The most frequent medical issue that arises during pregnancy is hypertension, which continues to be a critical contributor in both maternal and fetal morbidity and mortality. Almost 10% of all pregnancies are complicated by this cardiovascular pathology. Preterm birth, intrauterine growth restriction, perinatal death, acute renal or hepatic failure, antepartum hemorrhage, postpartum hemorrhage, and maternal death are all correlated with a heightened risk in pregnancies complicated by hypertension.[1].  

Preeclampsia is one of the most common hypertensive disorders in pregnancy accounting for >50,000 maternal deaths, and over 500,000 fetal deaths worldwide.[2] The incidence of preeclampsia is estimated to be 7 times higher in developing countries like India as compared to the rest of the world.[3]

According to the American College of Obstetricians and Gynecologists, preeclampsia is defined as a condition with hypertension (systolic blood pressure >140 mm hg or diastolic blood pressure >90 mm hg or both) and proteinuria or in absence of proteinuria, new-onset hypertension with any of thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, and unexplained headache usually occurring at or after 20 weeks’ gestation.[4]

It is well-established that preeclampsia and cardiovascular illnesses have similar risk factors. Obesity body mass index (BMI), parity, increasing age, chronic hypertension, gestational diabetes mellitus (GDM), chronic renal illness, previous preeclampsia, systemic lupus erythematosus, in vitro fertilization, and a family history of preeclampsia are established risk factors for preeclampsia.[5] Preeclampsia patients are more likely to have cardiovascular illness later in life, including an almost four-fold increased risk of hypertension, a roughly two-fold greater risk of fatal and non-fatal ischemic heart disease, stroke, and venous thromboembolism. This relation can be explained by two mechanisms involving common risk factors shared by both pathologies and lipid deposition in spiral arteries of uterus resembling early stages of atherosclerosis

The overall risk of preeclampsia is roughly 2–3 times higher in people who are obese or overweight.[6] Even when BMI is within the normal range, the risk of preeclampsia gradually rises. It is significant to note that the risk is elevated for both early or preeclampsia with severe features, which is linked to higher fetal morbidity and mortality, as well as for late or mild preeclampsia

According to a systematic review of controlled studies, nulliparity is a strong risk factor that almost triples the risk of preeclampsia (odds ratio 2.91, 95% confidence interval [95% CI] 1.28–6.61),[7] It is estimated that two-thirds of all cases occur in first pregnancies that progress beyond the first trimester.

Along with understanding the way the pathology affects the mother, it is also important to address the negative outcomes that it has on the fetus. Recent evidence suggests that infants born preterm are, in fact, physiologically immature compared to term infants.[8] Furthermore, there are several mechanisms which give preeclampsia the potential to disrupt fetal growth and development. In this study, we have also taken into account these factors and documented the distribution of the range of normal and abnormal gestational age, along with the distribution of fetal birth weight as a measure to define an underdeveloped fetus.[9]

This research study sets out to examine the prevalence of preeclampsia in a central government funded hospital in Hyderabad and document the frequency of occurrence of this disease with major risk factors such as obesity, parity, and severity of preeclampsia. Along with this, the study reports the gestational age of the mother at time of delivery, the mode of delivery, and also documents the status of fetal development by employing fetal birth weight as a measure of the same. At the same time, the presence of any significant maternal or fetal complications has also been recorded. Based on the review of literature, there is a lacuna in the studies conducted in India focusing solely on preeclampsia rather than hypertensive disorders during pregnancy as a whole.[10] Studies in India also lack in assessing the risk factors correlated with preeclampsia. There is less information on variation in epidemiological factors such as gestational age, mode of delivery, and the impacts preeclampsia has on a mother and fetus.[11].

This is a Institutional based cross sectional study design was conducted among women whose age was greater or equal to eighteen from January to April. Selected pregnant women who gave at least one child birth and those who were above 20 weeks of gestation for current pregnancy were included.

The sample size was determined using single population proportion formula using the following assumptions; the magnitude of preeclampsia, which is 8.4% in Dessie referral hospital , confidence interval 95%, the margin of error d = 0.05, Za/2 = 1.96 and with 10% non-respondent rate the final sample size was 129.

