A prospective study evaluating the association of specific risk factors with the development of preeclampsia

Budhram, Samantha (2015-12)

Thesis (MMed)--Stellenbosch University, 2015

Thesis

ENGLISH ABSTRACT: OBJECTIVE: To determine the association, if any, between certain risk factors for preeclampsia (PE) and the subsequent development of PE in a local cohort of South African women. DESIGN: A prospective study of women with any risk factor for PE for the duration of their pregnancy. METHOD: A prospective study was performed on selected women referred to Tygerberg Hospital, High-risk antenatal clinic, with specific risk factors for the development of PE. A history-based questionnaire was completed by participants at enrolment and biophysical parameters were recorded at each subsequent antenatal visit, admission and at confinement. All data was captured according to the attached data sheet. All information was kept confidential and was strictly for the purposes of this study. STATISTICS: Statistics were performed using the SPSS statistics software version 17.0. Pearson Chi-square test of independence was used for correlating maternal historical factors, mean arterial pressures (MAP) and cardio-metabolic risk with the development of PE in the index pregnancy. p values were considered significant at values < 0.05. RESULTS: The incidence of PE in the cohort was 11.4%. The age of the patient, parity, history of diabetes mellitus, MAP at booking and MAP at 24 weeks showed no significant association with the development of PE at any gestational age. There was a significant association between a history of PE in a previous pregnancy and the development of PE at any gestational age in the index pregnancy (p < 0.05). There were a significantly higher number of women with a history of chronic hypertension that developed PE in the index pregnancy (p < 0.0001). There were also a significantly greater number of obese women that developed PE at any gestational age in the index pregnancy (p < 0.05). The presence of any one or, a combination of cardio-metabolic risk factors was significantly associated with the development of PE at any gestational age (p < 0.005). CONCLUSION: The changing cardio-metabolic milieu, paralleling the pandemic in obesity, may be impacting on the development of PE. Screening for PE in South Africa may mean; validation of historical factors and MAP in prediction of PE in the local population, and if validated, incorporating it with the cardio-metabolic risk profile to triage women to appropriate levels of care. The pre-pregnancy, antenatal, postpartum and inter-pregnancy intervals can be used to optimise cardio-metabolic risk factors and these women, at the end of their reproductive careers, may benefit from life-long surveillance for cardiovascular disease.

AFRIKAANSE OPSOMMING: Doel: Om die assosiasie, indien enige, te bepaal tussen sekere risikofaktore vir pre-eklampsie (PE)1 en die daaropvolgende ontwikkeling van PE in 'n lokale kohort Suid-Afrikaanse vroue. Ontwerp: 'n Prospektiewe studie van vroue met enige risikofaktor vir PE vir die duur van hul swangerskap. Metode: 'n Prospektiewe studie is uitgevoer op geselekteerde vroue wat na Tygerberg Hospitaal hoë risiko voorgeboortekliniek verwys is met spesifieke risikofaktore vir PE. 'n Geskiedenis gebaseerde vraelys is met werwing voltooi en biofisiese parameters is met elke daaropvolgende besoek, toelating en verlossing voltooi. Alle data is volgens die datablad vasgelê. Alle inligting is vertroulik hanteer en was spesifiek vir die doeleindes van die studie. Statistiek: Statistiese ontleding is met SPSS sagteware weergawe 17 uitgevoer. Pearson chi-kwadraat toets is gebruik om moederlike historiese faktore, gemiddelde arteriële druk (MAP) en kardio-metaboliese risiko met die ontwikkeling van PE in die indeks swangerskap te korrelleer. p-waardes < 0.05 is as betekenisvol beskou. Resultate: Die insidensie van PE in die kohort was 11.4%. Die ouderdom van die pasiënt, pariteit, geskiedenis van diabetes mellitus, MAP met bespreking en MAP teen 24 weke swangerskapsduurte had geen betekenisvolle assosiasie met PE op enige swangerskapsduurte nie. Daar was 'n betekenisvolle assosiasie tussen 'n geskiedenis van PE in 'n vorige swangerskap en die ontwikkeling van PE op enige swangerskapsduurte in die indeksswangerskap (p < 0.05). Daar was betekenisvol meer vroue met 'n geskiedenis van chroniese hipertensie wat PE ontwikkel het in die indeksswangerskap (p < 0.0001). Daar was ook betekenisvol meer obees vroue wat PE in die indeksswangerskap ontwikkel het (p < 0.05). Die teenwoordigheid van een, of 'n kombinasie van kardio-metaboliese risikofaktore was betekenisvol geassosieer met die ontwikkeling van PE op enige swangerskapsduurte. (p < 0.05). Gevolgtrekking: Die veranderende kardio-metaboliese milieu, met die pandemie van obesiteit, mag impak op die ontwikkeling van PE. Sifting vir PE in Suid-Afrika mag beteken: bevestiging van historiese faktore en MAP in die voorspelling van PE in die plaaslike bevolking en indien bevestig, die insluiting van kardio-metaboliese risikoprofiel om vroue na toepaslike vlakke van sorg te stuur. Die pre-swangerskap, voorgeboortelike, postpartum, en inter-swangerskap intervalle kan gebruik word om kardio-metaboliese risikofaktore te optimaliseer en hierdie vroue mag aan die einde van hul reproduktiewe lewe baat by lewenslange opvolg vir kardiovaskulêe siekte.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98034
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