Prevalence of preeclampsia and the associated risk factors among pregnant women in Bangladesh

Genetic Appraisal of RAAS-Associated SNPs: REN (rs16853055), AGT (rs3789678) and ACE (rs4305) in Preeclamptic Women Living with HIV Infection

PURPOSE OF REVIEW

The primary goal of this review article was to determine whether the three RAAS-associated SNPs, Renin-rs16853055, AGT-rs3789678 and ACE-rs4305 are genetically linked to the development of hypertension in preeclampsia. The secondary goal was to establish if there was a link between these SNPs and HIV infection.

RECENT FINDINGS

There is a paucity of findings related to the aforementioned SNPs and preeclampsia. There are no recent findings on the rs16853055 renin polymorphism. The rs3789678 angiotensinogen polymorphism correlated significantly with gestational hypertension. The rs4305 ACE polymorphism showed no significant association with the development of pregnancy-induced hypertension. There are conflicting findings when determining the relationship between ethnicity and the predisposition of preeclampsia and hypertension in relation to the discussed RAAS-associated SNPs. To date, the association between RAAS-associated SNPs and preeclamptic women co-morbid with HIV in South Africa has revealed that certain alleles of the AGT gene are more prominent in HIV-infected PE compared to normotensive pregnant HIV-infected women.

Dietary fat intake with risk of gestational diabetes mellitus and preeclampsia: a systematic review and meta-analysis of prospective cohort studies

CONTEXT

Gestational diabetes mellitus (GDM) and preeclampsia (PE) are commonly observed medical complications in pregnancy. Dietary total fat and fatty acids associated with GDM and PE risk have been examined in several epidemiological studies. In some instances, systematic reviews and meta-analyses might provide more accurate dietary recommendations.

OBJECTIVES

This systematic review and dose-response meta-analysis was conducted to investigate the association between dietary total fat and fatty acids and the risk of GDM and PE.

DATA SOURCES

Research on dietary fat intake and the risk of GDM and PE was conducted through systematic searches of the PubMed, Scopus, and Web of Science databases for articles published up to August 19, 2023. An investigation of associations between dietary intake of total fat and fatty acids and the risk of GDM and PE was performed using prospective cohort study designs.

RESULTS

Twenty-one prospective cohort studies were considered eligible. Findings indicated that higher intakes of total fat (relative risk [RR], 1.08; 95% confidence interval [CI], 1.02-1.14), animal fat (RR, 1.56; 95%CI, 1.34-1.89), vegetable fat (RR, 1.23; 95%CI, 1.05-1.45), dietary cholesterol (RR, 1.48; 95%CI, 1.10-2.00), and omega-3 fatty acid (RR, 1.11; 95%CI, 1.02-1.20) are associated with a greater risk of GDM. However, no significant association was found between dietary total fat and fatty acids and the risk of PE. Dose-response meta-analyses suggested every 10% increment in total energy intake from total fat, 5% from animal fat, 5% from vegetable fat, and 100 mg from cholesterol was related to 15%, 12%, 7%, 14%, and 20% higher GDM risk, respectively.

CONCLUSIONS

Overall, total fat, animal fat, vegetable fat, dietary cholesterol, and omega-3 fatty acid consumption are associated with a small but statistically significant increase in GDM risk.

PROTOCOL REGISTRATION

PROSPERO (CRD42023466844).

Association between calcium supplementation and gestational hypertension, and preeclampsia: A Meta-analysis of 26 randomized controlled trials

BACKGROUND

Pre-eclampsia and eclampsia are common causes of morbidity and mortality, especially in low-income countries. Reducing adverse outcomes associated with hypertensive disorders of pregnancy has been the ultimate priority in recent years. We aim to evaluate the association between calcium supplementation and preeclampsia and gestational hypertension risk among pregnant women.

METHODS

A systematic literature search was performed in electronic databases from inception to 15th July 2023, including only randomized controlled trials. Odds ratio (OR) were, and their corresponding 95% confidence interval (95% CI).

RESULTS

A total of 26 studies with 20,038 patients (10,003 patients with calcium supplements and 10,035 patients with placebo group) were included in the analysis. The Pooled analysis of primary outcome shows that calcium supplements reduce the risk of preeclampsia by 49% (OR, 0.51(95%CI: 0.40-0.66), P<0.001), and reduce the risk of gestational hypertension by 30% (OR, 0.70 (95%CI: 0.58-0.85)), P<0.001) compared to placebo. There was a trend of lower incidence of preterm delivery (OR, 0.88 (95%CI: 0.71-1.09), P=0.23), labor induction (OR, 0.90 (95%CI: 0.78-1.03), P=0.13), small for gestational age (OR, 0.70 (95% CI:0.37-1.32), P = 0.27), low birth weight (OR, 0.96 (95%CI: 0.86-1.08), P=0.53), perinatal mortality (OR, 0.88 (95%CI: 0.72-1.09), P=0.24), and maternal mortality (OR, 0.48 (95%CI: 0.12-1.84), P=0.28) among calcium supplementation group compared with the placebo group, however, statistical signifance was not achieved.

CONCLUSION

This study shows that calcium supplements are associated with a significant reduction in the risk of preeclampsia and gestational hypertension and a trend toward better maternal and fetal-related outcomes.

