Main Article Content
Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortalities worldwide. Despite extensive research, the underlying cause of preeclampsia remains poorly understood. This study aimed to offer compelling evidence on the important risk factors of preeclampsia in Amhara region, Ethiopia.
A case control study was conducted in public health facilities of Bahir Dar city from September 2014 to January 2015. A total of 453 (151 cases and 302 controls) pregnant women were enrolled in this study. Hemoglobin level and urinary tract infection (UTI) status were collected from clinical notes. Oral examination was performed by a dentist for detection of periodontal diseases. Univariate and multiple logistic regression analysis was conducted to determine the relationship of all the independent variables with the outcome variable. A p-value <0.05 was declared statistically significant.
Advanced maternal age (AOR=4.79;95% CI 1.031-22.18), family history of hypertension (AOR=11.16;95% CI 5.41-41.43), history of diabetes mellitus (AOR=6.17;95% CI 2.11-20.33), UTI in the current pregnancy (AOR=6.58;95% CI 2.93-14.73), failure to comply with iron and folic acid supplement during pregnancy (AOR=8.32;95% CI 3.35-20.62), lack of exercise (AOR=3.33;95% CI 1.35-8.17), multiple pregnancy (AOR=4.05;95% CI 1.57-12.27), anemia (AOR=4.19;95% CI 1.27-13.92), and periodontal disease or gingivitis (AOR =3.51;95% CI 1.14-10.83) were associated with preeclampsia.
Family history of hypertension was the most dominant risk factor for preeclampsia in pregnant women. Encouraging pregnant women to have health seeking behavior during pregnancy would provide a chance to diagnose preeclampsia as early as possible.
Rath W, Fischer T. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Dtsch Arztebl Int 2009;106:733–8. doi: 10.3238/artebl.2009.0733.
Sidani M, Siddik-Sayyid MS. Preclampsia, a new perspective. MEJ Anesth 2011;21:207-15.
Dolea C, Abouzahr C. Global burden of hypertensive disorders of pregnancy. Geneva: World Health Organization;2003.
Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. BMC Pregnancy Childbirth 2009;9:8. doi: 10.1186/1471-2393-9-8.
McClure JH, Cooper GM, Clutton-Brock TH. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006-8: a review. Br J Anaesth 2011;107:127-32.
American Congress of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Washington, DC: American Congress of Obstetricians and Gynecologists;2013.
Edmonds K. Dewhurst’s textbook of obstetrics & gynaecology. 7th ed. Carlton, Victoria: Blackwell Publishing Asia Pty Ltd;2007.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009;33:130-7. doi: 10.1053/j.semperi.2009.02.010.
World Health Organization. Recommendations for prevention and treatment of preeclampsia and eclampsia. Geneva: World Health Organization; 2011.
Khan K, Wojdyla D, Say L, et al. World Health Organization analysis of causes of maternal death, a systematic review. Lancet 2006;367: 1066-74.
Uzan J, Carbonnel M, Piconne O, et al. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag 2011;7: 467–74.
Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. J Pregnancy 2011; Article ID 481095, 6 pages. doi: 10.1155/2011/481095.
Roberts JM, Gammill HS. Preeclampsia: recent insights. Hypertension 2005;46:1243-9.
Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011;377:1331-40. DOI: 10.1016/S0140- 6736(10)62233-7.
Luo B, Ma X. Risk factors for preeclampsia: a case–control study. Hypertens Pregnancy 2013;32:432-8. doi: 10.3109/10641955.2013. 824979.
Direkvand-Moghadam A, Khosravi A, Sayehmiri K. Predictive factors for preeclampsia in pregnant women: a univariate and multivariate logistic regression analysis. Acta Biochim Pol 2012;59:673-7.
Tebeu PM, Foumane P, Mbu R, et al. Risk factors for hypertensive disorders in pregnancy: a report from the Maroua Regional Hospital, Cameroon. J Reprod Infertil 2011;12:227-34.
Smits J, Monden C. Twinning across the developing world. Plos ONE 2011;6:e25239. doi:10.1371/journal.pone.0025239.
Lewis F, Modeste N, Singh P, et al. Excess maternal body weight and preeclampsia/eclampsia risk among women in San Bernardino County, 2007-2008. J Food Nutr 2015;1:1-6.
Dalmáz CA, dos Santos KG, Botton MR, et al. Risk factors for hypertensive disorders of pregnancy in southern Brazil. Rev Assoc Med Bras 2011;57:692-6.
