{'fraction_non_alphanumeric': 0.029752194515652915, 'fraction_numerical': 0.017400761283306143, 'mean_word_length': 5.153919694072658, 'pattern_counts': {'":': 0, '<': 3, '<?xml version=': 0, '>': 0, 'https://': 2, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Study of Serum Macronutrients – Calcium, Magnesium, and Phosphorus along with Lactate Dehydrogenase and Uric Acid in Prenatal Women with Pre-Eclampsia

Introduction: Serum calcium, serum phosphorus and serum magnesium decrease in preeclampsia, serum LDH and Uric acid increase. The present study on these parameters is essential in clinically diagnosed patients of hypertensive disorders to show their role in pathogenesis and diagnosis. Patients and Methods: 42 pre eclamptic women and 42 normotensive women are included in this study. Results: Serum calcium, magnesium and phosphorus are decreased, serum LDH and Uric acid are increased in pre-eclampsia. Conclusion: Macronutrients have role in pathogenesis of pre-eclampsia and there is correlation with serum LDH and serum uric acid. Introduction Hypertensive disorders of pregnancy are the most significant and unsolved problems in obstetrics. These disorders, together with haemorrhage and infection, form the deadly triad, which contributes significantly to maternal morbidity and mortality rates. The preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous, new-onset hypertension during pregnancy termed gestational hypertension is followed by signs and symptoms of preeclampsia almost half the time. More than half of these hypertension-related deaths can be prevented. Multiorgan involvement includes thrombocytopenia, renal dysfunction, hepatocellular necrosis, central nervous system perturbations, or pulmonary edema. Although preeclampsia is much more than merely gestational hypertension with proteinuria, the appearance of proteinuria remains an essential diagnostic criterion. Excretion of calcium and phosphate by kidney increases during pregnancy. Proteinuria and alterations of phosphate and, most notably, calcium excretion are characteristic findings of hypertension. The levels of calcium and magnesium in pregnancy mayimplicate their possible role in pregnancy-induced hypertension. Serum calcium and serum phosphorus decrease inpreeclampsia. Based on thetherapeutic effects of magnesium salts and the known vasodilating properties of magnesium, they suggested that a deficiency in magnesium contributed to the development of vasoconstriction in preeclampsia. The intracellular or membrane magnesium concentrations in preeclampsia are of more interest. Serum magnesium is found to decrease in preeclampsia. LDH rises in preeclampsia. UA is the end product of purine metabolism. It is filtrated through the glomeruli and almost completely http://jmscr.igmpublication.org/home/ ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.35


Introduction
Hypertensive disorders of pregnancy are the most significant and unsolved problems in obstetrics. These disorders, together with haemorrhage and infection, form the deadly triad, which contributes significantly to maternal morbidity and mortality rates. The preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous, new-onset hypertension during pregnancy termed gestational hypertension is followed by signs and symptoms of preeclampsia almost half the time. More than half of these hypertension-related deaths can be prevented. Multiorgan involvement includes thrombocytopenia, renal dysfunction, hepatocellular necrosis, central nervous system perturbations, or pulmonary edema. Although preeclampsia is much more than merely gestational hypertension with proteinuria, the appearance of proteinuria remains an essential diagnostic criterion. Excretion of calcium and phosphate by kidney increases during pregnancy. Proteinuria and alterations of phosphate and, most notably, calcium excretion are characteristic findings of hypertension. The levels of calcium and magnesium in pregnancy mayimplicate their possible role in pregnancy-induced hypertension. Serum calcium and serum phosphorus decrease inpreeclampsia. Based on thetherapeutic effects of magnesium salts and the known vasodilating properties of magnesium, they suggested that a deficiency in magnesium contributed to the development of vasoconstriction in preeclampsia. The intracellular or membrane magnesium concentrations in preeclampsia are of more interest. Serum magnesium is found to decrease in preeclampsia. LDH rises in preeclampsia. UA is the end product of purine metabolism. It is filtrated through the glomeruli and almost completely http://jmscr.igmpublication.org/home/ ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.35 reabsorbed in the PCT and is also actively secreted into the tubules. Increased Uric acid is found to be one of the earliest laboratory manifestations of preeclampsia. The present study on these parametersis essential in clinically diagnosed patients of hypertensive disorders to show their role in pathogenesis and to ascertain their role as biochemical markers of the disease for prevention, early diagnosis, and to monitor the prognosis of hypertensive disorders of pregnancy.

Patients and Methods
Cross sectional study was conducted between June 2017 to September 2019 in the Department of Biochemistry, King George Hospital, Visakhapatnam. 84 patients with age group 19 to 35 years were selected. Patients with pre-eclampsia attending OP or admitted in the department of obstetrics and Gynaecology. Subjects are divided into two groups, fulfilling inclusion and exclusion criteria. GROUP A: 42 Normotensive women GROUP B: 42 Preeclampsia women Data Collection: After proper Institutional Ethical Clearance and informed written consent from the participants. Every effort was made not to disclose the identity of participants. A detailed family and medical history of all the childbearing women with gestational age 24 weeks or more admitted with the features of HDP was recorded followed by a thorough clinical examination. Systolic and diastolic blood pressure of all the participants was carefully recorded every four hours. Blood pressure was measured in both arms and one with higher value was taken as the blood pressure of record. Korotkoff phase V readings were used for diastolic readings. Urine analysis was done in all subjects to measure the degree of proteinuria and to differentiate patients with gestational hypertension from preeclampsia. The degree of proteinuria was measured by dipstick and graded as Trace to 4+ (Trace, 0.1gm/L;1+, 0.3gm/L;2+, 1gm/L;3+, 3.0gm/L;4+, 10gm/L). At the same time blood was taken from the ante-cubital vein using a sterile needle and syringe early in the morning after overnight fasting for serum calcium measurement. Blood samples were allowed to clot and then centrifuged at 3000 revolutions per minute for 10 minutes.

