PREVALENCE OF HYPERTENSIVE DISORDERS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN SELECTED PUBLIC HOSPITALS IN ADDIS ABABA, ETHIOPIA
Keywords:Hypertension, Pregnancy. Associated Risk Factors, Antenatal Care Clinics
Purpose: This study sought to assess the prevalence of hypertension in pregnancy and associated risk factors among women attending antenatal care clinics in selected Pubic Hospitals in Addis Ababa, Ethiopia.
Materials and Methods: The research employed a cross-sectional descriptive study design. Study population was pregnant women who attended ANC care in selected hospital. The respondents were randomly selected from Tikur Anbesa specialized, Zewuditu Memorial and St. Paul’s Millennium medical college hospitals. Respondents for interview were selected using systematic random sampling at an interval of nine until a sample size of 297 was reached. The study used an adopting both quantitative and qualitative data collection methods. Quantitative data was collected using structured questionnaires from pregnant women attending antenatal care clinics while qualitative data was collected using key informant interview schedules and Focused Group Discussion guides with Nurses in charge of antenatal care clinics and primary respondents respectively. Key informants and focused group discussants were purposively selected. Descriptive data was analysed using Statistical Package for Social Sciences version 20.0 with the aid of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Qualitative data was analysed using thematic analysis and results triangulated with quantitative data as direct quotes or narrations. Inferential statistics were calculated using Chi-Square tests done at 95% confidence interval and a margin of error of 0.05 to establish the association between variables. Information generated were presented in the text in the form of tables, bar graphs and pie charts.
Results: The study results revealed that the prevalence of pregnancy induced hypertension in Addis Ababa was 21.9%. Socio-demographic factors such as age (p=0.030), occupation (p=0.031), income (p=0.0014), highest level of education (p=0.001) and health insurance (p=0.001) were significantly associated with occurrence of hypertension in pregnancy. Rreproductive and obstetric factors such as age at first pregnancy (p=0.001), gravidity (p=0.046), parity (p=0.001), history of obesity (p=0.001) and occurrence of gestational diabetes (p=0.002) were significantly associated with hypertension in pregnancy. More than a half (51.9%) of respondents had negative attitude towards hypertensive disorder in pregnancy. The level of attitude (p=0.040) was significantly associated with occurrence of hypertension in pregnancy.
Unique contribution to theory, practice and policy: The study recommends that the management of the 3 health facilities together with other stakeholders in health empower women to start income generating projects to increase their financial access to antenatal care services consequently reduces hindrances that may lead to pregnancy complications such as hypertensive disorders in pregnancy.
Abimbola J., Makanjuola A., Ganiyu S., Babatunde U., Adekunle DK., Olatayo A., (2016). Pattern of utilization of ante-natal and delivery services in a semi-urban community of north-Central Nigeria. Afr Health Sci.; (962–71)
Ahmed, S. S., Sultana, N., Begum, M. L., Lima, L. S., Abedin, M. F., & Hosen, M. K. (2017). Pregnancy induced hypertension and associated factors among pregnant women. Journal of Gynecology and Women’s Health Volume 2 Issue, 4.
Alsnes, I. V., Vatten, L. J., Fraser, A., Bjørngaard, J. H., Rich-Edwards, J., Romundstad, P. R., & Åsvold, B. O. (2017). Hypertension in pregnancy and offspring cardiovascular risk in young adulthood: prospective and sibling studies in the HUNT study (Nord-Trøndelag Health Study) in Norway. Hypertension, 69(4), 591-598.
Amer, L., Kausar, R., & Khurshid, R. (2015). Family History is an early Predictor of Obesity, Diabetes and Hypertension in adults. PAKISTAN JOURNAL OF MEDICAL & HEALTH SCIENCES, 9(3), 888-891.
Amugsi, D. A., Dimbuene, Z. T., Mberu, B., Muthuri, S., & Ezeh, A. C. (2017). Prevalence and time trends in overweight and obesity among urban women: an analysis of demographic and health surveys data from 24 African countries, 1991–2014. BMJ open, 7(10), e017344.
Ananth, C. V., Skjaerven, R., & Klunssoyr, K. (2015). Change in paternity, risk of placental abruption and confounding by birth interval: a population-based prospective cohort study in Norway, 1967–2009. BMJ open, 5(2), e007023.
