Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303830
Katherine Cameron, Mostafa Borahay, Xiumei Hong, Valerie Baker, Arthur Vaught, Xiaobin Wang
Study Question: What is the impact of the presence of uterine fibroids on the risk of developing hypertensive disorders of pregnancy (HDP) in a predominantly urban, low-income, Black, and Hispanic population of women with ultrasound or clinically diagnosed uterine fibroids with rich phenotypic data to carefully control for potential confounders? Summary answers: The odds of HDP were 39% higher in women with uterine fibroids compared to those without when controlled for age at delivery, race, prepregnancy BMI, education, parity, and smoking status; neither fibroid location or size modified this risk. What is known already: Studies are conflicting regarding the impact of uterine fibroids on risk of HDP; limitations of prior studies include primarily Western European populations and lack of measurement of potential confounders. Study design, size, and duration: A total of 7030 women from the Boston Birth Cohort (a racially diverse cohort recruited from 1998 to 2018) that had clinical and ultrasound data regarding uterine fibroid status were included in this analysis. Participants/materials, setting, and methods: Four hundred eighty-nine women with uterine fibroids and 6541 women without were included. Hypertensive disorders of pregnancy were ascertained from medical records. Logistic regression was performed to assess the risk of HDP in women with and without uterine fibroids. Covariates adjusted for included age at delivery, race, pre-pregnancy BMI, education, parity, and smoking status during pregnancy. Sub-analyses were performed to assess the impact of specific fibroid location and overall fibroid volume burden. Main results and the role of chance: The incidence of uterine fibroids in the cohort was 7% (N=489). Twelve percent of women without uterine fibroids and 17% of women with fibroids developed HDP; in multivariate analyses adjusted for the potential confounders above, the odds of HDP were 39% higher in women with uterine fibroids compared to those without (p=0.03). Women with a uterine fibroid diagnosis based on ICD code (n=297) versus asymptomatic incidental ultrasound diagnosis (n=192) had a significantly greater chance of developing HDP (20 vs 15%, p=0.006). There did not appear to be an association between number of fibroids or total fibroid volume and the risk of developing HDP. Limitations, reasons for caution: This study has a relatively small sample size. While post-hoc power calculation determined that there was adequate power to detect a 4.6% difference in the incidence of development of HDP between participants with uterine fibroids and those without, the sub-analyses based on fibroid size, location, and method of diagnosis were underpowered to determine a similar level of difference. Wider implications of the findings: In a racially diverse cohort, presence of uterine fibroids was a significant risk factor for developing HDP, regardless of uterine fibroid size or location. This may have implications for additional monitoring an
{"title":"Uterine fibroids and risk of hypertensive disorders of pregnancy; results from a racially diverse high-risk cohort","authors":"Katherine Cameron, Mostafa Borahay, Xiumei Hong, Valerie Baker, Arthur Vaught, Xiaobin Wang","doi":"10.1101/2024.03.05.24303830","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303830","url":null,"abstract":"Study Question: What is the impact of the presence of uterine fibroids on the risk of developing hypertensive disorders of pregnancy (HDP) in a predominantly urban, low-income, Black, and Hispanic population of women with ultrasound or clinically diagnosed uterine fibroids with rich phenotypic data to carefully control for potential confounders?\u0000Summary answers: The odds of HDP were 39% higher in women with uterine fibroids compared to those without when controlled for age at delivery, race, prepregnancy BMI, education, parity, and smoking status; neither fibroid location or size modified this risk.\u0000What is known already: Studies are conflicting regarding the impact of uterine fibroids on risk of HDP; limitations of prior studies include primarily Western European populations and lack of measurement of potential confounders. Study design, size, and duration: A total of 7030 women from the Boston Birth Cohort (a racially diverse cohort recruited from 1998 to 2018) that had clinical and ultrasound data regarding uterine fibroid status were included in this analysis. Participants/materials, setting, and methods: Four hundred eighty-nine women with uterine fibroids and 6541 women without were included. Hypertensive disorders of pregnancy were ascertained from medical records. Logistic regression was performed to assess the risk of HDP in women with and without uterine fibroids. Covariates adjusted for included age at delivery, race, pre-pregnancy BMI, education, parity, and smoking status during pregnancy. Sub-analyses were performed to assess the impact of specific fibroid location and overall fibroid volume burden.\u0000Main results and the role of chance: The incidence of uterine fibroids in the cohort was 7% (N=489). Twelve percent of women without uterine fibroids and 17% of women with fibroids developed HDP; in multivariate analyses adjusted for the potential confounders above, the odds of HDP were 39% higher in women with uterine fibroids compared to those without (p=0.03). Women with a uterine fibroid diagnosis based on ICD code (n=297) versus asymptomatic incidental ultrasound diagnosis (n=192) had a significantly greater chance of developing HDP (20 vs 15%, p=0.006). There did not appear to be an association between number of fibroids or total fibroid volume and the risk of developing HDP. Limitations, reasons for caution: This study has a relatively small sample size. While post-hoc power calculation determined that there was adequate power to detect a 4.6% difference in the incidence of development of HDP between participants with uterine fibroids and those without, the sub-analyses based on fibroid size, location, and method of diagnosis were underpowered to determine a similar level of difference.\u0000Wider implications of the findings: In a racially diverse cohort, presence of uterine fibroids was a significant risk factor for developing HDP, regardless of uterine fibroid size or location. This may have implications for additional monitoring an","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The inherent variability in the visual interpretation of cardiotocograms (CTGs) by obstetric clinical experts, both intra- and inter-observer, presents a substantial challenge in obstetric care. In response, we investigate automated CTG interpretation as a potential solution to enhance the early detection of fetal hypoxia during labor, which has the potential to reduce unnecessary operative interventions and improve overall maternal and neonatal care. This study employs deep learning techniques to reduce the subjectivity associated with visual CTG interpretation. Our results demonstrate that using objective umbilical cord blood pH outcome measurements, rather than clinician-defined Apgar scores, yields more consistent and robust model performance. Additionally, through a series of ablation studies, we explore the impact of temporal distribution shifts on the performance of these deep learning models. We examine tradeoffs between performance and fairness, specifically evaluating performance across demographic and clinical subgroups. Finally, we discuss the practical implications of our findings for the real-world deployment of such systems, emphasizing their potential utility in medical settings with limited resources.
