The Associations of Hypertensive Disorders in Pregnancy with Maternal and Neonatal Outcomes in Haiti Open Access

Bridwell, Matthew Edward (2016)

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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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