Asamoah B., Moussa K., Stafström M., Musinguzi G., (2011): Distribution of causes of Maternal mortality among different socio-demographic groups in Ghana; a descriptive study. BMC Public Health. (11:159).
Avcı, M. E., Şanlıkan, F., Celik, M., Avcı, A., Kocaer, M., & Göçmen, A. (2015). Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 28(17), 2080-2083.
Ayele, G., Lemma, S., & Agedew, E. (2016). Factors associated with hypertension during pregnancy in Derashie Woreda South Ethiopia, case control. Qual Prim Care, 24(5), 207-213.
Azubuike, S., & Danjuma, I. (2017). Hypertension in pregnancy among rural women in Katsina State, Nigeria. Journal of Basic and Clinical Reproductive Sciences, 6(1).
Badge, V. L., Pandey, M., Solanki, M. J., & Shinde, R. R. (2016). A cross-sectional study of migrant women with reference to their antenatal care services utilization and delivery practices in an urban slum of Mumbai. Journal of family medicine and primary care, 5(4), 759.
Barakat, R., Pelaez, M., Cordero, Y., Perales, M., Lopez, C., Coteron, J., & Mottola, M. F. (2016). Exercise during pregnancy protects against hypertension and macrosomia: randomized clinical trial. American journal of obstetrics and gynecology, 214(5), 649-e1.
Barasa, K. S., Wanjoya, A. K., & Waititu, A. G. (2015). Analysis of determinants of antenatal care services utilization in Nairobi County using logistic regression model. Am J Theor Appl Stat, 4(5), 322-8.
Baugh, N., Harris, D. E., Aboueissa, A. M., Sarton, C., & Lichter, E. (2016). The impact of maternal obesity and excessive gestational weight gain on maternal and infant outcomes in Maine: analysis of pregnancy risk assessment monitoring system results from 2000 to 2010. Journal of pregnancy, 2016.
Berg CJ., Callaghan WM., Swerson C., (2010): Pregnancy-related mortality in the United States,1998 to 2006. Obstet Gynecol 116(6):1302
Berg CJ., Harper M., Atkinson SM (2005): Preventability of pregnancy-related deaths. Obstet Gynecol (106:1228)
Bhat, A., & Kharde, S. (2019). Hypertensive Disorders of Pregnancy and Associated Factors. International Journal of Health Sciences and Research, 9(1), 128-131.
Bollampally, M., Chandershekhar, P., Kumar, K., Surakasula, A., Srikanth, S., & Reddy, T. (2016). Assessment of patient’s knowledge, attitude and practice regarding hypertension. Int J Res Med Sci, 4(6), 3299-304.
Butalia, S., Audibert, F., Côté, A. M., Firoz, T., Logan, A. G., Magee, L. A., ... & Nerenberg, K. A. (2018). Hypertension Canada’s 2018 guidelines for the management of hypertension in pregnancy. Canadian Journal of Cardiology, 34(5), 526-531.
Campbell D., MacGillivray I., Carr-Hill R., (2014): Pre-eclampsia in second pregnancy. Br J Obstet Gynaecol (92:131).
Cavkaytar, S., Seval, M. M., Atak, Z., Findik, R. B., Ture, S., & Kokanali, D. (2015). Effect of reproductive history, lactation, first pregnancy age and dietary habits on bone mineral density in natural postmenopausal women. Aging clinical and experimental research, 27(5), 689-694.
Chanda, M. M., Ortblad, K. F., Mwale, M., Chongo, S., Kanchele, C., Kamungoma, N., ... & Oldenburg, C. E. (2017). Contraceptive use and unplanned pregnancy among female sex workers in Zambia. Contraception, 96(3), 196-202.
Chasan-Taber, Lisa, Marushka Silveira, Penelope Pekow, Barry Braun, JoAnn E. Manson, Caren G. Solomon, and Glenn Markenson. "Physical activity, sedentary behavior and risk of hypertensive disorders of pregnancy in Hispanic women." Hypertension in pregnancy 34, no. 1 (2015): 1-16.
