ababa, Ethiopia
| | | | - Getu Engida Wakie
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Saba Desta Tessema
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia
| | - Agizew Endale
- Department of Nursing, Debre Berhan Health Science College, Debre Berhan, Amhara, Ethiopia
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Tadese M, Damesa WA, Solomon GS, Fitie GW, Mitiku YM, Tessema SD, Endale A. Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia. Front Pediatr 2024; 12:1345055. [PMID: 38390276 PMCID: PMC10881656 DOI: 10.3389/fped.2024.1345055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Background Preeclampsia is a new onset of hypertension and either proteinuria or end-organ failure after 20 weeks of gestation. It is a prevalent cause of perinatal mortality, morbidity, and neonatal complications in developing nations including Ethiopia. Thus, the aimed to assess the prevalence and determinants of adverse perinatal outcomes among women with preeclampsia with severity features (PEWSF) at two selected public hospitals in Addis Ababa, Ethiopia, 2023. Method A cross-sectional study was carried out among 348 mothers between January 1, 2023, and July 1, 2023. A structured, pre-tested questionnaire was used to gather data from in-person interviews and a review of the patient's medical record. The statistical program Epi-Data version 4.6 was used to enter the data, and SPSS version 26.0 was used for analysis. Binary logistic regression analysis was used to find factors that were associated with unfavorable perinatal outcomes. A p-value of less than 0.05 was used to declare the significance level. Result The overall prevalence of unfavorable perinatal outcomes was 59.2% (95% CI: 54.0-63.8). Among the complications, low birth weight, prematurity, NICU admission, and a low fifth-minute APGAR score, encompass 48.9%, 39.4%, 20.4%, and 14.7%, respectively. No formal education [OR = 5.14, 95% CI: (1.93-13.63)], unemployment [OR = 0.42, 95% CI: (0.24-0.73)], referral cases [OR = 2.03, 95% CI: (1.08-4.06), inadequate antenatal care (ANC) contact [OR = 3.63, 95% CI: (1.22-10.71)], and family history of hypertension [OR = 1.99, 95% CI: (1.03-3.85)] have shown a statistically significant association with unfavorable perinatal outcomes. Conclusion In this study, the prevalence of unfavorable perinatal outcomes was high compared to other studies in Ethiopia. Level of education, occupation, mode of admission, ANC contact, and family history of hypertension were significant predictors of unfavorable perinatal outcomes. Socio-economic development, improving referral systems, and adequate antenatal care contact are needed to improve unfavorable outcomes. Additionally, antenatal screening and specialized care for high-risk mothers, e.g., those with a family history of hypertension are recommended.
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Affiliation(s)
- Mesfin Tadese
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Wogene Asefa Damesa
- Department of Medicine, Obstetrician and Gynecologist, Abebech Gobena Mothers and Childrens Health Hospital, Addis Ababa, Ethiopia
| | | | - Girma Wogie Fitie
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Yohannes Moges Mitiku
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Saba Desta Tessema
- Department of Midwifery, School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Agizew Endale
- Department of Nursing, Debre Berhan Health Science College, Debre Berhan, Ethiopia
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Yan S, Jiang H, Yang Z, Tang X, Chen Z, Chen Z, Liu H, Zhang F. Physical activity trajectory during pregnancy and associations with maternal fatigue using a growth mixture modeling approach. Sci Rep 2024; 14:1020. [PMID: 38200232 PMCID: PMC10781982 DOI: 10.1038/s41598-024-51648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024] Open
Abstract
The purpose of this study was to investigate the associations of physical activity trajectories with maternal fatigue. Pregnant women provided objectively assessed physical activity data by Pregnancy Physical Activity Questionnaire four times. Fatigue scale-14 was used to assess fatigue during pregnancy. Growth mixture modelling characterized physical activity trajectories across pregnancy. The generalized estimating equations was used to analyze the relationship between different physical activity profiles and fatigue in pregnant women. A total of 626 pregnant women were included in analysis in a teaching hospital in Nantong city. Fatigue (total, mental and physical) was not different between two groups based on total energy expenditure of PA (constantly high vs. constantly low). The pregnant women in "constantly high household PA" group had the higher fatigue compared to "constantly low household PA" (P < 0.05) and "constantly medium household PA" (P < 0.05). The pregnant women in "constantly high sport PA" group had lower fatigue compared to "constantly low sport PA" (P < 0.05). Household PA and sport PA were still an independent influencing factor for fatigue after controlling for confounding variables. Specifically, we observed that higher household PA and lower sport PA were associated with higher fatigue during pregnancy.
