Summary:
Despite advances in maternal medicine,
pre-eclampsia continues to be a major contributor to maternal, fetal and
neonatal mortality and morbidity. Pre-eclampsia is not a single disorder
but a syndrome. The early onset disease is more severe, and is
considered to have a different pathophysiology than the late onset
disease. It is unlikely that one single model will accurately predict
both early and late onset disease. A HTA brief called for synthesis of
available evidence to identify the most accurate tests, separately and
in combination for the prediction of pre-eclampsia, including the early
onset type. We have identified over 50 published evidence synthesis
projects on this topic, and they are unable to provide clear conclusions
on the performance of the tests due to the limitations in the published
data.
We will obtain the individual data of all participants in relevant
studies, through our International Prediction of Pre-eclampsia IPD
Collaborative (IPPIC) Network. The Network comprises of researchers
involved in studies on this topic and we have the support of more than
70 researchers, with access to data from over 400,000 women. The IPPIC
Network is strengthened by support from the Global Obstetrics Research
Network (GONet), a group of international investigators that perform
clinical trials and observational studies in maternal fetal medicine and
obstetrics (www.globalobstetricsnetwork.org).
All collaborators will be involved in providing input into the project
and will be co-authors in any publication arising from the project.
Aims and objetives:
We will
develop separate prediction models for a. early (<34 weeks’ gestation)
and b. any pre-eclampsia.
Primary
1.To
update our systematic review on prediction models for pre-eclampsia and
externally validate the most accurate and robust models on IPD.
2.To
estimate the prognostic value of individual clinical, biochemical and
ultrasound markers in the prediction of pre-eclampsia analysis
3. To
use IPD from multiple studies to develop and externally validate (using
internal-external cross-validation) multivariable prediction models for
a. early (<34 weeks’
gestation) and b. any pre-eclampsia
based on (i) clinical characteristics only, and in combination with (ii)
biochemical markers,
(iii) ultrasound markers (iv) both ultrasound and
biochemical markers
4.To
assess the differential performance of the predictors in subgroups based
on population characteristics (unselected vs selected), timing of test
(first trimester vs any trimester) in predicting pre-eclampsia, and
treatment strategies
Secondary
5.To
evaluate the predictive accuracy of the individual tests and models for
maternal and fetal complications of pre-eclampsia
more..
