Table 1_The associations of maternal serum ferritin levels with hypertensive disorders of pregnancy: a longitudinal cohort study.docx

BackgroundThe longitudinal fluctuations in maternal serum ferritin (SF) levels during gestation, acting as indirect indicators of iron supplementation, have not been thoroughly investigated in relation to the incidence of hypertensive disorders of pregnancy (HDP).
MethodsA retrospective cohort investigation was carried out at a tertiary maternity hospital in Shanghai, involving women with serum ferritin (SF) measurements at 8.0–13.6 gestational weeks (GW) and at 29.0–31.6 GW. Logistic regression analysis was employed to evaluate the relationship between maternal SF levels, their longitudinal variations, with the risk of HDP.
ResultsThe study included 17,472 women, among whom 473(2.71%) developed gestational hypertension (GH) and 560(3.21%) developed preeclampsia (PE). Adjusted odds ratios (ORs; 95% confidence intervals) for HDP across ascending quartiles of SF concentrations were as follows: at 8.0–13.6 GW, 1.00 (reference), 1.043 (0.864–1.258), 1.060 (0.878–1.279), and 1.234 (1.027–1.482); and at 29.0–31.6 GW, 1.00 (reference), 0.973 (0.800–1.181), 1.076 (0.890–1.301), and 1.299 (1.082–1.560). Women with SF levels in the highest quartile at 8.0–13.6 GW exhibited reduced HDP risk when their SF levels declined to the lowest quartile by 29.0–31.6 GW. Conversely, those with SF levels in the lowest quartile early in pregnancy but transitioning to the highest quartile later in pregnancy demonstrated a significantly elevated HDP incidence (8.2%; OR: 1.445, 95% CI: 1.003–2.081).
ConclusionMaternal SF levels demonstrated an independent positive association with HDP risk during early and late gestational stages. These findings suggest that routine iron supplementation in iron-replete women may exacerbate HDP risk and warrants careful reconsideration.

**研究背景** 妊娠期母体血清铁蛋白（serum ferritin, SF）的纵向波动可作为补铁治疗的间接指标，但目前尚未有充分研究探讨其与妊娠高血压疾病（hypertensive disorders of pregnancy, HDP）发病风险的关联。
**研究方法** 本研究在上海某三级妇产医院开展回顾性队列研究，纳入了在妊娠8.0~13.6周（gestational weeks, GW）及29.0~31.6周（GW）完成血清铁蛋白检测的孕妇。采用logistic回归分析评估母体血清铁蛋白水平及其纵向变化与HDP发病风险的关联。
**研究结果** 本研究共纳入17472名孕妇，其中473例（2.71%）发生妊娠高血压（gestational hypertension, GH），560例（3.21%）发生子痫前期（preeclampsia, PE）。按血清铁蛋白浓度升序四分位数分组，妊娠8.0~13.6周时HDP的校正比值比（adjusted odds ratios, ORs；95%置信区间，95% CI）依次为：1.00（参照组）、1.043（0.864~1.258）、1.060（0.878~1.279）及1.234（1.027~1.482）；妊娠29.0~31.6周时则依次为：1.00（参照组）、0.973（0.800~1.181）、1.076（0.890~1.301）及1.299（1.082~1.560）。若孕妇在妊娠8.0~13.6周时血清铁蛋白处于最高四分位数组，而在29.0~31.6周时降至最低四分位数组，则其HDP发病风险降低。反之，若妊娠早期血清铁蛋白处于最低四分位数组，但妊娠晚期升至最高四分位数组，则其HDP发病率显著升高（8.2%；OR=1.445，95% CI：1.003~2.081）。
**研究结论** 妊娠早、晚期母体血清铁蛋白水平与HDP发病风险均呈独立正相关。本研究结果提示，对铁储备充足的孕妇常规补铁可能会加重HDP发病风险，亟需审慎重新评估该临床实践的合理性。