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Obstetrics & Gynecology International Journal

Conceptual Paper Volume 10 Issue 3

Study of serum lipid profile in pregnancy and its correlation with preeclampsia

Dr Nidhi,1 Dr Brinderjeet Kaur,2 Dr S Fayyaz3

1Senior Resident, Obstetrics & Gynecology, Santokhba Durlabhji Memorial Hospital, India
2Asst Consultant, Obstetrics and Gynecology, Santokhba Durlabhji Memorial Hospital, India
3HOD, Senior Consultant, Obstetrics & Gynecology, Santokhba Durlabhji Memorial Hospital, India

Correspondence: Dr Brinderjeet Kaur, Asst Consultant, Obstetrics and Gynecology, Santokba Durlabhji Memorial Hospital and Research Center, Bhawani Singh Road Jaipur, India, Tel 9829229289

Received: April 01, 2019 | Published: May 3, 2019

Citation: Kaur B. Study of serum lipid profile in pregnancy and its correlation with preeclampsia. Obstet Gynecol Int J. 2019;10(3):169-174. DOI: 10.15406/ogij.2019.10.00439

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Abstract

Objective: To study serum lipid profile between 13-20 week of pregnancy & to look for correlation, if any, of serum lipid levels in pregnancy with preeclampsia and to find out correlation, if any, between serum lipids profile and fetomaternal outcome.
Material and methods: We carried out a Longitudinal, Descriptive type of observational study in the department of Obstetrics and Gynecology at SDMH, Jaipur from June 2016 to April 2017.Total 125 patients were enrolled in study fulfilling inclusion and exclusion criteria between 13-20 weeks of gestation at SDMH, Jaipur, 14 patients were lost during follow up finally 111 patients remained for analysis .Serum lipid profile was done in all patients and these were followed till delivery for presence and absence of preeclampsia.
Results: The mean level of TC in participants developed preeclampsia was 224.36±43.68mg/dl. This was significantly higher as compared to normotensive group 180.77±36.58mg/dl.
Conclusion: Early prediction of preeclampsia can be used as a tool for primary prevention before the development of the disease. There is no single specific test available to predict the preeclampsia till date. So there is need of further research to discover the specific test to predict preeclampsia

Keywords: preeclampsia, lipid profile, pregnant woman

Introduction

There has been improvement in antenatal care all round the globe during past few decades. Pre-eclampsia is a serious complication of second half of Pregnancy that occurs with a frequency of 5-10%. The disease is a leading cause of maternal morbidity which can lead to maternal death, fetal growth retardation, infant morbidity and mortality.1 Preeclampsia is defined as a systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg on 2 occasions at least 4 hrs apart after 20weeks gestation in women with a previously normal blood pressure or ≥160mmHg systolic or ≥110mmHg diastolic, and proteinuria ≥300mg/ 24hrs or a Protein/creatinine ratio ≥0.3mg/dl or a dipstick reading of ≥1+.2

The pathogenesis of preeclampsia is unclear,3 however two important components have been identified, trophoblast cells and an accelerated maternal systemic response to trophoblastic tissue.4 A two-step model has been described for pathophysiology of preeclampsia.5 The first one pertaining to abnormal placentation leading to placental ischemia causing secretion of soluble factors that induce endothelial dysfunctioning and maternal preeclampsia6 in pregnant women. The second one is related to increase in free radicals and Reactive oxygen species causing cell damage7 and increased vascular tonicity causing prereclampsia.8 It implies that an abnormal lipid profile has a direct effect on endothelial dysfunction leading to decrease in PGI-TxA2 ratio and subsequent fibrinoid necrosis at uteroplacental implantation site.9 The possible correlation between the altered lipid profile and the severity of renal lesions, as reflected by proteinuria, may contribute towards clarify the complex patho physiology of preeclampsia.

Our study was designed to find any correlation, if any between serum lipids levels in pregnancy (13-20 weeks) by lipid profile estimation with preeclampsia and maternal outcome at term. The study is useful as maternal lipid levels can be easily measured in all clinical laboratories with routine, well-established lipid panels; thus, inexpensive lipid panels could serve as a cost-effective method for identifying pregnant women at risk for developing preeclampsia. These can be used as “powerful predictive tool” for obstetrician for early identification and expert management.

