External validation and clinical usefulness of first‐trimester prediction models for small‐ and large‐for‐gestational‐age infants: a prospective cohort study

Objective To assess the external validity of all published first‐trimester prediction models based on routinely collected maternal predictors for the risk of small‐ and large‐for‐gestational‐age (SGA and LGA) infants. Furthermore, the clinical potential of the best‐performing models was evaluated. D...

Full description

Saved in:

Bibliographic Details
Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 126; no. 4; pp. 472 - 484
Main Authors:	Meertens, LJE, Smits, LJM, Kuijk, SMJ, Aardenburg, R, Dooren, IMA, Langenveld, J, Zwaan, IM, Spaanderman, MEA, Scheepers, HCJ
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-03-2019 John Wiley and Sons Inc
Subjects:	Adult Age Birth weight Cohort analysis Cohort Studies Decision curve analysis Diabetes mellitus Epidemiology externsal validation Female fetal growth Fetal Macrosomia - epidemiology Fetuses first trimester Gestational age Gestational diabetes Health risk assessment Humans Infant, Newborn Infant, Small for Gestational Age Infants large for gestational age Minority & ethnic groups Models, Statistical Netherlands - epidemiology prediction Prediction models Pregnancy Pregnancy Trimester, First Prospective Studies Reproducibility of Results risk assessment small for gestational age Statistical analysis Statistics Netherlands risk assessment externsal validation first trimester small for gestational age prediction large for gestational age Decision curve analysis fetal growth
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective To assess the external validity of all published first‐trimester prediction models based on routinely collected maternal predictors for the risk of small‐ and large‐for‐gestational‐age (SGA and LGA) infants. Furthermore, the clinical potential of the best‐performing models was evaluated. Design Multicentre prospective cohort. Setting Thirty‐six midwifery practices and six hospitals (in the Netherlands). Population Pregnant women were recruited at <16 weeks of gestation between 1 July 2013 and 31 December 2015. Methods Prediction models were systematically selected from the literature. Information on predictors was obtained by a web‐based questionnaire. Birthweight centiles were corrected for gestational age, parity, fetal sex, and ethnicity. Main outcome measures Predictive performance was assessed by means of discrimination (C‐statistic) and calibration. Results The validation cohort consisted of 2582 pregnant women. The outcomes of SGA <10th percentile and LGA >90th percentile occurred in 203 and 224 women, respectively. The C‐statistics of the included models ranged from 0.52 to 0.64 for SGA (n = 6), and from 0.60 to 0.69 for LGA (n = 6). All models yielded higher C‐statistics for more severe cases of SGA (<5th percentile) and LGA (>95th percentile). Initial calibration showed poor‐to‐moderate agreement between the predicted probabilities and the observed outcomes, but this improved substantially after recalibration. Conclusion The clinical relevance of the models is limited because of their moderate predictive performance, and because the definitions of SGA and LGA do not exclude constitutionally small or large infants. As most clinically relevant fetal growth deviations are related to ‘vascular’ or ‘metabolic’ factors, models predicting hypertensive disorders and gestational diabetes are likely to be more specific. Tweetable The clinical relevance of prediction models for the risk of small‐ and large‐for‐gestational‐age is limited. Tweetable The clinical relevance of prediction models for the risk of small‐ and large‐for‐gestational‐age is limited.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Linked article This article is commented on by J Allotey and S Thangaratinam, p. 485 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.15564.
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.15516