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

Association of maternal serum magnesium with pre-eclampsia in African pregnant women: a systematic review and meta-analysis

Pre-eclampsia (PE) is a pregnancy-related disorder characterized by hypertension and proteinuria occurring after 20 weeks of gestation. Several studies have been performed to determine the serum magnesium (Mg) level in PE, but most report inconclusive results. Consequently, this study was designed to resolve this controversy among African women. PubMed, Hinari, Google Scholar and African Journals Online electronic databases were searched for studies published in English. The qualities of included articles were appraised using the Newcastle-Ottawa quality assessment tool. Stata 14 software was utilized for analysis and serum Mg levels in cases and normotensive controls were compared through mean and standardized mean difference (SMD) at the 95% confidence interval (CI). In this review, we found that the mean serum Mg level was significantly reduced in cases (0.910±0.762 mmol/L) vs controls (1.167±1.060 mmol/L). The pooled SMD of serum Mg was significantly lower in cases (-1.20 [95% CI -1.64 to -0.75]). Therefore, since serum Mg is reduced in cases vs controls, we propose that Mg is involved in the pathophysiology of PE. Nevertheless, to know the exact mechanisms of Mg in PE development will require large-scale prospective studies.

Serum Calcium and Magnesium Levels in Women Presenting with Pre-eclampsia: A Systematic Review and Meta-analysis Based on Observational Studies

BACKGROUND

Multiple studies have investigated the serum concentrations of calcium (Ca) and magnesium (Mg) in preeclampsia, but the results have been contradictory. The objective of this systematic review and meta-analysis was to examine the association between serum calcium and magnesium levels in patients with preeclampsia and those in the healthy pregnancies.

MATERIALS AND METHODS

A comprehensive search was conducted in various online databases, including PubMed/Medline, Scopus, Embase, Web of Sciences, and Cochrane library to identify relevant studies on Ca and Mg levels in preeclampsia up to July 2023. Inter-study heterogeneity across the included studies was assessed using the chi-square test and I2 statistic. Pooled effect size (ES) was calculated as weighted mean differences (WMDs) with corresponding 95% confidence intervals (CI).

RESULTS

A total of 76 articles (comprising 92 studies) were included, with a combined sample size of 10,482 participants (preeclampsia: n=3,991; controls: n=6,491). The random-effects model revealed significantly lower levels of calcium (WMD=-0.807 mg/dL, 95% CI: -0.983, -0.632, P0.01) and magnesium (WMD=-0.215, 95% CI: -0.338, -0.092, P0.01) in women with pre-eclampsia compared to the control group. However, the overall pooled WMD for calcium and magnesium levels did not significantly change when individual studies were excluded one by one.

CONCLUSION

This meta-analysis demonstrates that the circulating levels of calcium and magnesium in patients with preeclampsia are significantly lower than those in the control group.

The relation between serum uric acid and severity of preeclampsia in pregnant women: a cross-sectional study

Introduction

There are conflicting data regarding the relation between serum uric acid (SUA) and severity of preeclampsia (PE). The aim of the study was to assess the relation between SUA and the severity of PE.

Material and methods

A total of 110 pregnant women were studied; 55 with mild PE were compared to 55 women with severe PE in this cross-sectional study, which was conducted in Maternity Hospital. After thorough evaluation and renal function tests, spot urine samples were taken from participants for the protein/creatinine ratio. The urine proteins were measured by the Biuret colorimetric method. The urine creatinine was measured by the modified Jaffe test. The serum uric acid was measured by the enzymatic method. The collected participants' data were statistically analysed, and Pearson's coefficient was used to detect the relation between SUA and severity of PE.

Results

The serum uric acid was significantly higher in the severe PE group (7.65 ±0.61 mg/dl) compared to the mild PE group (5.26 ±0.79 mg/dl), (p = 0.04). There were significant positive relations between the SUA and both the systolic and diastolic blood pressures [r = 0.27 (p = 0.045) and r = 0.483 (p < 0.001), respectively] in the severe PE group. There were also significant positive relations between the SUA and both the systolic and diastolic blood pressures [r = 0.359 (p = 0.007) and r = 0.429 (p = 0.001), respectively] in the mild PE group.

Conclusions

There were significant positive relations between the SUA and both the systolic and dia-stolic blood pressures in the severe PE group. This study recommends the use of SUA as a reliable marker of the severity of PE.

Longitudinal Assessment of Calcium and Magnesium Levels in Women with Preeclampsia

The present study reports the levels of maternal serum calcium and magnesium from early pregnancy until delivery, along with cord levels, in women who developed preeclampsia (PE) and compares them with those without PE. A total of 324 pregnant women (216 non-PE and 108 PE women) were included in this retrospective case-control study of prospectively collected data nested in an observational cohort study. Maternal blood was collected at 4 time points during pregnancy (V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks, and V4 = at delivery) and umbilical cord blood at delivery. Independent t tests were used to compare calcium, magnesium, and their ratio between two groups, and their associations with PE were studied using regression models. Calcium levels were similar between groups at all time points. Magnesium levels were lower (p = 0.021) at V2 in PE group as compared with non-PE group. Maternal calcium and magnesium levels were negatively associated, with blood pressure in early pregnancy. In fully adjusted logistic regression analysis, lower magnesium levels were associated with an increased risk of PE at V2 (OR 0.25 [95% CI 0.07, 0.94] p = 0.04). Lower magnesium in mid-pregnancy was associated with higher risk of PE. These changes were observed before the diagnosis of PE, thereby suggesting that they may have a role in the etiology of PE.

Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia

BACKGROUND

Preeclampsia is a well-known cause of maternal mortality and morbidity in Ethiopia. The exact pathophysiology has not been fully understood. Calcium and magnesium deficiencies have been given emphasis to play roles in the pathophysiology. Although evidence is abundant, they are equivocal. The study aimed to see the association of dietary calcium intake, serum total calcium level and ionized calcium level with preeclampsia. It also evaluated the association between dietary calcium intake and serum calcium levels.

MATERIALS AND METHODS

An unmatched case-control study was conducted in Gandhi Memorial, Tikur Anbessa, and Zewditu Memorial Hospitals, all in Addis Ababa, between October to December, 2019. Cases were 42 women with preeclampsia and controls were 42 normotensive women. The medical and obstetric history was gathered using a structured questionnaire and the dietary calcium intake information using a 24-h dietary recall. The serum levels of total serum calcium and ionized (free) calcium were measured using an inductively coupled mass spectrophotometer. Bivariate and multivariate logistic regression and Pearson correlation test were utilized during data analysis.

RESULTS

In comparison with controls, women with preeclampsia had lower mean (± 1SD) levels of ionized calcium level (1.1 mmol/l ± 0.11), total serum calcium level (1.99 mmol/l ± 0.35) and lower median (IQR) dietary calcium intake (704 mg/24 h,458-1183). The odds of having preeclampsia was almost eight times greater in those participants with low serum ionized calcium level (OR 7.5, 95% CI 2.388-23.608) and three times higher in those with low total serum calcium level (OR 3.0, 95% CI 1.024-9.370). Low dietary calcium intake also showed statistically significant association with preeclampsia (OR 3.4, 95% CI 1.092 -10.723). Serum ionized calcium level and total serum calcium level showed positive correlation of moderate strength (p = 0.004, r = 0.307), but no correlation was found between dietary calcium intake with both forms of serum calcium levels.

CONCLUSION

This study showed significant association between low dietary calcium intake and low serum calcium levels with preeclampsia, hence this can be used as a supportive local evidence for the current context-specific recommendation of calcium supplementation in societies with low-dietary calcium consumption in an attempt to prevent preeclampsia, therefore implementation study should be considered in Ethiopia to look for the feasibility of routine supplementation.

Predictive Performance of Serum β-hCG MoM Levels for Preeclampsia Screening: A Meta-Analysis

OBJECTIVE

The aim of the present study was to investigate the predictive value of using the multiple of the median (MoM) of β-human chorionic gonadotropin (β-hCG) levels in patients with preeclampsia (PE) and healthy pregnant women.

METHODS

Electronic databases including PubMed, EBSCO, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, Wangfang and the Weipu Journal were searched up to May 31, 2020. Two reviewers independently selected the articles and extracted data on study characteristics, quality and results. A random-effects model was employed, and standardized mean difference and 95% confidence intervals were calculated. Twenty-one case-control studies were analyzed in the present meta-analysis, including a total of 2,266 cases and 25,872 healthy controls.

RESULTS

Women who were diagnosed with PE were found to have higher early second-trimester levels of serum β-hCG MoM compared with healthy controls, although the levels in the first trimester were not significantly different. Ethnicity subgroup analysis demonstrated that the MoM of β-hCG serum levels was significantly higher in PE patients in both Asian and Caucasian populations during the early second trimester.

CONCLUSION

The MoM of β-hCG serum levels was found to be a valuable clinical indicator for predicting PE in the early second trimester, but had little predictive value in the first trimester. However, further assessment of the predictive capacity of β-hCG within larger, diverse populations is required.

Serum calcium-magnesium ratio in women with pre-eclampsia at a tertiary hospital in Nigeria

OBJECTIVE

To determine the serum calcium-magnesium ratio in pre-eclampsia and compare with normotensives.

METHODS

A case-control study was conducted in a tertiary hospital between October 2017 and March 2018 among 81 pregnant women (27 cases and 54 controls matched for age, gestational age, and parity). An interviewer-administered questionnaire was used to obtain data on demography/clinical history. Venous blood was collected without stasis and sent for biochemical analysis. Statistical analysis used IBM SPSS 21.0.

