Dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia: a case control study

An association of deficiencies in balanced dietary practices and inadequate iron and folic acid supplement's intake during pregnancy and increasing risk of pre-eclampsia or eclampsia among Indian women

Pre-eclampsia or eclampsia is a serious reproductive health problem which can cause maternal, fetal and neonatal morbidity and mortality worldwide. However till the notable reasons of it is not very clear at all. The main essence of the present study was to examine the association between dietary intake, iron and folic acid consumption during pregnancy and the chances of occurrences of pre-eclampsia or eclampsia among Indian women. A cross sectional observational study was performed by using NFHS-5 (2019-21) data. 190,797 ever married women aged between 15-49 years who had a live birth in the past five years preceding the survey were availed for this study. Multivariable logistic regression analysis was carried out to find out the association between dietary and supplementary intake and occurrences of eclampsia. About 3.6% of the sample women had pre-eclampsia or eclampsia. The results of the study indicated that the likelihood of the prevalence of pre-eclampsia or eclampsia was significantly higher among those women who did not take adequate diet and as well as not consumed iron and folic acid tablet or syrup for at least 90 days during pregnancy compared to those women who took adequate diet and iron and folic acid supplementation even after controlling some maternal, health and lifestyle, socio-economic and demographic characteristics. Integrated and quality ANC services can only ensure adequate nutritional intake in terms of healthy and balanced diet. So, quality ANC services and with this micronutrients intake could be an effective way to reduce the prevalence of pre-eclampsia or eclampsia.

The association between antenatal coffee consumption and preeclampsia: a systematic review and meta-analysis

BACKGROUND

A growing body of evidence has documented unfavorable maternal outcomes attributed to excessive antenatal coffee consumption. Preeclampsia is one of the most common hypertensive disorders of pregnancy with several adverse maternal and neonatal outcomes. However, the association between antenatal coffee consumption and preeclampsia remains debatable. Herein, we performed a systematic review and meta-analysis of available evidence to investigate this association.

METHODS

After systematically reviewing PubMed and Scopus for eligible studies published until October 2023, we pooled the odds ratios (ORs) and their 95% confidence intervals (CIs) of preeclampsia for women who reported the highest versus the lowest frequencies of antenatal coffee consumption. We used the I2 statistic to measure heterogeneity across studies and the funnel plot asymmetry to assess publication bias.

RESULTS

This meta-analysis included seven retrospective studies (six case-control studies and one cross-sectional study) investigating 904 women with preeclampsia and 6,257 women without it. Combined, the highest frequencies of antenatal coffee consumption were associated with higher odds of preeclampsia: (pooled OR = 1.39, 95% CI: 1.03, 1.86), with a moderate heterogeneity across studies (I2 = 40.34% and p-value for heterogeneity = 0.122) and no publication bias (z = 0.610 and p-value for publication bias = 0.542). However, excluding the cross-sectional study, which contributed to 24.3% of the meta-analysis weight, left the association statistically non-significant: (pooled OR = 1.33, 95% CI: 0.91, 1.95; I2 = 44.59%). The association became even weaker after limiting the analysis to studies that excluded women with chronic hypertension: (pooled OR = 1.21, 95% CI: 0.77, 1.89; I2 = 41.64%) or after excluding studies with low quality: (pooled OR = 1.24, 95% CI: 0.70, 2.19; I2 = 65.79%).

CONCLUSION

The association between antenatal coffee consumption and preeclampsia remains inconclusive. Future prospective cohort studies are needed to better investigate this association.

Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study

Background and Aims

Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services.

Methods

An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance.

Results

In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m² (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE.

Conclusion

In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.

