Association of first trimester clinical and laboratory findings as an early predictor of preeclampsia

This study aimed to evaluate whether clinical and laboratory findings obtained during the first trimester of pregnancy can serve as early predictors for the development of preeclampsia (PE). This retrospective case-control study included 50 women who developed PE and 50 healthy controls. Demographic characteristics, first-trimester blood pressure, biochemical parameters (thyroid-stimulating hormone [TSH], calcium, uric acid, aspartate aminotransferase [AST], lactate dehydrogenase [LDH]), and inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], AST-to-platelet ratio index [APRI], systemic immune-inflammation index [SII]) were analyzed. Women who developed PE were significantly older (33.02±5.73 vs. 29.12±5.94 years, p=0.001) and had higher body mass index (32.95±5.71 vs. 29.17±4.68 kg/m², p=0.001) than controls. First-trimester blood pressures were significantly higher in the PE group: systolic (120.20±18.13 vs. 104±11.43 mmHg) and diastolic (76.80±13.32 vs. 63.20±7.13 mmHg) (both p<0.001). Inflammatory markers showed significantly elevated levels: NLR (4.09±1.24 vs. 3.20±0.81), APRI (7.84±3.05 vs. 6.17±2.75), and SII (1036.73±530.05 vs. 722.62±264.20) (all p≤0.005). ROC analysis revealed area under the curve values of 0.724 for NLR, 0.706 for SII, and 0.683 for APRI. Optimal cut-off values were: NLR ≥3.59 (sensitivity 66.0%, specificity 74.0%, positive predictive value [PPV] 69.5%, negative predictive value [NPV] 70.5%), APRI ≥6.33 (sensitivity 68.0%, specificity 70.0%, PPV 69.4%, NPV 68.6%), and SII ≥936.12 (sensitivity 52.0%, specificity 86.0%, PPV 78.8%, NPV 64.2%). Multivariate analysis identified maternal age (adjusted odds ratio [OR]=1.618, p=0.026), diastolic blood pressure (adjusted OR=1.276, p=0.044), low serum calcium (p=0.023), and elevated TSH (adjusted OR=6.640, p=0.049) as independent predictors. First-trimester maternal age, diastolic blood pressure, calcium, and TSH levels are independent predictors of PE development. Inflammatory markers demonstrated promising predictive ability. These parameters could potentially improve early risk stratification for PE, allowing for closer monitoring and interventions in high-risk women.