Original Article

Prevalence and Predictors of Pre-Existing Hypertension among Prenatal Women: A Cross-Sectional Study in Ghana


Background: We aimed to assess prevalence and predictors of pre-existing hypertension in pregnant women in three districts of Northern region, Ghana.

Methods: This cross-sectional study was conducted among 1626 women in the third trimester of pregnancy across four antenatal centers in 2018. A questionnaire was used to collect medical information including weight and height. We used descriptive statistics to characterize all qualitative variables and performed logistic regression analyses to estimate association of hypertension and other risk factors.

Results: We included 1626 women; mean age standard deviation (SD) of pregnant women was 27.4 (5.1) years. About 4.5% (95% confidence interval [CI]: 3.6-5.7) of pregnant women reported they had earlier been diagnosed of having hypertension by a doctor or midwife, before pregnancy. Obese pregnant women had 2.9 times increased adjusted odds of having hypertension relative to non-obese pregnant women (Odds Ratio (OR))=2.9, 95% [CI]: 1.39-5.85, P=0.004). Further, gestational diabetes was a predictor of pre-existing hypertension at an increased odds of 4.9 times relative to those without gestational diabetes (OR= 4.9, CI: 0.92-26.75, P=0.061). Women with two or more children had 3.2 times the adjusted odds of having hypertension (OR=3.2 CI: 1.59-6.69, P=0.001).

Conclusion: Although the prevalence pre-existing hypertension was not too high, obesity, gestational diabetes and number of children were independent predictors of pre-existing hypertension in pregnant women.

