Accuracy of body mass index in predicting pre-eclampsia: Bivariate meta-analysis

J. S. Cnossen, M. M G Leeflang, E. E M De Haan, B. W J Mol, J. A M Van Der Post, K. S. Khan, G. Ter Riet

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

Objective: The objective of this study was to determine the accuracy of body mass index (BMI) (pre-pregnancy or at booking) in predicting pre-eclampsia and to explore its potential for clinical application. Design: Systematic review and bivariate meta-analysis. Setting: Medline, Embase, Cochrane Library, MEDION, manual searching of reference lists of review articles and eligible primary articles, and contact with experts. Population: Pregnant women at any level of risk in any healthcare setting. Methods: Reviewers independently selected studies and extracted data on study characteristics, quality, and accuracy. No language restrictions. Main outcome measures: Pooled sensitivities and specificities (95% CI), a summary receiver operating characteristic curve, and corresponding likelihood ratios (LRs). The potential value of BMI was assessed by combining its predictive capacity for different prevalences of pre-eclampsia and the therapeutic effectiveness (relative risk 0.90) of aspirin. Results: A total of 36 studies, testing 1 699 073 pregnant women (60 584 women with pre-eclampsia), met the selection criteria. The median incidence of pre-eclampsia was 3.9% (interquartile range 1.4-6.8). The area under the curve was 0.64 with 93% of heterogeneity explained by threshold differences. Pooled estimates (95% CI) for all studies with a BMI ≥ 25 were 47% (33-61) for sensitivity and 73% (64-83) for specificity; and 21% (12-31) and 92% (89-95) for a BMI ≥ 35. Corresponding LRs (95% CI) were 1.7 (0.3-11.9) for BMI ≥ 25 and 0.73 (0.22-2.45) for BMI < 25, and 2.7 (1.0-7.3) for BMI ≥ 35 and 0.86 (0.68-1.07) for BMI < 35. The number needed to treat with aspirin to prevent one case of pre-eclampsia ranges from 714 (no testing, low-risk women) to 37 (BMI ≥ 35, high-risk women). Conclusions: BMI appears to be a fairly weak predictor for pre-eclampsia. Although BMI is virtually free of cost, noninvasive, and ubiquitously available, its usefulness as a stand-alone test for risk stratification must await formal cost-utility analysis. The findings of this review may serve as input for such analyses.

LanguageEnglish
Pages1477-1485
Number of pages9
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume114
Issue number12
DOIs
Publication statusPublished - 1 Dec 2007

Keywords

  • Accuracy
  • Body mass index
  • Likelihood ratio
  • Meta-analysis
  • Pre-eclampsia
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Cnossen, J. S., Leeflang, M. M. G., De Haan, E. E. M., Mol, B. W. J., Van Der Post, J. A. M., Khan, K. S., & Ter Riet, G. (2007). Accuracy of body mass index in predicting pre-eclampsia: Bivariate meta-analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 114(12), 1477-1485. https://doi.org/10.1111/j.1471-0528.2007.01483.x
Cnossen, J. S. ; Leeflang, M. M G ; De Haan, E. E M ; Mol, B. W J ; Van Der Post, J. A M ; Khan, K. S. ; Ter Riet, G. / Accuracy of body mass index in predicting pre-eclampsia : Bivariate meta-analysis. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 ; Vol. 114, No. 12. pp. 1477-1485.
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abstract = "Objective: The objective of this study was to determine the accuracy of body mass index (BMI) (pre-pregnancy or at booking) in predicting pre-eclampsia and to explore its potential for clinical application. Design: Systematic review and bivariate meta-analysis. Setting: Medline, Embase, Cochrane Library, MEDION, manual searching of reference lists of review articles and eligible primary articles, and contact with experts. Population: Pregnant women at any level of risk in any healthcare setting. Methods: Reviewers independently selected studies and extracted data on study characteristics, quality, and accuracy. No language restrictions. Main outcome measures: Pooled sensitivities and specificities (95{\%} CI), a summary receiver operating characteristic curve, and corresponding likelihood ratios (LRs). The potential value of BMI was assessed by combining its predictive capacity for different prevalences of pre-eclampsia and the therapeutic effectiveness (relative risk 0.90) of aspirin. Results: A total of 36 studies, testing 1 699 073 pregnant women (60 584 women with pre-eclampsia), met the selection criteria. The median incidence of pre-eclampsia was 3.9{\%} (interquartile range 1.4-6.8). The area under the curve was 0.64 with 93{\%} of heterogeneity explained by threshold differences. Pooled estimates (95{\%} CI) for all studies with a BMI ≥ 25 were 47{\%} (33-61) for sensitivity and 73{\%} (64-83) for specificity; and 21{\%} (12-31) and 92{\%} (89-95) for a BMI ≥ 35. Corresponding LRs (95{\%} CI) were 1.7 (0.3-11.9) for BMI ≥ 25 and 0.73 (0.22-2.45) for BMI < 25, and 2.7 (1.0-7.3) for BMI ≥ 35 and 0.86 (0.68-1.07) for BMI < 35. The number needed to treat with aspirin to prevent one case of pre-eclampsia ranges from 714 (no testing, low-risk women) to 37 (BMI ≥ 35, high-risk women). Conclusions: BMI appears to be a fairly weak predictor for pre-eclampsia. Although BMI is virtually free of cost, noninvasive, and ubiquitously available, its usefulness as a stand-alone test for risk stratification must await formal cost-utility analysis. The findings of this review may serve as input for such analyses.",
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Cnossen, JS, Leeflang, MMG, De Haan, EEM, Mol, BWJ, Van Der Post, JAM, Khan, KS & Ter Riet, G 2007, 'Accuracy of body mass index in predicting pre-eclampsia: Bivariate meta-analysis', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 114, no. 12, pp. 1477-1485. https://doi.org/10.1111/j.1471-0528.2007.01483.x

