Competing-risks model for pre-eclampsia and adverse pregnancy outcomes

A. Syngelaki; L. A. Magee; P. von Dadelszen; R. Akolekar; A. Wright; D. Wright; K. H. Nicolaides

doi:10.1002/uog.26036

Competing-risks model for pre-eclampsia and adverse pregnancy outcomes

A. Syngelaki, L. A. Magee, P. von Dadelszen, R. Akolekar, A. Wright, D. Wright, K. H. Nicolaides^*

^*Corresponding author for this work

Women & Children's Health

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Objective: The competing-risks model for assessment of risk for pre-eclampsia (PE) at 35–37 weeks' gestation identifies the majority of women who are at high risk of subsequent delivery with PE. We aimed to examine the incidence and relative risk of adverse pregnancy outcomes in patient groups stratified according to the estimated risk of delivery with PE. Methods: This was a prospective non-interventional, observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated using the competing-risks model, combining the prior distribution of gestational age at delivery with PE and the likelihood from multiples of the median values of mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase-1. The patients were assigned to one of the following five risk categories: Group A, ≥ 1 in 2; Group B, 1 in 5 to 1 in 3; Group C, 1 in 20 to 1 in 6; Group D, 1 in 50 to 1 in 21; and Group E, < 1 in 50. The outcome measures were delivery with PE, gestational hypertension (GH), small-for-gestational age (SGA) at birth, delivery by Cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for at least 48 h. In each risk category, the proportion of women with each adverse outcome was determined and relative risks (RR) were calculated as compared with the lowest-risk Group E. Results: In the study population of 29 035 women, 1.6%, 2.7%, 8.2%, 9.8% and 77.8% were categorized into Groups A, B, C, D and E, respectively. Compared with women in Group E, women in the higher-risk groups were more likely to have an adverse outcome. The RR of delivery with PE in Group A compared with Group E was 65.5 (95% CI, 54.1–79.1) and the respective values were 11.9 (95% CI, 9.1–15.5) for GH, 1.8 (95% CI, 1.5–2.1) for delivery by emergency Cesarean section, 1.5 (95% CI, 1.2–1.8) for delivery by elective Cesarean section, 8.9 (95% CI, 7.4–10.8) for SGA with birth weight < 3^rd percentile, 4.8 (95% CI, 4.3–5.4) for SGA with birth weight < 10^th percentile, 5.3 (95% CI, 1.4–20.5) for stillbirth and 3.4 (95% CI, 2.8–4.2) for NNU admission for ≥ 48 h. The RR for these pregnancy complications in higher-risk groups (vs Group E) was particularly high for cases with delivery within 2 weeks after assessment. In terms of SGA, both for birth weight < 10^th and < 3^rd percentiles, the 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 to allow meaningful comparisons between risk groups. Conclusion: Pregnant women 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 h.

Original language	English
Pages (from-to)	367-372
Number of pages	6
Journal	Ultrasound in Obstetrics and Gynecology
Volume	60
Issue number	3
DOIs	https://doi.org/10.1002/uog.26036
Publication status	Published - 1 Sept 2022

Keywords

Cesarean section
competing-risks model
gestational hypertension
neonatal death
neonatal unit admission
pre-eclampsia
small-for-gestational age
stillbirth

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/uog.26036

Cite this

@article{b61587cb1cb3405e9b3db5bae004571e,

title = "Competing-risks model for pre-eclampsia and adverse pregnancy outcomes",

