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Introduction
Directive Publications Fatimah Omar Alserehi to life. Research has shown that uninformed aspects and misbeliefs about PIH can lead to incompetent seeking of medical care, inadequate follow-up during pregnancy, and increased risks for motherhood and the baby (6) . However, high knowledge is fundamental as it helps strive for better maternal health results and alleviates the increasing burdens posed by PIH on the healthcare system (5, 7, 8) . Through raising general knowledge about PIH symptoms, signs, and risk factors, women can become more knowledgeable and recognise the warning signs early on, which can prompt them to take the appropriate medical help. Moreover, when myths and misunderstandings about PIH are cleared up, anxieties and concerns that prevent women from accessing help and care as necessary are reduced (8-10) . Overcoming public awareness and perception issues concerning the PIH among females is a complex process that can only be dealt with through a multi-dimensional approach that addresses the cultural, social, and structural barriers that hinder access to knowledge and care. Studies conducted across different regions, including Ethiopia (8) and Morocco (6) , have established that understanding the knowledge and attitudes regarding PIH among women is fundamental to the development of multi-dimensional approaches that may improve the knowledge, attitudes, and help-seeking behaviors. In Saudi Arabia, Radwan et al. (11) examined the knowledge and awareness of pre-eclampsia among Saudi women aged 18 to 49, found limited knowledge, and emphasized that addressing the established knowledge gap is significant for preventing pre-eclampsia-related maternal and foetal complications. In brief, public awareness and perception towards PIH among females are the essential issues that will ensure maternal health, reduce pregnancy complications, and improve overall pregnancy outcomes. However, there was no empirical evidence on public awareness and perceptions of pregnancy- induced hypertension among pregnant women in the Al- Madinah region, Kingdom of Saudi Arabia. Therefore, through the filling of the information gap, the demolition of myths as well as the empowering of women with information and the resources needed to identify and manage PIH independently, the quality of hospital care can be improved, the distress among women during pregnancy can be lessened, and a congenial environment can be created that prioritizes the well-being of pregnant women. The findings of this study can be used in developing integrated strategies that communicate self-awareness, early detection, and encourage women to be active in the management of their health during pregnancy. In addition, the findings will be used in developing an educational culture of support and motivation, screening women for possible health issues, and promoting proactive health seeking, thus leading to healthier outcomes for the mothers and babies. Hence, this study aimed to assess public awareness and perceptions of pregnancy-induced hypertension among pregnant women and identify the source of information regarding PIH among females in the Al-Madinah region, Kingdom of Saudi Arabia. MATERIALS AND METHODS This descriptive cross-sectional study was carried out in the Al-Madinah region, Kingdom of Saudi Arabia. The Al-Madinah region is a province in the western part of Saudi Arabia, situated along the Red Sea coast, covering about 700 sq km. It is a famous region and recognised as second holiest Islam city and the UNESCO World Heritage Site Hegra in Al-Ula. The region covers nine governorates and is a major region for religious tourism and historic Islamic sites, such as the Prophet's Mosque. Population and sampling The study targeted all pregnant females in the Madinah region of Saudi Arabia who were accessible during the study period. A consecutive sampling method was applied where all the eligible population who fulfilled the inclusion criteria were invited to participate in the study. A minimum sample size of 222 was required for data collection. The inclusion criteria were 1) residency in Madinah, Saudi Arabia; 2) aged 18 years or more; and 3) able to communicate and complete the questionnaire. Data Collection Methods All pregnant women in the Madinah region of Saudi Arabia were approached, and those who agreed to participate in the study were provided with informed consent forms. The objectives and procedures of the study were explained to the participants. Data collection was carried out while adhering to confidentiality and privacy, and data in the completed questionnaire were anonymized. Data was collected from eligible participants using a structured questionnaire. The questionnaire was developed by the researchers based on an intensive literature review and expert consultation. The questionnaire covered the following sections: Sociodemographic Data (6 items), medical and obstetrical history (5 items), knowledge regarding pregnancy-induced hypertension (12 items), and attitude toward pregnancy- induced hypertension (5 items). The knowledge items were multiple-choice and closed-ended, and scores were based on responses of " yes, no, " or " don’t know’. The attitude items were scored using a 3-point Likert scale: “agree, neutral, disagree”. The distribution of the questionnaires was conducted through online and email-based data collection means. Page - 2Open Access, Volume 18 , 2026
Fatimah Omar Alserehi Directive Publications Page - 3Open Access, Volume 18 , 2026 Data Analysis The data collected was reviewed and edited, checked for completeness, before being fed to the Statistical Package for the Social Sciences (SPSS). Descriptive statistics such as means, standard deviation, and ranges were analyzed for scale variables, while frequency distribution was used for qualitative variables. Socio-demographic variables in relation to the attitude scores towards PIH were analyzed using a one- way ANOVA test, with a statistical significance value of p<0.05. Ethical considerations This study was conducted in accordance with the Helsinki Declaration’s ethical research principles. The study was ethically approved before data collection process begun. Informed consent was obtained from the respondents. Confidentiality was maintained through the research process; no identification data was collected and all collected data were protected and accessible to authorized personnel only. RESULTS Sociodemographic Data The table 1 describes the socio-demographic characteristics of 222 pregnant women. The findings indicate that most of them (43.7%) are aged between 18-34 years, 38.3% years are aged between 35-44 years old, and 18% are aged 45 and above. The marital status shows that most of them are married (88.7%), a low percentage are single (7.2%), and divorced/widowed (4.1%). At the educational level, a good percentage (64.4%) of them are bachelor's degree holders or higher, with a smaller percentage being secondary school holders (26.1%), middle school holders (5.9%), and the lowest percentage completed elementary school (3.6%). Occupational status shows that 57.7% percent are unemployed, 27% are employed, and 12.2% are students. Responses in monthly income indicate that more than half of the respondents (55.9%) make less than 3000 units, with fewer women making between 3000- 6000 (17.1%), 6000-10000 (12.6%). The group with lower income earns less than 10000 per month (14.4%). Table 1. Socio-Demographic Characteristics of Study Participants (n = 222). Socio-demographic data No. % Age 18-34 97 43.7 35-44 85 38.3 45 or above 40 18.0 Gender Male 0 0.0 Female 222 100.0 Marital status Single 16 7.2 Married 197 88.7 Divorced /widow 9 4.1 Educational level Elementary school or below 8 3.6 Middle school 13 5.9 Secondary school 58 26.1 Bachelor’s degree or higher 143 64.4 Occupation Student 27 12.2 Employee 60 27.0 Retired 7 3.2 Unemployed 128 57.7 Monthly income <3000 124 55.9 3000-6000 38 17.1 6000-10000 28 12.6 >10000 32 14.4
Fatimah Omar Alserehi Directive Publications Page - 4Open Access, Volume 18 , 2026 Medical and Obstetrical history The medical and obstetric history of the participants is indicated in Table 2. Most of the women (76.1%) have no chronic health issues, although 15.3% have hypertension, 5.4% diabetes mellitus, and autoimmune diseases (2.7%) or other chronic issues (4.1%). Pregnancy history 72.5% of the respondents show between 1 and 4 pregnancies, and 27.5% have more than four pregnancies. Regarding the number of children, 18.9% do not have any children, 59.9% have 1-4 children, whereas 21.2% have more four children. The prevalence of pregnancy-induced hypertension (PIH) among women is low (15.3%). All the participants (222) are in the pregnancy stage. Table 2. Medical and Obstetric History of Study Participants (n = 222). Medical and Obstetrical history No. % Do you have any chronic health problems? # Hypertension 34 15.3 diabetes mellitus 12 5.4 Autoimmune disease 6 2.7 Others 9 4.1 No 169 76.1 How many times have you gotten pregnant? 0 0 0.0 1-4 161 72.5 >4 61 27.5 How many children do you have? 0 42 18.9 1-4 133 59.9 >4 47 21.2 Do you ever diagnose as PIH? Yes 34 15.3 No 188 84.7 Are you pregnant? Yes 222 100.0 No 0 0.0 Note: #= more than one answer Knowledge regarding Pregnancy-Induced Hypertension Table 3 provides the details of the knowledge of the participants regarding pregnancy-induced hypertension (PIH). Most of the respondents (76.1%) are aware of PIH, with 47.3% being aware via social media/internet and 47.3% via television, and fewer obtained their information from work (19.4%), and books (12.2%). However, on the definition of PIH, only 45.9% define it correctly, and 51.8% are not aware of the correct definition of PIH. Similarly, in the classification of PIH, 45.5% of the participants provided correct answers. Moreover, 58.1% thought that PIH can be cured after birth, and 64.9% thought that PIH is a severe threat to the mother and the fetus. The knowledge gap is observed when determining the risk factors of PIH because many of the women do not know other conditions, such as hypertension (38.7%) or obesity (33.8%). The knowledge regarding the PIH management is limited to 40.1%, and the awareness of the use of all the possible measures, including antihypertensive management in PIH management, is recognized by only 32.4%. Table 3. Participants' Knowledge Regarding Pregnancy-Induced Hypertension (n = 222). Section 2: knowledge regarding PIH No. % Heard of PIH? Yes 169 76.1 No 53 23.9 What is the source of your information? # Work 43 19.4 Social media /internet 105 47.3 Television 105 47.3
Fatimah Omar Alserehi Directive Publications Page - 5Open Access, Volume 18 , 2026 Books 27 12.2 Awareness campaigns 31 14.0 Others 19 8.6 PIH is systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) >90 mmHg Yes 102 45.9 No 5 2.3 Do not know 115 51.8 The broad classification of pregnancy-induced hypertension during pregnancy is gestational hypertension, pre- eclampsia, and eclampsia. Yes 101 45.5 No 5 2.3 Don't know 116 52.3 When PIH can start to occur Before 20 weeks of gestation 15 6.8 After 20 weeks of gestation 78 35.1 Don't know 129 58.1 Do you think that PIH can be healed after delivery or a few weeks after delivery? Yes 129 58.1 No 6 2.7 Don't know 87 39.2 Which of the following conditions could be a risk factor for having PIH?# Hypertension 86 38.7 Primigravida 32 14.4 Obesity 75 33.8 Age more than 30 years 51 23.0 insulin resistance 0 0.0 diabetes mellitus 42 18.9 gestational diabetes 43 19.4 Thrombophilia 25 11.3 Antiphospholipid syndrome (APS) 30 13.5 history of PIH in previous pregnancies 83 37.4 Don't know 98 44.1 Do you know any signs or symptoms of PIH? Yes 108 48.6 No 19 8.6 Don't know 95 42.8 PIH has a serious complication for the mother and her fetus : Yes 144 64.9 No 3 1.4 Don't know 75 33.8 Can PIH be treated? Yes 136 61.3 No 5 2.3 Don't know 81 36.5 Do you know any management of PIH? Yes 89 40.1 No 27 12.2 Don't know 106 47.7 Measures for PIH management include: # Conservative management 27 12.2 antihypertensive 64 28.8
Fatimah Omar Alserehi Directive Publications Page - 6Open Access, Volume 18 , 2026 Anticonvulsive 13 5.9 All 72 32.4 Don't know 98 44.1 Attitude toward Pregnancy-Induced Hypertension (PIH) Table 4 provides the attitudes of the respondents to pregnancy-induced hypertension. A significant percentage (75.2%) agreed that PIH has a high risk of fatality, and 92.8 % of them believed that regular antenatal screening of blood pressure is valuable. Moreover, 91.9% report that they plan to visit a health facility in case of PIH manifestations, and 77.5% accept that PIH is preventable. The results further show that 87.8% attached value to the antenatal care in early identification of PIH. The general attitude scores in relation to PIH have been reported in Table 5. The minimum score was 5, and the maximum score is 15, with an average score of 5.90 +-1.57. The median was 5.0, indicating that most of the participants have moderate positive attitude. Attitude has an average of 9.01% and a standard deviation of 15.69. These scores indicate that the majority of participants agreed that early detection and management of PIH are important. Table 4. Participants' Attitude Toward Pregnancy-Induced Hypertension (n = 222). Q Agree Neutral Disagree Mean SD. No. % No. % No.% 1 PIH carries a high risk of death 167 75.2 46 20.7 9 4.1 1.29 0.54 2 Frequent antenatal check-ups for blood pressure are important 206 92.8 12 5.4 4 1.8 1.09 0.34 3 I will go to a health facility if I have signs of PIH 204 91.9 12 5.4 6 2.7 1.11 0.39 4 Can PIH be prevented? 172 77.5 41 18.5 9 4.1 1.27 0.53 5 Antenatal care important for early detection of PIH 195 87.8 21 9.5 6 2.7 1.15 0.43 Table 5. Overall Attitude Score Toward Pregnancy-Induced Hypertension (n = 222). Total score Average Score % score Min. – Max. Mean ± SD. Median Mean ± SD. Min. – Max. Mean ± SD. Overall Attitude5.0 – 15.0 5.90 ± 1.57 5.0 1.18 ± 0.31 0.0 – 100.09.01 ± 15.69 SD: Standard deviation Correlation Between the overall score on the attitude towards PIH and socio-demographic Table 6 examined the socio-demographic variables in relation to the attitude scores towards PIH. The analysis shows that there is no significant difference in the attitude scores of ages (p=0.350), marital status (p=0.188), educational level (p=0.640), occupation (p=0.206), or monthly income (p=0.487); all the p-values are above 0.05. This indicates that the socio-demographic variables measured have no significant impact on the attitude of the participants towards PIH. Table 6. Relationship Between Socio-Demographic Characteristics and Attitude Toward Pregnancy-Induced Hypertension (n = 222). Socio-demographic data N Total score for Section 3: Attitude toward PIH F p Mean ± SD. Age 18-34 97 5.97 ± 1.62 1.054 0.350 35-44 85 5.98 ± 1.75 45 or above 40 5.58 ± 0.84 Marital status Single 16 5.56 ± 0.73 1.685 0.188 Married 197 5.96 ± 1.64 Divorced /widow 9 5.11 ± 0.33 Educational level
Fatimah Omar Alserehi Directive Publications Page - 7Open Access, Volume 18 , 2026 Elementary school or below 8 6.25 ± 2.05 0.563 0.640 Middle school 13 6.15 ± 1.77 Secondary school 58 6.03 ± 2.10 Bachelor's degree or higher 143 5.80 ± 1.25 Occupation Student 27 6.37 ± 2.29 1.536 0.206 Employee 60 5.63 ± 1.38 Retired 7 5.57 ± 0.79 Unemployed 128 5.95 ± 1.49 Monthly income <3000 124 5.98 ± 1.43 0.815 0.487 3000-6000 38 6.05 ± 1.79 6000-10000 28 5.54 ± 1.35 >10000 32 5.75 ± 1.97 SD: Standard deviation F: F for One-way ANOVA test p: p-value for comparison between the studied categories DISCUSSION This study assessed public awareness and perceptions of pregnancy-induced hypertension among pregnant women and identified the source of information regarding PIH among females in the Al-Madinah region, Kingdom of Saudi Arabia. The majority of respondents in this study (76.1%) reported having heard of PIH, which is higher compared to 58.0% reported by Berhe et al. among pregnant women in Tigray Regional State, Ethiopia (8) , and considerably higher compared to unawareness established among Moroccan women in Morocco and the Netherlands, where half of the respondents had never heard of hypertension in pregnancy (6) . The comparatively high level of general PIH awareness among respondents in the current study may be associated with the relatively higher level of education among most of them who had attained a bachelor’s degree or above, and the significant role of social media and television as sources of information cited by 47.3% of respondents. However, the current results on sources of information contradict the findings reported in sub-Saharan Africa, where health facilities were the main source of PIH-related information (8) and reflect the wider accessibility of digital health information in Saudi Arabia. Despite the high levels of general awareness among women, the current study noted critical gaps in substantive knowledge. Only 45.9% of participants provided a correct definition of PIH in terms of blood pressure thresholds, and only 45.5% also were able to provide accurate subtypes. These findings are consistent with the systematic review and meta-analysis conducted by Nigate et al. (12) , which found a pooled PIH awareness of 45.63% across African studies, and with a study carried out in Saudi Arabia by Radwan et al. (11), where only 11.3% of participants showed adequate awareness of pre- eclampsia, while 49.4% reporting inadequate knowledge. These findings underscore the presence of and persistent geographically widespread differences between awareness of the PIH concept and accurate clinical knowledge (13, 14) . Regarding the onset of PIH, current findings show that 35.1% participants correctly identified that it occurs after 20 weeks of gestation, while 58.1% indicated being unaware of its timing. This awareness is lower compared to 69.1% correct response rate reported among women in Saudi Arabia by Radwan et al. (11) . However, it is similar to the results of Berhe et al., in Ethiopia, where 78.0% were not aware of the PIH onset (8) . The presence of this knowledge gap implies that antenatal education programmes provide inadequate emphasis on the gestational period for PIH onset. Our findings established limited knowledge of PIH risk factors; as 44.1% of participants reported not knowing any risk factors, while only 38.7% identified pre-existing hypertension, and 33.8% obesity. This is consistent with the results of studies conducted in South Africa, where women had significant knowledge deficits related to PIH risk factors (5, 10) . Notably, insulin resistance was not identified by any respondent as a risk factor for PIH, suggesting a significant gap in awareness about the contribution of metabolic factors in PIH development Awareness of the signs and symptoms was reported by 48.6% of participants, aligning broadly with the previous studies indicating that pregnant women were able to identify at least one sign or symptom of PIH; however, the symptom and sign recognition continue to be suboptimal across the populations (8, 15, 16) . Furthermore, regarding severity and treatment of PIH, our findings show that 64.9% of participants acknowledged that PIH has serious complication to mother and fetus, and 61.3% were aware that it can be treated. These findings are congruent to the 70.7% among women in Ethiopia, who were aware of treatment possibilities of PIH (8). However, there was limited awareness of specific management strategies, with only 40.1% reporting awareness of any approach, and all management strategies, such as antihypertensive and
Fatimah Omar Alserehi Directive Publications Page - 8Open Access, Volume 18 , 2026 anticonvulsant therapy, were established among 32.4% in this study. These findings are consistent with other studies where knowledge of specific therapeutic interventions was found to be low among respondents (17-20) . Regarding attitudes towards PIH, our findings reported that the majority of the respondents had positive attitudes. The current findings highlight that 75.2% agreed that PIH has a significant risk of fatality, and 92.8% of them emphasized the significance of frequent antenatal blood pressure monitoring and antenatal care for early PIH detection (87.8%). Furthermore, 91.9% reported their intentions of seeking care when experiencing PIH symptoms, and 77.5% affirmed their perceptions of PIH as a preventable condition. These positive attitudes are congruent with attitudes among women in Ethiopia, where 89.9% of participants reported a positive perception of the significance of seeking care when PIH symptoms occur (8) , and in South Africa, where women with previous pregnancy experiences had positive attitudes toward PIH (10) . These positive attitudes are significant for public health interventions, suggesting that the willingness of pregnant women to engage with healthcare and accept measures for PIH prevention is prevalent among the studied population. However, negative attitudes toward PIH have been reported among women in Rwanda (16) and in Ethiopia (17) . Our findings established no statistically significant relationship between attitude and sociodemographic characteristics. This contradicts previous findings where educational level, occupation, and wealth index were significantly associated with PIH awareness and attitudes (16, 17, 21) . Such a lack of associations in the present study could be reflective of the relative homogeneity of the study population, with the majority of that population being married, possessing a bachelor's degree or higher, and living in an urban setting, factors which can reduce the effects of any individual sociodemographic variable on attitude outcomes. There is also a possibility that attitude, compared to knowledge, is less prone to change by sociodemographic profile, especially when cultural and religious norms of pregnancy and health-seeking behaviour are widely shared. This explanation is in line with the finding by Ouasmani et al. (6) that even women who had limited knowledge about PIH universally recognized the need to be informed and were willing to seek care regardless of their educational or geographical background. CONCLUSION The present findings highlight important findings regarding knowledge and perceptions of pregnancy-induced hypertension among pregnant women. Although most pregnant women in the Al-Madinah region had heard about PIH, there was still a limited understanding of the definition of PIH, the onset of gestation, risk factors, symptomatology, and management options. Social media and TV were the dominant sources of information, with critical implications on how health education messages could be framed and disseminated in this population. The participants had positive attitudes towards the use of antenatal monitoring, health facility utilisation, and PIH prevention. These findings suggest that targeted, media-integrated awareness campaigns that extend beyond surface knowledge should be developed by healthcare providers and policymakers in the Al-Madinah region and the wider Saudi context. Longitudinal and interventional designs should be used in future studies to determine whether targeted education can lead to increased knowledge, permanent attitude change, and better maternal and foetal outcomes. Acknowledgments Conflicts of Interest REFERENCES 1. Kintiraki E, Papakatsika S, Kotronis G, Goulis DG, Kotsis V. Pregnancy-induced hypertension. Hormones. 2015;14(2):211-23 2. Watanabe K, Naruse K, Tanaka K, Metoki H, Suzuki Y. Outline of definition and classification of “pregnancy induced hypertension (PIH)”. Hypertension Research in Pregnancy. 2013;1(1):3-4.10.14390/jsshp.1.3 3. Razak A, Florendo-Chin A, Banfield L, Abdul Wahab MG, McDonald S, Shah PS, et al. Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis. Journal of Perinatology. 2018;38(1):46-53.10.1038/jp.2017.162 4. Duley L, editor The global impact of pre-eclampsia and eclampsia2009 2009: Elsevier. 5. Maputle S, Khoza L, Lebese R. Knowledge towards pregnancy-induced hypertension among pregnant women in Vhembe District, Limpopo Province. Journal of human ecology. 2015;51(1-2):47- 54.10.31901/24566608.2015/51.1-2.07 6. Ouasmani F, Engeltjes B, Haddou Rahou B, Belayachi O, Verhoeven C. Knowledge of hypertensive disorders in pregnancy of Moroccan women in Morocco and in the Netherlands: a qualitative interview study. BMC pregnancy and childbirth. 2018;18(1):344.10.1186/ s12884-018-1980-1
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