Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa : a prospective cohort study
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Edinburgh University Global Health Society
Abstract
Background: Hypertensive disorders of pregnancy contribute to 14% of all
maternal deaths, the majority of which occur in low- and middle-income
countries. The aim of the study was to describe the maternal and perinatal
clinical outcomes of women with pre-eclampsia living in middle- and
low-income countries.
Methods The study was a prospective observational study of women with
pre-eclampsia (n = 1547, 42 twin pregnancies) at three South African tertiary
facilities. Using stepwise logistic regression model area under the receiver
operating characteristic curve (AUROC) values, the association between
maternal baseline and admission characteristics and risk of adverse
outcomes was evaluated. Main outcome measures were eclampsia, kidney
injury and perinatal death.
Results In 1547 women with pre-eclampsia, 16 (1%) died, 147 (9.5%)
had eclampsia, four (0.3%) had a stroke and 272 (17.6%) had kidney injury.
Of the 1589 births, there were 332 (21.0%) perinatal deaths; of these,
281 (84.5%) were stillbirths. Of 1308 live births, 913 (70.0%) delivered
<37 completed weeks and 544 (41.7%) delivered <34 weeks’ gestation.
Young maternal age (AUROC = 0.76, 95% confidence interval (CI) = 0.71-
0.80) and low Body Mass Index BMI (AUROC 0.65, 95% CI = 0.59-0.69)
were significant predictors of eclampsia. Highest systolic blood pressure
had the strongest association with kidney injury, (AUROC = 0.64, 95%
CI = 0.60-0.68). Early gestation at admission was most strongly associated
with perinatal death (AUROC = 0.81, 95% CI = 0.77-0.84).
Conclusions The incidence of pre-eclampsia complications, perinatal
death and preterm delivery in women referred to tertiary care in South
Africa was much higher than reported in other low- and middle-income
studies and despite access to tertiary care interventions. Teenage mothers
and those with low BMI were at highest risk of eclampsia. This information
could be used to inform guidelines, the research agenda and policy.
Description
CITATION: Nathan, H. L., et al. 2018. Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa : a prospective cohort study. Journal of Global Health, 8(2):020401, doi:10.7189/jogh.08.020401.
The original publication is available at http://jogh.org
The original publication is available at http://jogh.org
Keywords
Preeclampsia, Hypertension in pregnancy, Maternal death -- Mathematical models -- South Africa, Perinatal death -- Mathematical models -- South Africa, Premature born children
Citation
Nathan, H. L., et al. 2018. Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa : a prospective cohort study. Journal of Global Health, 8(2):020401, doi:10.7189/jogh.08.020401