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Affiliation(s)
- Shuhan Yan
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China
- Health School attached to Shanghai University of Medicine & Health Sciences, 200237, Shanghai, China
| | - Hui Jiang
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China
- Affiliated hospital of Nantong university, Nantong, China
| | - Ziyi Yang
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China
| | - Xinyan Tang
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China
| | - Zihang Chen
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China
| | - Zhifang Chen
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Huahua Liu
- Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong City, Jiangsu Province, China
| | - Feng Zhang
- School of Nursing, Nantong University, 19 QiXiu Road, Nantong City, Jiangsu Province, China.
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Gwak E, Kim T, Shin JY, Choi NK, Han S, Lee JY, Choe YJ, Choe SA. Effectiveness and Safety of COVID-19 Vaccination During Preconceptional and Preclinical Pregnancy Period: A National Population Study. J Korean Med Sci 2023; 38:e314. [PMID: 37873626 PMCID: PMC10593595 DOI: 10.3346/jkms.2023.38.e314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND We aimed to assess the risk of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and early abortive outcomes after the association between coronavirus disease 2019 (COVID-19) vaccination during the preconceptional period and preclinical pregnancy, which are likely to be inadvertent vaccination. METHODS We used data from the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort from December 2020 to December 2021. The vaccinated pregnant women were matched to unvaccinated pregnant controls at a 1:4 ratio. The risks of SARS-CoV-2 infection and intensive care unit (ICU) admission within 14 days of infection were analyzed to assess its effectiveness. For safety measures, the adjusted relative risks (aRRs) of early abortive outcomes for the first COVID-19 vaccination during the preconceptional and preclinical periods were calculated considering covariates. We compared the risk of early abortion between mRNA and viral vector vaccines. RESULTS The overall COVID-19 vaccination rates during the preconceptional period and preclinical pregnancy were 3.1% (6,662/215,211) and 2.6% (5,702/215,211), respectively. The cumulative incidence of ICU admission within 14 days of SARS-CoV-2 infection was 6/100,000 in the unvaccinated group, whereas there were no ICU admissions in the vaccinated groups. The risks of early abortive outcomes were not significantly different between the preconceptional vaccination group and the unvaccinated group (aRR, 1.04; 95% confidence interval [CI],0.99-1.10) or between preclinical pregnancy vaccination and their matched controls (1.02; 95% CI, 0.96-1.08). mRNA and viral vector vaccines have shown similar risks for early abortive outcomes and miscarriages. CONCLUSION Our findings have provided compelling evidence regarding the effectiveness and safety of COVID-19 vaccination prior to and during early pregnancy. Further research is required to extend the safety and efficacy profiles of COVID-19 vaccines to pregnant women and their babies.
