Author Identifier

Enoch Anto
Orcid: 0000-0001-9023-6612

Peter Roberts
Orcid: 0000-0001-9591-3395

David Coall
Orcid: 0000-0002-0488-2683

Wei Wang
Orcid: 0000-0002-1430-1360

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.