The role of calcium, magnesium, and zinc in pre-eclampsia

Dietary Calcium Intake, Serum Calcium Level, and their Association with Preeclampsia in Rural North India

Background:

Preeclampsia in pregnancy has been shown to be associated with low serum calcium level. Though the evidence is abundant, it is equivocal.

Objectives:

The study aimed to estimate the dietary calcium intake and serum calcium status among pregnant women, and to document the association of the dietary calcium intake and serum calcium status with incidence of preeclampsia in the 3rd trimester of pregnancy.

Materials and Methods:

A community-based cross-sectional study was conducted in the Health and Demographic Surveillance System (HDSS) site, Ballabgarh, Haryana, India. All pregnant women between 28 weeks and 36 weeks of gestation were interviewed. A semi-structured interview schedule and a 24-h dietary recall questionnaire were administered to assess the dietary calcium intake. AutoAnalyser (Biolis 24i) was used for measuring serum calcium.

Results:

We enrolled 217 pregnant women. The mean [standard deviation (SD)] dietary calcium intake was 858 (377) mg/day. The mean (SD) serum calcium level was 9.6 mg/dL (0.56). Incidence of preeclampsia was 13.4%. Preeclampsia was not associated with hypocalcemia [odds ratio (OR) = 1.2 95% confidence interval (CI); 0.27-3.98].

Conclusion:

The majority of pregnant women had inadequate dietary calcium intake. The prevalence of hypocalcemia was low. Low serum calcium level was not associated with preeclampsia. Calcium supplementation may not reduce preeclampsia in this population.

Comparison of Serum Calcium and Magnesium Between Preeclamptic and Normotensive Pregnant Nigerian Women in Abakaliki, Nigeria

Background:

Evidence suggests the involvement of calcium and magnesium metabolism in the pathophysiology of preeclampsia. However, findings from studies are heterogenous and inconsistent.

Aim:

The study aimed to compare the total serum calcium and magnesium levels in preeclamptic women with that of normotensive pregnant women.

Subjects and Methods:

A cross-sectional subjects of eighty pregnant women living in Abakaliki, Ebonyi state, South-East Nigeria, were recruited into the study. The present study compared serum calcium and magnesium in forty preeclamptic (cases) and forty normotensive (control) pregnant women matched for age, parity, and socioeconomic status. Serum calcium and magnesium levels were measured using atomic absorption spectrophotometer. Statistical analysis was done using SPSS Version 20 statistical software. Differences between means were compared using Student's t-test with P < 0.05 considered as statistically significant.

Results:

While the mean serum calcium was comparable between preeclamptic and normotensive pregnant women (13.99 [3.29] vs. 14.02 [5.68] μg/dl), the preeclamptic pregnant women have significantly (P < 0.001) lower serum magnesium in comparison to their normotensive counterparts (3.22 [1.05] vs. 4.15 [0.78]).

Conclusion:

It may be concluded that serum magnesium seems to play a crucial role in the pathophysiology of preeclampsia in this environment.

Comparison of serum zinc, calcium, and magnesium concentrations in women with pregnancy-induced hypertension and healthy pregnant women: A meta-analysis

OBJECTIVE

The relationship between serum zinc, magnesium, and calcium levels and pregnancy-induced hypertension (PIH) is controversial. The aim of our study was to determine whether or not serum zinc, magnesium, and calcium levels are associated with PIH.

METHODS

In our study, we searched databases, including Wangfang, Chinese National Knowledge Infrastructure, and PubMed, to find literature regarding the relationship between PIH and serum trace elements. Meta-analysis was performed using the Review Manager5.3 software.

RESULTS

A total of 14 articles were included in our study. The results of the meta-analysis indicated that patients with PIH had lower serum zinc (SMD = -1.14; 95% CI] = -1.69, -0.59; P < 0.05), calcium (MD = -0.26; 95% CI = -0.36, -0.15; P < 0.05), and magnesium concentration (MD = -0.0.06; 95% CI = -0.08, -0.05; P < 0.05) than healthy gravidas.

CONCLUSION

Our research suggests that serum zinc, calcium, and magnesium concentrations may have an effect on PIH. Thus, the serum zinc, calcium, and magnesium levels could be measured for PIH patients.

Validation of a Metallomics Analysis of Placenta Tissue by Inductively-Coupled Plasma Mass Spectrometry

Trace elements can play an important role in maternal health and fetal development, and deficiencies in some essential minerals including zinc and copper have been correlated in some individuals to the development of birth defects and adverse health outcomes later in life. The exact etiology of conditions like preeclampsia and the effects of fetal exposure to toxic metals has not been determined, making the assessment of trace element levels crucial to the elucidation of the causes of conditions like preeclampsia. Previous studies analyzing serum and placenta tissue have produced conflicting findings, suggesting the need for a robust, validated sample preparation and analysis method for the determination of trace elements in placenta. In this report, an acid digestion method and analysis by ICP-MS for a broad metallomics/mineralomics panel of trace elements is developed and validated over three experimental days for inter- and intraday precision and accuracy, linear range, matrix impact, and dilution verification. Spike recovery experiments were performed for the essential elements chromium (Cr), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), and zinc (Zn), and the toxic elements arsenic (As), cadmium (Cd), and lead (Pb) at levels equal to and in excess of native concentrations in control placenta tissue. The validated method will be essential for the development of scientific studies of maternal health and toxic metal exposure effects in childhood.

