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1. BMC Med. 2017 Nov 3;15(1):194. doi: 10.1186/s12916-017-0956-8. Prediction of uncomplicated pregnancies in obese women: a prospective multicentre study. Vieira MC(1)(2), White SL(1), Patel N(1), Seed PT(1), Briley AL(1)(3), Sandall J(1), Welsh P(4), Sattar N(4), Nelson SM(5), Lawlor DA(6)(7), Poston L(1)(3), Pasupathy D(8)(9)(10); UPBEAT Consortium. Collaborators: Poston L, Shennan A, Briley A, Singh C, Seed P, Sandall J, Sanders T, Patel N, Flynn A, Badger S, Barr S, Holmes B, Goff L, Hunt C, Filmer J, Fetherstone J, Scholtz L, Tarft H, Lucas A, Tekletdadik T, Ricketts D, Gill C, Ignatian AS, Boylen C, Adegoke F, Lawley E, Butler J, Maitland R, Vieira M, Pasupathy D, Oteng-Ntim E, Khazaezadeh N, Demilew J, O'Connor S, Evans Y, O'Donnell S, de la Llera A, Gutzwiller G, Hagg L, Robson S, Bell R, Hayes L, Kinnunen T, McParlin C, Miller N, Kimber A, Riches J, Allen C, Boag C, Campbell F, Fenn A, Ritson S, Rennie A, Durkin R, Gills G, Carr R, Nelson S, Sattar N, McSorley T, Alba H, Paterson K, Johnston J, Clements S, Fernon M, Bett S, Rooney L, Miller S, Welsh P, Cherry L, Whitworth M, Patterson N, Lee S, Grimshaw R, Hughes C, Brown J, Hinshaw K, Campbell G, Knight J, Farrar D, Jones V, Butterfield G, Syson J, Eadle J, Wood D, Todd M, Khalil A, Brown D, Fernandez P, Cousins E, Smith M, Wardle J, Croker H, Broomfield L, Godfrey K, Robinson S, Canadine S, Greenwood L, Nelson-Piercy C, Amiel S, Goldberg G, Rajasingham D, Jackson P, Kenyon S, Catalano P. Author information: (1)Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK. (2)Núcleo de Formação Específica em Ginecologia e Obstetrícia, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, 90610-000, Brazil. (3)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, UK. (4)Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA, UK. (5)School of Medicine, University of Glasgow, Glasgow, G4 0SF, UK. (6)MRC Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, BS8 2BN, UK. (7)NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 2BN, UK. (8)Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, SE1 7EH, UK. dharmintra.pasupathy@kcl.ac.uk. (9)NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 7EH, UK. dharmintra.pasupathy@kcl.ac.uk. (10)Department of Women and Children's Health, Women's Health Academic Centre KHP, St. Thomas' Hospital, Westminster Bridge Road, 10th Floor North Wing, London, SE1 7EH, UK. dharmintra.pasupathy@kcl.ac.uk. BACKGROUND: All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. METHODS: Data form obese women (BMI ≥ 30 kg/m2) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15+0 to 18+6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. RESULTS: Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m2), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. CONCLUSION: Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth. DOI: 10.1186/s12916-017-0956-8 PMCID: PMC5669007 PMID: 29096631 [Indexed for MEDLINE] Conflict of interest statement: AUTHORS’ INFORMATION: Not applicable. ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Ethical approval was obtained from the Brighton Research Ethics Committee and all women provided informed written informed consent prior to entering the study (UK integrated research application system, reference 09/H0802/5). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/downloads/coi_disclosure.pdf and declare: for the submitted work, MCV had financial support from Coordenadoria de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES); SLW had financial support from Diabetes UK; NP, PTS, ALB, LP and DP had financial support from Tommy’s Charity; PTS, ALB, JS, NS, SMN, DAL, LP and DP had financial support from Medical Research Council (MRC) and National Institute of Health Research (NIHR); no financial relationships with any organisations that might have an interest in the submitted work in the previous 5 years; and no other relationships or activities that could appear to have influenced the submitted work. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.