Developing an Effective and Simple Digital Screening Tool to Identify
Inadequate Calcium Intake in Pregnant Women: a prediction model in the
Rotterdam Periconception cohort
Abstract
Objective To develop an evidence-based and simple screening
tool to estimate calcium intake in pregnant women, suitable for use in
daily clinical practice. Design Cross-sectional analysis within
a cohort study Population and setting We extracted all data
from the Rotterdam Periconceptional cohort (PREDICT study) conducted at
the Erasmus MC, University Medical Centre in Rotterdam, the Netherlands,
between November 2014 and December 2020. Methods Data was
extracted from food frequency questionnaires. The estimated average
requirement of 750 m/day was defined as the lower limit for an adequate
calcium intake. We created a prediction model, using multivariable
binary logistic regression with backward stepwise selection. We
developed a simple screening tool based on the prediction model.
Main outcome measures Probability of adequate calcium intake
Results 694 participants are included, of which 201 (29%) had
an adequate calcium intake. Total daily or weekly intakes of cheese,
milk, and yogurt or curd were selected as predictors for the prediction
model. The model had excellent discrimination (AUC 0.858), a good fit
(Brier score 0.136, HL statistic p=0.499) and satisfactory calibration.
The test accuracy measures were: sensitivity 80.9%, specificity 77.1%,
PPV 89.7%, NPV 62.2%. A color coded digital screening tool was
developed for use in clinical practice. Conclusions This
evidence-based and simple screening tool is a reliable and efficient
instrument to predict inadequate calcium intakes in pregnancy, which can
easily be incorporated in daily clinical practice and existing pregnancy
coaching platforms.