Katherine M Johnson1, Rebecca Zash2, Miriam J Haviland3, Michele R Hacker3, Rebecca Luckett4, Modiegi Diseko5, Gloria Mayondi5, Roger Shapiro6. 1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States. Electronic address: kjohnso8@bidmc.harvard.edu. 2. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Botswana-Harvard Partnership, Gaborone, Botswana. 3. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States. 4. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States. 5. Botswana-Harvard Partnership, Gaborone, Botswana. 6. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Botswana-Harvard Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Abstract
OBJECTIVES: Perinatal morbidity in sub-Saharan Africa has been attributed to infection, obstetric emergencies, and preterm birth, but less is known about hypertension in pregnancy. Our objective was to characterize the prevalence of hypertension in pregnancy and the impact of hypertension on perinatal outcomes in sub-Saharan Africa. STUDY DESIGN: We performed surveillance of obstetric records at eight of the largest public hospitals in Botswana. Women were included in this analysis if they were HIV-uninfected and had singleton gestations and at least one prenatal blood pressure measurement. MAIN OUTCOME MEASURES: We measured stillbirth, preterm birth, small for gestational age, and neonatal death in women with and without hypertension in pregnancy. RESULTS: We included 14,170 pregnancies. Hypertension occurred in 3156 (22.2%) women, with 602 (19.1%) defined as severe. Severe hypertension increased risk of stillbirth (RR 4.4; 95% CI 3.2-6.2), preterm birth (RR 2.5; 95% CI 2.2-2.8), small for gestational age (RR 2.7; 95% CI 2.3-3.1) and neonatal death (RR 5.1; 95% CI 2.9-5.6). Non-severe hypertension increased risk of stillbirth (RR 2.0; 95% CI 1.5-2.7), preterm birth (RR 1.2; 95% CI 1.1-1.3), and small for gestational age (RR 1.6; 95% CI 1.4-1.8). Perinatal outcomes were worse in women with hypertension who had spontaneous preterm birth compared to those who underwent iatrogenic preterm delivery. CONCLUSIONS: Hypertension in pregnancy is common in Botswana and leads to a large number of adverse outcomes. Improved management of hypertension in pregnancy may improve perinatal morbidity and mortality.
OBJECTIVES: Perinatal morbidity in sub-Saharan Africa has been attributed to infection, obstetric emergencies, and preterm birth, but less is known about hypertension in pregnancy. Our objective was to characterize the prevalence of hypertension in pregnancy and the impact of hypertension on perinatal outcomes in sub-Saharan Africa. STUDY DESIGN: We performed surveillance of obstetric records at eight of the largest public hospitals in Botswana. Women were included in this analysis if they were HIV-uninfected and had singleton gestations and at least one prenatal blood pressure measurement. MAIN OUTCOME MEASURES: We measured stillbirth, preterm birth, small for gestational age, and neonatal death in women with and without hypertension in pregnancy. RESULTS: We included 14,170 pregnancies. Hypertension occurred in 3156 (22.2%) women, with 602 (19.1%) defined as severe. Severe hypertension increased risk of stillbirth (RR 4.4; 95% CI 3.2-6.2), preterm birth (RR 2.5; 95% CI 2.2-2.8), small for gestational age (RR 2.7; 95% CI 2.3-3.1) and neonatal death (RR 5.1; 95% CI 2.9-5.6). Non-severe hypertension increased risk of stillbirth (RR 2.0; 95% CI 1.5-2.7), preterm birth (RR 1.2; 95% CI 1.1-1.3), and small for gestational age (RR 1.6; 95% CI 1.4-1.8). Perinatal outcomes were worse in women with hypertension who had spontaneous preterm birth compared to those who underwent iatrogenic preterm delivery. CONCLUSIONS:Hypertension in pregnancy is common in Botswana and leads to a large number of adverse outcomes. Improved management of hypertension in pregnancy may improve perinatal morbidity and mortality.
Authors: Alan Buchbinder; Baha M Sibai; Steve Caritis; Cora Macpherson; John Hauth; Marshall D Lindheimer; Mark Klebanoff; Peter Vandorsten; Mark Landon; Richard Paul; Menachem Miodovnik; Paul Meis; Gary Thurnau Journal: Am J Obstet Gynecol Date: 2002-01 Impact factor: 8.661
Authors: Adeniran O Fawole; Archana Shah; Olukemi Tongo; Kabir Dara; Aliyu M El-Ladan; Augustine C Umezulike; Frank E Alu; Ademuyiwa B Eniayewun; Adetokunbo O Fabanwo; Adeniyi A Adewunmi; Omololu Adegbola; Amos A Adebayo; Felix O Obaitan; Olanrewaju E Onala; Yalwa Usman; Abdulkareem O Sullayman; Sikiratu Kailani; Mohammed Sa'id Journal: Int J Gynaecol Obstet Date: 2011-04-12 Impact factor: 3.561
Authors: J L Browne; K M Vissers; E Antwi; E K Srofenyoh; E L Van der Linden; I A Agyepong; D E Grobbee; K Klipstein-Grobusch Journal: Trop Med Int Health Date: 2015-10-20 Impact factor: 2.622
Authors: Kathleen M Powis; Douglas Kitch; Anthony Ogwu; Michael D Hughes; Shahin Lockman; Jean Leidner; Erik van Widenfelt; Claire Moffat; Sikhulile Moyo; Joseph Makhema; Max Essex; Roger L Shapiro Journal: J Infect Dis Date: 2011-08-15 Impact factor: 5.226
Authors: Joy E Lawn; Hannah Blencowe; Peter Waiswa; Agbessi Amouzou; Colin Mathers; Dan Hogan; Vicki Flenady; J Frederik Frøen; Zeshan U Qureshi; Claire Calderwood; Suhail Shiekh; Fiorella Bianchi Jassir; Danzhen You; Elizabeth M McClure; Matthews Mathai; Simon Cousens Journal: Lancet Date: 2016-01-19 Impact factor: 79.321
Authors: Rong Yang; Dan Luo; Yi-Ming Zhang; Ke Hu; Zheng-Min Qian; Li-Qin Hu; Long-Jiao Shen; Hong Xian; Juliet Iwelunmor; Su-Rong Mei Journal: Curr Med Sci Date: 2019-12-16
Authors: Lisa M Bebell; Kalynn Parks; Mylinh H Le; Joseph Ngonzi; Julian Adong; Adeline A Boatin; Ingrid V Bassett; Mark J Siedner; Alison D Gernand; Drucilla J Roberts Journal: J Infect Dis Date: 2021-12-08 Impact factor: 5.226
Authors: Elizabeth M Stringer; Michelle A Kendall; Shahin Lockman; Thomas B Campbell; Karin Nielsen-Saines; Fred Sawe; Susan Cu-Uvin; Xingye Wu; Judith S Currier Journal: PLoS One Date: 2018-07-18 Impact factor: 3.240
Authors: Adam Mabrouk; Amina Abubakar; Ezra Kipngetich Too; Esther Chongwo; Ifedayo M Adetifa Journal: Int J Environ Res Public Health Date: 2022-08-24 Impact factor: 4.614