RISK FACTORS ASSOCIATED WITH ADVERSE PREGNANCY OUTCOMES AMONG WOMEN OF REPRODUCTIVE AGE

(A CASE STUDY OF SOBA L.G.A KADUNA STATE)

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Author

Presented To

Department of Medicine

ABSTRACT
Adverse outcomes of pregnancy include: miscarriages, preterm delivery, low birth weight babies, stillbirth, maternal morbidity and maternal mortality. The most severe adverse outcome of pregnancy is the death of the mother or the offspring. Poor pregnancy outcomes are influenced by a myriad of biological, social and environmental factors. Maternal mortality In Nigeria is currently 545-630/100,000 live births. According to the World Health Organization 75% percent of the maternal deaths in Africa are attributable to direct obstetric complications, such as hemorrhage, obstructed labor, infection, toxemia, and unsafe induced abortion. However it is now clear that these complications are not necessarily fatal; they cause deaths only because they occur within the context of the severe socioeconomic deprivations that are present in these countries. This study was conducted to identify the risk factors associated with adverse pregnancy outcomes and measure their effect on maternal health. One research assistant and six data collectors were recruited and trained. We conducted a case control study using a structured pre-tested questionnaire involving 138 respondents (69 cases and 69 controls). Information was obtained on demographic, pregnancy outcomes, risk factors and current health status. Anthropometric measurements were obtained using weighing scales and standiometers. Body mass indices were subsequently calculated. Blood pressure measurements were taken using aneroid sphygmomanometers. Qualitative data was also obtained using six focus group discussions (FGDs) comprising grandmothers, mothers and teenagers. Univariate, bivariate and multivariate analysis was done using Epi-info version 3.5.3. Qualitative data were analyzed by thematic fields using a coding sheet in Microsoft excel software. viii The median age of cases: 25 years (Range: 16-43), controls: 27 years (Range: 16-44). Compared with controls, the cases did not differ significantly in terms of residence and income. Bivariate analysis showed Cases were more likely to: number of pregnancies ≥4 (OR: 5.6; 95% CI: 2.6-12.6), commence early antenatal (ANC) attendance <4months (OR: 0.4; 95% CI: 0.2-0.99) and height <1.52 meters (OR: 0.2; 95% CI 0.1-0.7) compared with controls. Unconditional logistic regression revealed: ANC attendance <4 months: (aOR: 0.32; 95%CI: 0.12-0.81) and Number of pregnancies ≥4: (aOR: 5.02; 95% CI: 1.97-12.82) to be protective and increase risk of adverse outcomes respectively. No respondent 0(0.0%) had ever received pre-conception care or counseling. Cases were more likely to have ongoing health problems (OR: 2.1; 95% CI: 0.8-5.4) though insignificant. Qualitative findings identified hypertension, bleeding and eclampsia as the commonest adverse pregnancy outcomes. Majority of respondents believed early antenatal care; delayed marriage and improved girl child education would improve outcomes. Risk factors significantly associated with adverse outcomes are multiple pregnancies and delayed antenatal care. We recommended introduction of pre-conception care and counseling, frequent community health talks, early antenatal care, and improvement of maternal care facilities at the rural hospital, girl child education and utilization of family planning services. KEY WORDS: Adverse, Hypertension, Miscarriage, Outcome, Pregnancy