Joint modeling of hypertension measurements and time-to-onset of preeclampsia among pregnant women attending antenatal care service at Arerti Primary Hospital, North Shoa, Ethiopia

Abstract

Preeclampsia is a hypertensive disorder of pregnancy that affects 2–8% of pregnant women. The purpose of this study was to identify factors associated with hypertension measurements and time-to-onset of preeclampsia among pregnant women attending antenatal care service at Arerti Primary Hospital. Separate and joint methods of longitudinal data analysis and survival data analysis were fitted to answer the research objectives. A retrospective longitudinal study design was employed on a total of 201 pregnant women attending the antenatal clinic of Arerti Primary Hospital between September 2018 and June 2019. To analyze our data we employed descriptive method, linear mixed effect model, Cox-PH model and joint models for longitudinal and survival outcomes. Relevant demographic and clinical covariates were included in sub models. This study revealed that baseline age, visiting times, weight, diabetes, history of Preeclampsia and parity had significantly associated with mean change in the blood pressure measurements. From the Cox model result, age, weight, history of Preeclampsia and marital status were associated with a significant hazard of developing preeclampsia. The uni-variate joint models reveal that each longitudinal blood pressure measurements are significantly associated with hazard of developing preeclampsia. Form the bivariate joint model; only diastolic blood pressure is significantly associated with risk of developing Preeclampsia. As the result obtained in this study, we summarized that, age, weight, history of Preeclampsia and marital status had a significant effect on time to developing preeclampsia. Furthermore, due to significance of association between the longitudinal blood pressure measurements and time to onset of preeclampsia, joint model analysis was suggested as it incorporates all information simultaneously and provides valid and efficient inferences over separate models analysis.

Keywords:

• joint model
• diastolic blood pressure
• systolic blood pressure
• time to onset of preeclampsia

PUBLIC INTEREST STATEMENT

Preeclampsia is the leading causes of maternal and perinatal morbidity and mortality worldwide and it is a hypertensive disorder which usually occurs after 20 weeks of gestation. It is a rapidly progressive condition characterized by elevated blood pressure and protein in the urine. Ethiopia is implementing Maternal, Newborn, and Child Health programs as a priority health agenda to reduce maternal and child morbidity and mortality. Identifying potential risk factors and the group of a population at risk is imperative to achieve Maternal, Newborn, and Child Health programs. Therefore, the finding from the analysis of longitudinal responses and survival time to onset of preeclampsia of pregnant women could be important for pregnant women, health programmers, antenatal care service providers and future researchers in prevention and management of PE.

Competing interests

All authors declare no competing interest.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical and Consents

The research thesis has checked and approved by ethical clearance committee of University of Gondar, and the medical director’s office of Arerti Primary Hospital granted permission to use the patients’ data for this study. For the purpose of confidentiality, there were no linkages with individual patients and all data had no personal identifier and were kept confidential.

Availability of Data and Materials

Yes it is applicable.

Authors contributions

Dawit Baye Haile: Contributed in the conceptualization of the research problem, study design, write the thesis, analysis of the data, interpretation of the final result.

Aragaw Eshetie Aguade (PhD): Contributed in guidance, consultation, continued follow up, encouragement from the beginning to the end of the study.

Moges Zerihun Fetene: Contributed in guidance, consultation, continued follow up, encouragement from the beginning to the end of the study and formulate the manuscript.

We all authors of the paper carefully read, edited and finally approved the final manuscript.

List of abbreviations

ANC – Antenatal Care

AR – Auto-regressive

BP – Blood Pressure

DBP –Diastolic Blood Pressure

PE – Preeclampsia

SBP – Systolic Blood Pressure

Additional information

Funding

This research did not receive any specific funding.

Notes on contributors

Dawit Baye Haile

Dawit Baye completed his Master’s Degree in Biostatistics from University of Gondar, Ethiopia. He is currently engaged in teaching statistics course, research supervision on Dilla University College of Natural and Computational Science Department of Statistics. Aragaw Eshetie received the B.S.c. And M.Sc. Degree in Statistics from the Addis Ababa University, Ethiopia, and a Ph.D. degree in Statistics from the Andhra University, Indias. He has more than 15 years of experience in teaching, research and community engagement. Currently, he works as an assistant professor at the University of Gondar, College of natural and computational sciences, Department of Statistics, Gondar, Ethiopia.

Moges Zerihun Fetene

Moges Zerihun completed his Master’s Degree in Biostatistics from University of Gondar, he completed his first degree bachelor of statistics from Dilla University, Ethiopia. He is currently engaged in teaching statistics course, research supervision as well as community engagement on University of Gondar College of Natural and Computational Science Department of Statistics.