DETERMINANTS AND MATERNAL–NEONATAL OUTCOMES OF HYPERTENSIVE DISORDERS OF PREGNANCY IN TERTIARY CARE HOSPITALS OF PAKISTAN: A MULTICENTER PROSPECTIVE COHORT STUDY

Abstract

Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and neonatal morbidity and mortality, particularly in low- and middle-income countries such as Pakistan. Understanding the determinants and associated outcomes is essential for improving maternal and neonatal health.

Objective: This multicenter prospective cohort study aimed to examine the socio-demographic and clinical determinants of HDP and evaluate its impact on maternal and neonatal outcomes in tertiary care hospitals of Pakistan.

Methods: A total of 1,000 pregnant women with gestational age ≥20 weeks were recruited from four tertiary care hospitals. Baseline socio-demographic and clinical data were collected, and participants were followed until delivery. Maternal and neonatal outcomes were recorded. Descriptive statistics, Chi-square tests, independent t-tests, and multivariate logistic regression were employed to identify determinants and assess associations, with p<0.05 considered statistically significant.

Results: The prevalence of HDP was 15%. Advanced maternal age (≥30 years), higher BMI, previous hypertension, diabetes mellitus, and fewer antenatal care visits were significant predictors of HDP (p<0.05). Women with HDP had higher rates of cesarean section (63% vs. 40%), postpartum hemorrhage (17% vs. 4%), ICU admission (10% vs. 1%), and maternal mortality (3% vs. 0.2%) compared to normotensive women. Neonates of hypertensive mothers had increased rates of preterm birth (40% vs. 14%), low birth weight (47% vs. 20%), NICU admission (37% vs. 13%), stillbirth (7% vs. 0.6%), and neonatal mortality (5% vs. 0.4%).

Conclusion: HDP is prevalent in Pakistani tertiary care settings and is associated with adverse maternal and neonatal outcomes. Early identification of high-risk women, enhanced antenatal care, and timely management are critical to reducing morbidity and mortality.