Abstract:
Background: Gestational hypertension (GH) and Preeclampsia, (PE) are the most complicated amongst
hypertensive disorders of pregnancy. The mechanism that links hypertension in pregnancy to adverse maternal
outcomes is not fully understood though some relate this to endothelial dysfunction originating from an
imbalanced angiogenic regulators and oxidative stress biomarkers. This study assessed the correlation between
angiogenic regulators and oxidative stress biomarker levels with adverse pregnancy outcomes among GH and PE
participants.
Methods: A cohort of pregnant women who received antenatal care at the Obstetrics and Gynaecology
department of the Komfo Anokye Teaching Hospital (KATH) were followed. During their antenatal visits, 100
developed PE and 70 developed GE, of these, 50 PE and 50 GH gave informed consent. Their blood samples
were taken at time of diagnosis and 48 h post-partum. 50 other aged-matched women who did not develop
neither GH nor PE were selected as controls. Placental growth factor (PLGF), soluble fms-like tyrosine kinase 1
(sFlt-1) and 8-epi-prostaglandin F2alpha (8-epi-PGF2α) levels were estimated by ELISA and total antioxidant
capacity (T-AOC) was measured spectrophotometrically. Graphpad Prism was used for data analysis.
Results: Median levels of sFlt-1, 8-epi-PGF2α and sFlt-1/PLGF were elevated among participants with PE co-existing with
intrauterine fetal death (IUFD), placental abruptio, placental previa, HELLP syndrome and intrauterine growth restriction
(IUGR) compared to PE without adverse outcomes (p = 0.041, p = 0.005, p = 0.0002). Levels of PLGF, T-AOC and PLGF/
sFlt-1 were significantly reduced among participants with PE co-existing with IUFD, placental abruptio, placental
previa, HELLP syndrome and IUGR compared to PE without adverse outcomes (p = 0.0013, p = 0.006, p < 0.0001).
A significant negative correlation of IUGR (p = 0.0030; p < 0.0001), placental abruptio (p < 0.0001; p < 0.0001), IUFD
(p < 0.0001; p < 0.0001), stillbirth (p = 0.0183 and p < 0.000), and postpartum haemorrhage (PPH) (p = 0.0420; p = 0.0044)
were associated with both PLGF and T-AOC whilst a significant positive correlation of IUGR, placental abruptio (p < 0.0001;
p < 0.0001), IUFD (p < 0.0001; p < 0.0001), stillbirth (p < 0.0001; p < 0.0001), and PPH (p = 0.0043; p = 0.0039) were observed
with both sFlt-1 and 8-epi-PGF2α in PE.
Conclusions: Imbalance in the levels of angiogenic regulators and oxidative stress biomarkers correlates with adverse
pregnancy outcomes among PE participants. Early identification of these imbalance would alert health care givers in
anticipation of adverse pregnancy outcome and thus increased surveillance during pregnancy and parturition and
measures to ameliorate the adverse outcome.
