Noor Hidayah, Oktia Woro Kasmini Handayani, Ari Yuniastuti, Dina Nur Anggraini Ningrum

Hypertension in Pregnancy: A Nested Case-Control Study

Introduction

Hypertension in pregnancy: a nested case-control study. Hypertension in pregnancy causes significant maternal/neonatal mortality. This study reveals gestational age >20 weeks, obesity, and non-primigravida status as key risk factors in Indonesia.

Abstract

Hypertension during pregnancy is the leading cause of maternal and neonatal morbidity and mortality. In Indonesia, 30 % of deaths are caused by hypertension. This study was conducted to analyze the risk factors for hypertension in pregnancy in mothers with high pregnancy risk. A nested case-control study design was employed, with data sourced from secondary records of obstetric medical documents from Gondosari Health Centre, Kudus Regency, Central Java Province, Indonesia, for the years 2021, 2022, and 2023. The number of hypertension cases was 46, and the number of controls was 92. The technique for collecting case data was based on reviewing the medical records of mothers with hypertension. In contrast, control data was taken by random sampling from mothers with high risk but who did not have hypertension. Statistical analysis used the chi-square (bivariate) and logistic regression (multivariate) tests. The study’s results stated that significant factors for hypertension in pregnancy were gestational age of 20 weeks, obesity, and primigravida with p 0.037, p 0.044, and p 0.010. Pregnant women > 20 weeks have a risk of 2.267 times to experience pregnancy hypertension, obesity has a risk of 4.288 times to experience hypertension in pregnancy, and non-primigravida status is at a higher risk of hypertension in pregnancy than primigravida mothers by 0.252 times. Mothers who have these three factors together have a probability of 80.79% of experiencing hypertension during pregnancy. This study concluded that gestational age > 20 weeks, obesity, and non-primigravida were related to the risk of hypertension in pregnancy at the study site; mothers who had gestational conditions > 20 weeks, obesity, and non-primigravida had the highest likelihood of developing hypertension in pregnancy.

Review

The study "Hypertension in Pregnancy: A Nested Case-Control Study" addresses a critically important public health issue, particularly in settings like Indonesia where hypertension during pregnancy contributes significantly to maternal and neonatal mortality. The chosen nested case-control design is appropriate for investigating risk factors within a defined cohort, utilizing readily available secondary data from medical records. The objective to analyze risk factors for hypertension in high-risk pregnancies at a specific health center is clear and highly relevant for local clinical practice and policy development. The study's focus on identifying potentially modifiable risk factors offers promising avenues for targeted interventions. The research effectively identified three statistically significant factors: gestational age > 20 weeks, obesity, and non-primigravida status. The reported odds ratios of 2.267 for gestational age > 20 weeks and 4.288 for obesity clearly quantify their impact, aligning with established understanding of these risk factors. The finding that mothers exhibiting all three factors have a high probability (80.79%) of developing hypertension during pregnancy provides a strong practical tool for risk stratification. However, the reporting for primigravida/non-primigravida requires clarification; the abstract states "non-primigravida status is at a higher risk... by 0.252 times," which is mathematically ambiguous if interpreted as an odds ratio for increased risk (typically >1). Clarification on whether primigravida status is protective (OR < 1) or non-primigravida status is a risk factor (OR > 1 relative to primigravida) would enhance precision. The use of chi-square and logistic regression for statistical analysis is appropriate given the study design and data type. While providing valuable insights, the study's reliance on secondary data from a single health center might introduce limitations regarding data completeness, accuracy, and generalizability to broader populations. The relatively small sample size (46 cases, 92 controls) for a nested case-control study, though appropriate for the specified setting, could limit the power to detect other potential risk factors or explore more complex interactions. Future research would benefit from larger, multi-center studies to confirm these findings and assess their wider applicability. Furthermore, investigating the specific mechanisms linking these identified factors to hypertension in pregnancy, or exploring intervention strategies based on these findings, could provide significant advancements. Despite these considerations, this study makes a meaningful contribution to understanding local risk profiles for pregnancy-induced hypertension and offers actionable information for healthcare providers at Gondosari Health Centre.

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