Preeclampsia prediction model using demographic, clinical, and sonographic data in the second trimester of Japanese nulliparous women

AIM

This study aimed to clarify the factors influencing preeclampsia (PE) development in nulliparous Japanese women and to develop a PE prediction model using second trimester sonographic and clinical data readily available to obstetricians.

METHODS

This historical cohort study examined the obstetric records of nulliparous women who delivered at Yamanashi Prefectural Central Hospital from January 2019 to May 2023. A model was constructed to predict the PE development rate, with a focus on 796 nulliparous women. The assessed outcome was PE, excluding superimposed PE. Data on maternal age, assisted reproductive technology, mean arterial pressure, uterine artery notching, and umbilical artery resistance index were extracted. Multivariable logistic regression analysis was conducted on these five factors.

RESULTS

The incidence of PE was 4.3% (34/796). Multivariable analysis indicated significant odds ratios for the association of PE with mean arterial pressure (adjusted odds ratio: 1.06, 95% confidence interval: 1.03-1.10) and uterine artery notching (adjusted odds ratio: 6.28, 95% confidence interval: 2.82-14.0) in nulliparous women. The PE prediction formula was established as follows: Probability of PE development (%) = (odds/1 + odds) × 100, odds = ex and x = -11.3 + 0.039 × maternal age (years) + 0.91 × assisted reproductive technology + 0.061 × mean arterial pressure (mmHg) + 1.84 × uterine artery notching + 1.84 × umbilical artery resistance index. The sensitivity and specificity of this model were 58.8% and 84.5%, respectively (area under the curve: 0.79).

CONCLUSIONS

This study is the first to provide a prediction formula targeting the Japanese population. Our specialized model for nulliparous women could guide obstetricians to educate women regarding the precise prospect of PE development.

Unraveling the Predictive Power: Placenta Growth Factor and Pregnancy-Associated Plasma Protein A in Pre-eclampsia

This review provides a comprehensive exploration of the roles of placenta growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) in the context of pre-eclampsia, a pregnancy-related hypertensive disorder with significant implications for maternal and fetal health. The background elucidates the clinical significance of pre-eclampsia, highlighting its prevalence and impact. The review delves into the biological importance of PlGF and PAPP-A, emphasizing their critical roles in normal placental development and their dysregulation in pre-eclampsia. Notably, altered levels of these biomarkers emerge as potential diagnostic indicators, offering insights into the pathophysiology of the disorder. The exploration of pathophysiological mechanisms, including angiogenic imbalance and placental dysfunction, provides a nuanced understanding of pre-eclampsia's molecular landscape. The therapeutic implications of targeting PlGF and PAPP-A open avenues for future research, aiming at effective intervention strategies. The conclusion summarizes key findings, outlines implications for future research, and underscores the crucial role of PlGF and PAPP-A in understanding and managing pre-eclampsia, with the ultimate goal of improving outcomes for both mothers and infants.

MTHFR A1298C polymorphism: a predictor of reduced risk of preeclampsia in Punjab, Pakistan

OBJECTIVES

This study aimed to investigate the genetic association between MTHFR (A1298C) SNP and preeclampsia (PE) in Punjab, Pakistan.

METHODS

A sample of 80 pregnant women (40 healthy pregnant women and 40 with PE) was pooled for genotyping MTHFR A1298C polymorphism by using the tetra-primer amplification refractory mutation system (ARMS) PCR. The Genotypic and allelic assessments were performed using various statistical techniques.

RESULTS

The AC genotype and C allele of MTHFR A1298C were found to be associated with decreased risk of PE (odds ratio [OR]: 0.31, risk ratio [RR]: 0.58, p = 0.01), and (odds ratio [OR]: 0.49, risk ratio [RR]: 0.61, p = 0.04), respectively.

CONCLUSION

In conclusion, genetic polymorphism A1298C in MTHFR may pose a protective effect in the studied population.

Prevalence and factors associated with metabolic syndrome in university students and academic staff in Bangladesh

Metabolic syndrome (MetS) is a group of medical conditions that increase the risk of cardiovascular disease, stroke, and type 2 diabetes. While there are numerous studies on the prevalence of MetS in the general adult population worldwide, limited information exists regarding its prevalence among university students and academic staff. This study aimed to determine the prevalence of MetS and associated risk factors among Bangladesh university students and academic staff. For this cross-sectional study, 583 participants were randomly selected from university students (n = 281) and academic staff (n = 302) in Bangladesh. The participants' fasting blood samples were collected, and their serum lipid profile levels, fasting blood glucose, and other parameters were measured using standard methods. MetS was defined according to the NCEP-ATP III model guidelines. Additionally, a questionnaire was administered to the participants to gather information on socio-demographics, lifestyle risk behaviours, and personal medical history. Multivariate logistic regression models were used to determine the risk factors associated with MetS. Overall, the prevalence of MetS was 27.7% in students and 47.7% in staff. There was a significant difference (p < 0.01) in MetS prevalence between male students (34.8%) and female students (17.2%). In contrast, it was comparatively higher in female staff (52.3%) than in male staff (45.8%), although the difference was not statistically significant. The prevalence of MetS and its components increased with age in student and staff groups. The most common component of MetS was low levels of HDL-C, which affected 78% and 81.4% of the students and staff, respectively. Logistic regression modelling showed that increased age, BMI, hypertension, dyslipidemia, low physical activity, and smoking were significantly associated with MetS in students (at least p < 0.05 for all cases). On the other hand, increased age and BMI, hypertension, and dyslipidemia were significantly associated with MetS in academic staff (at least p < 0.05 for all cases). In conclusion, this study indicates a high prevalence of MetS in university students and staff in Bangladesh. Age, BMI, hypertension and dyslipidemia were independently associated with the risk of MetS in both groups. The findings emphasize the importance of interventions for students and staff in academic settings in Bangladesh. It is crucial to implement health promotion activities such as healthy diet and exercise programs more rigorously. Further research with more representative samples is needed to get more clear insights into MetS prevalence in this particular population subgroup for targeted interventions.

