ABSTRACT

Background: Proteinuria refers to a condition where more than trace amounts of proteins are found in normal urine.

Proteinuria is a defining dysfunction of pre-eclampsia. Proteinuria is one of the cardinal indications of pre-eclampsia, a common and severe complication in pregnancy. Also, there are several factors responsible for its occurrence among pregnant women. The study aimed to establish the prevalence of proteinuria among pregnant women and to establish the predisposing factors of proteinuria among pregnant women attending antenatal care services in Buea Regional Hospital

Methods: This was a cross-sectional study where qualitative and quantitative data was collected and a dipstick urine was used to analyzed the urine sample. Women meeting eligibility criteria was involved until a sampled of 118 was achieved.

Results:  Out of 118 participants, the occurrence of proteinuria was 8.7% and it was increasing with the increase in the age of the pregnant women. Base on socio-demographic characteristics one third of the pregnant women were between the age of 21_30 years with a negative value of 65.1% with a (P-value=0.189).The predisposing factors of proteinuria in pregnancy were BMI 7 (5.0%) with a P value of 0.000 and gestation age 9 (6.5%) with a P value of 0.000.

Conclusions: Clients who receive antenatal care services in Buea Regional Hospital Should routinely be screened for proteinuria. Wider research about proteinuria among pregnant women should be done to establish a more nationalistic occurrence. Health education should emphasize the importance of pregnant women reporting urinary tract infections after being empowered with its signs and symptoms even without pain. This is because urinary tract infections can lead to complications in pregnancy and could become fatal.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Proteinuria is a sign of kidney damage and identifies those at risk for worsening kidney disease. Urinary protein excretion increases in normal pregnancy from less than 150 mg/day in non-pregnant individuals to up to 300 mg/day in pregnancy. Thus, the threshold of abnormal protein excretion for the diagnosis of preeclampsia is more than 300 mg/24 hours or more than 2+ by dipstick testing according to the American College of Obstetrics and Gynecology Guidelines. Proteinuria is a sign of kidney damage and identifies those at risk for worsening kidney disease. Urinary protein excretion increases in normal pregnancy from less than 150 mg/day in non-pregnant individuals to up to 300 mg/day in pregnancy. Thus, the threshold of abnormal protein excretion for the diagnosis of preeclampsia is more than 300 mg/24 hours or more than 2+ by dipstick testing according to the American College of Obstetrics and Gynecology Guidelines (ACOG, 2019).

The presence of proteinuria is seen as a possible indication of many complications in pregnancy, from urinary tract infection to chronic renal disease and it remains central to the diagnosis of pre-eclampsia in a hypertensive pregnancy.

The incidence of proteinuria arising in pregnancy varies according to parity, Body Mass Index (BMI), high alcohol intake, blood pressure, age and underlying medical disease (P.R Garner et al 1990).

Preeclampsia is a pregnancy-related disorder characterized by hypertension, peripheral edema, and proteinuria. It’s defined as a systolic blood pressure >140mmHg or diastolic blood pressure >90mmHg on two occasions after 20 weeks of pregnancy, as well as proteinuria of more than 300mg in 24 hours urine. It is also one of the leading causes of maternal and neonatal morbidity and mortality, affecting 2%-8% of pregnancies (Rao et al., 2022).   

Severe pre-eclampsia commonly occurs during the second trimester or third trimester of gestation, which is characterized by blood pressure, elevated than 160/110 mmHg, proteinuria greater than 5g per 24 hrs., visual disturbances, epigastric pain or more specifically right upper quadrant pain (Minere et al., 2013). The factors that have been postulated to influence the risk of pre-eclampsia in various studies include diabetes and gestational diabetes, obesity, multiple pregnancy, personal and family history of pre-eclampsia, chronic infections, urinary tract infection, first pregnancy and older maternal age or younger than 20 years age, renal disease and autoimmune disorder, the prolonged interval between pregnancies and the history of abortion and maternal diet (Dukitt et al., 2005).

