Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?

Figures & data

Table 1 General maternal and perinatal characteristics of the study sample

Parameters	Mean ± standard deviation
Age (years)	28.1±6.4
Weight (kg)	64.4±12.9
Height (cm)	1.60±0.2
Postpartum BMI (kg/m^2)	24.5±4.6
Gravidity	2.8±1.8
Parity	2.4±1.6
Gestational age (weeks)	38.4±2.3
Birth weight (g)	3,066.9±575.3
Apgar score	8±1.8

Table 2 Frequency of pre-pregnancy risk factors

	n	%
Non-pathologic risk factors
Age ≤18 years	77	3.7
Age ≥35 years	381	18.3
Single or not living with a partner	550	26.4
Height ≤150 cm	26	1.2
Primiparity	761	36.5
Multiparity ≥5	224	10.7
Pathologic risk factors
Hypertension in family	716	34.3
Diabetes in family	440	21.1
Previous tuberculosis	80	3.8
Personal diabetes	29	1.4
Drepanocytosis	42	2
Overweight/obesity	456	21.9
Previous miscarriage	692	33.2
Previous gestational diabetes	7	0.3
Previous preeclampsia/eclampsia	191	9.2
Previous premature rupture of membranes	130	6.2
Previous cesarean section	328	15.7
Previous postpartum hemorrhage	273	13.1
Previous prematurity	37	1.8
Previous stillbirth	65	3.1
Previous low birth weight	208	10
Previous macrosomia	208	10

Table 3 Maternal and perinatal outcomes during current/just-terminated pregnancy

	n	%
Maternal outcomes
Premature rupture of membranes	226	10.8
Preeclampsia/eclampsia	372	17.8
Urinary infection	700	33.6
Cesarean section	466	22.3
Postpartum hemorrhage	254	12.2
Perinatal outcomes
Prematurity	293	14
Apgar score <7	229	11
Low birth weight	218	10.5
Stillbirth	50	2.4
Macrosomia	110	5.3
Neonatal distress	105	5

Table 4 Risk factors influencing recurrence of adverse maternal and perinatal outcomes

Recurring outcomes	Risk factors	P-value	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
PEE	Maternal age ≥35 years	0.006	1.7 (1.2–2.6)	1.6 (1.1–2.4)
	Hypertension in family	0.003	1.7 (1.2–2.3)	0.5 (0.3–0.9)*
	Previous CS	0.004	1.8 (1.2–2.6)	1.7 (1.1–2.5)
	Previous PROM	0.001	15.9 (2.02–26.4)	20.7 (2.1–199.9)
CS	Previous stillbirth	0.000	23.1 (3.0–178.2)	19.6 (2.4–163.3)
	Previous macrosomia	0.000	5.7 (2.7–12.1)	3.2 (1.4–7.6)
Prematurity	Previous PROM	0.05	7.5 (0.8–68.9)*	3.3 (1.7–6.3)
PROM	Previous miscarriage	0.01	3.6 (1.4–9.8)	1.3 (0.5–3.3)*
	Previous macrosomia	0.04	2.9 (1.02–8.5)	3.0 (1.04–8)
Macrosomia	Overweight/obesity	0.003	2.5 (1.3–4.8)	2.3 (1.2–4.5)
LBW	Previous PPH	0.01	4.9 (0.8–31.7)*	0.1 (0.01–0.9)*

Note:

* Not significant (OR <1.5 or 95% CI containing 1).

Abbreviations: CI, confidence interval; CS, cesarean section; LBW, low birth weight; OR, odds ratio; PEE, preeclampsia/eclampsia; PPH, postpartum hemorrhage; PROM, premature rupture of membranes.