{"title":"Development and Evaluation of Deep Learning Models for Cardiotocography Interpretation","authors":"Nicole Chiou, Nichole Young-Lin, Christopher Kelly, Tiya Tiyasirichokchai, Abdoulaye Diack, Sanmi Koyejo, Katherine Heller, Mercy Nyamewaa Asiedu","doi":"10.1101/2024.03.05.24303805","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303805","url":null,"abstract":"The inherent variability in the visual interpretation of cardiotocograms (CTGs) by obstetric clinical experts, both intra- and inter-observer, presents a substantial challenge in obstetric care. In response, we investigate automated CTG interpretation as a potential solution to enhance the early detection of fetal hypoxia during labor, which has the potential to reduce unnecessary operative interventions and improve overall maternal and neonatal care. This study employs deep learning techniques to reduce the subjectivity associated with visual CTG interpretation. Our results demonstrate that using objective umbilical cord blood pH outcome measurements, rather than clinician-defined Apgar scores, yields more consistent and robust model performance. Additionally, through a series of ablation studies, we explore the impact of temporal distribution shifts on the performance of these deep learning models. We examine tradeoffs between performance and fairness, specifically evaluating performance across demographic and clinical subgroups. Finally, we discuss the practical implications of our findings for the real-world deployment of such systems, emphasizing their potential utility in medical settings with limited resources.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Innovative strategies are urgently needed to meet the World Health Organizations 2030 target of treating 90% of women with precancerous cervical lesions, especially in countries most affected by cervical cancer. We assessed the acceptability of self-administered intravaginal therapies for treating cervical precancer in women undergoing cervical cancer screening and precancer treatment in Kenya. Methods: We conducted a cross-sectional study among women aged 18 to 65 years undergoing cervical cancer screening or precancer treatment between January and October 2023 in Kisumu County, Kenya. Participants completed a questionnaire about their perceptions and perceived acceptability of self- or provider-administered topical therapies for cervical precancer treatment. Quantitative data were summarized using descriptive statistics. Results: A total of 379 questionnaires were completed. The median age of participants was 35 years (IQR 25-62), 62% had a primary education or less, and 71% earned $5 or less daily. All participants had been screened for cervical cancer, and 191 (51%) had received precancer treatment, primarily thermal ablation. Ninety-eight percent of participants were willing to use a self-administered intravaginal therapy for cervical precancer, if available. The majority, 91%, believed their male partner would support their use. Given a choice, 63% preferred self-admiration at home compared to provider-administration of a topical therapy in the clinic, citing time and cost savings. In multivariate analysis, married women were more likely to expect partner support for self-administration than single women. Participants preferred a therapy used less frequently but for a longer duration, compared to daily use therapy with a shorter duration of use. Conclusions: Self-administered intravaginal therapies for cervical precancer treatment are highly acceptable among women undergoing screening and precancer treatment in Kenya.
{"title":"Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya","authors":"Chemtai Mungo, Grace Ellis, Mercy Rop, Yating Zou, Jackton Omoto, Lisa Rahangdale","doi":"10.1101/2024.03.05.24303779","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303779","url":null,"abstract":"Purpose: Innovative strategies are urgently needed to meet the World Health Organizations 2030 target of treating 90% of women with precancerous cervical lesions, especially in countries most affected by cervical cancer. We assessed the acceptability of self-administered intravaginal therapies for treating cervical precancer in women undergoing cervical cancer screening and precancer treatment in Kenya. Methods: We conducted a cross-sectional study among women aged 18 to 65 years undergoing cervical cancer screening or precancer treatment between January and October 2023 in Kisumu County, Kenya. Participants completed a questionnaire about their perceptions and perceived acceptability of self- or provider-administered topical therapies for cervical precancer treatment. Quantitative data were summarized using descriptive statistics. Results: A total of 379 questionnaires were completed. The median age of participants was 35 years (IQR 25-62), 62% had a primary education or less, and 71% earned $5 or less daily. All participants had been screened for cervical cancer, and 191 (51%) had received precancer treatment, primarily thermal ablation. Ninety-eight percent of participants were willing to use a self-administered intravaginal therapy for cervical precancer, if available. The majority, 91%, believed their male partner would support their use. Given a choice, 63% preferred self-admiration at home compared to provider-administration of a topical therapy in the clinic, citing time and cost savings. In multivariate analysis, married women were more likely to expect partner support for self-administration than single women. Participants preferred a therapy used less frequently but for a longer duration, compared to daily use therapy with a shorter duration of use. Conclusions: Self-administered intravaginal therapies for cervical precancer treatment are highly acceptable among women undergoing screening and precancer treatment in Kenya.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.1101/2024.02.29.24303573
Eugenia Y Chock, Zeyan Liew, Lars Henning Pedersen, Mette Oestergaard Thunbo
Background: Prior studies indicated that women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are at twice higher risk of developing adverse pregnancy outcomes, this include preterm births and infants with low birth weight. A wide knowledge gap exists in our current understanding of how RA and JIA affect fetal growth during pregnancy. Objective: We aimed to evaluate fetal growth among patients with RA/JIA by comparing fetal growth indicators of offspring born to this population, compared to individuals without RA/JIA. We hypothesized that fetal growth among patients with RA/JIA is reduced, compared to individuals without RA/JIA. Study Design: We conducted a population-based cohort study in Denmark from 2008-2018 which included 503,491 individuals with singleton pregnancies. Among them, 2,206 were patients with RA and JIA. We linked several nationwide databases and clinical registries in Denmark to achieve our aim. Through the Danish Fetal Medicine Database (DFMD), we obtained fetal biometric measurements gathered from second trimester fetal ultrasound scans. We used International Classification of Diseases (ICD)-10 codes to identify pregnant patients with RA/JIA from the Danish National Patient Registry and linked them to the DFMD, other variables of interest were obtained from different Danish clinical registries. Next, we computed fetal growth gradient between second trimester and birth, using the mean difference in Z-score distances for each fetal growth indicator. We also estimated the risk of small for gestational age (SGA), all outcomes were compared between pregnant individuals with and without RA/JIA and adjusted for confounders. Results: Maternal RA and JIA was not associated with a reduction of estimated fetal weight (EFW) at mid-pregnancy [adjusted mean EFW Z-score difference of 0.05 (95% CI 0.01, 0.10; p=0.022)], but lower birth weights were observed among offspring [adjusted mean Z-score difference of -0.08 (95% CI -0.13, -0.04; p<0.001)]. We observed reduced mean Z-score differences in weight gradient from second trimester to birth among offspring of patients with RA/JIA who also used corticosteroids [-0.26 (95% CI -0.11, -0.41; p<0.001)], and sulfasalazine [-0.61 (95% CI -0.45, -0.77; p<0.001)] during pregnancy. Maternal RA/JIA was also associated with SGA [aOR of 1.47 (95% CI 1.16, 1.83; p<0.001)]. Similarly, the risk estimates were higher among corticosteroid [aOR 3.44 (95% CI 2.14, 5.25; p<0.001)] and sulfasalazine [(aOR 2.28 (95% CI 1.22, 3.88; p=0.005) users. Conclusion: Among pregnant patients with RA/JIA, fetal growth restriction may be most apparent after 18 to 22 weeks of gestational age. Closer antenatal monitoring around this period should be considered for this population.
