Abstract
BackgroundPre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes.MethodsWe performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels.ResultsData for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92–2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26–1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77–8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63–2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86–3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03–1.24) and severe anemia (AOR: 2.98; 95%CI 2.47–3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83–0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight.ConclusionChronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended.
Highlights
Pre-eclampsia has an immense adverse impact on maternal and perinatal health, especially in the developing world
The majority (65%) of deliveries was in institutions with higher capacity index scores except for Africa, where a greater portion (63%) of mothers delivered in lower-capacity facilities
The greatest proportions were in the lower-middle gross national income (GNI) per capita category (49%) and the low maternal mortality ratio (MMR) level (60%) overall, but these characteristics varied across regions
Summary
Pre-eclampsia has an immense adverse impact on maternal and perinatal health, especially in the developing world. While most studies have been undertaken in high-income settings, some inconsistencies exist (e.g. whether or not maternal education is a significant risk factor), especially in developing settings where pre-eclampsia risk factors have been explored less. Other conditions such as maternal infections, severe anemia and lack of antenatal care that are more prevalent in less developed regions require further investigation and validation of findings [8,9,10]. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes
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