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==Overview==
==Overview==
[[Hypertensive disorders of pregnancy]] ([[HDP]]), defined as a sex-specific cardiovascular disease is one of the leading causes of maternal and fetal morbidity and mortality globally and a critical threat to maternal and infant health. <ref></ref>
[[Hypertensive disorders of pregnancy]] ([[HDP]]), defined as a sex-specific [[cardiovascular disease]], is one of the leading causes of [[maternal]] and [[fetal morbidity]] and mortality globally and a critical threat to maternal and infant health. <ref>Garovic V, White W, Vaughan L, Saiki M, Parashuram S, Garcia-Valencia O,et al. Incidence and long-term outcomes of hypertensive disorders of pregnancy. J Am Coll Cardiol. 2020;75(18):2323–34</ref>[https://assets.researchsquare.com/files/rs-146936/v1/158664ad-2cb9-42ef-966d-0d398ec6ac45.pdf?c=1611006950 ] Preeclampsia is a pregnancy-related hypertensive disorder occurring usually after 20 weeks of [[gestation]] and if left untreated, it progresses to eclampsia.<ref> Medicine for Africa - Medical Information Service. preeclampsia/ eclampsia. 2008, http://www.medicinemd.com/</ref> Preeclampsia and eclampsia are not distinct disorders but the manifestation of the spectrum of clinical symptoms of the same condition.<ref> <ref name="pmid21547090">{{cite journal| author=Osungbade KO, Ige OK| title=Public health perspectives of preeclampsia in developing countries: implication for health system strengthening. | journal=J Pregnancy | year= 2011 | volume= 2011 | issue=  | pages= 481095 | pmid=21547090 | doi=10.1155/2011/481095 | pmc=3087154 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21547090  }} </ref> Although preeclampsia prevails to be a significant public health threat in both developed and developing nations bringing maternal and perinatal morbidity and mortality worldwide, <ref> World Health Organization. Global Program to Conquer Preeclampsia/Eclampsia. 2002. </ref><ref> McClure EM, Saleem S, Pasha O, Goldenberg RL. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. Journal of Maternal-Fetal and Neonatal Medicine. 2009;22(3):183–190. </ref>the impact of the disease is witnessed to be harsher in the developing countries <ref> Igberase G, Ebeigbe P. Eclampsia: ten-years of experience in a rural tertiary hospital in the Niger delta, Nigeria. Journal of Obstetrics and Gynaecology. 2006;26(5):414–417. </ref> <ref> Adamu YM, Salihu HM, Sathiakumar N, Alexander GR. Maternal mortality in Northern Nigeria: a population-based study. European Journal of Obstetrics Gynecology and Reproductive Biology. 2003;109(2):153–159. </ref>,where, unlike other more prevalent causes of maternal mortality (such as haemorrhage and sepsis), medical interventions may be ineffective due to late presentation of cases<ref> Ikechebelu JI, Okoli CC. Review of eclampsia at the Nnamdi Azikiwe University teaching hospital, Nnewi (January 1996-December 2000) Journal of Obstetrics and Gynaecology. 2002;22(3):287–290 </ref><ref> Onakewhor JUE, Gharoro EP. Changing trends in maternal mortality in a developing country. Nigerian Journal of Clinical Practice. 2008;11(2):111–120 </ref>. The problem is confounded by the continued ambivalence of the aetiology and the unpredictable behavior of the disease <ref> Duley L. Pre-eclampsia and the hypertensive disorders of pregnancy. British Medical Bulletin. 2003;67:161–176 </ref>. According to [[WHO]], the incidence of preeclampsia is seven times higher in [[developing countries]] (2.8% of live births) than in [[developed countries]] (0.4%).<ref> WHO. Make every mother and child count, in The world health report 2005. Geneva, Switzerland: World Health Organization; 2005. </ref> In developing countries the prevalence of preeclampsia, the precursor of eclampsia, ranges from 1.8% to 16.7% and from 1990 to 2019, the incidence, prevalence, death and YLDs were highest in populations aged 25–29 years.


