Assessment of Prevalence of Hypertension in pregnant women with its Complications: A Cross Sectional Study

 

S. Hemalatha¹, S. M. Shaheedha²*, Ramakrishna Borra³

¹Professor, Department of Pharmacognosy, Tagore College of Pharmacy,

Rathinamangalam, Chennai 600127, Tamilnadu, India.

²Associate Professor, Department of Pharmacognosy, Crescent School of Pharmacy,

B.S. Abdur Rahman Crescent Institute of Science and Technology, Seethakathi Estate,

GST Road, Vandalur, Chennai 600048, Tamilnadu, India.

³Sri Venkateswara College of Pharmacy, RVS Nagar, Tirupathi Road, Chittoor, Andhra Pradesh, India.

 

ABSTRACT:

Introduction: World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths. About 60% of deaths accounted of eclampsia. Aims and Objectives: To diagnose for hypertension in pregnant women. To evaluate the knowledge of pregnancy induced hypertension among the pregnant women. To investigate the complications reported in Pregnancy induced hypertension (PIH) women, during and after labor. Study area and period: The present study was conducted in Chittoor government hospital, Chittoor, during the period of Jan 2016 and Dec 2017. The information and materials required for the study have been collected from the gynecology and obstetrics departments of the respective hospital. Results: During the study period of Jan 2016 and Dec 2017, about 2234 number of pregnant women have visited the obstetrics and gynecology department. All the 2234 pregnant women were tested for blood pressure. Among which 198 women were found to have hypertension, which may be of early onset PIH or chronic hypertension (HTN). Different variables of the study population like period of gestation [<20 weeks, ≥20 weeks], previous cesarean section if present, previous preterm delivery if present, hypertension in previous pregnancy, history of paternal hypertension, history of abortions if have been, history of any still births, family history of PIH have been noted and reported in table 2. More than 8% of women were found to been falling in <20 weeks of gestational age (GA). Conclusion: The study included 2234 pregnant women, in which 198 women were diagnosed with hypertension. Thus, prior investigation and identification hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor. Better knowledge and treatment is required for managing hypertension in maternal women in gynecology and obstetrics department for maternal and fetal care.

 

 

 

INTRODUCTION:

Hypertension is simply defined as elevated or raised blood pressure, i.e., a systolic blood pressure (SBP) which is ≥ 140mm Hg and with a diastolic blood pressure (DBP) of ≥ 90mm Hg is usually referred to as elevated blood pressure or Hypertension¹.

 

For making it easy to evaluate and investigate hypertension for its better management JNC (Joint National Committee) has classified hypertension in adults falling under 18years and above as Normal, Prehypertension, Stage 1 Hypertension an Stage 2 Hypertension. Primary cause is environmental factors and genetic factors. Secondary cause is multiple etiologies like renal disease, vascular diseases, endocrine disorders. Primary causes for HTN accounts for more percentage of risk of HTN when compared to secondary causes. Only 2-10% of cases are evaluated to be of secondary causes. Whereas, about 90-95% of causes of HTN includes primary causes².

 

Hypertension during pregnancy has been reported in 6-10% of pregnant women all around the world, the causes for PIH is not clearly understood, however, it may result in various complications during and after pregnancy, i.e., prenatal and postnatal complications, which may include miscarriage, eclampsia, preeclampsia, preterm birth, low birth weight of neonate postpartum hemorrhage ,chronic hypertension preeclampsia with hemolysis, elevated liver enzymes with low platelet count (HELLP), hemorrhagic stroke, pulmonary edema³

 

Other short-term complications of PIH includes hepatocellular damage, thrombocytopenia disseminated intravascular coagulation (DIC) (generally acute phase is reported), oliguria, pulmonary edema, cerebrovascular events and placental abruption.⁴

 

Classification of Pregnancy Induced Hypertension:

The Canadian heart association has classified the PIH as Pre-existing (PE) hypertension, Gestational hypertension and PE, Pre-existing hypertension with superimposed gestational hypertension with proteinuria and Unclassified hypertension.⁵

 

World Health Organization has reported that pregnancy induced hypertension is one of the main causes for mortality and morbidity in maternal and fetal deaths⁶. About 60% of deaths accounted of eclampsia.

 

Management of Pregnancy Induced Hypertension:

Ways for management of hypertension I pregnancy includes both non-pharmacological and pharmacological approaches⁷. Non-pharmacological approaches for management includes, bed rest, better environmental resources, reduction of stress, better physical exercises, health food habits, adequate liquids intake, yoga and meditations⁸. Whereas, pharmacological approach for management of PIH include use of anti-hypertensive drugs, but, in particular beta-blockers like labetalol and other drugs like calcium channel blockers and methyldopa are recommended. Methyldopa is reported to be more effective when compared to labetalol in management of pre-eclampsia⁹.

 

The present study aimed to diagnose hypertension in pregnant women, evaluate the knowledge of pregnancy induced hypertension among the pregnant women also investigate the complications reported in PIH women, during and after labor. To improve the management strategies of PIH and to decrease the rates of morbidity and mortality in maternal and fetal deaths also estimate the prevalence of PIH in pregnant women.