Proteinuria as the Most Relevant Parameter Affecting Fetuin-A Levels in Preeclampsia

The present study aimed to examine the factors affecting the possible changes in serum fetuin-A in patients with preeclampsia (PE). The examined factors included the parameters of insulin resistance (IR) [(insulin sensitivity (HOMA%S), insulin resistance (HOMA2IR), and beta-cell functions (HOMA%B)], which were calculated using the HOMA2 calculator, and total and ionized calcium and magnesium levels.

Sixty PE patients and thirty healthy pregnant women, which comprised the study group and control group, respectively participated in the present study. Fetuin-A, estradiol, insulin, glucose, total and ionized calcium and magnesium, total protein, albumin, and globulins were measured in their sera.

The results of the present study showed that serum total and ionized magnesium and the I.Ca/Mg ratio decreased in PE women. Although the fasting insulin level and HOMA2IR were higher and HOMA2%S was lower in PE compared with the control women, PE did not appear as an overt insulin-resistant state. Serum fetuin-A was low in PE patients compared with the control group because PE women had proteinuria. Fetuin-A levels were not correlated with the characteristics and IR parameters, cations, and estradiol levels, but it was correlated with the severity of proteinuria.

These results confirmed the hypothesis that proteinuria results in the loss of fetuin-A because it has a low molecular weight.

Placental Cadmium Levels Are Associated with Increased Preeclampsia Risk

Environmental exposure to heavy metals is a potentially modifiable risk factor for preeclampsia (PE). Toxicologically, there are known interactions between the toxic metal cadmium (Cd) and essential metals such as selenium (Se) and zinc (Zn), as these metals can protect against the toxicity of Cd. As they relate to preeclampsia, the interaction between Cd and these essential metals is unknown. The aims of the present study were to measure placental levels of Cd, Se, and Zn in a cohort of 172 pregnant women from across the southeast US and to examine associations of metals levels with the odds of PE in a nested case-control design. Logistic regressions were performed to assess odds ratios (OR) for PE with exposure to Cd controlling for confounders, as well as interactive models with Se or Zn. The mean placental Cd level was 3.6 ng/g, ranging from 0.52 to 14.5 ng/g. There was an increased odds ratio for PE in relationship to placental levels of Cd (OR = 1.5; 95% CI: 1.1-2.2). The Cd-associated OR for PE increased when analyzed in relationship to lower placental Se levels (OR = 2.0; 95% CI: 1.1-3.5) and decreased with higher placental Se levels (OR = 0.98; 95% CI: 0.5-1.9). Similarly, under conditions of lower placental Zn, the Cd-associated OR for PE was elevated (OR = 1.8; 95% CI: 0.8-3.9), whereas with higher placental Zn it was reduced (OR = 1.3; 95% CI: 0.8-2.0). Data from this pilot study suggest that essential metals may play an important role in reducing the odds of Cd-associated preeclampsia and that replication in a larger cohort is warranted.

Association between zinc level and the risk of preeclampsia: a meta-analysis

BACKGROUND

Epidemiological studies evaluating the association between zinc level and the risk of preeclampsia have produced inconsistent results. We therefore conducted a meta-analysis to summarize the evidence for them.

METHODS

Pertinent studies were identified by a search in PubMed and Web of Knowledge up to April 2015. Standardized mean difference (SMD) was performed to combine the results. Random-effect model was used. Publication bias was estimated using Egger's regression asymmetry test.

RESULTS

Thirteen articles (11 case-control studies and 2 cross-sectional studies) involving 445 preeclampsia cases and 568 healthy controls were included in this meta-analysis. Our pooled results suggested that preeclampsia patients had a lower zinc level as compared with healthy, pregnant controls (summary SMD = -0.61, 95 % CI = -0.74, -0.48, I (2) = 88.5 %). The association was also significant in Asia (SMD = -0.73, 95 % CI = -0.88, -0.58), but not in Europe. No publication biases were found.

CONCLUSIONS

Our analysis indicated that zinc level in preeclampsia patients was significantly lower than that of healthy, pregnant women, especially among the Asian population.

