PREDICTION, TOOL VALIDATION, AND DEVELOPING RISK SCORE FOR PREECLAMPSIA AND ASSESSING WOMEN'S PERSPECTIVE OF THE DISEASE, AT WOLDIA COMPREHENSIVE SPECIALIZED HOSPITAL: A PROSPECTIVE FOLLOW-UP STUDY

Abstract
Background: Preeclampsia is associated with high risks of preterm delivery, intrauterine growth restriction, placental abruption, and perinatal mortality. Studies have shown that women who develop preeclampsia have different clinical, ultrasound, and biomarker findings. Despite this overwhelming research in the developed world, in Ethiopia, the area is still untouched. Therefore, this study aimed to predict preeclampsia, tool validating, and assess the perspectives of women for the disease, at Woldia Comprehensive Specialized Hospital.
Methods: A one-year prospective follow-up study was employed on 814 pregnant women and the perspective was studied among 858 women. The study used prospectively collected clinical and CBC parameters from pregnant women and their newborns. Descriptive statistics express the mean and standard deviation for numerical variables. Logistic regression models were applied for the initial visit (less than 20 weeks) to predict preeclampsia. The negative predictive value, positive predictive value, sensitivity, and specificity were also calculated for CBC and MAP parameters.
Results: Among 814 pregnant women (91% response rate) and 858 women (96.2% response rate) for the primary and secondary objectives, respectively. MAP showed the highest diagnostic accuracy (AUC = 0.95), with 95.56% sensitivity and 66.45% specificity. PLR demonstrated moderate predictive value (AUC = 0.66), while NLR, PDW, and MPV had limited significance. Key predictors for preeclampsia included self-history of preeclampsia, age above 35, NLR 3 and above, and MAP ≥ 82 mmHg (OR = 15.318), while PLR ≥ 119 was protective (OR = 0.182). A risk score classified women as low (≤2 points) or high risk (≥2 points). Awareness was moderate (59.9%), but misconceptions were common, with 40.5% attributing preeclampsia to stress.
Conclusion: MAP, self-history of preeclampsia, advanced maternal age, and NLR are key predictors of preeclampsia. The developed risk score aids in early risk stratification. Despite ANC awareness, misconceptions persist, emphasizing the need for enhanced health education. Routine blood indices and MAP screening could improve early detection and maternal-fetal outcomes.
Keywords: Preeclampsia, prediction, risk score, Mean arterial pressure, Neutrophil to Lymphocyte Ratio