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Zhu Y, Liu Z, Miao C, Wang X, Liu W, Chen S, Gao H, Li W, Wu Z, Cao H, Li H. Trajectories of maternal D-dimer are associated with the risk of developing adverse maternal and perinatal outcomes: a prospective birth cohort study. Clin Chim Acta 2023; 543:117324. [PMID: 37003516 DOI: 10.1016/j.cca.2023.117324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To assess the relationships of maternal D-dimer trajectories with the risk of developing adverse maternal and perinatal outcomes (AMPOs). METHODS A prospective birth cohort study was conducted in China, and 7,095 women who had singleton birth were included. The latent class growth model was used to determine the maternal D-dimer trajectory. RESULTS Three maternal D-dimer trajectories were identified: (1) slight increase (43.6%), (2) rapid rise (51.3%), (3) sustained high (5.1%). Compared to pregnant women with a slight increase in D-dimer trajectory, the risk of gestational diabetes mellitus, placenta previa, macrosomia, large for gestational age (LGA), and increased postpartum bleeding was significantly increased in those with a rapid rise trajectory (adjusted OR=1.22, 2.00, 1.80, and 1.56, adjusted β=15.92∼25.1ml, respectively, P<0.05), and women with a sustained high trajectory also demonstrated a relatively elevated risk of macrosomia and LGA (adjusted OR=2.11 and 1.82, respectively, P<0.05). While the odds of pregnancy-induced hypertension, low birth weight, and small for gestational age in pregnant women with the rapid rise D-dimer trajectory and fetal distress in those with sustained high trajectory exhibited a reduction (adjusted OR=0.62, 0.38, 0.54, and 0.64, respectively, P<0.05). CONCLUSION This study highlights the influence of inappropriate maternal D-dimer trajectories on the risk of AMPOs.
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Affiliation(s)
- Yibing Zhu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Key Laboratory of Women and Children's Critical Disease Research, Fuzhou 350001, China
| | - Zhaozhen Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Chong Miao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
| | - Xiaomei Wang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Wenjuan Liu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Children's Hospital, Fuzhou 350001, China
| | - Shali Chen
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Haiyan Gao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Wei Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Zhengqin Wu
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Obstetrics and Gynecology Hospital, Fuzhou 350012, China
| | - Hua Cao
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Key Laboratory of Women and Children's Critical Disease Research, Fuzhou 350001, China.
| | - Haibo Li
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China; Fujian Key Laboratory of Women and Children's Critical Disease Research, Fuzhou 350001, China
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Zhang Y, Li H, Guo W, Zhao H, Zheng N, Huang Y. Predictive value of coagulation function and D-dimer for pregnancy outcome in pregnancy-induced hypertension. Am J Transl Res 2023; 15:1150-1158. [PMID: 36915761 PMCID: PMC10006772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/23/2022] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To observe the predictive values of plasma prothrombin time (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT) and D-dimer (DD) levels for pregnancy outcome in parturients with hypertensive disorder complicating pregnancy (HDCP). METHODS A retrospective analysis was conducted on 107 parturients with gestational hypertension admitted to Xi'an International Medical Center Hospital from April 2018 to April 2021 (research group) and on 50 healthy parturients who underwent physical examination in the same period (control group). PT, FIB, APTT, and DD values of all parturients included in the study were examined at admission, and pregnancy outcomes were recorded. The working curve (ROC) of the relationship between coagulation function test indicators and pregnancy outcomes of parturients in the research group was analyzed. RESULTS Compared to the control group, PT and APTT values of parturients in the research group were lower, while FIB and DD levels were markedly higher (P < 0.05). Correlation analysis showed APTT and PT were negatively correlated with the severity of disease (both P < 0.001), while the expression of FIB and DD were positively correlated with it (both P < 0.001). Parturients were divided into an adverse outcome group and a normal outcome group. Logistic regression analysis showed that pre-pregnancy body mass index, PT, APTT, FIB, DD and other indicators were all risk factors for adverse outcome in HDCP parturients. ROC curve analysis showed that the area under the curve of these combined risk factors for predicting adverse outcome was 0.971. CONCLUSION Levels of PT, FIB, APTT, and DD are abnormal in parturients with different degrees of HDCP. Regular coagulation function tests can effectively detect HDCP, enabling improvement of pregnancy outcome.
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Affiliation(s)
- Yan Zhang
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Huan Li
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Wenting Guo
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Haixia Zhao
- Second Department of Obstetrics, Xi'an International Medical Center Hospital No. 777, Xitai Road, Chang'an District, Xi'an 710117, Shaanxi, China
| | - Ning Zheng
- Obstetrical Department, Xi'an Gaoxin Hospital No. 16, Tuanjie South Road, Yanta District, Xi'an 710075, Shaanxi, China
| | - Yongmei Huang
- Obstetrical Department, Xi'an Gaoxin Hospital No. 16, Tuanjie South Road, Yanta District, Xi'an 710075, Shaanxi, China
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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. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8264958. [PMID: 35402610 PMCID: PMC8986391 DOI: 10.1155/2022/8264958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022]
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 (χ2 = 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.
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Yuan X, Han X, Jia C, Long W, Wang H, Yu B, Zhou J. Investigation and Application of Risk Factors of Macrosomia Based on 10,396 Chinese Pregnant Women. Front Endocrinol (Lausanne) 2022; 13:837816. [PMID: 35557844 PMCID: PMC9088515 DOI: 10.3389/fendo.2022.837816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objective of this study was to examine the association of fetal macrosomia with maternal D-dimer and blood lipid levels, and explore whether D-dimer and blood lipids, either alone or in combination with traditional risk factors at hospital birth, could be used to predict subsequent delivery of macrosomia. METHODS From April 2016 to March 2017, 10,396 women with singleton pregnancy giving birth at around 28-41 weeks of gestation were recruited into the present study. D-dimer and blood lipid levels were measured at hospital admission; and data on birth outcomes were obtained from hospital records. RESULTS Multivariate logistic regression analysis showed that D-dimer, triglyceride and HDL-C levels were significantly associated with risk of macrosomia independent of traditional risk factors (for D-dimer: adjusted OR: 1.33, 95% CI, 1.23-1.43; for triglyceride: adjusted OR: 1.14, 95% CI, 1.05-1.23; for HDL-C: adjusted OR: 0.35, 95% CI, 0.24-0.51, all P <0.01). More importantly, incorporating D-dimer and blood lipids into the traditional model significantly increased the area under curve (AUC) for prediction of macrosomia (0.783 vs. 0.811; P <0.01). CONCLUSION Our study demonstrates that maternal D-dimer, triglyceride, and HDL-C levels before hospital birth could be significant and independent of risk factors of fetal macrosomia. Therefore, combining D-dimer and blood lipid levels with traditional risk factors might improve the ability to predict macrosomia in gestational diabetes mellitus and normal pregnancies.
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Affiliation(s)
- Xiaosong Yuan
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Xiaoya Han
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Chenbo Jia
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Wei Long
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
| | - Bin Yu
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
- *Correspondence: Bin Yu, ; Jun Zhou,
| | - Jun Zhou
- Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China
- *Correspondence: Bin Yu, ; Jun Zhou,
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