The Relationship between Serum Zinc Level and Preeclampsia: A Meta-Analysis

The association between serum zinc level and preeclampsia (PE) remains controversial. A systematic literature search was performed in PubMed, Web of Science and Embase for relevant available articles. The articles were limited to those in English from January 1990 to April 2015. Observational studies evaluating the association between serum zinc level and PE were included. The I² was used to assess heterogeneity and the random effect model (REM) was adopted as the pooling method. The pooled standard mean difference (SMD) with 95% confidence interval (CI) was used to estimate the association between serum zinc level and PE. Seventeen observational studies were included. Compared with healthy pregnancy controls, PE patients have lower serum zinc level in 14 studies about total PE (SMD (95% CI): −0.587 (−0.963, −0.212), Z = 3.06, p for Z = 0.002; I² = 88.4%, p for I² < 0.0001). In subgroup analysis, a lower serum zinc level in PE patients compared with healthy pregnancy controls was observed in studies conducted in Asia, studies with zinc level measured in serum, and studies involving fasting participants. The SMD did not differ significantly between studies with healthy pregnancy controls matched by individual age (yes or no), and by individual gestational age (yes or no), respectively. Results from this meta-analysis indicate that serum zinc level in PE patients is significantly lower than that in healthy pregnancy controls. A moderate amount of zinc supplementation during pregnancy is advocated to reduce the incidence of PE.

Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India

BACKGROUND

Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population.

MATERIALS AND METHODS

This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus.

RESULTS

Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%).

CONCLUSIONS

Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes.

Bioactive factors in uteroplacental and systemic circulation link placental ischemia to generalized vascular dysfunction in hypertensive pregnancy and preeclampsia

Preeclampsia is a pregnancy-associated disorder characterized by hypertension, and could lead to maternal and fetal morbidity and mortality; however, the pathophysiological mechanisms involved are unclear. Predisposing demographic, genetic and environmental risk factors could cause localized abnormalities in uteroplacental cytoactive factors such as integrins, matrix metalloproteinases, cytokines and major histocompatibility complex molecules leading to decreased vascular remodeling, uteroplacental vasoconstriction, trophoblast cells apoptosis, and abnormal development of the placenta. Defective placentation and decreased trophoblast invasion of the myometrium cause reduction in uteroplacental perfusion pressure (RUPP) and placental ischemia/hypoxia, an important event in preeclampsia. RUPP could stimulate the release of circulating bioactive factors such as the anti-angiogenic factors soluble fms-like tyrosine kinase-1 and soluble endoglin that cause imbalance with the pro-angiogenic factors vascular endothelial growth factor and placental growth factor, or cause the release of inflammatory cytokines, reactive oxygen species, hypoxia-induced factor-1 and AT1 angiotensin receptor agonistic autoantibodies. The circulating bioactive factors target endothelial cells causing generalized endotheliosis, endothelial dysfunction, decreased vasodilators such as nitric oxide and prostacyclin and increased vasoconstrictors such as endothelin-1 and thromboxane A2, leading to increased vasoconstriction. The bioactive factors also stimulate the mechanisms of VSM contraction including Ca(2+), protein kinase C, and Rho-kinase and induce extracellular matrix remodeling leading to further vasoconstriction and hypertension. While therapeutic options are currently limited, understanding the underlying mechanisms could help design new interventions for management of preeclampsia.

Adequately diversified dietary intake and iron and folic acid supplementation during pregnancy is associated with reduced occurrence of symptoms suggestive of pre-eclampsia or eclampsia in Indian women

Background/Objective

Pre-eclampsia or Eclampsia (PE or E) accounts for 25% of cases of maternal mortality worldwide. There is some evidence of a link to dietary factors, but few studies have explored this association in developing countries, where the majority of the burden falls. We examined the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E in Indian women.

Methods

Cross-sectional data from India’s third National Family Health Survey (NFHS-3, 2005-06) was used for this study. Self-reported symptoms suggestive of PE or E during pregnancy were obtained from 39,657 women aged 15-49 years who had had a live birth in the five years preceding the survey. Multivariable logistic regression analysis was used to estimate the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E after adjusting for maternal, health and lifestyle factors, and socio-demographic characteristics of the mother.

Results

In their most recent pregnancy, 1.2% (n=456) of the study sample experienced symptoms suggestive of PE or E. Mothers who consumed an adequately diversified diet were 34% less likely (OR: 0.66; 95% CI: 0.51-0.87) to report PE or E symptoms than mothers with inadequately diversified dietary intake. The likelihood of reporting PE or E symptoms was also 36% lower (OR: 0.64; 95% CI: 0.47-0.88) among those mothers who consumed iron and folic acid supplementation for at least 90 days during their last pregnancy. As a sensitivity analysis, we stratified our models sequentially by education, wealth, antenatal care visits, birth interval, and parity. Our results remained largely unchanged: both adequately diversified dietary intake and iron and folic acid supplementation during pregnancy were associated with a reduced occurrence of PE or E symptoms.

Conclusion

Having a adequately diversified dietary intake and iron and folic acid supplementation in pregnancy was associated with a reduced occurrence of symptoms suggestive of PE or E in Indian women.

