Predicting Hypertensive Disease in the First Trimester of Pregnancy: Risk Models and Analysis of Serum D-dimer Levels Combined with Plasma Pregnancy-Associated Protein A, Free β-Subunit of Human Chorionic Gonadotropin, and Fetal Nuchal Translucency

Abstract

We aimed to investigate the predictive ability of serum levels of D-dimer (DD) in the first trimester for the occurrence of hypertensive disorders of pregnancy (HDP). In this retrospective, case-cohort study, we measured the levels of DD, plasma pregnancy-associated protein A (PAPP-A), and free β-subunit of human chorionic gonadotropin (free β-hCG) and analyzed fetal nuchal translucency (NT) in 150 healthy gravidas, 126 cases of gestational hypertension (GH), 53 cases of preeclampsia (PE), and 41 cases with severe preeclampsia (SPE). Likelihood ratio models and risk models were built using single markers (DD, PAPP-A, free β-hCG, and NT) and combinations of those markers. Analyses showed that the levels of DD multiple of the median (MoM) in the GH, PE, and SPE groups were all significantly higher than those in the control group, with significant differences between groups ( χ 2 = 70.325 , P < 0.001 ). The area under curve (AUCs) for DD in the GH, PE, and SPE groups was 0.699, 0.784, and 0.893, respectively; the positive likelihood ratio (+LR) was 1.534, 1.804, and 2.941, respectively; and the negative likelihood ratio (-LR) was 0.022, 0.081, and 0, respectively. When the cut-off values of DD for the GH, PE, and SPE groups were 0.725, 0.815, and 0.945 MoM, respectively, the corresponding sensitivities were 0.992, 0.962, and 1.000, respectively. As gestational hypertension progressed, the levels of DD tended to increase gradually. The maternal serum level of DD in the first trimester had correlative and diagnostic value for HDP. The sensitivity and specificity of maternal serum levels of DD level in the first trimester for different types of HDP were significantly different; the best sensitivity and specificity were detected in the SPE group. First trimester DD level, combined with other biochemical markers, may improve our ability to diagnose HDP.

First-Trimester Screening Tests and Perinatal Outcomes

“…However, another study revealed a positive correlation between birth weight and PAPP-A levels in early pregnancy 8 . In these studies, no adjustments were made for smoking and maternal weight 9 . In another study 1622 pregnant women who were in IUGR and examined the levels of PAPP-A, free β-hCG, and fetal NT between the groups, and they found that only the PAPP-A level was 3.3 times significant in detecting IUGR below 0.50 MoM 10 .…”

Predicting the Frequency of Pregnancy Induced Hypertension in Early Pregnancy by Maternal Serum Beta Human Chorionic Gonadotropin Levels

“…In another study, the sensitivity and specificity of beta HCG in predicting pregnancy induced hypertension was found as 83.3% and 96.9% respectively. (7) The human beta-hCG is with lipid structure that is present in trophoblast and various malignant tumors as a glycoprotein. The function of Human placenta is that it synthesizes hormones, protein, and glycoprotein hormones throughout gestation.…”