Current Pediatric Research

Abstract

Background: According to the World Health Organization (WHO), the prevalence of hypertension caused by pregnancy is seven times higher in developing countries (2.8% of live childbirth) than in developed nations 0.4%. The goal of the research was to find out the relationship between demographic and reproductive characteristics and risk factors. Methodology design: "A descriptive-analytic non-probability study design" (purposeful sam-ple) of 80 pregnant with hypertension caused by pregnancy attending Al-Emam Al-Sadiq and Babylon teaching hospitals in "Al-Hilla City". Results: The study findings showed that most of the samples 87.5% were housewives, 36.3% of them were primary school, 51.25% of the participants were urban and 45% were overweight. The highest % age of the sample reported and accounted for in the second trimester 46.3% and the highest % age 51.25% is 1-3 number of gravid. The highest % age 52.5% of the sample reported having no. of miscarriage 1-2, 53.75% of the sample eating salty food, even 60% was unhealthy foods, the highest % age of the sample 76.25%. Conclusion: The highest % age of the sample reported eating salty food, their food was fatty. The highest % age has a family history of hypertension and they have urinary tract infection during pregnancy, there is an association between educational level, residency with dietary factors (pvalue> 0.05) while there was significantly associated between health history and occupation only. Also indicates that there is a highly significant association, between all reproductive variables, with "dietary factors except with parity". Recommendations: Health education program about physiological changes during pregnancy and early detection: management of mothers with "PIH" should be required as part of focused antenatal care. The study suggests that further studies assess dietary and lifestyle factors.

Keywords:

Maternal, Risk factors, Hypertensive disorders, Pregnancy.

Introduction

Hypertensive disorder of pregnancy is one of the greatest common complications in pregnancy forming a triplet together with infection and hemorrhage. It affects about 10% of pregnancies and contributes to significant perinatal and maternal mortality [1]. Hypertension is the most common pregnancy-associated disorder is complicating "2%-3%" of pregnancies occurs in "6%–8%" of all pregnancies it is a thoughtful cause of maternal and mortality in developing countries were associated as the most common medical health problems in pregnancy [2].

Important adaptations in the cardiovascular physiology of the mother are caused by hormonal differences in pregnancy. There is progesterone, estrogen, and relaxing floods (progesterone-like hormone; mediates release of nitric oxide) starting early in the 1st trimester, contributing to systemic vasodilation. At the same time, the Renin-Angiotensin-Aldosterone System (RAAS) is improved to produce salt and water retention, leading to plasma volume expansion [3-5].

Diabetes, persistent pre-pregnancy hypertension, chronic kidney diseases, nulliparity, twin or multiple pregnancies, family history of preeclampsia or eclampsia, obesity, immune deficiencies, and personal history of preeclampsia or eclampsia are factors leading to preeclampsia. However, its initial development is related to a greater likelihood of it happening in subsequent pregnancies [6]. During pregnancy, vitamin D is particularly important because low maternal vitamin D stores can lead to problems such as low birth weight and small for babies of gestational age, as well as an increased risk of maternal comorbidities [7]. The incidence is seven times higher in developing countries 2.8% of live births than in developed countries 0.4%, according to the World Health Organization (WHO). Eclampsia is associated with a maternal mortality rate 0.5%-10% that typically needs high-quality intensive care [8].

Methodology

"A descriptive-analytic non-probability study design "(purposeful sample) of 80 pregnant women with "PIH"attending; Al-Emam Al-Sadiq and Babylon, teaching hospital: in Al-Hilla City. A questionnaire was used as a data-gathering tool. The study carried out from (February–July 2020). Data collected through a questionnaire constructed for the purpose of this study, consists of 4 parts include; 5 items related to socio demographic; 4 items of reproductive characteristics; 6 items of dietary risk factors and 5 items of health history; these items are rated according to two level Likert scale (Yes, No), scored 2,1 cut of point of score=1.5. Descriptive statistical and Inferential analyses are used to analyze the data were analyzed using the statistical package for social sciences ("SPSS version 20").