Correlation between serum trace elements and risk of preeclampsia: A case controlled study in Riyadh, Saudi Arabia

Preeclampsia is a serious medical complication during pregnancy. In response to an increasing number of preeclamptic cases and scarcity of data concerning the interrelation between trace element levels and preeclampsia, we carried out a hospital based case–control study in Riyadh, Saudi Arabia to study the correlation between levels of serum trace elements and risk of preeclampsia. One hundred and twenty pregnant women were enrolled in this study and divided into three groups of 40 each—Control group, HR group (women at high risk of preeclampsia) and PET group (Preeclampsia group). Serum trace element levels were estimated by inductively coupled plasma optical emission spectrophotometer. The analysis found that mean values of Ca, Mg and Zn were 90.08 ± 6.38, 19.33 ± 3.32 and 1.30 ± 0.83 mg/L respectively in normotensive control and 77.85 ± 4.47, 15.44 ± 1.43 and 0.98 ± 0.63 mg/L respectively in the HR group. The mean values of Ca, Mg and Zn in the preeclamptic group were 70.37 ± 4.66, 13.58 ± 1.98 and 0.67 ± 0.59 mg/L, respectively. Interelement analysis reflected a negative correlation between Ca and Mg and between Mg and Zn whereas positive correlation between Ca and Zn in preeclamptic women. However the correlation was not statistically significant. In conclusion, our study suggests that decreased levels of these trace elements in serum may act as predisposing factors in pathogenesis of Preeclampsia.

Correlation of Vitamin D Levels in Term Normotensive and Pre-eclamptic Patients in Labor

OBJECTIVE

To evaluate maternal vitamin D levels in term normotensive and preeclamptic patients in labor and to assess additional factors such as maternal and cord blood levels of calcium, phosphorus, parathormone, and alkaline phosphatase and associated factors such as BMI, birth weight, and mode of delivery.

METHOD

This was a case control study carried out in Department of Obstetrics and Gynaecology, ESIC-PGIMSR, New Delhi, India from August 2012-April 2014. A total of 100 patients were divided into two equal groups (control and study groups of 50 each). Control group had women with singleton uncomplicated, term normotensive pregnant women in labor while the study group composed of term preeclamptic women in labor. Blood samples were drawn for vitamin D, serum calcium, serum phosphorus, serum alkaline phosphatase, and serum parathormone levels during first stage of labor, and subsequently, their levels were evaluated in cord blood also.

RESULTS

All the enrolled patients had vitamin D deficiency pointing toward a universal prevalence of this micronutrient deficiency in antenatal patients. We found more incidence of severe vitamin D deficiency (90 %) in preeclamptic patients as compared to normotensive patients (62 %). Also preeclamptic group had lower median vitamin D levels (3.9 ng/ml) when compared to normotensive group (9 ng/ml). Similarly, all the neonates were found to be vitamin D deficient as assessed by their cord blood levels. Neonates born to preeclamptic mothers had lower median cord blood vitamin D levels (4.4 ng/ml) when compared to those born to normotensive mothers (7.25 ng/ml). The mean maternal calcium levels followed trends observed in vitamin D levels with preeclamptic patients having consistently lower calcium levels (mean value of 8.50 ± 0.80 mg/dl) when compared to normotensive patients (mean value of 8.89 ± 0.56 mg/dl). Preeclamptic group was found to have more number of patients (58 %) with higher BMI when compared to normotensive group (32 % of patients). A slightly more incidence (36 %) of low birth weight babies is being born to preeclamptic mothers as compared to normotensive mothers (34 %). Significantly a more number of patients (36 %) with vitamin D levels below 15 ng/ml underwent cesarean section when compared to only 9 % of patients having vitamin D level above this level.

CONCLUSION

Preeclampsia is indeed associated with lower vitamin D levels, and its pathophysiology involves vitamin D and calcium metabolism.

Association between magnesium status, oxidative stress and inflammation in preeclampsia: A case-control study

BACKGROUND & AIMS

Preeclampsia is responsible for more than one-third of all maternal deaths in Brazil. The objectives of the present study were to evaluate magnesium status and its association with oxidative stress and inflammation in preeclamptic women, and to identify the predictor variables of the disorder.

METHODS

The study population consisted of 36 women divided into preeclamptic (n = 18) and control groups (n = 18). The preeclamptic group included women (≥20 weeks of pregnancy) with arterial pressure ≥ 140/90 mmHg and proteinuria >0.3 g/24 h, while the control group comprised pregnant women with no clinical/obstetric complications. Magnesium intake was assessed via a food frequency questionnaire validated for pregnant women in Brazil. Plasma, erythrocyte and urinary magnesium levels were determined by flame atomic absorption spectroscopy, while oxidative stress and inflammatory markers were assessed using standard protocols. Logistic regression analysis was used to identify the predictors of preeclampsia.

RESULTS

Preeclamptic and control groups were similar with respect to magnesium intake and urinary excretion, while plasma and erythrocyte magnesium concentrations were higher in the former group. Plasma magnesium was positively correlated with catalase and glutathione peroxidase activities and with concentrations of interleukin-6 and tumor necrosis factor alpha. Regression analysis showed that plasma magnesium and urinary 8-isoprostane were associated with preeclampsia.

CONCLUSION

Magnesium status appears to result from homeostatic imbalance and physiological alterations typical of preeclampsia. Increased plasma magnesium and decreased urinary 8-isoprostane were considered predictors of preeclampsia.

