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

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 \u3c 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

Suboptimal health pregnant women are associated with increased oxidative stress and unbalanced pro- and antiangiogenic growth mediators: A cross-sectional study in a Ghanaian population

Optimal oxidative stress (OS) is important throughout pregnancy; however, an increased OS may alter placental angiogenesis culminating in an imbalanced of angiogenic growth mediators (AGMs). Suboptimal Health Status (SHS), a physical state between health and disease, may be associated with increased OS and unbalanced AGMs. In this study, we explored the association between SHS, biomarkers of OS (BOS) and AGMs among normotensive pregnant women (NTN-PW) in a Ghanaian Suboptimal Health Cohort Study (GHOACS). This comparative GHOACS recruited 593 NTN-PW from the Komfo Anokye Teaching Hospital, Ghana. SHS was measured using a Suboptimal Health Status Questionnaire-25 (SHSQ-25). Along with the subjective SHS measure, objective BOS: 8-hydroxy-2-deoxyguanosine (8-OHdG), 8-epiprostaglandinF2 alpha (8-epi-PGF2α), total antioxidant capacity (TAC), and AGMs: vascular endothelial growth factor-A (VEGF-A), soluble fms-like tyrosine kinase receptor 1 (sFlt-1), placental growth factor (PIGF) and soluble endoglin (sEng) were evaluated. Compared to optimal health NTN-PW, levels of PlGF, VEGF-A and TAC were significantly (p \u3c 0.05) reduced and negatively associated with SHS whilst sEng, sFlt-1, 8-epiPGF2α, 8-OHdG, and combined ratios of sFlt-1/PlGF, 8-epiPGF2α/PlGF, 8-OHdG/PlGF, and sEng/PlGF were significantly increased and positively associated with SHS. The first quartile for PIGF (2.79-fold) and VEGF-A (5.35-fold), and the fourth quartile for sEng (4.31-fold), sFlt-1 (1.84-fold), 8-epiPGF2α (2.23-fold), 8-OHdG (1.90-fold) and urinary 8-OHdG (1.95-fold) were independently associated with SHS (p \u3c 0.05). SHS is associated with increased OS and unbalanced AGMs. Early identification of SHS-related OS and unbalanced AGMs may inform clinicians of the need for therapeutic options

Weight management merits attention in women with infertility: A cross-sectional study on the association of anthropometric indices with hormonal imbalance in a Ghanaian population

OBJECTIVE: This study determined the association of anthropometric indices with hormonal imbalance among infertile women in a Ghanaian population. RESULTS: Follicle stimulating hormone (FSH) levels (18.47 vs. 8.67, p-value = 0.002), and luteinizing hormone (LH) (12.43 vs. 8.01, p-value = 0.044) were higher in women with primary infertility compared with women presenting with secondary infertility. Waist circumference (WC) and waist-to-height ratio (WHtR) showed significant negative partial correlation with prolactin in both primary and secondary infertile women. Also a significant negative partial correlation was observed between BMI and prolactin in secondary infertile women only. Waist-to-hip ratio (WHR) showed a positive association with LH in both primary and secondary infertility. WHR also showed significant positive correlation to LH/FSH ratio in secondary infertility whereas body adiposity index (BAI) showed a negative correlation to LH/FSH ratio. In a correlation analysis of anthropometric measures with hormonal profile and causes of infertility as a fixed factor, the association between anthropometric indices and fertility hormones was largely dependent on the underlying causes of infertility

Oxidative stress as a key signaling pathway in placental angiogenesis changes in preeclampsia: Updates in pathogenesis, novel biomarkers and therapeutics

Background: Preeclampsia (PE) is a disorder of pregnancy characterised by persistent high blood pressure and proteinuria, which is usually detected after 20 weeks gestation. The pathophysiological mechanisms that underlie the pathogenesis of PE are unclear; although oxidative stress (OS), abnormal placental angiogenesis and endothelial dysfunction are reported to be contributing factors. Despite the synergistic roles OS and placental angiogenesis play in the pathogenesis of PE, very few studies have attempted to integrate both factors in the pathogenesis, diagnosis and treatment of PE. OS also influ-ences placental angiogenesis through redox-sensitive transcription factors; hence under-standing how OS influences placental angiogenesis may elucidate potential therapeutic targets for correcting abnormal placental angiogenesis and function in PE. Objective: This article aims to present an insight into the role of OS and angiogenic growth mediators (AGMs) in the pathogenesis of PE. It also provides evidence supporting the fact that OS may directly or indirectly influence placental angiogenesis changes in PE through the expression of a number of reactive oxygen species (ROS)-sensitive transcrip-tion factors. Additionally, it covers mainly diagnostic biomarkers of OS and AGMs along with existing biomarkers and treatment options currently available for PE. Conclusion: Understanding the dynamics of preeclampsia will create a window of oppor-tunity for predictive, preventive and personalised medicine (PPPM)

Determinants

This study aimed to investigate factors that influence antenatal care utilization and their association with adverse pregnancy outcomes (defined as low birth weight, stillbirth, preterm delivery or small for gestational age) among pregnant women in Kumasi. A quantitative cross-sectional study was conducted of 643 women aged 19–48 years who presented for delivery at selected public hospitals and private traditional birth attendants from July–November 2011. Participants’ information and factors influencing antenatal attendance were collected using a structured questionnaire and antenatal records. Associations between these factors and adverse pregnancy outcomes were assessed using chi-square and logistic regression. Nineteen percent of the women experienced an adverse pregnancy outcome. For 49% of the women, cost influenced their antenatal attendance. Cost was associated with increased likelihood of a woman experiencing an adverse outcome (adjusted OR = 2.15; 95% CI = 1.16–3.99; p = 0.016). Also, women with >5 births had an increased likelihood of an adverse outcome compared with women with single deliveries (adjusted OR = 3.77; 95% CI = 1.50–9.53; p = 0.005). The prevalence of adverse outcomes was lower than previously reported (44.6 versus 19%). Cost and distance were associated with adverse outcomes after adjusting for confounders. Cost and distance could be minimized through a wider application of the Ghana National Health Insurance Scheme

Association between adverse pregnancy outcome and maternal age.

<p>Association between adverse pregnancy outcome and maternal age.</p

Spearman rho partial correlation between maternal age and OS biomarkers and AGMs.

<p>Spearman rho partial correlation between maternal age and OS biomarkers and AGMs.</p

Serum levels of AGMs and OS biomarkers in relation to maternal age.

<p>Serum levels of AGMs and OS biomarkers in relation to maternal age.</p