Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study.

Background: Hypertensive disorders in pregnancy (HDPs) are associated with lifelong cardiovascular disease risk. Persistent postpartum hypertension in HDPs could suggest progression to chronic hypertension. This phenomenon has not been well examined in low- and middle-income countries (LIMCs), and most previous follow-ups typically last for maximally six weeks postpartum. We assessed the prevalence of persistent hypertension up to one year in women with HDPs in a low resource setting and determined associated risk factors. Methodology: A prospective cohort study of women conducted at eight tertiary health care facilities in seven states of Nigeria. Four hundred and ten women with any HDP were enrolled within 24 hours of delivery and followed up at intervals until one year postpartum. Descriptive statistics were performed to express the participants' characteristics. Univariable and multivariable logistic regressions were conducted to identify associated risk factors. Results: Of the 410 women enrolled, 278 were followed up to one year after delivery (follow-up rate 68%). Among women diagnosed with gestational hypertension and pre-eclampsia/eclampsia, 22.3% (95% CI; 8.3-36.3) and 62.1% (95% CI; 52.5-71.9), respectively, had persistent hypertension at six months and this remained similar at one year 22.3% (95% CI; 5.6-54.4) and 61.2% (95% CI; 40.6-77.8). Maternal age and body mass index were significant risk factors for persistent hypertension at one year [aORs = 1.07/year (95% CI; 1.02-1.13) and 1.06/kg/m2 (95% CI; 1.01-1.10)], respectively. Conclusion: This study showed a substantial prevalence of persistent hypertension beyond puerperium. Health systems in LMICs need to be organized to anticipate and maintain postpartum monitoring until blood pressure is normalized, or women referred or discharged to family physicians as appropriate. In particular, attention should be given to women who are obese, and or of higher maternal age.

Metabolic syndrome following hypertensive disorders in pregnancy in a low-resource setting: A cohort study.

OBJECTIVES: Hypertensive disorders in pregnancy (HDPs) are associated with risk of future metabolic syndrome. Despite the huge burden of HDPs in sub-Saharan Africa, this association has not been adequately studied in this population. STUDY DESIGN: This was a prospective cohort study on pregnant women recruited between August 2017 - April 2018 and followed up to one year after their deliveries and evaluated for presence of metabolic syndrome at delivery, nine weeks, six months and one year. MAIN OUTCOME MEASURES: Prevalence of metabolic syndrome RESULTS: A total of 488 pregnant women were included: 410 and 78 with HDPs and normotensive, respectively. None of the normotensive had metabolic syndrome until one year (1.7% = 1 out of 59 observations), while among those with HDPs were 17.4% (71 of 407), 8.7% (23 of 263), 4.7% (11 of 232) and 6.1% (17 of 278), at delivery, nine weeks, six months and one year postpartum, respectively. High BMI and blood pressure were the drivers of metabolic syndrome in this population. The incidence rate in HDPs versus normotensive at one year were, respectively, 57.5/1000 persons' year (95%CI; 35.8 - 92.6) and 16.9/1000 persons' years (95%CI; 2.4-118.3), with incidence rate ratio of 3.4/1000 person's years. Only parity significantly predicted the presence of metabolic syndrome at one year [(aOR= 3.26/delivery (95%CI; 1.21-8.79)]. CONCLUSION: HDPs were associated with a higher incidence of metabolic syndrome up to one year postpartum. Women with HDPs should be routinely screened for metabolic syndrome within the first year postpartum to reduce cardiometabolic risks.

Socio-demographic Factors Associated with Knowledge and Uptake of Family Planning Among Women of Reproductive Age in a Rural Community of Abuja, Nigeria / Jurnal Sains Kesihatan Malaysia

@#Nigeria has a population of about 180 million, estimated to double in 22 years due to low uptake of family planningservices. Low utilization of family planning is the major factor associated with high fertility pattern in Nigeria. Thistrend is higher among rural women in Northern Nigeria. Without a thorough understanding of, and due attention to thelocal context, utilization of family planning may continue to be low. Identification of correlates of family planning wouldbe invaluable in designing strategies for ultimately improving uptake of family planning services. This study becamerelevant as no previous study on family planning has been carried out in Ushafa Community. The study was conductedat Ushafa community, a rural community, located in Bwari Area Council on the northern axis of the Federal CapitalTerritory (FCT) of Nigeria. The study was a descriptive cross-sectional study, conducted among women of reproductiveage (15-49 years) who were permanent resident of Ushafa Community. Using proportion of contraceptive usage of 16%from a previous study, 240 women were recruited into the study by systematic sampling technique. Data was collected bymeans of a structured interviewer administered questionnaire, data was entered and analysed using statistical packagefor social sciences (SPSS) version 20. All tests were conducted using 2 tails while level of significance was set at 0.05.About a quarter of respondents (26.3%) knew that amenorrhoea could be a side effect of oral contraceptive pills, 51.1%knew that oral contraceptive pills must be taken daily, 58% were not using any form of family planning. Age (χ2 = 8.382,p = 0.01) and marital status (χ2 = 8.915, p = 0.01) were significantly associated with family planning knowledge. Levelof education was significantly associated with current use of family planning (χ2 = 10.78, p = 0.03). Educational statuswas significantly associated with likelihood of using family planning in the future (χ2 = 8.64, p = 0.04). Although therespondents had fairly good knowledge of family planning, the study observed some misconceptions especially withrespect to side effects and methodology of use of the commodities. Low uptake of family planning was observed amongthe respondents. Age and marital status were significantly associated with family planning knowledge; level of educationwas significantly associated with current use of family planning. There is need for incorporation of facts on usage andside effects of family planning in message disseminated by health workers in health facilities in Ushafa Community so as to correct misconceptions.