Prediction of adverse maternal and perinatal outcomes associated with pre-eclampsia and hypertensive disorders of pregnancy : a systematic review and meta-analysis
(2024) In EClinicalMedicine 76.- Abstract
Background: 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. Methods: 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... (More)
Background: 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. Methods: 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. Findings: 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 (I2 = 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. Interpretation: 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. Funding: VB is supported by the Swedish Research Council, Grant number 2020-01481. University of Gothenburg.
(Less)
- author
- organization
- publishing date
- 2024-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adverse outcomes, Hypertensive disorders, Pre-eclampsia, Prediction, Pregnancy
- in
- EClinicalMedicine
- volume
- 76
- article number
- 102861
- publisher
- Lancet Publishing Group
- external identifiers
-
- pmid:39391014
- scopus:85204947083
- ISSN
- 2589-5370
- DOI
- 10.1016/j.eclinm.2024.102861
- language
- English
- LU publication?
- yes
- id
- 691f6dd0-d57d-4b99-9d2b-533d00555876
- date added to LUP
- 2024-12-11 11:54:33
- date last changed
- 2025-07-10 05:00:19
@article{691f6dd0-d57d-4b99-9d2b-533d00555876,
abstract = {{<p>Background: 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. Methods: 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. Findings: 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 (I<sup>2</sup> = 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. Interpretation: 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. Funding: VB is supported by the Swedish Research Council, Grant number 2020-01481. University of Gothenburg.</p>}},
author = {{Bucher, Valentina and Mitchell, Alexandra Roddy and Gudmundsson, Pia and Atkinson, Jessica and Wallin, Nicole and Asp, Joline and Sennström, Maria and Hildén, Karin and Edvinsson, Camilla and Ek, Joakim and Hastie, Roxanne and Cluver, Catherine and Bergman, Lina}},
issn = {{2589-5370}},
keywords = {{Adverse outcomes; Hypertensive disorders; Pre-eclampsia; Prediction; Pregnancy}},
language = {{eng}},
publisher = {{Lancet Publishing Group}},
series = {{EClinicalMedicine}},
title = {{Prediction of adverse maternal and perinatal outcomes associated with pre-eclampsia and hypertensive disorders of pregnancy : a systematic review and meta-analysis}},
url = {{http://dx.doi.org/10.1016/j.eclinm.2024.102861}},
doi = {{10.1016/j.eclinm.2024.102861}},
volume = {{76}},
year = {{2024}},
}