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dc.contributor.authorAllotey, J
dc.contributor.authorWhittle, R
dc.contributor.authorSnell, KIE
dc.contributor.authorSmuk, M
dc.contributor.authorTownsend, R
dc.contributor.authorvon Dadelszen, P
dc.contributor.authorHeazell, AEP
dc.contributor.authorMagee, L
dc.contributor.authorSmith, GCS
dc.contributor.authorSandall, J
dc.contributor.authorThilaganathan, B
dc.contributor.authorZamora, J
dc.contributor.authorRiley, RD
dc.contributor.authorKhalil, A
dc.contributor.authorThangaratinam, S
dc.contributor.authorIPPIC Collaborative Network
dc.date.accessioned2022-02-02T02:19:29Z
dc.date.available2022-02-02T02:19:29Z
dc.date.issued2022-02
dc.date.submitted2021-04-20
dc.identifier.issn0960-7692
dc.identifier.otheruog23757
dc.identifier.otheruog-2021-0426.r1
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/333547
dc.description.abstractOBJECTIVE: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. METHODS: MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. RESULTS: Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. CONCLUSIONS: The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
dc.languageen
dc.publisherWiley
dc.subjectOriginal Paper
dc.subjectOriginal Papers
dc.subjectexternal validation
dc.subjectindividual participant data
dc.subjectintrauterine death
dc.subjectprediction model
dc.subjectstillbirth
dc.titleExternal validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis.
dc.typeArticle
dc.date.updated2022-02-02T02:19:28Z
prism.endingPage219
prism.issueIdentifier2
prism.publicationNameUltrasound Obstet Gynecol
prism.startingPage209
prism.volume59
dc.identifier.doi10.17863/CAM.80967
dcterms.dateAccepted2021-08-02
rioxxterms.versionofrecord10.1002/uog.23757
rioxxterms.versionAO
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc/4.0/
datacite.contributor.supervisorinvestigator: Coomarasamy, Arri
datacite.contributor.supervisorinvestigator: Kwong, Alex
datacite.contributor.supervisorinvestigator: Savitri, Ary I.
datacite.contributor.supervisorinvestigator: Salvesen, Kjell åsmund
datacite.contributor.supervisorinvestigator: Bhattacharya, Sohinee
datacite.contributor.supervisorinvestigator: Uiterwaal, Cuno S. P. M.
datacite.contributor.supervisorinvestigator: Staff, Annetine C.
datacite.contributor.supervisorinvestigator: Andersen, Louise Bjoerkholt
datacite.contributor.supervisorinvestigator: Olive, Elisa Llurba
datacite.contributor.supervisorinvestigator: Redman, Christopher
datacite.contributor.supervisorinvestigator: Sletner, Line
datacite.contributor.supervisorinvestigator: Daskalakis, George
datacite.contributor.supervisorinvestigator: Macleod, Maureen
datacite.contributor.supervisorinvestigator: Thilaganathan, Baskaran
datacite.contributor.supervisorinvestigator: Abdollahain, Mali
datacite.contributor.supervisorinvestigator: Ramírez, Javier Arenas
datacite.contributor.supervisorinvestigator: Massé, Jacques
datacite.contributor.supervisorinvestigator: Khalil, Asma
datacite.contributor.supervisorinvestigator: Audibert, Francois
datacite.contributor.supervisorinvestigator: Magnus, Per Minor
datacite.contributor.supervisorinvestigator: Jenum, Anne Karen
datacite.contributor.supervisorinvestigator: Baschat, Ahmet
datacite.contributor.supervisorinvestigator: Ohkuchi, Akihide
datacite.contributor.supervisorinvestigator: McAuliffe, Fionnuala M.
datacite.contributor.supervisorinvestigator: West, Jane
datacite.contributor.supervisorinvestigator: Askie, Lisa M.
datacite.contributor.supervisorinvestigator: Mone, Fionnuala
datacite.contributor.supervisorinvestigator: Farrar, Diane
datacite.contributor.supervisorinvestigator: Zimmerman, Peter A.
