Metabolic Syndrome, Oxidative Stress and Putative Risk Factors amongst Ghanaian Women Presenting with Pregnancy-Induced Hypertension

Pregnancy-Induced Hypertension, one of the commonest complications of pregnancy, is an important cause of maternal and perinatal morbidity and mortality. It is of great concern to obstetricians due to its sudden onset and non availability of a definitive cure. This current study, therefore, seeks to establish the incidence and prevalence rates of PIH among Ghanaian women obtaining antenatal care at the Komfo Anokye Teaching Hospital. It also seeks to determine the probable cause(s) or risk factors of PIH among Ghanaian women; develop appropriate screening modalities for the early detection and management of PIH; and the elucidation of the role of the Metabolic Syndrome as well as oxidative stress in the pathogenesis of PIH. A case-control study was conducted among pregnant women visiting Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana between November, 2006 and December, 2007. Thirty women with preeclampsia, seventy with gestational hypertension and fifty normotensive pregnant women (controls) in the second half of pregnancy were recruited for this study. After ethical approval and informed consent had been obtained, information on socio-demographic characteristics, medical history and previous obstetric history were obtained by face-to-face interviews from the respondents and assessed through medical records. Blood pressure, anthropometric measurements, urine sample for urine protein and blood sample were taken for some biochemical and hormonal analysis. Data was obtained from the Reproductive Health Unit of the hospital for the determination of percentage incidence and prevalence for the year under assessment. An incidence of 5.46, 6.01, and 11.46% for GH, PE and PIH respectively was obtained for 2006. In the year 2007, percentage incidences for the various clinical conditions were, 8.01, 9.03 and 17.04% respectively. The prevalence for the years under review was 5.87, 6.55 and 12.42% correspondingly. Additionally, increased prevalence for all three conditions in the rainy season was observed for the year under review as compared to the dry season. To assess risk factors for hypertensive pregnancy data was obtained from the questionnaire administered to the participants. Age was a significant risk factor for the development of PIH (PE+ GH); both the young and older mothers were at increased risk of the condition. Underweight [OR 7.5; 95%CI 0.4-150.4] and obesity [OR 4.7; 95%CI 1.7-12.7] increased the risk of Pregnancy-Induced Hypertension and the risk was even higher for the development of PE. Women without formal education or those who have attained only basic education were also at risk of developing PIH; intake of alcoholic beverages and high salt consumption increased the risk of developing PIH. Nulliparous women were protected from the risk of developing PE [OR 0.02; 95%CI 0.0-0.4] from this study. Family history of hypertension predisposed women to PIH [OR 5.5; 95%CI 2.0-15.1], GH [OR 10.6; 95%CI 3.6-31.4] and PE as well [OR 6.0; 95%CI 1.8-19.5]. Although, a history of abortion conferred some form of protection against preeclampsia and gestational hypertension, the number required varied in both cases. The use of contraceptives in either the male [OR 5.6; 95%CI 1.2-25.2] and the female [OR 1.7; 95%CI 0.8-3.5] partner similarly increased the risk of PIH. Partner change as well as placental hormonal imbalance (hPL) is also associated with increased risk of the clinical conditions. After assessing lipid peroxidation and oxidative stress among these women, there was a significant increase in triglycerides and LDL-cholesterol in the subject groups compared to the control. MDA, the lipid peroxidation marker among the PIH subjects was significantly increased as compared to the normotensive pregnant women (controls). A significant positive correlation between MDA and blood pressure (SBP and DBP) was also observed. There was a significant increase in the prevalence of the metabolic syndrome among the PIH (PE+GH) subjects as compared to the normotensive pregnant women (controls) using both the National Cholesterol Education Program (NCEPIII) and WHO criteria. From this study, the prevalence of GH, PE and PIH were 5.87, 6.55 and 12.42% respectively and with seasonal variations in their occurrence. The findings of this study suggests that, besides maternal aberrations posing risk factors for PIH, partner and placental roles could also be linked to the aetiology of Pregnancy-Induced Hypertension and these risk factors should be screened for during antenatal visits. This study also clearly indicates that Ghanaian women presenting with PIH are very prone to dyslipidaemia as well as lipid peroxidation, this might in part explain the oxidative stress and endothelial vascular dysfunction observed in these group of women. Ghanaian women presenting with PIH are also extremely prone to the development of the metabolic syndrome, thus the indices must be screened for during antenatal care.

Source: KNUST