Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

Abstract

Background: Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Multiparous women in our study presented a higher PTB prevalence compared to nulliparous women. Methods: In a cohort study from Northern Lebanon of 1996 women, 922 were multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. We compared 4 modified logistic regression models (up-sampling, lasso penalized regression) to develop a nomogram that can screen for preterm in multi-parous women. The models were validated on a separate set of data.Results: The best PTB prediction of the Logistic regression model reached around 88%. This was obtained using a Logistic Regression Model trained on up-sampled datasets and LASSO (Least Absolute Shrinkage and Selection Operator) penalized. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. Conclusions: The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. This tool will allow physicians to screen women and run furthermore adequate additional tests leading to better medical surveillance that can reduce PTB incidence.