{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:25:34Z","timestamp":1791300334623,"version":"4.1.0"},"reference-count":249,"publisher":"National Institute for Health and Care Research","issue":"72","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["14\/158\/02"],"award-info":[{"award-number":["14\/158\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk is needed to plan management.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To assess the performance of existing pre-eclampsia prediction models and to develop and validate models for pre-eclampsia using individual participant data meta-analysis. We also estimated the prognostic value of individual markers.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This was an individual participant data meta-analysis of cohort studies.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Source data from secondary and tertiary care.<\/jats:p>\n <\/jats:sec>\n \n Predictors<\/jats:title>\n We identified predictors from systematic reviews, and prioritised for importance in an international survey.<\/jats:p>\n <\/jats:sec>\n \n Primary outcomes<\/jats:title>\n Early-onset (delivery at <\u200934 weeks\u2019 gestation), late-onset (delivery at \u2265\u200934 weeks\u2019 gestation) and any-onset pre-eclampsia.<\/jats:p>\n <\/jats:sec>\n \n Analysis<\/jats:title>\n We externally validated existing prediction models in UK cohorts and reported their performance in terms of discrimination and calibration. We developed and validated 12 new models based on clinical characteristics, clinical characteristics and biochemical markers, and clinical characteristics and ultrasound markers in the first and second trimesters. We summarised the data set-specific performance of each model using a random-effects meta-analysis. Discrimination was considered promising for C<\/jats:italic>-statistics of \u2265\u20090.7, and calibration was considered good if the slope was near 1 and calibration-in-the-large was near 0. Heterogeneity was quantified using I<\/jats:italic>\n 2<\/jats:sup> and \u03c42<\/jats:sup>. A decision curve analysis was undertaken to determine the clinical utility (net benefit) of the models. We reported the unadjusted prognostic value of individual predictors for pre-eclampsia as odds ratios with 95% confidence and prediction intervals.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The International Prediction of Pregnancy Complications network comprised 78 studies (3,570,993 singleton pregnancies) identified from systematic reviews of tests to predict pre-eclampsia. Twenty-four of the 131 published prediction models could be validated in 11 UK cohorts. Summary C<\/jats:italic>-statistics were between 0.6 and 0.7 for most models, and calibration was generally poor owing to large between-study heterogeneity, suggesting model overfitting. The clinical utility of the models varied between showing net harm to showing minimal or no net benefit. The average discrimination for IPPIC models ranged between 0.68 and 0.83. This was highest for the second-trimester clinical characteristics and biochemical markers model to predict early-onset pre-eclampsia, and lowest for the first-trimester clinical characteristics models to predict any pre-eclampsia. Calibration performance was heterogeneous across studies. Net benefit was observed for International Prediction of Pregnancy Complications first and second-trimester clinical characteristics and clinical characteristics and biochemical markers models predicting any pre-eclampsia, when validated in singleton nulliparous women managed in the UK NHS. History of hypertension, parity, smoking, mode of conception, placental growth factor and uterine artery pulsatility index had the strongest unadjusted associations with pre-eclampsia.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n Variations in study population characteristics, type of predictors reported, too few events in some validation cohorts and the type of measurements contributed to heterogeneity in performance of the International Prediction of Pregnancy Complications models. Some published models were not validated because model predictors were unavailable in the individual participant data.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n For models that could be validated, predictive performance was generally poor across data sets. Although the International Prediction of Pregnancy Complications models show good predictive performance on average, and in the singleton nulliparous population, heterogeneity in calibration performance is likely across settings.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n Recalibration of model parameters within populations may improve calibration performance. Additional strong predictors need to be identified to improve model performance and consistency. Validation, including examination of calibration heterogeneity, is required for the models we could not validate.<\/jats:p>\n <\/jats:sec>\n \n Study registration<\/jats:title>\n This study is registered as PROSPERO CRD42015029349.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 24, No. 72. See the NIHR Journals Library website for further project information.