INTRODUCTION:

Pre-eclampsia is a significant cause of maternal, fetal, and neonatal morbidity and mortality associated with pregnancy; its impact related to the child health. Preeclampsia is a serious gestational complication.

This can happen around the 20th week of pregnancy; can lead to predominantly maternal and fetal, death, and morbidity. Preeclampsia also belongs to the most serious risks of pregnancy and of the pathophysiology of the condition is not well understood. The Potential function in genetic and immune tract etiology of preeclampsia has improved attention ^1,2.

The national high blood education programme had classified into five type of disorder ³.

i. Gestational hypertension

ii. Pre-eclampsia

iii. Eclampsia

iv. Preeclampsia superimposed on chronic hypertension

v. chronic hypertension

In India the maternal mortality ratio is 167 per 1 lakh Live births (2011-13 sample registration system), Hypertensive conditions cause 12 per cent eclampsia in particular for motherly deaths ⁴. Several studies have shown that hypertensive female neonates, especially those with preeclampsia, are more likely to have hematological permutation ^5-7. The etiology and pathogenesis of preeclampsia is not completely understood, a proinflammatory immune response is prevalent, and fetal hematopoiesis can be impaired. Some of the results on new-borns include neonatal thrombocytopenia, neutropenia, a reduction in regulatory T cells and an elevated cytotoxic natural killer cell profile ^8,9. Early screening for neonatal hematological will help to minimize morbidity and improve the baby's growth, development and survival ².

The aim of present study was to analyse and compare the impact of maternal preeclampsia on the hematological profile (haematology, including hemogram, complete Leukocyte count, RBC count, peripheral fibrillation, the number of reticulocytes) of new-borns as well as certain maternal and fetal outcomes with those of stable, normotensive women at tertiary care hospital.

AIM:

To study the Clinico-hematological profile of Pre-eclampsia on mothers and New-borns

OBJECTIVES OF STUDY:

To study the hematological profile in mothers suffering from pre-eclampsia.

To study the hematological profile in neonates.

MATERIAL AND METHODS:

Study Area:

The present study was conducted in the Department of Biochemistry and Dept. of Pathology of Jawaharlal Nehru Medical College, and AVBRH (Datta Meghe Institute of Medical Sciences) Sawangi, Meghe, Wardha in collaboration with Datta Meghe Medical College, Shalinitai Meghe Hospital and Research Centre, Hingana, Nagpur, Maharashtra India.

Study Population:

100 pregnant womens and 100 neonates were included in the study and were grouped as under.

Group 1: 50 normal pregnant womens.

Group II: 50 Normal Neonates of mothers having normal pregnancy

Group III: 50 pregnant mothers with gestational age between 32 and 36 weeks with preeclampsia.

Group IV: 50 Neonates of mothers having pre-eclampsia.

Study Type: Case control study

Patients selection criteria:

100 pregnant women were taken with following inclusion and exclusion criteria.

Inclusion criteria:

· Pregnant women within age 20-40

· Pregnant women with 20 weeks of gestation

· Pregnant women with HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome can also be included

· Pregnant women diagnosed with pre-eclampsia.

Exclusion criteria:

· Unwilling participant

· Pregnant women without pre-eclampsia or HELLP syndrome.

· Pregnant women suffering from gestational and essential hypertension, thyroid disorder (clinical or subclinical), immunosuppressed and any endocrine problems Were excluded from study. More than 35 was excluded from study. Those mothers who are self-medicated and do not follow the instructions was also excluded from study. Mother who is residing in study area less than 10 years was excluded from study.

SAMPLE PROCESSING:

5 ml venous blood sample were drawn and collected from the anticubital vein avoiding venostasis in all subjects in EDTA after written and informed consent in Marathi (Local language) and English language, in dry disposable syringe under aseptic conditions. And used for analysis of hematological profile (haematology, including hemogram, complete Leukocyte count, RBC count, peripheral fibrillation, the number of reticulocytes).

