Relationship between Age and Parity with Severe Preeclampsia Events in Achmad Mochtar

Bukittinggi Hospital in 2012 - 2013

Siqbal Karta Asmana1, Syahredi2, Noza Hilbertina3

Abstract
Preeclampsia can cause the complication that endanger maternal and fetal, until death. There are
many risk factors like extreme age (<20 & >35 years) and nuliparity that can not modify. The
objective of this study was to determine the relationship of maternal age and parity to the incidence of
severe preeclampsia. The research conducted at Medical Record Division of Achmad Mochtar
Hospital Bukittinggi about data of all hospitalized patients of obstetrics and gynecology on 2012 –
2013. This research used the analytical method with cross sectional study. Analysis of this research
used ratio prevalence and chi-square test with degree of confidence 95%. This research found 162
case (4.99%) severe preeclampsia. The highest proportion of this case was the extreme age groups
(9.90%) and multiparity group (8.68%). Analysis with the ratio prevalence concluded that extreme
age is a risk factor for severe preeclampsia (RP=1.476; CI= 1.094 – 1.922) and nuliparity can not
determined wheather a risk factor or protective factor (RP= 0.765; CI= 0.565 – 1.034). Analysis with
chi-square test concluded that there is a significant relationship between age with severe
preeclampsia (p= 0.014<0.05) and there is no significant relationship between parity with severe
preeclampsia (p= 0.096>0.05).
Keywords: preeclampsia, risk factors, age, parit

Preliminary

Preeclampsia is still a threatening problem in pregnancy, especially in developing

countries.1 Preeclampsia is a major cause of maternal death in the world.2 A study estimates that the
incidence of preeclampsia in the world ranges from 2% - 10%, in North America and Europe amounts
to 5-7 cases per 10,000 births, in North Africa, Egypt, Tanzania and Ethiopia ranging from 1.8% -
7.1% and in Nigeria ranging from 2% -16.7% .1 The prevalence of preeclampsia in Germany in the
year 2006 was 2.31%. 3 In the United States there was an increase in prevalence from 3.4% in 1980 to
3.8% in 2010.4 In Indonesia, in 2004, 2005 and 2006, the incidence of preeclampsia was found in
8,140 cases (4.82%), 8,379 cases (4.91%) and 7,848 cases (5.8%). 5-7 Other studies found the
incidence of preeclampsia in Indonesia ranged from 3% - 10% and accounted for 39.5% of deaths
maternal.8 At PKU Muhammadiyah General Hospital Yogyakarta t In 2007-2009, there were 118
cases of preeclampsia or around 3.9%. This disease also causes high mortality in Indonesia.
Preeclampsia accounted for 145 cases of death in 2004 with CFR 1.8%, 197 cases in 2005 with CFR
2.35%, and 166 cases in 2006 with CFR 2.1% .5-7 This data also found that preeclampsia is the
second leading cause of maternal death if viewed from the number of cases and occupies the first
position when viewed from CFR. 5-7
Preeclampsia can cause interference for both the fetus and the mother. The condition of preeclampsia
and eclampsia will adversely affect fetal health due to decreased utero placental perfusion,
hypovolaemia, vasospasm, and damage to placental vascular endothelial cells.10 It is said that
preeclampsia can cause intrauterine growth restriction / IUGR. A study also found that the fetus of a
mother who has preeclampsia will generally be born with a low birth weight.11 Even this disorder
can result in death for the fetus.10 In the maternal self, there will be adverse effects on various organs
caused by vasospasm and ischemia, especially in the cardiovascular system, hemodynamics,
hematology, kidneys, liver, brain etc.
The cause of preeclampsia is not yet known. There are various risk factors, including age and parity
which are risk factors that cannot be modified. In terms of age, pregnant women aged <20 years and>
35 years are considered at risk of developing preeclampsia.12 This is because as age increases, a
degenerative process will occur which increases the risk of chronic hypertension and women with the
risk of chronic hypertension will

