Dynamic changes of serum oxidative stress indexes in the second trimester of pregnancy and their predictive value for hypertensive disordersin pregnancy
Objective To explore the correlation between peripheral blood oxidative stress markers and hypertensive disorders in pregnancy(HDP).Methods A total of 120 patients diagnosed with HDP between January 2022 and August 2023 at Cangzhou People's Hospital were selected for the study,divided into three groups:gestational hypertension group(n=40),preeclampsia group(n=40),and severe preeclampsia group(n=40).Additionally,40 healthy pregnant women were randomly selected as the control group.Peripheral blood samples were collected during early and mid-pregnancy,and the levels of serum lipid reactive oxygen species(ROS),superoxide dismutase(SOD),heme oxygenase-1(HO-1),glutathione peroxidase(GSH-PX),and malondialdehyde(MDA)were measured.Multivariate logistic regression analysis was performed to assess the association between these indicators and the risk of HDP,and a risk nomogram prediction model for HDP was constructed and evaluated.Results In the examination results at 8-13+6 weeks of pregnancy,the serum levels of SOD and GSH-PX were sequentially decreased in the control group,gestational hypertension group,preeclampsia group,and severe preeclampsia group,with statistically significant differences(F=29.838 and 7.955,respectively,P＜0.05).The MDA levels in the gestational hypertension group,preeclampsia group,and severe preeclampsia group were sequentially increased,with a statistically significant difference(F=21.931,P＜0.05).In the 14-20 week measurements,the ROS and MDA levels were sequentially increased in the gestational hypertension,preeclampsia,and severe preeclampsia groups,while the SOD,HO-1,and GSH-PX levels were sequentially decreased,with statistically significant differences(F values ranged from 33.679 to 133.145,P＜0.05).Compared to the 8-13+6 week measurements,at 14-20 weeks,the ROS and MDA levels in HDP subgroups increased,while SOD and HO-1 levels decreased(t values ranged from 5.016 to 245.488,P＜0.05).Additionally,the GSH-PX level in the severe preeclampsia group at 14-20 weeks was lower than that at 8-13+6 weeks,with a statistically significant difference(t=5.227,P＜0.05).Multivariate logistic regression models showed that ROS and MDA at 14-20 weeks were independent risk factors for HDP(OR=1.917 and 1.818,respectively,P＜0.05),while SOD,HO-1,and GSH-PX were independent protective factors(OR=0.128,0.121,and 0.149,respectively,P＜0.05).As the levels of oxidative stress markers increased,the association between these markers and the risk of HDP also increased(P＜0.05).The nomogram risk prediction model constructed in this study showed an area under the receiver operating characteristic(ROC)curve of 0.837(0.816-0.871)before Bootstrap validation and 0.864(0.835-0.894)after validation.The calibration curve evaluation showed that the predicted values from the model were well-fitted with the actual values before and after validation.Conclusion In patients with gestational hypertension,preeclampsia,and severe preeclampsia at the 14-20 weeks of pregnancy,the levels of ROS and MDA were significantly increased,while the levels of SOD,HO-1,and GSH-PX were significantly decreased.The nomogram prediction model constructed using both ultrasound indices and oxidative stress markers demonstrated high accuracy and strong predictive ability.
oxidative stresshypertensive disorders of pregnancylipid reactive oxygen speciesadverse pregnancy outcomemalon-dialdehyde
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