Factors associated with pre eclampsia: A cross-sectional study
https://doi.org/10.52235/lp.v7i4.904
Keywords:
obesity, parity, pre-eclampsia, pregnancy, pregnant womenAbstract
Background: Preeclampsia remains a major cause of maternal and perinatal morbidity and mortality. Routine data from Musi Banyuasin Regency indicate an increase in reported cases from 460 in 2021 to 753 in 2025, while local evidence on factors associated with preeclampsia in referral hospitals remains limited.
Objective: To examine the associations of maternal age, parity, history of preeclampsia, obesity, and knowledge with preeclampsia and to estimate the independent associations of parity and obesity after adjustment in a multivariable model.
Methods: An analytical cross-sectional study was conducted at Sekayu Regional General Hospital, Musi Banyuasin Regency, from February to May 2026. A purposive sample of 97 pregnant women was included. Clinical variables were obtained from medical records, and knowledge was assessed using a structured questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for bivariable analyses; Fisher's exact test was applied when a zero cell occurred. Binary logistic regression was used for the multivariable model. Reporting was guided by STROBE.
Results: Of 97 participants, 38 (39.2%) had preeclampsia. In bivariable analysis, multiparous women had a higher proportion of preeclampsia than primiparous women; with primiparity as the exposure category, the OR was 0.245 (95% CI 0.101–0.596; p=0.002). A history of preeclampsia showed a very strong association, but the OR could not be estimated because of complete separation (Fisher's exact p<0.001). Obesity was associated with higher odds of preeclampsia (OR=6.000; 95% CI 2.394–15.036; p<0.001). Low knowledge was also associated with preeclampsia in bivariable analysis (OR=2.339; 95% CI 1.011–5.412; p=0.047), whereas maternal age was not significantly associated (OR=2.014; 95% CI 0.781–5.193; p=0.147). In the final model, obesity (aOR=5.848; 95% CI 2.218–15.423; p<0.001) and parity (aOR=0.253; 95% CI 0.096–0.663; p=0.005) remained associated with preeclampsia.
Conclusion: Obesity and parity were independently associated with preeclampsia in this hospital-based sample. A history of preeclampsia showed a strong association but could not be modeled using standard logistic regression because of complete separation. Interpretation should account for the cross-sectional design, purposive sampling, small sample size, and measurement limitations affecting several variables.
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References
Abdalla, R. A. H., Parveen, N., Iqbal, N., Mohamed, A. A. A., Shahid, S. M. A., Elhussein, G. E. M. O., Saleem, Mohd., & Khan, M. S. (2025). Adipokines in preeclampsia: disrupted signaling pathways and novel therapeutic strategies. European Journal of Medical Research, 30(1), 702. https://doi.org/10.1186/s40001-025-02972-y
Adu-Bonsaffoh, K., Antwi, D. A., Gyan, B., & Obed, S. A. (2017). Endothelial dysfunction in the pathogenesis of pre-eclampsia in Ghanaian women. BMC Physiology, 17(1), 5. https://doi.org/10.1186/s12899-017-0029-
Al-Jameil. (2013). A Brief Overview of Preeclampsia. Journal of Clinical Medicine Research. https://doi.org/10.4021/jocmr1682w
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG practice bulletin No. 222. Obstetrics & Gynecology, 135(6), e237–e260.
Aouache, R., Biquard, L., Vaiman, D., & Miralles, F. (2018). Oxidative Stress in Preeclampsia and Placental Diseases. International Journal of Molecular Sciences, 19(5). https://doi.org/10.3390/ijms19051496
Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., … Ishaku, S. (2018). Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations. Hypertension, 72(1), 24–43.
Chelli, S. B., Raveena. G Rachel, & Babu, D. S. (2024). A review on etiopathology and outcome in pre-eclampsia. Asian Journal of Health Sciences, 10(1).
Cífková, R. (2023). Hypertension in Pregnancy: A Diagnostic and Therapeutic Overview. High Blood Pressure & Cardiovascular Prevention, 30(4), 289–303. https://doi.org/10.1007/s40292-023-00582-5
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Dashe, J. S., Hoffman, B. L., Casey, B. M., & Spong, C. Y. (2022). Williams obstetrics (26th ed.). McGraw-Hill.
