Discriminatory Accuracy of Preeclampsia Risk Factors in Primary Care

BACKGROUND

Although it is common to use risk factors in the screening for preeclampsia, they do not always accurately identify patients who truly have this condition.

AIM OF THE STUDY

To determine the discriminatory accuracy of known preeclampsia risk factors, both individually and in combination.

METHODS

We studied patients undergoing prenatal care who were diagnosed with preeclampsia or eclampsia (n = 160 cases) in primary care and those who were not (n = 430 controls). Data on history of preeclampsia, type 2 diabetes, chronic hypertension, multiple gestation, first pregnancy, pregnancy interval ≥10 years, overweight/obesity, mean arterial pressure (MAP) ≥80 mmHg, and age (<20 years and ≥40 years) were obtained using a dichotomous scale. Discriminatory accuracy indicators were true-positive (TP) and false-positive (FP) rates, positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR), and the area under the receiver-operating characteristic (AUROC) curve; stratified by parity. The case-control status was the reference standard.

RESULTS

Certain combinations performed better than individual factors, independent of parity status. Among multiparous women, MAP ≥80 mmHg together with previous preeclampsia and overweight/obesity accumulated the greatest number of discriminatory accuracy indicators, with acceptable values: TP, 72.2%; FP, 1.5%; LR+, 48.4; LR-, 0.3; DOR, 171.6; and AUROC, 0.85.

CONCLUSIONS

Discriminatory accuracy was low for almost all individual preeclampsia risk factors. However, the accuracy improved after some factors were combined. To the best of our knowledge, this is the first study to examine the discriminatory accuracy of preeclampsia risk factors used for screening high-risk pregnancies in primary care in Mexico.

[Metabolic syndrome in workers of a second level hospital]

BACKGROUND

People with metabolic syndrome (20-25 % of the world population) are three times more likely to suffer a heart attack or stroke and twice as likely to die from this cause. The objective of this study was to assess the prevalence of metabolic syndrome in workers of a second level hospital.

METHODS

This was a cross-sectional study with 160 healthcare workers in Monterrey, México. Sociodemographic, anthropometric and biochemical data were obtained to assess the prevalence of metabolic syndrome. Bivariate and multiple logistic regression analysis were carried out in order to assess the relationship between metabolic syndrome and sociodemographic and occupational variables.

RESULTS

The prevalence of metabolic syndrome among workers was 38.1 %. Nurses were more affected with 32.8 %. Overweight and obesity were prevalent in 78 %. In the logistic regression there was a significant association between metabolic syndrome and not having partner (OR 3.98, 95 % CI [1.54-10.25]) and obesity (OR 4.69, 95 % CI [1.73-12.73]).

CONCLUSIONS

The prevalence of metabolic syndrome and obesity is alarming. Appropriate and prompt actions must be taken in order to reduce the risk of cardiovascular disease in this population.

[Single central obesity and combined with overweight/obesity in preeschool Mexican children]

Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n = 903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile > or = 75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile > or = 95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7 +/- 1.0 years. Mexican children's WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95% CI 22.3-28.0) and single, 15.4% (95 CI% 13.0-17.8). Prevalence of single abdominal obesity with WC at percentile > or = 90 was 4.4% (IC 95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.