TY - JOUR
T1 - Prediction of uncomplicated pregnancies in obese women
T2 - a prospective multicentre study
AU - Vieira, Matias C.
AU - White, Sara L.
AU - Patel, Nashita
AU - Seed, Paul T.
AU - Briley, Annette L.
AU - Sandall, Jane
AU - Welsh, Paul
AU - Sattar, Naveed
AU - Nelson, Scott M.
AU - Lawlor, Debbie A.
AU - Poston, Lucilla
AU - Pasupathy, Dharmintra
AU - on behalf of the UPBEAT Consortium
AU - Shennan, Andrew
AU - Briley, Annette
AU - Singh, Claire
AU - Sanders, Thomas
AU - Flynn, Angela
AU - Badger, Shirlene
AU - Barr, Suzanne
AU - Holmes, Bridget
AU - Goff, Louise
AU - Hunt, Clare
AU - Filmer, Judy
AU - Fetherstone, Jeni
AU - Scholtz, Laura
AU - Tarft, Hayley
AU - Lucas, Anna
AU - Tekletdadik, Tsigerada
AU - Ricketts, Deborah
AU - Gill, Carolyn
AU - Ignatian, Alex Seroge
AU - Boylen, Catherine
AU - Adegoke, Funso
AU - Lawley, Elodie
AU - Butler, James
AU - Maitland, Rahat
AU - Vieira, Matias
AU - Oteng-Ntim, Eugene
AU - Khazaezadeh, Nina
AU - Demilew, Jill
AU - O'Connor, Sile
AU - Evans, Yvonne
AU - O'Donnell, Susan
AU - de la Llera, Ari
AU - Gutzwiller, Georgina
AU - Hagg, Linda
AU - Robson, Stephen
AU - Bell, Ruth
AU - Hayes, Louise
AU - Kinnunen, Tarja
AU - McParlin, Catherine
AU - Miller, Nicola
AU - Kimber, Alison
AU - Riches, Jill
AU - Allen, Carly
AU - Boag, Claire
AU - Campbell, Fiona
AU - Fenn, Andrea
AU - Ritson, Sarah
AU - Rennie, Alison
AU - Durkin, Robin
AU - Gills, Gayle
AU - Carr, Roger
AU - McSorley, Therese
AU - Alba, Hilary
AU - Paterson, Kirsteen
AU - Johnston, Janet
AU - Clements, Suzanne
AU - Fernon, Maxine
AU - Bett, Savannah
AU - Rooney, Laura
AU - Miller, Sinead
AU - Cherry, Lynn
AU - Whitworth, Melissa
AU - Patterson, Natalie
AU - Lee, Sarah
AU - Grimshaw, Rachel
AU - Hughes, Christine
AU - Brown, Jay
AU - Hinshaw, Kim
AU - Campbell, Gillian
AU - Knight, Joanne
AU - Farrar, Diane
AU - Jones, Vicky
AU - Butterfield, Gillian
AU - Syson, Jennifer
AU - Eadle, Jennifer
AU - Wood, Dawn
AU - Todd, Merane
AU - Khalil, Asma
AU - Brown, Deborah
AU - Fernandez, Paola
AU - Cousins, Emma
AU - Smith, Melody
AU - Wardle, Jane
AU - Croker, Helen
AU - Broomfield, Laura
AU - Godfrey, Keith
AU - Robinson, Sian
AU - Canadine, Sarah
AU - Greenwood, Lynne
AU - Nelson-Piercy, Catherine
AU - Amiel, Stephanie
AU - Goldberg, Gail
AU - Rajasingham, Daghni
AU - Jackson, Penny
AU - Kenyon, Sara
AU - Catalano, Patrick
PY - 2017
Y1 - 2017
N2 - Background: All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. Methods: Data form obese women (BMI ≥ 30 kg/m2) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15+0 to 18+6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. Results: Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m2), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. Conclusion: Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth.
AB - Background: All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. Methods: Data form obese women (BMI ≥ 30 kg/m2) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15+0 to 18+6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. Results: Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m2), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. Conclusion: Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth.
KW - Birth
KW - Obesity
KW - Prediction
KW - Pregnancy outcome
KW - Risk stratification
KW - Uncomplicated pregnancy
UR - http://www.scopus.com/inward/record.url?scp=85032734413&partnerID=8YFLogxK
U2 - 10.1186/s12916-017-0956-8
DO - 10.1186/s12916-017-0956-8
M3 - Article
C2 - 29096631
AN - SCOPUS:85032734413
VL - 15
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
M1 - 194
ER -