 

MATERIALS AND METHODS:

Study area and period:

The present study was conducted in Chittoor Government Hospital, Chittoor, Andra Pradesh, India during Jan 2016 and Dec 2017.

 

Inclusion criteria: All pregnant women appeared in gynecology and obstetrics.

 

Exclusion criteria: Non-pregnant women

 

Methodology:

The women involved into study are collected with three readings of blood pressure in a day and the average mean of the reading is taken as their values of blood pressure. The various socio-demographic parameters like age group, educational status, occupation, socioeconomic status have been reported in the Table 1. Different variables of the study population like period of gestation, previous cesarean section, previous preterm delivery, hypertension in previous pregnancy, history of paternal hypertension, history of abortions, history of any still births, family history of PIH have been reported in Table 2. comparison of weights, height and age of overall study population. shown in table 3.

 

RESULTS:

All the 2234 pregnant women were tested for blood pressure and the results obtained are shown in table.

 

Table 1: socio-demographic parameters of hypertensive women and normotensive women with their significance

Socio-demographic parameters	Hypertension N= 198 (%)	Normotensive N= 2036 (%)	Total N= 2234 (%)	P-value
Age group
<25 years	109(10.2%)	954(89.74%)	1063(100%)	0.045
≥ 25 years	89(7.6%)	1082(92.4%)	1171(100%)
Educational status
Below graduates	121(8.9%)	1227(91.0%)	1348(100%)	0.003
Graduates and above	77(8.7%)	809(91.3%)	886(100%)
Occupation
Housewife	79(5.17%)	1447(94.8%)	1526(100%)
Laborer	89(18.4%)	395(81.6%)	484(100%)
Agriculture	28(13.0%)	189(87.1%)	217(100%)	0.021
Business	0(0.0%)	1(100%)	1(100%)
Service	2(33.3%)	4(66.6%)	6(100%)
Socioeconomic status
Upper middle+ upper	90(13.7%)	567(86.3%)	657(100%)	0.025
Lower+ lower middle+middle	110(6.9%)	1469(93.0%)	1579(100%)

Table 2: Different independent variables of population included in the study

Variables	Hypertension N= 198 (%)	Normotensive N=2036 (%)	Total N= 2234 (%)	P-value
Period of gestation
<20 weeks	121(8.8%)	1250(91.17%)	1371(100%)	0.035
≥20 weeks	77(8.9%)	786(91.1%)	863(100%)
Previous cesarean section
Yes	52(11.2%)	412(88.79%)	464(100%)	0.054
No	146(8.24%)	1624(91.7%)	1770(100%)
Previous preterm delivery
Yes	12(22.2%)	42(77.8%)	54(100%)	0.081
No	186(8.53%)	1994(91.5%)	2180(100%)
Hypertension in previous pregnancy
Yes	24(38.1%)	39(61.9%)	63(100%)	0.021
No	174(8.01%)	1997(91.9%)	2171(100%)
History of paternal hypertension
Yes	34(39.5%)	52(60.46%)	86(100%)	0.087
No	164(7.63%)	1984(92.3%)	2148(100%)
Gravid
>3	29(23.7%)	93(76.2%)	122(100%)	0.099
<3	169(8.0%)	1977(93.6%)	2112(100%)
History of abortions
Yes	34(7.01%)	451(92.9%)	485(100%)	0.037
No	164(9.4%)	1585(90.6%)	1749(100%)
History of still birth
Yes	9(28.1%)	23(71.8%)	32(100%)	0.046
No	189(8.6%)	2013(91.4%)	2202(100%)
Family history
Yes	31(31.63%)	67(68.36%)	98(100%)	0.059
No	167(7.8%)	1969(92.1%)	2136(100%)

 

Table 3: Comparison of weights, height and age of overall study population

Quantitative parameters	Hypertensive subjects (N=198)	Normotensive subjects (N= 2036)	P - value
Age (years)	24.2±2.7	21.9±3.6	0.032
Weight (kg)	56±3.1	54.1±9.4	0.002
Height (cm)	151±8.7	153±9.7	0.957

 

DISCUSSION:

The overall study population included 2234 pregnant women, among which 198 pregnant women have been diagnosed with pregnancy induced hypertension^10,11. Among the overall population 8.86% women were found to have hypertension and 91.14% of women were found to be normotensive. More than 8% of women were found to been falling in <20 weeks of gestational age. Different socio-demographic¹² parameters of the study population has been collected and their significance between hypertensive women and normotensive has been compared and calculated using SPSS version 17¹³. There has been found a significant difference between age and weight of hypertensive and normotensive women¹⁴. Whereas, no significant difference has been found between height of hypertensive and normotensive women.

 

CONCLUSION:

There is 8.86% women were diagnosed with pregnancy induced hypertension. Thus, prior investigation and identification of hypertension in pregnant women helps in better management of PIH and to overcome the complications that are reported due to PIH during and after labor.

 

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Received on 25.05.2020           Modified on 03.08.2020

Accepted on 06.09.2020         © RJPT All right reserved