Material and methods

The descriptive observational study was carried out in department of obstetrics and gynecology at SDMH, Jaipur from June 2016 to April2017. The study was approved by institutional ethics committee. Patients were explained about nature and purpose of study including cost of investigations. After obtaining their written informed consent they were enrolled in the present study. The participants were all pregnant women between 13-20 weeks of gestation, Singleton uncomplicated pregnancy, blood pressure reading: systolic less than 140mm Hg & diastolic less than 90mm Hg and those who were willing to follow up & deliver at SDM Hospital. The exclusion criteria were the presence of any of the following: Multiple pregnancy, Molar pregnancy, Chronic diseases (chronic hypertension, diabetes mellitus, severe anaemia, Grade III & Grade IV heart disease, renal disease), Patients with bad obstetrics history, Smoking and H/o hypertensive disorder in previous pregnancy. A total of 125 patients were included in study after sample size calculation at 95% confidence level & 80%study power, considering 11 independent variables for the prediction of preeclampsia.74

Venous blood from antecubital vein was withdrawn under strict aseptic condition after 12 hours fasting period. Patients were classified depending upon Serum lipid levels according to The National Cholesterol Education Program (NCEP) guidelines10 (Table 1) and on presence or absence of Preeclampsia these groups were studied further and statistical analysis was done using Medcalc 16.4.0 version software. Continuous variables were summarized as mean & standard deviation, whereas Nominal/Categorical variables as proportions. Unpaired T test was used for analysis of continuous variable while Chi sq test/fisher exact test was used for Nominal/Categorical variables. Odds ratio was calculated for all suspected predictors, Univariate analysis was done to identify independent predictors of preeclampsia. P<0.05 was taken as significant.

Total Cholesterol

Desirable : <200

Borderline high- 200-239

High: > or=240

Triglycerides

Normal: <150

Borderline high: 150-199

High: 200-499

Very high: > or =500

HDL Cholesterol

Low(removed HDL): <40

 Normal: 40-60

High: >60

LDL Cholesterol

Optimal: <100

Near Optimal: 100-129

Borderline high: 130-159

High: 160-189

Very high: > or = 190

Table 1 Lipid profile interpretation as par The National Cholesterol Education Program (NCEP) guidelines: (units in mg/dl)

Discussion

Preeclampsia is a systemic syndrome of pregnancy originating in the placenta. The present study was conducted to evaluate serum lipid profile between 13–20 weeks of gestation and to look for its correlation with preeclampsia. Total of 125 subjects were recruited in present study, 14 (11.2%) subjects lost during follow-up. Finally 111 subjects remained in the study for analysis. The maximum number of participants from preeclampsia group and control group was between 26-30 years. The difference between the groups was not statistically significant. (p>0.05) (Table 2). 65(58.56%) of participants were primigravidas in which 15(23.08%) developed pre-eclampsia & 50(76.92%) remained unaffected. 46(41.44%) of participants were multigravidas in which preeclamptic and normotensives were3 (6.52%) & 43(93.48%) respectively, the difference was statistically significant (Table 3).

Age (Years)

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

21-25

41

89.13

5

10.87

46

41.44

26-30

42

77.78

12

22.22

54

48.65

>30

10

90.91

1

9.09

11

9.91

Total

93

83.78

18

16.22

111

100

Table 2 Distribution of Study Participants According to Age

Chi-square =2.813 with 2 degrees of freedom; P=0.245

Gravida

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Primi

50

76.92

15

23.08

65

58.56

Multi

43

93.48

3

6.52

46

41.44

Total

93

83.78

18

16.22

111

100

Table 3 Distribution of Study Participants w.r.t. Gravidity

Odds ratio=4.300 (95% confidence interval: 1.166 to 15.856)
Chi-square=4.284 with 1 degree of freedom; P=0.038

11(61.11%) participants developed pre eclampsia & 6(6.45%) unaffected participants delivered at <37 weeks of gestation while87 (93.55%) of participants remained unaffected & 7 (38.89%) of participants developed pre eclampsia delivered at >37 weeks of gestational age. The difference is statistically highly significant (P<0.05) (Table 4). Out of total pre eclamptic patients 8(44.44%) were delivered by LSCS as compared to 13(13.98%) unaffected participants. This difference was statistically significant. (p <0.05) (Table 5).

