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Two-stage nomogram models in mid-gestation for predicting the risk of spontaneous preterm birth in twin pregnancy

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to develop two-stage nomogram models to predict individual risk of preterm birth at < 34 weeks of gestation in twin pregnancies by incorporating clinical characteristics at mid-gestation.

Methods

We used a case–control study design of women with twin pregnancies followed up in a tertiary medical centre from January 2018 to March 2019. Maternal demographic characteristics and transvaginal cervical length data were extracted. The nomogram models were constructed with independent variables determined by multivariate logistic regression analyses. The risk score was calculated based on the nomogram models.

Results

In total, 65 twin preterm birth cases (< 34 weeks) and 244 controls met the inclusion criteria. Based on univariate and multivariate logistic regression analyses, we built two-stage nomogram prediction models with satisfactory discrimination and calibration when applied to the validation sets (first-stage [22–24 weeks] prediction model, C-index: 0.805 and 0.870, respectively; second-stage [26–28 weeks] prediction model, C-index: 0.847 and 0.908, respectively). Restricted cubic splines graphically showed the risk of preterm birth among individuals with increased risk scores. Moreover, the decision curve analysis indicated that both prediction models show positive clinical benefit.

Conclusion

We developed and validated two-stage nomogram models at mid-gestation to predict the individual probability of preterm birth at < 34 weeks in twin pregnancy.

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Acknowledgements

We thank Yanying Lin, MD (Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital) for her help in revising the manuscript.

Funding

This research was supported by Fujian Key Laboratory of Women and Children’s Critical Diseases Research Fujian Maternity and Child Health Hospital], along with funds from Fujian Maternity and Child Health Hospital Innovation Project under Contract No.YCXZ18-21.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China

    Jun Zhang, Mian Pan, Lianghui Zheng & Xiaoxiang Jiang

  2. Department of Medical Ultrasonics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350108, Fujian, China

    Xiaoying Xue

  3. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China

    Wenqiang Zhan

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  1. Jun Zhang
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  2. Mian Pan
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  4. Lianghui Zheng
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Contributions

JZ: Project development, Data Collection, management and analysis, Manuscript writing. MP: Project development, Data management and analysis, Manuscript writing and editing. WZ: Data collection, management and analysis. LZ: Data analysis, Manuscript editing. XJ: Data collection and analysis. XX: Data collection.

Corresponding author

Correspondence to Mian Pan.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were approved by the Fujian Maternity and Child Health Hospital of China Ethics Committee (Ethical approval number: 2019-014) and are in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because our study was retrospective and all clinical data were anonymized, consent for participation was not required.

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Zhang, J., Pan, M., Zhan, W. et al. Two-stage nomogram models in mid-gestation for predicting the risk of spontaneous preterm birth in twin pregnancy. Arch Gynecol Obstet 303, 1439–1449 (2021). https://doi.org/10.1007/s00404-020-05872-0

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