{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T16:58:24Z","timestamp":1765817904102,"version":"3.48.0"},"reference-count":33,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Joint Funds for the Innovation of Science and Technology, Fujian Province","award":["2021Y9178"],"award-info":[{"award-number":["2021Y9178"]}]},{"name":"Fujian Provincial Natural Science Foundation of China","award":["2023J011213"],"award-info":[{"award-number":["2023J011213"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,8]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to develop and validate an effective prediction model for hypertensive disorder of pregnancy (HDP) in twin pregnancies after 28 weeks of gestation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Maternity hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We recruited twin pregnancies who delivered in Fujian Maternity and Child Health Hospital from January 2014 to December 2019 as a training cohort. Besides, we included twin pregnancies delivered at Fujian Maternity and Child Health Hospital; Women and Children\u2019s Hospital of Xiamen University from January 2020 to December 2021 as temporal validation set and geographical validation set, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>We performed univariate analysis, the least absolute shrinkage and selection operator regression and Boruta algorithm to screen variables. Then, we used multivariate logistic regression to construct a nomogram that predicted the risk of HDP in twin pregnancies. We employed the bootstrap resampling method for internal validation, used the receiver operating characteristic (ROC) curve to evaluate the predictive performance of the model and constructed decision curve analysis to assess the clinical benefit of the model. Thereafter validated the nomogram through the index of concordance (C-index) and calibration curves in the temporal validation set and geographical validation set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate logistic regression showed that primipara (OR=1.284, 95% CI=1.016 to 1.622), the higher pre-pregnancy body mass index (OR=1.077, 95% CI=1.039 to 1.116), the higher uric acid (OR=1.004, 95% CI=1.002 to 1.005), the higher urea nitrogen (OR=1.198, 95% CI=1.087 to 1.321), the higher creatinine (OR=1.011, 95% CI=1.002 to 1.020), the higher lactate dehydrogenase (OR=1.001, 95% CI=1.000 to 1.002), the higher ratio of large platelets (OR=1.034, 95% CI=1.020 to 1.048), the lower albumin (OR=0.887, 95% CI=0.852 to 0.924), the lower calcium (OR=0.148, 95% CI=0.058 to 0.375) are influencing factors of HDP in twin pregnancies. The area under the ROC curve of the prediction model was 0.763. The C-index were 0.842 and 0.746, respectively, on the temporal validation set and geographical validation set.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The new model for predicting HDP in twin pregnancies constructed by clinical characteristics and laboratory indicators had high clinical application value. It can be used to individually evaluate the occurrence of HDP in twin pregnancies after 28 weeks of gestation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-083654","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T22:25:34Z","timestamp":1733264734000},"page":"e083654","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Derivation and external validation of prediction model for hypertensive disorders of pregnancy in twin pregnancies: a retrospective cohort study in southeastern China"],"prefix":"10.1136","volume":"14","author":[{"given":"Shuisen","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yujuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Department of Obstetrics and Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuting","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoling","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Lin","sequence":"additional","affiliation":[{"name":"Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0959-2845","authenticated-orcid":false,"given":"Qing","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,12,3]]},"reference":[{"key":"2025121508543223000_14.12.e083654.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2011.01.006"},{"key":"2025121508543223000_14.12.e083654.2","first-page":"80","article-title":"Hypertensive Disorders in Pregnancy Current Practice Review","volume":"13","author":"Turner","year":"2017","journal-title":"Curr Hypertens Rev"},{"key":"2025121508543223000_14.12.e083654.3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(10)61351-7","article-title":"Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model","volume":"377","author":"von Dadelszen","year":"2011","journal-title":"The Lancet"},{"key":"2025121508543223000_14.12.e083654.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.118.313276"},{"key":"2025121508543223000_14.12.e083654.5","doi-asserted-by":"crossref","DOI":"10.3390\/biom10060953","article-title":"Pathogenesis of Preeclampsia and Therapeutic Approaches Targeting the Placenta","volume":"10","author":"Jena","year":"2020","journal-title":"Biomolecules"},{"key":"2025121508543223000_14.12.e083654.6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3233\/THC-218017","article-title":"Prediction of hypertensive disorders in pregnancy based on placental growth factor","volume":"29","author":"Xu","year":"2021","journal-title":"Technol Health Care"},{"key":"2025121508543223000_14.12.e083654.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2020.01.020","article-title":"A new model for screening for early-onset preeclampsia","volume":"222","author":"Serra","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"2025121508543223000_14.12.e083654.8","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/AOG.0000000000004506","article-title":"Outcomes Associated With Hypertensive Disorders of Pregnancy in Twin Compared With Singleton Gestations","volume":"138","author":"Aviram","year":"2021","journal-title":"Obstet Gynecol"},{"key":"2025121508543223000_14.12.e083654.9","first-page":"7222","article-title":"A new predicting model of preeclampsia based on peripheral blood test value","volume":"24","author":"Han","year":"2020","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025121508543223000_14.12.e083654.10","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2022.850149","article-title":"A New Model for the Predicting the Risk of Preeclampsia in Twin Pregnancy","volume":"13","author":"Han","year":"2022","journal-title":"Front Physiol"},{"key":"2025121508543223000_14.12.e083654.