背景：先前的研究表明，患有类风湿性关节炎（RA）和幼年特发性关节炎（JIA）的妇女发生不良妊娠结局的风险比正常人高一倍，其中包括早产和出生体重不足的婴儿。目前，我们对 RA 和 JIA 如何影响孕期胎儿生长的认识还存在很大差距。研究目的我们旨在通过比较RA/JIA患者与非RA/JIA患者的后代的胎儿生长指标，评估RA/JIA患者的胎儿生长情况。我们假设，与未患有 RA/JIA 的个体相比，RA/JIA 患者的胎儿发育会减慢。研究设计：我们于 2008-2018 年在丹麦开展了一项基于人群的队列研究，共纳入 503,491 名单胎妊娠者。其中，2206 人为 RA 和 JIA 患者。为了达到研究目的，我们将丹麦多个全国性数据库和临床登记处联系起来。通过丹麦胎儿医学数据库（Danish Fetal Medicine Database，DFMD），我们获得了从第二孕期胎儿超声扫描中收集到的胎儿生物测量数据。我们使用国际疾病分类（ICD）-10代码从丹麦全国患者登记册中识别出患有RA/JIA的孕妇，并将他们与DFMD连接起来，其他相关变量则从丹麦不同的临床登记册中获得。接下来，我们利用每个胎儿生长指标的 Z 评分距离的平均差，计算了第二孕期到出生时的胎儿生长梯度。我们还估算了胎龄过小（SGA）的风险，所有结果都在患有和未患有RA/JIA的孕妇之间进行了比较，并对混杂因素进行了调整。结果显示母体RA和JIA与孕中期估计胎儿体重（EFW）的降低无关[调整后的平均EFW Z-score差异为0.05（95% CI为0.01，0.10；p=0.022）]，但观察到后代出生体重较低[调整后的平均Z-score差异为-0.08（95% CI为-0.13，-0.04；p<0.001）]。我们观察到，在怀孕期间使用皮质类固醇[-0.26 (95% CI -0.11, -0.41；p<0.001)]和柳氮磺胺吡啶[-0.61 (95% CI -0.45, -0.77；p<0.001)]的RA/JIA患者，其后代从怀孕后三个月到出生时体重梯度的平均Z-score差异减小。母体 RA/JIA 也与 SGA 相关[aOR 为 1.47 (95% CI 1.16, 1.83; p<0.001)]。同样，皮质类固醇[aOR 3.44 (95% CI 2.14, 5.25; p<0.001)]和柳氮磺胺吡啶[(aOR 2.28 (95% CI 1.22, 3.88; p=0.005)]使用者的风险估计值更高。结论在患有 RA/JIA 的孕妇中，胎儿生长受限可能在胎龄 18-22 周后最为明显。应考虑在这一时期对该人群进行更密切的产前监测。
{"title":"Fetal Growth Associated with Maternal Rheumatoid Arthritis and Juvenile Idiopathic Arthritis.","authors":"Eugenia Y Chock, Zeyan Liew, Lars Henning Pedersen, Mette Oestergaard Thunbo","doi":"10.1101/2024.02.29.24303573","DOIUrl":"https://doi.org/10.1101/2024.02.29.24303573","url":null,"abstract":"Background: Prior studies indicated that women with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) are at twice higher risk of developing adverse pregnancy outcomes, this include preterm births and infants with low birth weight. A wide knowledge gap exists in our current understanding of how RA and JIA affect fetal growth during pregnancy. Objective: We aimed to evaluate fetal growth among patients with RA/JIA by comparing fetal growth indicators of offspring born to this population, compared to individuals without RA/JIA. We hypothesized that fetal growth among patients with RA/JIA is reduced, compared to individuals without RA/JIA. Study Design: We conducted a population-based cohort study in Denmark from 2008-2018 which included 503,491 individuals with singleton pregnancies. Among them, 2,206 were patients with RA and JIA. We linked several nationwide databases and clinical registries in Denmark to achieve our aim. Through the Danish Fetal Medicine Database (DFMD), we obtained fetal biometric measurements gathered from second trimester fetal ultrasound scans. We used International Classification of Diseases (ICD)-10 codes to identify pregnant patients with RA/JIA from the Danish National Patient Registry and linked them to the DFMD, other variables of interest were obtained from different Danish clinical registries. Next, we computed fetal growth gradient between second trimester and birth, using the mean difference in Z-score distances for each fetal growth indicator. We also estimated the risk of small for gestational age (SGA), all outcomes were compared between pregnant individuals with and without RA/JIA and adjusted for confounders. Results: Maternal RA and JIA was not associated with a reduction of estimated fetal weight (EFW) at mid-pregnancy [adjusted mean EFW Z-score difference of 0.05 (95% CI 0.01, 0.10; p=0.022)], but lower birth weights were observed among offspring [adjusted mean Z-score difference of -0.08 (95% CI -0.13, -0.04; p<0.001)]. We observed reduced mean Z-score differences in weight gradient from second trimester to birth among offspring of patients with RA/JIA who also used corticosteroids [-0.26 (95% CI -0.11, -0.41; p<0.001)], and sulfasalazine [-0.61 (95% CI -0.45, -0.77; p<0.001)] during pregnancy. Maternal RA/JIA was also associated with SGA [aOR of 1.47 (95% CI 1.16, 1.83; p<0.001)]. Similarly, the risk estimates were higher among corticosteroid [aOR 3.44 (95% CI 2.14, 5.25; p<0.001)] and sulfasalazine [(aOR 2.28 (95% CI 1.22, 3.88; p=0.005) users. Conclusion: Among pregnant patients with RA/JIA, fetal growth restriction may be most apparent after 18 to 22 weeks of gestational age. Closer antenatal monitoring around this period should be considered for this population.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140025441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.27.23300005
Magdalena Elisabeth Bachmann, Ioana Duta, Emily Mazey, William Cooke, Manu Vatish, Gabriel Davis Jones
Introduction: Artificial Intelligence (AI) is redefining healthcare, with Large Language Models (LLMs) like ChatGPT offering novel and powerful capabilities in processing and generating human-like information. These advancements offer potential improvements in Women's Health, particularly Obstetrics and Gynaecology (O&G), where diagnostic and treatment gaps have long existed. Despite its generalist nature, ChatGPT is increasingly being tested in healthcare, necessitating a critical analysis of its utility, limitations and safety. This study examines ChatGPT's performance in interpreting and responding to international gold standard benchmark assessments in O&G: the RCOG's MRCOG Part One and Two examinations. We evaluate ChatGPT's domain- and knowledge area-specific accuracy, the influence of linguistic complexity on performance and its self-assessment confidence and