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EPMA Journal

, Volume 10, Issue 3, pp 211–226 | Cite as

Integration of suboptimal health status evaluation as a criterion for prediction of preeclampsia is strongly recommended for healthcare management in pregnancy: a prospective cohort study in a Ghanaian population

  • Enoch Odame Anto
  • Peter Roberts
  • David Coall
  • Cornelius Archer Turpin
  • Eric Adua
  • Youxin Wang
  • Wei WangEmail author
Research
  • 63 Downloads

Abstract

Background

Normotensive pregnancy may develop into preeclampsia (PE) and other adverse pregnancy complications (APCs), for which the causes are still unknown. Suboptimal health status (SHS), a physical state between health and disease, might contribute to the development and progression of PE. By integration of a routine health measure in this Ghanaian Suboptimal Health Cohort Study, we explored the usefulness of a 25-question item SHS questionnaire (SHSQ-25) for early screening and prediction of normotensive pregnant women (NTN-PW) likely to develop PE.

Methods

We assessed the overall health status among a cohort of 593 NTN-PW at baseline (10–20 weeks gestation) and followed them at 21–31 weeks until 32–42 weeks. After an average of 20 weeks follow-up, 498 participants returned and were included in the final analysis. Hematobiochemical, clinical and sociodemographic data were obtained.

Results

Of the 498 participants, 49.8% (248/498) had ‘high SHS’ at baseline (61.7% (153/248) later developed PE) and 38.3% (95/248) were NTN-PW, whereas 50.2% (250/498) had ‘optimal health’ (17.6% (44/250) later developed PE) and 82.4% (206/250) were NTN-PW. At baseline, high SHS score yielded a significantly (p < 0.05) increased adjusted odds ratio, a wider area under the curve (AUC) and a higher sensitivity and specificity for the prediction of PE (3.67; 0.898; 91.9% and 87.8%), PE coexisting with intrauterine growth restriction (2.86, 0.838; 91.5% and 75.9%), stillbirth (2.52; 0.783; 96.6% and 60.0%), hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome (2.08; 0.800; 97.2% and 63.8%), acute kidney injury (2.20; 0.825; 95.3% and 70.0%) and dyslipidaemia (2.80; 0.8205; 95.7% and 68.4%) at 32–42 weeks gestation.

Conclusions

High SHS score is associated with increased incidence of PE; hence, SHSQ-25 can be used independently as a risk stratification tool for adverse pregnancy outcomes thereby creating an opportunity for predictive, preventive and personalized medicine.

Keywords

Suboptimal health status Preeclampsia Pregnancy complications Patient stratification Primary healthcare Risk assessment Population screening Education Predictive preventive personalized medicine 

Abbreviations

SHS

suboptimal health status

OHS

optimal health status

SHSQ-25

25-question-based suboptimal health status questionnaire

GHOACS

Ghanaian Suboptimal Health Cohort Study

PE

preeclampsia

APCs

adverse pregnancy complications

PPPM

preventive, predictive and personalized medicine

IUGR

intrauterine growth restriction

HELLP

hemolysis elevated liver enzymes and low platelet count

SBP

systolic blood pressure

DBP

diastolic blood pressure

Mg

magnesium

Ca

calcium

Na

sodium

K

potassium

Cl

chloride

LDH

lactate dehydrogenase

UA

uric acid

RDW

red cell distribution width

FBG

fasting blood glucose

TG

triglyceride

TC

total cholesterol

HDL-c

high-density lipoprotein cholesterol

LDL-c

low-density lipoprotein cholesterol

ALT

alanine aminotransferase

AST

aspartate aminotransferase

GGT

gamma glutamyl transferase

TP

total protein

ALB

albumin

ALP

alkaline phosphatase

aOR

adjusted odds ratio

CI

confidence interval

ROC

receiver’s operating characteristics

AUC

area under the ROC curve

Notes

Acknowledgements

We wish to thank the biomedical staff of the Department of Biochemistry and Serology, and midwives of the Department of Obstetrics and Gynaecology of the Komfo Anokye Teaching Hospital, Ghana, for their support during the participant’s recruitment and biological sample processing. We also thank the research assistants of the Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology for their support during the biological sample analysis. We finally thank the American Association of Clinical Chemistry (AACC) Academy Research Fellows for selecting our abstract coined from the present study entitled, ‘Algorithm of Suboptimal Health Status, Serum Magnesium and Calcium Levels as a Novel Approach for Prediction and Identification of Pregnant Women Likely to Develop Preeclampsia and Adverse Perinatal Complications in a Ghanaian Population’ for Scientific Excellence in Maternal and Foetal Medicine and AACC Academy’s Distinguished Abstract Award at the 71st AACC Scientific Annual Meeting, Anaheim, CA.

Authors’ contribution

EOA, PR, DC and WW conceived the study. EOA and CAT performed the investigation and collected the data. EOA performed the statistical analysis. EOA, PR, DC, EA, YW and WW wrote the paper. All authors read and approved the final manuscript.

Funding information

This work was supported by the Australia-China International Collaborative Grant (NHMRC-APP1112767-NSFC81561120) and Edith Cowan University (ECU)-Collaborative Enhancement Scheme Round 1 (G1003363). Enoch Odame Anto was supported by ECU-International Postgraduate Research Scholarship.

Compliance and ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for publication

Not applicable.

Ethical approval and consent to participate

Approval for this study was obtained from the Committee on Human Research Publication and Ethics (CHRPE) of the School of Medical Science (SMS) /KNUST and Komfo Anokye Teaching Hospital (KATH) (CHRPE/AP/146/17) and the Human Research Ethics Committee of Edith Cowan University (ECU) (17509). This study was conducted in accordance with the guidelines of the Helsinki Declaration. Written informed consent in the form of a signature and fingerprint was obtained from all participants and legally authorized representatives after the protocol of the study was explained to them in plain English language and native Ghanaian language where appropriate.

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Copyright information

© European Association for Predictive, Preventive and Personalised Medicine (EPMA) 2019

Authors and Affiliations

  1. 1.School of Medical and Health SciencesEdith Cowan UniversityPerthAustralia
  2. 2.Department of Molecular MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
  3. 3.Department of Obstetrics and GynaecologyKomfo Anokye Teaching HospitalKumasiGhana
  4. 4.Beijing Key Laboratory of Clinical Epidemiology, School of Public HealthCapital Medical UniversityBeijingChina
  5. 5.School of Public HealthTaishan Medical UniversityTaianChina

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