Project Materials

DETERMINATION OF SOME BIOCHEMICAL PARAMETERS IN DIABETIC AND HYPERTENSIVE PREGNANT SUBJECTS IN SOME REFERRAL HOSPITALS

Chapter one

INTRODUCTION

1.1 Background of the Study

Diabetes and hypertension in pregnant women are related with an increased risk of congenital malformations as compared to normal pregnancy (Hagay et al, 2005). The proportion of diabetes and hypertensive mothers is predicted to be 6-10% (Hagay and Reece, 2006).

Diabetes and hypertension are known to cause lipid profile changes during pregnancy (Caron and Kjos, 2000). In the current investigation, the following blood parameters were measured to determine the biochemical profile status of pregnant women with diabetes and hypertension (Kjos, 2000).

The serum lipid profile parameters to be evaluated with the Hitachi 902 Atom analyser are total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglycerides.

In relation to diabetes, the pregnant woman’s physiological changes support foetal growth and development. Pregnancy causes considerable changes in the activities of the typical liver.

Although the specific mechanism underlying these diverse modifications is not always evident, their identification is critical for a complete clinical evaluation (Angel, 2006).

Lipid metabolism alters during pregnancy (Brizzi et al., 2008). Normal pregnancy causes a natural rise in plasma lipids, however this occurrence is not atherogenic and is thought to be regulated by hormones (Rovinsky and Gaffin, 2010). However, in complex pregnancies, there may be a malfunction in the process for regulating physiologic hyperlipidaemia.

Plasma lipid profile in the first trimester of pregnancy may predict the occurrence and severity of pre-eclampsia. The anabolic phase of early pregnancy promotes lipogenesis and fat accumulation in preparation for accelerated foetal growth in late pregnancy.

Insulin resistance increases lipolysis, which increases the transit of fatty acids to the liver, boosting the production of very low-density lipoprotein (VLDLS) and increasing triglyceride (TG) concentration (Ross, 2007).

Because of a decrease in lipoprotein lipase activity, very-LDL persists in the plasma for extended periods of time, causing LDL to accumulate. Increased LDL is linked to the development of atherosclerosis (Ross, 2007).

Abnormal lipid metabolism appears to play an essential role in the development of pregnancy-induced hypertension. Pregnancy-related hypertension is defined by high blood pressure, proteinuria, and oedema (Dutta 2001).

Although PIH is considered rare in the United States, it occurs in 2 to 35% of pregnancies worldwide, depending on diagnostic criteria and population studies.

PIH, also known as preclampsia, most commonly affects young women during their first pregnancy. It is more likely in twin pregnancies, those with chronic hypertension, pre-existing diabetes, and women who have had PIH before.

Pregnancy hypertension is associated with major consequences for both the foetus and the mother (Hagay et al, 205). PIH occurs more frequently and is more severe in women with preexisting hypertension than in women who were normotensive previous to pregnancy. The hypertensive condition of pregnancy is a major public health issue in the United States and around the world.

The cause and characteristics of this illness are still poorly understood (Angel 2006). As a result, the presence investigation was conducted to compare plasma lipid concentrations in normal and hypertensive pregnancy in order to determine whether hypertension contains aberrant lipid concentrations that could be potential metabolic risk factors for pregnancy complications.

Lipid profile in normal pregnant women; various scientific evidences have raised concerns about the deleterious influence of aberrant blood lipid levels, such as cholesterol and other lipids and lipoproteins, on atherosclerotic disease.

The importance of routine assessment of the serum lipid and lipoprotein profile in human individuals, particularly during pregnancy, under illness conditions such as diabetes and hypertension has been well established (Seggmour, 2006). Gotto (2009) discovered that blood lipid and lipoprotein profiles vary with age, gender, diet, and race.

Many populations’ blood protein and lipoprotein profiles have yet to be defined. This study was also meant to investigate the variation in serum lipid and lipoprotein profiles among diabetics, hypertensives, and normal pregnant women.