02_Risk Factors Influencing Preeclampsia Amongst Women Receiving Treatment at UKMMC

7/30/2019 02_Risk Factors Influencing Preeclampsia Amongst Women Receiving Treatment at UKMMC

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Risk Factors of Pre-eclampsia slide 1

A CASE CONTROL STUDY OF

RISK FACTORS INFLUENCING

PREECLAMPSIA AMONGST WOMENRECEIVING TREATMENT AT UNIVERSITI

KEBANGSAAN MALAYSIA MEDICAL

CENTRE (UKMMC)

DR NORFAZILAH BINTI AHMAD

P 36529

Norfazilah, A.1 Azmi, M.T.1 Shamsuddin, K.1 Mahdy, A.Z.2

1 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia2Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia


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INTRODUCTION

Hypertension in pregnancy importantcause of maternal and perinatal morbidityand 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):

De novohypertension after 20 weeks ofgestation with properly documented proteinuria

Chronic hypertension with superimposedpreeclampsia:

Pregnant woman with chronic hypertensionthe appearance ofde novoproteinuria after 20weeks of gestation.( magnitude of blood pressure, proteinuria, thrombocytopenia abnormal liver enzymes)

(Brown et al. 2001)


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JUSTIFICATION

Lack of published local studies regarding riskfactors for preeclampsia

Useful information in identifying women at risk ofpre-eclampsia

For screening and prophylaxis, as well as forrecruitment into relevant clinical studies.


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LITERATURE REVIEW

Certain risk factors have stronger association thanothers..

All play a role in identifying women at risk of

preeclampsia

Possessing a risk factor does not necessarily

mean a woman will develop preeclampsia, neitherdoes the absence of any risk factor guarantee safety(Churchill & Beever 1999)


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Risk Factors of Pre-eclampsia

Obstetrics history

Pre-pregnancy body

mass index

REPRODUCTIVE HISTORY

Ethnic

SOCIO-DEMOGRAPHIC FACTOR

Chronic hypertension

FAMILY HEALTH

HISTORY

CONCURRENT

MATERNAL

MEDICAL HISTORY

Type 2 diabetes mellitus

Gestational diabetes

Type 2 diabetes mellitus

Chronic hypertension

Age

MATERNAL AND

PERINATAL

MORTALITY/MORBIDITY

PREECLAMPSIA


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OBJECTIVES

1. To determine the socio-demographic characteristics

of preeclamptic cases2. To determine the relationship between of the

following risk factors and preeclampsia:

i. Ethnicii. Ageiii. High pre-pregnancy body mass index

iv. Obstetrics history (parity)v. Concurrent maternal medical illnessvi. Family health history of chronic hypertension and

type 2 diabetes mellitus (either alone or combined)



METHODOLOGY

BACKGROUNDUKMMC

Case-Mix system

Medical record department

STUDY DESIGNA hospital based unmatched case control study



METHODOLOGY

SAMPLING METHOD

Cases (2002-2007)

Code: Hypertensivedisorder in pregnancyDefinition fulfilledReached the sample

size required (355)

Control

Code: normotensivepregnant women

Match by year to caseRandomly selected

from the database

Medical records: complete



RESULT



RESULT (DESCRIPTIVE)

Ethnic: Malay (case 75.2%; control 68.7%)

Age



Table 1:ORs and 95% CI according to riskfactors for preeclampsia

Risk factors Unadjusted *Adjusted

OR (95% CI) OR (95% CI)

Ethnic

Non-Malay 1.0 (referent)

Malay 0.79(0.99-1.92)

Age (years)

< 35 1.0 (referent) 1.0 (referent)

35 2.70 (175-4.17) 2.10(1.19-3.70)

Pre-pregnancy BMI Normal 1.0 (referent) 1.0 (referent)

Underweight 0.56(0.35-0.88) 0.60(0.37-0.97)

Overweight 7.87(4.41-14.07) 4.01(2.48-6.49)

Obese 14.54(6.40-33.04) 6.40(2.92-14.00)



Table 1:ORs and 95% CI according to riskfactors for preeclampsia


OR (95% CI) OR (95% CI)

Obstetrics history

Others 1.0 (referent) 1.0 (referent) Primigravida 1.24(0.84-1.840) 2.25(1.43-3.56)

Parity 2 2.24(1.48-3.39) 1.85(1.12-3.06)

Nulliparity 2.47(1.39-4.39) 3.15(1.63-6.08)

Concurrent medical history

No 1.0 (referent) 1.0 (referent)

Yes 7.22(3.21-16.24) 4.83(1.74-13.42)



* Backward Stepwise (Likelihood Ratio) Multiple Logistic Regression appliedModel adequacy was checked by using Hosmer and Lemeshow test (p = 0.352), overall correctly classifiedpercentage (69.5%) and area under the curve (0.77)No multicollinearity problem and interaction reportedNagelkerke 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)+ 0.78(family history of chronic hypertension).


