Gestational hypertension and progression towards preeclampsia in Northern Ethiopia: prospective cohort study

Abstract

Background Preeclampsia (PE) is one of the main causes of medical complication of pregnancy and is the main cause of perinatal mortality and morbidity. It is one of the top causes of maternal mortality in Ethiopia. Also known as transient hypertension, gestational hypertension (GH) is increased blood pressure during pregnancy without proteinuria, which is expected to return to normal by the 12th-week postpartum visit. PE is GH with proteinuria and /or other systemic manifestations. Evidence from high income countries show that GH significantly progresses towards PE. To our knowledge, this is the first study on the progression of GH towards PE in an African setting. The objective of this study is, therefore, to assess the incidence of GH, progression towards PE and factors associated with progression in Ethiopia. Methods This is a prospective cohort study conducted at Ayder Comprehensive Specialized Hospital (ACSH) and Mekelle General Hospital (MGH), the largest referral centers in Northern Ethiopia. Two hundred and forty women with GH were enrolled and followed up until delivery. Clinical and laboratory data at initial presentation and at follow-up were compared among women who progressed towards PE and who remained with the diagnosis of GH. Logistic regression analysis was employed to model the combined effects of the clinical and laboratory data as significant predictors of progression from GH to PE. Result The incidence of GH in this study was 6 % (4.9–8.5). The rate of progression was 17.1 % (13.4–23.8). Previous history of GH, anemia during pregnancy, previous second-trimester spontaneous abortion were significant predictors of progression. Conclusions There is a high rate of progression of GH towards PE. In a resource-limited setting where predictive and diagnostic tools are scarce, clinical profile of women should be taken into consideration for prediction and diagnosis of PE.

The Association Between High Hemoglobin Levels and Pregnancy Complications, Gestational Diabetes and Hypertension, Among Palestinian Women

“…It has been reported that the elevation of hematocrit and Hb levels increases blood viscosity and that increased viscosity through an effect on blood pressure may partly worsen cardiovascular function [28]. Another utility of this association lies in the early detection of high gestational hypertension risk pregnancies, prompting closer follow-ups and more intensive interventions to decrease its consequences on pregnant women, including progression to PE [29]. Other adverse effects of gestational hypertension include increased risk of cesarian delivery, preterm delivery, and intrauterine growth restriction [30].…”

Association between previous spontaneous abortion and preeclampsia: a case–control study

“…A total of 180 women were included in each study group (a ratio of 1:1); the sample size was calculated on the basis of previous data on the history (43.0%) of spontaneous abortions among women with preeclampsia in neighboring Ethiopia [ 6 ]. Therefore, we assumed that 40.0% of women with a history of spontaneous abortion would have preeclampsia and 25.0% of women with a history of spontaneous abortion would not have preeclampsia.…”

“…Moreover, most these studies have been conducted in high-income countries [ 7 , 9 , 13 , 16 ]. There is a scarcity of data on the history of abortion and preeclampsia in sub-Saharan African countries [ 6 ], and none of these studies have been conducted in Sudan. The risk factors for preeclampsia may differ in different populations.…”

The Hypertensive Disorders of Pregnancy: A Focus on Definitions for Clinical Nephrologists

“…Gestational or pregnancy-induced hypertension, which affects up to 10% of pregnant women, is recognized by all societies as new-onset blood pressure (BP) ≥ 140/90 mmHg at or after 20 gestational weeks. The risk of progression to PE is estimated as 17.1–25% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. About 50% of patients with gestational hypertension continue to have high BP levels after delivery.…”