The role of lipid profile as an early indicator of preeclampsia

Jeevika Gupta; Monica Soni; Harsha Charaya; Asmita Nayak

doi:10.4103/jcrsm.jcrsm_35_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 8 | Issue : 2 | Page : 162-167

The role of lipid profile as an early indicator of preeclampsia

Jeevika Gupta, Monica Soni, Harsha Charaya, Asmita Nayak
Department of Obstetrics and Gynaecology, Sardar Patel Medical College, Bikaner, Rajasthan, India

Date of Submission	04-May-2022
Date of Decision	15-Sep-2022
Date of Acceptance	19-Sep-2022
Date of Web Publication	23-Dec-2022

Correspondence Address:
Jeevika Gupta
H. No. 93, C Block, Sirsa, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcrsm.jcrsm_35_22

Abstract

Background: Preeclampsia is called the “disease of theories” because its direct cause is still debated. Among all maternal deaths worldwide, 19% of deaths are due to hypertension during pregnancy (World Health Organization 2014). Early diagnosis and management remain the cornerstone in the management of preeclampsia. Estimation of serum lipid profile early in pregnancy could help to identify high-risk cases prone to preeclampsia, thereby reducing morbidity and mortality associated with preeclampsia. The study aimed to determine the role of serum lipid profile in the early prediction of preeclampsia.
Methodology: This was a hospital-based prospective study done among pregnant women with a period of gestation of 20 ± 1 week enrolled after screening for inclusion and exclusion criteria and informed consent and institutional ethical committee approval, samples for lipid profile were taken. Patients were divided into two groups (100 each) based on lipid profile – Group A: normal lipid profile and Group B: abnormal lipid profile. Both groups were followed and closely observed for the development of hypertension, albuminuria, and signs and symptoms of preeclampsia. Data were collected and systematically analyzed.
Results: In Group A, eight participants developed preeclampsia, whereas in Group B, 27 participants developed preeclampsia during the study period. The difference was found statistically significant (P = 0.003).
Conclusion: In our study, it was observed that dyslipidemia in pregnancy is positively associated with an increased risk of preeclampsia.

Keywords: Dyslipidemia, lipid profile, preeclampsia

How to cite this article:
Gupta J, Soni M, Charaya H, Nayak A. The role of lipid profile as an early indicator of preeclampsia. J Curr Res Sci Med 2022;8:162-7

How to cite this URL:
Gupta J, Soni M, Charaya H, Nayak A. The role of lipid profile as an early indicator of preeclampsia. J Curr Res Sci Med [serial online] 2022 [cited 2023 Mar 20];8:162-7. Available from: https://www.jcrsmed.org/text.asp?2022/8/2/162/364497

Introduction

Pregnancy is marked by major physiological and metabolic changes to support the nutritional and metabolic needs of the growing conceptus. Metabolically important dynamic adjustment occurs including insulin resistance, hyperlipidemia, and changes in protein amino acid metabolism. The increase in plasma lipid level seen in normal pregnancy is physiologic and under hormonal control. Henceforth, it is not atherogenic.^[1],[2] When this mechanism of physiologic hyperlipidemia is altered, it leads to complications in pregnancy most remarkably preeclampsia.^{[3],[4],[5],[6]}

Early pregnancy dyslipidemia is associated with an increased risk of preeclampsia.^[7] Women with preeclampsia have significant differences in serum lipid parameters and increased susceptibility to lipoprotein oxidation when compared with women who have normal pregnancies. Disorders of lipoprotein metabolism are reported to be a major cause of hypertension and proteinuria in preeclampsia.^[8]

Preeclampsia is still called the “disease of theories” because its direct cause is still debated. Among all maternal deaths worldwide, 19% of deaths are due to hypertension in pregnancy (World Health Organization (2014).^[9] Together with hemorrhage and infection, it forms a deadly triad that contributes significantly to maternal morbidity and mortality rates. Since prevention is better than cure, therefore, various biological markers implicated in preeclampsia syndrome have been evaluated for primary prevention and early diagnosis of preeclampsia to identify and effectively treat this potentially unpredictable and fatal condition. These include biochemical markers such as human chorionic gonadotropin, alpha-fetoprotein, pregnancy associated plasma protien-A (PAPP-A), placental protein 13, kisspeptin, serum uric acid, atrial natriuretic peptide, various endothelial factors, and placental blood flow scans like Doppler velocimetry. However, currently, no single screening test for preeclampsia is predictable, reliable, valid, and economical. Due to the above discussion, the present study was planned to study the role of altered lipid profiles in the early prediction of preeclampsia. The objective of the present study was to determine the role of serum lipid profile in the early prediction of preeclampsia.

