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Discriminatory Accuracy of Preeclampsia Risk Factors in Primary Care
Hid Felizardo Cordero-Franco1, Ana María Salinas-Martínez2, Tania Abigail García-Alvarez3
1Unidad de Investigación Epidemiológica y en Servicios de Salud/CIBIN, Delegación Nuevo León, Instituto Mexicano del Seguro Social, Monterrey, México; Universidad Autónoma de Nuevo León, Facultad de Medicina, Monterrey, México.
Insights
Screening for preeclampsia using individual risk factors is often inaccurate. Combining factors like high mean arterial pressure, previous preeclampsia, and obesity improves detection accuracy in multiparous women.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health Screening
Background:
- Preeclampsia screening commonly relies on risk factors, but their individual accuracy is limited.
- Identifying effective screening methods is crucial for early detection and management of preeclampsia.
Purpose of the Study:
- To evaluate the discriminatory accuracy of individual and combined preeclampsia risk factors.
- To assess the effectiveness of these factors in screening high-risk pregnancies in primary care.
Main Methods:
- A case-control study involving 160 preeclampsia cases and 430 controls.
- Data collected on risk factors including medical history, lifestyle, and physiological measurements (e.g., MAP).
- Analysis of discriminatory accuracy using metrics like likelihood ratios and AUROC, stratified by parity.
Main Results:
- Individual risk factors showed low discriminatory accuracy for preeclampsia.
- Combinations of factors, particularly in multiparous women (MAP ≥80 mmHg, previous preeclampsia, overweight/obesity), significantly improved accuracy.
- Achieved high discriminatory indicators: TP 72.2%, FP 1.5%, LR+ 48.4, LR- 0.3, DOR 171.6, AUROC 0.85 for the best combination.
Conclusions:
- Combining preeclampsia risk factors enhances screening accuracy compared to individual factors.
- This study provides valuable insights into optimizing preeclampsia screening in primary care settings.
- Highlights the need for multifactorial approaches in identifying high-risk pregnancies for preeclampsia.
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.
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