Groups

GA at delivery

Total

Preterm

Term

No.

%

No.

%

No.

%

Pre-eclampsia

11

61.11

7

38.89

18

100

Normotensive

6

6.45

87

93.55

93

100

Total

17

15.32

94

84.68

111

100

Table 4 Comparison between Groups According to Gestational Age at Delivery

Odds ratio=22.786 (95% confidence interval: 6.476 to 80.165)
Chi-square=30.654 with 1 degree of freedom; P<0.001

Groups

Mode of delivery

Total

LSCS

Vaginal delivery

No.

%

No.

%

No.

%

Pre-eclampsia

8

44.44

10

55.56

18

100

Normotensive

13

13.98

80

86.02

93

100

Total

21

18.92

90

81.08

111

100

Table 5 Distribution of Study Participants According to Mode of Delivery

Odds ratio=4.923 (95% confidence interval: 1.640 to 14.776)
Chi-square=7.247 with 1 degree of freedom; P=0.007

Total cholesterol was deranged in 26(23.42%) participants, in which 10(38.46%) developed preeclampsia and 16(61.54%) remained normotensive, difference was statistically significant (p=0.001) (Table 6). The mean level of TC in participants developed preeclampsia 224.36±43.68mg/dl was significantly higher as compared to normotensive group 180.77±36.58mg/dl (p<0.001). Difference between the groups was statistically significant in this study and above mentioned studies. Similar results were also found in studies of Archana S et al.11 and Leela KPet al.12 The association of TC concentration with preeclampsia might explained by the fact that Hypercholesterolemia promoted the formation of free radicals.

TC

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Normal

77

90.59

8

9.41

85

76.58

Deranged

16

61.54

10

38.46

26

23.42

Total

93

83.78

18

16.22

111

100

Table 6 Association of Total Cholesterol with Preeclampsia

Odds ratio=6.016 (95% confidence interval: 2.054 to 17.615)
Chi-square=10.321 with 1 degree of freedom; P=0.001

HDL was deranged in 29(26.13%) participants, in which 9(31.03%) w developed preeclampsia and 20(68.97%) were remained normotensive. This difference was statistically significant. (p<0.05) (Table 7). The mean level of HDL in participants developed preeclampsia 39.68±7.50mg/dl was significantly lower as compared to normotensive group 43.72±7.35mg/dl (p=0.036) Difference between the groups was statistically significant in this study and above mentioned study. Similar results were also found in studies of Soundararajan P et al.13; El Khouly N14 and Leela KP et al.12 The association of HDL with pathogenesis of preeclampsia could explain as HDL cholesterol facilitates reverse cholesterol transport by caring excess, potentially harmful cholesterol from peripheral tissue to liver. The Low level of HDL in preeclampsia because of hypo-oestrogenaemia & insulin resistance causes excess harmful cholesterol involve in pathogenesis of preeclampsia.

HDL

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Normal

73

89.02

9

10.98

82

73.87

Deranged

20

68.97

9

31.03

29

26.13

Total

93

83.78

18

16.22

111

100

Table 7 Association of HDL with Preeclampsia

Odds ratio=3.650 (95% confidence interval: 1.280 to 10.410)
Chi-square=4.954 with 1 degree of freedom; P=0.026

LDL was deranged in 32(28.83%) participants, in which 11(34.38%) developed preeclampsia and 21(65.63%) remained normotensive, the difference was statistically significant (p=0.003) (Table 8). The Mean levelof LDL in participants developed preeclampsia 132.87±23.74mg/dl was significantly higher as compared to normotensive group 112.14±25.15mg/dl(p=0.002). Difference between the groups was statistically significant in this study and above mentioned studies. Similar results were also found in studies of Archana S et al.,11; Soundararajan P et al.13; El Khouly N14 and Leela KP et al.12 The association of LDL concentration with preeclampsia is biologically plausible. It has been seen that oxidized LDL increased sensitivity to the presser agents and inhibit epithelial dependent vasodilatation .It is found that the lipid fractions increased in pre-eclamptic patients and plasma lipid peroxidase and free radicals were activated. Also platelet and erythrocyte membrane antioxidant systems were inactivated.