Dahlan, M. S. (2022). Statistik untuk kedokteran dan kesehatan (Edisi 6). Jakarta: Epidemiologi Indonesia.
Direktorat Kesehatan Keluarga. (2023). Pedoman pelayanan antenatal terpadu. Kementerian Kesehatan RI.
Duley, L., Meher, S., Abalos, E., & Steyn, D. (2019). Management of pre-eclampsia. BMJ, 366, l5119.
Erez, O., Romero, R., Jung, E., Chaemsaithong, P., Bosco, M., Suksai, M., Gallo, D. M., & Gotsch, F. (2022). Preeclampsia and eclampsia: the conceptual evolution of a syndrome. American Journal of Obstetrics and Gynecology, 226(2), S786–S803. https://doi.org/10.1016/j.ajog.2021.12.001
Fox, R., Kitt, J., Leeson, P., Aye, C. Y. L., & Lewandowski, A. J. (2019). Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. Journal of Clinical Medicine, 8(10), 1625. https://doi.org/10.3390/jcm8101625
Gestational Hypertension and Preeclampsia. (2020). Obstetrics & Gynecology, 135(6), e237–e260. https://doi.org/10.1097/AOG.0000000000003891
Grove, S. K., & Gray, J. R. (2021). Understanding nursing research: Building an evidence-based practice (8th ed.). Elsevier
Gupta, S., Agarwal, A., & Sharma, R. K. (2005). The role of placental oxidative stress and lipid peroxidation in preeclampsia. Obstetrical & Gynecological Survey, 60(12), 807–816. https://doi.org/10.1097/01.ogx.0000193879.79268.59
Haram, K., Mortensen, J. H., Myking, O., Magann, E. F., & Morrison, J. C. (2019). The Role of Oxidative Stress, Adhesion Molecules and Antioxidants in Preeclampsia. Current Hypertension Reviews, 15(2), 105–112. https://doi.org/10.2174/1573402115666190119163942
Hasnah. (2019). Gambaran pengetahuan tenaga kesehatan tentang preeklampsia (Skripsi, Universitas Islam Negeri Alauddin Makassar). Repository UIN Alauddin Makassar. https://repositori.uin-alauddin.ac.id/19397/
Hosmer, D. W., Lemeshow, S., & Sturdivant, R. X. (2021). Applied logistic regression (4th ed.). Wiley.
Hutcheon, J. A., Lisonkova, S., & Joseph, K. S. (2019). Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology, 57, 1–15.
Jung, E., Romero, R., Yeo, L., Gomez-Lopez, N., Chaemsaithong, P., Jaovisidha, A., Gotsch, F., & Erez, O. (2022). The etiology of preeclampsia. American Journal of Obstetrics and Gynecology, 226(2), S844–S866. https://doi.org/10.1016/j.ajog.2021.11.1356
Karrar SA, M. D. H. P. (2024, February 25). Preeklamsia. StatPearls Publishing.
Kementerian Kesehatan Republik Indonesia. (2022). Profil kesehatan Indonesia 2021. Kemenkes RI.
Kementerian Kesehatan Republik Indonesia. (2023). Pedoman pencegahan dan penatalaksanaan preeklampsia. Kemenkes RI
Kunawati Tungga Dewi. (2025). Prevalence and Associated Factors of Severe Preeclampsia Among Pregnant Women. Bulletin of Inspiring Developments and Achievements in Midwifery, 2(1), 36–44. https://doi.org/10.69855/bidan.v2i1.152
Laresgoiti-Servitje, E., & Gomez-Lopez, N. (2012). The Pathophysiology of Preeclampsia Involves Altered Levels of Angiogenic Factors Promoted by Hypoxia and Autoantibody-Mediated Mechanisms1. Biology of Reproduction, 87(2). https://doi.org/10.1095/biolreprod.112.099861
Lestari, D. (2024). Hubungan faktor predisposisi dan faktor biologis terhadap kejadian preeklampsia di RSUD A. Jurnal Kesehatan Ibu dan Anak, 12(1), 45–53.
Magee, L. A., von Dadelszen, P., Stones, W., & Mathai, M. (2022). The FIGO textbook of pregnancy hypertension. International Federation of Gynecology and Obstetrics.
