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Global Burden of Disease 2000 Global burden of hypertensive disorders of pregnancy in the year 2000

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Dolea Carmen
Dolea Carmen
Carla Abouzahr
Carla Abouzahr
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Global Burden of Disease 2000
Global burden of hypertensive disorders of
pregnancy in the year 2000
Carmen Dolea1, Carla AbouZahr2
Evidence and Information for Policy (EIP),
World Health Organization,
Geneva, July 2003
1. Introduction
Hypertensive disorders of pregnancy (HDP) represent a group of conditions associated with high
blood pressure during pregnancy, proteinuria and in some cases convulsions. The most serious
consequences for the mother and the baby result from pre-eclampsia and eclampsia. These are
associated with vasospasm, pathologic vascular lesions in multiple organ systems, increased platelet
activation and subsequent activation of the coagulation system in the micro-vasculature1. Eclampsia is
usually a consequence of pre-eclampsia consisting of central nervous system seizures which often
leave the patient unconscious; if untreated it may lead to death. The long-term sequelae of both pre-
eclampsia or eclampsia are not well evaluated, and the burden of hypertensive disorders of
pregnancy stems mainly from deaths.
In the GBD 1990 hypertensive disorders of pregnancy ranked 75th in terms of DALYs and were
responsible for 6% of the burden of all maternal conditions. It was estimated that deaths due to
hypertensive disorders of pregnancy represented 13% of all maternal deaths. This draft paper
summarises the data and methods used to produce the Version 2 estimates of burden of hypertensive
disorders of pregnancy for the year 2000.
2. Case and sequelae definitions
The classification of HDP is difficult because of limited knowledge about its etiology and the lack of
conformity of definitions1. A WHO Study Group recommended the definitions listed in Table 2.1.
Further amendments to these definitions have been made by the American College of Obstetricians
and Gynaecologists, particularly for clinical purposes2. According to these, pre-eclampsia
superimposed is likely in women with hypertension alone who develop new proteinuria, or in women
with pre-existing hypertension and proteinuria who have sudden increase in blood pressure or
proteinuria, thrombocytopenia, or increases in hepatocellular enzymes.
1 Epidemiology and Burden of Disease WHO Geneva
2 Reproductive Health and Research, WHO, Geneva
2
Global Burden of Disease 2000
Table 2.1 Types of hypertension during pregnancy (WHO 1987)
Gestational hypertension Hypertension without the development of significant proteinuria (<0.3 g/l), after
20 weeks of gestation or during labour and/or within 48 hours of delivery
Unclassified hypertension
in pregnancy Hypertension found when blood pressure is recorded for the first time after 20
weeks of gestation or during labour and/or within 48 hours of delivery a)
Gestational proteinuria Development of significant proteinuria (>=0.3 g/l) after 20 weeks of gestation or
during labour and/or within 48 hours of delivery
Pre-eclampsia Development of gestational hypertension and significant proteinuria after 20
weeks of gestation or during labour and/or within 48 hours of delivery
Eclampsia Convulsions ante, intra- or postpartum
Underlying hypertension
or renal disease Underlying hypertension, or renal disease, or other known causes of
hypertension (such as pheochromocytoma)
Pre-existing hypertension
or renal hypertension and
or proteinuria in
pregnancy
Pre-existing hypertension, pre-existing renal disease, pre-existing other
causes of hypertension
Superimposed pre-
eclampsia/eclampsia a) Pre-existing hypertension with superimposed pre-eclampsia or eclampsia
(a worsening of hypertension, with an increase in diastolic blood pressure to at
least of 15 mm Hg above non-pregnancy values, accompanied by the
development or worsening of proteinuria
b) pre-existing renal disease with superimposed pre-eclampsia or eclampsia
a) This type of hypertension should be reclassified as gestational hypertension if blood pressure returns to normal during postnatal period,
although some of these patients may have underlying hypertension caused by renal disease
The definitions used by GBD 2000 are listed in table 2.2
Table 2.2 GBD 2000 case and sequelae definitions for hypertensive disorders of pregnancy
Cause category GBD 2000 Code ICD 9 codes ICD 10 codes
Hypertensive disorders of
pregnancy U045 642 O10-O16
Sequela Definition
Cases Pre-eclampsia: Gestational hypertension with significant proteinuria (>= 0.3
g/l) after 20 weeks of gestation or during labor and/or within 48 hours of
delivery (WHO 1987)
Eclampsia: convulsions occurring ante-, intra- or postpartum, associated with
high blood pressure and proteinuria
3. Incidence
Assessing the epidemiology of pre-eclampsia is difficult due to lack of conformity of the definitions
described above. There may also be measurement bias and errors in the ascertainment of both
hypertension and proteinuria. Because uniform diagnostic criteria are not always followed by those
3
Global Burden of Disease 2000
who study and report on hypertensive disorders of pregnancy, reported incidence may not be readily
comparable between sites1.
As a result, incidence of pre-eclampsia and eclampsia was based on a systematic review by Villar et
al. (unpublished) in which only studies where investigators made efforts to control and/or assure the
diagnosis of pre-eclampsia and eclampsia (blood pressure and proteinuria measurements,
documentation of seizure, etc.) were included. Some studies lacking details of diagnostic quality
assessment, but whose data demonstrated overall good quality were also included. The data
included in the review was population based and came from recently published reports as well as a
series of large recent data sets available to WHO. Estimates of incidence were stratified into data
from developing countries and more developed countries.
