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已发表论文
妊娠期高血压疾病中的红细胞叶酸和同型半胱氨酸：与妊娠结局的关联
Authors Geng H, Jian F, Zhang T, Dong K, Duan B
Received 11 October 2025
Accepted for publication 12 December 2025
Published 11 February 2026 Volume 2026:18 568633
DOI https://doi.org/10.2147/IJWH.S568633
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Vinay Kumar
Hui Geng, Feng Jian, Ting Zhang, Kun Dong, Bide Duan
Department of Obstetrics, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
Correspondence: Bide Duan, Email 18560290399@163.com
Background: Hypertensive disorders complicating pregnancy (HDCP) are a major cause of maternal and fetal morbidity. This study aims to examine the relationship between red blood cell folate (RBCF) and homocysteine (Hcy) levels and HDCP severity, as well as to assess their predictive value for pregnancy outcomes.
Methods: This retrospective study included 326 HDCP patients and 153 controls. The diagnostic criteria for HDCP were based on the American College of Obstetricians and Gynecologists. RBCF and Hcy levels were measured at diagnosis using automated immunoassays. ROC curve analysis was performed to assess the predictive value of RBCF and Hcy for poor pregnancy outcomes.
Results: A total of 326 women with HDCP and 153 normotensive controls were included. Blood pressure was significantly higher in the HDCP group (both p < 0.001). HDCP patients exhibited markedly lower RBC folate (286.08 ± 59.04 vs 334.83 ± 51.95 ng/mL, p < 0.001) and higher Hcy levels (8.41 ± 1.39 vs 7.58 ± 1.40 μmol/L, p < 0.001) than controls. Across HDCP severity, RBCF declined progressively from gestational hypertension to mild and severe preeclampsia, while Hcy increased correspondingly. Among HDCP patients, adverse pregnancy outcomes occurred in 44.5%, including prematurity (34.4%), low birth weight (19.3%), and fetal distress (12.9%). Compared with women with good outcomes, those with poor outcomes had significantly lower RBCF (255.61 ± 51.56 vs 310.45 ± 53.13 ng/mL, p < 0.001) and higher Hcy (9.04 ± 1.36 vs 7.90 ± 1.25 μmol/L, p < 0.001). ROC analysis showed that combined RBCF–Hcy testing provided the highest predictive performance for adverse outcomes (AUC = 0.85, 95% CI 0.81– 0.89; sensitivity 85.52%; specificity 75.14%), outperforming either biomarker alone.
Conclusion: RBCF and Hcy are crucial biomarkers for assessing the severity of HDCP and predicting adverse pregnancy outcomes.
Keywords: hypertensive disorders complicating pregnancy, red blood cell folate, homocysteine, pregnancy outcomes, predictive biomarkers
Department of Obstetrics, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
Correspondence: Bide Duan, Email 18560290399@163.com
Background: Hypertensive disorders complicating pregnancy (HDCP) are a major cause of maternal and fetal morbidity. This study aims to examine the relationship between red blood cell folate (RBCF) and homocysteine (Hcy) levels and HDCP severity, as well as to assess their predictive value for pregnancy outcomes.
Methods: This retrospective study included 326 HDCP patients and 153 controls. The diagnostic criteria for HDCP were based on the American College of Obstetricians and Gynecologists. RBCF and Hcy levels were measured at diagnosis using automated immunoassays. ROC curve analysis was performed to assess the predictive value of RBCF and Hcy for poor pregnancy outcomes.
Results: A total of 326 women with HDCP and 153 normotensive controls were included. Blood pressure was significantly higher in the HDCP group (both p < 0.001). HDCP patients exhibited markedly lower RBC folate (286.08 ± 59.04 vs 334.83 ± 51.95 ng/mL, p < 0.001) and higher Hcy levels (8.41 ± 1.39 vs 7.58 ± 1.40 μmol/L, p < 0.001) than controls. Across HDCP severity, RBCF declined progressively from gestational hypertension to mild and severe preeclampsia, while Hcy increased correspondingly. Among HDCP patients, adverse pregnancy outcomes occurred in 44.5%, including prematurity (34.4%), low birth weight (19.3%), and fetal distress (12.9%). Compared with women with good outcomes, those with poor outcomes had significantly lower RBCF (255.61 ± 51.56 vs 310.45 ± 53.13 ng/mL, p < 0.001) and higher Hcy (9.04 ± 1.36 vs 7.90 ± 1.25 μmol/L, p < 0.001). ROC analysis showed that combined RBCF–Hcy testing provided the highest predictive performance for adverse outcomes (AUC = 0.85, 95% CI 0.81– 0.89; sensitivity 85.52%; specificity 75.14%), outperforming either biomarker alone.
Conclusion: RBCF and Hcy are crucial biomarkers for assessing the severity of HDCP and predicting adverse pregnancy outcomes.
Keywords: hypertensive disorders complicating pregnancy, red blood cell folate, homocysteine, pregnancy outcomes, predictive biomarkers