datacite.contributor.supervisorinvestigator: Smits, Luc J. M.
datacite.contributor.supervisorinvestigator: Riddell, Catherine
datacite.contributor.supervisorinvestigator: Kingdom, John C.
datacite.contributor.supervisorinvestigator: van de Post, Joris
datacite.contributor.supervisorinvestigator: Illanes, Sebastián E.
datacite.contributor.supervisorinvestigator: Holzman, Claudia
datacite.contributor.supervisorinvestigator: van Kuijk, Sander M. J.
datacite.contributor.supervisorinvestigator: Carbillon, Lionel
datacite.contributor.supervisorinvestigator: Villa, Pia M.
datacite.contributor.supervisorinvestigator: Eskild, Anne
datacite.contributor.supervisorinvestigator: Chappell, Lucy
datacite.contributor.supervisorinvestigator: Prefumo, Federico
datacite.contributor.supervisorinvestigator: Velauthar, Luxmi
datacite.contributor.supervisorinvestigator: Seed, Paul
datacite.contributor.supervisorinvestigator: van Oostwaard, Miriam
datacite.contributor.supervisorinvestigator: Verlohren, Stefan
datacite.contributor.supervisorinvestigator: Poston, Lucilla
datacite.contributor.supervisorinvestigator: Ferrazzi, Enrico
datacite.contributor.supervisorinvestigator: Vinter, Christina A.
datacite.contributor.supervisorinvestigator: Nagata, Chie
datacite.contributor.supervisorinvestigator: Brown, Mark
datacite.contributor.supervisorinvestigator: Vollebregt, Karlijn C.
datacite.contributor.supervisorinvestigator: Takeda, Satoru
datacite.contributor.supervisorinvestigator: Langenveld, Josje
datacite.contributor.supervisorinvestigator: Widmer, Mariana
datacite.contributor.supervisorinvestigator: Saito, Shigeru
datacite.contributor.supervisorinvestigator: Haavaldsen, Camilla
datacite.contributor.supervisorinvestigator: Carroli, Guillermo
datacite.contributor.supervisorinvestigator: Olsen, Jørn
datacite.contributor.supervisorinvestigator: Wolf, Hans
datacite.contributor.supervisorinvestigator: Zavaleta, Nelly
datacite.contributor.supervisorinvestigator: Eisensee, Inge
datacite.contributor.supervisorinvestigator: Vergani, Patrizia
datacite.contributor.supervisorinvestigator: Lumbiganon, Pisake
datacite.contributor.supervisorinvestigator: Makrides, Maria
datacite.contributor.supervisorinvestigator: Facchinetti, Fabio
datacite.contributor.supervisorinvestigator: Sequeira, Evan
datacite.contributor.supervisorinvestigator: Gibson, Robert
datacite.contributor.supervisorinvestigator: Ferrazzani, Sergio
datacite.contributor.supervisorinvestigator: Frusca, Tiziana
datacite.contributor.supervisorinvestigator: Norman, Jane E.
datacite.contributor.supervisorinvestigator: Figueiró, Ernesto A.
datacite.contributor.supervisorinvestigator: Lapaire, Olav
datacite.contributor.supervisorinvestigator: Laivuori, Hannele
datacite.contributor.supervisorinvestigator: Lykke, Jacob A.
datacite.contributor.supervisorinvestigator: Conde‐Agudelo, Agustin
datacite.contributor.supervisorinvestigator: Galindo, Alberto
datacite.contributor.supervisorinvestigator: Mbah, Alfred
datacite.contributor.supervisorinvestigator: Betran, Ana Pilar
datacite.contributor.supervisorinvestigator: Herraiz, Ignacio
datacite.contributor.supervisorinvestigator: Trogstad, Lill
datacite.contributor.supervisorinvestigator: Smith, Gordon G. S.
datacite.contributor.supervisorinvestigator: Steegers, Eric A. P.
