The Role of cfDNA Biomarkers and Patient Data in the Early Prediction of Preeclampsia: Artificial Intelligence Model

OBJECTIVE

Accurate individualized assessment of preeclampsia risk enables the identification of patients most likely to benefit from initiation of low-dose aspirin at 12-16 weeks' gestation when there is evidence for its effectiveness, as well as guiding appropriate pregnancy care pathways and surveillance. The primary objective of this study was to evaluate the performance of artificial neural network models for the prediction of preterm preeclampsia (<37 weeks' gestation) using patient characteristics available at the first antenatal visit and data from prenatal cell-free DNA (cfDNA) screening. Secondary outcomes were prediction of early onset preeclampsia (<34 weeks' gestation) and term preeclampsia (≥37 weeks' gestation).

METHODS

This secondary analysis of a prospective, multicenter, observational prenatal cfDNA screening study (SMART) included singleton pregnancies with known pregnancy outcomes. Thirteen patient characteristics that are routinely collected at the first prenatal visit and two characteristics of cfDNA, total cfDNA and fetal fraction (FF), were used to develop predictive models for early-onset (<34 weeks), preterm (<37 weeks), and term (≥37 weeks) preeclampsia. For the models, the 'reference' classifier was a shallow logistic regression (LR) model. We also explored several feedforward (non-linear) neural network (NN) architectures with one or more hidden layers and compared their performance with the LR model. We selected a simple NN model built with one hidden layer and made up of 15 units.

RESULTS

Of 17,520 participants included in the final analysis, 72 (0.4%) developed early onset, 251 (1.4%) preterm, and 420 (2.4%) term preeclampsia. Median gestational age at cfDNA measurement was 12.6 weeks and 2,155 (12.3%) had their cfDNA measurement at 16 weeks' gestation or greater. Preeclampsia was associated with higher total cfDNA (median 362.3 versus 339.0 copies/ml cfDNA; p<0.001) and lower FF (median 7.5% versus 9.4%; p<0.001). The expected, cross-validated area under the curve (AUC) scores for early onset, preterm, and term preeclampsia were 0.782, 0.801, and 0.712, respectively for the LR model, and 0.797, 0.800, and 0.713, respectively for the NN model. At a screen-positive rate of 15%, sensitivity for preterm preeclampsia was 58.4% (95% CI 0.569, 0.599) for the LR model and 59.3% (95% CI 0.578, 0.608) for the NN model.The contribution of both total cfDNA and FF to the prediction of term and preterm preeclampsia was negligible. For early-onset preeclampsia, removal of the total cfDNA and FF features from the NN model was associated with a 6.9% decrease in sensitivity at a 15% screen positive rate, from 54.9% (95% CI 52.9-56.9) to 48.0% (95% CI 45.0-51.0).

CONCLUSION

Routinely available patient characteristics and cfDNA markers can be used to predict preeclampsia with performance comparable to other patient characteristic models for the prediction of preterm preeclampsia. Both LR and NN models showed similar performance.

LGNN: a novel linear graph neural network algorithm

The emergence of deep learning has not only brought great changes in the field of image recognition, but also achieved excellent node classification performance in graph neural networks. However, the existing graph neural network framework often uses methods based on spatial domain or spectral domain to capture network structure features. This process captures the local structural characteristics of graph data, and the convolution process has a large amount of calculation. It is necessary to use multi-channel or deep neural network structure to achieve the goal of modeling the high-order structural characteristics of the network. Therefore, this paper proposes a linear graph neural network framework [Linear Graph Neural Network (LGNN)] with superior performance. The model first preprocesses the input graph, and uses symmetric normalization and feature normalization to remove deviations in the structure and features. Then, by designing a high-order adjacency matrix propagation mechanism, LGNN enables nodes to iteratively aggregate and learn the feature information of high-order neighbors. After obtaining the node representation of the network structure, LGNN uses a simple linear mapping to maintain computational efficiency and obtain the final node representation. The experimental results show that the performance of the LGNN algorithm in some tasks is slightly worse than that of the existing mainstream graph neural network algorithms, but it shows or exceeds the machine learning performance of the existing algorithms in most graph neural network performance evaluation tasks, especially on sparse networks.

A Brain-Inspired Decision-Making Linear Neural Network and Its Application in Automatic Drive

Brain-like intelligent decision-making is a prevailing trend in today’s world. However, inspired by bionics and computer science, the linear neural network has become one of the main means to realize human-like decision-making and control. This paper proposes a method for classifying drivers’ driving behaviors based on the fuzzy algorithm and establish a brain-inspired decision-making linear neural network. Firstly, different driver experimental data samples were obtained through the driving simulator. Then, an objective fuzzy classification algorithm was designed to distinguish different driving behaviors in terms of experimental data. In addition, a brain-inspired linear neural network was established to realize human-like decision-making and control. Finally, the accuracy of the proposed method was verified by training and testing. This study extracts the driving characteristics of drivers through driving simulator tests, which provides a driving behavior reference for the human-like decision-making of an intelligent vehicle.