The Association of Race and Ethnicity with Severe Maternal Morbidity among Individuals Diagnosed with Hypertensive Disorders of Pregnancy.

OBJECTIVE: This study aimed to examine whether there are racial disparities in severe maternal morbidity (SMM) in patients with hypertensive disorders of pregnancy (HDP). STUDY DESIGN: Secondary analysis of an observational study of 115,502 patients who had a live birth at ≥20 weeks in 25 hospitals in the United States from 2008 to 2011. Only patients with HDP were included in this analysis. Race and ethnicity were categorized as non-Hispanic White, non-Hispanic Black (NHB), and Hispanic and were abstracted from the medical charts. Patients of other races and ethnicities were excluded. Associations were estimated between race and ethnicity, and the primary outcome of SMM, defined as any of the following, was estimated by unadjusted logistic and multivariable backward logistic regressions: blood transfusion ≥4 units, unexpected surgical procedure, need for a ventilator ≥12 hours, intensive care unit (ICU) admission, or failure of ≥1 organ system. Multivariable models were run classifying HDP into three levels as follows: (1) gestational hypertension; (2) preeclampsia (mild, severe, or superimposed); and (3) eclampsia or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. RESULTS: A total of 9,612 individuals with HDP met inclusion criteria. No maternal deaths occurred in this cohort. In univariable analysis, non-Hispanic White patients were more likely to present with gestational hypertension whereas NHB and Hispanic patients were more likely to present with preeclampsia. The frequency of the primary outcome, composite SMM, was higher in NHB patients compared with that in non-Hispanic White or Hispanic patients (11.8 vs. 4.5% in non-Hispanic White and 4.8% in Hispanic, p < 0.001). This difference was driven by a higher frequency of blood transfusions and ICU admissions among NHB individuals. Prior to adjusting the analysis for confounding factors, the odds ratio (OR) of primary composite outcomes in NHB individuals was 2.85 (95% confidence interval [CI]: 2.38, 3.42) compared with non-Hispanic White. After adjusting for sociodemographic and clinical factors, hospital site, and the severity of HDP, the OR of composite SMM did not differ between the groups (adjusted OR [aOR] = 1.26, 95% CI: 0.95, 1.67 for NHB, and aOR = 1.29, 95% CI: 0.94, 1.77 for Hispanic, compared with non-Hispanic White patients). Sensitivity analysis was done to exclude one single site that was an outliner with the highest ICU admissions and demonstrated no difference in ICU admission by maternal race and ethnicity. CONCLUSION: NHB patients with HDP had higher rates of the composite SMM compared with non-Hispanic White patients, driven mainly by a higher frequency of blood transfusions and ICU admissions. However, once severity and other confounding factors were taken into account, the differences did not persist. KEY POINTS: · Black patients with HDP had higher frequency of SMM compared with non-Hispanic White patients.. · The SMM disparities were driven by blood transfusions and ICU admissions.. · After adjustment for confounders, including HDP severity, the significant difference in SMM did not persist..

Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California.

BACKGROUND: Birth hospital has recently emerged as a potential key contributor to disparities in severe maternal morbidity, but investigations on its contribution to racial and ethnic differences remain limited. OBJECTIVE: We leveraged statewide data from California to examine whether birth hospital explained racial and ethnic differences in severe maternal morbidity. STUDY DESIGN: This cohort study used data on all births at ≥20 weeks gestation in California (2007-2012). Severe maternal morbidity during birth hospitalization was measured using the Centers for Disease Control and Prevention index of having at least 1 of the 21 diagnoses and procedures (eg, eclampsia, blood transfusion, hysterectomy). Mixed-effects logistic regression models (ie, women nested within hospitals) were used to compare racial and ethnic differences in severe maternal morbidity before and after adjustment for maternal sociodemographic and pregnancy-related factors, comorbidities, and hospital characteristics. We also estimated the risk-standardized severe maternal morbidity rates for each hospital (N=245) and the percentage reduction in severe maternal morbidity if each group of racially and ethnically minoritized women gave birth at the same distribution of hospitals as non-Hispanic white women. RESULTS: Of the 3,020,525 women who gave birth, 39,192 (1.3%) had severe maternal morbidity (2.1% Black; 1.3% US-born Hispanic; 1.3% foreign-born Hispanic; 1.3% Asian and Pacific Islander; 1.1% white; 1.6% American Indian and Alaska Native, and Mixed-race referred to as Other). Risk-standardized rates of severe maternal morbidity ranged from 0.3 to 4.0 per 100 births across hospitals. After adjusting for covariates, the odds of severe maternal morbidity were greater among nonwhite women than white women in a given hospital (Black: odds ratio, 1.25; 95% confidence interval, 1.19-1.31); US-born Hispanic: odds ratio, 1.25; 95% confidence interval, 1.20-1.29; foreign-born Hispanic: odds ratio, 1.17; 95% confidence interval, 1.11-1.24; Asian and Pacific Islander: odds ratio, 1.26; 95% confidence interval, 1.21-1.32; Other: odds ratio, 1.31; 95% confidence interval, 1.15-1.50). Among the studied hospital factors, only teaching status was associated with severe maternal morbidity in fully adjusted models. Although 33% of white women delivered in hospitals with the highest tertile of severe maternal morbidity rates compared with 53% of Black women, birth hospital only accounted for 7.8% of the differences in severe maternal morbidity comparing Black and white women and accounted for 16.1% to 24.2% of the differences for all other racial and ethnic groups. CONCLUSION: In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.

