A COMPARATIVE STUDY OF SERUM β HCG CONCENTRATION AND LIPID PROFILE IN PREGNANCY INDUCED HYPERTENSIVE AND NORMOTENSIVE WOMEN IN THIRD TRIMESTER OF PREGNANCY

Jadab Kishore Phukan. Hypertensive disorders are among the commonest and unpredictable medical disorders during pregnancy contributing significantly high to maternal and perinatal morbidity and mortality. Human chorionic gonadotropin (hCG) is a glycoprotein that is produced during pregnancy by the developing embryo and later by the syncytio trophoblast of the placenta mainly. Serum β hCG is found to be abnormally raised in the urine and serum of pregnant women with pregnancy induced hypertension. The aim of the study was to evaluate the concentration of serum β hCG and lipid profile level and its correlation with pregnancy induced hypertension. To compare the serum β hCG and lipid profile level between study and control group. The study was carried out in the department of Biochemistry, Assam Medical College and Hospital, Dibrugarh. The study includes two group cases and controls. The cases included in the study were taken from Obstetrics and Gynaecology Department, Assam Medical College & Hospital during the period of study. The cases comprised of 50 clinically established cases of Pregnancy Induced Hypertension (PIH) in their third trimester and the control group comprised of 50 cases of normotensive pregnant patients in the third trimester. The differences of mean serum β hCG concentration in cases and in controls were statistically highly significant (p < 0.001). It is also found that there is positive correlation between serum β hCG concentration with Blood pressure levels both systolic and diastolic pressure. Total Cholesterol, LDLCholesterol and Triglycerides were found to high value in cases than controls with statistically significant (p < 0.01) differences. Pregnant women with pregnancy induced hypertension have higher level of serum β hCG and serum lipid profile in comparison to normotensive women.

the first time are potentially at high risk of eclampsia. Socioeconomic status and nutritional standard of a nation and the quality of antenatal care have a remarkable bearing on the incidence of this disease and maternal and perinatal loss 2 .
A number of biochemical and biophysical markers have been proposed as predictors for development of PIH in later pregnancy and the role of Placental hormones being one of them. Human chorionic gonadotropin (hCG) is a glycoprotein that is produced during pregnancy by the developing embryo and later by the syncytio trophoblast of the placenta mainly. Estimation of blood hCG titres are especially helpful in the diagnosis and management of trophoblastic disease and ectopic pregnancies. Other clinical conditions associated with increased secretion of β hCG are Down"s syndrome, neural tube defects, fetal aneuploidy and twin or higher pregnancies. Decreased levels are found in women at risk of carrying fetus with trisomy 18, ectopic pregnancy and blighted ovum. Besides the above diseases and chromosomal anomalies, hCG was also found to be abnormally raised in the urine and serum of pregnant women with pregnancy induced hypertension 3 .
Soheila Akbari et al (2009) studied to assess association between preeclampsia and serum level of β human chorionic gonadotropin (βhCG) on 75 pregnant women. Subjects divided into 3 groups: Normotensive pregnancies, mild preeclampsia and severe preeclampsia. Then level of β hCG was measured using Enzyme linked Immunosorbent Assay (ELISA) method. The mean level of β hCG was significantly higher (p<0.001) in severe preeclampsia than normotensive and mild preeclamptic groups. However, there was no significant difference between normotensive and mild preeclamptic groups regarding mean level of β hCG. They concluded that β hCG may be a good indicator for severe preeclampsia but it is not suitable for early diagnosis of the disease 4 .
Dayal Meena et al (2011) did a retrospective clinical study of serum markers (β hCG, α -fetoprotein and inhibin A) as predictors of preeclampsia in 50 antenatal women by ELISA technique and found that 10 women developed preeclampsia (20%). A significant rise of mean serum β hCG was found in those who developed preeclampsia 5 . Kaaja et al (1995) postulated that lipid abnormalities play a role in the pathogenesis of gestational hypertension, causing altered endothelial function and vascular damage 6 .
Sillman et al (1994) in the same year concluded that insulin resistance may contribute to pathogenesis of PIH. Insulin has an important role in lipid metabolism. High concentration of free fatty acids in PIH is due to their increased mobilization from adipose tissues. In case of insulin resistance, there is increased triglycerides concentration in blood as lipoprotein lipase does not metabolise triglycerides 7 .
The Free Fatty Acids and Triglyceride levels begin to rise 15-20 weeks of gestation before clinical parameters of preeclampsia are seen. The dramatic increase in Triglyceride results in an increase in VLDL, small changes in LDL and decreased HDL. Elevation of Free Fatty Acids and Triglyceride deposition in endothelial cells may point out oxidative stress induced by cytokines. Serum Triglyceride, Low Density Lipoprotein Cholesterol (LDL-C) was found to be significantly higher in PIH case than normal controls 8 .
So, keeping the above facts in mind and preeclampsia being much prevalent in our part of the country, this study was done with to evaluate the concentration of serum Beta human Chorionic Gonadotropin (β hCG) and Lipid Profile level and its correlation with pregnancy induced hypertension and to compare the serum β hCG concentration and Lipid Profile level between study and control group.