The blood-brain barrier-gatekeeper to neuronal homeostasis: clinical implications in the setting of stroke

The blood-brain barrier is part of the neurovascular unit and serves as a functional and anatomical barrier between the blood and the extracellular space. It controls the flow of solutes in and out of the brain thereby providing an optimal environment for neuronal functioning. Paracellular transport between endothelial cells is restricted by tight junctions and transendothelial transport is reduced and more selective compared to capillaries of other organs. Further, the blood-brain barrier is involved in controlling blood flow and it is the site for signaling damage of the nervous system to the peripheral immune system. As an important player in brain homeostasis, blood-brain barrier dysfunction has been implicated in the pathophysiology of many brain diseases including stroke, traumatic brain injury, brain tumors, epilepsy and neurodegenerative disorders. In this article - highlighting recent advances in basic science - we review the features of the blood-brain barrier and their significance for neuronal homeostasis to discuss clinical implications for neurological complications following cerebral ischemia.

Serum copper, zinc and lipid peroxidation in pregnant women with preeclampsia in gorgan

The aim of study was to assay serum copper, zinc and lipid peroxidation levels in pregnant women with and without preeclampsia. There were significant differences between systolic, diastolic blood pressures and copper, Cu/Zn ratio and malondialdehyde among two groups. There were significant differences in weight, pre-pregnancy body mass index, systolic, diastolic blood pressures and copper, Cu/Zn ratio and malondialdehyde levels when compared to healthy pregnant women with mild and severe preeclampsia patients. A positive correlation was observed between systolic and diastolic blood pressure and copper, malondialdehyde and Cu/Zn ratio. Copper and malondialdehyde may play a role in the pathophysiology of preeclampsia.

Levels of Serum Calcium and Magnesium in Pre-eclamptic and Normal Pregnancy: A Study from Coastal India

BACKGROUND

Pre-eclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the aetiology is obscure, recent studies indicate that serum levels of calcium and magnesium may have a role in pre-eclampsia.

AIM

The aim of this study was to find out the relationship of serum levels of calcium and magnesium in pre-eclamptic pregnancies compared to normal pregnancies in women from southern coastal India.

SETTINGS AND DESIGN

This study was done in a medical college hospital in southern coastal India.

MATERIALS AND METHODS

The blood samples from 60 pre-eclamptic women and an equal number of controls were analysed for calcium and magnesium levels. Data on Body Mass Index, maternal and gestational ages, serum calcium and magnesium were compared between the two groups. Outcome of pregnancy was analysed in both the groups and compared.

STATISTICAL ANALYSIS

Data was expressed as Mean ± Standard Deviation. Data analysis was done by SPSS version 20. Comparison of serum levels of the elements between the two groups was performed by Independent t-test and Chi-square test and P-value of < 0.05 was considered as statistically significant.

RESULTS

The serum calcium concentration was significantly lower in the pre-eclamptic group compared to normotensives (7.84 ± 0.87 mg/dl Vs 8.97± 0.69 mg/dl, p<0.001) whereas the levels of serum magnesium showed a marginal difference in both the groups. (1.43± 0.55 mg/dl Vs, 1.57 ± 0.72 mg/dl P 0.257) The study also showed that pre-eclamptic women were older, their BMI was higher and birth weight of babies lower compared to normotensives.

CONCLUSION

According to the results of our research, intake of supplements, mainly calcium may help in the reduction of incidence of pre-eclampsia especially in a population of a developing country like ours where the nutrition is poor. Not many studies have been done in developing countries to assess the role of these elements in pre-eclampsia. The actual role of magnesium and calcium supplements needs further investigation.

Preconception zinc deficiency disrupts postimplantation fetal and placental development in mice

Zinc is an essential nutrient for optimal fertility, but the effects of preconception zinc deficiency on postimplantation development are not known. Female mice were fed a control or a zinc-deficient diet (ZDD) for 4-5 days before ovulation (preconception). Embryonic and/or placental development were evaluated on Days 3.5, 6.5, 10.5, 12.5, and 16.5 of pregnancy. The findings show a decrease in embryo length (31%, Day 10.5; 13%, Day 12.5; 10%, Day 16.5) and weight (23%, Day 16.5) in embryos from mothers fed a ZDD preconception. Zinc deficiency also caused a high incidence of pregnancy loss (46%, Day 10.5; 34%, Day 12.5; 51%, Day 16.5) compared to control (2%, Day 10.5; 7%, Day 12.5; 9%, Day 16.5). ZDD embryos transferred to normal recipients were 38% smaller and implantation rate was only 10% compared to 40% for controls. Trophoblast cell differentiation and implantation on Day 6.5 of pregnancy were compromised by preconception zinc deficiency. On Day 12.5 of pregnancy, placenta weight and area of fetal placenta were decreased 37% and 31%, respectively, by preconception zinc deficiency. Consistent with a smaller fetal placenta, expression of key placental transcripts, including Ar, Esx1, Syna, Tfeb, Dlx3, and Gcm1 mRNA, but not Ctsq mRNA, were decreased 30%-70% in the ZDD group. Preconception zinc deficiency caused 41%-57% of embryos to exhibit delayed or aberrant neural tube development, as examined by light microscopy and magnetic resonance imaging. Collectively, the findings provide evidence for the importance of preconception zinc in promoting optimal fertility and oocyte developmental potential.

