Routinely collected antenatal data for longitudinal prediction of preeclampsia in nulliparous women: a population-based study

AbstractThe objective was to evaluate the sequentially updated predictive capacity for preeclampsia during pregnancy, using multivariable longitudinal models including data from antenatal care. This population-based cohort study in the Stockholm-Gotland Counties, Sweden, included 58,899 pregnancies of nulliparous women 2008–2013. Prospectively collected data from each antenatal care visit was used, including maternal characteristics, reproductive and medical history, and repeated measurements of blood pressure, weight, symphysis-fundal height, proteinuria, hemoglobin and blood glucose levels. We used a shared-effects joint longitudinal model including all available information up until a given gestational length (week 24, 28, 32, 34 and 36), to update preeclampsia prediction sequentially. Outcome measures were prediction of preeclampsia, preeclampsia with delivery < 37, and preeclampsia with delivery ≥ 37 weeks’ gestation. The area under the curve (AUC) increased with gestational length. AUC for preeclampsia with delivery < 37 weeks’ gestation was 0.73 (95% CI 0.68–0.79) at week 24, and increased to 0.87 (95% CI 0.84–0.90) in week 34. For preeclampsia with delivery ≥ 37 weeks’ gestation, the AUC in week 24 was 0.65 (95% CI 0.63–0.68), but increased to 0.79 (95% CI 0.78–0.80) in week 36. The addition of routinely collected clinical measurements throughout pregnancy improve preeclampsia prediction and may be useful to individualize antenatal care.

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Routinely Collected Antenatal Data for Longitudinal Prediction of Preeclampsia in Nulliparous Women: A Population-based Study

10.21203/rs.3.rs-602138/v1 ◽

2021 ◽

Author(s):

Anna Sandström ◽

Jonathan M Snowden ◽

Matteo Bottai ◽

Olof Stephansson ◽

Anna-Karin Wikström

Keyword(s):

Antenatal Care ◽

Area Under The Curve ◽

Population Based ◽

Repeated Measurements ◽

Longitudinal Models ◽

Gestational Length ◽

Predictive Capacity ◽

Maternal Characteristics ◽

Glucose Levels ◽

Nulliparous Women

Abstract The objective was to evaluate the sequentially updated predictive capacity for preeclampsia during pregnancy, using multivariable longitudinal models including data from antenatal care. This population-based cohort study in the Stockholm-Gotland Counties, Sweden, included 58899 pregnancies of nulliparous women 2008–2013. Prospectively collected data from each antenatal care visit was used, including maternal characteristics, reproductive and medical history, and repeated measurements of blood pressure, weight, symphysis-fundal height, proteinuria, hemoglobin and blood glucose levels. We used a shared-effects joint longitudinal model including all available information up until a given gestational length (week 24, 28, 32, 34 and 36), to update preeclampsia prediction sequentially. Outcome measures were prediction of preeclampsia, preeclampsia with delivery < 37, and preeclampsia with delivery ≥ 37 weeks’ gestation. The area under the curve (AUC) increased with gestational length. AUC for preeclampsia with delivery < 37 weeks’ gestation was 0.73 (95% CI 0.68–0.79) at week 24, and increased to 0.87 (95% CI 0.84–0.90) in week 34. For preeclampsia with delivery ≥ 37 weeks’ gestation, the AUC in week 24 was 0.65 (95% CI 0.63–0.68), but increased to 0.79 (95% CI 0.78–0.80) in week 36. The addition of routinely collected clinical measurements throughout pregnancy improve preeclampsia prediction and may be useful to individualize antenatal care.

