The risk factors of pregnancy-induced hypertension: A case- control study

The risk factors of pregnancy-induced hypertension: A case- control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The risk factors of pregnancy-induced hypertension: A case- control study Rogayeh Farajzadeh, Samira Shahbazzadegan, shahla farzipour, Farhad Pourfarzi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5955408/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pregnancy-induced hypertension (PIH) is a major health problem in pregnant women and is one of the main causes of maternal and perinatal mortality. Considering its many complications and effects on the mother and the fetus, identifying the effective factors on occurrence is a priority. This research was conducted to determine the risk factors of PIH. Methods This case-control (descriptive-analytical) study was conducted at 2023 in Ardabil city. 115 women higher than 35 years old who had PIH in their last pregnancy were selected as a case group and the same number of women without this disease in their last pregnancy selected as the control group (after matching age groups). Data were collected from a retrospective comprehensive study of Persian cohort. Women in both groups were interviewed and information including demographic, PIH and diabetes history, GDM, Colelityasis, Renal failer, Heart failer, romatological disease, H. pylori , twin pregnancy, history of high blood pressure in previous pregnancies, smoking, alcohol, hookah, drugs use were obtained. Findings: Gestational diabetes mellitus or GDM, previous history of PIH, history of H. pylori infection and BMI were identified as effective risk factors for the occurrence of PIH. Conclusion GDM was identified as the most important risk factor for PIH in Ardabil province. Infection H.pylori bacteria, history of PIH, and hight BMI were as other PIH risk factors. It is necessary for women with these risk factors to take the necessary care for early diagnosis, including visiting and having a pre-pregnancy check-up. pregnancy induced hypertension risk factors gestational hypertention preeclampsia Background High blood pressure is the most common medical problem that occurs in 10–15% of pregnancies, which is described as pregnancy-induced hypertension (PIH) ( 1 ). PIH is a major health problem in pregnant women, which is one of the main causes of maternal and perinatal mortality. On the other hand, considering the many complications and effects on the mother and the fetus, identifying the effective factors on PIH can be considered among the priorities for treatment system. PIH is occur in the second half of pregnancy and may last up to 6 weeks after delivery ( 1 ). Sometimes the severity of these effects is so high that it can be life-threatening ( 2 ). According to the guidelines of the American Heart Association (AHA), high blood pressure is defined as systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mmHg or both ( 3 , 4 ). According to the classification of the National Heart Lung and Blood Center (NHLBI), the classification of hypertension during pregnancy includes gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on existing hypertension (2 and 5). PIH is a type of hypertension that occurs after the 20th week of pregnancy in women who previously had normal blood pressure ( 5 ). The World Health Organization estimates that at least one woman dies every seven minutes due to the complications of pregnancy hypertension ( 6 ). One of the main complications of this type of high blood pressure is progression to preeclampsia; the relative risk of this development depends on the time of initial presentation and ranges from 40% before the 30th week of pregnancy to 7% after the 38th week of pregnancy ( 1 ). If high blood pressure is severe, it increases the risk of heart failure, heart attack, renal failure and cerebrovascular accidents in the mother ( 5 ). Placental abruption, stroke and pre-eclampsia are other maternal complications ( 7 ). In addition, the fetus is at risk of increased complications such as poor placental oxygen transfer, growth restriction, prematurity, premature birth, placental abruption, stillbirth and perinatal death ( 5 , 7 ). Another complication of PIH is preeclampsia; Pre-eclampsia and eclampsia have the greatest effect on morbidity and mortality of mothers and babies. Globally, preeclampsia is one of the main causes of maternal and neonatal mortality and morbidity, mainly in developing countries ( 8 ). Examining the risk factors of PIH can help in diagnosing and preventing the occurrence of pre-eclampsia. Since about half of the population of our country and the world are women, when a woman gets sick, in addition to the mentioned complications, huge diagnostic and treatment costs are imposed on the family economy and health systems. On the other hand, the combination of these factors may lead to the disability of women. Considering all the above cases, we find out to what extent the peace and comfort of the family is subject to turmoil and crisis when one of the people (especially the mother) gets sick. Some risk factors were reported in preveus studies that effect PIH. Among them, context diseases, microbial contamination, diet and nutrition, addiction, age, and other factors can be mentioned ( 9 – 12 ). Considering the importance and breadth of the issue, and the fact that no independent research has been conducted in our region in recent years, and there is still no accurate information about the important risk factors and epidemiological status of PIH, this study was conducted aimed to determine the risk factors for PIH. Methods Study design and samples size This case-control (descriptive-analytical) study was conducted by ethics code IR.ARUMS.MEDICINE.REC.1402.099. Groups were selected randomly among 1000 women with available data based on Persian Cohort in 2023 in Ardabil city. The sample size was calculated by formula, The prevalence of each of the risk factors were extracted based on previous studies ( 13 – 19 ). The sample size was approximately 230 (115 case and 115 control group). Woman who had PIH in their last pregnancy (blood pressure greater than or equal to 130/80 and after 20 weeks pregnancy) was considered as the case group, and women who did not have PIH in their last pregnancy as the control age group. The control group was matched in 5-year age so age were adjusted for groups. The inclusion criteria were having a history of pregnancy, age higher than 35 years, living in Ardabil province. Exclusion criteria were having chronic hypertension before pregnancy or hypertension before 20 weeks of pregnancy. Demographic characteristics (age, first pregnancy age, education, job, income, BMI and number of pregnancy) and PIH and diabete history, GDM, Colelityasis, Renal failer, Heart failer, romatological disease, H. pylori , twin pregnancy, history of high blood pressure in previous pregnancies, smoking, alcohol, hookah, drugs ues were assessed. The prevalence of H. pylori bacteria was investigated using HPS-Ag (helicobacter antigen in feces). The variables differences between the two groups were expressed using Chi-Square and Fisher's exact test. Bivariate and multivariate logistic regression model was also used for investigating relationship between variables, and PIH. The OR value was used to examine the risk ratio in groups. In the logistic regression model, α = 5% and β = 10% was set, a significance level were 0.05. The data was analyzed using SPSS version 26 software. Result Demographic information of participants was showen in table 1. The average age of the case and control groups were 44.60 ± 6.83 and 44.57 ± 7.16 years, respectively. Thers was no significant differene of the age of participants in study groups (p = 1.00). Age of first pregnancy (year) also was not significant different in two groups (p = 0.857). The highest number of studied women in both groups had primary education and Housewife.The economic status of people were poor to middle. There were no significant difference about edcation, job, economic status and number of pregnancy between to study groups. The mean and standard deviation of BMI in the case group was 32.90 ± 5.52 kg /m 2 and in the control group was 30.52 ± 4.82 kg /m 2 , that was statistically significant difference (0.013). The highest frequency of BMI in the case group was 37.4% that belonged to first class of obesity, and in the control group 38.3% in overweight class. Twin pregnancy was not observed in groups. Table 1- Demographic information on groups Risk factors in case and control groups were showen in Table 2. Chi-square and Fisher statistical tests, showed a significant difference between the case and control groups (p = 0.00). 