Results
The [mean ± SD] serum calcium levels in cases where 8.29±0.69 mg/ dl and in controls 8.94±0.26 mg/dl. There is a high statistical significance in the serum calcium levels between the two groups.  The [mean ± SD] serum uric acid levels in cases were 7.74 ±1.48mg/dl and in controls 3.44±0.64mg/dl. There is a high statistical significance in the serum uric acid levels between the two groups.
Table1: Correlation of serum calcium with blood pressure.
There is a highly statistically significant correlation between systolic blood pressure and serum calcium levels at a 90% confidence interval. (r=-0.279)r-Karl Pearson correlation Co-efficient.  There is a highly statistically significant correlation between systolic blood pressure and serum uric acid levels. (r=0.3128). There is no statistically significant correlation between diastolic blood pressure and serum uric acid levels.
(r = -0.023, r-Karl Pearson correlation Co-efficient) Graph 6: Correlation of serum calcium with systolic blood pressure  There is a high statistical significance in the blood pressure, both systolic and diastolic, between the two groups. The results in the present study are in accordance with the studies of Naser et al, [1] Idougoun et al, [2] chanvitya et al, [3] Sukopan et al, [4] where the p-value is <0.001.   statistically significant difference between the two groups, and magnesium levels were lower in a patient with preeclampsia than that of normal pregnant women. Like serum calcium, the mean serum magnesium level in preeclampsia was lower than in normal pregnancy. The results of the present study are in accordance with the results of the study done by Seema et al., Sukonpan et al., Akinloye et al, [6] and Fatemeh et al where the p-value is <0.001. The [mean ± SD] serum phosphorus levels in cases were 3.68±0.42mg/ dl and in controls 4.24±0.53mg/dl. The results of the present study show that there is a statistically significant difference between the two groups. Recent studies by Ikaraoha et al report a relationship between phosphorus deficiency and preeclampsia, but this result is contradictory to studies done by Abdrabo et al [7] and Bhowal et al where they showed that there is no difference in serum phosphorus levels in normal pregnant women and women with preeclampsia.
The [mean ± SD] serum LDH levels in cases were 1019.3±640.03IU/l and in controls 482.85±153.07 IU/l. The results of the present study show that there is a statistically significant difference between the two groups, and LDH levels were significantly higher in a patient with preeclampsia than that of normal pregnant women. Qublan et al, [8] found in their study that the mean LDH levels in normal controls were 299 ± 79 IU/l, in patients with severe preeclampsia was 774 ± 69.61 IU/l. Thus, they demonstrated a significant association of serum LDH levels with severe preeclampsia (P<0.001).
The [mean ± SD] serum uric acid levels in cases were 7.74±1.48 mg/ dl and in controls 3.44± 0.64mg/dl. The results of the present study show that there is a statistically significant difference between the two groups, and uric acid levels are significantly higher in women with pre-eclampsia as compared with normal women.The results of the present study areinaccordance with the studies done by Saldhana CL et al, [9] Mansi Gandhi et al. [10] It is found that as the systolic blood pressure increase, there is a decrease in the serum calcium values, which correlates more with the systolic blood pressure than diastolic blood pressure indicating that the severe the preeclampsia lower are the values of serumcalcium. These results are in accordance with the studies of Chanvitya et al. LDH increases with an increase in blood pressure. There is a positive correlation between blood pressure and serum LDH levels. There is more correlation with the systolic blood pressure than the diastolic blood pressure. The results are in accordance with previous studies. Uric acid has a strong positive correlation with the systolic blood pressure as compared with the diastolic blood pressure. As the systolic blood pressure increases, serum uric acid also increases.

Limitations of the study
The present study was conducted on a small group of childbearing women with hypertensive disorder of pregnancy. In future we can think of conducting the study on larger group and also we can give supplemental calcium, magnesium and phosphorus either through diet or tablets to all childbearing women from the first trimester onwards till delivery and can look for development, severity of HDP and overall maternal and perinatal outcome.

Conclusion
1) The etiology of preeclampsia is very complex, involving many factors. Nutrition is one of the etiological factors. 2) This study estimated the serum levels of calcium, magnesium, and phosphorus in 42 patients who are diagnosed with severe preeclampsia to know their role in causing preeclampsia. 3) This study also estimated the serum levels of LDH and Uric acid. LDH and uric acid are to measure the severity of the disease. 4) This study also established that the levels of calcium, magnesium, and phosphorus are significantly reduced in pregnant women with pre-eclampsia. The success of magnesium therapy in the treatment for eclamptic seizures and its known effect on vascular responses in vitrosuggests that magnesium might be deficient in women with pre-eclampsia. 5) LDH and Uric acid are significantly elevated in diagnosed cases of preeclampsia. 6) These findings support the hypothesis that hypocalcemia, hypomagnesemia and hypophosphatemia are possible etiologies of preeclampsia. In light of the reduction in the concentration of these elements, dietary supplementation with these elements should be done in susceptible women atleast in developing countries like India. 7) The increase in levels of LDH and uric acid correlates with an increase in blood pressure and also correlates with the decrease in serum calcium levels. This further strengthens the hypothesis that macronutrient deficiency is a risk factor in developing preeclampsia and the progression of preeclampsia into eclampsia.