Association between perinatal behaviors and hypertensive disorders among pregnant and postpartum women in Southern Africa

Abstract

Background: Hypertensive Disorders of Pregnancy (HDP) are among the primary causes of maternal and newborn infant deaths and morbidity globally. It affects between 5 to 10% of pregnancies, and 14% of pregnant women worldwide die due to HDP related complications. There are several known HDP risk factors, both those that can be changed and those that cannot. However, there are conflicting reports on the impacts of dietary and behavioral habits on HDP. As a result, the role of perinatal behaviors on HDP outcomes remains unclear. Objective: This study aims to determine the prevalence of HDP and examine the association between perinatal behaviors and HDP among pregnant and postpartum women in three Southern African countries (South Africa, Namibia, and Lesotho). Methodology: This investigation employed a cross-sectional study design utilizing secondary data from the most recent population-based DHS programs for South Africa (2016), Lesotho (2014), and Namibia (2013). The study population comprised 1273 pregnant and postpartum women with complete blood pressure measurements. Chi-square statistical tests were conducted to describe the prevalence of HDP. Adjusted and unadjusted binary logistic regression analyses assessed the relationship between perinatal behaviors and HDP. Stata statistical software (v.14) was used for data management and analysis. Results: Of the 1273 participants enrolled in the study, about 221 (17.36%) HDP cases were identified, while the majority, 1052 (82.6%), had no HDP in all three Southern African countries. The prevalence of HDP was higher in Namibia (23.78%) and South Africa (23.75%) than Lesotho (11.54%). After accounting for confounders, only iron supplement intake, was confirmed to be a significant predictor of HDP. Iron supplement intake increased the odds of HDP by three fold among study participants (AOR: 2.99; CI: 2.00 to 3.72; p < 0.05). Conclusion This study concluded that of the five main predictor variables analyzed in this study, routine iron supplementation was the only significant predictor of HDP among pregnant and postpartum women in these three Southern African countries. HDP prevalence was notably higher in these three countries compared to global and regional estimates, with Namibia and South Africa showing higher rates than Lesotho, despite their upper middle-income status