Sonal Sogani and Poornima Dey Sarkar

Department of Biochemistry, M.G.M. Medical College, Indore - 452 001, India.    

Abstract

To investigate the concentration of acute phase reactant (hs-CRP) in women with healthy and preeclamptic pregnancy and to compare it with non pregnant women. Non-pregnant normotensive women (n=30), healthy pregnant women (n=30), women with preeclampsia (n=30) were included in the study. Preeclamptic group was further divided into two subgroups mild (n=21) and severe preeclampsia (n=9). Higher values of serum hs-CRP were found in mild and severe preeclamptic women than those of non-pregnant women and normal pregnant women in third trimester.

Keywords

Preeclampsia; hs-CRP; endothelial cell; dysfunction; inflammation

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Copy the following to cite this article: Sogani S, Sarkar P. D. Maternal Serum High Sensitive C-reactive Protein in Non-gestation and Preeclamptic Gestation. Biomed Pharmacol J 2013;6(1)

Copy the following to cite this URL: Sogani S, Sarkar P. D. Maternal Serum High Sensitive C-reactive Protein in Non-gestation and Preeclamptic Gestation. Biomed Pharmacol J 2013;6(1). Available from: http://biomedpharmajournal.org/?p=2637

Introduction

Preeclampsia develops in 5-8% of human pregnancies¹. It is characterized by an elevated blood pressure and proteinuria and develops after 20^th weeks of gestation². It is a complication of pregnancy constituting a major cause of maternal and fetal morbidity and mortality. Several etiologies have been implicated in the development of preeclampsia including abnormal trophoblast invasion of uterine blood vessels, immunological intolerance between fetoplacental and maternal tissues, maladaptation to the cardiovascular changes, dietary deficiencies and genetic abnormalities³.

Endothelial cell dysfunction and inflammation are considered to have a role in the pathophysiology of preeclampsia^{4, 5}. A generalized activation of circulating leukocytes, characteristics of inflammation, has been found during preeclampsia ⁶. Mediators of an inflammatory response are altered in women with preeclampsia, including increased hs-CRP ⁷. CRP is a sensitive marker of inflammatory activity in the body. CRP level increases during inflammatory response to tissue injury. ⁸

Material and methods 

This case control study was conducted in the Department of Biochemistry M.G.M. Medical College and associated M.Y. Hospital. Indore. The subjects were pregnant women clinically diagnosed as preeclampsia during third trimester (28-40 weeks) with the age 18-35 years (GROUP-C) visiting obstetrics OPD and wards of MY Hospital, The study group was further divided into two subgroups. It   comprised of 21 mild preeclamptic pregnant women (SUBGROUP C1) and 9 severe preeclamptic pregnant women (SUBGROUP C2) on the basis of blood pressure, (both systolic and diastolic) proteinuria and pathological edema, which is the diagnostic criteria of preeclampsia. As a control group 30 non pregnant women (GROUP-A) and 30 healthy pregnant women (GROUP-B) were taken. The healthy pregnant women were also in the third trimester (28-40 weeks) of their pregnancy with the age 18-35 years. Group A women were normotensive, nonproteinuric and in child bearing age of 20-40 years. Inclusion criteria for women included in the study were: should not be using any kind of oral contraceptives, anticoagulant drugs, should be non-smokers and non alcoholics and exclusion criteria was: past history of diabetes, systemic or endocrine disorder, chronic infection, chronic renal disease and  hypertension (in group A & B only), women in the labour pains, were excluded from the study.

Preeclampsia was diagnosed according to American college of Obstetrics and Gynecology (ACOG) criteria: a blood pressure higher than 140/90 mm Hg and proteinuria more than 300mg/24hr were observed on at least two occasions more than 6hrs apart after the 20^th weeks of pregnancy. Preeclamspia were classified as severe if diastolic blood pressure increased to at least 110mmHg, proteinuria >5000mg per day and the presence of headache, visual disturbances, epigastric pain, oliguria, elevated LFT, elevated RFT, thrombocytopenia.

Blood samples were collected in the morning in a plain bulb with aseptic conditions. In the preeclampsia group, blood samples were collected when the patients presented for evaluation and before initiation of medical therapy. Serum hs-CRP levels were measured by kits using an immunoturbidimetric method. The results were expressed as mean ± SD and analyzed by an independent samples t-test and groups were compared using ANOVA.

Statistical analysis was carried out by using SPSS software, version 20. The level of significance was set at < 0.05.

Results 

The Anthropometric factors of the study groups are summarized in table1.

Maternal age and body mass index (BMI) were not significantly different between the groups. (p>0.05, Table 1) Gestational age, systolic and diastolic blood pressures were significantly higher in preeclamptic groups as compared to non-pregnant and healthy pregnant women (p<0.001, Table 1). The same when compared between mild and severe preeclamptic groups were significantly higher in severe preeclamptic group (p<0.001, Table 1).

Observations and Tables 

Table 1: Comparison of mean and standard deviation of Anthropometric factors of study subjects.