WITHDRAWN: Prevalence of Non-Proteinuric Preeclampsia at Mansoura University Hospitals

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Iron metabolism and ferroptosis: A pathway for understanding preeclampsia

Preeclampsia (PE) is a serious medical condition that poses a significant health risk to women and children worldwide, particularly in the middle- and low-income countries. It is a complex syndrome that occurs as a result of abnormal pregnancy. Hypertension is the most common symptom of PE, with proteinuria and specific organ systems as detrimental targets. PE's pathogenesis is diverse, and its symptoms can overlap with other diseases. In early pregnancy, when the placenta takes over control, oxidative stress may be closely associated with ferroptosis, a type of cell death caused by intracellular iron accumulation. Ferroptosis in the placenta is defined by redox-active iron availability, loss of antioxidant capacity and phospholipids containing polyunsaturated fatty acids (PUFA) oxidation. Recent studies suggest a compelling potential link between ferroptosis and PE. In this article, we comprehensively review the current understanding of PE and discuss one of its emerging underlying mechanisms, the ferroptosis pathway. We also provide perspective and analysis on the implications of this process in the diagnosis, prevention, and treatment of preeclampsia. We aim to bridge the gap between clinicians and basic scientists in understanding this harmful disease and challenge the research community to put more effort into this exciting new area.

Association between liver enzymes and metabolic syndrome: a study in Bangladeshi adults

BACKGROUND

This study aimed to investigate the association between serum liver enzymes and the presence of metabolic syndrome (MetS) among Bangladeshi adults.

RESEARCH DESIGN AND METHODS

A total of 602 participants (424 males and 178 females) were enrolled in this cross-sectional study. Serum levels of liver enzymes (ALT, AST, GGT and ALP) and other biochemical parameters were measured by standard colorimetric methods. The relationship between liver enzymes and MetS was assessed by multivariable logistic regression models.

RESULTS

Overall, the prevalence of MetS was 34.9% among the participants. Of the four liver enzymes, the mean levels of serum ALT and GGT were significantly higher among subjects with MetS than those without MetS (p < 0.01). When liver enzyme levels were categorized into normal and elevated ranges, MetS and its component's prevalence was higher in the elevated group except for ALP. Serum ALT and GGT showed a significant relationship with the maximum components of MetS. According to the logistic regression analysis, elevated levels of ALT and GGT were significantly associated with the prevalence of MetS (p < 0.01 and p < 0.001, respectively).

CONCLUSIONS

This study showed that elevated ALT and GGT levels were independently associated with MetS and its components.

Extracellular matrix metalloproteinases inducer gene polymorphism and reduced serum matrix metalloprotease-2 activity in preeclampsia patients

Preeclampsia increases the risk of pregnancy-related complications, nevertheless a successful spiral vessel remodeling, and trophoblast invasion reduces disorders of pregnancy. Matrix metalloproteinase-2 (MMP-2) clears the path for trophoblast invasion, and activation of MMP-2 largely depends on extracellular matrix metalloproteinases inducer (EMMPRIN) protein. This study aimed to investigate EMMPRIN gene polymorphism and MMP-2 activity in preeclampsia patients. Archival whole blood and serum samples of 74 preeclampsia and 66 normotensive pregnant women age-matched were used in this case-control study. Genomic DNA was extracted from the whole blood samples and EMMPRIN gene amplified with specific primers following fragments sequence mutation analysis. Serum MMP-2 activity was determined using enzyme-linked immunosorbent assay (ELISA) and socio-demographic data of participants retrieved from the database. Age of preeclampsia patients (32.78 ± 6.39) years and body mass index (BMI) (33.09 ± 7.27) kg/m2 compared with the normotensive counterparts (32.33 ± 5.56) years and (32.33 ± 5.56) kg/m2,respectively, were not statistically significant (P > 0.05). Serum matrix metalloprotease-2 (MMP-2) activity was significantly reduced in preeclampsia group (16.34 ± 7.07) compared with the normotensives (25.63 ± 4.56) (P < 0.001), and rs424243T/G variant (55.6%) was overrepresented among the cases compared with the normotensives (16.7%). The single-nucleotide polymorphism T/G was found to be associated with preeclampsia (odds ratio [OR] = 7.63; 95% confidence interval [CI] = 3.95-14.75; P < 0.0001). Decreased activity of MMP-2 and rs424243T/G SNP of EMMPRIN gene was reported in preeclampsia. These preliminary data warrant a further investigation into the relationship between EMMPRIN gene polymorphism and MMP-2 activity in preeclampsia.