Sampling procedure and data collection instrument

First, we obtained the annual report of the pregnant mothers with gestational age of greater than 20 weeks in ANC then we divide by 12 to get the flow of pregnant mothers per month. Then finally we found about 139 pregnant mothers who come for ANC follow up. Then the total sample size required was collected consecutively within the given period.

The questionnaire is adopted and modified from reviewing different literatures and scientific facts .^[12]. Data were collected by face to face interview technique using structured and pretested questionnaire. Medical records were also reviewed for some clinical and laboratory results, including proteinuria and blood pressure measurement.

Data quality control

A questionnaire was first prepared in English and then translated to national language (Amharic) and was translated back to English by another individual in order to check and maintain its consistency.

After necessary modifications and correction was made and ensured its reliability by the pre-test, the actual data were collected by four midwife nurses. To maintain the quality of the data the 3 days of training was given for the data collectors. Questionnaires which were collected were checked for its completeness and consistency of the filled questionnaires on a daily basis. Blood pressure was taken under standard operating procedure by two data collectors for each participant, to keep its reliability of measurement and to correctly diagnose preeclampsia. Current multiple pregnancy was also confirmed by both the physical examination and ultrasound evaluation. The medical registration numbers of the participants who were involved in the study were recorded on a separate sheet to avoid repeated recruitment of the study participants who come for the next visit.

In addition, the data were thoroughly cleaned and carefully entered into computer for beginning of analysis.

Operational definition

Gestational age: is calculated from the last normal menstrual period (LNMP) and for those women who didn’t recall their last menstrual period, fundal height and/or ultrasound result was used.

Gravidity: the total number of pregnancies, including abortion, ectopic pregnancy and any other pregnancies documented on the chart.

Parity: the number of deliveries after 28 weeks of gestation including IUFD and still birth documented in the chart.

Pre-eclampsia: denotes for women with blood pressure of ≥140 mmHg systolic or ≥ 90 mmHg diastolic on two separate readings taken at least four to six hours apart after 20 weeks gestation in an individual with previously normal blood pressure and proteinuria in pregnancy ^[13].

Proteinuria: is assessed using the urine dipstick method. Those women levels of + 1 and above are classified as having proteinuria.

Data processing and analysis

Data was entered using epi-data manager and exported, cleaned and analyzed using statistical package for social science (SPSS) version 21. Finally, variables (age, current multiple pregnancy and participant history of diabetic mellitus) with p value < 0.05 were taken as strong predictor variables of preeclampsia.

Ethical consideration

Approval letter was obtained from Mizan-Tepi University, college of medicine and health sciences. The necessary information regarding to the importance of the study was addressed for each participant. Written consent was taken from each participant and their confidentiality and privacy was maintained.

A total of 110 preeclampsia cases were observed among 3,200 patients visiting the Obstetrics and Gynecology departments of the concerned hospitals. Family history, chronic hypertension, gestational diabetes, and patient age were analyzed as associated risk factors for hypertensive patients.

Table 1. Association between hypertensive disorders and diabetes among pregnant women (n=65).

Table 2. Sociodemographic characteristics of patients with hypertension (n=65).

Table 3. Hypertensive clinical features among pregnant women (n=65).

For maternal and fetal outcomes, a total of 100 patients with preeclampsia were observed in detail. These patients were further investigated for sociodemographic characteristics, clinical features, and maternal and neonatal outcomes. The predominant age group was ≤25 years, and more than half of the subjects (64.0%) were from urban areas. A high percentage of middle- (n=48, 48.0%) and low-income (n=45, 45.0%) patients were observed to have preeclampsia as compared to patients of high economic status (n=7, 7.0%). In this study, 38 (38.0%) women had a family history of preeclampsia. Severe preeclampsia was diagnosed in 24 (24.0%) patients, and 36 (36.0%) had mild stage, while 40 (40.0%) subjects were at the normal stage of preeclampsia (Tables 4-5).

Table 4. Sociodemographic characteristics of participants with preeclampsia (n=100).

