Prediction of stillbirth: an umbrella review of evaluation of prognostic variables.
Epidemiology: perinatal
fetal medicine: perinatal diagnosis
fetal medicine: serum screening
systematic reviews
ultrasound
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
accepted:
17
08
2020
pubmed:
16
9
2020
medline:
5
3
2021
entrez:
15
9
2020
Statut:
ppublish
Résumé
Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth. To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development. MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019. We included systematic reviews of association of individual variables with stillbirth without language restriction. Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded. The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension. We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias. Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
Sections du résumé
BACKGROUND
Stillbirth accounts for over 2 million deaths a year worldwide and rates remains stubbornly high. Multivariable prediction models may be key to individualised monitoring, intervention or early birth in pregnancy to prevent stillbirth.
OBJECTIVES
To collate and evaluate systematic reviews of factors associated with stillbirth in order to identify variables relevant to prediction model development.
SEARCH STRATEGY
MEDLINE, Embase, DARE and Cochrane Library databases and reference lists were searched up to November 2019.
SELECTION CRITERIA
We included systematic reviews of association of individual variables with stillbirth without language restriction.
DATA COLLECTION AND ANALYSIS
Abstract screening and data extraction were conducted in duplicate. Methodological quality was assessed using AMSTAR and QUIPS criteria. The evidence supporting association with each variable was graded.
RESULTS
The search identified 1198 citations. Sixty-nine systematic reviews reporting 64 variables were included. The most frequently reported were maternal age (n = 5), body mass index (n = 6) and maternal diabetes (n = 5). Uterine artery Doppler appeared to have the best performance of any single test for stillbirth. The strongest evidence of association was for nulliparity and pre-existing hypertension.
CONCLUSION
We have identified variables relevant to the development of prediction models for stillbirth. Age, parity and prior adverse pregnancy outcomes had a more convincing association than the best performing tests, which were PAPP-A, PlGF and UtAD. The evidence was limited by high heterogeneity and lack of data on intervention bias.
TWEETABLE ABSTRACT
Review shows key predictors for use in developing models predicting stillbirth include age, prior pregnancy outcome and PAPP-A, PLGF and Uterine artery Doppler.
Identifiants
pubmed: 32931648
doi: 10.1111/1471-0528.16510
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
238-250Subventions
Organisme : Medical Research Council
ID : MR/P027938/1
Pays : United Kingdom
Organisme : Stillbirth and Neonatal Death Society (SANDS)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 John Wiley & Sons Ltd.
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