Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis
Top Cited Papers
Open Access
- 21 March 2014
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (3), e91198
- https://doi.org/10.1371/journal.pone.0091198
Abstract
Pre-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. We 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. Data 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. Chronic 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.Keywords
This publication has 21 references indexed in Scilit:
- Double Burden of Noncommunicable and Infectious Diseases in Developing CountriesScience, 2012
- Risk Factors for Preeclampsia in Women from Colombia: A Case-Control StudyPLOS ONE, 2012
- Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysisThe Lancet, 2011
- Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern SudanBMC Research Notes, 2011
- Maternal and obstetric risk factors for low birth weight and preterm birth in rural Gambia: a hospital-based study of 1579 deliveriesOpen Journal of Obstetrics and Gynecology, 2011
- The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidityBulletin of the World Health Organization, 2010
- The Global Impact of Pre-eclampsia and EclampsiaSeminars in Perinatology, 2009
- Countdown to 2015 for maternal, newborn, and child survival: the 2008 report on tracking coverage of interventionsThe Lancet, 2008
- Methodological considerations in implementing the WHO Global Survey for Monitoring Maternal and Perinatal HealthBulletin of the World Health Organization, 2008
- Maternal infection and risk of preeclampsia: Systematic review and metaanalysisAmerican Journal of Obstetrics and Gynecology, 2008