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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 21-25

The association of lipid profile and uric acid levels in normotensive, preeclamptic pregnancy – A hospital-based study


Department of Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission24-Jan-2020
Date of Decision24-Jan-2020
Date of Acceptance03-Feb-2020
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Archana Dhok
Department of Biochemistry, Jawaharlal Nehru Medical College and Datta Meghe Institute of Medical Science, Sawangi (Meghe), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_19_20

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  Abstract 


Background: Eclampsia is a severe complication of preeclampsia (PE). This can create additional complications during pregnancy. It is a rare but serious condition where high blood pressure (BP) results in seizures during pregnancy and associated with risk for mother and fetus. The investigations of serum lipid profile serum uric acid are and BP with body mass index (BMI) highly suggested the feature of disease. Objective: The objective of the study is to find out the association between serum lipid profile and serum uric acid level in normotensive and preeclamptic pregnant women. Materials and Methods: A prospective case–control study was conducted in the Department of Biochemistry at Jawaharlal Nehru Medical College and Datta Meghe Institute of Medical Sciences, Sawangi (Meghe) Wardha, Maharashtra, India, with individuals suffering with severe PE to the obstetric unit of hospital. Serum lipid profile and uric acid levels were done by 159 patients suffer from PE and compare with 150 age-matched normotensive controls. Results: The average BMI in study group (preeclamptic pregnant women) was significantly higher than control group (P < 0.001). The BP was high in preeclamptic pregnant women than normal women. Statistically significant difference was observed in the levels of CH, triglycerides, high-density lipoprotein (HDL), and uric acid in the age group up to 25 and 26–32 years. There was no statically significantly difference observed in the age group of 33–39 years. HDL level was statically insignificant in both the groups. Conclusion: Serum lipid profile and serum uric acid are very useful markers for early detection, to identification of complications, and reduce the risk of occurrence in PE. Early detection is going to aid in better management which is important to improve the maternal and fetal complications.

Keywords: Blood pressure, body mass index, eclampsia, high-density lipoprotein cholesterol, lipid profile, low-density lipoprotein cholesterol, preeclampsia, total cholesterol, triglycerides, very low-density lipoprotein cholesterol and uric acid


How to cite this article:
Ambad R, Dhok A. The association of lipid profile and uric acid levels in normotensive, preeclamptic pregnancy – A hospital-based study. J Datta Meghe Inst Med Sci Univ 2020;15:21-5

How to cite this URL:
Ambad R, Dhok A. The association of lipid profile and uric acid levels in normotensive, preeclamptic pregnancy – A hospital-based study. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 20];15:21-5. Available from: http://www.journaldmims.com/text.asp?2020/15/1/21/297974




  Introduction Top


Worldwide 3%–5% of pregnancies were affected by preeclampsia (PE).[1] In India, the incidence rate of PE is 8%–10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with PE in 5.4% of the study population in India.[2]

The symptoms of PE showed in late 2nd or 3rd trimester, mostly after the 32nd week of pregnancy. PE is a disorder of pregnancy; the evidence suggest that the pathology originates from the placenta and causes variable maternal and fetal problems, which are characterized by hypertension like hypertensive disorders of pregnancy are eclampsia, gestational hypertension, and chronic hypertension and proteinuria that develop after 20 weeks of gestation in previously normotensive women.[3] Early detection of the maladaptive changes in pregnancy may assist in predicting the severity of disease. Family history of hypertension is the major risk factor for developing PE, and there may also be related with the risk of PE and the metabolic syndrome.[4] PE and eclampsia are associated with risks for the fetus. These include prematurity death and growth restriction for fetus and mother risk of renal failure, stroke, pulmonary edema, and death.

Eclampsia is a severe complication of PE. The condition can go undetected until it develops into eclampsia. This can create additional complications during pregnancy. It is a rare but serious condition where high blood pressure (BP) results in seizures during pregnancy. Eclampsia is one of the leading causes of high maternal mortality and morbidity and also high perinatal mortality. According to the WHO estimation, eclampsia probably accounts for 50,000 maternal deaths a year worldwide, and in India, the incidence rate of eclampsia was from 0.179% to 3.7%.[5],[6]

Furthermore, considerable researches, the etiology of PE remain unclear, and there are no clinically useful screening tests to identify PE.[7] Several theories have been proposed to explain the pathophysiology of PE such as placental ischemia, genetics, immune maladaptation, and oxidative stress.[8] In which oxidative stress is most widely accepted. It has been linked with lipid abnormalities and vascular dysfunction.