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Risk of cesarean delivery in ongoing pregnancies of nulliparous women after 37 weeks of gestation: a prospective cohort study

10.22541/au.163253033.36490819/v1 ◽

2021 ◽

Author(s):

Thibaud Quibel ◽

Camille Bouyer ◽

Patrick Rozenberg ◽

Jean Bouyer

Keyword(s):

Cohort Study ◽

Regression Models ◽

Outcome Measure ◽

Population Based ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Perinatal Network ◽

Gestational Week ◽

Labor Onset ◽

Caesarean Delivery Rate

Objective: To study the risk of CD for each gestational week among ongoing pregnancies of nulliparous women at term. Design: A retrospective, population-based cohort study from January 1, 2016, through December 31, 2017 Setting: a French perinatal network of the Yvelines district, France Population: 11 308 nulliparous women with a singleton fetus in a cephalic presentation and delivered at term (≥37-week +0 day) Methods: for each week of gestation at term, we defined ongoing pregnancies as all pregnancies undelivered at the start of each week. Regression models adjusted by maternal characteristics and hospital status were used to compare the CD risk between ongoing pregnancies and the pregnancies delivered the preceding week. The same methods were applied to subgroups defined by the mode of labor onset. Main outcome measure: The caesarean delivery rate (CD) Results: Ongoing pregnancies > 40 weeks+0 days were associated with a higher risk of CD compared with pregnancies delivered the previous week: 24.3% in ongoing pregnancies ≥ 40 weeks +0 days versus 19.9% in deliveries between 39 weeks +0 days and 39 weeks+6 days (Odd ratio adjusted of 1.28, 95%CI [1.15-1.44]; 30.4% in ongoing pregnancies ≥ 41 weeks +0 days versus 19.6% in deliveries between 40 weeks +0 days and 40 weeks+6 days (OR 1.73, 95%CI [1.51-1.96]). This was also shown for all modes of labor onset and in every maternity unit. Conclusions: CD rates increased starting at 40 weeks +0 days in ongoing pregnancies, regardless of the mode of labor onset.

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Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

American Journal of Perinatology ◽

10.1055/s-0037-1608847 ◽

2017 ◽

Vol 35 (07) ◽

pp. 660-668 ◽

Cited By ~ 3

Author(s):

U. M. Reddy ◽

C. C. Huang ◽

T. C. Auguste ◽

D. Bauer ◽

R. T. Overcash ◽

...

Keyword(s):

Vaginal Delivery ◽

Characteristic Curve ◽

Area Under The Curve ◽

Predictive Ability ◽

Induction Of Labor ◽

Stepwise Logistic Regression ◽

Chronic Hypertension ◽

Stepwise Logistic Regression Analysis ◽

Maternal Characteristics ◽

Nulliparous Women

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770). Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

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Sexual violence and neonatal outcomes: a Norwegian population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2014-005935 ◽

2014 ◽

Vol 4 (10) ◽

pp. e005935 ◽

Cited By ~ 4

Author(s):

Lena Henriksen ◽

Berit Schei ◽

Siri Vangen ◽

Mirjam Lukasse

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Sexual Violence ◽

Gestational Age ◽

Population Based ◽

Neonatal Outcomes ◽

Gestational Length ◽

Birth Registry ◽

Maternal Characteristics ◽

Behavioural Factors

ObjectiveThe objective of this study was to explore the association between sexual violence and neonatal outcomes.DesignNational cohort study.SettingWomen were recruited to the Norwegian Mother and Child Cohort Study (MoBa) while attending routine ultrasound examinations from 1999 to 2008.PopulationA total of 76 870 pregnant women.MethodsSexual violence and maternal characteristics were self-reported in postal questionnaires during pregnancy. Neonatal outcomes were retrieved from the Medical Birth Registry of Norway (MBRN). Risk estimations were performed with linear and logistic regression analysis. Outcome measures: gestational age at birth, birth weight, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA).ResultsOf 76 870 women, 18.4% reported a history of sexual violence. A total of 4.7% delivered prematurely, 2.7% had children with a birth weight <2500 g and 8.1% children were small for their gestational age. Women reporting moderate or severe sexual violence (rape) had a significantly reduced gestational length (2 days) when the birth was provider-initiated in an analysis adjusted for age, parity, education, smoking, body mass index and mental distress. Those exposed to severe sexual violence had a significantly reduced gestational length of 0.51 days with a spontaneous start of birth. Crude estimates showed that severe sexual violence was associated with PTB, LBW and SGA. When controlling for the aforementioned sociodemographic and behavioural factors, the association was no longer significant.ConclusionsSexual violence was not associated with adverse neonatal outcomes. Moderate and severe violence had a small but significant effect on gestational age; however, the clinical influence of this finding is most likely limited. Women exposed to sexual violence in this study reported more of the sociodemographic and behavioural factors associated with PTB, LBW and SGA compared with non-abused women.