Results

Table 1 depicts the highest percentage of the sample age at 32-36 years were house wife, primary educational level 51.25% of the participants were in urban and were just enough economics status.

Table 1. Women’s socio demographic characteristics of pregnant women with PIH number 80.

Table 2 reveals that the highest percentage of the sample reported were 1-3 time of pregnancy, now in second trimester, 56.3% of the sample reported were birth number 2-4, they have 1-2 time of abortion.

Table 2. Women’s reproductive characteristics of pregnant women with PIH number 80.

Table 3 depicts that the highest percentage of the pregnant women reported eating salty food, eating vegetables, their food were fatty, 65.0% of them were taking fruit also were not taking folic acid before pregnancy. The highest percentage of the sample reported not exposure vitamin D.

Table 3. Dietary risk factors of pregnancy induce hypertension.

Table 4 reveals that the highest percentage of the participants has no history of gestational diabetes were not anemic, but have family history of hypertension, and 78.75% of the samples don’t have family history of diabetes but most of them with "UTI" during pregnancy.

Table 4. Health history of pregnancy induces hypertension.

Table 5 shows that there is association between educational levels, residency with dietary factors but there was association health history with occupation only.

Table 5. Association between demographical characteristics with dietary and health history.

Table 6 reveals that there is a high significant association between all reproductive variables with dietary factors except with parity number but there was no associated with all health history.

Table 6. Relationships of dietary and health history with reproductive characteristics. HS: Highly Sig. at P<0.01; S: Sig. at P<0.05; NS: Non Sig. at P>0.05.

Discussion

Related to socio-demographic characteristics

The highest percent of sample age between 32-36 years. This finding is not in the same line with Hafez et al. who found that most participants aged between 30-35 years but in in agreement with Hafez et al. who found that most samples were not working [9]. Other studies have indicated that higher age is also a significant risk factor for hypertension during pregnancy, especially in developed countries Assis et al. and found that the risk of preeclampsia superimposed on chronic hypertension is associated with age above 30 years [10].

The largest percentage of the sample recorded at the primary education level. This outcome is in line with Mekonen et al. research which found that primary education was accounted 154 [8]. As for residence, the largest percentage of the sample was residing in urban areas with the economic status of just enough. This result is not in line with Kahsay et al. the study which found that rural residents were higher among the cases but is in line with Kahsay et al. the level of income.

Regarding reproductive characteristics; gestational age the highest percentage of the sample reported in the second trimester, and was a gravidity number 1-3, while parity number 2-4. This result is not in the same line with Hafez et al. who found that (59.6%) of the sample in the third trimester, also approximately half of them (47%) had between 5-11. while agreeing with gravidity number whereas found the gravidity number 1-3. but the result of this study related to gestational age is in the same line with Maputle et al. who found that 60.0% of the sample in the 2nd trimester [11]. Concerning, number of miscarriages the highest percentage of the sample reported they have 1-2 aborted. This result is in agreement with Hafez et al. showed that 35% had 2 or more previous abortions.

Concerning dietary risk factors; eating salty food the highest percentage of the sample reported eating salty food, and they are accounted for 53.75%. This result is not consistent with Shoukry et al. showed that 61.54% women are taking a low salt diet among all women who agreed that a high salt diet is a major cause of high BP [12]. Concerning, eating vegetables the highest percentage 72.5% of the sample were eating per day. This result is unlike with Kahsay et al. who showed that 57.3% of the sample was not using vegetables daily. Also, the current study showed that 65.0 % of the sample is taking fruit daily. The result of the current study consistent with 19 who found that 54.5% of participants taking fruit [13-19].

Regarding, eating fatty food the highest percentage of the sample was eating fatty food, and they are accounted 60% this result in the same line with Kahsay et al. who reported that the most of study group consumption of trans fatty food and accounted 47.1% [20]. The highest percentage of the sample reported was not taking folic acid before pregnancy, and they are accounted for 71.25%. This finding inconsistent with Larry et al. who stated that most participants' preconceptions start the use of folic acid [21]. The highest percentage of the sample reported no exposure to vitamins D and they are accounted for 76.25%. This finding is inconsistent with Makhlouf et al. who stated that most participants in the study group 49.4% take vitamins D [22].

Regarding health history , results of this study show that history gestational diabetes 93.75% of the sample free of history gestational diabetes, this result is in the same line with Kahsay et al. found that majority of the sample did not have gestational diabetes mellitus. Regarding, history of anemia the present study found that most samples were not having anemia 56.25% this result is in disagreement with Kahsay et al. found that the highest percentage 85.5% of them was the presence of anemia at the first visit [23]. Concerning, history of pregnancy-induced hypertension results of this study shows that 51.25% of the sample didn't have a history of pregnancy-induced hypertension [24]. This result is in the same line with Mekonen et al. who found that 94.1% of the sample did not have a history of pregnancy-induced hypertension. Most of the participants having urinary tract infections and this may be due to this common during pregnancy according to physiological changes during the conception [25].

Part (5): Association between demographical characteristics with dietary and health history

The present study shows that an insignificant relationship between age and risk factors. This result disagrees with Kahsay et al. who found a significant relationship at P-value 0.006 between age groups and hypertensive disorders of pregnancy but in agreement with Kahsay et al. about association between residence and hypertensive disorders of pregnancy. Concerning, level of education and occupation the current study revealed that there is a significant relationship between maternal education and occupation and risk factors, the result of the current study is in the same line with Liu et al. found that high significant relationship between low educational level and risk factors p=0.0052 .

So, the study underhand depicts that there is not a significant relationship between economic status and risk factors. This result is in agreement with Kahsay et al. found that no significant relationship at P-value 0.8 between the Income category and hypertensive disorders of pregnancy. The present study report that no significant relationship between socio-economic status and risk factors related to hypertension during pregnancy. This result not in the same line with Tebeu et al. found a significant relationship between income and pre-eclampsia.

Part (6): Relationship of dietary and health history with reproductive characteristics

The current study shows that there is a significant relationship between the history of abortion and risk factors. This result is incongruent with Kahsay et al. found that no significant relationship at P-value 0.263 between abortion and hypertensive disorders of pregnancy. The current study report that the significant relationship between gravidity and risk factor of pregnancy-induced hypertension. This result is in agreement with O’Brien et al. who found a significant relationship between the distribution of hypertension disorders of pregnancy according to gravidity (p=0.040)

The present study revealed that the highest percentage of mother with hypertension eating fruit. This result is dis agreement with Kahsay et al. study found that mothers who consume less fruits in their diets were at higher risk of developing hypertensive disorders of pregnancy. The current study report that the highest % of mother doesn’t have gestational diabetes and anemia. This result is not in same line with Kahsay et al. study found that mothers with gestational diabetes would have higher predisposition (p=0.02), also the maternal with not anemic problem was not a significant risk factor for PIH. The present study report that highest % of mother doesn’t have family history of chronic hypertension. This result is disagreeing with Timmermans et al. reported an increased risk of hypertensive disorders with a positive family history of chronic hypertension.

