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van Montfort P, Willemse JP, Dirksen CD, van Dooren IM, Meertens LJ, Spaanderman ME, Zelis M, Zwaan IM, Scheepers HC, Smits LJ. Implementation and Effects of Risk-Dependent Obstetric Care in the Netherlands (Expect Study II): Protocol for an Impact Study. JMIR Res Protoc 2018; 7:e10066. [PMID: 29728345 PMCID: PMC5960040 DOI: 10.2196/10066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Recently, validated risk models predicting adverse obstetric outcomes combined with risk-dependent care paths have been made available for early antenatal care in the southeastern part of the Netherlands. This study will evaluate implementation progress and impact of the new approach in obstetric care. OBJECTIVE The objective of this paper is to describe the design of a study evaluating the impact of implementing risk-dependent care. Validated first-trimester prediction models are embedded in daily clinical practice and combined with risk-dependent obstetric care paths. METHODS A multicenter prospective cohort study consisting of women who receive risk-dependent care is being performed from April 2017 to April 2018 (Expect Study II). Obstetric risk profiles will be calculated using a Web-based tool, the Expect prediction tool. The primary outcomes are the adherence of health care professionals and compliance of women. Secondary outcomes are patient satisfaction and cost-effectiveness. Outcome measures will be established using Web-based questionnaires. The secondary outcomes of the risk-dependent care cohort (Expect II) will be compared with the outcomes of a similar prospective cohort (Expect I). Women of this similar cohort received former care-as-usual and were prospectively included between July 1, 2013 and December 31, 2015 (Expect I). RESULTS Currently, women are being recruited for the Expect Study II, and a total of 300 women are enrolled. CONCLUSIONS This study will provide information about the implementation and impact of a new approach in obstetric care using prediction models and risk-dependent obstetric care paths. TRIAL REGISTRATION Netherlands Trial Register NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143 (Archived by WebCite at http://www.webcitation.org/6t8ijtpd9).
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Affiliation(s)
- Pim van Montfort
- Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Jessica Ppm Willemse
- Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Carmen D Dirksen
- Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ivo Ma van Dooren
- Department of Obstetrics and Gynecology, Sint Jans Gasthuis Weert, Weert, Netherlands
| | - Linda Je Meertens
- Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Marc Ea Spaanderman
- School for Oncology and Developmental Biology, Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Maartje Zelis
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Iris M Zwaan
- Department of Obstetrics and Gynecology, Laurentius Hospital, Roermond, Netherlands
| | - Hubertina Cj Scheepers
- School for Oncology and Developmental Biology, Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Luc Jm Smits
- Care and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, Netherlands
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102
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Antwi E, Klipstein-Grobusch K, Browne JL, Schielen PC, Koram KA, Agyepong IA, Grobbee DE. Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women. Reprod Health 2018; 15:56. [PMID: 29587776 PMCID: PMC5870183 DOI: 10.1186/s12978-018-0492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. METHODS This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight, height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models. RESULTS Three hundred and seventy three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64-0.86) and 0.89(0.73-1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74-0.89) and 0.95 (0.87-1.00) for multiparous and primigravid women respectively. CONCLUSION Adding the biomarkers PAPP-A and PlGF to maternal characteristics to a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.
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Affiliation(s)
- Edward Antwi
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. .,Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana.
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter C Schielen
- Center for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Irene A Agyepong
- Ghana Health Service, P.M.B, Ministries, Accra, Greater Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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103
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Wang X, Chen Y, Du L, Li X, Li X, Chen D. Evaluation of circulating placenta-related long noncoding RNAs as potential biomarkers for preeclampsia. Exp Ther Med 2018; 15:4309-4317. [PMID: 29725373 PMCID: PMC5920431 DOI: 10.3892/etm.2018.5968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022] Open
Abstract
Increasing evidence has indicated that circulating placental RNAs may reflect the pathophysiology of the placenta. In the current study, circulating placenta-related long noncoding RNAs (lncRNAs) were evaluated as potential biomarkers for preeclampsia (PE). Two parts of the case-control study were simultaneously executed, including the following sets: 52 patients with late-onset PE (LOPE) (diagnosed after 34 weeks) and 52 gestational age (GA)-matched controls; 58 patients with early-onset PE (EOPE) (diagnosed before 34 weeks) and 58 GA-matched controls. LncRNA expression was detected in the placenta analysis part, and the participants were delivered by caesarean sections. The levels of circulating placenta-associated lncRNAs were measured in the plasma analysis part and all pregnant women were included. Using microarray analysis, 163 differentially expressed lncRNAs were identified in placental samples from patients with LOPE, some of which were also detected in plasma samples from pregnant women. There were significant positive correlations between plasma, and placental expression levels of NONHSAT116812 and NONHSAT145880, which in plasma provided high diagnostic efficiencies for LOPE and EOPE. The present study demonstrated that circulating placenta-associated lncRNAs, paticularly NONHSAT116812 and NONHSAT145880 have potential as biomarkers for PE.