The pooled incidence of pre-eclampsia for developing countries was estimated to be 3.4%. This
figure was used for all WHO sub-regions B through to E. Two developed country studies were
included in the review for the incidence of pre-eclampsia. The incidence of pre-eclampsia was
estimated at 2.8% from the Norwegian Birth Registry for the period 1967-1998. The South East
Thames Study estimated pre-eclampsia incidence to be 0.4% for the period 1997-1998. A pooled
incidence rate was not estimated as it was not possible to disaggregate the Norwegian study by year.
The 0.4% incidence rate estimate from the South East Thames Study was therefore used as the
estimate of pre-eclampsia incidence for all WHO A sub-regions.
Incidence for eclampsia from the systematic review was 2.3% of pre-eclampsia cases for developing
regions and 0.8% of pre-eclampsia cases for developed regions.
Table 3.1. Regional incidence rates for pre-eclampsia and eclampsia
WHO region Pre-eclampsia incidence rate (%
births) Eclampsia incidence rate (as %
pre-eclampsia)
AFRO D 2.8 2.3
AFRO E 2.8 2.3
AMRO A 0.4 0.8
AMRO B 2.8 2.3
AMRO D 2.8 2.3
EMRO B 2.8 2.3
EMRO D 2.8 2.3
EURO A 0.4 0.8
EURO B1 2.8 2.3
EURO B2 2.8 2.3
EURO C 2.8 2.3
SEARO B 2.8 2.3
SEARO D 2.8 2.3
WPRO A 0.4 0.8
WPRO B1 2.8 2.3
WPRO B2 2.8 2.3
WPRO B3 2.8 2.3
4
Global Burden of Disease 2000
3.3 Time trends in hypertensive disorders of pregnancy
An assessment of the time trends of hypertensive disorders of pregnancy is difficult, due to lack of
consensus about the definitions used. Eclampsia is easier to recognise and incidence surveys have
been undertaken in England and Wales since 1922; these show a continuous decline in both
incidence and deaths from the condition1. As the incidence of eclampsia is influenced by the
availability and quality of antenatal care1, eclampsia mortality remains important in settings of high
maternal mortality3. Epidemiological studies conducted during the last decade show no decline in the
incidence of eclampsia in developing countries, suggesting an urgent need to better identify women at
risk and to improve access to treatment.
3.4 Risk factors for the development of hypertensive disorders of
pregnancy
Several risk factors have been found to be associated with an increased risk of developing pre-
eclampsia: the presence of type 1 diabetes, gestational diabetes, twin birth and obesity (body mass
index >29)4. The likelihood of progression from gestational hypertension to pre-eclampsia may be
increased by a prior miscarriage5,6. A study on a large cohort of Latin American and Caribbean
women identified the following risk factors for developing pre-eclampsia: nulliparity, multiple
pregnancy, history of chronic hypertension, gestational diabetes, maternal age over 35 years, fetal
malformation and obesity7. Using the same source of data (the Latin American and Caribbean
Perinatal System database) Conde-Agudelo et al. showed that interpregnancy intervals longer than
59 months are associated with an increased risk of pre-eclampsia and eclampsiaError! Bookmark not
defined..
4. Mortality and case fatality
Although eclampsia is responsible for the majority of deaths associated with hypertensive disorders
of pregnancy, death can occur in the absence of convulsions1. Evidence on case fatality rates of
eclampsia is limited to mainly hospital-based studies (table 4.1) where rates are likely to be higher.
As for other maternal conditions, deaths due to hypertensive disorders of pregnancy were estimated
using a proportional mortality model. A first set of regional estimates of total number of maternal
deaths have been produced using the methodology developed for WHO/UNICEF 1995 estimates
of maternal mortality8. Available information on cause of death distributions in each region, including
data from vital registration systems9, were then used to estimated the proportion of different causes
of maternal mortality10. Table 4.2 presents available data on the proportion of deaths due to
eclampsia among all maternal deaths.
Based on this evidence, the GBD 2000 study estimates the following case fatality rates for
hypertensive disorders of pregnancy (Table 4.3). As discussed above, case fatality reports from
hospital-based studies may be biased due to a selected high risk population.
