Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

Abstract

D-Dimer (DD) is the smallest fragment of plasmin-mediated cleavage of fibrin. There is a progressive increase in DD concentration with advancing gestation in normal pregnancies, making the upper limit of 0.5 μg/ml used in non-pregnant population an unfavorable marker during pregnancy. Coagulation and fibrinolysis parameters are also markedly disturbed in pregnancies complicated by various pathologies. We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by preeclampsia (PE), severe preeclampsia (SPE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). In addition, we aimed to determine the diagnostic value of DD in PE and SPE. In this retrospective observational cohort study, 250 normal and 178 complicated pregnancies were included. Normal pregnancies included 88-first trimester, 101-second trimester and 61-third trimester pregnancies. Complicated pregnancy included 34 PE, 44 SPE, 32 GDM, 33 PROM, and 35 PPROM cases during the third trimester. Predefined exclusion criteria were used. The period of gestation (POG) accounted for 41.9% of the variance in DD, with strong correlation between the POG and DD. The trimester specific reference intervals were computed. The distribution for severe preeclampsia was statistically different compared to other categories in the third trimester. This exceptional distribution led to the generation of a receiver operating characteristic (ROC) curve with an area under curve of 0.828, attesting its possible role in predicting severe preeclampsia. We determined trimester specific reference intervals of DD. The role of DD has been explored, and it may be of diagnostic value in severe preeclampsia.

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

“…However, there have been few studies using a DD + AFP + free β-hCG model to predict HDP in the second trimester. Baboolall et al showed that the AUC of third trimester DD for SPE was 0.828, proving its predictive value for SPE [ 12 ]. The results of our study showed that the AUC values of second trimester DD for GH, PE, and SPE were 0.642, 0.767, and 0.905, respectively, and the AUC values of DD for GH, PE, and SPE were all higher than our previous results for third trimester DD (0.560, 0.614, and 0.640, respectively) [ 32 ].…”

“…D-dimer (DD) is a small protein fragment that is degraded by fibrinolysis. It is the smallest fragment of the fibrin degradation products and increases significantly during pregnancy [ 12 , 13 ]. DD is one of the most valuable indicators for the diagnosis and management of thrombotic states in those with venous thromboembolism, atrial fibrillation, and cancer, as well as those who are pregnant or undergoing surgery.…”

Coronavirus disease 2019 pregnancy outcomes in a racially and ethnically diverse population

“… 24 However, in both complicated and uncomplicated pregnancies, D-dimer levels are known to increase above baseline, although reference ranges are inconsistent. 25 Our study presents novel data on D-dimer trends in SARS-CoV-2–positive symptomatic and asymptomatic women in relation to delivery. CRP has emerged as another independent predictor of adverse outcomes in nonpregnant patients with COVID-19.…”

Association of D-dimers with acute kidney injury in pregnant women: a retrospective study

“…In the field of pregnancy, the D-dimer concentration has been studied in patients with gestational hypertensive disorders (GHDs). Baboolall et al 22 performed a retrospective observational cohort study of 443 women and concluded that the Ddimer concentration might predict severe preeclampsia (AUC, 0.828). Similarly, Kim et al 23 performed a retrospective cohort study of pregnant women with GHD and noted that patients with severe GHD had significantly higher D-dimer concentrations than those with non-severe GHD.…”

“…Baboolall et al. 22 performed a retrospective observational cohort study of 443 women and concluded that the D-dimer concentration might predict severe preeclampsia (AUC, 0.828). Similarly, Kim et al.…”