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Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: a population-based study

BMC Cancer ◽

10.1186/s12885-021-08105-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuxin Ding ◽

Runyi Jiang ◽

Yuhong Chen ◽

Jing Jing ◽

Xiaoshuang Yang ◽

...

Keyword(s):

Head And Neck ◽

Health Management ◽

External Validation ◽

Area Under The Curve ◽

Population Based ◽

Survival Prediction ◽

Cancer Specific Survival ◽

Cox Models ◽

Lentigo Maligna Melanoma ◽

Clinical Tools

Abstract Background Previous studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. We aimed at comparing the characteristics of HNM and BM, developing and validating nomograms for predicting the survival of patients with HNM or BM. Methods The information of patients with HNM or BM from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The HNM group and BM group were randomly divided into training and validation cohorts. We used the Kaplan-Meier method and multivariate Cox models to identify independent prognostic factors. Nomograms were developed via the rms and dynnom packages, and were measured by the concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration plots. Results Of 70,605 patients acquired, 21% had HNM and 79% had BM. The HNM group contained more older patients, male sex and lentigo maligna melanoma, and more frequently had thicker tumors and metastases than the BM group. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.1 ± 0.3% and 74.4 ± 0.4% in the HNM group and 92.5 ± 0.1% and 85.8 ± 0.2% in the BM group, respectively. Eight variables (age, sex, histology, thickness, ulceration, stage, metastases, and surgery) were identified to construct nomograms of CSS and OS for patients with HNM or BM. Additionally, four dynamic nomograms were available on web. The internal and external validation of each nomogram showed high C-index values (0.785–0.896) and AUC values (0.81–0.925), and the calibration plots showed great consistency. Conclusions The characteristics of HNM and BM are heterogeneous. We constructed and validated four nomograms for predicting the 3-, 5- and 10-year CSS and OS probabilities of patients with HNM or BM. These nomograms can serve as practical clinical tools for survival prediction and individual health management.

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PvMSP8 as a Novel Plasmodium vivax Malaria Sero-Marker for the Peruvian Amazon

Pathogens ◽

10.3390/pathogens10030282 ◽

2021 ◽

Vol 10 (3) ◽

pp. 282

Author(s):

Elizabeth Villasis ◽

Katherine Garro ◽

Angel Rosas-Aguirre ◽

Pamela Rodriguez ◽

Jason Rosado ◽

...

Keyword(s):

Plasmodium Vivax ◽

Area Under The Curve ◽

Surface Protein ◽

Merozoite Surface Protein ◽

Population Based ◽

Peruvian Amazon ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Malaria Exposure ◽

Plasmodium Vivax Malaria

The measurement of recent malaria exposure can support malaria control efforts. This study evaluated serological responses to an in-house Plasmodium vivax Merozoite Surface Protein 8 (PvMSP8) expressed in a Baculovirus system as sero-marker of recent exposure to P. vivax (Pv) in the Peruvian Amazon. In a first evaluation, IgGs against PvMSP8 and PvMSP10 proteins were measured by Luminex in a cohort of 422 Amazonian individuals with known history of Pv exposure (monthly data of infection status by qPCR and/or microscopy over five months). Both serological responses were able to discriminate between exposed and non-exposed individuals in a good manner, with slightly higher performance of anti-PvMSP10 IgGs (area under the curve AUC = 0.78 [95% CI = 0.72–0.83]) than anti-PvMSP8 IgGs (AUC = 0.72 [95% CI = 0.67–0.78]) (p = 0.01). In a second evaluation, the analysis by ELISA of 1251 plasma samples, collected during a population-based cross-sectional survey, confirmed the good performance of anti-PvMSP8 IgGs for discriminating between individuals with Pv infection at the time of survey and/or with antecedent of Pv in the past month (AUC = 0.79 [95% CI = 0.74–0.83]). Anti-PvMSP8 IgG antibodies can be considered as a good biomarker of recent Pv exposure in low-moderate transmission settings of the Peruvian Amazon.

