Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
Print this page Email this page Users Online: 24

  Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 52-56  

A study of epidemiological factors in antenatal mothers with pregnancy-induced hypertension at the tertiary care hospital


1 Department of Community Medicine, Dr DY Patil Medical College, Hospital and Research Centre, Dr DY Patil Vidyyapeeth, Pune, Maharashtra, India
2 Department of Community Medicine, B J Medical College, Pune, Maharashtra, India
3 Department of Community Medicine, Government Medical College, Latur, Maharashtra, India

Date of Submission08-Jun-2020
Date of Decision03-Jul-2020
Date of Acceptance09-Jul-2020
Date of Web Publication22-Jan-2021

Correspondence Address:
Sadhana V Lakhute
Department of Community Medicine, D Y Patil Medical College, DPU, Pimpri, Pune, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_112_20

Rights and Permissions
  Abstract 


Background: Pregnancy-induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity, affecting about 5%–8% of pregnant women. The risk factors postulated to influence the risk of PIH among the mothers include sociodemographic factors, genetic factors, pregnancy-related complications, or personal factors. Objectives: The objective of this study is to study the sociodemographic profile, prevalence, and epidemiological risk factors of PIH in antenatal patients. Materials and Methods: A cross-sectional study was conducted at GMC Latur, Maharashtra, India, as a part of postgraduation thesis work and was approved by MUHS Nashik. A total of 1600 antenatal care cases were selected. The study variables included mother's age, parity, height, body mass index, socioeconomic profile, and diet. Interviewer administered questionnaires were used to capture the demographic data and obstetric history. PIH prevalence in this study was found to be 6.06%. Primi-parity, age above 30 years, poor socioeconomic status, less education, joint family, >36 weeks of gestation, >5 g of salt intake, and moderate-to-severe anemia are some of the important epidemiological risk factors found to be associated with PIH. Conclusion: Pregnancy in later stages and primigravida's should be monitored carefully for PIH, and it should be prevented. Health education should be given about the consumption of iron tablets and iron rich food items to prevent anemia.

Keywords: Demography, pregnancy-induced hypertension, risk factors, socioeconomic profile


How to cite this article:
Lakhute SV, Kendre V, Dixit J. A study of epidemiological factors in antenatal mothers with pregnancy-induced hypertension at the tertiary care hospital. Med J DY Patil Vidyapeeth 2021;14:52-6

How to cite this URL:
Lakhute SV, Kendre V, Dixit J. A study of epidemiological factors in antenatal mothers with pregnancy-induced hypertension at the tertiary care hospital. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Mar 3];14:52-6. Available from: https://www.mjdrdypv.org/text.asp?2021/14/1/52/307663




  Introduction Top


Hypertensive disorders during pregnancy are classified into preeclampsia, eclampsia, gestational hypertension, and chronic hypertension. The term “pregnancy-induced hypertension (PIH)” suggests a disorder of blood pressure that arises because of the pregnancy. It is defined as, “A blood pressure of ≥140/90 mmHg on two occasions more than apart of 4 h in a pregnant lady of more than 20 weeks of gestation.”[1] Accompanied by proteinuria it is known as preeclampsia. Preeclampsia when complicated with convulsion and/or coma is called eclampsia.

The risk factors postulated to influence the risk of PIH among the mothers include sociodemographical factors (extremes of reproductive age and socioeconomic status), genetic factors, pregnancy factors (primigravida and multipregnancy), or personal medical history (obesity, chronic renal disease, chronic hypertension, diabetes mellitus, and thrombophilia).[2]

History of preeclampsia and eclampsia in a previous pregnancy, exposure to passive smoking, inadequate antenatal supervision, family history of hypertension in one or more 1st-degree relative, living in a joint family, overweight, and lower socioeconomic class are also the risk factors.[3]

In this part of India, very few studies have been conducted to assess the epidemiological factors of preeclampsia. In this context, a study was conducted to find out the prevalence and to know the epidemiological factors in ante-natal mothers with PIH attending antenatal clinic at the tertiary care hospital.


  Materials and Methods Top


The present cross-sectional study was undertaken at GMC Latur, Maharashtra, as a part of postgraduation thesis work to study the epidemiological factors in antenatal mothers with PIH attending antenatal clinic at the tertiary care hospital. The study was conducted during 2 years from 2014 to 2016, after getting approval of the Institutional Ethical Committee and was approved by MUHS Nashik, vide their list of approved title of dissertation for academic year 2014–2015 under the faculty of medicine.

