Pregnancy Induced Hypertension in Kabo Local Government Area of Kano State, Nigeria

polyhydramnios, essential hypertension, kidney disease, high salt intake, obesity and stress. The study concludes that global pregnancy induced hypertension caused high maternal death in pregnant women in Kabo. The study recommends that pregnant women should visit the hospital regularly, especially to check their blood pressure and should be educated about the signs of pregnancy induced hypertension.


Introduction
Despite the high technological inclination in the 21st century, especially in the area of health, the rates of maternal mortalities and morbidities are still very high in women worldwide. The occurrence of maternal hypertensive disorders is found to have about 20.7 million women in 2013 and about 10% of pregnancies globally are complicated resulting from pregnancy induced hypertension normotensive women 8.4 per 1000 live births in china Xiong T, et al. [3]. Pregnancy Induced Hypertensions (PIHs) are responsible for 70,000 maternal deaths universally, killing one woman every 11 minutes Magee, et al. [4]. It is the second leading cause of maternal mortality in Bangladesh, according to the Bangladesh Maternal Mortality Survey (2017), about 24 percent of the country's maternal deaths are caused by pre-eclampsia/eclampsia (PE/E) NIPORT, et al. [5], which affects women during pregnancy, childbirth, as well as postpartum. Factors, such as lack of health care provider capacities to detect, prevent, and manage PE/E, late referrals of HIP clients, late attendance and lack of antenatal care (ANC) and awareness about PE/E among communities have been associated as reasons for most of these preventable deaths Warren, et al. [6].
Deruelle, et al. [7] reported that about 25 percent of women with PIH, especially those with a dangerous condition, experience a decline of end-organ functions during puerperium (the 6 to 8 weeks after delivery, during which pregnancy changes return to baseline). PE early in pregnancy (less 34 weeks of gestation), presenting in a severe form, or persistence of proteinuria more than three to six months after delivery suggests possible chronic hypertension or renal disease. Women with pre-eclampsia are also at increased risk for venous thromboembolism in the postnatal period (after delivery), and those women should receive thromboembolic prophylaxis after delivery until they are fully recovered, usually within four to six weeks RCOG [8]. Similarly, women with preterm pre-eclampsia and gestational hypertension have been found to develop persistent cardiovascular impairment one year after delivery Melchiorre, et al. [9], including other chronic diseases such as chronic hypertension, stroke, renal disease, diabetes mellitus, and ischemic heart disease. Infants born to women with PIH also require special attention in the immediate postnatal period due to a combination of short and long term risks. Standard international guidelines recommend lifelong care and monitoring, or a minimum of care and monitoring for six months to one year after delivery. This study therefore aims to fill this gap by considering pregnancyinduced hypertension, the signs, associated risk factors and prevention and management among pregnant woman attending antenatal service in Kabo.

Basic Tools of Scientific Inquiry
The study was guided by the following research questions:

Pregnancy Induced Hypertension in Nigeria
In Nigeria, an incidence of 20.8% of pregnancy induced hypertension had been reported in a study of pregnant women attending antenatal clinics in a Teaching Hospital in South-South Ebeigbe, et al. [23]. Similarly, prevalence rates of hypertensive conditions of pregnancy range from 17% to 34.1% Singh, et al. [24]. In 2009, the occurrence of PIH ranges between 2% to 16.7% Abubakar, et al. [25]. In 2011, Enugu town had 3.3% per 77 cases of PIH out of 2337 cases Ugwu, et al. [26]. In 2014, according to Singh, et al. [27], the prevalence of hypertensive disorders was estimated to be higher than 17% in Nigeria. Akeju, et al. [28]

Theoretical Framework
This study is anchored on two theories, which include: the  [42]. This is why there is a connection between the study and the theory, since the tenets of the theories are located within the pore of the study.

Methodology
The were interviewed by structural interview method, using tape recorder, note book and biro as data gathering instruments. The respondents were tag with codes like respondent 1, 2, 3, 4 and 5, etc. Based on the in-depth interview method, the data was presented using interpretative analysis.