Prevalence of dyslipidemia and its associated factors among university academic staff and students in Bangladesh

BACKGROUND

Dyslipidemia is one of the important contributors to cardiovascular disease and type 2 diabetes. There is little or no information on dyslipidemia among academic staff and students in Bangladesh. Therefore, this study aimed to investigate the prevalence and factors related to dyslipidemia among university academic staff and students in Bangladesh.

METHODS

A total of 533 participants (302 academic staff and 231 students) were enrolled in this cross-sectional study. A simple random sampling technique was used to enrol the participants. Fasting blood samples were obtained from the participants, and serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured using the standard methods. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP-III) model guideline. Multivariable logistic regression was conducted to identify the factors related to lipid marker abnormalities.

RESULTS

Overall, the prevalence of dyslipidemia was 81.5%, of which 85% was in staff and 76.5% in students. A significant difference was found in the prevalence of dyslipidemia between males and females only in the student group (p < 0.01). Among staff, hypertriglyceridemia prevalence was 49.7%, hypercholesterolemia 23%, high LDL-C 24.7% and low HDL-C 77.3%. On the other hand, hypertriglyceridemia prevalence was 39%, hypercholesterolemia 25.6%, high LDL-C 26.5% and low HDL-C 69.3% among students. The most common lipid abnormality was low HDL-C in both groups. The prevalence of mixed dyslipidemia was 14.2% and 14.1% in staff and students, respectively. According to the regression analysis, increased age, obesity, diabetes, and inadequate physical activity were significantly associated with dyslipidemia.

CONCLUSIONS

Dyslipidemia was prevalent among the majority of the study participants. Increased age, obesity, diabetes, and inadequate physical activity were significantly associated with dyslipidemia. The study's results highlight the importance of implementing interventions to address the associated risk factors of dyslipidemia among academic staff and students in Bangladesh.

Platelet count in preeclampsia: a systematic review and meta-analysis

OBJECTIVE

Many studies have reported the association between platelets and preeclampsia. However, sample sizes were small, and their findings were inconsistent. We conducted a systematic review and meta-analysis to evaluate the association in pooled samples and in detail.

DATA SOURCES

A systematic literature search was performed using Medline, Embase, ScienceDirect, Web of Science, Cochrane Library, NICHD-DASH, LILACS, and Scopus from inception to April 22, 2022.

STUDY ELIGIBILITY CRITERIA

Observational studies comparing platelet count between women with preeclampsia and normotensive pregnant women were included.

METHODS

The mean differences with 95% confidence interval in platelet count were calculated. Heterogeneity was assessed using I2 statistics. Sensitivity and subgroup analyses were conducted. Statistical analysis was performed using RevMan 5.3 and ProMeta 3 software.

RESULTS

A total of 56 studies comprising 4892 preeclamptic and 9947 normotensive pregnant women were included. Meta-analysis showed that platelet count was significantly lower in women with preeclampsia than in normotensive controls (overall: mean difference, -32.83; 95% confidence interval, -40.13 to -25.52; P<.00001; I2=92%; mild preeclampsia: mean difference, -18.65; 95% confidence interval, -27.17 to -10.14; P<.00001; I2=84%; severe preeclampsia: mean difference, -42.61; 95% confidence interval, -57.53 to -27.68; P<.00001; I2=94%). Significantly lower platelet count was also observed in the second trimester (mean difference, -28.84; 95% confidence interval, -44.59 to -13.08; P=.0003; I2=93%), third trimester (mean difference, -40.67; 95% confidence interval, -52.14 to -29.20; P<.00001; I2=92%), and before the diagnosis of preeclampsia (mean difference, -18.81; 95% confidence interval, -29.98 to -7.64; P=.009; I2=87%), but not in the first trimester (mean difference, -15.14; 95% confidence interval, -37.71 to 7.43; P=.19; I2=71%). Overall, the pooled sensitivity and specificity of platelet count were 0.71 and 0.77, respectively. The area under the curve was 0.80.

CONCLUSION

This meta-analysis confirmed that platelet count was significantly lower in preeclamptic women, irrespective of severity and presence or absence of associated complications, even before the onset of preeclampsia and in the second trimester of pregnancy. Our findings suggest that platelet count may be a potential marker to identify and predict preeclampsia.

The prevalence and factors associated with obesity and hypertension in university academic staff: a cross-sectional study in Bangladesh