uncertainty, essential for safe clinical decision-making. Methods: A dataset of MRCOG examination questions from sources beyond the reach of LLMs was developed to mitigate the risk of ChatGPT's prior exposure. A dual-review process validated the technical and clinical accuracy of the questions, omitting those dependent on previous content, duplicates, or requiring image interpretation. Single Best Answer (SBA) and Extended Matching (EMQ) Questions were converted to JSON format to facilitate ChatGPT's interpretation, incorporating question types and background information. Interaction with ChatGPT was conducted via OpenAI's API, structured to ensure consistent, contextually informed responses from ChatGPT. The response from ChatGPT was recorded and compared against the known accurate response. Linguistic complexity was evaluated using unique token counts and Type-Token ratios (vocabulary breadth and diversity) to explore their influence on performance. ChatGPT was instructed to assign confidence scores to its answers (0-100%), reflecting its self-perceived accuracy. Responses were categorized by correctness and statistically analysed through entropy calculation, assessing ChatGPT's capacity for self-evaluating certainty and knowledge boundaries. Findings: Of 1,824 MRCOG Part One and Two questions, ChatGPT's accuracy on MRCOG Part One was 72.2% (95% CI 69.2-75.3). For Part Two, it achieved 50.4% accuracy (95% CI 47.2-53.5) with 534 correct out of 989 questions, performing better on SBAs (54.0%, 95% CI 50.0-58.0) than on EMQs (45.0%, 95% CI 40.1-49.9). In domain-specific performance, the highest accuracy was in Biochemistry (79.8%, 95% CI 71.4-88.1) and the lowest in Biophysics (51.4%, 95% CI 35.2-67.5). The best-performing subject in Part Two was Urogynaecology (63.0%, 95% CI 50.1-75.8) and the worst was Management of Labour (35.6%, 95% CI 21.6-49.5). Linguistic complexity analysis showed a marginal increase in unique token count for correct answers in Part One (median 122, IQR 114-134) compared to incorrect (median 120, IQR 112-131, p=0.05). TTR analysis revealed higher medians
{"title":"Exploring the Capabilities of ChatGPT in Women's Health","authors":"Magdalena Elisabeth Bachmann, Ioana Duta, Emily Mazey, William Cooke, Manu Vatish, Gabriel Davis Jones","doi":"10.1101/2024.02.27.23300005","DOIUrl":"https://doi.org/10.1101/2024.02.27.23300005","url":null,"abstract":"Introduction: Artificial Intelligence (AI) is redefining healthcare, with Large Language Models (LLMs) like ChatGPT offering novel and powerful capabilities in processing and generating human-like information. These advancements offer potential improvements in Women's Health, particularly Obstetrics and Gynaecology (O&G), where diagnostic and treatment gaps have long existed. Despite its generalist nature, ChatGPT is increasingly being tested in healthcare, necessitating a critical analysis of its utility, limitations and safety. This study examines ChatGPT's performance in interpreting and responding to international gold standard benchmark assessments in O&G: the RCOG's MRCOG Part One and Two examinations. We evaluate ChatGPT's domain- and knowledge area-specific accuracy, the influence of linguistic complexity on performance and its self-assessment confidence and uncertainty, essential for safe clinical decision-making. Methods: A dataset of MRCOG examination questions from sources beyond the reach of LLMs was developed to mitigate the risk of ChatGPT's prior exposure. A dual-review process validated the technical and clinical accuracy of the questions, omitting those dependent on previous content, duplicates, or requiring image interpretation. Single Best Answer (SBA) and Extended Matching (EMQ) Questions were converted to JSON format to facilitate ChatGPT's interpretation, incorporating question types and background information. Interaction with ChatGPT was conducted via OpenAI's API, structured to ensure consistent, contextually informed responses from ChatGPT. The response from ChatGPT was recorded and compared against the known accurate response. Linguistic complexity was evaluated using unique token counts and Type-Token ratios (vocabulary breadth and diversity) to explore their influence on performance. ChatGPT was instructed to assign confidence scores to its answers (0-100%), reflecting its self-perceived accuracy. Responses were categorized by correctness and statistically analysed through entropy calculation, assessing ChatGPT's capacity for self-evaluating certainty and knowledge boundaries. Findings: Of 1,824 MRCOG Part One and Two questions, ChatGPT's accuracy on MRCOG Part One was 72.2% (95% CI 69.2-75.3). For Part Two, it achieved 50.4% accuracy (95% CI 47.2-53.5) with 534 correct out of 989 questions, performing better on SBAs (54.0%, 95% CI 50.0-58.0) than on EMQs (45.0%, 95% CI 40.1-49.9). In domain-specific performance, the highest accuracy was in Biochemistry (79.8%, 95% CI 71.4-88.1) and the lowest in Biophysics (51.4%, 95% CI 35.2-67.5). The best-performing subject in Part Two was Urogynaecology (63.0%, 95% CI 50.1-75.8) and the worst was Management of Labour (35.6%, 95% CI 21.6-49.5). Linguistic complexity analysis showed a marginal increase in unique token count for correct answers in Part One (median 122, IQR 114-134) compared to incorrect (median 120, IQR 112-131, p=0.05). TTR analysis revealed higher medians","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139988363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-27DOI: 10.1101/2024.02.26.24303280