Macedo, T. C. C., Montagna, E., Trevisan, C. M., Zaia, V., de Oliveira, R., Barbosa, C. P., Laganà, A. S., & Bianco, B. (2020). Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 248, 177–186. https://doi.org/10.1016/j.ejogrb.2020.03.043
Mahendra, I. G. A. A., Putra, I. G. N. E., & Suryadhi, N. T. (2021). Faktor risiko kejadian preeklampsia pada ibu hamil. Jurnal Kesehatan Reproduksi, 12(2), 85–94.
Melamed, N., Ray, J. G., Hladunewich, M., & Cox, B. (2019). Gestational hypertension and preeclampsia: Are they the same disease? Journal of Obstetrics and Gynaecology Canada, 41(5), 609–614.
Ministry of Health Republic of Indonesia. (2020). Indonesia maternal mortality profile. MoH RI
Mustary, M., Ansariadi, Syam, A., Riskiyani, S., Erika, K. A., Moedjiono, A. I., & Lubis, M. (2024). Preeclampsia: Etiology, Pathophysiology, Risk Factors, Impact and Prevention: A Narrative Review. Iranian Journal of Public Health, 53(11), 2392–2403. https ://doi.org/10.18502/ijph.v53i11.16941
Peck Palmer, O. M., & Das, S. (2020). Preeclampsia: New Decade, New Diagnostic Efforts. The Journal of Applied Laboratory Medicine, 5(6), 1149–1152. https://doi.org/10.1093/jalm/jfaa124
Phipps, E., Prasanna, D., Brima, W., & Jim, B. (2019). Preeclampsia: Updates in pathogenesis, definitions, and guidelines. Clinical Journal of the American Society of Nephrology, 14(6), 953–962.
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Possomato-Vieira, J. S., & Khalil, R. A. (2016). Mechanisms of Endothelial Dysfunction in Hypertensive Pregnancy and Preeclampsia. Advances in Pharmacology (San Diego, Calif.), 77, 361–431. https://doi.org/10.1016/bs.apha.2016.04.008
Pratiwi, R., Indriyani, I., & Putra, R. T. (2024). Trends in the initial management of severe preeclampsia and eclampsia in Indonesia: A medical record study (2018–2021). Innovation in Health for Society, 4(2), 101–109. https://doi.org/10.31603/ihs.12533
Putri Ariyan, F. A., Sukowati, E. G., & Fatmawati, W. (2022). Preeclampsia correlates with maternal and perinatal outcomes in Regional Public Hospital, Madiun, Indonesia. Majalah Obstetri & Ginekologi, 30(1), 24–31. https://doi.org/10.20473/mog.V30I12022.24-31
Rahayu, S., & Lestari, D. (2022). Hubungan usia dan paritas dengan kejadian preeklampsia. Jurnal Kebidanan Indonesia, 13(1), 45–53.
Rahmawati, N., Pratama, A., & Yuliana, S. (2023). Determinasi kejadian preeklampsia berdasarkan model PRECEDE–PROCEED di rumah sakit Z. Jurnal Kesehatan Reproduksi Indonesia, 14(2), 102–110.
Roberts, J. M., & Hubel, C. A. (2019). The two stage model of preeclampsia: Variations on the theme. Placenta, 84, 1–5.
Rohaeni, E., & Simanjuntak, H. H. (2024). Prevalensi Preeklampsia dan Faktor yang Berhubungan dengan Kejadian Preeklampsia pada Ibu Bersalin. Health Sciences Journal, 8(1), 45–57. https://doi.org/10.24269/hsj.v8i1.2590
Sari, F., Ningrum, N. W., & Yuandari, E. (2023). Faktor-Faktor yang Berhubungan dengan Kejadian Preeklamsia pada Ibu Hamil di RSUD Pambalah Batung. Health Research Journal of Indonesia, 1(5).
Sari, M., & Handayani, R. (2022). Analisis faktor-faktor yang berhubungan dengan kejadian preeklampsia pada ibu hamil di RSUD Y tahun 2022. Jurnal Ilmiah Kebidanan Nasional, 8(3), 120–128.
Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J., … Alkema, L. (2018). Global causes of maternal death. The Lancet Global Health, 2(6), e323–e333.
