TY - JOUR
T1 - A Model for Preconceptional Prediction of Recurrent Early-Onset Preeclampsia: Derivation and Internal Validation
AU - van Kuijk, Sander M. J.
AU - Nijdam, Marie-Elise
AU - Janssen, Kristel J. M.
AU - Sep, Simone J. S.
AU - Peeters, Louis
AU - Delahaije, Denise H. J.
AU - Spaanderman, Marc
AU - Bruinse, Hein W.
AU - Franx, Arie
AU - Bots, Michiel L.
AU - Langenveld, Josje
AU - van der Post, Joris A. M.
AU - van Rijn, Bas B.
AU - Smits, Luc
PY - 2011/11
Y1 - 2011/11
N2 - Objective: To develop a model to identify women at very low risk of recurrent early-onset preeclampsia. Methods: We enrolled 407 women who had experienced early-onset preeclampsia in their first pregnancy, resulting in a delivery before 34 weeks' gestation. Preeclampsia was defined as hypertension (systolic blood pressure >= 140 mm Hg and/or diastolic blood pressure >= 90 mm Hg) after 20 weeks' gestation with de novo proteinuria (>= 300 mg urinary protein excretion/day). Based on the previous published evidence and expert opinion, 5 predictors (gestational age at previous birth, prior small-for-gestational-age newborn, fasting blood glucose, body mass index, and hypertension) were entered in a logistic regression model. Discrimination and calibration were evaluated after adjusting for overfitting by bootstrapping techniques. Results: Early-onset disease recurred in 28 (6.9%) of 407 women. The area under the receiver operating characteristic (ROC) curve of the model was 0.65 (95% CI: 0.56-0.74). Calibration was good, indicated by a nonsignificant Hosmer-Lemeshow test (P = .11). Using a predicted absolute risk threshold of, for example, 4.6% (ie, women identified with an estimated risk either above or below 4.6%), the sensitivity was 100%, with a specificity of 26%. In such a strategy, no women who developed preeclampsia were missed, while 98 of the 407 women would be regarded as low risk of recurrent early-onset preeclampsia, not necessarily requiring intensified antenatal care. Conclusion: Our model may be helpful in the identification of women at very low risk of recurrent early-onset preeclampsia. Before widespread application, our model should be validated in other populations.
AB - Objective: To develop a model to identify women at very low risk of recurrent early-onset preeclampsia. Methods: We enrolled 407 women who had experienced early-onset preeclampsia in their first pregnancy, resulting in a delivery before 34 weeks' gestation. Preeclampsia was defined as hypertension (systolic blood pressure >= 140 mm Hg and/or diastolic blood pressure >= 90 mm Hg) after 20 weeks' gestation with de novo proteinuria (>= 300 mg urinary protein excretion/day). Based on the previous published evidence and expert opinion, 5 predictors (gestational age at previous birth, prior small-for-gestational-age newborn, fasting blood glucose, body mass index, and hypertension) were entered in a logistic regression model. Discrimination and calibration were evaluated after adjusting for overfitting by bootstrapping techniques. Results: Early-onset disease recurred in 28 (6.9%) of 407 women. The area under the receiver operating characteristic (ROC) curve of the model was 0.65 (95% CI: 0.56-0.74). Calibration was good, indicated by a nonsignificant Hosmer-Lemeshow test (P = .11). Using a predicted absolute risk threshold of, for example, 4.6% (ie, women identified with an estimated risk either above or below 4.6%), the sensitivity was 100%, with a specificity of 26%. In such a strategy, no women who developed preeclampsia were missed, while 98 of the 407 women would be regarded as low risk of recurrent early-onset preeclampsia, not necessarily requiring intensified antenatal care. Conclusion: Our model may be helpful in the identification of women at very low risk of recurrent early-onset preeclampsia. Before widespread application, our model should be validated in other populations.
KW - prediction
KW - recurrence
KW - preeclampsia
KW - risk
U2 - 10.1177/1933719111410708
DO - 10.1177/1933719111410708
M3 - Article
SN - 1933-7191
VL - 18
SP - 1154
EP - 1159
JO - Reproductive Sciences
JF - Reproductive Sciences
IS - 11
ER -