Biochemical Markers for Prediction of Hypertensive Disorders of Pregnancy

Abstract

SummaryBackground:Gestational hypertension (GH) and pre eclampsia (PE) are the most common gestational complications. Several placental biochemical markers are used to predict GH/PE, but with conflicting results.Methods:The study aim was to estimate the biochemical markers’ ability to predict hypertensive disorders in pregnancy. On the first ultrasonographic examination, 104 healthy pregnant women were recruited. At the regular pregnancy check-ups, BMI, blood pressure, occurrence of gestational hypertension (early or late onset), preeclampsia, eclampsia and other complications were recorded. Serum concentrations (in multiples of median – MoM) of human chorionic gonadotropin (HCG) and pregnancyassociated plasma protein A (PAPPA) were measured from the 11th to 14th gestational week, while HCG, alpha feto protein (AFP), estriol and inhibin were determined between the 16th and 19th gestational week.Results:Hypertensive disorders throughout pregnancy were diagnosed in 20.2% women. Early-onset GH was registered in 7 and PE in 6 patients, while 14 had late-onset GH and 10 additional women PE. There were no significant differences (p≥0.05) in biochemical markers concentrations between women with and without GH/PE. PAPPA levels in the first and HCG in the second trimester correlated with early and late GH/PE. Moreover, higher AFP concentrations were registered in women with preeclampsia signs/symptoms. According to ROC analysis, AFP>1.05 MoM properly identified 80% of GH/PE cases. Obtained models imply that HCG, PAPPA and AFP should be used for GH/PE prediction.Conclusions:Biochemical markers HCG, PAPPA and AFP could be useful in predicting gestational hypertension and preeclampsia. However, different markers should be used for early and late onset GH/PE.

Evaluation of total LDH and its isoenzymes as markers in preeclampsia

“…The most plausible explanations of the pathogenesis of preeclampsia focus on the placenta (7). The initial event of placentation involves the formation of the non-invasive trophoblastic shell, which progresses into an invasive phenotype, causing an exponential rise in the entry of oxygenated maternal blood into the intervillous space (11). The opening of intervillous space and the consequent increase in PO 2 , reduces HIF-1 alpha expression, augmenting trophoblastic differentiation along the invasive pathway (11).…”

“…The initial event of placentation involves the formation of the non-invasive trophoblastic shell, which progresses into an invasive phenotype, causing an exponential rise in the entry of oxygenated maternal blood into the intervillous space (11). The opening of intervillous space and the consequent increase in PO 2 , reduces HIF-1 alpha expression, augmenting trophoblastic differentiation along the invasive pathway (11). Preeclampsia progresses through a proposed twostage model that includes poorly perfused placentation (Stage 1) arresting trophoblastic invasion, increasing vascular resistance and subsequent nutrient deprivation which modifies maternal metabolism to increase nutrient availability; inability to tolerate this modification leads to the clinical manifestations of preeclampsia (Stage 2) (12).…”

“…Preeclampsia is characterised by disturbed trophoblastic migration of maternal spiral arteries leading to increased uteroplacental vascular resistance and dysfunction, resulting in reduced intervillous blood flow, oxygen and nutrient deprivation to the foetus (10,11). The central mechanism of preeclampsia revolves around placental under perfusion, associated hypoxia and cellular death, emphasizing the pivotal role of lactate dehydrogenase (LDH: an intracellular cytoplasmic enzyme of glucose metabolism, a key indicator of anaerobiosis and cell death) in the pathophysiology of preeclampsia.…”

Influence of selenium supplementation on carbohydrate metabolism and oxidative stress in pregnant women with gestational diabetes mellitus

“…The hypoglycemic power of Se and its ability to delay diabetes complications are thus exalted during type II diabetes, but exclusively in deficient or sub-deficient people in this micronutrient (22). However, a French study reported that the anti-diabetogenic properties of Se occur only in men and reduce the risk that they develop type II diabetes to 50% (23). The beneficial effect of this micronutrient supplementation (200 mg/d for 06 weeks) in the reduction of exacerbated state of insulin resistance has been proven in other diseases such as polycystic ovary syndrome (24) and central obesity (25).…”

“…The beneficial effect of this micronutrient supplementation (200 mg/d for 06 weeks) in the reduction of exacerbated state of insulin resistance has been proven in other diseases such as polycystic ovary syndrome (24) and central obesity (25). In contrast, other studies have advised against the use of Se supplementation, considering it as a promoting factor of type II diabetes in healthy women (23) and mice (8), which leads to the worsening of sugar metabolism disorders (24), especially in the Caucasian race (12), and in seleniferous zones (9). Se is a trace element involved in the regulation of energy metabolism at several levels (11).…”