Description of baseline characteristics and determinants for maternal morbidity in pregnant women attending first antenatal visit in Southern Mozambique

Abstract

INTRODUCTION In low-income countries a high proportion of maternal deaths are due to preventable causes. For many of the essential interventions in antenatal care (ANC) it is crucial to have early identification of underlying conditions. Identification of determinants for adverse health outcomes at first ANC visit can guide preventive strategies needed to ensure safe motherhood, particularly in HIV-infected pregnant women, who represent an especially vulnerable population group. MATERIALS AND METHODS This is a descriptive study of data obtained prospectively as part of a clinical trial performed at the ANC clinic in Manhic¸a District Hospital (MDH), in southern Mozambique. Clinical characteristics were collected from all pregnant women attending the first ANC visit. For a sub-sample of 561 HIV-infected women hospital admissions and outpatient visits during pregnancy were also recorded. Baseline factors associated with these morbidity outcomes were analyzed using multivariate logistic regression models. RESULTS A total of 3586 pregnant women attended the first ANC visit at MDH between March 2010 and January 2012. Out of 2664, 622 (23%) were adolescents (≤19 years) and 62% had anemia (Hb <11 g/dl). Prevalence of HIV was 28% and 37% were in their third trimester of pregnancy. Among HIV- infected women, 3% had malnutrition (middle upper arm circumference <23 cm), 5% had severe anemia (Hb ≤7 g/dl), 36% had a CD4 count <350 cells/mm3, 56% had HIV-1 RNA >1000 copies/ml and incidence of hospital admissions and outpatient visits during pregnancy were 66/241.65 and 174/241.65 episodes/person year respectively. Factors associated with hospital admissions in these women were: adolescence [RR 3.23 (95%CI 1.48; 7.08) P = 0.03], severe anemia [RR 4.14 (95%CI 2.05; 8.40) P <0.001], CD4 count <350 cells/mm3 [RR 1.65 (95%CI 1.00; 2.71) P = 0.05] and malnutrition [RR 4.19 (95% CI 1.64; 10.67) P = 0.03]. Being in the third trimester [RR 0.60 (95%CI 0.39; 0.95) P = 0.028], adolescence [RR 2.38 (95% CI 1.38; 4.11) P = 0.02] and severe anemia [RR 2.62 (95%CI 1.57; 4.39) P <0.001] were associated with outpatient visits during pregnancy. CONCLUSIONS A high proportion of pregnant women attend late in pregnancy and present treatable underlying conditions at first ANC visit in this area of southern Mozambique. Adolescence, anemia, immune-suppression and malnutrition are important drivers of maternal morbidity in HIV-infected pregnant women and should be targeted by ANC preventive strategies.