45 women (39.1%) in case group and 19 women (16.5%) in control group had PIH history. Frequancy of GDM in the case group was 11 women (9.6%) and in the control group one woman (0.9%). Chi-Square and Fisher's Exact Tests showen statistically significant differencee between the groups (p = 0.008). 73% of the studied women in the case group had a history of H.pylori infection; while Corresponding value was 60% in the control group. 66.1% of all the studied women had a history of infection with this bacterium. According to the chi-square test, the prevalence of H.pylori bacteria in the case groups was significantly higher than control groups (p = 0.03). Difference between groups were not significant about diabetes history, Colestais, Renal diseas, Heart diseas, Romatologhic, Smoking, and Hookah. None of the people in the case and control groups had a history of drug and alcohol use. Table 2- Difference between risk factors in Case and control groups The variables simultaneously were entered into the multivariate regression model and was adjusted, Should be noted that in the evaluations, the control group was considered as a reference and the subjects in the mentioned cases were measured in the case group compared to the control group. In the final and adjusted model according to table 3, previous history of PIH, GDM and history of H. pylori had significance relationship with PIH. In the final model according to Table (3) previous history of PIH (OR: 18.268; 95% Cl: 6.121–54.526: p < 0.001), GDM (OR: 50.133; 95% CI: 5.123-490.612: p < 0.001), and history of H.pylori infection (OR: 27.565; 95% Cl: 8.473–89.677: p < 0.001) had significance relationship with PIH. In addition, among the BMI categories, only grade two obesity was significant (OR: 3.896; CI 95%: 1.188–12.775, p = 0.025). thus, gestational diabetes, history of previous hypertension in pregnancies and infection with H. Pylori bacteria with OR > 1 were identified as risk factors for PIH. However, in the index categories Body mass: No specific pattern was found between increasing or decreasing BMI and the incidence of this disease (in addition to the fact that BMI was not significant except for one grade in the rest of its categories, this variable also lacked dose dependency). Finally, gestational diabetes was identified as the most important risk factor for PIH OR = 50.133. Table 3- Logistic regression model Dicussion In the present study, GDM, history of H. pylori , previous history of PIH, and BMI had significance relationship with PIH. Among these risk factors, GDM was the most important risk factor for PIH. Diabetes is abnormal glucose metabolism caused by many factors, often induced by abnormal secretion of insulin, pancreatic islet dysfunction, or tissue resistance to insulin, which may aggravate various complications during pregnancy. In the present study, 9.6% of women in the case group had GDM, while 0.9% of women in the control group had GDM. Significant relationship was also found between GDM and PIH. Zhou et al., 2021 showed that higher fasting blood glucose (FBS), 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, 1-hour postprandial insulin, and 2-hour postprandial insulin in women with PIH, that is in accordance whit our results. One of suggested reasons is increase of the of insulin growth factor effect caused to proliferation of vascular smooth muscle cells that leads to narrowing of blood vessels and increased vascular resistance, and ultimately increases blood pressure and disturbances in the diastolic function of the left ventricle ( 20 ). Savidov et al. 2002 showed that in pregnant women with insulin-dependent diabetes mellitus, brachial artery dilation by flow was significantly lower than in healthy pregnant women (6.43 ± 3.66% vs. 9.43 ± 3.69%, respectively; P = 0.0008). This difference was present even after adjusting for blood vessel diameter, which differed between them. As a result, maternal insulin-dependent diabetes mellitus is associated with impaired vasodilator response ( 21 ). Hinkosaw et al. in Ethiopia reported that positive history of diabetes is a risk factor for blood pressure disorders during pregnancy (OR 5.03, CI 95%: 1.59, 15.89) ( 22 ). In the current study, 73% of the women in the case group had a history of H. pylori infection while 60% of women in the control group had it. The relationship between H.pilory and PIH was significant. Pourfarzi et al (2018) were conducted a study to investigate of H. pylori prevalence rate in residents aged 1 to 69 years of Ardabil; they reported to 50.1% infected by H. pylori ( 23 ) which indicates the high prevalence of H. pylori bacterium in the population of Ardabil. Galan et al 2024 and Mirteimouri et al 2024 reached to similar results ( 24 , 25 ). In a study about H.pylori infection and the prevalence of hypertension among Chinese adults in 2018, Wan et al showed that H. pylori infection was positively associated with the prevalence of hypertension with an odds ratio 1.23 ( 26 ). In 2021, a study was conducted by Li et al. to investigate the effects of H. pylori infection on pregnancy-related diseases, which showed that PIH, preeclampsia, and premature delivery in diabetic and pre-diabetic was increased with H.pylori infection ( 27 ), that is in agreement with oure study. Shazli and Abdulhamid conducted a case-control and comparative study in 2023 to evaluate the incidence of H.pylori among pregnant women with preeclampsia and those without this disease and showed that preeclampsia, especially in severe and complicated cases, was associated with maternal H. pylori infection ( 28 ). In the present study, a significant relationship was observed between the history of hypertension and PIH. 39.1% of women in the case group had a history of hypertension in previous pregnancies, compared to 16.5% in the control group, and a significant relationship was found between history of hypertension and PIH, which is consistent with Ajan et al. in 2021 study. They identified the prevalence of PIH and previous history of PIH as the most important risk factors for this disease (OR 1.276, 95% CI; 0.125–11.836) ( 29 ). Our study showed a significant difference in terms of BMI between the two groups. BMI in the first class of obesity (BMI 30 to 34.9) had highest frequency in the case group (37.4%). The average BMI in the case group was higher than that of the control group. Lewandowska et al. conducted a study to investigate the obesity before pregnancy, excess weight gain during pregnancy and the risk of high blood pressure and gestational diabetes caused by pregnancy. In their study, 10.8% of women were obese before pregnancy had a BMI ≥ 30 kg/m 2 . The results of their studies showed that pre-pregnancy obesity was associated with PIH (OR = 4.94 and P < 0.001) ( 30 ). Deborah et al. showed an increase in the odds of PIH with incrieas BMI in pregnant women ( 31 ). Bilayhun et al. 2021, showed having a history of renal disease as a risk factor for PIH (OR 3.14: CI 95%:1.05–9.38) ( 32 ); However, in the present study, there was no significant difference in history of kidney disease including kidney failure and history of kidney stones with PIH. The insufficient number of patients in our study can be reason for this insignificance (one patient in the control group and the absence of kidney failure in the case group). In terms of the history of heart disease, rheumatological diseases, history of diabetes, no significant difference was observed between groups. Pan et al. (2020) showed relationship between systemic lupus erythematosus and polycystic ovary with PIH and preeclampsia ( 29 ). Tian et al. 2023 reported that pregnant women with RA were significantly more likely to develop preeclampsia than women without RA ( 33 ). These studies results are in opposition with our results. There was no significant difference in the number of previously pregnancies between the two groups. In a study conducted in India by Nasser et al., 75% of patients with hypertension were multigravida and 25% were their first pregnancy ( 34 ). Twin pregnancy was not reported in our study. Therefore, twin pregnancy could not be investigated as an effective risk factor. Hinkosaw et al reported that twin pregnancy is a risk factor for blood pressure disorders during pregnancy (OR 3.78, CI 95% ,9.39, 1.52) ( 22 ). Smoking and hookah consumption were not considered as significant risk factors, since significant differences were not observed between groups. Only one person from each of the case and control groups had smoking, and the difference between the two groups was not significant. None of the studied women had alcohol and drug use. Probably, these results have been obtained in the context of the culture and tradition that governs Iranian families. In relation to age, the findings indicate that although the disease was more prevalent in the elderly, this factor could not be investigated as a risk factor in our study due to matching the control group with the case group in terms of age. Women with more than 35 years were included in the study, and this is probably the reason for the high average age of the research compared to some other studies.The average age of the women was 44.60 ± 6.83 years. This average was reported as 32.59 ± 5.04 years in Izadi et al. (2017) study ( 35 ). In a retrospective study conducted by Nie et al. in Beijing, the mean age for preeclampsia was reported as 32.74 ± 5.25 ( 34 ). Based on the results of Hinkosa et al. age ≥ 35 is considered a risk factor for PIH (OR 2.51, CI 95%,1.08, 5.83) ( 22 ). Also, Timofeev et al, showed that PIH was more common in women aged 35 or older (frequency of 8.5% compared to 7.8% in mothers aged 25–29) ( 37 ). There was no statistically significant difference between the two groups in terms of economic status and income. Shah et al 2019; showed that mothers from the lower middle class are at high risk and more vulnerable to high blood pressure disease ( 38 ). One of the possible reasons could be that women in low socio-economic status often face to inappropriate nutrition, unhygienic conditions and receive less prenatal care. These results are consistent with the studies of Parmar et al. and Shazia et al., that they reported mothers who are in a lower socio-economic class have significantly higher rates of PIH and cesarean section surgery ( 38 , 39 ). There was no significant relationship between job and PIH, which could be related to cultural issues and women's reluctance to work outside the home in the region. Izadi et al. 2017 found that women working in management, legal and social services, education, consulting and health services are more at risk suffering PIH compared to women working in industries such as food, cosmetics and hygiene ( 35 ). Limitations of the study, due to the low level of education of the majority of the researched people, the given information may have a low confidence factor to some extent. Due to cultural issues, there is a possibility of concealment in people self-report about risky behaviors such as smoking, hookah, drugs and alcohol; therefore, a detailed evaluation of these behaviors and finding their relationship and impact on the dependent variable of the present study was not achieved. Considering the criterion of the last pregnancy of the research subjects and the possibility of a time gap, there is possible that they may make mistakes in remembering details such as weight and not give accurate information. Conclusion Gestational Diabetes Mellitus, infection H.pylori bacteria, history of PIH, and hight BMI were identified as a PIH risc factors. Due to the relatively high prevalence of PIH, it is suggested to conduct a wider study with a larger sample size. Considering that, PIH is often diagnosed after infection and sometimes even in more dangerous stages such as pre-eclampsia and eclampsia, it is recommended that all people who have risk factors for PIH undergo proper screening and consulting to evaluate risk factors and control blood pressure before trying to get pregnant. Considering the low income and the prevalence of obesity of women in this study, it is recommended to provide the necessary training in terms of proper nutrition and sufficient physical activity to control women's weight. Abbreviations AHA American Heart Association BMI Body Mass Index GDM Gestational Diabetes Mellitus H.pylori Helicobacter pylori NHLBI National Heart, Lung, and Blood Institute PIH Pregnancy Induced Hypertension Declarations Acknowledgment The authors would like to appreciate all participating students in this study. Conflict of interest The authors declare no conflict of interest. Methods were performed in accordance with the relevant guidelines and regulations. Ethics approval was obtained from the Ardabil University if medical sciences, Research Ethics Committee on IR.ARUMS.REC.1402.099. Consent for publication Not applicable. Availability of data and materials The datasets generated during and analyzed during the current study are available from the corresponding author. Competing interests The authors declare that have no competing interests. Funding No funding. Author’s contributions RF, FP, Sh P, and SSh made substantial contributions to the conception and design of the study. RF, FP are responsible for the overall logistical aspect of the trial and general acquisition of data. SSh drafted the manuscript. All authors critically revised the manuscript and agreed to be accountable for all aspects of the manuscript ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved. 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Tables Table 1- Demographic information on groups P* Total )N=230 ( Control )N=115 ( Case )N=115 ( 1.000 72 (31.3%) 36 (31.3%) 36 (31.3%) Lower than 40 Age (year) 58 (25.2%) 29 (25.2%) 29 (25.2%) 40-44 54 (23.5%) 27 (23.5%) 27(23.5%) 45-49 22 (9.6%) 11 (9.6%) 11 (9.6%) 50-54 24 (10.4%) 12 (10.4%) 12 (10.4%) Higher than 55 0.857 9 (4%) 6 (5.4%) 3 (2.6%) Lower than 15 First pregnancy age (year) 90 (40%) 46 (41.8%) 44 (38.2%) 15-19 83 (36.88%) 37 (33.6%) 46 (40%) 20-24 31 (13.77%) 15 (13.6%) 16 (13.9%) 25-29 6 (2.66%) 3 (2.7%) 3 (2.6%) 30-34 6 (2.66%) 3 (2.7%) 3 (2.6%) Higher than 35 0.853 32 (13.9%) 18 (15.7%) 14 (12.2%) 0 Education (Class) 76 (33%) 40 (34.8%) 36 (31.3%) 1-5 36 (15.7%) 19 (16.5%) 17 (14.8%) 6-9 17 (7.4%) 7 (6.1%) 10 (8.7%) 10-11 45 (19.6%) 19 (16.5%) 26 (22.6%) 12 3 (1.3%) 2 (1.7%) 1 (0.9%) 14 18 (7.8%) 8 (7%) 10 (8.7%) 16 Bsc 3 (1.3%) 2 (1.7%) 1 (0.9%) Higher than 16 PhD and MSc 0.697 9 (3.9%) 4 (3.5%) 5 (4.3%) Emploee Job 10 (4.3%) 3 (2.6%) 6 (5.2%) Teacher 10 (4.3%) 6 (5.2%) 4 (3.5%) Tecnical 8 (3.5%) 5 (4.3%) 3 (2.6%) saeler 1 (0.4%) 0 (0%) 1 (0.9%) Driver 193 (83.9%) 97 (84.3%) 96 (83.5%) Housewife 0.203 49 (21.3) 31 (27%) 18 (15.7%) Very poor Economic status 49 (21.3%) 20 (17.4%) 29 (25.2%) poor 62 (27%) 32 (27.8%) 30 (26.1%) Middle 37 (16.1%) 18 (15.7%) 19 (16.5%) Wealth 33 (14.3%) 14 (12.2%) 19 (16.5%) Very Wealth 0.013 0 (0%) 0 (0%) 0 (0%) Low 18.5 BMI (kg/m 2 ) 17 (7.4%) 10 (8.7%) 7 (6.1%) Normal 18.5-24.9 73 (31.7%) 44 (38.3%) 29 (25.2%) Overweight 25-29.9 85 (37%) 42 (36.5%) 43 (37.4%) Obesity I 30-34.9 41 (17.8%) 11 (9.6%) 30 (26.1%) Obesity II 35-39.9 14 (6.1%) 8 (7%) 6 (5.2%) Obesity III 40 0.321 2 (0.9%) 2 (1.8%) 0 (0%) 0 Number of pregnancy 67 (29.5%) 34 (30.4%) 33 (28.7%) 1-2 114 (50.3%) 55 (49.2%) 59 (51.3%) 3-4 36 (15.8%) 18 (15.7%) 18 (15.7%) 5-6 8 (3.5%) 3 (2.7%) 5 (4.4%) 7 and more * Chi-Square and Fisher's Exact Tests Table 2- Difference between risk factors in Case and control groups p Total )N=230 ( Control )N=115 ( Case )N=115( Situation Risc factors 0.000 64(27.8%) 19(16.5%) 45(39.1%) Yes PIH History 166(72.2%) 96(83.5%) 70(60.9%) No 0.107 28(12.2) 10(8.7) 18(15.7) Yes Diabetes history 202(87.8) 105(91.3) 97(84.3) No 0.008 12(5.2%) 1(0.9%) 11(9.6%) Yes Diabetes GDM 218(94.8%) 114(99.1%) 104(90.4%) No 0.073 37(16.1%) 13(11.3%) 24(20.9%) Yes Colestais 193(83.9%) 102(88.7%) 91(79.1%) No 0.316 1(0.4%) 1(0.9%) 0(0%) Yes Renal diseas 229(99.6%) 114(99.1%) 115(100%) No 0.252 21(9.1%) 8(7%) 13(11.3%) Yes Heart diseas 209(90.9%) 107(93%) 102(887%) NO 0.766 62(27%) 30(26.1%) 32(27.8%) Yes Romatologhic 168(73%) 85(73.9%) 83(72.2%) No 0.036 153(66.5%) 69(60%) 84(73%) Yes H.pylori Contamination 77(33.5%) 46(40%) 31(27 %) No 1.000 2(0.9%) 1(0.9%) 1(0.9%) yes Smoking 228(91%) 114(91%) 114(91%) No 1.000 3 (1.3%) 1(0.9%) 2(1.7%) Yes Hookah 227 (98.7%) 114 (99.1%) 113 (98.3%) No Chi-Square and Fisher's Exact Tests Table 3- Logistic regression model Variable Regression Coeffecent p Odds ratio CI 95% Sup Inf BMI 2.651 <0.000 14.164 6.585 30.464 PIH history 2.905 < 0.000 18.268 6.121 54.526 GDM 3.915 0.000 50.133 50123 490.612 H.pilory 3.317 < 0.000 27.565 8.473 89.677 Additional Declarations No competing interests reported. 