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CENTRE (UKMMC)
DR NORFAZILAH BINTI AHMAD P 36529
Norfazilah, A.1 Azmi, M.T.1 Shamsuddin, K.1 Mahdy, A.Z.2 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia 2Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia Risk Factors of Pre-eclampsia
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INTRODUCTION
Hypertension in pregnancy important cause of maternal and perinatal morbidity and mortality Can be classified into: Gestational hypertension Preeclampsia and eclampsia Chronic hypertension Chronic hypertension with superimposed preeclampsia
(Brown et al.2001)
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INTRODUCTION
Preeclampsia (PE): gestation with properly documented proteinuria Chronic hypertension with superimposed preeclampsia: Pregnant woman with chronic hypertension the appearance of de novo proteinuria after 20 weeks of gestation.
( magnitude of blood pressure, proteinuria, thrombocytopenia abnormal liver enzymes)
JUSTIFICATION
Lack of published local studies regarding risk factors for preeclampsia Useful information in identifying women at risk of pre-eclampsia For screening and prophylaxis, as well as for recruitment into relevant clinical studies.
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LITERATURE REVIEW
Certain risk factors have stronger association than others.. All play a role in identifying women at risk of preeclampsia Possessing a risk factor does not necessarily mean a woman will develop preeclampsia, neither does the absence of any risk factor guarantee safety
(Churchill & Beever 1999)
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PREECLAMPSIA
REPRODUCTIVE HISTORY Pre-pregnancy body mass index Obstetrics history MATERNAL AND PERINATAL MORTALITY/ MORBIDITY
Chronic hypertension
Type 2 diabetes mellitus
OBJECTIVES
1. To determine the socio-demographic characteristics of preeclamptic cases 2. To determine the relationship between of the following risk factors and preeclampsia: i. ii. iii. iv. v. vi. Ethnic Age High pre-pregnancy body mass index Obstetrics history (parity) Concurrent maternal medical illness Family health history of chronic hypertension and type 2 diabetes mellitus (either alone or combined)
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METHODOLOGY BACKGROUND
UKMMC Case-Mix system Medical record department
STUDY DESIGN
A hospital based unmatched case control study
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Code: normotensive pregnant women Match by year to case Randomly selected from the database
RESULT
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RESULT (DESCRIPTIVE)
Ethnic: Malay (case 75.2%; control 68.7%)
Age
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< 35
35 Pre-pregnancy BMI Normal Underweight Overweight Obese
Risk Factors of Pre-eclampsia
1.0 (referent)
2.70 (175-4.17) 1.0 (referent) 0.56(0.35-0.88) 7.87(4.41-14.07) 14.54(6.40-33.04)
1.0 (referent)
2.10(1.19-3.70) 1.0 (referent) 0.60(0.37-0.97) 4.01(2.48-6.49) 6.40(2.92-14.00)
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Risk factors
Obstetrics history Others Primigravida Parity 2 Nulliparity Concurrent medical history
Unadjusted
OR (95% CI) 1.0 (referent) 1.24(0.84-1.840) 2.24(1.48-3.39) 2.47(1.39-4.39)
*Adjusted
OR (95% CI) 1.0 (referent) 2.25(1.43-3.56) 1.85(1.12-3.06) 3.15(1.63-6.08)
No
Yes
1.0 (referent)
7.22(3.21-16.24)
1.0 (referent)
4.83(1.74-13.42)
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No
Yes Family history of Type 2 diabetes mellitus No Yes Family history of chronic hypertension and type 2 diabetes mellitus No Yes
1.0 (referent)
3.12(2.30-4.25) 1.0 (referent) 1.96(1.39-2.75)
1.0 (referent)
2.18(1.55-3.09)
Model adequacy was checked by using Hosmer and Lemeshow test (p = 0.352), overall correctly classified percentage (69.5%) and area under the curve (0.77) No multicollinearity problem and interaction reported Nagelkerke R Square = 0.285 Final model equation: Preeclampsia = -1.43 + 0.74(aged 35 years) + 1.39(overweight) + 1.86(obese) + 0.81(being primigravida) 0.62(parity 2) + 1.15(nulliparity) + 1.58(having concurrent medical illness) Risk Factors of Pre-eclampsia slide 14 + 0.78(family history of chronic hypertension).
DISCUSSION
ETHNIC:
Hashimah et al. (2007) place design HKL & UKMMC case control 75 cases HKL (72) UKMMC (3) Non-Malay to Malay aOR 2.4 (0.7 - 8.2) Loi et al. (2007) Singapore cross-sectional
n=
comparison
93 cases
Malay to Chinese p = 0.001 Malay to Indian p = 0.170 Malay to Others p = 0.086 Malay=majority late booker
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DISCUSSION
AGE:
place design 35 years Loi et al. (2007) Singapore cross-sectional p = 0.01 Ustun et al. (2005) Turkey retrospective cohort p = 0.001
DISCUSSION
OBSTETRICS HISTORY: nulliparity
Eskenazi et al. (1991) design n= reference parity case control 193 cases multiparous nulliparous aOR 5.4 (2.8-10.3) Anorlu et al. (2005) case control 128 cases >1 nulliparous aOR 4.77 (2.90-7.78) 1 nulliparous aRR 2.38 (2.28-2.49) Conde-Agudelo et al. (2000) cross-sectional
Eskenazi et al. (1991); Stone et al. (1994); Anorlu et al. (2005) & Gaugler-Senden et al. (2005)
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DISCUSSION
DISCUSSION
Ness et al.(2003)
cohort n=85/2211 (3.8%) 1: aRR 1.5 (0.1-2.5) 2: aRR 2.2 (1.1-4.5) Qiu et al. (2003) case control n = 190 aOR 2.0 (1.2-5.5)
Eskenazi et al.
(1991) aOR 1.7 (0.92-3.2) Stone et al. (1994)
Ness et al.
(2003) 1: aRR 1.3 (0.7-2.3) 2: aRR 1.1
Sanchez et al.
(2003) aOR 3.4 (1.4-8.4) -more aware of parental history of diabetes mellitus Qiu et al. (2003) aOR 1.8 (1.1-3.1)
Sanchez et al.
(2003) aOR 1.6 (0.9-2.7)
case control n = 70 cases 21% vs 19% Sanchez et al. (2003) case control n = 169 cases aOR 1.2 (0.7-2.2)
(0.5-5.0)
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CONCLUSION
o Difficult to conduct epidemiological studies for preeclampsia in the absence of a database o UKMMC pioneered the case-mix system in Malaysia o The accessibility of which facilitated identification of specific disease cases, including pre-eclampsia
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THANK YOU
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