A model for preconceptional prediction of recurrent early-onset preeclampsia: derivation and internal validation

van Kuijk, Sander M.J., Nijdam, Marie-Elise, Janssen, Kristel J.M., Sep, Simone J.S., Peeters, Louis L., Delahaije, Denise H.J., Spaanderman, Marc, Bruinse, Hein W., Franx, Arie, Bots, Michiel L., Langenveld, Josje, van der Post, Joris, van Rijn, Bas B. and Smits, Luc (2011) A model for preconceptional prediction of recurrent early-onset preeclampsia: derivation and internal validation. Reproductive Sciences, 18 (11), 1154-1159. (doi:10.1177/1933719111410708). (PMID:21673281)

Abstract

Objective: To develop a model to identify women at very low risk of recurrent early-onset preeclampsia.

Methods: We enrolled 407 women who had experienced early-onset preeclampsia in their first pregnancy, resulting in a delivery before 34 weeks' gestation. Preeclampsia was defined as hypertension (systolic blood pressure ?140 mm Hg and/or diastolic blood pressure ?90 mm Hg) after 20 weeks' gestation with de novo proteinuria (?300 mg urinary protein excretion/day). Based on the previous published evidence and expert opinion, 5 predictors (gestational age at previous birth, prior small-for-gestational-age newborn, fasting blood glucose, body mass index, and hypertension) were entered in a logistic regression model. Discrimination and calibration were evaluated after adjusting for overfitting by bootstrapping techniques.

Results: Early-onset disease recurred in 28 (6.9%) of 407 women. The area under the receiver operating characteristic (ROC) curve of the model was 0.65 (95% CI: 0.56-0.74). Calibration was good, indicated by a nonsignificant Hosmer-Lemeshow test (P = .11). Using a predicted absolute risk threshold of, for example, 4.6% (ie, women identified with an estimated risk either above or below 4.6%), the sensitivity was 100%, with a specificity of 26%. In such a strategy, no women who developed preeclampsia were missed, while 98 of the 407 women would be regarded as low risk of recurrent early-onset preeclampsia, not necessarily requiring intensified antenatal care.

Conclusion: Our model may be helpful in the identification of women at very low risk of recurrent early-onset preeclampsia. Before widespread application, our model should be validated in other populations.

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