Risk factors and risk prediction model for adverse pregnancy outcomes in pregnant women with pregnancy-induced hypertension treated with low-molecular-weight heparin combined with low-dose Aspirin
Zhou Jumei, Lei Fei, Liu Xinmei, et al
1. Department of Obstetrics, 3201 Hospital, Shaanxi,Hanzhong 723000, China; 2. Department of Obstetrics and Gynecology, Xi'an Fifth Hospital, Shaanxi, Xi'an710002, China; 3. Department of Obstetrics, Northwest Women's and Children's Hospital, Shaanxi ProvincialMaternal and Child Healthcare Hospital, Shaanxi, Xi'an 710061, China
Abstract: 【Abstract】 Objective To explore the risk factors and risk prediction model construction for adverse pregnancy outcomes in pregnant women with pregnancy-induced hypertension (PIH) treated with lowmolecular-weight heparin combined with low-dose Aspirin. Method A retrospective study was conductedon 147 pregnant women who were first diagnosed with PIH in Department of Obstetrics, 3201 Hospitalfrom February 2022 to November 2023. They were divided into good outcome group (n=106) and adverseoutcome group (n=41) based on their pregnancy outcomes. Demographic data and various laboratoryindicators of two groups were collected. Using multiple Logistic regression analysis to explore the riskfactors for adverse pregnancy outcomes in pregnant women with PIH, a prediction model for adversepregnancy outcomes was constructed based on the risk factors. The Hosmer-Lemeshow test and receiveroperating characteristic (ROC) curve were used to test the calibration and discrimination of the PIH adverse pregnancy outcome prediction model, and the value of the model was tested in the validation group. Statistical methods performed by t-test and χ2 test. Result Compared with the good outcome group, the proportion of pregnant women aged ≥ 35 years, the proportion of severe PIH, the proportion of 24-hour urine protein quantification ≥ 2 g at admission, high-sensitivity C-reactive protein, blood uric acid, lactate dehydrogenase, and D-dimer in the adverse outcome group were significantly increased (all P<0.001), while albumin and platelet counts were significantly decreased (all P<0.05). There were no statistically significant differences in pre-pregnancy body mass index, primiparous women, history of miscarriage, family history of hypertension, mode of delivery, diagnosed gestational week, systolic blood pressure at admission, diastolic blood pressure at admission, blood urea nitrogen, blood creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, fibrinogen, hemoglobin, triglycerides, total cholesterol, white blood cell count, and neutrophil count between the two groups (all P>0.05). Multiple Logistic regression analysis showed that age ≥ 35 years, severe PIH, 24-hour urinary protein quantification ≥ 2 g at admission, elevated high-sensitivity C-reactive protein, elevated blood uric acid, elevated lactate dehydrogenase, elevated D-dimer, decreased albumin, and decreased platelet counts were the risk factors for adverse pregnancy outcomes in PIH pregnant women (P<0.05). The area under the curve (AUC) for predicting adverse pregnancy outcomes in pregnant women was 0.798 (95% CI: 0.710- 0.886, P<0.05), with the sensitivity of 80.49%, and the specificity of 83.02% the Hosmer-Lemeshow test results indicate good goodness of fit (P=0.203); external validation showed that the AUC of the model was 0.775 (95% CI: 0.682-0.867, P<0.001), and the Hosmer-Lemeshow test results suggested that the model had good predictive value for adverse pregnancy outcomes (P=0.962). Calculate the predictive score of risk factors for adverse pregnancy outcomes in pregnant women based on regression coefficients, with a cut-off value of 2 points and AUC of 0.853 (95% CI: 0.780-0.926, P<0.05), with the sensitivity of 87.80%, and the specificity of 84.91%; external validation showed that the AUC of the model was 0.832 (95% CI: 0.755-0.910, P<0.001), and the Hosmer-Lemeshow test indicated that the model had good predictive value for adverse pregnancy outcomes (P=0.817). Conclusion Age ≥ 35 years, severe PIH, 24-hour urine protein quantification ≥ 2 g at admission, elevated high-sensitivity C-reactive protein, elevated blood uric acid, elevated lactate dehydrogenase, elevated D-dimer, decreased albumin, and decreased platelet counts are the risk factors for adverse pregnancy outcomes in pregnant women with PIH. Based on these, establishing the risk predictio n model has high diagnostic efficacy
周菊梅 雷斐 刘新美 王少丽. 妊娠期高血压综合征孕妇低分子肝素联合小剂量阿司匹林治疗后出现不良妊娠结局的危险因素及风险预测模型[J]. 发育医学电子杂志, 2025, 13(3): 195-201.
Zhou Jumei, Lei Fei, Liu Xinmei, et al. Risk factors and risk prediction model for adverse pregnancy outcomes in pregnant women with pregnancy-induced hypertension treated with low-molecular-weight heparin combined with low-dose Aspirin. Journal of Developmental Medicine(Electronic Version), 2025, 13(3): 195-201.
2025, Vol. 13 