have a greater risk of developing preeclampsia.12 Based on German Perinatal Quality Registry data,
the incidence of preeclampsia is higher at the age of 35 years, which is 2.6%, and at the age of under
35 years only ranges from 2.2% - 2.3% .3 in Dr. Hospital M. Djamil Padang, also found the incidence
of preeclampsia was higher at the age of under 20 years and above 35 years. 13 Based on parity, it is
believed parity 0 is a risk factor for preeclampsia, where this disorder is more common in
primigravida. 9 This is presumably because in the first pregnancy there was a failure to form blocking
antibodies to placental antigens resulting in an unfavorable immune response.9 Research on German
data Perinatal QualityRegistry found that the incidence of preeclampsia was higher in the parity 0
group or first pregnancy, which was 3.1%, compared to the subsequent pregnancy of only 1.5%. 3
Other studies found that the risk of preeclampsia in the first pregnancy was 4.1 %, whereas it will
decrease in subsequent pregnancies to 1.7% .14 Although theoretically it is explained that there is a
relationship between age and parity with preeclampsia, but some studies show results that conflict
with existing theories. Research in the PKU Muhammadiyah Yogyakarta General Hospital in 2007
found that preeclampsia was actually more dominated by age group 20-35 years.9 Research at Dr.
General Hospital Saiful Anwar Malang also found that there was no significant relationship between
age and preeclampsia.15 Research carried out in Germany also found that the incidence of
preeclampsia in pregnant women under the age of 20 years was lower than those aged 20-35 years.3
In terms of parity , research at the Kardinah Regional General Hospital in Tegal City found that there
was no significant relationship between parity and preeclampsia.16 Research at Dr. Hospital M.
Djamil Padang also got the same result that there was no relationship between parity and
preeclampsia.
Method

population in this study were all pregnant women hospitalized in the Obstetrics and
Gynecology Ward of Achmad Mochtar Bukittinggi Hospital. Samples were taken totally sampling
with a minimum number of samples calculated based on the formula. Based on the sample formula, a
minimum sample size of 356 samples was obtained. Sample determination is based on inclusion and
exclusion criteria. The inclusion criteria for this study were pregnant women with gestational age ≥20
weeks and had a medical record that met the variables studied. Exclusion criteria are pregnant women
with incomplete medical record, obesity, diabetes mellitus, history of kidney disease and a history of
chronic hypertension.
The data obtained were grouped into frequency distribution tables and tables of age relationships with
severe preeclampsia. This data was analyzed using ratio prevalence and chi-square test with a
confidence degree of 95% (α = 5%). Hypothesis.

