Assessment of D-Dimer Levels in Southwestern Nigerian Pregnant Women

Aim: This study evaluated D-dimer level in pregnant and non-pregnant women in Southwestern Nigeria in order to provide more information on the concentration and liable risks in this region.

Study Design: This is a cross sectional study where convenience sampling method was applied in sample collection.

Place and Duration of Study: Blood samples were collected from pregnant women attending the antenatal clinics of Federal Teaching Hospital Ido-Ekiti (FETHI), Ekiti; Federal Medical Centre (FMC), Owo; and LAUTECH Teaching Hospital (LTH), Osogbo in Southwestern Nigeria.

Methodology: Exactly three hundred pregnant (300) and one hundred and fifty (150) apparently healthy non pregnant women were recruited for this study. The blood samples were analysed for haematocrit (HCT) and platelet count using Sysmex KX-2IN (Japan); prothrombin time (PT) and activated partial thromboplastin time (APTT) by Diagen reagents (Diagnostic Ltd., UK); the international normalized ratio (INR) was calculated from the PT results; and D-dimer quantitative assay using Tina Quant Gen 2 on Cobas C111 (Roche). Data analysis was performed using IBM-SPSS version 25.0; mean and standard deviation was used to summarize continuous variables and descriptive and Inferential statistical tests were employed with level of statistical significance was determined at p<0.05.

Results: The mean D-dimer levels were significantly higher in the pregnant women (0.87 ± 1.00 ugFEU/ml) than in controls (0.31 ± 0.22 ugFEU/ml) with 42% of the pregnant population having elevated concentration while the mean PT, INR and HCT were significantly higher in controls than the subjects (p<0.05).Furthermore, the HCT, platelet, PT and INR were observed to be highest at first trimester; 36.04±5.09 (L/L), 182.72±35.11 (x109/L), 11.80±1.86 (seconds) and 0.35±0.15 respectively, decreasing across the second and the third trimester. On the other hand, the D-dimer and APTT increased exponentially from the first trimester; 0.42±0.18 (ugFEU/ml) and 30.80±3.30 (seconds), through the second and third trimesters respectively (p>0.05).

Conclusion: This study shows a significant increase in D-dimer in the pregnant subjects when compared with the control and an exponential increase in the third trimester, also a significant reduction in some other baseline coagulation profile hence depicting D-dimer as a notable significant marker of coagulation and fibrinolysis. This therefore emphasizes the hypercoagulable state of pregnancy and a need for adequate monitoring.