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Global Burden of Disease 2000
Table 4.1. Case fatality rates for eclampsia
Region Setting Type of study Year Incidence per
100 live
births
Case fatality
rate (%) References
AFRO D
Burkina Faso,
Mali,
Mauritania,
Niger,
Senegal, Cote
d'ivoire*
Ouagadougou
, Bamako,
Nouakchott,
Niamey,
Kaolack
region,
Abidjan*
population-
based,
multicentre;
door-to-door
census of all
pregnant
women
1994-1996 0.19 18.4 Prual A,
Bouvier-Colle
MH et al, Bull
WHO 2000
Burkina Faso University
hospital,
maternity
wards,
Ouagadougou
retrospective
hospital
based
1992-1995 0.88 15.7 Prual A,
Bouvier-Colle
MH et al, Bull
WHO 2000
Niger Niamey, 6
maternity
wards
maternity
wards-based,
longitudinal
1997 0.22 5.9 Prual A et al,
Afr J reprod
Health1998
AFRO E
South Africa Kalafong and
Pretoria
Academic
hospitals
preospective
descriptive
multicentre
study: audit of
maternal near
miss (daily
case notes
review)
Sept 1996-
aug 1997 0.28 26.3 Buga Ga,
East Afr MEd
J, 1999
South Africa Ga-Rankuwa
Hospital Retrospective
hospital
based
Jan 1994-
Dec 1995 0.36 21.2
AMRO D
Peru Hospital
Nacional
Cayetano
hospital
based
prospective
1991-1997 0.4 8.0 Conde-
Agudelo A et
al, BMJ 2000
EURO A
UK 279 hospitals
in UK with a
consultant
obstetric unit
prospective
hospital
based and
questionnaire
s to
physicians
1992 0.05 1.8 Knuist M, Int
J oB Gyn,
1998
SEARO B
Thailand Rajavithi
Hospital,
Bangkok
hospital
based
retrospective
review
1988-1997 0.05 3.3 Chinayon P,
J Med Assoc
Thai 1988
6
Global Burden of Disease 2000
Table 4.2. Proportion of maternal deaths due to eclampsia
Region Setting Type of study Year Total
maternal
deaths
Proportion
maternal
deaths
associated with
eclampsia
Ref.
AFRO D
Guinea-Bissau The 5 northern
regions of
Guinea-Bissau
(82% of
population)
RAMOS∗ 1989-
1996 144 5.1 11
Guinea-Bissau All country RAMOS 1989-
1990 145 4.6 12
Burkina Faso,
Mali,
Mauritania,
Niger, Senegal,
Cote d'Ivoire
(AFRO E)
5 urban areas
and 1 rural area population based
prospective study 1994-
1996 55 10.9 13
AMRO A
USA Non federal
Maryland
hospitals
retrospective
hospital based 1984-
1997 135 22.2 14
SEARO D
Bangladesh Matlab area,
Bangladesh Verbal autopsy in
demographic
surveillance
system
1987-
1993 174 17.2 15
India RG Kar Med
Coll Hospital,
Calcutta, India
Retrospective
hospital based 1995-
1997 203 53.2 16
∗RAMOS = Reproductive Age Mortality Study
5. Disease model for hypertensive disorders of pregnancy
A disease model was developed for hypertensive disorders of pregnancy as described in figure 5.1.
During pregnancy, delivery or shortly thereafter (within 6 weeks), women with hypertensive
disorders of pregnancy may have renal or liver damage, pulmonary oedema and cerebral
haemorrhage. However, no long-term follow-up studies have been performed to evaluate the
consequences of eclampsia over time. A retrospective study at the King Edward VIII hospital in
Durban, South Africa, identified 140 cases of neurological complication during pregnancy among
14,881 deliveries within one year17. All but one of these cases had eclampsia, and all of them
recovered completely before discharge. A study from Norway using record linkage from 2 registers
between 1967 and 1992, the national medical birth register and the national register of causes of
7
Global Burden of Disease 2000
death, showed that women who had pre-eclampsia may have an increased risk of death from
cardiovascular causes in later life than non-pre-eclamptic women18.
Figure 5.1. Hypertensive disorders of pregnancy disease model.
a = incidence of pre-eclampsia and eclampsia
b = CFR for eclampsia
GM = general mortality
In the GBD 2000 neurological complications were therefore no longer considered as sequelae of
eclampsia and pre-eclampsia. Long-term follow-up studies are needed to evaluate the extent to
which women with hypertensive disorders of pregnancy and particularly eclampsia, will develop
long-term complications.
Table 5.1. Comparison between GBD 1990 and GBD 2000 disease models
GBD 1990 GBD 2000
Stages/Sequela
e Hypertensive disorders of pregnancy
Neurological sequelae
Pre-eclampsia / Eclampsia
Incidence rates Eclampsia: 0.5% of live births in
developing countries and 0.1% in
developed countries
Assumptions made for the rest of
HDP led to a world average of 5.5%
Pre-eclampsia: 2.8% of live births for developing
countries and 0.4% of live births in developed
countries.
Eclampsia: 2.3% of pre-eclampsia in developing
countries and 0.8% of pre-eclampsia in developed
countries
Assumed pre-eclampsia/eclampsia account for
50% of all hypetensive
Case fatality 2.9-16.4% 0.1% to 4.0%
Mortality 13% of all maternal deaths 14% of all maternal deaths
Pregnant
women
Pre-eclampsia/Eclampsia
Deaths
b
GM
a
8
Global Burden of Disease 2000
6. Regional incidence, prevalence and mortality estimates
Table 6.1. Hypertensive disorders of pregnancy: age-specific incidence and mortality rate
estimates for WHO epidemiological subregions, 2000.
