THE EFFECTS OF PRENATAL CARE, PRENATAL EDUCATION, AND WEIGHT ON PRE-ECLAMPSIA AND ECLAMPSIA IN HAITI 公开
Sekkarie, Ahlia (2014)
Abstract
Purpose: The research aims of this study were to determine the prevalence and trends of eclampsia and pre-eclampsia, defined as hypertension along with proteinuria, among women at Maison de Naissance (MN), a rural maternal health center in Torbeck, Haiti. The patient data from MN were analyzed to determine the extent to which prenatal care and education and maternal weight explain the risk of pre-eclampsia in the MN population.
Methods: A case-control study design was used with cases defined as pregnant women who presented at MN with a pregnancy induced hypertension (PIH), pre-eclampsia or eclampsia diagnosis and controls defined as those women who delivered babies at MN and were not diagnosed with a hypertensive disorder. The cohort included women, age 15 and above, who conceived between April 22, 2010 and October 11, 2012. The original cohort size was 899 and the number of cases was 80. However, 210 subjects were dropped from the analysis because they were duplicates, were missing case status, or were missing demographic information which was required for linking to other characteristics. Odds ratios were calculated using multivariate logistic regression.
Results: The incidence of pre-eclampsia and eclampsia was 7.0%. Prenatal care and education were not significantly associated with pre-eclampsia/eclampsia. Older maternal age at delivery (OR=3.18; 95%CI: 1.31, 7.76) and heavier maternal weight (OR=3.24; 95%CI: 1.76, 5.98) measured during prenatal care were both significantly associated with PIH/pre-eclampsia/eclampsia.
Conclusions: The prevalence of preeclampsia/eclampsia in this cohort was high, relative to rates in other developing countries. Although MN does a good job of providing prenatal care, more is required to reduce the rate of preeclampsia perhaps by targeting older and heavier women for further interventions.
Table of Contents
Table of Contents
CHAPTER I: Background & Literature Review 1
Background 1
Pre-eclampsia and Maternal Morbidity and Mortality. 2
Associations: Pre-eclampsia and Eclampsia Risk Factors. 4
CHAPTER II: Manuscript 11
Introduction. 11
Methods 13
Results 21
Discussion 26
REFERENCES 31
TABLES 39
Table 1. Descriptive Statistics for Continuous Variables. 39
Table 2. Frequencies of Categorical Variables. 40
Table 3. Crude ORs for the Odds of PIH/Pre-eclampsia/Eclampsia. 41
Table 4. Initial and Final Models with Prenatal Care Visits as Primary Exposure 42
Table 5. Initial and Final Models with Prenatal Danger Signs Education as Primary Exposure. 43
Table 6. Model comparing PIH cases to Pre-eclampsia/eclampsia cases. 44
FIGURES 45
Figure 1. Directed Acyclic Graph. 45
CHAPTER III: Public Health Implications & Future Directions 46
APPENDICES 50
Appendix A. Tabulated Prevalence of Pre-eclampsia/Eclampsia. 50
Appendix B. Tabulated Magnitude of Pre-eclampsia/Eclampsia Risk Factors. 51
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