Dietary inflammatory index, inflammation biomarkers and preeclampsia risk: a hospital-based case-control study

This study evaluated the association between inflammatory diets as measured by the Dietary Inflammatory index (DII), inflammation biomarkers and the development of preeclampsia among the Chinese population. We followed the reporting guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology statement for observational studies. A total of 466 preeclampsia cases aged over 18 years were recruited between March 2016 and June 2019, and 466 healthy controls were 1:1 ratio matched by age (±3 years), week of gestation (±1 week) and gestational diabetes mellitus. The energy-adjusted DII (E-DII) was computed based on dietary intake assessed using a seventy-nine item semiquantitative FFQ. Inflammatory biomarkers were analysed by ELISA kits. The mean E-DII scores were -0·65 ± 1·58 for cases and -1·19 ± 1·47 for controls (P value < 0·001). E-DII scores positively correlated with interferon-γ (r s = 0·194, P value = 0·001) and IL-4 (r s = 0·135, P value = 0·021). After multivariable adjustment, E-DII scores were positively related to preeclampsia risk (Ptrend < 0·001). The highest tertile of E-DII was 2·18 times the lowest tertiles (95 % CI = 1·52, 3·13). The odds of preeclampsia increased by 30 % (95 % CI = 18 %, 43 %, P value < 0·001) for each E-DII score increase. The preeclampsia risk was positively associated with IL-2 (OR = 1·07, 95 % CI = 1·03, 1·11), IL-4 (OR = 1·26, 95 % CI = 1·03, 1·54) and transforming growth factor beta (TGF-β) (OR = 1·17, 95 % CI = 1·06, 1·29). Therefore, proinflammatory diets, corresponding to higher IL-2, IL-4 and TGF-β levels, were associated with increased preeclampsia risk.

Determinants of Pregnancy-Induced Hypertension among Mothers Attending Public Hospitals in Wolaita Zone, South Ethiopia: Findings from Unmatched Case-Control Study

BACKGROUND

It has been estimated that approximately 14% of maternal death has resulted due to pregnancy-induced hypertension. Evidence also suggests that pregnancy-induced hypertension may result in adverse maternal and child outcomes. The aim of this study was to assess the determinants of pregnancy-induced hypertension among mothers attending antenatal and delivery services at public health hospitals in Wolaita zone, southern Ethiopia.

METHODS

An institutionally based unmatched case-control study was conducted at three public hospitals. A total of 283 study participants were recruited for this study. Cases were selected consecutively as they were being diagnosed for pregnancy-induced hypertension, and two controls were selected for each case. Data were collected via the face-to-face interview technique using a pretested questionnaire. Unconditional logistic regression analysis was used to identify the independent predictor variables and produced odds ratio (OR) as a measure of association.

RESULTS

The mean ± (SD) ages of cases and controls were 26.1 ± 5.4 and 26.1 ± 4.5 years, respectively. Being rural residents (AOR: 2.25, 95% CI: 1.09-4.65), illiterate (AOR: 3.12, 95% CI: 1.20-8.08), having the history of pregnancy-induced hypertension (AOR: 6.62, 95% CI: 2.48-17.71), history of kidney disease (AOR: 3.14, 95% CI: 1.05-9.38), and family history of hypertension (AOR: 5.59, 95% CI: 2.73-11.45) were determinants that increased the odds of suffering from hypertensive disorders of pregnancy. More importantly, eating vegetables and fruit reduces the odds of suffering from pregnancy-induced hypertension by 77% (AOR: 0.23, 95% CI: 0.06-0.79).

CONCLUSION

Being rural residents, illiterate, having a history of pregnancy-induced hypertension, and history of kidney disease, as well as the family history of hypertension were identified determinates of hypertensive disorders of pregnancy in the study area. Furthermore, fruit and vegetable intakes were identified as protective factors for pregnancy-induced hypertension. Therefore, early diagnosis and intervention of this disorder are warranted to reduce adverse outcomes.

Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study

BACKGROUND

In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk.

METHODS

A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model.

RESULTS

We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25).

CONCLUSION

Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.

