Prediction of stillbirth: an umbrella review of evaluation of prognostic variables

R Townsend; FG Sileo; J Allotey; J Dodds; A Heazell; L Jorgensen; VB Kim; L Magee; B Mol; J Sandall; GCS Smith; B Thilaganathan; P Dadelszen; S Thangaratinam; A Khalil

doi:10.1111/1471-0528.16510

Prediction of stillbirth: an umbrella review of evaluation of prognostic variables

R Townsend, FG Sileo, J Allotey, J Dodds, A Heazell, L Jorgensen, VB Kim, L Magee, B Mol, J Sandall, GCS Smith, B Thilaganathan, P Dadelszen, S Thangaratinam, A Khalil

Metabolism and Systems Research

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Abstract

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.

Original language	English
Pages (from-to)	238-250
Number of pages	13
Journal	BJOG: An International Journal of Obstetrics & Gynaecology
Volume	128
Issue number	2
Early online date	15 Sept 2020
DOIs	https://doi.org/10.1111/1471-0528.16510
Publication status	Published - Jan 2021

Keywords

Epidemiology: perinatal
fetal medicine: perinatal diagnosis
fetal medicine: serum screening
systematic reviews
ultrasound

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TownsendR2020Prediction
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Townsend, R., Sileo, FG., Allotey, J., Dodds, J., Heazell, A., Jorgensen, L., Kim, VB., Magee, L., Mol, B., Sandall, J., Smith, GCS., Thilaganathan, B., Dadelszen, P., Thangaratinam, S., & Khalil, A. (2021). Prediction of stillbirth: an umbrella review of evaluation of prognostic variables. BJOG: An International Journal of Obstetrics & Gynaecology, 128(2), 238-250. https://doi.org/10.1111/1471-0528.16510

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abstract = "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.",

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author = "R Townsend and FG Sileo and J Allotey and J Dodds and A Heazell and L Jorgensen and VB Kim and L Magee and B Mol and J Sandall and GCS Smith and B Thilaganathan and P Dadelszen and S Thangaratinam and A Khalil",

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Townsend, R, Sileo, FG, Allotey, J, Dodds, J, Heazell, A, Jorgensen, L, Kim, VB, Magee, L, Mol, B, Sandall, J, Smith, GCS, Thilaganathan, B, Dadelszen, P, Thangaratinam, S & Khalil, A 2021, 'Prediction of stillbirth: an umbrella review of evaluation of prognostic variables', BJOG: An International Journal of Obstetrics & Gynaecology, vol. 128, no. 2, pp. 238-250. https://doi.org/10.1111/1471-0528.16510

TY - JOUR

T1 - Prediction of stillbirth

T2 - an umbrella review of evaluation of prognostic variables

AU - Townsend, R

AU - Sileo, FG

AU - Allotey, J

AU - Dodds, J

AU - Heazell, A

AU - Jorgensen, L

AU - Kim, VB

AU - Magee, L

AU - Mol, B

AU - Sandall, J

AU - Smith, GCS

AU - Thilaganathan, B

AU - Dadelszen, P

AU - Thangaratinam, S

AU - Khalil, A

PY - 2021/1

Y1 - 2021/1

N2 - 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.

AB - 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.

KW - Epidemiology: perinatal

KW - fetal medicine: perinatal diagnosis

KW - fetal medicine: serum screening

KW - systematic reviews

KW - ultrasound

U2 - 10.1111/1471-0528.16510

DO - 10.1111/1471-0528.16510

M3 - Article

SN - 1470-0328

VL - 128

SP - 238

EP - 250

JO - BJOG: An International Journal of Obstetrics & Gynaecology

JF - BJOG: An International Journal of Obstetrics & Gynaecology

IS - 2

ER -

Prediction of stillbirth: an umbrella review of evaluation of prognostic variables

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Keywords

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