Materials and Methods

This was a hospital-based observational study conducted on pregnant women registered from July 2020 to June 2021. With a period of gestation of 20 ± 1 weeks attending antenatal clinic in the department of obstetrics and gynecology, at a tertiary care hospital after approval of the departmental and Institutional Ethical Committee 29 (Acad) SPMC/2020/298 and written informed consent of participants. Those with chronic hypertension, hypertension before 20 weeks of gestation, preexisting diabetes, ischemic heart disease, renal disease, liver disease, thyroid disease, known history of any peripheral vascular disease, multiple pregnancies, and ultrasound proved congenital malformations, smoking, or any drug addiction and treatment with drugs that may affect lipid profile were excluded from the study. A general physical examination was done and vital parameters were taken. Arterial blood pressure (BP) was measured by auscultatory method with a mercury sphygmomanometer in a sitting position by placing a cuff on the right arm. Body mass index (BMI) was also calculated. The obstetrical examination was done, and a venous blood sample of participants was taken after 12–14 h of overnight fasting, centrifuged within 2 h, and refrigerated at − 10°C for lipid profile (high-density lipoprotein [HDL], total cholesterol [TC], triglycerides [TGs], very low-density lipoproteins [VLDLs], and low-density lipoprotein [LDL]).

Definition of preeclampsia

It is a multisystem inflammatory disorder beyond 20 weeks of pregnancy with significant proteinuria characterized by de novo onset of hypertension (BP ≥140/90 mmHg). More recently, an atypical variant of preeclampsia is recognized which is accompanied by neurological, hematological, hepatic, renal manifestations, or fetal growth restriction, in the absence of proteinuria.^[10]

Normal lipid profile values were considered when LDL ranged between 70 and 200 mg/dl, TG 86 and 284 mg/dl, VLDL 12 and 46 mg/dl, TC 128 and 280 mg/dl, and HDL 27 and 66 mg/dl. Dyslipidemia was considered when ≥3/5 parameters were deranged.

Patients were divided into two groups based on lipid profile – Group A: normal lipid profile and Group B: abnormal lipid profile. One hundred cases were enlisted in each group making a total of 200 participants. Both groups were followed and closely observed for the development of hypertension, albuminuria, signs and symptoms of preeclampsia, maternal and fetal complications, and mode of delivery. Data were collected and systematically analyzed.

Results

The majority of the participants were 21–25 years of age in Group A (58%) and Group B (51%), whereas the minimum was of 31–35 years of age in Group A (4%) and Group B (2%). In Group A, 51% were rural and 61% were literate, whereas in Group B, 36% were rural and 71% were literate. According to B G Prasad's classification, the majority of the participants were in category V in Group A (55%) and Group B (49%). Sixty percent of the participants in Group A were multigravida and 40% were primigravida, and in Group B, 59% were multigravida and 41% were primigravida. The majority of the participants were of BMI 18.5–24.9 kg/m² in Group A (68%) and Group B (70%). The two groups were comparable concerning socio-demographic status (P > 0.05).

In Group A, women with normal lipid profiles were recruited. The mean value of LDLs was (122.61 ± 28.29 mg/dl), TGs (157.25 ± 42.15 mg/dl), VLDLs (24.16 ± 7.72 mg/dl), TC (195.94 ± 37.34 mg/dl), and HDLs (44.46 ± 8.45 mg/dl). In Group B, women with dyslipidemia (≥3/5 parameters deranged) were enrolled. The mean value of LDL was (163.56 ± 25.78 mg/dl), TG (230.38 ± 30.43 mg/dl), VLDL (50.91 ± 10.58 mg/dl) TC (264.13 ± 25.67 mg/dl), and HDL (43.99 ± 7.32 mg/dl). The two groups had a statistically significant difference in lipid profile except in HDL. The participants were followed to study the development of preeclampsia in women in both groups [Table 1].

Table 1: Baseline parameters of the study participants

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In our study, the mean systolic BP in Group A at 26 weeks period of gestation was 104.68 ± 5.40 and 104.61 ± 5.68 in Group B, and the difference in both groups was statistically insignificant. On subsequent follow-up, the mean systolic BP increased in both groups. The rise in BP was higher in Group B. The difference was statistically insignificant at 34 weeks but statistically significant at 36, 38, and 40 weeks follow-up [Figure 1]. The mean diastolic BP in Group A was 70.5 ± 2.89 and 70.6 ± 2.76 in Group B at 26 weeks, and the difference in both groups was statistically insignificant. On subsequent follow-up, the mean diastolic BP increased in both groups. The rise was higher in Group B and the difference in both groups was statistically significant at 36 (P = 0.003) and 38 weeks (P = 0.003) [Figure 1].

