Risk factors for abnormal cervical cytology in pregnant women attending the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico.

OBJECTIVE: Approximately 30% of women diagnosed with cervical cancer are in their childbearing years, and 5-8% of pregnant women seeking prenatal care are found to have an abnormal Papanicolaou smear. Prenatal visits are an excellent opportunity for cervical cytology testing and patient education because of close follow-up. The objective of this study is to examine the overall prevalence of cervical dysplasia and associated risk factors in pregnant women aged 15 to 30 years attending the high-risk obstetrics clinics at the University Hospital in San Juan, Puerto Rico between December 2005 and May 2007. METHODS: We performed a systematic review of 237 prenatal charts from patients attending the high-risk obstetrics clinics at the University Hospital in San Juan. The variables studied were age, place of birth, gestational age at first visit, gravidity, age at first coitus, number of sexual partners, tobacco use, Papanicolaou smear results, and cervical gonorrhea and Chlamydia test results. The relationship between cervical cytology results and the aforementioned variables was statistically assessed. RESULTS: Abnormal cervical cytology was found in 16 (6.8%) of the patients. Of these, 75% were atypical squamous cells of unknown significance (ASCUS), 19% low-grade squamous intraepithelial lesion (LGSIL), and 6% high-grade squamous intraepithelial lesion (HGSIL). Gravidity > 3 was observed in 16.5% of the patients, and 48.7% were in their second trimester of gestation. Their first coitus was at age 17 or earlier (66.5%), and 78% had between 1 and 3 sexual partners. Having a positive Chlamydia test was significantly (p < 0.05) associated with the risk of having an abnormal cervical cytology. Other variables such as gravidity, age at first coitus, number of sexual partners, and tobacco use were not statistically associated with an abnormal cervical cytology test. CONCLUSION: The overall prevalence of cervical dysplasia among pregnant women who attend the high-risk obstetrics clinic at the University Hospital in San Juan, Puerto Rico is similar to what has been reported elsewhere. Among all variables studied, only a positive Chlamydia test was found to be associated with an abnormal cervical cytology test. Given the high number of women seeking prenatal care and the close follow-up provided during this period, prenatal care is an excellent opportunity for cervical cytology testing and patient education.

Factors associated with metabolic syndrome in a sample of women in Puerto Rico.

OBJECTIVE: The aim of this study was to determine the association between metabolic syndrome (MetS) and demographic, health, and lifestyle characteristics in a sample of women living in Puerto Rico. METHODS: The study group consisted of 214 women aged 36 to 82 years, residing in the metropolitan area of San Juan, Puerto Rico. Demographic, reproductive, lifestyle, and metabolic variables were assessed through an annual questionnaire and blood chemistries. MetS was defined according to the criteria set by the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults/Adult Treatment Panel III (NCEP/ATP III) and the International Diabetes Federation (IDF). RESULTS: The overall prevalence of MetS was 24% according to NCEP/ATP III criteria and 33% according to IDF criteria. When using the IDF criteria, 37% of participants older than 51 years have MetS, in contrast to 28% when using the NCEP/ATP III criteria. Obese women have an increased probability of MetS when adjusting for age, education level, menopause status, and/or alcohol use (IDF criteria: estimated odds ratio [OR], 2.68; 95% CI, 1.44-4.97; NCEP/ATP III criteria: estimated OR, 3.42; 95% CI, 1.71-6.84). A higher education level (estimated OR, 0.45; 95% CI, 0.23-0.92 [IDF criteria]) and alcohol consumption (estimated OR, 0.48; 95% CI, 0.23-0.99 [NCEP/ATP III criteria]) seem to provide a protective effect, when adjusting for confounders. CONCLUSIONS: Our study confirms obesity as an important risk factor associated with MetS in this sample of women in Puerto Rico. Alcohol consumption and a higher education level seem to decrease the prevalence of MetS. In view of this, patient counseling regarding weight reduction and lifestyle modification should be emphasized in the primary prevention and management of MetS. Additional studies are warranted to further characterize the effect of menopause status on MetS.