Preeclampsia: Materanl Risk Factors & Perinatal Outcomes

Abstract

Background:  Pre-eclampsia (PE) is the commonest hypertensive disorder in pregnancy. Adverse maternal and perinatal outcomes of pre-eclampsia are representing the big burden on national health system.

Objectives: Is to identify the maternal risk factors of pre-eclamsia among pregnant women as well as  to find out the maternal and perinatal outcomes of this problem.

Methods: A prospective follow up study was conducted in Obstetrics & Gynecology Department (OGD) of Al-Zahraa Maternity and Pediatric Hospital (ZMPH) in Al-Muqdadia District in Diyala province from the period 1^st of February 2017 to 31^st of January 2018. The study sample comprised 60 pregnant women with pre-eclampsia and 60 healthy pregnant women as controls. The diagnosis of PE was established according to American College of Obstetricians and Gynecologists (ACOG) diagnostic criteria of PE.

Results: Maternal risk factors related significantly to pre-eclampsia in comparison to controls were increased woman's age, obesity and primigravidity. There was a highly significant association between high cesarean section rates and pre-eclamptic women. A significant association was observed between neonates of pre-eclamptic women and low birth weight  preterm birth , low Apgar score at 1 minute . low Apgar score at 5 minutes and admission to neonatal intensive care unit .  

 Conclusion: The main maternal risk factors for pre-eclampsia are advanced reproductive age, obesity and primigravidity, while the common adverse maternal outcome is the cesarean section. The common perinatal outcomes  of PE are low birth weight, prematurity, low Apgar scores at 1 & 5 minutes and high NICU admission. 

Keywords

• Pre-eclapsia,Obesity,Perinatal outcome

Preeklampsi: Maternal Risk Faktörleri ve Perinatal Sonuçlar

Abstract

Amaç: Preeklampsi (PE) gebelikte en sık görülen hipertansif hastalıktır. Preeklampsinin olumsuz maternal ve perinatal sonuçları, ulusal sağlık sistemi üzerindeki büyük yükü temsil etmektedir.Gebelerde preeklampsinin maternal risk faktörlerini belirlemek ve bu problemin maternal ve perinatal sonuçlarını bulmak.

Metodlar: Diyala ili / Irak'ta El-Mukaradia Bölgesi'ndeki Kadın Hastalıkları ve Doğum Kliniği (ZMPH)’de 1 Şubat 2017 - 31 Ocak 2018 tarihleri ​​arasında prospektif bir izlem çalışması yapıldı. Çalışma örnekleminde preeklampsili 60 gebe ve kontrol grubu olarak 60 normal gebe alındı. PE tanısı, Amerikan Kadın Doğum Kliniği ve Jinekologlar Koleji (ACOG) PE tanı kriterlerine göre kondu.

Bulgular: Kontrole kıyasla preeklampsiyle anlamlı derecede ilişkili anne risk faktörleri, kadının yaşı, şişmanlığı ve primigraviditesinde artış idi. Sezaryen doğum oranları ile preeklampsi arasında oldukça anlamlı bir ilişki vardı. Preeklamptik kadınların yenidoğanları ile düşük doğum ağırlıklı erken doğum, 1 dakikada düşük Apgar skoru,  düşük 5 dakika Apgar skoru ve yenidoğan bakım ünitesine yatış arasında anlamlı bir ilişki gözlendi.

  Sonuç: Preeklampsi için ana maternal risk faktörleri ileri derecede üreme yaşı, obezite ve primigravidite iken, ortak ters maternal sonuç sezaryendir. PE'nin sık görülen perinatal sonuçları düşük doğum ağırlığı, prematürite, 1-5 dakikada düşük Apgar skorları ve yüksek NICU kabulüdür.

Keywords

• Preeklampsi,Obezite,Perinatal sonuç,Prematüre

References

1. 1. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122(5):1122-1131.
2. 2. Mustafa R, Ahmed S, Gupta A, Venuto RC. A comprehensive review of hypertension in pregnancy. J Pregnancy 2012; 2012:105918.
3. 3. Cecil RL, Goldman L, Schafer AI. Goldman's Cecil medicine (24th ed). Philadelphia, PA: Elsevier Saunders; 2012.
4. 4. Al-Kayat ES. Maternal Mortality in cities of Iraq for Three Years. Int J Curr Microbiol App Sci 2016; 5(1): 590-611.
5. 5. Shen M, Smith GN, Rodger M, White RR, Walker MC, Wen SW. Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia. Räisänen SH, ed. PLoS ONE 2017; 12(4):e0175914.
6. 6. Awqati NA, Ali MM, Al-Ward NJ, Majeed FA, Salman K, Al-Alak M, et al. Causes and differentials of childhood mortality in Iraq. BMC Pediatrics 2009; 9:40.
7. 7. Tranquilli AL, Landi B, Giannubilo SR, Sibai BM. Preeclampsia: no longer solely a pregnancy disease. Pregnancy Hypertens 2012; 2(4):350–357.
8. 8. Steegers EA, Von Dadelszen P, Duvekott JJ, Pijnenborg R. Pre eclampsia. Lancet 2010; 376(9741):631–644.

