Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa : a prospective cohort study

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dc.contributor.authorNathan, Hannah L.en_ZA
dc.contributor.authorSeed, Paul T.en_ZA
dc.contributor.authorHezelgrave, Natasha L.en_ZA
dc.contributor.authorDe Greeff, Annemarieen_ZA
dc.contributor.authorLawley, Elodieen_ZA
dc.contributor.authorConti-Ramsden, Francesen_ZA
dc.contributor.authorAnthony, Johnen_ZA
dc.contributor.authorSteyn, Wilhelmen_ZA
dc.contributor.authorHall, David R.en_ZA
dc.contributor.authorChappell, Lucy C.en_ZA
dc.contributor.authorShennan, Andrew H.en_ZA
dc.date.accessioned2020-04-17T18:11:50Z
dc.date.available2020-04-17T18:11:50Z
dc.date.issued2018
dc.descriptionCITATION: 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.
dc.descriptionThe original publication is available at http://jogh.org
dc.description.abstractBackground: 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.en_ZA
dc.description.urihttp://www.jogh.org/issue201802.htm
dc.description.versionPublisher's version
dc.format.extent10 pages
dc.identifier.citationNathan, 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
dc.identifier.issn2047-2986 (online)
dc.identifier.issn2047-2978 (print)
dc.identifier.otherdoi:10.7189/jogh.08.020401
dc.identifier.urihttp://hdl.handle.net/10019.1/107708
dc.language.isoen_ZAen_ZA
dc.publisherEdinburgh University Global Health Society
dc.rights.holderAuthors retain copyright
dc.subjectPreeclampsiaen_ZA
dc.subjectHypertension in pregnancyen_ZA
dc.subjectMaternal death -- Mathematical models -- South Africaen_ZA
dc.subjectPerinatal death -- Mathematical models -- South Africaen_ZA
dc.subjectPremature born childrenen_ZA
dc.titleMaternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa : a prospective cohort studyen_ZA
dc.typeArticleen_ZA
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