Figure 1
Map of Nigeria with the states in which the study sites were located.
Figure 2
Flowchart of Participants enrollment and follow up process.*
* The loss to follow up were actually cases of missed appointment as specific time period. Also, some of the missed appointees at 9 weeks reported at 6 months and or at 1 year follow up.
Table 1
Socio-demographic and obstetric characteristics of the of 410 women with HDPs enrolled in the study.
| Variables | Number (%) | Mean (SD) | GHT | CHT | PE | EC |
|---|---|---|---|---|---|---|
| Mean age (SD) | – | 28.9 (6.4) | 33.3 (28.9) | 35.2 (6.8) | 28.4 (5.7) | 24.6 (6.3) |
| Mean BMI at booking (SD) | – | 28.8 (7.7) | 31.6 (8.5) | 31.7 (11.7) | 27.7 (6.2) | 24.9 (4.2) |
| Parity (N = 366) | ||||||
| Para 0 n(%) | 78 (21.4) | – | 9 (12.0) | 1 (3.0) | 45 (22.5) | 23 (40.3) |
| Para 1 – 3 n(%) | 200 (54.8) | – | 51 (68.0) | 14 (42.4) | 108 (54) | 27 (47.4) |
| ≥para 4 n(%) | 87 (23.8) | – | 15 (20.0) | 18 (54.6) | 47 (23.5) | 7 (12.3) |
| Booking status n(%) | ||||||
| Booked | 247 (60.2) | 60 (80.0) | 23 (70.0) | 117 (58.5) | 21 (36.8) | |
| Unbooked | 163 (39.8) | 15 (20.0) | 10 (30.0) | 83 (41.5) | 36 (63.2) | |
| Number enrolled per HDP types | – | – | 76 (18.5) | 47 (11.5) | 205 (50.0) | 82 (20.0) |
| Number reviewed at 9 weeks per HDP types | – | – | 54 (20.5) | 24 (9.0) | 143 (54.5) | 42 (16.0) |
| Number reviewed at 6 months per HDP types | – | – | 44 (19.0) | 24 (10.5) | 122 (52.5) | 42 (18.0) |
| Number reviewed at 1 year per HDP types | – | – | 69 (25) | 42 (15) | 136 (49) | 31 (11) |
| Mean Gestational age at booking | – | – | 24.9 (6.7) | 23.8 (4.6) | 23.1 (6.3) | 23 (6.7) |
| Distribution of GA at booking n(%) | ||||||
| ≤12 weeks | 14 (3.4) | – | 3 (4.0) | 0 (0.0) | 7 (3.5) | 2 (3.5) |
| 13 – 20 weeks | 73 (17.8) | – | 14 (18.7) | 6 (18.2) | 43 (21.5) | 6 (10.5) |
| >20 weeks | 323 (78.8) | – | 58 (77.3) | 27 (81.8) | 150 (75) | 49 (86) |
| Mean Gestational age at onset of HDP | – | 33.2 (8.8) | 36.9 (4.1) | – | 33 (8.5) | 34.5 (6.5) |
| GA distribution of onset of HDP | ||||||
| ≥ 34 weeks | 239 (65.5) | – | 61 (81.3) | – | 122 (61) | 42 (73.7) |
| <34 weeks | 126 (34.5) | – | 11 (14.7) | – | 78 (39) | 15 (26.3) |
| Mean Gestational age at delivery (SD) | – | 36.5 (4.1) | 38.7 (1.9) | 36.1 (3.9) | 36 (4.3) | 35.5 (4.3) |
| Distribution of GA at delivery n(%) | ||||||
| >=37 weeks | 265 (64.6) | – | 67 (89.3) | 18 (54.5) | 103 (51.5) | 31 (54.4) |
| <37 weeks | 145 (35.4) | – | 8 (10.7) | 15 (45.5) | 97 (48.5) | 26 (45.6) |
| Mode of Delivery n(%) | ||||||
| Spontaneous Vaginal Delivery | 165 (45.1) | – | 42 (56) | 18 (54.5) | 82 (41) | 23 (40.4) |
| Assisted Vaginal Delivery | 6 (1.6) | – | 2 (2.7) | 0 (0.0) | 3 (1.5) | 1 (1.8) |
| Elective Caesarean section | 19 (5.2) | – | 6 (8) | 2 (6.1) | 11 (5.5) | 0 (0.0) |
