INTRODUCTION:

Pre–eclampsia also known as pregnancy induced hypertension is a condition characterized by high blood pressure (> 140/90mmHg) developing during pregnancy in a woman whose blood pressure was previously normal. It is accompanied by proteinuria and excessive fluid retention (Iyengar, 2001). Pre – eclampsia is one of the primary causes of maternal mortality and morbidity in both developed and developing countries (Bery et al., 1996). About 585,000 women die each year of pregnancy related causes, 95% of them occur in developing countries (WHO, 1998) and 13% of these deaths are due to hypertensive disorders of pregnancy particularly eclampsia (WHO, 1998).

The etiology of pre – eclampsia remains unknown but current hypotheses suggest placental ischemia, immune maladaptation, genetic predispositions and vascular mediated factors (Van and Peteers, 1998; Sibai, 2004).

Pre–eclampsia is a serious but poorly understood complication which most pregnant women present with especially during their 2^nd and mostly 3^rd trimester of gestation. Pre – eclampsia is not easily diagnosed because the predisposing factors are not well known while in other cases, the diagnosis is not done on time (WHO, 1998). Thus this study aimed at evaluating the occurrence and associated risk factors for pre – eclampsia amongst pregnant women during their 3^rd trimester of gestation attending the Bamenda sub– divisional Medicalized health center Nkwen. The study of risk factors can be used to access risk at antennal booking so that a suitable surveillance routine to detect pre – eclampsia can be planned for the high risk pregnant women who will likely develop pre – eclampsia.

MATERIALS AND METHODS:

Study Area:

This cross – sectional hospital based descriptive study was conducted at the Bamenda sub–divisional Medicalized health center Nkwen located in the North West Region of Cameroon. This hospital was selected because it has an antenatal clinic and a well – constructed laboratory.

Study Population:

A total of 160 pregnant women in their 3^rd trimester who accepted to participate were randomly selected to take part in the study.

Data Collection:

A pre – tested well-structured questionnaire composed of open and closed ended questions was used to collect demographic and clinical data from the participants.

Sample Collection:

The pregnant women who were randomly selected were given sterile wide – neck leak proof urine containers to collect a clean catch mid – stream urine sample which were tested immediately.

Determination of Proteinuria:

Proteinuria was determined using combi–2 strips (CYBOW) as follows; the strip was dipped into the freshly collected urine sample and the results read by comparing with a standard chart from manufacturer.

Determination of Blood Pressure:

Blood pressure was taken using a sphygmomanometer.

Data Analysis:

The data collected were analyzed using SPSS version 17 and results represented on tables.

Ethical considerations:

An informed consent form was attached to each questionnaire so that each participant signed the consent form before participating. Full confidentiality and participants rights were maintained. Authorization for the study was sought from the North West Regional Delegation of Public Health and from the Medical officer of the Bamenda sub – divisional Medicalized health center Nkwen.

RESULTS AND DISCUSSION:

Prevalence of pre – eclampsia:

Out of the 160 pregnant women who participated in this study, 10 were positive for pre–eclampsia giving a prevalence of 6.3%. This prevalence is slightly higher compared to the findings of Agustin and José (1999) who reported a 4.8% prevalence of pre – eclampsia in Latin America and Caribbean.

Demographic presentation of the study population:

From the results, most of the participants were within the age range of 21 – 27 years (50%) and were mostly students (28.8%) with most of them having secondary level as their highest level of education (62.5%). This could be explained by the fact that most of the participants were students who were still struggling to update their academic profile.

Table 1: Demography of the study population

Variable		%(n)
Age groups (years)	14-20	11.3(18)
	21-27	50.6(81)
	28-34	24.4(39)
	35-41	13.1(21)
	42-48	0.6(1)
Occupation	Students	28.8(46)
	Teachers	18.1(29)
	Farmer	3.8(6)
	Traders	22.5(36)
	Medical personnel	4.4(7)
	Others	22.5(36)
Level of Education	Primary	13.8(22)
	Secondary	62.5(100)
	University	23.1(37)
	None	0.6(1)

Distribution of some risk factors for pre – eclampsia:

The prevalent risk factors identified in this study were family history of hypertension (18.1%), past history of pre –eclampsia (15.6%), maternal age ≥ 35 years (13.6%), obesity (7.5%) and family history of diabetes mellitus (5.6%). There are consistent findings of a positive association between family history of diabetes and hypertension and pre – eclampsia risk (Siddigi et al., 1991). Family history of hypertension is a proxy measure of hereditary factors as well as common environment or behavioral exposures that may underline pre – eclampsia risk (Caren and Solomon, 2001).

