BMJ medicine最新文献

{"title":"Proactive therapeutic drug monitoring of biologic drugs in patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis: systematic review and meta-analysis.","authors":"Dena Zeraatkar, Tyler Stacy Pitre, Sarah Kirsh, Tanvir Jassal, Michael Ling, Muizz Hussain, Rachel J Couban, Leticia Kawano-Dourado, Eirik K Kristianslund, Per Olav Vandvik","doi":"10.1136/bmjmed-2024-000998","DOIUrl":"10.1136/bmjmed-2024-000998","url":null,"abstract":"<p><strong>Objective: </strong>To address the efficacy and safety of proactive therapeutic drug monitoring of biologic drugs for patients with inflammatory bowel disease, inflammatory arthritis, and psoriasis.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Medline, Embase, Central, and CINAHL, from database inception to 23 May 2024.</p><p><strong>Eligibility criteria for selecting studies: </strong>Trials including people with inflammatory bowel disease, inflammatory arthritis, and psoriasis were selected. Selected trials also randomly assigned people to either proactive therapeutic drug monitoring of tumour necrosis factor-alpha inhibitors or other biologic drugs in the intervention group, and to either no therapeutic drug monitoring or standard care in the control group. Reviewers worked independently and in duplicate to screen search records and collect data from eligible trials. For each outcome, a frequentist, pairwise, random effects meta-analysis was done and the certainty of evidence was assessed using GRADE (grading of recommendations, assessment, development, and evaluations).</p><p><strong>Results: </strong>Of 10 eligible trials identified, reporting on 2383 patients, two investigated induction with infliximab (533 patients), four assessed maintenance with infliximab (901 patients), and three assessed maintenance with adalimumab (710 patients). One trial was of maintenance with infliximab, adalimumab, and etanercept (239 patients). For patients who had induction with infliximab, the effects of proactive therapeutic drug monitoring on remission and adverse events were uncertain. Low certainty evidence suggested that proactive therapeutic drug monitoring may have little or no effect on disease activity, physical function, mental health, and quality of life. For patients who had maintenance with infliximab, low certainty evidence suggested that proactive therapeutic drug monitoring may increase the proportion of patients who had sustained disease control or remission (relative risk 1.26 (95% confidence interval (CI) 1.14 to 1.40), absolute risk difference of 146 more per 1000 patients treated for one year (95% CI 78 to 224). Additionally, this treatment and monitoring may reduce disease worsening, and may have little or no effect on disease activity, physical function, mental health, and quality of life. The effects of proactive therapeutic drug monitoring of infliximab on adverse events and formation of anti-drug antibodies were uncertain. For patients who had maintenance with adalimumab, the effects of proactive therapeutic drug monitoring were uncertain.</p><p><strong>Conclusion: </strong>Proactive therapeutic drug monitoring of infliximab during maintenance may help patients to have sustained disease control or remission. No compelling evidence supported the effectiveness of proactive therapeutic drug monitoring of infliximab during induction or proactive therapeutic drug monit","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000998"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus nonavalent (HPV9) vaccination and risk of immune mediated diseases, myocarditis, pericarditis, and thromboembolic outcomes in Denmark: self-controlled case series study.","authors":"Kristýna Faksová, Anna D Laksafoss, Anders Hviid","doi":"10.1136/bmjmed-2024-000854","DOIUrl":"10.1136/bmjmed-2024-000854","url":null,"abstract":"<p><strong>Objective: </strong>To assess the associations between vaccination with the nonavalent human papillomavirus (HPV9) vaccine and immune mediated diseases, myocarditis, pericarditis, arterial thromboembolism, and venous thromboembolism with or without thrombocytopenia, in adolescent girls and boys in Denmark.</p><p><strong>Design: </strong>Self-controlled case series study.