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Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening.

ABSTRACT: BACKGROUND:Preeclampsia (PE) is associated with a high risk of perinatal morbidity and mortality. However, there is no consensus in the definition of high-risk women. AIM:To question current definition of high PE risk and propose a definition that considers individual heterogeneity to improves risk classification. METHODS:A stratified analysis by parity was conducted using the Swedish Birth Register between 2002-2010 including 626.600 pregnancies. The discriminatory accuracy (DA) of traditional definitions of high-risk women was compared with a new definition based on 1) specific combinations of individual variables and 2) a centile cut-off of the probability of PE predicted by a multiple logistic regression model. RESULTS:None of the classical risk-factors alone reached an acceptable DA. In multiparous, any combination of a risk-factor with previous PE or HBP reached a +LR>10. The combination of obesity and multiple pregnancy reached a good DA particularly in the presence of previous preeclampsia (positive likelihood ratio (LR+) = 26.5 or chronic hypertension (HBP) LR+ = 40.5. In primiparous, a LR+>15 was observed in multiple pregnancies with the simultaneous presence of obesity and diabetes mellitus or with HBP. Predicted probabilities above 97 centile in multiparous and 99 centile in primiparous provided high (LR+ = 12.5), and moderate (LR+ = 5.85), respectively. No one risk factor alone or in combination provided a LR- sufficiently low to rule-out the disease. CONCLUSIONS:In preeclampsia prediction the combination of specific risk factors provided a better discriminatory accuracy than traditional single risk approach. Our results contribute to a more personalized risk estimation of preeclampsia.

SUBMITTER: Rodriguez-Lopez M

PROVIDER: S-EPMC5444844 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening.

Rodriguez-Lopez Merida M Wagner Philippe P Perez-Vicente Raquel R Crispi Fatima F Merlo Juan J

PloS one 20170525 5

<h4>Background</h4>Preeclampsia (PE) is associated with a high risk of perinatal morbidity and mortality. However, there is no consensus in the definition of high-risk women.<h4>Aim</h4>To question current definition of high PE risk and propose a definition that considers individual heterogeneity to improves risk classification.<h4>Methods</h4>A stratified analysis by parity was conducted using the Swedish Birth Register between 2002-2010 including 626.600 pregnancies. The discriminatory accurac ...[more]

PMID: 28542517

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Project description:ObjectivesSmall for gestational age (SGA) is considered as an indicator of intrauterine growth restriction, and multiple maternal and newborn characteristics have been identified as risk factors for SGA. This knowledge is mainly based on measures of average association (ie, OR) that quantify differences in average risk between exposed and unexposed groups. Nevertheless, average associations do not assess the discriminatory accuracy of the risk factors (ie, its ability to discriminate the babies who will develop SGA from those that will not). Therefore, applying measures of discriminatory accuracy rather than measures of association only, our study revisits known risk factors of SGA and discusses their role from a public health perspective.DesignCross-sectional study. We measured maternal (ie, smoking, hypertension, age, marital status, education) and delivery (ie, sex, gestational age, birth order) characteristics and performed logistic regression models to estimate both ORs and measures of discriminatory accuracy, like the area under the receiver operating characteristic curve (AU-ROC) and the net reclassification improvement.SettingData were obtained from the Swedish Medical Birth Registry.ParticipantsOur sample included 731?989 babies born during 1987-1993.ResultsWe replicated the expected associations. For instance, smoking (OR=2.57), having had a previous SGA baby (OR=5.48) and hypertension (OR=4.02) were strongly associated with SGA. However, they show a very small discriminatory accuracy (AU-ROC?0.5). The discriminatory accuracy increased, but remained unsatisfactorily low (AU-ROC=0.6), when including all variables studied in the same model.ConclusionsTraditional risk factors for SGA alone or in combination have a low accuracy for discriminating babies with SGA from those without SGA. A proper understanding of these findings is of fundamental relevance to address future research and to design policymaking recommendations in a more informed way.

Dataset Information

Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening.

Publications

Revisiting the discriminatory accuracy of traditional risk factors in preeclampsia screening.

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