The prevalence of preeclampsia in developing countries ranges from 1.8% to 16.7% (Kayode and Olusimbo, 2011)

The majority of deaths due to preeclampsia or eclampsia are avoidable through the provision of timely and effective care to the women presenting with the complications. Improving healthcare to prevent and treat women with hypertensive disorders is a necessary step towards reducing maternal and infant mortality and morbidity (WHO, 2011).

Preeclampsia is of global public health importance and the most common medical threat in both developed and developing countries contributing to maternal and perinatal morbidity and mortality (NICE, 2019).

When proteinuria is absent, preeclampsia is diagnosed in association with liver dysfunction, thrombocytopenia, pulmonary oedema, new onset of kidney dysfunction, or new-onset of cerebral or visual disturbances. It can cause severe morbidity, chronic disability, and even death of mothers and babies. Moreover, it is linked with an increased risk of cardiovascular diseases and type 2 diabetes in a mother’s later life (ACOG, 2013).

In developing countries, women are at 14 times higher risk of dying from obstetric complications compared to developed countries. Pregnancy complications caused around 289,000 deaths of women worldwide in 2013 and 99% of them were from developing countries (Tiessama et al., 2015).

Eclampsia is defined as the development of convulsion and/or unexplained coma during pregnancy or postpartum period. It is one of the leading causes of high maternal mortality and morbidity and high perinatal mortality. The World Health Organization estimates that eclampsia is the cause of 12% of all maternal deaths globally (Nobis and Hajong, 2016).

In previous versions of the guidelines, proteinuria was required for the diagnosis of preeclampsia. Under the current guidelines, preeclampsia may be diagnosed in the absence of proteinuria if hypertension plus another severe feature is present. This change was driven by two important observations. First, the severity of proteinuria is not strongly associated with adverse maternal and neonatal outcomes. Second, preeclampsia sometimes can occur in the absence of proteinuria: up to 10% of women with preeclampsia and 20% of women with eclampsia have no proteinuria on initial presentation (Williams et al., 2008).

Proteinuria in pregnancy is a clinical entity which is of interest to the obstetrician, nephrologist, urologist, general physician as well as the patients general practitioner. More importantly, it is worrying for the pregnant patient and her family. In view of this, it is pertinent to understand the pathophysiology, differential diagnosis, investigation and management of proteinuria in pregnancy.  

Previous studies in a few countries in Africa indicate that the knowledge on preeclampsia of women is generally low (5-8). This study aimed to determine the occurrence of proteinuria and associated risk factor among pregnant women attending antenatal care in Buea Regional Hospital.

1.2 Statement of the Problem

Pre-eclampsia is a frequent disorder that occurs only during pregnancy and postpartum period and affect both the mother and the unborn baby. However geographic, social, economic and racial differences are thought to be responsible for incidence rates up to 3 times higher in some populations (Lopez-Jaramillo et al., 2002). The prevalence of preeclampsia in African countries ranges from 1.8% to 16.7% (Kayode and Olusimbo, 2011). In Cameroon, it represents a major pathological entity in hypertensive diseases on pregnancy with 77.88% of hypertensive patients and frequency of 4.97%. It is therefore a worrying pathology because of its high prevalence and its complication involving the materno-fetal vital prognosis in the short term. The aim of this study was to determine the prevalence and risk factors associated with proteinuria among pregnant women.

1.3 Research Questions

1. What is the prevalence of proteinuria among pregnant women?
2. What is the prevalence of proteinuria among pregnant women with respect to socio-demographics?
3. What are the pre-disposing factors of proteinuria among pregnant women?

1.4 Research Objectives

1.4.1 Main objective

To determine the prevalence of proteinuria and its associated risk factors among pregnant women attending ANC Buea Regional Hospital.

1.4.2 Specific objectives

1. To determine the prevalence of proteinuria among pregnant women.
2. To determine the prevalence of proteinuria among pregnant women with respect to socio-demographics.
3. To determine the pre-disposing factors of proteinuria among pregnant women.