DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20150061

Maternal serum ischemia modified albumin as a marker for hypertensive disorders of pregnancy: a pilot study

Sapna Vyakaranam, Aparna Varma Bhongir, Dakshayani Patlolla, Rekha Chintapally

Abstract


Background: Hypoxia driven oxidative stress of the placenta contributes to the pathogenesis of preeclampsia. Serum Ischemia Modified Albumin (IMA) has recently emerged as an oxidative stress marker, used in diagnosis of cardiac ischemia. Aim: To determine the efficiency of serum IMA in differentiating hypertensive disorders of pregnancy (pregnancy induced hypertension, preeclampsia) from normal pregnancy.

Methods: It was a case control study. Pregnant women ≥32 weeks of gestation. Study population were included 3 groups, 19 Normotensive Pregnant (NP) women as controls, 18 pregnant women with Pregnancy Induced Hypertension (PIH) and 19 with preeclampsia (PE). Serum IMA was estimated by Enzyme Linked Immune Sorbent Assay (ELISA). Results were analyzed by student ‘t’test. Critical values for serum IMA were obtained by Receiver Operation Characteristics (ROC) curves.

Results: Serum IMA levels were significantly elevated in PE (56.84 ± 21.57 ng/ml) when compared with PIH (36.24 ± 14.51 ng/ml) and NP (35.47 ± 11.58 ng/ml) (P value <0.001). With a cutoff of 38.33 ng/ml, sensitivity and specificity for preeclampsia was 88.9% and 73.7% respectively.

Conclusions: Our study demonstrated that serum IMA, an oxidative stress marker is elevated in PE & PIH. Hence serum IMA can undergo further evaluation as a marker of PE.  


Keywords


Ischemia modified albumin, Pregnancy induced hypertension, Preeclampsia, Early marker

Full Text:

PDF

References


National High Blood Pressure Education Program Working Group. Report on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183:S1-22.

Dekkar G, Sibai B. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998;179:1359-75.

Papageoghiour AT, Prefumo F, Leslie K, Gaze DC, Collinson PO, Thilaganathan B. Defective endovascular trophoblast invasion in first trimester is associated with increased maternal serum ischemia modified albumin. Hum Reprod. 2008;23(4):803-6.

Burton GJ, Jauniaux E. Placental oxidative stress: from miscarriage to preeclampsia. J Soc Gynaecol Invest. 2004;11:342-52.

Jauniaux E, Hempstock J, Greenwold N, Burton GJ. Trophoblastic oxidative stress in relation to temporal and regional differences in maternal placental blood flow in normal and abnormal early pregnancies. Am J Pathol. 2003;162:115-25.

Anwaruddin S, Januzzi JL Jr, Baggish, Lewandrowski EL, Lewandrowski KB. Ischemia-modified albumin improves the usefulness of standard cardiac biomarkers for the diagnosis of myocardial ischemia in the emergency department setting. Am J Clin Pathol. 2005;123:140-5.

Roberts JM. Preeclampsia: what we know and what we do not know? Semin Perinatol. 2000;24:24-48.

Uotila J, Solakivi J, Jaakkola T, Tumila O, Lehtimaki R. Antibodies against copper oxidized and malondialdehyde - modified low density lipoproteins in preeclampsia pregnancies. Br J Obstet Gynaecol. 1998;105:1113-7.

Bahinipati J, Mohapatra PC, Pradhan T. Role of maternal serum ischemia modified albumin as a biochemical marker in preeclampsia. Biomed Res. 2014;25(2):153-6.

D’souza JM, Pai VP, Harish S, Shriyan C, D’souza N. IMA and IMAR in serum and saliva of preeclampsia - a preliminary study. Hypertens Pregnancy. 2014 Nov;33(4):440-8.

Ustan Y, Ustun YE, Ozturk O, Alanbay I, Yaman H. Ischemia-modified albumin as an oxidative stress marker in preeclampsia. J Maternal-Fetal Neonatal Med. 2011;24(3):418-21.

Gafsou B, Lefevre G, Hennache B, Debarge VH, Bouthers A. Maternal serum ischemia modified albumin: a biomarker to distinguish between normal pregnancy and preeclampsia. Hypertens Pregnancy. 2010;29:101-11.

Rijn V, Franx A, Sikkema JM, Herman JM, Bruinse H, Hieronymus Voorbij AM. Ischemia modified albumin in normal pregnancy and preeclampsia. Hypertens Pregnancy. 2008;27:159-67.

Brown AM, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Preeclampsia (ISSHP). Hypertens Pregnancy. 2001;20(1):9-14.

Procedures for the collection of diagnostic blood specimens by venipuncture. Approved Standard. 4th ed. Wayne PA: National committee for Clinical Laboratory Standards; 1998.

Procedures for handling and transport of domestic diagnostic specimens and etiologic agents. Approved Standard. 3rd ed. Wayne PA: National committee for Clinical Laboratory Standards; 1994.

Urinanalysis and collection, transportation and preservation of urine specimens. Approved Guidelines. 2nd ed. National committee for Clinical Laboratory Standards GP-16A2. 2008;21(19):4-21.

Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co (2+) and Ni (2+) binding amino acid residues of the N-terminus of human albumin. An insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem. 2001;268:42-7.

Borderie D, Allanore Y, Meune C, Devaux JY, Ekindjian OG, Kahan A. High ischemia-modified albumin concentration reflects oxidative stress but not myocardial involvement in systemic sclerosis. Clin Chem. 2004;50:2190-3.

Sharma R, Gaze DC, Pellerin D, Mehta RL, Gregson H, Streather CP, et al. Ischemia-modified albumin predicts mortality in ESRD. Am J Kidney Dis. 2006;47:493-502.

Apple FS, Quist HE, Otto AP, Mathews WE, Murakami MM. Release characteristics of cardiac biomarkers and ischemia-modified albumin as measured by the albumin cobalt-binding test after a marathon race. Clin Chem. 2002;48:1097-100.

Bar-Or D, Rael LT, Bar-Or R, Slone DS, Mains CW, Rao NK, et al. The cobalt-albumin binding assay: insights into its mode of action. Clin Chim Acta. 2008;387:120-7.

Pijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta. 2006;27:939-58.

Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynaecol. 1998;179:1359-75.

Clavant SP, Sastra SA, Osicka TM, Comper WD. The analysis and characterization of immuno-unreactive urinary albumin in healthy volunteers. Clin Biochem. 2006;39:143-51.

Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia - a preliminary report. J Emerg Med. 2000;19:311-5.

Khong TY, De Wolf F, Robertson WB, Brosen I. Inadequate maternal vascular response to placentation in pregnancies complicated by preeclampsia and by small for gestational age infants. Br J Obstet Gynaecol. 1986;93:1049-59.