title: Pre-pregnancy high-risk factors at first antenatal visit: how predictive are these of pregnancy outcomes?
abstract: OBJECTIVE
  To determine relationships between pre-pregnancy risk factors at first antenatal visit booking and pregnancy outcomes.
  
  
  METHODS
  This was a multicenter, cross-sectional study involving women admitted for singleton delivery from July 1 until October 31 (3 months), 2013, at nine major maternity clinics in Kinshasa, Democratic Republic of Congo. All women were checked for hereditary, community, and personal medical/surgical risk situations and mother/infant problems in previous pregnancies. Maternal and perinatal complications related to current/just-terminated pregnancy were analyzed according to pre-pregnancy risk factors in order to establish their prediction concerning maternal and perinatal complications related to current/just-terminated pregnancy (odds ratios). Results are given with 95% confidence intervals, and P<0.05 was considered significant.
  
  
  RESULTS
  The study sample comprised 2,086 women. Primiparity (36.5%), single relationship status (26.4%), and maternal age ≥35 years (18.3%) were the most important non-pathologic risk factors, while arterial hypertension in family (34.3%), previous miscarriage (33.2%), overweight/obesity (21.9%), diabetes in family (21.1%), previous cesarean section (15.7%), previous postpartum hemorrhage (13.1%), low birth weight (10%), previous macrosomia (10%), and previous premature rupture of membranes (6.2%) predominated among pathologic risk factors. Major adverse outcomes recurred in some women, with recurrence rates of 21/37 (57%), 111/208 (53%), 74/208 (36%), 191/598 (32%), 132/466 (28%), 24/130 (18%), and 4/65 (6%) for prematurity, low birth weight, macrosomia, preeclampsia/eclampsia, cesarean section, premature rupture of membranes, and stillbirth, respectively. Outcomes that were significantly influenced by non-pathologic risk factors were also significantly influenced by pathologic risk factors.
  
  
  CONCLUSIONS
  Pregnancy adverse outcomes are strongly influenced by either non-pathologic or pathologic pre-pregnancy risk factors at first antenatal visit booking. The recurrence potential of complications is one reason to establish the predictability and preventability of morbidity such that the most appropriate referrals and best options throughout the pregnancy can be determined.
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Barthélémy
authors.initials: B
authors.lastname: Tandu-Umba
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Muela Andy
authors.initials: MA
authors.lastname: Mbangama
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Kitenge Marc Brunel
authors.initials: KM
authors.lastname: Kamongola
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Armel Georges
authors.initials: AG
authors.lastname: Kamgang Tchawou
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Mawamfumu Perthus
authors.initials: MP
authors.lastname: Kivuidi
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Sam
authors.initials: S
authors.lastname: Kasonga Munene
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Irène
authors.initials: I
authors.lastname: Kambashi Meke
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Oscar
authors.initials: O
authors.lastname: Kapuku Kabasele
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Bituemi Jackson
authors.initials: BJ
authors.lastname: Kondoli
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Kibundila Rolly
authors.initials: KR
authors.lastname: Kikuni
authors.affiliation: Department of Obstetrics and Gynecology, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo.
authors.forename: Simon
authors.initials: S
authors.lastname: Kasikila Kuzungu
keywords: developing countries; maternal/perinatal outcomes; pre-pregnancy risk factors; recurrence