Booking Status, Maternal Education and Gestational Age at Presentation as Correlates of Perinatal Outcome among Women Managed for Hypertensive Disorders of Pregnancy: A Cross-Sectional Hospital Record Review

Timi Fiekumo Buseri, Osuji Franklin Chukwuemeka, Ruth Ebiegberi Obidake, Buseri, Oyintokoni Beauty, Esther Oduru

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Abstract

Background: Late or absent antenatal booking remains a well-documented risk marker for adverse pregnancy outcome in sub-Saharan Africa, yet its interaction with maternal education and gestational age at presentation among women with hypertensive disorders of pregnancy is less frequently quantified at the level of individual hospital cohorts. Objective: To examine associations between educational attainment, antenatal booking status, gestational age at presentation, and perinatal outcome among women managed for preeclampsia/eclampsia. Methods: A retrospective cross-sectional analysis was conducted on de-identified hospital records of 107 women managed for hypertensive disorders of pregnancy; 104 records with complete outcome data were analysed. Associations between categorical variables were tested using Pearson's chi-square test of independence, with Fisher's exact test and Cramér's V reported where expected cell counts were small. Statistical significance was set at p < 0.05. Results: Booking status was strongly associated with educational attainment (χ²(3) = 21.17, p < 0.001, V = 0.45): only 31.2% of women with secondary education were booked compared with 68.8% of those with tertiary education. Gestational age at admission was significantly associated with neonatal birth weight (χ²(9) = 21.57, p = 0.010, V = 0.28) and showed a borderline association with fetal outcome (χ²(3) = 7.49, p = 0.058), with the highest stillbirth proportion (34.0%) occurring among women admitted at 30–39 weeks. Unbooked women had significantly more incomplete perinatal documentation (missing Apgar and birth-weight records) than booked women (p < 0.05 for all three indices). Conclusion: Educational disadvantage and lack of antenatal booking cluster together and are linked to later presentation and less complete perinatal assessment, reinforcing the case for targeted, education-sensitive antenatal outreach in hypertensive pregnancy care.

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