Simple prepregnant prediction rule for recurrent

[caryn]

...Early-onset preeclampsia and/or HELLP recurred in 16 (9%) of 186 next pregnancies. The prediction model included high-density lipoprotein (mmol/L) and 24-hour urinary total protein excretion (mg/mmol creatinine). The receiver operating characteristic area was 0.77 (95% confidence interval: 0.68-0.87). Predictive sensitivity and specificity were 94% (69%-99%) and 53% (45%-60%), respectively. Nearly 50% of the women could be classified as having <1% risk of recurrent early-onset disease...

http://www.ncbi.nlm.nih.gov/pubmed/19144890

Great. My HDL is low.

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[kara]

Can you dumb that down a bit, Caryn? Did they weed out those with clotting, renal and other disorders? And where does the HDL come in?

[jgrumet]

Wow, I didn't understand any of that

[caryn]

Oh, I'm just ranting. They've developed an algorithm that will let them plug in your personal variables -- like your age, your gestational age at onset, your HDL levels, your 24-hour proteinuria -- and then it will tell you if you're at low risk of recurrence regardless of the fact that you've got a history of PE.

In other words, it picks out the subset of women who've had it, and who *probably* won't get it again.

And the fact that they mentioned HDL so prominently means that it was kind of important. There's some reason to think that the risk for later cardiovascular disease onset is related to low HDL, too.

IIRC, you can raise HDL with niacin and hard exercise. (...Caryn goes off to pick up the weights. Again.)

[alviarin]

Can I borrow those weights?

My "good" cholesterol is low too, darn it.

[kara]

hmm...I have high LDL and high HDL. My doc is ok with my cholesterol because the good is high, even thought he bad is high. Which seems a bit bizarre to me, but then again I was probably the only, healthy, active, fit 12 year old with high cholesterol. But then again I gotta bunch of other underlying disorders, so it probalby doesn't pertain to me anyway.

[darateacher]

My cholesterol ratio has been a bit off for a while due to family inheritance. However, since I am a runner when I'm not pg, my HDL is usually far above 40, where the docs like to see it. I think at last check up in '05-06, I was at 54, or something like that.

[jules2]

This is an old post I know - but i really like this article it as I plugged my numbers in and it gives me a much much lower risk of early recurrence than my OB suggests.

He told me 10-15% risk of early recurrence (before 30 weeks - I delivered last time at 26+1). Its only 2.9% for me according to this [I do lots of hard exercise and have high HDL - last time 1.7mmol/l, think thats about 68 in US units - and it was higher before pregnancy and PE).

I think I might send this to my OB.

Thanks

[rosalinda]

I'm confused, what is the formula and how do I plug in my numbers?

[jules2]

They don't spell it out in the article very clearly. If you can send me your high-density lipoprotein (mmol/L) and 24-hour urinary total protein excretion (mg/mmol creatinine), I will plug it in for you. I have epidemiology PhD so am very comfortable with this [but also know the limitations of these statistical models - and wonder why HDL is so powerful in this one?]. The most reassuring thing in this article is that nearly all these women managed to get a lot further in a subsequent pregnancy.