Rationale for using clinical indicators to stratify pregnant women according to risk of preeclampsia severity
Tezikov Yu.V., Lipatov I.S., Khalitova A.I., Tyutyunnik V.L., Kan N.E., Yurasova E.V., Rudneva A.A., Garazhankin A.D.
Objective: To evaluate the feasibility of using clinical indicators to stratify pregnant women based on preeclampsia severity.
Materials and methods: Ninety-nine pregnant women with moderate preeclampsia were studied, including 48 with progression to severe preeclampsia (group I) and 51 without progression to severe preeclampsia (group II). The control group consisted of 30 healthy women with healthy pregnancies (group III). The examination was performed at hospital admission with moderate preeclampsia and included the progression of preeclampsia to severe preeclampsia. It comprises the determination of the type of 24-hour blood pressure (24h BP) profile, assessment of the frequency of nocturia (NU), periods of gestational sleep apnea, subjective evaluation of sleep characteristics, and the distribution of adipose tissue.
Results: A comparative analysis of high-risk factors for preeclampsia, timing of preeclampsia manifestation, concomitant pregnancy complications, and diagnostic criteria for preeclampsia revealed a lack of predictive capability of the indicators regarding the severity of this pregnancy complication. Analysis of the examination findings using descriptive statistics, univariate and multivariate logistic regression, ROC analysis, and clinical epidemiology tests enabled the development of a prognostic risk stratification model for identifying pregnant women at a high risk of developing severe preeclampsia. The most effective variables were the pathological types of 24-h BP and quantitative assessment of NU (AUC=0.849 –"very good" quality, 95% CI 0.735–0.923, p<0.001). Calculation of the main performance characteristics of clinical epidemiology showed a higher prognostic significance of the model compared to individual clinical criteria (Se=85.3 %, Sp=79.2 %, p<0.001).
Conclusion: A comprehensive clinical approach to predicting severe preeclampsia using the calculation of an integral indicator, has proven its validity and potential for timely diagnosis of early clinical manifestations of the pathological process. This ensures a rational choice of obstetric strategies and addresses the critical issue of preventing life-threatening obstetric complications.
Authors’ contributions: Khalitova A.I., Yurasova E.V., Rudneva A.A., Garazhankin A.D. – data collection and analysis;
Tezikov Yu.V., Lipatov I.S. – conception and design of the study, review of the relevant literature, drafting of the manuscript; Tyutyunnik V.L., Kan N.E. – data interpretation, editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Samara State Medical University.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Tezikov Yu.V., Lipatov I.S., Khalitova A.I., Tyutyunnik V.L., Kan N.E., Yurasova E.V.,
Rudneva A.A., Garazhankin A.D. Rationale for using clinical indicators to
stratify pregnant women according to risk of preeclampsia severity.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (1): 44-54 (in Russian)
https://dx.doi.org/10.18565/aig.2024.255
Keywords
preeclampsia
severe preeclampsia
prognosis
nocturia
24-hour blood pressure profile
apnea
insomnia
insulin resistance
References
- Серов В.Н., Нестерова Л.А. Особенности современного акушерства. Акушерство и гинекология. 2022; 3: 5-11. [Serov V.N., Nesterova L.A. Features of modern obstetrics. Obstetrics and Gynecology. 2022; (3): 5-11 (in Russian)]. https://dx.doi.org/10.18565/aig.2022.3.5-11.
- Testo A.A., McBride C., Bernstein I.M., Dumas J.A. Preeclampsia and its relationship to pathological brain aging. Front. Physiol. 2022; 13: 979547. https://dx.doi.org/10.3389/fphys.2022.979547.
- Федеральная служба государственной статистики. Здравоохранение в России. Статистический сборник 2023. М.: Росстат; 2023. 179 с. [Federal State Statistics Service. Healthcare in Russia. Statistical collection 2023. Moscow: Rosstat; 2023. 179 p. (in Russian)].
- Сидорова И.С., Никитина Н.А., Гусева Е.В. Результаты конфиденциального аудита материнской смертности от преэклампсии и эклампсии в России в 2017-2018 гг. Акушерство и гинекология. 2020; 1: 119-27. [Sidorova I.S., Nikitina N.A., Guseva E.V. The results of a confidential audit of maternal mortality due to preeclampsia and eclampsia in Russia in 2017-2018. Obstetrics and Gynecology. 2020; (1): 119-27. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.1.119-127.
