Predictive Models for Very Preterm Birth: Developing a Point-of-Care Tool

Abstract

Objective The objective of this study was to create three point-of-care predictive models for very preterm birth using variables available at three different time points: prior to pregnancy, at the end of the first trimester, and mid-pregnancy. Study Design This is a retrospective cohort study of 359,396 Ohio Medicaid mothers from 2008 to 2015. The last baby for each mother was included in the final dataset. Births prior to 22 weeks were excluded. Multivariable logistic regression was used to create three models. These models were validated on a cohort that was set aside and not part of the model development. The main outcome measure was birth prior to 32 weeks. Results The final dataset contained 359,396 live births with 6,516 (1.81%) very preterm births. All models had excellent calibration. Goodness-of-fit tests suggested strong agreement between the probabilities estimated by the model and the actual outcome experience in the data. The mid-pregnancy model had acceptable discrimination with an area under the receiver operator characteristic curve of approximately 0.75 in both the developmental and validation datasets. Conclusion Using data from a large Ohio Medicaid cohort we developed point-of-care predictive models that could be used before pregnancy, after the first trimester, and in mid-pregnancy to estimate the probability of very preterm birth. Future work is needed to determine how the calculator could be used to target interventions to prevent very preterm birth. Key Points The work was conceived and designed by S.G.G and P.T.G., S.L., G.N., and C.L.H. Data analysis and interpretation were performed by S.L., G.N., and J.B. and G.P.. The article was drafted jointly by C.L.H., G.N., S.L., S.G.G, and P.T.G. All authors reviewed and critically revised the article. All authors approved the final version. IRB approval for all aspects of this study was obtained through the Ohio Department of Health IRB (Protocol numbers 2016–41, approved July 26, 2016 and 2017–39, date of initial approval July 25, 17) and the Ohio State University IRB (protocol number 2016B02291, date of initial approval September 25, 2016). ^* Presently an independent consultant. Received: 28 February 2020 Accepted: 13 June 2020 Publication Date: 23 August 2020 (online) © 2020. Thieme. All rights reserved. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.