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

A model for preconceptional prediction of recurrent early-onset preeclampsia: derivation and internal validation
A model for preconceptional prediction of recurrent early-onset preeclampsia: derivation and internal validation
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.
prediction, recurrence, preeclampsia, risk
1933-7191
1154-1159
van Kuijk, Sander M.J.
ec1e0b6e-aa32-4500-8e54-c66d54663996
Nijdam, Marie-Elise
28fc3494-c52e-4df9-aaa1-959654733ce7
Janssen, Kristel J.M.
0fef49cb-bef0-44a8-8ed9-9a33063810d1
Sep, Simone J.S.
dd157b5f-5618-44ea-adeb-8b97fd7c09bb
Peeters, Louis L.
e0e87326-8ef4-4c43-9c75-231e4ce0b26b
Delahaije, Denise H.J.
03776be6-1f93-449e-ba5e-0584be8304f6
Spaanderman, Marc
b773e0a4-6b11-4bd6-9205-5b39ce029403
Bruinse, Hein W.
9cf35612-505e-4035-a2b8-c63a0ec15421
Franx, Arie
2376857f-07db-4821-9512-a7b55036b6f0
Bots, Michiel L.
1c573cd6-8751-4e70-bff4-aa8895ba842b
Langenveld, Josje
9f65f87e-1106-47bc-8fc0-14391003f88d
van der Post, Joris
3e07a3b2-0740-4005-ac96-43166c8c8c82
van Rijn, Bas B.
c958dfb5-2010-46de-a350-4903295ac340
Smits, Luc
e4661d7e-808d-4f7d-b627-9e2d4f518639
van Kuijk, Sander M.J.
ec1e0b6e-aa32-4500-8e54-c66d54663996
Nijdam, Marie-Elise
28fc3494-c52e-4df9-aaa1-959654733ce7
Janssen, Kristel J.M.
0fef49cb-bef0-44a8-8ed9-9a33063810d1
Sep, Simone J.S.
dd157b5f-5618-44ea-adeb-8b97fd7c09bb
Peeters, Louis L.
e0e87326-8ef4-4c43-9c75-231e4ce0b26b
Delahaije, Denise H.J.
03776be6-1f93-449e-ba5e-0584be8304f6
Spaanderman, Marc
b773e0a4-6b11-4bd6-9205-5b39ce029403
Bruinse, Hein W.
9cf35612-505e-4035-a2b8-c63a0ec15421
Franx, Arie
2376857f-07db-4821-9512-a7b55036b6f0
Bots, Michiel L.
1c573cd6-8751-4e70-bff4-aa8895ba842b
Langenveld, Josje
9f65f87e-1106-47bc-8fc0-14391003f88d
van der Post, Joris
3e07a3b2-0740-4005-ac96-43166c8c8c82
van Rijn, Bas B.
c958dfb5-2010-46de-a350-4903295ac340
Smits, Luc
e4661d7e-808d-4f7d-b627-9e2d4f518639

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)

Record type: Article

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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More information

e-pub ahead of print date: 14 June 2011
Published date: November 2011
Keywords: prediction, recurrence, preeclampsia, risk
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 352044
URI: http://eprints.soton.ac.uk/id/eprint/352044
ISSN: 1933-7191
PURE UUID: d618e175-8a41-4589-a282-1e515f8a0761

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Date deposited: 01 May 2013 11:58
Last modified: 14 Mar 2024 13:46

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Contributors

Author: Sander M.J. van Kuijk
Author: Marie-Elise Nijdam
Author: Kristel J.M. Janssen
Author: Simone J.S. Sep
Author: Louis L. Peeters
Author: Denise H.J. Delahaije
Author: Marc Spaanderman
Author: Hein W. Bruinse
Author: Arie Franx
Author: Michiel L. Bots
Author: Josje Langenveld
Author: Joris van der Post
Author: Bas B. van Rijn
Author: Luc Smits

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