Role of Serum Lactate Dehydrogenase in Pregnancy Induced Hypertension with its Adverse Feto-Maternal Outcome- A Case-control Study

Abstract

Introduction: Hypertensive Disorders of Pregnancy (HDP) affect 6-8% of all pregnancies, contributing immensely to maternal morbidity and mortality. Pre-eclampsia is a common, yet a major medical complication of pregnancy and is responsible for 10%-15% of maternal deaths. Lactate Dehydrogenase (LDH) is an intracellular enzyme, which when present in serum signifies tissue damage and haemolysis. Aim: To study the correlation of serum LDH levels with blood pressure range in patients with gestational hypertension and pre-eclampsia, and the feto-maternal outcome. Materials and Methods: Based on the eligibility criteria, 150 hypertensive pregnant women were enrolled as cases. Also, 150 normotensive women admitted after 28 weeks of gestation were taken as controls in the study. Serum LDH was measured in both the groups and its correlation with blood pressure was studied, after applying appropriate clinical tests. (Quantitative variables-unpaired t-test/Mann-Whitney test between two groups and ANOVA/Kruskal Wallis test between more than two groups; Qualitative variables: chi-square/Fisher exact test. Pearson/Spearsman correlation coefficient was used to assess correlation between various quantitative parameters) Association of other biochemical parameters with feto-maternal outcome was also studied. Results: The mean age of women in hypertensive group was 25.06±4.13 years, while that in normotensive group was 24.38±3.8 years. Most women belonged to lower and lower middle class (75.33%). The mean serum LDH levels in hypertensive group was 1011.81±539.31 IU/L, while it was 555.24±237.69 IU/L in normotensive groups (p-value=0.017). Serum LDH levels were significantly associated with the range of blood pressure (p-value<0.0005). High levels of LDH were found in pre-eclamptic women with adverse maternal outcomes (p-value=0.001). Elevated levels of LDH (1058.88±575.19 IU/L) were also associated with Low Birth Weight (LBW) babies and poor foetal outcome, including low Apgar, higher rates of NICU admission and neonatal mortality (p-value<0.0005). Conclusion: LDH level estimation and its correlation with range of blood pressure is a simple and reliable method for prediction of adverse maternal and foetal outcome in hypertensive disorders of pregnancy. It may also help in assessing the severity of the condition.

Keywords

• adverse maternal effects
• gestational hypertension
• lactate dehydrogenase
• pre-eclampsia
• unfavourable foetal fallouts