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. 2018 Dec;8(2):020401.
doi: 10.7189/jogh.08.020401.

Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa: a prospective cohort study

Hannah L Nathan  1 , Paul T Seed  1 , Natasha L Hezelgrave  1 , Annemarie De Greeff  1 , Elodie Lawley  1 , Frances Conti-Ramsden  1 , John Anthony  2 , Wilhelm Steyn  3 , David R Hall  3 , Lucy C Chappell  1 , Andrew H Shennan  1
Affiliations

Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa: a prospective cohort study

Hannah L Nathan et al. J Glob Health. 2018 Dec.

Abstract

Background: Hypertensive disorders of pregnancy contribute to 14% of all maternal deaths, the majority of which occur in low- and middle-income countries. The aim of the study was to describe the maternal and perinatal clinical outcomes of women with pre-eclampsia living in middle- and low-income countries.

Methods: The study was a prospective observational study of women with pre-eclampsia (n = 1547, 42 twin pregnancies) at three South African tertiary facilities. Using stepwise logistic regression model area under the receiver operating characteristic curve (AUROC) values, the association between maternal baseline and admission characteristics and risk of adverse outcomes was evaluated. Main outcome measures were eclampsia, kidney injury and perinatal death.

Results: In 1547 women with pre-eclampsia, 16 (1%) died, 147 (9.5%) had eclampsia, four (0.3%) had a stroke and 272 (17.6%) had kidney injury. Of the 1589 births, there were 332 (21.0%) perinatal deaths; of these, 281 (84.5%) were stillbirths. Of 1308 live births, 913 (70.0%) delivered <37 completed weeks and 544 (41.7%) delivered <34 weeks' gestation. Young maternal age (AUROC = 0.76, 95% confidence interval (CI) = 0.71-0.80) and low Body Mass Index BMI (AUROC 0.65, 95% CI = 0.59-0.69) were significant predictors of eclampsia. Highest systolic blood pressure had the strongest association with kidney injury, (AUROC = 0.64, 95% CI = 0.60-0.68). Early gestation at admission was most strongly associated with perinatal death (AUROC = 0.81, 95% CI = 0.77-0.84).

Conclusions: The incidence of pre-eclampsia complications, perinatal death and preterm delivery in women referred to tertiary care in South Africa was much higher than reported in other low- and middle-income studies and despite access to tertiary care interventions. Teenage mothers and those with low BMI were at highest risk of eclampsia. This information could be used to inform guidelines, the research agenda and policy.

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Conflict of interest statement

Competing interests: No conflict of interest is declared. No financial relationships with any organisation that might have interest in the submitted work in the previous 3 years are declared. No other relationships or activities that could appear to have influenced the submitted work are declared. All authors had full access to all of the data in the study and can take full responsibility for the integrity of the data and the accuracy of the data analysis. King’s College London is the guarantor for the study. The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdfb(availableonrequestfromthecorrespondingauthor), and declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of participants.
See this image and copyright information in PMC

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