Gabriel Davis Jones, William Cooke, Manu Vatish
Introduction: Fetal heart rate (FHR) monitoring is one of the commonest and most affordable tests performed during pregnancy worldwide. It is critical for evaluating the health status of the baby, providing real-time insights into the physiology of the fetus. While the relationship between patterns in these signals and adverse pregnancy outcomes is well-established, human identification of these complex patterns remains sub-optimal, with experts often failing to recognise babies at high-risk of outcomes such as asphyxia, growth restriction and stillbirth. These outcomes are especially relevant in low- and middle-income countries where an estimated 98% of perinatal deaths occur. Pre-term birth complications are also the leading cause of death in children <5 years of age, 75% of which can be prevented. While advances have been made in developing low-cost digital solutions for antenatal fetal monitoring, there is still substantial progress to be made in developing tools for the identification of high-risk, adverse outcome pre-term pregnancies using these FHR systems. In this study, we have developed the first machine learning algorithm for the identification of high-risk preterm pregnancies with associated adverse outcomes using fetal heart rate monitoring. Methods: We sourced antepartum fetal heart rate traces from high-risk, pre-term pregnancies that were assigned at least one of ten adverse conditions. These were matched with normal pregnancies delivered at term. Using an automated, clinically-validated algorithm, seven distinct fetal heart rate patterns were extracted from each trace, subsequently filtered for outliers and normalized. The data were split into 80% for model development and 20% for validation. Six machine learning algorithms were trained using k-fold cross-validation to identify each trace as either normal or high-risk preterm. The best-performing algorithm was further evaluated using the validation dataset based on metrics including the AUC, sensitivity, and specificity at three distinct classification thresholds. Additional assessments included decision curve analysis and gestational age-specific and outcome-specific performance evaluations. Results: We analysed antepartum fetal heart rate recordings from 4,867 high-risk, pre-term pregnancies with adverse outcomes and 4,014 normal pregnancies. Feature extraction and preprocessing revealed significant differences between the groups (p<0.001). The random forest classifier was the most effective model, achieving an AUC of 0.88 (95% CI 0.87-0.88). When evaluating specific adverse outcomes, the median AUC was 0.85 (IQR 0.81-0.89) and the model consistently exceeded an AUC of 0.80 across all gestational ages. The model's robustness was confirmed on the validation dataset with an AUC of 0.88 (95% CI 0.86-0.90) and a Brier score of 0.14. Decision curve analysis showed the model surpassed both the treat-none and treat-all strategies over most probability thresholds (0.11-1.0). Perf
简介胎儿心率（FHR）监测是全球最常见、最经济实惠的孕期检查之一。它对评估胎儿的健康状况至关重要，能实时了解胎儿的生理状况。虽然这些信号的模式与不良妊娠结局之间的关系已得到证实，但人类对这些复杂模式的识别能力仍未达到最佳水平，专家们往往无法识别窒息、生长受限和死胎等高风险胎儿。这些结果与中低收入国家的关系尤为密切，估计有 98% 的围产期死亡发生在这些国家。早产并发症也是导致 5 岁儿童死亡的主要原因，其中 75% 是可以预防的。虽然在开发用于产前胎儿监护的低成本数字解决方案方面取得了进展，但在开发使用这些 FHR 系统识别高风险、不良结局早产妊娠的工具方面仍有待取得重大进展。在本研究中，我们开发了首个机器学习算法，利用胎儿心率监测识别高风险早产及相关不良结局。研究方法我们从高危早产孕妇的产前胎心率追踪中获取了至少十种不良情况中的一种。这些孕妇与足月分娩的正常孕妇进行了比对。使用经临床验证的自动算法，从每个跟踪数据中提取出七种不同的胎儿心率模式，随后过滤异常值并进行归一化处理。数据分为 80% 用于模型开发，20% 用于验证。使用 k 倍交叉验证对六种机器学习算法进行了训练，以将每个迹线识别为正常或高风险早产。根据三个不同分类阈值下的 AUC、灵敏度和特异性等指标，使用验证数据集对表现最佳的算法进行了进一步评估。其他评估包括决策曲线分析以及特定孕龄和特定结果的性能评估。结果：我们分析了产前胎儿心率记录，这些记录来自 4867 例有不良预后的高危早产妊娠和 4014 例正常妊娠。特征提取和预处理显示两组之间存在显著差异（p<0.001）。随机森林分类器是最有效的模型，AUC 为 0.88（95% CI 0.87-0.88）。在评估特定不良结局时，AUC 的中位数为 0.85（IQR 0.81-0.89），该模型在所有妊娠年龄段的 AUC 均超过了 0.80。该模型的稳健性在验证数据集上得到了证实，AUC 为 0.88 (95% CI 0.86-0.90)，Brier 得分为 0.14。决策曲线分析表明，在大多数概率阈值（0.11-1.0）上，该模型都超过了 "不治疗 "和 "全部治疗 "策略。使用 Youden 指数的性能指标如下：灵敏度 76.2% (95% CI 72.6-80.5%)、特异度 87.5% (95% CI 83.3-91.0)、F1 分数 81.7 (95% CI 79.6-83.9)、Cohen's kappa 62.8 (95% CI 59.6-66.4)，表明妊娠结局之间具有很高的鉴别能力。结论我们的研究成功地证明了机器学习算法能够通过胎儿心率监测识别高风险早产妊娠及相关不良妊娠结局。这些研究结果证明了机器学习在提高产前胎儿监护的准确性和有效性方面的潜力，尤其是对于及时干预至关重要的高风险病例。这种算法可以大大改善妊娠结局预测，从而改善孕产妇和新生儿护理，尤其是在不良结局负担较重的中低收入国家。
