Unexpected finding of a high prevalence of perinatal hypertension in a rural Haitian village: An observational study

Background Hypertensive disorders in pregnancy are associated with maternal mortality worldwide. In Haiti, the risk of perinatal maternal death is high with sparse data concerning the prevalence of gestational hypertension (HTN) reported from remote regions. Maternal morbidity associated with HTN-related sequellae will place a strain on the family unit. Thus, it is vital to the health of mothers as well as the rural communities to gain a better understanding of HTN with the goal of decreasing perinatal morbidity and mortality in areas without access to advanced healthcare. Methods In this study, we measured the prevalence of HTN in perinatal women in the Thomazeau region of Haiti who presented to a regional clinic staffed by volunteer international providers. Retrospective pre- and postpartum data was analyzed from 436 women who presented between January 2013 and July 2015. Additionally, a subset of current (June-July 2015) prepartum (n=200) and postpartum (n=82) women had a urinalysis performed to access for proteinuria and other urine markers. Demographic data collected included blood pressure, age, weight, height, gravidity, and parity. The criteria for HTN was defined as two blood pressure readings taken at separate time points with systolic and diastolic pressures greater than 140 and 90 mmHg, respectively. Results In this cohort of 436 women, 57 (13.1%) met the criteria of HTN before giving birth and 98 (22.5%) afterwards. Of the women found to be hypertensive, 64 (65.3%) of the hypertensive women after birth had not been hypertensive prepartum. Within the two-week current period assessing 282 women, 3 (1.5%) prepartum and 13 (15.9%) postpartum women with HTN had trace proteinuria. Conclusions In this cohort of rural women, we describe an unusually high prevalence of new onset postpartum HTN. As complications of gestational HTN including preeclampsia and eclampsia may contribute to perinatal morbidity and mortality for both mother and baby in developing countries, early identification with treatment is critical. Investigation into possible etiologies and prevention will be essential as peripartum health care is rare in rural Haiti. Deaths from HTN-related diseases can leave children parentless and perpetuate the cycle of poverty and lack of education in rural communities