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
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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.
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.
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.
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.
KeywordsSuboptimal health status Preeclampsia Pregnancy complications Patient stratification Primary healthcare Risk assessment Population screening Education Predictive preventive personalized medicine
suboptimal health status
optimal health status
25-question-based suboptimal health status questionnaire
Ghanaian Suboptimal Health Cohort Study
adverse pregnancy complications
preventive, predictive and personalized medicine
intrauterine growth restriction
hemolysis elevated liver enzymes and low platelet count
systolic blood pressure
diastolic blood pressure
red cell distribution width
fasting blood glucose
high-density lipoprotein cholesterol
low-density lipoprotein cholesterol
gamma glutamyl transferase
adjusted odds ratio
receiver’s operating characteristics
area under the ROC curve
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.
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.
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
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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