Conceptual, epidemiological and methodological design aspects for the study of pre-eclampsia
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We read with high interest the article by Alzate et al1, and hereby we share comments about its design, study population and statistical approach along with revisiting some key concepts of the disease.
The prevalence of preeclampsia in Colombia is 4.5%2 and a case-control study is appropriate to investigate risk and protective factors associated in such setting and their corresponding Odds Ratios. However, in the population studied by Alzate et al, the proportion of preeclampsia is 10% (387/3866 ). Under this scenario, a retrospective cohort study design is also appropriate and allows for direct estimation of incidences and relative risks could also be considered with direct estimates of relative risk. The exposure under study here (calcium prescription) is easy to measure from medical or administrative records or electronic files, therefore its comprehensive assessment in the whole population is feasible, cheap and easy to detect. Case-control studies are usually recommended when these requirements are not met for the exposure variable.
Alzate A, Herrera-Medina R, Pineda LM. Preeclampsia prevention: a case-control study nested in the cohort. Colomb Med (Cali). 2015; 46(4): 156-61 DOI: https://doi.org/10.25100/cm.v46i4.1887
Salazar JA, Triana JC, Prieto FE. Characterising hipertensive disorders during pregnancy in Villavicencio, Colombia. Rev Colomb Obstet Ginecol. 2004; 55(4): 279-86 DOI: https://doi.org/10.18597/rcog.572
Lazcano-Ponce E, Salazar-Martínez E, Hernández-Avila M. Estudios epidemiológicos de casos y controles. Fundamento teórico, variantes y aplicaciones. Salud Pública Méx. 2001; 43(2): 35-50 DOI: https://doi.org/10.1590/S0036-36342001000200009
Hofmeyr GJ, Belizán JM, von Dadelszen P on behalf of the calcium and pre-eclampsia (CAP) study Group. Low-dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary. BJOG. 2014; 121: 951-57 DOI: https://doi.org/10.1111/1471-0528.12613
Herrera, J.A., Arévalo-Herrera, M., Herrera, S. Prevention of preeclampsia by linoleic acid and calcium supplementation. Obstet Gynecol. 1998; 91:585–90. DOI: https://doi.org/10.1016/S0029-7844(97)00711-4
Herrera JA, Shahabuddin AKM, Ersheng G, Wei Y, Garcia RG, López-Jaramillo P. Calcium plus linoleic acid therapy for pregnancy-induced hypertension. Int J Obstet Gynecol. 2005; 91(3): 221-27 DOI: https://doi.org/10.1016/j.ijgo.2005.08.018
Imdad A, Jabeen A, Bhutta ZA. Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-anaylisis of studies from developing countries. BMC Public Health. 2011; 11(3): s18 DOI: https://doi.org/10.1186/1471-2458-11-S3-S18
Jasti S, Siega-Riz AM, Cogswell ME, Hartzema AG, Bentley ME. Pill count adherence to prenatal multivitamin/mineral supplement use among low-income women. J Nutr. 2005; 135(5): 1093-1101 DOI: https://doi.org/10.1093/jn/135.5.1093
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