Hypertension in women of reproductive age: a cross-sectional analysis of prevalence and risk factors across 21 low-income and middle-income countries using Demographic and Health Surveys (2013-2023).

Abstract

Objective Women of reproductive age (WRA) in low-income and middle-income countries (LMICs) bear a disproportionate burden of hypertension, with limited pooled analyses exploring its prevalence and associated risk factors. This study investigates hypertension prevalence and key determinants among WRA in 21 LMICs. Design Retrospective, cross-sectional study. Participants Nationally representative data were obtained from the Demographic and Health Survey conducted in 21 LMICs between 2013 and 2023. This research focused on female participants aged 15-49 who were selected for blood pressure monitoring, resulting in a weighted sample of 818 325 WRA (36 970 pregnant and 781 355 non-pregnant). Primary outcome measures The primary outcomes were the prevalence of hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) and the identification of individual, household and community-level risk factors associated with the condition. Descriptive statistics of proportions between pregnant and non-pregnant women were assessed. Multilevel logistic regression identified individual, household and community factors affecting hypertension. Results The study found the prevalence of hypertension was 8.20% (95% CI 7.95% to 8.45%) among pregnant women and 10.52% (95% CI 10.42% to 10.62%) among non-pregnant women, with substantial regional disparities. Côte d'Ivoire and Haiti exhibited the highest prevalence (48.00% in pregnant women; 57.30% in non-pregnant women, respectively), while the Philippines reported the lowest (0.00% in pregnant women and 0.50% in non-pregnant women). Among pregnant versus non-pregnant women, risk factors included advanced age (35-49 years) (adjusted OR (aOR) 3.31, 95% CI 2.89 to 3.80 vs 3.69, 95% CI 3.60 to 3.77), low education levels (aOR 1.15, 95% CI 1.02 to 1.30 vs 1.33, 95% CI 1.30 to 1.35), not currently employed (aOR 1.08, 95% CI 1.01 to 1.15 vs 1.05, 95% CI 1.04 to 1.09), higher body mass index (BMI) (aOR 1.79, 95% CI 1.76 to 1.81; non-pregnant women), rural residence (aOR 1.14, 95% CI 1.04 to 1.24 vs 1.14, 95% CI 1.12 to 1.16) and limited healthcare access were linked to higher hypertension rates (aOR 1.03, 95% CI 0.94 to 1.13 vs 1.01, 95% CI 1.00 to 1.03). Conclusions The burden of hypertension among WRA is driven by advanced age, lower education, high BMI and rural residence. Policymakers should prioritise targeted interventions addressing key sociodemographic and geographic risk factors. Strengthening education, equitable healthcare access and community-based strategies is essential to reducing hypertension-related risks and associated maternal health complications among WRA in LMICs.