Associations of Hypertension and Antenatal Care-Seeking With Perinatal Mortality: A Nested Case-Control Study in Rural Bangladesh

Abstract

Introduction: Hypertension may be an important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. Methods: This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Findings: Among 191 cases and 934 matched controls, hypertension prevalence was 14∙1% among cases and 7∙7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2∙90, 95% CI 1∙29, 6∙57), but not among women with diagnosis during pregnancy (OR 1∙68, 95% CI 0∙98, 2∙98). We found no association between the number of antenatal care contacts and perinatal death (p=0∙66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Interpretation: Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh. Funding Information: The Bill and Melinda Gates Foundation. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approval for the study was provided by the Ethical Review Committee of the International Centre for Diarrhoeal Disease Research, Bangladesh.