Bucher Valentina, Mitchell Alexandra Roddy, Gudmundsson Pia, Atkinson Jessica, Wallin Nicole, Asp Joline, Sennström Maria, Hildén Karin, Edvinsson Camilla, Ek Joakim, Hastie Roxanne, Cluver Catherine, Bergman Lina
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Melbourne, Australia.
EClinicalMedicine. 2024 Sep 27;76:102861. doi: 10.1016/j.eclinm.2024.102861. eCollection 2024 Oct.
Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. If women at high risk for developing complications could be identified early, level of care could be triaged, limited resources could be correctly allocated and targeted interventions to prevent complications could be implemented.
We updated a systematic review and meta-analysis and added single outcomes. Women with hypertensive disorders of pregnancy were included. Exposures were tests predicting adverse maternal and/or perinatal outcomes. We searched Medline, Embase, CINAHL, and Cochrane library from January 2016-February 2024. We included studies identified from the previous review. We calculated effect measures. For similar predictive tests and outcomes, area under the receiver-operating-characteristic curve (AUROC) were pooled. This study was registered by PROSPERO: CRD42022336368.
Of the 2898 studies identified, 80 were included. Thirty were added from the previous review resulting in 110 included studies with 506,178 women. Despite more than 1500 tests being performed, most outcomes could not be pooled due to heterogeneity in populations, tests, and outcome definitions. For maternal outcomes, only studies reporting on the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) model could be pooled. For the composite outcome within 48-h the AUROC was 0.78 (95% CI 0.71-0.86, N = 8). There was significant heterogeneity ( = 95.7%). For perinatal outcomes, data were pooled for pulsatility index in the umbilical artery and soluble FMS-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio. Biomarkers like the sFlt-1/PlGF ratio showed promising predictive performance for some outcomes but were not externally validated.
Despite including over 100 studies with more than 1500 predictors, we were unable to pool any single maternal outcomes and only a few individual perinatal outcomes. The fullPIERS model was externally validated, showing moderate accuracy which varied across studies and should be validated in each new population. Angiogenic biomarkers showed promise but need validation. Future studies should use standardized outcome measures and validate promising tests.
VB is supported by the Swedish Research Council, Grant number 2020-01481. University of Gothenburg.
妊娠期高血压疾病是孕产妇和围产期发病及死亡的主要原因。如果能够早期识别有发生并发症高风险的女性，就可以对护理级别进行分类，正确分配有限的资源，并实施针对性干预措施以预防并发症。
我们更新了一项系统评价和荟萃分析，并增加了单一结局。纳入患有妊娠期高血压疾病的女性。暴露因素为预测孕产妇和/或围产期不良结局的检测方法。我们检索了2016年1月至2024年2月期间的Medline、Embase、CINAHL和Cochrane图书馆。我们纳入了上次综述中识别出的研究。我们计算了效应量。对于相似的预测性检测方法和结局，合并了受试者工作特征曲线下面积（AUROC）。本研究已在PROSPERO注册：CRD42022336368。
在识别出的2898项研究中,纳入了80项。在上次综述的基础上新增了30项，最终纳入110项研究，涉及506,178名女性。尽管进行了1500多项检测，但由于人群、检测方法和结局定义的异质性，大多数结局无法合并。对于孕产妇结局，仅能合并报告子痫前期综合风险评估（fullPIERS）模型的研究。对于48小时内的复合结局，AUROC为0.78（95%CI 0.71 - 0.86，N = 8）。存在显著异质性（I² = 95.7%）。对于围产期结局，合并了脐动脉搏动指数和可溶性FMS样酪氨酸激酶-1（sFlt-1）/胎盘生长因子（PlGF）比值的数据。像sFlt-1/PlGF比值这样的生物标志物对某些结局显示出有前景的预测性能，但未经过外部验证。
尽管纳入了100多项研究及1500多个预测指标，但我们无法合并任何单一的孕产妇结局，仅能合并少数几个围产期个体结局。fullPIERS模型经过了外部验证，显示出中等准确性，且在不同研究中有所差异，应在每个新人群中进行验证。血管生成生物标志物显示出前景，但需要验证。未来的研究应使用标准化结局指标，并验证有前景的检测方法。
VB得到瑞典研究理事会的支持，资助编号2020 - 01481。哥德堡大学。
