Severe anemia, sickle cell disease, and thalassemia as risk factors for hypertensive disorders in pregnancy in developing countries

Objective: Hypertensive disorders during pregnancy are one of main causes for maternal and perinatal morbidity and mortality in developing countries. This study is to determine whether specific types of anemia are risk factors for hypertensive disorders during pregnancy in developing countries. Methods: Using data from the World Health Organization Global Survey for Maternal and Perinatal Health, collected in hospitals in six African and six Latin American countries from 2007 to 2008 and in four Asian countries from 2004 to 2005, we examined the associations between severe anemia, sickle cell disease and thalassemia, and gestational hypertension or preeclampsia/eclampsia. Results: A total of 214,067, 112,531, and 9,325 women were included in the analyses on severe anemia, sickle cell disease, and thalassemia, respectively. Multiparous women with severe anemia were at an increased risk of gestational hypertension (adjusted odds ratio (aOR): 1.73; 95% confidence interval (Cl): 1.25-2.39). Severe anemia had a significant association with preeclampsia/eclampsia for nulliparous (aOR: 3.74; 95% Cl: 2.90-4.81) and multiparous (aOR: 3.45; 95% Cl: 2.79-4.25) women. Sickle cell disease exhibited a significant association with gestational hypertension among nulliparous (aOR: 2.41; 95% Cl: 1.42-4.10) and multiparous (aOR: 3.26; 95% Cl: 2.32-4.58) women. No significant associations were found between sickle cell disease and preeclampsia/eclampsia, or between thalassemia and either gestational hypertension or preeclampsia/eclampsia. Conclusions: Severe anemia appears to be a risk factor for preeclampsia/eclampsia, while sickle cell disease may be a risk factor for gestational hypertension among women seeking hospital care in developing countries.