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

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    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
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    Affiliation
    Division of Women's Health, King's College London, London, United Kingdom. robyn.north@kcl.ac.uk
    Issue Date
    2011-04
    MeSH
    Adult
    Early Diagnosis
    Female
    Humans
    Parity
    Pre-Eclampsia
    Pregnancy
    Pregnancy Outcome
    Referral and Consultation
    Risk Assessment
    Risk Factors
    Ultrasonography, Doppler
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    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.)
    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
    ISSN
    1468-5833
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