abstract = "Objective: The competing-risks model for assessment of risk for pre-eclampsia (PE) at 35–37 weeks' gestation identifies the majority of women who are at high risk of subsequent delivery with PE. We aimed to examine the incidence and relative risk of adverse pregnancy outcomes in patient groups stratified according to the estimated risk of delivery with PE. Methods: This was a prospective non-interventional, observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated using the competing-risks model, combining the prior distribution of gestational age at delivery with PE and the likelihood from multiples of the median values of mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase-1. The patients were assigned to one of the following five risk categories: Group A, ≥ 1 in 2; Group B, 1 in 5 to 1 in 3; Group C, 1 in 20 to 1 in 6; Group D, 1 in 50 to 1 in 21; and Group E, < 1 in 50. The outcome measures were delivery with PE, gestational hypertension (GH), small-for-gestational age (SGA) at birth, delivery by Cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for at least 48 h. In each risk category, the proportion of women with each adverse outcome was determined and relative risks (RR) were calculated as compared with the lowest-risk Group E. Results: In the study population of 29 035 women, 1.6%, 2.7%, 8.2%, 9.8% and 77.8% were categorized into Groups A, B, C, D and E, respectively. Compared with women in Group E, women in the higher-risk groups were more likely to have an adverse outcome. The RR of delivery with PE in Group A compared with Group E was 65.5 (95% CI, 54.1–79.1) and the respective values were 11.9 (95% CI, 9.1–15.5) for GH, 1.8 (95% CI, 1.5–2.1) for delivery by emergency Cesarean section, 1.5 (95% CI, 1.2–1.8) for delivery by elective Cesarean section, 8.9 (95% CI, 7.4–10.8) for SGA with birth weight < 3rd percentile, 4.8 (95% CI, 4.3–5.4) for SGA with birth weight < 10th percentile, 5.3 (95% CI, 1.4–20.5) for stillbirth and 3.4 (95% CI, 2.8–4.2) for NNU admission for ≥ 48 h. The RR for these pregnancy complications in higher-risk groups (vs Group E) was particularly high for cases with delivery within 2 weeks after assessment. In terms of SGA, both for birth weight < 10th and < 3rd percentiles, the 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 to allow meaningful comparisons between risk groups. Conclusion: Pregnant women 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 h.",

keywords = "Cesarean section, competing-risks model, gestational hypertension, neonatal death, neonatal unit admission, pre-eclampsia, small-for-gestational age, stillbirth",

author = "A. Syngelaki and Magee, {L. A.} and {von Dadelszen}, P. and R. Akolekar and A. Wright and D. Wright and Nicolaides, {K. H.}",

note = "Funding Information: The study was supported by grants from the Fetal Medicine Foundation (UK Charity No: 1037116). Reagents and equipment for the measurement of serum PlGF and sFlt‐1 were provided free of charge by Thermo Fisher Scientific, Hennigsdorf, Germany. These bodies had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2022 International Society of Ultrasound in Obstetrics and Gynecology.",

year = "2022",

month = sep,

day = "1",

doi = "10.1002/uog.26036",

language = "English",

volume = "60",

pages = "367--372",

journal = "Ultrasound in Obstetrics and Gynecology",

issn = "0960-7692",

publisher = "John Wiley and Sons Ltd",

number = "3",

}

TY - JOUR

T1 - Competing-risks model for pre-eclampsia and adverse pregnancy outcomes

AU - Syngelaki, A.

AU - Magee, L. A.

AU - von Dadelszen, P.

AU - Akolekar, R.

AU - Wright, A.

AU - Wright, D.

AU - Nicolaides, K. H.

N1 - Funding Information: The study was supported by grants from the Fetal Medicine Foundation (UK Charity No: 1037116). Reagents and equipment for the measurement of serum PlGF and sFlt‐1 were provided free of charge by Thermo Fisher Scientific, Hennigsdorf, Germany. These bodies had no involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. Publisher Copyright: © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Objective: The competing-risks model for assessment of risk for pre-eclampsia (PE) at 35–37 weeks' gestation identifies the majority of women who are at high risk of subsequent delivery with PE. We aimed to examine the incidence and relative risk of adverse pregnancy outcomes in patient groups stratified according to the estimated risk of delivery with PE. Methods: This was a prospective non-interventional, observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated using the competing-risks model, combining the prior distribution of gestational age at delivery with PE and the likelihood from multiples of the median values of mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase-1. The patients were assigned to one of the following five risk categories: Group A, ≥ 1 in 2; Group B, 1 in 5 to 1 in 3; Group C, 1 in 20 to 1 in 6; Group D, 1 in 50 to 1 in 21; and Group E, < 1 in 50. The outcome measures were delivery with PE, gestational hypertension (GH), small-for-gestational age (SGA) at birth, delivery by Cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for at least 48 h. In each risk category, the proportion of women with each adverse outcome was determined and relative risks (RR) were calculated as compared with the lowest-risk Group E. Results: In the study population of 29 035 women, 1.6%, 2.7%, 8.2%, 9.8% and 77.8% were categorized into Groups A, B, C, D and E, respectively. Compared with women in Group E, women in the higher-risk groups were more likely to have an adverse outcome. The RR of delivery with PE in Group A compared with Group E was 65.5 (95% CI, 54.1–79.1) and the respective values were 11.9 (95% CI, 9.1–15.5) for GH, 1.8 (95% CI, 1.5–2.1) for delivery by emergency Cesarean section, 1.5 (95% CI, 1.2–1.8) for delivery by elective Cesarean section, 8.9 (95% CI, 7.4–10.8) for SGA with birth weight < 3rd percentile, 4.8 (95% CI, 4.3–5.4) for SGA with birth weight < 10th percentile, 5.3 (95% CI, 1.4–20.5) for stillbirth and 3.4 (95% CI, 2.8–4.2) for NNU admission for ≥ 48 h. The RR for these pregnancy complications in higher-risk groups (vs Group E) was particularly high for cases with delivery within 2 weeks after assessment. In terms of SGA, both for birth weight < 10th and < 3rd percentiles, the 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 to allow meaningful comparisons between risk groups. Conclusion: Pregnant women 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 h.

