Analysis of risk factors and prediction model construction of preeclampsia pregnant women complicated with postpartum anxiety

ObjectiveTo analyze the risk factors of postpartum anxiety in preeclampsia pregnant women, and to initially construct a clinical risk prediction model for preeclampsia pregnant women complicated with postpartum anxiety.

MethodsTwo prospective collections of preeclampsia pregnant women were enrolled in the cohort.Among them, 264 cases were collected from January 2017 to January 2019 as training samples to construct a prediction model, and 100 cases collected from March 2019 to January 2020 were used as validation samples for clinical validation of the prediction model.After the research subjects were included in the cohort, their basic data were collected according to standard operating procedures, and various physiological and biochemical indicators were obtained by laboratory examinations.The end point of the study was whether there was postpartum anxiety at 6 weeks postpartum.Firstly, the cohort from January 2017 to January 2019 was established with a prediction model, and a stepwise regression method was used to perform multivariate logistic regression analysis to screen independent risk factors for preeclampsia pregnant women complicated with postpartum anxiety, and to construct a prediction model.Then, Hosmer-Lemeshow was used to test the calibration of the model, and the area under the ROC curve was used to evaluate the discriminative ability of the model.Lastly, the cohort from March 2019 to January 2020 was used to prospectively validate the prediction model to evaluate the clinical applicability of the model.

ResultsTwenty-three cases of 264 training samples were excluded due to loss of follow-up and poor outcome, and 241 cases completed the study, of which 63 cases developed postpartum anxiety, accounting for 26.14% (63/241).Analysis of baseline data of 241 pregnant women complicated with preeclampsia showed that the relationship between couples, whether family members had sex discrimination, hematocrit (Hct), estradiol (E₂), and interleukin 6 (IL-6) might be influencing factors of preeclampsia pregnant women complicated with postpartum anxiety (P < 0.05 to P < 0.01).Logistic regression analysis showed that poor relationship between couples, gender discrimination in family members, Hct ≥53.70%, E₂≤45.80 pg/mL, IL-6 ≥58.66 pg/mL were risk factors for preeclampsia pregnant women complicated with postpartum anxiety (P < 0.05 to P < 0.01).A prediction model of postpartum anxiety in preeclampsia pregnant women was constructed: Logit (P)=0.725×couple feelings+0.752×sex discrimination in family members + 1.277×Hct+1.657×E2+0.787 × (IL-6)-3.670.The area under the ROC curve of this prediction model was 0.829 (95%CI: 0.768-0.890), the threshold of the model was 0.411 through the maximum Youden index (0.521), the corresponding sensitivity was 0.821, and the specificity was 0.800.The goodness of fit test was used to evaluate the calibration of the prediction model, which showed that the prediction model had good fitting degree and high accuracy (χ²=5.26, P>0.05).It was clinically verified that the sensitivity of this model to predict postpartum anxiety in pregnant women with preeclampsia was 84.00%, the specificity was 78.79%, and the accuracy was 80.22%.

ConclusionsPoor relationship between couples, gender discrimination in family members, Hct≥53.70%, E₂≤45.80 pg/mL, IL-6≥58.66 pg/mL are risk factors for preeclampsia pregnant women complicated with postpartum anxiety.The prediction model based on those has good differentiation ability, high calibration, high accuracy, strong operability and high clinical value.