Table 5 Maternal and perinatal adverse outcomes according to pre-pregnancy risk factors

Outcomes	Risk factors
	≥35 years	Single	P1	P≥5	HPT in family	Diabetes in family	Previous PEE	Previous PROM	Overweight/obesity	Previous miscarriage	Previous CS	Previous PPH	Previous stillbirth	Previous LBW	Previous macros
	Unadjusted OR (95% CI)
Urinary infection	1.2	2.3	1	1.2	1.3	2	2	1	1	1.1	1.4	1.9	1	1	1
	–	(1.6–3.1)	–	–	–	(1.6–2.4)	(0.7–5.7)	–	–	–	–	(1.4–2.4)	–	–	–
PEE	2.3	1.2	1	2	2.7	1.7	2	1.7	2	1	2.8	4	2	2	1
	(1.6–3.1)	–	–	(1.3–2.8)	(1.9–3.7)	(1.1–2.5)	(1.6–2.5)	(1–2.9)	(1.5–2.7)	–	(2.2–3.7)	(1.9–8.9)	(1–4)	(1.5–3.2)	–
PROM	1.2	1.7	1	1.5	1	1.2	–	1.7	1 –	1	1.5	1.2	1.3	1.6	1.6
	–	(1.3–2.1)	–	(1–2.2)	–	–		(1–2.9)		–	(1–2.2)	–	–	(1.1–2.5)	(1–2.5)
CS	1.7	1.4	1	1.3	1.6	1.6	3.5	1	1.7	1	2.9	5	3.8	1.4	2
	(1.3–2.1)	–	–	–	(1.3–2)	(1.3–2)	(1.4–8.9)	–	(1.3–2)	–	(2.2–3.7)	(3–9)	(2.3–6.2)	–	(1.5–2.7)
PPH	1.7	1.6	1.3	1.5	1.8	1.6	–	1.5	2.7	1	1.5	2.5	4	1.3	1
	(1.3–2.1)	(1–2.7)	–	(1–2.3)	(1.4–2.3)	(1.2–2.2)		(0.80–2.6)	(1.8–4)	–	(1–2)	(1.8–3.4)	(1–16)	–	–
Prem	1.7	1.3	1	1.6	1	2	–	3.2	1	1	2	5	1.4	1.3	1.2
	(1.3–2.1)	–	–	(1.1–2.3)	–	(1.4–2.9)		(2.2–4.8)	–	–	(1.4–3)	(2.7–10.7)	–		–
NDIST	1.7	1.9	1	1.4	1.7	1.9	1.6	1.5	1.2	1	1.5	6	1.7	6	1
	(1.3–2.1)	(1–3.6)	–	–	(1.3–2.3)	(1.3–2.8)	(0.4–5.7)	(0.9–2.5)	–	–	–	(2.5–12.5)	–	(4.4–8.2)	–
Stillbirth	1.7	1.2	1.8	1.6	1.3	2	–	2.1	1.3	1.5	1.4	2.4	2.8	3.2	1.5
	(1.3–2.1)	–	(1–3.5)	(0.7–3.5)	–	(0.8–4.6)		(0.5–5)	–	–	–	(0.7–7.5)	(1–8)	(2.3–4.5)	(0.6–3.3)
LBW	1.7	2	1	1	1	1.7	1.9	1.5	1.2	1	1.4	4	2.7	5.5	1.4
	(1.3–2.1)	(1.4–3.2)	–	–	–	(1.2–2.5)	(0.3–12.7)	(0.9–2.5)	–	–	–	(2–8)	(1.5–4.9)	(3–9.9)	–
Macros	2	1.5	1.3	1.3	1	1	1	1.2	1.7	1.3	1.3	1	1.9	6	28
	(1.4–3.2)	(1–2.4)	–	–	–	–	–	–	(1–2.6)	–	–	–	(0.7–4.4)	(1.5–24)	(18–43.7)

Note: Significant values are in bold.