All antenatal mothers more than or equal to 20 weeks gestational age attending antenatal care (ANC) clinic at obstetrics and gynecology (OBGY) department during the study period and those willing to participate were included in the study.

The antenatal mothers <20 weeks of gestation and not willing to participate in the study were excluded from the study.

A total of 1600 ANCs were enrolled in the study. As per the required sample size by the formula n = 4pq/L2 considering 6%–8% prevalence. The study population was antenatal mothers attending antenatal clinic of OBGY department. All antenatal mothers more than or equal to 20 weeks gestational age attending ANC clinic at OBGY department and willing to participate were included in the study. Blood pressure was measured using the manual mercury sphygmomanometer by the auscultatory method. The age and other parameters were recorded based on ANC card, as told by patient or with the help of leading questions if not known. At least, four visits to ANC clinic were required to be called adequate as recommended by the Government Health Department guidelines. Expected date of delivery calculated using Naegele's formula. Socioeconomic status as suggested by BG Prasad was adopted and modified as per the all India consumer price Index of May 2016. Height was measured in the standing position with bare foot against the wall. The weight was recorded to the nearest 0.5 kilogram and body mass index by weight (kg)/height (m)2 formula. All data analysis had been performed by using the SPSS software (version 19), IBM, Endicott, New York, USA for Windows. The initial measures of each group were compared with the final measures of the study period and compared between the groups by using the Student's t-test and Chi-square test.

The study as a part of mandatory thesis work during the postgraduation course was conducted after obtaining clearance from the Institutional Ethics Committee on November 20, 2014 and the same was accepted by MUHS, Nasik. The data collection was done by using prestructured and pretested questionnaire. All the information regarding sociodemographic factors, past, and present obstetric history was collected.

Questionnaire: The questionnaire was pretested and prestructured. It was used to record the data regarding the various epidemiological factors, demographic profile, and personal history in ANC patients.

At the time of visit to the antenatal clinic blood pressure, height, weight, and fundal height were measured.


  Results Top


  • Out of the 1600 antenatal mothers, 97 (6.06%) had PIH. The proportion of PIH was 6.06%
  • The majority of the antenatal mothers in the study were between 21 and 25 years 41.69%. The pregnant women >35 years were 2%
  • The mean age among the study population was 22.31 ± 2.93 years.
  • About 56.88% of antenatal mothers got married in the age group of 20–30 years. It was observed that 66% antenatal mothers had their age of first pregnancy in age group 20–30 years followed by the age group of >30 years (17.32%)
  • The maximum 1057 (66.06%) antenatal mothers were from joint families, whereas 469 (29.31%) belonged to the nuclear family
  • The socioeconomic classification showed that out of 1600 antenatal mothers, majority were from Class IV (45%) followed by Class III and Class II (33% and 11.31%), respectively
  • The majority (42.69%) of the antenatal mothers were primi-gravida. It was observed that 965 (60.31%) pregnant women had gestational age above 36 weeks, whereas gestational age 20–28 weeks was seen only in 128 (8%) antenatal mothers
  • The majority 900 (56.25%) of the pregnant women done ANC registration below 3 months of gestation
  • Out of the total 917 antenatal mothers, 311 (34%) of women had a history of preterm delivery
  • It was observed that majority 1406 (87.87%) of the antenatal mothers had swelling of legs and face followed by headache 843 (52.68%), breathlessness 302 (18.87%), vomiting 221 (13.81%), convulsions 201 (12.56%), and giddiness 191 (11.93%)
  • The division of PIH cases according to age showed that majority of antenatal mothers were in the age group of >35 years (23.71%) and 31–35 years (23.71%)
  • When age was clubbed together with the age up to 30 years and above 30 years, the difference was statistically significant (P < 0.05). This suggests that there was association between age and PIH
  • In the present study, out of 1600 antenatal mothers, majority were Hindus, i.e., 869 followed by Muslims and Buddhist, i.e., 432 and 192, respectively. While the remaining were Christian, i.e., 55 and others which includes individuals from Sikh, Jain, etc., religions, i.e., 52. The prevalence of PIH among those patients was as follows: Hindu 6.1%, Muslim 6.71%, Buddhist 3.65%, and Christians 9%
  • The majority of the antenatal mothers in the study were the residents of urban areas (55.19%), whereas 44.81% of antenatal mothers were from the rural areas. The residence was compared with the urban and rural areas; the difference was not statistically significant (P > 0.05). This suggests that there was no association between the residence of antenatal mothers and PIH
  • In the present study, among antenatal mothers with PIH 12.37% were illiterate. The education was clubbed together up to secondary school and above secondary; the difference was statistically significant (P < 0.05). This suggests that the prevalence of PIH is more in less educated antenatal mothers
  • In the present study, among antenatal mothers with PIH, 44.33% were unemployed as against 1.03% professionals
  • When the type of family was clubbed together as joint and three generation against nuclear the difference was statistically significant (P < 0.05), this suggests that the prevalence of PIH is more in nuclear families than joint family
  • In the present study, among antenatal mothers with PIH, 18.55% were from Class I as against 3.09% Class V
  • In the present study, among antenatal mothers with PIH, 60.83% were primigravida as against 6.19% >G5
  • Among antenatal mothers with PIH, 63.92% were with gestational age >36 weeks as against 3.09% with gestational age 20–28 weeks
  • When ANC visits were compared as adequate and inadequate, the difference was statistically not significant (P > 0.05). This suggests that there was no association between the ANC visits of antenatal mothers and PIH
  • When salt intake was compared as less salt and more salt intake, the difference was statistically significant (P < 0.05), it suggests that there was association between salt intake of antenatal mothers and PIH
  • In the present study, among antenatal mothers with PIH, 7.22% were with height <140 cms as against 1.03% height >170 cm
  • In the present study, among antenatal mothers with PIH, 54.64% were with body mass index (BMI) >25 as against 13.40% BMI <18.5
  • In the present study, among antenatal mothers with PIH, 18.56% were nonanemic as against 6.18% with severe anemia.



