Abstract:
This cross sectional study was conducted on the pregnant women attending the
Gynecology and Obstetrics Department of tertiary care hospitals of Peshawar,
North West Frontier Province (NWFP) Pakistan. A total of 402 pregnant women
at gestational age of > 20 weeks were registered in the study after taking their
informed consent. The study subjects were divided into four groups of pregnant
women; with three patient groups (A, B, C) of Pregnancy Induced Hypertension
(PIH) and one control group (D).
History of each participant was recorded on a pre designed questionnaire. Height,
weight and blood pressure was measured and 5 ml of venous blood was drawn
from patients and control groups. Biochemical analysis of lipoprotein included
Total Cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low
Density Lipoprotein Cholesterol (LDL-C), Very Low Density Lipoprotein
Cholesterol (VLDL-C), Triglycerides (TG), Apolipoprotein-A1 (APO-A1),
Apolipoprotein- B100 (100), Lipoprotein-a (LPA) and hematological parameters
including Hemoglobin (Hb) and Platelet count. These investigations were
performed in PMRC Research Centre, Khyber Medical College, Peshawar and in
the Pathology labs of Post Graduate Medical Institute (PGMI) Lady Reading
Hospital, Peshawar. The data was processed on computer software package SPSS
version 10.
Statistically highly significant (P < 0.001) differences were noted in most of
maternal serum lipids and lipoprotein concentrations in the three individual patient
groups when compared with the control pregnant women, except changes in LDL-
C (P > 0.05). Changes in the TC were non significant in group A and B, while
difference in group C were significant (P < 0.05) when compared with the control
group D. Similarly was non significant (P > 0.05), markedly significant (P <
0.01) and highly significant (P <0.001) in group A, B & C respectively when
compared with group D. Mean concentrations of 100 were non significant in
group B, while it was significant (P < 0.05) in group A and C when compared
with group D. Changes in the mean values of LPA were non significant in group
A and B, while it was highly significant (P < 0.001) in group C as compared to
iiicontrol group D. Amongst the different lipoprotein ratio TC: HDL-C, LDL-C:
HDL-C, TG: HDL-C and HDL-C: VLDL-C ratio were found highly significant (P
< 0.001) in patient groups of A, B and C, as compared with group D. Women who
developed hypertension (group A+B+C) had 5.45%, 3.5%, 39%, 38.6% and
26.98% higher concentrations of TC, LDL-C, VLDL-C, TG and LPA levels
respectively, than control subjects. A significant decrease of (16.76%) and
(18.5%) was respectively noted in HDL-C and APO-A1 of patient group when
compared with control pregnant women, while no significant change in 100 levels
was seen among the groups. TC: HDL ratios, LDL-C: HDL-C ratio and TG:
HDL-C ratios were higher (32.3%, 29.8% & 66.4% respectively) among women
with PIH and were found highly significant (P<0.001) as compared to
normotensive women. In the PIH group LDL-C: 100 was raised to the marked
significant level of P < 0.01, while the difference between the two groups of test
and control was found non significant for LDL-C: 100 ratio (P > 0.05). HDL-C:
VLDL-C ratio were decreased by 38.23% in the patients and were highly
significant as compared with control subjects (P <0.001).
A significant difference was found in maternal TG levels, VLDL-C, TC: HDL-C,
TG: HDL-C and HDL-C: VLDL-C ratio, when the PIH group of patients with
systolic blood pressure (SBP) < and > 150 mmHg were compared. Similarly PIH
patients had significantly elevated serum HDL-C, VLDL-C, TG, TC: HDL-C, TG:
HDL-C, HDL-C: VLDL-C and LDL-C: 100 ratio when patients with diastolic
blood pressure (DBP) < 110 were compared with DBP > 110 mmHg.
Undesirable TC > 240 mg/dl in 35.8% patients, undesirable HDL-C in 50%
patients, high concentrations of TG (73.2%), borderline high concentration of
LDL-C (23.6%), undesirable TC ratio > 5.2 in 52.3% and undesirable LDL-C
ratio > 1.6 were noted all in the patients of eclampsia group ‘C’.
A 1.5-fold increase in the risk of PIH among women with TC >240 mg/dl was
noted, as compared with women whose TC concentration was < 200 mg/dl (95%
CI (0.80-2.75) χ 2 1.81, P 0.17). Women in the lowest group of HDL-C
concentration, experienced an 8.6-fold increased risk of PIH as compared with
women in the highest group (95% CI (3.28-22.71) χ 2 27.9, P <0.0001) as referent.
The women having LDL-C in the range of 130-159 mg/dl experienced a 1.5-fold
ivincreased risk of PIH as compared with women in the lowest group (95% CI
(0.67-3.40). Women in the TG concentrations (200-499 mg/dl) experienced a 3.5-
fold increased risk of PIH as compared with those women in the lowest group as
referent (95% CI (1.50 to 8.22) χ 2 10.82, P < 0.001). The risk of PIH increased
4.5 times for HDL-C ratio > 5.1 (95% CI (2.-8.87) χ 2 24.39, P < 0.0001). Women
with the highest LDL-C: HDL-C ratio experienced an almost 2.4-fold increased
risk of PIH (OR 2.43, 95% CI 1.18 to 4.98, χ 2 7.09, P 0.007) as compared with
women whose ratio values were <1.21 (lower group).
A significant change was seen in the concentration of HDL-C (P < 0.01), VLDL-
C (P < 0.05), triglycerides (P < 0.05), 100 (P < 0.05) and LPA (P < 0.05), when
PIH women in the second trimester were compared with those in their third
trimester. Significant changes were observed in the systolic (P< 0.05) and DBP (P
< 0.01) of PIH women, when 2 nd trimester was compared with the 3 rd trimester.
In the patient group 85.6% pregnant women were anemic as compared to 84.5%
in the control group. Majority of women with severe anemia (Hb < 7.7 g %) were
present in the three patient groups as compared to the normal pregnant women.
Normal platelet count > 150 thousand/μL was recorded in 85 (95.5%) of control
pregnant women against 70 (78.3%) in the group of PIH. The number of women
with severe thrombocytopenia (platelet count < 100 thousand/μL) were more in
group C of eclampsia (13.6%) versus 1.1% in the control women.
In conclusion, the results of our study propose that an abnormal lipid metabolism
and predominantly low HDL-C and high TG concentrations, may add to the
promotion of vascular dysfunction and oxidative stress seen in pregnancy induced
hypertension. It is, therefore, essential that, blood lipid concentrations be
estimated in pregnant women during antenatal care since it could be useful in the
early revealing and prevention of obstetric complications such as pregnancy
induced hypertension.