AB - Objective: The competing-risks model for assessment of risk for pre-eclampsia (PE) at 35–37 weeks' gestation identifies the majority of women who are at high risk of subsequent delivery with PE. We aimed to examine the incidence and relative risk of adverse pregnancy outcomes in patient groups stratified according to the estimated risk of delivery with PE. Methods: This was a prospective non-interventional, observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated using the competing-risks model, combining the prior distribution of gestational age at delivery with PE and the likelihood from multiples of the median values of mean arterial pressure, placental growth factor and soluble fms-like tyrosine kinase-1. The patients were assigned to one of the following five risk categories: Group A, ≥ 1 in 2; Group B, 1 in 5 to 1 in 3; Group C, 1 in 20 to 1 in 6; Group D, 1 in 50 to 1 in 21; and Group E, < 1 in 50. The outcome measures were delivery with PE, gestational hypertension (GH), small-for-gestational age (SGA) at birth, delivery by Cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for at least 48 h. In each risk category, the proportion of women with each adverse outcome was determined and relative risks (RR) were calculated as compared with the lowest-risk Group E. Results: In the study population of 29 035 women, 1.6%, 2.7%, 8.2%, 9.8% and 77.8% were categorized into Groups A, B, C, D and E, respectively. Compared with women in Group E, women in the higher-risk groups were more likely to have an adverse outcome. The RR of delivery with PE in Group A compared with Group E was 65.5 (95% CI, 54.1–79.1) and the respective values were 11.9 (95% CI, 9.1–15.5) for GH, 1.8 (95% CI, 1.5–2.1) for delivery by emergency Cesarean section, 1.5 (95% CI, 1.2–1.8) for delivery by elective Cesarean section, 8.9 (95% CI, 7.4–10.8) for SGA with birth weight < 3rd percentile, 4.8 (95% CI, 4.3–5.4) for SGA with birth weight < 10th percentile, 5.3 (95% CI, 1.4–20.5) for stillbirth and 3.4 (95% CI, 2.8–4.2) for NNU admission for ≥ 48 h. The RR for these pregnancy complications in higher-risk groups (vs Group E) was particularly high for cases with delivery within 2 weeks after assessment. In terms of SGA, both for birth weight < 10th and < 3rd percentiles, the 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 to allow meaningful comparisons between risk groups. Conclusion: Pregnant women 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 h.

KW - Cesarean section

KW - competing-risks model

KW - gestational hypertension

KW - neonatal death

KW - neonatal unit admission

KW - pre-eclampsia

KW - small-for-gestational age

KW - stillbirth

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U2 - 10.1002/uog.26036

DO - 10.1002/uog.26036

M3 - Article

C2 - 35866878

AN - SCOPUS:85137135606

SN - 0960-7692

VL - 60

SP - 367

EP - 372

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

IS - 3

ER -

Competing-risks model for pre-eclampsia and adverse pregnancy outcomes

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Keywords

UN SDGs

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