{"title":"Identifying high-risk pre-term pregnancies using the fetal heart rate and machine learning","authors":"Gabriel Davis Jones, William Cooke, Manu Vatish","doi":"10.1101/2024.02.26.24303280","DOIUrl":"https://doi.org/10.1101/2024.02.26.24303280","url":null,"abstract":"Introduction: Fetal heart rate (FHR) monitoring is one of the commonest and most affordable tests performed during pregnancy worldwide. It is critical for evaluating the health status of the baby, providing real-time insights into the physiology of the fetus. While the relationship between patterns in these signals and adverse pregnancy outcomes is well-established, human identification of these complex patterns remains sub-optimal, with experts often failing to recognise babies at high-risk of outcomes such as asphyxia, growth restriction and stillbirth. These outcomes are especially relevant in low- and middle-income countries where an estimated 98% of perinatal deaths occur. Pre-term birth complications are also the leading cause of death in children <5 years of age, 75% of which can be prevented. While advances have been made in developing low-cost digital solutions for antenatal fetal monitoring, there is still substantial progress to be made in developing tools for the identification of high-risk, adverse outcome pre-term pregnancies using these FHR systems. In this study, we have developed the first machine learning algorithm for the identification of high-risk preterm pregnancies with associated adverse outcomes using fetal heart rate monitoring. Methods: We sourced antepartum fetal heart rate traces from high-risk, pre-term pregnancies that were assigned at least one of ten adverse conditions. These were matched with normal pregnancies delivered at term. Using an automated, clinically-validated algorithm, seven distinct fetal heart rate patterns were extracted from each trace, subsequently filtered for outliers and normalized. The data were split into 80% for model development and 20% for validation. Six machine learning algorithms were trained using k-fold cross-validation to identify each trace as either normal or high-risk preterm. The best-performing algorithm was further evaluated using the validation dataset based on metrics including the AUC, sensitivity, and specificity at three distinct classification thresholds. Additional assessments included decision curve analysis and gestational age-specific and outcome-specific performance evaluations. Results: We analysed antepartum fetal heart rate recordings from 4,867 high-risk, pre-term pregnancies with adverse outcomes and 4,014 normal pregnancies. Feature extraction and preprocessing revealed significant differences between the groups (p<0.001). The random forest classifier was the most effective model, achieving an AUC of 0.88 (95% CI 0.87-0.88). When evaluating specific adverse outcomes, the median AUC was 0.85 (IQR 0.81-0.89) and the model consistently exceeded an AUC of 0.80 across all gestational ages. The model's robustness was confirmed on the validation dataset with an AUC of 0.88 (95% CI 0.86-0.90) and a Brier score of 0.14. Decision curve analysis showed the model surpassed both the treat-none and treat-all strategies over most probability thresholds (0.11-1.0). Perf","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139977802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23DOI: 10.1101/2024.02.21.24302996
Soren Vinther Larsen, Anders Pretzmann Mikkelsen, Kathrine Bang Madsen, Xiaoqin Liu, Trine Munk-Olsen, Vibe Gedso Frokjaer, Oejvind Lidegaard
Introduction: Hormonal contraception is used by over a quarter of a billion worldwide. In Denmark, 84% have used it before their first pregnancy. After pregnancy, mothers are routinely advised to consider contraception to avoid short interpregnancy intervals due to perinatal and maternal health risks. Yet, mothers are not recommended to start combined hormonal contraception within six weeks postpartum due to an increased thromboembolic risk. This study provides an overview of postpartum hormonal contraceptive use in Denmark. Material and methods: This descriptive study is based on Danish national health registries on mothers who delivered during 1997-2021. The cumulative incidence of HC initiation one year after delivery is reported by calendar year and age group. Timing of initiation is reported as the median time from delivery. Hormonal contraception was categorized according to hormone type and method of administration. Results: A total of 676 759 first-time and 552 142 second-time mothers were registered, with a cumulative incidence of hormonal contraceptive initiation of 41.0% (95% CI, 40.9-41.1) and 40.5% (95% CI, 40.4-40.6), respectively. From 1997 to 2021, the cumulative incidence of first-time mothers who initially used progestogen-only pills increased from 3.8% (95% CI, 3.5-4.0) to 14.4% (95% CI, 13.9-14.8) and intrauterine levonorgestrel-releasing systems from 0.1% (95% CI, 0.1-0.2) to 12.6% (95% CI, 12.3-13.0). In contrast, combined oral contraception initiation decreased from 31.3% (95% CI, 30.7-31.8) to 7.8% (95% CI, 7.5-8.2). Among first-time mothers initiating hormonal contraception, the median time of initiation decreased from 4.7 (Q1-Q3, 2.5-7.5) months during 1997-2001 to 2.5 (Q1-Q3, 2-0-4.0) months during 2017-2021. The cumulative incidence of first-time mothers using combined hormonal contraception six weeks after delivery decreased from 1.5% (95% CI, 1.5-1.6) during 2007-2011 to 0.5% (95% CI, 0.5-0.5) during 2017-2021. Conclusions: Within the first year after childbirth, 41% of first- and second-time mothers initiated hormonal contraception in Denmark during 1997-2021. Throughout 1997-2021, mothers started earlier after delivery and more often used progestogen-only contraception. Few started combined hormonal contraception within 6 weeks after delivery in accordance with national guidelines. Taken together, the pattern of HC use over time reflects a change to safer contraceptive methods postpartum which minimizes thromboembolic risk.