Obesity is a major risk factor for hypertension, type 2 diabetes and other morbidities. On the other hand, hypertension is a leading cause of cardiovascular disease. The presence of obesity in hypertensive persons increases cardiovascular risk and related mortality. Data on the prevalence of obesity and hypertension in academic staff in Bangladesh are scarce. This study aimed to determine the prevalence and factors associated with obesity and hypertension among university academic staff in Bangladesh. In total, 352 academic staff were enrolled in this study from two universities in Bangladesh. A pre-structured questionnaire was used to obtain data on anthropometric, demographic and lifestyle-related factors. Bivariate and multivariate logistic regression analyses were performed to assess the factors associated with obesity and hypertension. Overall, the prevalence of general and abdominal obesity and hypertension was 26.7%, 46.9% and 33.7%, respectively. Female staff had a significantly higher prevalence of both general and abdominal obesity (41% and 64.1%, respectively) than male staff (21.5% and 34.9%, respectively) (p < 0.001). In contrast, male staff had a higher prevalence of hypertension (36.9%) than female staff (25.6%)(p < 0.001). An increased prevalence of hypertension was found in the higher BMI and WC groups of the participants. The prevalence of general obesity, abdominal obesity and hypertension was higher in the 30-40 years, > 50 years and 41-50 years age groups, respectively. According to the regression analysis, female gender and inadequate physical activity were independently associated with general and abdominal obesity. On the other hand, increased age, BMI, WC, presence of diabetes and smoking showed a significant association with hypertension. In conclusion, the prevalence of obesity and hypertension was higher among university academic staff members in Bangladesh. Our findings suggest that comprehensive screening programs are needed to facilitate the diagnosis, control, and prevention of obesity and hypertension in high-risk population groups.

Interleukin 12B rs3212227 and rs6887695 single nucleotide polymorphisms are associated with the susceptibility to preeclampsia: Genetic, haplotype and bioinformatics analysis

It is well-known that functional single nucleotide polymorphisms (SNPs) in IL-12B gene might intensely change the protein expression level, or modify its functions, which might result in immune disorders. The association between common IL-12B SNPs with preeclampsia (PE) risk has remained unclear yet. In a case-control study, 253 PE patients and 250 healthy subjects were genotyped for SNPs in IL-12B rs3212227 by PCR-RFLP and in IL-12B rs6887695 by AS-PCR. Novel in-silico analysis were performed to predict the potential functions of these polymorphisms, as well. The rs3212227 variation in IL12B gene showed an association with susceptibility to PE. The AC and CC genotypes and also C allele of this SNP were more frequent in patients. Likewise, they were frequent in early onset and late onset PE. The G allele and GC and CC genotype of rs6887695 SNP correlated negatively with PE development and it shown protective effect on PE risk. In addition, the AG and CC haplotypes of IL-12B were more prevalent in PE patients. Then, IL12B AC haplotype was less frequent in PE compare to healthy pregnant women. In-silico analysis of IL-12B rs3212227 gene polymorphism might not have significant impact on the mRNA structure and transcription of IL-12B. The results of our study revealed a significant relationship between rs3212227A/C and rs6887695G/C polymorphisms in IL-12B gene and the risk of PE in the Iranian population.

Association between hyperuricemia and chronic kidney disease: a cross-sectional study in Bangladeshi adults

BACKGROUND AND AIMS

Chronic kidney disease (CKD) is a public health concern worldwide and has been recognized as a significant risk factor for cardiovascular disease. The elevated level of uric acid (hyperuricemia) has been suggested to be associated with obesity, hypertension, cardiovascular disease and diabetes. However, there is limited information on the relationship between hyperuricemia and CKD. Therefore, this study aimed to estimate the prevalence of CKD and assess its relationship with hyperuricemia in Bangladeshi adults.

METHODS

In this study, blood samples were collected from 545 participants (398 males and 147 females) aged ≥ 18 years. Biochemical parameters such as serum uric acid (SUA), lipid profile markers, glucose, creatinine and urea were measured by colorimetric methods. The estimated glomerular filtration rate (eGFR) and CKD were determined based on serum creatinine levels with existed formula. Multivariate logistic regression analysis was performed to evaluate the association between SUA and CKD.

RESULTS

The overall prevalence of CKD was 5.9% with 6.1% in males and 5.2% in females. Hyperuricemia was prevalent in 18.7% of participants with 23.2% in males and 14.6% in females. An increasing trend of CKD prevalence was observed with increasing age in the groups. The mean eGFR level was significantly lower in male (95.1 ± 31.8 ml/min/1.73m²) than in female (109.3 ± 77.4 ml/min/1.73m²) subjects (p < 0.01). The mean level of SUA was significantly higher (p < 0.01) in participants having CKD (7.1 ± 1.9 mg/dL) than in participants without CKD (5.7 ± 1.6 mg/dL). A decreasing trend for eGFR concentration and an increasing trend for CKD prevalence was observed across the SUA quartiles (p < 0.001). In regression analysis, a significant positive association was found between hyperuricemia and CKD.

CONCLUSION

This study showed an independent association between hyperuricemia and CKD in Bangladeshi adults. Further mechanistic studies are needed to explore the potential link between hyperuricemia and CKD.

