Predicting Hypertensive Conditions in Pregnant Women
Study Objectives: 1) To develop a method of predicting hypertensive disorders in pregnant women based on investigating thrombophilia genes, measuring anti-β 2-glycoprotein I antibodies (β 2GPI) and D-dimer levels, and determining the atherogenic index; and 2) to assess the efficacy of this method. Study Design: This was a prospective case-control study. Materials and Methods: The study included 175 women in their third trimester of pregnancy, 131 of whom had pre-eclampsia (PE) of varying severity, and 44 of whom had unaffected pregnancies. A prognostic model of PE was created, based on the investigation of gene polymorphisms (675 4G/5G in the plasminogen activator inhibitor-1 [PAI-1] gene and 455 G→A in the fibrinogen ß gene by PCR), levels of anti-β 2GPI antibodies (ELISA), D-dimer levels (immunoturbidimetric assay), and the atherogenic index value. Results: The sensitivity of this prognostic model was 96.8% (95% CI, 89.7-98.8%) and its specificity was 67.8% (95% CI, 54.4-79.4%). This model accounts not only for each prognostic factor separately, but also for their interaction. Testing this prognostic model in a group of women in their first trimester showed its high effectiveness: The rate of PE in the group with a low predicted risk was 2.5% vs. 57.1% in the group with a high predicted risk (p < 0.05). Conclusion: The authors proposed a prognostic model of PE that provides a highly accurate assessment of the risk for hypertensive disorders in pregnant women.