Prevalence, Risk Factors, and Fetal and Maternal Outcomes of Hypertensive Disorders of Pregnancy: A Retrospective Study in Western Saudi Arabia

Knowledge and attitude of pregnant women about preeclampsia in King Abdulaziz Medical City, Western Region: A cross-sectional study

INTRODUCTION

Preeclampsia is a serious obstetrics condition generally diagnosed by the presence of high blood pressure (≥140/90 mmHg) and significant protein in urine (≥ 2++ on dipstick urine test) developing for the first time after 20 weeks of pregnancy. It poses severe risks to both mother and newborn, including the potential for maternal and neonatal mortality and morbidity. Although preeclampsia is a well-recognized pregnancy-related complication, there is a notable lack of knowledge and awareness among pregnant women in Saudi Arabia, particularly concerning its signs, symptoms, risk factors, and the importance of timely medical intervention. This study aims to assess the level of knowledge and attitude regarding preeclampsia among pregnant women attending King Abdulaziz Medical City in Jeddah, Saudi Arabia.

METHODS

In this quantitative cross-sectional study, 122 pregnant women visiting the Obstetrics and Gynecology Outpatient Department were surveyed from April to June 2023. The research employed a structured questionnaire to collect detailed information on participants' sociodemographic backgrounds, knowledge about preeclampsia symptoms, risk factors, complications, and attitudes toward its prevention and the recognition of danger signs. Data were analyzed using descriptive statistics as well as ANOVA test, T-test, and Pearson correlation to explore relationships and significance among study variables.

RESULTS

The study revealed an average knowledge score of 25.43 (SD = 5.67), indicating that many participants demonstrated a moderate understanding of preeclampsia. On the other hand, the attitude score averaged 23.39 (SD = 3.11), showing that participants held favorable attitudes toward the risk factors, prevention, and complications of preeclampsia. Notably, participants with higher education levels and those who were employed demonstrated higher knowledge scores.

CONCLUSION

The findings reflect a moderate level of understanding among participants but also highlight critical areas where knowledge enhancement is necessary to enable timely intervention and reduce adverse maternal and neonatal outcomes.

Infants of Diabetic Mothers and Associated Complications in the Neonatal Intensive Care Unit

Background The incidence of pregnancy-associated diabetes has increased in recent decades, leading to neonatal adverse outcomes like metabolic and hematologic disorders, respiratory distress, cardiac disorders, and neurologic impairment. Macrosomia, a common consequence of diabetes, is influenced by maternal blood glucose levels, impacting adverse neonatal outcomes. Aim The current study aimed to assess the neonatal and maternal outcomes of the infants of diabetic mothers. Methods An observational retrospective study was conducted among infants of diabetic mothers at Maternity and Children Hospital, Saudi Arabia, from 2022 to 2023. The data included socio-demographic details, diabetes-related information, and maternal and neonatal outcomes.  Results A study of 400 mothers aged 18-40 years found that 54.3% had 1-4 previous pregnancies, while 35.5% had more than four. The majority had gestational diabetes mellitus (GDM), with 25.5% having diabetes for more than five years. The most common complications were preeclampsia (7.5%), polyhydramnios (6%), UTI (5.3%), PROM (4.3%), and pregnancy-induced hypertension (4.3%). The majority had no complications, while 12.5% of neonates had respiratory and metabolic complications. Conclusion The study found that most women with gestational diabetes had previously been diagnosed with diabetes mellitus (DM) and are multiparous, with Caesarean delivery being the dominant mode. While maternal complications were seen in only less than one-third of mothers, neonatal complications were noted in 12.5%.