Frequency of consumption of specific food items and symptoms of preeclampsia and eclampsia in Indian women

BACKGROUND

Preeclampsia/eclampsia is responsible for upwards of 20% of maternal morbidity and mortality in developing countries.

OBJECTIVE

We examined the relationship between frequency of food intake and symptoms of preeclampsia eclampsia and eclampsia among Indian women aged 15-49 (n = 39,657) for the most recent live birth in the 5 years preceding the National Family Health Survey-3 (2005-2006). Multiple logistic regression analysis was used to estimate the association between frequency of intake of specific food items, and self-reported symptoms of preeclampsia eclampsia and eclampsia, adjusting for maternal age, and other potential socio-demographic confounders.

RESULTS

Daily consumption of milk or curd (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.96), green leafy vegetables, chicken/meat and weekly pulses/beans consumption are associated with substantially lower risk of preeclampsia eclampsia. Eclampsia risk is higher among those who consumed fruits (ORs ranges from 1.18 to 1.44) and chicken/meat occasionally (OR: 1.28; 95% CI: 1.11-1.48), and lower among those consuming vegetables daily.

CONCLUSION

Frequency of consumption of specific food items is associated with occurrence of preeclampsia eclampsia and eclampsia symptoms in Indian women.

Comparison of Maternal Serum Magnesium Level in Pre-eclampsia and Normal Pregnant Women

Background:

Preeclampsia is a pregnancy multisystem disorder of unknown etiology. It is a significant cause of maternal and fetal morbidity and mortality.

Objectives:

Due to the significant role of magnesium in physiological regulation of blood pressure, this study was conducted to measure the level of magnesium in pre-eclampsia and control groups since the beginning of the pregnancy.

Materials and Methods:

We enrolled 500 pregnant women with gestational age of 18-22 weeks who had referred to the Section of Obstetrics and Gynecology of Hafez hospital of Shiraz. Initially, blood samples were obtained from all subjects. 26 cases with diagnosis of preeclampsia were detected at the next referral. For each case, two normal pregnant women, at the same gestational age, were considered as the control group. The second blood samples were obtained from all the cases and controls. All of the samples were sent to check the level of magnesium. The data was analyzed with the SPSS and Student’s t-test.

Results:

The initial level of magnesium in pre-eclampsia women was not only significantly less than the control group (1.81 ± 0.25 mg/dl vs. 2.3 ± 0.44 mg/dl, P < 0.001), but also the secondary level was low, when the diagnosis was confirmed (1.72 ± 0.38 mg/dl vs. 2.2 ± 0.63 mg/dl, P < 0.05).

Conclusions:

We found a gradual decrease in mean serum magnesium level with increasing period of gestation in the pre-eclampsia women. This implicates that the level of magnesium in preeclampsia was lower than the control group since the beginning of pregnancy. According to our results, checking the level of magnesium should be considered as the predicting factor of preeclampsia during the first evaluation of pregnancy.

SLC41A1 is the only magnesium responsive gene significantly overexpressed in placentas of preeclamptic women

OBJECTIVE

To examine expression profile of magnesium responsive genes (MRGs) in placentas of normoevolutive and preeclamptic women.

METHODS

The expression profiles of MRGs were determined in placentas of normoevolutive (N=26) and preeclamptic (N=25) women by RT-qPCR.

RESULTS

Among all tested MRGs (9) only SLC41A1 (encoding for Na(+)/Mg(2+) exchanger) was significantly overexpressed in ~54.2% of preeclamptic (n=24) and in ~9.5% of normoevolutive (n=21) specimens. On average, SLC41A1 was overexpressed sixfold in the preeclamptic group. Presence of SLC41A1 in placentas was confirmed by Western blot analysis. CONCLUSION. SLC41A1 is significantly overexpressed in nearly 55% of preeclamptic placentas. This may indicate a direct contribution of changed Mg homeostasis in the development of preeclampsia.

