Author Identifier

Enoch Anto Orcid: Peter Roberts Orcid: David Coall Orcid: Wei Wang Orcid:

Document Type

Journal Article

Publication Title

EPMA Journal




School of Medical and Health Sciences




Australia-China International Collaborative Grant (NHMRC-APP1112767-NSFC81561120).

Edith Cowan University (ECU)-Collaborative Enhancement Scheme Round 1 (G1003363).

Grant Number

NHMRC Number : 1112767


This is a post-peer-review, pre-copyedit version of an article published as: Anto, E. O., Roberts, P., Coall, D., Turpin, C. A., Adua, E., Wang, Y., & Wang, W. (2019). 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. EPMA Journal, 10(3), 211-226. The final authenticated version is Available online here


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 < 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.



Research Themes

Society and Culture

Priority Areas

Individual, economic, organisational, political and social transformation