Findings and Discussion
In attempt to mention the signs of pregnancy induced hypertension, respondent 1 states that: "signs of pregnancy induced hypertension are many, however, she stated the following as part of the signs as follows: chest pain and headache". Corroborating, respondent 2 put forward the followings as some of the signs: "blurred vision and dizziness," while respondents 3, 4, 5 and 6 agreed that pedal oedema and epitaxies are also among the signs.
Similarly, a study by Haque [44]  . When asked about the risk factors associated with pregnancy induced hypertension, respondent 1 states that: "parts of the risk factors associated with pregnancy induced hypertension are indefinitely large numerically, nonetheless, she listed the followings as part of the risk factors: "multiple gestations, elderly prim gravida and high parity." Moreover, respondent 2 stated "polyhydramnios and essential hypertension," while respondent 3 stated "kidney disease." All the respondents agreed that high salt intake (in diet), obesity and stress also contribute to the risk factors associated with pregnancy induced hypertension. Bansode [47] also found that some of the factors associated with pregnancy induced hypertension include first pregnancy, new partner/paternity, age <18 years or >35years, black race, obesity (Body Mass Index, BMI ≥ 30), inter-pregnancy interval <2 years or > 10 years and use of selective serotonin reuptake inhibitors (SSRIs) beyond the first trimester; while placental or fetal risk factors include multiple gestation, hydropsfetalis, gestational trophoblastic disease and triploidy. Similarly, Umegbolu [48] reported that the overall incidence of PIH among pregnant women in Enugu State, Southeast Nigeria (2006-2015) was found to be 5.9%.
The study identified annual variations in the incidence of PIH (rising and falling trends between 2006 and 2015) among the pregnant women. The incidence of PIH was highest among those women above 35 years (13.5%), compared to those whose age is less than 20 years (9.1%) and those between 20-35 years (5.1%).
The occurrence was also higher in the nulliparous (prim gravidae) (7.7%) compared to the multiparous ones (5.5%). Furthermore, Anujeet, et al. [49] stated that hypertension, collagen vascular disease, obesity, black race, insulin resistance, diabetes mellitus, gestational diabetes, increased serum testosterone concentrations and thrombophilia, clotting disorders, and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome are also responsible risk factors for PIH. Similarly, age and parity are two of the identified maternal risk factors for the development of pregnancy induced hypertension. Extreme ages (age below 20 years and above 35 years) are known to be associated with higher incidence of pregnancy induced hypertension. Like the overall incidence of pregnancy induced hypertension, incidence among various age groups and parity varies from place to place. In Karachi, Rehman, et al. [50] found an incidence of 9% among older women and 27% among prim gravidae. However, Sajith, et al. [51] reported an incidence of pregnancy induced hypertension of 41.3% among 18-22 years old patients in their study.
Furthermore, Ahmed, et al. [52] states that educational attainment of women is also a factor that contributes to developing pregnancy induced hypertension. This is because illiterate mothers are more likely to suffer from hypertension during pregnancy than their counter parts. There is every tendency that educated a potential source of concern and anxiety. In addition, Zusterzeel, et al. [53] had emphasized immunological intercourse as the prevention of this maternal-fetal conflict called pregnancy induced hypertension. There is an association of pregnancy-induced hypertension with duration of sexual co-habitation before the first conception. Male ejaculation is said to protect a woman if she has been repeatedly been exposed to it.  [57]. In addition, Donovan [58] says the choice of antihypertensive drugs to be used depends on whether breastfeeding is tried or attempted. When the woman desires to breastfeed, deliberation must be given to potential transfer of the drug into breast milk. This is due to the established evidence that most drugs safely used in pregnancy are excreted in low amounts into breast milk and are compatible with breastfeeding. (Table 1) shows antihypertensive drugs of those to use and those to avoid during lactation.

Recommendations
The study recommends the following, based on the finding of the study: 1. The study recommends that pregnant women in Kabo Local Government should visit the hospital regularly; especially to check their blood pressure.

The women in Kabo Local
Government should be educated about the signs of pregnancy induced hypertension. This will help them to know how to seek for medical services early.

3.
Finally, women in Kabo Local Government should be educated on factors that will assist them to stay healthy and avoid pregnancy induced hypertension.