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7594","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"key":"2025121508543223000_14.12.e083654.12","first-page":"227","article-title":"Guidelines for Diagnosis and Treatment of Hypertensive Disorders in Pregnancy (2020)","volume":"55","year":"2020","journal-title":"Chin J Obstet Gynecol"},{"key":"2025121508543223000_14.12.e083654.13","doi-asserted-by":"publisher","DOI":"10.1177\/096228029600500306"},{"key":"2025121508543223000_14.12.e083654.14","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003891"},{"key":"2025121508543223000_14.12.e083654.15","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1111\/jog.12408","article-title":"Clinical features and prenatal risk factors for hypertensive disorders in twin pregnancies","volume":"40","author":"Taguchi","year":"2014","journal-title":"J Obstet Gynaecol Res"},{"key":"2025121508543223000_14.12.e083654.16","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1111\/aogs.13890","article-title":"Screening for preeclampsia in low\u2010risk twin pregnancies at early gestation","volume":"99","author":"Chen","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025121508543223000_14.12.e083654.17","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1017\/thg.2016.17","article-title":"Twin Chorionicity and the Risk of Hypertensive Disorders: Gestational Hypertension and Pre-eclampsia","volume":"19","author":"Bartnik","year":"2016","journal-title":"Twin Res Hum Genet"},{"key":"2025121508543223000_14.12.e083654.18","doi-asserted-by":"publisher","DOI":"10.1080\/14767050500246045"},{"key":"2025121508543223000_14.12.e083654.19","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1080\/10641955.2016.1242605","article-title":"Developing a new algorithm for first and second trimester preeclampsia screening in twin pregnancies","volume":"36","author":"Maymon","year":"2017","journal-title":"Hypertens Pregnancy"},{"key":"2025121508543223000_14.12.e083654.20","doi-asserted-by":"crossref","first-page":"3623","DOI":"10.1080\/14767058.2019.1686757","article-title":"A preeclampsia risk prediction model based on maternal characteristics and serum markers in twin pregnancy","volume":"34","author":"Kim","year":"2021","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025121508543223000_14.12.e083654.21","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1080\/01443615.2022.2099253","article-title":"An observational study of pro- and anti-angiogenic factors in hypertensive disorders of pregnancy in women of African ancestry","volume":"42","author":"Soobryan","year":"2022","journal-title":"J Obstet Gynaecol"},{"key":"2025121508543223000_14.12.e083654.22","first-page":"392","article-title":"Evaluation of total LDH and its isoenzymes as markers in preeclampsia","volume":"39","author":"Saleem","year":"2020","journal-title":"J Med Biochem"},{"key":"2025121508543223000_14.12.e083654.23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2174\/1573402116666200720001032","article-title":"Role of Lactate Dehydrogenase in the Prediction of Severity in Pre- Eclampsia","volume":"16","author":"Khidri","year":"2020","journal-title":"Curr Hypertens Rev"},{"key":"2025121508543223000_14.12.e083654.24","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s13224-014-0645-x","article-title":"LDH (Lactate Dehydrogenase): A Biochemical Marker for the Prediction of Adverse Outcomes in Pre-eclampsia and Eclampsia","volume":"66","author":"Dave","year":"2016","journal-title":"J Obstet Gynaecol India"},{"key":"2025121508543223000_14.12.e083654.25","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ejogrb.2018.01.008","article-title":"Maternal serum uric acid levels and blood pressure during pregnancy: A community-based cohort study","volume":"222","author":"Zhou","year":"2018","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025121508543223000_14.12.e083654.26","first-page":"115","article-title":"Risk factors for postpartum hypertension in women with twin pregnancies","volume":"40","author":"Morikawa","year":"2011","journal-title":"J Perinat Med"},{"key":"2025121508543223000_14.12.e083654.27","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2174\/1573402114666181112141953","article-title":"Maternal Serum Uric Acid as a Predictor of Severity of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study","volume":"15","author":"Kumar","year":"2019","journal-title":"Curr Hypertens Rev"},{"key":"2025121508543223000_14.12.e083654.28","article-title":"Calcium supplementation commencing before or early in pregnancy, for preventing hypertensive disorders of pregnancy","volume":"9","author":"Hofmeyr","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121508543223000_14.12.e083654.29","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.tjog.2019.01.014","article-title":"Maternal serum uric acid and calcium as predictors of hypertensive disorder of pregnancy: A case control study","volume":"58","author":"Kumar","year":"2019","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2025121508543223000_14.12.e083654.30","doi-asserted-by":"crossref","first-page":"3602","DOI":"10.1080\/14767058.2020.1833322","article-title":"The clinical utility of D-dimer\/platelet count ratio in pregnant women","volume":"35","author":"Limonta","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025121508543223000_14.12.e083654.31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.preghy.2021.02.013","article-title":"Platelet counts during normal pregnancies and pregnancies complicated with hypertensive disorders","volume":"24","author":"Ushida","year":"2021","journal-title":"Pregnancy Hypertens"},{"key":"2025121508543223000_14.12.e083654.32","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.108.127977"},{"key":"2025121508543223000_14.12.e083654.33","unstructured":"Zhong W , Wang X , QI H , et al . Exploration of establishing a risk prediction model for gestational hypertension disease. J Pract Obstet Gynecol 2022;38."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-083654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T16:54:40Z","timestamp":1765817680000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-083654"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12,3]]},"published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1136\/bmjopen-2023-083654"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-083654","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2024,12]]}}}