Prediction of stillbirth: an umbrella review of evaluation of prognostic variables. (13th October 2020)

• Record Type: Journal Article
• Authors: Townsend, R; Sileo, FG; Allotey, J; Dodds, J; Heazell, A; Jorgensen, L; Kim, VB; Magee, L; Mol, B; Sandall, J; Smith, GCS; Thilaganathan, B; von Dadelszen, P; Thangaratinam, S; Khalil, A
• Is Part Of: BJOG. Volume 128:Number 2(2021)
• Page Start: 238
• Page End: 250
• Publication Date: 2020-10-13
• Subjects: Epidemiology: perinatal -- fetal medicine: perinatal diagnosis -- fetal medicine: serum screening -- systematic reviews -- ultrasound; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.16510
• Languages: English
• ISSNs: 1470-0328

Abstract

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. 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.