</p><p><strong>Setting: </strong>Population based study of linked nationwide health registers in Denmark for HPV vaccination and hospital diagnosis data, 1 October 2017 (or age 10 years) to 31 December 2022 or censored. Personal data were obtained from the Central Person Register. Information on dates of HPV vaccination and type of vaccine were obtained from the Danish Vaccination Register. Primary or secondary diagnoses of inpatient or outpatient hospital contact were sourced from the Danish National Patient Register.</p><p><strong>Participants: </strong>Source cohort 854 586. 350 687 individuals aged 10-17 years living in Denmark received at least one dose of HPV9 vaccine. Self-controlled case series analysis of 3354 individuals (1913 girls and 1441 boys) who received at least one dose of HPV9 vaccine and had at least one outcome.</p><p><strong>Main outcome measures: </strong>Rate ratios of the study outcomes in a 28 day or 180 day risk period (depending on the type of outcome) after HPV9 vaccination compared with the reference period were calculated. 47 immune mediated diseases, myocarditis, pericarditis, and seven thromboembolic outcomes were assessed. A safety signal for a specific outcome was identified if at least three outcomes were seen in the risk period after vaccination, the rate ratio was significantly increased (lower bound of the 95% confidence interval (CI) for the self-controlled case series rate ratio >1.0), and the false discovery rate adjusted P value was significant (<0.05).</p><p><strong>Results: </strong>696 776 doses of any HPV vaccine were given during the study period, including 673 530 doses of HPV9 vaccine in 350 687 individuals who received at least one dose. In the self-controlled case series analysis, rate ratios of all immune mediated outcomes combined were 0.99 (95% CI 0.86 to 1.13) and 1.03 (0.89 to 1.20) in girls and boys, respectively, after HPV9 vaccination. Rate ratios for any of the 47 analysed immune mediated outcomes were not increased in the risk periods in girls after vaccination. The only increased rate ratio seen was for Raynaud's disease (rate ratio 2.62, 95% CI 1.07 to 6.40) after HPV9 vaccination in boys, which did not fulfil the criteria of a safety signal. These findings should be interpreted in the light of the study limitations. None of the other 55 outcomes examined showed an association with HPV9 vaccination.</p><p><strong>Conclusions: </strong>The results of this study did not suggest an association between HPV9 vaccination and the study outcomes in adolescent boys and girls aged 10-17 years. This study contributes ","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000854"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose co-transporter-2 inhibitors in patients with chronic kidney disease with or without type 2 diabetes: systematic review and meta-analysis.","authors":"Xinyu Zou, Qingyang Shi, Per Olav Vandvik, Yunhe Mao, Arnav Agarwal, Belen Ponte, Xiaoxi Zeng, Gordon Guyatt, Qinbo Yang, Xianghang Luo, Chang Xu, Ping Fu, Haoming Tian, Thomas Agoritsas, Sheyu Li","doi":"10.1136/bmjmed-2024-001009","DOIUrl":"10.1136/bmjmed-2024-001009","url":null,"abstract":"<p><strong>Objective: </strong>To examine cardiovascular and kidney benefits and harms of sodium-glucose co-transporter-2 (SGLT-2) inhibitors stratified by risk in adults with chronic kidney disease regardless of diabetes status.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources: </strong>Ovid Medline, Embase, and Cochrane Central from database inception to 15 June 2024.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials that compared SGLT-2 inhibitors with placebo or standard care with no SGLT-2 inhibitors in adults with chronic kidney disease with a follow-up duration of ≥12 weeks were eligible. Secondary analyses based on subpopulations from randomised controlled trials and publications not in English language were excluded.</p><p><strong>Data synthesis: </strong>Random effects meta-analyses were conducted, with effect estimates presented as risk ratios with 95% confidence intervals (CIs). Absolute treatment effects were estimated over a five year duration for individuals with varied risks of cardiovascular and kidney complications based on the Kidney Disease Improving Global Outcomes (KDIGO) risk stratification system. Certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.