==Epidemiology and Demographics of Eclampsia==
==Epidemiology and Demographics of Eclampsia==
Eclampsia is a leading cause of maternal and perinatal mortality.  The prevalence of eclampsia is reported to be 0.56 per 1,000 births (US data from 1979-86) versus 26 per 1,000 births for pre-eclampsia.<ref>{{cite journal |journal= Am J Obstet Gynecol. 1990 Aug;163(2): 460-5. | title=Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. |author=Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. |pmid=2396132}}</ref> While mortality can be kept low when antenatal care and [[maternal-fetal medicine| maternal-fetal services]] are provided, mortality rates are substantial in challenging settings. Thus in a setting in India , [[maternal mortality]] and [[perinatal mortality]] were reported to be 32% and 39%, respectively, in 1993.<ref> {{cite journal |author= Swain S, Ojha KN, Prakash A, Bhatia BD.| title=Maternal and perinatal mortality due to eclampsia. |journal=Indian Pediatr. 1993 Jun;30(6):771-3}}</ref>
===Incidence===
*Since [[preeclampsia]] and [[eclampsia]] are one of the main causes of maternal deaths, the data on [[incidence]] is required at both national and local levels to inform policies to further target the affected population and for the focused distribution of resources.
*According to [[WHO]], the incidence of preeclampsia is seven times higher in [[developing countries]] (2.8% of live births) than in [[developed countries]] (0.4%).<ref> WHO. Make every mother and child count, in The world health report 2005. Geneva, Switzerland: World Health Organization; 2005. </ref>
*The incidence of eclampsia in the developed countries of [[North America]] and [[Europe]] is similar and estimated to be about 5–7 cases per 10,000 deliveries. On the other hand, incidence of eclampsia in developing nations varies widely, ranging from 1 case per 100 pregnancies to 1 case per 1700 pregnancies [2, 14]. Rates from African countries such as [[South Africa]], [[Egypt]], [[Tanzania]], and [[Ethiopia]] range from 1.8% to 7.1% <ref> Kimbally KG, Barassoumbi H, Buambo SF, et al. Arterial hypertension: epidemiological aspects and risk factors on pregnant and delivered woman. Dakar Médical. 2007;52(2):148–152 </ref><ref> Teklu S, Gaym A. Prevalence and clinical correlates of the hypertensive disorders of pregnancy at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Ethiopian Medical Journal. 2006;44(1):17–26. </ref>. The prevalence in Nigeria spans between 2% to 16.7%.<ref> Omole-Ohonsi A, Ashimi AO. Pre-eclampsia: a study of risk factors. Nigerian Medical Practitioner. 2008;53(6):99–102. </ref><ref> Population Council Nigeria. Administering Magnesium Sulfate to Treat Severe Pre-eclampsia and Eclampsia. 2009,http://www.popcouncil.org/projects/134_AdminMagSulfPreeclampsia.asp. </ref>
*A systematic review conducted for the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally, representing 39 million women from 40 countries, estimates the incidence to be 4.6% (95% uncertainty range 2.7-8.2), and 1.4% (95% uncertainty range 1.0-2.0) of all deliveries for preeclampsia and eclampsia respectively, with a wide variation across regions.<ref name="pmid23746796">{{cite journal| author=Abalos E, Cuesta C, Grosso AL, Chou D, Say L| title=Global and regional estimates of preeclampsia and eclampsia: a systematic review. | journal=Eur J Obstet Gynecol Reprod Biol | year= 2013 | volume= 170 | issue= 1 | pages= 1-7 | pmid=23746796 | doi=10.1016/j.ejogrb.2013.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23746796 }} </ref>
*The incidence of hypertensive disorders of pregnancy increased from 16.30 million to 18.08 million worldwide, with a total increase of 10.92% from 1990 to 2019.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The [[age-standardized incidence rate]] decreased, with an estimated annual percentage change of -0.68 (95% CI -0.49 to -0.86). Worldwide, the age-standardized incidence rate (ASIR) decreased from 579 (95% UI 482 to 689) per 100,000 population in 1990 to 463 (95% UI 392 to 541) per 100,000 population in 2019. Age-standardized incidence rates were higher in countries/regions with lower [[sociodemographic]] indices and [[human development indices]].<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The estimated incidence rate was lowest in the group aged 25-29 years and higher in the youngest and oldest groups.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The Estimated Annual Percentage Change fot the age-standardized deaths rate (ASDR) was − 2.38 (95% CI 1.67 to -6.27).
*Positive associations between incidence and sociodemographic index and human development index were found for all countries and regions in 2019.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
 
