Lipid Peroxidation and Antioxidant Status in Preeclampsia

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A l A m e e n J M e d S c i ( 2 0 1 0 ) 3 ( 1 ) : 3 8 - 4 1
I S S N 0 9 7 4 - 1 1 4 3

Lipid Peroxidation and Antioxidant Status in Preeclampsia

S.V. Kashinakunti 1*, Sunitha H1, K. Gurupadappa 1, D.S.
Shankarprasad 1, G.Suryaprakash 2 and J.B Ingin 2

1Department of Biochemistry. S. Nijalingappa Medical College, H.S.K. Hospital
Research Centre Bagalkot, Karnataka, India and 2Department of Biochemistry, M.R.
Medical College, Gulbarga, Karnataka, India.

The current theory suggests that in preeclampsia there is an increase in the lipid peroxidation
products and leads to decrease in the serum antioxidants except uric acid, contributing to the
pathogenesis of preeclampsia. In this context, this study was undertaken to determine the
changes in blood levels of lipid peroxide and antioxidant levels in women with
preeclampsia.Method: Case control study consisting of 30 preeclamptic and 30 healthy
pregnant women. Fasting venous blood samples were collected during antepartum period and
serum levels of malondialdehyde, ascorbic acid (Vitamin C) and uric acid were measured. In
the preeclamptic group malondialdehyde (MDA), a lipid peroxidation product was
significantly increased, while serum antioxidant ascorbic acid was significantly decreased (P<
0.001), where as uric acid level increased significantly (P<0.001). The findings of the present
study are consistent with previous studies, suggesting that lipid peroxidation is an important
factor in the pathogenesis of preeclampsia. In preeclampsia serum antioxidants are
excessively utilized to counteract the cellular changes mediated by free radicals.
Keywords. : Preeclampsia, Lipid peroxidation, Antioxidants

Pregnancy is a physiological stress in which many changes occur in the milieu
interior of the body, more and more stress is being laid on the biochemical changes,
which occur in the blood during normal pregnancy becomes exaggerated in
complications of pregnancy like pre-eclampsia. Pre-eclampsia occurs during second
and third trimester of pregnancy and it is more common in nulliparous women. It is
characterized by 1) BP 140/90 mm Hg or greater at least on two occasions, six or
more hours apart 2) Proteinuria ≥300 mg/24 hours or greater or equal to 1+ by
dipstick response[1]. Oxidative stress increases during pre-eclampsia and results in
increased production of lipid peroxides, reactive oxygen species and superoxide
anion radicals to cause endothelial injury and dysfunction, platelet and neutrophil
activation[2-3]. These observations in pre-eclampsia have given rise to increased
interest in antioxidants such as Ascorbic acid(Vitamin C), Vitamin E and Uric acid.
In this context the present study has been undertaken to determine the changes in
serum levels of peroxidation product ie Malondialdehyde (MDA) and antioxidant
levels namely ascorbic acid and uric acid in women with pre-eclampsia.
Materials and Methods
In the present study 30 cases of pre-eclampsia and 30 normal pregnant women from
HSK (Hangal Shree Kumareshwar) Hospital and Research Centre Bagalkot were
selected. The controls were normotensives. Both the cases and controls were primi

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Al Ameen J Med. Sci, Volume3, No.1, 2010 Kashinakunti SV .et al

between 18 and 30 years of age and having more than 29 weeks of gestation. The
cases and controls having past history of diabetes mellitus, hypertension, renal
diseases, liver disorder and with the history of multivitamin intake were excluded.
History and examination findings of both cases and control were noted. Fasting
Blood samples were collected, the serum was separated and analyzed for the
following parameters. MDA was measured by Thiobarbituric acid reactive
substances assay (TBRAS) method[4] and ascorbic acid by Dinitrophenyl
Hydrazine ( DNPH) method.[5] The uric acid was measured by uricase method using
Human diagnostics kit[6-8]. The optical densities of MDA and ascorbic acid were
measured at 532 nm and 520nm respectively using spectrophotometer.

Blood pressure and BMI (Body Mass Index) of cases and controls is shown in Table
1. The mean value of SBP (Systolic blood pressure) in cases is 144.67±10.56 and in
control 115.3±6.81,there is significant difference (P<0.001) between cases and
controls. The DBP(Diastolic Blood Pressure) mean in cases and control is 97.73±5.7
and 75.45 ± 5.25 respectively, there is significant difference (P<0.001) between
cases and controls. The mean BMI ( Body Mass Index) of controls is 25.53± 3.08
and in study group 26.83± 3.28, P value is more than 0.05 , which is insignificant.
Table-1: Blood Pressure and Body Mass Index of Cases and Controls

Cases = 30
Controls n = 30
P Value
SBP mm Hg 144.67 ± 10.56
115.3 ± 6.81
P < 0. 00 1

DBP mm Hg 97.73 ± 5. 7
75.45 ± 5.25
P < 0. 00 1
BMI (kg/M2)
26.83 ± 3.28
25.53 ± 3.08
P > 0.05
Values are mean ±SD; BP :Blood Pressure , SBP, Systolic blood pressure; DBP, Diastolic blood
pressure ;BMI, Body mass index

Biochemical parameters to assess lipid peroxidation and antioxidant status of cases
and controls were illustrated in Table-2.

