A Nomogram for Prediction of Risk Factors for Preeclampsia during Antenatal Care at a Tertiary Maternity Hospital
Abstract
Objective: The study aims to create a nomogram for prediction of risk factors for preeclampsia (PE) during antenatal care (ANC) in a tertiary maternity hospital.
Materials and Methods: A cross-sectional study was conducted between May 2016 and December 2017 in a tertiary maternity hospital. Two hundred thirty pregnant women were included, at first visit, personal data, family history of risk factors for PE, maternal medical, and obstetric history was collected. Physical examination, including blood pressure, weight, signs of edema, and urine analysis were done. Then follow up at 24 weeks and after 32 weeks gestation to know if she developed PE or not through the physician. Included nomogram, which was built based on the data of regression analysis, was used to predict the value of one or more responses from a set of predictors.
Results: The study included 230 women. Cases diagnosed with PE during all the follow up are 37 cases (16.1%). Five factors were not significant; maternal age (P=0.154, OR=1.076), consanguinity (P=0.821, OR=1.104), age at marriage (P=0.266, OR=1.404), age at first pregnancy (P=0.319, OR=0.735) and order of pregnancy (3rd or more) (P=0.951, OR=0.984). Only two factors significant; a history of diabetes mellitus (P=0.010, OR=5.923) and history of hypertension (P=0.045, OR=7.838). Probability of PE based on the finding of the nomogram was 68% with good discrimination.
Conclusion: History of diabetes mellitus and hypertension were the predictors in the final model among pregnant women for the development of preeclampsia.
Keywords: Prediction; Preeclampsia; Risk factors; Nomogram
Introduction
Hypertensive disorders of pregnancy are one of the leading causes of maternal and infant morbidity and mortality. Worldwide, hypertensive disorders of pregnancy affect 5-10% of all pregnancies and cause approximately 50,000 deaths among women every year [1]. The incidence of preeclampsia (PE) is influenced by parity, racial, genetic predisposition, and environmental factors may also have a role. The incidence of PE varies greatly worldwide. World Health Organization (WHO) estimates the incidence of PE to be seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%) which is due to poor healthseeking behaviours and un-availability of health care facilities and personnel [2,3].
Maternal mortality due to PE varies between (2-30%) and is much higher in rural areas. In Egypt, the prevalence of PE is (10.7%) in a community-based study while, in hospital-based studies ranged from (9.1-12.5%) of all deliveries [1,4,5].
Prevention of PE may be primary, secondary. Primary prevention involves avoiding pregnancy in women at high risk for PE, modifying lifestyles or improving nutrients intake in the whole population to decrease the incidence of the disease. Therefore, probably most of the cases of PE are unpreventable. Secondary prevention is based on interruption of known pathophysiological mechanisms of the disease before its establishment. Recent efforts have focused on the selection of high-risk women and have proposed an effective intervention, as early as it is possible, to avoid the disease or its severe complications [6].
The aim of the study was to create a nomogram for prediction of PE causing risk factors during antenatal care at a tertiary maternity hospital.
Patients and Methods
A cross-sectional study was conducted at Antenatal Care Clinic (ANC) in Assiut Women Health Hospital. This clinic is the main largest clinic in Assiut Governorate which provides antenatal care services for pregnant women.
A convenience sampling of pregnant women who attended at ANC for six months period from the beginning of May 2016 till the end of December 2016 and follow up waves ended in (March 2017). The total number of the study sample composed of 230 pregnant women was included and continued until the end of the study. All pregnant women who agree to participate in the study were included if gestational age was from 4th to 18th weeks and without mental disorders.
Two tools were utilized in the current study:
Tool 1
Structured interview questionnaire developed after reviewing the literature and previous research which were relevant to the present study, it included the following (3) parts:
Part 1: included the following:
1. Personal data scale which included: Age, name, telephone number, level of education, occupation …etc.
2. Family history of risk factors for PE such as previous PE, a family history of (diabetes mellitus, chronic hypertension, chronic kidney disease, cardiovascular diseases, thrombophilia, lupus, and smoking).
3. Maternal medical and obstetric history such as Gestational age at the beginning of the current study, consanguinity, age at marriage, age at first pregnancy, history of (preeclampsia, hypertension, diabetes mellitus.etc.).
Part 2
Physical examination of pregnant women, including (blood pressure, weight, signs of edema, and urine analysis).
During the first contact with the women that were enrolled, the physical examination (blood pressure, urine analysis, and signs of edema) was done.
Part 3
It included following up the pregnant women through three waves after the first contact with the pregnant women (4:18 weeks)
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