Cheng, T. S., Loy, S. L., Cheung, Y. B., Godfrey, K. M., Gluckman, P. D., Kwek, K., ... & Chan, J. K. Y. (2016). Demographic characteristics, health behaviors before and during pregnancy, and pregnancy and birth outcomes in mothers with different pregnancy planning status. Prevention Science, 17(8), 960-969.
Cunningham F. Gary., Kenneth J. Leveno., Steven L. Bloom., (2014). Williams Obstetrics, 24th Edition. USA, Chapter 42 (p. 1148)
Davids, J. S., Scully, R. E., & Melnitchouk, N. (2017). Impact of procedural training on pregnancy outcomes and career satisfaction in female postgraduate medical trainees in the United States. Journal of the American College of Surgeons, 225(3), 411-418.
Dawson LM., Parfrey PS., Hefferton D., (2013): Familial risk of preeclampsia in Newfoundland: A population-based study. J Am Soc Nephrol (13:1901).
Deborah M., Augustinus A., Fred YB., Anthony E., Lyonne M., Sam Newton & Charles Agyemang. (2013) Rural and urban differences in blood pressure and pregnancy-induced hypertension among pregnant women in Ghana, Globalization and Health
Dekker GA., Sibai BM., (2016). Etiology and pathogenesis of preeclampsia: current concepts. Am J ObstetGynecol (179:1359)
Deputy, N. P., Sharma, A. J., Kim, S. Y., & Hinkle, S. N. (2015). Prevalence and characteristics associated with gestational weight gain adequacy. Obstetrics and gynecology, 125(4), 773.
Dietl, Anna, and Juliane Farthmann. 2015. “Gestational Hypertension and Advanced Maternal Age.” The Lancet.
Duckitt K., Harrington D., (2005). Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies. BMJ 2005 (330:565).
Egharevba, J., Pharr, J., van Wyk, B., & Ezeanolue, E. (2017). Factors influencing the choice of child delivery location among women attending antenatal care services and immunization clinic in Southeastern Nigeria. International Journal of MCH and AIDS, 6(1), 82.
Jabuya Eucabeth Agola. Treatment compliance among women with pregnancy induced hypertension attending selected health facilities in Rachuonyo North Sub-County, Homabay County, Kenya. Diss. Kenyatta University, 2016.
Eze, E. D., Barasa, A., Adams, M. D., Rabiu, K. M., Ezekiel, I., Sulaiman, S. O., & Ponsiano, N. (2018). Determination, knowledge and prevalence of pregnancy-induced hypertension/eclampsia among women of childbearing age at same district Hospital in Tanzania. Int J Med Med Sci, 10(2), 19-26.
Fadare, R. I., Akpor, O. A., & Oziegbe, O. B. (2016). Knowledge and attitude of pregnant women towards management of pregnancy-induced hypertension in Southwest Nigeria. Journal of Advances in Medical and Pharmaceutical Sciences, 1-10.
Farland, L. V., Grodstein, F., Srouji, S. S., Forman, J. P., Rich-Edwards, J., Chavarro, J. E., & Missmer, S. A. (2015). Infertility, fertility treatment, and risk of hypertension. Fertility and sterility, 104(2), 391-397.
Gandhi K., & Rao V., (2014). Socio-demographic and other risk factors of pre-eclampsia at a Tertiary care hospital, karnataka: case control study. Journal of clinical and diagnostic research: JCDR, 8(9), JC01–JC4. doi:10.7860/JCDR/2014/10255.4802
Ganjali, M., Sepehri, Z., Amjadi, N., Bagheri, S., & Davoodi, M. (2017). Knowledge, attitude and functioning toward pregnancy induced hypertension in pregnant women referred to health centers in Zabol, 2014. Indian Journal of Forensic Medicine & Toxicology, 11(2), 241-245.
Garomssa H., Dwivedi A., (2008). Maternal mortality in Ambo Hospital: a five year Retrospective review. Ethiopian J Reprod Health. (2:2–13)
Gaugler I., Berends A., de Groot C., Steegers E., (2008) severe very early onset of Preeclampsia: subsequent pregnancies and future parental cardiovascular health. Eur J ObstetGynecolReprodBiol (140:171)
Gaym A., Bailey P., BLuwei P., Admasu K., Gebrehiwot Y., (2011): Disease burden due to Pre-Eclampsia/eclampsia and the Ethiopian health system’s response. Int J Gynecol Obstet (115:112–6).