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PIH is a major health problem in pregnant women, which is one of the main causes of maternal and perinatal mortality. On the other hand, considering the many complications and effects on the mother and the fetus, identifying the effective factors on PIH can be considered among the priorities for treatment system. PIH is occur in the second half of pregnancy and may last up to 6 weeks after delivery (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Sometimes the severity of these effects is so high that it can be life-threatening (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). According to the guidelines of the American Heart Association (AHA), high blood pressure is defined as systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;130 mm Hg or diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;80 mmHg or both (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). According to the classification of the National Heart Lung and Blood Center (NHLBI), the classification of hypertension during pregnancy includes gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on existing hypertension (2 and 5). PIH is a type of hypertension that occurs after the 20th week of pregnancy in women who previously had normal blood pressure (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization estimates that at least one woman dies every seven minutes due to the complications of pregnancy hypertension (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). One of the main complications of this type of high blood pressure is progression to preeclampsia; the relative risk of this development depends on the time of initial presentation and ranges from 40% before the 30th week of pregnancy to 7% after the 38th week of pregnancy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIf high blood pressure is severe, it increases the risk of heart failure, heart attack, renal failure and cerebrovascular accidents in the mother (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Placental abruption, stroke and pre-eclampsia are other maternal complications (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In addition, the fetus is at risk of increased complications such as poor placental oxygen transfer, growth restriction, prematurity, premature birth, placental abruption, stillbirth and perinatal death (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother complication of PIH is preeclampsia; Pre-eclampsia and eclampsia have the greatest effect on morbidity and mortality of mothers and babies. Globally, preeclampsia is one of the main causes of maternal and neonatal mortality and morbidity, mainly in developing countries (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Examining the risk factors of PIH can help in diagnosing and preventing the occurrence of pre-eclampsia. Since about half of the population of our country and the world are women, when a woman gets sick, in addition to the mentioned complications, huge diagnostic and treatment costs are imposed on the family economy and health systems. On the other hand, the combination of these factors may lead to the disability of women. Considering all the above cases, we find out to what extent the peace and comfort of the family is subject to turmoil and crisis when one of the people (especially the mother) gets sick.\u003c/p\u003e \u003cp\u003eSome risk factors were reported in preveus studies that effect PIH. Among them, context diseases, microbial contamination, diet and nutrition, addiction, age, and other factors can be mentioned (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Considering the importance and breadth of the issue, and the fact that no independent research has been conducted in our region in recent years, and there is still no accurate information about the important risk factors and epidemiological status of PIH, this study was conducted aimed to determine the risk factors for PIH.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and samples size\u003c/h2\u003e\n \u003cp\u003eThis case-control (descriptive-analytical) study was conducted by ethics code IR.ARUMS.MEDICINE.REC.1402.099. Groups were selected randomly among 1000 women with available data based on Persian Cohort in 2023 in Ardabil city. The sample size was calculated by formula,\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1739195525.png\"\u003e The prevalence of each of the risk factors were extracted based on previous studies (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). The sample size was approximately 230 (115 case and 115 control group). Woman who had PIH in their last pregnancy (blood pressure greater than or equal to 130/80 and after 20 weeks pregnancy) was considered as the case group, and women who did not have PIH in their last pregnancy as the control age group. The control group was matched in 5-year age so age were adjusted for groups. The inclusion criteria were having a history of pregnancy, age higher than 35 years, living in Ardabil province. Exclusion criteria were having chronic hypertension before pregnancy or hypertension before 20 weeks of pregnancy.\u003c/p\u003e\n \u003cp\u003eDemographic characteristics (age, first pregnancy age, education, job, income, BMI and number of pregnancy) and PIH and diabete history, GDM, Colelityasis, Renal failer, Heart failer, romatological disease, \u003cem\u003eH. pylori\u003c/em\u003e, twin pregnancy, history of high blood pressure in previous pregnancies, smoking, alcohol, hookah, drugs ues were assessed. The prevalence of \u003cem\u003eH. pylori\u003c/em\u003e bacteria was investigated using HPS-Ag (helicobacter antigen in feces).\u003c/p\u003e\n \u003cp\u003eThe variables differences between the two groups were expressed using Chi-Square and Fisher\u0026apos;s exact test. Bivariate and multivariate logistic regression model was also used for investigating relationship between variables, and PIH. The OR value was used to examine the risk ratio in groups. In the logistic regression model, \u0026alpha;\u0026thinsp;=\u0026thinsp;5% and \u0026beta;\u0026thinsp;=\u0026thinsp;10% was set, a significance level were 0.05. The data was analyzed using SPSS version 26 software.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eDemographic information of participants was showen in table 1. The average age of the case and control groups were 44.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83 and 44.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.16 years, respectively. Thers was no significant differene of the age of participants in study groups (p\u0026thinsp;=\u0026thinsp;1.00). Age of first pregnancy (year) also was not significant different in two groups (p\u0026thinsp;=\u0026thinsp;0.857). The highest number of studied women in both groups had primary education and Housewife.The economic status of people were poor to middle. There were no significant difference about edcation, job, economic status and number of pregnancy between to study groups.\u003c/p\u003e \u003cp\u003eThe mean and standard deviation of BMI in the case group was 32.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52 kg /m\u003csup\u003e2\u003c/sup\u003e and in the control group was 30.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.82 kg /m\u003csup\u003e2\u003c/sup\u003e, that was statistically significant difference (0.013). The highest frequency of BMI in the case group was 37.4% that belonged to first class of obesity, and in the control group 38.3% in overweight class. Twin pregnancy was not observed in groups.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;1- Demographic information on groups\u003c/p\u003e \u003cp\u003eRisk factors in case and control groups were showen in Table\u0026nbsp;2. Chi-square and Fisher statistical tests, showed a significant difference between the case and control groups (p\u0026thinsp;=\u0026thinsp;0.00). 