Socio Demographic Determinants of Eclampsia and Their Association with Maternal and Perinatal Outcomes
DOI:
https://doi.org/10.51699/cajmns.v7i4.3409Keywords:
Eclampsia, Postpartum Hemorrhage, Education, Maternal and Perinatal Outcomes, Vaginal DeliveryAbstract
Background: Eclampsia is a major preventable cause of maternal and perinatal death around the world and disproportionately affects low- and middle-income countries (LMICs). To make targeted interventions, it is important to understand the socio-demographic risk factors for eclampsia and how these factors affect later outcomes.
Methods: This is a cross-sectional study of 115 women diagnosed with eclampsia, performed in Hospitals in Baghdad, Iraq. The socio-demographic characteristics (age, parity, education, and referral status), clinical presentation, and maternal and perinatal outcomes were recorded. Independent risk factors for adverse outcomes were identified using multivariable logistic regression.
Findings: 1.1% of deliveries were complicated by eclampsia. The mean age was 27.4 years (SD ±6.3). Adolescent mothers (aged <20 years) accounted for 34% and were 2.5 times more likely than older mothers (95% CI 1.8–3.4). 43.9% of mothers were nulliparous, and they were associated with high perinatal mortality (AOR 1.74, 95% CI 1.01–3.00). The rates of maternal complications were 64.3%, and those of perinatal mortality were 20.1%, respectively. Vaginal delivery (AOR 5.5; 95% CI 2.3–13.3) and postpartum hemorrhage (AOR 3.2; 95% CI 1.2–8.3) were independent risk factors for perinatal death. The majority of cases were antepartum eclampsia (63.8%).
Conclusion: Socio-demographic factors such as low education, nulliparity, and young maternal age are important factors associated with eclampsia and adverse perinatal outcomes.
References
S. Rana, E. Lemoine, J. P. Granger, and S. A. Karumanchi, “Preeclampsia: Pathophysiology, challenges, and perspectives,” Circulation Research, vol. 124, pp. 1094–1112, 2019.
A. Filipek and E. Jurewicz, “Preeclampsia—A disease of pregnant women,” Postępy Biochemii, vol. 64, pp. 232–239, 2018.
C. T. Wu, C. F. Kuo, C. P. Lin, Y. T. Huang, S. W. Chen, H. M. Wu, and P. H. Chu, “Association of family history with incidence and gestational hypertension outcomes of preeclampsia,” International Journal of Cardiology Hypertension, vol. 9, Art. no. 100084, 2021.
A. C. Staff, “The two-stage placental model of preeclampsia: An update,” Journal of Reproductive Immunology, vol. 134, pp. 1–10, 2019.
T. L. Weissgerber and L. M. Mudd, “Preeclampsia and diabetes,” Current Diabetes Reports, vol. 15, Art. no. 9, 2015.
A. Y. Wassie and W. Anmut, “Prevalence of eclampsia and its maternal-fetal outcomes at Gandhi Memorial Hospital, Addis Ababa, Ethiopia, 2019: A retrospective study,” International Journal of Women’s Health, vol. 13, pp. 231–237, 2021.
S. K. Shaeen, Z. H. Tharwani, W. Bilal, Z. Islam, and M. Y. Essar, “Maternal mortality in Pakistan: Challenges, efforts, and recommendations,” Annals of Medicine and Surgery, vol. 81, Art. no. 104380, 2022.
T. Wainstock and E. Sheiner, “Clinical factors associated with preeclampsia recurrence,” Pregnancy Hypertension, vol. 30, pp. 31–35, 2022.
A. Tassi, A. Sala, A. Mazzera, I. Restaino, S. Vizzielli, G. Driul, and L. [surname not provided], “Long-term outcomes of patients with preeclampsia: A review of the literature,” Hypertension in Pregnancy, vol. 42, no. 1, Art. no. 2217448, 2023.
E. Dimitriadis, D. L. Rolnik, W. Zhou, G. Estrada-Gutierrez, K. Koga, R. P. V. Francisco, et al., “Pre-eclampsia,” Nature Reviews Disease Primers, vol. 9, no. 1, Art. no. 8, 2023, doi: 10.1038/s41572-023-00417-6.
H. M. Lugobe, M. Kayondo, C. M. McEniery, J. M. Catov, I. B. Wilkinson, B. J. Wylie, et al., “Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda,” AJOG Global Reports, vol. 3, no. 1, Art. no. 100163, 2023.
U. Shamsi, S. Saleem, and N. Nishter, “Epidemiology and risk factors of preeclampsia: An overview of observational studies,” Al Ameen Journal of Medical Sciences, vol. 6, no. 4, pp. 292–300, 2013.
Kenya National Bureau of Statistics, Kenya Demographic and Health Survey 2014. Nairobi, Kenya, 2014.
G. Logan, “Replication data for: Determinants of preeclampsia and eclampsia among women delivering in county hospitals in Nairobi, Kenya,” Harvard Dataverse, V1, 2020.
G. A. Tessema, A. Tekeste, and T. A. Ayele, “Preeclampsia and associated factors among pregnant women attending antenatal care in Dessie Referral Hospital, Northeast Ethiopia: A hospital-based study,” BMC Pregnancy and Childbirth, vol. 15, Art. no. 73, 2015.
U.S. Preventive Services Task Force, K. Bibbins-Domingo, D. C. Grossman, et al., “Screening for preeclampsia: U.S. Preventive Services Task Force recommendation statement,” JAMA, vol. 317, no. 16, pp. 1661–1667, 2017.
T. Grum, A. Seifu, M. Abay, et al., “Determinants of pre-eclampsia/eclampsia among women attending delivery services in selected public hospitals of Addis Ababa, Ethiopia: A case-control study,” BMC Pregnancy and Childbirth, vol. 17, no. 1, Art. no. 307, 2017.
N. C. Ngene and J. Moodley, “Preventing maternal morbidity and mortality from preeclampsia and eclampsia, particularly in low- and middle-income countries,” Best Practice & Research Clinical Obstetrics & Gynaecology, Art. no. 102473, 2024.
A. Malik, B. Jee, and S. K. Gupta, “Preeclampsia: Disease biology and burden, its management strategies with reference to India,” Pregnancy Hypertension, vol. 15, pp. 23–31, 2019.
J. C. Giordano, M. A. Parpinelli, J. G. Cecatti, S. M. Haddad, M. L. Costa, F. G. Surita, et al., “The burden of eclampsia: Results from a multicenter study on surveillance of severe maternal morbidity in Brazil,” PLoS ONE, vol. 9, no. 5, Art. no. e97401, 2014.
V. Katsi, A. Svigkou, I. Dima, and K. Tsioufis, “Diagnosis and treatment of eclampsia,” Journal of Cardiovascular Development and Disease, vol. 11, no. 9, Art. no. 257, 2024.
