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Hypertensive disorders in pregnancy: A leading cause of maternal mortality in Gambia

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By Dr Muhammed Lamin Touray

Pregnancy, a time of great anticipation and joy, should ideally be a period of health and well-being for both the expectant mother and her unborn child. However, in many parts of the world, including The Gambia, hypertensive disorders in pregnancy continue to pose a significant threat to maternal health and safety. These conditions, often characterized by high blood pressure, can lead to severe complications that endanger the lives of pregnant women. This article explores the prevalence, risk factors, consequences, and potential interventions related to hypertensive disorders in pregnancy, with a specific focus on their impact on maternal mortality in The Gambia.


Hypertensive disorders in pregnancy encompass a range of conditions characterized by elevated blood pressure. These disorders can manifest at various stages of pregnancy and are a leading cause of maternal mortality globally. In The Gambia, where maternal mortality rates have been a longstanding concern, hypertensive disorders contribute significantly to the grim statistics. Understanding the nature and implications of these disorders is vital for improving maternal health and reducing the number of lives lost during pregnancy and childbirth.

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Prevalence of hypertensive disorders in pregnancy in Gambia

The prevalence of hypertensive disorders in pregnancy in The Gambia is a matter of growing concern. While there is limited comprehensive data available, a study published in the African Health Sciences Journal in 2020 reported that hypertensive disorders in pregnancy accounted for 14.8% of maternal deaths in a tertiary healthcare center in the country. Although this data is from a specific healthcare facility, it underscores the broader issue of hypertensive disorders contributing to maternal mortality in the nation.

Moreover, studies suggest that the prevalence of hypertensive disorders in pregnancy may be underreported in The Gambia due to challenges in access to healthcare services, data collection, and documentation. The true burden of these disorders in the country may be even higher than reported.

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Risk factors for hypertensive disorders in pregnancy

Hypertensive disorders in pregnancy are influenced by a combination of factors. These risk factors can be broadly categorized into maternal, fetal, and environmental factors.

Maternal factors

i.          First pregnancy: Primigravida women, particularly those under the age of 20 or over the age of 35, are at an increased risk.

ii.         Pre-existing hypertension: Women with pre-existing hypertension have a higher likelihood of developing hypertensive disorders during pregnancy.

iii.        Obesity: Maternal obesity is associated with a significantly increased risk of hypertensive disorders.

iv.        Diabetes: Women with diabetes are at higher risk of developing gestational hypertension or preeclampsia.

Fetal factors

i.          Multiple gestations: Women carrying multiple fetuses, such as twins or triplets, are at an elevated risk.

ii.         Hydramnios: An excessive accumulation of amniotic fluid can increase the risk of hypertension in pregnancy.

Environmental factors

I.          Inadequate prenatal care: Late initiation of prenatal care or infrequent visits to healthcare facilities can lead to undetected or poorly managed hypertensive disorders.

ii.         Socioeconomic Factors: Women with limited access to healthcare, lower education levels, and lower socioeconomic status are at greater risk.

Consequences of hypertensive disorders in pregnancy

Hypertensive disorders in pregnancy can have devastating consequences for both the mother and the developing fetus. These disorders can lead to severe complications, including:

i.          Preeclampsia: Characterized by high blood pressure and damage to organs, preeclampsia can lead to seizures (eclampsia), stroke, and multi-organ failure.

ii.         HELLP syndrome: A severe form of preeclampsia, HELLP syndrome can cause liver and blood-clotting problems.

iii.        Premature birth: Hypertensive disorders may necessitate premature delivery, increasing the risk of health issues for the baby.

iv.        Low birth weight: Babies born to mothers with hypertensive disorders are more likely to have low birth weight, which can lead to health problems.

v.         Maternal mortality: In severe cases, hypertensive disorders can result in maternal mortality due to complications such as cerebral hemorrhage and organ failure.

Intervention and prevention

Preventing and managing hypertensive disorders in pregnancy is a multi-faceted challenge that requires a comprehensive approach. Key strategies include:

i.          Early and adequate prenatal care: Ensuring that pregnant women receive timely and regular prenatal care is essential for the early detection and management of hypertensive disorders.

ii.         Monitoring blood pressure: Regular monitoring of blood pressure during pregnancy can help identify and manage hypertensive disorders promptly.

iii.        Lifestyle modification: Promoting a healthy lifestyle that includes a balanced diet, regular physical activity, and weight management can reduce the risk of hypertensive disorders.

iv.        Education and awareness: Raising awareness among women, families, and healthcare providers about the risks, symptoms, and consequences of hypertensive disorders is crucial.

v.         Access to healthcare services: Improving access to quality healthcare services, particularly in remote or underserved areas, is essential to ensure that women receive the care they need.

vi.        Medication: In some cases, medication may be necessary to manage blood pressure and prevent severe complications.


Hypertensive disorders in pregnancy pose a substantial risk to maternal health and are a leading cause of maternal mortality in The Gambia. The prevention, early detection, and management of these disorders are crucial for reducing maternal mortality rates in the country. A concerted effort involving healthcare professionals, policymakers, communities, and individuals is needed to address this pressing issue and ensure that pregnancy is a time of joy and health for women in The Gambia. Maternal health is not only a human right but also a cornerstone of sustainable development and the overall well-being of the nation.

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