Determinants of Preeclampsia and Maternal and Perinatal Outcomes Among Women in Narok County, Kenya

Abstract

Preeclampsia is a critical hypertensive disorder in pregnancy that significantly impacts maternal and neonatal health outcomes. The World Health Organization (WHO) recognizes it as a key direct factor in global maternal mortality, especially in low- and middle-income countries. The disease is prevalent in Sub-Saharan Africa, posing a considerable threat to women and their infants. In resource-limited settings like Narok County, Kenya, delays in accessing healthcare and gaps in screening and treatment have worsened the impact of preeclampsia. This study aimed to identify the key factors associated with preeclampsia and to evaluate its effects on mothers and their newborns in Narok County. A retrospective cross-sectional review of 5,801 delivery records from January to December 2023 was conducted, from which 331 were systematically sampled, and 217 met the inclusion criteria for final analysis using a standardized data extraction tool. Descriptive analysis revealed that most preeclampsia cases (88.2%) were severe and commonly presented with symptoms such as severe headache, followed by visual disturbances, and epigastric pain. Cesarean section was performed in 17.6% of cases, maternal complications occurred in 58.8%, and the maternal mortality rate was 5.9%. Common maternal complications included HELLP syndrome and eclampsia. Neonatal outcomes were poor, with 27.8% stillbirths, 50% low birth weight, and 44.4% low Apgar scores. Neonatal complications and deaths occurred in 7.7% and 5.6% of cases, respectively. Inferential analysis using Chi-square or Fisher’s exact tests followed by binary logistic regression identified multiple gestation (OR = 3.46; 95% CI: 1.04–11.50; p = 0.043) and primigravidity (p = 0.026) as significant determinants of preeclampsia. Rural residence (OR = 4.50; p = 0.054) showed no significant association. Preeclampsia poses a substantial burden on maternal and perinatal health in Narok County. Multiple gestations and first-time pregnancy were identified as key determinants, and preeclampsia resulted to higher rates of antenatal complications, adverse maternal outcomes, and poor neonatal outcomes such as prematurity and low birth weight. Strengthening antenatal care through early screening, risk-based monitoring, and timely interventions is essential to mitigate these risks.