Main findings
We have shown that a CPM based on pre-pregnancy and early pregnancy
variables can moderately discriminate women destined for a severely
morbid event or death from those likely to have uncomplicated
pregnancies. The inclusion of prior pregnancy factors slightly enhanced
these metrics. Our CPM displayed good calibration, indicating that a
combination of routinely measured pre-pregnancy and early pregnancy
factors can estimate the absolute risk of acute end-organ injury or
death with reasonable accuracy. Using this CPM effectively increased the
probability of identifying a very high-risk woman with this outcome by
40%, and reduced the probability in someone considered very low-risk by
20%31, but was less useful in classifying women in
intermediate risk categories. This suggests that additional clinical,
laboratory, or paraclinical factors are needed to accurately predict
morbidity in all women, and further, that a certain proportion of these
events are truly sudden and unpredictable.