Development of Pre-eclampsia and Eclampsia in Relation to Drinking Water Salinity in Coastal Bangladesh

Council researchers have been investigating an association between drinking water salinity and the development of pre-eclampsia/eclampsia among pregnant women in Bangladesh.

The Issue

Several small studies have been published over the last few years suggesting an association between drinking water salinity and the development of pre-eclampsia/eclampsia among pregnant women in Bangladesh.  These studies all had very small sample sizes generated from communities in a few coastal districts.  We were interested in furthering progress on this issue by:

  1. Using a geospatial approach to analyze secondary data that could be replicated in other settings.
  2. Conducting primary data collection in coastal areas to follow a cohort of pregnant women over time, recording drinking water salinity and development of hypertension, pre-eclampsia or eclampsia.

We interviewed 779 pregnant women (enrolled at less than 20 weeks gestation) and followed them up during third trimester and six weeks after delivery. We collected blood pressure measures, tested urine for protein, tested the salinity levels of their drinking water to better understand the timing of salinity exposure during pregnancy, and asked about their perceptions  and adaptations to high salinity drinking water.

The Progress

We integrated data from a groundwater survey, remotely sensed elevation, satellite derived rainfall, and the national health surveillance system. Our results found a strong association between groundwater salinity and district level pre-eclampsia/eclampsia rates. The results also showed higher pre-eclampsia/eclampsia rates in the low elevation coastal zone (coastally contiguous elevation under 10 meters), which we assume has higher groundwater salinity because of coastal intrusion and sea level rise.   We also found higher rates of pre-eclampsia/eclampsia reported in the dry season – this may be because in the dry season as shallow groundwater evaporates it is not replenished with fresh water from rainfall, so the available water is more saline.

The primary data collection study found that pregnant women in coastal areas of Bangladesh are vulnerable to experiencing hypertension if they drink or cook with saline water.

The Impact

This body of research is intended for use by policy makers across Bangladesh to ensure clean drinking water for pregnant women in low-lying coastal areas and that monitoring for pre-eclampsia is a priority. Reducing their risk of eclampsia and pre-eclampsia will result in lower maternal mortality rates in Bangladesh.  This methodology can and should be replicated in more coastal settings—the only published research is from Bangladesh. 

Principal Investigator

Journal Articles (1)