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Competing-risks model for pre-eclampsia and adverse pregnancy outcomes.

A Syngelaki¹, L A Magee², P von Dadelszen²

¹Fetal Medicine Research Institute, King's College Hospital, London, UK.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology

|July 22, 2022

Summary

The competing-risks model accurately identifies pregnant women at high risk for pre-eclampsia (PE) and other adverse outcomes like gestational hypertension and stillbirth. This risk stratification aids in managing pregnancy complications.

Keywords:

Cesarean section competing-risks model gestational hypertension neonatal death neonatal unit admission pre-eclampsia small-for-gestational age stillbirth

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Area of Science:

Maternal-fetal medicine
Obstetrics
Perinatal outcomes

Background:

Pre-eclampsia (PE) poses significant risks to maternal and fetal well-being.
Accurate risk assessment for PE is crucial for timely intervention.
Existing models aim to identify high-risk pregnancies for better management.

Purpose of the Study:

To evaluate the incidence and relative risk of adverse pregnancy outcomes in women stratified by PE risk.
To validate the competing-risks model for predicting PE and associated complications.

Main Methods:

Prospective observational study of 29,035 women at 35-37 weeks gestation.
Utilized a competing-risks model incorporating maternal factors and biomarkers to estimate PE risk.
Categorized women into five risk groups (A-E) and assessed outcomes including PE, gestational hypertension, SGA, and Cesarean section.

Main Results:

Higher risk groups showed significantly increased likelihood of adverse outcomes compared to the lowest-risk group (Group E).
Relative risks (RR) for PE delivery in Group A vs. E was 65.5.
Elevated RRs observed for gestational hypertension (11.9), SGA (4.8-8.9), Cesarean section (1.5-1.8), and stillbirth (5.3).

Conclusions:

The competing-risks model effectively identifies women at high risk for PE.
High-risk pregnancies identified by the model are also associated with increased risks of gestational hypertension, Cesarean section, stillbirth, and SGA.
This model aids in predicting multiple adverse pregnancy outcomes, enabling targeted clinical management.