title: Perinatal outcomes after hypertensive disorders in pregnancy in a low resource setting.
abstract: OBJECTIVE
  The objective of this study was to evaluate perinatal outcomes of pregnancies complicated by hypertensive disorders in pregnancy in an urban sub-Saharan African setting.
  
  
  METHODS
  A prospective cohort study of 1010 women of less than 17 weeks of gestation was conducted at two antenatal clinics in Accra, Ghana, between July 2012 and March 2014. Information about hypertensive disorders was available for analysis on 789 pregnancies. The main outcomes were pre-term birth, birthweight, Apgar scores, small for gestational age and mortality. Relative risk (RR, 95% confidence interval (CI)) for the association between hypertensive disorders of pregnancy and perinatal outcomes was assessed using logistic regression adjusting for potential confounders.
  
  
  RESULTS
  A total of 88.7% of women remained normotensive, 7.5% developed pregnancy-induced hypertension, 2.0% had chronic hypertension, and 1.7% developed (pre-)eclampsia. No adverse effects were observed in women with pregnancy-induced hypertension. Women with chronic hypertension were more likely to have a lower gestational age at delivery (38.0 ± 2.3 weeks vs. 39.0 ± 1.9 weeks, P = 0.04) and higher risk of pre-term delivery (aRR 4.63, 95% CI 1.35-15.91). Women with pre-eclampsia had emergency Caesarean section significantly more often (88.9% vs. 50%, P = 0.04), with a higher risk for low birthweight infants (aRR 7.95, 95% CI 1.41-44.80) and a higher risk of neonatal death (aRR 18.41, 95% CI 1.20-283.22).
  
  
  CONCLUSIONS
  Comparable to high-income countries, in Accra hypertensive disorders during pregnancy were associated with increased risk of adverse perinatal outcomes necessitating maternal and newborn care.
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Browne
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Gelderse Vallei Hospital, Ede, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Vissers
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Ghana Health Service, Accra, Ghana.
authors.forename: E
authors.initials: E
authors.lastname: Antwi
authors.affiliation: Ridge Regional Hospital, Ghana Health Service, Accra, Ghana.
authors.forename: E K
authors.initials: EK
authors.lastname: Srofenyoh
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E L
authors.initials: EL
authors.lastname: Van der Linden
authors.affiliation: Department of Health Policy, Planning and Management, University of Ghana, Accra, Ghana.
authors.forename: I A
authors.initials: IA
authors.lastname: Agyepong
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: K
authors.initials: K
authors.lastname: Klipstein-Grobusch
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D002908:Chronic Disease; D003906:Developing Countries; D005260:Female; D005865:Gestational Age; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D066087:Perinatal Death / Q000209:etiology; D011203:Poverty; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D015995:Prevalence; D011446:Prospective Studies; D012016:Reference Values; D014505:Urban Population; D055815:Young Adult
keywords: Apgar scores; chronic hypertension; perinatal outcome; pre-eclampsia; pre-term birth; pregnancy-induced hypertension