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Affiliation(s)
- Xin Wang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China.,Department of Obstetrics and Gynecology, Affiliated Hangzhou Hospital (Hangzhou First People's Hospital), Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yanhong Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Lili Du
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Xiaomei Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Xiuying Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
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104
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van de Kamp K, Pajkrt E, Zwinderman A, van der Post J, Snijders R. Validation of Reference Charts for Mid-Trimester Fetal Biometry. Fetal Diagn Ther 2018. [DOI: 10.1159/000486094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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105
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Reijnders IF, Mulders AG, Koster MP. Placental development and function in women with a history of placenta-related complications: a systematic review. Acta Obstet Gynecol Scand 2017; 97:248-257. [DOI: 10.1111/aogs.13259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Ignatia F. Reijnders
- Department of Obstetrics and Gynecology; Erasmus MC; University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Annemarie G.M.G.J. Mulders
- Department of Obstetrics and Gynecology; Erasmus MC; University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Maria P.H. Koster
- Department of Obstetrics and Gynecology; Erasmus MC; University Medical Center Rotterdam; Rotterdam the Netherlands
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106
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Aluvaala J, Collins GS, Maina M, Berkley JA, English M. A systematic review of neonatal treatment intensity scores and their potential application in low-resource setting hospitals for predicting mortality, morbidity and estimating resource use. Syst Rev 2017; 6:248. [PMID: 29212522 PMCID: PMC5719732 DOI: 10.1186/s13643-017-0649-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Treatment intensity scores can predict mortality and estimate resource use. They may therefore be of interest for essential neonatal care in low resource settings where neonatal mortality remains high. We sought to systematically review neonatal treatment intensity scores to (1) assess the level of evidence on predictive performance in predicting clinical outcomes and estimating resource utilisation and (2) assess the applicability of the identified models to decision making for neonatal care in low resource settings. METHODS We conducted a systematic search of PubMed, EMBASE (OVID), CINAHL, Global Health Library (Global index, WHO) and Google Scholar to identify studies published up until 21 December 2016. Included were all articles that used treatments as predictors in neonatal models. Individual studies were appraised using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS). In addition, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used as a guiding framework to assess certainty in the evidence for predicting outcomes across studies. RESULTS Three thousand two hundred forty-nine articles were screened, of which ten articles were included in the review. All of the studies were conducted in neonatal intensive care units with sample sizes ranging from 22 to 9978, with a median of 163. Two articles reported model development, while eight reported external application of existing models to new populations. Meta-analysis was not possible due heterogeneity in the conduct and reporting of the identified studies. Discrimination as assessed by area under receiver operating characteristic curve was reported for in-hospital mortality, median 0.84 (range 0.75-0.96, three studies), early adverse outcome and late adverse outcome (0.78 and 0.59, respectively, one study). CONCLUSION Existing neonatal treatment intensity models show promise in predicting mortality and morbidity. There is however low certainty in the evidence on their performance in essential neonatal care in low resource settings as all studies had methodological limitations and were conducted in intensive care. The approach may however be developed further for low resource settings like Kenya because treatment data may be easier to obtain compared to measures of physiological status. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016034205.