Circadian Regulation of Lipid Metabolism during Pregnancy

A cluster of metabolic changes occur to provide energy for fetal growth and development during pregnancy. There is a burgeoning body of research highlighting the pivotal role of circadian rhythms in the pathogenesis of metabolic disorders and lipid homeostasis in mammals. Perturbations of the circadian system and lipid metabolism during gestation might be responsible for a variety of adverse reproductive outcomes comprising miscarriage, gestational diabetes mellitus, and preeclampsia. Growing studies have confirmed that resynchronizing circadian rhythms might alleviate metabolic disturbance. However, there is no clear evidence regarding the specific mechanisms by which the diurnal rhythm regulates lipid metabolism during pregnancy. In this review, we summarize previous knowledge on the strong interaction among the circadian clock, lipid metabolism, and pregnancy. Analyzing the circadian clock genes will improve our understanding of how circadian rhythms are implicated in complex lipid metabolic disorders during pregnancy. Exploring the potential of resynchronizing these circadian rhythms to disrupt abnormal lipid metabolism could also result in a breakthrough in reducing adverse pregnancy outcomes.

Public health and system approach in eliminating disparities in hypertensive disorders and cardiovascular outcomes in non-Hispanic Black women across the pregnancy life course

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Hypertensive Disorders of Pregnancy in Saudi Arabia: Evaluating Maternal and Neonatal Risks, Outcomes, and Aspirin Prophylaxis: A Review Article

Hypertensive disorders during pregnancy, including pre-eclampsia and eclampsia, pose significant risks to both maternal and neonatal health. This review article evaluates the prevalence, maternal and neonatal outcomes, and the efficacy of aspirin prophylaxis in managing these conditions in Saudi Arabia. Utilizing data from multiple retrospective studies and recent guidelines, we highlight the regional variations in the outcomes of hypertensive disorders of pregnancy. Severe complications such as Hemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome occurred in 6.6% of cases, while eclampsia was reported in 6.7% of cases. Cesarean sections were notably high, with rates reaching up to 79% among affected pregnancies. Maternal risk factors identified include chronic hypertension (prevalence 17%), diabetes (ranging from 10.4% to 26.3%), and advanced maternal age. Neonatal complications often involve preterm birth, reported in 26.5% to 26.7% of cases, intrauterine growth restriction (ranging from 15.7% to 25%), and increased NICU admissions, reported in 2.4% of cases. No data were found in the included studies to evaluate the prophylactic use of low-dose aspirin in reducing the incidence of pre-eclampsia or improving fetomaternal outcomes. Despite the effectiveness of aspirin, awareness and implementation of prophylaxis guidelines remain suboptimal among healthcare providers in Saudi Arabia. A national survey revealed that only a fraction of obstetrical care providers were fully knowledgeable about aspirin prophylaxis guidelines. This review underscores the necessity for enhanced educational programs and standardized guidelines to improve maternal and neonatal outcomes in hypertensive pregnancies within the region.

Prevalence of pre-eclampsia in women in the Middle East: a scoping review

Hypertensive disorders of pregnancy are the second most common cause of maternal deaths worldwide. Metabolic syndrome is recognized as one of the risk factors for pre-eclampsia. A recent study revealed a high prevalence of metabolic syndrome in the United Arab Emirates (UAE), particularly amongst Emirati women compared with global estimates. This finding raises the possibility that the prevalence of pre-eclampsia in the region may also be higher as research is increasingly demonstrating an association between pre-eclampsia and metabolic syndrome. We therefore conducted this scoping review of the literature to investigate the nature and extent of studies evaluating the prevalence of pre-eclampsia within the Middle East region to enable subsequent comparison of these findings with the global burden of pre-eclampsia, objectively identify gaps in the literature and inform the design of future studies to address these gaps. PubMed and Scopus were used to extract studies published over the last 20 years (2003-2023). The search terms used included ("Pre-eclampsia" AND "Prevalence") OR ("Hypertension in pregnancy" AND "Prevalence") OR ("Pregnancy" AND "Pre-eclampsia") OR ("Pre-eclampsia" AND "Epidemiology"). We limited our studies to those from the Middle East (ME). A total of 556 relevant articles were identified following which 11 were shortlisted for review. There were four studies from Iran, two from Saudi Arabia, two from Qatar, one from Jordan, and one from Bahrain. The remaining study included 29 countries from Africa, Asia, Latin America, and the Middle East of which data from Jordan, Lebanon, the Occupied Palestinian Territory, and Qatar were included. There were four retrospective, two cross-sectional, and two cohort studies, one prospective study, one meta-analysis, and one descriptive-analytical study. The prevalence of pre-eclampsia in the studies ranged from 0.17 to 5%. We did not find any study investigating the prevalence of pre-eclampsia in the United Arab Emirates. Based on our findings, we conclude that there is a significant scarcity of research in this area, especially within the Middle East, and notably an absence of studies specifically pertaining to the UAE. Consequently, we assert that there is a pressing requirement for additional research to evaluate the prevalence of pre-eclampsia in the region.

