Determinants of Preeclampsia Among Pregnant Mothers Attending Antenatal Care (ANC) and Delivery Service in Gedeo Zone, Southern Ethiopia: Case Control-Study

Pregnancy-Induced Hypertensive Disorders predictors among pregnant and delivery mothers receiving care in public health institutions in Sidama, Ethiopia: a multicenter case control study

BACKGROUND

Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5-10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.

OBJECTIVE

To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.

METHODS

A multi-center unmatched case-control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer-Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.

RESULTS

Out of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5-10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M2 (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).

CONCLUSIONS

The study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don't ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects.

Determinants of preeclampsia among women who gave birth at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia: a case-control study

Pre-eclampsia and eclampsia are the second leading causes of maternal mortality and morbidity. It also results in high perinatal mortality and morbidity. Since eclampsia is preceded by preeclampsia and shows the progression of the disease, they share the same pathogenesis and determining factors. The purpose of this study was to determine determinants of preeclampsia, since it is essential for its prevention and/or its associated consequences. An unmatched case-control study was conducted from September 1-30, 2023 among women who gave birth from June 1, 2020, to August 31, 2023, at Hiwot Fana Comprehensive Specialized University Hospital. Women who had preeclampsia were considered cases, while those without were controls. The sample size was calculated using EPI Info version 7 for a case-control study using the following assumptions: 95% confidence interval, power of 80%, case-to-control ratio of 1:2, and 5% non-response rate were 305. Data was collected using Google Form, and analyzed using SPSS version 26. Variables that had a p-value of < 0.05 on multivariable logistic regression were considered statistically significant, and their association was explained using an odds ratio at a 95% confidence interval. A total of 300 women (100 cases and 200 controls) with a mean age of 24.4 years were included in the study. Rural residence (AOR 2.04, 95% CI 1.10-3.76), age less than 20 years (AOR 3.04, 95% CI 1.58-5.85), history of hypertensive disorders of pregnancy (AOR 5.52, 95% CI 1.76-17.33), and no antenatal care (AOR 2.38, 95% CI 1.19-4.75) were found to be the determinants of preeclampsia. We found that living in a rural areas, previous history of preeclampsia, no antenatal care, and < 20 years of age were significantly associated with preeclampsia. In addition to previous preeclampsia, younger and rural resident pregnant women should be given attention in preeclampsia screening and prevention.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia.

METHODS

To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model.

RESULTS

Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia.

CONCLUSIONS

When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

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.

Risk Factors of Pre-eclampsia: A Hospital-Based Case-Control Study

Introduction Pre-eclampsia is a pregnancy-specific hypertensive disorder and is one of the leading causes of maternal and infant morbidity and mortality in India and worldwide. Evidence of the association between various risk factors and pre-eclampsia is scarce in developing countries. As pre-eclampsia remains a leading cause of maternal mortality and morbidity, focusing on the causes and risk factors of pre-eclampsia during antenatal surveillance would prevent maternal deaths and reduce the maternal mortality rate. Our study aimed to determine the risk factors of pre-eclampsia. Materials and methods An unmatched case-control study was conducted at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Burla, Odisha, taking 100 cases of pre-eclampsia and 100 controls without pre-eclampsia from January 2021 to January 2023. The study population included patients admitted to the Obstetrics & Gynecology labor room. Study participants were selected randomly from the labor room thrice weekly. Data were collected using a predesigned pre-tested questionnaire and case report format. Data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Appropriate statistical tests (Odds ratio, proportions, Chi-square test) were applied, and the final interpretation was made. Results Family history of hypertension (AOR = 4.2), history of chronic hypertension (AOR = 13.7), and AB blood group (AOR = 3.6) were found to be significant risk factors for pre-eclampsia. No significant association was found between pre-eclampsia and factors such as mother's age, caste, mother's education, type of family, socioeconomic status, education and occupation of husband, family history of diabetes mellitus, parity, history of abortion, and anemia. Conclusion Risk factors identified in the present study can be used to identify women at risk of pre-eclampsia during antenatal check-ups to minimize the complications of pre-eclampsia in both the mother and the fetus.

Determinants of pre-eclampsia among women attending delivery services in public health institutions of Debre Tabor Town: a case-control study

Background

The burden of pre-eclampsia has been continued as a public health importance in both developed and developing countries. However, the consequence of the disease is significantly high in developing countries, where treatment may be unsuccessful due to unclear etiology and late presentation of cases. The determinants of pre-eclampsia are not well known in the Ethiopian population specifically in the study area. Therefore, this study was aimed to identify the determinant factors of pre-eclampsia among women attending delivery services in public health institutions of Debre Tabor Town.

Methods

Unmatched case–control study was conducted from December 1, 2020, to January 15, 2021, among 264 mothers (88 cases and 176 controls). A case–control incidence density sampling technique was applied and data were collected using an interviewer-administered pre-tested questionnaire. Data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. Bivariate and multivariable logistic regression analyses were conducted. Finally, a significant association was declared at a p-value of ≤ 0.05 with 95% CI.

Results

Young age at menarche (10–15 years) (AOR: 7.69; 95% CI: 3.10–25.29), status of the current pregnancy (AOR: 5.88; 95% CI:2.93–22.42), new partner (AOR: 4.16; 95% CI: 3.49–17.03), family history of pre-eclampsia (AOR: 1.52; 95% CI: 1.40–4.18), and alcohol drinking (AOR: 2.18; 95% CI: 2.04–11.79) were found to be significantly associated with pre-eclampsia.