</p><p><strong>Results: </strong>Evidence from 13 randomised controlled trials (29 614 patients) informed treatment effect estimates. In relative terms, SGLT-2 inhibitors reduced all cause death (risk ratio 0.85 (95% CI 0.74 to 0.98)), cardiovascular death (0.84 (0.74 to 0.96)), kidney failure (0.68 (0.60 to 0.77)), non-fatal stroke (0.73 (0.57 to 0.94)), non-fatal myocardial infarction (0.75 (0.60 to 0.93)), and admission to hospital for heart failure (0.68 (0.60 to 0.78)). No credible subgroup effects were found from diabetes status, heart failure status, estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, and follow-up duration. Absolute effect estimates across these outcomes over a five year period varied across risk groups based on baseline risks of cardiovascular and kidney events. Effects of SGLT-2 inhibitors in the group at low risk included seven fewer all- cause deaths, four fewer admissions to hospital for heart failure per 1000 individuals, and no effects on kidney failure. Effects in the higher risk group included 48 fewer all cause deaths, 58 fewer kidney failures, and 25 fewer admissions to hospital for heart failure per 1000 individuals. Although SGLT-2 inhibitor use was associated with a relative increase in the risk of harms, including genital infection (2.66 (95% CI 2.07 to 3.42)), ketoacidosis (2.27 (1.30 to 3.95)), and symptomatic hypovolaemia (1.29 (1.15 to 1.44)), absolute differences for all harm outcomes were small.</p><p><strong>Conclusions: </strong>Among people who have chronic kidney disease either with type 2 diabetes or not, SGLT-2 inhibitors improved cardiov","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e001009"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between maternal mRNA covid-19 vaccination in early pregnancy and major congenital anomalies in offspring: population based cohort study with sibling matched analysis.","authors":"Sarah C J Jorgensen, Samantha S M Drover, Deshayne B Fell, Peter C Austin, Rohan D'Souza, Astrid Guttmann, Sarah A Buchan, Sarah E Wilson, Sharifa Nasreen, Kevin A Brown, Kevin L Schwartz, Mina Tadrous, Kumanan Wilson, Jeffrey C Kwong","doi":"10.1136/bmjmed-2023-000743","DOIUrl":"10.1136/bmjmed-2023-000743","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between maternal mRNA covid-19 vaccination during the first trimester of pregnancy and the prevalence of major congenital anomalies in offspring.</p><p><strong>Design: </strong>Population based cohort study with sibling matched analysis.</p><p><strong>Setting: </strong>Multiple health administrative databases, linked and analysed at ICES, an independent, non-profit research institute that collects and analyses healthcare and demographic data, Ontario, Canada, from 16 October 2021 to 1 May 2023.</p><p><strong>Population: </strong>174 296 singleton live births >20 weeks' gestation with an expected birth date between 16 October 2021 and 1 May 2023: 34 181 (20%) born to mothers who received one or two doses of an mRNA covid-19 vaccine in the first trimester and 34 951 (20%) born to mothers who did not receive a vaccine before or during pregnancy. The sibling matched analysis included 13 312 infants exposed to a covid-19 vaccine in the first trimester and 15 089 matched older siblings with the same mother, with an expected birth date after 16 October 2016 and no reported in utero exposure to a covid-19 vaccine.</p><p><strong>Main outcome measures: </strong>Major congenital anomalies, overall and grouped by specific organ systems, diagnosed within 28 days of birth.</p><p><strong>Results: </strong>Major congenital anomalies were present in 832 (24.3 per 1000 live births) infants exposed to an mRNA covid-19 vaccine in the first trimester compared with 927 (26.5 per 1000 live births) infants not exposed to a vaccine, resulting in an adjusted prevalence ratio of 0.89 (95% confidence interval (CI) 0.79 to 1.01). Major congenital anomalies were present in 283 (21.3 per 1000 live births) and 343 (22.7 per 1000 live births) infants exposed to an mRNA covid-19 vaccine in the first trimester and their older siblings not exposed to a vaccine, respectively (adjusted prevalence ratio 0.91, 95% CI 0.77 to 1.07). First trimester vaccination was not associated with an increase in major congenital anomalies grouped by specific organ system in the primary or sibling matched analyses. Results were similar across a range of subgroup and sensitivity analyses.