Serum homocysteine and lipid profiles in preeclamptic patients at kenyatta national hosptal - a comparative descriptive cross sectional study

Abstract

Pre eclampsia has been described since the early eighteenth century and occurs in 2 - 6-% of all pregnancies It is characterized by elevated blood pressure, proteinuria and I or oedema. 1ne primary pathology is in the vascular system and hence affects almost all the organ systems in the body. The cause of preeclampsia is still largely unknown. It is thought that vasospasm or inc.reased vascular reactivity and endothelial cell dysfunction may be the final common pathway .. Some of the identified risk factors are multiple gestation, primiparity, diabetes mellitus, underlying hypertension, activated protein C resistance and thrornbophillia. Inflammatory makers e.g C reactive protein (CRP), Tumour necrosis factor a (TNF a), interleukins 6 and 8 have been shown to be elevated in pre eclamptic patients. It has also been noted that patients with pre eclampsia have increased levels of homocysteine and lipids, both of which have been associated with cardiovascular disease. The rational of this study was that despite the fact that pre eclampsia is an important contributor to fetal maternal morbidity, its aetiology remains unknown but current theory points to vascular endothelial dysfunction. Homocysteine and plasma lipids are known risk factors of thrombotic vascular disease and may have a role in pre eclampsia. Objectives: The objective was to compare serum homocysteine, total cholesterol, HDL cholesterol and LDL cholesterol levels in pre eclamptic patients and non-eclamptic pregnant women attending Kenyatta National Hospital Methods: This was a cross sectional comparative study conducted at Kenyatta National Hospital between August 2005 to January 2006, both months inclusive. One hundred (100) subjects, comprising of fifty (50) pre eclamptic patients and a similar number of normotensive mothers for comparison were studied. Demographic and medical data from the participating subjects was obtained. Blood was drawn for estimation of serum totsl, LDL and HDL cholesterol plus homocysteine.

Rtsuits. There were 50 preeclamptic patients and a similar number of normotensive mothers. The mean homocysteine concentration, 12.78 ± 5.0, among the preeclamptic patients was higher than that in normotensive mothers, 8.13 ± 3.0 (p value < O.OOi). The mean total and LDL cholesterol in women with preeclampsia 6.50 ± 0.66 and 4.41 ± 0.52 was higher than in the normotensive mothers, 6.01 ± 0.37 and 3.85 ± 0.46 (p value = 0.01). The mean uric acid concentration among the preeclamptic patients and the controls was 350.6 ± 30.9 umollL and 222.2 ± 16 umolfL respectively ( p- value = 0.001). Cenclusion: Homocysteine concentration IS significantly increased in patients with preeclampsia as compared to normotensive pregnant mothers. Hyperlipidemia of pregnancy is more marked in patients with preeclampsia. Uric acid concentration is increased in patients with preeclampsia as compared to normotensive pre