Global Journal of Health Science; V

Global Journal of Health Science; Vol. 6, No. 2; 2014
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
138
Risk Factors on Hypertensive Disorders among Jordanian Pregnant
Women
Amal K. Suleiman1
1
Pharmacy School, Department of Clinical Pharmacy, Princess Nora bint Abdul Rahman University, Kingdom of
Saudi Arabia
Correspondence: Amal K. Suleiman, Pharmacy School, Princess Nora bint Abdul Rahman University, Riyadh,
Saudi Arabia. Tel: [phone]. E-mail: [e-mail]
Received: October 16, 2013 Accepted: November 17, 2013 Online Published: December 20, 2013
doi:10.5539/gjhs.v6n2p138 URL: http://dx.doi.org/10.5539/gjhs.v6n2p138
Abstract
Eight percent of pregnancies involve hypertensive disorders, which can have serious complications for mothers
and children. There has only been minimal research into hypertension in pregnancy in developing countries,
including Jordan. Therefore, this study aimed to identify how frequent certain risk factors that apply to hypertensive
disorders during pregnancy were among women in the Jordanian capital of Amman. A prospective
case-control study was conducted on 184 Jordanian pregnant patients with hypertensive disorders and 172
age-matched control subjects recruited from the maternity ward of a tertiary public hospital in Ammn city; they
were followed-up until 85 days after the birth (late puerperium). A standardized questionnaire pilot-tested was
completed by participants that included demographic data and known risk factors for hypertension in pregnancy.
Statistical analysis SPSS was conducted to compare the frequency of risk factors using Fisher’s exact test,
chi-square, Student’s t-tests, as well as multivariate logistic regression was conducted to identify independent
risk factors. The results showed that chronic hypertension, prenatal hypertension, family history of preeclampsia,
diabetes, high BMI, nulliparity, previous preeclampsia history and low education level were identified as risk
factors for hypertensive disorders in pregnancy in this population; Moreover, diabetes, chronic hypertension and
family history of preeclampsia were found to be independent risk factors. The results of the study contribute to
the currently limited knowledge about the modifiable risk factors for hypertensive disorders during pregnancy
among the Jordanian population, and could therefore be extremely useful for clinicians providing prenatal care.
Keywords: hypertension, pregnancy, risk factors, Jordan, Amman
1. Introduction
The most common pregnancy-associated disorder is hypertension, complicating 2-3% of pregnancies (Michael et
al., 2012), occurs in 6–8 percent of all gestations (O’Brien et al., 2007; Helewa et al., 1997), it is a serious cause
of maternal and mortality in developing countries where related as the most common medical problem in
gestations (Mosca et al., 2011). In fact, not only developing countries are facing this medical problem, it has
been found the most common medical problem in among developed countries women pregnancy. A study done
by Colin (2012) in UK, found hypertensive disorders complicating up to 15% of pregnancies and a quarter of all
antenatal admissions. Another study done by Chang et al. (2003) in the United States found that
pregnancy-induced hypertension the major reason for 15.7% of maternal deaths, where Hedderson and Ferrara
(2008) went further and fund can be a major risk of gestational diabetes mellitus.
In fact, hypertensive pregnancy disorders very seriously have been linked to increased perinatal and maternal
morbidity and mortality. A study done by Dekker & Sibai (2001) where data obtained from the Nationwide
Inpatient Sample of the Healthcare Cost and Utilization Project and the National Hospital Discharge Survey
shows marked increases in the incidence of gestational hypertension and preeclampsia over the past two decades,
and that an increasing number of women are entering pregnancy with chronic (preexisting) hypertension and
they found also such cases have a markedly increased risk of severe adverse outcomes, including placental
abruption and maternal cerebrovascular accidents, compared to normotensive women. It is therefore important to
monitor blood pressure (BP) in pregnant women, in order to diagnosis and manage hypertensive disorders on
time. Women with chronic hypertension (essential or secondary) need to be monitored frequently during
pregnancy by an experienced obstetrician and physician. High BP in pregnancy may be a sign of preeclampsia,
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 6, No. 2; 2014
139
which is a serious condition that occurs in the second half of pregnancy and puerperium (O’Brien et al., 2007).
The frequency rate of preeclampsia is 5% of pregnancies, and it is responsible for 16% of maternal deaths
globally (WHO, 2003). Perinatal mortality doubles in women with preeclampsia (O’Brien et al., 2007).
