Conclusions

The incidence of PE was high among SHS compared to OHS pregnant women. There is an imbalance in biomarkers of OS as well as AGMs at both early 2nd trimester and mid-pregnancy among SHS rather than OHS NTN-PW who later developed PE. The single biomarkers of OS and AGMs yielded fair discriminating power or prognostic accuracies, but their combined biomarkers perform better as a prognostic marker for PE. The combination of biomarkers of OS and AGMs, particularly the mid-pregnancy 8-OHdG/PlGF ratio is the best marker for predicting PE and its subtypes. The combination of biomarkers of OS and AGMs will increase our knowledge of the new prognostic markers and inform clinicians of the need for a combined antioxidant plus pro-angiogenic supplementation for women who develop PE. The concept of SHS allows early stratification and intervention for NTN-PW, who are at high risk of developing PE. Thus, it should be recommended as an additional health assessment tool for antenatal care in resource-limited communities.