Cultural perceptions influencing obstetric complications among women in Kaduna, Northwestern Nigeria.

BACKGROUND: Maternal mortality remains a public health challenge despite the global progress made toward its reduction. Cultural beliefs and traditional practices contribute to delays and poor access to maternal health services. This study examined cultural perceptions influencing obstetric complications among women who delivered at Yusuf Dantsoho Memorial Hospital, Tudun-Wada, Kaduna. METHODOLOGY: The study was a cross-sectional study conducted at the Obstetrics and Gynecology Department of Yusuf Dantsoho Memorial General Hospital, Tudun-Wada, Kaduna, from February to April 2014. Two hundred and six women who delivered during the study period irrespective of their booking status and consented to participate in the study were recruited consecutively. Data were collected using a structured questionnaire. RESULTS: Majority of the participants were Hausas (74.8%), Muslims (94.7%), married (99.0%), unemployed (45.1%), and within the age group of 20-29 years (58.7%). Most had secondary education (44.2%). The most frequent maternal complications encountered were prolonged obstructed labor (27.7%), obstetric hemorrhage (23.4%), severe preeclampsia/eclampsia (18.2%), and sepsis (5.8%). "Feeling embarrassed if delivered in hospital" was significantly associated with prolonged obstructed labor, while "feeling proud if delivered at home" was five times more significantly associated with obstetric hemorrhage. CONCLUSION AND RECOMMENDATIONS: Cultural perceptions and traditional practices are major causes of primary delay in accessing maternal health services. The study emphasizes the importance of maternal health education among women in this region. Cultural perceptions and their influence on maternal mortality and morbidity should be integrated into health education programs.

Pregnancy-Related Hypertensive Disorders and Immigrant Status: A Systematic Review and Meta-analysis of Epidemiological Studies.

Immigrants are often considered a vulnerable population. Paradoxically, some researchers have reported lower risk of pregnancy-related hypertension (PRH) among immigrants when compared to their non-immigrant counterparts. The lack of consistency and the absence of a synthesis of studies investigating the associations between immigration status and PRH represent a gap in our understanding of socioecological roots of PRH. Of studies published in during the study period, 16 met the inclusion criteria. For each study, we computed relative risks that compared PRH risk by migrant status. The pooled estimate of the relative risk of PRH represented a statistically significantly lower risk among immigrants (RR = 0.74; 95 % CI 0.67, 0.82). The body of evidence indicates that immigrant status is generally associated with reduced risk of PRH. However the strength of this association could vary by country of origin of immigrants.

Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.

OBJECTIVE: To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries. DESIGN: Cross-country comparative study of linked population-based databases. SETTING: Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden. POPULATION: All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010). METHODS: Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries). RESULTS: There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest. CONCLUSION: Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Maternal near-miss among women with a migrant background in Germany.

OBJECTIVE: To examine the association between region of origin and severe illness bringing a mother close to death (near-miss). DESIGN: Retrospective cohort study. SETTING: Maternity units in Lower Saxony, Germany. POPULATION: 441 199 mothers of singleton newborns in 2001-2007. METHODS: Using chi-squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near-miss outcomes with prospectively collected perinatal data up to seven days postpartum. MAIN OUTCOME MEASURES: Hysterectomy, hemorrhage, eclampsia and sepsis rates. RESULTS: Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60-3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15-4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66-6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36-5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19-2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55-0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis. CONCLUSION: Region of origin was a strong predictor for near-miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near-miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks.

Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan.