1. Mammaro A, Carrara S, Cavaliere A, et al (2009). Hypertensive disorders of pregnancy. J Prenat Med, 3(1):1-5.
2. Egeland GM, Skurtveit S, Staff AC, et al (2018). Pregnancy‐related risk factors are associated with a significant burden of treated hypertension within 10 years of delivery: findings from a population‐based Norwegian cohort. J Am Heart Assoc, 7(10):e008318.
3. Bramham K, Parnell B, Nelson-Piercy C, et al (2014). Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ, 348:g2301.
4. Foo L, Tay J, Lees CC, et al (2015). Hypertension in Pregnancy: Natural History and Treatment Options. Curr Hypertens Rep, 17(5):36.
5. Adu-Bonsaffoh K, Oppong SA, Binlinla G, et al (2013). Maternal deaths attributable to hypertensive disorders in a tertiary hospital in Ghana. Int J Gynaecol Obstet, 123(2):110-3.
6. Ministry of Health, (2012). Republic of Ghana National Policy for the Prevention and Control of Chronic Non-Communicable Diseases in Ghana.
7. Amoakoh-Coleman M, Klipstein-Grobusch K, Agyepong IA, et al (2016). Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: A Ghanaian cohort study. BMC Pregnancy Childbirth, 16: 369.
8. Guedes-Martins L, Carvalho M, Silva C, et al (2015). Relationship between body mass index and mean arterial pressure in normotensive and chronic hypertensive pregnant women: A prospective, longitudinal study. BMC Pregnancy Childbirth, 15:281.
9. Lawler J, Osman M, Shelton JA, et al (2007). Population-based analysis of hypertensive disorders in pregnancy. Hypertens Pregnancy, 26(1):67–76.
10. Seely WE, Ecker J (2014). Chronic hypertension in pregnancy. Circulation, 129(11), 1254-61.
11. Hanson U, Persson B (1998). Epidemiology of pregnancy-induced hypertension and preeclampsia in type 1 (insulin-dependent) diabetic pregnancies in Sweden. Acta Obstet Gynecol Scand,77(6):620-4.
12. Rosenn B, Miodovnik M, Combs CA, at el (1993). Poor glycemic control and antepartum obstetric complications in women with insulin‐dependent diabetes. Int J Gynaecol Obstet,43(1):21-8.
13. Singh S, Ahmed EB, Egondu SC, et al (2014). Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital. Niger Med J, 55(5): 384–388.
14. Banegas JR, López-García E, Graciani A, et al (2007). Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly. Eur J Cardiovasc Prev Rehabil,14(3):456-62.
15. Podymow T, August P (2008). Update on the use of antihypertensive drugs in pregnancy. Hypertension, 51(4):960-9.
16. Dietl A, Farthmann J (2015). Gestational hypertension and advanced maternal age. Lancet, 386(10004):1627-8.
17. Nyarko SH (2019). Unintended Pregnancy among Pregnant Women in Ghana: Prevalence and Predictors. J Pregnancy, 2019:2920491.
18. Li C, Binongo JN, Kancherla V (2019). Effect of parity on pregnancy-associated hypertension among Asian American women in the United States. Matern Child Health J, 23(8):1098-1107.
19. Hussein H, Shamsipour M, Yunesian M (2020). Fuel type use and risk of respiratory symptoms: A cohort study of infants in the Northern region of Ghana. Sci Total Environ, 755:142501.
20. Zhou W, Wang T, Zhu L, et al (2019). Association between age at menarche and hypertension among females in southern China: a cross-sectional study. Int J Hypertens, 2019:9473182.
21. Acheampong K, Nyamari JM, Ganu D, et al (2019). Predictors of Hypertension among Adult Female Population in Kpone-Katamanso District, Ghana. International Journal of Hypertension, doi.org/10.1155/2019/1876060.
22. World Health Organization (2018). WHO recommendations on antenatal care for a positive pregnancy experience: summary: highlights and key messages from the World Health Organization's 2016 global recommendations for routine antenatal care. World Health Organization.
23. Nyarko SH (2016). Prevalence and Sociodemographic Determinants of Hypertension History among Women in Reproductive Age in Ghana. Int J Hypertens, 2016:3292938.
24. Qiu C, Williams MA, Leisenring WM, et al (2003). Family history of hypertension and type 2 diabetes in relation to preeclampsia risk. Hypertension, 41(3):408-13.
25. Chen H-Y, Chauhan SP (2019). Hypertension among women of reproductive age: Impact of 2017 American College of Cardiology/American Heart Association high blood pressure guideline. Int J Cardiol Hypertens, 1:100007.
26. Van Scheltinga JA, Krabbendam I, Spaanderman ME (2013). Differentiating between gestational and chronic hypertension; an explorative study. Acta Obstet Gynecol Scand, 92(3):312-7.
27. Owiredu WK, Ahenkorah L, Turpin CA, (2012). Putative risk factors of pregnancy-induced hypertension among Ghanaian pregnant women. J Med Biomed Sci, 1(3):62-76.
28. Pace R, Rahme E, Dasgupta K (2019). Considering parents as a unit: Associations of gestational diabetes and gestational hypertension with postpartum diabetes and hypertension in couples. Pregnancy Hypertens, 16:32-37.
29. Leon MG, Moussa HN, Longo M, et al (2016). Rate of gestational diabetes mellitus and pregnancy outcomes in patients with chronic hypertension. Am J Perinatol, 33(08):745-50.
30. Taylor JY, Chambers AN, Funnell B, et al (2008). Effects of parity on blood pressure among African-American women. J Natl Black Nurses Assoc, 19(2):12-9.
31. Berhe AK, Kassa GM, Fekadu GA, et al (2018). Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC Pregnancy Childbirth, 18(1):34.
32. Tunçalp Ӧ, Were WM, MacLennan C, et al (2015). Quality of care for pregnant women and newborns—the WHO vision. BJOG, 122(8):1045-9.
33. United Nations Human Rights Council (2012). Technical guidance on the application of a human-rights based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality. Report of the Office of the United Nations High Commissioner for Human Rights.
34. Biau DJ, Kernéis S, Porcher R (2008). Statistics in brief: The importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res, 466(9):2282–2288.
IssueVol 50 No 6 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i6.6428
Antenatal care Obesity Hypertension Gestational diabetes Ghana

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How to Cite
Hussein H, Shamsipour M, Yunesian M, Hassanvand MS, Assan A, Fotouhi A. Prevalence and Predictors of Pre-Existing Hypertension among Prenatal Women: A Cross-Sectional Study in Ghana. Iran J Public Health. 2021;50(6):1266-1274.