| Background: Hypertensive diseases of pregnancy,also known as HDP,are a collection of maternal diseases that are distinguished by an increase in the mother’s systolic blood pressure of more than 140 mm Hg and/or diastolic blood pressure of more than 90 mm Hg while she is pregnant."Hypertensive disease of pregnancy" is a catch-all phrase that refers to chronic hypertension,gestational hypertension,preeclampsia,and eclampsia.Chronic hypertension complicating pregnancy is defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90mm Hg before 20 weeks of gestation,with no significant exacerbation during pregnancy;or hypertension first diagnosed after 20 weeks of gestation and persisting beyond 12 weeks of postpartum.Gestational hypertension is defined as hypertension with a systolic blood pressure ≥140mm Hg and/or diastolic blood pressure ≥90 mm Hg that develops after 20 weeks of gestation and returns to normal within 12 weeks of delivery,as well as negative urine protein.Preeclampsia is defined as the presence of systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90mm Hg after 20 weeks of gestation,accompanied by urinary protein≥0.3g/24 h,or positive random urine protein,or the absence of proteinuria but in combination with any of thrombocytopenia,hepatic impairment,renal impairment,pulmonary oedema,new central nervous system abnormalities or visual disturbances.Eclampsia is defined as the occurrence of convulsions on top of pre-eclampsia that cannot be explained by other causes.The prevalence of hypertensive disease in pregnancy varies significantly between published research and geographical locations around the world.The global prevalence of hypertensive disease during pregnancy ranges between 4.6 and 13.1 percent.This condition accounts for 9.2% of all maternal and neonatal deaths.In developing countries,the prevalence of hypertension disease during pregnancy ranges from 4.0 to12.3 percent.On the other hand,the prevalence of hypertensive disease in pregnancy varies from 1% to 6% in developed countries.According to the various research that has been conducted on hypertensive disease of pregnancy,the prevalence of hypertensive disease in pregnancy in China ranges anywhere from 5 percent to 10 percent.According to the China2017 health-statistics yearbook,hypertension disease of pregnancy is one of the top three causes of maternal death,which is responsible for 10.4%of maternal mortality in China.Furthermore,the hypertensive disorder of pregnancy is one of the primary causes of incapacity among pregnant women around the world.Women who are pregnant and have hypertensive disease are more likely to have obstetric problems,stay in the hospital for a longer period of time,and develop cardiovascular disease later in life.Women who have hypertension disease of pregnancy are more likely to have less favourable health outcomes,and this is especially true for women who experience hypertensive disease of pregnancy in the first 34 weeks of their pregnancies.In addition,hypertensive disease of pregnancy is linked to a number of unfavourable outcomes for both the mother and the fetus,and the public health burden posed by this condition constitute a significant risk to pregnant women.In most developing countries,pregnant women face a series of challenges such as limited access to standard antenatal care services,blood pressure monitoring,and failure to meet daily dietary consumption requirements due to economic hardship,increasing their risk of HDP.Although the issue of hypertensive disease during pregnancy remains largely unclear,evidence suggests that diet plays a major role in its occurrence.Also,few studies have reported that metabolic imbalance similar to those found in cardiovascular diseases and type 2 diabetes mellitus(T2DM),inclusive of oxidative stress,insulin resistance,and dyslipidaemia,increases the risk of HDP.Furthermore,several observational studies conducted in Sweden,Albuquerque,Birmingham,Cleveland,Memphis,Poland,and North America,revealed that obesity,environmental and genetic factors,smoking habits,family history of hypertension,pre-existing diabetes,gestational diabetes mellitus,maternal age ≥40 years,stillbirth,and multiple pregnancies,are factors that increase the risk of HDP.Also,in China,HDP is associated with adverse maternal and fetal outcomes,and its public health burden is considered a significant threat to the health of pregnant mothers.Previous Studies assessing hypertension in pregnancy among Chinese women,revealed that migration from rural to urban cities and changes in activities of daily living due to urbanization,greatly influence the prevalence of overweight and obesity among pregnant mothers,leading to increased risk for hypertensive disease in pregnancy.Further,a previous study findings revealed that the two-child policy implementation in 2015 lead to increase number of pregnant women aged ≥40 years,which significantly increased the risk hypertension among pregnant women in China.Although numerous studies on hypertension disease in pregnancy have been carried out in China,it is crucial to note that these studies have been done in different parts of China,and their conclusions are generally inconsistent with one another.Moreover,those previous studies only assessed a small number of possible risk variables for hypertensive diseases during pregnancy and used a much smaller sample size,which may not have been representative of the actual research environment.This is something that needs to be taken into consideration.Most importantly,there is not enough research conducted in South China to determine the prevalence of hypertension disease in pregnancy or the factors that contribute to hypertensive disease of pregnancy.Objective: To assess the prevalence and analyse the risk factors and establish the predictive model of hypertensive disease in pregnancy in South China.Methods: This study was a multicenter retrospective study.A total of 155,566 pregnant women who were admitted to the obstetric or gynecological department