Evaluation of a simple risk score to predict preterm pre-eclampsia using maternal characteristics: a prospective cohort study.
BJOG : an international journal of obstetrics and gynaecology
Blackwell Publishing Inc.
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Sovio, U., & Smith, G. (2019). Evaluation of a simple risk score to predict preterm pre-eclampsia using maternal characteristics: a prospective cohort study.. BJOG : an international journal of obstetrics and gynaecology, 126 (8), 963-970. https://doi.org/10.1111/1471-0528.15664
Objectives (1) To derive a simple risk score for preterm preeclampsia based on the model used in the ASPRE trial, and (2) to compare it (i) with the original ASPRE algorithm, (ii) with the NICE Guideline score, and (iii) with and without biochemical and ultrasonic predictors. Design Prospective cohort study. Setting Cambridge, UK. Population or Sample 4,184 nulliparous women from the Pregnancy Outcome Prediction study. Methods Maternal history model coefficients from the ASPRE algorithm were translated into a risk score, preserving the relative weight of each coefficient. Main Outcome Measures Preterm delivery with a diagnosis of preeclampsia Results The area under the ROC curve (AUC) for preterm preeclampsia was 0.846 (95% CI 0.787-0.906) for the risk score and 0.854 (95% CI 0.795-0.914) for the original ASPRE algorithm (P=0.14). 9.1% of women had a risk score of ≥30 and their risk ratio (RR) for preterm PE was 13.3 (95% CI 6.3-27.8), the sensitivity was 57.1% (37.5-74.8%), the false positive rate (1-specificity) was 8.8% (8.0-9.7%), and LR+ was 6.5 (4.6-9.1). The score had higher specificity than the NICE Guideline criteria. First trimester levels of PAPP-A and PlGF were not predictive when included in a model with the risk score. In contrast, mean arterial pressure at booking and 20 week uterine artery Doppler were independently associated with preterm preeclampsia and the latter modestly increased the AUC (by ~0.02). Conclusions A simple risk score derived from the ASPRE screening study predictive model provided clinically useful prediction of the risk of preterm preeclampsia.
Humans, Pre-Eclampsia, Premature Birth, Pregnancy-Associated Plasma Protein-A, Membrane Proteins, False Positive Reactions, Risk Assessment, Risk Factors, Regression Analysis, Sensitivity and Specificity, Prospective Studies, Predictive Value of Tests, ROC Curve, Gestational Age, Pregnancy, Pregnancy Trimester, First, Algorithms, Adult, Female, Biomarkers
The work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre (Women’s Health theme), the Medical Research Council (United Kingdom; G1100221), and the Stillbirth and neonatal death society (Sands).
Stillbirth and Neonatal Death Society (SANDS) (JE/DICT4/97771/14)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
External DOI: https://doi.org/10.1111/1471-0528.15664
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289515