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

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Study Justification:
– The study aimed to assess whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of gestational hypertension in Ghanaian pregnant women.
– This research is important because gestational hypertension is a significant health issue that can lead to adverse outcomes for both the mother and the baby. Improving prediction models can help identify women at risk and provide appropriate interventions to prevent complications.
Study Highlights:
– The study included 373 pregnant women from two public hospitals in Accra, Ghana.
– The predictive ability of the model with only maternal clinical characteristics was assessed using the Area Under the Receiver Operating Characteristic Curve (AUC).
– The AUC for multiparous women was 0.75, and for primigravid women, it was 0.89.
– After including both PAPP-A and PlGF biomarkers in the model, the AUC improved to 0.82 for multiparous women and 0.95 for primigravid women.
– These findings suggest that adding PAPP-A and PlGF to the prediction model improves its accuracy in identifying women at risk of gestational hypertension.
Recommendations for Lay Reader and Policy Maker:
– The study recommends further research using larger sample sizes in similar settings to validate the findings.
– Implementing the use of PAPP-A and PlGF biomarkers in the prediction model for gestational hypertension can improve the identification of at-risk women and enable appropriate interventions to prevent complications.
– Policy makers should consider incorporating these biomarkers into routine antenatal care protocols to enhance the prediction and management of gestational hypertension.
Key Role Players:
– Researchers and scientists: Conducting further research to validate the findings and explore the implementation of PAPP-A and PlGF biomarkers in clinical practice.
– Obstetricians and gynecologists: Incorporating the use of biomarkers in the prediction and management of gestational hypertension in their clinical practice.
– Public health officials: Developing guidelines and policies to integrate the use of biomarkers in routine antenatal care to improve the prediction and prevention of gestational hypertension.
Cost Items for Planning Recommendations:
– Research funding: Allocating resources for larger sample sizes and validation studies.
– Laboratory equipment and supplies: Acquiring and maintaining the necessary equipment and reagents for biomarker analysis.
– Training and education: Providing training for healthcare professionals on the use and interpretation of PAPP-A and PlGF biomarkers.
– Implementation and integration: Budgeting for the integration of biomarkers into routine antenatal care protocols, including updating guidelines, training healthcare staff, and ensuring access to necessary resources.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study was nested in a prospective cohort of 1010 pregnant women, which provides a good sample size. The biomarkers PAPP-A and PlGF were included in the prediction model, and their addition improved the predictive ability. However, the abstract does not provide specific details about the statistical analysis performed or the significance of the results. To improve the evidence, the abstract could include more information about the methodology, such as the specific logistic regression model used and the p-values or confidence intervals for the AUCs. Additionally, it would be helpful to mention any limitations or potential biases in the study, as well as recommendations for future research.

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.

This study was nested in a prospective cohort of 1010 adult pregnant women with a singleton pregnancy and without known pre-existent hypertension recruited between July 2012 and March 2014 at Ridge Regional Hospital and Maamobi General Hospital in Accra. Accra, the capital city of Ghana, is cosmopolitan with high, middle and low-income persons from different ethnic backgrounds living and working in the city [18]. Persons from all the social strata access health services, including antenatal and delivery care in these public hospitals. These hospitals were also chosen because they have a high attendance so the recruitment of pregnant women into the study could be completed in a shorter time. Eligibility criteria for this study were gestational age at enrollment of between between 8 and 13 weeks, based on ultrasound scan. This specific subset of women was selected based on evidence that prediction with these biomarkers is most appropriate at this gestational age [7–10, 19–21]. Women with gestational age at enrollment of less than 8 weeks or more than 13 weeks (n = 411), without PlGF MoM values (n = 95) or women without outcome data (n = 131) were excluded. We used the principle of 10 outcome events per variable for logistic and Cox regression analysis [22–25] to obtain a sample size adequate for our analysis. With an incidence of gestational hypertension of 10% in the Ghanaian population [26], and eight variables in the prediction model, a sample size of 393 women was considered adequate for the analysis. The women were included in the study after they had given written informed consent and were interviewed by trained research assistants using a structured questionnaire for socio-demographic characteristics and obstetric history. They were followed up at each antenatal clinic visit till they delivered. None of the women who developed gestational hypertension progressed to preeclampsia. Pregnancy outcomes were obtained at delivery and from the hospital maternity register.