Abbreviations: CI, confidence interval; CS, cesarean section; HPT, arterial hypertension; LBW, low birth weight; Macros, macrosomia; NDIST, neonatal distress; OR, odds ratio; P1, parity 1; P≥5, parity ≥5; PEE, preeclampsia/eclampsia; PPH, postpartum hemorrhage; Prem, prematurity; PROM, premature rupture of membranes.

Table 6 Adverse outcomes according to main pathologic factors adjusted for non-pathologic risk variables (age ≥35 years, single status, and parity ≥5)

Outcomes	PRFs	Model 1 (age ≥35 years)			Model 2 (single status)			Model 3 (parity ≥5)
		OR	CI		OR	CI		OR	CI
Urinary infection	Diabetes in family	2.0	1.6	2.4	1.9	1.6	2.4	2.0	1.6	2.4
	Prev PPH	1.9	1.4	2.4	1.8	1.4	2.4	1.8	1.4	2.4
PEE	HPT in family	1.7	1.3	2.1	1.6	1.3	2.0	1.6	1.3	2.1
	Prev PEE	2.0	1.6	2.5	1.9	1.5	2.4	2.0	1.6	2.5
	Prev CS	1.9	1.4	2.5	1.9	1.4	2.5	1.9	1.4	2.5
	Prev PPH	1.5	1.1	2.0	1.4	1.1	1.9	1.5	1.1	2.0
PROM	Prev PROM	2.0	1.3	3.3	1.9	1.2	3.0	1.8	1.1	2.9
	Prev LBW	1.7	1.1	2.5	1.6	1.1	2.4	1.6	1.1	2.4
	Prev macrosomia	1.7	1.2	2.6	1.6	1.1	2.4	1.6	1.1	2.4
CS	Overweight/obesity	1.6	1.2	2.0	1.5	1.2	1.9	1.6	1.3	2.1
	Prev CS	2.9	2.2	3.7	2.9	2.3	3.7	2.9	2.3	3.7
	Prev stillbirth	3.7	2.2	6.0	3.5	2.1	5.8	3.8	2.3	6.2
	Prev macrosomia	1.8	1.3	2.5	1.9	1.4	2.6	2.0	1.4	2.7
PPH	HPT in family	1.8	1.4	2.3	1.7	1.3	2.2	1.8	1.4	2.3
	Diabetes in family	1.6	1.2	2.2	1.5	1.1	2.1	1.6	1.2	2.2
	Prev PEE	1.7	1.3	2.3	1.7	1.3	2.2	1.7	1.3	2.3
	Prev CS	1.5	1.1	2.1	1.5	1.1	2.1	1.5	1.1	2.1
	Prev PPH	2.5	1.8	3.4	2.4	1.7	3.3	2.5	1.8	3.5
Prematurity	Prev PROM	3.3	2.2	4.9	2.9	2.0	4.3	3.0	2.0	4.5
	Prev LBW	6.0	4.4	8.2	5.7	4.1	7.8	5.8	4.3	8.0
NDIST	Prev LBW	3.2	2.2	4.5	3.1	2.2	4.4	3.1	2.2	4.5
Stillbirth	Prev LBW	5.3	2.9	9.6	5.2	2.9	9.5	5.3	2.9	9.7
LBW	Prev stillbirth	2.6	1.5	4.8	2.6	1.4	4.7	2.7	1.5	4.9
	Prev LBW	18.9	13.5	26.5	19.1	13.6	26.8	19.8	14.1	27.9
Macrosomia	Overweight/obesity	1.6	1.0	2.4	1.6	1.1	2.5	1.6	1.1	2.5
	Prev macrosomia	27.8	17.8	43.4	28.5	18.3	44.3	28.4	18.3	44.1

Abbreviations: CS, cesarean section; HPT, arterial hypertension; LBW, low birth weight; NDIST, neonatal distress; OR, odds ratio; PEE, preeclampsia/eclampsia; PPH, postpartum hemorrhage; Prev, previous; PRFs, pathologic risk factors; PROM, premature rupture of membranes; CI, confidence interval.