45 women (39.1%) in case group and 19 women (16.5%) in control group had PIH history. Frequancy of GDM in the case group was 11 women (9.6%) and in the control group one woman (0.9%). Chi-Square and Fisher's Exact Tests showen statistically significant differencee between the groups (p\u0026thinsp;=\u0026thinsp;0.008). 73% of the studied women in the case group had a history of \u003cem\u003eH.pylori\u003c/em\u003e infection; while Corresponding value was 60% in the control group. 66.1% of all the studied women had a history of infection with this bacterium. According to the chi-square test, the prevalence of \u003cem\u003eH.pylori\u003c/em\u003e bacteria in the case groups was significantly higher than control groups (p\u0026thinsp;=\u0026thinsp;0.03).\u003c/p\u003e \u003cp\u003eDifference between groups were not significant about diabetes history, Colestais, Renal diseas, Heart diseas, Romatologhic, Smoking, and Hookah. None of the people in the case and control groups had a history of drug and alcohol use.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;2- Difference between risk factors in Case and control groups\u003c/p\u003e \u003cp\u003eThe variables simultaneously were entered into the multivariate regression model and was adjusted, Should be noted that in the evaluations, the control group was considered as a reference and the subjects in the mentioned cases were measured in the case group compared to the control group. In the final and adjusted model according to table 3, previous history of PIH, GDM and history of \u003cem\u003eH. pylori\u003c/em\u003e had significance relationship with PIH. In the final model according to Table\u0026nbsp;(3) previous history of PIH (OR: 18.268; 95% Cl: 6.121\u0026ndash;54.526: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), GDM (OR: 50.133; 95% CI: 5.123-490.612: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and history of \u003cem\u003eH.pylori\u003c/em\u003e infection (OR: 27.565; 95% Cl: 8.473\u0026ndash;89.677: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had significance relationship with PIH. In addition, among the BMI categories, only grade two obesity was significant (OR: 3.896; CI 95%: 1.188\u0026ndash;12.775, p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e \u003cp\u003ethus, gestational diabetes, history of previous hypertension in pregnancies and infection with \u003cem\u003eH. Pylori\u003c/em\u003e bacteria with OR\u0026thinsp;\u0026gt;\u0026thinsp;1 were identified as risk factors for PIH. However, in the index categories Body mass: No specific pattern was found between increasing or decreasing BMI and the incidence of this disease (in addition to the fact that BMI was not significant except for one grade in the rest of its categories, this variable also lacked dose dependency). Finally, gestational diabetes was identified as the most important risk factor for PIH OR\u0026thinsp;=\u0026thinsp;50.133.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;3- Logistic regression model\u003c/p\u003e"},{"header":"Dicussion","content":"\u003cp\u003eIn the present study, GDM, history of \u003cem\u003eH. pylori\u003c/em\u003e, previous history of PIH, and BMI had significance relationship with PIH. Among these risk factors, GDM was the most important risk factor for PIH. Diabetes is abnormal glucose metabolism caused by many factors, often induced by abnormal secretion of insulin, pancreatic islet dysfunction, or tissue resistance to insulin, which may aggravate various complications during pregnancy. In the present study, 9.6% of women in the case group had GDM, while 0.9% of women in the control group had GDM. Significant relationship was also found between GDM and PIH. Zhou et al., 2021 showed that higher fasting blood glucose (FBS), 1-hour postprandial blood glucose, 2-hour postprandial blood glucose, 1-hour postprandial insulin, and 2-hour postprandial insulin in women with PIH, that is in accordance whit our results. One of suggested reasons is increase of the of insulin growth factor effect caused to proliferation of vascular smooth muscle cells that leads to narrowing of blood vessels and increased vascular resistance, and ultimately increases blood pressure and disturbances in the diastolic function of the left ventricle (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Savidov et al. 2002 showed that in pregnant women with insulin-dependent diabetes mellitus, brachial artery dilation by flow was significantly lower than in healthy pregnant women (6.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66% vs. 9.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69%, respectively; P\u0026thinsp;=\u0026thinsp;0.0008). This difference was present even after adjusting for blood vessel diameter, which differed between them. As a result, maternal insulin-dependent diabetes mellitus is associated with impaired vasodilator response (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Hinkosaw et al. in Ethiopia reported that positive history of diabetes is a risk factor for blood pressure disorders during pregnancy (OR 5.03, CI 95%: 1.59, 15.89) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the current study, 73% of the women in the case group had a history of \u003cem\u003eH. pylori\u003c/em\u003e infection while 60% of women in the control group had it. The relationship between \u003cem\u003eH.pilory\u003c/em\u003e and PIH was significant. Pourfarzi et al (2018) were conducted a study to investigate of \u003cem\u003eH. pylori\u003c/em\u003e prevalence rate in residents aged 1 to 69 years of Ardabil; they reported to 50.1% infected by \u003cem\u003eH. pylori\u003c/em\u003e (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) which indicates the high prevalence of \u003cem\u003eH. pylori\u003c/em\u003e bacterium in the population of Ardabil. Galan et al 2024 and Mirteimouri et al 2024 reached to similar results (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In a study about \u003cem\u003eH.pylori\u003c/em\u003e infection and the prevalence of hypertension among Chinese adults in 2018, Wan et al showed that \u003cem\u003eH. pylori\u003c/em\u003e infection was positively associated with the prevalence of hypertension with an odds ratio 1.23 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In 2021, a study was conducted by Li et al. to investigate the effects of \u003cem\u003eH. pylori\u003c/em\u003e infection on pregnancy-related diseases, which showed that PIH, preeclampsia, and premature delivery in diabetic and pre-diabetic was increased with \u003cem\u003eH.pylori\u003c/em\u003e infection (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), that is in agreement with oure study. Shazli and Abdulhamid conducted a case-control and comparative study in 2023 to evaluate the incidence of \u003cem\u003eH.pylori\u003c/em\u003e among pregnant women with preeclampsia and those without this disease and showed that preeclampsia, especially in severe and complicated cases, was associated with maternal \u003cem\u003eH. pylori\u003c/em\u003e infection (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, a significant relationship was observed between the history of hypertension and PIH. 39.1% of women in the case group had a history of hypertension in previous pregnancies, compared to 16.5% in the control group, and a significant relationship was found between history of hypertension and PIH, which is consistent with Ajan et al. in 2021 study. They identified the prevalence of PIH and previous history of PIH as the most important risk factors for this disease (OR 1.276, 95% CI; 0.125\u0026ndash;11.836) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study showed a significant difference in terms of BMI between the two groups. BMI in the first class of obesity (BMI 30 to 34.9) had highest frequency in the case group (37.4%). The average BMI in the case group was higher than that of the control group. Lewandowska et al. conducted a study to investigate the obesity before pregnancy, excess weight gain during pregnancy and the risk of high blood pressure and gestational diabetes caused by pregnancy. In their study, 10.8% of women were obese before pregnancy had a BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e. The results of their studies showed that pre-pregnancy obesity was associated with PIH (OR\u0026thinsp;=\u0026thinsp;4.94 and P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Deborah et al. showed an increase in the odds of PIH with incrieas BMI in pregnant women (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBilayhun et al. 2021, showed having a history of renal disease as a risk factor for PIH (OR 3.14: CI 95%:1.05\u0026ndash;9.38) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e); However, in the present study, there was no significant difference in history of kidney disease including kidney failure and history of kidney stones with PIH. The insufficient number of patients in our study can be reason for this insignificance (one patient in the control group and the absence of kidney failure in the case group).