Competing-risks model for pre-eclampsia and adverse pregnancy outcomes.
Journal article
Syngelaki, A., Magee, L., Dadelszen, P von, Akolekar, R., Wright, A, Wright, D and Nicolaides, K H 2022. Competing-risks model for pre-eclampsia and adverse pregnancy outcomes. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.26036
| Authors | Syngelaki, A., Magee, L., Dadelszen, P von, Akolekar, R., Wright, A, Wright, D and Nicolaides, K H |
|---|---|
| Abstract | The competing risks model for assessment of risk for pre-eclampsia (PE) at 35-36 weeks' gestation identifies the majority of women whose pregnancies are at high-risk for subsequent delivery with PE. To objective of this study was to examine, according to the estimated risk of delivery with PE, the incidence of adverse pregnancy outcomes and relative risks for such outcomes, by stratum of risk. Prospective non-intervention observational study in women with singleton pregnancies attending a routine hospital visit at 35 0/7 to 36 6/7 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated by the competing risks model, combining the prior distribution of gestational age at delivery with PE, together with likelihoods from multiple of the median values of mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase (sFlt-1). The patients were assigned to one of the following five risk categories: A: ≥1 in 2; B: 1 in 5 to 1 in 3; C: 1 in 20 to 1 in 6; D: 1 in 50 to 1 in 21; and E: <1:50. The outcome measures were delivery with PE, gestational hypertension (GH), birth of small for gestational age (SGA) neonates, delivery by cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for a minimum of 48 hours. In each risk category proportions of women for each adverse outcome were determined and the risk ratios (RR) calculated, relative to the lowest-risk group E. In the study population of 29,035 women, 1.6%, 2.7%, 8.2%, 9.8%, and 77.7% were in the risk strata A, B, C, D and E, respectively. Compared with women in the <1:50 stratum, women in higher-risk strata were more likely to have an adverse outcome. For example, the RR (95% confidence interval) of delivery with PE in group A relative to group E was 65.5 (54.1, 79.1) and the respective values were 11.9 (9.1, 15.5) for GH, 1.8 (1.5, 2.1) for delivery by emergency cesarean section, 1.5 (1.2, 1.8) for delivery by elective cesarean section, 8.9 (7.4, 10.8) for SGA with birthweight <3 percentile, 4.8 (4.3, 5.4) for SGA with birthweight <10 percentile, 5.3 (1.4, 20.5) for stillbirth, and 3.4 (2.8, 4.2) for NNU admission for ≥48 hours. The higher RR for these pregnancy complications in higher risk categories (vs. category E) was more marked for deliveries within two weeks of assessment. In the case of SGA, both for birth weight <10 and <3 percentile, the observed trend in all cases was stronger than that observed when the analysis was confined to normotensive pregnancies. The rates of neonatal death were too small for meaningful comparisons between risk categories. Women with pregnancies identified by the competing risks model to be at high-risk of PE are also at increased risk of GH, cesarean section, stillbirth, SGA, and NNU admission for ≥48 hours. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.] |
| Keywords | Small for gestational age; Gestational hypertension; Neonatal death; Competing risks model; Stillbirth; Neonatal unit admission; Cesarean section; Pre-eclampsia |
| Year | 2022 |
| Journal | Ultrasound in Obstetrics & Gynecology |
| ISSN | 1469-0705 |
| Digital Object Identifier (DOI) | https://doi.org/10.1002/uog.26036 |
| Publication dates | |
| Online | 22 Jul 2022 |
| Publication process dates | |
| Accepted | 14 Jul 2022 |
| Deposited | 19 Sep 2024 |
| Output status | Published |
| Page range | 10.1002/uog.26036 |
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https://repository.canterbury.ac.uk/item/960yw/competing-risks-model-for-pre-eclampsia-and-adverse-pregnancy-outcomes
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