A model for predicting risk of pre-eclampsia

January 01, 0001

A model for predicting risk of pre-eclampsia

These international researchers created a model for pre-eclampsia risk in nulliparous women based on clinical risk factors, and sought to identify sub groups of patients who should be referred for specialist care. They performed a multicenter cohort study in New Zealand, Australia, Ireland and the United Kingdom, enrolling 3572 nulliparous women

The researchers found: "Of the 3529 women, 186 (5.3%) developed pre- eclampsia, including 47 (1.3%) with preterm pre-eclampsia. Clinical risk factors at 14-16 weeks’ gestation were age, mean arterial blood pressure, body mass index (BMI), family history of pre-eclampsia, family history of coronary heart disease, maternal birth weight, and vaginal bleeding for at least five days. Factors associated with reduced risk were a previous single miscarriage with the same partner, taking at least 12 months to conceive, high intake of fruit, cigarette smoking, and alcohol use in the first trimester. The area under the receiver operating characteristics curve (AUC), under internal validation, was 0.71. Addition of uterine artery Doppler indices did not improve performance (internal validation AUC 0.71). A framework for specialist referral was developed based on a probability of pre-eclampsia generated by the model of at least 15% or an abnormal uterine artery Doppler waveform in a subset of women with single risk factors. Nine per cent of nulliparous women would be referred for a specialist opinion, of whom 21% would develop pre- eclampsia. The relative risk for developing pre-eclampsia and preterm pre- eclampsia in women referred to a specialist compared with standard care was 5.5 and 12.2, respectively."

The researchers concluded: "The ability to predict pre-eclampsia in healthy nulliparous women using clinical phenotype is modest and requires external validation in other populations. If validated, it could provide a personalised clinical risk profile for nulliparous women to which biomarkers could be added."

The beginnings of a clinical predictive model for determining risk of pre-eclampsia in nulliparous women, though further study is warranted.

For the full abstract, click here.

BMJ 342:d1875, 7 April 2011 © 2011 BMJ Publishing Group Ltd.
Clinical risk prediction for pre-eclampsia in nulliparous women: development of model in international prospective cohort. Robyn A North, Lesley M E McCowan, Gustaaf A Dekker, et al. Correspondence to R A North: [email protected]

Category: W. Pregnancy, Family Planning. Keywords: pre-eclampsia, pregnancy, nulliparous, risk, model, cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 29 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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