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Research article
Prediction of pre-eclampsia in nulliparous women using routinely collected maternal characteristics: A model development and validation study
Ziad TA Al-Rubaie
The University of Notre Dame Australia - Sydney Campus Broadway
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
Background Guidelines recommend identifying in early pregnancy women at elevated risk of pre-eclampsia. The aim of this study was to develop and validate a pre-eclampsia risk prediction model for nulliparous women attending routine antenatal care “the Western Sydney (WS) model”; and to compare its performance with the National Institute of Health and Care Excellence (NICE) risk factor-list approach for classifying women as high-risk.
Methods This retrospective cohort study included all nulliparous women who gave birth in three public hospitals in the Western-Sydney-Local-Health-District, Australia 2011-2014. Using births from 2011-2012, multivariable logistic regression incorporated established maternal risk factors to develop and internally validate the WS model. The WS model was then externally validated using births from 2013-2014, assessing its discrimination and calibration. We fitted the final WS model for all births from 2011-2014, and compared its accuracy in predicting pre-eclampsia with the NICE approach.
Results Among 12,395 births to nulliparous women in 2011-2014, there were 293 (2.4%) pre-eclampsia events. The WS model included: maternal age, body mass index, ethnicity, multiple pregnancy, family history of pre-eclampsia, autoimmune disease, chronic hypertension and chronic renal disease. In the validation sample (6201 births), the model c-statistic was 0.70 (95% confidence interval 0.65–0.75). The observed:expected ratio for pre-eclampsia was 0.91, with a Hosmer-Lemeshow goodness-of-fit test p-value of 0.20. In the entire study sample of 12,395 births, 374 (3.0%) women had a WS model-estimated pre-eclampsia risk ≥8%, the pre-specified risk-threshold for considering aspirin prophylaxis. Of these, 54 (14.4%) developed pre-eclampsia (sensitivity 18% (14–23), specificity 97% (97–98)). Using the NICE approach, 1173 (9.5%) women were classified as high-risk, of which 107 (9.1%) developed pre-eclampsia (sensitivity 37% (31-42), specificity 91% (91–92)). The final model showed similar accuracy to the NICE approach when using lower risk-threshold of ≥4% to classify women as high-risk for pre-eclampsia.
Conclusion The WS risk model that combines readily-available maternal characteristics achieved modest performance for prediction of pre-eclampsia in nulliparous women. The model did not outperform the NICE approach, but has the advantage of providing individualised absolute risk estimates, to assist with counselling, inform decisions for further testing, and consideration of aspirin prophylaxis.
Keywords
Antenatal care, Australia, Maternal Health, National Institute of Health and Care Excellence, Pre-eclampsia, Prediction, Risk assessment, Risk prediction model.
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CURRENT STATUS: Published
Version 3
Posted 31 Dec, 2019
Published
On 06 Jan, 2020
No community comments so far
Editorial decision: Accept
On 27 Dec, 2019
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 25 Dec, 2019
Editor invited
On 25 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2019
Editor assigned
On 16 Dec, 2019
Submission checks complete
On 15 Dec, 2019
Editor invited
On 15 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 03 Dec, 2019
Review #2 received
Received 16 Nov, 2019
Review #3 received
Received 16 Nov, 2019
Reviewer #3 agreed
On 14 Nov, 2019
Reviewer #2 agreed
On 10 Nov, 2019
Review #1 received
Received 08 Nov, 2019
Reviewers invited
Invitations sent on 04 Nov, 2019
Reviewer #1 agreed
On 04 Nov, 2019
Submission checks complete
On 30 Oct, 2019
Editor assigned
On 29 Oct, 2019
Editor invited
On 28 Oct, 2019
First submitted
On 26 Oct, 2019
Metrics
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PDF Downloads: ...
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Subject Areas
Obstetrics & Gynecology
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Prediction of pre-eclampsia in nulliparous women using routinely collected maternal characteristics: A model development and validation study
Ziad TA Al-Rubaie
The University of Notre Dame Australia - Sydney Campus Broadway
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 31 Dec, 2019
Published
On 06 Jan, 2020
No community comments so far
Editorial decision: Accept
On 27 Dec, 2019
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 25 Dec, 2019
Editor invited
On 25 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 23 Dec, 2019
Editor assigned
On 16 Dec, 2019
Submission checks complete
On 15 Dec, 2019
Editor invited
On 15 Dec, 2019
No comments provided
Editorial decision: Minor revision
On 03 Dec, 2019
Review #2 received
Received 16 Nov, 2019
Review #3 received
Received 16 Nov, 2019
Reviewer #3 agreed
On 14 Nov, 2019
Reviewer #2 agreed
On 10 Nov, 2019
Review #1 received
Received 08 Nov, 2019
Reviewers invited
Invitations sent on 04 Nov, 2019
Reviewer #1 agreed
On 04 Nov, 2019
Submission checks complete
On 30 Oct, 2019
Editor assigned
On 29 Oct, 2019
Editor invited
On 28 Oct, 2019
First submitted
On 26 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Obstetrics & Gynecology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
Background Guidelines recommend identifying in early pregnancy women at elevated risk of pre-eclampsia. The aim of this study was to develop and validate a pre-eclampsia risk prediction model for nulliparous women attending routine antenatal care “the Western Sydney (WS) model”; and to compare its performance with the National Institute of Health and Care Excellence (NICE) risk factor-list approach for classifying women as high-risk.
Methods This retrospective cohort study included all nulliparous women who gave birth in three public hospitals in the Western-Sydney-Local-Health-District, Australia 2011-2014. Using births from 2011-2012, multivariable logistic regression incorporated established maternal risk factors to develop and internally validate the WS model. The WS model was then externally validated using births from 2013-2014, assessing its discrimination and calibration. We fitted the final WS model for all births from 2011-2014, and compared its accuracy in predicting pre-eclampsia with the NICE approach.
Results Among 12,395 births to nulliparous women in 2011-2014, there were 293 (2.4%) pre-eclampsia events. The WS model included: maternal age, body mass index, ethnicity, multiple pregnancy, family history of pre-eclampsia, autoimmune disease, chronic hypertension and chronic renal disease. In the validation sample (6201 births), the model c-statistic was 0.70 (95% confidence interval 0.65–0.75). The observed:expected ratio for pre-eclampsia was 0.91, with a Hosmer-Lemeshow goodness-of-fit test p-value of 0.20. In the entire study sample of 12,395 births, 374 (3.0%) women had a WS model-estimated pre-eclampsia risk ≥8%, the pre-specified risk-threshold for considering aspirin prophylaxis. Of these, 54 (14.4%) developed pre-eclampsia (sensitivity 18% (14–23), specificity 97% (97–98)). Using the NICE approach, 1173 (9.5%) women were classified as high-risk, of which 107 (9.1%) developed pre-eclampsia (sensitivity 37% (31-42), specificity 91% (91–92)). The final model showed similar accuracy to the NICE approach when using lower risk-threshold of ≥4% to classify women as high-risk for pre-eclampsia.
Conclusion The WS risk model that combines readily-available maternal characteristics achieved modest performance for prediction of pre-eclampsia in nulliparous women. The model did not outperform the NICE approach, but has the advantage of providing individualised absolute risk estimates, to assist with counselling, inform decisions for further testing, and consideration of aspirin prophylaxis.
Figure 1
Figure 2
Figure 3
Figure 4