Anti-oxidant Vitamin (Vit C, Vit E) Levels of Selected Normotensive and Pre-eclamptic Women in Bangladesh

Abstract

Pre -eclampsia is a disorder of 2nd half of pregnancy, which is characterized by a combination of hypertension, proteinuria and edema, secondary to decreased placental perfusion. Clinical studies suggest that antioxidant vitamins, such as Vit C and Vit. E can stabilize reactive free radicals, which are produced due to placental hypo perfusion, thereby preventing the development of pre-eclampsia. Pre-eclampsia remain a major cause of infant and maternal mortality and morbidity. In developing countries, pre-eclampsia causes an estimated 50,000 maternal deaths per year. Only a small number of studies have however, been conducted in Bangladesh. Objective: To compare the serum levels of antioxidants in selected pre-eclamptic and normotensive pregnant women. Methods: 220 pregnant women were selected with inclusion and exclusion criteria from 3 different medical colleges and divided into 2 groups – A study group, consisting of 110 pre-eclamptic women and a control group consisting of 110 normotensive pregnant women. Dietary information was collected by 7 days food frequency questionnaire and food score was determined. Anthropometric and biochemical tests were performed. Biochemical analysis such as serum vitamin C levels were measured by spectrophotometric method, and serum vitamin E levels were measured by HPLC (High Performance Liquid Chromatography) method. Results: The mean serum levels of Vit. C and Vit E were found to be significantly lower in the study group, compared to the control group. Anthropometric study revealed that the babies born to pre-eclamptic mothers had lower birth weight than those born to normotensive mothers. Conclusion: Therefore, low antioxidant levels do play a key role in the development of preeclampsia in pregnant women. DOI: https://doi.org/10.3329/jdmc.v29i1.51172 J Dhaka Med Coll. 2020; 29(1) : 53-58 1. Dr. Nahid Ahmed Khan, Associate Professor, Dept. of Anatomy, Holy Family Red Crescent Medical College. 2. Prof. Khaleda Islam, Professor, Institute of Nutrition and food Science, University of Dhaka. 3. Dr. Nuzaira Nahid, Honorary Medical Officer, working in BMCH 4. Dr. Mohammad Mahfuzul Hoque, Assistant Professor of Medicine, Dhaka Medical College, Dhaka 5. Dr. Md. Shaifullah, Assistant Professor of Medicine, Dhaka Medical College, Dhaka 6. Dr. Md. Rafiquzzaman, Indoor Medical Officer, Dhaka Medical College 7. Dr. Ponkaj Kanti Datta, Assistant Professor of Medicine, Dhaka Medical College, Dhaka 8. Dr. Md. Golam Morshed, Junior Consultant, Department of Medicine, OSD, DGHS, Dhaka 9. Dr. Abdullah Al Masum, Department of Internal Medicine, BSMMU, Dhaka 10.Dr. Partho Protim Chowdhury, Assistant Professor of Medicine, Dhak Medical College, Dhaka Correspondence: Dr. Nahid Ahmed Khan, Associate Professor, Dept. of Anatomy, Holy Family Red Crescent Medical College, E-mail: nahidmelia@gmail.com Mobile No: 01914222818 Received: 10-01-2020 Revision: 19-01-2020 Accepted: 21-03-2020 Introduction: Pre-eclampsia is a multi system disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mmHg or more with proteinuria after 20th week of gestation in a previously normotensive woman. Pre-eclampsia has been associated with intrauterine growth retardation, preterm birth, maternal and perinatal death.1 The incidence of pre-eclampsia is 2-10%, and itt occurs in 47% of pregnant women worldwide.3 The etiology of pre-eclampsia is still unknown, although a number of hypothesis have been accepted. Four hypotheses currently accepted are: 1) the placental ischemia hypothesis 2) genetic hypothesis 3) the immune maladaption 4) hypothesis of the imbalance between free oxygen radicals and scavangers in favour of oxidants. Pre-eclampsia is a disorder of the second half of pregnancy. It is a 2 stage disease. Stage 1 is decreased placental perfusion. Stage 2 is the maternal syndrome of pre-eclampsia comprising of hypertension, protenuria and edema.4 One theory suggests that the linkage between the 2 stages is the generation of mediators of oxidative stress in the intervillous space.4 Dysfunction of vascular endothelium and inadequate trophoblastic invasion, leads to high resistance and low uteroplacental circulation that causes placental ischemia and hypoxia. Hypoxia causes production of reactive oxygen species or free radicals like superoxide, which are capable of damaging proteins, DNA and inducing lipid peroxidation, ultimately resulting in widespread endothelial damage.4 Pre-eclampsia is a leading cause of infant and maternal, with an estimated 50,000 maternal deaths per year in developing countries like Bangladesh mortality.4 It has now been suggested that deficiency of antioxidant can lead to the development of preeclampsia.Antioxidant vitamins like Vit C, Vit E with their ability to stabilize highly reactive free redicals, act as the first line of defense against superoxide attack and lipid peroxidation5. Therefore in this study we tried to evaluate the serum levels of antioxidants in pre-eclamptic and normotensive pregnant women of Bangladesh. Materials and Method A comparative cross sectional study was done for three years from June 2015 to May 2018. Study groups were selected from three major tertiary hospitals located in Dhaka City: Dhaka Medical College and Hospital, Sir Salimullah Medical College and Mitford Hospital and Holy Family Red Crescent Medical College and Hospital. To calculate the prevalence and proportion of pre-eclampsia, we followed the standard procedure. A total number of 10,800 pregnant patients, admitted in Gynae and Obs Department of aforesaid hospitals from June, 2015 to May, 18 were selected. Amongst them, a total of 1800 were complicated with pre-eclampsia. So, Sample size was calculated, n=217. Selection of cases was based on strict inclusion and exclusion criteria: Incase of pre-eclamptic women age groups: 18 to 40 years, Pregnancy status: third trimester of pregnancy, Blood Pressure: Diastolic Blood Pressure above 90 mm of Hg. Clinically oedema of legs present; Proteinuria: Confirmed by biochemical tests. Exclusion Criteria: Less than 18, greater than 40; No oedema; No preteinuria; Normal Blood Pressure (diastolic < 90 mm of Hg). A questionnaire was developed to obtain relevant information regarding socio economic status, age, obstetric history, monthly income, living area, family size, education, type of jobs and usual habit of food before admission to hospital. Ethical permission has been obtained from Ethical review committee of Bangladesh Medical and Research Council (B.M.R.C). Written consent was taken from both pre-eclamptic and normal pregnant women. Haematological and BioChemical Assays: CBC, HB%, ESR and Fasting Blood Sugar, serum Vit C and serum Vit E, Urine for Albumin: assessed by Heat Coagulation Test were measured. Nutritional Status: measured by Mid Upper Arm Circumference (MUAC), using a measuring tape (in cm). Dietary Information: Dietary information was measured by 7 days food frequency questionnaire. Measurement of weight: Body weight was measured by bathroom scale, to the nearest 0.5 kg. Measurement of height: A wooden height scale was used to record height with bared heels, standing in upright position, height was measured to nearest 0.1 cm. Blood Pressure Measurement: The blood pressure was measured by sphygmomanometer machine and stethoscope. Birth weights of new born babies: Birth weights of new born babies were recorded to the nearest 20 grams after delivery without clothes on a beam balance (Dedecto medic, Delecto scale inc., U.S.A.) J Dhaka Med Coll. Vol. 29, No. 1. April, 2020