</p><p><strong>Conclusions: </strong>In this large population based cohort study and sibling matched analysis, mRNA covid-19 vaccination during the first trimester of pregnancy was not associated with an increase in major congenital anomalies in offspring, overall or grouped by organ system.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000743"},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity in emergency departments: urgent need for integrated care.","authors":"Youri Yordanov, Agathe Beauvais, Pierre-Clément Thiébaud","doi":"10.1136/bmjmed-2024-000989","DOIUrl":"10.1136/bmjmed-2024-000989","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000989"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive pulmonary fibrosis: a need for real world data to solve real world clinical problems.","authors":"Huajian Liu, Kerri-Marie Heenan, Liam Coyle, Nazia Chaudhuri","doi":"10.1136/bmjmed-2024-000911","DOIUrl":"10.1136/bmjmed-2024-000911","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000911"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity and adverse outcomes following emergency department attendance: population based cohort study.","authors":"Michael C Blayney, Matthew J Reed, John A Masterson, Atul Anand, Matt M Bouamrane, Jacques Fleuriot, Saturnino Luz, Marcus J Lyall, Stewart Mercer, Nicholas L Mills, Susan D Shenkin, Timothy S Walsh, Sarah H Wild, Honghan Wu, Stela McLachlan, Bruce Guthrie, Nazir I Lone","doi":"10.1136/bmjmed-2023-000731","DOIUrl":"10.1136/bmjmed-2023-000731","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department.</p><p><strong>Design: </strong>Population based cohort study.</p><p><strong>Setting: </strong>Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019.</p><p><strong>Participants: </strong>Adults (≥18 years) attending emergency departments.</p><p><strong>Data sources: </strong>Linked data from emergency departments, hospital discharges, and cancer registries, and national mortality data.</p><p><strong>Main outcome measures: </strong>Multimorbidity was defined as at least two conditions from the Elixhauser comorbidity index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30 day mortality (primary outcome), hospital admission, reattendance at the emergency department within seven days, and time spent in emergency department (secondary outcomes). Primary analysis was stratified by age (<65 <i>v</i> ≥65 years).</p><p><strong>Results: </strong>451 291 people had 1 273 937 attendances to emergency departments during the study period. 43 504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 <i>v</i> 43 years), more likely to arrive by emergency ambulance (57.8% <i>v</i> 23.7%), and more likely to be triaged as very urgent (23.5% <i>v</i> 9.2%) than people who do not have multimorbidity. After adjusting for other prognostic covariates, multimorbidity, compared with no multimorbidity, was associated with higher 30 day mortality (8.2% <i>v</i> 1.2%, adjusted odds ratio 1.81 (95% confidence interval (CI) 1.72 to 1.91)), higher rate of hospital admission (60.1% <i>v</i> 20.5%, 1.81 (1.76 to 1.86)), higher reattendance to an emergency department within seven days (7.8% <i>v</i> 3.5%, 1.41 (1.32 to 1.50)), and longer time spent in the department (adjusted coefficient 0.27 h (95% CI 0.26 to 0.27)). The size of associations between multimorbidity and all outcomes were larger in younger patients: for example, the adjusted odds ratio of 30 day mortality was 3.03 (95% CI 2.68 to 3.42) in people younger than 65 years versus 1.61 (95% CI 1.53 to 1.71) in those 65 years or older.</p><p><strong>Conclusions: </strong>Almost one in ten patients presenting to emergency department had multimorbidity using Elixhauser index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000731"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors.","authors":"Sofie Kruckow, Janne S Tolstrup","doi":"10.1136/bmjmed-2023-000685","DOIUrl":"10.1136/bmjmed-2023-000685","url":null,"abstract":"<p><strong>Objective: </strong>To assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups.</p><p><strong>Design: </strong>Nationwide cohort study of socioeconomic predictors.