  Discussion Top


It was observed that, out of the 1600 antenatal mothers 97 (6.06%) had PIH. The prevalence of PIH was 6.06%. Similar findings were seen in the study by Sajith et al.[4] where the overall prevalence of hypertensive disorders in pregnancy was 7.8%.

Sociodemographic factors

Age

The proportion of PIH according to the age showed that majority of antenatal mothers were in the age group of >35 years (23.71%) and 31–35 years (23.71%). In a study done by Duckitt and Harrington,[5] where the risk of preeclampsia was increased in women with maternal age >40 (1.96, 1.34–2.87, for multiparous women).

In the study done by Ramesh et al.,[6] age of <20 years (odds ratio = 3.8) found to be the significant risk factors of preeclampsia.

Religion

When compared between Hindu and religions such as Muslim, Buddhist, Christian, and others, the difference was not statistically significant (P > 0.05). This suggests that there was no association between religion and PIH. The prevalence of PIH among those patients was as follows: Hindu 6.1%, Muslim 6.71%, Buddhist 3.65%, and Christians 9%. Similar findings were seen in the study done by Borade et al.[7] and Singh et al.[8] where both the studies show no statistical association between religion and PIH (P = 0.06).

Urban/rural

When residence was compared with the urban and rural areas, the difference was not statistically significant (P > 0.05). The findings were in contrast to the present study in done by Saxena et al.[9] were the women who developed PIH were majority from the rural areas (68.57%).

Education

When education was clubbed together up to secondary school and above secondary, the difference was statistically significant (P < 0.05) in favor of education, and hence, the prevalence of PIH is more in less educated antenatal mothers. A study in Australia done by Cerón-Mireles et al.[10] found similar association between maternal education and preeclampsia.

Employment

When occupation was clubbed together as unemployed and unskilled against skilled, semi-professional, and professional, the difference was statistically significant (P < 0.05) in favor of unemployed and unskilled workers. Mental stress associated with skilled or professional workers might be the contributory factor. The findings were in contrast to the study done by Singh et al.[8] were the study shows no statistical association between occupation and PIH (P = 0.41).

Socioeconomic status

Low socioeconomic factors act as the multiple risk factors for preeclampsia. Low socioeconomic factors are associated with nutritional issues, reduced ante-natal care, and unsanitary hygienic conditions. When socioeconomic status was clubbed together as Class I, II, and III against the Class IV and V difference was statistically significant (P < 0.05), i.e., more PIH prevalence in low socioeconomic group.

Parity

When gravidity was clubbed together as primigravida (G1) against multigravida (G2/3/4/5), the difference was statistically significant (P < 0.05). In the study done by Duckitt and Harrington,[5] determined risk of preeclampsia is increased in women with nulliparity. The failure of the normal invasion of trophoblastic cells leads to maladaptation of the spiral arterioles, which are related to the causation of preeclampsia.

Gestational age

When gestational age was clubbed together as gestational age up to 36 weeks against gestational age above 36 weeks, the difference was statistically significant (P < 0.05). Similar findings were seen in the study by Singh et al.[8] were the majority of pregnant women with PIH were having gestational age >38 weeks (77.78%) with statistical significance.

