Objective: The study aimed to identify the risk factors of preeclampsia (PE) and establish a novel prediction model.

Study design: A retrospective, single-center analysis was conducted using clinical data from 5099 pregnant women who gave birth at Peking University People's Hospital between June 2015 and December 2020 who had placental growth factor (PIGF) levels records at 13-20 + 6 gestation weeks. The participants were randomly divided into a training set (70%, n = 3569) and a validation set (30%, n = 1030), between which the consistency was checked, and the analysis was performed according to whether PE occurred during pregnancy. Factors with univariate logistic analysis outcome of p < 0.2 were incorporated into the multivariate logistic regression analysis model, then variable selection by stepwise regression with AIC as the criterion was executed to finally identify the variables used for modeling. The model's discriminative ability was assessed using the receiver operating characteristic (ROC) curve, and its calibration was evaluated through calibration curves and Hosmer-Lemesow test. In addition, decision curve analysis (DCA) was used for clinical net benefit appraisal.

Results: Logistic regression analysis identified nine risk factors for PE, including: maternal age (OR = 1.072, 95%CI = 1.025-1.120), parity(OR = 0.718,95%CI = 0.470-1.060), pre-pregnancy BMI (OR = 2.842,95%CI = 1.957-4.106), family hypertension history (OR = 3.604,95%CI = 2.433-5.264), pregestational diabetes mellitus(PGDM) (OR = 8.399, 95%CI = 4.138-15.883), pregnancy complicating nephropathy (OR = 7.931, 95% CI = 2.584-20.258),pregnancy complicating immune system disorders (OR = 3.134, 95% CI = 1.624-5.525), mean arterial pressure(MAP) at 11-13 + 6 gestational weeks (OR = 1.098, 95% CI = 1.078-1.119) and PIGF (OR = 0.647, 95% CI = 0.448-0.927) at 13-20 + 6 gestational weeks (P < 0.05). The restricted spline regression analysis (RCS) analysis results showed that PIGF and the risk of PE presented an approximately "L-shaped" relationship, with the risk of PE rising sharply with the decrease of PIGF when PIGF < 90 pg/ml, and little change with the increase of PIGF when PIGF > 90 pg/ml. A risk prediction model for PE during the first and second trimester was constructed based on the above selected 11 factors. The area under the ROC curve (AUC) for the model was 0.781(95%CI = 0.709-0.853), and the sensitivity and specificity at the optimal cut-off value (threshold probability) were 0.571 and 0.879 respectively. Chi-square of 9.616 and P value of 0.293 from Hosmer-Lemeshow test indicated that the model was well calibrated. Finally, the model showed good clinical net benefits in the threshold range of 0.03-0.3.

Conclusion: The incidence of PE was associated with maternal age, pre-pregnancy weight and BMI, family hypertension history, PGDM, pregnancy complicating nephropathy, gestational complicating immune system disorders, blood pressure (systolic, diastolic, mean arterial pressure) at 11-13 + 6 gestational weeks, and PIGF at 13-20 + 6 gestational weeks. When PIGF < 90 pg/ml at 13-20 + 6 gestational week, the risk of PE increased significantly with the reduction of PIGF. The nomogram based on the above results was simpler and more practical in clinical application for PE predicting during the first and second trimester, and may provide an important reference for doctors and patients.

Keywords: Medical history; Multivariate logistic regression; Nomogram; Preeclampsia prediction model; The first and second trimester.

© 2025. The Author(s).

目的： 研究旨在识别子痫前期（PE）的风险因素并建立新的预测模型。

研究设计： 本研究采用回顾性单中心分析，使用2015年6月至2020年12月在北京大学人民医院分娩的5099名孕妇的临床数据。这些妇女在妊娠13-20+6周时记录了胎盘生长因子（PIGF）水平。参与者被随机分为训练组（70%，n = 3569）和验证组（30%，n = 1030），并在两者之间进行了一致性检查，然后根据孕期是否发生子痫前期进行分析。单变量逻辑回归分析结果为p

结果： 逻辑回归分析确定了九个PE的风险因素，包括：母亲年龄(OR = 1.072, 95%CI = 1.025-1.120)，分娩次数 (OR = 0.718, 95%CI = 0.470-1.060)，孕前BMI (OR = 2.842, 95%CI = 1.957-4.106)，家族高血压史(OR = 3.604, 95%CI = 2.433-5.264)，妊娠前期糖尿病(PGDM)(OR = 8.399, 95%CI = 4.138-15.883)，妊娠并发肾病(OR = 7.931, 95% CI = 2.584-20.258)，妊娠并发免疫系统紊乱 (OR = 3.134, 95% CI = 1.624-5.525)，在11-13+6周时的平均动脉压(MAP)(OR = 1.098, 95% CI = 1.078-1.119) 和妊娠13-20+6周时PIGF (OR = 0.647, 95% CI = 0.448-0.927)（P 90 pg/ml时，随着PIGF的增加，风险变化很小。根据上述选择的11个因素构建了一种针对孕早期和中期的PE风险预测模型。该模型下的ROC曲线下面积（AUC）为0.781(95%CI = 0.709-0.853)，在最佳切值时敏感性和特异性分别为0.571 和0.879。Hosmer-Lemeshow检验得到卡方值为9.616和P值为0.293，表明模型校准良好。最后，在阈值范围为0.03-0.3时，该模型显示出良好的临床净效益。

结论： PE的发病率与母亲年龄、孕前体重和BMI、家族高血压史、PGDM、妊娠并发肾病以及13-20+6周时PIGF水平相关。当在13-20+6周时，如果PIGF

关键词： 医疗史；多变量逻辑回归；诺莫图；子痫前期预测模型；孕早期与中期。