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Open AccessArticle

Predictions of Preterm Birth from Early Pregnancy Characteristics: Born in Guangzhou Cohort Study

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Division of Birth Cohort Study, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
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Department of Obstetrics and Gynecology, Guangzhou Women and Children Medical Center, Guangzhou Medical University, Guangzhou 510623, China
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Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
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Department of Woman and Child Health Care, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
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Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
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Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria 3204, Australia
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Department of Neonatal Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(8), 185; https://doi.org/10.3390/jcm7080185
Received: 4 July 2018 / Revised: 25 July 2018 / Accepted: 25 July 2018 / Published: 27 July 2018
(This article belongs to the Section Obstetrics & Gynecology)
Preterm birth (PTB, <37 weeks) is the leading cause of death in children <5 years of age. Early risk prediction for PTB would enable early monitoring and intervention. However, such prediction models have been rarely reported, especially in low- and middle-income areas. We used data on a number of easily accessible predictors during early pregnancy from 9044 women in Born in Guangzhou Cohort Study, China to generate prediction models for overall PTB and spontaneous, iatrogenic, late (34–36 weeks), and early (<34 weeks) PTB. Models were constructed using the Cox proportional hazard model, and their performance was evaluated by Harrell’s c and D statistics and calibration plot. We further performed a systematic review to identify published models and validated them in our population. Our new prediction models had moderate discrimination, with Harrell’s c statistics ranging from 0.60–0.66 for overall and subtypes of PTB. Significant predictors included maternal age, height, history of preterm delivery, amount of vaginal bleeding, folic acid intake before pregnancy, and passive smoking during pregnancy. Calibration plots showed good fit for all models except for early PTB. We validated three published models, all of which were from studies conducted in high-income countries; the area under receiver operating characteristic for these models ranged from 0.50 to 0.56. Based on early pregnancy characteristics, our models have moderate predictive ability for PTB. Future studies should consider inclusion of laboratory markers for the prediction of PTB. View Full-Text
Keywords: preterm birth; prediction; early pregnancy; Chinese; external validation preterm birth; prediction; early pregnancy; Chinese; external validation
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He, J.-R.; Ramakrishnan, R.; Lai, Y.-M.; Li, W.-D.; Zhao, X.; Hu, Y.; Chen, N.-N.; Hu, F.; Lu, J.-H.; Wei, X.-L.; Yuan, M.-Y.; Shen, S.-Y.; Qiu, L.; Chen, Q.-Z.; Hu, C.-Y.; Cheng, K.K.; Mol, B.W.J.; Xia, H.-M.; Qiu, X. Predictions of Preterm Birth from Early Pregnancy Characteristics: Born in Guangzhou Cohort Study. J. Clin. Med. 2018, 7, 185.

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