Subregion Age-specific Incidence/1000
women 15-49 Age-specific mortality/100,000
women 15-49
AFRO D 11.50 18.46
AFRO E 11.72 20.49
AMRO A 0.41 0.11
AMRO B 5.21 2.10
AMRO D 7.16 9.32
EMRO B 6.94 1.05
EMRO D 7.83 4.46
EURO A 0.34 0.05
EURO B1 3.67 0.58
EURO B2 4.80 0.72
EURO C 2.25 0.10
SEARO B 5.26 2.76
SEARO D 7.75 8.59
WPRO A 0.35 0.03
WPRO B1 3.76 0.07
WPRO B2 5.86 4.27
WPRO B3 9.03 4.68
World 5.35 4.56
7. Global burden of hypertensive disorders of pregnancy in
2000
General methods used for the estimation of the global burden of disease are given elsewhere19. The
tables and graphs below summarise the global burden of hypertensive disorders of pregnancy
estimates for the GBD 2000 and compare them with the hypertensive disorders of pregnancy
estimates from the GBD 199020 .
9
Global Burden of Disease 2000
Table 7.1. Hypertensive disorders of pregnancy: global total YLD, YLL and DALY
estimates, 1990 and 2000.
GBD 1990 GBD 2000
Deaths (‘000) 57 73
YLD('000) 75 -
YLL('000) 1,656 2,231
DALY('000) 1,731 2,231
Table 7.2. Hypertensive disorders of pregnancy: YLD, YLL and DALY estimates for WHO
epidemiological subregions, 2000.
Subregion YLD/100,000 YLL/100,000 YLD(‘000) YLL(‘000) DALY(‘000)
AFRO D 0 293.2 0 492 492
AFRO E 0 344.0 0 584 584
AMRO A 0 1.9 0 3 3
AMRO B 0 48.2 0 108 108
AMRO D 0 199.7 0 71 71
EMRO B 0 21.1 0 14 14
EMRO D 0 105.2 0 72 72
EURO A 0 0.7 0 1 1
EURO B1 0 8.4 0 7 7
EURO B2 0 4.7 0 1 1
EURO C 0 1.3 0 2 2
SEARO B 0 74.4 0 147 147
SEARO D 0 107.2 0 700 700
WPRO A 0 0.3 0 0 0
WPRO B1 0 1.0 0 6 6
WPRO B2 0 26.9 0 19 19
WPRO B3 0 74.8 0 2 2
World 0 74.3 0 2,231 2,231
10
Global Burden of Disease 2000
8. Conclusions
These are Version 3 estimates for the GBD 2000. Apart from the uncertainty analysis, updating
estimates to reflect revisions of mortality estimates and any new or revised epidemiological data or
evidence, it is not intended to undertake any major addition revision of these estimates.
We welcome comments and criticisms of these draft estimates, and information on additional sources
of data and evidence. Please contact Colin Mathers (Evidence and Information for Policy, WHO
Geneva) on email mathersc@who.int.
Acknowledgements
We particularly wish to thank Stephen Lim, who carried out final revisions of the estimates and
documentation during the second half of 2003.
We particularly wish to thank colleagues from the Reproductive Health Research Department who
provided comments and suggestions on data sources and assumptions, particularly Metin Gulmezoglu,
José Villar, Luc de Bernis and Ana Betran. We thank Susan Piccolo for excellent secretarial
assistance. We would like to acknowledge the help of the many staff of the Global Programme on
Evidence for Health Policy who contributed to the development of life tables and cause of death
analysis. In particular we thank Omar Ahmad, Brodie Ferguson, Mie Inoue, Alan Lopez, Rafael
Lozano Doris Ma Fat, Christopher Murray and Chalapati Rao. This study has been supported by a
grant from the National Institute on Aging, USA.
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Full-text available
  • Jun 2024
Background: Hypertension in pregnancy continue to be among the major causes of maternal and perinatal morbidity and mortality, affecting 5-6% of pregnancies globally and contributing to a significant disease burden. Aims and objectives: To assess prevalence and factors associated with pregnancy induced hypertension among pregnant women aged 15 to 49 years at three general hospitals of Lusaka District. Methodology: Conducted cross sectional study with 413 systematically selected pregnant women attending antenatal clinics at Chawama, Chipata and Matero general hospitals from January 2019 to July 2020. The sample size for each hospital was determined proportionally based on twelve months of antenatal care visit data. Blood pressure, heights, weights, Body mass index and urinalysis were measured on all the study participants. A structured questionnaire collected data on social demographic and economic factors, reproductive and medical history. Data was analyzed using STATA version 13. Chi
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... [4] Null parity, multiple pregnancies, gestational diabetes, fetal malformation, obesity, extreme maternal age (less than 20 or over 40 years), history of PIH in previous pregnancies, chronic diseases like renal disease, diabetes mellitus, cardiac disease, unrecognized chronic hypertension, positive family history of PIH showing genetic susceptibility, psychological stress, alcohol use, rheumatoid arthritis, extreme underweight, and other factors increase the risk of PIH. [7,8] Understanding the prevalence, risk factors, and complications of each disease is necessary for its prevention. [4] Hence the present study was conducted to find out the incidence rate, highrisk factors, and maternal and perinatal outcomes associated with the hypertensive disorder. ...
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... According to the World Health Organization (WHO), its incidence is seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%) [6]. In the United States of America, pre-eclampsia is believed to be responsible for 15% of premature deliveries and 17.6% of maternal deaths [7]. ...