LDL

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Normal

72

91.14

7

8.86

79

71.17

Deranged

21

65.63

11

34.38

32

28.83

Total

93

83.78

18

16.22

111

100

Table 8 Association of LDL with Preeclampsia

Odds ratio=5.388 (95% confidence interval: 1.857 to 15.630)
Chi-square=9.115 with 1 degree of freedom; P=0.003

VLDL was deranged in 39(35.14%) participants, in which 11(28.21%) developed preeclampsia and 28(71.79%) remained normotensive. This difference was statistically significant. (p<0.05) (Table 9) The mean level of VLDL in participants developed preeclampsia 36.51±8.10mg/dl was significantly higher as compared to normotensive group 31.10±6.64mg/dl (p=0.003). Difference between the groups was statistically significant in this study and above mentioned study. Similar results were also found in studies of Archana S et al.11; Soundararajan Pet al.13 and Leela et al.12 In pathogenesis of preeclampsia, VLDL lipoproteins accumulate over the maternal vascular endothelium, particularly those of uterine and renal vessels & may cause injury to the endothelium.

VLDL

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Normal

65

90.28

7

9.72

72

64.86

Deranged

28

71.79

11

28.21

39

35.14

Total

93

83.78

18

16.22

111

100

Table 9 Association of VLDL with Preeclampsia

Odds ratio=3.648 (95% confidence interval: 1.282 to 10.384)
Chi-square=5.073 with 1 degree of freedom; P=0.024

 TGs were deranged in 39(35.14%) participants, in which 11(28.21%) developed preeclampsia and 28(71.79%) remained normotensive. On application of statistical tests the difference was statistically significant (p=0.024). (Table 10) mean level of TG in participants developed preeclampsia 184.48±35.63mg/dl was significantly higher as compared to normotensive group 157.09±28.10 (p<0.001) (Table 11). Difference between the groups was statistically significant in this study and above mentioned studies. Increased TG, found in preeclampsia, is likely to be deposited in predisposed vessels, such as the uterine spiral arteries and contributes to the endothelial dysfunction, both directly and indirectly through generation of small, dense LDL & hypertriglyceridemia may be associated with hypercoagulability.

TGs

Normotensive

Pre-eclampsia

Total

No.

%

No.

%

No.

%

Normal

65

90.28

7

9.72

72

64.86

Deranged

28

71.79

11

28.21

39

35.14

Total

93

83.78

18

16.22

111

100

Table 10 Association of Triglycerides with Preeclampsia

Odds ratio=3.648 (95% confidence interval: 1.282 to 10.384)
Chi-square=5.073 with 1 degree of freedom; P=0.024

Lipid Profile

Normotensive

Preeclampsia

P value

TC

180.77±36.58

224.36±43.68

<0.001

HDL

43.72±7.35

39.68±7.50

0.036

LDL

112.14±25.15

132.87±23.74

0.002

VLDL

31.10±6.64

36.51±8.10

0.003

TG

157.09±28.10

184.48±35.63

<0.001

Table 11 Lipid Profile Levels of Preeclamptic and Normotensive Women

In this study, 13(27.08 %) participants who had dyslipidemia delivered by LSCS as compared to 8(12.70 %) in unaffected participants. This difference was not statistically significant (p >0.05) (Table 12).

Dyslipidemia

Mode of delivery

Total

LSCS

Vaginal delivery

No.

%

No.

%

No.

%

No

8

12.7

55

87.3

63

100

Yes

13

27.08

35

72.92

48

100

Total

21

18.92

90

81.08

111

100

Table 12 Association of Dyslipidemia with Mode of Delivery

Odds ratio=2.554 (95% confidence interval: 0.961 to 6.786)
Chi-square=2.797 with 1 degree of freedom; P=0.094

The results of our study are similar to those by Despande H et al.15; Vani et al., Khaliq et al., Iftikha et al., Gohil et al., Saha D et al. and Nayan S et al. (Table 13).