Preeclampsia: Recent Advances in Predicting, Preventing, and Managing the Maternal and Fetal Life-Threatening Condition

Preeclampsia accounts for one of the most common documented gestational complications, with a prevalence of approximately 2 to 15% of all pregnancies. Defined as gestational hypertension after 20 weeks of pregnancy and coexisting proteinuria or generalized edema, and certain forms of organ damage, it is life-threatening for both the mother and the fetus, in terms of increasing the rate of mortality and morbidity. Preeclamptic pregnancies are strongly associated with significantly higher medical costs. The maternal costs are related to the extra utility of the healthcare system, more resources used during hospitalization, and likely more surgical spending due to an elevated rate of cesarean deliveries. The infant costs also contribute to a large percentage of the expenses as the babies are prone to preterm deliveries and relevant or causative adverse events. Preeclampsia imposes a considerable financial burden on our societies. It is important for healthcare providers and policy-makers to recognize this phenomenon and allocate enough economic budgets and medical and social resources accordingly. The true cellular and molecular mechanisms underlying preeclampsia remain largely unexplained, which is assumed to be a two-stage process of impaired uteroplacental perfusion with or without prior defective trophoblast invasion (stage 1), followed by general endothelial dysfunction and vascular inflammation that lead to systemic organ damages (stage 2). Risk factors for preeclampsia including race, advanced maternal age, obesity, nulliparity, multi-fetal pregnancy, and co-existing medical disorders, can serve as warnings or markers that call for enhanced surveillance of maternal and fetal well-being. Doppler ultrasonography and biomarkers including the mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and serum pregnancy-associated plasma protein A (PAPP-A) can be used for the prediction of preeclampsia. For women perceived as high-risk individuals for developing preeclampsia, the administration of low-dose aspirin on a daily basis since early pregnancy has proven to be the most effective way to prevent preeclampsia. For preeclamptic females, relevant information, counseling, and suggestions should be provided to facilitate timely intervention or specialty referral. In pregnancies complicated with preeclampsia, closer monitoring and antepartum surveillance including the Doppler ultrasound blood flow study, biophysical profile, non-stress test, and oxytocin challenge test can be arranged. If the results are unfavorable, early intervention and aggressive therapy should be considered. Affected females should have access to higher levels of obstetric units and neonatal institutes. Before, during, and after delivery, monitoring and preparation should be intensified for affected gravidas to avoid serious complications of preeclampsia. In severe cases, delivery of the fetus and the placenta is the ultimate solution to treat preeclampsia. The current review is a summary of recent advances regarding the knowledge of preeclampsia. However, the detailed etiology, pathophysiology, and effect of preeclampsia seem complicated, and further research to address the primary etiology and pathophysiology underlying the clinical manifestations and outcomes is warranted.

Analysis of serum calcium, sodium, potassium, zinc, and iron in patients with pre-eclampsia in Bangladesh: A case-control study

Background and Aims

Pre-eclampsia is a particular type of pregnancy condition. Although the primary etiology of pre-eclampsia is unclear, it hypothesizes that the alteration of trace elements and macro-minerals may play a crucial function in the pathogenesis of Pre-eclampsia. Therefore, our research sought to ascertain the serum level of trace elements (zinc, iron) and macro-minerals (sodium, calcium, potassium) and their possible association with pre-eclampsia.

Methods

The present study was conducted with 74 pre-eclampsia pregnant women (case) and 118 pregnant women having normal blood pressure (controls). Atomic Absorption Spectroscopy determined the serum level of trace components and electrolytes.

Results

The researchers discovered notable differences in maternal age, gestational period, body mass index, systolic and diastolic blood pressure, hemoglobin, and creatinine level. Results of serum analysis revealed that calcium (52.06 ± 3.71 mg/L vs. 65.93 ± 2.57 mg/L, p < 0.05) and potassium (63.44 ± 5.33 mg/L vs. 102.54 ± 4.25 mg/L, p < 0.001) concentrations were substantially lower in the patient group than in control. Serum zinc (0.34 ± 0.02 mg/L vs. 0.52 ± 0.02 mg/L, p < 0.001) and iron (0.38 ± 0.03 mg/L vs. 0.46 ± 0.02 mg/L, p < 0.05) concentration were also considerably decreased in pre-eclampsia participants compared with a pregnant normotensive group. Pearson's correlation research results in the patient group revealed a connection between trace elements or macro minerals. In addition, the systolic blood pressure was positively correlated with sodium (r = 0.392, p < 0.01) and negatively correlated with potassium (r = -0.257, p < 0.05) in the control group.

Conclusions

This study concludes that calcium, potassium, iron, and zinc levels were lower, whereas sodium levels were higher in Bangladeshi pre-eclampsia patients compared to controls. These findings with Pearson's correlation and the inter-element relationship between the patient and a control subject results can act as critical indication factors for patients with pre-eclampsia in Bangladesh and, as a result, may require a higher intake of calcium, potassium, iron, and zinc for effective therapeutic intervention and reduce the intake of sodium.

Association of serum xanthine oxidase levels with hypertension: a study on Bangladeshi adults

