Abstract
Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death. Our study aimed to develop and validate a prognostic prediction model for severe maternal outcomes among Chinese population with pre-eclampsia. We conducted a 10-year cohort study in a referral center by collecting all pregnant women who diagnosed as pre-eclampsia and delivered from 2005 to 2014. A composite of severe maternal outcomes, including maternal near-miss defined by World Health Organization, cortical blindness/retinal detachment, temporary facial paralysis and maternal death, were adopted. We used logistic regression model to develop Model 1 by retaining the predictors of p < 0.05, and further conducted Model 2 by adding quadratic terms and interaction terms to Model 1. We undertook a bootstrapping validation and estimated the model performance. A total of 397 pregnant women suffered from severe maternal outcomes among 2,793 eligible participants, with an incidence of 14.21% (95% confidence interval (CI) 12.91%–15.51%). Of 13 predictors were finally selected in Model 1. Combined with quadratic and interactive terms, the Model 2 showed higher area under the ROC curve (82.2%, 95% CI 79.6%–84.7%) and good calibration. By the bootstrapping validation, similar model performances were present.
Highlights
Pre-eclampsia is a severe hypertensive disorder of pregnancy and could lead to severe maternal morbidities and death
By collecting the data of all pregnant women who diagnosed as pre-eclampsia and delivered at West China Second Hospital from May 1, 2005 to December 31, 2014, we developed and validated a prediction model for severe maternal outcomes in pregnant women with pre-eclampsia
To comprehensively consider multiple organ dysfunction caused by pre-eclampsia, this study adopted a composite of severe maternal outcomes in pregnant women, including maternal near-miss and maternal death
Summary
This study was reported in accordance with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. By collecting the data of all pregnant women who diagnosed as pre-eclampsia and delivered at West China Second Hospital from May 1, 2005 to December 31, 2014, we developed and validated a prediction model for severe maternal outcomes in pregnant women with pre-eclampsia. To comprehensively consider multiple organ dysfunction caused by pre-eclampsia, this study adopted a composite of severe maternal outcomes in pregnant women, including maternal near-miss and maternal death. In this study, based on previous literatures and accessibility of indicators in clinical practice, candidate predictors were considered from the following six aspects: demographic characteristics (maternal age (years), registered residential place, height (meter), pre-pregnancy weight (kilogram), and prepregnancy body mass index (BMI, kg/m2)), gestational characteristics (gestational age at admission (weeks), gestational age at delivery (weeks), gravidity, parity, use of assisted reproductive technology (ART), number. All statistical analyses were conducted by STATA 13.0 (StataCorp, College Station, TX, USA)
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