Prevalence of Preeclampsia Causing Pregnancy Complications and Its Associated Risk Factors Among Women in Rajshahi Region

Abstract

Preeclampsia is an acute multi-system obstetrical disorder that claims the lives of more than 70,000 women and 500,000 of their fetuses and newborns each year. This investigation was a cross-sectional study that was conducted mainly in Rajshahi Medical College Hospital and its vicinity. This study reports the prevalence of preeclampsia as well as some unfocused but potential risk factors such as the effects of environmental pollution (air, water and sound), maternal mental stress, etc. The relationship between concerned gynecological and obstetrical factors and preeclampsia was also reported. The number of pregnant mothers admitted into Rajshahi Medical College Hospital (RMCH) for delivery or obstructed complications was found to increase from 11,532 to 17,201 during the year 2013 to 2017. Consequently, the number of preeclamptic patients was increased from 407 to 435. The average number of preeclamptic patients found in RMCH per year was 484 (during the last five years). This is equivalent to 3.21% of total pregnant mothers admitted into RMCH for delivery or with obstructed complications. The incidence rate of preeclampsia in pregnant women in Rajshahi region was decreasing with respect to time. With the observed trend, it can be forecasted that in the years 2020, 2023 and 2026 the preeclampsia incidence rate should be 2.02%, 1.30% and 0.58% respectively. The age of the participating preeclamptic patients ranged from 16 to 40 years, with an average of 25.90 ± 0.65 years. The 69% of the preeclamptic patients were below the age of 29 years. About one-fourth of the preeclamptic mothers were below 20 years, whereas only 1% mother was at 40 years. This reflected that the youngest mothers were at high risk of preeclampsia.

On the basis of BMI values obtained, the preeclamptic patients were classified as Underweight (< 18.5), Normal (18.5–24.9), Overweight (25–29.9) and Obese (≥ 30). It was found that as the patients were more obese, the occurrence of preeclampsia was increased more. The nutritional status of the preeclamptic patients was: Obese (40%) > Overweight (29%) = Normal (29%) > Underweight (2%). The gained weight for the pregnant women at 40 weeks gestation was 11.3 - 15.9 kg for normal, 6.8–11.3 kg for overweight and 5.0–9.1 kg for obese mother. The obese or overweight pregnant preeclamptic mothers were associated with some additional complications including severe edema, severe headache, vomiting, lower abdominal pain and hyperacidity. The preeclamptic patients’ had mainly A+, B+ or O+ blood groups. The prevalence of preeclampsia based on patients’ blood grouping was as follows: A+ (39%) > B+ (33%) > O+ (24%) > AB+ (2%) = O– (2%). No preeclamptic patients had A–, B– and AB– blood groups and only 2% patients had very rare O– blood group. The prevalence of graduate and masters level completed preeclamptic patients was found as 20.00%. The vulnerable preeclamptic patients were under matriculated, which accounted for 66.67%. Thus two-thirds of the patients completed education level 10. The 4.44% preeclamptic patients were also illiterate. This indicates that the preeclamptic patients were not very conscious about preventing preeclampsia. Socio-economic Index (SEI) is a measure of social class, which was determined from patientʼs occupation, education, income level and wealth. Out of 90 preeclamptic patients, 69 were within the SEI range of 10–30, whereas 21 were above the range. This reflects that about three-fourths of the concerned patients were of lower social class.

The 89% patients were Muslims and 11% were Hindus. 38 patients (42.22%) were from Single Families, whereas 52 (57.78%) from Joint Families. On the basis of patients’ occupation, 80 (88.89%) were housewives, 6 (6.67%) were teachers and 4 (4.44%) were in other services. Regarding ethnicity all were local women, not migrated. Among the pregnant women, 61% were white, 13% were gray and 26% were black. The pregnant women took more protein, vegetables and fruits than average person. But they took less amount of required liquid, which is essential for expanding extra-cellular space and amniotic fluid. The 51.11% of total women took drinking water below the recommended level of 2.2 L/day. Most of the patients’ living rooms were within 15 feet from kitchen. Only 10% patients had good room ventilation, while the remaining 90% patients had either moderate or poor room ventilation. Hence the preeclamptic patients were subjected to moderate CO2 exposure. The 78.89% of the preeclamptic patients’ living rooms were less than 50 ft from the nearest roads. The value was 84.44% for 100 ft distance. Therefore, it is reasonable that they would experience sound pollution. The sources of intense sound pollution included intense sound of Govt. owned sugar mill, private sugarcane crusher mill, diesel driven power generator, hydraulic horn of some trucks and buses, movement of rail car with whistle, etc. Combination of these two factors revealed that 60% of the preeclamptic patients experienced moderate to intense sound pollution. Comparison of the groundwater data with WHO guideline values reveals that Arsenic (As), Calcium (Ca), Magnesium (Mg), Iron (Fe) and Sodium (Na) concentrations in the patients’ drinking water were comparatively high. The higher values of Ca and Mg indicate that the waters were hard. This along with elevated

