What to expect when you’re expecting?
Predictive models can improve the risk assessment conducted in the first trimester of pregnancy.
At the start of a woman's pregnancy, the obstetrician makes a risk assessment using a checklist with questions about her medical history. The result of this risk assessment indicates who can best provide medical care to the expecting mother. If the risk of complications is low, it is appropriate for the obstetrician to continue to provide medical care during the pregnancy, but if the risk is high, a multidisciplinary team at the hospital will take over. However, many women under the care of an obstetrician are subsequently referred to the hospital, later on in their pregnancy or when they give birth, because they develop complications, such as gestational diabetes or pre-eclampsia.
Marije Lamain-de Ruiter, who received her PhD on 22 June, carried out a PhD study into the use of predictive models for pregnancy complications. Marije wanted to know whether the risk assessment at the start of the pregnancy could be improved by using existing predictive models. These models were therefore tested on nearly 4,000 pregnant women receiving medical care from obstetricians and hospitals in the Utrecht region. In addition, her research looked into whether the findings of predictive models could be used to develop tailored preventive care to prevent that expecting mothers or their babies fall sick, develop complications or even die. For this purpose, she set up the RESPECT study, which focused on gestational diabetes and pre-eclampsia, the two main complications with major consequences for both expecting mothers and their babies.
Marije found that predictive models can improve the risk assessment conducted in the first trimester, and that they are easy to use in practice and more cost effective than the current checklist method. Marije: "By using a predictive model, you can more specifically identify early on in their pregnancy which women have an increased risk and offer them preventive care. We hope this will enable us to protect as many women as possible against developing gestational diabetes. In addition, we can avoid unnecessary testing of women with a low risk."
The follow-up study RESPECT II that is currently conducted looks into whether the use of a predictive model for gestational diabetes actually has the desired effect in practice.