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

Show simple item record North, RA en McCowan, Lesley en Dekker, GA en Poston, L en Chan, Eliza en Stewart, Alistair en Black, MA en Taylor, Rennae en Walker, JJ en Baker, Philip en Kenny, LC en 2011-11-04T02:17:10Z en 2011-04-07 en
dc.identifier.citation British Medical Journal (BMJ) 342:11 pages Article number d1875 07 Apr 2011 en
dc.identifier.issn 0959-8138 en
dc.identifier.uri en
dc.description.abstract Objectives To develop a predictive model for preeclampsia based on clinical risk factors for nulliparous women and to identify a subgroup at increased risk, in whom specialist referral might be indicated. Design Prospective multicentre cohort. Setting Five centres in Auckland, New Zealand; Adelaide, Australia; Manchester and London, United Kingdom; and Cork, Republic of Ireland. Participants 3572 “healthy” nulliparous women with a singleton pregnancy from a large international study; data on pregnancy outcome were available for 3529 (99%). Main outcome measure 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. Results Of the 3529 women, 186 (5.3%) developed preeclampsia, including 47 (1.3%) with preterm preeclampsia. 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 preeclampsia. 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. Conclusions 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. en
dc.language EN en
dc.publisher B M J PUBLISHING GROUP en
dc.relation.ispartofseries BMJ en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.rights.uri en
dc.subject BODY-MASS INDEX en
dc.subject FAMILY-HISTORY en
dc.subject BLOOD-PRESSURE en
dc.subject GENERATION-R en
dc.subject PREGNANCY en
dc.subject METAANALYSIS en
dc.subject POPULATION en
dc.subject DISORDERS en
dc.title Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort en
dc.type Journal Article en
dc.identifier.doi 10.1136/bmj.d1875 en
pubs.volume 342 en
dc.rights.holder Copyright: B M J PUBLISHING GROUP en
dc.identifier.pmid 21474517 en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 209402 en Medical and Health Sciences en School of Medicine en Obstetrics and Gynaecology en
pubs.number d1875 en
pubs.record-created-at-source-date 2011-09-09 en
pubs.dimensions-id 21474517 en

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