Evidence of under-reporting of early-onset preeclampsia using register data.
Evidence of under-reporting of early-onset preeclampsia using register data.
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使用登记数据未充分报告早发性先兆子痫的证据。
DOI：
10.1111/ppe.12759
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发表时间：
2021-09
影响因子：
2.8
通讯作者：
Arkema EV
中科院分区：
文献类型：
--
作者：
Simard JF;Rossides M;Wikström AK;Falasinnu T;Palmsten K;Arkema EV
早发型先兆子痫，传统上定义为在妊娠34周之前出现，与晚发型先兆子痫相比，与更高的围产期死亡、胎盘剥离和中风风险相关。我们评估了狼疮妊娠高危人群和一般人群中分娩时孕龄定义的先兆子痫表型与首次先兆子痫诊断相比的错误分类程度。纳入了来自瑞典的狼疮患者和一般人群对照，在医学出生登记中有≥1例单胎妊娠，并记录了先兆子痫的ICD代码（2002-2016）。我们使用分娩时的胎龄（<34周与≥34周）来区分先兆子痫早发型与晚发型，然后根据患者登记册中的首次先兆子痫诊断日期进行重新分类。我们将这两个定义交叉制表，并使用基于访视的定义作为一般人群和狼疮妊娠的参考标准，计算敏感性，总体和未经产妇女。331例妊娠被诊断为先兆子痫，其中322例同时登记。其中，58例是早发性的，基于分娩时的胎龄（狼疮妊娠中n=29）。总体而言，9%的狼疮早发性先兆子痫（敏感性91%，95%置信区间[CI] 75，98）被错误分类为晚发性，而一般人群中为19%（敏感性81%，95% CI 64，92）。我们注意到在未经产的妇女中有类似的错误分类（4%对22%）。在一般人群中，早发性先兆子痫比高危狼疮人群更有可能被错误分类为晚发性先兆子痫。依靠分娩时的胎龄来判断先兆子痫的表型，这种方法低估了早发性先兆子痫的发生率。这也表明早发性先兆子痫作为一个公共卫生问题的负担可能被低估，尽管这可能更适用于采用期待治疗的轻度先兆子痫。早发型先兆子痫的生物学和母体预测因子的研究可能会处理不同的错误分类结果或样本。
Early-onset preeclampsia, traditionally defined as presenting before 34 gestational weeks, is associated with even higher risks of perinatal death, placental abruption, and stroke, than late-onset preeclampsia. We estimated the degree of misclassification in a high-risk population of lupus pregnancies and a general population comparator when gestational age at delivery defined preeclampsia phenotype compared to first preeclampsia diagnosis. Patients with lupus and general population comparators from Sweden with ≥1 singleton pregnancy in the Medical Birth Register with a documented ICD code for preeclampsia were included (2002-2016). We used gestational age at delivery (<34 versus ≥34 weeks) to phenotype preeclampsia early- versus late-onset, and then reclassified based on first preeclampsia diagnosis date in the Patient Register. We cross-tabulated the two definitions and calculated sensitivity using the visit-based definition as the reference standard for general population and lupus pregnancies, overall and among nulliparous women. 331 pregnancies were diagnosed with preeclampsia, of which 322 were in both registers. Of those, 58 were early-onset based on gestational age at delivery (n=29 in lupus pregnancies). Overall 9% of early-onset preeclampsia in lupus (sensitivity 91%, 95% confidence interval [CI] 75, 98) was misclassified as late-onset compared to 19% in the general population (sensitivity 81%, 95% CI 64, 92). We noted similar misclassification (4% v 22%) among nulliparous women. In the general population, early-onset preeclampsia was more likely misclassified as late-onset than in the high-risk lupus population. Relying on gestational age at delivery to phenotype preeclampsia this way underestimates the occurrence of early-onset preeclampsia. This also suggests that the burden of early-onset preeclampsia as a public health concern may be under-reported, although this may be more applicable to milder preeclampsia where expectant management is employed. Research of biological and maternal predictors of early-onset preeclampsia may be dealing with differentially misclassified outcomes or samples.
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影响因子：
7.2
作者：
Bicocca, Matthew J.;Mendez-Figueroa, Hector;Sibai, Baha M.
通讯作者：
Sibai, Baha M.
影响因子：
9.8
作者：
Tache, Veronique;Baer, Rebecca J.;Jelliffe-Pawlowski, Laura L.
通讯作者：
Jelliffe-Pawlowski, Laura L.
影响因子：
2.8
作者：
Simard JF;Arkema EV;Nguyen C;Svenungsson E;Wikström AK;Palmsten K;Salmon JE
通讯作者：
Salmon JE
影响因子：
3.8
作者：
Herzog, Emilie M.;Eggink, Alex J.;Steegers-Theunissen, Regine P. M.
通讯作者：
Steegers-Theunissen, Regine P. M.
DOI：
10.1016/j.preghy.2013.04.006
发表时间：
2013-01-01
影响因子：
2.2
作者：
Tranquilli, Andrea L.;Brown, Mark A.;Sibai, Baha M.
通讯作者：
Sibai, Baha M.