Gestational diabetes mellitus, hypertension, and dyslipidemia as the risk factors of preeclampsia

Gestational diabetes mellitus (GDM) is a known risk factor for gestational hypertension which further progress toward conditions like proteinuria, dyslipidemia, thrombocytopenia, pulmonary edema leading to Preeclampsia (PE). Pregnancy can be a challenging time for many women, especially those diagnosed with GDM and PE. Thus, the current prospective study investigates the association of OGTT glucose levels with systolic and diastolic blood pressure and lipid profile parameters in pregnant women diagnosed with GDM and PE. A total of 140 pregnant women were stratified into GDM (n = 50), PE (n = 40) and controls (n = 50). Two hour 75 g oral glucose tolerance test (OGTT) was performed for screening GDM. Biochemical parameters analysis of OGTT, total cholesterol (TC), triglyceride (Tg), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), urinary albumin and creatinine were tested to find urinary albumin creatinine ratio (uACR). Statistical analysis was performed using ANOVA followed by post hoc test and regression analysis. Among the studied groups, GDM and PE groups showed no significant difference in age and increased BMI. Increased 2 h OGTT & TC in GDM group; elevated uACR, systolic/diastolic blood pressure, Tg, HDL-C, LDL-C in PE group was observed and differ significantly (p < 0.0001) with other groups. A significant positive effect of 2 h OGTT was observed on blood pressure (R2: GDM = 0.85, PE = 0.71) and lipid profile determinants (R2: GDM = 0.85, PE = 0.33) at p < 0.0001. The current study concludes that glucose intolerance during the later weeks of pregnancy is associated with gestational hypertension and hyperlipidemia as a risk factor for PE. Further research is needed for a detailed assessment of maternal glucose metabolism at various pregnancy stages, including the use of more sensitive markers such as C-peptide and their relation to pregnancy-related hypertensive disorders.

Development and validation of a short tool to assess the awareness of hypertensive disorders of pregnancy: a cross-sectional study among pregnant women in Lebanon

BACKGROUND

Hypertensive disorders of pregnancy (HDPs) are responsible for most perinatal and fetal mortality. Few programs are patient-centered during pregnancy, thereby increasing the risks of misinformation and misconceptions among pregnant women and, as a result, malpractices.

OBJECTIVE

This study aims to develop and validate a form to assess the knowledge and attitudes of pregnant women about HDPs.

STUDY DESIGN

A cross-sectional pilot study was conducted over 4 months, targeting 135 pregnant women from 5 obstetrics and gynecology clinics. A self-reported survey was developed and validated, and an awareness score was generated.

RESULTS

The mean maternal age of the participants was 27.3 (5.3) years. About 80% of the participants reported that they monitored their weight during pregnancy, and 70.4% monitored their blood pressure, out of which 73.8% performed it at the doctor's clinic only. Overall, participants had a total score of 16.9 (3.1) over 25 with higher attitude scores than knowledge scores. Less than half of the patients (45.2%) knew the cut-off for hypertension. With respect to knowledge statements, higher scores were noted for statements related to the symptoms of HDPs, and lower scores were reported for statements related to some HDP complications. Older women and those who monitored their blood pressure during pregnancy had significantly higher awareness scores. Those working had higher awareness of HDPs (67.4%), whereas about half of nonworkers (53.9%) showed lower awareness scores (P=.019).