at 18 randomly selected hospitals until discharge were included in the study.The time period for the study was from January1,2017,to December 31,2018.A total of 18 districts or counties within South China were sample for inclusion.Within each sampled district or county,a single hospital that had more than one thousand births in a given year was selected by cluster random sampling technique for inclusion.We began the process of selecting the hospitals by first tallying the number of medical facilities that fulfilled the criteria for inclusion within each surveillance district or county.One hospital with 1000 or more than 1000 childbirth in a year within each sample district or county within South China was randomly selected for inclusion.Because the primary focus of the research was on pregnant women who were admitted in the obstetrics or genecology departments of hospitals in South China,the researchers did not include non-pregnant women or moms who were not hospitalized throughout their pregnancies.The database that was used contained information on maternal health both before and throughout pregnancy that was gathered from the collaborating hospitals.A validated version of China’s Annex 1 Critical Maternal Surveillance questionnaire was used to collect data from the electronic medical records kept at each of the participating hospitals.The researcher and two research assistants who had received medical training were responsible for collecting this data.During the time that we were collecting the data,we made sure to check them twice,and then we coded them numerically so that we could maintain the highest level of confidentiality possible.The questionnaire that was employed is broken up into three distinct parts(A,B,and C).The topic of discussion in the first section(A)is the sociodemographic parameters and obstetric characteristics of the mothers.In the second section(B),the focus is on the maternal-neonatal variables.In the last section(C),the main points of discussion are the comorbidities and complications of pregnancy and childbirth.The dependent variable(Y-variable)was hypertensive disease during pregnancy(HDP)and the independent variables included:sociodemographic profile of participants(maternal age,marital status,and educational level),obstetrical characteristics(parity,gravidity,ANC examination,and times of previous caesarean section),maternal-neonatal characteristics(number of a fetus in pregnancy,and birth weight),and comorbidities/complications of pregnancy(systemic infection/sepsis,urinary system infection,upper respiratory tract infection,cardiopathy,hepatopathy,anemia,Pneumopathy,nephropathy,diabetes).At the start of the data analysis,the frequency for each variable was inspected and cleaned for any missing data or outliers.After that,a univariate analysis was carried out in order to determine the significance of the connection that existed between the independent variables and the dependent variable.Cramer’s V statistics were utilized in the course of the univariate analysis to perform an evaluation of the correlation that existed between the variables that were taken into consideration.In the multiple logistic regression model,we included all of the independent variables that had a p-value of <0.001 or lower,indicating that they had some kind of statistical significance.In particular,a forward stepwise logistic regression analysis was done to find the odds ratio(OR)and the 95 percent confidence interval(CI)for the different risk factors that were found to be linked to hypertensive disease in pregnancy.During the process of doing the regression analysis,the data entry and removal points were respectively established at 0.10 and 0.15.For the purposes of the study,a two-sided probability P-value of less than 0.05 was regarded as statistically significant.For all of the analysis,version 26.0 of the Statistical Package for the Social Sciences(SPSS)was used,and version 7 of Endnote was used to list the sources.Results: The research assessed a total of 155,566 medical records of women of reproductive age who had been hospitalized and treated in the obstetrics and/or gynecology departments of various medical facilities.(1)In this study population,1.4% of pregnant women were <20years old,4.6% were between 20-24 years old,20.9% were 25-29 years old,44.3% were 30-34 years old,and the remaining 28.8% were of advanced maternal age(age≥35 years old);the vast majority(99.2%)of pregnant women were married or cohabiting.In addition,34.8% of pregnant women had received tertiary education at university or above,47.5% had a high school education,16.9% had a junior high school education and 0.8% had only completed compulsory primary education or were illiterate.(2)Of 155,566 pregnant women,a total of 7,672 pregnant women were found to have a hypertensive disease during pregnancy,resulting in a4.9 percent estimated prevalence among all study participants.In particular,there were 3,207 pregnant women who suffered from gestational hypertension,which corresponds to a prevalence of 2.1 percent.There was a total of 784 pregnant women who suffered from chronic hypertension,which resulted in a prevalence of 0.5 percent.There were 1,404 pregnant women who were diagnosed with mild preeclampsia,which resulted in a prevalence of 0.9 percent.In addition,2,234 pregnant women had severe preeclampsia,which resulted in a prevalence of 1.4 percent,and a total of43 pregnant women had eclampsia,which resulted in a prevalence of 0.3percent.Among the group of pregnant women with hypertensive disorders during pregnancy,0.8% were younger than 20 years old,3.5% were between 20 and 24 years old,15.2% were 25-29 years old,39.2% were 30-34 years old,and the remaining 41.4% were 35 years old and above;99.3%of pregnant women had a marital status of married or The other 0.7% were single,divorced or widowed;34.0% of pregnant women had a college education or above,10.9% had a high school education,54.0% had a junior high school education and 1.2% had a primary school education