Department of Clinical Science and Education, Unit of Obstetrics and Gynecology, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
Department of Clinical Sciences, Intervention & Technology, Karolinska Institutet, Stockholm, Sweden.
PLoS One. 2018 Nov 19;13(11):e0206940. doi: 10.1371/journal.pone.0206940. eCollection 2018.
To develop a model for prediction of stillbirth after the 28th gestational week in singleton pregnancies of women with overweight or obesity.
This is a register-based cohort study. The first trimester screening database including data from 2006 until 2015 was cross-linked with the Swedish Medical Birth Register and the Swedish Register of Total Population. The final study cohort comprised 145,319 pregnancies, out of which 45,859 pregnancies were complicated by overweight or obesity and without pre-gestational diabetes. There were in total 282 stillbirths. Prediction models for stillbirth in pregnancies with overweight or obesity were constructed based on maternal characteristics, pregnancy complications and biochemical markers. Receiver Operating Characteristic (ROC) and area under curve (AUC) were calculated, based on logistic regression analyses.
The prevalence of stillbirth was 1.6/1000 births and 2.6/1000 births in normal weight and overweight/obese women, respectively. The final predictive model had an AUC of 0.69 (95% CI: 0.64-0.74) with a sensitivity of 28% at a 90% fixed specificity.
It is possible to predict 28% of stillbirths in overweight or obese women, at a false positive rate of 10%. In particular, growth-restricted fetuses are at increased risk of stillbirth.
为超重或肥胖的单胎妊娠女性 28 孕周后的死产建立预测模型。
这是一项基于登记的队列研究。2006 年至 2015 年的早孕期筛查数据库与瑞典医学出生登记处和瑞典总人口登记处进行了交叉链接。最终的研究队列包括 145319 例妊娠，其中 45859 例妊娠并发超重或肥胖且无妊娠前糖尿病。共有 282 例死产。基于母体特征、妊娠并发症和生化标志物，构建了超重或肥胖妊娠死产的预测模型。基于逻辑回归分析计算了受试者工作特征（ROC）曲线和曲线下面积（AUC）。
正常体重和超重/肥胖女性的死产发生率分别为 1.6/1000 活产和 2.6/1000 活产。最终的预测模型 AUC 为 0.69（95%CI：0.64-0.74），固定特异度为 90%时的灵敏度为 28%。
可以预测超重或肥胖女性 28%的死产，假阳性率为 10%。特别是生长受限的胎儿死产风险增加。
