Second trimester maternal serum D-dimer combined with alpha-fetoprotein and free β-subunit of human chorionic gonadotropin predict hypertensive disorders of pregnancy: a systematic review and retrospective case–control study

Abstract

Background This 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 methods In 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. Results DD 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. Conclusion DD 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.

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

“…Our research also showed that the AUCs of DD in the first trimester for GH, PE, and SPE were 0.699, 0.784 and 0.893, respectively; these values were greater than the results we obtained previously in later pregnancy (the AUCs of DD for GH, PE, and SPE were 0.560, 0.614, and 0.640, respectively) [ 26 ], but was slightly lower than the results in the second trimester (the AUCs of DD for GH, PE, and SPE were 0.642, 0.767, and 0.905, respectively) [ 27 ]. These findings indicated that the levels of DD in the first trimester had a higher diagnostic value than in the middle and late trimesters for GH and PE.…”

Investigation and Application of Risk Factors of Macrosomia Based on 10,396 Chinese Pregnant Women

“…D-dimer is one of the most valuable biomarkers to exclude venous thromboembolism disorders in pregnant women and non-pregnant population ( 10 , 11 ). Previous studies have shown that D-dimer levels might predict a higher risk of pregnancy failure in women who underwent in-vitro fertilization and guide anticoagulant treatment in recurrent pregnancy loss associated with antiphospholipid syndrome; the high levels of D-dimer detected at more than 20 weeks of gestation were related to the severity of preeclampsia and maternal serum D-dimer combined with alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) at the second trimester of pregnancy might be used to predict hypertensive disorders of pregnancy ( 12 – 15 ). However, there has been little research on the associations of maternal D-dimer level with fetal birthweight.…”