CONCLUSION

Pregnant women had moderate awareness of HDPs. The short 25-item tool developed in the present study can be used in obstetric clinics to explore the awareness of women of HDPs.

Cytomegalovirus Specific Cell-Mediated Immunity Status in Women with Preeclampsia: A Case-Control Study

Background

Preeclampsia, a pregnancy-specific complication, has been associated with cytomegalovirus (CMV) infection in observational studies. CMV-specific T cell response plays a major role in viremia clearance. We explored whether CMV-specific cell-mediated immunity (CMI) status is associated with preeclampsia in pregnant women.

Materials and Methods

CMV-specific CMI was assessed using CMV-QuantiFERON (QF-CMV) assay in plasma serum of 35 women with preeclampsia as well as 35 normal pregnant controls, retrospectively. Participants were matched for gestational age in a 1:1 ratio. The proportion of reactive results, the mean value of interferon-gamma (IFN-γ) level produced in mitogen and antigen tubes were compared between the cases and controls through Chi-square and Wilcoxon rank-sum tests, respectively. The odds ratio and confidence interval were calculated as well.

Results

No significant differences observed between demographic characteristics of the case and control groups. The QF-CMV assay turned reactive (QF-CMV [ + ]) Women with preeclampsia had lower mean IFN-γ levels in antigen tube compared with normal pregnant controls. There were no statistically significant differences in the value of mitogen tube between case and controls women with suppressed CMV-CMI were 6.3 times more likely to have preeclampsia. This result even strengthened after adjustment for age, gestational age, and gravidity.

Conclusions

Our findings support an association between suppressed CMV-specific CMI and preeclampsia.

Maternal Mercury Exposure and Hypertensive Disorders of Pregnancy: A Systematic Review

OBJECTIVE

 The present review aimed to synthesize the evidence regarding mercury (Hg) exposure and hypertensive disorders of pregnancy (HDP).

DATA SOURCES

 The PubMed, BVS/LILACS, SciELO and UFRJ's Pantheon Digital Library databases were systematically searched through June 2021.

STUDY SELECTION

 Observational analytical articles, written in English, Spanish, or Portuguese, without time restriction.

DATA COLLECTION

 We followed the PICOS strategy, and the methodological quality was assessed using the Downs and Black checklist.

DATA SYNTHESIS

 We retrieved 77 articles, of which 6 met the review criteria. They comprised 4,848 participants, of which 809 (16.7%) had HDP and 4,724 (97.4%) were environmentally exposed to Hg (fish consumption and dental amalgam). Mercury biomarkers evaluated were blood (four studies) and urine (two studies). Two studies found a positive association between Hg and HDP in the group with more exposure, and the other four did not present it. The quality assessment revealed three satisfactory and three good-rated studies (mean: 19.3 ± 1.6 out 28 points). The absence or no proper adjustment for negative confounding factor, such as fish consumption, was observed in five studies.

CONCLUSION

 We retrieved only six studies, although Hg is a widespread toxic metal and pregnancy is a period of heightened susceptibility to environmental threats and cardiovascular risk. Overall, our review showed mixed results, with two studies reporting a positive association in the group with more exposure. However, due to the importance of the subject, additional studies are needed to elucidate the effects of Hg on HDP, with particular attention to adjusting negative confounding.