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... Pregnancy-induced hypertension (PIH) is a syndrome of hypertension with or without proteinuria and edema occurring after 20 weeks of gestation, and in some cases, convulsions occur when systolic blood pressure (BP) is greater than 140 mmHg and diastolic BP is greater than 90 mmHg. [1][2][3] Out of about 800 maternal deaths that occur globally, 99% are said to occur in low-and middle-income countries. 4,5 Notably, 80% of these deaths are due to four major causes: severe hemorrhage, infections, preeclampsia/eclampsia, and unsafe terminations. ...
Comparative sonographic assessment of renal volume and arterial Doppler velocimetric indices among women with pregnancy-induced hypertension and normotensive controls in Northern Nigeria
Article
Full-text available
  • Apr 2024
Introduction Pregnancy-induced hypertension is a global public health problem, worsening maternal morbidity and mortality. Renal complications have additional devastating consequences on maternal morbidity. Renal Doppler ultrasound is a valuable tool in the management of pregnancy-induced hypertension. It helps in the assessment of renal hemodynamics with the potential to monitor renal function and predict complications. We aimed to determine the relationship between the renal volume and arterial Doppler velocimetric indices in pregnancy-induced hypertension and matched normotensive controls. Methods Following the documentation of demographic and basic obstetric characteristics of 150 women with pregnancy-induced hypertension and an equal number of their matched controls, a 3.5-MHz convex transducer was used to measure the maternal renal volumes and renal arterial Doppler velocimetric indices (peak systolic velocity, end diastolic velocity, resistive index, pulsatility index, and systolic–diastolic radio). Student’s t-test and linear regression were used to determine the differences and relationships between the quantitative variables among women with pregnancy-induced hypertension and their controls. The association chi-square test was used to determine the association between the qualitative and categorical variables. A p-value of less than 0.05 was considered significant. Results The mean renal volume of pregnancy-induced hypertension patients is higher bilaterally when compared to normotensive women. The mean peak systolic velocity and resistive index in pregnancy-induced hypertension patients were significantly higher compared to normotensives (59.13 ± 13.5 vs 54.19 ± 9.8 cm/s; p < 0.001) and (0.74 ± 0.2 vs 0.68 ± 0.3). Conclusion The maternal renal volume and peak systolic velocity of the renal arteries are significantly higher in women with pregnancy-induced hypertension compared to normotensives.
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... HDP represents a group of conditions associated with high BP during pregnancy. There are, thus, several risk factors for an increased hypertension among women and adolescent girls during their pregnancy [19]. ...
Severe Hypertension During Pregnancy: Considerations for Preventive Measures by Health Care Providers
Article
Full-text available
  • Jul 2021
Medical professionals advocate that getting good health care before, during, and after pregnancy (which occurs when a sperm fertilizes an egg after it is released from the ovary during ovulation) is very important. This practice can help baby grow and develop sound physical and mental health during later stages of their life. Further, it is equally important to ensure that pregnant women are not subjected to hypertension situations. Furthermore, severe hypertension (defined as severely elevated blood pressure) can be risky from reproductive health (RH) point of view. However, pregnancy-induced hypertension (PIH) is common among pregnant women in many countries, especially in regions characterized by acute poverty and resulting malnutrition situations. It has been reported that the PIH, a form of high blood pressure (BP) in pregnancy, occurs, on an average, in about 7–10% of all pregnancies. It has also been found that many women are confronted with another type of high BP: chronic hypertension, a medical condition, wherein high BP prevails before pregnancy begins. These situations make it significant that the issue of severe hypertension during pregnancy is addressed adequately. It is in this context that the present research paper has been authored, wherein attempts have been made to investigate into strategic interventions that health care providers need to envisage, while treating pregnant women with severe hypertension conditions. This forms the specific objective of this research. With regards to general objectives, this review paper will briefly (a) address the important considerations in management of hypertension during pregnancy, and (b) discuss the future directions in this field. In terms of research mythology employed here, the author has collected secondary data from sources, such as books, book chapters, journal articles, government publications, as well as publications (and policy documents) brought out by the inter-governmental organizations. Data sources are quoted under reference section of the research. Data used are largely ‘qualitative’ in nature. Method of data analysis is ‘descriptive’. It involves desk-based research, as various research reports and other documents (including policy review reports) on subject areas related to hypertension during pregnancy have been studied by the author in order to derive conclusions and key findings (in accordance with objectives). This paper concludes that health care providers should ensure that women with chronic hypertension undergo a pre-pregnancy evaluation, with a focus on medication profile.
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... The majority of feto-maternal complications of HPD have occurred in the low-and middle-income countries due to lack of healthcare service as well as poor quality of maternal and neonatal care [9,10]. WHO estimated that the incidence of preeclampsia was 7 times higher in low-and middle-income countries than in high-income countries, and the risk of pregnant women in a low-income country dying of pre-eclampsia/eclampsia was 300 times higher than those in a high-income country [11]. However, few studies have been done to assess the fetomaternal outcomes and identify the predictors of adverse perinatal outcome among women with HDP in these countries. ...
