Abstract
BackgroundThis study investigated whether maternal serum D-dimer (DD) alone or DD combined with alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP).Materials and methodsIn this retrospective case–control study, the data of gravidas patients who delivered at hospital were divided into the following groups: control (n = 136), gestational hypertension (GH, n = 126), preeclampsia (PE, n = 53), and severe preeclampsia (SPE, n = 41). Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic value of maternal serum DD, AFP, and free β-hCG levels for HDP.ResultsDD levels of the GH, PE, and SPE groups were significantly higher than that of the control group (P < 0.001). The order of effectiveness for models predicting HDP was as follows: DD + AFP + free β-hCG > DD > DD + AFP > DD + free β-hCG > AFP + free β-hCG > AFP > free β-hCG. For predicting different types of HDP, DD alone had the best diagnostic value for SPE, followed by PE and GH. DD alone had a sensitivity of 100% with a 0% false negative rate and had the highest positive likelihood ratio (+ LR) for SPE. DD alone in combination with AFP alone, free β-hCG alone and AFP + free β-hCG could reduce false positive rate and improve + LR.ConclusionDD is possible the best individual predictive marker for predicting HDP. Levels of DD alone in the second trimester were positively correlated with the progression of elevated blood pressure in the third trimester, demonstrating the predicting the occurrence of HDP. The risk calculation model constructed with DD + free β-hCG + AFP had the greatest diagnostic value for SPE.
Highlights
This study investigated whether maternal serum D-dimer (DD) alone or DD combined with alphafetoprotein (AFP) and free β-subunit of human chorionic gonadotropin in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP)
The second trimester gestational age of the Gestational hypertension (GH), PE and severe preeclampsia (SPE) groups was lower than that of the control group, and there was no statistical difference between groups (F = 1.460, P = 0.225)
The results demonstrated that levels of DD in the second trimester were significantly higher in the GH, PE, and SPE groups than in the control group (P < 0.001)
Summary
This study investigated whether maternal serum D-dimer (DD) alone or DD combined with alphafetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP). Hypertensive disorders of pregnancy (HDP) are obstetric complications that can lead to adverse events for both the pregnant woman and the fetus, including increased risk of maternal stroke, lower birth weight, neonatal intensive care needs, and maternal and perinatal deaths [1,2,3]. HDP complicate up to 10% of pregnancies worldwide, seriously threatening pregnant women and perinatal children, and are the second leading cause of maternal death and amniotic fluid embolism, but their etiology and pathogenesis are not fully clear [4, 5]. HDP are known to predispose women to ongoing hypertension and associated cardiovascular morbidity later in life [8]
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