Preeclampsia is usually asymptomatic; it is detected by routine screening, and increased blood pressure and the
presence of protein in the urine are considered to be indicators of preeclampsia (Wrobel et al., 2011)
Preeclampsia can range from mild to severe forms. In most cases, women progress slowly from one end of the
spectrum to the other, and in some cases the disorder does not exceed mild preeclampsia. Progression in the most
serious cases can be fulminant, with preeclampsia or eclampsia evolving from mild to severe within days, or
even hours. Therefore, for the purposes of clinical management, it is important to over-diagnose preeclampsia,
because the prevention of maternal and perinatal morbidity and mortality is a main goal, primarily through
timing of delivery.
Hypertension during pregnancy, specifically pre-eclampsia, is an important obstetrical problem in less-developed
countries (Amal & Syed, 2010; Dekker & Sibai, 2001). In particular, hypertensive disorders and their
complications are the most common cause of maternal death in Middle East (WHO, 2003). Early diagnosis and
treatment of this problem is important in pregnant women. However, many of the biophysical and biochemical
tests that are currently used to identify women at risk are invasive, whereas others require expensive techniques
or special expertise that precludes their utility in routine screening, and they generally have low levels of
sensitivity and poor predictive values (Dekker & Sibai, 2001).
Another setback is that the risk factors for these hypertensive disorders are not clear in less developed countries;
therefore, more research is required in this area (Amal & Syed, 2010; Dalmáz1 et al., 2011). The following
factors have been reported for other populations: family history of preeclampsia and preeclampsia in a previous
pregnancy (Caritis et al., 1998), chronic hypertension (Lykke et al., 2009), extremely young and old maternal age
(Dekker & Sibai, 2001), obesity (O’Brien et al., 2007), Nulliparity and diabetes (Pipkin, 2001), and multifetal
gestation (Wen et al., 2004).
If the risk factors in a population are known, patients predisposed to developing hypertensive disorders can be
identified and subsequently administered adequate prenatal care (Amal & Syed, 2010). In this study, we have
tried to better understand and identify the frequency of known risk factors for hypertensive disorders in
pregnancy among Jordanian women, since the risk factors are not known for this population (Dalmáz1 et al.,
2011). To the best of our knowledge, this is the first such study in the Jordanian population.
2. Method
This prospective case-control study was conducted on 184 Jordanian pregnant patients with hypertensive
disorders and 172 age-matched control subjects. From June to August 2011, we recruited subjects from the
maternity ward of a tertiary public hospital in the capital of Jordan; they were followed-up until 85 days after the
birth (late puerperium), as preeclampsia can occur in the post-puerperal period. Hypertensive disorders were
classified as for pregnancy based on American Guideline. These included mild or severe preeclampsia,
non-proteinuric gestational hypertension, mild preeclampsia superimposed on chronic hypertension, and severe
preeclampsia superimposed on chronic hypertension. A standardized questionnairewere pilot-tested was
completed by participants that included demographic data and known risk factors for hypertension in pregnancy.
The following risk factors were assessed: prenatal hypertension, smoking, low education level, chronic
hypertension, diabetes, nulliparity, high BMI, multifetal gestation, previous preeclampsia history, and family
history of preeclampsia. BMI were calculated from weight and height measurements obtained at the booking
appointment. All samples had signed a written consent prior to their inclusion, and approval for the study
protocol was obtained from the ethics committee of the hospital.
SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL) was used for the statistical analyses. The Fisher’s exact
test, chi-square test, and Student’s t-tests were used to compare the frequencies of risk factors between study
groups depending on whether they were non-parametric or parametric variables. The variables tested in the
univariate analysis included family and previous history of preeclampsia, multifetal gestation, BMI, nulliparity,
diabetes, chronic hypertension, smoking habits and level of education. The continuous variable (BMI) was
entered as a linear factor after being tested for nonlinearity. Multivariate logistic regression analysis was
performed with a backward logistic regression analysis method to assess the independent roles of clinical, social
and demographic variables that had been identified to be associated with hypertensive disease in pregnancy
according to the univariate analysis. P-values

ผลลัพธ์ (คลิงออน) 1:

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HaD pong dekker sibai (2001) nuqDaq Suq vo' nationwide De' & Qu'inpatient Sample Healthcare Cost 'ej Utilization jInmol je National ropyaH qach Discharge Surveycha' ghur qaStaHvIS gestational hypertension preeclampsia 'ej incidence decades jIvumlI' cha' rIn ghItlh.'ej 'e' chronic (preexist) hypertension pregnancy ghur mI' be' 'ejje ghur markedly jISuDrup severe adverse outcomes, DaH nobvam placental ghaj qabwIj cases QamtaH chaHabruption 'ej maternal cerebrovascular accidents, taHtaHghach normotensive be'. 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HochHom progressionSagh cases laH fulminant, preeclampsia eclampsia evolving vo' ralchugh, vaj severe 'emvo' jaj, pagh paghrep ngeD tu'lu'. vaj, wImevmo' clinical management, 'oH potlh over-diagnose preeclampsia.HoSqu'mo' maternal 'ej perinatal morbidity mortality 'ej prevention 'elbogh ngoQ, primarily veghQo'noS timing delivery.hypertension during pregnancy, specifically pre-eclampsia, potlh obstetrical qay' qaStaHvIS qup-Hachcountries (Amal & Syed, 2010; Dekker & Sibai, 2001). In particular, hypertensive disorders and theircomplications are the most common cause of maternal death in Middle East (WHO, 2003). Early diagnosis andtreatment of this problem is important in pregnant women. However, many of the biophysical and biochemicaltests that are currently used to identify women at risk are invasive, whereas others require expensive techniquesor special expertise that precludes their utility in routine screening, and they generally have low levels ofsensitivity and poor predictive values (Dekker & Sibai, 2001).Another setback is that the risk factors for these hypertensive disorders are not clear in less developed countries;therefore, more research is required in this area (Amal & Syed, 2010; Dalmáz1 et al., 2011). The followingfactors have been reported for other populations: family history of preeclampsia and preeclampsia in a previouspregnancy (Caritis et al., 1998), chronic hypertension (Lykke et al., 2009), extremely young and old maternal age(Dekker & Sibai, 2001), obesity (O’Brien et al., 2007), Nulliparity and diabetes (Pipkin, 2001), and multifetalgestation (Wen et al., 2004).If the risk factors in a population are known, patients predisposed to developing hypertensive disorders can beidentified and subsequently administered adequate prenatal care (Amal & Syed, 2010). In this study, we havetried to better understand and identify the frequency of known risk factors for hypertensive disorders inpregnancy among Jordanian women, since the risk factors are not known for this population (Dalmáz1 et al.,2011). To the best of our knowledge, this is the first such study in the Jordanian population.2. MethodThis prospective case-control study was conducted on 184 Jordanian pregnant patients with hypertensivedisorders and 172 age-matched control subjects. From June to August 2011, we recruited subjects from thematernity ward of a tertiary public hospital in the capital of Jordan; they were followed-up until 85 days after thebirth (late puerperium), as preeclampsia can occur in the post-puerperal period. Hypertensive disorders wereclassified as for pregnancy based on American Guideline. These included mild or severe preeclampsia,non-proteinuric gestational hypertension, mild preeclampsia superimposed on chronic hypertension, and severepreeclampsia superimposed on chronic hypertension. A standardized questionnairewere pilot-tested wascompleted by participants that included demographic data and known risk factors for hypertension in pregnancy.The following risk factors were assessed: prenatal hypertension, smoking, low education level, chronichypertension, diabetes, nulliparity, high BMI, multifetal gestation, previous preeclampsia history, and familyhistory of preeclampsia. BMI were calculated from weight and height measurements obtained at the bookingappointment. All samples had signed a written consent prior to their inclusion, and approval for the studyprotocol was obtained from the ethics committee of the hospital.SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL) was used for the statistical analyses. The Fisher’s exacttest, chi-square test, and Student’s t-tests were used to compare the frequencies of risk factors between studygroups depending on whether they were non-parametric or parametric variables. The variables tested in theunivariate analysis included family and previous history of preeclampsia, multifetal gestation, BMI, nulliparity,diabetes, chronic hypertension, smoking habits and level of education. The continuous variable (BMI) wasentered as a linear factor after being tested for nonlinearity. Multivariate logistic regression analysis wasperformed with a backward logistic regression analysis method to assess the independent roles of clinical, socialand demographic variables that had been identified to be associated with hypertensive disease in pregnancyaccording to the univariate analysis. P-values<0.05 were considered to show statistical significance.