</p><p><strong>Setting: </strong>Denmark, 1 January 2010 to 31 December 2022.</p><p><strong>Participants: </strong>All Danes of ages 15 to 24 years during the study period summing to a total of 9 314 807 person years and 2297 deaths. Participant and parental information were linked to obtain information on socioeconomic background to investigate differences in parents' educational level, employment status, and family's disposable income, using annually updated nationwide registers.</p><p><strong>Main outcome measures: </strong>All cause and cause specific mortality including natural deaths (ie, medical conditions and diseases) and unnatural deaths (accidents, suicides, and homicides). Poisson regression was used to calculate incidence rate ratios and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Overall mortality rate was 24.7 (95% CI 23.7 to 25.7) and higher for men (33.2 (31.5 to 34.8)) compared with women (15.8 (14.6 to 16.9)). All cause and cause specific mortality were higher in financially disadvantaged groups compared with more affluent groups, and consistently so for all three measures of socioeconomic position. Results generally reflected a dose dependent association showing a higher mortality with lower levels of socioeconomic position. For instance, incidence rate ratios of all cause mortality related to parents' education was 2.3 (95% CI 2.0 to 2.7) for elementary level, 1.5 (1.3 to 1.6) for low, and 1.3 (1.1 to 1.4) for medium level as compared with high level. For deaths, incidence rate ratios of elementary education level compared with the most well educated group were 2.2 (1.5 to 3.2) for natural causes, 3.3 (2.5 to 4.4) for accidents, 1.6 (1.2 to 2.2) for suicides, and 3.1 (0.8 to 12) for homicides. Associations were similar in strata of men and women and by age group (15-17 <i>v</i> 18-24 years). Mortality in young men was considerably higher than in young women for all of the causes.</p><p><strong>Conclusion: </strong>Young people from disadvantaged backgrounds have a markedly higher mortality from all causes than those from more affluent families. The socioeconomic position of their parents was associated with premature mortality in a dose dependent manner meaning that this effect is not only a concern for marginalised groups. Public health attention should be directed to respond to these inequities by strengthening advocacy for adolescent health, ensuring focus on adolescents in health policies and strategies, using the response to adolescent health as an indicator of equity, and prioritising research into the underlying mechanisms linking socioeconomic position in adolescence and mortality.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000685"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a prognostic model to predict birth weight: individual participant data meta-analysis.","authors":"John Allotey, Lucinda Archer, Kym I E Snell, Dyuti Coomar, Jacques Massé, Line Sletner, Hans Wolf, George Daskalakis, Shigeru Saito, Wessel Ganzevoort, Akihide Ohkuchi, Hema Mistry, Diane Farrar, Fionnuala Mone, Jun Zhang, Paul T Seed, Helena Teede, Fabricio Da Silva Costa, Athena P Souka, Melanie Smuk, Sergio Ferrazzani, Silvia Salvi, Federico Prefumo, Rinat Gabbay-Benziv, Chie Nagata, Satoru Takeda, Evan Sequeira, Olav Lapaire, Jose Guilherme Cecatti, Rachel Katherine Morris, Ahmet A Baschat, Kjell Salvesen, Luc Smits, Dewi Anggraini, Alice Rumbold, Marleen van Gelder, Arri Coomarasamy, John Kingdom, Seppo Heinonen, Asma Khalil, François Goffinet, Sadia Haqnawaz, Javier Zamora, Richard D Riley, Shakila Thangaratinam, Alex Kwong, Ary I Savitri, Sohinee Bhattacharya, Cuno Spm Uiterwaal, Annetine C Staff, Louise Bjoerkholt Andersen, Elisa Llurba Olive, Christopher Redman, Maureen Macleod, Baskaran Thilaganathan, Javier Arenas Ramírez, Francois Audibert, Per Minor Magnus, Anne Karen Jenum, Fionnuala M McAuliffe, Jane West, Lisa M Askie, Peter A Zimmerman, Catherine Riddell, Joris van de Post, Sebastián E Illanes, Claudia Holzman, Sander M J van Kuijk, Lionel Carbillon, Pia M Villa, Anne Eskild, Lucy Chappell, Luxmi Velauthar, Miriam van Oostwaard, Stefan Verlohren, Lucilla Poston, Enrico Ferrazzi, Christina A Vinter, Mark Brown, Karlijn C Vollebregt, Josje Langenveld, Mariana Widmer, Camilla Haavaldsen, Guillermo Carroli, Jørn