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 Table of Contents  
REVIEW ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 31-34

A Study on Pathophysiology, Diagnostic and Treatment Procedures for Preeclampsia Syndrome


1 Department of Medical Sciences, Young Researchers and Elites Club, Qom Branch, Islamic Azad University, Qom, Iran
2 Chronic Diseases Care Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Golestan BLv Ahvaz, Iran
3 Health Policy and Promotion Research Center, Qom University of Medical Sciences, Qom, Iran

Date of Web Publication22-Sep-2015

Correspondence Address:
Dr. Siamak Mohebi
Health Policy and Promotion Research Center, Qom University of Medical Sciences, Qom
Iran
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Source of Support: None, Conflict of Interest: None


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  Abstract 

Preeclampsia falls under a top priority pursued by the World Health Organisation. Despite several decades of extensive research into its aetiology, this disease has remained unknown. It seems that more than one pathophysiological factor contributes to increased blood pressure. With regard to the importance of preeclampsia, researchers have attempted to examine the hypotheses concerning the pathophysiology of the disease so as to obtain a broad approach to causes, possible treatments and early diagnosis. This study is based on the literature review relying on a total of 61 papers retrieved from several information banks and academic search engines, including, PubMed, Proquest, Elsevier and Scopus. These papers were selected through a number of designs such as cross-sectional, cohort, clinical trial and systematic review. Furthermore, the Persian papers were selected from databases such as Iranmedex and Medlib, as well as article search, on local web-based scientific journals. The investigation revealed that zinc plays a key role in prevention from preeclampsia. On the other hand, preeclampsia can be diagnosed, and potential risks can be evaluated based on measurements made during periods sooner than the third trimester. Moreover, preeclampsia can be treated by prescribing vitamin supplements and modification of diet. Furthermore, the additional supply of calcium has been useful in the treatment of preeclampsia in some areas, while it might be ineffective in some others. Finally, it can be argued that higher beta-human chorionic gonadotropin can indicate the severity of the disease, but it is of little value in early diagnosis of the medical condition. Having examined the studies done so far, it was found out that there are numerous parameters for early diagnosis and treatment of preeclampsia, even though they are far from comprehensive. These methods seem to be responding differently in every region. Therefore, it is recommended that such parameters be evaluated in various regions so as to pinpoint their effects.

Keywords: Nitrite, preeclampsia, preeclampsia parameters, zinc


How to cite this article:
Zadeh Baeis MG, MiladiNia M, Baraz S, Mohebi S. A Study on Pathophysiology, Diagnostic and Treatment Procedures for Preeclampsia Syndrome. J Hum Health 2015;1:31-4

How to cite this URL:
Zadeh Baeis MG, MiladiNia M, Baraz S, Mohebi S. A Study on Pathophysiology, Diagnostic and Treatment Procedures for Preeclampsia Syndrome. J Hum Health [serial online] 2015 [cited 2019 Sep 16];1:31-4. Available from: http://www.jhhjournal.org/text.asp?2015/1/2/31/165909


  Introduction Top


The complications of pregnancy and childbirth every year lead to a great number of deaths in woman with gestational hypertension or preeclampsia.[1] One of the issues concerning pregnant women and obstetricians is the incidence of preeclampsia. As a common disorder affecting 5–8% of pregnancies with complication, preeclampsia costs 5000 lives annually in women around the world.[2] This syndrome is the second leading cause of maternal mortality worldwide right after vaginal bleeding.[3],[4] In developed countries, up to 25% of all prenatal deaths occur due to high blood pressure.[5]

Preeclampsia is recognised as one of the major factors contributing to preterm delivery, intrauterine growth retardation, early placental abruption, prenatal asphyxia and maternal mortality worldwide.[6],[7],[8] This condition is observed in women experiencing theirfirst pregnancy.[5] The classic clinical protests entail blood pressure >140.90 after the 20th week of pregnancy (no previous history of hypertension), together with more than 300 mg of protein excretion in a 24-h urinary. Preeclampsia falls under a top priority pursued by the World Health Organisation. Despite several decades of extensive research into its aetiology, this disease has remained unknown. It seems that more than one pathophysiological factor contributes to increased blood pressure.[6]

Preeclampsia is clinically obvious when the pathophysiology of the condition is approaching its final stages. Hence, it is crucial to examine the indicators assisting early diagnosis, which in turn brings about early treatment.[2] Finally, with regard to the importance of preeclampsia, researchers attempted to review the literature revolving around preeclampsia, evaluated the hypotheses concerning various pathologies of the condition and obtained a broad insight into the causes, treatments and early diagnosis.