BACKGROUND AND PURPOSE: The occurrence of preeclampsia-eclampsia during pregnancy has been reported to increase the risk of stroke in mainly Western populations. However, few studies have evaluated stroke risk in Asian populations and followed women beyond the early postpartum period. Thus, the present study determined the risk of stroke in women in Taiwan during pregnancy and the first postpartum year. METHODS: A population-based cohort study was performed on 1,132,019 parturients during 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Stroke-free survival rates were estimated using the Kaplan-Meier method, and the log-rank test was used to examine the effect of preelampsia-eclampsia on the prevalence of stroke. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine the adjusted odds ratios of preeclampsia-eclampsia on the risk of hemorrhagic and ischemic stroke during pregnancy and within the first postpartum year. RESULTS: The incidence of stroke was 21.47 cases per 100,000 deliveries. There were 139 cases of hemorrhagic stroke and 107 cases of ischemic stroke. The respective adjusted relative risk of preeclampsia-eclampsia for hemorrhagic and ischemic stroke were 10.68 (95% CI, 3.40 to 33.59) and 40.86 (95% CI, 12.14 to 137.47) within 3 months antepartum; 6.45 (95% CI, 1.42 to 29.29) and 34.71 (95% CI, 11.08 to 108.68) in the first 3 days postpartum; 5.61 (95% CI, 0.71 to 44.10) and 11.23 (95% CI, 2.45 to 51.59) from 3 days to 6 weeks postpartum; 11.76 (95% CI, 4.05 to 34.11) and 11.60 (95% CI, 3.30 to 40.82) from 6 weeks to 6 months pospartum; and 19.90 (95% CI, 7.75 to 51.11) and 4.35 (95% CI, 0.58 to 32.92) from 6 months to 12 months postpartum. CONCLUSIONS: Women with preeclampsia-eclampsia have a significantly higher risk of stroke during pregnancy and in the first postpartum year. These results suggest that women with preeclampsia-eclampsia should be closely monitored even after pregnancy.

Eclampsia in the Netherlands.

OBJECTIVE: The incidence of maternal mortality due to hypertensive disorders of pregnancy in the Netherlands is greater than in other Western countries. We aimed to confirm and explain this difference by assessing incidence, risk factors, and substandard care of eclampsia in the Netherlands. METHODS: In a nationwide population-based cohort study, all cases of eclampsia were prospectively collected during a 2-year period (2004-2006). All pregnant women in the Netherlands in the same period acted as reference cohort (n=371,021). Substandard care was assessed in all cases. A selection of cases was extensively audited by an expert panel. Main outcome measures were incidence, case fatality rate, possible risk factors, and substandard care. RESULTS: All 98 Dutch maternity units participated (100%). There were 222 cases of eclampsia, for an incidence of 6.2 per 10,000 deliveries. Three maternal deaths occurred; the case fatality rate was 1 in 74. Risk factors in univariable analysis included multiple pregnancy, primiparity, young age, ethnicity, and overweight. Prophylactic magnesium sulfate was given in 10.4% of women, and antihypertensive medication was given in 39.6% of women with a blood pressure on admission at or above 170/110 mm Hg. Additionally, substandard care was judged to be present by an expert panel in 15 of 18 audited cases (83%). CONCLUSION: The incidence of eclampsia in the Netherlands is markedly increased as compared with other Western European countries. Substandard care was identified in many cases, indicating the need for critical evaluation of the management of hypertensive disease in the Netherlands.

The angiotensinogen gene M235T polymorphism and development of preeclampsia/eclampsia: a meta-analysis and meta-regression of observational studies.

OBJECTIVE: The angiotensinogen gene M235T polymorphism is related to an increased risk of hypertension. Hypertension and pregnancy-induced hypertension have been suggested to share common etiologic factors. We examined whether this mutation also increases the risk of preeclampsia/eclampsia. METHODS: Pubmed/Medline, Web of Science and EMBASE were searched and a hand search of bibliographies was conducted. In all, 17 studies (including 1446 cases and 3829 controls) published in English between 1993 and October 2006 on the association of angiotensinogen gene M235T polymorphism with preeclampsia/eclampsia were selected. RESULTS: The overall odds ratio (OR) under a random effects model revealed that individuals homozygous for the T allele were 1.62 times more likely to develop preeclampsia/eclampsia [95% confidence interval (CI), 1.12 to 2.33; P = 0.01) compared to individuals homozygous for the M allele. The relation in Caucasians (OR = 1.99; 95% CI, 1.18-3.36; P = 0.01) was similar to that in East Asian populations (OR = 1.74; 95% CI, 0.92-3.28; P = 0.09), although the latter was not statistically significant due to lower numbers of studies. Under additive, recessive and dominant genetic models positive associations were also found. A meta-regression analysis showed that ethnic background was a significant source of between-study heterogeneity (P = 0.04) but design of the study, study size and Hardy-Weinberg equilibrium deviation were not. There was a low probability of publication bias. CONCLUSION: Our meta-analysis expands the findings on hypertension by showing that the presence of the T allele of the angiotensinogen gene is associated with an increased risk to develop preeclampsia/eclampsia.