===Prevalance===
[[File:Prevalance of HDP.png|Center|thumb|Overview of HDP by country and region for both sexes combined. (A) The prevalence of HDP in 2019 (B) The ASIR of HDP per 100,000 population in 2019. (C) The EAPC in the ASDR of HDP from 1990 to 2019. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; EAPC, estimated annual percentage change; HDP, hypertensive disorders of pregnancy. ]]
*In developing countries the prevalence of preeclampsia, the precursor of eclampsia, ranges from 1.8% to 16.7%.
*From 1990 to 2019, prevalence, death and YLDs were highest in populations aged 25–29 years, followed by populations aged 30–34 and 20–24 years and lowest in those 10–14 and 55–59 years old.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The prevalence rate of HDP based on pregnant women was the lowest in the group aged 25–29 years but higher in the youngest and oldest age groups.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The prevalence of eclampsia was reported to be 0.56 per 1,000 births (from US data from 1979-86) and 26 per 1,000 births for pre-eclampsia.<ref>{{cite journal |journal= Am J Obstet Gynecol. 1990 Aug;163(2): 460-5. | title=Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. |author=Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. |pmid=2396132}}</ref>  
*While mortality can be kept low when antenatal care and [[maternal-fetal medicine| maternal-fetal services]] are provided, mortality rates are substantial in challenging settings. In a setting in India, [[maternal mortality]] and [[perinatal mortality]] were reported to be 32% and 39%, respectively, in the year 1993.<ref> {{cite journal |author= Swain S, Ojha KN, Prakash A, Bhatia BD.| title=Maternal and perinatal mortality due to eclampsia. |journal=Indian Pediatr. 1993 Jun;30(6):771-3}}</ref>
 
===Age===
*From 1990 to 2019, incidence, prevalence, death and YLDs were highest in populations aged 25–29 years, followed by populations aged 30–34 and 20–24 years and lowest in those 10–14 and 55–59 years old.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
*The incidence and prevalence rate of HDP based on pregnant women was the lowest in the group aged 25–29 years but higher in the youngest and oldest age groups.<ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
 
===Gender===
Eclampsia, one of the four [[hypertensive disorders of the pregnancy]], has been defined as a female [[sex-specific]] [[cardiovascular]] disorder, usually during or after the 20<sup>th</sup> week of [[gestation]] or in the [[postpartum period]].
 
===Race===
Eclampsia patterns varies by race and ethnicity. Non-Hispanic black women are more probable to have a pregnancy with chronic hypertension and to develop mild, severe or superimposed preeclampsia/eclampsia syndrome.
 
===Impact===
*Total deaths attributable to pregnancy-related causes are over half a million and 99% of these deaths come from low- to middle-income nations.
*High blood pressure during pregnancy is seen in ten percent of women and preeclampsia complicates 2% to 8% of pregnancies which can include problems in the liver, kidneys, brain and the clotting system and risks for the baby include poor growth and prematurity.<ref name="pmid19464502">{{cite journal| author=Duley L| title=The global impact of pre-eclampsia and eclampsia. | journal=Semin Perinatol | year= 2009 | volume= 33 | issue= 3 | pages= 130-7 | pmid=19464502 | doi=10.1053/j.semperi.2009.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19464502  }} </ref>
*Although preeclampsia can be devastating and life-threatening the outcome is often good and manageable.
*Overall, 10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia and most of these deaths are attributable to eclampsia, rather than preeclampsia.<ref name="pmid19464502">{{cite journal| author=Duley L| title=The global impact of pre-eclampsia and eclampsia. | journal=Semin Perinatol | year= 2009 | volume= 33 | issue= 3 | pages= 130-7 | pmid=19464502 | doi=10.1053/j.semperi.2009.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19464502  }} </ref>
*Perinatal mortality is high following preeclampsia, and even higher following eclampsia.
*The Millennium Development Goals have placed maternal health at the core of the struggle against poverty and inequality, as a matter of human rights.
*The number of deaths attributed to hypertensive disorders of pregnancy was approximately 27.83 thousand in 2019 which was a 30.05% decrease from the year 1990. <ref>Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-146936/v1]</ref>
 
