D-Dimer Plasma Levels in Each Trimester of Diabetic Pregnant Women, A Case Control Study

Kanar Sadraddin  Shamsaddin; Shahla Kareem  Alalaf

doi:10.56056/amj.2025.349

Authors

Kanar Sadraddin Shamsaddin M.B.Ch.B., Trainee at Kurdistan Higher Council of Medical Specialities in Obstetrics & Gynecology; Maternity Teaching Hospital, Erbil City, Kurdistan Region/Iraq
Shahla Kareem Alalaf M.B.Ch.B., FICOG; Professor in Obstetrics & Gynecology; College of Medicine-Hawler Medical University, Erbil City-Kurdistan Region/Iraq

DOI:

https://doi.org/10.56056/amj.2025.349

Keywords:

D-dimer, Diabetes, Pregnancy, Plasma level range, Venous thromboembolism

Abstract

Background and objectives: Pregnancy increases D-dimer levels, making it a non-specific test for venous thromboembolism. This study compared D-dimer levels by trimester in healthy and diabetic pregnant women.

Methods: A case-controlled study was conducted from May 2022 to August 2023 at Gestational Diabetes Clinic/Maternity Teaching Hospital, Erbil City, Kurdistan Region, Iraq to compare D-dimer levels between two groups: 360 pregnant women diagnosed with diabetes (cases) and 360 normoglycemic pregnant women (controls). Blood samples were obtained once from each participant during a prenatal visit. Samples were collected from a vein and analyzed using a latex-based immunofluorescence assay on a Biozek DCR1000 machine to measure D-dimer concentration.

Results: D-dimer levels steadily increased throughout pregnancy in both groups, peaking in the third trimester. Notably, pregnant women with diabetes consistently had significantly higher D-dimer levels compared to controls across all trimesters (p < 0.001). Within the diabetic group, women with type 1 diabetes displayed the highest mean D-dimer concentration (1887.3 ng/ml), significantly higher than both type 2 diabetes (1518.0 ng/ml; p = 0.036) and gestational diabetes (1155.8 ng/ml; p = 0.004).

Conclusions: This study highlights a substantial rise in D-dimer levels throughout pregnancy, even in healthy women. Importantly, pregnant women with diabetes have considerably higher D-dimer levels compared to controls, with the highest observed in type 1 diabetes. These findings emphasize the need to consider diabetes when interpreting D-dimer levels for venous thromboembolism diagnosis in pregnancy.

Downloads

Download data is not yet available.

References

Varrias D, Spanos M, Kokkinidis DG, Zoumpourlis P, Kalaitzopoulos DR. Venous Thromboembolism in Pregnancy: Challenges and Solutions. Vasc Health Risk Manag. 2023 Dec 31:469-84.

Tsai CT, Chao TF. Incidence and risk factors for pregnancy-associated venous thromboembolism: are there differences between east and west. Thromb Haemost. 2023 Sep;123(09):911-2.

Xu Q, Dai L, Chen HQ, Xia W, Wang QL, Zhu CR,el at. Specific changes and clinical significance of plasma D-dimer during pregnancy and puerperium: a prospective study. BMC Pregnancy Childbirth. 2023 Apr 13;23(1):248.

Hovine A, Chauleur C, Gault C, Rancon F, Gris JC, Tardy B, el at. Serum D-dimer is not predictive of placenta-mediated complications in pregnancy at high risk: The multicentric prospective cohort AngioPred study. Front Cell Dev Biol. 2023 Jan 12; 11:1115622.

Zuin M, Rigatelli G, Bongarzoni A, Enea I, Bilato C, Zonzin P, el at. Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism. Eur Heart J Acute Cardiovasc Care. 2023 Feb 1;12(2):80-6.

Felis S, Marchese B, Gavini I. Venous Thromboembolism During Pregnancy. Med Clin Res, 8 (8), 01. 2023;14.

Cheng E, Chen D. Correlation between serum D-dimer and risk of gestational diabetes mellitus. IJCT. 2022 Nov 30:805-9.

Zaitoun MM, Elbhiedy TM, Jama II, Wasfy MA. Study of Plasma D-Dimer Level in Normal Pregnancy and Complicated Pregnancy. Egypt J Hosp Med. 2023 Jan 1;90(2):3266-72.

Maughan BC, Marin M, Han J, Gibbins KJ, Brixey AG, Caughey AB, el at.Venous thromboembolism during pregnancy and the postpartum period: risk factors, diagnostic testing, and treatment. Obstet Gynecol Surv. 2022 Jul 1;77(7):433-44.

Ram S, Ram HS, Neuhof B, Shperling RB, Chodick G, Yogev Y. Venous thromboembolism during pregnancy: Trends, incidence, and risk patterns in a large cohort population. Obstet Gynecol Int J. 2023 Mar;160(3):962-8.

Deischinger C, Dervic E, Nopp S, Kaleta M, Klimek P, Kautzky-Willer A. Diabetes mellitus is associated with a higher relative risk for venous thromboembolism in females than in males. Diabetes Res Clin Prac.t2022 Dec 1;194:110190.

Zhu Y, Liu Z, Miao C, Wang X, Liu W, Chen S, el at. Trajectories of maternal D-dimer are associated with the risk of developing adverse maternal and perinatal outcomes: A prospective birth cohort study. Clin Chim Acta. 2023 Mar 15; 543:117324.

Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus.Endocr Rev. 2022 Oct 1;43(5):763-93.

Siennicka A, Kysz M, Chestowski K, Tabaczniuk A, Marcinowska Z, Tarnowska P, el at. Reference values of D-Dimers and fibrinogen in the course of physiological pregnancy: the potential impact of selected risk factors—a pilot study. International BR. 2020 May 24;2020.

Cheng AY, Gomes MB, Kalra S, Kengne AP, Mathieu C, Shaw JE. Applying the WHO global targets for diabetes mellitus. Nat Rev Endocrinol. 2023 Apr;19(4):194-200.

Gregg EW, Buckley J, Ali MK, Davies J, Flood D, Mehta R, el at. Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact. The Lancet. 2023 Apr 15;401(10384):1302-12.