Beyond severe acute maternal morbidity: a mixed‐methods study on the long‐term consequences of (severe pre‐)eclampsia in rural Tanzania

Abstract

objectives To explore the long-term (perceived) consequences of (severe pre-)eclampsia in rural Tanzania. methods Women were traced for this mixed-methods study 6-7 years after the diagnosis of (severe pre-)eclampsia. Demographic and obstetric characteristics were noted, and blood pressure was recorded. Questionnaires were used to assess physical and mental health. The qualitative part consisted of semi-structured interviews (SSI). A reference group consisted of women without hypertensive disorders of pregnancy. results Of 74 patients, 25 (34%) were available for follow-up, and 24 were included. Five (20%) had suffered from (pre-)eclampsia twice. Hypertension was more common after (pre-)eclampsia than in the reference group (29% vs. 13%). Thirteen women (56%) had feelings of anxiety and depression, compared to 30% in the reference group. In SSIs, experiences during the index pregnancy were explored, as well as body functions, reproductive life course and limitations in daily functioning, which were shown to be long-lasting. conclusions Women who suffered from (severe pre-)eclampsia may experience long-term sequelae, including hypertension, depression and anxiety. Women lack information about their condition, and some are worried to conceive again. To address their specific needs, a strategy along the continuum of care is needed for women following a complicated pregnancy, starting with a late postnatal care visit 6 weeks after giving birth.

Risk of future cardiovascular diseases in different years postpartum after hypertensive disorders of pregnancy: A systematic review and meta-analysis

“…These studies were conducted in Europe (27 studies), [ 35 , 39 , 40 , 42 , 45 , 46 , 48 , 50 , 52 , 54 – 57 , 60 , 61 , 64 , 66 , 68 , 70 , 73 , 76 , 79 , 82 – 84 , 88 , 92 ] North America (14 studies), [ 34 , 36 – 38 , 51 , 53 , 58 , 59 , 65 , 69 , 72 , 77 , 81 , 87 ] Asia (12 studies), [ 41 , 47 , 49 , 62 , 63 , 67 , 71 , 74 , 78 , 80 , 89 , 90 ] and other regions of the world. [ 43 , 44 , 75 , 85 , 86 , 91 ] The study design of the studies included was the retrospective cohort for 36 of them [ 34 , 35 , 37 , 38 , 41 , 44 , 46 , 49 , 52 – 56 , 63 – 68 …”

“…[ 36 , 39 , 40 , 42 , 54 , 55 , 58 , 72 , 80 ] Only 21 studies clearly showed the adjustment for both key confounding factors (age, smoking, and body mass index) and other factors, [ 37 , 38 , 43 , 45 , 51 , 53 , 54 , 56 , 57 , 59 , 61 , 64 , 68 , 69 , 73 , 77 , 81 , 84 , 88 , 89 , 91 ] while 8 studies did not adjust for any factors. [ 44 , 50 , 60 , 71 , 85 – 87 , 92 ] Adequate follow-up duration was reported in 27 studies. Data regarding completeness of follow-up were unavailable in 25 studies [ 37 , 38 , 43 , 44 , 46 , 49 – 51 , 53 , 54 , 56 , 57 , 59 , 60 , 63 , 65 – 68 , 72 , 76 , 78 , 88 , 90 , 91 ] and 7 of them had follow-up rates that were <80%.…”

“…[44,50,60,71,[85][86][87]92] Adequate follow-up duration was reported in 27 studies. Data regarding completeness of follow-up were unavailable in 25 Arnaout, 2019 [77] United States Retrospective cohort Gestational hypertension, preeclampsia 99,492 1,539,445 2.7 (median) Myocardial infarction, heart failure, stroke Huang, 2020 ‡ [78] Taiwan Retrospective cohort Hypertensive pregnancy 41,870 125,610 4.9 ¶ Hypertension, heart disease, stroke Scheres, 2020 [79] Netherlands Retrospective cohort Hypertensive pregnancy, preeclampsia 264,135 1,624,849 13.7 (median) Venous thromboembolism Wagata, 2020 [80] Japan Retrospective cohort Hypertensive pregnancy 1585 31,827 NS Hypertension Garovic, 2020 [81] United States Retrospective cohort Hypertensive pregnancy 571 1142 35.9 (median) Myocardial infarction, heart failure, stroke, dementia, hypertension Bergman, 2020 [82] Sweden Retrospective cohort Preeclampsia 34,923 857,502 NS Cardiovascular disease Moe, 2020 [83] Norway Prospective cohort Gestational hypertension, early-and late-onset preeclampsia 116 94 1.1 (median) Hypertension Sharma, 2021 [84] Sweden Prospective cohort Preeclampsia 115 2319 49.9 (median) Cardiovascular diseases Mooij, 2021 [85] Tanzania Retrospective cohort Severe preeclampsia, eclampsia 24…”

Role of male partners in the long-term well-being of women who have experienced severe pre-eclampsia and eclampsia in rural Tanzania: a qualitative study

“…In general, perinatal deaths are common in SAMM, and in our original sample of 81 episodes of (pre-) eclampsia the perinatal death rate was 30% (Mooij et al 2015). This means long-term effects after SAMM arise not only due to persistent maternal illness but also because of the perinatal loss in childbearing (de Kok et al 2010;Mooij et al 2021).…”

Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review

“…Significantly higher rates of hypertension (mean follow-up time 6–10 years) were also reported among Iranian women with a history of PE (adjusted HR 3.6) or GH/PE (adjusted RR 2.8), Jordanian women with history of PE (RR 13.0) or GH (RR 7.7), Pakistani women with a history of HDP (adjusted OR 2.2) and Turkish women with a history of PE (RR NR) ( 81 , 83 , 90 , 93 , 122 – 124 ). Among Tanzanian women, prevalence of hypertension was increased (29% vs. 13%) 5–7 years after pregnancy complicated by PE ( 111 ). Among US women, higher rates of hypertension after PE were reported in non-Hispanic Black women (21%) compared to Hispanic and Non-Hispanic White women on average 3 years postpartum ( 105 ).…”