- Title
- Development and internal validation of a non-invasive clinical tool to predict sufficient omega-3 levels in early pregnancy
- Creator
- Fu, Joanna Y. X.; Wang, Carol A.; Liu, Ge; Mead, Elyse; Phung, Jason; Makrides, Maria; Pennell, Craig E.
- Relation
- BMC Pregnancy and Childbirth Vol. 23, no. 442
- Publisher Link
- http://dx.doi.org/10.1186/s12884-023-05687-2
- Publisher
- BioMed Central (BMC)
- Resource Type
- journal article
- Date
- 2023
- Description
- Background: Complications from preterm birth (PTB) are the leading cause of death and disability in those under five years. Whilst the role of omega-3 (n-3) supplementation in reducing PTB is well-established, growing evidence suggests supplementation use in those replete may increase the risk of early PTB. AIM: To develop a non-invasive tool to identify individuals with total n-3 serum levels above 4.3% of total fatty acids in early pregnancy. Methods: We conducted a prospective observational study recruiting 331 participants from three clinical sites in Newcastle, Australia. Eligible participants (n = 307) had a singleton pregnancy between 8 and 20 weeks' gestation at recruitment. Data on factors associated with n-3 serum levels were collected using an electronic questionnaire; these included estimated intake of n-3 (including food type, portion size, frequency of consumption), n-3 supplementation, and sociodemographic factors. The optimal cut-point of estimated n-3 intake that predicted mothers with total serum n-3 levels likely above 4.3% was developed using multivariate logistic regression, adjusting for maternal age, body mass index, socioeconomic status, and n-3 supplementation use. Total serum n-3 levels above 4.3% was selected as previous research has demonstrated that mothers with these levels are at increased risk of early PTB if they take additional n-3 supplementation during pregnancy. Models were evaluated using various performance metrics including sensitivity, specificity, area under receiver operator characteristic (AUROC) curve, true positive rate (TPR) at 10% false positive rate (FPR), Youden Index, Closest to (0,1) Criteria, Concordance Probability, and Index of Union. Internal validation was performed using 1000-bootstraps to generate 95% confidence intervals for performance metrics generated. Results: Of 307 eligible participants included for analysis, 58.6% had total n-3 serum levels above 4.3%. The optimal model had a moderate discriminative ability (AUROC 0.744, 95% CI 0.742-0.746) with 84.7% sensitivity, 54.7% specificity and 37.6% TPR at 10% FPR. Conclusions: Our non-invasive tool was a moderate predictor of pregnant women with total serum n-3 levels above 4.3%; however, its performance is not yet adequate for clinical use. Trial Registration: This trial was approved by the Hunter New England Human Research Ethics Committee of the Hunter New England Local Health District (Reference 2020/ETH00498 on 07/05/2020 and 2020/ETH02881 on 08/12/2020).
- Subject
- omega-3 polyunsaturated fatty acids; n-3; pregnancy; prediction model; development; internal validation
- Identifier
- http://hdl.handle.net/1959.13/1487987
- Identifier
- uon:52326
- Identifier
- ISSN:1471-2393
- Rights
- x
- Language
- eng
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