Table 5. Demographic characteristics of preeclamptic patients (n=100).

Table 6. Clinical features related to preeclampsia among pregnant women (n=100).

No maternal mortality was observed in this study. Maternal outcomes, such as mode of delivery and clinical complications like pulmonary and renal diseases leading to ICU admissions, were reported. It was observed that most of the women (n=65, 65.0%) had cesarean deliveries compared to vaginal deliveries (n=35, 35.0%). Sixty-three (63.0%) patients fully recovered without any severe outcomes after delivery; 20 (20.0%) patients had low Hb levels, and 9 (9.0%) had kidney infections. Pulmonary edema was reported in 7 (7.0%) patients. Five (5.0%) patients faced serious conditions and were admitted to the ICU for closer observation.

High blood pressure levels also had an effect on premature birth rates. A total of 45 premature births were documented in this study. Among these, 14 (14.0%) of newborns had preterm births due to the mother’s blood pressure being ≤140/90 mmHg, and mothers of 25 (25.0%) premature babies had a mild blood pressure of >140/90 mmHg to 160/90 mmHg. However, all women with extremely high blood pressure levels (≥160/110 mmHg) had premature babies (n=6, 6.0%)

This study provides valuable insights into the prevalence, risk factors, clinical features, and maternal-fetal outcomes associated with hypertensive disorders during pregnancy. [16]Hypertension in pregnancy remains a significant public health concern, contributing to maternal complications, preterm births, and neonatal morbidity.

Prevalence and Risk Factors

The findings revealed that hypertensive disorders affected a notable proportion of pregnant women, with preeclampsia being one of the most commonly observed conditions. Several risk factors were associated with the development of hypertension, including advanced maternal age, family history, gestational diabetes, and chronic hypertension. [17] The high prevalence of preeclampsia among middle- and low-income groups suggests that socioeconomic factors play a crucial role in disease development, potentially due to disparities in access to healthcare, nutrition, and prenatal monitoring.[18]

Blood pressure measurements at the time of diagnosis indicated that a significant proportion of patients exhibited mild to moderate hypertension, with a smaller percentage presenting with severe hypertension (≥160/110 mmHg). Proteinuria was prevalent among preeclamptic women, reinforcing its role as a key diagnostic marker. In addition, other complications such as gestational diabetes, kidney disease, and a history of abdominal surgery were observed in hypertensive pregnant women, indicating that comorbid conditions can exacerbate maternal health risks.[19]

In terms of maternal outcomes, cesarean section was the predominant mode of delivery, likely due to the increased risks associated with vaginal birth in hypertensive patients. While the majority of patients fully recovered post-delivery, some experienced low haemoglobin levels, kidney infections, and pulmonary edema. A small percentage of women required ICU admission for close monitoring due to severe complications, highlighting the importance of early detection and management of hypertensive disorders to prevent life-threatening conditions.[20]

Neonatal outcomes were also significantly affected by maternal hypertension, with a high rate of premature births observed among hypertensive mothers. Notably, all women with extremely high blood pressure (≥160/110 mmHg) had preterm deliveries, emphasizing the strong correlation between severe maternal hypertension and adverse fetal outcomes. These findings align with existing literature that links hypertensive disorders in pregnancy to increased risks of fetal growth restriction, low birth weight, and preterm delivery.[21]

The results of this study underscore the need for early screening, continuous monitoring, and timely intervention to improve maternal and neonatal outcomes. Healthcare providers should focus on early identification of high-risk patients based on known risk factors such as family history, pre-existing hypertension, and gestational diabetes. Additionally, educational programs on the importance of prenatal care, lifestyle modifications, and blood pressure management should be promoted to reduce the burden of hypertensive disorders during pregnancy.[22].

In conclusion, this study highlights the significant impact of hypertension on both maternal and neonatal health. The high prevalence of hypertensive disorders, associated complications, and increased rates of cesarean delivery and preterm births emphasize the urgent need for comprehensive prenatal care and improved management strategies. Further research should focus on long-term maternal and neonatal outcomes, as well as effective interventions to reduce the risks associated with hypertensive disorders in pregnancy.

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