Perinatal outcomes among different Asian-American subgroups.

OBJECTIVE: The objective of the study was to investigate the differences in perinatal outcomes between various Asian ethnic subgroups at a national level. STUDY DESIGN: This is a retrospective cohort study of all non-Hispanic Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese, Samoan, Guamanian, and Hawaiian women whose deliveries were recorded by US birth certificates within the year 2003. Perinatal outcomes were compared between groups and potential confounders controlled for with multivariable logistic regression. RESULTS: We found significant differences (P < .001) in the incidence of all perinatal outcomes of interest among the different Asian subgroups. These differences persisted after adjusting for potential confounders. The incidence of diabetes in pregnancy varied from 2.9% (Korean) to 5.7% (Filipina). CONCLUSION: Our study demonstrates significant differences in preterm labor, primary cesarean delivery, pregnancy-associated hypertension, eclampsia, diabetes in pregnancy, low birthweight, macrosomia, and cephalopelvic disproportion among Asian subgroups at a national level, affirming the importance of examining these subgroups separately.

Descriptive and clinical epidemiology of preeclampsia and eclampsia in Florida.

OBJECTIVE: To calculate preeclampsia/eclampsia rates for Florida and identify risk factors for prolonged length of stay (PLOS) among women hospitalized throughout Florida for preeclampsia/eclampsia and discharged in 2001. DESIGN: Analyses were performed using a statewide hospital discharge dataset from Florida. Hospital discharge rates per Florida female population and risk per 100 deliveries were calculated for women hospitalized for preeclampsia. Binomial regression was used to calculate relative risks (RR) of PLOS among 5495 women. Generalized estimating equations were used to account for nesting by facility. RESULTS: Non-Whites had higher preeclampsia discharge rates per 10,000 population than Whites in every age group. The overall risk of preeclampsia was 3.9 per 100 deliveries, with the highest risks in the youngest and oldest age groups. The strongest risk factor for PLOS was having a diagnosis of preeclampsia/eclampsia superimposed on pre-existing hypertension. These patients had 2.64 times the risk of PLOS than patients who had mild or unspecified preeclampsia (P value <.0001). Diabetics were also at a higher risk of PLOS (adjusted RR=1.26, P=.003). Women who were admitted from the emergency department were 26% less likely than women admitted from other sources to have PLOS (adjusted RR=.74, P=.01). For every 10-year increase in maternal age, there was a 23% increase in the risk of PLOS (adjusted RR=1.23, P<.0001). CONCLUSIONS: Advancing maternal age, Black race, diabetes, severe preeclampsia, and preeclampsia (or eclampsia) superimposed on existing hypertension increased the risk of PLOS, while being admitted from the emergency department was associated with a decreased risk of PLOS.

Racial disparity in hypertensive disorders of pregnancy in New York State: a 10-year longitudinal population-based study.

OBJECTIVES: We studied trends of hypertensive disorders of pregnancy by residential socioeconomic status (SES) and racial/ethnic subgroups in New York State over a 10-year period. METHODS: We merged New York State discharge data for 2.5 million women hospitalized with delivery from 1993 through 2002 with 2000 US Census data. RESULTS: Rates of diagnoses for all hypertensive disorders combined and for preeclampsia individually were highest among Black women across all regions and neighborhood poverty levels. Although hospitalization rates for preeclampsia decreased over time for most groups, differences in rates between White and Black women increased over the 10-year period. The proportion of women living in poor areas remained relatively constant over the same period. Black and Hispanic women were more likely than White women to have a form of diabetes and were at higher risk of preeclampsia; preeclampsia rates were higher in these groups both with and without diabetes than in corresponding groups of White women. CONCLUSIONS: An increasing trend of racial/ethnic disparity in maternal hypertension rates occurred in New York State during the past decade. This trend was persistent after stratification according to SES and other risk factors. Additional research is needed to understand the factors contributing to this growing disparity.

