Abstract
Background: Preclampsia is a leading cause of maternal morbidity and mortality which accounts for 5%-10% of deaths worldwide. Several studies have attempted to effectively predict preclampsia early in pregnancy. The effective method of detection and treatment are yet to be determined. Early identification of women at risk would enhance prompt monitoring and treatment of both mother and fetus. International Federation of Gynaecology and obstetrics FIGO recommends that the use of risk factors along with biomarkers would be beneficial in predicting the disease among pregnant women. Thus, the discovery of a sensitive and specific biomarker would reduce the unwanted effect of preeclampsia. Several biomarkers have been studied but efforts to find an effective one for the prediction of preeclampsia is still elusive.
 The study evaluated the relationship between pregnancy-associated plasma protein-A (P PPA) and preeclampsia as a biomarker in predicting preeclampsia. 
 Objectives: To determine the relationship between the levels of pregnancy-associated plasma protein-A and the onset of pre-eclampsia among pregnant women with risk factors for preeclampsia and those without known risk factors (control).
 Materials and Methods: A prospective cohort study of consenting patients who presented at the maternity unit of Ifako-Ijaiye Mother and Child Centre between 11-15 weeks gestation with risk factors for preeclampsia (cases) and those without known risk factors for preeclampsia (controls). Blood samples were obtained and sent to Lagos State University Teaching Hospital Medical Research Laboratory for analysis of Pregnancy Associated Plasma Protein-A (PAPP-A).
 Results: No significant correlation was found between the onset of preeclampsia and the levels of Pregnancy Associated Plasma Protein-A in pregnant women with risk as well as those without risk factors who later on developed the disease. p>0.05. Among women without identifiable risk of preeclampsia, median Pregnancy Associated Plasma Protein-A was significantly higher in pregnant women who did not develop Preeclampsia compared to those who subsequently developed preeclampsia (p=0.004).
 There was a statistically significant difference in the median PAPP-A levels between patients at risk of preeclampsia (cases) compared with those without risk (controls). p<0.05.
 Conclusion: There was a significantly lower median level of PAPP-A among patients with risk factors for preeclampsia when compared with low-risk patients. Meanwhile, there is no significant correlation between the levels of PAPP-A and onset of preeclampsia among those who subsequently developed the disease in those at risk and those without.
Highlights
Preeclampsia (PE), a pregnancy-specific syndrome in humans, has a worldwide incidence of approximately 2–8%.1 It is a life-threatening multi-systemic disorder of unknown aetiology and a leading cause of maternal and fetal morbidity and mortality worldwide.2, 3,4Preeclampsia accounts for more than 50,000 deaths worldwide each year.[2]
Studies carried out in Benin City and Sokoto, both in Nigeria and Dessie, in Ethiopia revealed a prevalence of 5.6%, 6% and 8.4% respectively.[4, 5], A major challenge in modern obstetrics is the early identification of pregnancies at risk of early onset of preeclampsia.[7]
The study was conducted at Mother and Child Centre (MCC), the obstetric arm of Lagos State University Teaching Hospital, located at Ifako Ijaiye, Lagos State, Nigeria
Summary
Preeclampsia (PE), a pregnancy-specific syndrome in humans, has a worldwide incidence of approximately 2–8%.1 It is a life-threatening multi-systemic disorder of unknown aetiology and a leading cause of maternal and fetal morbidity and mortality worldwide.2, 3,4Preeclampsia accounts for more than 50,000 deaths worldwide each year.[2]. According to the World Health Organization, its incidence is seven times higher in developing countries (28%) than in developed countries (4%).[2] It is a major cause of maternal and perinatal mortality and morbidity in the United Kingdom and responsible for 24% of all maternal deaths in India.[2, 3]. The study evaluated the relationship between pregnancy-associated plasma protein-A (PAPP-A) and preeclampsia as a biomarker in predicting preeclampsia. Objectives: To determine the relationship between the levels of pregnancy-associated plasma protein-A and the onset of preeclampsia among pregnant women with risk factors for preeclampsia and those without known risk factors (control). Results: No significant correlation was found between the onset of preeclampsia and the levels of Pregnancy Associated Plasma Protein-A in pregnant women with risk as well as those without risk factors who later on developed the disease (p>0.05). There is no significant correlation between the levels of PAPP-A and onset of preeclampsia among those who subsequently developed the disease in those at risk and those without
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