Effect of hypertension on pregnancy outcomes at UNRWA health centres in Gaza governorates: a comparative study.

BACKGROUND

Hypertensive disorders affect 10% of all pregnant women and increase the risk of adverse maternal and neonatal outcomes and the psychological wellbeing and quality of life of women. This study is to the best of my knowledge the first to investigate these issues in the Gaza Strip. I compared adverse effects in pregnancy between hypertensive and non-hypertensive women.

METHODS

In this comparative study, eligible participants were hypertensive and non-hypertensive women attending health centres for postnatal care between August, 2016, and May, 2017. Six UNRWA health centres of 21 in Gaza Strip were selected randomly and quota sampling was applied after written informed consent was obtained. Data were collected by face-to-face interview and completion of the WHOQOL-BREF scale and SF-36 to assess quality of life. Additionally, data were extracted from patients' electronic primary medical records. Differences were analysed with Student's t test and the χ test, using SPSS version 22.

FINDINGS

430 mothers were enrolled, including 215 with hypertension and 215 without. Mean age was 28·0 years (SD 6·15). The mean gravidity and parity were 4·3 and 3·4, respectively, in the hypertensive group and 3·6 and 2·7 in the non-hypertensive group. Compared with the non-hypertensive group, the hypertensive group had a greater mean body-mass index (30·7 kg/mvs 25·8 kg/m), number of antenatal care visits (8·6 vs 6·6), and rate of pre-eclampsia (29%). 45 (21%) women in the hypertensive group had persistent hypertension after the postnatal period. Hypertensive mothers had higher rates of caesarean section (80 [37%] vs 35 [16%], p=0·001), delivery induction (58 [27%] vs 18 [8%], p=0·001). antepartum haemorrhage (30 [14%] vs six [3%], p=0·001), and postpartum haemorrhage (15 [7%] vs three [1·4%], p=0·003). Neonates born to women in the hypertensive group were at increased risk of having preterm birth (32 [15%] of 213 vs 16 [8%] of 215, p=0·013), low birthweight (21 [10%] vs 6 [3%], p=0·003), and neonatal admissions (26 [13%] vs 14 [7%], p=0·044) compared with those born to women in the non-hypertensive group. Hypertensive mothers had a lower mean quality of life score than women in the non-hypertensive group (64·2 vs 71·3, p=0·001).

INTERPRETATION

Neonatal admission in the hypertensive group and the caesarean section rates were lower than expected given the rates of preterm birth and low birthweight. These findings might be attributed to inadequate specialised management due to limited resources, blockade, receiving specialist treatment outside Gaza Strip, and political context. However, higher number of antenatal care visits suggests that hypertensive women receive more antenatal care from health-care providers at UNRWA clinics than non-hypertensive women. Secondary and tertiary maternal care in Gaza Strip need to be improved. A limitation of this study was poor documentation of some secondary health care data in electronic primary medical records but was overcome by reviewing hospital records.

FUNDING

None.