\u003c/p\u003e \u003cp\u003eIn terms of the history of heart disease, rheumatological diseases, history of diabetes, no significant difference was observed between groups. Pan et al. (2020) showed relationship between systemic lupus erythematosus and polycystic ovary with PIH and preeclampsia (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Tian et al. 2023 reported that pregnant women with RA were significantly more likely to develop preeclampsia than women without RA (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). These studies results are in opposition with our results.\u003c/p\u003e \u003cp\u003eThere was no significant difference in the number of previously pregnancies between the two groups. In a study conducted in India by Nasser et al., 75% of patients with hypertension were multigravida and 25% were their first pregnancy (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Twin pregnancy was not reported in our study. Therefore, twin pregnancy could not be investigated as an effective risk factor. Hinkosaw et al reported that twin pregnancy is a risk factor for blood pressure disorders during pregnancy (OR 3.78, CI 95% ,9.39, 1.52) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Smoking and hookah consumption were not considered as significant risk factors, since significant differences were not observed between groups. Only one person from each of the case and control groups had smoking, and the difference between the two groups was not significant. None of the studied women had alcohol and drug use. Probably, these results have been obtained in the context of the culture and tradition that governs Iranian families.\u003c/p\u003e \u003cp\u003eIn relation to age, the findings indicate that although the disease was more prevalent in the elderly, this factor could not be investigated as a risk factor in our study due to matching the control group with the case group in terms of age. Women with more than 35 years were included in the study, and this is probably the reason for the high average age of the research compared to some other studies.The average age of the women was 44.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.83 years. This average was reported as 32.59\u0026thinsp;\u0026plusmn;\u0026thinsp;5.04 years in Izadi et al. (2017) study (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In a retrospective study conducted by Nie et al. in Beijing, the mean age for preeclampsia was reported as 32.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25 (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Based on the results of Hinkosa et al. age\u0026thinsp;\u0026ge;\u0026thinsp;35 is considered a risk factor for PIH (OR 2.51, CI 95%,1.08, 5.83) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Also, Timofeev et al, showed that PIH was more common in women aged 35 or older (frequency of 8.5% compared to 7.8% in mothers aged 25\u0026ndash;29) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference between the two groups in terms of economic status and income. Shah et al 2019; showed that mothers from the lower middle class are at high risk and more vulnerable to high blood pressure disease (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). One of the possible reasons could be that women in low socio-economic status often face to inappropriate nutrition, unhygienic conditions and receive less prenatal care. These results are consistent with the studies of Parmar et al. and Shazia et al., that they reported mothers who are in a lower socio-economic class have significantly higher rates of PIH and cesarean section surgery (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no significant relationship between job and PIH, which could be related to cultural issues and women's reluctance to work outside the home in the region. Izadi et al. 2017 found that women working in management, legal and social services, education, consulting and health services are more at risk suffering PIH compared to women working in industries such as food, cosmetics and hygiene (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimitations of the study, due to the low level of education of the majority of the researched people, the given information may have a low confidence factor to some extent. Due to cultural issues, there is a possibility of concealment in people self-report about risky behaviors such as smoking, hookah, drugs and alcohol; therefore, a detailed evaluation of these behaviors and finding their relationship and impact on the dependent variable of the present study was not achieved. Considering the criterion of the last pregnancy of the research subjects and the possibility of a time gap, there is possible that they may make mistakes in remembering details such as weight and not give accurate information.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGestational Diabetes Mellitus, infection \u003cem\u003eH.pylori\u003c/em\u003e bacteria, history of PIH, and hight BMI were identified as a PIH risc factors. Due to the relatively high prevalence of PIH, it is suggested to conduct a wider study with a larger sample size. Considering that, PIH is often diagnosed after infection and sometimes even in more dangerous stages such as pre-eclampsia and eclampsia, it is recommended that all people who have risk factors for PIH undergo proper screening and consulting to evaluate risk factors and control blood pressure before trying to get pregnant. Considering the low income and the prevalence of obesity of women in this study, it is recommended to provide the necessary training in terms of proper nutrition and sufficient physical activity to control women's weight.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAHA American Heart Association\u003c/p\u003e\n\u003cp\u003eBMI Body Mass Index \u003c/p\u003e\n\u003cp\u003eGDM Gestational Diabetes Mellitus \u003c/p\u003e\n\u003cp\u003e\u003cem\u003eH.pylori\u003c/em\u003e\u003cem\u003e \u003c/em\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNHLBI National Heart, Lung, and Blood Institute\u003c/p\u003e\n\u003cp\u003ePIH Pregnancy Induced Hypertension\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to appreciate all participating students in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Ardabil University if medical sciences, Research Ethics Committee on IR.ARUMS.REC.1402.099.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and analyzed during the current study are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRF, FP, Sh P, and SSh made substantial contributions to the conception and design of the study. RF, FP are responsible for the overall logistical aspect of the trial and general acquisition of data. SSh drafted the manuscript. All authors critically revised the manuscript and agreed to be accountable for all aspects of the manuscript ensuring that questions related to the accuracy or integrity of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to appreciate the all participant of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePalma-Reis I, Vais A, Nelson-Piercy C, Banerjee A. Renal disease and hypertension in pregnancy. Clinical Medicine. 2013;13(1):57-62.\u003c/li\u003e\n\u003cli\u003eMustafa R, Ahmed S, Gupta A, Venuto RC. A comprehensive review of hypertension in pregnancy. 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Determinants of pregnancy‐induced hypertension among mothers attending public hospitals in Wolaita Zone, South Ethiopia: findings from unmatched case‐control study. international Journal of Hypertension. 2021;2021(1):6947499\u003c/li\u003e\n\u003cli\u003eTian L, Zhang Z, Mao Y, Zong M. Association between pregnant women with rheumatoid arthritis and preeclampsia: A systematic review and meta-analysis. Medicine. 2023;102(26):e34131.