Pregnancy induced hypertension (PIH) is a major complication of pregnancy and is associated with high maternal and perinatal morbidity and mortality. The aim of this study was to investigate the possible causal association of PIH with maternal serum
PAPP-A and urinary
protein-
creatinine ratio (UPCr) as well as to evaluate the usefulness of these two variables as predictive markers of PIH. A total 200 women of 8-16 weeks of pregnancy were enrolled in this study. All the patients were followed up till delivery for the development of
pregnancy induced hypertension. Thirty patients were lost in the follow up, 3(1.76%) developed
preeclampsia (PE) and 14(8.23%)
gestational hypertension (GH). By a nested case-control design the 17
pregnancy induced hypertension cases were compared with 48 Controls with normal pregnancy outcome. Maternal serum
PAPP-A was significantly lower in the
pregnancy induced hypertension group compared to Control [mIU/ml, median (range) 1.8(0.70-4.1) vs. 5.45(2.7-10), p<0.001]. UPCr was significantly higher in the
pregnancy induced hypertension group compared to Control (mg/mmol, mean+/-SD, 6.86+/-1.56 vs. 4.75+/-0.96, p<0.001). When tested as a predictive marker of
pregnancy induced hypertension the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of maternal serum
PAPP-A in the lowest 25th percentile were 82%, 95%, 87% and 93%. At 75th percentile the sensitivity, specificity, PPV and NPV of UPCr were 52%, 85%, 56% and 83% respectively.