Abstract
Introduction This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. Objectives We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. Methods Pregnant women who were normotensive, at a gestational age at recruitment of between 8 and 13 weeks and provided a blood sample for biomarker analysis were eligible for inclusion. From serum, biomarkers PAPP-A and PlGF concentrations were measured by the AutoDELFIA immunoassay method and multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated. To obtain prediction models, these biomarkers were included with clinical predictors maternal weight,height, diastolic blood pressure, a previous history of gestational hypertension, history of hypertension in parents and parity in a logistic regression to obtain prediction models. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to assess the predictive ability of the models. Results Three hundred and seventy-three women participated in this study. The area under the curve (AUC) of the model with only maternal clinical characteristics was 0.75 (0.64–0.86) and 0.89(0.73–1.00) for multiparous and primigravid women respectively. The AUCs after inclusion of both PAPP-A and PlGF were 0.82 (0.74–0.89) and 0.95 (0.87–1.00) for multiparous and primigravid women respectively. Discussion Adding the biomarkers PAPP-A and PlGF to maternal characteristics in a prediction model for gestational hypertension in a cohort of Ghanaian pregnant women improved predictive ability. Further research using larger sample sizes in similar settings to validate these findings is recommended.
Highlights
We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women
This study was conducted in antenatal clinic settings in Ghana to investigate whether adding two biomarkers, placental growth factor and pregnancy associated plasma protein A, to a previously developed prediction model based on maternal clinical characteristics improved the performance of the model
Adding biomarkers to a previously validated prediction model improved the performance of the model for gestational hypertension
Summary
We assessed whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of a previously developed model for gestational hypertension in a cohort of Ghanaian pregnant women. Hypertensive disorders of pregnancy (HDP) are leading causes of maternal morbidity and mortality globally and affect about 5 to 10% of all pregnancies [1, 2]. The burden of these conditions is greatest in low and middle income countries (LMICs) [3, 4]. Prediction models have been used to identify women at high risk of HDPs, preeclampsia [3,4,5,6]. In the ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) trial with risk selection based on screening, a reduction in the incidence of preterm preeclampsia in the aspirin arm by 62% was observed [12]
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