Maternal and perinatal outcomes of hypertensive disorders in pregnancy: Insights from the National Hospital of Obstetrics and Gynecology in Vietnam
Article
Full-text available
Introduction Hypertension is the common disorder encountered during pregnancy, complicating 5% to 10% of all pregnancies. Hypertensive disorders in pregnancy (HDP) are also a leading cause of maternal and perinatal morbidity and mortality. The majority of feto-maternal complications due to HPD have occurred in the low- and middle-income countries. However, few studies have been done to assess the feto-maternal outcomes and the predictors of adverse perinatal outcome among women with HDP in these countries. Methods A prospective cohort study was conducted on women with HDP who were delivered at National Hospital of Obstetrics and Gynecology, Vietnam from March 2023 to July 2023. Socio-demographic and obstetrics characteristics, and feto-maternal outcomes were obtained by trained study staff from interviews and medical records. Statistical analysis was performed using SPSS version 26.0. Bivariate and multiple logistic regressions were done to determine factors associated with adverse perinatal outcome. A 95% confidence interval not including 1 was considered statically significant. Results A total of 255 women with HDP were enrolled. Regarding adverse maternal outcomes, HELLP syndrome (3.9%), placental abruption (1.6%), and eclampsia (1.2%) were three most common complications. There was no maternal death associated with HDP. The most common perinatal complication was preterm delivery developed in 160 (62.7%) of neonates. Eight stillbirths (3.1%) were recorded whereas the perinatal mortality was 6.3%. On bivariate logistic regression, variables such as residence, type of HDP, highest systolic BP, highest diastolic BP, platelet count, severity symptoms, and birth weight were found to be associated with adverse perinatal outcome. On multiple logistic regression, highest diastolic BP, severity symptoms, and birth weight were found to be independent predictors of adverse perinatal outcome. Conclusion Our study showed lower prevalence of stillbirth, perinatal mortality, and maternal complication compared to some previous studies. Regular antenatal care and early detection of abnormal signs during pregnancy help to devise an appropriate monitoring and treatment strategies for each women with HDP.
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... Preeclampsia is a complex disorder that affects about 5-8% of pregnant women after the 20th week of pregnancy [2]. The World Health Organization estimates that 7-8% of women aged 14 to 59 years in the East Mediterranean region suffer from preeclampsia [3]. ...
Correction to: Comparison of Retinopathy of Prematurity Incidence in Preterm Infants of Mothers with Preeclampsia and Infants of Healthy Mothers
Article
  • Nov 2023
Introduction Preeclampsia is one of the four leading causes for pregnancy complications, maternal–fetal and neonatal mortal�ity. This study was aimed at comparing the incidence of retinopathy of prematurity in neonates of mothers with preeclampsia and neonates of healthy mothers. Methods This cross-sectional study was performed among 213 mothers, including 49 healthy mothers and 164 mothers with preeclampsia whose neonates were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran, during 2016–2021. The participants were chosen using the convenience sampling method. The data collection tool was a researcher�made checklist including items on laboratory evaluation, maternal and neonatal characteristics, and eye examination. The data were analyzed using t-test and Chi-square. Results In the two groups, gestational age (P=0.112), frst-minute Apgar score (P=0.209), and ffth-minute Apgar score (P=0.949) were not signifcantly diferent. There was a signifcant diference between the two groups in terms of maternal age (P=0.0001), type of delivery (P=0.0001), premature rupture of membranes (P=0.003), and eye condition (P=0.033). Conclusion The results of our study show that preeclampsia afects the prognosis of infants, and in neonates with preeclamp�tic mothers, the rate of premature rupture of the membranes, cesarean delivery, and retinopathy of prematurity were higher. Keywords Preeclampsia · Neonatal · Retinopathy of prematurity · Premature rupture of membranes
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Maternal Mortality in Guinea-Bissau: The use of verbal autopsy in a multi-ethnic population
Article
Full-text available
  • Mar 1999
In developing countries with scanty resources it is very important to have reliable data to establish priorities for the health sector; e.g. to reduce maternal mortality it is necessary to determine the most important causes. The majority of deaths, however, occur without previous contact with the health system and consequently conventional analyses of death certificates are not feasible. Instead, studies have been carried out in some developing countries with various forms of post-mortem interviews, the so-called verbal autopsies (VA). We developed a structured interview with filter questions, which was applied to all deaths of women of fertile age in a cohort of 10,000 women living in 100 clusters in Guinea-Bissau and followed over a period of 6 years. The cause of death was ascertained by means of a series of diagnostic algorithms for the most common causes of maternal mortality, including postpartum haemorrhage, antepartum haemorrhage, puerperal infection, obstructed labour, eclampsia, abortion, and ectopic pregnancy. Of the 350 deaths of women of fertile age, 32% were maternal and it seems unlikely that a significant proportion of maternal deaths have not been classified correctly. Using the diagnostic algorithm 70% could be given a specific diagnosis, the most important causes being postpartum haemorrhage (42% [29/69]), obstructed labour (19% [13/69]), and puerperal infection (16% [11/69]). We attempted to identify the factors that are critical for obtaining sufficient information to reach a diagnosis. In the univariate analyses, it was important whether the respondent had been present during the last illness (P = 0.04) and whether the death occurred more than one week after delivery (P = 0.04). The husband was a better respondent than a co-wife (P = 0.08), and men in general provided more specific information than women (P = 0.08). Furthermore, information appeared to be better if the woman had died in the rainy season (P = 0.08). The length of the recall period, parity, age of woman, place of death, rural/urban residence, and ethnic group were not decisive. In the multivariate analysis sex and presence of respondent and time after delivery were significantly associated with the risk of not reaching a specific diagnosis. Women are less likely to provide adequate information for a diagnosis than men (odds ratio [OR] 3.1; 95% confidence interval [CI]: 1.2-8.1). Respondents that did not reside in the village during the departed woman's illness/delivery carried equal risk of not reaching a conclusion (OR 3.1; CI: 1.1-9.1). Deaths occurring more than one week after delivery were also less likely to be classified (OR 6.1; CI: 1.7-22.0). The VA described in the present paper left 30% of the maternal deaths unclassified without a specific diagnosis. Had all interviews been with husbands, only 14% would have remained unclassified. If we had only asked people who were present during the terminal phase of the victim's illness the proportion of classified deaths would have risen from 70% to 75%. It is likely that delayed maternal deaths have not been adequately covered by the present algorithms, but they may also simply be more difficult to describe due to the duration of the disease episode. In contrast to methods by which cause of death is established by a panel of medical experts, the present VA should be economically and technically viable in areas where health workers have only minimal training.
