Abstract
The study aimed to investigate the association of plasma aldosterone concentration (PAC) on admission before delivery with preeclampsia, admission blood pressure, and pregnancy outcomes. In this multicenter observational study (May 2023-December 2024), 886 pregnancies (125 preeclampsia, 761 controls) from six hospitals were analyzed. Associations were evaluated using multivariable logistic regression, Spearman’s correlation, and restricted cubic spline models, with sensitivity analysis employing Winsorization. Piecewise regression was employed to identify breakpoint and examine threshold effect. Preeclamptic women had significantly lower PAC than controls (16.73 [11.03, 32.59] vs. 28.16 [15.99, 52.82] ng/dL, P < 0.001). Lower PAC was independently associated with preeclampsia (adjusted OR: 0.98; 95% CI 0.98–0.99; P < 0.001) and correlated with higher systolic blood pressure (ρ = −0.170, P < 0.001) and adverse outcomes (P < 0.05). A significant nonlinear relationship was observed (P < 0.001), with a breakpoint at 11.74 ng/dL where each 1-unit increase reduced preeclampsia odds by 30% below it (adjusted OR 0.70; 0.57–0.87) and only by 2% at or above it (adjusted OR 0.98; 0.97–0.99). Lower PAC showed an independent, nonlinear association with preeclampsia, characterized by a threshold effect around 11.74 ng/dL, and is linked to elevated systolic blood pressure and adverse maternal-fetal outcomes.
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Data availability
The datasets generated during and/or analysed during the current study are not publicly available due to privacy restrictions of the study populations but are available from the corresponding author on reasonable request.
Abbreviations
- RAAS:
-
Renin–angiotensin–aldosterone system
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- Apgar-1:
-
Apgar score at 1 minute
- BMI:
-
Body mass index
- DBP:
-
Diastolic blood pressure
- FGR:
-
Fetal growth restriction
- GDM:
-
Gestational diabetes
- HDP:
-
Hypertensive disorders of pregnancy
- PAC:
-
Plasma aldosterone concentration
- RCS:
-
Restricted cubic splines
- SBP:
-
Systolic blood pressure
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Acknowledgements
We thank the Tianshan Talent Training Program-Science and Technology Innovation Team for invaluable project support. We thank all staff and participants who contributed to the study.
Funding
This work was supported by the Tianshan Talent Training Program-Science and Technology Innovation Team (2023TSYCTD0016).
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M.Y., M.H.W., Q.Z., and N.F.L. conceived and designed the study. M.Y., M.H.W., and Q.Z. were responsible for data acquisition, analysis, and interpretation. M.Y. drafted the manuscript. M.Y., M.H.W., and Q.Z. prepared the figures. N.F.L. supervised the study and substantively revised the manuscript. All authors have read, revised, and approved the final manuscript, and agree to be accountable for all aspects of the work.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the People’s Hospital of Xinjiang Uygur Autonomous Region of China (approval number KY2023042001, approval date is April 20, 2023). All experiments were performed in accordance with relevant guidelines and regulations. Written informed consent was obtained from all participants.
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Yang, M., Wang, M., Zhu, Q. et al. Multicentre evidence for an independent association between third-trimester hypoaldosteronism and preeclampsia. Sci Rep (2026). https://doi.org/10.1038/s41598-026-48499-y
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DOI: https://doi.org/10.1038/s41598-026-48499-y