Fetomaternal Outcomes and Associated Factors among Mothers with Hypertensive Disorders of Pregnancy in Suhul Hospital, Northwest Tigray, Ethiopia

Background

Hypertensive disorder of pregnancy is the leading cause of maternal and perinatal morbidity and mortality worldwide and the second cause of maternal mortality in Ethiopia. The current study is aimed at assessing fetal-maternal outcomes and associated factors among mothers with hypertensive disorders of pregnancy complication at Suhul General Hospital, Northwest Tigray, Ethiopia, 2019. Methods:A hospital-based cross-sectional study was conducted from Oct. 1^st, 2019, to Nov. 30, 2019, at Suhul General Hospital women's chart assisted from July 1^st, 2014, to June 31^st, 2019. Charts were reviewed consecutively during five years, and data were collected using data abstraction format after ethical clearance was assured from the Institutional Review Board of Mekelle University College of Health Sciences. Data were entered into Epi-data 3.5.3 and exported to SPSS 22 for analysis. Bivariable and multivariable analyses were done to ascertain fetomaternal outcome predictors. Independent variables with p value < 0.2 for both perinatal and maternal on the bivariable analysis were entered in multivariable logistic regression analysis and the level of significance set at p value < 0.05.

Results

Out of 497 women, 328 (66%) of them were from rural districts, the mean age of the women was 25.94 ± 6.46, and 252 (50.7%) were para-one. The study revealed that 252 (50.3%) newborns of hypertensive mothers ended up with at least low Apgar score 204 (23.1%), low birth weight 183 (20.7%), preterm gestation 183 (20.7%), intensive care unit admissions 90 (10.2%), and 95% CI (46.1% -54.9%), and 267 (53.7%) study mothers also developed maternal complication at 95% (49.3-58.1). Being a teenager (AOR = 1.815: 95%CI = 1.057 − 3.117), antepartum-onset hypertensive disorders of pregnancy (AOR = 7.928: 95%CI = 2.967 − 21.183), intrapartum-onset hypertensive disorders of pregnancy (AOR = 4.693: 95%CI = 1.633 − 13.488), and low hemoglobin level (AOR = 1.704: 95%CI = 1.169 − 2.484) were maternal complication predictors; rural residence (AOR = 1.567: 95%CI = 1.100 − 2.429), antepartum-onset hypertensive disorders of pregnancy (AOR = 3.594: 95%, CI = 1.334 − 9.685), and intrapartum-onset hypertensive disorders of pregnancy (AOR = 3.856: 95%CI = 1.309 − 11.357) were predictors of perinatal complications.

Conclusions

Hypertensive disorder during pregnancy leads to poor fetomaternal outcomes. Teenage age and hemoglobin levels were predictors of maternal complication. A rural resident was the predictor of poor perinatal outcome. The onset of hypertensive disorders of pregnancy was both maternal and perinatal complication predictors. Quality antenatal care services and good maternal and childcare accompanied by skilled healthcare providers are essential for early detection and management of hypertensive disorder of pregnancy.

Perinatal Outcomes and Associated Factors among women with hypertensive Disorders of Pregnancy Delivered in Jimma Zone Hospitals, Southwest Ethiopia

BACKGROUND

Hypertensive disorders of pregnancy are multisystem diseases that increase the risk of adverse perinatal outcomes worldwide. It Led to early and late serious health consequence on the baby, with a significant proportion occurring in low-income countries. Hence the objective of this study was to determine perinatal outcomes and associated factors among women with hypertensive disorders of pregnancy delivered in Jimma zone hospitals.

METHOD

A Facility based cross-sectional study design was employed from March to May 2020 on 211 hypertensive women delivered in the four randomly selected hospitals. The data were collected by reviewing medical record and face to face interview using consecutive sampling technique. Binary and multivariable logistic regression was performed to identify association.

