title: Prediction of progression to a high risk situation in women with gestational hypertension or mild pre-eclampsia at term.
abstract: OBJECTIVE
  To evaluate whether progression to a high-risk situation is predictable in women with gestational hypertension (GH) or mild pre-eclampsia (PE) at term.
  
  
  METHODS
  Women with a singleton pregnancy, a fetus in cephalic position, between 36 and 41 weeks of gestation, complicated by GH or mild PE that were managed expectantly, were selected from the HYPITAT trial. We evaluated the predictability of progression to a high-risk situation. Logistic regression was used to determine the predictive value of clinical characteristics or laboratory findings and to generate a prediction model for progression to a high-risk situation. The predictive value of this model was assessed with receiver-operating characteristic (ROC) analysis, calibration and internal validation.
  
  
  RESULTS
  We included 703 women, of whom 244 (34.7%) had progression to a high-risk situation. After multivariable analysis, nulliparity (OR 1.87), maternal age (OR 1.05 per year), gestational age (OR 0.88 per week), previous abortion (OR 1.26), ethnicity (OR 2.05 for non-Caucasian ethnicity), diastolic (OR 1.04 per mmHg), systolic blood pressure (OR 1.02 per mmHg) and the laboratory parameters proteinuria, haemoglobin, platelets, uric acid and alanine aminotransferase were included in the final model. The area under the ROC curve of this model was 0.71 (95% CI, 0.67-0.74). Even though the goodness of fit was moderate (P=0.40), internal validation showed the model could hold in the overall population.
  
  
  CONCLUSIONS
  In the prediction of progression to a high-risk situation, in women with GH or mild PE at term, a distinction can be made between women with a low risk and women with high risk.
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands. k.van.der.tuuk@og.umcg.nl
authors.forename: Karin
authors.initials: K
authors.lastname: van der Tuuk
authors.forename: Corine M
authors.initials: CM
authors.lastname: Koopmans
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aarnoudse
authors.forename: Paul P
authors.initials: PP
authors.lastname: van den Berg
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: van Beek
authors.forename: Frans J A
authors.initials: FJ
authors.lastname: Copraij
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kleiverda
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.forename: Robbert J P
authors.initials: RJ
authors.lastname: Rijnders
authors.forename: Paulien C M
authors.initials: PC
authors.lastname: van der Salm
authors.forename: Job G
authors.initials: JG
authors.lastname: Santema
authors.forename: Robert H
authors.initials: RH
authors.lastname: Stigter
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
mesh_terms: D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis* / Q000628:therapy; D007751:Labor, Induced; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D055815:Young Adult