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Risk factors for pre-eclampsia in a large cohort of Latin America and Caribbean women
Article
  • Jan 2000
  • BJOG-INT J OBSTET GY
Objective To study risk factors for pre-eclampsia in a large cohort of Latin American and Caribbean women. Design Retrospective cross-sectional study from the Perinatal Information System, the database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay. Setting Latin America and the Caribbean, 1985–1997. Population 878,680 pregnancies at 700 hospitals; of these 42,530 were complicated by pre-eclampsia and 1872 by eclampsia. Main outcome measures Crude and adjusted relative risks (RR) of risk factors for pre-eclampsia. Adjusted relative risks were obtained after adjustment for potential confounding factors through multiple logistic regression models based on the method of generalised estimating equations. Results The following risk factors were significantly associated with increased risk of pre-eclampsia: nulliparity (RR 2.38; 95% CI 2.28–2.49); multiple pregnancy (RR 2.10; 95% CI 1.90–2.32); history of chronic hypertension (RR 1.99; 95% CI 1.78–2.22); gestational diabetes mellitus (RR 1.93; 95% CI 1.66–2.25); maternal age ≥ 35 years (RR 1.67; 95% CI 1.58–1.77); fetal malformation (RR 1.26; 95% CI 1.16–1.37); and mother not living with infant's father (RR 1.21; 95% CI 1.15–1.26). Pre-eclampsia risk increased according to pre-pregnancy body mass index (BMI). In comparison with women with a normal pre-pregnancy BMI (19.8 to 26.0), the RR estimates were 1.57 (95% CI 1.49–1.64) and 2.81 95% CI 2.69–2.94), respectively, for overweight women (pre-pregnancy BMI = 26.1 to 29.0) and obese women (pre-pregnancy BMI > 29.0). Cigarette smoking during pregnancy and a pre-pregnancy BMI < 19.8 were significant protective factors against the development of pre-eclampsia. The pattern of risk factors among nulliparous and multiparous women was quite similar. Conclusions Risk factors for pre-eclampsia observed among Latin American and Caribbean women are similar to those found among North American and European women.
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[Gynecology-obstetrics at the Yalgado-Ouédraogo National Hospital Center. Eclampsia: epidemiologic, clinical and prognostic aspects]
Article
  • Jul 1997
We present the results of a retrospective study carried out between 1992 and 1995 aimed at describing the epidemiological, clinical and developmental profile of eclampsia in an African maternity unit towards the end of the 20th Century. The incidence of eclampsia was 108 cases in 12,175 births (0.89%), mostly in young patients during their first pregnancy. 40.7% of the patients were less than 20 years old and 59.3% were expecting their first child. Eclampsia occurred between the 28th and 37th weeks of amenorrhea in 37% of cases. Thirty four patients (31.5%) had had at least three episodes of eclampsia prior to admission. Diastolic arterial blood pressure was higher than 120 mmHg in 25.9% of cases. Eclampsia occurred before labor in 30.6% of cases, during labor in 38% of cases and after giving birth in 31.5% of cases. Postpartum episodes occurred an average of 67 +/- 18.7 hours after the birth. There were complication with infection in 7 cases, renal insufficiency in 14 cases and one case of retro placental hematoma. Seventeen patients died, giving a death rate of 15.7%. During the same period, 3.4% of maternal deaths were due to eclampsia. The perinatal mortality rate was 23.1%. A quantitative and qualitative improvement in prenatal consultations should make it possible to reduce the incidence of eclampsia. Measuring arterial blood pressure daily for at least 14 days after the birth appears to be necessary for diagnosis and treatment of all cases of hypertension.
