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Multicenter Study
. 2018 Mar 27;15(1):56.
doi: 10.1186/s12978-018-0492-9.

Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women

Edward Antwi  1   2 , Kerstin Klipstein-Grobusch  3   4 , Joyce L Browne  3 , Peter C Schielen  5 , Kwadwo A Koram  6 , Irene A Agyepong  7 , Diederick E Grobbee  3
Affiliations
Multicenter Study

Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women

Edward Antwi et al. Reprod Health. .

Abstract

Background: 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: This study was nested in a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. 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.

Conclusion: Adding the biomarkers PAPP-A and PlGF to maternal characteristics to 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.

Keywords: Biomarkers; Gestational hypertension; Hypertensive disorders of pregnancy; Prediction model.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval for this study was granted by the Ghana Health Service Ethics Review Committee (Committee Reference Number: GHS-ERC 07/09/11). All participating women gave written informed consent before they were enrolled in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart illustrating participant selection
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curves of prediction models for multiparous women. Model 1 (black line): Maternal characteristics only, Model 2 (red line): Maternal characteristics and PlGF MoM, Model 2 (red line): Maternal characteristics and PlGF MoM, Model 2 (red line): Maternal characteristics and PlGF MoM
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