Pregnancy-related mortality from preeclampsia and eclampsia.

OBJECTIVE: To examine the role of preeclampsia and eclampsia in pregnancy-related mortality. METHODS: We used data from the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System to examine pregnancy-related deaths from preeclampsia and eclampsia from 1979 to 1992. The pregnancy-related mortality ratio for preeclampsia-eclampsia was defined as the number of deaths from preeclampsia and eclampsia per 100,000 live births. Case-fatality rates for 1988-1992 were calculated for preeclampsia and eclampsia deaths per 10,000 cases during the delivery hospitalization, using the National Hospital Discharge Survey. RESULTS: Of 4024 pregnancy-related deaths at 20 weeks' or more gestation in 1979-1992, 790 were due to preeclampsia or eclampsia (1.5 deaths/100,000 live births). Mortality from preeclampsia and eclampsia increased with increasing maternal age. The highest risk of death was at gestational age 20-28 weeks and after the first live birth. Black women were 3.1 times more likely to die from preeclampsia or eclampsia as white women. Women who had received no prenatal care had a higher risk of death from preeclampsia or eclampsia than women who had received any level of prenatal care. The overall preeclampsia-eclampsia case-fatality rate was 6.4 per 10,000 cases at delivery, and was twice as high for black women as for white women. CONCLUSION: The continuing racial disparity in mortality from preeclampsia and eclampsia emphasizes the need to identify those differences that contribute to excess mortality among black women, and to develop specific interventions to reduce mortality from preeclampsia and eclampsia among all women.

Prothrombin G20210A mutation: is it associated with pre-eclampsia?

OBJECTIVE: A strong independent association between the prothrombin G20210A gene mutation and pre-eclampsia has been reported in an Italian population. This result was not confirmed in a subsequent study in a Dutch population. The objective of this study was to further test the hypothesis that the prothrombin G20210A mutation is associated with pre-eclampsia/eclampsia. METHODS: Seventeen eclamptics and 67 pre-eclamptics were recruited from 34 multicase Australian/New Zealand families. An additional 105 unrelated pre-eclamptic/eclamptic women and 119 parous women were recruited as controls. RESULTS: The overall incidence for the prothrombin G20210A gene mutation in the pre-eclamptic group was 3.6% (95% CI 1.2-8.2%) which was not significantly different from the control group 2.5% (95% CI 0.5-7.2%) (p = 0.73, OR 1.44, 95% CI 0.34-6.17). CONCLUSION: This study provides little evidence of a significant relationship between the prothrombin G20210A gene mutation and pre-eclampsia. Based on our results, we do not recommend testing for the prothrombin G20210A mutation in the routine investigation of women with pre-eclampsia.

The influence of maternal hypertension on low birth weight: differences among ethnic populations.

OBJECTIVE: To determine the influence of maternal hypertension on the risk of low birth weight among white, black, and Hispanic residents of New York City. METHODS: New York City birth certificates, 1988 through 1994, provided data on maternal and infant characteristics. Hypertension was self-reported on birth certificates, and was categorized as chronic or pregnancy-related hypertension. The complication of preeclampsia/eclampsia was also noted. The risk of low birth weight (<2500 grams) for maternal hypertension was determined. RESULTS: The prevalence of hypertension during pregnancy was 3.8% overall, and was highest for blacks and lowest for whites. Low birth weight rates for white, black, and Hispanic babies were 5.0%, 12.8%, and 7.5%, respectively. Low birth weight rates among hypertensive mothers for whites, blacks and Hispanics were 16.8%, 24.4% and 19.5% respectively. The trends were similar for chronic and pregnancy-related hypertension, as well as for preeclampsia/eclampsia. The relative risk of low birth weight offspring among all hypertensive mothers was highest among whites (3.58, 95% CI = 3.39-3.79), and lowest among blacks (1.99, 95% CI = 1.93-2.06). This trend persisted for chronic and pregnancy-related hypertensive mothers, and those with preeclampsia/eclampsia, after adjusting for other maternal socioeconomic characteristics. Due to the higher prevalence of hypertension among black mothers, the population attributable risk of low birth weight was highest among black babies (557 per 100,000 live births) and lowest among whites (309 per 100,000 live births). CONCLUSION: Maternal hypertension is an important risk factor for low birth weight. Its impact, however, differed by race/ethnicity groups.

Maternal hypertension and spontaneous preterm births among black women.