The serum lipid profile is associated with gestational hypertension and suggested to some new diagnostic tools. Early pregnancy dyslipidemia is associated with an increased risk of PE.[9] In previous study, it showed that the uric acid is a suitable marker to identify pregnant women with greater risk for PE and eclampsia.[10]

Excessive cellular activity associated placental ischemia leads to overproduction of uric acid, abnormal renal function, increased tissue breakdown, acidosis, and increased activity of the enzyme xanthine oxidase or dehydrogenase which serves as a marker of disease.[11],[12]

In view of the above findings, it is postulated that the alteration of lipid metabolism and uric acid may play a key role in the development of symptoms of PE and eclampsia. The present study was designed to the estimation of serum lipid profile (cholesterol, triglycerides [TG], and high-density lipoprotein [HDL]), and serum uric acid may be of good predictive indicator for, preeclamptic and eclamptic women. Therefore, the present study was conducted to find out any correlation between lipid profile and serum uric acid in PE, eclamptic pregnancy.


  Materials and Methods Top


The present study was carried out in the Central Clinical Laboratory of Biochemistry Department in Collaboration with the Department of OBGY at Jawaharlal Nehru Medical College and Datta Meghe Institute of Medical Sciences, Sawangi (Meghe) Wardha, Maharashtra. A total of 309 individuals were selected for the study. Of 150 were normal pregnant women, 159 were suffered from PE. Informed consent was taken from all pregnant women included in the study.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of JNMC, Sawangi (Meghe), Wardha, on 22nd Oct 2019. With ethical clearance no DMIMS(DU)/IEC/2019-20/398

Sample collection

Blood sample was collected in-plane test tube allowed to clot, and the serum was separated by centrifugation and used for assay of serum total CH, TG, HDL-cholesterol (HDL-C), and serum uric acid. The estimation of total cholesterol (TC), TG, HDL-C was carried out using commercially available kits,[13],[14],[15] and serum uric acid level was estimated by caraways method.[16]

Inclusion criteria for normal group

Normotensive pregnant women between 18 and 35 years of age in 3rd trimester (gestational age of >32 weeks), singleton live fetus and body mass index (BMI) ≤25 were included in the study.

Inclusion criteria for the study group

Gravid women, preeclamptic pregnant women between 18 and 35 years of age in 3rd trimester (gestational age of >32 weeks), singleton live fetus, and BMI ≤25 were included in the study.

Exclusion criteria

Patients with essential hypertension, diabetes mellitus with or without treatment, renal disease, liver disorder, and thyroid disorder, multiple pregnancies, and gestational age of <32 weeks excluded from the study.

Data analysis

Data were expressed as mean ± standard deviation. Mean values were assessed for significance by unpaired Student's t-test. A statistical analysis was performed using the Statistical Package for the Social Science Program (SPSS, 24.0 (IBM Corp., Armonk, NY)). Frequencies and percentages were used for the categorical measures. P < 0.05 was considered statistically significant.


  Observations and Results Top


In the present study, 309 pregnant women in their 3rd trimester between the 18 and 40 years of age; 159 were suffering from PE in the study group and 150 normotensive were pregnant women in the control group. PE was diagnosed on the basis of history, clinical examination, BP findings, and presence of proteinuria. Moreover, based on the definition of the American College of Obstetrics and Gynecologists as follows:[17]

  1. Systolic BP >140 mmHg
  2. Diastolic BP >90 mmHg
  3. Proteinuria of 300 mg or greater in 24-h urine collection.


Individuals were distributed as; between up to 25 years, between 26–32 years, and 33–39 years of age.

