Expert ReviewsThe competing risk approach for prediction of preeclampsia
Section snippets
Prediction by risk scoring systems
The established method of assessing the risk for development of preeclampsia is to identify risk factors from maternal demographic characteristics and medical history; in the presence of such factors, the patient is classified as high risk and, in their absence, as low risk.4,5 In the United Kingdom, according to guidelines by the National Institute for Health and Clinical Excellence, women should be considered to be at high risk of the development of preeclampsia if they have any 1 high-risk
Clinical Implementation of the Competing Risks Approach
The competing risk model can be used for precision medicine and risk stratification at different stages of pregnancy. The objective of screening in the first trimester is the identification of a high-risk group that would benefit from preventative therapeutic interventions. The objective of screening in the second and third trimesters is the identification of a high-risk group that would benefit from close monitoring for early diagnosis of preeclampsia, thereby minimizing unexpected adverse
Validation
The competing risk model for use in first-trimester screening has been validated prospectively in 2 studies.40 In these studies, risks were produced, blinded to outcome with the use of a prespecified algorithm in 25,226 pregnancies, which included 712 pregnancies with preeclampsia of which 201 pregnancies were delivered at <37 weeks gestation and 84 pregnancies were delivered at <34 weeks gestation. Performance was assessed by (1) the ability of the model to discriminate between the
Conclusions
The defining features of our approach to prediction of preeclampsia are the use of a time-to-event model for the gestational age at delivery with preeclampsia and the application of Bayes theorem to update the personalized distribution of gestational age at delivery with preeclampsia. Treating delivery with preeclampsia as an event in time allows the prediction of preeclampsia before different gestational ages to be accommodated into the same model; it is a natural way of allowing for
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This work was supported by grants from the Fetal Medicine Foundation (Charity No: 1037116).
The Fetal Medicine Foundation had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
The authors report no conflict of interest.