Predictors of preeclampsia with severe features: A multi-center analysis of maternal and health system factors in Thai tertiary hospitals.

BACKGROUND

Preeclampsia (PE) with severe features threatens maternal and neonatal health. This study examined maternal and health-service factors associated with severe features and compared maternal and neonatal outcomes in Thailand.

METHODS

This case-control study enrolled 156 postpartum women with PE (52 with and 104 without severe features) and 111 nurse-midwives in antenatal care, labor, and postpartum units across four Thai tertiary hospitals. Data were collected using postpartum and nurse-midwife questionnaires, and a maternal-neonatal health record form. Group differences were assessed using independent t-test, chi-square or Fisher's exact tests. Multivariable binary logistic regression examined factors associated with severe features, adjusting for antenatal care visits and gravidity.

RESULTS

Women with severe features more often had a history of PE (32.7% vs. 13.5%, p = 0.006) and differed in BMI distribution (p = 0.007). Three maternal factors were independently associated with severe features: history of PE (aOR = 5.99, 95% CI 2.13-16.83), BMI (aOR = 0.92 per kg/m2, 95% CI 0.86-0.98), and moderate versus low PE knowledge (aOR = 0.13, 95% CI 0.04-0.50). No health-service variable, including nurse training, was independently associated with severe features after adjustment (all p > 0.05). The model explained 29.4% (Nagelkerke R2) of the variance in PE severity and correctly classified 75.8% of cases. Infant birth weight was lower among women with severe features (p < 0.05); delivery mode, hospital stay, birth asphyxia, and NICU admission did not differ significantly.

CONCLUSION

A history of PE was associated with higher odds, and moderate (versus low) PE knowledge and higher BMI with lower odds, of severe features. These findings support prioritizing screening for prior PE history and structured antenatal knowledge counseling, together with adequately powered, multilevel studies to clarify the role of health-service factors in PE severity.