Objective  To analyze the relationship between changes in platelet-activating factor (PAF), fibulin-3, and umbilical artery blood flow during late pregnancy in pregnant women with gestational hypertension (GH) and neonatal outcomes.

Methods  The data of 420 pregnant women with GH who underwent regular prenatal examinations and who delivered at our hospital between January 2020 and December 2024 were collected. The pregnant women were divided into a good outcome group (n = 319) and a poor outcome group (n = 101) according to the neonatal outcomes. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of adverse neonatal outcomes, and a prediction model was constructed based on the results of risk factors analysis. The receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow test were adopted to evaluate the discrimination ability and calibration ability of the model.

Results  Statistically significant differences were observed between the poor outcome group and the good outcome group in terms of age, pre-pregnancy body mass index (BMI), severe GH, PAF, fibulin-3, and umbilical artery blood flow parameters (ratio of peak systolic velocity to end-diastolic maximum velocity S/D, pulsatility index PI, and resistance index RI) (P < 0.05). Multivariate logistic regression analysis showed that elevated serum PAF, decreased fibulin-3, and increased umbilical artery S/D, PI, and RI were independent risk factors for adverse neonatal outcomes in pregnant women with GH ( P < 0.05). A prediction model was constructed based on the results of the multivariate analysis, and the model formula was manifested as Logit (P) = 1.364 × S/D + 4.199 × PI + 5.303 × RI + 0.534 × PAF (μg/L) － 0.229 × fibulin-3 (ng/mL) － 7.996. ROC curve analysis revealed that the area under the curve (AUC), sensitivity, and specificity of the model were 0.945 (95% CI: 0.923-0.898), 85.90%, and 89.10%, respectively. The Hosmer-Lemeshow goodness-of-fit test revealed χ ² = 12.538 and P = 0.129.

Conclusion  Changes in serum PAF, fibulin-3, and umbilical artery blood flow parameters in pregnant women with GH are associated with neonatal outcomes. Increased fibulin-3 is a protective factor, whereas decreased serum PAF level and decreased umbilical artery S/D, PI, and RI are risk factors. The prediction model based on fibulin-3, PAF, S/D, PI, and RI in this study demonstrates high clinical applicability and potential for broader use.