Content Analysis of Patient-Facing Information Related to Preeclampsia

Abstract

Background: Previous research has shown pregnant people are not knowledgeable about preeclampsia, a significant cause of maternal morbidity and mortality. This lack of knowledge may impact their ability to report symptoms, comply with recommendations, and receive appropriate follow-up care. Pregnant people commonly seek information from sources outside their treating clinician, including pregnancy-specific books and online sources. We examined commonly used preeclampsia information sources to evaluate whether pregnant people are receiving up-to-date, guideline-based information.

Methods: We conducted a content analysis of preeclampsia-related information in top-ranking websites and bestselling pregnancy books. We used American College of Obstetricians and Gynecologists preeclampsia guidelines to construct a codebook, which we used to examine source content completeness and accuracy. For each source, we analyzed information about preeclampsia diagnosis, patient-reported symptoms, risk factors, prevention, treatment, and complications.

Results: Across 19 included sources (13 websites and 6 books), we found substantial variation in completeness and accuracy of preeclampsia information. We found high rates of mentions for preeclampsia symptoms. Risk factors were more commonly included in online sources than book sources. Most sources mentioned treatment options, including blood pressure medication and giving birth; however, one-third of online sources positively mentioned the nonrecommended treatment of bed rest. Prevention methods, including prenatal aspirin for high-risk pregnancies, and long-term complications of preeclampsia were infrequently mentioned.

Conclusions: Varying rates of accuracy in patient-facing preeclampsia information mean there is substantial room for improvement in these sources. Ensuring pregnant people receive current guideline-based information is critical for improving outcomes and implementing shared decision-making.

Figure 1:

Patient-Reported Preeclampsia Symptoms Notes: Two sources (Medscape and Harvard Health) required registration or were behind a paywall. One source (Preeclampsia Foundation) required extensive navigation to reach patient-facing information. For each of these online sources, we coded information available as described in the Methods section.

Figure 2:

Preeclampsia Risk Factors Notes: *indicates risk factor not mentioned in any of the online sources. †indicates risk factor not mentioned in any of the book sources. Two sources (Medscape and Harvard Health) required registration or were behind a paywall. One source (Preeclampsia Foundation) required extensive navigation to reach patient-facing information. For each of these online sources, we coded information available as described in the Methods section. Sociodemographic characteristics included African American race or low socioeconomic status. Personal history factors specifically mentioned in the ACOG guidelines included low birth weight or small for gestational age, previous adverse pregnancy outcome, or more than 10-year pregnancy interval.

Figure 3:

Preeclampsia Prevention Information Notes: Two sources (Medscape and Harvard Health) required registration or were behind a paywall. One source (Preeclampsia Foundation) required extensive navigation to reach patient-facing information. For each of these online sources, we coded information available as described in the Methods section.

Figure 4:

Preeclampsia Treatment Notes: †Magnesium sulfate indicates mentioning of magnesium sulfate or anticonvulsant. Two sources (Medscape and Harvard Health) required registration or were behind a paywall. One source (Preeclampsia Foundation) required extensive navigation to reach patient-facing information. For each of these online sources, we coded information available as described in the Methods section.

Figure 5:

Pregnancy, Intrapartum, and Future Complications of Preeclampsia Notes: †indicates complication not mentioned in any of the book sources. Two sources (Medscape and Harvard Health) required registration or were behind a paywall. One source (Preeclampsia Foundation) required extensive navigation to reach patient-facing information. For each of these online sources, we coded information available as described in the Methods section.