Mean arterial pressure ≥89 mmHg before 20+0 weeks of gestation as a predictor of early-onset preeclampsia: a case-control study.

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Introduction: early-onset preeclampsia (EOPE) contributes substantially to maternal and perinatal morbidity in low- and middle-income countries (LMICs). Mean arterial pressure (MAP) has been evaluated as a potential predictor of EOPE; however, its predictive performance before 20+0 weeks of gestation remains unclear in LMIC settings. This study evaluated the predictive performance of MAP ≥89 mmHg measured before 20+0 weeks in predicting EOPE among at-risk women at Kenyatta National Hospital (KNH). Methods: an unmatched case-control study was conducted at KNH, including 582 women (194 cases, 388 controls) with at least one preeclampsia risk factor identified before 20+0 weeks. Recorded blood pressure measurements were used to calculate MAP. Predictive performance was assessed using sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis, with the area under the ROC curve (AUROC) reported. Multivariable logistic regression was used to assess independent associations. Results: median MAP was higher among EOPE cases than controls (94.56 mmHg (IQR: 87.00-104.58) vs 83.33 mmHg (IQR: 77.67-89.83); p <0.001). Mean arterial pressure ≥89 mmHg was associated with EOPE (OR = 5.66, 95% CI: 3.89-8.24, p <0.001), and remained an independent predictor (aOR = 3.04, 95% CI: 1.96-4.71, p <0.001). Discriminatory performance was fair (AUROC = 0.783) and improved when combined with maternal risk factors (AUROC = 0.810). Sensitivity and specificity were 68.04% and 72.68%, respectively, while the positive and negative predictive values were 55.46% and 81.98%, respectively. Conclusion: mean arterial pressure ≥89 mmHg before 20+0 weeks independently predicts EOPE among at-risk women and may support early risk stratification in LMIC settings.