Sharma, D. D., Chandresh, N. R., Javed, A., Girgis, P., Zeeshan, M., Fatima, S. S., Arab, T. T., Gopidasan, S., Daddala, V. C., Vaghasiya, K. V, Soofia, A., & Mylavarapu, M. (2024). The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions. Cureus, 16(1), e51512. https://doi.org/10.7759/cureus.51512
Sibai, B. M. (2020). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics & Gynecology, 135(2), 485–494.
Siregar, R. N., & Nasution, S. S. (2021). Obesitas sebagai faktor risiko preeklampsia. Jurnal Kesehatan Masyarakat, 16(3), 210–218.
Steegers, E. A. P., von Dadelszen, P., Duvekot, J. J., & Pijnenborg, R. (2019). Pre-eclampsia. The Lancet, 376(9741), 631–644.
Umairo, G., Solehah, I., Komariah, E., & Rahmah, I. F. (2025). Determinants of Preeclampsia among Pregnant Women in Indonesia: A Cross-Sectional Study. Medical-Surgical Journal of Nursing Research, 4(1).
Utami, S. M., & Handayani, F. (2020). Ecological Analysis of Preeclampsia/Eclampsia Case in Sidoarjo Regency, Indonesia, 2015-2019. Indian Journal of Forensic Medicine & Toxicology. https://doi.org/10.37506/ijfmt.v14i4.12164
World Health Organization. (2019). WHO recommendations on antenatal care for a positive pregnancy experience. WHO.
World Health Organization. (2022). WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. WHO.
Wulandari, A., & Putri, R. A. (2020). Riwayat hipertensi dan kejadian preeklampsia. Jurnal Kesehatan Ibu dan Anak, 14(2), 98–105.
Yulianti, E., Handayani, L., & Sari, D. P. (2023). Faktor dominan kejadian preeklampsia di rumah sakit rujukan. Jurnal Ilmu Kesehatan, 11(1), 55–64.
Zhang, J., Zeisler, J., Hatch, M. C., & Berkowitz, G. (2019). Epidemiology of pregnancy-induced hypertension. Epidemiologic Reviews, 19(2), 218–232
Badan Pusat Statistik. (2023). Angka Kematian Ibu/AKI (Maternal Mortality Rate/MMR) Hasil Long Form SP2020 Menurut Provinsi, 2020. BPS-Statistics Indonesia.
Bartsch, E., Medcalf, K. E., Park, A. L., & Ray, J. G. (2016). Clinical risk factors for pre-eclampsia determined in early pregnancy: Systematic review and meta-analysis of large cohort studies. BMJ, 353, i1753. https://doi.org/10.1136/bmj.i1753
Chappell, L. C., Cluver, C. A., Kingdom, J., & Tong, S. (2021). Pre-eclampsia. The Lancet, 398(10297), 341–354. https://doi.org/10.1016/S0140-6736(20)32335-7
Heinze, G., & Schemper, M. (2002). A solution to the problem of separation in logistic regression. Statistics in Medicine, 21(16), 2409–2419. https://doi.org/10.1002/sim.1047
Kementerian Kesehatan Republik Indonesia. (2024). Profil Kesehatan Indonesia 2023. Kementerian Kesehatan Republik Indonesia.
Magee, L. A., Brown, M. A., Hall, D. R., Gupte, S., Hennessy, A., Karumanchi, S. A., Kenny, L. C., McCarthy, F., Myers, J., Poon, L. C., Rana, S., Saito, S., Staff, A. C., Tsigas, E., & von Dadelszen, P. (2022). The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension, 27, 148–169. https://doi.org/10.1016/j.preghy.2021.09.008
Sun, M., et al. (2024). Impact of multiple obesity metrics on hypertensive disorders of pregnancy: A meta-analysis and Mendelian randomisation study. Heart. https://doi.org/10.1136/heartjnl-2024-324038
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLOS Medicine, 4(10), e296. https://doi.org/10.1371/journal.pmed.0040296
Xiong, Y., Chen, J., Wu, Y., Zhao, P., Liao, M., Guo, J., Liu, C., Zheng, M., Ren, Y., Zou, K., Sun, X., & Tan, J. (2025). The effect of maternal pre-pregnancy body mass index on hypertensive disorders of pregnancy (HDP): A systematic review and dose-response meta-analysis of cohort studies involving 50 million pregnancies. EClinicalMedicine, 86, 103395. https://doi.org/10.1016/j.eclinm.2025.103395
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