[Table 1] shows the distribution of normal, preeclamptic, and eclamptic pregnant women. One hundred and fifty normal pregnant women were selected as control group, 159 women were clinically diagnosed as PE.
Table 1: Age-wise distribution of normotensive and preeclamptic pregnant women

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[Table 2] shows the average BMI in normal group and study group (preeclamptic pregnant women), which was significantly higher than the control group (P < 0.001).
Table 2: Distribution of body mass index in normotensive and preeclamptic pregnant women

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[Table 3] shows the BP was high in preeclamptic pregnant women than normal women. Monitoring BP is an important part of prenatal care because the first sign of PE is increase in BP. The blood vessels do not function properly because the blood vessels narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.
Table 3: Distribution of blood pressure in normotensive and preeclamptic pregnant women

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[Table 4] shows cholesterol levels in various age groups in normotensive and preeclamptic patients. Up to 25 years of age group, there was a significant difference in the cholesterol levels of normotensive (165.64 ± 18.95) and preeclamptic (203.03 ± 23.97) patients (P < 0.00001). In 26–32 years of age group, cholesterol levels of normotensive were 167.65 ± 19.16 and in preeclamptic were 199.62 ± 37.33 (P < 0.00001), while in 33–39 years of age group, cholesterol levels of normotensive were 191.97 ± 23.16 and in preeclamptic were 196.80 ± 17.21 patients (P < 0.0376).
Table 4: Total cholesterol levels (mg/dl) in normotensive and preeclamptic pregnant women in the different age groups

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[Table 5] shows triglyceride levels (mg/dl) in normotensive and pre-eclamptic pregnant women in the age group up to 25 years were 130.9 ± 10.06 and 234.7 ± 39.23, respectively (P < 0.00001). In 26–32 years of age group, triglyceride levels of normotensive were 137.69 ± 9.98 and in preeclamptic were 239.52 ± 34.44 (P < 0.00001), while in 33–39 years of age group, triglyceride levels of normotensive were 138.57 ± 7.95 and in preeclamptic were 245.06 ± 28.15 patients (P < 0.0014). Statistically significant difference was observed in all three groups.
Table 5: Triglyceride levels (mg/dl) in normotensive and preeclamptic pregnant women different age groups

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[Table 6] shows HDL-C levels (mg/dl) in normotensive and preeclamptic pregnant women in the age group up to 25 years were 34.78 ± 6.38 and 38.4 ± 10.28, respectively (P = 0.00252). In 26–32 years of age group, HDL-C levels of normotensive were 33.21 ± 6.96 and in preeclamptic were 43.28 ± 13.22 (P < 0.00001), while in 33–39 years of age group, HDL-C levels of normotensive were 30.43 ± 5.75 and in preeclamptic were 30.43 ± 5.75 patients (P = 0.159). Statistically significant difference was observed in 26–32 years of age groups.
Table 6: High-density lipoprotein cholesterol levels (mg/dl) in normotensive and preeclamptic pregnant women different age groups

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[Table 7] shows in the age group of up to 25 years, serum uric acid levels (mg/dl) in normotensive and preeclamptic pregnant women were 4.46 ± 0.78 and 7.87 ± 1.03, respectively (P < 0.00001). In 26–32 years of age group, it was 4.04 ± 0.9 and 8.3 ± 0.85, respectively, in normotensive and preeclamptic pregnant women (P < 0.00001). These results were highly significant. In 33–39 years of age group, serum uric acid levels in normotensive and preeclamptic pregnant women were 4.32 ± 0.91 and 8.5 ± 1.06, respectively (P = 0.0005).
Table 7: Serum uric acid levels (mg/dl) in normotensive and pre-eclamptic pregnant women different age groups

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  Discussion Top


Formerly, it is called toxemia, PE is a condition that pregnant women develop. Its marked by BP in women who had not high BP before. Preeclamptic women will have a proteinuria and often also have swelling in the feet, legs, and hands. This condition usually appears late in pregnancy, though it can happen earlier and may even develop just after delivery. In the present study, we are trying to show the association of lipid profile and uric acid in normotensive preeclamptic pregnancy.

