A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcome
Keywords:Eclampsia, Gestational hypertension, Lactate dehydrogenase enzyme, Preeclampsia
Background: A spectrum of hypertensive disorders in pregnancy contribute to maternal and perinatal morbidity and mortality. For prediction and early diagnosis of preeclampsia various biochemical markers, vascular function test and renal markers have been developed. The objective of the study is to measure the lactate dehydrogenase enzyme (LDH) levels in pregnant women with pregnancy induced hypertensive disorders and correlate the levels with the severity of condition, maternal and the perinatal outcome.
Methods: In this prospective observational study, a total of 150 pregnant women were studied. Out of these 150 women, 30 women had normal blood pressure, 30 women had gestational hypertension, 30 women had mild preeclampsia, 30 women had severe preeclampsia and 30 women had eclampsia. The serum LDH levels were measured in third trimester and patients followed up until early postpartum period and babies were followed up till early neonatal period to assess the maternal and neonatal outcomes.
Results: Higher lactate dehydrogenase enzyme (LDH) levels were observed in pregnant women with severe form of hypertensive disorder and those who had a poor maternal and perinatal outcome. This is statistically significant (p<0.001).
Conclusions: Lactate dehydrogenase enzyme (LDH) level is a useful biochemical marker to assess and predict the severity of disease, maternal and perinatal outcome as higher levels of the enzyme are associated with worsening severity of disease, a poor maternal and perinatal outcome.
Preeclampsia Foundation. Preeclampsia and Maternal Mortality: a Global Burden, 2013. Available at https://www.preeclampsia.org/health-information/149-advocacy-awareness/332-preeclampsia-and-maternal-mortality-a-global-burden. Accessed 01 May 2013.
Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol. 2009;113:1299-306.
Fabry IG, Richart T, Chengz X, Van Bortel LM, Staessen JA. Diagnosis and treatment of hypertensive disorders during pregnancy. Acta Clin Belg. 2010;65(4):229-36.
Villar J, Say L, Gulmezoglu AM, Marialdi M, Lindheimer MD, Betran AP, et al. Pre-Eclampsia Eclampsia: A Health Problem for 2000 Years. In Preeclampsia, Critchly, H., MacLean, A., Poston, L. and Walker, J., Eds., Preeclampsia, RCOG Press, London; 2003:189-207.
Ronsmans C, Graham WJ, Phill D. On behalf of the Lancet Maternal Survival Series steering group. Maternal mortality; who, when, where and why. Lancet. 2006;368(9542):1189-2000.
Preeclampsia Foundation, Preeclampsia: A Decade of Perspective, Building a Global Call to Action., Melbourne, Florida; 2010.
Davison JM, Homuth V, Jeyabalan A. New aspects in pathophysiology of preeclampsia. J Am Soc Nephrol. 2004;15(9):2440-8.
Fisher SJ, Roberts JM. Defects in placentation and placental perfusion. In: Linhheimer MD, Roberts JM, Cunningham FG, eds. Chesley's Hypertensive Disorders in Pregnancy. 2nd ed. Stanford, CT: Appleton and Lange; 1999:377-394.
August P, Lindheimer MD. Pathophysiology of pre-eclampsia In: Laragh JL, Brenner BM, eds. Hypertension. 2nd. New York, NY: Raven Press; 1995:2407-2426.
Hanretty KP, Whittle MJ, Rubin PC. Doppler uteroplacental waveforms in pregnancy-induced hypertension: a re-appraisal. Lancet. 1998;1:850-2.
Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol. 1998;16:5-15.
Taylor RN, Roberts JM. Hypertensive Disorders in Pregnancy 2nded. Stanford, CT: Appleton and Lange; 1999:395-429.
Jaiswar SP, Gupta A, Rekha S. Lactic Dehydrogenase: a biochemical marker for preeclampsia and eclampsia. J Obstet Gynecol India. 2011;61(6):645-8.
Fong A, Chau CT, Pan D. Clinical morbidities, trends, and demographics of eclampsia: a population-based study. Am J Obstet Gynecol. 2013;209:229.e1-7.
Qublan HS, Ammarin V, Bataineh O, Al-Shraideh Z, Tahat Y, Awamleh I, et al. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe preeclampsia. Med Sci Monit. 2005;11(8):CR393-7.
Shu He, Bremme K, Kallner A. Increased concentrations of lactate dehydrogenase in pregnancy with preeclampsia: a predictor for birth of small-for-gestational-age infants. Gynecol Obstet Invest. 1995;39:234-8.