Detection and risk factors for preeclampsia.

Throughout the world, preeclampsia is a leading cause of maternal mortality. In Mexico, it accounts for almost a third of maternal deaths. Research on epidemiology of preeclampsia is difficult because of differences in definition and inaccuracy in diagnosis. Several classification systems for hypertensive disorders of pregnancy have been proposed, however, evaluation of them is lacking. This dissertation aimed to estimate the prevalence of hypertensive disorders of pregnancy, to evaluate two main classification systems of hypertensive disorders of pregnancy proposed by the National High Blood Pressure Education Program (NHBPEP) and the Australasian Society for the Study of Hypertension in Pregnancy (ASSHP) with respect to maternal and fetal outcomes, and to compare both systems with clinical diagnoses. We then evaluated the association between a potential modifiable risk factor, physical activity, and hypertensive disorders of pregnancy. Finally, we identified socioeconomic factors associated with a particularly high risk. A cross-sectional study was conducted in among 3299 uninsured women delivering at the Hospital Infantil of Sonora, Mexico from September 2003 to March 2004. The ASSHP detected 15% more preeclamptic women than the NHBPEP (5.1% and 4.5% respectively). Both classification systems stratified women by probability of adverse maternal and fetal outcomes. Sensitivity of clinical diagnosis for preeclampsia, chronic hypertension and preeclampsia superimposed upon chronic hypertension was low (56.3%, 5.6% and 9.1% respectively). Increasing time spent in household activities was associated with decreasing risk of preeclampsia, (aOR=0.40, 95% CI: 0.20, 0.81 for more than 15 weekly hours). Women expending more than 17.5 METs per week in moderate activities also had a decreased risk for preeclampsia (aOR=0.44, 95% CI; 0.23, 0.85). Socially disadvantaged primiparous women had increased risk for preeclampsia, primiparas having low income (aOR=4.08, 95% CI; 2.24, 7.45), compared with women having high income and parity 2 or 3. Women with low income had also and increased risk to experience chronic hypertension (aOR=1.83, 95% CI; 1.02, 3.28). In conclusion, to reduce the mortality associated with preeclampsia, unifying medical criteria for preeclampsia diagnosis is required, while promotion of moderate physical activity and targeted public health interventions in high-risk primiparous women is needed.Ph.D.Health and Environmental SciencesObstetricsPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/125625/2/3208431.pd

Risk factors for pre-eclampsia/eclampsia among working women in Mexico City

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74315/1/j.1365-3016.2001.00315.x.pd

Development and First Phase Evaluation of a Maternity Leave Educational Tool for Pregnant, Working Women in California

Despite the provision of maternity leave offered to mothers, many American women fail to take leave.We developed an evidence-based maternity leave educational tool for working women in California using participatory design. We tested its short-term efficacy with a randomized controlled trial of pregnant English-speakers (n=155).Among intervention participants exposed to the tool, 65% reported that they learned something new; 38% were motivated to seek more information; and 49% said it helped them plan their maternity leave. Among participants who delivered at ≥ 37 weeks gestation and said the tool helped them plan their leave, 89% took more than one week of prenatal leave, a significantly higher proportion than among controls who did not receive the tool (64%, p=0.049). Other findings favored trial participants, but were not statistically significant in this small sample. More intervention participants took some prenatal leave (80%) vs. controls (74%, p=0.44). Among participants who had returned to work when surveyed (n=50), mean postnatal leave uptake was on average 1 week longer for intervention participants vs. controls (13.3 vs. 12.2 weeks, p=0.54).The first-phase evaluation of this tool shows that it successfully informed women about maternity leave options, clarified complex regulations, encouraged women to seek further information and helped plan maternity leave. Compared to controls, trial participants who used the tool to plan their leave were far more likely to take prenatal leave close to term. Future evaluation of the tool when mediated by a health provider or employer is warranted