Comparative study of serum zinc, copper, manganese, and iron in preeclamptic pregnant women

Preeclampsia complicates 2-8 % of all pregnancies and it is one of the leading causes of maternal mortality and pre-term delivery in the world. Unfortunately, there is scarcity of document discussing the circulating level of several essential trace elements in preeclampsia patients in Bangladesh. The present study was designed to evaluate the serum concentration of four trace elements, namely zinc, copper, manganese, and iron, in preeclamptic pregnant women. The study was conducted as a case-control study with 50 preeclamptic pregnant women as cases and 58 normotensive pregnant women as controls. Obstetric, anthropometric, and clinical data were collected at routine obstetric visits. Serum trace elements were determined by flame atomic absorption spectroscopy. Independent sample t test and Pearson's correlation test were done for the statistical analysis using the statistical software package SPSS, version 16.0 (SPSS Inc., Chicago, IL). We observed significant differences for gestational age, body mass index, and systolic and diastolic blood pressure between patient and control groups (p < 0.05). Analysis of serum trace elements explored significantly lower level of all the four elements in preeclampsia patients in comparison to the control group (p < 0.05). Pearson's correlation analysis explored that the correlation between serum level of different trace elements was statistically insignificant (p > 0.05) except the correlation between zinc and iron in preeclampsia patients (p < 0.05). Establishment of inter-element relationship strongly supports that there was a disturbance in the element homeostasis in patient with preeclampsia. In conclusion, our study suggests that preeclampsia patients have considerably lower level of serum zinc, copper, manganese, and iron compared to the healthy pregnant women.

A prospective study of selenium concentration and risk of preeclampsia in pregnant Iranian women: a nested case-control study

Preeclampsia remains a leading cause of maternal and perinatal mortality and morbidity worldwide; however, its specific etiology still remains obscure. Some studies implicate poor maternal selenium status predisposing the mother to preeclampsia. This study was designed to determine changes in plasma selenium levels in women having preeclampsia as compared with those with normal pregnancy. In a nested case-control study, 650 normal primigravida in their first 24-28 weeks participated in the study. After 3 months of follow-up of all subjects, blood selenium levels were measured in 38 women presenting consecutively with preeclampsia and in 38 women having a normal pregnancy by atomic absorption spectrophotometry. Birth outcomes were recorded, such as gestational age at delivery, height, weight, birth head circumflex and 1-min Apgar score. Preeclampsia affects about 5.84 % of pregnancies, and in our study, there were no significant differences in age, anthropometric indices, and family history of preeclampsia between the preeclamptic and control groups. The selenium concentrations in plasma in women with preeclampsia were significantly lower as compared with those in women with normal pregnancy (70.63 ± 21.41 versus 82.03 ± 15.54 μg/L, p < 0.05). Being in the bottom tertile of selenium concentration (less than 62.2 μg/L) was associated with greater risk of preeclampsia in pregnant women. The reduced selenium in the maternal circulations observed in the preeclamptic mothers support the hypothesis that insufficient selenium concentration may be a contributing factor to the pathophysiological mechanisms associated with preeclampsia, and optimizing the dietary selenium intake through supplementation could produce demonstrable clinical benefits.

Serum levels of zinc, calcium, and iron are associated with the risk of preeclampsia in pregnant women

Evidence indicates that various elements, including antioxidant minerals, might play an important role in preeclampsia (PE). This study was carried out to investigate the relationship between serum mineral levelsof zinc, calcium, iron, and selenium and the risk of preeclampsia in Korean women. Twenty-nine normal controls and 30 women with preeclampsia were recruited for the study. Preeclampsia was defined as having high blood pressure (≥ 140/90 mm Hg after 20 weeks gestation) and proteinuria (≥300 mg/24 hours). Serum mineral content was determined by instrumental neutron activation analysis. Serum zinc (P < .0001) and calcium (P = .0188) levels were lower in women with preeclampsia than those of normal women, while serum iron was significantly higher in women with preeclampsia (P = .0045). The odds ratio for preeclampsia was lower in women with higher serum zinc levels than those with lower levels after adjustment for age, height, and weight before delivery (P < .0001). The adjusted odds ratio for preeclampsia also decreased across tertiles of serum calcium concentration (P = .0452). However, there was an increased adjusted odds ratio for preeclampsia across tertiles of serum iron level (P = .0104). These results suggest that levels of serum minerals such as zinc, calcium, and iron may be associated with the risk of preeclampsia in Korean pregnant women.

Role of Heme Oxygenase, Leptin, Coenzyme Q10 and Trace Elements in Pre-eclamptic Women

The objective of this study to evaluate heme oxygenase (COHb), leptin and coenzyme Q10 (CoQ10) in pre-eclamptic women. Also Zinc, copper, Iron, total iron binding capacity, Ferritin and uric acid were assessed. 120 female subjects were included in this study. They were divided into, 60 female with normal pregnancy attending the outpatient clinic, 60 pre-eclamptic patients were recruited from obstetrics and gynaecology department El-kasr El-Aini hospital. The results showed that in pre-eclampatic group, leptin level was significantly increased while COHb and CoQ10 was significantly decreased. It is concluded that hemeoxygenase, leptin and coenzyme CoQ10 can be considered as new markers for prediction of pre-eclampsia.