Stastical Analysis:

1. Data Were collected in excel sheet

2. Patients details were not enclosed

3. data were summarized using frequencies and percentages by using SPSS software (Statistical Package for Social Sciences) version 23.0.

4. P value < 0.05 (0.01) will be considered as statically significant (highly significant) at 95% confidence interval.

ETHICAL CONSIDERATION:

Informed and written consent (Marathi and English) was taken from each subject before collecting data and blood sample. Only those individuals, who volunteer to participate in the study, was included and the data was kept confidential. The study was not imposing any burden on the subjects and the Institute; therefore, the study is ethically justified. The proposed study was undertaken subject to approval by Institutional Ethical Committee.

RESULT AND OBSERVATIONS:

There were 1274 deliveries conducted at Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Nagpur in collaboration with JNMC, DMIMSU, Sawangi, Meghe, Wardha in 2020, among them 50 cases of pre-eclampsia patients and 50 normal pregnant women were included in the present study.

Table no 1: Demographic data of Group I and Group III pregnant women

Demographic data	Group I	Group III
Below 20	06	08
21- 25	13	14
25-30	19	18
31-35	12	10
Systolic BP	128 ± 05 mmHg	146 ± 20 mmHg
Diastolic BP	90±4 mmHg	92±8 mmHg
BMI	24.9 ± 6.2	26.9 ±7.8
Gestational age	33 ± 2	34 ±2

The above table no 1 showing demographic data of normal pregnant womens and pregnant mothers with gestational age between 32 and 36 weeks with preeclampsia. The blood Pressure of pre-eclamptic women was high compare to normal pregnant women. Slight change found in BMI, but it is not statistically significant.

Table no 2: Hematological profile of Group I and Group III

	Group I	Group III	‘P’ value
Hemoglobin (gm/dl)	10.2±1.18	10.01±1.32	0.0035
Red Blood Cell (million/cumm)	4.16±0.28	4.18±1.63	0.0001
Platelets	3.54±0.66	2.54±0.42	0.0023
TLC (/cumm)	8242.0±1122.62	10186±2154.38	0.0035
Neutrophils (%)	67.21±8.38	71.63±9.45	0.0023
Eosinophils (%)	3.36±1.28	3.63±1.38	0.0001
Lymphocytes (%)	17.14±4.56	19.69±6.61	0.0035
Monocytes (%)	2.41±0.64	3.20±1.20	0.0001

Table no 2 shows comparatively lower platelet count in preeclamptic women as compared to normal pregnant women. Also total leucocyte count was relatively on lower side. Neutrophils and monocytes were raised in preeclamptic women when compared with normal pregnant women. Rest of all the parameters were not significantly affected.

Table no 3: Hematological profile of Group II and Group IV

	Group I	Group III	‘P’ value
Hemoglobin (gm/dl)	18.2±1.12	8.21±0.32	0.0023
Red Blood Cell (million/cumm)	5.16±0.22	2.18±2.74	0.0001
Platelets	9.54±4.66	12.04±0.82	0.0035
TLC (/cumm)	2242.0±1422.62	1176±244.38	0.0023
Neutrophils (%)	27.21±42.38	21.23±6.45	0.0001
Eosinophils (%)	0.36±1.08	0.43±1.22	0.0035
Lymphocytes (%)	2.14±8.56	1.69±6.61	0.0023
Monocytes (%)	0.41±2.64	0.20±1.20	0.0035

Table no 3 clearly shows that in case of new-borns of mothers who are preeclamptic, haemoglobin and red blood cell count were significantly lowered. But platelet counts and total lymphocyte count was raised when compared with new-borns of normal pregnant women.

DISCUSSION:

100 pregnant women and 100 neonates were included in our study out of which, 50 were normal pregnant women, 50 were Normal Neonates of mothers having normal pregnancy, 50 were pregnant mothers with gestational age between 32 and 36 weeks with preeclampsia. 50 were Neonates of mothers having pre-eclampsia. In our study, we found that average weight, length, Circumference of the head, weight of placenta and gestational age in neonates born to women with preeclampsia were substantially lower than those of healthy normal females ^5,10.