9. 9. Gruslin A, Lemyre B. Pre-eclampsia: fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011; 25(4):491–507.
10. 10. Dalmáz CA, Santos KG, Botton MR, Roisenberg I. Risk factors for hypertensive disorders of pregnancy in Southern Brazil. Rev Assoc Med Bras 2011; 57(6):692–696.
11. 11. Jasovic-Siveska E, Jasovic V. Demographic characteristics in preeclamptic women in Macedonia. Rev Med Chil 2011; 139(6):748–754.
12. 12. Altaei A, Mohammad JM. Incidence and Risk Factors of Pre-eclampsia among Iraqi Pregnant women. AJPS 2012; 12 (2): 52-60.
13. 13. World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. 2011; Available at: http://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf
14. 14. Liang J, Zhu J, Dai L, Li X. Maternal mortality in China, 1996-2005. Int J Gynaecol Obstet 2010; 110: 93-96. Available at: http://dx.doi.org/10.1016/j.ijgo.2010.03.013
15. 15. Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008. BMC Pregnancy and Childbirth 2012; 12:47.
16. 16. English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integrated Blood Pressure Control 2015; 8:7-12.
17. 17. Thomopoulos C, Tsioufis C, Michalopoulou H, Makris T, Papademetriou V, Stefanadis C. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review. J Hum Hypertens 2013; 27(3):148–157.
18. 18. Jackson RA, Gibson KA, YW W, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 2004; 103(3):551–563.
19. 19. Ogawa K, Urayama KY, Tanigaki S, Sago H, Sato S, Saito S, et al. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy and Childbirth 2017; 17:349.
20. 20. Endeshaw M, Abebe F, Worku S, Menber L, Assress M, Assefa M. Obesity in young age is a risk factor for preeclampsia: a facility based case-control study, northwest Ethiopia. BMC Pregnancy and Childbirth 2016; 16:237.
21. 21. Jeyabalan A. Epidemiology of preeclampsia: Impact of obesity. Nutrition reviews 2013; 71(0 1):10.1111/nure.12055.
22. 22. Roberts JM, Bodnar LM, Patrick TE, Powers RW. The Role of Obesity in Preeclampsia. Pregnancy hypertension 2011; 1(1):6-16.
23. 23. Rasmussen KM, Yaktine AL, Institute of Medicine (U.S.) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. National Academies Press; Washington, DC: 2009.
24. 24. Robb AO, Mills NL, Din JN, Smith IB, Paterson F, Newby DE, et al. Influence of the menstrual cycle, pregnancy, and preeclampsia on arterial stiffness. Hypertension 2009; 53(6):952-958.
25. 25. van der Tuuk K, van Pampus MG, Koopmans CM, Aarnoudse JG, van den Berg PP, van Beek JJ, et al. Prediction of cesarean section risk in women with gestational hypertension or mild preeclampsia at term. Eur J Obstet Gynecol Reprod Biol 2015; 191:23-27.
26. 26. Cho GJ, Kim LY, Min K-J, Sung YN, Hong S-C, Oh M-J, et al. Prior cesarean section is associated with increased preeclampsia risk in a subsequent pregnancy. BMC Pregnancy and Childbirth 2015; 15:24.
27. 27. Tang S, Li X, Wu Z. Rising cesarean delivery rate in primiparous women in urban China: evidence from three nationwide household health surveys. Am J Obstet Gynecol 2006; 195(6):1527–1532.
28. 28. Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB. Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced? J Matern Fetal Neonatal Med 2010; 23(5):383-388.
29. 29. Backes CH, Markham K, Moorehead P, Cordero L, Nankervis CA, Giannone PJ. Maternal Preeclampsia and Neonatal Outcomes. Journal of Pregnancy 2011; 2011:214365.
30. 30. Obaid KA, Kadoori MB, Baker GM. Effect of Maternal Hypertension on Neonatal Outcome in Diyala Province, Iraq. Diyala Journal of Medicine 2013; 5 (2): 69-74.
31. 31. Doddamani GB, Doddamani UG. Perinatal Outcome in Pre-Eclampsia: A Prospective Study. Sch. J. App. Med Sci 2014; 2(1C):291-293.
32. 32. Masoura S, Kalogiannidis I, Margioula-Siarkou C, Diamanti E, Papouli M, Drossou-Agakidou V, et al. Neonatal outcomes of late preterm deliveries with pre-eclampsia. Minerva Ginecol 2012; 64(2):109-115.