Prenatal Care and Hypertensive Gestational Syndromes: A Systematic Review

The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103).

Results

The seven studies hada lowriskof bias,withmethodological quality scores ranging fromsix to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size.

Conclusion

Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.

Keywords:
prenatal care; medical assistance; prenatal education; hypertension pregnancy-induced; gestation

Authors, year, country	Type of study	Setting	Sample size	Prevalence; age (years)	Categorization of prenatal care	Categorization of PIH	Statistical analysis	Results	Quality
Sekkarie et al. (2016),¹²12 Sekkarie A, Raskind-Hood C,Hogue C. The effects ofmaternalweight and age on pre-eclampsia and eclampsia in Haiti. J Matern Fetal NeonatalMed 2016;29(04):602-606.Doi: 10.3109/14767058.2015.1012064 https://doi.org/10.3109/14767058.2015.10... Haiti	Case-control	Rural maternity	689 subjects (67 cases and 622 controls	7.0%; 15–46	No appointments; 1–3 appointments; 4 or more appointments	Preclampsia and eclampsia	Univariate and multivariate	Prenatal care not associated with reduction in risk of PIH: 1–3 appointments (p= 0.71; OR = 1.10) and 4 or more appointments (p= 0.50; OR = 1.20)	7 (10)
Luo and Ma (2013),¹⁰10 Luo B, Ma X. Risk factors for preeclampsia: a case-control study. Hypertens Pregnancy 2013;32(04):432-438. Doi: 10.3109/10641955.2013.824979 https://doi.org/10.3109/10641955.2013.82... China	Case-control	Tertiary reference hospital	1233 subjects (650 cases and 583 controls)	Prevalence not reported; mean case: 30 + ; control: 28)	Case - mean: M 2.68 ± 6.18 appointments; control - mean: 9.19 ± 4.49 appointments	Preeclampsia	Univariate and multivariate	Preeclampsia associated with fewer prenatal care appointments (p< 0.001; OR = 2.04)	7 (10)
Herrera et al. (2014),¹⁶16 Herrera JA, Herrera-Medina R, Herrera-Escobar JP, Nieto-Díaz A. Reduction of maternal mortality due to preeclampsia in Colombia- an interrupted time-series analysis. ColombMed (Cali) 2014; 45(01):25-31 Colombia	Prospective cohort	National Department of Statistics	387,000	Private service (pre- eclampsia = 0.4%- 1.4%); Without private service (preeclampsia = 1.4% - 32%); mean: 24.2 ± 6.5 and 25.1 ± 6.9	Implantation of BPSM program	Preeclampsia	Univariate and multivariate	Implantation of BPSM program reduced incidence of pre-eclampsia by 22% (OR = 0.78, 95% CI: 0.67–0.88)	6 (10)
Berhan and Endeshaw (2015),¹⁴14 Berhan Y, Endeshaw G. Maternal mortality predictors in women with hypertensive disorders of pregnancy: a retrospective cohort study. Ethiop J Health Sci 2015;25(01):89-98 Ethiopia	Retrospective cohort	University teaching hospitals	1015	612 (60.3%) preeclampsia, 346 (34.1%)eclampsia and 57 (5.6%) other type of PIH; mean: 2.8;range: 15–46.	Prenatal care: yes or no	Chronic hypertension, preeclampsia and eclampsia	Univariate and multivariate	Lack of prenatal care increased risk of PIH (OR 2.3; 95% CI: 1.19 - 4.38).	7 (10)
Assarag et al. (2015),¹¹11 Assarag B, Dujardin B, Delamou A, Meski FZ, De Brouwere V. Determinants of maternal near-miss in Morocco: too late, too far, too sloppy? PLoS One 2015;10(01):e0116675. Doi: 10.1371/journal.pone.0116675 https://doi.org/10.1371/journal.pone.011... Morocco	Case-control	Three reference hospitals	299 subjects (80 cases and 219 controls)	Chronic hypertension: 52% of case group and 47% of control group; mean: 29.2 in case group and 28.4 in control group; range: 18–49	Prenatal care: yes or no	Preeclampsia, eclampsia, preeclampsia and eclampsia complicated by hemorrhage	Univariate and multivariate	Lack of prenatal care associated with PIH [OR = 3.97; 95% CI: (1.42–11.09)].	8 (10)
Correia et al. (2015),¹⁵15 Correia S, Rodrigues T, Barros H. Assessing the effect on outcomes of public or private provision of prenatal care in Portugal.Matern Child Health J 2015;19(07):1574-1583.Doi: 10.1007/s10995-015-1667-4 https://doi.org/10.1007/s10995-015-1667-... Portugal	Transversal	Five public maternities	7,325	3.19%;55.4% 25–34; 29.7% ≤24; 14.9% ≥ 35	Does not know; 1–2 appointments, 3–6 appointments, 7–9 appointments, ≥10 appointments	Gestational hypertensive disorders (gestational hypertension, preeclampsia and eclampsia)	Univariate and multivariate	Larger or smaller number of appointments in public or private sector did not affect occurrence of PIH (low-risk pregnancy: OR = 1.12; high-risk pregnancy: OR = 0.53)	6 (10)
Männistö et al. (2013),¹³13 Männistö T,Mendola P,Vääräsmäki M,et al. Elevatedbloodpressure inpregnancyandsubsequent chronicdisease risk. Circulation 2013; 127(06):681-690. Doi: 10.1161/CIRCULATIONAHA.112.128751 https://doi.org/10.1161/CIRCULATIONAHA.1... Finland	Prospective cohort	Community maternity care clinics	10314	17%; mean: 66.7 (62.6 to 72.6)	Prenatal care: ≥ 5 appointments	ISH, IDH, DHP, GH,Preeclampsia /Eclampsia, CH	Univariate and multivariate	Prenatal care associated with ISH, IDH, DHP (p< 0.0001); GH (p< 0.05); and CH (p< 0.001)	7 (10)

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[1] Address for correspondence Gláucya Raquel Souza da Fonsêca Dutra, MSc, Rua Miguel Antônio da Silva Neto, s/n, Aeroporto, 59607-360, Mossoró, RN, Brazil (e-mail: glaucyra@hotmail.com).