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Affiliation(s)
- Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenyatta National Hospital, P. O. Box 19676-00202, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
| | - Gary S. Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, OX3 7LD UK
| | - Michuki Maina
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
| | - James A. Berkley
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
- The Childhood Acute Illness & Nutrition (CHAIN) Network, P.O Box 43640 – 00100, Nairobi, Kenya
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, P.O Box 43640 – 00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ UK
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107
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Gerry S, Birks J, Bonnici T, Watkinson PJ, Kirtley S, Collins GS. Early warning scores for detecting deterioration in adult hospital patients: a systematic review protocol. BMJ Open 2017; 7:e019268. [PMID: 29203508 PMCID: PMC5736035 DOI: 10.1136/bmjopen-2017-019268] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early warning scores (EWSs) are used extensively to identify patients at risk of deterioration in hospital. Previous systematic reviews suggest that studies which develop EWSs suffer methodological shortcomings and consequently may fail to perform well. The reviews have also identified that few validation studies exist to test whether the scores work in other settings. We will aim to systematically review papers describing the development or validation of EWSs, focusing on methodology, generalisability and reporting. METHODS We will identify studies that describe the development or validation of EWSs for adult hospital inpatients. Each study will be assessed for risk of bias using the Prediction model Risk of Bias ASsessment Tool (PROBAST). Two reviewers will independently extract information. A narrative synthesis and descriptive statistics will be used to answer the main aims of the study which are to assess and critically appraise the methodological quality of the EWS, to describe the predictors included in the EWSs and to describe the reported performance of EWSs in external validation. ETHICS AND DISSEMINATION This systematic review will only investigate published studies and therefore will not directly involve patient data. The review will help to establish whether EWSs are fit for purpose and make recommendations to improve the quality of future research in this area. PROSPERO REGISTRATION NUMBER CRD42017053324.
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Affiliation(s)
- Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jacqueline Birks
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Timothy Bonnici
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shona Kirtley
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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108
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Rolnik DL, O'Gorman N, Roberge S, Bujold E, Hyett J, Uzan S, Beaufils M, da Silva Costa F. Early screening and prevention of preterm pre-eclampsia with aspirin: time for clinical implementation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:551-556. [PMID: 28887883 DOI: 10.1002/uog.18899] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 06/07/2023]
Affiliation(s)
- D L Rolnik
- Perinatal Services, Monash Medical Centre, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - N O'Gorman
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - S Roberge
- Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | - E Bujold
- Department of Obstetrics and Gynecology, Laval University, Quebec, Canada
| | - J Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, Australia
| | - S Uzan
- Pierre et Marie Curie University, Paris, France
| | | | - F da Silva Costa
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash Ultrasound for Women, Melbourne, Australia
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109
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Meertens LJE, Scheepers HC, De Vries RG, Dirksen CD, Korstjens I, Mulder AL, Nieuwenhuijze MJ, Nijhuis JG, Spaanderman ME, Smits LJ. External Validation Study of First Trimester Obstetric Prediction Models (Expect Study I): Research Protocol and Population Characteristics. JMIR Res Protoc 2017; 6:e203. [PMID: 29074472 PMCID: PMC5680517 DOI: 10.2196/resprot.7837] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A number of first-trimester prediction models addressing important obstetric outcomes have been published. However, most models have not been externally validated. External validation is essential before implementing a prediction model in clinical practice. OBJECTIVE The objective of this paper is to describe the design of a study to externally validate existing first trimester obstetric prediction models, based upon maternal characteristics and standard measurements (eg, blood pressure), for the risk of pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), small-for-gestational-age (SGA) infants, and large-for-gestational-age (LGA) infants among Dutch pregnant women (Expect Study I). The results of a pilot study on the feasibility and acceptability of the recruitment process and the comprehensibility of the Pregnancy Questionnaire 1 are also reported. METHODS A multicenter prospective cohort study was performed in The Netherlands between July 1, 2013 and December 31, 2015. First trimester obstetric prediction models were systematically selected from the literature. Predictor variables were measured by the Web-based Pregnancy Questionnaire 1 and pregnancy outcomes were established using the Postpartum Questionnaire 1 and medical records. Information about maternal health-related quality of life, costs, and satisfaction with Dutch obstetric care was collected from a subsample of women. A pilot study was carried out before the official start of inclusion. External validity of the models will be evaluated by assessing discrimination and calibration. RESULTS Based on the pilot study, minor improvements were made to the recruitment process and online Pregnancy Questionnaire 1. The validation cohort consists of 2614 women. Data analysis of the external validation study is in progress. CONCLUSIONS This study will offer insight into the generalizability of existing, non-invasive first trimester prediction models for various obstetric outcomes in a Dutch obstetric population. An impact study for the evaluation of the best obstetric prediction models in the Dutch setting with respect to their effect on clinical outcomes, costs, and quality of life-Expect Study II-is being planned. TRIAL REGISTRATION Netherlands Trial Registry (NTR): NTR4143; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4143 (Archived by WebCite at http://www.webcitation.org/6t8ijtpd9).
