Incidence and natural history of preeclampsia/eclampsia at the university maternity of Antananarivo, Madagascar: high prevalence of the early-onset condition

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 32; no. 19; p. 3266
• Main Authors: Ratsiatosika, Andriamanetsiarivo Tanjona, Razafimanantsoa, Eric, Andriantoky, Valéry Bruno, Ravoavison, Noël, Andrianampanalinarivo Hery, Rakotovao, Boukerrou, Malik, Iacobelli, Silvia, Robillard, Pierre-Yves
• Format: Journal Article
• Language: English
• Published: England 02.10.2019
• Subjects: Academic Medical Centers; Adult; Age of Onset; Eclampsia - epidemiology; Eclampsia - pathology; Female; Fetal Mortality; Gestational Age; Humans; Incidence; Infant; Infant Mortality; Infant, Newborn; Madagascar - epidemiology; Maternal Health Services; Maternal Mortality; Pre-Eclampsia - epidemiology; Pre-Eclampsia - pathology; Pregnancy; Pregnancy Outcome - epidemiology; Prevalence; Young Adult; Madagascar; epidemiology; developing countries; Preeclampsia; early-onset preeclampsia
• ISSN: 1476-4954
• DOI: 10.1080/14767058.2018.1462323

To investigate the incidence of early - (delivery <34 weeks) (EOP) versus late-onset (delivery ≥34 weeks) (LOP) in Madagascar. Eight months observational study of all preeclamptic/eclamptic women delivering at the maternity of the University Hospital of Befelatanana, Antananarivo, Madagascar. Sociodemographical and obstetrical risk factors are analyzed. Over the study period, we found 142 combined preeclampsia/eclampsia among 4316 births (incidence 3.3% for singleton pregnancies), of which 65 eclampsia (1.5% of all deliveries). The rate of delivery <34 weeks of gestation in preeclamptic women was 37.3% and 38.5% in eclamptic ones. The overall rate of fetal and neonatal mortality was of 50% (71/142). In EO forms the infant death rate was 83% (44/53), of which approximately 33% were due to intrauterine fetal death. In LO forms, the infant death rate was 20% in preeclampsia (15% of fetal deaths), while in case of maternal eclamptic seizures the infant mortality rate was doubled (40%). There were seven maternal deaths (of which four were eclamptic women). We have in Madagascar a high rate of early-onset preeclampsia/eclampsia EOP (37% versus approximately 10% in international literature) and a consequent worrying rate of maternal-fetal mortality. We could find other high incidence of EOP in nine other geographical locations: Guadeloupe (31%), Réunion (31%), Mauritius (34%), Cameroon (37.4%), China (38%), Zimbabwe (58%), Thailand (34%), Turkey (29%), and India (26%). Emerging and tropical countries may belong to the "high rate of EOP standard." There is an urgent need to have additional data from these areas to confirm the hypothesis.