References

1. Kahsay H, Gashe F, Ayele W. Risk factors for hypertensive disorders of pregnancy among mothers in Tigray region, Ethiopia: matched case-control study, BMC Pregnancy and Childbirth 2018; 18: 482.
2. Amal K, Syed A. Elevated blood pressure among patients with hypertension in general hospital of penang, malaysia: Does poor adherence matter?. Int J Pharm Pharm Sci 2010; 2(1): 24-32.
3. Kodogo V, Azibani F, Sliwa K. Role of pregnancy hormones and hormonal interaction on the maternal cardiovascular system: A literature review. Clin Res Cardiol 2019; 108(8): 831-846.
4. Lumbers ER, Pringle KG. Roles of the circulating renin-angiotensin-aldosterone system in human pregnancy. Am J Physiol Regul Integr Comp Physiol 2014; 306(2): 91-101.
5. Ngene NC, Moodley J. Physiology of blood pressure relevant to managing hypertension in pregnancy. J Matern Fetal Neonatal Med 2019; 32(8): 1368-1377.
6. Sasan S, Zandvakili F, Soufizadeh N, et al. The effects of vitamin d supplement on prevention of recurrence of preeclampsia in pregnant women with a history of preeclampsia. Obstet Gynecol Int 2017; pp: 1-5.
7. Fahim A, Qureshi A, Nizamani GS, et al. Pregnancy induced hypertension: Assessment of prognostic value of platelet count in women with varying degree. Prof Med J 2014; 21(3): 436-440.
8. Mekonen L, Shiferaw Z, Wubshet E, et al. Pregnancy induced hypertension and associated factors among pregnant women in Karamara hospital, Jijiga, Eastern Ethiopia. J Preg Child Health 2018; 5(2): 3.
9. Hafez S, Dorgham L, Sayed S. Profile of high risk pregnancy among Saudi women in Taif-ksa. World J Medical Sci 2014; 11 (1): 90-97,
10. Assis TR, Viana FP, Rassi S. Study on the major maternal risk factors in hypertensive syndromes. Arq Bras Cardiol 2008; 91(1): 11-7.
11. Maputle S, Khoza L, Lebese R. Knowledge towards pregnancy-induced hypertension among pregnant women in Vhembe district, Limpopo province. J Hum Ecol 2015; 51(1,2): 47-54 .
12. Shoukry LR, Mohamed AN, Sharaf AEA, et al. Diagnostic markers for early detection of neonatal sepsis. Journal of Scientific Research in Medical and Biological Sciences 2021; 2(3): 13-26.
13. Singh V, Srivastava M. Associated risk factors with pregnancy-induced hypertension: A hospital-based KAP study. Int J Med Public Health 2015; 5(1): 59-62.
14. Aksornphusitaphong A, Phupong V. Risk factors of early and late onset pre-eclampsia. J Obstet Gynaecol Res 2013; 39(3): 627–631.
15. Liu X, Ruan Y, Liu Y, et al. Relationship between maternal age and hypertensive disorders in pregnancy. Z Red Flower Y IX UE za Z Hi 2015; 95(1): 19-22.
16. Tebeu PM, Foumane P, Mbu R, et al. Risk factors for hypertensive disorders in pregnancy: A report from the Maroua regional hospital, Cameroon. J Reprod Infertil 2011; 12(3): 227–234.
17. Silva LM, Coolman M, Steegers EA, et al. Low socioeconomic status is a risk factor for preeclampsia: The Generation R Study. J Hypertens 2008; 26(6): 1200–08.
18. O’Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of: A systematic overview. Epidemiology 2007; 14: 368-374.
19. Subki AH, Algethami MR, Baabdullah WM, et al. Prevalence, risk factors, and fetal and maternal outcomes of hypertensive disorders of pregnancy: A retrospective study in western Saudi Arabia. Oman Med J 2018; 33(5)409–415.
20. Kahsay HB, Gashe FE, Ayele WM. Risk factors for hypertensive disorders of pregnancy among mothers in Tigray region, Ethiopia: matched case-control study. BMC pregnancy and childbirth 2018; 18(1): 482.
21. Larry J, Wisdom T, Wisdom KA, et al. Risk factors associated with pregnancy induced hypertension in the hohoe municipality of Ghana. J Prev Med Health 2017; 1(3): 1011.
22. Makhlouf AMA, Mahmoud AM, Ibrahim, RG, et al. Effects of vitamin d and simvastatin on inflammatory and oxidative stress markers of high-fat diet-induced obese rats. Journal of Scientific Research in Medical and Biological Sciences 2021; 2(3): 39-50.
23. Timmermans S, Steegers-Theunissen RP, Vujkovic M, et al. Major dietary patterns and blood pressure patterns during pregnancy: The Generation R Study. Am J Obstet Gynecol 2011; 205(4): 337-e1.
24. Abd-Elhussien ZA, Khudair FW. Risk factors contributed to gestational hypertension among women at primary health care centers in Al-Nana city. Journal of Pharmaceutical Sciences and Research 2019; 11(4): 1534-40.
25. Tessema GA, Tekeste A, Ayele TA. Preeclampsia and associated factors among     pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: A hospital-based study. BMC pregnancy and childbirth 2015; 15(73): 1–7.