CASE STUDY OF SERUM LIPID PROFILE IN PREGNANCY INDUCED HYPERTENSION IN JMC, JHALAWAR.

Only one group was investigated for serum lipid profile in third trimester of pregnancy in which included all PIH patients admitted in labor room in Department of Obstetrics in Jhalawar Medical College and was substantially compared with the normal values of Lipids in women. In this study we investigate the role of lipid profile in PIH. LDL value increase, HDL value decrease, TG value increase and VLDL value increase in PIH patients and also TG: HDL ration increased significantly in PIH patients. Dyslipidemia mediated activation of endothelial cells to placentally derived endothelial disturbing factors like lipid peroxides and trophoblastic components as possible contributors for pathogenesis of PIH. Thus assessment of blood lipids may be helpful in preventions of complications in PIH.


INTRODUCTION
Pre-eclampsia, a non cancel convulsive form of pregnancy induced hypertension accounts for a significant proportion of maternal and fetal morbidity and mortality 1 . Over 100,000 women develop eclampsia per year. Eclampsia contributes 16% of maternal mortality on a national basis which is equivalent to about 4500 maternal death in one year. The risk of developing eclampsia appears to be greater in women who have family history of essential hypertension and their may also be a relationship between risk of preeclampsia and the metabolic syndrome 2 . Pre-eclampsia when complicated with convulsion is called eclampsia.
The disorder complicates approximately 5 to 7 percent of pregnancies 3-5 . Severe PIH is associated with substantial risk for the foetus these include intrauterine growth restriction death and prematurity with attendant complications where as the mother is at risk of renal failure, pulmonary edema, stroke and death. Despite considerable research the cause or causes of pre-eclampsia remain unclear and there are no clinically useful screening tests to identify women in whom it will develop 6 . Early pregnancy dyslipidemia is associated with an increased risk of severe PIH 7 . The association of alteration of serum profile in pregnancy induced hypertension is well documented. In PIH patient an abnormal lipid profile is known to be strongly associated with atherosclerotic changes and direct effect on endothelial dysfunction. The most important feature in toxaemia of pregnancy in hypertension which is supposed to be due to vasospastic phenomenon in kidney, uterus, placenta and brain 8 . Altered lipid synthesis leading to decrease in PGI2: TXA2 ratio is also supposed to be important way of pathogenesis in PIH. Abnormal lipid metabolism seems important in pathogenesis of PIH 9 .
Objective: To analyse the lipid profile values in Pregnancy Induced Hypertension patient. Sample size: 60 pregnant women of 3rd trimester with PIH.

Methodology-Random blood sugar samples were taken from 60 pregnant patients with Pregnancy Induced Hypertension (PIH)
The samples were subjected to analysis of lipid profile.

Specimen-
Freshly collected plasma. Anticoagulant used was EDTA.
Procedure -The lipid profiles of the samples were determined using a semiautomated analyser.
Study Design: Case Control Study.

Inclusion Criteria
Pregnant women in the third trimester diagnosed as PIH with no other associated complications.

MATERIALS & METHODS
The study was performed in the department of biochemistry of medical college and hospital, JMC Jhalawar. All subjects were in age group of 18-35 years with low socio-economic status and dietary habits. They were not abstained from smoking and alcoholism.
No subject of PIH was suffering from any acute or chronic illness during study nor they had any post history of cardiac, renal, hepatic dysfunction or dyslipidaemia.
In PIH all patients were studied who had BP more than 140/90 mm of Hg, proteinuria, oedema in third trimester of pregnancy.
Data collection technique: Study was performed in department of Biochemistry in JMC Jhalawar. Blood sample drawn from all subjects at the time of admissions and analyzed for serum triglycerides (TG), serum LDL, serum VLDL and serum HDL. Data were statistically analyzed by student's "t" test and significance was expressed in term of "P" value.

RESULTS
The data were intended in Ms Excel and we find out the mean and SD of lipid profile in PIH patients and we show that:  Increased TG found in PIH is likely to be deposited in predisposed vessels such as uterine spiral arteries and contributes to the endothelial dysfunctions and both directly and indirectly through generation of small dense LDL 11 . This hypertriglyceridemia may be associated with hypercoagulability 12 .
In present study, no significant alteration in total cholesterol level could be observed and third trimester of normal pregnancy in any of the groups. These findings are similar to Satter et al 13 . However, others have found significant increase in serum total cholesterol in toxaemia of pregnancy. 13,14 In our study, significant decreases in HDL were observed in severe PIH (PE & E) pregnant women. Estrogen is responsible for induction of TG and HDL and suppression of serum LDL and estrogen level falls in severe PIH (Pre-Eclampsia). 15 The low level of HDL in preeclampsia is however not only because of hypoestrogenemea but also due to insulin resistance 16 .
Findings reported in this study suggest that the women who develop pre-eclampsia and eclampsia have disturbed lipid profile due to abnormal lipid metabolism, increased TG level and delayed TG clearance and high blood pressure are reason for the development of the pre-eclampsia and eclampsia. So the need of lipid profile in early PIH patients may help in developing strategies for prevention and early diagnosis of preeclampsia and eclampsia.