Prenatal vitamin D supplementation reduces blood pressure and improves placental angiogenesis in an animal model of preeclampsia

BACKGROUND

Preeclampsia (PE), a pregnancy complication, is characterized by abnormal placental angiogenesis. The current study examines the effect of vitamin D deficiency/supplementation on pregnancy outcome and placental angiogenesis using an animal model of PE.

METHODS

Pregnant Wistar rats were divided into four groups: Control; PE; Vitamin D deficient with PE (VDD-PE) and Vitamin D supplemented with PE (VDS-PE). PE was induced by administering l-nitroarginine methyl ester (l-NAME) at the dose of 50 mg per kg body weight per day from day 14 to day 19 gestation in all the 4 groups. During the pre-pregnancy and pregnancy period, the rats from the Control and PE groups were fed a control diet, the VDD-PE group received a vitamin D deficient diet and the VDS-PE group received a vitamin D supplemented diet. Dams were sacrificed at d20 of gestation.

RESULTS

l-NAME administration increased systolic as well as diastolic blood pressure in both PE and VDD-PE groups as compared to the control (p < 0.01). Vitamin D supplementation was beneficial in reducing the blood pressure. Vitamin D deficiency also lowered the placental protein levels of pro-angiogenic proteins VEGF and Flt-1 (p < 0.05 and p < 0.01, respectively), while the levels of these proteins in the VDS-PE group were similar to those in the control group. Vitamin D status did not influence the levels of PlGF and Hif1α.

CONCLUSION

A low dose vitamin D supplementation given from pre-pregnancy and throughout pregnancy was beneficial in reducing the blood pressure and normalizing the placental levels of VEGF and Flt-1. This has implications for reducing the severity of preeclampsia.

Prevalence and determinants of hypertensive disorders of pregnancy in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Hypertensive disorder of pregnancy is the second commonest causes of maternal death globally. Different public health studies were conducted on hypertensive disorder of pregnancy which presented inconsistent result. Therefore, this systematic review and meta-analysis was commenced to summarize the findings conducted in several parts of the country and to generate the nationwide representative data on the prevalence and risk factors of hypertensive disorder of pregnancy in Ethiopia.

METHODS AND MATERIALS

Electronic databases such as PubMed, Scopus, Google Scholar, Hinari, and African Journals Online were searched for studies published in English up to March, 2020. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument and Newcastle-Ottawa Scale were used for data extraction and quality assessment of the included studies. The meta- regression analysis was computed at 95% CI to present the pooled prevalence and risk factors of hypertensive disorder of pregnancy.

RESULTS

Thirty four studies were included in this systematic review and meta-analysis. The pooled prevalence of hypertensive disorder of pregnancy and preeclampsia in Ethiopia were 6.82% (95% CI (5.90, 7.74)) and 4.74% (95% CI (3.99, 5.49)) respectively. Maternal age ≥35 years (Adjusted Odds Ratio (AOR): 2.91 (95% CI: 1.60, 5.26)), twin pregnancy (AOR: 3.04 (95% CI: 1.89, 4.87)), previous history of preeclampsia (AOR: 5.36 (95% CI: 3.37, 8.53)), family history of hypertension (AOR: 4.01 (95% CI: 2.65, 6.07)), family history of diabetes mellitus (AOR: 3.07 (95% CI: 1.66, 7.70)), body mass index ≥25 (AOR: 3.92 (95% CI: 1.82, 8.42)), alcohol consumption (AOR: 1.77 (95% CI: 1.11, 2.83)), urinary tract infection (AOR: 4.57 (95% CI: 3.47, 6.02)), lack of nutritional counseling during antenatal period (AOR: 4.87 (95% CI: 3.36, 7.06)), lack of fruits (AOR: 3.49 (95% CI: 2.29, 5.30)), and vegetables consumption (AOR: 2.94 (95% CI: 2.01, 4.31)) were the risk factors of hypertensive disorder of pregnancy in Ethiopia.

