ABSTRACT
OBJECTIVE: The relationship between sickle cell disease (SCD) and severe pre-eclampsia is poorly established. It is also unknown whether the occurrence of HIV infection among women with SCD modifies their risk level for severe pre-eclampsia. We hypothesized that pregnant women with SCD are at an elevated risk for severe pre-eclampsia as a result of heightened endothelial damage; and the combination of SCD-HIV augments the inflammatory processes of endothelial damage leading to amplified risk for severe pre-eclampsia. STUDY DESIGN: We analyzed more than 57 million pregnancy-related hospitalizations and births in the US from January 1, 2002 through December 31, 2014. MAIN OUTCOME MEASURES: We applied multivariable survey logistic regression to generate odds ratios for the association between SCD, HIV and SCD-HIV status and severe pre-eclampsia with adjustment for potential confounders. RESULTS: Of the total 57,326,459 pregnant women, 57,198,505 (99.78%) did not have SCD or HIV, 73,064 (12.7 per 10,000) had HIV only, 54,890 (9.58 per 10,000) had SCD only and 222 (0.39 per 100,000) had both SCD and HIV. Mothers with SCD and HIV-SCD experienced a significant elevation in risk for severe pre-eclampsia of about 60% (ORâ¯=â¯1.61; 95% CIâ¯=â¯1.44, 1.79) and of more than 300% (ORâ¯=â¯4.28; 95% CIâ¯=â¯1.35, 13.62) respectively. CONCLUSION: In the largest study on SCD and pre-eclampsia in the world, we established SCD to be strongly associated with severe pre-eclampsia. Another unique finding is the synergistic effect of amplified risk for severe pre-eclampsia among mothers with the combined SCD-HIV status.
Subject(s)
Anemia, Sickle Cell/epidemiology , HIV Infections/epidemiology , Pre-Eclampsia/epidemiology , Adolescent , Adult , Anemia, Sickle Cell/diagnosis , Databases, Factual , Female , HIV Infections/diagnosis , Health Surveys , Humans , Logistic Models , Middle Aged , Multivariate Analysis , Odds Ratio , Pre-Eclampsia/diagnosis , Pregnancy , Prevalence , Prognosis , Risk Assessment , Risk Factors , Severity of Illness Index , United States/epidemiology , Young AdultABSTRACT
En el último número de la RAMR Vol 2 de 2014 he leído el trabajo "Hipertensión Pulmonar Registro de un centro de referencia en la Argentina"de Talavera M y col que considero un trabajo de relevancia, gran utilidad y alto valor científico. Según la Real academia el término Registro (Del lat. regestum, sing. de regesta, -orum) es laacción y efecto de registrar. Lugar desde donde se puede registrar o ver algo, protocolo del notario o registrador. El registro constituye la condición esencial para lograr una base de datos, el principio para diferenciar la realidad de la leyenda o el mito y poder comparar resultados
