Incidence and Risk Factors of Pre-Eclampsia in the Paropakar Maternity and Women's Hospital, Nepal: A Retrospective Study

Diagnostic Accuracy of Serum Glycosylated Fibronectin in Prediction of Preeclampsia: A Nested Case-Control Study

BACKGROUND

Preeclampsia is a life-threatening complication of pregnancy that occurs in approximately 7% of all pregnancies. In India, the incidence of preeclampsia is 8%-10% and the prevalence is 5.4%, whereas the prevalence of hypertensive disorders of pregnancy is 7.8%.

AIM AND OBJECTIVES

This study was aimed at evaluating the diagnostic accuracy of serum glycosylated fibronectin (S. GlyFn) in the prediction of preeclampsia.

METHODS

A nested case-control study was carried out for 16 months in the department of obstetrics and gynecology. A total of 240 women were recruited and followed after written consent and ethical clearance. Six were lost to follow-up, 15 had second-trimester abortions (excluded from the study), and 32 women developed hypertensive disorders of pregnancy (cases), out of which 1 woman developed antepartum eclampsia, 10 women developed preeclampsia with severe features, and 21 women developed preeclampsia without severe features. One hundred and eighty-seven women remained normotensive throughout the pregnancy until 6 weeks postpartum. After randomization, out of these samples, 54 were analyzed and considered controls. Levels of S. GlyFn were estimated using an ELISA kit using the ELISA technique.

RESULTS

The mean S. GlyFn level was significantly higher at the time of enrollment among those women who later developed preeclampsia (127.59 ± 27.68 ng/m) as compared to controls (107.79-53.51 ng/mL). GlyFn at a cutoff value of 126.70 ng/mL significantly (P = 0.034) discriminates cases of preeclampsia with severe features from healthy controls with a sensitivity of 90.00%, a specificity of 63.00%, a 31.03% positive predictive value, and 97.14% negative predictive value.

CONCLUSION

S. GlyFn, at a cutoff value of 126.70 ng/mL, had good sensitivity to discriminate PE from normotensive and was also a good prognostic marker.

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.

Association between iron-folic acid supplementation and pregnancy-induced hypertension among pregnant women in public hospitals, Wolaita Sodo, Ethiopia 2021: a case- control study

BACKGROUND

Pregnancy-induced hypertension is the new onset of high blood pressure after 20 weeks of gestation in women with previously normal blood pressure. To the best of our knowledge, no study has been conducted in our country to investigate the association between this pregnancy problem and iron-folic acid supplementation. The aim of this study was to determine the association between iron-folic acid supplementation and pregnancy-induced hypertension (PIH) in pregnant women at public hospitals in the Wolaita Sodo zone.

METHODS

An institution-based case-control study was conducted among pregnant women who visited public hospitals in the Wolaita Sodo zone from March 3, 2022, to August 30, 2022. A consecutive sampling method was used to select the study participants. The total sample size was 492, of which 164 were cases and 328 were controls. The data were collected by conducting face-to-face interviews and measurements. The data were entered into EpiData version 4.6 and exported to STATA 14 for analysis. Those variables with a p-value less than 0.05 were considered statistically significant. Descriptive statistics and odds ratios were presented using texts, tables, and figures.

RESULTS

A total of 471 women participated in this study, yielding a response rate of 96%. The cases had a mean age of 25 ± 4.43, while the controls had a mean age of 25 ± 3.99. The mean age at first pregnancy among cases was 20 ± 2.82 and among controls was 20 ± 2.97. The average number of deliveries for cases and controls was 1.97 ± 1.41 and 1.95 ± 1.38, respectively. There is no significant association between iron-folic acid supplementation and PIH. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it (AOR = 3.65; 95% CI: 1.0-12.9). Eating kocho (AOR = 14.4; 95% CI: 1.2-16.7) was positively associated with PIH.

CONCLUSIONS

There is no association between iron-folic acid supplementation during pregnancy and pregnancy-induced hypertension. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it. There is an association between kocho consumption and PIH. More research should be done using stronger designs.

A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia

In India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality. The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level. Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia). Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %). Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients.

Description and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in North-Eastern Bihar: A retrospective study

Background

Hypertension is one of the most common medical disorders complicating pregnancy. In India, high blood pressure contributes to 7.1% of maternal deaths. This study was carried out to describe the characteristics and pregnancy outcomes of patients presenting with eclampsia or pre-eclampsia to a secondary care hospital in rural India.

Methods

Patients diagnosed with pre-eclampsia or eclampsia between January 2018 and April 2021 were identified and included in the study. Medical records were searched and general patient characteristics, obstetrical history, information about the antenatal period, mode of delivery and outcomes were documented and analysed.

