Comparison of national factor-based models for preeclampsia screening

Objective

To compare the predictive values of the American College of Obstetricians and Gynecologist (ACOG), the National Institute for Health and Care Excellence (NICE) and the Society of Obstetricians and Gynecologist of Canada (SOGC) factor-based models for preeclampsia (PE) screening.

Methods

We conducted a secondary analysis of maternal and birth data from 32 hospitals. For each delivery, we calculated the risk of PE according to the ACOG, the NICE and the SOGC models. Our primary outcomes were PE and preterm PE (PE combined with preterm birth) using the ACOG criteria. We calculated the detection rate (DR or sensitivity), the false-positive rate (FPR or 1-specificity), the positive (PPV) and negative (NPV) predictive values of each model for PE and for preterm PE using receiver-operator characteristics (ROC) curves.

Results

We used 130,939 deliveries including 4635 (3.5 %) cases of PE and 823 (0.6 %) cases of preterm PE. The ACOG model had a DR of 43.6 % for PE and 50.3 % for preterm PE with FPR of 15.6 %; the NICE model had a DR of 36.2 % for PE and 41.3 % for preterm PE with FPR of 12. 8 %; and the SOGC model had a DR of 49.1 % for PE and 51. 6 % for preterm PE with FPR of 22.2 %. The PPV for PE of the ACOG (9.3 %) and NICE (9.4 %) models were both superior than the SOGC model (7.6 %; p < 0.001), with similar trend for the PPV for preterm PE (1.9 % vs 1.9 %, vs 1.4 %, respectively; p < 0. 01). The area under the ROC curves suggested that the ACOG model is superior to the NICE for the prediction of PE and preterm PE and superior to the SOGC models for the prediction of preterm PE (all with p < 0.001).

Conclusion

The current ACOG factor-based model for the prediction of PE and preterm PE is superior to the NICE and SOGC models.