Also husband’s age ≥ 40 years (37.6%) and primiparternity (6.3%) and work stress (9.4%) were found to be the pregnancy associated risk factors for pre – eclampsia. Harlap et al., 2002 reported that the risk of pre – eclampsia was 24% higher if men were 35 – 44 years and 80% if they were 45 years and older. The term primiparternity (change in partner) was introduced by Robillard and Husley (1996). According to this theory, pre – eclampsia may be a problem of primiparternity rather than primigravidity. Many studies have shown that change in partner raises the risk for pre – eclampsia in subsequent pregnancies (Odegard et al., 2000).

Distribution of pre–eclampsia based on some risk factors:

From the distribution of pre – eclampsia based on some risk factors, most of the positive cases were within the age range of 14 – 20 years (1.9%) and 35 – 41 years (1.9%). Some studies have reported the association between age and pre – eclampsia especially in pregnant elderly women above the age of 35 years while others have shown an association of pre – eclampsia with younger age groups. Thus advancing maternal age as well as young maternal age is a risk factor for pre – eclampsia (Duckitt and Harrington, 2005). Also, Mostello et al., 2002 reported that a high proportion of pre – eclampsia cases occur in those at the extreme ends of the productive age. These reports are consistent to the results obtained in this study.

Also based on occupation (work), most of the positive cases were found amongst teachers (1.9%) followed by farmers (1.3%) and traders (1.3%). This is similar to the epidemiological study by Ceron – Mireless et al., 2001 who reported that pre – eclampsia increases with work related stress. Also Klonoff et al., 1996 reported that working women had 2.3 times the risk of developing pre – eclampsia compared with non – working women.

Table 2: Distribution of some risk factors identified in the study population

Variables		%(n)
Maternal specific risk factors	Maternal age (years)
	14-20	11.8(18)
	21-27	50.6(81)
	28-34	24.4(39)
	35-41	13.1(21)
	42-48	0.6(1)
	Body mass index
	Normal weight	85.6(137)
	Over weight	6.9(11)
	Obessed	7.5(12)
	Past history of preeclampsia
	Yes	15.6(25)
	No	84.4(135)
	Family history of Diabetes mellitus
	Yes	5.6(9)
	No	94.4(151)
	Total	100.0(160)
	Family History of Hypertension
	Yes	18.1(29)
	No	81.9(131)
Pregnancy Associated Rick factors	Paternity
	Primiparternity	6.3(10)
	same partner	93.8(150)
	Husband age(years)
	19-25	7.5(12)
	26-32	35.6(57)
	33-39	21.3(34)
	40-46	25.0(40)
	47-53	7.5(12)
	54-6	3.1(5)
	Total	100.0(160)
Exogenous factors	Work stress
	Yes	9.4(15)
	No	90.6(145)

Table 3: Distribution of pre – eclampsia based on some risk factors

Parameters		Pre–eclampsia cases % (n)
Maternal Age range (years)	14-20	1.9(3)
	21-27	1.3(2)
	28-34	1.3(2)
	35-41	1.9(3)
	42-48	0.0(0)
Occupation	Students	0.6(1)
	Teachers	1.9(3)
	Farmers	1.3(2)
	Traders	1.3(2)
	Medical Personnels	0.6(1)
	Others	0.6(1)

CONCLUSION:

From this study, the prevalence of pre – eclampsia was high (6.3%) at the Sub – divisional Medicalized health center, Nkwen with the most prevalent risk factors being maternal age ≥ 35 years (13.7%), family history of hypertension (18.1%) and past history of pre – eclampsia (15.6%).

ACKNOWLEDGEMENT:

We wish to acknowledge the medical officer at the sub – divisional Medicalized health center Nkwen and to the entire working staff for their collaboration during this study. Also we are indebted to the women who gave us their time to participate in this study. It is our prayer that the results be used to monitor pre –eclampsia occurrence amongst the pregnant women in the area.

Limitations:

This study is important with reference to the study area but was a cross – sectional study thus conclusions are casual. We therefore solicit for help from any organization so that a longitudinal study could be carried out on a larger scale and involving a larger number of women from other institutions to further increase reliability; so that the results obtained will be recommended for implementation in routine antennal booking for any pregnant woman in the area.

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Received on 02.08.2014 Modified on 18.08.2014

Res. J. Pharmacology & P’dynamics. 6(4): Oct. - Dec.2014; Page 190-192