{"title":"Postpartum hormonal contraceptive use in Denmark during 1997-2021","authors":"Soren Vinther Larsen, Anders Pretzmann Mikkelsen, Kathrine Bang Madsen, Xiaoqin Liu, Trine Munk-Olsen, Vibe Gedso Frokjaer, Oejvind Lidegaard","doi":"10.1101/2024.02.21.24302996","DOIUrl":"https://doi.org/10.1101/2024.02.21.24302996","url":null,"abstract":"Introduction: Hormonal contraception is used by over a quarter of a billion worldwide. In Denmark, 84% have used it before their first pregnancy. After pregnancy, mothers are routinely advised to consider contraception to avoid short interpregnancy intervals due to perinatal and maternal health risks. Yet, mothers are not recommended to start combined hormonal contraception within six weeks postpartum due to an increased thromboembolic risk. This study provides an overview of postpartum hormonal contraceptive use in Denmark.\u0000Material and methods: This descriptive study is based on Danish national health registries on mothers who delivered during 1997-2021. The cumulative incidence of HC initiation one year after delivery is reported by calendar year and age group. Timing of initiation is reported as the median time from delivery. Hormonal contraception was categorized according to hormone type and method of administration. Results: A total of 676 759 first-time and 552 142 second-time mothers were registered, with a cumulative incidence of hormonal contraceptive initiation of 41.0% (95% CI, 40.9-41.1) and 40.5% (95% CI, 40.4-40.6), respectively. From 1997 to 2021, the cumulative incidence of first-time mothers who initially used progestogen-only pills increased from 3.8% (95% CI, 3.5-4.0) to 14.4% (95% CI, 13.9-14.8) and intrauterine levonorgestrel-releasing systems from 0.1% (95% CI, 0.1-0.2) to 12.6% (95% CI, 12.3-13.0). In contrast, combined oral contraception initiation decreased from 31.3% (95% CI, 30.7-31.8) to 7.8% (95% CI, 7.5-8.2). Among first-time mothers initiating hormonal contraception, the median time of initiation decreased from 4.7 (Q1-Q3, 2.5-7.5) months during 1997-2001 to 2.5 (Q1-Q3, 2-0-4.0) months during 2017-2021. The cumulative incidence of first-time mothers using combined hormonal contraception six weeks after delivery decreased from 1.5% (95% CI, 1.5-1.6) during 2007-2011 to 0.5% (95% CI, 0.5-0.5) during 2017-2021.\u0000Conclusions: Within the first year after childbirth, 41% of first- and second-time mothers initiated hormonal contraception in Denmark during 1997-2021. Throughout 1997-2021, mothers started earlier after delivery and more often used progestogen-only contraception. Few started combined hormonal contraception within 6 weeks after delivery in accordance with national guidelines. Taken together, the pattern of HC use over time reflects a change to safer contraceptive methods postpartum which minimizes thromboembolic risk.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"299 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139946598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23DOI: 10.1101/2024.02.21.24303142
Chemtai Mungo, Anagha Guliam, Lameck Chinula, Federica Inturrisi, Lizzie Msowoya, Tawonga Mkochi, Sinyia Jawadu, Silvia de Sanjose, Mark Schiffman, Jennifer H Tang, Jennifer S Smith
Background: The World Health Organization (WHO) recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries (LMICs) account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. Methods: We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis - cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to <CIN2. Results: 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses. Of these, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. Conclusion: In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.
{"title":"Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi","authors":"Chemtai Mungo, Anagha Guliam, Lameck Chinula, Federica Inturrisi, Lizzie Msowoya, Tawonga Mkochi, Sinyia Jawadu, Silvia de Sanjose, Mark Schiffman, Jennifer H Tang, Jennifer S Smith","doi":"10.1101/2024.02.21.24303142","DOIUrl":"https://doi.org/10.1101/2024.02.21.24303142","url":null,"abstract":"Background: The World Health Organization (WHO) recommends human papillomavirus (HPV) testing for primary cervical cancer screening, including among women living with HIV (WLWH). Low-and-middle-income countries (LMICs) account for 85% of the cervical cancer burden globally, yet have limited access to HPV-based screening, largely due to cost. This study aims to compare the performance of a rapid, isothermal amplification HPV assay (ScreenFire) to that of the Xpert HPV assay for the detection of HPV and cervical precancer among WLWH in Malawi. Methods: We utilized stored self- and provider-collected specimens from a prospective cohort study of WLWH in Malawi from July 2020 to February 2022. Specimens were tested with both Xpert and ScreenFire HPV assays. The overall and within-channel non-hierarchical agreement between ScreenFire and Xpert was determined for both self- and provider-collected specimens. Hierarchical ScreenFire HPV positivity by channel was compared to Xpert for each histological diagnosis - cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared to <CIN2. Results: 315 matched self- and provider-collected specimens had valid results from both Xpert and ScreenFire testing and were included in analyses. Of these, 245 (78%) had normal pathology, 21 CIN1 (7%), 14 CIN2 (4%), and 35 CIN3 (11%). Among provider-collected specimens, the assays had 80% agreement on overall HPV positivity (unweighted kappa 0.59, 95% 0.50-0.69). ScreenFire was HPV-positive in 90% of self-collected specimens that were HPV-positive on Xpert. Channel agreement between the assays was high for both self- and provider-collected specimens, but slightly lower for HPV18/45. In hierarchical analysis, ScreenFire demonstrated high concordance with Xpert testing for detecting CIN2+ cases in all channels, missing no HPV 16 or HPV 18/45 positive CIN2+ case that was positive on Xpert, in both self- and provider-collected specimens. Conclusion: In this study of stored specimens, the ScreenFire HPV assay performed well in the detection of HPV and CIN2+ among WLWH compared to the Xpert HPV assay. If supported by larger validation studies, ScreenFire could be an affordable alternative point-of-care HPV assay for use in LMICs.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139946627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1101/2024.02.13.24302756
Archie Watt, Holden Eaton, Kate Eastwick-Jones, Elizabeth T Thomas, Annette Pluddemann
Objective: Iron deficiency during pregnancy poses a significant risk to both maternal and foetal health. Despite increased iron requirements during pregnancy, current UK NICE guidelines do not give clear advice on antenatal iron supplementation for non-anaemic women. We aimed to assess whether the benefits of routine antenatal supplementation outweigh potential harms for non-anaemic women. Methods: The Cochrane Library, MEDLINE, Embase and clinical trial registries were searched for randomised control trials (RCTs) and observational studies comparing oral iron supplementation with placebo or no supplement in non-anaemic pregnant women. The relevant data were extracted, and the risk of bias for included studies was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Where appropriate, meta analysis was conducted using R. Results: 23 eligible studies were identified including 4492 non-anaemic women who were followed through pregnancy. Haemoglobin and ferritin levels were consistently higher in individuals receiving iron compared with control groups, although both findings were associated with a high degree of heterogeneity (I2 = 92% and 87% respectively) and therefore did not warrant a pooled analysis. Iron supplementation was associated with a significant reduction in rate of maternal anaemia (OR = 0.36; 95% CI = 0.22 - 0.61, p<.001; I2 = 54%; moderate certainty, NNT 8). There was no significant effect of intervention on birth weight (MD = 22.97g, 95% CI = -56.27 to 102.22, p = 0.57; I2 = 64%; very low certainty). Of the 18 studies reporting adverse effects, none found a significant influence of supplementation on GI disturbance, caesarean sections or preterm births. Conclusions: Prophylactic iron supplementation reduces the risk of maternal anaemia in pregnancy. Limited evidence was found relating to the harms of supplementation in non-anaemic pregnant women, highlighting the need for further research to inform practice guidelines and support clinical decision making. Registration: The study protocol was registered on the Open Science Framework (DOI 10.17605/OSF.IO/HKZ4C).