Sharami et al.[18] showed the pregnant women with PE had significantly higher BMI than normotensive pregnant women; these findings are correlated with our study findings. Due to increased insulin resistance and a state of inflammation were associated with obesity.[19] Insulin resistance leads to lipolysis and due to increased flux of fatty acids to liver to increasing synthesis of TG.[20]

In our study, it was found that the mean levels of TC and TG in normotensive women and in preeclamptic women were statistically significant (P < 0.05). Furthermore, there was a significant decrease in HDL in the study group as compared to control (P < 0.05). The study conducted by Nagtilak,[9] it was observed that the levels of TC, HDL, very low-density lipoprotein (VLDL), and TG level among normal and preeclamptic cases is statistically significant (P < 0.05). Similar findings were observed in the study conducted by Vani et al.[21] Lipid profile abnormality in preeclamptic is due to the dysfunction of endothelial cells. In the endothelial cell, oxidative stress is stimulated by linoleic acid. During pregnancy, serum lipoprotein levels increase considerably and are two times higher in PE women.

In the present study, the level of cholesterol increased found in preeclamptic pregnant women. The hypercholesterolemia promotes the formation of free radicals. Thus, many studies have been linked “atherogenic” lipid profile as a potential contributor to increased risk of PE.[19]

Particularly, the level of TG is highly significantly increased (P < 0.001) found in preeclamptic women than normotensive in our study which correlated with the findings of Bishnoi et al.[22] The principle modulator of hypertriglyceridemia is estrogen as pregnancy is linked with hyperestrogenemia. Estrogen induces hepatic biosynthesis of endogenous TG, which is carried by VLDL-C[23] and hypertriglyceridemia may be linked to hypercoagulability.[24] It is observed that there is decreased activity of lipoprotein lipase which is responsible for decreased catabolism at adipose tissue level, in PE, also there is hypertriglyceridemia whereas placental VLDL receptors are upregulated.

In our study, we found that the levels of HDL-C were decrease. Estrogen is responsible for the induction of TG and HDL-C and suppression of low-density lipoprotein-cholesterol (LDL-C) and estrogen level falls in PE.[25] The decreased level of HDL-C in preeclamptic pregnant women is however not only because of hypoestrogenemia but also due to insulin resistance.[26] This is in consistency with the results of Gohil et al. demonstrated significant decrease in HDL-C in preeclamptic women than normal pregnant women. HDL-C activates lipoproteins which releases the fatty acids that can be oxidized by β-oxidation pathway. Low levels of HDL may compromise these functions.

A significant increase in LDL-C level in 3rd trimester of preeclamptic pregnant women was observed in the present study, while LDL-C level decreases in normal pregnant women may be attributed to hyperestrogenemia, was also reported by Wakatsuki et al.,[27] in 3rd trimester of preeclamptic pregnancy. The level of LDL increases arterial sensitivity to pressor agents and inhibits endothelium-dependent vasodilatation. This endothelial dysfunction leads to glomerular lesions and subsequently proteinuria, which also gives an indication of its severity.[11]

Uric acid is a metabolite end product of purine catabolism. Bainbridge and Roberts[28] suggested that hyperuricemia in PE is multifactorial. In PE, elevated levels of uric acid are not only attributed to decreased renal excretion but also to increased oxidative stress resulting from placental ischemia and increased activity of xanthine oxidase enzyme.[29] One of the major causes for elevated serum uric acid has been increased reabsorption and decreased excretion of uric acid in proximal tubules, similar to the physiologic response to hypovolemia.

In the present study, we found that the increased level of serum uric acid in preeclamptic women was statistically highly significant (P < 0.05) compare with normotensive. Other studies support the finding with our results.[10],[22],[28]

Uric acid plays an important role in vascular damage and oxidative stress. Hyperuricemia may also reflect impaired endothelial integrity and contribute to the pathogenesis of PE. Early estimation of serum uric acid might reduce systemic complications and maternal deaths due to PE.[30] Increased level of serum uric acid often precedes clinical manifestations of the eclampsia. The present study has confirmed the association between severe PE and abnormality of lipid profile and increased level serum uric acid.[31]


  Conclusion Top


Based on our findings, we concluded that the serum lipid profile and uric acid are very useful markers for early detection and identification of complications of PE and it also helps in reducing the risk factors associated with PE. Early detection is going to aid in better management which is important to improve the maternal and fetal complications. A larger sample size improves the results, but the homogeneous population and age-matched controls used in this study ensured the reliability of our results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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