 

Total cholesterol

HDL

LDL

VLDL

Triglyceride

Deshpande H et al.15

N=163.8±8.83

N=49.56±4.08

N=120.2±7.98

N=35.4±3.62

N=158±9.96

P= 208.8±12.64

P=38.06±3.01

P= 140.36± 10.8

P=52.76±4.96

P=201.06±10.6

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Vani I et al.16

N=199±34

N=58±5

N=101±32

N=39±8

N=196±41

P=227±31

P=51±5

P=132±34

P=43±10

P=219±58

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Khaliq F et al.17

N=187.66±31.87

N=53.77±10.45

N=94.61±28.23

N=39.31±7.01

N=196.62±35.06

P=220.95±45.38

P=77.17±11.89

P=124.61±40.88

P=52.10±15.46

P=260.83±77.35

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Iftikhar U et al.18

N=209±13.6

N=35.4±2.7

N=148.4±13.6

N=36.8±4.8

N=186.3±20.9

P= 238±28.8

P=32.8±3.40

P=162.1±24.8

P=50.1±11.1

P=2.45±53.5

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Gohil JT et al.19

N=219.1±3.1

N=60.3±1.2

N= 115.7±3.4

N=43.04±0.40

N=215.2±1.9

P=232±2.9

P= 41.75±3.40

P=135.8±4.1

P=54.1±0.31

P=270±2.1

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Saha D et al.20

N=219.23±3.27

N=60.28±3.20

N=114.27±3.188

N=42.45±1.525

N=215.20±1.6

P= 235.37±4.125

P= 41.75±3.41

P= 135.97±3.659

P= 53.89±1.15

P=273.12±8.1

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Nayan S et al.21

135±8.7

N=61.1±2.8

N=83±4.7

N= 26±5

N=120±20

348±4.5

P= 34.3±4.3

P=210±17.6

P=107±11

P=368±39

p<0.001

p<0.001

p<0.001

p<0.001

p<0.001

Table 13 Comparison with other studies

Despande H et al.15 conducted comparative observational study on 60 pregnant women with objective to analyze the lipid profile in normotensive & preeclamptic patients and to assess abnormal lipid profile in relation to severity of hypertension,maternal outcome & perinatal outcome. It was seen that mean Cholesterol level in PIH cases was 208.8±12.64mg/dl and in normal cases was 163.8±8.83mg/dl, mean HDL level in PIH cases was 38.06±3.01mg/dl and in normal cases was 49.56±4.08mg/dl, mean LDL level in PIH cases was 140.36±10.8 mg/dl and in normal cases was 120.2±7.98mg/dl, mean VLDL level in PIH cases was 52.76±4.96mg/dl and in normal cases was 35.4±3.62mg/dl and mean Triglyceride level in PIH cases was 201.06±10.67mg/dl and in normal cases was 158.8±9.96mg/dl. The association of Mean cholesterol, HDL, LDL, VLDL and Triglyceride level among normal and PHT cases are statistically significant. (p<0.05).They concluded that the association between dyslipidemia and risk of preeclampsia is biologically plausible and is compatible with what is known about pathophysiology of preeclampsia.

Vani I et al.16 conducted an open labeled clinical study to compare the lipid profile in normotensive and hypertensive pregnant women. The study included two groups-50 normotensive and 50 preeclamptic pregnant women in whom fasting blood samples were sent for estimation of serum lipid profile during their third trimester. There was a significant increase (p<0.5) in total cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides in preeclamptic group compared to normotensive group. There was a significant decrease in HDL cholesterol in preeclamptic group compared to normotensive group. This study in correlation with various other studies concluded that dyslipidemia plays an important role in the pathogenesis of preeclampsia.

Khaliq F et al.17 performed a cross sectional study to determine serum lipid and lipoprotein cholesterol in pre-eclamptic women in their third trimester, taking normal pregnant women in third trimester as controls. The values were compared in patients of different parity. It was observed that serum triglycerides (TG), cholesterol (ChoD, LDL-c, VLDL-c, phospholipids (PL) and total lipids (TL) were significantly raised, while HDL-c, was significantly lower in pre-eclampsia compared to normal pregnancy. TG and VLDL-c were found to be increased significantly with parity.