George, M., George, N., & Ramesh, N. (2016). Awareness regarding anemia, gestational diabetes and pregnancy induced hypertension among antenatal women attending outpatient department in a rural hospital. Hindu, 142, 94-7.
Gizachew A., Abebe T., Tadesse A., (2015): Preeclampsia and associated factors among Pregnant women attending antenatal care in Dessie referral hospital. BMC Pregnancy and Childbirth (15:73).
Govender, T., Reddy, P., & Ghuman, S. (2018). Obstetric outcomes and antenatal access among adolescent pregnancies in KwaZulu-Natal, South Africa. South African Family Practice, 60(1).
Greiner, K. S., Speranza, R. J., Rincón, M., Beeraka, S. S., & Burwick, R. M. (2020). Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine, 33(8), 1427-1433.
Gu Y., Warren J., Walker N., Kennelly J., (2013): Gender differences in cardiovascular disease risk management for Pacific Islanders in primary care. Quality in primary care (21).
Gwamaka S., (2012): Utilization and factors affecting delivery in health facility among recent Delivered women in Nkasi District. Rukwa: Muhimbili University of Health and Allied Sciences
Haffejee, F., O’Connor, L., Govender, N., Reddy, P., Sibiya, M. N., Ghuman, S., ... & Borg, D. (2018). Factors associated with unintended pregnancy among women attending a public health facility in KwaZulu-Natal, South Africa. South African Family Practice, 60(3), 1-5.
Haji Mam, A. (2018). Does an antenatal educational programme decrease adverse pregnancy outcomes among obese pregnant women? A feasibility study in Kurdistan Region of Iraq.
Hercus, A., Dekker, G., & Leemaqz, S. (2020). Primipaternity and birth interval; independent risk factors for preeclampsia. The journal of maternal-fetal & neonatal medicine, 33(2), 303-306.
Hu, R., Li, Y. X., Di, H. H., Li, Z. W., Zhang, C. H., Shen, X. P., ... & Yan, W. R. (2015). Risk factors of hypertensive disorders among Chinese pregnant women. Journal of Huazhong University of Science and Technology [Medical Sciences], 35(6), 801-807.
Imoro, W. D. S. (2018). Awareness and health seeking behaviour of pregnant women about pregnancy induced hypertension in the Tamale Metropolis (Doctoral dissertation).
Kaphagawani, N. C., & Kalipeni, E. (2017). Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi. Global public health, 12(6), 694-710.
Kasim, R., Draman, N., Kadir, A. A., & Muhamad, R. (2016). Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan. Education in Medicine Journal, 8(4).
Khan KS., Wojdyla D., Say L., (2006): WHO analysis of causes of maternal death: a Systematic review. Lancet (367:1066).
Khosravi, S., Dabiran, S., Lotfi, M. and Asnavandy M., (2014): Study of the Prevalence of Hypertension and Complications of Hypertensive Disorders in Pregnancy. Open Journal of Preventive Medicine (860:867).
Kigenyi O., Tefera G., Nabiwemba E/, Orach C., (2013) Quality of intrapartum care at Mulago National referral hospital, Uganda: clients’ perspective. BMC Pregnancy Childbirth. (1:162).
Koo, B. K., Lee, J. H., Kim, J., Jang, E. J., & Lee, C. H. (2016). Prevalence of gestational diabetes mellitus in Korea: a national health insurance database study. PLoS One, 11(4).
Lee, K. W., Ching, S. M., Ramachandran, V., Yee, A., Hoo, F. K., Chia, Y. C., ... & Veettil, S. K. (2018). Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC pregnancy and childbirth, 18(1), 494.
Leng, J., Shao, P., Zhang, C., Tian, H., Zhang, F., Zhang, S., ... & Hu, G. (2015). Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PloS one, 10(3).
Li, X., Tan, H., Huang, X., Zhou, S., Hu, S., Wang, X., ... & Wen, S. W. (2016). Similarities and differences between the risk factors for gestational hypertension and preeclampsia: A population based cohort study in south China. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 6(1), 66-71.
Lim, C. C., & Mahmood, T. (2015). Obesity in pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 29(3), 309-319.
Luke, B. (2017). Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies. American journal of obstetrics and gynecology, 217(3), 270-281.