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Affiliation(s)
- Eunseon Gwak
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Taemi Kim
- Department of Public Health, Korea University, Seoul, Korea
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Korea
| | - Seungbong Han
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Yeon Lee
- Department of Obstetrics & Gynecology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
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Kim JH, Kim S, Ryu KJ, Park H, Kim YJ, Choe SA. Socioeconomic Factors and Abortive Outcomes of Clinical Pregnancy After Embryo Transfer in the Setting of Universal Health Insurance Coverage of IVF. J Korean Med Sci 2023; 38:e293. [PMID: 37750367 PMCID: PMC10519783 DOI: 10.3346/jkms.2023.38.e293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/31/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND In vitro fertilization-embryo transfer (IVF-ET), an expensive option for infertile couples, started to be fully covered by the National Health Insurance (NHI) from October 2017 in South Korea. We investigated the association between woman's socioeconomic status (SES) and abortive outcomes in pregnancies after IVF-ET in the setting of universal coverage of the treatment. METHODS Using the NHI database in South Korea, we conducted a retrospective cohort study of all women who achieved clinical pregnancy after ET between October 2017 and February 2019. A total of 44,038 clinical pregnancy episodes of 29,847 women who underwent ET were analyzed. We used employment status, income in percentiles, and living in the Seoul capital area as indicators of SES. Relative risks (RRs) for abortive pregnancy outcomes were calculated for each socioeconomic stratum, using log-binomial regression models included woman's age, body mass index, fasting blood glucose, fresh ET, month of ET, and history of smoking. RESULTS While most pregnancy outcomes were live births (n = 30,783, 69.9%), 11,215 (25.5%) cycles ended with abortion or early pregnancy loss, 1,779 (4.0%) cycles were ectopic pregnancy, 45 (0.1%) were coded as molar pregnancy, and 224 (0.5%) were fetal death in utero or stillbirth. The risk of overall abortive outcomes was higher when a woman was unemployed (adjusted RR, 1.08; 95% confidence interval [CI], 1.05-1.11) or living in a non-Seoul capital area (1.11; 95% CI, 1.08-1.14). The association between relative income level and abortive outcomes was close to null. Living outside Seoul capital area was associated with the greater risk of abortive outcomes especially in younger women. CONCLUSION Unemployment and living in non-capital areas were associated with a higher risk of abortive outcomes among pregnancies after ET, even in the setting of universal coverage of IVF-ET. This suggests potential impact of socioeconomic position on the IVF-ET pregnancy.
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Affiliation(s)
- Jee Hyun Kim
- Department of Fertility Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seyoung Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Ki-Jin Ryu
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hyuntae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Seung-Ah Choe
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
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Oh JW, Kim S, Yoon JW, Kim T, Kim MH, Ryu J, Choe SA. Women's Employment in Industries and Risk of Preeclampsia and Gestational Diabetes: A National Population Study of Republic of Korea. Saf Health Work 2023; 14:272-278. [PMID: 37818217 PMCID: PMC10562116 DOI: 10.1016/j.shaw.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 10/12/2023] Open
Abstract
Background Some working conditions may pose a higher physical or psychological demand to pregnant women leading to increased risks of pregnancy complications. Objectives We assessed the association of woman's employment status and the industrial classification with obstetric complications. Methods We conducted a national population study using the National Health Information Service database of Republic of Korea. Our analysis encompassed 1,316,310 women who experienced first-order live births in 2010-2019. We collected data on the employment status and the industrial classification of women, as well as their diagnoses of preeclampsia (PE) and gestational diabetes mellitus (GDM) classified as A1 (well controlled by diet) or A2 (requiring medication). We calculated odds ratios (aORs) of complications per employment, and each industrial classification was adjusted for individual risk factors. Results Most (64.7%) were in employment during pregnancy. Manufacturing (16.4%) and the health and social (16.2%) work represented the most prevalent industries. The health and social work exhibited a higher risk of PE (aOR = 1.11, 95% confidence interval [CI]: 1.03-1.21), while the manufacturing industry demonstrated a higher risk of class A2 GDM (1.20, 95% CI: 1.03-1.41) than financial intermediation. When analyzing both classes of GDM, women who worked in public administration and defense/social security showed higher risk of class A1 GDM (1.04, 95% CI: 1.01, 1.07). When comparing high-risk industries with nonemployment, the health and social work showed a comparable risk of PE (1.02, 95% CI: 0.97, 1.07). Conclusion Employment was associated with overall lower risks of obstetric complications. Health and social service work can counteract the healthy worker effect in relation to PE. This highlights the importance of further elucidating specific occupational risk factors within the high-risk industries.
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Affiliation(s)
- Jeong-Won Oh
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seyoung Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Jung-won Yoon
- Department of Obstetrics and Gynecology, National Medical Center, Republic of Korea
| | - Taemi Kim
- Department of Public Health, Korea University, Seoul, Republic of Korea
| | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, Seoul, Republic of Korea
| | - Jia Ryu
- Department of Occupational Medicine, Catholic Kwandong University, Gangwon, Republic of Korea
| | - Seung-Ah Choe
- Department of Public Health, Korea University, Seoul, Republic of Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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