Conclusions

The current study identified that young age at menarche, the status of current pregnancy, new partner, family history of pre-eclampsia, and alcohol drinking were some of the determinant factors of pre-eclampsia. We suggested that health care providers should use these identified factors as a screening means for prediction, early diagnoses, and timely interventions of pre-eclampsia. Health care professionals should also deliver information regarding the risk of alcohol drinking during pregnancy in the preconception period and at early antenatal care services.

Pre-eclampsia has continued as a burden in both developed and developing countries. However, the consequence of the disease is significantly high in developing countries, where treatment may be unsuccessful due to unclear etiology and late presentation of cases.

Unmatched case–control study was conducted from December 1, 2020, to January 15, 2021, among 264 mothers (88 cases and 176 controls). A case–control incidence density sampling approach was applied and data were collected using an interviewer-administered pre-tested questionnaire.

Young age at menarche (10–15 years), the status of the current pregnancy, new partner, family history of pre-eclampsia, and alcohol drinking were found to be the significant determinant factors of pre-eclampsia. The authors recommended that health care providers should use the identified factors as a screening means for prediction, early diagnoses, and timely interventions of pre-eclampsia. Health care professionals should also deliver information regarding the risk of alcohol drinking during pregnancy in the preconception period and at early antennal care service.

Risk factors of preeclampsia among pregnant women admitted at labor ward of public hospitals, low income country of Ethiopia; case control study

BACKGROUND

Preeclampsia is a pregnancy-specific, multisystem disorder of unknown etiology, which characterized by new onset of high blood pressure & proteinuria after 20 weeks of gestation. Globally, it contributes 76,000 maternal deaths, 500,000 infant deaths annually, and the second common cause of maternal deaths. In Ethiopia, 19% of maternal deaths result from hypertensive disorder of Pregnancy.

OBJECTIVE

To assess the risk factors of preeclampsia among pregnant women admitted in labor ward of Public hospitals, Amhara Region Ethiopia, METHODS: A facility based unmatched case-control study design was conducted in two public hospitals of North Wollo Zone. Cases were pregnant women, who had confirmed diagnosis of preeclampsia, controls were those who had no evidence of preeclampsia, and 65 cases and 195 controls were selected by convenience and systematic random sampling techniques respectively. The collected data was interred in to in EPI INFO version 7.1, transferred, and analyzed using SPSS version 20.00 statistical software. Multivariate logistic regression was used to identify independent variables. Factors with P-value < 0.05 were taken as statistically significant of pre-eclampsia among pregnant women.

RESULT

All of the respondents of cases and controls were participated in the study. Factors associated with preeclampsia were respondents who had read and write (AOR = 3.22, 95% CI: (1.05-9.84)) and attended primary school [AOR = 7.02, 95% CI: (1.57-31.45)]. Those pregnant women, who had at least two ANC visit [AOR = 8.69, 95%CI: (1.43-52.85)] and those who had three visit [AOR = 12.59, 95%CI: (3.06-56.05)]. In addition to these, birth Interval less than 24 month [AOR = 4.09, 95% CI: (1.33-12.61)]. Birth Interval 24-35 month [AOR = 2.53, 95% CI: (1.38-11.87], respondents with family history of HPN (AOR = 5.93, 95%CI: (2.39-14.67), family history of DM [AOR = 2.15, 95%CI: (1.12-6.98)], and respondents with previous history of preeclampsia (AOR = 4.14 95%CI: (1.66-10.33) were identified significant factors of preeclampsia among pregnant women attended in labour ward.

CONCLUSION AND RECOMMENDATION

Educational status, antenatal care, lower birth interval, having family history of chronic HPN and DM, and history of preeclampsia were identified as major risk factors for occurrence of preeclampsia. Early detection of cases and intensive screening of pregnant women in every visit should be done and large-scale study will be done to identify other risk factors of preeclampsia.

Individual and Obstetric Risk Factors of Preeclampsia among Singleton Pregnancy in Hospitals of Southern Ethiopia

Background

Preeclampsia is the second most common problem that causes maternal morbidity and complication in low-income countries. In contrast to death due to other direct causes, preeclampsia-related death is appeared to be connected with multiple factors; yet, factors have paucity and are limited. Considering the clinical significance, this study aimed to identify that individual and obstetric factors of preeclampsia can be an input for disease identification involving clinicians in southern Ethiopia.

Methods

A case-control study was conducted among mothers with a singleton pregnancy who attended perinatal care in all six public hospitals in the provinces around the Omo stream. A sample size of 487 women with a singleton pregnancy (163 cases and 326 controls) was involved in the study. All cases were enrolled, while controls were selected consecutively using a random sampling technique. Data were gathered using a structured questionnaire and data extraction sheet. Descriptive data were presented using percentages and numbers. Multivariable logistic regression analysis was carried out to identify factors at a p value of less than 0.05.

Results

There was a statistically significant association between the family history of hypertension (AOR = 2.42, 95% CI: 1.16–5.05), no pregnancy interval (AOR = 1.62; 95% CI: 1.03–2.55), and normal body mass index (AOR = 0.42, 95% CI: 0.21–0.87) and the occurrence of preeclampsia.

Conclusion

Primary relatives with a history of chronic hypertension and no pregnancy interval were identified as risk factors of preeclampsia, while having a normal body mass index was found to be a protective factor of preeclampsia occurrence. To improve early detection and timely management of preeclampsia, the clinician should give attention to women who have no previous childbirth and whose close relatives had a history of chronic hypertension, as well as working on the protective factor is recommended.