Predicting adverse outcomes in pregnant patients positive for SARS-CoV-2: a machine learning approach- a retrospective cohort study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Dylan Young - , Ryerson University, University of Toronto (Author)
  • Bita Houshmand - , Ryerson University, University of Toronto (Author)
  • Chunyi Christie Tan - , University of Toronto (Author)
  • Abirami Kirubarajan - , McMaster University (Author)
  • Ashna Parbhakar - , University of Toronto (Author)
  • Jazleen Dada - , University of Toronto (Author)
  • Wendy Whittle - , University of Toronto (Author)
  • Mara L. Sobel - , University of Toronto (Author)
  • Luis M. Gomez - , Inova Health System (Author)
  • Mario Rüdiger - , Center for feto/neonatal Health (Author)
  • Ulrich Pecks - , Kiel University (Author)
  • Peter Oppelt - , Kepler University Hospital (Author)
  • Joel G. Ray - , University of Toronto (Author)
  • Sebastian R. Hobson - , University of Toronto (Author)
  • John W. Snelgrove - , University of Toronto (Author)
  • Rohan D’Souza - , University of Toronto, McMaster University (Author)
  • Rasha Kashef - , Ryerson University, University of Toronto (Author)
  • Dafna Sussman - , Ryerson University, University of Toronto (Author)

Abstract

Background: Pregnant people are particularly vulnerable to SARS-CoV-2 infection and to ensuing severe illness. Predicting adverse maternal and perinatal outcomes could aid clinicians in deciding on hospital admission and early initiation of treatment in affected individuals, streamlining the triaging processes. Methods: An international repository of 1501 SARS-CoV-2-positive cases in pregnancy was created, consisting of demographic variables, patient comorbidities, laboratory markers, respiratory parameters, and COVID-19-related symptoms. Data were filtered, preprocessed, and feature selection methods were used to obtain the optimal feature subset for training a variety of machine learning models to predict maternal or fetal/neonatal death or critical illness. Results: The Random Forest model demonstrated the best performance among the trained models, correctly identifying 83.3% of the high-risk patients and 92.5% of the low-risk patients, with an overall accuracy of 89.0%, an AUC of 0.90 (95% Confidence Interval 0.83 to 0.95), and a recall, precision, and F1 score of 0.85, 0.94, and 0.89, respectively. This was achieved using a feature subset of 25 features containing patient characteristics, symptoms, clinical signs, and laboratory markers. These included maternal BMI, gravidity, parity, existence of pre-existing conditions, nicotine exposure, anti-hypertensive medication administration, fetal malformations, antenatal corticosteroid administration, presence of dyspnea, sore throat, fever, fatigue, duration of symptom phase, existence of COVID-19-related pneumonia, need for maternal oxygen administration, disease-related inpatient treatment, and lab markers including sFLT-1/PlGF ratio, platelet count, and LDH. Conclusions: We present the first COVID-19 prognostication pipeline specifically for pregnant patients while utilizing a large SARS-CoV-2 in pregnancy data repository. Our model accurately identifies those at risk of severe illness or clinical deterioration, presenting a promising tool for advancing personalized medicine in pregnant patients with COVID-19.

Details

Original languageEnglish
Article number553
JournalBMC pregnancy and childbirth
Volume23
Issue number1
Publication statusPublished - 2 Aug 2023
Peer-reviewedYes

External IDs

PubMed 37532986

Keywords

ASJC Scopus subject areas

Keywords

  • COVID-19, Machine learning, Pregnancy, Prognostication, SARS-CoV-2, Parturition, Humans, COVID-19/diagnosis, Pregnancy Complications, Infectious/diagnosis, Fetal Death, Female, Retrospective Studies, Infant, Newborn, Pregnancy Outcome

Library keywords