Height and body mass index

When height was clubbed together as <140 cm against above 140 cm, the difference was statistically not significant (P > 0.05). Similar findings were seen in the study done by Paknahad et al.[11] and study done by Borade et al.[7] where height among the study groups shows no statistical significance.

When BMI was clubbed together as <25 against above 25, the difference was statistically significant (P < 0.05). Similar findings were seen in a study done by Singh et al.[8] were they found that BMI >27 kg/m2 was associated significantly with the risk of the development of hypertensive disorders of pregnancy.

Anemia

When hemoglobin levels were compared as normal (Hb >11) and anemic (Hb <11), the difference was statistically significant (P < 0.05). Anemic mothers were more prone to have PIH. Similar findings were seen in the study done by Ali et al.[12] where women with severe anemia had 3.6 times higher risk of preeclampsia than women with no anemia. The susceptibility of women with severe anemia to preeclampsia could be explained by a deficiency of micronutrients and antioxidants.

[TAG:2]Conclusion [/TAG:2]

[TAG:2]In the present study, overall proportion of PIH was found to be 6.06%. Primiparity, age above 30 years, poor socioeconomic status, less education, joint family, >36 weeks of gestation, >5 g of salt intake, and moderate-to-severe anemia are some of the important epidemiological risk factors found to be associated with PIH.[/TAG:2]

Late pregnancy and primigravida's should be monitored carefully for PIH, and it should be prevented. Health education should be given about consumption of iron tablets and iron rich food items to prevent anemia as this was found to be risk factor for PIH.

Need for more community-based research specifically in the area of preventive management of PIH cases so has to minimize the complications.

Acknowledgment

We would like to thank the staff members of the Departments of Community Medicine, Government Medical College, Latur, and Dr. D Y Patil Medical College, Pimpri, India, for their kind assistance.

Financial support and sponsorship

Self-funded.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dutta D. Hypertensive Disorders in Pregnancy. Textbook of Obstetrics. 6th ed..Jaypee Brothers Medical Publishers, New Delhi, India. 2010. p. 221-42.  Back to cited text no. 1
    
2.
Lee CJ, Hsieh TT, Chiu TH, Chen KC, Lo LM, Hung TH. Risk factors for pre-eclampsia in an Asian population. Int J Gynaecol Obstet 2000;70:327-33.  Back to cited text no. 2
    
3.
Nanjundan P, Bagga R, Kalra JK, Thakur JS, Raveendran A. Risk factors for early onset severe pre-eclampsia and eclampsia among north Indian women. J Obstet Gynaecol 2011;31:384-9.  Back to cited text no. 3
    
4.
Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res 2014;5:163-170.  Back to cited text no. 4
    
5.
Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005;330:565.  Back to cited text no. 5
    
6.
Ramesh K, Gandhi S, Rao V. Socio-demographic and other risk factors of pre eclampsia at a tertiary care hospital, Karnataka: Case control study. J Clin Diagn Res 2014;8:JC01-4.  Back to cited text no. 6
    
7.
Borade PV, Haralkar SJ, Wadagale AV. Hypertensive disorders of pregnancy: An ongoing holocoust. National J Community Med 2014;5:61-5.  Back to cited text no. 7
    
8.
Singh S, Ahmed EB, Egondu SC, Ikechukwu NE. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital. Niger Med J 2014;55:384-8.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Saxena S, Srivastava PC, Thimmaraju KV, Ayaz K. Mallick AK, Dalmia K, et al. Socio-demographic profile of pregnancy induced hypertension in a tertiary care centre School. J App Med Sci 2014;2:3081-6.  Back to cited text no. 9
    
10.
Cerón-Mireles P, Harlow SD, Sánchez-Carrillo CI, Núñez RM. Risk factors for pre-eclampsia/eclampsia among working women in Mexico City. Paediatr Perinat Epidemiol 2001;15:40-6.  Back to cited text no. 10
    
11.
Paknahad Z, Talebi N, Azadbakht L. Dietary determinants of pregnancy induced hypertension in Isfahan. JRMS 2008;13:17-21.  Back to cited text no. 11
    
12.
Ali AA, Rayis DA, Abdallah TM, Elbashir MI, Adam I. Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, Eastern Sudan. BMC Res Notes 2011;4:311.  Back to cited text no. 12
    




 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
   Materials and Me...
  Results
  Discussion
  Conclusion
   References

 Article Access Statistics
    Viewed144    
    Printed4    
    Emailed0    
    PDF Downloaded37    
    Comments [Add]    

Recommend this journal