Journal of Developmental Medicine(Electronic Version)  2025, Vol. 13 Issue (3): 195-201 DOI: 10.3969/j.issn.2095-5340.2025.03.006 |
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| 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
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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
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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
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Received: 12 March 2024
Published: 31 May 2025
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