External validation and clinical usefulness of first-trimester prediction models for small- and large-for-gestational-age infants: a prospective cohort study

Autor: Josje Langenveld, M. Spaanderman, Ima van Dooren, Robert Aardenburg, Lje Meertens, Hcj Scheepers, Smj van Kuijk, Ljm Smits, IM Zwaan
Přispěvatelé: RS: CAPHRI - R5 - Optimising Patient Care, Promovendi PHPC, Epidemiologie, MUMC+: KIO Kemta (9), RS: CAPHRI - R2 - Creating Value-Based Health Care, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), RS: GROW - R4 - Reproductive and Perinatal Medicine
Jazyk: angličtina
Rok vydání: 2019
Předmět:
MACROSOMIA
Percentile
large for gestational age
Fetal Macrosomia
Cohort Studies
small for gestational age
0302 clinical medicine
Pregnancy
Medicine
Prospective Studies
Prospective cohort study
Netherlands
education.field_of_study
030219 obstetrics & reproductive medicine
INDEPENDENT RISK-FACTOR
Obstetrics
UTERINE ARTERY DOPPLER
Obstetrics and Gynecology
Gestational age
risk assessment
BIRTH-WEIGHT CENTILES
Gestational diabetes
PREECLAMPSIA
Infant
Small for Gestational Age
Female
PLACENTAL VOLUME
Risk assessment
Adult
medicine.medical_specialty
externsal validation
MATERNAL SERUM
Population
Decision curve analysis
External validity
03 medical and health sciences
MORBIDITY
Humans
education
Models
Statistical
business.industry
MORTALITY
Infant
Newborn
Reproducibility of Results
prediction
medicine.disease
Pregnancy Trimester
First
Small for gestational age
business
FETAL-GROWTH RESTRICTION
first trimester
fetal growth
Zdroj: Bjog-an International Journal of Obstetrics and Gynaecology, 126(4), 472-484. Wiley
ISSN: 1470-0328
Popis: Objective To assess the external validity of all published first-trimester prediction models based on routinely collected maternal predictors for the risk of small- and large-for-gestational-age (SGA and LGA) infants. Furthermore, the clinical potential of the best-performing models was evaluated. Design Multicentre prospective cohort. Setting Thirty-six midwifery practices and six hospitals (in the Netherlands). Population Pregnant women were recruited at Methods Prediction models were systematically selected from the literature. Information on predictors was obtained by a web-based questionnaire. Birthweight centiles were corrected for gestational age, parity, fetal sex, and ethnicity. Main outcome measures Predictive performance was assessed by means of discrimination (C-statistic) and calibration. Results The validation cohort consisted of 2582 pregnant women. The outcomes of SGA 90th percentile occurred in 203 and 224 women, respectively. The C-statistics of the included models ranged from 0.52 to 0.64 for SGA (n = 6), and from 0.60 to 0.69 for LGA (n = 6). All models yielded higher C-statistics for more severe cases of SGA ( 95th percentile). Initial calibration showed poor-to-moderate agreement between the predicted probabilities and the observed outcomes, but this improved substantially after recalibration. Conclusion The clinical relevance of the models is limited because of their moderate predictive performance, and because the definitions of SGA and LGA do not exclude constitutionally small or large infants. As most clinically relevant fetal growth deviations are related to 'vascular' or 'metabolic' factors, models predicting hypertensive disorders and gestational diabetes are likely to be more specific. Tweetable abstract The clinical relevance of prediction models for the risk of small- and large-for-gestational-age is limited.
Databáze: OpenAIRE
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