Materials and methods:-
The study was carried out in the department of Biochemistry, Assam Medical College and Hospital, Dibrugarh. The study includes two group cases and controls. The cases included in the study were taken from Obstetrics and Gynaecology Department, AMCH during the period of study. The cases comprised of 50 clinically established cases of Pregnancy Induced Hypertension (PIH) in their third trimester and the control group comprised of 50 cases of normotensive pregnant patients in the third trimester.
Aims:-1) To evaluate the concentration of serum β hCG and lipid profile level and its correlation with pregnancy induced hypertension.
2) To compare the serum β hCG and lipid profile level between study and control group.
Inclusion criteria:-Pregnant woman with systolic blood pressure of at least 140mmHg with a >30 mmHg rise and /or diastolic blood pressure at least 90mmHg with rise of >15 mmHg occurring on two or more occasions after 24weeks of gestation was included in the study.
All the patients in the study was subjected to detail history regarding age, parity, height, pre pregnancy weight and weight at the time of blood collection. Maternal family history of preeclampsia, past obstetric history, past medical history, smoking habit, medical histories of first degree family members and physical activity during pregnancy was noted. Systemic examination with special reference to oedema, blood pressure and gestational week was carried out and routine antenatal investigation was done.

Blood sampling and preparation of serum Beta hCG:-
The venepuncture was done in the cubital fossa. About 4 ml of blood was drawn using perfectly dry and sterile syringe. The sample is allowed to clot for thirty minutes at room temperature. Samples were centrifuged at 5000 rpm for 10 minutes as soon as after formation of the clot. The supernatant clear serum was then pipetted out using dry piston pipettes with disposable tips. The samples were analysed on the same day. Serum Fasting Lipid profile were estimated in Semi-auto analyzer from the study sample.

683
VLDL is the primary triglyceride carrying form in the fasting state; its concentration can be approximated by dividing the amount of plasma triglyceride by 5. Statistical analysis:-The present study is a randomised case control study and results were expressed as Arithmetic Mean + Standard Deviations (SD) and analysed by unpaired Student"s t-test on continuous measurements and results on categorical measurements were presented in Number (%). Pearson coefficient of correlation (r) was used to find out the correlation between Blood pressure and the serum β hCG concentration. P-Value: p < 0.05 is considered significant, p < 0.01 is considered highly significant, p < 0.001 is considered very highly significant, p > 0.05 is considered not significant.

Results:-
In the present study it is found that the mean serum β hCG concentration in cases was 42.94±18.91 ranging from 15-78 IU/mL and in controls was 24.18±11.34 ranging from 10-49 IU/mL and it was statistically very highly significant (p < 0.001). Thus, the serum β hCG concentration increases in PIH patients. It is also found that there is positive correlation between serum β hCG concentration with Blood pressure levels both systolic and diastolic pressure with Pearson Correlation co-efficient "r" values 0.64 for systolic pressure and 0.62 for diastolic pressure.  Table-3) The mean serum levels of HDL Cholesterol in hypertensive are (39.47±6.89) mg/dl and in normotensive is (39.88±5.48) mg/dl. t-test revealed not significant differences (p<0.74) in HDL Cholesterol values in between hypertensive and normotensive groups. (Table-3) The mean serum levels of LDL Cholesterol in hypertensive are (112.08±31.49) mg/dl and in normotensive is (74.09±19.98) mg/dl. t-test revealed very highly significant differences (p<0.01) in LDL Cholesterol values in between hypertensive and normotensive groups. (Table-3) The mean serum levels of VLDL Cholesterol in hypertensive are (40.11±8.51) mg/dl and in normotensive is (32.57±4.38) mg/dl. t-test revealed very highly significant differences (p<0.01) in VLDL Cholesterol values in between hypertensive and normotensive groups. (Table-3)  Table 4 shows that there is very weak positive correlation between blood pressure and lipid profile of pregnancy induced hypertension patients and it is not significant statistically.

Discussion:-
In the 50 hypertensive cases which were studied, the maximum number of 16 cases (32%) belonged to the 16-20 years age group and 8 (16%) were from the age group of 20-25 years. After combining both the groups, we get the highest number of 26 cases (48%) were found 16-25 years age group. Similar findings were also found by Farnoosh et al (2012) 13 who recorded maximum incidence in age group 15-25 age group. In the age group of ≤ 20 years there were 16 hypertensive cases which constitute 32% of total number of participants. In 31-35 years age group 32% were hypertensive. This can be attributed to the fact that increased episodes of preeclampsia occurs in extremes of maternal age.
In the present study there were 32 (64%) who were primigravidas and 18(32%) were multigravidas in the hypertensive study group. Surraya  So it can be stated that the elevation of blood pressure in hypertension of pregnancy was influenced by the lipid profile and thus the lipid profile of a hypertensive pregnant women can with all probabilities be used as a biochemical marker of the disease. .
Pearson"s coefficient between blood pressure and Lipid Profile of Hypertensive group shows weakly positive correlation and are statistically not significant.

Conclusion:-
From the present study it can be concluded that pregnant women with pregnancy induced hypertension have higher level of serum β hCG in comparison to normotensive women. It is also observed that higher value of lipid profile parameters in comparison to normotensive women. Serial estimation of serum βhCG and Lipid Profile can very well be used as biochemical markers of the disease and also can be used in better management of established cases of eclampsia or preeclampsia.
The metabolic disorder that occurs in pregnancies with pregnancy induced hypertension may be important and may be a predictor of future systemic diseases in these women. Therefore more studies are warranted into the implications of these predictors of hypertension during pregnancy.