Maternal Risk, Potassium Intake, and Differential Clinical Recovery in Preeclampsia: A Longitudinal Study from Primary Healthcare in Indonesia

Abstract

Objective: To evaluate maternal risk factors, nutritional determinants, antihypertensive treatment response, longitudinal changes in blood pressure and proteinuria, and pregnancy outcomes among pregnant women with preeclampsia in Medan, Indonesia, within an integrated syndromic management approach.
Methods: This quasi-experimental longitudinal cohort study included 104 pregnant women: 52 with preeclampsia and 52 normotensive controls. Maternal risk factors, calcium, potassium, sodium and fat intake, calcium supplementation adherence, nifedipine therapy, blood pressure, proteinuria, and pregnancy outcomes were assessed. Analyses included bivariate tests, Mann–Whitney, Wilcoxon signed-rank, Friedman, and multivariable logistic regression.
Results: Obesity, previous preeclampsia, and hypertension history were significantly associated with preeclampsia. Previous preeclampsia showed the strongest association (OR=15.040; p=0.013), while obesity remained independently associated (OR=3.403; p=0.022). Potassium intake was the only nutritional factor independently associated with lower odds of preeclampsia after adjustment, whereas calcium showed a non-significant protective tendency. Calcium supplementation adherence was associated with blood pressure at the fourth visit among normotensive women (p=0.027), but not with proteinuria in women with preeclampsia. Nifedipine treatment was associated with reduced systolic and diastolic blood pressure, with significant differences between standard and intensive regimens. Blood pressure and proteinuria decreased significantly across four visits, although proteinuria showed a small effect size. Prematurity was significantly associated with preeclampsia (OR=9.517; 95% CI: 2.991–30.285; p=0.001), whereas low birth weight, intrauterine fetal death, and neonatal asphyxia were not.
Conclusion: An integrated approach combining maternal risk stratification, nutritional assessment, antihypertensive management, and longitudinal monitoring may strengthen primary-care management of preeclampsia. Differential trajectories of blood pressure and proteinuria highlight the need for multidimensional clinical monitoring, while prematurity remains an important adverse outcome.