===Challenges in prevention of eclampsia===
*[[Primary prevention]] of any disease process requires:
**recognising the risk factors and preventing exposure to them by altering unhealthy or unsafe behaviours via the availability of methods for prediction of those at high risk for the disorder
*[[Secondary prevention]] of any disease process requires:
**early detection, and
**early treatment
*Even though a myriad of clinical and biochemical examinations and investigations have been suggested for prediction or timely detection of preeclampsia, most remain unrealistic for extensive use in most developing nations. Currently, not a single reliable and cost-effective screening test exists for preeclampsia which can be recommended for use in most developing countries<ref> Wagner LK. Diagnosis and management of preeclampsia. American Family Physician. 2004;70(12):2317–2324. </ref>.
*Although some studies on [[uterine artery Doppler]] studies and first-trimester [[maternal serum markers]] for early detection of preeclampsia have shown promise<ref> Kharb S. Serum markers in pre-eclampsia. Biomarkers. 2009;14(6):395–400. </ref><ref> Audibert F, Boucoiran I, An N, et al. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. American Journal of Obstetrics and Gynecology. 2010;203(4):383.e1–383.e8. </ref><ref> Yale University. Simple test can help predict and diagnose preeclampsia. ScienceDaily. February 5, 2010  </ref>. There is not enough evidence to suggest their routine use in clinical practice, more so in resource poor settings<ref> Papageorghiou AT, Campbell S. First trimester screening for preeclampsia. Current Opinion in Obstetrics and Gynecology. 2006;18(6):594–600. </ref>.
*In terms of prophylaxis, [[aspirin]] therapy has been shown to be beneficial in decreasing the occurrence of preeclampsia in specific populations, for example, those with abnormal second trimester uterine Doppler flow<ref> Louden K, Kilby M. Low-dose aspirin: the rationale for preventing pre-eclampsia and intra-uterine growth retardation: a role after CLASP? In: Bonnar J, editor. Recent Advances in Obstetrics and Gynaecology, No 19. Edinburgh, UK: Churchill Livingstone; 1995. </ref><ref> Bujold E, Roberge S, Lacasse Y, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstetrics and Gynecology. 2010;116(2):402–414.  </ref><ref> Duley L, Henderson-Smart D, Knight M, King J. Antiplatelet drugs for prevention of pre-eclampsia and its consequences: systematic review. British Medical Journal. 2001;322(7282):329–333. </ref>. However, to recommend its widespread use in all patients is not judicious or evidence-based.
*Similarly, even though the Cochrane review has stated some usefulness of [[calcium]] supplementation, especially for those at greatest risk and those with low baseline calcium consumption<ref> Atallah AN, Hofmeyr GJ, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 2002;(1) Article ID CD001059. [PubMed] [Google Scholar]
</ref><ref> Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews. 2010;8 Article ID CD001059. </ref>, the dilemma of choosing appropriate patients to be started on the therapy can be demanding from a public health perspective.
*Also, findings of earlier studies that previously indicated the benefits of vitamin supplementation<ref> Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. Journal of Clinical Endocrinology and Metabolism. 2007;92(9) </ref> <ref> Marya RK, Rathee S, Manrow M. Effect of calcium and vitamin D supplementation on toxaemia of pregnancy. Gynecologic and Obstetric Investigation. 1987;24(1):38–42. </ref><ref> Olsen SF, Secher NJ. A possible preventive effect of low-dose fish oil on early delivery and pre-eclampsia: Indications from a 50-year-old controlled trial. British Journal of Nutrition. </ref><ref> Bodnar LM, Tang G, Ness RB, Harger G, Roberts JM. Periconceptional multivitamin use reduces the risk of preeclampsia. American Journal of Epidemiology. 2006;164(5):470–477. </ref>have been refuted by a recent study by the WHO particularly for vitamins C and E <ref> Villar J, Purwar M, Merialdi M, et al. World Health Organisation multicentre randomised trial of supplementation with vitamins C and e among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries. BJOG. 2009;116(6):780–788. </ref>.


==References==
==References==

Latest revision as of 14:21, 13 August 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [10]

Overview

Hypertensive disorders of pregnancy (HDP), defined as a sex-specific cardiovascular disease, is one of the leading causes of maternal and fetal morbidity and mortality globally and a critical threat to maternal and infant health. [1][11] Preeclampsia is a pregnancy-related hypertensive disorder occurring usually after 20 weeks of gestation and if left untreated, it progresses to eclampsia.[2] Preeclampsia and eclampsia are not distinct disorders but the manifestation of the spectrum of clinical symptoms of the same condition. Although preeclampsia prevails to be a significant public health threat in both developed and developing nations bringing maternal and perinatal morbidity and mortality worldwide, [3][4]the impact of the disease is witnessed to be harsher in the developing countries [5] [6],where, unlike other more prevalent causes of maternal mortality (such as haemorrhage and sepsis), medical interventions may be ineffective due to late presentation of cases[7][8]. The problem is confounded by the continued ambivalence of the aetiology and the unpredictable behavior of the disease [9]. According to WHO, the incidence of preeclampsia is seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%).[10] In developing countries the prevalence of preeclampsia, the precursor of eclampsia, ranges from 1.8% to 16.7% and from 1990 to 2019, the incidence, prevalence, death and YLDs were highest in populations aged 25–29 years.