Based on the provided information, the innovation in this study is the inclusion of biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) in a prediction model for gestational hypertension in Ghanaian pregnant women. This innovation aims to improve the predictive ability of the model and ultimately improve access to maternal health by identifying women at risk for gestational hypertension earlier in their pregnancy.
AI Innovations Description
The recommendation based on the study is to further develop and validate the prediction model for gestational hypertension by including the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) in a cohort of Ghanaian pregnant women. The study found that adding these biomarkers to maternal clinical characteristics improved the predictive ability of the model.

To implement this recommendation and improve access to maternal health, the following steps can be taken:

1. Conduct further research: Conduct additional studies with larger sample sizes in similar settings to validate the findings of this study. This will help ensure the accuracy and reliability of the prediction model.

2. Collaboration with healthcare providers: Collaborate with healthcare providers in Ghana to implement the use of the prediction model in routine antenatal care. This can involve training healthcare professionals on how to use the model and interpret the results.

3. Integration into existing healthcare systems: Integrate the prediction model into existing healthcare systems, such as electronic medical records or antenatal care guidelines. This will help ensure that the model is easily accessible and can be used consistently by healthcare providers.

4. Education and awareness: Conduct educational campaigns to raise awareness among pregnant women and their families about the importance of early detection and prevention of gestational hypertension. This can include providing information about the prediction model and its benefits.

5. Monitoring and evaluation: Continuously monitor and evaluate the implementation of the prediction model to assess its effectiveness in improving access to maternal health. This can involve collecting data on the number of women screened using the model, the accuracy of the predictions, and the impact on maternal health outcomes.

By implementing these recommendations, it is expected that access to maternal health will be improved through early detection and prevention of gestational hypertension, leading to better health outcomes for pregnant women in Ghana.
AI Innovations Methodology
The study titled “Improved prediction of gestational hypertension by inclusion of placental growth factor and pregnancy associated plasma protein-a in a sample of Ghanaian women” aimed to assess whether adding the biomarkers Pregnancy Associated Plasma Protein-A (PAPP-A) and Placental Growth Factor (PlGF) to maternal clinical characteristics improved the prediction of gestational hypertension in a cohort of Ghanaian pregnant women.

The methodology used in this study involved a prospective cohort of 1010 pregnant women attending antenatal clinics in two public hospitals in Accra, Ghana. The inclusion criteria were normotensive pregnant women with a gestational age at recruitment between 8 and 13 weeks, who provided a blood sample for biomarker analysis. The biomarkers PAPP-A and PlGF concentrations were measured from the serum using the AutoDELFIA immunoassay method. Multiple of the median (MoM) values corrected for gestational age (PAPP-A and PlGF) and maternal weight (PAPP-A) were calculated.

Logistic regression was used to develop prediction models by including the biomarkers PAPP-A and PlGF along with clinical predictors such as maternal weight, height, diastolic blood pressure, previous history of gestational hypertension, history of hypertension in parents, and parity. The predictive ability of the models was assessed using the Area Under the Receiver Operating Characteristic Curve (AUC).

The results showed that the model with only maternal clinical characteristics had an AUC of 0.75 for multiparous women and 0.89 for primigravid women. After including both PAPP-A and PlGF, the AUCs improved to 0.82 for multiparous women and 0.95 for primigravid women. This improvement in predictive ability suggests that adding these biomarkers to maternal characteristics can enhance the prediction of gestational hypertension in Ghanaian pregnant women.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve conducting a larger-scale study in similar settings with a diverse population of pregnant women. The study could include a control group that receives standard prenatal care without the addition of biomarkers and a treatment group that receives prenatal care with the inclusion of PAPP-A and PlGF biomarkers. The impact on access to maternal health could be assessed by measuring outcomes such as the incidence of gestational hypertension, the rate of timely diagnosis and intervention, and the overall improvement in maternal health outcomes. This methodology would provide valuable evidence on the effectiveness of these recommendations in improving access to maternal health.

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