Published by : PROFESSIONAL MEDICAL PUBLICATIONS
July - September 2009
Maternal plasma lipid concentrations in first
trimester of pregnancy and risk of sever preeclapmsia
Akhavan Setareh1, Modarres Gilani Mitra2, Borna Sedigheh3,
Shahghaibi Shoaleh4, Yousefinejad Vahid5, Shahsavari Siroos6
Objective: The role of abnormal lipid profile as a risk factor in pathology of pre-eclampsia is controversial. We investigated the relationship between early pregnancy plasma lipid concentrations and risk of severe pre-eclampsia.
Methodology: It was a prospective cohort study, in which one thousand maternal blood samples were collected at first trimester of pregnancy. We selected 63 women who developed severe preeclampsia from the cohort and 280 normotensive as control group matched with pre-eclamptic group. Plasma lipid concentrations were measured enzymatically. Data was analyzed with student t-test, and Relative risk with 95% confidence interval was calculated.
Results: The risk of severe preeclampsia among women with serum triglyceride level >175 mg/dl was 13.14 fold the ones with serum triglyceride level <100 (95% CI 1.84-265.4).
Conclusion: This study has showed that early pregnancy dyslipidemia is associated with an increased risk of severe pre-eclampsia.
KEYWORDS: Lipids, Pregnancy, Severe Pre-eclampsia.
Pak J Med Sci July - September 2009 Vol. 25 No. 4 563-567
How to cite this article:
Setareh A, Mitra MG, Sedigheh B, Shoaleh S, Vahid Y, Siroos S. Maternal plasma lipid concentrations in first trimester of pregnancy and risk of sever preeclapmsia. Pak J Med Sci 2009;25(4):563-567.
1. Akhavan Setareh, MD,
Assistant Professor of Obstetric and Gynecology,
2. Modarres Gilani Mitram, MD,
3. Borna Sedigheh MD,
2,3: Associate Professor of Obstetric and Gynecology,
Tehran University of Medical Sciences,
Imam Khomeini Hospital, Tehran.
4. Shahghaibi Shoaleh, MD,
Assistant Professor of Obstetric and Gynecology,
5. Yousefinejad Vahid MD,
General Practitioner, Researcher,
6. Shahsavari Siroos, MSc,
1,3,4-6: Kurdistan University of Medical Sciences,
Behsat Hospital, Sanandaj, Iran.
Dr. Akhavan Setareh,
* Received for Publication: December 3, 2008
* Revision Received: June 10, 2009
* Revision Accepted: June 22, 2009
Preeclampsia is one of the most important pregnancy’s disorders, diagnosed with hypertension and proteinuria and is the leading cause of fetal and maternal morbidity and mortalities.1,2
Natural rising of plasma lipids is being seen in normal pregnancy, but this event is not atherogenic in normal pregnancy, and it is believed this process is under hormonal control. But in complicated pregnancy there is a possible defect in mechanism of adjusting physiologic heperlipidemia.2 There have been various studies carried out to evaluate the relationship between hyperlipidemia and incidence of preeclampsia that majority of them were based on case control study,3,4-9 and some of them were prospective.1,10-15 There were a few studies done for evaluation of relationship between plasma lipid concentrations and severity of preeclampsia.9,16
We investigated the relationship between early pregnancy plasma lipid concentrations and risk of severe preeclampsia.
This was a prospective cohort study. Subjects were recruited from pregnant women before sixteenth week of pregnancy referred to the treatment and health care centers for prenatal care in Sanandaj city after approval of Kurdistan University of Medical Sciences ethics committee. The demographic characteristics and midwifery information were collected by questionnaire. The written informed consent was obtained from all women who participated in the study and then Fasting venous blood sample was taken from subjects. Plasma was separated from blood and stored at -80°C until the time of assay.
Individuals with background of midwifery’s complications containing: abortion, preterm delivery, pre-eclampsia, intra uterine fetal death (IUFD), and also patients involving systematic disorders such as chronic hypertension, diabetes history, and other chronic diseases were excluded. Blood pressure was recorded in first trimester before the sixteenth week of pregnancy, and care was continued.
Severe pre eclampsia was defined by criteria of BP >160/110 mm Hg after 20 weeks’ gestation, proteinuria 2.0 g/24 hours or >2+ dipstick, serum creatinine >1.2 mg/dl unless known to be previously elevated, platelets < 100,000/mm3, microangiopathic hemolysis (increased LDH), elevated ALT or AST, persistent headache or other cerebral or visual disturbance, and persistent epigastric pain.2
Sixty three women developed severe preeclampsia from the cohort and 280 normotensive as control group matched for age, parity, and cigarette consuming with preeclamptic group. After liquefying frozen plasma’s samples, standard enzymatically assays of plasma lipids were performed on both groups. Enzymatic colorimetric test was used to define serum triglyceride, total cholesterol, and Low-density Lipoprotein (LDL) cholesterol (GPO-PAP, CHOD-PAP, and LDL-C method respectively; Parsazmun Co kits, Iran/ Auto analyzer RA100, USA). High-density lipoprotein (HDL) cholesterol was determined by detergent-based isolation and enzyme-linked colorimetric detection (CHOD-PAP; Parsazmun Co kits, Iran/ Auto analyzer RA100, USA).
