Association between Plasma Protein C Activity and Adverse Pregnancy Outcome in Pregnant Women: A Retrospective Cohort Study

¹ Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021 Jinan, Shandong, China

² Department of Traditional Chinese Medicine, The First People’s Hospital of Taian, 271002 Taian, Shandong, China

^*Correspondence: drwangshan@163.com (Shan Wang)

Clin. Exp. Obstet. Gynecol. 2023, 50(11), 242; https://doi.org/10.31083/j.ceog5011242

Submitted: 1 August 2023 | Revised: 20 September 2023 | Accepted: 25 September 2023 | Published: 22 November 2023

(This article belongs to the Special Issue Prenatal Diagnosis and Pregnancy Outcome)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: To assess the variations in protein C (PC) activity throughout pregnancy and investigate potential correlations between plasma PC activities and adverse pregnancy outcomes. Methods: A retrospective cohort study was conducted among 1511 women who underwent PC activity testing at a hospital in China from June 2011 to August 2021. t-test, Kruskal Wallis, Fisher’s exact test, logistic regression and receiver operator characteristic (ROC) analysis were used for analysis of data. Results: The PC activity demonstrated a significant increase during the second trimester of pregnancy. The PC activity was found to be lower in pregnant women with a history of thrombosis (median, 95.70% [interquartile range (IQR), 85.50–114.60%]) as compared to those without (median, 109.00% [IQR, 95.00–124.60%], p = 0.008) or with current thrombosis (median, 101.10% [IQR, 85.30–117.00%]) compared to those without such events (median, 109.00% [IQR, 95.00–124.78%], p = 0.013). History of thrombosis was the independent risk factor of current thrombosis during pregnancy (odd ratio (OR) 260.57; 95% confidence interval (95% CI), 76.751–884.689; p $<$ 0.001). The PC activity of 125 cases of threatened abortion was significantly lower than that of asymptomatic women (median, 100.80% [IQR, 91.30–113.15%] vs median, 110.00% [IQR, 95.65–125.00%], p $<$ 0.001). Multivariate analysis showed that the low PC activity (OR 0.985; 95% CI, 0.976–0.994, p = 0.001), gestational age (OR 0.960; 95% CI, 0.946–0.975; p $<$ 0.001) and hypothyroidism (OR 1.888; 95% CI, 1.054–3.381; p $<$ 0.05) were risk factors for threatened abortion. There was no difference in PC activity between fetal loss, hypertensive disorder complicating pregnancy (HDCP), fetal growth restriction (FGR), oligohydramnios, placental abruption and those without. Conclusions: Women with a history of thrombosis and decreased PC activity are risk factors for thrombosis and threatened abortion during pregnancy, respectively. However, no significant correlation was observed between PC activity and fetal loss, HDCP, FGR, oligohydramnios or placental abruption.

Keywords

protein C

thrombosis

fetal loss

hypertensive disorder complicating pregnancy

fetal growth restriction

Funding

YDZX2022096/Central Government Guides Local Scientific and Technological Development Fund Projects

2022YFC2704600/National Key Research and Development Program of China

81741038/National Natural Science Foundation of China

202134014/Jinan Science and Technology Program

Figures

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Fig. 1.

Comparison of PC activity among women at different stages of pregnancy. Statistical comparisons were made between non-pregnancy and the first trimester (p ${}^{\text{a}}$ ), non-pregnancy and the second trimester (p ${}^{\text{b}}$ ), the first and second trimesters (p ${}^{\text{c}}$ ), the second and third trimesters (p ${}^{\text{d}}$ ), and the first and third trimesters (p ${}^{\text{f}}$ ).

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Clin. Exp. Obstet. Gynecol. Print ISSN 0390-6663 Electronic ISSN 2709-0094