Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study

Abstract

Background: In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk.

Methods: A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model.

Results: We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR=2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR=3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR=3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR=2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR=2.81, 95% CI: 1.63-4.86), low maternal assets (AOR=2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR=2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR=2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR=1.94, 95% CI: 1.15-3.25).

Conclusion: Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.