In follow up blood pressure of both severe pre-eclampsia and control group were recorded again in 38th week of pregnancy and pr delivery. Data were analyzed by using descriptive tables, student t-test and calculating Relative risk with 95% confidence interval by SPSS statistical software.
Characteristic of study subjects are presented in Table-I. There was a significant difference in all the plasma lipid concentrations between two groups (Table-II). Severe preeclampsia group had more LDL concentration, triglyceride, LDL/HDL ratio in comparison to control group (P=0.000).
The HDL concentration among severe pre eclampsia group were less than control group (P=0.000). But the mean of total cholesterol concentration among severe pre eclampsia group were less than control group (P=0.002).
There was 13.14 fold increases seen in risk of severe preeclampsia among subjects with triglyceride level >175mg/dl in comparison to ones with triglyceride level <100 mg/dl (95%CI 1.84-265.4). The calculated relative risks of the association between severe preeclampsia risk and maternal plasma lipid concentrations are presented in Table-III.
There was also 3.28 fold increases seen in risk of severe preeclampsia among women with LDL>108 mg/dl in comparison to individuals have LDL<83.3 mg/dl (95% CI 1.93-153.8).
Our results are in line with to majority of previous studies in this field which have reported significant relationship between hyperlipidemia, and preeclampsia, specially for triglyceride.1,3,4,8-13,16 but is contrary to limited previous studies which have not mentioned any differences in lipid concentrations in both groups.5,7
The limited studies which have evaluated the relationship between plasma lipid concentrations and severity of preeclampsia.9,16 The triglyceride levels at 20 and 34 weeks gestation were significantly higher than controls in women with mild and severe preeclampsia.16 These findings are in agreement with our results.
The association between hyper triglyceridemia and severity of preeclampsia at 28-37 weeks gestation was evaluated in a study in the United States. In that study patients with mild preeclampsia had significant increase in plasma triglyceride levels while patients with severe preeclampsia had comparable triglyceride levels to controls.9 That is not comparable with our results. The time variation of taking blood samples to assess plasma lipids that was in third trimester in Mikhail and et al study9 and first trimester in our study, would be noticeable in interpretation of two studies’ results.
In another study performed in Spain, at 20 and 34 weeks’ gestation, triglyceride levels were significantly higher than controls in women with severe gestational hypertension, mild and severe preeclampsia16 and the significant elevation in triglycerides was already present at 10 weeks in mild and severe preeclampsia, this result is in agreement with our findings.
There was 4.15 fold increase in preeclampsia among subjects with triglyceride above 133 mg/dl comparing ones having triglyceride under 93 mg/dl in the performed cohort study in the United States (95% CI 1.50-11.49).10 In our study, severe preeclampsia risk was 13.14 fold of increase among individuals having triglyceride above 175 mg/dl comparing ones under 100 mg/dl (95% CI 1.84-265.4).
In our study the mean of total serum’s cholesterol in severe pre-eclampsia group comparing normal group was lower slightly, but it is significant, and risk of pre-eclampsia among individuals having total cholesterol above 205 mg/dl, was 0.2 as compared to those having cholesterol less than 172 mg/dl (95% CI 0.03-0.94). This result is similar to the findings by with Turner and colleague’s study that reported less cholesterol concentration among pre-eclampsia group,6 Studies performed in France and Spain did not have a meaningful difference in cholesterol concentration in both groups,7,16 but the total cholesterol serum concentrations have been cited more in pre-eclampsia group in other studies.3,4,10,11
Comparing our results and those of other studies, it seems the role of hypertriglyce-ridemia and high LDL cholesterol level in pathogenesis of preeclampsia is seen in majority of studies. However, there is controversy as regards total cholesterol concentrations in several studies. As such it is essential to perform more studies in different populations in view of the present limited studies and some controversial findings about the relationship between severity of preeclampsia and plasma lipid concentrations.
Our results have shown early changes in plasma lipid concentrations, which suggest their role in causation and severity of the disease. As such it is considered as a significant etiologic and pathophysiologic factor in this prevalent complication of pregnancy. Plasma lipid profile assay in first trimester of pregnancy is noticeable to predict incidence and severity of preeclampsia.
This study was done with financial support of Deputy of Research of Kurdistan University of Medical Sciences. The authors also appreciate cooperation of the participants in this study.
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