The implications of the Fetal Medicine Foundation 35-36 week preeclampsia prediction competing risk model on timing of birth.
Journal article
von Dadelszen, Peter, Syngelaki, Argyro, Wright, Alan, Akolekar, Ranjit, Magee, Laura A, Wright, David and Nicolaides, Kypros H 2022. The implications of the Fetal Medicine Foundation 35-36 week preeclampsia prediction competing risk model on timing of birth. American Journal of Obstetrics and Gynecology. 228 (4), pp. 457.e1-457.e7. https://doi.org/S0002-9378(22)00804-3
| Authors | von Dadelszen, Peter, Syngelaki, Argyro, Wright, Alan, Akolekar, Ranjit, Magee, Laura A, Wright, David and Nicolaides, Kypros H |
|---|---|
| Abstract | Preeclampsia (PE) is associated with increased risks of life-threatening, -altering, and -ending complications. Assessment of risk for PE at 35-36 weeks' gestation by the Fetal Medicine Foundation (FMF36) competing risk model identifies about 75% of women who will develop term PE, at 10% screen positive rate. To assess whether the FMF36 model can provide personalized guidance to women about the probable timing of their delivery, whether or not they develop pregnancy hypertension. In this prospective non-intervention screening study at 2 maternity hospitals in England, women who did not have PE (American College of Obstetricians and Gynecologists definition) and were attending a routine hospital visit at 35 0/7 to 36 6/7 weeks' gestation underwent assessment of risk for PE, including maternal demographic characteristics, medical history, mean arterial pressure, and serum placental growth factor and soluble fms-like tyrosine kinase-1. FMF36 risk categories for subsequent PE were defined as: A ≥0.500; B 0.20 - 0.499; C 0.05 - 0.199; D 0.020 - 0.049; and E <0.020. Obstetrical records were examined for all women to identify their gestational age at delivery, and whether they experienced a spontaneous onset of labor (irrespective of mode of delivery) or they had a medically-indicated birth (either induction of labor or unlabored cesarean delivery). The cumulative incidence of delivery and risk ratios (RR), for all deliveries and for spontaneous deliveries, was assessed. Among 29,035 women with singleton pregnancies, 1.0%, 2.9%, 3.3%, 5.0%, 9.9%, and 77.9% were in A, B, C, D and E risk strata, respectively. In stratum A (vs E) stratum, 71.95% (vs 33.52%) of births were medically-indicated. Compared with women in stratum E, women in higher risk strata were more likely to deliver, and to deliver following spontaneous labor, before their due date. For example, of the women in stratum A (vs E), 14.2% (vs 1.1%; RR 12.5 (95% confidence interval 9.45 - 15.35)), 48.5% (vs 5.1%; RR 8.47 (7.48 - 9.35)), 69.6% (vs 15.5%; RR 3.86 (3.59 - 4.08)), and 90.1% (vs 44.8%; RR 6.72 (4.53 - 9.95)) gave birth before 37 0/7, 38 0/7, 39 0/7, and 40 0/7 weeks, respectively. For women in stratum A (vs E), when censored for medically-indicated births, spontaneous labor occurred more commonly before 37 0/7 (RR 4.31 (1.99 - 6.57)), 38 0/7 (RR 3.71 (2.48 - 4.88)), 39 0/7 (RR 2.87 (2.22 - 3.46), and 40 0/7 (RR 1.42 (1.14 - 1.77). Women in higher-risk strata gave birth earlier, and more frequently following medically-indicated delivery, than those in lower-risk strata. Importantly, the proportion of women who gave birth following spontaneous onset of labor before their due date was also greater in higher (vs. lower) risk women. The FMF36 competing risk model incorporates biomarkers of placental aging, including angiogenic imbalance; these results imply that a fetoplacental response to placental aging may be an important trigger for the onset of labor at term. [Abstract copyright: Copyright © 2022. Published by Elsevier Inc.] |
| Keywords | Placental aging; Competing risk model; Spontaneous labor; Angiogenic imbalance; Gestational age at delivery |
| Year | 2022 |
| Journal | American Journal of Obstetrics and Gynecology |
| Journal citation | 228 (4), pp. 457.e1-457.e7 |
| Publisher | Elsevier |
| ISSN | 1097-6868 |
| Digital Object Identifier (DOI) | https://doi.org/S0002-9378(22)00804-3 |
| https://doi.org/10.1016/j.ajog.2022.09.047 | |
| Official URL | https://www.sciencedirect.com/science/article/pii/S0002937822008043 |
| Publication dates | |
| Online | 04 Oct 2022 |
| Publication process dates | |
| Deposited | 10 Oct 2022 |
| Accepted | 30 Sep 2022 |
| Output status | Published |
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https://repository.canterbury.ac.uk/item/92w4v/the-implications-of-the-fetal-medicine-foundation-35-36-week-preeclampsia-prediction-competing-risk-model-on-timing-of-birth
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