Hypertension during pregnancy and risk of stillbirth: challenges in a developing country

Abstract

Objective

To explore the factors associated with hypertensive disorders of pregnancy (HDP) in women experiencing stillbirth (SB).

Material and methods

It was an observational, analytical case-control study, done as part of the World Health Organization South-East Asian Region Office SB project. The epidemiological profile, history, clinical features, and investigations of stillborn cases having HDP were noted, an equal number of age and parity matched subjects with HDP having livebirth were taken as controls.

Results

Out of 46,816 deliveries, 1239 (26.2/1000) were stillborn. The maternal causes contributed 374/1239 (30.2%) stillbirths according to the CODAC classification, HDP was the most common maternal cause (304/1239, 24.9%). Subjects with HDP were included as cases. On comparing the cases with controls it was found that significantly more number of cases had inadequate antenatal visits (p < .001, OR −4.8), two or more abortions (p < .001, OR −1.9), early onset of hypertension (p < .0001, OR −5.6) and complications such as fetal growth restriction (FGR) (p < .001, OR −2.3) and abruption (p < .001, OR −4.0). Women with preeclampsia were less likely to have SB compared to those with gestational or chronic hypertension (p = .0001, OR −2.3). The birth weight/placental weight ratio of more than eight had the highest odds ratio regarding contribution to SB among hypertensive women (p = .0001 OR −6.7).

Conclusion

In women with HDP, adequate antenatal care would lead to the prevention of complications such as anemia, abruption, and FGR, and thus prevent SB. The high BW/PW ratio is a potential marker of risk of SB.

Keywords:

• Baby weight/placental weight ratio
• causes of stillbirth
• CODAC classification
• fetal growth restriction
• hypertension
• preeclampsia

Ethical statement

There is no conflict of interest among authors.

Contribution of authors

Manisha Kumar – conception, planning, carrying out, analyzing and writing up of the work. Abha Singh – Planning of research, co-writing the manuscript. Rashi Garg – carrying out and co -analyzing the data. Manish Goel – Analyzing the data and revising the manuscript. V. Ravi – reanalysis of data and final draft of the manuscript.

Acknowledgements

We are thankful to Ms Manju Sharma for her contribution as a computer data operator of the project.

Disclosure statement

There are no relevant financial, personal, political, intellectual or religious interests among authors to disclose.

Additional information

Funding

The project has been funded by WHO SEARO.