Results

Among the 3651 women who delivered in this hospital during this time period, 2.3% (n = 83) presented with eclampsia and 1.9% (n = 71) with pre-eclampsia. More than 50% of the women delivered by lower segment caesarean section among both the eclamptics and pre-eclamptics. The stillbirth rate among those with either pre-eclampsia or eclampsia was 1 per 1000. The number of low birth weight babies born to those presenting with eclampsia (66.7%) was significantly more than those presenting with pre-eclampsia (48.6%). Eclampsia/pre-eclampsia accounted for 21% of all maternal deaths with a case fatality rate of 2.6%.

Conclusions

This study identified that in this setting the patients presenting with eclampsia were much higher than those presenting with pre-eclampsia which is in stark contrast to the status even in developing countries. This could be an important finding indicating poorer health-seeking behaviour among the population and will need more studies on various interventions to change this status.

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.

Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world

Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.

Epigenetic Modification in Methylene Tetrahydrofolate Reductase (MTHFR) Gene of Women with Pre-eclampsia

Background

Genetic and epigenetic factors play significant roles in the aetio-pathogenesis of pre-eclampsia (PE). The effects may vary across racial and geographical boundaries. The role of epigenetic modification in pre-eclampsia was studied among African populations in Lagos, Nigeria.

Aim and Objectives

This study aimed to determine the pattern of Methylene tetrahydrofolate reductase gene (MTHFR) CpG island methylation in pre-eclampsia, and evaluate associated covariates.

Methodology

This study was an observational, cross-sectional, study conducted at the Lagos University Teaching Hospital and the Lagos State Island Maternity Hospital. A total of 400 pregnant women consisting of 200 pregnant women diagnosed with pre-eclampsia (study group) and 200 pregnant normotensive and apparently healthy women (control group) were recruited for the study. Demographic and clinical histories were obtained through questionnaires. The DNA Methylation status of the CpG Island in promoter region of the MTHFR gene was assessed using bisulphite conversion and methylation specific PCR method. The biochemical parameters measured in the study were: red cell folate, vitamin B12, plasma homocysteine (Hcy) and methylene tetrahydrofolate reductase enzyme level.

Results

Homozygous MTHFR CpG island hypomethylation pattern was significantly associated with pre-eclampsia (χ ² = 22.96; p = 0.000), Mean values of plasma homocysteine in PE women with homozygous hypomethylation (26.1 ± 9.1 umol/L) were significantly higher than (20.1 ± 4.2 umol/L) observed in PE subjects with homozygous hypermethylation (p = 0.008). Homozygous CpG island hypomethylated pattern of the MTHFR promoter region, was associated with the lowest median MTHFR enzyme level (72.8 ± 39.8 pmol/L) compared with heterozygous methylated pattern (91.3 ± 60.9 pmol/L; p = 0.047) and homozygous methylated pattern (82.3 ± 31.0 pmol/L; 0.047). Red cell folate and Vitamin B12 levels were not significantly associated with CpG island methylation status.

Conclusion

Epigenetic modification plays significant role in the pathogenesis of pre-eclampsia.

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study

Background

Severe pre-eclampsia is more dominant in low and middle-income countries. In Sub-Saharan Africa, severe pre-eclampsia remains a major public health problem contributing to high rates of maternal mortality. Few studies have investigated the relationship between severe pre-eclampsia and associated factors in East Africa. The aim of this study was to determine the prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar.

Methods

A hospital based analytical cross-sectional study design was used. Purposive sampling was utilized for the selection of hospitals. Proportionate sampling was used for selection of representatives from each hospital and participants were selected using systematic random sampling. Postpartum mothers were included in the study. The study was conducted by an interviewer who administered a questionnaire with close ended questions and chart review for data gathering. SPSS version 23 was used for data analysis and descriptive and multiple logistic regression was performed for control of confounders.

Results

This study included a total of 400 participants with a 100% response rate. Participants ranged from 17 to 45 years of age with mean age (SD) of 28.78 (±6.296). The prevalence of severe pre-eclampsia among postpartum women was 26.3% (n = 105). After adjusting for the possible confounders, factors associated with severe pre-eclampsia were; maternal age group of 15–20 years (AOR 3.839; 95% C. I 1.037–14.210), pregnancy from new partner/husband (AOR 7.561; 95% C. I 3.883–14.724), family history of high blood pressure (AOR 6.446; C. I 3.217–12.917), diabetes prior to conception (AOR 55.827; 95% C. I 5.061–615.868), having high blood pressure in a previous pregnancy (AOR 19.382; 95% C. I 4.617–81.364), paternal age above 45 (AOR 2.401; 95% C. I 1.044–5.519) and multifetal gestation (AOR 7.62; 95% CI 2.01–28.84).

Conclusion

The prevalence of severe pre-eclampsia among postpartum women in Zanzibar is high. Common risk factors in this setting include maternal age of 15–20 years, pregnancy with a new partner, family history of high blood pressure, pre-existing diabetes prior to conception, a history of high blood pressure in previous pregnancy paternal age greater than 45 and multifetal gestation.

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.