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta24720","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T13:15:06Z","timestamp":1608297306000},"page":"1-252","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":30,"title":["Validation and development of models using clinical, biochemical and ultrasound markers for predicting pre-eclampsia: an individual participant data meta-analysis"],"prefix":"10.3310","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4134-6246","authenticated-orcid":true,"given":"John","family":"Allotey","sequence":"first","affiliation":[{"name":"Barts Research Centre for Women\u2019s Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"},{"name":"Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3212-7826","authenticated-orcid":true,"given":"Hannele","family":"Laivuori","sequence":"first","affiliation":[{"name":"Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland"},{"name":"Institute of Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland"},{"name":"Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland"},{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9373-6591","authenticated-orcid":true,"given":"Kym IE","family":"Snell","sequence":"additional","affiliation":[{"name":"Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1594-1458","authenticated-orcid":true,"given":"Melanie","family":"Smuk","sequence":"additional","affiliation":[{"name":"Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1063-0917","authenticated-orcid":true,"given":"Richard","family":"Hooper","sequence":"additional","affiliation":[{"name":"Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0821-4068","authenticated-orcid":true,"given":"Claire L","family":"Chan","sequence":"additional","affiliation":[{"name":"Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8755-8546","authenticated-orcid":true,"given":"Asif","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6219-3379","authenticated-orcid":true,"given":"Lucy C","family":"Chappell","sequence":"additional","affiliation":[{"name":"Department of Women & Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4136-3070","authenticated-orcid":true,"given":"Peter","family":"von Dadelszen","sequence":"additional","affiliation":[{"name":"Department of Women & Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6041-1456","authenticated-orcid":true,"given":"Julie","family":"Dodds","sequence":"additional","affiliation":[{"name":"Barts Research Centre for Women\u2019s Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"},{"name":"Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4561-8256","authenticated-orcid":true,"given":"Marcus","family":"Green","sequence":"additional","affiliation":[{"name":"Action on Pre-eclampsia (APEC), Evesham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9011-759X","authenticated-orcid":true,"given":"Louise","family":"Kenny","sequence":"additional","affiliation":[{"name":"Vice Chancellor\u2019s Office, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":true,"given":"Asma","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George\u2019s University Hospitals NHS Foundation Trust and Molecular and Clinical Sciences Research Institute, St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-7312","authenticated-orcid":true,"given":"Khalid S","family":"Khan","sequence":"additional","affiliation":[{"name":"Barts Research Centre for Women\u2019s Health (BARC), 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7108-211X","authenticated-orcid":true,"given":"George","family":"Daskalakis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5625-761X","authenticated-orcid":true,"given":"Diane","family":"Farrar","sequence":"additional","affiliation":[{"name":"Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-2084","authenticated-orcid":true,"given":"Ahmet A","family":"Baschat","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-7933","authenticated-orcid":true,"given":"Paul T","family":"Seed","sequence":"additional","affiliation":[{"name":"Department of Women & Children\u2019s Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-714X","authenticated-orcid":true,"given":"Federico","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0765-7780","authenticated-orcid":true,"given":"Fabricio","family":"da Silva Costa","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6629-318X","authenticated-orcid":true,"given":"Henk","family":"Groen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2697-3826","authenticated-orcid":true,"given":"Francois","family":"Audibert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Universit\u00e9 de Montr\u00e9al, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-5478","authenticated-orcid":true,"given":"Jacques","family":"Masse","sequence":"additional","affiliation":[{"name":"Department of Molecular Biology, Medical 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University Hospital, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4708-3267","authenticated-orcid":true,"given":"Camilla","family":"Haavaldsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynacology, Akershus University Hospital, L\u00f8renskog, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4897-2119","authenticated-orcid":true,"given":"Chie","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4453-9425","authenticated-orcid":true,"given":"Alice R","family":"Rumbold","sequence":"additional","affiliation":[{"name":"South Australian Health and Medical Research Institute, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5949-0874","authenticated-orcid":true,"given":"Seppo","family":"Heinonen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-5544","authenticated-orcid":true,"given":"Lisa M","family":"Askie","sequence":"additional","affiliation":[{"name":"NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-1345","authenticated-orcid":true,"given":"Luc JM","family":"Smits","sequence":"additional","affiliation":[{"name":"Care and Public Health Research Institute, Maastricht University Medical Centre, Maastricht, the 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