The platelet counts of neonates born to pre-eclamptic mothers were significantly higher than those of stable normotensive people. There was no statistically significant difference between the two classes in the white blood cells or absolute neutrophilic counts ¹¹.

Hypertensive diseases are the most common medical conditions in pregnancy and are the primary causes of maternal, fetal, and neonatal morbidity and death ^5,10,11. Preeclampsia is by far the greatest concern for obstetricians due to its uncertain origin and its pathophysiology is complex and incompletely understood ⁵. These mothers' new-borns are vulnerable to short-term morbidity such as breathing distress syndrome, deficiency of micronutrients, bronchopulmonary dysplasia, and gastrointestinal issues ^11,12. Also in babies of women with preeclampsia, low Apgar score at both 1 and 5 minutes was significantly more common than that of normotensive women.

CONCLUSION:

In our research, it has been observed that a positive correlation between preeclampsia and neonatal thrombocytopenia. Prematurity, insufficiency of the placenta and fetal development Restriction and need for neonatal resuscitation in babies born to pre-eclamptic women were found to be substantially higher compared to those born to stable normotensive people. Hematological parameters of female neonates with preeclampsia should be carefully assessed and monitored to reduce the chances of developing complications associated with these abnormalities, especially neonatal thrombocytopenia.

REFERENCES:

1. Yadav, S et al. A comparative study of serum lipid profile of women with preeclampsia and normotensive pregnancy. Journal of Datta Meghe Institute of Medical Sciences University, 2018; 13(2):83–83.

2. Ambad R et al. The Role of Serum Urea, Creatinine, Uric Acid in Diagnosis of Pre-Eclampsia and Eclampsia. International Journal of Medical and Biomedical Studies, 2019.3(9); 77-80.

3. Cunningham, Leveno, Bloom, Hauth, Rouse, William’s Obstetrics. Hypertensive disorders of Pregnancy. 23rd ed. McGraw Hill; 2010. p. 693–694.

4. Park K, Park’s Textbook of Preventive and Social Medicine. 24th ed. Jabalpur, India: M/s Banarsidas Bhanot publishers; 2017: 593-598.

5. Ambad R et al. Role of Oxidative Stress and Antioxidant in Preeclampsia: A Study in Rural Population. Int. J. Res. Pharm. Sci., 2020, 11(3), 3322-3328.

6. Meher P et al. Cord blood parameters change in pregnancy induced hypertension. International Journal of Research in Medical Sciences. 2017; 5(5): 2099.

7. Bhat Y et al. Neonatal thrombocytopenia associated with maternal pregnancy induced hypertension. Indian Journal of Paediatrics, 2008; 75(6):571–573.

8. Nelson S et al. Hypertensive disorders of pregnancy: preventative-, immediate- and long-term management. Expert Review of Pharmacoeconomics and Outcomes Research, 2006; 6(5): 541–554.

9. Marins, L et al. How does preeclampsia affect neonates? Highlights in the disease's immunity, The Journal of Maternal-Fetal and Neonatal Medicine, 2019; 32(7): 1205–1212.

10. Yadav S et al. A Comparative Study of Serum Lipid Profile of Women with Preeclampsia and Normotensive Pregnancy.” Journal of Datta Meghe Institute of Medical Sciences University. 2018; 13(2): 83–86.

11. Mohammad A. A. et. al. Effect of Maternal Preeclampsia on Hematological Profile of New-borns in Qatar. BioMed Research International Volume 2020, Article ID 7953289, 1-6 pages

12. Nakade M, Jungari M, Ambad R, Dhingra G. Status of Vitamins and Minerals in Pregnancy: Still A Point of Concern in Central India. Int J Cur Res Rev | Vol 12 Issue 14 (Special Issue) July 2020; 45-49.

Received on 21.11.2020 Modified on 28.12.2020

Research J. Pharm. and Tech 2021; 14(10):5527-5530.

DOI: 10.52711/0974-360X.2021.00964