datacite.contributor.supervisorinvestigator: Salim, Read
datacite.contributor.supervisorinvestigator: Huang, Tianhua
datacite.contributor.supervisorinvestigator: Adank, Annemarijne
datacite.contributor.supervisorinvestigator: Zhang, Jun
datacite.contributor.supervisorinvestigator: Meschino, Wendy S.
datacite.contributor.supervisorinvestigator: Browne, Joyce L.
datacite.contributor.supervisorinvestigator: Allen, Rebecca E.
datacite.contributor.supervisorinvestigator: Costa, Fabricio Da Silva
datacite.contributor.supervisorinvestigator: Klipstein‐Grobusch Browne, Kerstin
datacite.contributor.supervisorinvestigator: Crowther, Caroline A.
datacite.contributor.supervisorinvestigator: Jørgensen, Jan Stener
datacite.contributor.supervisorinvestigator: Forest, Jean‐Claude
datacite.contributor.supervisorinvestigator: Rumbold, Alice R.
datacite.contributor.supervisorinvestigator: Mol, Ben W.
datacite.contributor.supervisorinvestigator: Giguère, Yves
datacite.contributor.supervisorinvestigator: Kenny, Louise C.
datacite.contributor.supervisorinvestigator: Ganzevoort, Wessel
datacite.contributor.supervisorinvestigator: Odibo, Anthony O.
datacite.contributor.supervisorinvestigator: Myers, Jenny
datacite.contributor.supervisorinvestigator: Yeo, Seon Ae
datacite.contributor.supervisorinvestigator: Goffinet, Francois
datacite.contributor.supervisorinvestigator: McCowan, Lesley
datacite.contributor.supervisorinvestigator: Pajkrt, Eva
datacite.contributor.supervisorinvestigator: Teede, Helena J.
datacite.contributor.supervisorinvestigator: Haddad, Bassam G.
datacite.contributor.supervisorinvestigator: Dekker, Gustaaf
datacite.contributor.supervisorinvestigator: Kleinrouweler, Emily C.
datacite.contributor.supervisorinvestigator: LeCarpentier, Édouard
datacite.contributor.supervisorinvestigator: Roberts, Claire T.
datacite.contributor.supervisorinvestigator: Groen, Henk
datacite.contributor.supervisorinvestigator: Skråstad, Ragnhild Bergene
datacite.contributor.supervisorinvestigator: Heinonen, Seppo
datacite.contributor.supervisorinvestigator: Eero, Kajantie
datacite.contributor.supervisorinvestigator: Anggraini, Dewi
datacite.contributor.supervisorinvestigator: Souka, Athena
datacite.contributor.supervisorinvestigator: Cecatti, Jose Guilherme
datacite.contributor.supervisorinvestigator: Monterio, Ilza
datacite.contributor.supervisorinvestigator: Pillalis, Athanasios
datacite.contributor.supervisorinvestigator: Souza, Renato
datacite.contributor.supervisorinvestigator: Hawkins, Lee Ann
datacite.contributor.supervisorinvestigator: Gabbay‐Benziv, Rinat
datacite.contributor.supervisorinvestigator: Crovetto, Francesca
datacite.contributor.supervisorinvestigator: Figuera, Francesc
datacite.contributor.supervisorinvestigator: Jorgensen, Laura
datacite.contributor.supervisorinvestigator: Dodds, Julie
datacite.contributor.supervisorinvestigator: Patel, Mehali
datacite.contributor.supervisorinvestigator: Aviram, Amir
datacite.contributor.supervisorinvestigator: Papageorghiou, Aris
datacite.contributor.supervisorinvestigator: Khan, Khalid
dc.contributor.orcidAllotey, J [0000-0003-4134-6246]
dc.contributor.orcidThilaganathan, B [0000-0002-5531-4301]
dc.contributor.orcidKhalil, A [0000-0003-2802-7670]
dc.identifier.eissn1469-0705
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (RG52380)
pubs.funder-project-idCambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
cam.issuedOnline2022-02


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