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

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

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Algorithms
  • Biomarkers / blood
  • Cohort Studies
  • Early Diagnosis
  • Female
  • Follow-Up Studies
  • Ghana / epidemiology
  • Humans
  • Hypertension, Pregnancy-Induced / blood
  • Hypertension, Pregnancy-Induced / diagnosis*
  • Hypertension, Pregnancy-Induced / epidemiology
  • Maternal Serum Screening Tests*
  • Models, Biological*
  • Parity
  • Placenta Growth Factor / blood*
  • Pregnancy
  • Pregnancy Trimester, First
  • Pregnancy-Associated Plasma Protein-A / analysis*
  • Prospective Studies
  • Risk
  • Sensitivity and Specificity
  • Up-Regulation*
  • Young Adult

Substances

  • Biomarkers
  • PGF protein, human
  • Placenta Growth Factor
  • Pregnancy-Associated Plasma Protein-A
  • PAPPA protein, human