Plasma Proteins in Toxemias of Pregnancy

Abstract

Numerous studies of the toxemias of late pregnancy have consistently demonstrated the association of pre-eclampsia and eclampsia with disturbances of protein metabolism indicated by derangements in the protein composition of the blood. Whether these changes in themselves cause the symptoms of toxemia or are secondary to the elusive "toxic" factor has not been determined. Many circumstances are known to provide the basis for protein deficiency within the human body, by increasing the tissue requirement for protein or by interfering with assimilation and utilization of an intake which would otherwise be adequate (1, 2). Evidence relating to the possible relationship of nutritional disturbances to the occurrence of toxemia is contradictory (3)(4)(5)(6)(7)(8)(9). In an excellent analysis of the problem of comparing conflicting reports in the literature, M0ller-Christensen and Thygesen (10) emphasized the intimate connection between changes in protein balance and accompanying shifts in water and salt balances, and suggested the possibility of derangement in function of the adrenal in protein metabolism in toxemia. A complex explanation involving the presence of a toxic protein (an atypical euglobulin) in the circulating blood during menstruation, labor, and toxemia of pregnancy has been advanced by Smith and Smith (11,12).While a relationship between disturbed protein metabolism and toxemia of pregnancy has been established, the evidence does not show that the disturbance results from dietary protein deficiency. Dieckmann (13) believes that hypoproteinemia is neither the cause of pre-eclampsia and eclampsia, nor the cause of edema. Novak and Lustig (14) caution against identification of the hypoproteinemia of pregnancy with hypoproteinemia due to malnutrition and believe that within limits it is a physiologic condition. The finding by Bibb (15) that most women who developed toxemia had some previously existing hypoproteinemia would be expected. Despite suggestive data, theories relating toxemia to nutritional deficiency fail, as do all other hypotheses advanced, to explain many features of this disorder, notably its singular predilection for the primigravida. Our increased understanding in the past few years of the importance of interrelationships among various components of the food intake may provide a key to further elucidation of the role of nutrition in toxemias of pregnancy, but it seems likely that both nutritional and physiologic factors may be involved, the number varying perhaps with still other conditions. Certainly, even with respect to the part played by well-established changes in blood proteins, eclampsia remains "the disease of theories."The conflicting reports in the literature and the recent development of the electrophoretic technique of analysis were responsible for the decision to determine the distribution of plasma proteins in the blood of women during pregnancy, at delivery, and in the puerperium. A preceding publication (16) reported the distribution of proteins in the plasma of healthy women...

Thyroxine-Binding by Serum Protein in Pregnancy and in the Newborn

“…per cent in nonpregnant adults, and 3.4 Gm. per cent in pregnancy and in the newborn (17). The basis for the use of assumed rather than measured albumin values, and other assumptions involved in the calculations are considered in the discussion.…”

Cerebral spinal fluid and serum ionized magnesium and calcium levels in preeclamptic women during administration of magnesium sulfate

“…This could not be explained solely by a diminished quantity of protein (59). Numerous studies have confirmed a loss of the serum proteins, albumin and gamma-globulin, in normal pregnancy (60)(61)(62)(63)(64). In 1970, Studd and co-workers (64-67) published a series of articles, which indicated that several proteins, in addition to albumin and gamma-globulin, are decreased in late pregnancy and more so in preeclampsia (viz., transferrin and hemopexin).…”

Recent Contributions of Electrophoresis to Clinical Pathology

“…23 Absolute values for serum albumin and globulin are lower in toxemias than in uncomplicated pregnancies. 41 ' 93 Parviainen and coworkers 108 found all the plasma protein fractions, except fibrinogen, in the urine of patients with toxemias of pregnancy of varying severity. In mild toxemia, the percentage of albumin was lower and that of alpha globulin higher than in the plasma; in pre-eclampsia and eclampsia, the urinary albumin was higher and alpha globulin lower.…”