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Affiliation(s)
| | - Hubertina Cj Scheepers
- School for Oncology and Developmental Biology (GROW), Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Raymond G De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.,Research Centre for Midwifery Science, Faculty of Health, Zuyd University, Maastricht, Netherlands
| | - Carmen D Dirksen
- Care and Public Health Research Institute (CAPHRI), Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Faculty of Health, Zuyd University, Maastricht, Netherlands
| | - Antonius Lm Mulder
- School for Oncology and Developmental Biology (GROW), Department of Pediatrics, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science, Faculty of Health, Zuyd University, Maastricht, Netherlands
| | - Jan G Nijhuis
- School for Oncology and Developmental Biology (GROW), Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marc Ea Spaanderman
- School for Oncology and Developmental Biology (GROW), Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Luc Jm Smits
- Care and Public Health Research Institute (CAPHRI), Department of Epidemiology, Maastricht University, Maastricht, Netherlands
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van Eekelen R, van Geloven N, van Wely M, McLernon DJ, Eijkemans MJ, Repping S, Steyerberg EW, Mol BW, Bhattacharya S, van der Veen F. Constructing the crystal ball: how to get reliable prognostic information for the management of subfertile couples. Hum Reprod 2017; 32:2153-2158. [DOI: 10.1093/humrep/dex311] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/22/2017] [Indexed: 12/18/2022] Open
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111
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Allen RE, Zamora J, Arroyo-Manzano D, Velauthar L, Allotey J, Thangaratinam S, Aquilina J. External validation of preexisting first trimester preeclampsia prediction models. Eur J Obstet Gynecol Reprod Biol 2017; 217:119-125. [PMID: 28888181 DOI: 10.1016/j.ejogrb.2017.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/14/2017] [Accepted: 08/23/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To validate the increasing number of prognostic models being developed for preeclampsia using our own prospective study. STUDY DESIGN A systematic review of literature that assessed biomarkers, uterine artery Doppler and maternal characteristics in the first trimester for the prediction of preeclampsia was performed and models selected based on predefined criteria. Validation was performed by applying the regression coefficients that were published in the different derivation studies to our cohort. We assessed the models discrimination ability and calibration. RESULTS Twenty models were identified for validation. The discrimination ability observed in derivation studies (Area Under the Curves) ranged from 0.70 to 0.96 when these models were validated against the validation cohort, these AUC varied importantly, ranging from 0.504 to 0.833. Comparing Area Under the Curves obtained in the derivation study to those in the validation cohort we found statistically significant differences in several studies. CONCLUSION There currently isn't a definitive prediction model with adequate ability to discriminate for preeclampsia, which performs as well when applied to a different population and can differentiate well between the highest and lowest risk groups within the tested population. The pre-existing large number of models limits the value of further model development and future research should be focussed on further attempts to validate existing models and assessing whether implementation of these improves patient care.