RESULTS

The levels of serum Ca²⁺ (7.73 + 1.24 vs 9.17 + 0.77; P<0.001), Ca²⁺ -Mg²⁺ ratio (3.36 + 0.60 vs 3.83 + 0.41; P=0.001), and Mg²⁺ (2.35 + 0.35 vs 2.41 + 0.16; P=0.469) were lower among cases. Serum Ca²⁺ level correlated negatively with systolic (r=0.45, P=0.05) and diastolic blood pressure (r=0.50, P=0.010) among the cases. Hypocalcemia was a risk factor (adjusted odds ratio [AOR] 7.63, 95% confidence interval [CI] 1.64-35.37) while social classes 2 and 3 were protective factors (AOR 0.01, 95% CI 0.00-0.46 and AOR 0.01, 95% CI 0.00-0.24, respectively) against pre-eclampsia.

CONCLUSION

The result of this research supported the implication of micronutrients in pre-eclampsia and may help to understand the pathophysiological process of pre-eclampsia. It will also help to establish and enhance existing preventive strategies for the condition. The recommendation by WHO on calcium supplementation in pregnancy as a step in preventing the occurrence of pre-eclampsia should be practiced.

Maternal Serum Uric Acid as a Predictor of Severity of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study

Objective: To assess the relationship between maternal serum uric acid and severity of Hypertensive disorders of pregnancy in a rural tertiary care centre.

Materials and Methods: Present study was conducted in Obstetrics and Gynaecology department of rural tertiary care cen-tre of Northern India over seven months (October 2016-May 2017) on 110 women admitted with a Hypertensive disorder of pregnancy (Gestational hypertension, Pre-eclampsia, Eclampsia) at ≥34 weeks gestation. Maternal serum uric acid levels were compared in three groups in relation to disease severity, mode of delivery, maternal outcome.

Results: Of total 110 women with a Hypertensive disorder of pregnancy; 35 (31.81%) had Gestational Hypertension, 49 (44.54%) preeclampsia and 26 (23.63%) had eclampsia. Mean±SD values for serum uric acid were 5.47±1.93 mg/dl in women with Gestational Hypertension; 6.72±2.15 mg/dl in Pre-eclampsia and 8.71±2.97 mg/dl in the eclamptic group. Of 110 women 34(97.14%) with gestational hypertension, 27(55.10%) with pre-eclampsia and one (3.85%) with eclampsia re-mained stable in post-partum period, 17 (34.69%) women with severe pre-eclampsia and 15 (57.69%) with eclampsia re-quired intensive care in postpartum period and one (2.86%) women with gestational hypertension, five (10.20%) with pre-eclmapsia and ten (38.46%) with eclampsia required ventilator support and high dependency unit care. Of these 16 women with the severe disease, ten succumbed to death. Also, in women with serum uric acid,>6mg/dl, most common mode of de-livery was a lower segment cesarean section (50.90%).

Conclusion: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome.

The Role of Uric Acid in Preeclampsia: Is Uric Acid a Causative Factor or a Sign of Preeclampsia?

PURPOSE OF REVIEW

Because of the significant discrepancies on this topic, this review will focus on the role of uric acid in PE, uric acid as a predictor of preeclampsia and fetal growth retardation. We considered eligible review and original articles relevant to the research question.

RECENT FINDINGS

Hypertensive disorders of pregnancy such as preeclampsia (PE) are a major cause of both maternal and fetal morbidity and mortality worldwide. Uric acid has been reported as a key factor contributing to the pathogenesis of PE. Some studies have indicated that serum uric acid levels increase with the severity of PE, while several studies have shown contradictory results. Some studies suggested high uric acid levels lead to PE, while others state that PE causes an increase in uric acid levels. Despite the strong association of uric acid in the pathogenesis of preeclampsia, current data is still contradictory hence genetic and high-end laboratory investigations may clarify this enigma.

Serum magnesium and calcium in preeclampsia: a comparative study at the Korle-Bu Teaching Hospital, Ghana

Background

A large percentage (16% of maternal mortality in developed countries, compared to 9% in developing countries), is due to hypertensive disorders in pregnancy. The etiology of preeclampsia remains unknown, with poorly understood pathophysiology. Magnesium and calcium play an important role in vascular smooth muscle function and therefore a possible role in the development of preeclampsia.

Aim

We aimed to compare serum magnesium and total calcium levels of preeclamptic and normal pregnant women at the Korle-Bu Teaching Hospital in Ghana.

Patients and methods

A comparative cross-sectional study involving 30 normal pregnant and 30 preeclamptic women with >30 weeks gestation and aged 18–35 years, was conducted at the Korle-Bu Teaching Hospital. Magnesium and calcium were determined using a flame atomic absorption spectrometer.

Results

Mean serum magnesium and total calcium levels in preeclamptic women were 0.70±0.15 and 2.13±0.30 mmol/L, respectively. Mean serum magnesium and total calcium levels in normal pregnant women were 0.76±0.14 and 2.13±0.35 mmol/L, respectively. There was a statistically nonsignificant difference in serum magnesium and total calcium in preeclamptic women compared to normal pregnant women, with p-values of 0.092 and 0.972, respectively.

Conclusion

Serum magnesium and total calcium, therefore, seem not to differ in preeclamptic women compared to normal pregnant women in Ghana.