Accuracy of body mass index in predicting pre-eclampsia : Bivariate meta-analysis. / Cnossen, J. S.; Leeflang, M. M G; De Haan, E. E M; Mol, B. W J; Van Der Post, J. A M; Khan, K. S.; Ter Riet, G.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 114, No. 12, 01.12.2007, p. 1477-1485.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Accuracy of body mass index in predicting pre-eclampsia

T2 - BJOG: An International Journal of Obstetrics and Gynaecology

AU - Cnossen, J. S.

AU - Leeflang, M. M G

AU - De Haan, E. E M

AU - Mol, B. W J

AU - Van Der Post, J. A M

AU - Khan, K. S.

AU - Ter Riet, G.

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N2 - Objective: The objective of this study was to determine the accuracy of body mass index (BMI) (pre-pregnancy or at booking) in predicting pre-eclampsia and to explore its potential for clinical application. Design: Systematic review and bivariate meta-analysis. Setting: Medline, Embase, Cochrane Library, MEDION, manual searching of reference lists of review articles and eligible primary articles, and contact with experts. Population: Pregnant women at any level of risk in any healthcare setting. Methods: Reviewers independently selected studies and extracted data on study characteristics, quality, and accuracy. No language restrictions. Main outcome measures: Pooled sensitivities and specificities (95% CI), a summary receiver operating characteristic curve, and corresponding likelihood ratios (LRs). The potential value of BMI was assessed by combining its predictive capacity for different prevalences of pre-eclampsia and the therapeutic effectiveness (relative risk 0.90) of aspirin. Results: A total of 36 studies, testing 1 699 073 pregnant women (60 584 women with pre-eclampsia), met the selection criteria. The median incidence of pre-eclampsia was 3.9% (interquartile range 1.4-6.8). The area under the curve was 0.64 with 93% of heterogeneity explained by threshold differences. Pooled estimates (95% CI) for all studies with a BMI ≥ 25 were 47% (33-61) for sensitivity and 73% (64-83) for specificity; and 21% (12-31) and 92% (89-95) for a BMI ≥ 35. Corresponding LRs (95% CI) were 1.7 (0.3-11.9) for BMI ≥ 25 and 0.73 (0.22-2.45) for BMI < 25, and 2.7 (1.0-7.3) for BMI ≥ 35 and 0.86 (0.68-1.07) for BMI < 35. The number needed to treat with aspirin to prevent one case of pre-eclampsia ranges from 714 (no testing, low-risk women) to 37 (BMI ≥ 35, high-risk women). Conclusions: BMI appears to be a fairly weak predictor for pre-eclampsia. Although BMI is virtually free of cost, noninvasive, and ubiquitously available, its usefulness as a stand-alone test for risk stratification must await formal cost-utility analysis. The findings of this review may serve as input for such analyses.

AB - Objective: The objective of this study was to determine the accuracy of body mass index (BMI) (pre-pregnancy or at booking) in predicting pre-eclampsia and to explore its potential for clinical application. Design: Systematic review and bivariate meta-analysis. Setting: Medline, Embase, Cochrane Library, MEDION, manual searching of reference lists of review articles and eligible primary articles, and contact with experts. Population: Pregnant women at any level of risk in any healthcare setting. Methods: Reviewers independently selected studies and extracted data on study characteristics, quality, and accuracy. No language restrictions. Main outcome measures: Pooled sensitivities and specificities (95% CI), a summary receiver operating characteristic curve, and corresponding likelihood ratios (LRs). The potential value of BMI was assessed by combining its predictive capacity for different prevalences of pre-eclampsia and the therapeutic effectiveness (relative risk 0.90) of aspirin. Results: A total of 36 studies, testing 1 699 073 pregnant women (60 584 women with pre-eclampsia), met the selection criteria. The median incidence of pre-eclampsia was 3.9% (interquartile range 1.4-6.8). The area under the curve was 0.64 with 93% of heterogeneity explained by threshold differences. Pooled estimates (95% CI) for all studies with a BMI ≥ 25 were 47% (33-61) for sensitivity and 73% (64-83) for specificity; and 21% (12-31) and 92% (89-95) for a BMI ≥ 35. Corresponding LRs (95% CI) were 1.7 (0.3-11.9) for BMI ≥ 25 and 0.73 (0.22-2.45) for BMI < 25, and 2.7 (1.0-7.3) for BMI ≥ 35 and 0.86 (0.68-1.07) for BMI < 35. The number needed to treat with aspirin to prevent one case of pre-eclampsia ranges from 714 (no testing, low-risk women) to 37 (BMI ≥ 35, high-risk women). Conclusions: BMI appears to be a fairly weak predictor for pre-eclampsia. Although BMI is virtually free of cost, noninvasive, and ubiquitously available, its usefulness as a stand-alone test for risk stratification must await formal cost-utility analysis. The findings of this review may serve as input for such analyses.

KW - Accuracy

KW - Body mass index

KW - Likelihood ratio

KW - Meta-analysis

KW - Pre-eclampsia

KW - Sensitivity and specificity

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