O24. Prediction of pre-eclampsia in obese nulliparous women

Abstract

Introduction Obese women have an increased risk of pre-eclampsia and may have a distinct mechanism of disease due to factors associated with adiposity and insulin resistance. Objective To develop a prediction model for pre-eclampsia in obese women. Methods SCOPE was a prospective cohort study of 5690 primiparous women. We investigated whether in obese SCOPE participants (BMI ⩾ 30kg/m 2 ) clinical factors and biomarkers measured at 15 weeks gestation, and ultrasound parameters at 20 weeks gestation could predict pre-eclampsia (blood pressure ⩾ 140/90mmHg after 20 weeks' gestation with either proteinuria ⩾ 300mg/24hour urine or protein: creatinine ratio ⩾ 30mg/mmol or urine dipstick protein ⩾ ++ or any multisystem complication of pre-eclampsia). The variables of interest were selected based on a-priory hypothesis. Univariate logistic regression selected factors ( p Results 834 (14.7%) of the SCOPE participants comprised the study population for this analysis. Median BMI was 33.1kg/m 2 (IQR 31.3–36.1kg/m 2 ). Median gestation at delivery was 40 weeks (IQR 38–41 weeks) and median birth weight was 3520g (IQR 3150–3850g). 9.2% (77 cases) developed pre-eclampsia. Factors associated with pre-eclampsia in univariate analysis were family history of venous thromboembolism (VTE) or cerebrovascular accident (CVA) ( p ( p =0.029); hip circumference at 15 weeks ( p =0.020); HDL cholesterol ( p =0.003); adiponectin ( p =0.037); natriuretic peptide A (ANP) propeptide ( p =0.046); natriuretic peptide B (BNP) ( p =0.031); placental growth factor (PLGF) ( p 0.001) and abnormal uterine artery Doppler (UtA-RI) ( p =0.002). In multivariate analysis family history of VTE or CVA (OR 2.7; 95%CI 1.5–4.7); HDL cholesterol 50mg/dl (OR 2.7; 95%CI 1.5–5.1) and PLGF (per log unit) (OR 0.6; 95%CI 0.4–0.7) were selected by stepwise procedure. The final model had an area under (AU) ROC of 0.68 (95%CI 0.62–0.75). Detection rates were 25.9% and 53.2% for a false positive rate of 10% and 25%, respectively. Conclusion The factors associated with later onset of pre-eclampsia in obese women are mainly cardiovascular but have only a moderate predictive performance.