First-trimester serum hepcidin as an early predictor of preeclampsia: A prospective cohort study
DOI:
https://doi.org/10.37800/RM.3.2026.858Keywords:
preeclampsia, hepcidin, C-reactive protein , ferritin, predictionAbstract
Relevance: Preeclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality worldwide. Hepcidin, the “master regulator” of iron homeostasis, is upregulated by inflammatory stimuli involved in preeclampsia pathophysiology, but its predictive value remains controversial.
The study aimed to assess the predictive utility of first-trimester serum hepcidin, C-reactive protein, and ferritin for preeclampsia.
Materials and Methods: This prospective cohort study included pregnant women at 9-13 weeks of gestation. Of 345 women approached, 45 declined or had early pregnancy loss, leaving 300 women followed through delivery. Serum hepcidin, C-reactive protein (CRP), and ferritin were measured at recruitment; participants were classified as having no, mild, or severe preeclampsia.
Results: Of the 300 women, 40 (13.3%) developed preeclampsia (30 mild, 10 severe). First-trimester hepcidin was significantly higher in women who later developed preeclampsia (29.28 ± 13.49 vs 14.75 ± 8.66 ng/mL, p < 0.001) and increased with severity (mild: 26.63 ± 11.70; severe: 37.22 ± 15.95 ng/mL; p < 0.001). Hepcidin correlated with CRP overall (r = 0.153, p = 0.008) and more strongly within the preeclampsia group (r = 0.625, p < 0.001). Hepcidin’s area under the curve (AUC) was 0.804, similar to CRP (0.799) and higher than ferritin (0.700); the combined model reached an AUC of 0.839. After adjustment for maternal age, BMI, gravidity, parity, and gestational age at sampling, hepcidin remained independently associated with preeclampsia (adjusted OR = 1.06, 95% CI 1.01-1.11, p = 0.010; adjusted model AUC = 0.90).
Conclusion: First-trimester serum hepcidin is significantly elevated in women who subsequently develop preeclampsia and tends to be higher in severe disease; this association is not dependent on maternal age, BMI, gravidity, parity, or gestational age at sampling. Hepcidin shows predictive performance comparable to CRP and, combined with other markers, may aid early risk stratification for preeclampsia.
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