SERUM LIPID LEVELS IN EARLY SECOND TRIMESTER OF PREGNANCY AS A PREDICTOR OF PRE-ECLAMPSIA AT IRRUA SPECIALIST TEACHING HOSPITAL, IRRUA, EDO STATE
Pre-clampsia is a leading cause of maternal and fetal/neonatal morbidity and mortality worldwide. The early identification of patients with an increased risk for pre-eclampsia is one of the most important goals in obstetrics. Attempts have been made to evaluate various markers to predict pre-eclampsia, however none have been found reliable. Hence the quest for new reliable markers as predictors. The availability of highly sensitive and specific physiologic and biochemical makers would allow not only detection of patients at risk but also permit a close surveillance, an exact diagnosis, as well as simplified recruitment for future studies looking at therapeutic medications and additional prospective markers. Today, several markers may offer the potential advantage to be used, either singly or preferably in combination analysis as predictors, or diagnostic tools.
Serum lipid is chosen in this study in early second trimester of pregnancy as a predictive tool for the occurrence of pre-eclampsia
The study aimed at testing the hypothesis that women with abnormal serum lipid profile in early second trimester (14-20 weeks) have increased risk of developing pre-eclampsia.
Serum lipid was evaluated among 170 pregnant women between 14 and 20 weeks of pregnancy, who attended antenatal clinic at Irrua Specialist Teaching Hospital (ISTH). This was done by Enzymatic colorimetric test and lipid clearing factor (LCF) in, and was correlated with the risk of pre-eclampsia/pregnancy-induced hypertension in the course of pregnancy.
Out of the 170 pregnant women who completed the study, 18(10.6%) women subsequently developed pre-eclampsia(PE) while 20(11.8%) had pregnancy-induced hypertension(PIH). The remaining 132(77.6%) participants remained normotensive. Coincidentally, 18 participants had abnormal lipid (at 14-20weeks). Fourteen (14) out of the eighteen (77.8%) participants with dyslipidaemia had PE, 3(16.7%) had PIH and 1(5.5%) normotensive. The serum levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein(LDL) and very low density lipoprotein(VLDL) in women who subsequently developed PE/PIH were significantly increased compared to the normal group (p<0.0001). While the serum levels of high density lipoprotein (HDL) were significantly reduced in participants who developed PE/PIH compared to the normal group (p<0.0001). The mean values for TC, TG, LDL and VLDL were significantly increased in PE/PIH groups than the normal group, while the mean values for HDL were significantly reduced in PE/PIH groups than the normal group. The percentage detection of PE/PIH using serum lipid was 44.7%, while the percentage detection of only PE using serum lipid was 77.8%. However, very low density lipoprotein (VLDL) is the most accurate predictor of pre- eclampsia and PIH at serum level of 25.5mg/dl with AUC curve of 0.885.
The study shows that abnormal lipid levels (especially VLDL) in early second trimester can be considered as a good predictor of pre-eclampsia. Therefore, screening of antenatal pregnant women in the obstetric population (especially the high-risk patients ) will aid early detection of at-risk patients, and subsequent management of pre-eclamptic patients in order to have good foeto-maternal outcomes.