or were illiterate;46.2% were primiparous and 53.8% were 29.8% of pregnant women had their first pregnancy,59.5% had their second to fourth pregnancy and 10.6% had their fifth or more pregnancy;0.9% of pregnant women had no antenatal check-ups during their current pregnancy,3.5%had one to three antenatal check-ups,66.9% had four to nine antenatal check-ups The majority of pregnant women had a history of previous caesarean section and 26.2% had no previous caesarean section;93.2% had a singleton pregnancy and 6.8% had a multiple pregnancy;94.9% had a normal or cephalic position and 5.1% had an abnormal position.The fetal position was abnormal in 5.1% of pregnancies;25.7% of newborns were low birth weight,69.3% were normal birth weight and 4.9% were large.In addition,among pregnant women with hypertensive disorders during pregnancy,the distribution of pregnancy-related complications or complications is as described below.The prevalence of infectious diseases was 0.2% for systemic infections or septicaemia,0.2% for urinary tract infections and 1.9% for upper respiratory tract infections.Regarding the occurrence of pregnancy complications,only 6 pregnant women had thrombophlebitis,51(0.7%)had heart disease,201(2.7%)had liver disease,6(0.1%)had lung disease,70(0.9%)had kidney disease,1 had AIDS,1 had cancer,21.9% had diabetes,while 33.1% of pregnant women had anaemia during pregnancy.(3)The maternal sociodemographic characteristics were analysed using univariate analysis to assess the significant relationship to hypertension diseases of pregnancy.Among the three independent sociodemographic variables assessed,maternal age,and education level shows a significant relationship to hypertensive disease of pregnancy.However,the marital status shows no significant association with hypertension diseases during pregnancy among the study participants.The univariate analysis was performed to assess the significant relationship maternal obstetric characteristics to hypertensive disease of pregnancy among the study participants.The four independent variables(parity,gravidity,ANC history,and times of the previous caesarean section)assessed all show a significant relationship to hypertensive disease during pregnancy.These significant independent variables were all included in the multivariate logistic regression model.The univariate analysis was performed to assess the significant relationship of maternal obstetric characteristics to hypertensive disease of pregnancy among the study participants.The three independent variables(number of fetuses per pregnancy,fetus presentation,and birth weight)assessed all show a significant relationship to hypertensive disease of pregnancy.These significant independent variables were not included in the multivariate logistic regression model.The univariate analysis was used to assess the significant relationship between pregnancy-related comorbidities to hypertensive disease of pregnancy among the study participants.Twelve independent variables(systemic infection/sepsis,urinary system infection,upper respiratory tract infection,thrombophlebitis,cardiopathy,hepatopathy,anemia,Pneumopathy,nephropathy,diabetes,HIV/ AIDS,and cancer)were assessed for a significant relationship to hypertensive disease in pregnancy.Nine of these variables showed a significant relationship to the occurrence of hypertension disease of pregnancy.Thrombophlebitis,HIV/ AIDS and cancer were variables that had no significant relationship to hypertensive disease of pregnancy.The significant independent variables were included in the multivariate logistic regression model.(4)In the multivariate analyses,the following were identified as potential risk factors for hypertensive disease in pregnancy among the study participants: multiparity(OR = 1.544,95% CI: 1.435-1.660),low(0-3)ANC examinations(OR=1.509,95% CI: 1.269-1.793),systemic infection(OR=1.853,95% CI: 1.567-2.191),diabetes(OR=1.896,95%CI: 1.764-2.038),Nephropathy(OR=3.980,95% CI: 2.188-4.676),upper respiratory tract infection(OR=1.593,95% CI: 1.265-2.006),Cardiopathy(OR=2.243,95% CI: 1.476-3.408),and hepatopathy(OR=1.283,95% CI:1.081-1.522)Previous caesarean section(OR=0.809,95% CI: 0.748-0.875)was found to be a protective factor against hypertensive disease of pregnancy among the study participants.The receiver operating characteristic curve(ROC curve)reflected the predictive performance of the model using a single dependent variable and combined risk factors of HDP(Figure 1).In the predictive model,the area under the ROC curve(AUC)and 95% confidence interval with a p-value for the combined identified risk factors of pregnant women was AUC=0.808(95% CI: 0.792-0.905,P<0.001).From the predictive analysis,the value of the AUC(reflects a relatively good predictive model for this study.Conclusion: There is a relatively low prevalence of hypertensive disease during pregnancy and its subtypes among pregnant women in South China.On the other hand,a number of risk factors for hypertensive disease in pregnancy have been found.These risk factors include nephropathy,placenta abruption,cardiopathy,diabetes,systemic infection,upper respiratory tract infection,multiparity,and hepatopathy.It was found that pregnant women who had nephropathy,placenta abruption,cardiopathy,diabetes,or a systemic infection had a considerably increased risk of hypertensive disease during pregnancy.As a result,medical professionals are advised to pay closer attention to pregnant women who have the risk factors that have been identified,in order to facilitate quick preventative intervention.In addition,additional efforts are required for the expansion of maternal healthcare capacity across all of China in order to assist in the delivery of high-quality healthcare services to all women while they are pregnant.Clinicians are also strongly encouraged to keep emphasizing how important it is to go in for regular ANC exams all the way through the pregnancy.4 Figures,7 Tables,69 References... |
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