title: Early prediction of hypertension during pregnancy in a low-resource setting.
abstract: OBJECTIVE
  To evaluate the role of maternal factors, biomarkers, and uterine-artery Doppler in the prediction of hypertension during pregnancy.
  
  
  METHODS
  A prospective cohort study was performed between December 2012 and November 2014. All singleton pregnancies between 11 weeks and 13 weeks, 6 days of pregnancy were included. Patients had their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), mean arterial pressure, uterine-artery Doppler pulsatility index, and pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin levels recorded. Any patients diagnosed with hypertension during follow-up were assigned to the case cohort; all other patients were assigned to the control group.
  
  
  RESULTS
  Hypertension during pregnancy was observed in 198 (9.7%) of 2042 patients that attended follow-up. The mean BMI, mean arterial pressure, uterine-artery Doppler pulsatility index, and the PAPP-A level at study enrollment were all significantly correlated with the later development of hypertension (P<0.001 for all variables). The combined sensitivity, specificity, positive predictive value, and negative predictive value of using the investigated parameters to predict hypertension was 76%, 80%, 31%, and 93%, respectively.
  
  
  CONCLUSIONS
  Patient BMI, mean arterial pressure, PAPP-A, and pulsatility index were found to be effective predictors of hypertension during pregnancy. Combining these predictors may be beneficial in selecting individuals for close monitoring and early intervention during pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India. Electronic address: manishaonly@gmail.com.
authors.forename: Manisha
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Gupta
authors.affiliation: Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Bhattacharjee
authors.affiliation: Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Singh
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Preventive Medicine, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Goel
authors.affiliation: Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Karuna
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of biochemistry, Vallabhbhai Patel Chest Institute, New Delhi, India.
authors.forename: Mujeeb U
authors.initials: MU
authors.lastname: Rehman
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016022:Case-Control Studies; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006295:Health Resources; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D007194:India; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011446:Prospective Studies; D011673:Pulsatile Flow; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A
keywords: Body mass index; PAPP-A; Pre-eclampsia screening; Uterine-artery Doppler