Iftikhar U et al.18 conducted a comparative cross-sectional study to assess the relation between serum leptin levels and lipid profile in women with pre-eclampsia and to evaluate their atherogenic role in the pathophysiology of pre-eclampsia. They found that all the variables of the lipid profile of pre-eclamptic patients, were found to be significantly elevated as compared to controls. The total lipid profile was also compared to the severity of pre-eclampsia and total cholestrol was found to be significantly raised (p<0.01) in severe pre-eclampsia when compared to mild. On correlating serum leptin with lipid profile, again total cholestrol was found to be significantly high (p <0.05) in pre-eclamptic group compared to controls. This study concludedthat serum leptin levels during pre-eclampsia are strongly associated with total cholesterol whereas association with other variables is insignificant. With severity of pre-eclampsia when leptin level rises, total cholesterol also rises. These changes may be the result of oxidative stress and may contribute to atherogenesis and pathogenesis of pre-eclampsia.

Gohil et al.19 conducted study to evaluate lipid profiles in subjects with preeclampsia and to determine if there is any change in lipid profiles in subject of preeclampsia as compared to normal antenatal females, non-pregnant females and postpartum females. Each serum sample from different groups was evaluated for Total cholesterol (mg/dl), Triglyceride (mg/dl), HDL-cholesterol (mg/dl), LDL-cholesterol (mg/dl) and VLDL-cholesterol (mg/dl). They found that Dyslipidemia in the form of significantly decreased HDL concentration and significantly increased total cholesterol, LDL, VLDL & Triglycerides concentration is conspicuously evident in subjects of preeclampsia as compared to non pregnant, normotensive pregnant and postpartum subjects & concluded that Dyslipidemia is significantly evident in preeclampsia and plays an important pathological role.

Saha D et al.20 conducted a case-control study to evaluate the association of lipid profile in pre- eclampsia mother as compared to no pregnant woman and normotensive pregnant mother. They evaluated 180patients of which 60 were non-pregnant normotensive, 60 were pregnant normotensive and 60 were pre-eclamptic mother. Serum lipid profile of all patients were monitored .They found in preeclampsia there is significant decrease of High density lipoprotein(HDL) and significantly increase of Low density lipoprotein(LDL),Very low density lipoprotein (VLDL) and Triglycerides concentration seen compared to non pregnant normotensive and pregnant normotensive subjects. They concluded that lipid metabolism plays a key role in the pathophysiology of Pre-eclampsia and Eclampsia.

Nayan S et al.21 conducted study to compare the serum lipid levels in women with pregnancy induced hypertension and normal pregnancy. Forty women were selected in each group after applying exclusion and inclusion criteria. After a detailed history and clinical examination, routine investigation and lipid profile of all was evaluated and data analyzed. Serum lipid levels in the PIH group were significantly higher compared to normal group. Women with PIH had significantly higher values of total cholesterol (348mg/dl, SD+45), Triglycerides (368mg/dl, SD+39), LDL (201mg/dl, SD+17)and VLDL (107mg/dl, SD+11) as compared to normotensive pregnant women, total cholesterol (135mg/dl, SD+8.7), Triglycerides(120mg/dl, SD+20), LDL(83mg/dl, SD+4.7)and VLDL(26mg/dl, SD+ 5) with p value of 0.0001. However HDL level is found to be significantly higher (p value<0.05) in normal group (61 mg/dl, SD 2.81) as compared to PIH group (34.3mg/dl, SD 4.3). They concluded, women with PIH have higher total cholesterol, triglycerides, LDL, VLDL and low HDL levels as compared to normotensive pregnant women. Antenatal screening for serum lipids levels can be useful in early detection of PIH.

From our perspective, these conflicting results might be explained, by differences in research design, small sample sizes, incomplete adjustment for confounders, and differences in study populations. Another point of concern is with the sampling time. Future parallel studies are required to explore the underlying mechanisms of this discrepancy. Our hospital is a private hospital, here maximum patients are booked patients who are otherwise on regular antenatal checkup and treatment, so viewing major complications is less.

Recommendations

Early prediction of preeclampsia can be used as a tool for primary prevention before the development of the disease. So, if there is any test to predict the preeclampsia which can be easily measured & available will be helpful to classify the patient. There is no single specific test available to predict the preeclampsia till date. So there is need of further research to discover the specific test to predict preeclampsia.

Acknowledgments

None.

Conflicts of interest

Author has no conflict of interest to declare.

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