Since the detection of prenatal and maternal care can reduce the risk of premature birth [9] or newborns at risk, therefore, this paper intends to examine several parameters such as nitrate, nitrite, malondialdehyde (MDA), ceruloplasmin, Vitamin C, calcium and beta-human chorionic gonadotropin (βHCG) as well as their role in early diagnosis and treatment for preeclampsia.


  Methodology Top


This study is based on the literature review relying on several information banks and academic search engines such as PubMed, Proquest, Elsevier, Scopus and keywords, including, embryo, mother, birth weight and haematocrit. The articles were selected with a number of designs such as cross-sectional, cohort, clinical trial and systematic review. The Persian papers were selected from databases such as Iranmedex and Medlib, as well as article search, on local web-based scientific journals.

The time span for including the articles covered 1985 until 2012. Having run a preliminary search, a total of 35 articles were found and evaluated separately. At the end, 21 articles met the inclusion criterion, which was relevance to the research subject. The results of each article were carefully examined and elaborated based on the conclusions below.

A few instances of the articles applied in this study [Table 1]:
Table 1: Reviewed studies in this survey

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Evaluation of serum level of zinc in preeclampsia

Zinc plays an important role during organogenesis and foetal growth.[10],[11] In most studies, the results showed that there was a significant relationship between low serum zinc level and preeclampsia. In their study in 2005, Rezavand et al. found out that the mean of zinc serum level in the preeclampsia group was 76.55 μg/cc while it was 99.65 μg/cc in healthy pregnant women. In fact, the comparison of the two groups indicated that subjects with preeclampsia had significantly lower zinc serum level (P < 0.0001).[12] The study by Moghadam-Banaem et al. showed that reduced levels of zinc can contribute in affecting preeclampsia.[13] Mokhlesi et al. study showed that reducing the daily intake of antioxidant nutrients (such as zinc) can contribute to the occurrence of preeclampsia.[14] According to the results of these studies can be used to prevent pregnancy complications such as preeclampsia to understand and perhaps Prescribing mothers with zinc supplements might be beneficial. Finally, it is vital to conduct further studies on the prescription of zinc and how it affects the patients.

Evaluation of plasma level of nitrite, nitrate and malondialdehyde in preeclampsia

One of the most popular hypotheses about the aetiology of preeclampsia involves poor endothelial performance as a result of membrane lipid peroxidation.[15] There are numerous factors contributing to physiological mechanisms of placental angiogenesis and regulation of vascular contraction that may in turn play an important role in the pathogenesis of abnormal placenta. One of the factors is nitric oxide.[16]

One of the most important factors contributing to poor performance of endothelial cells is excessive levels of lipid peroxidase.[17],[18] The heightened MDA concentration may be due to increased production of oxygen free radicals caused by excessive oxidative damage in the patients. These reactive oxygen species can oxidise important biomolecules including membrane lipids. Lipid peroxides and free radicals may contribute to the pathogenesis of preeclampsia.[19]

The results from the majority of relevant studies demonstrated the tremendous effect of nitrite, nitrate and MDA. In their study, Rostami et al. (2009) revealed that serum levels of nitrite, nitrate and MDA in the preeclampsia group were 6.12, 8.23 and 7.9 micromoles/L, respectively, while they were 7.8, 4.16 and 3.6 micromoles/L, respectively, in the control group, which indicated a statistically significant correlation between these substances and preeclampsia. In studies done by Pasaoglu et al., Krishna Mohan and Venkataramana, Tug et al. and Adiga et al., similar results were obtained, that is, plasma level of MDA in eclamptic patients was higher than that in the control group.[20],[21],[22],[23] Considering the increased level of these substances in preeclampsia, they might be useful as auxiliary tests in the diagnosis of preeclampsia or even the disease assessment of severity. On the other hand, the measurement of these substances before the third trimester may also facilitate the diagnosis or assess the risk of preeclampsia, preventive measures and treatment.

