URIC ACID CONTENT, RENIN CONCENTRATION IN PATIENTS WITH PRE-ECLAMPSIA, DEPENDING ON THE LEVEL OF VITAMIN D AND CHARACTERISTICS OF EPIDURAL ANALGESIA IN LABOR
https://doi.org/10.21292/2078-5658-2019-16-1-56-62
Abstract
The objective: to investigate the correlation of renin concentration and uric acid content in pregnant women with pre-eclampsia and vitamin D deficiency and their impact on the course of pregnancy, childbirth, and infant status.
Subjects and methods. The content of uric acid, vitamin D, endothelin and renin concentration were studied in pregnant women with pre-eclampsia and the control group; enzyme immunoassay and spectrophotometric tests were used. Venous blood was used as a specimen for tests.
Results. Hyperuricemia (435.61 ± 24.05 μmol/l) and a 10-fold increase of renin concentration were observed in patients with severe pre-eclampsia and vitamin D deficiency (11.23 ± 1.60 ng/ml). Vitamin D deficiency is associated with a higher need for epidural administration of local anesthetics during labor analgesia in patients with pre-eclampsia versus the control group; it is also associated with unfavorable perinatal outcomes.
Conclusions. The following was detected in the patients with pre-eclampsia: low levels of vitamin D, hyperuricemia, elevated blood renin concentration, which was associated with the severity of pain and increased blood pressure. For adequate analgesia and blood pressure control during labor, they needed a higher rate of local anesthetic administration. Perhaps, replenishing vitamin deficiencies during pregnancy may improve perinatal outcomes.
About the Authors
E. V. OreshnikovRussian Federation
Candidate of Medical Sciences,
27, M. Sespel St., Cheboksary, 428000
E. N. Vasilieva
Russian Federation
Associate Professor of Obstetrics and Gynecology Department,
27, M. Sespel St., Cheboksary, 428000
L. I. Maltseva
Russian Federation
Branch of Russian Medical Academy of Continuing Professional Education, Professor of Obstetrics and Gynecology Department,
11, Mushtari St., Kazan, 420012
T. G. Denisova
Russian Federation
Vice Rector for Research and Information Technology,
27, M. Sespel St., Cheboksary, 428000
References
1. Аkusherstvo. [Obstetrics]. V.E. Radzinskiy, А.M. Fuks, eds., Moscow, GEOTAR-Media Publ., 2016, 1040 p.
2. Аkusherstvo. Natsionalnoye rukovodstvo. [Obstetrics. National guidelines]. V.I. Kulakov, E.K. Аylamazyan, V.E. Radzinskiy, eds. Moscow, GEOTAR-Media Publ., 2008, 1200 p.
3. Clinical recommendations (treatment protocol). Ministry of Health of the Russian Federation: Letter No. 15-4/10/2-3483 dated June 7, 2016, by the Russian Ministry of Health On Hypertensive Disorders During Pregnancy, in Labor and in Postpartum Period. Pre-eclampsia. Eclampsia. (In Russ.)
4. Kuznetsova L.V., Khadzhieva E.D., Zazerskaya I.E. The level of vitamin D in pregnant women with pre-eclampsia. Аrterialnaya Gipertenziya, 2015, vol. 21, no. 6, pp. 623-629. (In Russ.)
5. Maltseva L.I., Vasilieva E.N., Denisova T.G. Vitamin D and pre-eclampsia. Rossiysky Vestnik Akushera-Ginekologa, 2016, vol. 16, no. 1, pp. 79-83. (In Russ.)
6. Maltseva L.I., Vasilieva E.N., Denisova T.G. The importance of vitamin D deficiency for the development of severe pre-eclampsia in women from high risk groups. Аkusherstvo i Ginekologiya, 2018, no. 9, pp. 120-125. (In Russ.)
7. Coordinating meeting on maternal and child health: WHO meeting report. Geneva, Regional Office for Europe, WHO, 2015, 22 p. (In Russ.)
8. Arriagada G., Paredes R., van Wijnen A.J. et al. 1alpha,25-dihydroxy vitamin D(3) induces nuclear matrix association of the 1alpha,25-dihydroxy vitamin D(3) receptor in osteoblasts independently of its ability to bind DNA. J. Cell. Physiol., 2010, vol. 222, pp. 336-346.
9. Bodnar L.M., Klebanoff M.A., Gernand A.D. et al. Maternal vitamin D status and spontaneous preterm birth by placental histology in the US Collaborative Perinatal Project. Am. J. Epidemiol., 2014, vol. 179, no. 2, pp. 168-176.
10. Cnossen J.S. Accuracy of serum uric acid determination in predicting pre-eclampsia. Acta Obstet. Gynecol. Scand., 2006, vol. 85, no. 5, pp. 519-525.
11. Deruelle P., Coudoux E., Ego A. et al. Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome. A study in 453 consecutive pregnancies. Eur. J. Obstet. Gynecol. Reprod. Biol., 2006, vol. 125, no. 1, pp. 59-65.
12. Haugen M., Brantsaeter A.L., Trogstad L. et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology, 2009, vol. 20, no. 5, pp. 720-726.
13. Holick M.F. Vitamin D deficiency. New Engl. J. Med., 2007, vol. 357, pp. 266-281.
14. Parlak M., Kalay S., Kalay Z. et al. Severe vitamin D deficiency among pregnant women and their newborns in Turkey. J. Matern. Fetal. Neonatal. Med., 2015, vol. 28, no. 5, pp. 548-551.
15. Powers R.W. Uric acid concentrations in early pregnancy among pre-eclamptic women with gestational hyperuricemia at delivery. Am. J. Obstet. Gynecol., 2006, vol. 1, pp. 160.
16. Roberts J.M., Bodnar L.M., Lain K.Y. et al. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension, 2005, vol. 46, no. 6, pp. 1263-1269.
17. Thangaratinam S., Ismail K.M., Sharp S. et al. Accuracy of serum uric acid in predicting complications of pre-eclampsia. Brit. J. Obstet. Gynecol., 2006, vol. 113, no. 4, pp. 369-378.
18. Thorne-Lyman A., Fawzi W.W. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Pediatr. Perinat. Epidemiol., 2012, vol. 26, suppl. 1, pp. 75-90.
Review
For citations:
Oreshnikov E.V., Vasilieva E.N., Maltseva L.I., Denisova T.G. URIC ACID CONTENT, RENIN CONCENTRATION IN PATIENTS WITH PRE-ECLAMPSIA, DEPENDING ON THE LEVEL OF VITAMIN D AND CHARACTERISTICS OF EPIDURAL ANALGESIA IN LABOR. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2019;16(1):56-62. (In Russ.) https://doi.org/10.21292/2078-5658-2019-16-1-56-62