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Affiliation(s)
- Rebecca E Allen
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Ramon y Cajal, (IRYCIS) Madrid, Spain and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - David Arroyo-Manzano
- Clinical Biostatistics Unit, Hospital Ramon y Cajal, (IRYCIS) Madrid, Spain and CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Luxmilar Velauthar
- Barts Health NHS Trust, Newham University Hospital, Plaistow, London, E13 8SL, United Kingdom
| | - John Allotey
- Women's Health Research Unit, Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Shakila Thangaratinam
- Women's Health Research Unit, Multidisciplinary Evidence Synthesis Hub (mEsh), Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Joseph Aquilina
- Barts Health NHS Trust, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
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112
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Burke N, Burke G, Breathnach F, McAuliffe F, Morrison JJ, Turner M, Dornan S, Higgins JR, Cotter A, Geary M, McParland P, Daly S, Cody F, Dicker P, Tully E, Malone FD. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter Genesis study. Am J Obstet Gynecol 2017; 216:598.e1-598.e11. [PMID: 28213060 DOI: 10.1016/j.ajog.2017.02.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable method to predict the requirement for such potentially hazardous obstetric procedures during labor and delivery. This issue is important, as there are greater rates of morbidity and mortality associated with unplanned CD performed in labor compared with scheduled CDs. A prediction algorithm to identify women at risk of an unplanned CD could help reduced labor associated morbidity. OBJECTIVE In this primary analysis of the Genesis study, our objective was to prospectively assess the use of prenatally determined, maternal and fetal, anthropomorphic, clinical, and ultrasound features to develop a predictive tool for unplanned CD in the term nulliparous woman, before the onset of labor. MATERIALS AND METHODS The Genesis study recruited 2336 nulliparous women with a vertex presentation between 39+0 and 40+6 weeks' gestation in a prospective multicenter national study to examine predictors of CD. At recruitment, a detailed clinical evaluation and ultrasound assessment were performed. To reduce bias from knowledge of these data potentially influencing mode of delivery, women, midwives, and obstetricians were blinded to the ultrasound data. All hypothetical prenatal risk factors for unplanned CD were assessed as a composite. Multiple logistic regression analysis and mathematical modeling was used to develop a risk evaluation tool for CD in nulliparous women. Continuous predictors were standardized using z scores. RESULTS From a total enrolled cohort of 2336 nulliparous participants, 491 (21%) had an unplanned CD. Five parameters were determined to be the best combined predictors of CD. These were advancing maternal age (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09 to 1.34), shorter maternal height (OR, 1.72; 95% CI, 1.52 to 1.93), increasing body mass index (OR, 1.29; 95% CI, 1.17 to 1.43), larger fetal abdominal circumference (OR, 1.23; 95% CI, 1.1 to 1.38), and larger fetal head circumference (OR, 1.27; 95% CI, 1.14 to 1.42). A nomogram was developed to provide an individualized risk assessment to predict CD in clinical practice, with excellent calibration and discriminative ability (Kolmogorov-Smirnov, D statistic, 0.29; 95% CI, 0.28 to 0.30) with a misclassification rate of 0.21 (95% CI, 0.19 to 0.25). CONCLUSION Five parameters (maternal age, body mass index, height, fetal abdominal circumference, and fetal head circumference) can, in combination, be used to better determine the overall risk of CD in nulliparous women at term. A risk score can be used to inform women of their individualized probability of CD. This risk tool may be useful for reassuring most women regarding their likely success at achieving an uncomplicated vaginal delivery as well as selecting those patients with such a high risk for CD that they should avoid a trial of labor. Such a risk tool has the potential to greatly improve planning hospital service needs and minimizing patient risk.
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Affiliation(s)
- Naomi Burke
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland.
| | - Gerard Burke
- Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - Fionnuala McAuliffe
- UCD School of Medicine and Medical Science, National Maternity Hospital, Dublin, Ireland
| | | | - Michael Turner
- UCD Center for Human Reproduction Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | - John R Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Amanda Cotter
- Department of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Michael Geary
- Obstetrics & Gynecology, St. Michael's Hospital, Toronto, University of Toronto, Toronto, Canada
| | | | - Sean Daly
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Fiona Cody
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Pat Dicker
- Coombe Women and Infants University Hospital, Dublin, Ireland; Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Tully
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - Fergal D Malone
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW Perioperative prediction models can help to improve personalized patient care by providing individual risk predictions to both patients and providers. However, the scientific literature on prediction model development and validation can be quite technical and challenging to understand. This article aims to provide the necessary insight for clinicians to assess the value of a prediction model that they intend to use in their clinical practice. RECENT FINDINGS Recent developments in prediction model research include the continuous development of new performance characteristics for prediction models, increasing insight into the limitations of old characteristics, as well as an improved understanding of the generalizability of prediction models to new populations and practices. SUMMARY Clinicians can assess the value of a prediction model for their practice by first identifying what the usage of the model will be. Second, they can recognize which performance characteristics are relevant to their assessment of the model. Finally, they need to decide whether the available scientific evidence sufficiently matches their clinical practice to proceed with implementation.