Olsen, Nelly Zavaleta, Inge Eisensee, Patrizia Vergani, Pisake Lumbiganon, Maria Makrides, Fabio Facchinetti, Marleen Temmerman, Robert Gibson, Tiziana Frusca, Jane E Norman, Ernesto A Figueiró-Filho, Hannele Laivuori, Jacob A Lykke, Agustin Conde-Agudelo, Alberto Galindo, Alfred Mbah, Ana Pilar Betran, Ignacio Herraiz, Lill Trogstad, Gordon G S Smith, Eric A P Steegers, Read Salim, Tianhua Huang, Annemarijne Adank, Wendy S Meschino, Joyce L Browne, Rebecca E Allen, Kerstin Klipstein-Grobusch, Caroline A Crowther, Jan Stener Jørgensen, Jean-Claude Forest, Ben W Mol, Yves Giguère, Louise C Kenny, Anthony O Odibo, Jenny Myers, SeonAe Yeo, Lesley McCowan, Eva Pajkrt, Bassam G Haddad, Gustaaf Dekker, Emily C Kleinrouweler, Édouard LeCarpentier, Claire T Roberts, Henk Groen, Ragnhild Bergene Skråstad, Kajantie Eero, Athanasios Pilalis, Renato T Souza, Lee Ann Hawkins, Francesc Figueras, Francesca Crovetto","doi":"10.1136/bmjmed-2023-000784","DOIUrl":"10.1136/bmjmed-2023-000784","url":null,"abstract":"<p><strong>Objective: </strong>To predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit.</p><p><strong>Design: </strong>Individual participant data meta-analysis.</p><p><strong>Data sources: </strong>Individual participant data of four cohorts (237 228 pregnancies) from the International Prediction of Pregnancy Complications (IPPIC) network dataset.</p><p><strong>Eligibility criteria for selecting studies: </strong>Studies in the IPPIC network were identified by searching major databases for studies reporting risk factors for adverse pregnancy outcomes, such as pre-eclampsia, fetal growth restriction, and stillbirth, from database inception to August 2019. Data of four IPPIC cohorts (237 228 pregnancies) from the US (National Institute of Child Health and Human Development, 2018; 233 483 pregnancies), UK (Allen et al, 2017; 1045 pregnancies), Norway (STORK Groruddalen research programme, 2010; 823 pregnancies), and Australia (Rumbold et al, 2006; 1877 pregnancies) were included in the development of the model.</p><p><strong>Results: </strong>The IPPIC birth weight model was developed with random intercept regression models with backward elimination for variable selection. Internal-external cross validation was performed to assess the study specific and pooled performance of the model, reported as calibration slope, calibration-in-the-large, and observed versus expected average birth weight ratio. Meta-analysis showed that the apparent performance of the model had good calibration (calibration slope 0.99, 95% confidence interval (CI) 0.88 to 1.10; calibration-in-the-large 44.5 g, -18.4 to 107.3) with an observed versus expected average birth weight ratio of 1.02 (95% CI 0.97 to 1.07). The proportion of variation in birth weight explained by the model (R²) was 46.9% (range 32.7-56.1% in each cohort). On internal-external cross validation, the model showed good calibration and predictive performance when validated in three cohorts with a calibration slope of 0.90 (Allen cohort), 1.04 (STORK Groruddalen cohort), and 1.07 (Rumbold cohort), calibration-in-the-large of -22.3 g (Allen cohort), -33.42 (Rumbold cohort), and 86.4 g (STORK Groruddalen cohort), and observed versus expected ratio of 0.99 (Rumbold cohort), 1.00 (Allen cohort), and 1.03 (STORK Groruddalen cohort); respective pooled estimates were 1.00 (95% CI 0.78 to 1.23; calibration slope), 9.7 g (-154.3 to 173.8; calibration-in-the-large), and 1.00 (0.94 to 1.07; observed <i>v</i> expected ratio). The model predictions were more accurate (smaller mean square error) in the lower end of predicted birth weight, which is important in informing clinical decision making.</p><p><strong>Conclusions: </strong>The IPPIC birth weight model allowed birth weight predictions for a range of possible gestational ages. The model explained about 50% of individual variation in birth weights, was well calibrated (especiall","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e000784"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting birth weight at booking.","authors":"Emily Prior, Sabita Uthaya","doi":"10.1136/bmjmed-2024-001018","DOIUrl":"10.1136/bmjmed-2024-001018","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"3 1","pages":"e001018"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}