Dyslipidemia in Preeclampsia – Risk Factor for Future Maternal Cardiovascular Diseases

Abstract

Preeclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. It is associated with insulin resistance & increase in Free Fatty Acids and plasma Triglycerides well above that seen in normal pregnancy. The pattern of dyslipidemia seen in preeclampsia may predispose these women to future cardiovascular diseases. The aim of this study was to compare the alteration in lipid profile and also the calculated risk ratios of women who developed Preeclampsia with normotensive pregnant women. This cross sectional study was carried out in Mahatma Gandhi Memorial Government Hospital, Trichy, Tamilnadu.100 women with preeclampsia and 100 normotensive pregnant women as controls were included in the study after obtaining their informed consent. The diagnosis of Preeclampsia was done as per the norms of American college of Obstetrics and Gynecologists. Fasting blood samples were collected. Serum glucose, cholesterol, triglycerides, and HDL-C were estimated by standard methods using standard kits. LDL-C was calculated by Friedwald's equation. All the results were analyzed statistically using ANOVA technique. There was significant elevation of total cholesterol, triglycerides, LDL, VLDL and risk ratios TC/HDL and TGL/HDL and decrease in HDL in Preeclamptic group compared to normotensives (p<0.0001). The dyslipidemic pattern of elevated TGL and reduced HDL which was also reflected in highly elevated TGL/HDL seen in preeclamptic patients is definitely atherogenic and may lead to future maternal cardiovascular disease. Hence simple measurement of lipid profile at 20 weeks of gestation can help in preventing the complications of PIH and future cardio vascular risk of the mother. Further studies in larger population in various ethnic groups are required to predict maternal future cardiovascular risk and its prevention by lifestyle modifications and therapy.

Study of high sensitive c-reactive protein in preeclampsia

“…There is impairment in the formation of Dehydroepiandrosterone (DHEA) by fetal adrenal glands due to decreased uteroplacental blood flow there by leading to decreased uptake of lipids by the fetus. 13 DHEA is the important source of estrogen in pregnancy. .The decrease in utero-placental blood flow leads to relative stasis of maternal blood in the intervillous space which leads to redistribution of steroids formed in syncytium back to the fetus instead of entering into maternal circulation which also results in a state of hypoestrogenemia.…”

“….The decrease in utero-placental blood flow leads to relative stasis of maternal blood in the intervillous space which leads to redistribution of steroids formed in syncytium back to the fetus instead of entering into maternal circulation which also results in a state of hypoestrogenemia. 13 Oxidative stress has been implicated in the pathogenesis of several complication of human pregnancy including preeclampsia. In preeclampsia dyslipidemia pattern of increased concentration of triglyceride, cholesterol and LDL and decreased concentration of HDL have been noticed Preeclampsia is associated with elevated lipid peroxidation and reduced antioxidant status.…”

Assessment of serum β‐hCG and lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy

“…In hypertensive disorders of pregnancy, the rise in blood pressure is due to vasospasm and impaired angiogenesis causing hypoxia and hyperplasia of trophoblastic cells, resulting in increased secretion of human chorionic gonadotropin (hCG) . In cases of pre‐eclampsia, it has been noted that there is insulin resistance, and that free fatty acids and plasma triglycerides are elevated . Increased triglycerides found in pregnancy‐induced hypertension are likely to be deposited in uterine spiral arteries, contributing to endothelial dysfunction both directly and indirectly through generation of small, dense low‐density lipoprotein …”

“…In cases of pre‐eclampsia, it has been noted that there is insulin resistance, and that free fatty acids and plasma triglycerides are elevated . Increased triglycerides found in pregnancy‐induced hypertension are likely to be deposited in uterine spiral arteries, contributing to endothelial dysfunction both directly and indirectly through generation of small, dense low‐density lipoprotein …”

“…8 In cases of pre-eclampsia, it has been noted that there is insulin resistance, and that free fatty acids and plasma triglycerides are elevated. 9 Increased triglycerides found in pregnancy-induced hypertension are likely to be deposited in uterine spiral arteries, contributing to endothelial dysfunction both directly and indirectly through generation of small, dense low-density lipoprotein. 9 The aim of the present study was to determine whether serum β-hCG and lipid profile in the early second trimester can predict hypertensive disorders of pregnancy and, if so, whether β-hCG or lipid profile is a better marker.…”