Evaluation of serum level of ceruloplasmin in preeclampsia

In a study done by Ghaseminejad et al. in Tehran (2009), the results indicated that mean of serum ceruloplasmin in women with severe and mild preeclampsia was significantly higher than that of the control group (P < 0.001). Moreover, the mean of serum ceruloplasmin in severe preeclampsia was higher than that in mild preeclampsia, while it was higher in early preeclampsia than in late preeclampsia (P<0.01).[24]

According to the study by Engin-Ustun et al., ceruloplasmin in preeclampsia tends to rise in norm tension pregnant subjects. Such increase is greater in server preeclampsia than in the mild type, while it tends to be higher in the preterm type than in the late.[4] The results obtained by Aksoy and Khetsurian also indicated that cerium ceruloplasmin rises in preeclampsia.[25],[26]

Given the facts mentioned above, it is recommended that women facing a high risk of preeclampsia have the serum level of certain chemical factors such as ceruloplasmin measured in order to prognosis the incidence of preeclampsia prior to emergence if medical symptoms, which would ultimately prevent prenatal maternal mortality and morbidity.

Furthermore, using antioxidants such as Vitamin C or E can postpone the course of preeclampsia.

Evaluation of plasma level of Vitamin C in preeclampsia

The vascular endothelial damage plays an important role in the pathophysiology of preeclampsia.[27] Studies show that free radicals are present in the lipid peroxidation leading to damage in the endothelial cells.[28] Antioxidants such as Vitamin C can hinder free radicals and their complicating outcomes.[29]

In a study done by Dehghan et al., the results indicated that mean of plasma level of Vitamin C in preeclampsia subjects was significantly lower than healthy pregnant women.

The more severe preeclampsia, the lower the serum Vitamin C,[30] which is consistent with results obtained by Kharab.[31] Finally, the measurement of Vitamin C can help diagnose preeclampsia and its severity, while the condition can be treated through prescribing vitamin supplements and a modified diet.

Evaluation of serum beta-human chorionic gonadotropin level in preeclampsia

The trophoblast dysfunction is an aetiology expressed in preeclampsia. Since βHCG is the serum reflecting the trophoblast activity, its measurement can be a reflection of varied secretory response in preeclampsia placenta, raising the possibility that such measurement can be helpful in the diagnosis of preeclampsia. In a study done by Akbari et al., it was found out that βHCG was higher in the severe preeclampsia group as compared to the normal group and the mild preeclampsia, indicating no statistically significant difference. However, there was no significant relationship between the norm tension group and the mild preeclampsia group despite the βHCG level being higher in the mild group as compared to the norm tension.[32] Other studies yielded similar results.[33],[34] Finally, it can be argued that increased βHCG can indicate the disease severity, but proves little value in early diagnosis of the condition.

Evaluation of serum level of calcium in preeclampsia

Changes in calcium metabolism, as well as its deficiency, have been proposed as a hypothetical factor contributing to the pathophysiology of preeclampsia.[35] It has been demonstrated that low levels of calcium can lead to vascular smooth muscle contraction and higher vascular resistance.[36] There are controversial results obtained by studies on the role of calcium in preeclampsia. In their studies, Rudsari, Power and Richards observed no relationship between calcium and preeclampsia.[35] But In studies done by Kosch and Seely results showed that there was a link between the loss of calcium and preeclampsia.[36],[37]

Furthermore, the studies by Nirumanesh, Kulier and Villar revealed that supplementary calcium diet leads to lower risk of preeclampsia.[38],[39] Having evaluated various relevant studies, it can be understood that different regions yielded non-identical results in examination of calcium for preeclamptic subjects, which is probably due to ethnic differences, nutrition and geographical conditions, etc. Therefore, it can be stated that the additional supply of calcium has been useful in the treatment of preeclampsia in some areas examined separately, while it might be ineffective in some others.


  Conclusions Top


Having examined the studies done so far, it was found out that there are numerous parameters for early diagnosis and treatment of preeclampsia, even though they are far from comprehensive. These methods seem to be responding differently in every region. Therefore, it is recommended that such parameters be evaluated in various regions so as to pinpoint their effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Mokhlesi S, Mohebi S, Moghadam-Banaem L. The survey of the daily intake rate of antioxidants' nutrients and their relation to preeclampsia among pregnant women from Tehran in 2012. J Health Syst Res 2014;10:618-27.  Back to cited text no. 14
    
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[PUBMED]    
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Tug N, Celik H, Cikim G, Ozcelik O, Ayar A. The correlation between plasma homocysteine and malondialdehyde levels in preeclampsia. Neuro Endocrinol Lett 2003;24:445-8.  Back to cited text no. 21
    
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Pasaoglu H, Bukan N, Bulduk G, Celen S. Lipid peroxidation, nitrate and nitrite levels in eclamptic and intrauterine growth retarded pregnancies. Turk J Med Sci 2003;33:89-93.  Back to cited text no. 23
    
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