Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: Analysis from BUNMAP Cohort in Ethiopia - PubMed (original) (raw)

Development and Validation of a Risk Score to Predict Low Birthweight Using Characteristics of the Mother: Analysis from BUNMAP Cohort in Ethiopia

Hamid Y Hassen et al. J Clin Med. 2020.

Abstract

At least one ultrasound is recommended to predict fetal growth restriction and low birthweight earlier in pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. Hence, we developed and validated a model and risk score to predict low birthweight using maternal characteristics during pregnancy, for use in resource limited settings. We developed the model using a prospective cohort of 379 pregnant women in South Ethiopia. A stepwise multivariable analysis was done to develop the prediction model. To improve the clinical utility, we developed a simplified risk score to classify pregnant women at high- or low-risk of low birthweight. The accuracy of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration plot. All accuracy measures were internally validated using the bootstrapping technique. We evaluated the clinical impact of the model using a decision curve analysis across various threshold probabilities. Age at pregnancy, underweight, anemia, height, gravidity, and presence of comorbidity remained in the final multivariable prediction model. The AUC of the model was 0.83 (95% confidence interval: 0.78 to 0.88). The decision curve analysis indicated the model provides a higher net benefit across ranges of threshold probabilities. In general, this study showed the possibility of predicting low birthweight using maternal characteristics during pregnancy. The model could help to identify pregnant women at higher risk of having a low birthweight baby. This feasible prediction model would offer an opportunity to reduce obstetric-related complications, thus improving the overall maternal and child healthcare in low- and middle-income countries.

Keywords: decision curve analysis; low birthweight; model; prediction; pregnant women; risk score.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

Figure 1

(a) Area under the ROC curve for the prediction model, and (b) predicted versus observed low birthweight probability in the sample. This analysis includes neonates born at term (n = 379). The calibration plot created using “_givitiCalibrationBelt_” in R programming. Linear predictors for estimated risk of low birthweight = 1/(1 + exp − (−2.54 + 1.593 × age(<20) + 1.516 × BMI (<18.5) + 1.213 × hemoglobin (<11) + 1.225 * height (<155) + 0.606 × prim-gravid + 1.475 × comorbidity. ROC = receiver operating characteristic.

Figure 2

Figure 2

A decision curve plotting net benefit of the model against threshold probability and corresponding cost-benefit ratio.

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