RESULT

Ninety-one (43.1%) of fetuses developed unfavorable perinatal outcome. Inability to read and write (AOR=2.5; 95% CI:1.03-6.17), being primipara (AOR=4.6; 95% CI:1.6-13.2) and multi-para (AOR=3.1; 95% CI:1.09-9.17), Lack of antenatal care visit (AOR=4.2; 95% CI:1.2-15.01), having preeclampsia (AOR=4.2; 95% CI:1.1-16.6) and eclampsia (AOR=5.8; 95% CI:1.2-26.2) and late provision of drug (AOR=3.9;95% CI:1.9-7.9) were independent factors.

CONCLUSION

Pregnancy complicated with hypertensive disorders was associated with increased unfavorable perinatal outcomes. Preeclampsia and eclampsia, inability to read and write, primipara and multipara, lack of antenatal care and late provision of drug were factors associated with unfavorable perinatal outcomes.

Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study

OBJECTIVES

To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP).

METHODS

Multicenter, prospective, national cohort study.

RESULTS

Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively.

CONCLUSIONS

Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.

Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia

BACKGROUND

Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications.

OBJECTIVES

Assess the effect of AMA on maternal and neonatal outcomes.

DESIGN

Analytical cross-sectional study of medical records.

SETTINGS

In-patient hospital tertiary care setting in Jeddah.

PATIENTS AND METHODS

All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes.

MAIN OUTCOME MEASURES

Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery.

SAMPLE SIZE

1586 women.

RESULTS

Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P<.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2-3.5, P<.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P<.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2-1.9, P=.002).

CONCLUSION

Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery.

LIMITATIONS

Cross-sectional design, small sample size, single hospital.

CONFLICT OF INTEREST

None.

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

Objective:

Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women.

Materials and Methods:

This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters.

Results:

Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05).

Conclusion:

Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.

Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India

Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention. Methods This prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results In our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socio-economic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia. Conclusion Routine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.

Prevalence of Eclampsia and Its Maternal-Fetal Outcomes at Gandhi Memorial Hospital, Addis Ababa Ethiopia, 2019: Retrospective Study

Background

Eclamptic disorder during pregnancy is one of the common problems in sub-Saharan countries and forms one of the deadly triads along with hemorrhage and infection which complicates feto-maternal outcomes of pregnancy. So, the purpose of this study was to assess the prevalence of eclampsia and its maternal and fetal outcome in Gandhi Memorial Hospital, Addis Ababa Ethiopia, 2019.

Methods

A descriptive retrospective cross-sectional study was employed on a review of all cases of women who were delivered at Gandhi memorial Hospital from 1st of September 2017 to –last of August 2018. Data were analyzed using SPSS version 25 software. Descriptive statistics were used to calculate frequencies and percentages and data was presented using texts and, tables.

Results

Out of the total deliveries, the prevalence of eclampsia was found to be 6.2%. In our experience of a very high rate of eclampsia, fortunately, we had only 3 maternal deaths out of the total cases. However, neonatal mortality and stillbirths had been extremely high: 41 (22.1%) of stillbirths and 30.3% neonatal deaths (a total burden of 52.4% of perinatal mortality). About 70.8% had reported a history of prior pregnancy-induced hypertension and 73.5% induced their current pregnancy following eclampsia. From mothers who required interventions to terminate the pregnancy by induction, 47.8% ended by cesarean section secondary to non-reassuring fetal status (29.2%). The majority (91.9%) had taken magnesium sulfate for the management of convulsion and 86.5% had taken hydralazine for hypertension management. Abruption of the placenta (96.2%), postpartum-hemorrhage (89.2%), and HELLP syndrome (83.8%) were major maternal adverse outcomes reported, and 22.1% of pregnancy was ended as stillbirth. Over 53.6% of delivered babies, 18.4% of neonates required admission to nursery/NICU referral.

Conclusion

The prevalence of eclampsia was relatively high, with corresponding high maternal and perinatal morbidity and mortality. Increasing early detection before pregnancy, antenatal screening, and the use of magnesium sulfate to control convulsions will reduce the disorder and associated morbidity and mortality for both mother and fetus.