- Севостьянова О.Ю., Мартиросян С.В., Салимова И.В., Савельева Е.В., Коровникова О.В., Перевозкина О.В. Результаты аудита клинического протокола по предупреждению преэклампсии у беременных женщин группы риска в перинатальном центре. Уральский медицинский журнал. 2020; 6(189): 34-8. [Sevostyanova O.Y., Martirosyan S.V., Salimova I.V., Savelyeva E.V., Korovnikova O.V., Perevozkina O.V. Results of the audit of the clinical protocol for the prevention of preeclampsia in pregnant women of risk group in the perinatal center. Ural Medical Journal. 2020; 6(189): 34-8. (in Russian)]. https://dx.doi.org/10.25694/ URMJ.2020.06.09.
- Le Y., Ye J., Lin J. Expectant management of early-onset severe preeclampsia: a principal component analysis. Ann. Transl. Med. 2019; 7(20): 519. https://dx.doi.org/10.21037/atm.2019.10.11.
- Липатов И.С., Тезиков Ю.В., Шмаков Р.Г., Азаматов А.Р., Мартынова Н.В. «Беременность – естественная модель метаболического синдрома»: результаты динамического исследования физиологической гестации. Акушерство и гинекология. 2020; 9: 88-96. [Lipatov I.S., Tezikov Yu.V., Shmakov R.G., Azamatov A.R., Martynova N.V. Pregnancy as a natural model of metabolic syndrome: results of a dynamic study of physiological gestation. Obstetrics and Gynecology. 2020; (9): 88-96. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.9.88-96.
- Ходжаева З.С., Ошхунова М.С., Муминова К.Т., Горина К.А., Холин А.М. Прогнозирование и ранняя диагностика преэклампсии: научные перспективы и клинические возможности. Акушерство и гинекология. 2022; 12: 57-65. [Khodzhaeva Z.S., Oshkhunova M.S., Muminova K.T., Gorina K.A., Kholin A.M. Prediction and early diagnosis of preeclampsia: scientific perspectives and clinical opportunities. Obstetrics and Gynecology. 2022; (12): 57-65. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.218.
- Липатов И.С., Тезиков Ю.В., Азаматов А.Р., Шмаков Р.Г. Общность клинических проявлений преэклампсии и метаболического синдрома: поиск обоснования. Акушерство и гинекология. 2021; 3: 81-9. [Lipatov I.S., Tezikov Yu.V., Azamatov A.R., Shmakov R.G. Identity of preeclampsia and metabolic syndrome clinical manifestations: searching for substantiation. Obstetrics and Gynecology. 2021; (3): 81-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.3.81-89.
- Игнатко И.В., Флорова В.С., Кузнецов А.С., Кузина Е.Ю. Роль биохимических маркеров в стратификации риска развития преэклампсии: взгляд клинициста. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2017; 4(4): 181-6. [Ignatko I.V., Florova V.S., Kuznetsov A.S., Kuzina E.Yu. The role of biochemical markers in the risk stratification for development of preeclampsia: the clinician's view. Archives of Obstetrics and Gynecology named after V.F. Snegirev. 2017; 4(4): 181-6. (in Russian)]. https://dx.doi.org/10.18821/2313-8726-2017-4-4-181-186.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации. Преэклампсия. Эклампсия. Отеки, протеинурия и гипертензивные расстройства во время беременности, в родах и послеродовом периоде. М.; 2024. 74 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Pre-eclampsia. Eclampsia. Edema, proteinuria and hypertensive disorders during pregnancy, childbirth and postpartum period. Moscow; 2024. 74 р. (in Russian)].
- Мирошниченко А.И., Иванов К.М. Влияние ночного повышения артериального давления на ремоделирование сердца у пациентов с артериальной гипертонией. Аспирантский вестник Поволжья. 2019; 1-2: 65-9. [Miroshnichenko A.I., Ivanov K.M. The effect of nocturnal increase in blood pressure on remodeling of the heart in patients with arterial hypertension. Aspirantskii vestnik Povolzh'ya. 2019; (1-2): 65-9. (in Russian)]. https://dx.doi.org/ 10.17816/2072-2354.2019.19.1.65-69.
- Altikardes Z.A., Kayikli A., Korkmaz H., Erdal H., Baba A.F., Fak A.S. A novel method for dipper/non-dipper pattern classification in hypertensive and non-diabetic patients. Technol. Health Care. 2019; 27(S1): 47-57. https://dx.doi.org/ 10.3233/THC-199006.
- Osman A.M., Carter S.G., Carberry J.C., Eckert D.J. Obstructive sleep apnea: current perspectives. Nat. Sci. Sleep. 2018; 10: 21‐34. https://dx.doi.org/ 10.2147/NSS.S124657.
