Cohabitation duration, obstetric, behavioral and nutritional factors predict preeclampsia among nulliparous women in West Amhara Zones of Ethiopia: Age matched case control study

Background
Preeclampsia is a major cause of maternal and perinatal mortality in developing countries. Identifying its risk factors is essential for early diagnosis and management. However, there has been a paucity of information on predictors of preeclampsia among nulliparous women in a resource limited setting. This study bridges the gap in this regard by examining the association of cohabitation duration, obstetric, behavioral and nutrition factors with preeclampsia among nulliparous women in West Amhara Zones of Ethiopia.
Methods
Age matched case-control study design was employed among 110 preeclamptic and 220 non-preeclamptic women who came for delivery services at Felege Hiwot, Addis Alem, and Debre Tabor hospitals. Double population proportion formula with an assumption of 95% confidence interval, 80% power and a 2:1 control to case ratio was used to calculate sample size. Epi data 3.1 and SPSS 20 were used for data entry and analysis, respectively. Magnitudes of cohabitation duration, obstetric, behavioral and nutritional factors among nulliparous women with preeclampsia and their controls were calculated and the differences were tested with a Chi-square test. Conditional bivariable and multivariable logistic regression analysis were fitted to identify predictors of preeclampsia. Odds ratio along with their 95% confidence interval were used to identify the strength, direction and significance of association. Ethical clearance was secured from the research ethics committee of the School of Public Health in Addis Ababa University.
Results
A total of 107 cases and 214 controls completed the interview giving a response rate of 97.27% for both cases and controls. Short cohabitation duration (AOR = 2.13, 95% CI (1.10, 4.1)), unplanned pregnancy (AOR = 2.35, 95% CI (1.01, 5.52)), and high body weight (AOR = 2.00, 95% CI (1.10, 3.63)) were found to be significant risk factors for preeclampsia. Whereas, antenatal advice about nutrition (AOR = 0.52, 95% CI (0.29, 0.96)), vegetable intake (AOR = 0.42, 95% CI (0.22, 0.82)) and fruit intake during pregnancy (AOR = 0.45, 95% CI (0.24, 0.87)) were protective factors for preeclampsia.
Conclusion
Special attention should be given to nulliparous women with short cohabitation duration, unplanned pregnancy, and high body weight to minimize the effect of preeclampsia. Nutritional counseling shall be stressed during antenatal care follow ups.

背景
子痫前期（preeclampsia）是发展中国家孕产妇与围产儿死亡的主要诱因之一。明确其危险因素对早期诊断与临床管理至关重要。然而，在资源受限的医疗环境中，关于初产妇（nulliparous women）子痫前期预测因素的相关研究信息较为匮乏。本研究聚焦埃塞俄比亚西阿姆哈拉州的初产妇群体，探讨同居时长、产科相关因素、行为因素及营养因素与子痫前期的关联，以此填补该领域的研究空白。

方法
本研究采用年龄匹配的病例对照研究设计，纳入在费莱盖希沃特（Felege Hiwot）医院、阿迪斯阿莱姆（Addis Alem）医院及德布雷塔博尔（Debre Tabor）医院接受分娩服务的110例子痫前期患者与220名非子痫前期孕妇。样本量计算采用双总体比例公式，预设95%置信区间、80%检验效能，且对照与病例比例为2:1。数据录入采用Epi Data 3.1软件，数据分析采用SPSS 20软件。分别计算初产妇中子痫前期患者与对照者的同居时长、产科、行为及营养因素的检出情况，并通过卡方检验比较组间差异。采用条件性双变量及多变量logistic回归分析识别子痫前期的预测因素，以比值比（odds ratio, OR）及其95%置信区间明确关联的强度、方向与统计学显著性。本研究已获得亚的斯亚贝巴大学公共卫生学院研究伦理委员会的伦理批准。

结果
最终共有107例病例与214名对照完成访谈，病例组与对照组的应答率均为97.27%。分析显示，短同居时长（调整后比值比AOR=2.13，95%CI(1.10, 4.1)）、非计划妊娠（AOR=2.35，95%CI(1.01, 5.52)）及高体重（AOR=2.00，95%CI(1.10, 3.63)）为子痫前期的显著危险因素；而孕期产前营养咨询（AOR=0.52，95%CI(0.29, 0.96)）、孕期蔬菜摄入（AOR=0.42，95%CI(0.22, 0.82)）及孕期水果摄入（AOR=0.45，95%CI(0.24, 0.87)）则为子痫前期的保护因素。

结论
应重点关注同居时长较短、非计划妊娠及体重偏高的初产妇，以降低子痫前期带来的不良影响。产前保健随访过程中，需强化营养咨询相关工作。