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Comparison of Risk Factors Preeclampsia and Gestational Hypertension in a Population-based Cohort Study
Article
  • Jul 1998
  • AM J EPIDEMIOL
The objective of this study was to evaluate and compare risk factor patterns in association with preeclampsia and gestational hypertension. The data were collected from The Swedish Medical Birth Register and include all nulliparas aged 34 years or less who gave birth at the University Hospital of Uppsala, Sweden, during 1987-1993. Of these 10,666 women, 4.4% developed gestational hypertension, and 5.2% developed preeclampsia. The following risk factors were significantly associated with increased risk of preeclampsia: type 1 diabetes (odds ratio = 5.58, 95% confidence interval 2.72-11.43), gestational diabetes (odds ratio = 3.11, 95% confidence interval 1.61-6.00), and twin birth (odds ratio = 4.17, 95% confidence interval 2.30-7.55). The positive associations between these variables and the risk of gestational hypertension were weaker and nonsignificant. Compared with underweight women (body mass index < 19.8), obese women (body mass index > 29) had increased risks of both gestational hypertension (odds ratio = 4.85, 95% confidence interval 1.97-11.92) and preeclampsia (odds ratio = 5.19, 95% confidence interval 2.35-11.48). Significantly lower risks of preeclampsia and gestational hypertension were observed for women born outside Nordic countries and in association with maternal smoking and summer birth. The similarities in risk factor patterns may indicate similarities in the biologic mechanisms underlying the two conditions.
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A comparison of three verbal autopsy methods to ascertain levels and causes of maternal deaths in Matlab, Bangladesh
Article
  • Sep 1998
Verbal autopsies have been widely used to determine the levels and causes of maternal death but few studies have assessed the reliability of various methods. We compared the levels and causes of maternal mortality in three data sources from Matlab, Bangladesh: (1) maternal deaths identified through a unique demographic surveillance system (DSS); (2) maternal deaths identified as a result of a previous detailed investigation into the levels and causes of maternal mortality; and (3) maternal deaths identified in the current special study. All studies used lay reporting, but differed in terms of the nature of the study, the sex of the interviewer, the format of the questionnaire and the procedure to derive the diagnosis. There were substantial disagreements between the routine reporting and the special studies. The DSS identified 67.2% of all deaths occurring during pregnancy or within 42 days postpartum (82.3% of direct obstetric deaths, 70.0% of deaths due to induced abortions and 42.4% of indirect obstetric deaths). Extending the definition of maternal deaths to 90 days postpartum increased the numbers of maternal deaths between 1987 and 1993 from 174 to 196. The two special studies also disagreed in the ascertainment of the causes of maternal deaths and yielded different cause of death distributions; the proportion of direct obstetric deaths (excluding abortion) was 50.4% in the current system compared to 44.5% previously (P = 0.001). This study confirms the known difficulties in the ascertainment of the levels and causes of maternal mortality. The large disparities in the levels and causes of maternal mortality using three different methods of lay reporting in a population with an almost complete vital registration system add to the growing concern about the inaccuracies in the measurement of maternal mortality.
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Does gestational hypertension become pre-eclampsia?
Article
  • Dec 1998
  • Br J Obstet Gynaecol
To determine the likelihood of progression from gestational hypertension (GH) to pre-eclampsia (PE) in hypertensive pregnant women and whether this change can be identified in advance by available clinical and laboratory measures. A retrospective analysis and a prospective study. St George Hospital, Sydney, a teaching hospital of the University of New South Wales delivering 2500 women per year. Eight hundred and forty-five women with new hypertension in the second half of pregnancy, managed by a uniform protocol (661 in the retrospective analysis, 184 in the prospective study). Clinical and laboratory data at initial presentation were compared among women with GH who developed PE and those who remained with a diagnosis of GH until delivery. Data predictive for progression from GH to PE were analysed by logistic regression analysis. Progression from GH to PE. In the retrospective analysis, 416 women initially presented as having GH and 62 (15%) progressed to PE. In the prospective study, 112 women initially presented with GH and 29 (26%) progressed to PE, giving an overall progression of 17%. In both studies, women who developed PE from GH presented earlier than those who remained with GH until delivery. In multiple logistic regression analyses prior miscarriage and early gestation at presentation were associated with increased likelihood of progressing from GH to PE. Approximately 15-25% of women initially diagnosed with GH will develop PE and this is more likely with earlier presentation or if the woman has had a prior miscarriage. Women with gestational hypertension diagnosed after 36 weeks of gestation have only about 10% risk of developing PE. These data should help stratify the risks of mildly hypertensive pregnant women being managed as outpatients in their third trimester.
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Neurological complications associated with the pre-eclampsia/eclampsia syndrome
Article
  • Jan 2001
Neurological complications are the most common cause of maternal morbidity and mortality associated with pre-eclampsia in Durban South Africa. To evaluate factors associated with neurological complications a retrospective study was conducted in the country. 140 records of patients with neurological complications of pre-eclampsia at King Edward VIII Hospital Durban over a 1-year period were reviewed. 139 women had eclampsia of which 16 had neurological complications. The most common neurological complication was hemiparesis (n = 6) while pre-eclamptic or eclamptic patients also developed transient cortical blindness and facial nerve affectations. Predisposing events leading to neurological complications were associated with increased permeability of the brain capillary endothelial cells and loss of cerebral autoregulation secondary to hypertension. Thus it is suggested that timely and appropriate lowering of high blood pressure is needed to decrease morbidity and mortality in pre-eclampsia/eclampsia syndrome.
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