Epidemiology and Demographics of Eclampsia

Incidence

  • Since preeclampsia and eclampsia are one of the main causes of maternal deaths, the data on incidence is required at both national and local levels to inform policies to further target the affected population and for the focused distribution of resources.
  • According to WHO, the incidence of preeclampsia is seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%).[11]
  • The incidence of eclampsia in the developed countries of North America and Europe is similar and estimated to be about 5–7 cases per 10,000 deliveries. On the other hand, incidence of eclampsia in developing nations varies widely, ranging from 1 case per 100 pregnancies to 1 case per 1700 pregnancies [2, 14]. Rates from African countries such as South Africa, Egypt, Tanzania, and Ethiopia range from 1.8% to 7.1% [12][13]. The prevalence in Nigeria spans between 2% to 16.7%.[14][15]
  • A systematic review conducted for the incidence of hypertensive disorders of pregnancy (HDP) with the objective of evaluating its magnitude globally, representing 39 million women from 40 countries, estimates the incidence to be 4.6% (95% uncertainty range 2.7-8.2), and 1.4% (95% uncertainty range 1.0-2.0) of all deliveries for preeclampsia and eclampsia respectively, with a wide variation across regions.[16]
  • The incidence of hypertensive disorders of pregnancy increased from 16.30 million to 18.08 million worldwide, with a total increase of 10.92% from 1990 to 2019.[17]
  • The age-standardized incidence rate decreased, with an estimated annual percentage change of -0.68 (95% CI -0.49 to -0.86). Worldwide, the age-standardized incidence rate (ASIR) decreased from 579 (95% UI 482 to 689) per 100,000 population in 1990 to 463 (95% UI 392 to 541) per 100,000 population in 2019. Age-standardized incidence rates were higher in countries/regions with lower sociodemographic indices and human development indices.[18]
  • The estimated incidence rate was lowest in the group aged 25-29 years and higher in the youngest and oldest groups.[19]
  • The Estimated Annual Percentage Change fot the age-standardized deaths rate (ASDR) was − 2.38 (95% CI 1.67 to -6.27).
  • Positive associations between incidence and sociodemographic index and human development index were found for all countries and regions in 2019.[20]

Prevalance

Overview of HDP by country and region for both sexes combined. (A) The prevalence of HDP in 2019 (B) The ASIR of HDP per 100,000 population in 2019. (C) The EAPC in the ASDR of HDP from 1990 to 2019. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; EAPC, estimated annual percentage change; HDP, hypertensive disorders of pregnancy.
  • In developing countries the prevalence of preeclampsia, the precursor of eclampsia, ranges from 1.8% to 16.7%.
  • From 1990 to 2019, prevalence, death and YLDs were highest in populations aged 25–29 years, followed by populations aged 30–34 and 20–24 years and lowest in those 10–14 and 55–59 years old.[21]
  • The prevalence rate of HDP based on pregnant women was the lowest in the group aged 25–29 years but higher in the youngest and oldest age groups.[22]
  • The prevalence of eclampsia was reported to be 0.56 per 1,000 births (from US data from 1979-86) and 26 per 1,000 births for pre-eclampsia.[23]
  • While mortality can be kept low when antenatal care and maternal-fetal services are provided, mortality rates are substantial in challenging settings. In a setting in India, maternal mortality and perinatal mortality were reported to be 32% and 39%, respectively, in the year 1993.[24]

Age

  • From 1990 to 2019, incidence, prevalence, death and YLDs were highest in populations aged 25–29 years, followed by populations aged 30–34 and 20–24 years and lowest in those 10–14 and 55–59 years old.[25]
  • The incidence and prevalence rate of HDP based on pregnant women was the lowest in the group aged 25–29 years but higher in the youngest and oldest age groups.[26]

Gender

Eclampsia, one of the four hypertensive disorders of the pregnancy, has been defined as a female sex-specific cardiovascular disorder, usually during or after the 20th week of gestation or in the postpartum period.

Race

Eclampsia patterns varies by race and ethnicity. Non-Hispanic black women are more probable to have a pregnancy with chronic hypertension and to develop mild, severe or superimposed preeclampsia/eclampsia syndrome.

