Methods A total of 33 pregnant women with PE who underwent prenatal examination and delivered in Central Hospital Affiliated to Shandong First Medical University after symptomatic treatment from April 2017 to December 2018 were selected as research subjects.According to mild and severe PE, they were included into mild PE group (n=21) and severe PE group (n=12), respectively. And 130 healthy pregnant women who gave birth in the same hospital during the same period were selected as control and were included into control group. General clinical data and serum triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), vitamin D and folic acid levels in the first trimester (<12 gestational weeks), second trimester (20-24 gestational weeks) and third trimester (32-34 gestational weeks) were collected. One-way ANOVA or chi-square test was used for statistical comparison of the above index. Spearman correlation coefficient was used to analyze the correlation of serum vitamin D, folic acid and blood lipid levels with the severity of PE. Multivariate unconditional logistic regression was used to analyze influencing factors of PE. This study was approved by Shandong Provincial Medical Ethics Committee (Approval No. IACUC20180105). Clinical research informed consent was obtained from all pregnant women and their family members. There were no statistical differences among three groups in serum levels of TG, TC, LDL, vitamin D and folic acid in the first trimester (P>0.05).
Results ①The age, systolic blood pressure, diastolic blood pressure, weight gain during pregnancy, gravidity, parity, menstrual cycle, menstrual period, and proportions of family history of PE, completion of prenatal examination as required, supplement of vitamin D and folic acid during pregnancy showed statistically significant differences among mild PE group, severe PE group and control group (P<0.05). ②There were statistically significant differences in serum levels of LDL, vitamin D and folic acid in second trimester, and serum levels of TG, LDL, vitamin D and folic acid in third trimester among three groups in overall comparison (second trimester: F=7.061, 100.268, 73.755, P≤0.001; third trimester: F=15.109, 18.157, 255.431, 194.986, P<0.001). Further comparison showed that in second trimester, serum levels of LDL in mild PE group and severe PE group were significantly higher than that of control group, while serum levels of vitamin D and folic acid were significantly lower than those of control group, moreover, serum levels of vitamin D and folic acid in severe PE group were significantly lower than those of mild PE group, and all differences were statistically significant (P<0.05). In third trimester, serum levels of TG and LDL in severe PE group were significantly higher than those in mild PE group and control group, while serum levels of vitamin D and folic acid were significantly lower than those in mild PE group and control group, moreover, serum levels of TG and LDL of pregnant women in mild PE group were significantly higher than those in control group, while serum vitamin D and folic acid levels were significantly lower than those in control group, and all differences were statistically significant (P<0.05). ③Among mild and severe PE pregnant women, serum levels of TG, TC and LDL were positively correlated with severity of PE (rs=0.529, 0.481, 0.533; P<0.001), while serum levels of vitamin D and folic acid were negatively correlated with severity of PE (rs=-0.458, -0.473; P<0.001). ④Results of multivariate unconditional logistic regression analysis showed that systolic blood pressure, diastolic blood pressure, gravidity, parity, menstrual cycle, vitamin D and folic acid supplementation during pregnancy, and serum TG, TC, LDL, vitamin D, and folic acid levels all were independent influencing factors of PE in pregnant women (OR=2.534, 3.547, 2.392, 2.879, 2.653, 2.490, 2.413, 3.319, 3.731, 2.936, 2.012, 2.176, 95%CI: 1.304-4.069, 1.363-7.613, 1.860-5.397, 1.954-6.878, 1.238-4.297, 1.922-4.874, 1.979-5.585, 1.027-9.902, 1.043-4.144, 1.933-4.492, 1.480-4.800, 1.010-4.309, P<0.05).