OR (95% CI) OR (95% CI)

Family history of chronic hypertension

No 1.0 (referent) 1.0 (referent) Yes 3.12(2.30-4.25) 2.18(1.55-3.09)

Family history of Type 2 diabetes mellitus

No 1.0 (referent)

Yes 1.96(1.39-2.75)

Family history of chronic hypertension andtype 2 diabetes mellitus

No 1.0 (referent)

Yes 3.18(2.34-4.33)



DISCUSSION

ETHNIC:

Hashimah et al. (2007) Loi et al. (2007)

place HKL & UKMMC Singapore

design case control cross-sectional

n=75 cases

HKL (72) UKMMC (3) 93 cases

comparison Non-Malay to Malay Malay to Chinese

aOR 2.4 (0.7 - 8.2) p = 0.001

Malay to Indian

p = 0.170Malay to Others

p = 0.086

Malay=majority late booker



DISCUSSION

AGE: Loi et al. (2007) Ustun et al. (2005)place Singapore Turkey

design cross-sectional retrospective cohort

35 years p = 0.01 p = 0.001

Doherty et al. (2006) Bhattacharya et al. (2007)

reference normal BMI normal BMI

result overweight (aOR 1.45 [0.72-2.90]) overweight (aOR 1.6 [1.2-1.8])

obese (aOR 3.74 [1.95-7.17]) obese (aOR 3.1 [2.8-3.5])

morbidly obese (aOR 7.2 [4.7-11.2])

PRE-PREGNANCY BMI: Increasing risk throughoutthe BMI distribution



DISCUSSION

OBSTETRICS HISTORY: nulliparityEskenazi et al.

(1991)

Anorlu et al.

(2005) Conde-Agudelo et al. (2000)

design case control case control cross-sectional

n= 193 cases 128 casesreference multiparous > 1 1

parity nulliparous nulliparous nulliparous

aOR 5.4 (2.8-10.3)

aOR 4.77

(2.90-7.78) aRR 2.38 (2.28-2.49)

CONCURRENT MATERNAL MEDICAL HISTORY:Eskenazi et al. (1991); Stone et al. (1994); Anorlu et al. (2005) &

Gaugler-Senden et al. (2005)



DISCUSSIONFAMILY HEALTH HISTORY

DISCUSSION

Chronic hypertension Type 2 diabetes mellitus Combinedagreement X agreement X agreement X

Ness et al.(2003) Eskenazi et al. Ness et al. Sanchez et al. Sanchez et al. Qiu et al. (2003)

cohort (1991) (2003) (2003) (2003) aOR 1.9

n=85/2211 (3.8%) aOR 1.7 (0.92-3.2) 1: aRR 1.3 aOR 3.4 (1.4-8.4) aOR 1.6 (1.3-2.9)

1: aRR 1.5 (0.7-2.3) -more aware of (0.9-2.7)

(0.1-2.5) Stone et al. (1994) parental history

2: aRR 1.1 of diabetes

2: aRR 2.2 case control (0.5-5.0) mellitus

(1.1-4.5) n = 70 cases

21% vs 19% Qiu et al. (2003)

Qiu et al. (2003) aOR 1.8 (1.1-3.1)

case control Sanchez et al.

n = 190 (2003)

aOR 2.0 (1.2-5.5) case control

n = 169 cases

aOR 1.2 (0.7-2.2)



CONCLUSION

o Difficult to conduct epidemiologicalstudies for preeclampsia in the absence of adatabase

o UKMMC pioneered the case-mix systemin Malaysia

o The accessibility of which facilitatedidentification of specific disease cases,including pre-eclampsia


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THANK YOU

02_Risk Factors Influencing Preeclampsia Amongst Women Receiving Treatment at UKMMC

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