Xanthine oxidase (XO) is a metalloflavoenzyme associated with the uric acid formation in purine metabolism. Serum XO has been suggested to be associated with liver and kidney dysfunction, diabetes and cardiovascular diseases. However, there is limited information on the relationship between serum XO levels and hypertension. This study aimed to assess the relationship between serum XO levels and hypertension in Bangladeshi adults. In this study, fasting blood samples were collected from 312 participants (225 males and 87 females), aged ≥ 20 years. Serum levels of XO were determined by ELISA and other biochemical parameters including serum uric acid (SUA) were measured by colorimetric methods. Hypertension was defined as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or self-reported recent use of anti-hypertensive medications. Association between serum XO levels and hypertension was evaluated by multinomial logistic regression analysis. The mean level of XO was significantly higher (p < 0.001) in females (5.8 ± 3.2 U/L) than in males (3.9 ± 2.5 U/L). When the participants were divided by blood pressure levels, the mean level of serum XO was significantly higher (p < 0.01) in the hypertensive group (5.0 ± 2.7 U/L) compared to the normotensive control group (4.0 ± 2.7 U/L). An increasing trend for SBP and DBP levels was observed across the XO quartiles (at least p < 0.01 for both cases). A significant positive correlation was found for XO with SBP and DBP (p < 0.01). In regression analysis, the serum levels of XO showed a significant and independent association with hypertension prevalence. In conclusion, the mean level of serum XO was significantly higher in hypertensive individuals and XO was independently associated with the prevalence of hypertension. Our results indicate that XO may have a potential role in the pathophysiology of elevated blood pressure through generating of reactive oxygen species. Further large-scale longitudinal studies are needed to determine the underlying mechanisms between XO and hypertension.

Assessment of the relationship between serum xanthine oxidase levels and type 2 diabetes: a cross-sectional study

Xanthine oxidase (XO) is an enzyme associated with purine metabolism. The relationship between XO levels and type 2 diabetes (T2D) is not clear yet or little is known so far. Therefore, we conducted a cross-sectional study to determine the association of XO levels with T2D in a Bangladeshi adult cohort. A total of 325 participants (234 males and 91 females) were enrolled in the study. The participants were divided into three groups; diabetic (n = 173), prediabetic (n = 35), and non-diabetic control (n = 117). Serum levels of XO were measured by enzyme-linked immunosorbent assay (ELISA) and other biochemical parameters including fasting blood glucose (FBG), serum uric acid (SUA), and lipid profile markers measured by colorimetric methods. Participants with T2D were confirmed according to the definition of the American Diabetic Association. The association between serum XO levels and T2D was determined by logistic regression models. The mean level of serum XO was significantly higher in females (6.0 ± 3.7 U/L) compared to male (4.0 ± 2.8 U/L) participants (p < 0.001). In contrast, males had a higher mean level of SUA (6.1 ± 1.9 mg/dL) than female (4.4 ± 1.9 mg/dL) participants (p < 0.001). The mean level of XO was significantly higher in the diabetic group (5.8 ± 3.6 U/L) compared to the prediabetic (3.7 ± 1.9 U/L) and control (2.9 ± 1.8 U/L) groups (p < 0.001). On the other hand, the mean SUA concentration was significantly lower in the diabetic group than in the other two groups (p < 0.001). A significant increasing trend was observed for FBG levels across the XO quartiles (p < 0.001). A decreasing trend was found for SUA levels in the XO quartiles (p < 0.001). Serum levels of XO and SUA showed a positive and negative correlation with FBG, respectively. In regression analysis, serum XO levels showed an independent association with T2D. In conclusion, this study reports a positive and independent association between XO levels and T2D in Bangladeshi adults. Monitoring serum levels of XO may be useful in reducing the risk of T2D. Further research is needed to determine the underlying mechanisms of the association between elevated XO levels and T2D.

Prevalence and risk factors of general and abdominal obesity and hypertension in rural and urban residents in Bangladesh: a cross-sectional study

Background

Obesity and hypertension are global health concerns. Both are linked with increased risks of all-cause and cardiovascular mortality. Several early studies reported the prevalence of obesity and hypertension in Bangladeshi adults, but the associated factors in this country population are not clear yet. We aimed to estimate the prevalence and related risk factors of general and abdominal obesity and hypertension in rural and urban adults in Bangladesh.

Methods

In this cross-sectional study, data (n = 1410) was collected on rural (n = 626) and urban (n = 784) adults from eight divisional regions of Bangladesh. Both anthropometric and socio-demographic measurements were recorded in a standardized questionnaire form. General and abdominal obesity were defined based on WHO proposed cut-off values and hypertension was defined by SBP ≥ 140 mmHg and/or, DBP ≥ 90 mmHg and/or, intake of anti-hypertensive drugs at the time of data collection. Multivariable logistic regression analyses were performed to assess the relationship of general and abdominal obesity and hypertension with various factors.

Results

The overall prevalence of general obesity, abdominal obesity and hypertension was 18.2, 41.9 and 30.9%, respectively. The women had a higher prevalence of general obesity (25.2%), abdominal obesity (56.1%) and hypertension (32.3%) compared to the men (12.2, 29.0, and 29.7%, respectively). The prevalence of both general and abdominal obesity was higher in urban participants (21.7 and 46.6%, respectively) than in the rural participants (13.8 and 35.1%, respectively), whereas, the rural participants had a higher prevalence of hypertension (35.1%) compared to the urban participants (27.5%). In geographical region comparison, the prevalence of general and abdominal obesity and hypertension were higher in participants enrolled from Dhaka (30.8%), Khulna (63.6%) and Mymensingh (43.5%) regions, respectively compared to other regions. In regression analysis, increased age, place of residence and less physical activity were positively associated with the increased risk of both types of obesity and hypertension. The analysis also showed a significant positive association between high BMI and an increased risk of hypertension.

