Pregnancy-Induced Hypertensive Disorders Predictors Among Pregnant and Delivery Mothers Receiving Care in Public Health Institutions in Sidama, Ethiopia: a Multicenter Case Control Study

Background: Pregnancy-Induced Hypertensive Disorders (PIHD) include conditions like Pre-Eclampsia, Eclampsia, and Gestational Hypertension, impacting 5-10% of pregnancies globally. These disorders are responsible for 16% of maternal deaths in Sub-Saharan Africa and account for 16.9% of maternal mortality in Ethiopia, representing 10% of the country's total maternal deaths.

Objective: To identify predictors of PIHD among pregnant and delivery women in public hospitals and primary health care units (health centers) in Sidama, Ethiopia.

Methods: A multi-center unmatched case-control study was conducted on women in antenatal care and obstetrics/gynecology departments at 12 randomly selected public health institutions, including one specialized teaching hospital, two general hospitals, three primary hospitals, and six health centers. The study involved 920 women (230 cases and 690 controls) selected from December 2023 to February 2024. Cases included pregnant or delivery women at 20 + weeks gestation with PIHD such as pre-eclampsia, eclampsia, gestational hypertension, and chronic hypertension with superimposed preeclampsia. Controls were normotensive pregnant women or delivering mothers without PIHD after 20 weeks gestation. Data was manually verified, entered, and validated using Epidata software, followed by analysis with SPSS 22. Univariate analysis assessed predictors of PIHD, while binary logistic regression evaluated the relationships between factors. Model fitness was checked using collinearity assessments and the Hosmer-Lemeshow test, with variables having a P value < 0.05 deemed independent predictors.

Results: Out of 920 planned participants, 686 were included, resulting in a response rate of 94.35%. Factors associated with PIHD in women included age at first conception (AOR = 1.26), mid (AOR = 6.05) and high (AOR = 5.01) wealth index levels, multigravidity (AOR = 4.34), pregnancy age ≥ 42 weeks (AOR = 3.65), maternal mid-upper arm circumference (MUAC) (AOR = 1.29), hemoglobin levels of 6.5-10.9 g/dL (AOR = 5.59), pre-pregnancy Body Mass Index (BMI) ≥ 25 kg/M (AOR = 0.81), preexisting hypertension (AOR = 8.97), family history of diabetes mellitus (AOR = 20.02), former alcohol consumption (AOR = 0.27), and total physical activity during pregnancy (AOR = 0.54).

Conclusions: The study identifies key predictors of PIHD in women, including age at conception, wealth index, multigravidity, gestational age, and pre-pregnancy BMI. It underscores the link between socioeconomic status and maternal health, highlighting that financial resources alone don't ensure better outcomes without educational access. The research advocates for a health intervention strategy focusing on socioeconomic factors and public health initiatives to reduce maternal health disparities while exploring the role of partner stability and psychosocial aspects.