Table- 2:Biochemical parameters to assess lipid peroxidation and antioxidant status of cases
and controls
Cases n = 30
Controls n = 30
P Value
MDA n mol/L
346.13 ± 110.54
205.07 ± 26.06
P < 0. 001
S. Ascorbic acid mg/dl
0.62 ± 0.21
0.97 ± 0.19
P < 0. 001
S. Uric acid mg/dl
7.16 ± 1.68
4.75 ± 0.91
P < 0. 001
Values are mean ±SD; MDA : Malondialdehyde.

© 2010. Al Ameen Charitable Fund Trust, Bangalore

Al Ameen J Med. Sci, Volume3, No.1, 2010 Kashinakunti SV .et al

The mean MDA in cases and controls is 346.13±110.54 nmol/L and 205.07±26.06
nmol/L respectively. MDA is significantly more in pre-eclampsia patients compared
to controls ( P<0.001). The mean ascorbic acid level in cases and control is 0.62 ±
0.21 mg/ dl and 0.97 ± 0.19 mg/dl respectively. There is significant decrease in
ascorbic acid levels (P<0.001) in cases as compared to controls. The mean uric acid
level in cases and controls is 7.16±1.68mg/dl and 4.75±0.91 mg/dl, respectively.
There is significant elevation of uric acid (P<0.001) in study group in comparison to

The pathophysiology of pre eclampsia is poorly understood. Free radicals and other
damaging reactive oxygen species, such as the superoxide anions are in oxidative
metabolic processes, their activation is thought to increase during pre-eclampsia[9].
Foetoplacental unit may be the origin of oxygen free radicals and lipid peroxides[10-
11].Recent investigation suggested that endothelial cell injury may be the initiator of
the pathophysiological events of pre-eclampsia[12]. Either placental hypercorrection
of lipid peroxides or decreased placental antioxidant enzyme activity can lead to
endothelial dysfunction. Insufficient antioxidant capacity leads to oxidative stress
and subsequently oxidative injury may occur in both the maternal and placental
compartments9. A number of reports indicate that blood levels of lipid peroxidation
products are elevated in women with pre-eclampsia relative to normal pregnancy
[3,9,13-15]. Furthermore placental production of lipid peroxides have been
demonstrated to be abnormally increased in pre-eclampsia10, consistent with previous
reports, in the present study also there is increase in serum levels(P<0.001) of MDA
in the pre-eclamptic patients. Pre-eclampsia is associated with increased utilization of
antioxidants. Several studies have demonstrated decreased serum levels of ascorbic
acid compared to normal pregnant women, [3,11,16] similarly in the present study
we have observed a significant decrease in serum levels of ascorbic acid in the pre-
eclamptic patients(P<0.001). Uric acid is water soluble and a weak serum
antioxidant. Nevertheless, the patients with pre-eclampsia show hyperuricemia,
which mean that the serum levels doesn’t protect the pre-eclamptic patients against
free radical activity [9,16-17]. The present study has also shown a significant rise in
serum uric acid (P<0.001). The rise in uric acid in pre-eclampsia is not merely a non-
specific reflection of kidney damage, but a sign of antioxidative response, possibly
related to the pathogenesis of pre-eclampsia[13]. In conclusion the present study is
consistent with previous studies suggests that lipid peroxidation appears to be of
immense value in understanding the pathogenesis of preeclampsia.In preeclamptic
patients antioxidants may be utilized to a greater extent to counteract free radical
mediated cellular changes, resulting in the reduction of plasma antioxidant levels.

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Dutta DC, Konar HL, Test Book of Obstetrics, 6th edn. New Central Book Agency
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© 2010. Al Ameen Charitable Fund Trust, Bangalore

Al Ameen J Med. Sci, Volume3, No.1, 2010 Kashinakunti SV .et al

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*All correspondences to: Kashinakunti.SV.,Assistant Professor, Department of Biochemistry, S.Nijalingappa
Medical College,Navanagar, Bagalkot – 587102, Karnataka,India.Email : [email protected]

© 2010. Al Ameen Charitable Fund Trust, Bangalore