Boutin Amélie, Gasse Cédric, Demers Suzanne, Giguère Yves, Tétu Amélie, Bujold Emmanuel
Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Centre, Québec City, QC.
Reproduction, Mother and Child Health Unit, CHU de Québec-Université Laval Research Centre, Québec City, QC; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, QC.
J Obstet Gynaecol Can. 2018 May;40(5):572-578. doi: 10.1016/j.jogc.2017.07.025. Epub 2017 Oct 24.
Low-dose aspirin started in early pregnancy significantly reduces the risk of preeclampsia (PE) in high-risk women, especially preterm PE. This study aimed to evaluate the influence of maternal characteristics on the risk of PE in nulliparous women.
The Great Obstetrical Syndromes (GOS) study recruited nulliparous women with singleton pregnancies at 11 to 13 weeks. The following maternal characteristics were collected: age, BMI, ethnicity, chronic diseases, smoking, and assisted reproductive technologies. Relative weight analyses were conducted, and predictive multivariate proportional hazard models were constructed. Receiver operating characteristic curve analyses with their area under the curve (AUC) were used to evaluate the value of each factor for the prediction of PE and preterm PE. The study also evaluated the SOGC guidelines for identification of women at high risk of PE.
Of 4739 participants, 232 (4.9%) developed PE, including 30 (0.6%) with preterm PE. In univariate analyses, only BMI was significantly associated with the risk of PE (AUC 0.60; 95% CI 0.55-0.65) and preterm PE (AUC 0.64; 95% CI 054-0.73). Adding other maternal characteristics to BMI had a non-significant and marginal impact on the discriminative ability to the models for PE (AUC 0.62; 95% CI 0.58-0.66) and preterm PE (AUC 0.65; 95% CI 0.56-0.74). At a false-positive rate of 10%, maternal characteristics could have predicted 23% of PE and 19% of preterm PE. The SOGC guidelines were not discriminant for PE (detecting 96% of PE and 93% of preterm PE with a 94% false-positive rate).
In nulliparous women, BMI is the most discriminant maternal characteristic for the prediction of PE. Maternal characteristics should not be used alone to identify nulliparous women at high risk of PE.
妊娠早期开始服用低剂量阿司匹林可显著降低高危女性患先兆子痫（PE）的风险，尤其是早产型PE。本研究旨在评估产妇特征对初产妇患PE风险的影响。
大产科综合征（GOS）研究招募了孕11至13周的单胎初产妇。收集了以下产妇特征：年龄、体重指数、种族、慢性病、吸烟情况及辅助生殖技术。进行了相对权重分析，并构建了预测性多变量比例风险模型。采用受试者工作特征曲线分析及其曲线下面积（AUC）来评估各因素对PE和早产型PE预测的价值。该研究还评估了加拿大妇产科医师协会（SOGC）关于识别PE高危女性的指南。
在4739名参与者中，232人（4.9%）患了PE，其中30人（0.6%）为早产型PE。在单因素分析中，只有体重指数与PE风险（AUC 0.60；95%可信区间0.55 - 0.65）和早产型PE风险（AUC 0.64；95%可信区间0.54 - 0.73）显著相关。将其他产妇特征加入体重指数后，对PE模型（AUC 0.62；95%可信区间0.58 - 0.66）和早产型PE模型（AUC 0.65；95%可信区间0.56 - 0.74）的判别能力有不显著的微小影响。在假阳性率为10%时，产妇特征可预测23%的PE和19%的早产型PE。SOGC指南对PE的判别能力不强（在假阳性率为94%时，能检测出96%的PE和93%的早产型PE）。
在初产妇中，体重指数是预测PE最具判别力的产妇特征。产妇特征不应单独用于识别PE高危初产妇。