Impact

  • Total deaths attributable to pregnancy-related causes are over half a million and 99% of these deaths come from low- to middle-income nations.
  • High blood pressure during pregnancy is seen in ten percent of women and preeclampsia complicates 2% to 8% of pregnancies which can include problems in the liver, kidneys, brain and the clotting system and risks for the baby include poor growth and prematurity.[27]
  • Although preeclampsia can be devastating and life-threatening the outcome is often good and manageable.
  • Overall, 10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia and most of these deaths are attributable to eclampsia, rather than preeclampsia.[27]
  • Perinatal mortality is high following preeclampsia, and even higher following eclampsia.
  • The Millennium Development Goals have placed maternal health at the core of the struggle against poverty and inequality, as a matter of human rights.
  • The number of deaths attributed to hypertensive disorders of pregnancy was approximately 27.83 thousand in 2019 which was a 30.05% decrease from the year 1990. [28]

Challenges in prevention of eclampsia

  • Primary prevention of any disease process requires:
    • recognising the risk factors and preventing exposure to them by altering unhealthy or unsafe behaviours via the availability of methods for prediction of those at high risk for the disorder
  • Secondary prevention of any disease process requires:
    • early detection, and
    • early treatment
  • Even though a myriad of clinical and biochemical examinations and investigations have been suggested for prediction or timely detection of preeclampsia, most remain unrealistic for extensive use in most developing nations. Currently, not a single reliable and cost-effective screening test exists for preeclampsia which can be recommended for use in most developing countries[29].
  • Although some studies on uterine artery Doppler studies and first-trimester maternal serum markers for early detection of preeclampsia have shown promise[30][31][32]. There is not enough evidence to suggest their routine use in clinical practice, more so in resource poor settings[33].
  • In terms of prophylaxis, aspirin therapy has been shown to be beneficial in decreasing the occurrence of preeclampsia in specific populations, for example, those with abnormal second trimester uterine Doppler flow[34][35][36]. However, to recommend its widespread use in all patients is not judicious or evidence-based.
  • Similarly, even though the Cochrane review has stated some usefulness of calcium supplementation, especially for those at greatest risk and those with low baseline calcium consumption[37][38], the dilemma of choosing appropriate patients to be started on the therapy can be demanding from a public health perspective.
  • Also, findings of earlier studies that previously indicated the benefits of vitamin supplementation[39] [40][41][42]have been refuted by a recent study by the WHO particularly for vitamins C and E [43].

References

  1. ↑ Garovic V, White W, Vaughan L, Saiki M, Parashuram S, Garcia-Valencia O,et al. Incidence and long-term outcomes of hypertensive disorders of pregnancy. J Am Coll Cardiol. 2020;75(18):2323–34
  2. ↑ Medicine for Africa - Medical Information Service. preeclampsia/ eclampsia. 2008, http://www.medicinemd.com/
  3. ↑ World Health Organization. Global Program to Conquer Preeclampsia/Eclampsia. 2002.
  4. ↑ McClure EM, Saleem S, Pasha O, Goldenberg RL. Stillbirth in developing countries: a review of causes, risk factors and prevention strategies. Journal of Maternal-Fetal and Neonatal Medicine. 2009;22(3):183–190.
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  7. ↑ Ikechebelu JI, Okoli CC. Review of eclampsia at the Nnamdi Azikiwe University teaching hospital, Nnewi (January 1996-December 2000) Journal of Obstetrics and Gynaecology. 2002;22(3):287–290
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  15. ↑ Population Council Nigeria. Administering Magnesium Sulfate to Treat Severe Pre-eclampsia and Eclampsia. 2009,http://www.popcouncil.org/projects/134_AdminMagSulfPreeclampsia.asp.
  16. ↑ Abalos E, Cuesta C, Grosso AL, Chou D, Say L (2013). "Global and regional estimates of preeclampsia and eclampsia: a systematic review". Eur J Obstet Gynecol Reprod Biol. 170 (1): 1–7. doi:10.1016/j.ejogrb.2013.05.005. PMID 23746796.
  17. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [1]
  18. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [2]
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  20. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [4]
  21. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [5]
  22. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [6]
  23. ↑ Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. "Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986". Am J Obstet Gynecol. 1990 Aug;163(2): 460-5. PMID 2396132.
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  26. ↑ Wei Wang, Xin Xie, Ting Yuan et al. Epidemiological Trends of Maternal Hypertensive Disorders of Pregnancy at the Global, Regional, and National Levels: A Population-Based Study, 18 January 2021, PREPRINT (Version 1) available at Research Square [8]
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  29. ↑ Wagner LK. Diagnosis and management of preeclampsia. American Family Physician. 2004;70(12):2317–2324.
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