{"title":"The benefits and harms of oral iron supplementation in non-anaemic pregnant women: A systematic review and meta-analysis.","authors":"Archie Watt, Holden Eaton, Kate Eastwick-Jones, Elizabeth T Thomas, Annette Pluddemann","doi":"10.1101/2024.02.13.24302756","DOIUrl":"https://doi.org/10.1101/2024.02.13.24302756","url":null,"abstract":"Objective: Iron deficiency during pregnancy poses a significant risk to both maternal and foetal health. Despite increased iron requirements during pregnancy, current UK NICE guidelines do not give clear advice on antenatal iron supplementation for non-anaemic women. We aimed to assess whether the benefits of routine antenatal supplementation outweigh potential harms for non-anaemic women.\u0000Methods: The Cochrane Library, MEDLINE, Embase and clinical trial registries were searched for randomised control trials (RCTs) and observational studies comparing oral iron supplementation with placebo or no supplement in non-anaemic pregnant women. The relevant data were extracted, and the risk of bias for included studies was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Where appropriate, meta analysis was conducted using R.\u0000Results: 23 eligible studies were identified including 4492 non-anaemic women who were followed through pregnancy. Haemoglobin and ferritin levels were consistently higher in individuals receiving iron compared with control groups, although both findings were associated with a high degree of heterogeneity (I2 = 92% and 87% respectively) and therefore did not warrant a pooled analysis. Iron supplementation was associated with a significant reduction in rate of maternal anaemia (OR = 0.36; 95% CI = 0.22 - 0.61, p<.001; I2 = 54%; moderate certainty, NNT 8). There was no significant effect of intervention on birth weight (MD = 22.97g, 95% CI = -56.27 to 102.22, p = 0.57; I2 = 64%; very low certainty). Of the 18 studies reporting adverse effects, none found a significant influence of supplementation on GI disturbance, caesarean sections or preterm births.\u0000Conclusions: Prophylactic iron supplementation reduces the risk of maternal anaemia in pregnancy. Limited evidence was found relating to the harms of supplementation in non-anaemic pregnant women, highlighting the need for further research to inform practice guidelines and support clinical decision making.\u0000Registration: The study protocol was registered on the Open Science Framework (DOI 10.17605/OSF.IO/HKZ4C).","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139751902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-13DOI: 10.1101/2024.02.12.24302705
Gabriel Davis Jones, Beth Albert, William Cooke, Manu Vatish
Objectives: This study aims to rigorously evaluate the Dawes-Redman computerised cardiotocography algorithm's effectiveness in assessing antepartum fetal wellbeing. It focuses on analysing the algorithm's performance using extensive clinical data, examining accuracy, sensitivity, specificity, and predictive values in various scenarios. The objectives include assessing the algorithm's reliability in identifying fetal wellbeing across different risk prevalences, its efficacy in the context of temporal proximity to delivery, and its performance across ten specific adverse pregnancy outcomes. This comprehensive evaluation seeks to clarify the algorithm's utility and limitations in contemporary obstetric practice, particularly in high-risk pregnancy scenarios. Methods: Antepartum fetal heart rate recordings from term singleton pregnancies between 37 and 42 gestational weeks were extracted from the Oxford University Hospitals database, spanning 1991 to 2021. Traces with significant data gaps or incomplete Dawes-Redman analyses were excluded. For the ten adverse outcomes, only traces performed within 48 hours prior to delivery were considered, aligning with clinical decision-making practices. A healthy cohort was established using rigorous inclusion and exclusion criteria based on clinical indicators. Propensity score matching, controlling for gestational age and fetal sex, ensured balanced comparisons between healthy and adverse outcome cohorts. The Dawes-Redman algorithm's categorisation of FHR traces as either 'criteria met' (an indicator of wellbeing) or 'criteria not met' (indicating a need for further evaluation) informed the evaluation of predictive performance metrics. Performance was assessed using accuracy, sensitivity, specificity, and predictive values (PPV, NPV), adjusted for various risk prevalences. Results: 4,196 term antepartum FHR traces were identified, matched by fetal sex and gestational age. The Dawes-Redman algorithm showed a high sensitivity of 91.7% for detecting fetal wellbeing. However, specificity for adverse outcomes was low at 15.6%. The PPV varied with population prevalence, high in very low-risk settings (99.1%) and declined with increased risk. Temporal proximity to delivery indicated robust sensitivity (>91.0%). Specificity notably decreased over time, impacting the algorithm's discriminative power for identifying adverse outcomes. Across different adverse conditions, the algorithm's performance remained consistent, with high sensitivity but varying NPVs, confirming its utility in detecting fetal wellbeing rather than adverse outcomes. Conclusion: These findings reveal the Dawes-Redman algorithm is effective for detecting fetal wellbeing in term pregnancies, evidenced by its high sensitivity and PPV. However, its low specificity suggests limitations in its ability to identify fetuses at risk of adverse outcomes. The predictive accuracy of the algorithm is significantly affected by the prevalence of healthy pregnancie
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