Eclampsia among adolescent mothers in low- and middle-Income countries

Everyday, approximately 800 pregnant women die from preventable causes, with 95% of these deaths occurring in low- and middle-income countries. Adolescent mothers are disproportionally affected. Hypertensive disorders, including eclampsia, contribute to around 20% of direct maternal deaths, many of which are preventable with simple, cost-effective interventions. This study aims to quantify the risk of eclampsia among adolescent mothers in low- and middle-income countries. This secondary analysis used data from three large multi-center studies within the CRADLE programme of work, conducted across ten regions in Sub-Saharan Africa, India, and Haiti. Data on eclampsia and maternal age were prospectively collected from routine sources and active case finding. The incidence rates of eclampsia were calculated, and the relative risk of eclampsia in adolescents were calculated and compared to non-adolescent mothers. Among 601,343 deliveries, 3,098 cases of eclampsia were recorded (0·51%). The incidence of eclampsia varied widely, from 22 per 10,000 deliveries in Zambia to 142 per 10,000 deliveries in Sierra Leone, a 6·5-fold variation. Adolescents accounted for 34% of eclampsia cases (1065/3098). The relative risk of eclampsia in adolescents compared to older mothers ranged from 1·50 (95% CI 1.32 to 1.83) to 3·45 (95% CI 2.71 to 4.41) across sites (p<0.0001). Adolescent mothers in low- and middle- income countries studied faced a significantly higher risk of eclampsia compared to older mothers. The reproducibility of this finding across diverse settings and time periods highlights the vulnerability of adolescent mothers to health inequalities associated with hypertensive disorders. Further research is needed to explore mechanisms underlying eclampsia in this group, independent of the severity of maternal or fetal disease. Developing targeted interventions and strategies to improve maternal and perinatal outcomes in this high-risk group should be a priority.