Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort.

Hdl Handle:
http://hdl.handle.net/10147/135426
Title:
Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort.
Authors:
North, Robyn A; McCowan, Lesley M E; Dekker, Gustaaf A; Poston, Lucilla; Chan, Eliza H Y; Stewart, Alistair W; Black, Michael A; Taylor, Rennae S; Walker, James J; Baker, Philip N; Kenny, Louise C
Affiliation:
Division of Women's Health, King's College London, London, United Kingdom. robyn.north@kcl.ac.uk
Citation:
Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. 2011, 342:d1875 BMJ
Journal:
BMJ (Clinical research ed.)
Issue Date:
Apr-2011
URI:
http://hdl.handle.net/10147/135426
PubMed ID:
21474517
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/21474517
Abstract:
To develop a predictive model for pre-eclampsia based on clinical risk factors for nulliparous women and to identify a subgroup at increased risk, in whom specialist referral might be indicated.; Prospective multicentre cohort.; Five centres in Auckland, New Zealand; Adelaide, Australia; Manchester and London, United Kingdom; and Cork, Republic of Ireland.; 3572 "healthy" nulliparous women with a singleton pregnancy from a large international study; data on pregnancy outcome were available for 3529 (99%).; Pre-eclampsia defined as ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg, or both, on at least two occasions four hours apart after 20 weeks' gestation but before the onset of labour, or postpartum, with either proteinuria or any multisystem complication. Preterm pre-eclampsia was defined as women with pre-eclampsia delivered before 37(+0) weeks' gestation. In the stepwise logistic regression the comparison group was women without pre-eclampsia.; Of the 3529 women, 186 (5.3%) developed pre-eclampsia, including 47 (1.3%) with preterm pre-eclampsia. Clinical risk factors at 14-16 weeks' gestation were age, mean arterial blood pressure, body mass index (BMI), family history of pre-eclampsia, family history of coronary heart disease, maternal birth weight, and vaginal bleeding for at least five days. Factors associated with reduced risk were a previous single miscarriage with the same partner, taking at least 12 months to conceive, high intake of fruit, cigarette smoking, and alcohol use in the first trimester. The area under the receiver operating characteristics curve (AUC), under internal validation, was 0.71. Addition of uterine artery Doppler indices did not improve performance (internal validation AUC 0.71). A framework for specialist referral was developed based on a probability of pre-eclampsia generated by the model of at least 15% or an abnormal uterine artery Doppler waveform in a subset of women with single risk factors. Nine per cent of nulliparous women would be referred for a specialist opinion, of whom 21% would develop pre-eclampsia. The relative risk for developing pre-eclampsia and preterm pre-eclampsia in women referred to a specialist compared with standard care was 5.5 and 12.2, respectively.; The ability to predict pre-eclampsia in healthy nulliparous women using clinical phenotype is modest and requires external validation in other populations. If validated, it could provide a personalised clinical risk profile for nulliparous women to which biomarkers could be added. Trial registration ACTRN12607000551493.
Item Type:
Article
Language:
en
MeSH:
Adult; Early Diagnosis; Female; Humans; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Referral and Consultation; Risk Assessment; Risk Factors; Ultrasonography, Doppler
ISSN:
1468-5833

Full metadata record

DC FieldValue Language
dc.contributor.authorNorth, Robyn Aen
dc.contributor.authorMcCowan, Lesley M Een
dc.contributor.authorDekker, Gustaaf Aen
dc.contributor.authorPoston, Lucillaen
dc.contributor.authorChan, Eliza H Yen
dc.contributor.authorStewart, Alistair Wen
dc.contributor.authorBlack, Michael Aen
dc.contributor.authorTaylor, Rennae Sen
dc.contributor.authorWalker, James Jen
dc.contributor.authorBaker, Philip Nen
dc.contributor.authorKenny, Louise Cen
dc.date.accessioned2011-07-06T14:32:05Z-
dc.date.available2011-07-06T14:32:05Z-
dc.date.issued2011-04-
dc.identifier.citationClinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. 2011, 342:d1875 BMJen
dc.identifier.issn1468-5833-
dc.identifier.pmid21474517-
dc.identifier.urihttp://hdl.handle.net/10147/135426-
dc.description.abstractTo develop a predictive model for pre-eclampsia based on clinical risk factors for nulliparous women and to identify a subgroup at increased risk, in whom specialist referral might be indicated.-
dc.description.abstractProspective multicentre cohort.-
dc.description.abstractFive centres in Auckland, New Zealand; Adelaide, Australia; Manchester and London, United Kingdom; and Cork, Republic of Ireland.-
dc.description.abstract3572 "healthy" nulliparous women with a singleton pregnancy from a large international study; data on pregnancy outcome were available for 3529 (99%).-
dc.description.abstractPre-eclampsia defined as ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg, or both, on at least two occasions four hours apart after 20 weeks' gestation but before the onset of labour, or postpartum, with either proteinuria or any multisystem complication. Preterm pre-eclampsia was defined as women with pre-eclampsia delivered before 37(+0) weeks' gestation. In the stepwise logistic regression the comparison group was women without pre-eclampsia.-
dc.description.abstractOf the 3529 women, 186 (5.3%) developed pre-eclampsia, including 47 (1.3%) with preterm pre-eclampsia. Clinical risk factors at 14-16 weeks' gestation were age, mean arterial blood pressure, body mass index (BMI), family history of pre-eclampsia, family history of coronary heart disease, maternal birth weight, and vaginal bleeding for at least five days. Factors associated with reduced risk were a previous single miscarriage with the same partner, taking at least 12 months to conceive, high intake of fruit, cigarette smoking, and alcohol use in the first trimester. The area under the receiver operating characteristics curve (AUC), under internal validation, was 0.71. Addition of uterine artery Doppler indices did not improve performance (internal validation AUC 0.71). A framework for specialist referral was developed based on a probability of pre-eclampsia generated by the model of at least 15% or an abnormal uterine artery Doppler waveform in a subset of women with single risk factors. Nine per cent of nulliparous women would be referred for a specialist opinion, of whom 21% would develop pre-eclampsia. The relative risk for developing pre-eclampsia and preterm pre-eclampsia in women referred to a specialist compared with standard care was 5.5 and 12.2, respectively.-
dc.description.abstractThe ability to predict pre-eclampsia in healthy nulliparous women using clinical phenotype is modest and requires external validation in other populations. If validated, it could provide a personalised clinical risk profile for nulliparous women to which biomarkers could be added. Trial registration ACTRN12607000551493.-
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/21474517en
dc.subject.meshAdult-
dc.subject.meshEarly Diagnosis-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshParity-
dc.subject.meshPre-Eclampsia-
dc.subject.meshPregnancy-
dc.subject.meshPregnancy Outcome-
dc.subject.meshReferral and Consultation-
dc.subject.meshRisk Assessment-
dc.subject.meshRisk Factors-
dc.subject.meshUltrasonography, Doppler-
dc.titleClinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort.en
dc.typeArticleen
dc.contributor.departmentDivision of Women's Health, King's College London, London, United Kingdom. robyn.north@kcl.ac.uken
dc.identifier.journalBMJ (Clinical research ed.)en

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