Maternal Risk Factors and Adverse Birth Outcomes Associated with Preeclampsia: A Prospective Cohort Study in Zanzibar

Background: Preeclampsia (PE) is a significant multi-organ system disorder of pregnancy and is responsible for global maternal morbidity and mortality. In Zanzibar, it affects approximately 26.3% of postnatal women. However, there is limited knowledge regarding the maternal risk factors and birth outcomes associated with PE. This study aimed to examine the maternal risk factors and adverse birth outcomes related to preeclampsia among pregnant women in Zanzibar. Methods: A prospective cohort study was conducted in 2021 across public health facilities on Unguja, Zanzibar. A total of 728 pregnant women at ≥20 weeks gestation with or without preeclampsia were enrolled and followed through three phases: during antenatal care (ANC), within 24 hours of delivery, and up to 28 days postpartum. Data were analyzed using SPSS version 26.0. Chi-square and regression analyses were conducted, with statistical significance set at p Results: The incidence of preeclampsia was 7.7%. The median age of women diagnosed with preeclampsia was 28 years (IQR: 24 - 33). Women with a family history of hypertension were significantly more likely to develop preeclampsia (adjusted odds ratio [aOR] = 1.92, 95% CI: 1.05 - 3.51, p = 0.033). Women with a history of chronic hypertension (aOR 3.69, 95% CI: 1.01-13.54, p = 0.049) and those with a previous history of preeclampsia or eclampsia were likely to develop preeclampsia in their subsequent pregnancies (aOR = 3.11, 95% CI: 1.11 - 8.71, p = 0.031). Additionally, women who delivered low-birth-weight infants according to certain criteria had greater odds of developing preeclampsia compared to women who delivered infants weighing 2.5 - 3.9 kg (aOR = 0.35, 95% CI: 0.15 - 0.82, p = 0.016). Conclusion: Preeclampsia affects a significant proportion of pregnant women in Unguja, Zanzibar. A family history of hypertension is significantly associated with an increased risk of developing preeclampsia. Early detection and effective management of preeclampsia, along with targeted health promotion during routine ANC services, through identifying and assessing potential risks to the mother and the baby, such as maternal conditions, family history, and lifestyle factors, may reduce the burden of preeclampsia and the associated maternal and neonatal outcomes in Unguja Zanzibar.