Preeclampsia and low sodium (PALS): A case and systematic review

Powel, Jennifer E.; Rosenthal, Emily; Roman, Amanda; Chasen, Stephen T.; Berghella, Vincenzo

doi:10.1016/j.ejogrb.2020.03.052

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…Hsu et al [ 64 ] showed that hyponatremia in pre-eclampsia can lead to maternal respiratory and circulatory arrest. This is also confirmed by Powel et al [ 65 ], based on a case report of a twin pregnancy and data from the literature showing that pregnant women should be screened for water–electrolyte balance as part of a risk assessment for pre-eclampsia, as elevated Na levels can also be a risk factor for this condition [ 66 ].…”

Section: Discussionsupporting

confidence: 59%

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Grzeszczak

Kapczuk

Kupnicka

et al. 2023

Life

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Calcium (Ca), potassium (K), sodium (Na), and magnesium (Mg) are the elements responsible for the fundamental metabolic and biochemical processes in the cells of the body. The demand for these elements increases significantly during pregnancy, where an adequate supply protects women from the hypertension common in pre-eclampsia and preterm labor. This study aimed to evaluate the association between macro-elements (Ca, Mg, Na, and K) in the placenta, fetal membrane, and umbilical cord and the morphometric parameters of newborns from multiple pregnancies. The study involved 57 pregnant European women with healthy uncomplicated twin pregnancies (n = 52) and triple pregnancies (n = 5); 40 pairs of dichorionic diamniotic twins, 11 pairs of monochorionic diamniotic twins, 1 pair of monochorionic monoamniotic twins, 3 trichorionic triamniotic triplets, and 2 dichorionic triamniotic triplets. Placentas (n = 107), umbilical cords (n = 114), and fetal membranes (n = 112) were collected immediately following delivery, and then weighed and measured. The levels of Ca, K, Na, and Mg were determined using inductively coupled plasma atomic emission spectroscopy (ICP-OES) in a Thermo Scientific ICAP 7400 Duo (Waltham, MA, USA). The respective mean concentrations of Ca, K, Na, and Mg (mg/kg−1 dry mass) were: 2466, 8873, 9323, and 436 in the placenta; 957, 6173, 26,757, and 326 in the umbilical cord, and 1252, 7460, 13,562, and 370 in the fetal membrane. In the studied materials from northwestern Poland, we found strong positive correlations between Ca and Mg concentrations in both the umbilical cord (r = 0.81, p = 0.00) and the fetal membrane (r = 0.73, p = 0.00); between K and Mg concentrations in the umbilical cord (r = 0.73, p = 0.00); between Ca and K concentrations in the fetal membrane (r = 0.73, p = 0.00), and we found moderately positive correlations between placental Ca concentration and placental weight (ρ = 0.42, p = 0.00) and between umbilical cord Mg concentrations and the length of the pregnancy (ρ = 0.42, p = 0.00). Negative correlations were found between Na and Ca concentrations in the fetal membrane (r = −0.40, p = 0.00) and Na concentrations in the fetal membrane and Mg concentrations in the placenta (r = −0.16, p = 0.02). Negative correlations were confirmed between the length of pregnancy and head circumference (ρ = −0.42; p = 0.00), infant weight (ρ = −0.42; p = 0.00), infant length (ρ = −0.49; p = 0.00), shoulder width (ρ = −0.49; p = 0.00); and between the infant weight and head circumference (ρ = −0.62; p = 0.00), weight before delivery (ρ = −0.36; p = 0.00), infant length (ρ = −0.45; p = 0.00), shoulder width (ρ = −0.63; p = 0.00), and weight gain during pregnancy (ρ = −0.31; p = 0.01). We found statistically significant correlations between cigarette smoking before pregnancy and the women’s weight before delivery (ρ = 0.32, p = 0.00), and a negative correlation between the women’s ages and infant head circumference (ρ = −0.20, p = 0.02). This is probably the first study to evaluate Ca, Na, K, and Mg concentrations in the afterbirth tissues of multiple pregnancies. It adds to the knowledge of elemental concentrations in multiple pregnancies and their possible effects on fetal morphometric parameters.

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Section: Discussionsupporting

confidence: 59%

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Grzeszczak

Kapczuk

Kupnicka

et al. 2023

Life

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“…Seizures can occur at sodium levels <125 mmol/L. 1 During normal pregnancy there is physiological hyponatraemia 3 that can be worsened by pre-eclampsia, 4 oxytocin administered in glucose solutions 5 and hypotonic fluid overdose. 6 Furthermore, excessive oral fluid intake can exacerbate hyponatraemia.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication

et al. 2021

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Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.

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“…11 In some cases, the underlying pathology is thought to be mediated by syndrome of inappropriate ADH secretion (SIADH) and hypervolaemia. 12 Careful fluid assessment and fluid restriction in this situation is the mainstay of treatment. There is no safety data for the use of vasopressin antagonists (tolvaptan) in pregnancy.…”

Section: Peripartum Hyponatraemiamentioning

confidence: 99%

Metabolic emergencies in pregnancy

Mohan

Banerjee

2021

Clinical Medicine

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In pregnancy, women are more likely to develop certain metabolic disturbances as a result of the physiological changes that occur. Diabetic ketoacidosis and hypoglycaemia occur at increased frequency in women with pre-existing and gestational diabetes, and starvation ketoacidosis can present towards the end of pregnancy and can cause severe illness. Peripartum hyponatraemia is increasingly recognised and can be associated with maternal and neonatal morbidity. This review describes these conditions in detail as well as treatment priorities and the impact on both mother and baby.

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Preeclampsia and low sodium (PALS): A case and systematic review

Cited by 11 publications

References 14 publications

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Calcium, Potassium, Sodium, and Magnesium Concentrations in the Placenta, Umbilical Cord, and Fetal Membrane from Women with Multiple Pregnancies

Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication

Metabolic emergencies in pregnancy

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