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Prefumo F. Re: Validation of a first-trimester screening model for pre-eclampsia in an unselected population. E. Scazzocchio, F. Crovetto, S. Triunfo, E. Gratacós and F. Figueras. Ultrasound Obstet Gynecol 2017; 49: 188-193. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:169. [PMID: 28169498 DOI: 10.1002/uog.17395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- F Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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115
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Crombag NMTH, Lamain-de Ruiter M, Kwee A, Schielen PCJI, Bensing JM, Visser GHA, Franx A, Koster MPH. Perspectives, preferences and needs regarding early prediction of preeclampsia in Dutch pregnant women: a qualitative study. BMC Pregnancy Childbirth 2017; 17:12. [PMID: 28061818 PMCID: PMC5219667 DOI: 10.1186/s12884-016-1195-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/13/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To improve early risk-identification in pregnancy, research on prediction models for common pregnancy complications is ongoing. Therefore, it was the aim of this study to explore pregnant women's perceptions, preferences and needs regarding prediction models for first trimester screening for common pregnancy complications, such as preeclampsia, to support future implementation. METHOD Ten focus groups (of which five with primiparous and five with multiparous women) were conducted (n = 45). Six focus groups were conducted in urban regions and four in rural regions. All focus group discussions were audio taped and NVIVO was used in order to facilitate the thematic analysis conducted by the researchers. RESULTS Women in this study had a positive attitude towards first trimester screening for preeclampsia using prediction models. Reassurance when determined as low-risk was a major need for using the test. Self-monitoring, early recognition and intensive monitoring were considered benefits of using prediction models in case of a high-risk. Women acknowledged that high-risk determination could cause (unnecessary) anxiety, but it was expected that personal and professional interventions would level out this anxiety. CONCLUSION Women in this study had positive attitudes towards preeclampsia screening. Self-monitoring, together with increased alertness of healthcare professionals, would enable them to take active actions to improve pregnancy outcomes. This attitude enhances the opportunities for prevention, early recognition and treatment of preeclampsia and probably other adverse pregnancy outcomes.
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Affiliation(s)
- Neeltje M T H Crombag
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.
| | - Marije Lamain-de Ruiter
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Anneke Kwee
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jozien M Bensing
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands.,The Netherlands Institute for Health Services Research Utrecht, Utrecht, The Netherlands
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Room KE04.123.1, P.O. Box 85090, 3508AB, Utrecht, The Netherlands.,Department of obstetrics and gynaecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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116
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Allotey J, Snell KIE, Chan C, Hooper R, Dodds J, Rogozinska E, Khan KS, Poston L, Kenny L, Myers J, Thilaganathan B, Chappell L, Mol BW, Von Dadelszen P, Ahmed A, Green M, Poon L, Khalil A, Moons KGM, Riley RD, Thangaratinam S. External validation, update and development of prediction models for pre-eclampsia using an Individual Participant Data (IPD) meta-analysis: the International Prediction of Pregnancy Complication Network (IPPIC pre-eclampsia) protocol. Diagn Progn Res 2017; 1:16. [PMID: 31093545 PMCID: PMC6460674 DOI: 10.1186/s41512-017-0016-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pre-eclampsia, a condition with raised blood pressure and proteinuria is associated with an increased risk of maternal and offspring mortality and morbidity. Early identification of mothers at risk is needed to target management. METHODS/DESIGN We aim to systematically review the existing literature to identify prediction models for pre-eclampsia. We have established the International Prediction of Pregnancy Complication Network (IPPIC), made up of 72 researchers from 21 countries who have carried out relevant primary studies or have access to existing registry databases, and collectively possess data from more than two million patients. We will use the individual participant data (IPD) from these studies to externally validate these existing prediction models and summarise model performance across studies using random-effects meta-analysis for any, late (after 34 weeks) and early (before 34 weeks) onset pre-eclampsia. If none of the models perform well, we will recalibrate (update), or develop and validate new prediction models using the IPD. We will assess the differential accuracy of the models in various settings and subgroups according to the risk status. We will also validate or develop prediction models based on clinical characteristics only; clinical and biochemical markers; clinical and ultrasound parameters; and clinical, biochemical and ultrasound tests. DISCUSSION Numerous systematic reviews with aggregate data meta-analysis have evaluated various risk factors separately or in combination for predicting pre-eclampsia, but these are affected by many limitations. Our large-scale collaborative IPD approach encourages consensus towards well developed, and validated prognostic models, rather than a number of competing non-validated ones. The large sample size from our IPD will also allow development and validation of multivariable prediction model for the relatively rare outcome of early onset pre-eclampsia. TRIAL REGISTRATION The project was registered on Prospero on the 27 November 2015 with ID: CRD42015029349.