| Emergency Caesarean section | 176 (48.1) | – | 25 (33.3) | 13 (39.4) | 104 (52) | 33 (57.8) |
| Apgar score at 1 min n(%) | ||||||
| Apgar >= 7 | 224 (61.4) | – | 58 (77.3) | 20 (60.6) | 117 (58.5) | 29 (50.9) |
| Apgar < 7 | 141 (38.6) | – | 17 (22.7) | 13 (39.4) | 83 (41.5) | 28 (49.1) |
| Apgar score at 5 min n(%) | ||||||
| Apgar >= 7 | 308 (84.4) | – | 72 (96.0) | 29 (87.9) | 163 (81.5) | 44 (77.2) |
| Apgar < 7 | 57 (16.6) | – | 3 (4.0) | 4 (12.1) | 37 (18.5) | 13 (22.8) |
| Perinatal deaths n(%) | ||||||
| Stillbirths | 29 (70.7) | – | 2 (66.7) | 1 (33.3) | 20 (69) | 6 (100.0) |
| Early neonatal deaths | 12 (29.3) | – | 1 (33.3) | 2 (66.7) | 9 (31) | 0 (0.0) |
| Proportion of HDPs with BP ≥150/100 mmHg within five days of delivery on anti-hypertensive medications | 33% | – |
[i] HDP = Hypertensive disorders in pregnancy, SD = standard deviation, GHT = Gestational hypertension, CHT = Chronic hypertension, PE = Pre-eclampsia, EC = Eclampsia, GA = gestational age, BP = Blood pressure.
Figure 3
Prevalence of persistent hypertension (BP >140/90 mmHg) based on HDP sub-types and total over one year of follow up.
HDPs = Hypertensive disorders in pregnancy; PE/E = Pre-eclampsia/eclampsia.
Figure 4
Trend in mean systolic and diastolic blood pressure over one year of follow up.
BP = Blood pressure, HDP = Hypertensive disorders in pregnancy.
Table 2
Univariable and multivariable logistic regression analysis of factors associated with persistent hypertension among 254 women with HDPs (excluding chronic hypertension) at one year after delivery.
| Variable | Univariate | Multivariate | ||
|---|---|---|---|---|
| OR (95% CI) | P-value | OR (95%CI) | P-value | |
| Age | 1.11 (1.06–1.15) | 0.000 | 1.07 (1.02–1.13) | 0.011 |
| BMI at baseline | 1.03 (1.00–1.07) | 0.147 | 1.06 (1.01–1.10) | 0.010 |
| Random blood glucose at baseline | 0.99 (0.90–1.09) | 0.869 | 0.92 (0.80–1.06) | 0.258 |
| Gestational age at onset of HDP | 0.97 (0.94–1.00) | 0.055 | 0.99 (0.96–1.05) | 0.948 |
| Gestational age at delivery | 0.97 (0.92–1.04) | 0.513 | 0.98 (0.91 –1.07) | 0.729 |
| Systolic BP at baseline | 1.01 (1.00–1.02) | 0.030 | 1.01 (0.99–1.03) | 0.633 |
| Diastolic BP at baseline | 1.02 (1.00–1.03) | 0.067 | 1.01 (0.98–1.04) | 0.421 |
| Diagnosis of gestational hypertension | 0.25 (0.09–0.71) | 0.009 | 0.71 (0.44–1.15) | 0.164 |
| Diagnosis of pre-eclampsia | 0.20 (0.08–0.52) | 0.001 | ||
| Raised creatinine >90 mmol/L | 1.04 (0.90–1.20) | 0.061 | 1.06 (0.90–1.25) | 0.477 |
| Raised uric Acid >446 mmol/L | 1.01 (0.95–1.06) | 0.797 | 1.03 (0.96–1.10) | 0.471 |
| Raised Triglycerides>1.7 mmol/l | 0.99 (0.88–1.11) | 0.871 | 0.95 (0.80–1.12) | 0.520 |
| Raised cholesterol>200 mg/dL | 0.99 (0.99–1.00) | 0.634 | 0.99 (0.99–1.00) | 0.594 |
[i] * p < 0.05, OR = Odd ratios, BP = Blood pressure, HDP = Hypertensive disorders in pregnancy.