Maputle, S., Khoza, L., & Lebese, R. (2015). Knowledge towards pregnancy-induced hypertension among pregnant women in Vhembe District, Limpopo Province. Journal of Human Ecology, 51(1-2), 47-54.
Masho, S. W., Morris, M. R., & Wallenborn, J. T. (2016). Role of marital status in the association between prepregnancy body mass index and breastfeeding duration. Women's Health Issues, 26(4), 468-475.
Matejić B., Milićević M., Vasić V., Djikanović B., (2014) maternal satisfaction with organized Perinatal care in Serbian public hospitals. BMC Pregnancy Childbirth (1:14).
Mbouemboue, O. P., Cellou, D., Tamanji, M. T., Blakga, C., Kamdje, A. H. N., Ngoufack, J. O., & Youmbi, A. (2016). A Study on Factors Related to Hypertensive Disorders in Pregnancy in Ngaoundere (Adamawa Region, Cameroon). Clinical Medicine Research, 5(2), 6-12.
Mehta, B., Kumar, V., Chawla, S., Sachdeva, S., & Mahopatra, D. (2015). Hypertension in pregnancy: a community-based study. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 40(4), 273.
Misganaw A., (2012): Ethiopian Ministry of Health: Health and Health Related Indicators: Validity of Verbal Autopsy Method to determine causes of death among adults in the urban setting of Ethiopia. BMC Med Res Methodology (12:130).
Mpofu, J. J., de Moura, L., Farr, S. L., Malta, D. C., Iser, B. M., Bernal, R. T. I., ... & Lobelo, F. (2016). Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil—2011. Preventive medicine reports, 3, 333-337.
Muti, M., Tshimanga, M., Notion, G. T., Bangure, D., & Chonzi, P. (2015). Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC cardiovascular disorders, 15(1), 111.
Nilsson E, SalonenRos H, Cnattingius S, Lichtenstein P (2015): The importance of genetic and Environmental effects for pre-eclampsia and gestational hypertension: a family study. BJOG; (111:200).
Nimi, T., Fraga, S., Costa, D., Campos, P., & Barros, H. (2016). Prenatal care and pregnancy outcomes: a cross-sectional study in Luanda, Angola. International Journal of Gynecology & Obstetrics, 135, S72-S78.
Oso Y., Onen, D., (2009) A General Guide to Writing a Research Proposal and Report. Nairobi: Jomo Kenyatta Foundation.
Osungbade K., Ige O., (2011): Public health perspectives of preeclampsia in developing Countries: implication for health system strengthening J Pregnancy (2011:1095).
Otieno O., (2014): Factors influencing implementation of Free Maternal Services in Kenya. A Case of Public Hospitals in Nairobi County. Nairobi University of Nairobi Printing Press.
Otieno W., (2013). ’’Kenya’s Other Great Catastrophe: Women and Infants Dying in Childbirth,” The Guardian.
Patel, B. B., Gurmeet, P., Sinalkar, D. R., Pandya, K. H., Mahen, A., & Singh, N. (2016). A study on knowledge and practices of antenatal care among pregnant women attending antenatal clinic at a Tertiary Care Hospital of Pune, Maharashtra. Medical Journal of Dr. DY Patil University, 9(3), 354.
Phad, N., Dahlstrom, J. E., Ellwood, D., & Kent, A. L. (2015). The effect of pregnancy‐induced hypertensive disorders on placental growth along short and long axes and neonatal outcomes. Australian and New Zealand Journal of Obstetrics and Gynaecology, 55(3), 239-244.
Piveta, V., Campaner Ferrari Bernardy, C., & Malagutti Sodré, T. (2016). Perception of pregnancy risk by a group of pregnant women hypertensive hospitalized. Ciência, Cuidado e Saúde, 15(1).
Rocheleau, C. M., Bertke, S. J., Lawson, C. C., Romitti, P. A., Desrosiers, T. A., Agopian, A. J., ... & National Birth Defects Prevention Study. (2017). Factors associated with employment status before and during pregnancy: Implications for studies of pregnancy outcomes. American journal of industrial medicine, 60(4), 329-341.
Sachdeva P., Patel B., (2011) Bhatt M., A study of incidence and management of pregnancy Induced hypertension in Central Gujarat, India. International Journal of Universal Pharmacy and Life Sciences (61:70).