\u003c/li\u003e\n\u003cli\u003eNaseer S, Wani MA, Altaf T, Uzma S, Mubashir S. Socio-demographic determinants of pregnancy-induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2022;11(7):1939-46.\u003c/li\u003e\n\u003cli\u003eIzadi N, Aminian O, Estakhrian P, Akbarpour S, Pishkuhi MA, Saraei M. Evaluation of the Relationship Between Types of Occupational Risk Factors and Pregnancy Induced Hypertension Among Iranian Employed Pregnant Women. Acta Medica Iranica. 2019:430-4.\u003c/li\u003e\n\u003cli\u003eNie X, Xu Z, Ren H. Analysis of risk factors of preeclampsia in pregnant women with chronic hypertension and its impact on pregnancy outcomes. BMC Pregnancy and Childbirth. 2024;24(1):307.\u003c/li\u003e\n\u003cli\u003eTimofeev J, Reddy UM, Huang C-C, Driggers RW, Landy HJ, Laughon SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstetrics \u0026amp; Gynecology. 2013;122(6):1184-95.\u003c/li\u003e\n\u003cli\u003eShah A, Khan MS, Rashid A, Parvez T, Kaisar M, Mudassar S. Pregnancy Induced Hypertension: Clinicopathological Characteristics and Clinical Correlations. Clinical Medicine and Diagnostics. 2019;9(2):21-5.\u003c/li\u003e\n\u003cli\u003eParmar MT, Solanki HM, Gosalia VV. Study of risk factors of perinatal death in pregnancy induced hypertension (PIH). National Journal of Community Medicine. 2012;3(04):703-7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u0026nbsp;Table 1- Demographic information on groups\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTotal\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=230\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003eControl\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=115\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCase\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=115\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e72 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e36 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e36 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLower than 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e58 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e29 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e29 (25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e54 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e27 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e27(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e22 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e50-54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e24 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12 (10.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher than 55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e9 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLower than 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFirst pregnancy age (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e90 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e46 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e44 (38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e83 (36.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e37 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e46 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e31 (13.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e15 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e16 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (2.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (2.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher than 35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e32 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eEducation\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e(Class)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e76 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e40 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e36 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1-5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e36 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e19 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e17 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6-9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e17 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10-11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e45 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e19 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e26 (22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e16 Bsc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHigher than 16\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003ePhD and MSc\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e9 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eEmploee\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eJob\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eTeacher\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e4\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eTecnical \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003esaeler\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eDriver\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e193 (83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e97 (84.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e96\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eHousewife\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e49 (21.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e31 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003eVery poor\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eEconomic status\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e49 (21.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e20 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e29\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003epoor\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e62 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e32 (27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e37 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e19\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eWealth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e33 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14 (12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e19\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eVery Wealth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLow \u0026nbsp;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eBMI\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e17 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNormal 18.5-24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e73 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e44 (38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e29\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOverweight \u0026nbsp;25-29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e85 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e42 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e43\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObesity \u0026nbsp;I \u0026nbsp;30-34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e41 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObesity II \u0026nbsp;35-39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e14 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e6\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObesity III \u0026nbsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eNumber of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e67 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e34 (30.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e33\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114 (50.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e55 (49.