Blood lead, calcium, and phosphorus in women with preeclampsia in Edo State, Nigeria

The authors investigated the effect of blood lead (BPb) and its relationship with calcium and phosphorus in the development of preeclampsia in Nigeria. Blood samples were collected from 59 preclamptics, 150 normal pregnant, and 122 nonpregnant women. Blood lead and serum Ca and P were determined. Blood lead was significantly higher (p < .001), whereas serum Ca and P were significantly lower (p < .001) in preclamptics than in normal pregnant women (60.2 ± 12.8 vs 26.3 ± 8.0 μg/dL for Pb, 1.39 ± 0.33 vs 2.03 ± 0.22 mmol/L for Ca, and 0.76 ± 0.10 vs 0.99 ± 0.13 mmol/L for P, respectively). There was significant increase (p < .05) in BPb and decreases (p < .01) in serum Ca and P in pregnant women than in nonpregnant women (35.7 ± 18.0 vs 13.1 ± 6.4 μg/dL for Pb, 1.85 ± 0.33 vs 2.33 ± 0.20 mmol/L for Ca, and 0.93 ± 0.38 vs 1.24 ± 0.26 mmol/L for P). Also, BPb was negatively correlated with serum Ca and, P, and positively correlated with systolic and diastolic blood pressures in pregnancy (r = -.804 for Ca, r = -.728 for P, r = .908 for SBP, and r = .842 for DBP) and preeclampsia (p < .01). It appears that increase in blood lead, which parallels decreases in serum calcium and phosphorus, may be related to the development and progression of preeclampsia in this environment.

The possible options for the prevention of preeclampsia

This review summarizes the possible options for the prevention of preeclampsia based on important factors of patomechanism. The effects of antioxidants have been described in numerous clinical researches based on the oxidative hypothesis. Another important factor is the change of nitric oxide activity. Nitric oxide donors are able to compensate the symptoms of preeclampsia. The inverse relationship between the calcium intake and gestational hypertension has been known for a long time. The calcium supplementation seems to be a good opportunity to prevent preeclampsia. With low molecular weight heparins we can intervene in the patomechanisms of preeclampsia by antithrombocyte effects, vasoactive properties and impact on throphoblast cell morphology and differentiation. Thrombocyte aggregation inhibitors were examined in number of studies because they reduced thromboxane mediated vasoconstriction and inhibited placental thrombosis. Several studies verify whether prophylaxis with low molecular weight heparins and low dose aspirin could improve pregnancy outcome in preeclampsia. Orv. Hetil., 2012, 153, 144–151.

The importance of antioxidant micronutrients in pregnancy

Pregnancy places increased demands on the mother to provide adequate nutrition to the growing conceptus. A number of micronutrients function as essential cofactors for or themselves acting as antioxidants. Oxidative stress is generated during normal placental development; however, when supply of antioxidant micronutrients is limited, exaggerated oxidative stress within both the placenta and maternal circulation occurs, resulting in adverse pregnancy outcomes. The present paper summarises the current understanding of selected micronutrient antioxidants selenium, copper, zinc, manganese, and vitamins C and E in pregnancy. To summarise antioxidant activity of selenium is via its incorporation into the glutathione peroxidase enzymes, levels of which have been shown to be reduced in miscarriage and preeclampsia. Copper, zinc, and manganese are all essential cofactors for superoxide dismutases, which has reduced activity in pathological pregnancy. Larger intervention trials are required to reinforce or refute a beneficial role of micronutrient supplementation in disorders of pregnancies.

Severe anaemia is associated with a higher risk for preeclampsia and poor perinatal outcomes in Kassala hospital, eastern Sudan

Background

Anaemia during pregnancy is major health problem. There is conflicting literature regarding the association between anaemia and its severity and maternal and perinatal outcomes.

Methods

This is a retrospective case-control study conducted at Kassala hospital, eastern Sudan. Medical files of pregnant women with severe anaemia (haemoglobin (Hb) < 7 g/dl, n = 303) who delivered from January 2008 to December 2010 were reviewed. Socio-demographic and obstetric data were analysed and compared with a similar number of women with mild/moderate anaemia (Hb = 7-10.9 g/dl, n = 303) and with no anaemia (Hb > 11 g/dl, n = 303). Logistic regression analysis was performed separately for each of the outcome measures: preeclampsia, eclampsia, preterm birth, low birth weight (LBW) and stillbirth.

Results

There were 9578 deliveries at Kassala hospital, 4012 (41.8%) women had anaemia and 303 (3.2%) had severe anaemia. The corrected risk for preeclampsia increased only in severe anaemia (OR = 3.6, 95% CI: 1.4-9.1, P = 0.007). Compared with women with no anaemia, the risk of LBW was 2.5 times higher in women with mild/moderate anaemia (95% CI: 1.1-5.7), and 8.0 times higher in women with severe anaemia (95% CI: 3.8-16.0). The risk of preterm delivery increased significantly with the severity of anaemia (OR = 3.2 for women with mild/moderate anaemia and OR = 6.6 for women with severe anaemia, compared with women with no anaemia). The corrected risk for stillbirth increased only in severe anaemia (OR = 4.3, 95% CI: 1.9-9.1, P < 0.001).

Conclusions

The greater the severity of the anaemia during pregnancy, the greater the risk of preeclampsia, preterm delivery, LBW and stillbirth. Preventive measures should be undertaken to decrease the prevalence of anaemia in pregnancy.