DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195341

First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia

Renu Arora, Sueba Salmani, Rekha Bharti, B. C. Kabi, Anjali Dabral

Abstract


Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.

Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.

Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (<13.5 ng/ml) and hs-CRP (>9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.

Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D.


Keywords


Gestational hypertension, hs-C reactive protein, Preeclampsia, Prediction, Uterine artery doppler, Vitamin D

Full Text:

PDF

References


Dhall K, Dhall GI, Chugh KS, Dutta BN. A clinico–pathological diagnosis of hypertensive disorders of pregnancy. Asia Oceania J Obstet Gynaecol. 1985;11(2):219-25.

Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. IJPSR. 2014;5(4):163-70.

Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol. 2003;102:181-92.

Jain K, Kavi V, Raghuveer CV, Sinha R. Placental pathology in pregnancy induced hypertension (PIH) with or without intrauterine growth retardation. Indian J Pathol Microbiol 2007;50(3):533-7.

Roberge S, Giguère Y, Villa P, Nicolaides K, Vainio M, Forest JC, et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol. 2012;29(7):551-6.

Wu P, van den Berg C, Alfirevic Z, O'Brien S, Röthlisberger M, Baker PN, et al. Early pregnancy biomarkers in pre-eclampsia: a systematic review and meta-analysis. Int J Mol Sci. 2015;16(9):23035-56.

Hyppönen E. Vitamin D for the prevention of preeclampsia? A hypothesis. Nutr Rev. 2005;63:225-32.

Evans KN, Bulmer JN, Kilby MD, Hewison M. Vitamin D and placental-decidual function. J Soc Gynecol Invest. 2004;11:263-71.

Hyppönen E, Cavadino A, Williams D, Fraser A, Vereczkey A, Fraser WD, et al. Vitamin D and pre-eclampsia: original data, systematic review and meta-analysis. Ann Nutr Metab. 2013;63(4):331-40.

Tabesh M, Salehi-Abargouei A, Tabesh M, Esmaillzadeh A. Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98(8):3165-73.

Ghosh TK, Ghosh S, Bhattacharjee D. C-reactive protein levels in women with pregnancy induced hypertension. BJMS. 2011;10(3):159-62.

Timms PM, Mannan N, Hitman GA, Noonan K, Mills PG, Syndercombe-Court D, et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM. 2002;95(12):787-96.

Hwang HS, Kwon JY, Kim MA, Park YW, Kim YH. Maternal serum hs-CRP in normal pregnancy in pre-eclampsia. Int J Gynaecol Obstet. 2007;98(2):105-9.

Wen SW, Huang L, Liston R, Heaman M, Baskett T, Rusen ID, et al. Severe maternal morbidity in Canada, 1991-2001. CMAJ. 2005;173(7):759-64.

Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet. 2001;357(9249):53-6.

Campbell S, Diaz-Recasens J, Griffin DR, Cohen-Overbeek TE, Pearce JM, Willson K et al. New Doppler technique for assessing uteroplacental blood flow. Lancet. 1983;26:675–7.

Costa FS, Murthi P, Keogh R, Woodrow N. Early screening for preeclampsia. Rev Bras Ginecol Obstet. 2011;33(11):367-75.

Thilaganathan B, Wormald B, Zanardini C, Sheldon J, Ralph E, Papageorghiou AT. Early-pregnancy multiple serum markers and second-trimester uterine artery doppler in predicting preeclampsia. Obstet Gynecol 2010;115(6):1233-8.

Cunnigham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams obstetrics 23rd editions, New York. McGraw-Hill; 2010.

Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92:3517-22.

Baker AM, Haeri S, Camargo CA, Espinola JA, Stuebe AM. A nested case- control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clin Endocrinol Metab. 2010;95:5105-9.

Hossain N, Khanani R, Hussain-Kanani F, Shah T, Arif S, Pal L. High prevalence of Vitamin-D in Pakistani mothers and their newborns. Int journal Gynae Obs. 2011;112:229-33.

Tabesh M, Salehi-Abargouei A, Tabesh M, Esmaillzadeh A. Maternal Vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98:3165-73.

Dhok AJ, Daf S, Mohod K, Kumar S. Role of early second trimester hs-CRP for prediction of adverse pregnancy outcome. J.K. Sci. 2011;13:141-4.

Nanda K, Sadanand G, Muralidhara Krishna CS, Mahadevappa KL. C-reactive protein as a predictive factor of preeclampsia. Int J Biol Med Res. 2012;3(1):1307-10.

Elkady OS, Kamel OI, Elmohsen WA, Badawy M. Role of The First Trimester maternal serum high sensitivity c–reactive protein and second trimester placental volume measurement by 3D doppler ultrasound in early detection of pre-eclampsia. EJHM. 2017;68(3):1442-51.

Kurdi W, Campbell S, Aquilina J, England P, Harrington K. The role of color Doppler imaging of the uterine arteries at 20 weeks’ gestation in stratifying antenatal care. Ultrasound Obstet Gynecol. 1998;12:339-45.

Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi, MT, Romero R, Lee W, et al. Should bilateral uterine artery notching be used in the risk assessment for preeclampsia, small-for-gestational-age, and gestational hypertension. J Ultrasound Med. 2010;29(7):1103-15.