Women on the Other Side of War and Poverty : Its Effect on the Health of Reproduction

D-dimer is a minor protein product, which is found in circulation in negligible amounts because of endogenous fibrinolysis (1,2). The normal or negative (decreased level) D-dimer result could exclude the serious intravascular thrombotic conditions, while the positive result (increased level) can be an indicator for the presence of an acute disorder related to abnormal clot formation such as venous thromboembolism (VTE). However, the site and/ or cause of the abnormal blood clot cannot be recognized by this test (3). High D-dimer plasma level was reported during normal pregnancy and was described with proportional increase with gestational age as a result of enhancing maternal coagulation and increase the production of intrinsic and extrinsic coagulation factors (4,5). During pregnancy, females with elevated concentrations of D-dimer are required to have further testing to exclude suspected VTE (6). A very recent study by Goodacre et al in 2018 demonstrated that D-dimer test must not be used for clinical examination of pulmonary embolism (PE) in pregnancy (7). However, another recent study by Choi et al in 2018 showed that the normal D-dimer results could be useful in excluding PE during pregnancy and postpartum patients. They showed that D-dimer level was above 0.5 mg/L (i.e. normal level) in all patients with PE (8). In 2004, it has been found that D-dimers level significantly increases at 16 weeks of gestation (9). Another study was performed on healthy pregnant women and showed an increase in D-dimer level with each trimester (10). Moreover, D-dimer level was found to be significantly high among pregnant women with complicated disorders such as diabetes, preeclampsia, and abruption placentae (11,12). A study by Manolov et al reported that during the third trimester of pregnancy, the preeclampsia development is correlated with the increased value of D-dimer compared with regular pregnancy (12). A significant increase in the level of D-dimer was also seen during the pregnancy complicated with diabetes compared to uncomplicated third trimester pregnancies (11). The current study was keen to estimate the plasma level of D-dimer in both normal and complicated pregnancies in Saudi pregnant women who attended the gynecology clinic in the medical center in Makkah region. This study was the first to be performed among Saudi females in the Western region of the Kingdom. Abstract Objectives: The purpose of the current work is to evaluate D-dimer plasma level among both normal and complicated pregnancies such as gestational diabetes (GD) and hypertension (GH) among Saudi females. It is also focused on exhibiting any possible factors that could also play a role in rising D-dimer levels besides the age of the pregnant woman and the period of gestation. Materials and Methods: A semi-quantitative latex agglutination assay was performed in the blood sample of healthy non-pregnant, pregnant and pregnant females with GD and GH. Results: The results exhibited that 92% of pregnancies with GH and 90% of multiple pregnancies had high D-dimer levels. The analysis of the effect of age of pregnant women on D-dimer concentrations presented that 100% of pregnant women with GD, GH or multiple pregnancies aged above 40, had high levels of D-dimer. The results of the relationship between gestational age of pregnancies and D-dimer showed that by reaching the third trimester, about 66.6% of women who had multiple pregnancies had D-dimer concentration above 2000 ng/mL. Interestingly, all the pregnant females with GH had D-dimer concentrations above 2000 ng/mL. Conclusions: This study postulated that the concentrations of D-dimer significantly increase during pregnancy associated with common complications such as GD and GH. It is the first study to demonstrate the possible risk factors during pregnancy, which include age, number of pregnancies, gestational age and pregnancies with GD and GH, especially among Saudi Arabian women.