Tessema GA, Tekeste A, Ayele TA. Preeclampsia and associated factors among pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based study. BMC Pregnancy Childbirth 2015;15:73. DOI: 10.1186/s12884-015-0502-7.
Rasmussen S, Irgens LM. Pregnancy-induced hypertension in women who were born small. Hypertension 2007;49:806-12.
Rosenberg TJ, Garbers S, Lipkind H, et al. Maternal obesity and diabetes as risk factors for adverse pregnancy outcomes: differences among four racial/ethnic groups. Am J Public Health 2005;95:9:1545-51.
Mazor-Dray E, Levy A, Schlaeffer F, et al. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med 2009;22: 124-8.
Xiong X, Buekens P, Fraser WD, et al Periodontal disease and adverse pregnancy outcomes: a systematic review. BJOG 2006;113: 135-43.
Agrawal S, Walia GK. Prevalence and risk factors for pre-eclampsia in Indian women. J Womens Health Issues Care 2014;3:6. doi: 10.4172/2325-9795.1000169.
Ali AA, Rayis DA, Abdallah TM, et al. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan. BMC Res Notes 2011;4:311. doi: 10.1186/1756-0500-4-311.
Lardoeyt R, Vargas G, Lumpuy J, et al. Contribution of genome-environment interaction to pre-eclampsia in a Havana maternity hospital. MEDICC Rev 2013;15:22-9.
Owiredu WKBA, Ahenkorah L, Turpin CA, et al. Putative risk factors of pregnancy-induced hypertension among Ghanaian pregnant women. J Med Biomed Sci 2012;1:62-76.
Bodnar L, Tang G, Ness R, et al. Periconceptional multivitamin use reduces the risk of preeclampsia. Am J Epidemiol 2006;164:470-7.
Trogstad L, Magnus P, Skjærven R, et al. Previous abortions and risk of pre-eclampsia. Int J Epidemiol 2008;37:1333-40.
Wolde Z, Segni H, Woldie M. Hypertensive disorders of pregnancy in Jimma University Specialized hospital. Ethiop J Health Sci 2011; 21:147-54.
Teklu S, Gaym A. Prevalence and clinical correlates of the hypertensive disorders of pregnancy at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Ethiop Med J 2006;44:17-26.
Fanga R, Dawsona A, Lohsoonthorna V, et al. Risk factors of early and late onset preeclampsia among Thai women. Asian Biomed 2009;3:477-86.
Carranza FA, Newman MG, Takei HH, et al. Carranza’s clinical periodontology. 10th ed. St. Louis (Mo): Saunders Elsevier; 2006.
World Health Organization. Guideline: daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization; 2012.
Polyzos NP, Polyzos IP, Zavos A, et al. Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis. BMJ 2010;341:c7017. doi: 10.1136/bmj.c7017.
Gambone JC, Marsden DE. Essentials of obstetrics and gynecology. 4th ed. Philadelphia (PA): Elsevier Saunders;2007.
Eiland E, Nzerue C, Faulkner M. Preeclampsia 2012. J Pregnancy 2012;2012:586578. doi: 10.1155/2012/586578.
Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;365:785–99.
Minassian C, Thomas SL, Williams DJ, et al. Acute maternal infection and risk of pre-eclampsia: a population-based case-control study. PLoS ONE 2013;8:e73047. doi: 10.1371/journal. pone.0073047.
Parihar AS, Katoch V, Rajguru SA, et al. Periodontal disease: a possible risk factor for adverse pregnancy outcome. J Int Oral Health 2015;7:137.
Bdolah Y, Lam C, Rajakumar A, et al. Twin pregnancy and the risk of preeclampsia: bigger placenta or relative ischemia? Am J Obstet Gynecol 2008;198:428.e1-e6.
Endeshaw M, Abebe F, Bedimo M, et al. Diet and preeclampsia: a prospective multicentre case-control study in Ethiopia. Midwifery 2015; 31:617-24. doi: 10.1016/j.midw.2015.03.003.
Chuang CZ, Boyles A, Legardeur B, et al. Effects of riboflavin and folic acid supplementation on plasma homocysteine levels in healthy subjects. Am J Med Sci 2006;331:65-71.
Lindblad B, Zaman S, Malik A, et al. Folate, vitamin B12, and homocysteine levels in South Asian women with growth retarded fetuses. Acta Obstet Gynecol Scand 2005;84:1055–61.
MacKenzie KE, Wiltshire EJ, Gent R, et al. Folate and vitamin B6 rapidly normalize endothelial dysfunction in children with type 1 diabetes mellitus. Pediatrics 2006;118:242–53.