- Калачин К.А., Пырегов А.В., Шмаков Р.Г. Гестационное сонное апноэ. Связь беременности и преэклампсии с синдромом обструктивного апноэ сна. Альманах клинической медицины. 2019; 47(3): 266-75. [Kalachin K.A., Pyregov A.V., Shmakov R.G. Gestational sleep apnea. The relationship of pregnancy and preeclampsia with obstructive sleep apnea syndrome. Almanac of Clinical Medicine. 2019; 47(3): 266-75. (in Russian)]. https://dx.doi.org/10.18786/2072-0505-2019-47-031.
- Gordon D.J., Emeruwa C.J., Weiss J.P. Management strategies for nocturia. Curr. Urol. Rep. 2019; 20(11): 75. https://dx.doi.org/10.1007/s11934-019-0940-2.
- Lombardo R., Tubaro A., Burkhard F. Nocturia: the complex role of the heart, kidneys, and bladder. Eur. Urol. Focus. 2020; 6(3): 534-6. https://dx.doi.org/10.1016/j.euf.2019.07.007.
- Гасанова Б.М., Полина М.Л., Оразмурадов А.А. Влияние кардиальных фенотипов на течение и исходы беременности при гипертензивных расстройствах. Акушерство и гинекология: новости, мнения, обучение. 2019; 7(3): 31-40. [Gasanova B.M., Polina M.L., Orazmuradov A.A. The effect of cardiac phenotypes on the course and outcomes of pregnancy among patients with hypertensive disorders. Obstetrics and Gynecology: News, Opinions, Training. 2019; 7(3): 31-40. (in Russian)]. https://dx.doi.org/10.24411/2303-9698-2019-13904.
- Муминова К.Т., Ходжаева З.С., Шмаков Р.Г. Особенности течения беременности у пациенток с гипертензивными расстройствами. Доктор.Ру. 2019: 11(166): 14-21. [Muminova K.T., Khodzhaeva Z.S., Shmakov R.G. Specifics of pregnancy in patients with hypertensive disorders. Doctor.Ru. 2019; 11(166): 14-21. (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2019-166-11-14-21.
- Боровкова Л.В., Колобова С.О., Боровкова Н.Ю., Полякова И.В., Некрасов А.А., Тимощенко Е.С., Андосова Л.Д., Шахова К.А., Тихомирова Ю.Р., Лазарькова А.Д. Современные методы прогнозирования гестационных осложнений у беременных с артериальной гипертензией. Женское здоровье и репродукция. 2020; 3(46). [Borovkova L.V., Kolobova S.O., Borovkova N.Yu., Polyakova I.V., Nekrasov A.A., Timoschenko E.S., Andosova L.D., Shakhova K.A., Tikhomirova Yu.R., Lazarkova A.D. Modern methods in forecasting gestational complications in pregnant women with arterial hypertension. Women's Health and Reproduction. 2020; 3(46). (in Russian)].
- Ляшенко Е.А., Левин О.С. Расстройства сна в клинической практике. Справочник поликлинического врача. 2017; 4: 57-61. [Lyashenko E.A., Levin O.S. Sleep disorders in clinical practice. Handbook for Practitioners Doctors. 2017; (4): 57-61. (in Russian)].
- Тезиков Ю.В., Липатов И.С., Зуморина Э.М., Азаматов А.Р., Тютюнник В.Л., Кан Н.Е., Чекаловец А.Л., Борисова А.И., Голоднова А.М. Клинико-патогенетическое обоснование двухэтапной профилактики преэклампсии у женщин высокого риска с применением инсулиносенситайзера для преконцепционной подготовки. Акушерство и гинекология. 2023; 9: 60-71. [Tezikov Yu.V., Lipatov I.S., Zumorina E.M., Azamatov A.R., Tyutyunnik V.L., Kan N.E., Chekalovets A.L., Borisova A.I., Golodnova A.M. Clinical and pathogenetic rationale for two-stage prevention of preeclampsia in high-risk women using an insulin sensitizer for preconception preparation. Obstetrics and Gynecology. 2023; (9): 60-71. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.139.
- Серов В.Н. Метаболический синдром (нейрообменно-эндокринный синдром). Medica mente. Лечим с умом. 2015; 1: 16-9. [Serov V.N. Metabolic syndrome (neuro-endocrine syndrome). Medica mente. Lechim s umom. 2015; (1): 16-9. (in Russian)].
