Article
The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review
BJOG: an International Journal of Obstetrics and Gynaecology
(2016)
Abstract
Background: Risk prediction models may be valuable to identify
women at risk of pre-eclampsia to guide aspirin prophylaxis in
early pregnancy.
Objective: To assess the performance of ‘simple’ risk models for
pre-eclampsia that use routinely collected maternal characteristics;
compare with ‘specialised’ models that include specialised tests;
and to guideline recommended decision rules.
Search strategy MEDLINE, Embase and PubMed were searched
to June 2014.
Selection criteria: We included studies that developed or validated
pre-eclampsia risk models using maternal characteristics with or
without specialised tests and reported model performance.
Data collection and analysis: We extracted data on study
characteristics; model predictors, validation and performance
including area under the curve (AUC), sensitivity and
specificity.
Main results: We identified 29 studies that developed 70 models
including 22 simple models. Studies included 151–9149 women
with a pre-eclampsia prevalence of 1.2–9.5%. No single
predictor was included in all models. Four simple models were
externally validated, with a model using parity, pre-eclampsia
history, race, chronic hypertension and conception method to
predict early-onset pre-eclampsia achieving the highest AUC
(0.76, 95% CI 0.74–0.77). Nine studies comparing simple versus
specialized models in the same population reported AUC
favouring specialised models. A simple model achieved fewer
false positives than a guideline recommended risk factor list, but
sensitivity to classify risk for aspirin prophylaxis was not
assessed.
Conclusion: Validated simple pre-eclampsia risk models
demonstrate good risk discrimination that can be improved with
specialised tests. Further research is needed to determine their
clinical value to guide aspirin prophylaxis compared with decision
rules.
Disciplines
Publication Date
2016
DOI
10.1111/1471-0528.14029
Citation Information
Al-Rubaie, Z. T. A., Askie, L., Ray, J., Hudson, H., and Lord, S. (2016). The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review. BJOG: an International Journal of Obstetrics and Gynaecology, Online First. DOI: 10.1111/1471-0528.14029