Multiple markers for predicting preeclampsia in women with priori high risk.

ABSTRACT Background: Preeclampsia (PE) is a medical condition which arises in pregnancy and it is associated with high blood pressure and a concomitant significantly raised levels of proteinuria. It is a multi-organ system disease of pregnancy with unknown etiology. It is a maternal syndrome, characterized by high blood pressure, abnormal clotting, proteinuria and edema. PE negatively impacts on the renal system and other organs due to the release of some toxic factors from the placenta. The current study, sought to investigate the accuracy, sensitivity, specificity, reproducibility and cost effectiveness of multiple markers for the prediction of preeclampsia in women at high risk of developing Preeclampsia. Methods: A case - control study comprising of two hundred primigravidae, singleton and second trimester pregnant women with preeclampsia (case) age-matched with two hundred normotensive pregnant women in the same trimester (controls), were recruited from the Obstetrics and Gynaecology Departments of the Komfo Anokye Teaching Hospital, Kumasi and Ridge Regional Hospital, Accra, all in Ghana, between January and December, 2016. After ethical approval and informed consent were obtained, information on socio-demographic characteristics, medical history, booking visit and previous obstetric history were obtained by face-to-face interviews from the respondents and assessed through medical records. Blood pressure, anthropometric measurements, urine protein and micro albuminuria were measured and blood samples taken for magnesium, calcium, Hemoglobin, human chorionic gonadotropin, prolactin and Progesterone measurements. Results: The mean serum calcium and magnesium levels were significantly lower in the case group than the controls (1.53 ± 0.90, 2.36 ± 0.17) and (0.56 ± 0.08, 0.88 ± 0.08) respectively (p <0.001). The mean systolic, diastolic blood pressure, gestation at booking, microalbuminuria and BMI were significantly higher in the case group than the control (p <0.001). However, the mean hemoglobin (Hb) was significantly lower among the cases (10.01 ± 0.73) than the controls (13.76 ± 0.80) (p <0.001). There was no significant difference amongst the serum levels of progesterone, prolactin and β-hCG between the cases and the controls (p = 0.730, 0.903 and 0.930 respectively). Greater proportion of the studied participants were within the (26 – 35) years age range. Most of the cases had informal education. Prevalence of hypocalcaemia, hypomagnesaemia and anaemia were (51.75%), (50.0%) and (42.5%) respectively. Conclusion: The findings of this study have shown the clinical importance of early commencement of antenatal care (ANC). Early ANC ensures the screening begins early to identify women who are at risk of this condition and start treatment before it threatens the survival of both the mother and fetus. The results of this study have also shown that hormones such as BhCG, Prolactin and Progesterone are not good markers for screening pregnant women in the second trimester for preeclampsia. This study shows a significant reduction of serum calcium and magnesium levels in the women who had preeclampsia compared to the normotensives. This supports the hypothesis that hypocalcemia and hypomagnesaemia play a very significant role in the etiology of preeclampsia. Calcium and magnesium supplementation are needed in the prevention of preeclampsia especially in a developing country like Ghana. Furthermore, the results of this study shows that microalbuminuria plays an important role in the etiology of preeclampsia as all the pregnant women with PE have high levels of microalbuminuria.

Source: KNUST