level of Fe might favor constipation. Na might assist in developing mild hypertension. The observed high level of arsenic in drinking water (maximum concentration of 164 μg L-1) might facilitate several adverse health effects of acute lethality to chronic effects including vascular diseases, hypertension, cancer, genotoxicity, hyperpigmentation, diabetes mellitus, repeated abortions, stillbirth, preeclampsia, etc. Therefore, safe drinking water is a concern for preeclamptic patients. The study reveals that 94% of the preeclamptic mothers were under high or very high mental stress, of which 24% were very high and 70% were high. High mental pressure might induce hypertension and hence it is a potential risk factor for preeclampsia. The preeclamptic patients’ first period was in the range of 11-15 years, averaging 12.9 years. Before being pregnant, 85.45% patients’ period was regular; whereas only 5.5% irregular. The 58% of the patients became pregnant earlier, of which 20% had their children. In this case, the delivery order was as follows: NDV > C/S > Abortion. After giving birth, 48% of them used steroid contained pills as contraceptive method. The 60% patients had no record of past surgical history. Appendisectomy, DE&C, MR, left Salphingo-oophorectomy and previous C/S occurred for other cases. The principal family history include: Hypertension > Diabetes > Heart disease > Preeclampsia > Cancer. Among the major complications of the preeclampsia, severe edema alone represented 44%, whereas headache and neck pain 19%, edema and hyperacidity 17%, lower abdominal and chest pain 12%, edema and vomiting 5% and blurring of vision 3%. The patients’ blood pressure fluctuated fairly, but remained in higher level. The highest blood pressure was recorded as 210/140 for the patient of 40 weeks gestation. It was generally found that after delivery, the patients’ B.P. fell down. But the trend was not uniform.

The bio-chemical investigations played a very vital role for proper diagnosis of the pregnant mothers for preeclampsia. Serum Albumin test, a liver function test, measures the amount of albumin in clear liquid portion of blood that was generated by liver. Fairly lower values of serum albumin (average 1.54 g/dL) were observed in all the preeclamptic mothers. This indicates the increase in plasma volume that occurs during the pregnancy leading to hemodilution. The observed slight lower values of serum urea (average 5.92 mmol/L) and blood urea nitrogen (BUN) (average 17 mg/dL) reflected higher possibility of low-birth weight (LBW) neonatal output. The observed relatively higher values of serum creatinine (> 0.8 mg/dL) suggested intravascular volume contraction or renal involvement in preeclampsia. The relative lower values of platelet count (average 2.34 million/mm3) threw light on the presence of mild preeclampsia. The fairly lower values of hemoglobin (average of 9.02 g/dL) reflected that the studied preeclamptic mothers are highly anemic. Thus, they were under greater risk of preeclampsia, preterm delivery, LBW and stillbirth. The random blood sugar (R.B.S.) levels of the preeclamptic mothers were not very elevated (6.10%) reflecting that the patients were not under diabetics and this was important to ensure the best chance of a successful pregnancy. The preeclamtic patients were confirmed based upon patients’ B.P., edema and serum albumin along with physiological complications and other laboratory investigations. For drug management purpose Methyldopa, Nifedipine, Labetalol, Magnesium sulfate and Phenobarbital were applied. The maximum and minimum gestational ages during delivery were 40 and 32 weeks respectively, averaging 37 weeks. About three-fourths of the patients’

deliveries were made by C/S, while the rest by NVD. Two patients were released for being admitted into other hospital. In general, after delivery, the concerned mothers’ health conditions were good, whereas new-born infants’ condition were bad. But before delivery, the mothers’ conditions were bad. It was found that out of 88 patients, one had died after giving birth (that generated maternal morbidity rate of 1.14%), which was probably due to conversion to severe eclampsia or HELLP syndrome. It was interesting to note that her female infant (weighing 2.0 kg) was in good condition. Only one case of twin-pregnancy was recorded. The new-born infants were both female and in good health conditions having weights of 3.0 and 2.5 kg. With regard to maternal heath after giving births, 28% had no complications, whereas the remaining (72%) had either mild or severe complications. Male children dominated (about 60%) over female children (about 40%) in case of preeclamptic mothers. In the study, a total of 9 neonatal deaths were recorded out of 88, representing 10.23% of total. Among the alive infants, 41.77% were premature having body weight of < 2.5 kg, while the rest (58.23%) were with standard health (≥ 2.5 kg). About 28% of the newly born infants had no complications, while the rest (72%) were under mild or severe complications. Such complications included Asphyxia, IUGR, etc.