Nutritional Factors Associated with Oedema as a Risk Factor for Preeclampsia among Pregnant Women Attending Antenatal Clinic in the La-Nkwantanang -Madina Municipality of the Greater Accra Region

Abstract

Background: Nutritional factors such as micronutrient deficiencies and excess gestational weight gain have been reported to be involved in the development of oedema in preeclampsia. Oedema is one of the common symptoms of preeclampsia. This study aimed to determine nutritional factors associated with oedema as a risk factor for preeclampsia among a cohort of pregnant women attending antenatal clinic in the La-Nkwantanang-Madina municipality of the Greater Accra region of Ghana. Methods: This was a longitudinal study in which 130 women between 30 and 33 weeks of pregnancy attending antenatal clinics at Madina Polyclinic, Kekele and Pentecost Hospital in the La-Nkwantanang-Madina municipality were recruited. At recruitment, structured questionnaires were used to collect data on socio-demographic characteristics, pica practice, iron and folic acid supplementation, and iodised salt use. Women’s height and mid-upper arm circumference (MUAC) were measured. Clinical, biochemical, obstetric and medical history including anaemia at first antenatal clinic (ANC) visit, hypertension, sickle cell disease, prior adverse birth outcome, prior pregnancy complication and prior labour complication were recorded from their antenatal cards. Women’s blood pressure, weight, and dietary diversity were measured at both baseline and end line (36 weeks of pregnancy), whereas the presence of oedema at any point during pregnancy was recorded at 36 weeks of pregnancy. Multivariate logistic regression was used to determine the nutritional predictors of oedema. A variable was selected for the multivariate logistic regression model if it was significantly associated with oedema at α < 0.2 in a bivariate analysis. Only women who completed the study were included in the statistical analysis. Data collection took place between May and June, 2018. Results: In all, 86 women completed the study. The women who completed the study and those who did not complete the study significantly differed in occupation (p-value= < 0.001) but not in age (p-value = 0.65), formal education completed (p-value = 0.90) and monthly income (p-value = 0.32). On average, the women who completed the study were aged 31 years when recruited, all of them were either married or cohabiting, and their mean age of gestation at ANC booking was 17.4 weeks. At recruitment, 8.1% of the women had inadequate dietary diversity (consumed <5 food groups during the 24 hours preceding the interview), 32.6% practised pica, and 62.8% ‘never’ or ‘sometimes’ used iodised salt. Furthermore, 37.2% of the women were anaemic at first ANC visit, and 52.3% reportedly consumed iron and folic acid supplements after completing the first trimester. Using MUAC measured at recruitment, 6.3% of the women were underweight (< 25 cm) and 10.5% (≥ 33 cm) were overweight/obese. At 36 gestation weeks, 48.8% had inadequate gestational weight gain, 9.3% had inadequate dietary diversity (consumed <5 food groups during the 24 hours preceding the interview), and 16.1% had inadequate dietary diversity at either baseline or 36 weeks. The prevalence of oedema at any point during pregnancy was 33.7%. In a bivariate analysis, oedema at any point during pregnancy was significantly associated with mean systolic blood pressure (p-value = 0.006), but not mean diastolic blood pressure (p-value = 0.74). The timing of initiation of iron and folic acid supplementation and gestational weight gain were the nutritional factors significantly associated with oedema at α < 0.2 in the bivariate analyses. In the multivariate logistic model, the initiation of iron and folic acid supplementation after completing the first trimester (compared to the first trimester) was associated with more than 3-fold increase in the odds (95% CI) of developing oedema at any point during pregnancy [AOR = 3.3 (1.1, 10.1); p-value = 0.034], after adjusting for highest maternal education completed. Conclusion: The prevalence of oedema as a risk factor for preclampsia was high. The prevalence of oedema was negatively associated with mean systolic blood presure. Among pregnant women attending the Madina Polyclinic at Kekele and the Pentecost Hospital in the La-Nkwantanang Madina Municipality, the timing of initiation of iron and folic acid supplementation and gestational weight gain were the nutritional factors significantly associated with the development of oedema at any point in time during pregnancy in the bivariate analysis. In a multivariate logistic regression model, the timing of initiation of iron and folic acid supplementation after the first-trimester was independently associated with increased odds of developing oedema at any point during pregnancy after adjusting for highest maternal education completed.