- Чабанова Н.Б., Василькова Т.Н. Особенности жирового обмена у беременных в зависимости от срока гестации, массы тела и характера жироотложения. Современные проблемы науки и образования. 2018; 5: 27-9. [Chabanova N.B., Vasil'kova T.N. Features of fat metabolism in pregnant women depending on gestational age, body weight and the nature of fat deposition. Modern Problems of Science and Education. Surgery. 2018; (5): 27-9. (in Russian)].
- Стрижаков А.Н., Тезиков Ю.В., Липатов И.С., Шарыпова М.А.. Анпилогова И.В., Азизов К.У., Костянова Е.В. Стандартизация диагностики и клиническая классификация хронической плацентарной недостаточности. Вопросы гинекологии, акушерства и перинатологии. 2014; 13(3): 5-12. [Strizhakov A.N., Tezikov Yu.V., Lipatov I.S., Sharypova M.A., Anpilogova I.V., Azizov K.U., Kostyanova E.V. Diagnostic standardization and clinical classification of chronic placental insufficiency. Issues of Gynecology, Obstetrics and Perinatology. 2014; 13(3): 5-12. (in Russian)].
- Ланг Т., Альтман Д. Основы описания статистического анализа в статьях, публикуемых в биомедицинских журналах. Руководство «Статистический анализ и методы в публикуемой литературе (САМПЛ)». Медицинские технологии. Оценка и выбор. 2014; 1(15): 11-6. [Lang T., Altman D. Basic statistical reporting for articles published in clinical medical journals: the SAMPL guidelines. Medical technologies. Evaluation and selection. 2014; 1(15): 11-6. (in Russian)].
- de Moel-Mandel C. Understanding and communicating epidemiological measures of risk and benefit. Fam. Pract. 2023; 40(2): 423-5. https://dx.doi.org/10.1093/fampra/cmac117.
- Chen X., Stein T.P., Steer R.A., Scholl T.O. Individual free fatty acids have unique associations with inflammatory biomarkers, insulin resistance and insulin secretion in healthy and gestational diabetic pregnant women. BMJ Open Diabetes Res. Care. 2019; 7(1): e000632. https://dx.doi.org/10.1136/bmjdrc-2018-000632.
- Макацария А.Д., Бицадзе В.О., Акиньшина С.В. Тяжелые формы преэклампсии как проявление тромботической микроангиопатии. Акушерство и гинекология. 2017; 4: 21-6. [Makatsaria A.D., Bitsadze V.O., Akinshina S.V. Severe forms of preeclampsia as a manifestation of thrombotic microangiopathy. Obstetrics and Gynecology. 2017; (4): 21-6. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.4.21-6.
- Кудрявцева У.В., Ковалев В.В., Баранов И.И. Способ прогнозирования тяжелой преэклампсии. Патент на изобретение RU 2739694 C1. 2020. 14с. [Kudryavtseva U.V., Kovalev V.V., Baranov I.I. Method for predicting severe preeclampsia. Patent RU 2739694 S1. 2020. 14p. (in Russian)].
Received 18.10.2024
Accepted 18.12.2024
About the Authors
Yurii V. Tezikov, Professor, Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine, Samara State Medical University,Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, yra.75@inbox.ru, Researcher ID: С-6187-2018, SPIN: 2896-6986,
Author ID: 161372, Scopus Author ID: 6603787595, https://orcid.org/0000-0002-8946-501X
Igor S. Lipatov, Professor, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, i.lipatoff2012@yandex.ru, Researcher ID: С-5060-2018, SPIN: 9625-2947, Author ID: 161371, Scopus Author ID: 6603787595, https://orcid.org/0000-0001-7277-7431
Anastasia I. Khalitova, 6 th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, nsts.nvk@yandex.ru, SPIN: 6245-2050, Authors ID: 1146911, https://orcid.org/0000-0003-4604-9099
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at Research and Development Service, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(903)969-50-41, tioutiounnik@mail.ru,
Researcher ID: B-2364-2015, SPIN: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director of Science, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(926)220-86-55, kan-med@mail.ru, Researcher ID: B-2370-2015,
SPIN: 5378-8437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Ekaterina V. Yurasova, 4 th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, kate163ura@gmail.com, https://orcid.org/0009-0009-2077-6301
Anastasia A. Rudneva, 5 th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, rudneva2002nastia@yandex.ru, https://orcid.org/0009-0002-6867-6894
Anton D. Garazhankin, 6 th year student of the Institute of Clinical Medicine, Samara State Medical University, Ministry of Health of Russia, 443099, Russia, Samara, Chapaevskaya str., 89, +7(846)958-24-18, garazankin2012@yandex.ru, https://orcid.org/0009-0002-8863-3242
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