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Association between Adherence with Recommended Antenatal Care in Low-Risk, Uncomplicated Pregnancy, and Maternal and Neonatal Adverse Outcomes: Evidence from Italy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010173 ◽

2020 ◽

Vol 18 (1) ◽

pp. 173

Author(s):

Giovanni Corrao ◽

Anna Cantarutti ◽

Anna Locatelli ◽

Gloria Porcu ◽

Luca Merlino ◽

...

Keyword(s):

Antenatal Care ◽

Prevalence Ratio ◽

Population Based ◽

Adverse Outcomes ◽

Low Risk ◽

Neonatal Outcomes ◽

Lombardy Region ◽

Uncomplicated Pregnancy ◽

Maternal And Neonatal Outcomes ◽

Estimate Prevalence

Antenatal care (ANC) aims of monitoring wellbeing of mother and foetus during pregnancy. We validate a set of indicators aimed of measuring the quality of ANC of women on low-risk, uncomplicated pregnancy through their relationship with maternal and neonatal outcomes. We conducted a population-based cohort study including 122,563 deliveries that occurred between 2015 and 2017 in the Lombardy Region, Italy. Promptness and appropriateness of number and timing of gynaecological visits, ultrasounds and laboratory tests were evaluated. We assessed several maternal and neonatal outcomes. Log-binomial regression models were used to estimate prevalence ratio (PR), and corresponding 95% confidence interval (95% CI), for the exposure→outcome association. Compared with women who adhered with recommendations, those who were no adherent had a significant higher prevalence of maternal intensive care units admission (PR: 3.1, 95%CI: 1.2–7.9; and 2.7, 1.1–7.0 respectively for promptness of gynaecological visits, and appropriateness of ultrasound examinations), low Apgar score (1.6, 1.1–1.2; 1.9, 1.3–2.7; and 2.1, 1.5–2.8 respectively for appropriateness and promptness of gynaecological visits, and appropriateness of ultrasound examinations), and low birth weight (1.8, 1.5–2.3 for appropriateness of laboratory test examinations). Benefits for mothers and newborn are expected from improving adherence to guidelines-driven recommendations regarding antenatal care even for low-risk, uncomplicated pregnancies.

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First trimester prediction of maternal glycemic status

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0149 ◽

2015 ◽

Vol 43 (3) ◽

Cited By ~ 8

Author(s):

Rinat Gabbay-Benziv ◽

Lauren E. Doyle ◽

Miriam Blitzer ◽

Ahmet A. Baschat

Keyword(s):

Risk Score ◽

Predictive Value ◽

Challenge Test ◽

Area Under The Curve ◽

First Trimester ◽

Tolerance Test ◽

Oral Glucose ◽

Operating Characteristics ◽

Maternal Characteristics ◽

Predictive Algorithm

AbstractTo predict gestational diabetes mellitus (GDM) or normoglycemic status using first trimester maternal characteristics.We used data from a prospective cohort study. First trimester maternal characteristics were compared between women with and without GDM. Association of these variables with sugar values at glucose challenge test (GCT) and subsequent GDM was tested to identify key parameters. A predictive algorithm for GDM was developed and receiver operating characteristics (ROC) statistics was used to derive the optimal risk score. We defined normoglycemic state, when GCT and all four sugar values at oral glucose tolerance test, whenever obtained, were normal. Using same statistical approach, we developed an algorithm to predict the normoglycemic state.Maternal age, race, prior GDM, first trimester BMI, and systolic blood pressure (SBP) were all significantly associated with GDM. Age, BMI, and SBP were also associated with GCT values. The logistic regression analysis constructed equation and the calculated risk score yielded sensitivity, specificity, positive predictive value, and negative predictive value of 85%, 62%, 13.8%, and 98.3% for a cut-off value of 0.042, respectively (ROC-AUC – area under the curve 0.819, CI – confidence interval 0.769–0.868). The model constructed for normoglycemia prediction demonstrated lower performance (ROC-AUC 0.707, CI 0.668–0.746).GDM prediction can be achieved during the first trimester encounter by integration of maternal characteristics and basic measurements while normoglycemic status prediction is less effective.

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