Figure 1: Distribution of participants according to their mean systolic and diastolic BP. BP: Blood pressure

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In Group A, seven participants had urine albumin positive during the study period, three had +1, and four had +2 category albuminuria (one at 34 weeks and six at 38 weeks). In Group B, a total of 23 participants had urine albumin positive. Out of these, nine had albuminuria in the +1 category and 14 had albuminuria in the +2 category (two diagnosed at 34 weeks, three at 36 weeks, 17 at 38 weeks, and one at 40 weeks). The incidence of albuminuria was higher in Group B. The difference between the two groups was statistically significant (P = 0.004).

In Group A, eight participants developed signs and/or symptoms of preeclampsia. In Group B, a total of 27 had shown signs and/or symptoms of preeclampsia. Out of them, two at 34 weeks, three at 36 weeks, 21 at 38 weeks, and one at 40 weeks showed signs and symptoms of preeclampsia. The incidence of signs and/or symptoms of preeclampsia was higher in Group B with a statistically significant value of P (P = 0.003) [Table 2].

Table 2: Distribution of participants according to their urine albumin and signs and symptoms of preeclampsia

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In Group A, eight participants developed preeclampsia, whereas in Group B, 27 participants developed preeclampsia during the study period. The difference was found statistically significant (P = 0.003) [Table 3] and [Figure 2].

Table 3: Distribution of participants according to the incidence of preeclampsia

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Figure 2: Distribution of participants according to the incidence of preeclampsia

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Eighty-four participants delivered vaginally in Group A and 16 underwent LSCS. In Group B, 82 participants delivered vaginally and 18 underwent LSCS. The difference between the two groups was statistically insignificant (P = 0.851). The incidence of intra uterine foetal death (IUFD) and preterm deliveries were also comparable between the two groups (P = 0.576).

Discussion

This was a hospital-based prospective study. It comprised 200 women enrolled after fulfilling the inclusion and exclusion criteria and written consent. Pregnant women with a period of gestation of 20 ± 1 weeks attending the antenatal clinic of obstetrics and gynecology department of a tertiary care hospital were screened for enrollment. Women with normal lipid profiles were enrolled in Group A and those with dyslipidemia in Group B.

The majority of the participants were 21–25 years of age in Group A (58%) and Group B (51%), whereas the minimum was of 31–35 years of age in Group A (4%) and Group B (2%). The mean age in Group A was 24.57 ± 3.26 years, and in Group B, it was 24.02 ± 3.23 years with an age range from 18 to 35 years. The two groups were comparable concerning age distribution. Whereas Mahmood et al.^[12] in their study on 102 women found that the mean age was 31.5 ± 4.2 years and the mean gestational age was 33.3 ± 6.2 weeks.

Sixty percent of participants in Group A were multigravida and 40% were primigravida, whereas in Group B, 59% were multigravida and 41% were primigravida, and the difference was found statistically insignificant (P = 1.000). Due to less awareness and low acceptability of family planning services in our state, a significant number of patients were multigravida but comparable groups rule out the possibility of parity confounding the results.

The majority of the participants were of BMI 18.5–24.9 kg/m² in Group A (68%) and Group B (70%), whereas the minimum was 25.0–29.9 kg/m2 in Group A (12%) and Group B (12%). The mean BMI was 23.57 ± 4.48 kg/m² in Group A and 23.32 ± 3.68 in Group B. The difference between the two groups concerning BMI was found statistically insignificant. Other studies like Rajesh et al.^[11] have also used BMI comparable groups to evaluate the relationship between serum lipid concentrations and risk of preeclampsia.

