Assessing pre-eclampsia awareness among pregnant women in Syria: a cross-sectional study on knowledge and perceptions

Preeclampsia (PE) is characterized by high blood pressure and proteinuria at 300 mg/day in pregnant women [1]. This condition is one of the primary causes of maternal and child mortality in low-income countries and is accompanied by symptoms, such as edema, hypertension, and proteinuria [2]. As per the assessment conducted by the World Health Organization (WHO), the prevalence of preeclampsia spans from 2 to 10% across global pregnancies. Nevertheless, developing countries exhibit a reported incidence ranging from 1.8 to 16.7% [3].

Although the exact pathogenic mechanism of preeclampsia remains unclear, some animal and human studies have suggested that defective trophoblast invasion coupled with reduced uteroplacental perfusion may be the underlying cause [4].

Preeclampsia poses a variety of risk factors, including a history of preeclampsia, pregestational diabetes mellitus, chronic high blood pressure, antiphospholipid syndrome, and obesity. Furthermore, other critical factors contribute to the risk, such as advanced maternal age, nulliparity, history of chronic kidney disease, and use of assisted reproductive technologies [5]. Preeclampsia includes two stages: stage I is pre-clinical, which includes abnormal development of the uterine circulation, and stage II is the clinical stage, which manifests as the development of preeclampsia by relaying factors into the maternal circulation. The link between these two stages, proposed in 1993 by Roberts and Redman as endothelial dysfunction, suggests that the maternal endothelium serves as the primary target (leading to the development of stage II hypertension and proteinuria) for placenta-derived factors (generated in stage I) [6].

Preeclamptic pregnancies increase the long-term risk of cardiovascular disease and death in women, with the risk ranging from double the norm to an 8- to 9-fold increase in those who gave birth before 34 weeks of gestation [7]. The diagnosis of PE requires a new onset of hypertension and proteinuria during the second half of gestation. However, their presence does not always lead to complications and does not fully predict the serious consequences of PE. Current efforts focus on identifying this disorder, its pathogenesis, and its multisystemic nature to improve the prediction of early diagnosis and estimation of prognosis for maternal and fetal survival [8].

Adequate knowledge of preeclampsia is essential for the early detection, management, and prevention of adverse maternal and fetal outcomes. However, a significant knowledge gap remains concerning pre-eclampsia in low-income countries, preventing the implementation of effective preventive measures and timely interventions to improve maternal and neonatal health. Prior studies have asserted that informing patients about the disease has great benefits in complying with treatment and in reducing complications associated with the disease [9]. To address these problems, we need to assess women’s attitudes toward predictive and diagnostic tests and how they can influence decisions about treatment and early delivery [10].

Syria is middle east country that suffered from prolonged political and socioeconomic crisis for 11 years, leading to a marked decline in living standards and a substantial degradation of the healthcare infrastructure. The accessibility of healthcare services is notably constrained due to security-related impediments. Furthermore, the provision of maternal and child health services at the primary healthcare (PHC) level is disrupted. The ramifications for maternal and child morbidity and mortality stemming from deliveries occurring amidst the conflict are not definitively ascertained [11].

Given the importance of this matter on the lives of pregnant women and their fetuses and the absence of previous studies rating the awareness of pregnant Syrian women towards preeclampsia, we conducted this study to assess the knowledge and attitudes of pregnant Syrian women towards preeclampsia.

Preeclampsia (PE) is a prevalent contributor to maternal morbidity and mortality on a global scale, impacting an estimated 2–8% of pregnancies worldwide, with rates escalating to 10% in low-income nations [12]. Given the profound implications of this condition for both pregnant women and their fetuses, coupled with the dearth of prior investigations assessing the awareness of preeclampsia among pregnant Syrian women, this study was undertaken to assess their comprehension of this medical concern. The gravity of preeclampsia in jeopardizing the well-being of pregnant women and their unborn offspring motivated our inquiry. Our findings revealed that 52.1% of all participants demonstrated an awareness of preeclampsia. In contrast, a study conducted in Ghana [9] reported that 88.4% of respondents exhibited inadequate awareness of preeclampsia. Nonetheless, a minority of respondents in both our study and the Ghanaian research possessed limited insights into the signs, symptoms, risk factors, and consequences of preeclampsia. This observation underscores the need for further investigation to elucidate the potential underlying factors that could inform the development of pertinent health promotion interventions. Based on sociodemographic characteristics, age between 25 and 35 years, city residency, university-level education, good income, prior preeclampsia, and family history of preeclampsia were significantly associated with greater odds of having adequate knowledge of preeclampsia. Participants who had experienced prior preeclampsia and those with a family history of preeclampsia were significantly more likely to have adequate knowledge about preeclampsia. Similarly, having a higher level of education and being of a more advanced age were substantially linked with better chances of having a sufficient understanding of PE [13]. Because patients’ knowledge of an illness favorably affects their compliance to treatment and helps abate difficulties connected with the condition, evidence suggests that a good understanding of a disorder helps with its prevention, control, and management [13, 14]. For instance, MacGillivray et al. conducted an intervention trial in Jamaica and found that providing cards depicting the symptoms of PE resulted in fewer adverse events occurring among patients [15]. This demonstrates that having a solid understanding of preeclampsia is directly related to better clinical results, and that the opposite is true. Therefore, determining the prevalence of preeclampsia among high-risk populations and improving their understanding of the condition may be vital for reducing the rising incidence of the illness and its associated adverse effects.

