Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis

Abstract

BackgroundPre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes.MethodsWe performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels.ResultsData for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92–2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26–1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77–8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63–2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86–3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03–1.24) and severe anemia (AOR: 2.98; 95%CI 2.47–3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83–0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight.ConclusionChronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended.

The Examination of the Risk factors for Pre-Eclampsia in the Pregnant Coming to Fatemiyeh Hospital, Hamadan, 2005-2015 (Retrospective Case-Control Study)

“…In Lecarpentier et al (2013) study also showed that chronic blood pressure in women before pregnancy increased the risk of preeclampsia which was consistent with the results of the present study [30]. The Results also showed that number of nulliparous individuals is higher in both groups than the others, and the prevalence of preeclampsia was higher in women without pregnancy, which is consistent with findings by Bilano [31]. Also, in Kashaniyan et al study, the occurrence of nulliparity was significantly higher among the women of the case group, so that nulliparity was considered as a risk factor for preeclampsia can be suggested the background of genetic or behavioral phenomenon in an individual [32].…”

Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

“…It affects 5-10% of pregnancies worldwide and 4.6% of pregnancies in India. 1,2 It forms one member of the deadly triad, along with hemorrhage and infection that contribute greatly to maternal morbidity and mortality (14% worldwide, 29.54% in India). 3,4 Studies have shown that defective trophoblastic invasion of the placenta plays a crucial role in the pathogenesis of preeclampsia.…”

Fosfomycin Therapy for Non-Complicated Lower Urinary Tract Infections during Pregnancy: Tanta University Experience

“…Asymptomatic bacteruria should be treated to prevent the occurrence of symptomatic bacteruria as cystitis and pyelonephritis and to prevent its hazards on pregnancy outcomes. At the same time it should be known that asymptomatic bacteruria carries a great risk for development of pre-eclampsia, chorio-amnionitis and preterm delivery [18] [19] [20].…”