Abstract

Preeclampsia is defined as pregnancy-induced hypertension affecting between 2% and 8% of pregnancies and accounting for about 10-15% of maternal deaths worldwide. Eclampsia is defined as the occurrence of one or more episodes of seizures in a pregnant woman related only to a preeclampsia diagnosis. Preeclampsia, if poorly managed, can progress to eclampsia resulting in injury and death to both mother and infant. The etiology of preeclampsia is not completely understood. Oxidative stress leading to abnormal placenta development and endothelial dysfunction are thought to be key components in the biological mechanism of preeclampsia.

Modifiable risk factors include maternal body weight and nutrition status, and preexisting medical conditions such as chronic hypertension and diabetes. Nonmodifiable risk factors include maternal age, ethnicity, parity and genetics. African American women experience increased preeclampsia risk compared to women of other ethnicities.

The purpose of this cross-sectional study was to investigate the relationship between maternal smoking status, pre-pregnancy body mass index (BMI), Institute of Medicine (lOM) weight gain recommendations and preeclampsia, and eclampsia risk. Additionally to investigate how these relationships are affected by early prenatal care and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIG). San Bernardino County community health indicators highlight many socio-demographic challenges which may influence preeclampsia and eclampsia risk as well as other maternal and infant outcomes. The San Bernardino County Birth Cohort data from 2007-2008 were used in this study.

Frequencies, percentages, and multivariable logistic regression were used to investigate demographic characteristics of respondents and evaluate the relationship between maternal smoking, body mass index and preeclampsia and eclampsia risk. Statistical analyses were conducted using the Statistical Analysis Systems (SAS) software [version 9.3].

Results confirmed a strong association between maternal pre-pregnancy overweight/obesity and risk for preeclampsia and eclampsia. Respondents who were overweight or obese based on their pre-pregnancy BMI had increased odds of developing preeclampsia or eclampsia compared to those with normal pre-pregnancy BMI. Those gaining more than the lOM recommended weight gain also had increased odds of developing preeclampsia or eclampsia compared to those whose weight gain followed lOM recommendations. Finally, respondents who never smoked were noted to have a reduction in preeclampsia risk compared to those who smoked during pregnancy. No significant associations were noted between preeclampsia and eclampasia and smoking cessation at recognition of pregnancy. Associations were also noted when accounting for the effects of WIC enrollment and early prenatal care.

In conclusion maternal overweight and obesity status remains a strong risk factor for preeclampsia and eclampsia. The relationship between maternal smoking and preeclampsia risk is an area which requires further exploration. Participation in the WIC program and early prenatal care are viable solutions to addressing maternal overweight or obesity status and nutritional deficiencies as well as smoking habits for the reduction of preeclampsia and eclampsia risk. Further investigation is warranted in exploring these options.

School

School of Public Health

First Advisor

Naomi N. Modeste

Second Advisor

Ronald Mataya

Third Advisor

Pramil Singh

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2013

Date (Title Page)

6-2013

Language

English

Library of Congress/MESH Subject Headings

Pre-Eclampsia -- etiology; Pre-Eclampsia -- prevention & control; Eclampsia -- etiology; Eclampsia -- prevention & control; Pregnancy Complications -- etiology; Pregnancy Complications -- prevention & control; Risk Factors; Weight Gain; Smoking -- in pregnancy; Maternal Exposure; Pregnancy Outcome -- San Bernardino County -- statistics -- 2007-2008; Infant, Newborn -- San Bernardino County -- statistics -- 2007-2008; Cross-Sectional Studies

Subject - Local

San Bernardino County (Calif.)

Type

Dissertation

Page Count

x; 118

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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