When women are informed about the potential outcomes of the symptoms they experience, there is a greater likelihood that they will seek urgent medical attention. The low levels of awareness of preeclampsia found in this study are concerning; nevertheless, they are not insurmountable because the variables that impacted those levels of knowledge were not fixed or general demographic characteristics. Having a high educational level, being economically well off, having a family history of preeclampsia, and having previously experienced preeclampsia were the only factors independently associated with adequate knowledge of preeclampsia after adjusting for other factors that could influence the relationship. This suggests that educating women about preeclampsia through effective methods, such as during antenatal visits, media channels, and with family members, could help improve patients’ understanding of the condition and potentially reduce preeclampsia-related deaths in Syria, similar to the results of a study conducted in Ghana [9], where a higher educational level was found to be associated with better knowledge of preeclampsia. Enhancing patient awareness of preeclampsia has been demonstrated to result in earlier reporting of symptoms, potentially leading to more rapid intervention and better health outcomes for both mother and baby [16, 17]. You et al. proposed that a significant reduction in the severe consequences of preeclampsia might be achieved by increasing the knowledge of the condition and reporting symptoms at an earlier stage [18]. Similarly, research conducted in the United States by Ogunyemi et al. suggested that patient education could have prevented 72% of the instances of eclampsia [19]. Furthermore, due to the plausible relationship between preeclampsia knowledge and improved clinical outcomes, these earlier findings support our argument that improving knowledge of preeclampsia among pregnant women is crucial for reducing the prevalence, complications, and mortality associated with the disease.

Our findings underscore the need to enhance the awareness and knowledge of preeclampsia among pregnant Syrian women. Despite its significant impact on maternal and fetal health, a substantial knowledge gap exists regarding preeclampsia symptoms, risk factors, and complications. Tailored educational initiatives are crucial to address this gap, especially for those with lower education levels and limited healthcare access. These programs should be integrated into antenatal care, community workshops, and digital platforms, offering comprehensive information to empower women to make informed decisions regarding their health.

Moreover, we should highlight the importance of mitigating the anxiety associated with diagnostic tests by fostering effective communication and psychological support. Shared decision making should be promoted among healthcare professionals and pregnant women to ensure that treatment choices align with individual preferences and evidence-based guidance. In the long term, policy efforts must improve the healthcare infrastructure and equitable access to care, guaranteeing that all pregnant women have equal opportunities for education, early detection, and proper management of preeclampsia. By addressing these recommendations, healthcare systems can make significant strides toward reducing the burden of preeclampsia on maternal and neonatal health in Syria and similar contexts.

The study’s inability to fully explore participants’ answer options in light of their pre-existing knowledge was constrained by closed-ended questions. Women selected to participate in the research after making an in-person visit to the clinic or hospital may have different characteristics than women who had consultations by phone, creating the possibility of selection bias. The second set of females may have responded differently, leading to different research results. There is also the possibility of skewed results because the survey was administered online to those who were more likely to be college-educated, have their own cell phones, and live in urban areas. The cross-sectional study design presents potential bias and cannot prove a causal relationship. The utilized sample size surpassed the prescribed quantity for the investigation to guarantee adequacy, addressing the potential occurrence of recurrent or unfinished responses. The economic status has not categorized according to a certain. This online cross-sectional study employed social media platforms as a means of data acquisition; although a proficient investigator oversaw the data collection, the potential for bias remains inherent. The sample, drawn from various Syrian governorates, is limited in size, thereby precluding its comprehensive representation of the entirety of the Syrian female population.

Our investigation identified knowledge lacunae pertaining to preeclampsia among Syrian women. Nevertheless, education plays a crucial role in augmenting awareness and understanding of this ailment. Notably, personal or familial history of preeclampsia emerges as the most pivotal determinant for fostering a comprehensive comprehension of the condition. This underscores the imperative to intensify attempt aimed at enlightening women about preeclampsia to enhance the prospects of healthier pregnancies. The dissemination of information can be derived from diverse channels such as contextual health education administered during antenatal care, media platforms, and national educational initiatives. The amplification of educational campaigns is recommended to bolster awareness on the subject. Furthermore, healthcare providers specializing in obstetrics are well-positioned to contribute to education by imparting knowledge to pregnant individuals attending their clinics or hospitals, thereby mitigating the risk of severe complications associated with this disease.