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e59\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e36 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5-6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp dir=\"LTR\"\u003e5 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp dir=\"LTR\"\u003e7 and more\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*\u0026nbsp;Chi-Square and Fisher\u0026apos;s Exact Tests\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 2- Difference between risk factors in Case and control groups\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTotal\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=230\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003eControl\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=115\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCase\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e)N=115(\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSituation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eRisc factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e64(27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e19(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e45(39.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003ePIH History\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e166(72.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e96(83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e70(60.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e28(12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e10(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e18(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDiabetes history\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e202(87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e105(91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e97(84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e12(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e11(9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDiabetes GDM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e218(94.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114(99.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e104(90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e37(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e13(11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e24(20.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eColestais\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e193(83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e102(88.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e91(79.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRenal diseas\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e229(99.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114(99.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e115(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e21(9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e8(7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e13(11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHeart diseas\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e209(90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e107(93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e102(887%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e62(27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e30(26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e32(27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRomatologhic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e168(73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e85(73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e83(72.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e153(66.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e69(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e84(73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cem\u003eH.pylori\u003c/em\u003e Contamination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e77(33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e46(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e31(27 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e228(91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114(91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114(91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e3 (1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e1(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e2(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"LTR\"\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cem\u003eHookah\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp dir=\"LTR\"\u003e227 (98.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e114 (99.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"LTR\"\u003e113 (98.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eNo\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eChi-Square and Fisher\u0026apos;s Exact Tests\u003c/p\u003e\n\u003cp\u003eTable 3- Logistic regression model\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eRegression Coeffecent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eCI 95%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eSup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eInf\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e14.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e6.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e30.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePIH history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e2.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt; 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e18.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e6.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e54.526\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e50.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e490.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003eH.pilory\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt; 0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e27.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e8.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e89.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pregnancy induced hypertension, risk factors, gestational hypertention, preeclampsia","lastPublishedDoi":"10.21203/rs.3.rs-5955408/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5955408/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnancy-induced hypertension (PIH) is a major health problem in pregnant women and is one of the main causes of maternal and perinatal mortality. Considering its many complications and effects on the mother and the fetus, identifying the effective factors on occurrence is a priority. This research was conducted to determine the risk factors of PIH.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis case-control (descriptive-analytical) study was conducted at 2023 in Ardabil city. 115 women higher than 35 years old who had PIH in their last pregnancy were selected as a case group and the same number of women without this disease in their last pregnancy selected as the control group (after matching age groups). Data were collected from a retrospective comprehensive study of Persian cohort. Women in both groups were interviewed and information including demographic, PIH and diabetes history, GDM, Colelityasis, Renal failer, Heart failer, romatological disease, \u003cem\u003eH. pylori\u003c/em\u003e, twin pregnancy, history of high blood pressure in previous pregnancies, smoking, alcohol, hookah, drugs use were obtained.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eGestational diabetes mellitus or GDM, previous history of PIH, history of H. pylori infection and BMI were identified as effective risk factors for the occurrence of PIH.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGDM was identified as the most important risk factor for PIH in Ardabil province. Infection \u003cem\u003eH.pylori\u003c/em\u003e bacteria, history of PIH, and hight BMI were as other PIH risk factors. It is necessary for women with these risk factors to take the necessary care for early diagnosis, including visiting and having a pre-pregnancy check-up.\u003c/p\u003e","manuscriptTitle":"The risk factors of pregnancy-induced hypertension: A case- control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-10 13:59:19","doi":"10.21203/rs.3.rs-5955408/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4df838ca-84c1-487b-91cf-22c3e4e3a1bc","owner":[],"postedDate":"February 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-14T07:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-10 13:59:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5955408","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5955408","identity":"rs-5955408","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}