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Affiliation(s)
- John Allotey
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Kym I. E. Snell
- 0000 0004 0415 6205grid.9757.cResearch Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Claire Chan
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard Hooper
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Ewelina Rogozinska
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Khalid S. Khan
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
| | - Lucilla Poston
- 0000 0001 2322 6764grid.13097.3cDivision of Women’s Health, Women’s Health Academic Centre, King’s College London, London, UK
| | - Louise Kenny
- 0000000123318773grid.7872.aIrish Centre for Fetal and Neonatal Translational Research [INFANT], University College Cork, Cork, Ireland
| | - Jenny Myers
- 0000000121662407grid.5379.8Maternal and Fetal Heath Research Centre, Manchester Academic Health Science Centre, University of Manchester, Central Manchester NHS Trust, Manchester, UK
| | - Basky Thilaganathan
- grid.264200.2Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Lucy Chappell
- 0000 0001 2322 6764grid.13097.3cDivision of Women’s Health, Women’s Health Academic Centre, King’s College London, London, UK
| | - Ben W. Mol
- 0000 0004 1936 7304grid.1010.0The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Peter Von Dadelszen
- 0000 0001 2161 2573grid.4464.2Institute of Cardiovascular and Cell Sciences, St George’s, University of London, London, UK
| | - Asif Ahmed
- 0000 0004 0376 4727grid.7273.1Aston Medical School, Aston University, Birmingham, UK
| | - Marcus Green
- Action on Pre-eclampsia (APEC) Charity, Worcestershire, UK
| | - Liona Poon
- 0000 0004 0391 9020grid.46699.34Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
- 0000 0004 1937 0482grid.10784.3aDepartment of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Asma Khalil
- grid.264200.2Fetal Medicine Unit, St George’s University Hospitals NHS Foundation Trust and Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Karel G. M. Moons
- 0000000090126352grid.7692.aJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Richard D. Riley
- 0000 0004 0415 6205grid.9757.cResearch Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Shakila Thangaratinam
- 0000 0001 2171 1133grid.4868.2Women’s Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- 0000 0001 2171 1133grid.4868.2Multidisciplinary Evidence Synthesis Hub (MESH), Queen Mary University of London, London, UK
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117
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Prefumo F. Validation of predictive models for pre-eclampsia. Pregnancy Hypertens 2017. [DOI: 10.1016/j.preghy.2016.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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118
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Thrift AP, Kanwal F, El-Serag HB. Prediction Models for Gastrointestinal and Liver Diseases: Too Many Developed, Too Few Validated. Clin Gastroenterol Hepatol 2016; 14:1678-1680. [PMID: 27574756 DOI: 10.1016/j.cgh.2016.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Aaron P Thrift
- Section of Gastroenterology and Hepatology, Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Fasiha Kanwal
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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119
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Measuring circulating placental RNAs to non-invasively assess the placental transcriptome and to predict pregnancy complications. Prenat Diagn 2016; 36:997-1008. [DOI: 10.1002/pd.4934] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/30/2016] [Indexed: 11/07/2022]
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120
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Wynants L, Collins GS, Van Calster B. Key steps and common pitfalls in developing and validating risk models. BJOG 2016; 124:423-432. [DOI: 10.1111/1471-0528.14170] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 01/09/2023]
Affiliation(s)
- L Wynants
- KU Leuven Department of Electrical Engineering‐ESAT STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics KU Leuven iMinds Medical IT Department Leuven Belgium
| | - GS Collins
- Centre for Statistics in Medicine Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford Oxford UK
| | - B Van Calster
- KU Leuven Department of Development and Regeneration Leuven Belgium
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121