CONCLUSIONS

The pooled prevalence of hypertensive disorder of pregnancy is relatively higher compared with the previous reports. Maternal age ≥35 years, twin pregnancy, previous history of preeclampsia, family history of hypertension, family history of diabetes mellitus, body mass index ≥25, alcohol consumption, urinary tract infection, lack of fruits and vegetables during pregnancy were risk factors of hypertensive disorder of pregnancy. The governments and stakeholders should work to strengthen the antenatal care practice to include the possible risk factors of hypertensive disorders of pregnancy.

Systematic and meta-analysis of factors associated with preeclampsia and eclampsia in sub-Saharan Africa

Background

Preeclampsia and eclampsia are common complications of pregnancy globally, including sub-Saharan African (SSA) countries. Although it has a high burden on maternal and neonatal mortality and morbidity, evidence on the risk of the problem is limited. Therefore, the aim of this review was to examine the factors associated with preeclampsia and eclampsia among mothers in SSA countries.

Methods

We searched article from SSA countries using electronic database MEDLINE, EMBASE, PubMed, CINAHL published in English from January 2000 to May 2020. Two reviewers independently screened, extracted and assessed the quality of the articles. Both random and fixed effect model were used for analysis. Heterogeneity of the studies and publication bias were checked. STATA 16 used for analysis.

Results

Fifty-one studies met the inclusion criteria and included in this review. The following factors were identified through meta-analysis: being primiparous (OR: 2.52; 95% CI:1.19, 3.86), previous history of maternal preeclampsia/eclampsia (OR:5.6; 95% CI:1.82, 9.28), family history of preeclampsia/eclampsia (OR:1.68; 95% CI:1.26, 2.11), high maternal body mass index (OR: 1.69; 95% CI:1.17, 2.21), chronic hypertension (OR: 2.52; 95% CI:1.29, 3.74), anaemia during pregnancy (OR: 3.22; 95% CI:2.70, 3.75) and lack of antenatal care visits (OR: 2.71; 95% CI:1.45, 3.96). There was inconclusive evidence for a relationship with a number of other factors, such as nutrition and related factors, antenatal care visits, birth spacing, and other factors due to few studies found in our review.

Conclusions

The risk of preeclampsia and eclampsia is worse among women who have a history of preeclampsia/eclampsia (either themselves or family members), primiparous, obesity and overweight, living with chronic disease, having anaemia during pregnancy and absence from ANC visits. Therefore, investment must be made in women’s health needs to reduce the problem and health service providers need to give due attention to high-risk women.

Adherence to a Dietary Approaches to Stop Hypertension (DASH)-style Diet in Relation to Preeclampsia: A Case-Control Study

Maternal diet is an important potential factor associated with the risk of preeclampsia. However, it is unclear whether adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet can reduce the development of preeclampsia. To examine the potential association, we conducted a hospital-based case-control study at the First Affiliated Hospital of Zhengzhou University, China. A total of 449 cases with preeclampsia and 449 controls were studied. Dietary information was collected using a validated food frequency questionnaire (FFQ). DASH scores were calculated according to nutrients/food emphasised or minimised in the DASH diet. The calculated DASH scores ranged from 11 to 38 for all of the participants, and the DASH scores of the cases were significantly lower than those of the controls (23.48 ± 4.58 vs 24.51 ± 4.51; p = 0.001). Participants in the fourth quartile of the DASH score were 45% less likely to have preeclampsia than those in the first quartile in the crude model (Q4 vs Q1, odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.38, 0.80; p_trend = 0.001). The relationship remained significant in the model adjusted for multiple confounders, especially for major risk factors of preeclampsia (OR: 0.53; 95% CI: 0.36, 0.78; p_trend = 0.001). Our findings suggest an inverse relationship between adherence to a DASH-style diet and the odds of preeclampsia. Further larger-scale cohort studies or randomised controlled trials are warranted to confirm these relationships.