Risk score to stratify miscarriage risk levels in preconception women
Risk score to stratify miscarriage risk levels in preconception women
Spontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.
Choo, Xin Hui
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Ku, Chee Wai
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Cheung, Yin Bun
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Godfrey, Keith
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Chong, Yap-Seng
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Shek, Lynette Pei-Chi
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Tan, Kok Hian
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Tan, Thiam Chye
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Sadhana, Nadarajah
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Yap, Fabian
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Colega, Marjorelee T.
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Chong, Mary Foong-Fong
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Chan, Shiao-Yng
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Loy, See Ling
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Chan, Jerry Kok Yen
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8 June 2021
Choo, Xin Hui
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Ku, Chee Wai
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Cheung, Yin Bun
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Godfrey, Keith
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Chong, Yap-Seng
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Shek, Lynette Pei-Chi
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Tan, Kok Hian
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Tan, Thiam Chye
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Sadhana, Nadarajah
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Yap, Fabian
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Colega, Marjorelee T.
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Chong, Mary Foong-Fong
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Chan, Shiao-Yng
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Loy, See Ling
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Chan, Jerry Kok Yen
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Choo, Xin Hui, Ku, Chee Wai, Cheung, Yin Bun, Godfrey, Keith, Chong, Yap-Seng, Shek, Lynette Pei-Chi, Tan, Kok Hian, Tan, Thiam Chye, Sadhana, Nadarajah, Yap, Fabian, Colega, Marjorelee T., Chong, Mary Foong-Fong, Chan, Shiao-Yng, Loy, See Ling and Chan, Jerry Kok Yen
(2021)
Risk score to stratify miscarriage risk levels in preconception women.
Scientific Reports, 11 (1), [12111].
(doi:10.1038/s41598-021-91567-8).
Abstract
Spontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.
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Accepted/In Press date: 28 May 2021
e-pub ahead of print date: 8 June 2021
Published date: 8 June 2021
Additional Information:
Funding Information:
This work is supported by the Singapore National Research Foundation under its TCR Flagship Programme and administered by the Singapore Ministry of Health’s NMRC, Singapore—NMRC/TCR/004-NUS/2008; NMRC/ TCR/012-NUHS/2014. Singapore Institute for Clinical Sciences, A*STAR, Singapore has provided additional funding support for the project. KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus + Programme ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP), British Heart Foundation (RG/15/17/3174) and the US National Institute On Aging of the National Institutes of Health (Award No. U24AG047867). SYC is supported by a Clinician Scientist Award from the Singapore NMRC (NMRC/CSA-INV/0010/2016). JKYC is supported by the Singapore NMRC (CSA(SI)/008/2016). No role was played by the funders in the study design, data collection and analysis, decision to publish or preparation of the manuscript.
Funding Information:
The study was conducted according to the guidelines laid down in the Declaration of Helsinki. The Singhealth Centralised Institute Review Board approved the study protocol (reference 2014/692/D). All participants provided written informed consent. This study was registered at www.clinicaltrials.gov, NCT03531658 (22/05/2018). The project is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore—NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR). The funders did not take part in the conduction of this research or writing of the present manuscript.
Funding Information:
KMG, YSC and FY received reimbursement for speaking at conferences sponsored by companies selling nutritional products. KMG, YSC and SYC are part of an academic consortium that received research funding from Abbott Nutrition, Nestle and Danone. All other authors declare no competing interests. Completed disclosure of interest forms are available to view online as supporting information.
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© 2021, The Author(s).
Identifiers
Local EPrints ID: 449708
URI: http://eprints.soton.ac.uk/id/eprint/449708
ISSN: 2045-2322
PURE UUID: 1c0a9629-81f8-4d6c-b129-421754c55146
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Date deposited: 11 Jun 2021 16:31
Last modified: 17 Mar 2024 02:38
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Contributors
Author:
Xin Hui Choo
Author:
Chee Wai Ku
Author:
Yin Bun Cheung
Author:
Yap-Seng Chong
Author:
Lynette Pei-Chi Shek
Author:
Kok Hian Tan
Author:
Thiam Chye Tan
Author:
Nadarajah Sadhana
Author:
Fabian Yap
Author:
Marjorelee T. Colega
Author:
Mary Foong-Fong Chong
Author:
Shiao-Yng Chan
Author:
See Ling Loy
Author:
Jerry Kok Yen Chan
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