Nomogram for predicting adverse perinatal outcomes in hypertensive disorders of pregnancy complicated by fetal growth restriction.

Abstract

Objectives: Hypertensive disorders of pregnancy (HDP) when combined with fetal growth restriction (FGR) increase the risk of adverse perinatal outcomes (APO). This study aimed to investigate the predictive value of fetal hemodynamic indicators for APO and to construct a nomogram for individualized risk assessment in pregnancies with HDP and FGR.

Methods: This retrospective study included 198 pregnant women with HDP and FGR in the training set and 85 patients in the validation set, admitted between January 2022 and December 2024. Demographic, clinical, biochemical (uric acid, free thyroxine [FT4]), and Doppler parameters (umbilical artery pulsatility index [UA-PI], middle cerebral artery PI [MCA-PI], and cerebroplacental ratio [CPR]) were collected. Multivariate logistic regression was used to identify independent predictors, and a nomogram was constructed.

Results: Seven independent predictors were identified: family history of hypertension (odds ratio [OR]=2.986), pre-eclampsia or chronic hypertension with superimposed pre-eclampsia (OR=2.811), uric acid (OR=1.036), FT4 (OR=0.813), abnormal UA-PI (OR=7.262), abnormal MCA-PI (OR=6.620), and abnormal CPR (OR=6.702). The nomogram demonstrated good discrimination, with an area under the curve (AUC] of 0.905 in the training set and 0.806 in the validation set.

Conclusions: We developed a nomogram integrating maternal clinical history, serum biomarkers (uric acid, FT4), and fetal Doppler indices that showed good predictive accuracy for APO in HDP complicated by FGR. External validation in multi-center cohorts is required before clinical implementation.