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Comparative Study
. 2025 Nov 5;25(1):1166.
doi: 10.1186/s12884-025-07941-1.

Comparing the risk of maternal and perinatal complications among women with hypertensive disorders of pregnancy to normotensive women: an institution-based cohort review in Kenya

Mwangi Collins Mwaniki  1 , Kimbley Asaso Omwodo  2 , Omondi Ogutu  1   3 , Ann Pulei  1   3   4 , Rose Jepchumba Kosgei  1   3 , George Gwako Nyakundi  1   3 , Eunice Jeptoo Cheserem  1   3 , Patrick Muia Ndavi  1   3 , Diana Kerubo Ondieki  1   3 , Anne Njoroge  4 , Sarah Masyuko  4 , Cyrus Mugo Wachira  1   3 , Alfred Osoti Onyango  1   3   4
Affiliations
Comparative Study

Comparing the risk of maternal and perinatal complications among women with hypertensive disorders of pregnancy to normotensive women: an institution-based cohort review in Kenya

Mwangi Collins Mwaniki et al. BMC Pregnancy Childbirth. .

Abstract

Background: Hypertensive disorders of pregnancy (HDP) remain a major cause of maternal and perinatal morbidity and mortality globally. Quantifying the effects of HDP on complications during pregnancy is vital for enhancing risk prediction and improving pregnancy outcomes.

Methods: This study leveraged data from a cohort of 3652 women from a prior study investigating the prevalence of HDP at a tertiary maternity hospital in Kenya - between 1st January, 2018 and 31st December, 2019. Sociodemographic characteristics, pregnancy outcomes, and complications among women diagnosed with HDP compared with normotensive women were analysed. The maternal complications explored included acute renal injury, antepartum haemorrhage and postpartum haemorrhage. The perinatal complications included intrauterine foetal demise, intrauterine growth restriction, small-for-gestational-age neonates, preterm birth and low APGAR (7 or below). Log-binomial regression was used to estimate the risk ratios of maternal and perinatal complications between these groups. Both composite and individual complication analyses were done.

Results: The rate of maternal complications within the study was 1.3% (46/3652), whereas perinatal complications occurred in 13.0% (474/3652). After adjusting for maternal age ≥ 35 years and caesarean delivery, women with HDP had 3.34 times the risk of maternal composite complications compared to normotensive women (adjusted risk ratio 3.34; 95% CI 1.81- 6.16). These complications included acute renal injury and postpartum haemorrhage. Furthermore, there was a significant association between HDP and composite perinatal complications (adjusted risk ratio 1.38; 95% CI 1.07- 1.77). Specifically, the risk of intrauterine foetal demise and intrauterine growth restriction was elevated among the HDP group compared to normotensive women.

Conclusion: HDP continues to pose a significant burden on pregnancy and childbirth in Kenya. A strong association between pregnancy complications and HDP has been demonstrated. Regionally adapted pregnancy surveillance and optimised management approaches for acute kidney injury, post partum haemorrhage and perinatal morbidity prevention are urgently needed.

Keywords: Acute kidney injury; Hypertension; Kenya; Maternal morbidity; Perinatal morbidity; Postpartum haemorrhage; Pregnancy outcome; Pregnancy-induced; Retrospective study.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol received review and approval by the Kenyatta National Hospital and the University of Nairobi Ethics and Research Committee (KNH/UON ERC) before the commencement of the study. Approval number: P65B/11/2020. Institutional permission to conduct the study was obtained from Kenyatta National Hospital. Informed consent was waived as anonymized data were collected from medical records. Confidentiality was maintained throughout the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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