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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 as associated with an increase incidence of congenital abnormalities when compared with normal pregnancy (Hagay et al, 2005). Frequency of diabetic and hypertensive mother is estimated to be 6-10% (Hagay and Reece, 2006). Alteration in lipid profile is known to occur in diabetic and hypertensive pregnancy (Caron and Kjos, 2000). In the present study, the following parameters were assessed in the serum to elucidate the biochemical profile status in pregnant women with diabetes and hypertensive (Kjos, 2000). Serum lipid profile parameters to be determined are total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein chore sterol (LDL-C) and triglyceride using Hitachi 902 Atom analyzer. In reference to diabetes, the pregnant woman experiences physiological changes to support foetal growth and development. Pregnancy is associated with significant change in the functions of the normal liver. Although the precise mechanism underlying these various alterations is not clear in every case, their recognition is essential to a proper clinical evaluation (Angel, 2006).

Lipid metabolism change during pregnancy (Brizzi et al, 2008) Natural rising of plasma lipid is seen in normal pregnancy, but this event is not atherogenic and it is believed that this process is under hormonal control (Rovinsky and gaffin, 2010). But in complicated pregnancy, there a possible defect in the mechanism of adjusting physiologic hyperlipidemia. Plasma lipid profile in the first trimester of pregnancy may predict the incidence and severity of pre-eclampsia. The anabolic phase of early pregnancy encourages lipogeneses and fat storage in preparation for rapid foetal growth in late pregnancy. Lipolysis is increased as a result of insulin resistance, leading to increased a s a result of insulin resistance, leading to increased flux of fatty acids to the liver promoting the synthesis of very low-density lipoprotein (VLDLS0 and increased triglyceride (TG) concentration (Ross, 2007). Because of a decrease in the activity of lipoprotein lipase, very-LDL remains in the plasma for longer and leads to the accumulation of LDL. An increase LDL is associated with the development of atherosclerosis (Ross, 2007). Abnormal lipid metabolism also seems important in the pathogenesis of pregnancy-included hypertension (PIH). Pregnancy included hypertension is characterized by elevated blood pressure, proteinuria, and edema (Dutta, 2001). Although considered to be relatively rare in the United States, PIH occurs world wide in from 2 to 35 percent of pregnancies, depending on diagnostic criteria and study of population. PIH is also called preclampsia and it occurs most often in young women with first pregnancy. It is more common in twin pregnancies, in with chronic hypertension, pre-existing diabetes, and in women who had PIH in a previous pregnancy. Hypertensive disorder of pregnancy, contribute significantly to serious complications for both the fetus and the mother (Hagay et al, 205). PIH occurs more frequently and is more severed women with preexisting hypertension then in women who are normotensive prior to pregnancy. The hypertensive disorder of pregnancy collectively represent a significant public health problem in the United States and throughout the world.

The cause and nature of this disorder is only partially understood (Angel, 2006). Therefore, the presence study was carried out to evaluate plasma lipid concentrations in normal and hypertensive pregnancy in order to establish whether hypertension includes abnormal lipid concentrations that could constitute potential metabolic risks factors for pregnancy complication.
Lipid profile in normal pregnant women, many scientific evidences have raise concern about the adverse effect of abnormal blood lipid levels, like cholesterol and other lipids and lipoproteins, on atherosclerotic disease (Gotto, 2009). The important attached to the need for routine examination of the serum lipid and lipoprotein profile in human subjects especially during pregnancy under disease condition such as diabetes and hypertension is well established (seggmour, 2006). Gotto, (2009) have revealed that serum lipid and lipoprotein profile varies with age, sex, diet and race. The serum protein and lipoprotein profile of many communities, remain to be established. This study was other fore, designed to access the variation of the serum lipid and lipoprotein profile among the diabetics, hypertensive and normal pregnant.