In Group A, women with normal lipid profiles were recruited. It was observed that LDL values ranged between 70 and 200 mg/dl with mean value of 122.61 ± 28.29 mg/dl, TG values ranged between 86 and 284 mg/dl with mean value of 157.25 ± 42.15 mg/dl, VLDL values ranged between 12 and 46 mg/dl with mean value of 24.16 ± 7.72 mg/dl, TC values ranged between 128 and 280 mg/dl with mean value of 195.94 ± 37.34 mg/dl, and HDL values ranged between 27 and 66 mg/dl with mean value of 44.46 ± 8.45 mg/dl. In Group B, women with dyslipidemia (≥3/5 parameters deranged) were recruited. It was observed that LDL values ranged between 115 and 281 mg/dl with mean value of 163.56 ± 25.78 mg/dl, TG values ranged between 138 and 295 mg/dl with mean value of 230.38 ± 30.43 mg/dl, VLDL values ranged between 23 and 71 mg/dl with mean value of 50.91 ± 10.58 mg/dl, TC values ranged between 180 and 385 mg/dl with mean value of 264.13 ± 25.67 mg/dl, and HDL values ranged between 30 and 72 mg/dl with mean value of 43.99 ± 7.32 mg/dl. The two groups had a statistically significant difference in lipid profile except in HDL. Women in Group B had significantly higher levels of LDL, VLDL, TGs, and TC as compared to women in Group A. Similarly, Tesfa et al.^[13] found that the mean values of TG, TC, LDL-cholesterol, and VLDL-cholesterol were significantly higher in preeclamptic women as compared with normotensive pregnant women (TG = 229.61 ± 88.27 vs. 147.00 ± 40.47, TC = 221.46 ± 45.90 vs. 189.67 ± 39.18, LDL = 133.92 ± 38.77 vs. 112.41 ± 36.08, and VLDL = 41.44 ± 19.68 vs. 26.64 ± 7.87, respectively). The serum HDL cholesterol level was lower, but it was not statistically significant (HDL = 51.02 ± 16.01 vs. 61.80 ± 25.63) in preeclamptic women as compared with controls. Furthermore, Nidhi et al.^[14] conducted a longitudinal, descriptive type of observational study on 125 patients at Jaipur and found that the mean level of TC in participants who developed preeclampsia was 224.36 ± 43.68 mg/dl. This was significantly higher as compared to the normotensive group 180.77 ± 36.58 mg/dl. Furthermore, Aljaffar^[15] found that TG and VLDL were significantly increased, whereas HDL was significantly decreased in preeclamptic compared to normal pregnant women.

In our study, we observed that the mean systolic BP in Group A at 26 weeks period of gestation was 104.68 ± 5.40 mmHg and 104.61 ± 5.68 mmHg in Group B. The difference between the two groups was statistically insignificant. On subsequent follow-up, the mean systolic BP increased in both groups. The rise in BP was higher in Group B. The difference was statistically insignificant at 34 weeks but statistically significant at 36, 38, and 40 weeks follow-up. The mean diastolic BP in Group A was 70.5 ± 2.89 mmHg and 70.6 ± 2.76 mmHg in Group B at 26 weeks and the difference was statistically insignificant. On subsequent follow-up, the mean diastolic BP increased in both groups. The rise was higher in Group B and the difference in both groups was statistically significant at 36 (P = 0.003) and 38 weeks (P = 0.003). Rajesh et al.^[11] also reported a significant difference in the rise in blood pressure on follow-up visits. Maria et al.^[16] also found that deranged serum lipid profiles, especially TGs were positively associated with the rise in blood pressure in pregnancy.

In Group A, seven participants had urine albumin positive during the study period, three had +1, and four had +2 category albuminuria (one at 34 weeks and six at 38 weeks). In Group B, a total of 23 participants had urine albumin positive. Out of these, nine had albuminuria in the +1 category and 14 had albuminuria in the +2 category (two diagnosed at 34 weeks, three at 36 weeks, 17 at 38 weeks, and one at 40 weeks). The incidence of albuminuria was higher in Group B. The difference in both groups was statistically significant (P = 0.004). Various studies have reported an association between second-trimester hyperlipidemia and the development of albuminuria in the third trimester.

In our study, eight participants in Group A showed clinical features of preeclampsia during the study period. In Group B, a total of 27 had shown signs and/or symptoms of preeclampsia during the study period. Out of them, two at 34 weeks, three at 36 weeks, 21 at 38 weeks, and one at 40 weeks showed the clinical features of preeclampsia. The incidence of signs or symptoms of preeclampsia was higher in Group B with a statistically significant value of P (P = 0.003).

In Group A, eight participants developed preeclampsia, whereas in Group B, 27 participants developed preeclampsia during the study period. The difference was found statistically significant (P = 0.003). In a study conducted by Rajesh et al.,^[11] 12 out of a total of 90 participants developed preeclampsia, whereas 69 remained normotensive. They concluded that women with high levels of serum LDL and TC at early gestation developed preeclampsia later. They also emphasized that oxidative stress caused due to deranged serum lipid profile may be a potential contributor to vascular dysfunction leading to the development of preeclampsia. Many studies also concluded that TG, TC, VLDL, and LDL values for those women who developed preeclampsia were significantly higher than those who were normotensive till term.^{[17],[18],[19]} Tesfa et al.^[13] found that the maternal serum levels of TG, TC, LDL, and VLDL were significantly associated with the risk of preeclampsia.

Limitations

This was a hospital-based study that represents a smaller number of pregnant women in the community. A large sample size and community-based study can give better results.

Conclusion

In our study, it was observed that dyslipidemia in early pregnancy is positively associated with an increased risk of preeclampsia. We concluded that second-trimester dyslipidemia can be used as an early indicator of preeclampsia. Further larger studies that allow for causal inference are needed to confirm the etiological role of blood lipids in preeclampsia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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