Predictors of preeclampsia with severe features: A multi–center analysis of maternal and health system factors in Thai tertiary hospitals
- 1Doctor of Nursing Science (Candidate), Faculty of Nursing, Mahidol University, Bangkok, Thailand.
- 2Department of Obstetrics and Gynaecology Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
- 3Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Abstract
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.
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BibTeX
@article{boonyaporn2026predictors,
title = {{Predictors of preeclampsia with severe features: A multi–center analysis of maternal and health system factors in Thai tertiary hospitals}},
author = {Tippawan Boonyaporn and Piyanun Limruangrong and Ameporn Ratinthorn and Thitipong Tankumpuan},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0361195},
url = {https://doi.org/10.1371/journal.pone.0361195},
note = {CC BY},
}
RIS
TY - JOUR
TI - Predictors of preeclampsia with severe features: A multi–center analysis of maternal and health system factors in Thai tertiary hospitals
AU - Tippawan Boonyaporn
AU - Piyanun Limruangrong
AU - Ameporn Ratinthorn
AU - Thitipong Tankumpuan
PY - 2026
DA - 2026/10/21
JO - PLOS One
DO - 10.1371/journal.pone.0361195
UR - https://doi.org/10.1371/journal.pone.0361195
AB - 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.
SN - 1932-6203
ER -