Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/67187
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort
Author: North, R.
McCowan, L.
Dekker, G.
Poston, L.
Chan, E.
Stewart, A.
Black, M.
Taylor, R.
Walker, J.
Baker, P.
Kenny, L.
Citation: British Medical Journal, 2011; 342(7803):1-11
Publisher: British Med Journal Publ Group
Issue Date: 2011
ISSN: 0959-535X
1756-1833
Statement of
Responsibility: 
Robyn A North, Lesley M E McCowan, Gustaaf A Dekker, Lucilla Poston, Eliza H Y Chan, Alistair W Stewart, Michael A Black, Rennae S Taylor, James J Walker, Philip N Baker, Louise C Kenny
Abstract: Objectives 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. 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 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. 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.
Keywords: Humans; Pre-Eclampsia; Ultrasonography, Doppler; Early Diagnosis; Pregnancy Outcome; Risk Assessment; Risk Factors; Parity; Pregnancy; Adult; Referral and Consultation; Female
Rights: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
RMID: 0020105665
DOI: 10.1136/bmj.d1875
Appears in Collections:Obstetrics and Gynaecology publications

Files in This Item:
File Description SizeFormat 
hdl_67187.pdfPublished version206.51 kBAdobe PDFView/Open


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.