Predictors of adverse pregnancy outcomes in severe preeclampsia: A retrospective observational study

Severe preeclampsia (PE) is associated with adverse pregnancy outcomes. The present study aims to identify risk factors contributing to these outcomes in women diagnosed with severe PE. This retrospective observational study included pregnant women diagnosed with severe PE from January 2023 to December 2023. Adverse pregnancy outcomes defined as hypertension accompanied by any of the following: elevated liver enzymes, low platelet count, disseminated intravascular coagulation, placental abruption, pulmonary edema, cerebral hemorrhage, seizures, or death-and adverse fetal outcomes-defined as iatrogenic delivery, small-for-gestational-age, abnormal umbilical hemodynamics, or death. A total of 351 patients with severe PE were included in the analysis (adverse pregnancy outcome group, n = 184; control group, n = 167). Multivariate logistic regression analysis identified gestational age at delivery (odds ratio [OR] = 0.924; 95% confidence interval [CI]: 0.896-0.953, P < .001), twin pregnancy (OR = 5.586; 95% CI: 2.774-11.250, P < .001), reduced placental growth factor (PlGF) levels (OR = 0.999; 95% CI: 0.998-1.000, P = .011), and elevated total cholesterol levels (OR = 1.562; 95% CI: 1.320-1.849, P < .001 were independent risk factors for adverse pregnancy outcomes. The combination of gestational age, PlGF, and total cholesterol demonstrated high predictive accuracy, with an area under the curve of 0.867 (95% CI: 0.826-0.908), 79.35% sensitivity, and 90.42% specificity. This study suggests that lower gestational age, twin pregnancy, reduced PlGF, and elevated total cholesterol may be significant risk factors for adverse pregnancy outcomes in women diagnosed with severe PE.