Department of Midwifery, Varamin - Pishva Branch, Islamic Azad University, Tehran, Iran; Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Eur J Obstet Gynecol Reprod Biol. 2023 May;284:125-130. doi: 10.1016/j.ejogrb.2023.03.025. Epub 2023 Mar 23.
Thyroid dysfunction and TPOAb positivity during pregnancy are associated with adverse pregnancy outcomes such as preterm delivery. The aim of this study was to predict preterm delivery based on identified risk factors, especially TPOAb levels.
A secondary analysis was run on data collected in the Tehran Thyroid and Pregnancy study (TTPs). We used the data of 1515 pregnant women with singletons. The association between risk factors and preterm birth (delivery before 37 completed weeks of gestation) was investigated in univariate analysis. Multivariate logistic regression analysis was performed to identify independent risk factors, and a stepwise backward elimination method was used to determine the helpful combination of risk factors. The nomogram was developed based on a multivariate logistic regression model. The performance of the nomogram was evaluated using a concordance index and calibration plots with bootstrap samples. Statistical analysis was performed using STATA software package; the significance level was set at P < 0.05.
Based on multivariate logistic regression analysis, a combination of previous preterm delivery [OR: 5.25; 95 %CI: (2.13-12.90), p < 0.01], TPOAb [OR: 1.01; 95 %CI: (1.01-1.02), and T4 [OR: 0.90; 95 %CI: (0.83-0.97); p = 0.04] as independent risk factors that most precisely predicted preterm birth. The area under the curve (AUC) was 0.66 (95% CI: 0.61-0.72). The calibration plot suggests that the fit of the nomogram is reasonable.
A combination of T4, TPOAb, and previous preterm delivery was identified as independent risk factors that accurately predicted preterm delivery. The total score obtained based on the nomogram designed based on risk factors can predict the risk of preterm delivery.
甲状腺功能障碍和 TPOAb 阳性在孕期与不良妊娠结局相关，如早产。本研究旨在根据已确定的风险因素，特别是 TPOAb 水平，预测早产。
对 Tehran Thyroid and Pregnancy 研究（TTPs）中收集的数据进行了二次分析。我们使用了 1515 名单胎孕妇的数据。在单变量分析中，研究了风险因素与早产（分娩前 37 周完成）之间的关系。使用多元逻辑回归分析识别独立的风险因素，并使用逐步后退消除法确定风险因素的有用组合。根据多元逻辑回归模型制定了列线图。使用 bootstrap 样本的一致性指数和校准图评估列线图的性能。使用 STATA 软件包进行统计分析；显著性水平设置为 P < 0.05。
基于多元逻辑回归分析，以前的早产史[OR：5.25；95%CI：（2.13-12.90），p < 0.01]、TPOAb[OR：1.01；95%CI：（1.01-1.02）]和 T4[OR：0.90；95%CI：（0.83-0.97）；p = 0.04]是最能准确预测早产的独立风险因素。曲线下面积（AUC）为 0.66（95%CI：0.61-0.72）。校准图表明列线图的拟合合理。
T4、TPOAb 和以前的早产史被确定为独立的风险因素，可以准确预测早产。基于风险因素设计的列线图获得的总评分可以预测早产的风险。