Differential expression of serum GBP-28, NBP-Cyc 3 and TIMP-1 complicates pregnancy in hypertensive disorder pregnancy

The current study is aimed at analyzing the correlation and differential expression of three entities namely, TIMP metallopeptidase inhibitor-1 (TIMP-1), a glycoprotein, serum adipokine (GBP-28), an amino acid protein and neuroendocrine basic polypeptide NBP-cystatin3 (NBP-Cyc 3) in HDP (Hypertensive Disorders complicating Pregnancy). A total of 63 patients, diagnosed with HDP at the study hospital during the study period, was placed under treatment (HDP) group. While healthy group had a total of 50 women with normal pregnancy during the same period. Both these groups were compared in terms of GBP-28, TIMP-1 and NBP-Cyc 3 levels. Further, the author also checked the correlation, diagnostic value and prognosis for the three factors and HDP. There was a significant increase observed in the expression levels of serum TIMP-1 and NBP-Cyc 3 in HDP during ELISA compared to GB. However, HDP group recorded low value of serum GBP-28 than healthy group (all P < 0.001). There is a relationship between the expressions of GBP-28, TIMP-1 and NBP-Cyc 3 and the abnormalities in lipid and glucose metabolisms, resulting in severe clinical conditions among HDP patients. The inference from spearman correlation analysis is that serum GBP-28 and the severity of HDP are negatively correlated. While Serum TIMP-1 and NBP-Cyc 3 had a positive correlation with the severity of HDP (all P < 0.001). When diagnosing HDP, the AUC values of both GBP-28 and NBP-Cyc 3 single diagnosis were above 0.8. Multivariate conditional logistic regression was deployed to assess the risk factors associated with HDP. The results listed the independent risk factors such as GBP-28, TIMP-1 and NBP-Cyc 3 and disease severity for the prognosis of HDP. Among HDP patients, upregulated expressions of serum TIMP-1and NBP-Cyc 3 were observed while in case of GBP-28, it was vice versa. The significant role, played by GBP-28, TIMP-1 and NBP-Cyc 3 in the progression of HDP, makes these entities potential serum biomarkers in diagnosis and assessment of HDP.

Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000-2019: A Systematic Review, Meta-Analysis, and Meta-Regression

Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute's tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5-14.6%, I² , 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2-26.7% I² , 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0-16.5%, I² , 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5-25.5%, I² , 97.1%), in their third trimester (20.0%, 95% CI, 13.1-27.9%, I² , 98.8%), and who were obese (17.2%, 95% CI, 12.8-22.0%, I² , 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1-13.4%, I² , 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1-16.0%, I² , 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018100629.

Exposure to electronic screen before nocturnal sleep increases the risk of hypertensive disorders of pregnancy: A case-control study

AIM

Previous studies indicated that excessive screen time was associated with hypertension in children and adolescents. In our hospital, pregnant women tended to spend a lot of time on electronic devices like smartphones. We aimed to explore the relationship between the screen time and hypertensive disorders of pregnancy (HDP).

METHODS

A case-control study was conducted from November 2019 to May 2020. A total of 160 women with HDP and 197 healthy controls who gave birth to children in the same hospital were recruited and information was recorded by questionnaires. Multivariate analysis was conducted to assess the effect of screen time on HDP.

RESULTS

The results showed that, exposure to electronic screen before nocturnal sleep in cases was significantly longer than that in controls (P = 0.011, odds ratio = 1.50). Smartphones (and/or tablet computers) used only for entertainment also significantly increased the susceptibility to HDP (P < 0.001, odds ratio = 2.84). Other related factors were following: work experience during pregnancy (P = 0.034, odds ratio = 0.53), history of diabetes mellitus (P = 0.013, odds ratio = 2.55), history of family hypertension (P < 0.001, odds ratio = 3.81), body mass index of pre-pregnancy (>25 kg/m² ) (P < 0.001, odds ratio = 6.16).

