孕妇分娩恐惧风险列线图预测模型的构建及验证

Construction and validation of a nomogram prediction model for the risk of pregnant women's fear of childbirth

目的构建并验证孕妇分娩恐惧风险列线图预测模型。方法采用便利抽样法选取2022年7月至9月河北省唐山市某三级甲等医院675名产检孕妇为建模组,2022年10月至12月唐山市某二级甲等医院290名产检孕妇为验证组。通过Logistic回归分析确定危险因素,采用R 4.1.2软件绘制列线图。结果共6个预测因子进入模型:包括产前教育、文化程度、抑郁、妊娠并发症、焦虑和倾向分娩方式。建模组、验证组受试者工作特征曲线下面积分别为0.834、0.806,最佳临界值分别为0.113、0.200,灵敏度分别为67.2%、77.1%,特异度分别为87.3%、74.0%,约登指数分别为0.545、0.511;建模组、验证组校准图显示实际曲线和理想曲线重合度较好,Hosmer-Lemeshow拟合优度检验结果分别为χ^(2)=6.541(P=0.685)、χ^(2)=5.797(P=0.760),Brier得分分别为0.096、0.117;建模组、验证组决策曲线分析显示当分娩恐惧发生的阈值概率处于0.00~0.70、0.00~0.70时,具有临床实用价值。结论构建的列线图模型具有较好的区分度、校准度及临床适用性,能有效预测孕妇分娩恐惧的发生风险,为临床早期识别高危孕妇和给予针对性干预提供参考。

Objective To construct and verify the nomogram prediction model of pregnant women's fear of childbirth.Methods A convenient sampling method was used to select 675 pregnant women in tertiary hospital in Tangshan City,Hebei Province from July to September 2022 as the modeling group,and 290 pregnant women in secondary hospital in Tangshan City from October to December 2022 as the verification group.The risk factors were determined by logistic regression analysis,and the nomogram was drawn by R 4.1.2 software.Results Six predictors were entered into the model:prenatal education,education level,depression,pregnancy complications,anxiety and preference for delivery mode.The areas under the ROC curves of the modeling group and the verification group were 0.834 and 0.806,respectively.The optimal critical values were 0.113 and 0.200,respectively,with sensitivities of 67.2%and 77.1%,the specificities were 87.3%and 74.0%,and the Jordan indices were 0.545 and 0.511,respectively.The calibration charts of the modeling group and the verification group showed that the coincidence degree between the actual curve and the ideal curve was good.The results of Hosmer-Lemeshow goodness of fit test wereχ^(2)=6.541(P=0.685)andχ^(2)=5.797(P=0.760),and Brier scores were 0.096 and 0.117,respectively.DCA in modeling group and verification group showed that when the threshold probability of fear of childbirth were 0.00 to 0.70 and 0.00 to 0.70,it had clinical practical value.Conclusion The nomogram model has good discrimination,calibration and clinical applicability,which can effectively predict the risk of pregnant women's fear of childbirth and provide references for early clinical identification of high-risk pregnant women and targeted intervention.