TY - JOUR
T1 - Prediction of stillbirth
T2 - an umbrella review of evaluation of prognostic variables
AU - Townsend, R.
AU - Sileo, F. G.
AU - Allotey, J.
AU - Dodds, J.
AU - Heazell, A.
AU - Jorgensen, L.
AU - Kim, V. B.
AU - Magee, L.
AU - Mol, B.
AU - Sandall, J.
AU - Smith, G. C.S.
AU - Thilaganathan, B.
AU - von Dadelszen, P.
AU - Thangaratinam, S.
AU - Khalil, A.
N1 - Funding Information:
AH,BT, AK, ST and BWM report a grant from the Stillbirth and Neonatal Death Society. GCS reports grants and personal fees from GlaxoSmithKline Research and Development Limited, grants and non‐financial support from Sera Prognostics Inc, non‐financial support from Illumina Inc, grants, personal fees and non‐financial support from Roche Diagnostics Ltd, outside the submitted work. In addition GCS has a patent pending for a biomarker test to predict human fetal growth restriction. .
Publisher Copyright:
© 2020 John Wiley & Sons Ltd.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. Objectives: To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. Search strategy: MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. Selection criteria: We included systematic reviews of association of individual variables with stillbirth without language restriction. Data collection and analysis: Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. Results: The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. Conclusion: We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. Tweetable abstract: Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
AB - Background: Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. Objectives: To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. Search strategy: MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. Selection criteria: We included systematic reviews of association of individual variables with stillbirth without language restriction. Data collection and analysis: Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. Results: The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. Conclusion: We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. Tweetable abstract: Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
KW - Epidemiology: perinatal
KW - fetal medicine: perinatal diagnosis
KW - fetal medicine: serum screening
KW - systematic reviews
KW - ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85092333301&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.16510
DO - 10.1111/1471-0528.16510
M3 - Review article
C2 - 32931648
AN - SCOPUS:85092333301
SN - 1470-0328
VL - 128
SP - 238
EP - 250
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 2
ER -