CONCLUSION

In conclusion, long exposure to electronic screen before nocturnal sleep and the smartphones usage for only entertainment may be associated with the susceptibility to HDP.

Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world

Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.

Predictors of Postpartum Persisting Hypertension Among Women with Preeclampsia Admitted at Carlos Manuel de Cèspedes Teaching Hospital, Cuba

PURPOSE

We established the prevalence and predictors of persisting hypertension in women with preeclampsia admitted at the Carlos Manuel de Cèspedes Teaching Hospital in Cuba so as to guide the health-care providers in early identification of the patients at risk for timely intervention.

PATIENTS AND METHODS

A three-year prospective cohort study was conducted between March 2017 and March 2020. A cohort of 178 women diagnosed with preeclampsia at the hypertension unit of Carlos Manuel de Cèspedes Teaching Hospital were recruited. Interviewer administered questionnaires and laboratory and ultrasound scan result forms were used to collect the data. Binary logistic regression was conducted to determine the predictors. All data analyses were conducted using STATA version 14.2.

RESULTS

Forty-five (27.8%) of the studied 162 patients were still hypertensive at 12 weeks postpartum. Maternal age of 35 years or more (aRR=1.14,95% CI:1.131-4.847, p=0.022), early onset preeclampsia (before 34 weeks of gestation) (aRR=7.93, 95% CI:1.812-34.684, p=0.006), and elevated serum creatinine levels of more than 0.8mg/dl (aRR=1.35, 95% CI:1.241-3.606, p=0.032) were the independent predictors of persisting hypertension at 12 weeks postpartum.

CONCLUSION

Recognition of these predictors and close follow-up of patients with preeclampsia will improve the ability to diagnose and monitor women likely to develop persisting hypertension before its onset for timely interventions.

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study

Background

Severe pre-eclampsia is more dominant in low and middle-income countries. In Sub-Saharan Africa, severe pre-eclampsia remains a major public health problem contributing to high rates of maternal mortality. Few studies have investigated the relationship between severe pre-eclampsia and associated factors in East Africa. The aim of this study was to determine the prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar.

Methods

A hospital based analytical cross-sectional study design was used. Purposive sampling was utilized for the selection of hospitals. Proportionate sampling was used for selection of representatives from each hospital and participants were selected using systematic random sampling. Postpartum mothers were included in the study. The study was conducted by an interviewer who administered a questionnaire with close ended questions and chart review for data gathering. SPSS version 23 was used for data analysis and descriptive and multiple logistic regression was performed for control of confounders.

Results

This study included a total of 400 participants with a 100% response rate. Participants ranged from 17 to 45 years of age with mean age (SD) of 28.78 (±6.296). The prevalence of severe pre-eclampsia among postpartum women was 26.3% (n = 105). After adjusting for the possible confounders, factors associated with severe pre-eclampsia were; maternal age group of 15–20 years (AOR 3.839; 95% C. I 1.037–14.210), pregnancy from new partner/husband (AOR 7.561; 95% C. I 3.883–14.724), family history of high blood pressure (AOR 6.446; C. I 3.217–12.917), diabetes prior to conception (AOR 55.827; 95% C. I 5.061–615.868), having high blood pressure in a previous pregnancy (AOR 19.382; 95% C. I 4.617–81.364), paternal age above 45 (AOR 2.401; 95% C. I 1.044–5.519) and multifetal gestation (AOR 7.62; 95% CI 2.01–28.84).

Conclusion

The prevalence of severe pre-eclampsia among postpartum women in Zanzibar is high. Common risk factors in this setting include maternal age of 15–20 years, pregnancy with a new partner, family history of high blood pressure, pre-existing diabetes prior to conception, a history of high blood pressure in previous pregnancy paternal age greater than 45 and multifetal gestation.

Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis

BACKGROUND

Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia.

METHODS

A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger's test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies.

RESULT

Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%).

CONCLUSIONS

In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.