The Associations of Hypertensive Disorders in Pregnancy with Maternal and Neonatal Outcomes in Haiti Open Access
Bridwell, Matthew Edward (2016)
Abstract
Objective: The objective of this study was to determine reported prevalence of hypertensive disorders in pregnancy (HDP) and maternal and neonatal outcomes associated with these disorders among women delivering at selected hospitals across Haiti.
Methods: A retrospective review of 8,822 singleton deliveries between January 2012 and December 2014 was conducted at four hospitals in separate Departments throughout Haiti. Researchers examined the proportion of women with reported HDP (hypertension, preeclampsia, eclampsia) in 4 hospitals and the association between women with HDP and three neonatal outcomes: low birth weight (<2500 grams), preterm birth (<37 weeks' gestation), and stillbirths; and two maternal outcomes: placental abruption and maternal death (prior to hospital discharge) in Hôpital Albert Schweitzer (HAS). Odds ratios for associations between HDP and perinatal outcomes were assessed using logistic regression, adjusting for potential confounders.
Results: Of the 8,822 singleton births included in the study, 510 (5.8%) had a reported HDP (including 285 (55.9%) were preeclamptic, 119 (23.3%) eclamptic, and 106 (20.8%) hypertensive diagnoses). Prevalence of HDP among each hospital was: HAS (13.5%), HIC (3.2%), Fort Liberté (4.3%), and HSC (3.0%). Among women at HAS with HDP, the adjusted odds of having a low birth weight baby was four times that of women without HDP (aOR 4.17, 95% CI 3.19-5.45), more than three times that for stillbirths (aOR 3.51, 95% CI 2.43-5.06), and five times as likely to result in maternal death (aOR 5.13, 95% CI 1.53-17.25). Among the 3 types of HDP, eclampsia was associated with the greatest odds of adverse events with five times the odds of having a low birth weight baby (aOR 5.00, 95% CI 2.84), six times the odds for stillbirths (aOR 6.34, 95% CI 3.40-11.82), and more than twelve times as likely to result in maternal death (aOR 12.70, 95% CI 2.33-69.31).
Conclusions: HDP was associated with higher rates of adverse maternal and neonatal outcomes in one hospital with possibly better reporting of maternal complications than other hospitals in Haiti. This finding is comparable to studies of HDP conducted in high-income countries.
Table of Contents
Glossary i
Chapter I: Literature Review 1
Hypertensive Disorders in Pregnancy: A Global Problem 2
HDP Research in the Developed World 4
Health System in Haiti 6
Health Complications Faced by Haitian Women 8
Hypertensive Disorders in Pregnancy Research in Haiti 9
Challenges in Health Statistics in Haiti 11
Conclusion 12
Chapter II: Manuscript 13
Abstract 13
Introduction 14
Methods 16
Results 19
Discussion 22
Tables 28
Table 1: Prevalence of hypertensive disorders in pregnancy in 4 hospitals by 6-month intervals 28
Table 2: Comparison of clinical presentation of women at 4 hospitals in Haiti 29
Table 3: Clinical presentation of women with and without stillbirth at HAS, by entire cohort and by HDP mothers only 30
Table 4: Clinical presentation of women by maternal death status at HAS, by entire cohort and by HDP mothers only 31
Table 5: Logistic regression on the association between HDP and outcomes for women at HAS 32
Figures 33
Figure 1: Geographic Distribution of Targeted Hospitals 33
Figure 2: Cohort chart 34
References 35
Chapter III: Public Health Implications 42
Appendix: SAS Code 44
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