Characteristic and Prognostic Value of Serum Bone Turnover Markers in Pregnant Women With Pre-Eclampsia: A Prospective Cohort Study

Background: Pre-eclampsia is a severe pregnancy complication affecting about 4%–5% of pregnancies, but the causes and clinical management were full of controversial. Bone turnover markers (BTMs) were sensitive indicators for estimating bone metabolism and were found to be changed in many pregnancy-related diseases. However, the characteristic and prognostic value of serum BTMs with pre-eclampsia was uncovered.

Methods: A multicenter prospective cohort study was performed in three different hospitals in West China. Pre-eclampsia patients and healthy pregnant women were recruited from January 2023 to January 2024. Clinical information of included participants was collected, and serum BTM levels were detected by electrochemiluminescence immunoassay. Clinical outcomes including disease aggravation (severe pre-eclampsia, eclampsia, and HELLP syndrome), low live birth weight (LBW), and premature delivery were followed up.

Results: A total of 69 pre-eclampsia patients and 75 healthy pregnant women were recruited finally, and 48 pre-eclampsia patients and 48 healthy controls who matched for age and gestational weeks were selected among them. The pre-eclampsia patients had elevated BTM levels compared with healthy controls. ß-CTX was an independent risk factor for disease aggravation, LBW, and premature delivery among pre-eclampsia patients. ß-CTX was a valuable predictive factor for disease aggravation, LBW, and premature delivery among pre-eclampsia patients (AUC were 0.772, 0.768, and 0.930, respectively, and p values were 0.001, 0.002, and < 0.001, respectively).

Conclusion: Pre-eclampsia patients may have an activated bone metabolism status compared with healthy controls. Pre-eclampsia patients with elevated bone resorptive marker ß-CTX should pay more attention to the risk of disease aggravation and adverse pregnancy outcomes.