title: Hypertensive disease in pregnancy in Botswana: Prevalence and impact on perinatal outcomes.
abstract: OBJECTIVE
  Perinatal morbidity in sub-Saharan Africa has been attributed to infection, obstetric emergencies, and preterm birth, but less is known about hypertension in pregnancy. Our objective was to characterize the prevalence of hypertension in pregnancy and the impact of hypertension on perinatal outcomes in sub-Saharan Africa.
  
  
  METHODS
  We performed surveillance of obstetric records at eight of the largest public hospitals in Botswana. Women were included in this analysis if they were HIV-uninfected and had singleton gestations and at least one prenatal blood pressure measurement.
  
  
  METHODS
  We measured stillbirth, preterm birth, small for gestational age, and neonatal death in women with and without hypertension in pregnancy.
  
  
  RESULTS
  We included 14,170 pregnancies. Hypertension occurred in 3156 (22.2%) women, with 602 (19.1%) defined as severe. Severe hypertension increased risk of stillbirth (RR 4.4; 95% CI 3.2-6.2), preterm birth (RR 2.5; 95% CI 2.2-2.8), small for gestational age (RR 2.7; 95% CI 2.3-3.1) and neonatal death (RR 5.1; 95% CI 2.9-5.6). Non-severe hypertension increased risk of stillbirth (RR 2.0; 95% CI 1.5-2.7), preterm birth (RR 1.2; 95% CI 1.1-1.3), and small for gestational age (RR 1.6; 95% CI 1.4-1.8). Perinatal outcomes were worse in women with hypertension who had spontaneous preterm birth compared to those who underwent iatrogenic preterm delivery.
  
  
  CONCLUSIONS
  Hypertension in pregnancy is common in Botswana and leads to a large number of adverse outcomes. Improved management of hypertension in pregnancy may improve perinatal morbidity and mortality.
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States. Electronic address: kjohnso8@bidmc.harvard.edu.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Johnson
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Botswana-Harvard Partnership, Gaborone, Botswana.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zash
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States.
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Haviland
authors.affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Luckett
authors.affiliation: Botswana-Harvard Partnership, Gaborone, Botswana.
authors.forename: Modiegi
authors.initials: M
authors.lastname: Diseko
authors.affiliation: Botswana-Harvard Partnership, Gaborone, Botswana.
authors.forename: Gloria
authors.initials: G
authors.lastname: Mayondi
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Botswana-Harvard Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
authors.forename: Roger
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D001902:Botswana / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007223:Infant; D007226:Infant Mortality; D007236:Infant, Small for Gestational Age; D007751:Labor, Induced; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult