{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:46:35Z","timestamp":1792604795431,"version":"4.5.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Preeclampsia (PE) with severe features threatens maternal and neonatal health. This study examined maternal and health\u2013service factors associated with severe features and compared maternal and neonatal outcomes in Thailand.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This case\u2013control study enrolled 156 postpartum women with PE (52 with and 104 without severe features) and 111 nurse\u2013midwives in antenatal care, labor, and postpartum units across four Thai tertiary hospitals. Data were collected using postpartum and nurse\u2013midwife questionnaires, and a maternal\u2013neonatal health record form. Group differences were assessed using independent t\u2013test, chi\u2013square or Fisher\u2019s exact tests. Multivariable binary logistic regression examined factors associated with severe features, adjusting for antenatal care visits and gravidity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Women with severe features more often had a history of PE (32.7% vs. 13.5%, p\u2009=\u20090.006) and differed in BMI distribution (p\u2009=\u20090.007). Three maternal factors were independently associated with severe features: history of PE (aOR = 5.99, 95% CI 2.13\u201316.83), BMI (aOR = 0.92 per kg\/m\n 2<\/jats:sup>\n , 95% CI 0.86\u20130.98), and moderate versus low PE knowledge (aOR = 0.13, 95% CI 0.04\u20130.50). No health\u2013service variable, including nurse training, was independently associated with severe features after adjustment (all p\u2009>\u20090.05). The model explained 29.4% (Nagelkerke R\n 2<\/jats:sup>\n ) of the variance in PE severity and correctly classified 75.8% of cases. Infant birth weight was lower among women with severe features (p\u2009<\u20090.05); delivery mode, hospital stay, birth asphyxia, and NICU admission did not differ significantly.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n A history of PE was associated with higher odds, and moderate (versus low) PE knowledge and higher BMI with lower odds, of severe features. These findings support prioritizing screening for prior PE history and structured antenatal knowledge counseling, together with adequately powered, multilevel studies to clarify the role of health\u2013service factors in PE severity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0361195","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T17:33:55Z","timestamp":1792604035000},"page":"e0361195","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of preeclampsia with severe features: A multi\u2013center analysis of maternal and health system factors in Thai tertiary hospitals"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0551-9306","authenticated-orcid":true,"given":"Tippawan","family":"Boonyaporn","sequence":"first","affiliation":[{"name":"Mahidol University","place":["Bangkok, Thailand"],"department":["Doctor of Nursing Science (Candidate), Faculty of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7081-9283","authenticated-orcid":true,"given":"Piyanun","family":"Limruangrong","sequence":"additional","affiliation":[{"name":"Mahidol University","place":["Bangkok, Thailand"],"department":["Department of Obstetrics and Gynaecology Nursing, Faculty of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameporn","family":"Ratinthorn","sequence":"additional","affiliation":[{"name":"Mahidol University","place":["Bangkok, Thailand"],"department":["Department of Obstetrics and Gynaecology Nursing, Faculty of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thitipong","family":"Tankumpuan","sequence":"additional","affiliation":[{"name":"Mahidol University","place":["Bangkok, Thailand"],"department":["Department of Surgical Nursing, Faculty of 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