Conclusion

This study shows a high prevalence of obesity and hypertension in rural and urban adults. Increased age, inadequate physical activity and place of residence were significant determinants of general and abdominal obesity and hypertension. A comprehensive intervention program focusing on modifiable risk factors such as lifestyles and food habits is needed to increase awareness and prevent the burden of obesity and hypertension in the Bangladeshi population.

The prevalence of general obesity, abdominal obesity, and hypertension and its related risk factors among young adult students in Bangladesh

Hypertension is a major cause of cardiovascular disease and related mortality worldwide. The presence of general and abdominal obesity in hypertensive individuals increases the risk of cardiovascular mortality. However, evidence on the burden of obesity and hypertension and associated factors are lacking or limited among young adult students in Bangladesh. This study measured the prevalence and factors associated with general and abdominal obesity and hypertension among university students in Bangladesh. In this study, a total of 1011 students (647 males and 364 females) were enrolled on nine public universities in eight divisional regions of Bangladesh. Data were collected on socio‐demographic, anthropometric, and lifestyle in a questionnaire form. Unadjusted and adjusted logistic regression analyses were performed to evaluate the association of general obesity, abdominal obesity and hypertension with different factors. The prevalence of general obesity, abdominal obesity and hypertension was 8.3%, 20.7%, and 10.2%, respectively. The females had a higher prevalence of general obesity (8.8%) and abdominal obesity (26.3%) compared to the males (8.0% and 17.7%, respectively). However, a higher prevalence of hypertension was observed in males (12.2%) than in the female (6.1%) patients. In regression analysis, age showed a significant association with general obesity, whereas, age and female sex were significantly associated with abdominal obesity. The analysis also identified the male sex and high BMI as the increased risk factors for hypertension. Our study suggests a comprehensive screening program and campaigns to increase awareness about obesity and hypertension and its risk factors among young adults in Bangladesh.

Correlation of Blood Lipid and Serum Inflammatory Factor Levels With Hypertensive Disorder Complicating Pregnancy

Purpose

To explore the changes of blood lipid and serum inflammatory factors in pregnant women with hypertensive disorder complicating pregnancy (HDP) and the relationship with disease development.

Methods

107 pregnant women with HDP who had regular prenatal examination in our hospital from July 2018 to July 2021 were selected as the research objects. According to the severity of the disease, they were divided into gestational hypertension group, mild preeclampsia group and severe preeclampsia group. 30 healthy pregnant women who underwent prenatal examination in the same period were selected as the healthy group. Serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipaseA2 (Lp-PLA2), C- reactive protein (CRP), interleukin -6 (IL-6), tumor necrosis factor-α (TNF-α) were measured. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of blood lipid and serum inflammatory factors in pregnant women with HDP.

Results

The levels of serum TC, TG and LDL-C increased with the progression of HDP, the level of serum HDL-C decreased with the progression of HDP (P < 0.05). The levels of serum Lp-PLA2, CRP, IL-6 and TNF-α increased with the progression of HDP (P < 0.05). The AUC of serum TC, TG, HDL-C and LDL-C levels for predicting HDP were 0.759, 0.854, 0.770 and 0.785, respectively. The AUC of serum Lp-PLA2, CRP, IL-6 and TNF-α levels for predicting HDP were 0.873, 0.991, 0.966 and 0.999, respectively.

Conclusion

The levels of blood lipid and serum inflammatory factor are closely related to HDP, which has certain value in predicting the occurrence and development of HDP.

The association between elevated lipid profile and liver enzymes: a study on Bangladeshi adults

Dyslipidemia, a major contributor to cardiovascular diseases, is rapidly increasing in Asian countries including Bangladesh. In addition to the cardiovascular system, abnormal lipid levels are also known to cause complications in renal and hepatic systems. The data regarding dyslipidemia and its relationship with liver enzymes are scarce for the Bangladeshi population. Therefore, this study was conducted to estimate the prevalence of dyslipidemia and determine the relationship between lipid profile and liver enzymes in Bangladeshi adults. A total of 405 participants (318 males and 87 females) were enrolled in the study. Serum levels of TG, TC, LDL, HDL and liver enzymes including ALT, AST, GGT and ALP were analyzed using standard methods. Dyslipidemia and liver function tests abnormalities were defined according to the international standard guidelines. The association between elevated lipid profile markers and liver enzyme abnormalities was assessed by logistic regression analysis. Overall, the prevalence of elevated TG, TC, LDL and low HDL were 30.9%, 23.7%, 26.2% and 78.8%, respectively. On the other hand, the prevalence of elevated liver enzymes ALT, AST, GGT and ALP were 18.8%, 21.6%, 12.9% and 21.9%, respectively. Dyslipidemia and liver enzyme abnormalities were higher in diabetic and hypertensive participants than in the healthy participants. About 61% of participants with dyslipidemia had at least one or more elevated liver enzymes. In regression analysis, an independent association was observed between serum GGT and all lipid components. In conclusion, a high prevalence of dyslipidemia and liver enzyme abnormalities were observed among the study participants. Of the four liver enzymes, the serum levels of GGT showed an independent association with all lipid components. Moreover, this study indicates that subjects with dyslipidemia often have a higher chance of having liver diseases than subjects with no dyslipidemia. However, large-scale prospective studies are needed to understand the underlying mechanisms of lipid-induced hepatic dysfunction in the Bangladeshi population.