Abstract
<title>Abstract</title> <p> <bold>Background</bold> Pre-eclampsia is a multifactorial pregnancy disorder marked by hypertension and proteinuria after the first trimester, contributing to maternal and fetal morbidity and mortality. Early identification of at-risk women is critical in obstetric care. Disruptions in steroid hormone homeostasis, particularly estradiol and testosterone, may play a role in its pathogenesis. Investigating the estradiol-to-testosterone (E2/T) ratio in early pregnancy may offer a promising biomarker for prediction. <bold>Methods</bold> A prospective cohort study was conducted over one year following ethical approval at the Departments of Obstetrics and Gynaecology and Fetomaternal Medicine, BMU, Dhaka and Islami Bank Hospital, Dhaka. Pregnant women in their first trimester who met inclusion and exclusion criteria were consecutively enrolled. A total of 224 participants were recruited. Data were collected using a semi-structured, pre-tested questionnaire covering sociodemographic details, clinical history, and laboratory investigations. Serum estradiol and testosterone levels were measured in the first trimester using chemiluminescent immunoassays. Participants were followed until delivery for development of pre-eclampsia (PE). Based on outcomes, Group A included women who developed PE, while Group B consisted of those who did not. Statistical analysis was performed using SPSS version 25.0. Continuous variables were summarized using means, medians, and standard deviations, while categorical variables were expressed as frequencies and percentages. Group comparisons used Pearson's chi-square test, Student's t-test, or Mann–Whitney U test. Predictive value of the E2/T ratio was evaluated using ROC curve analysis. A p-value < 0.05 was considered significant. <bold>Results</bold> Of 224 women, 14.7% developed preeclampsia. They had significantly lower estradiol levels (1411.6 ± 823.2 pg/mL) and E2/T ratios (3.6 ± 2.8) compared to non-preeclamptic participants (2043.7 ± 1132.7 pg/mL; 6.0 ± 4.3), with p = 0.002 and p < 0.001 respectively. ROC analysis showed fair predictive accuracy (AUC = 0.733, 95% CI: 0.640–0.825, p < 0.001). A cut-off ≤ 3.92 yielded 78.8% sensitivity, 65.4% specificity, and 94.7% negative predictive value. Women with ratios ≤ 3.92 had a 5.33-fold higher risk (95% CI: 2.42–11.75, p < 0.001). Logistic regression confirmed E2/T as an independent predictor (Adjusted OR = 0.73; 95% CI: 0.60–0.89; p = 0.002). <bold>Conclusion</bold> The first-trimester E2/T ratio demonstrated significant potential as a predictive biomarker for preeclampsia. An E2/T ratio ≤3.92 was associated with a more than five-fold increased risk, highlighting its value for early risk stratification. This cost-effective hormonal marker could support early prediction and timely intervention. </p>