OBJECTIVE: To examine effects of maternal hypertension on spontaneous preterm birth (birth at less than 37 weeks' gestation) among black women. METHODS: Using hospital discharge summary records from the National Hospital Discharge Survey between 1988 and 1993, we conducted a case-control study to assess the risk of spontaneous preterm birth among black women with chronic hypertension preceding pregnancy and pregnancy-induced hypertension. Logistic regression was used to derive odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Preterm births were almost two times more likely for women with pregnancy-induced hypertension (OR = 1.8; 95% CI, 1.5, 2.2), more than 1.5 times more likely for women with chronic hypertension preceding pregnancy (OR = 1.6; 95% CI, 1.3, 2.1), and more than four times more likely for women with pregnancy-aggravated hypertension (OR = 4.4; 95% CI, 2.9, 6.7) compared with normotensive women. Preterm births also were associated significantly with antepartum hemorrhage, poor fetal growth, marital status, and source of payment. The odds of preterm birth by maternal hypertension were increased among women with chronic hypertension and genitourinary infection, whereas the odds of preterm birth were reduced among women with pregnancy-induced hypertension and genitourinary infection. CONCLUSION: These findings are important in demonstrating the relation between type of hypertension in pregnancy and preterm birth. The relationships between maternal hypertension and preterm birth need to be further investigated to provide some guidelines in the management of hypertension in pregnancy and assessment of prenatal care compliance for black women, particularly when genitourinary infection is present.

Perceived causes of eclampsia in four ethnic groups in Borno State, Nigeria.

This study was conducted among the four major ethnic groups(Kanuri, Babur, Shuwa and Marghi) of Borno State, North-east Nigeria. The aim of the study was to identify the perceived causes of eclampsia, a leading cause of maternal death in the State. The data were obtained through focus group discussions (FGDs), questionnaires and in-depth interviews. A total of 16 FGDs and 1,167 questionnaire interviews were conducted among the rural populace. In-depth interviews were conducted on relatives of thirty eclamptic patients admitted to the University of Maiduguri Teaching Hospital. The findings revealed that evil spirits/witches and wizards, poor nutrition, heredity early marriage, destiny from God and machinations of co-wives are the perceived causes of eclampsia in the area. These perceptions result in the use of the following as means of treatment: drinks of various concoctions, inhalation of smoked herbs in rooms, potash drinks, and the wearing of talisman around the neck. These perceptions and traditional medications have implications for design of educational and informational messages aimed at reducing maternal mortality from eclampsia in Borno State.

Eclampsia in Kuwait 1981-1993.

The aim of this study is to investigate the maternal and fetal outcome and the risk factors for developing eclampsia in Kuwait. The study includes all patients with eclampsia observed at the Maternity Hospital, Kuwait during the period from 1981 to 1993. It revealed that the risk factors predisposing to eclampsia were primiparity, a maternal age below 30 years, multiple pregnancy and the presence of preeclampsia. The pregnancy outcome in terms of the stillbirth rate, neonatal death rate and low birth-weight babies was significantly higher in mothers with eclampsia than in noneclamptic mothers. The operative delivery and maternal mortality rates were also significantly higher in these patients.

PIP: Data from 1981 to 1993 (excluding 1990-1991 due to Iraqi invasion) obtained from the Maternity Hospital in Kuwait were analyzed to examine pregnancy outcomes of eclamptic women and the risk factors for eclampsia in Kuwait. During the study period, 101 of 167,080 mothers had eclampsia for an incidence rate of 6/10,000. Eclampsia incidence did not change significantly during the study period. The incidence was 33/1000 for preeclampsia and 32/1000 for hypertension. Strong, significant risk factors for eclampsia included primiparity (relative risk [RR] = 8.93), age 30 years or younger (RR = 3.86), multiple pregnancy (RR = 4.15), preeclampsia (RR = 8.69), and low birth weight of 2500 g or less (RR = 13.96). Eclamptic women were significantly more likely to experience stillbirth, early neonatal death, and cesarean section. Maternal complications included need for intubation, disseminated intravascular coagulation, postpartum hemorrhage, maternal death, persistent increase in blood pressure, and proteinuria 1 week postpartum. One woman died from eclampsia for a maternal mortality rate of 0.99%, which is significantly higher than that for preeclampsia and for hypertension (0.0405 and 0.0396%, respectively). These findings show that risk factors for eclampsia are primiparity, young maternal age, multiple pregnancy, and presence of preeclampsia, and that eclamptic mothers experienced poorer pregnancy outcomes than other mothers.