Abstract
Purpose: Maternal lipid profile in second trimester has rarely been investigated in the risk assessment for pre-eclampsia (PE). Since early-onset PE often companied by much worse clinical outcomes, thus, we aimed to evaluate the predictive value of second-trimester maternal lipid profiling for early-onset PE.Methods: A prospective cohort study was conducted to measure the second-trimester maternal lipid profile of pregnant women from January to December 2019. The pairwise association between maternal lipid profile and PE onset or pregnancy termination time was quantified. Multiple logistic regression was preformed to define risk factors for early-onset PE, and a nomogram for early-onset PE was developed. The net benefit of our model was evaluated by calibration curve and decision curve analyses.Results: We enrolled 5,908 pregnant women and they were divided into healthy (n = 5,789), late-onset PE (n = 64), and early-onset PE (n = 55) groups. Total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-c) were elevated in patients with PE, while high-density lipoprotein cholesterol (HDL-c) was decreased in patients with PE. TC, TG, and LDL-c were negatively correlated with PE onset time or gestational week at delivery. Receiver operating characteristic curves (ROC) defined the cutoff values of TG and HDL-c, and the final regression model included five statistically significant risk predictors for early-onset PE (maternal age of ≥35 years, multipara, pre-pregnancy body mass index (BMI) ≥25 kg/m2, second trimester TG ≥ 2.59 mmol/L and second trimester HDL-c ≤ 2.03 mmol/L. The nomogram had an excellent diagnostic performance (area under the curve = 0.912, sensitivity = 92.7%, and specificity = 76%) and was further validated with good calibration and positive net benefits in a decision curve analysis.Conclusions: An abnormally increased TG concentration and a decreased HDL-c concentration might serve as predictors of early-onset PE. Whether blood lipid-lowering measures can improve severe PE prognosis require further clarification.
Highlights
Pre-eclampsia (PE) is defined as new-onset hypertension (>140/90 mmHg) occurring after the 20th week of gestation accompanied by one or more of new-onset proteinuria, maternal organ dysfunction, or uteroplacental dysfunction [1]
The process might result in neovascularization and placental dysfunction, which cause release of humoral substances into the maternal circulation, leading to clinical manifestation [3], while some other scholars believed that abnormal pre-pregnancy maternal cardiovascular function may lead to trophoblast malperfusion and may be the origin of PE [4] PE can be roughly divided into early-onset and late-onset subtypes, each with its etiopathogenic background [5]
PE is defined as new-onset hypertension (>140/90 mmHg) and proteinuria (>300 mg/d) after the 20th week of gestation or absence of proteinuria but fulfillment of other criteria for PE according to the American College of Obstetricians and Gynecologists’ 2019 Practice Bulletin (Gestational Hypertension and Pre-eclampsia)
Summary
Pre-eclampsia (PE) is defined as new-onset hypertension (>140/90 mmHg) occurring after the 20th week of gestation accompanied by one or more of new-onset proteinuria, maternal organ dysfunction, or uteroplacental dysfunction [1]. The process might result in neovascularization and placental dysfunction, which cause release of humoral substances into the maternal circulation, leading to clinical manifestation [3], while some other scholars believed that abnormal pre-pregnancy maternal cardiovascular function may lead to trophoblast malperfusion and may be the origin of PE [4] PE can be roughly divided into early-onset and late-onset subtypes, each with its etiopathogenic background [5]. Early-onset PE is defined as disease developing before 34 weeks of gestation and is usually associated with an increased risk of adverse pregnancy outcomes, severe pre-eclampsia with maternal end-organ damage. Any treatments that prolong pregnancy would enable the fetus to mature further and reduce the maternal organ damage are considered beneficial
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