Saftlas A., Olson D., Franks A., (2014): Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. J ObstetGynecol (163:460).
Saucedo M., Deneux C., Bouvier C., (2013): Ten years of confidential inquiries into maternal Deaths in France, 1998–2007.ObstetGynecol (4:752).
Sekaran, U., Bougie R., John W., Son I., (2013): Research methods for business: skill building Approach 4th ed., p. (436).
Shikha S., Chandra S., Thimmaraju K., Mallick A., Kanchan D., Biswajit D., (2014): Socio-Demographic Profile of Pregnancy Induced Hypertension in a Tertiary Care Centre, Sch. App. Med. Sci (3081:3086)
Sibai B., Mercer B., Sarinoglu C., (2014): Severe preeclampsia in the second trimester: Recurrence risk and long-term prognosis. Am J ObstetGynecol (165:1408).
Sibai B., Nazer A., Gonzalez A., (2014): Severe preeclampsia-eclampsia in young prim gravid Women: subsequent pregnancy outcome and remote prognosis. Am J ObstetGynecol (155:1011).
Singh, V., & Srivastava, M. (2015). Associated risk factors with pregnancy-induced hypertension: A hospital-based KAP study. International Journal of Medicine and Public Health, 5(1).
Spracklen, C. N., Ryckman, K. K., Triche, E. W., & Saftlas, A. F. (2016). Physical activity during pregnancy and subsequent risk of preeclampsia and gestational hypertension: a case control study. Maternal and child health journal, 20(6), 1193-1202.
Steegers E., Dadelszen P., Duvekot J., Pijnenborg R., (2010): Preeclampsiaa. Lancet. (376:631–41).
Stüber, T. N., Künzel, E. C., Zollner, U., Rehn, M., Wöckel, A., & Hönig, A. (2015). Prevalence and associated risk factors for obesity during pregnancy over time. Geburtshilfe und Frauenheilkunde, 75(09), 923-928.
Tessema, G. A., Tekeste, A., & Ayele, T. A. (2015). Preeclampsia and associated factors among pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based study. BMC pregnancy and childbirth, 15(1), 73.
Umesawa, M., & Kobashi, G. (2017). Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertension Research, 40(3), 213-220.
Van Der Hoeven, T., Browne, J. L., Uiterwaal, C. S., Van Der Ent, C. K., Grobbee, D. E., & Dalmeijer, G. W. (2017). Antenatal coffee and tea consumption and the effect on birth outcome and hypertensive pregnancy disorders. PloS one, 12(5).
Van Rijn B., Hoeks L., Bots M., (2006): Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia. Am J ObstetGynecol (195:723).
Wolde Z., Segni H., Woldie M., (2011): hypertensive disorders of pregnancy in Jimma University specialized hospital. Ethiopia J Health Sci. (21(3):147).
World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.
Xiong X., Fraser WD., Demianczuk N., (2012) History of abortion, preterm, term birth, and risk of preeclampsia: a population-based study. Am J ObstetGynecol (187:1013).
Yeoh, P. L., Hornetz, K., & Dahlui, M. (2016). Antenatal care utilisation and content between low-risk and high-risk pregnant women. PLoS One, 11(3).
Yuce, T., Keskin, M., Seval, M. M., & Söylemez, F. (2015). Effect of the timing of delivery on perinatal outcomes at gestational hypertension. Interventional Medicine and Applied Science, 7(2), 59-62.
Yuniarini, Y. (2017, September). Adolescent Pregnancy Worldwide: A Narrative Review. In Proceedings of the International Conference on Applied Science and Health (No. 2, pp. 34-38).
Zhang, S., Wang, L., Leng, J., Liu, H., Li, W., Zhang, T., ... & Hu, G. (2017). Hypertensive disorders of pregnancy in women with gestational diabetes mellitus on overweight status of their children. Journal of human hypertension, 31(11), 731-736.
Zhuang, C., Gao, J., Liu, J., Wang, X., He, J., Sun, J., ... & Liao, S. (2019). Risk factors and potential protective factors of pregnancy‐induced hypertension in China: A cross‐sectional study. The Journal of Clinical Hypertension, 21(5), 618-623.