Anthropometric factors	Group A		Group B		Group C1		Group C2		p value
	mean	±SD	mean	±SD	mean	±SD	mean	±SD
Age (yrs)	23.23	4.2	23.06	2.8	22.90	3.4	22.22	1.48	0.892
BMI (Kg/m2)	24.29	.136	24.02	1.5	23.98	1.23	24.42	2.39	0.805
Gestational age (wks)	——-	——	39.73	3.21	36.38	1.48	33.33	0.88	<0.001
Systolic blood pressure (mm of Hg)	114.7	8.01	114.33	7.27	142.38	6.24	163.22	9.66	<0.001
Diastolic blood pressure (mm of Hg)	74.5	7.23	75	5.08	92.09	6.01	107.77	4.4	<0.001

 

Serum hs-CRP in healthy pregnant women was raised when compared with non-pregnant women (p<0.001) and was found to be highest in preeclamptic women also as compared to non-pregnant women and healthy pregnant women (p<0.001, Table2). When hs-CRP in mild preeclamptic women was compared with severe preeclamptic women, it was found to be elevated in the latter group and the difference was significantly higher (p<0.001, Table 2).

Table 2: Comparison of mean and standard deviation of hs-CRP of study subjects

Acute Phase Reactant (hs-CRP)	Group A		Group B		Group C1		Group C2		p value
	mean	±SD	mean	±SD	mean	±SD	mean	±SD
(hs-CRP)	2.93	0.86	4.39	0.7	13.21	2.31	17.5	4.05	<0.001

Discussion

Preeclampsia is a disease of pregnancy associated with endothelial cell damage and endothelial cell activation. There is an increasing evidence that preeclampsia is a systemic inflammatory disease ⁹.

Studies have shown that markers associated with endothelial cell activation or damage and inflammation have an active role in preeclampsia ⁷. CRP is produced by the liver and the production is stimulated by the inflammatory cytokines interleukin-6 and TNF-alpha. It is a sensitive marker of tissue damage and inflammation plays an important role in elicitating the inflammatory response characteristics of preeclampsia ⁹.CRP acts as a scavenger and is responsible for the clearance of membranes and nuclear antigens ¹⁰. Higher concentration of CRP has been reported during preeclampsia ⁷. In this study it is shown that serum CRP levels were significantly higher in preeclamptic women as compared to non-pregnant and healthy pregnant women. The levels of CRP in severe as compared with that of mild preeclamptic group were significantly higher with similar chronological age, gestational age and body mass index (Table 2). Present results support the hypothesis that systemic inflammation is involved in the pathogenesis of preeclampsia.

In accordance with previous reports^{7, 9, 11} and our study, preeclampsia is associated with increased CRP levels.

Conclusion

It is concluded from the study that high levels of hs-CRP were found in preeclamptic group as compared to non-pregnant and healthy pregnant groups. As compared with mild preeclamptic group, the level of hs-CRP was significantly higher in severe preeclamptic group giving the evidence that preeclamptic pregnancy is a generalized intravascular inflammatory response syndrome.

References

1. WHO, 2004. Bethesda, MD. Global Burden of Disease for the Year 2001 by World Bank Region, for Use in Disease Control Priorities in Developing Countries, National Institutes of Health: WHO. Make every mother and child count. World Health Report, 2005, Geneva: World Health Organization, 2005. 2^nd ed.
2. Power RW, Bodnar LM, Ness RB, Cooper KM, Gallaher MJ, Frank MP, Daftary AR, Roberts JM. Uric acid concentrations in early pregnancy among preeclamptic women with gestational hyperuricemia at delivery. Am J Obstet Gynecol.2006;194(1):160.
3. Stekkinger E, Zandstra M, Peeters LL, Spaandernen ME. Early-onset preeclampsia and the prevalence of postpartum metabolic syndrome. Obstet Gynaecol 2009 Nov; 114(5):1076-84.
4. Creasy RK, Resnick R, Iams JD, editors. Maternal-Fetal Medicine: Principles and Practice.5^th ed. Philadelphia: WB Saunders; 2005.
5. James DK, Steer PJ, Weiner CP, Gonik B, editors. High Risk Pregnancy Management Option.3^rd ed. Philadelphia: WB Saunders; 2005.
6. Garcia R.G., Celedon J., Sierra –Laguado J., Alarcon M.A., Luengas C., Silva F., Arenas –Mantilla M., Lopez-Jaramillo P. Raised CRP and impaired flow mediated vasodilation precede the development of preeclampsia. Am. J. Hypertens 2007;20(1):98-110
7. Teran E, Escudero C, Moya W, Flores M, Vallance P, Lopez-Jaramillo P. Elevated CRP and proinflammatory cytokines in Andean women with preeclampsia.Int J Gynaecol Obstet 2001;75(3):243-249.
8. Braekke K, Holthe MR, Harsem NK. Fagerhol MK, Staff AC. Calprotectin, a marker of inflammation is elevated in the maternal but not in the fetal circulation in preeclampsia. Am J Obstet Gynaecol 2005; 193(1):227-33.
9. Ustun y, Engin-ustun Y, Kamaci M. Association of fibrinogen and CRP with severity of preeclampsia. Eur J Obstet Gynaecol Biol 2005; 121(2):154-8.
10. Du Clos TW. The interaction of C-reactive protein and serum Amyloid P component with nuclear antigens. Mol Biol Rep 1996; 23(3-4):253-260.
11. Belo, L., A. Santos-Silva and M. Caslake. Neutrophil activation and CRP concentration in preeclampsia. Hypertens Pregnancy 2003; 22(2):129-14.

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