DISCUSSION

Based on the research conducted, the incidence of severe preeclampsia was 162 cases
(4.99%) out of 3,248 inpatient populations in the Obstetrics and Gynecology Ward of Achmad
Mochtar Bukittinggi Hospital. This figure is not much different from the data from the Indonesian
Health Profile in 2004, 2005 and 2006, which were 4.82%, 4.91% and 5.8% .7 respectively. A study
also found the incidence of preeclampsia in Indonesia it ranges from 3-10% .8 Research in the Atma
Jaya Hospital in 2009 - 2011 found that the number of preeclampsia cases was not much different,
namely 6.3% .17 Research conducted at PKU Muhammadiyah General Hospital Yogyakarta in 2007 -
2009 had a slightly lower incidence of preeclampsia, which was 3.9%. 9 In West Sumatra alone, the
same research had been carried out at Dr. Hospital. M. Djamil Padang in 2004 - 2005 and got slightly
lower results, which was 3.56% .13 The variation in the incidence of preeclampsia can be caused by
differences in the proportion of each risk factor in each study, such as age, parity, obesity , diabetes
mellitus, and so on. The surge in cases of preeclampsia in May 2012 and June 2013 was caused by an
increase in the number of pregnancies in the month, considering that preeclampsia would not develop
without a pregnancy.
Based on Table 1, it can be seen that of 162 cases of severe preeclampsia, 96 cases (59.26%) were in
the age group of 20-35 years. This means that of all cases, the dominant age group is the age group
20-35 years which is not a risk factor. Research has been conducted at Dr. Hospital. H. Soewondo
Kendal also found that severe preeclampsia was more dominant in the age group 20-35 years, namely
78 cases (78%), while in the age group <20 years and> 35 years only 22 cases (22%). 18 The same
results were also found in research at the Kardinah Regional General Hospital Tegal City in 2011,
where severe preeclampsia was dominated in the age group 20-35 years, namely as many as 52 cases
(62.5%) .16 Research at Dr. General Hospital Saiful Anwar Malang also got the same results, where
the incidence of severe preeclampsia was more prevalent in the age group 20-35 years, namely 19
cases (61.3%) .15 Likewise research has been conducted at Dr. Hospital. M. Djamil Padang in 2004 -
2005, where the incidence of preeclampsia was dominated by the age group 20-35 years, namely
67.68% .13 There was a difference in this data with existing theories which could be caused by
differences in the number of samples in both age groups, where the sample in the 20-35 year age
group is far more. For this reason, it is necessary to look at the proportion of the incidence of severe
preeclampsia in each age group. At the age of <20 years and> 35 years, the proportion of severe
preeclampsia was 9.90%, whereas in the age group 20-35 years the proportion of severe preeclampsia
was 6.7%. This means that the highest proportion of preeclampsia is in the age group <20 years and>
35 years, and the results obtained are in accordance with the existing theory. The significance of the
age relationship with severe preeclampsia was tested by ratio prevalence and chi-square test. The
results of the analysis showed that there was a relationship between age with severe preeclampsia (p =
0.014) with age <20 years and> 35 years was a risk factor (RP = 1.476; CI = 1.094 - 1.922).
Based on Table 3, it can be seen that of 162 cases of severe preeclampsia, 97 cases (59.88%) of which
were parity groups ≥1, this means that severe preeclampsia was dominated by parity groups ≥1 which
were not a risk factor. Similar to the age factor, because there are differences in the number of
samples in the two parity groups, it is necessary to look at the proportion of the incidence of severe
preeclampsia in both parity groups. However, based on the proportion obtained, the proportion of
severe preeclampsia remained higher in the parity group ≥1, which was the proportion of 8.68%. The
same thing was also found in research that had been done at Dr. Hospital. M. Djamil Padang in 2004 -
2005, where the frequency of most preeclampsia was found in multiparas, namely 64 cases (64.65%).
Proof of the significance of the relationship between parity and severe preeclampsia, a statistical
analysis was performed using ratio prevalence and chi-square test. From the analysis it was found that
there was no significant relationship between parity with severe preeclampsia (p = 0.096) and parity 0
could not be determined whether it was a risk factor or protective factor (RP = 0.765; CI = 0.565 -
1.034). Research conducted at the Muhammadiyah General Hospital in North Sumatra in 2011-2012
also found that there was no significant relationship between parity and preeclampsia. 19
Parity 0 is a risk factor for severe preeclampsia. This is because in the first pregnancy there was an
imperfection of the formation of blocking antibodies against placental antigens, resulting in an
unfavorable immune response.9 There was a difference between the results of this study with the
theory can be caused by various factors. Among them is the presence of a study sample with parity ≥1
which is not a risk factor group, but has an age risk factor, which is over 35 years of age. In addition,
there is also the possibility of confusion in the diagnosis of preeclampsia, especially in pregnant
women whose blood pressure before pregnancy or at the beginning of pregnancy is unknown, and do
not carry out routine antenatalcare (ANC). This has led to the difficulty of distinguishing
preeclampsia and chronic hypertension by superimposed preeclampsia. 12 Not knowing the state of
blood pressure before pregnancy or previous history of blood pressure, this will also cause
forgetfulness from the sample exclusion process for patients who have a history of unknown
hypertension.
This cross sectional research design, of course there are advantages and disadvantages. In research
with this design, data collection will be faster and more efficient, and thus, this study can use a large
number of samples.20 This means that the number of samples chosen will be very representative of
the existing population. Compared to other analytical epidemiological research designs, this design is
the weakest research design.20 Data retrieval and observation are done at the same time, then the
results obtained are not enough to determine how much the relationship between the variables studied

CONCLUSION

There is a relationship between age and severe preeclampsia with age <20 years and> 35
years as a risk factor. There is no relationship between parity and preeclampsia. Parity 0 cannot be
determined whether it is a risk factor or protective factor.