Jin Pei-Pei, Ding Ning, Dai Jing, Liu Xiao-Yan, Mao Pei-Min
Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Blood Transfusion, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Heliyon. 2023 Jul 5;9(7):e17983. doi: 10.1016/j.heliyon.2023.e17983. eCollection 2023 Jul.
Normal pregnancy is a hypercoagulable state with an increase in coagulation factor levels and a decrease in natural anticoagulation. However, a higher hypercoagulable state with prolonged activated partial thromboplastin time (APTT), prothrombin time (PT), increased D-dimer, and mean platelet volume is seen in women with preeclampsia at the time of onset. In addition, endothelial dysfunction occurs before the clinical symptoms of preeclampsia. Therefore, we undertook this study to investigate the coagulation profile in the first trimester in women who developed preeclampsia later. A total of 853 pregnant women with singleton births at the Obstetrics and Gynecology Hospital of Fudan University between January 2021 and December 2021 were included in this case-control study. In the comparison with the controls (n = 531), the mean value of D-dimer, APTT, thrombin time (TT), antithrombin (AT)), and fibrin degradation products (FDP) was significantly lower in preeclamptic women at the time of diagnosis (n = 322). The changes in the coagulation profile were not associated with the severity or the time of onset. The reduced values of D-dimer, AT, and FDP, and increased values of TT were also observed in the first trimester in women who developed preeclampsia later and were not associated with the severity, or the time of onset of preeclampsia. After adjusting for maternal age and BMI, the values of D-dimer and AT in the first trimester were correlated to the risk of developing preeclampsia. Our findings suggest that there is an abnormal maternal response to the hemostatic system in early gestational age in women who developed preeclampsia later and measuring the coagulation profile could be an additional predictive marker of preeclampsia.
正常妊娠是一种高凝状态，凝血因子水平升高，天然抗凝作用降低。然而，子痫前期妇女在发病时会出现更高的高凝状态，活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）延长，D-二聚体升高，平均血小板体积增加。此外，子痫前期的临床症状出现之前就会发生内皮功能障碍。因此，我们进行了这项研究，以调查后来发生子痫前期的妇女在孕早期的凝血情况。本病例对照研究纳入了2021年1月至2021年12月在复旦大学附属妇产科医院单胎分娩的853名孕妇。与对照组（n = 531）相比，子痫前期妇女在诊断时（n = 322）D-二聚体、APTT、凝血酶时间（TT）、抗凝血酶（AT）和纤维蛋白降解产物（FDP）的平均值显著降低。凝血情况的变化与严重程度或发病时间无关。后来发生子痫前期的妇女在孕早期也观察到D-二聚体、AT和FDP值降低，TT值升高，且与子痫前期的严重程度或发病时间无关。在调整产妇年龄和BMI后，孕早期D-二聚体和AT值与发生子痫前期的风险相关。我们的研究结果表明，后来发生子痫前期的妇女在孕早期母体对止血系统存在异常反应，检测凝血情况可能是子痫前期的一个额外预测指标。