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Browne JL, Klipstein-Grobusch K, Franx A, Grobbee DE. Prevention of Hypertensive Disorders of Pregnancy: a Novel Application of the Polypill Concept. Curr Cardiol Rep 2016; 18:59. [PMID: 27209297 PMCID: PMC4875943 DOI: 10.1007/s11886-016-0725-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to identify eligible candidates for a polypill for the prevention of HDP. A comprehensive review of systematic reviews on drug and dietary interventions to prevent HDP was conducted. Interventions were evaluated based on efficacy, dose, route of administration, and side effects. Fourteen interventions were assessed. Low-dose aspirin and calcium were identified as candidates for a polypill, with risk reduction estimations for pregnancy-induced hypertension and preeclampsia ranging between 10 and 62 %, depending on patient population characteristics including a priori risk, and gestation age at start of intervention. Their effect may be augmented through the addition of vitamin D, vitamin B12, and folic acid. The effect and optimal composition needs to be evaluated in future trials. Given the persistent burden of maternal and perinatal mortality associated with HDP, prevention of these disorders is key-especially in low-resource settings. The polypill approach with a combination of aspirin, calcium, vitamin D, vitamin B12, and folic acid is a promising strategy to improve maternal and perinatal health outcomes.
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Affiliation(s)
- J. L. Browne
- />Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
| | - K. Klipstein-Grobusch
- />Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
- />Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A. Franx
- />Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D. E. Grobbee
- />Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
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Macdonald-Wallis C, Silverwood RJ, de Stavola BL, Inskip H, Cooper C, Godfrey KM, Crozier S, Fraser A, Nelson SM, Lawlor DA, Tilling K. Antenatal blood pressure for prediction of pre-eclampsia, preterm birth, and small for gestational age babies: development and validation in two general population cohorts. BMJ 2015; 351:h5948. [PMID: 26578347 PMCID: PMC4647185 DOI: 10.1136/bmj.h5948] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY QUESTION Can routine antenatal blood pressure measurements between 20 and 36 weeks' gestation contribute to the prediction of pre-eclampsia and its associated adverse outcomes? METHODS This study used repeated antenatal measurements of blood pressure from 12 996 women in the Avon Longitudinal Study of Parents and Children (ALSPAC) to develop prediction models and validated these in 3005 women from the Southampton Women's Survey (SWS). A model based on maternal early pregnancy characteristics only (BMI, height, age, parity, smoking, existing and previous gestational hypertension and diabetes, and ethnicity) plus initial mean arterial pressure was compared with a model additionally including current mean arterial pressure, a model including the deviation of current mean arterial pressure from a stratified normogram, and a model including both at different gestational ages from 20-36 weeks. STUDY ANSWER AND LIMITATIONS The addition of blood pressure measurements from 28 weeks onwards improved prediction models compared with use of early pregnancy risk factors alone, but they contributed little to the prediction of preterm birth or small for gestational age. Though multiple imputation of missing data was used to increase the sample size and minimise selection bias, the validation sample might have been slightly underpowered as the number of cases of pre-eclampsia was just below the recommended 100. Several risk factors were self reported, potentially introducing measurement error, but this reflects how information would be obtained in clinical practice. WHAT THIS STUDY ADDS The addition of routinely collected blood pressure measurements from 28 weeks onwards improves predictive models for pre-eclampsia based on blood pressure in early pregnancy and other characteristics, facilitating a reduction in scheduled antenatal care. FUNDING, COMPETING INTERESTS, DATA SHARING UK Wellcome Trust, US National Institutes of Health, and UK Medical Research Council. Other funding sources for authors are detailed in the full online paper. With the exceptions of CM-W, HMI, and KMG there were no competing interests.
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Affiliation(s)
- Corrie Macdonald-Wallis
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Bianca L de Stavola
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford OX3 7LE, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol BS8 2BN, UK School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
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