Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 261823

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : February | Volume : 5 | Issue : 1 | Page : 66 - 69 Full Version

The Role Of Serum Electrolytes In Pregnancy Induced hypertension


Published: February 1, 2011 | DOI: https://doi.org/10.7860/JCDR/2011/.1153
INDUMATI V+, KODLIWADMATH M V*, SHEELA M K**

+ M.D (Biochemistry), Associate Professor, Department of Biochemistry, VIMS, Bellary, * M.D (Biochemistry), Prof & HOD, Department of Biochemistry, Navodaya Medical College, Raichur ** M.S (OBG), Prof & HOD, Department of OBG; Navodaya Medical College, Raichur, India

Correspondence Address :
Dr. Indumati V,
Associate Professor,
Dept of Biochemistry, VIMS, Cantonment, Bellary-583104
Karnataka, India
E-mail: bioindu@yahoo.co.in
Mb. No: 9480755564

Abstract

Background and Objectives:Pregnancy Induced Hypertension (PIH) is one of the most common complications of pregnancy and it contributes significantly to the maternal mortality, premature birth, intra uterine growth retardation (IUGR) and perinatal mortality. The study of electrolytes is gaining ground in the pathophysiology of hypertension. Multiple strategies have been proposed and evaluated for the prevention and management of PIH, which include the moderate dietary restriction of sodium and the administration of magnesium and calcium.

Methods: Our study consisted of 50 normal non-pregnant women, 50 normal primigravida in the second or third trimester of pregnancy and 50 pregnant women with PIH. The present study was undertaken to evaluate the serum ionized calcium, magnesium, sodium and potassium levels in PIH and to find out if the deficiency of these electrolytes was a predisposing factor in the genesis of PIH.

Results: There was a linear fall in serum ionized calcium, magnesium and sodium levels in the normal pregnancy cases as compared to those in the non-pregnant controls (P< 0.001), with a further significant fall in the PIH cases as compared to the normal pregnancy cases (P< 0.0001). There was no significant change in the potassium levels in the PIH cases as compared to those in the normal pregnancy cases (P<0.457). A decreased calcium intake leads to an increase in the parathyroid hormone, which increases intracellular calcium, thus leading to an increase in the vascular smooth muscle contraction and thus, an elevation in the blood pressure. Low levels of magnesium and sodium cause hypocalcaemia, which in turn increases the blood pressure. Thus, along with a moderate dietary restriction of sodium, a dietary supplementation of calcium and magnesium in the form of milk, cheese, soybean products, leafy vegetables, etc. during pregnancy, could result in a reduction in the incidence of PIH

Keywords

Calcium, Electrolytes, Magnesium, PIH, Sodium

Introduction

Hypertension is a universal problem and it complicates at least 10% of all the pregnancies. It is a well known fact that electrolytes play an important role in the aetiopathogenesis of hypertension. Dietary sodium restriction is one of the prime treatments of high blood pressure. Preeclampsia (hypertension in pregnancy in association with the excretion of > 300 mg of urinary protein per day after 20 weeks of gestation) is an important cause of both perinatal and maternal morbidity and mortality.
Calcium plays a critical role in the function of the cardiac and vascular smooth muscles. It is known that the deficiency of calcium may lead to irritable nervous muscular symptoms, even tetanic convulsions, bleeding diathesis, capillary haemorrhages, tissue exudation and osteomalacia. These features have got some resemblance to the clinical manifestations and pathological findings in pregnancy induced hypertension (PIH), particularly eclampsia. Increase in the intracellular calcium causes vasoconstriction, increase in the peripheral resistance and therefore, an increase in the blood pressure (1). Magnesium modulates the cardiovascular effect of sodium and potassium and it is the co-factor for the sodium-potassium ATPase activity (2). Since the electrolytes: calcium, magnesium, sodium and potassium contribute significantly in the functioning of the vascular smooth muscles, the present study was designed to evaluate the role of these electrolytes in the genesis of PIH.

Material and Methods

The Ethical and Research Committee of the Medical College and Hospital approved the study protocol and informed consent was obtained from the controls and the patients before the collection of the blood samples. The study included 50 normal, healthy, non-pregnant women in the age group of 20-40 yrs as the controls, 50 cases of healthy primigravida of the same age receiving antepartum care at the outpatients department and 50 cases of pregnant women with PIH who were admitted to the Dept. of Obstetrics and Gynaecology, District Hospital. All cases were selected by taking a detailed medical history and by physical examination.

Inclusion Criteria
Patients with an onset of hypertension i.e. more than 140/90 mmHg during the second or third trimester of pregnancy,
• Excretion of more than 300 mg of urinary Protein per 24 hrs,
• oedema,
• Patients with or without convulsions and
• sudden weight gain.
Exclusion Criteria: Patients suffering from
• Diabetes mellitus,
• Nephritis or
• Any other systemic disease.
About 2ml of venous blood was collected from the antecubital vein by taking aseptic precautions. Care was taken to prevent venous stasis during the sample collection. The blood was allowed to clot and the serum was separated by centrifugation. The estimation of the parameters was carried out within 4-6 hrs. The samples were analysed for serum total calcium by the O-Cresolphthalein complexone method (3), for serum ionized calcium by ion selective electrode method (4), for serum magnesium by the calmagite dye method (5) and for serum sodium and potassium by the flame photometer method (Systronics). The internal control sera of two different levels were used to calibrate the instruments.
The normal values of different parameters under standard conditions are:
• Serum Total calcium 9-11mg/dl,
• Serum ionized calcium 4.5-5.5mg/dl,
• Serum magnesium 1.8-3 mg/dl,
• Serum sodium 135-145meq/L and
• Serum potassium 3.5-5 meq/L.

One way ANOVA, followed by the Bonferroni multiple comparison test, was employed for the statistical analysis of the data to compare the groups.

Results

The age of the PIH patients was 25.6  3.46 (range 20-29) years. A majority (51.3%) of the patients were in the age group of 21 to 25 years. Of the 50 PIH patients, 34 were primigravida (68%) and 16 were multigravida (32%). On an average, preeclampsia was noted at 33.73 ± 5.91 gestational weeks. The results of various biochemical parameters in normal, non-pregnant, normal primigravida cases and in PIH cases, along with age and body mass index (BMI) are shown in (Table/Fig 1).

(Table/Fig 1): Serum levels of total Calcium, ionized calcium, magnesiam, sodium and Potassium in non-pregnant (Controls), normal primigravida and Pregnancy with PIH.

Serum total calcium, ionized calcium and magnesium levels were significantly decreased in the normal primigravida cases as compared to those in the non-pregnant healthy controls (p<0.001). Further, a highly significant decrease was observed in the PIH cases as compared to the normal primigravida cases (p<0. 001).
It was observed that serum sodium and potassium levels were decreased significantly in the normal primigravida cases as compared to those in the non-pregnant controls (p<0. 001). Serum sodium levels were further decreased significantly in the PIH cases as compared to those in the normal pregnancy cases (p<0.001), but there was no significant change in the serum potassium levels(p<0.457).

Discussion

The estimation of serum electrolytes in PIH provides a very useful index for the study of physiological and pathological changes during pregnancy. In the present study, a significant decrease in serum total and ionized calcium levels was seen in the normal primigravida cases as compared to the non-pregnant controls, with a further highly significant decrease in the PIH cases as compared to the normal pregnancy cases. This indicates an association between calcium deficiency and PIH. This contention is amply supported by a few other studies (6),(7). Seely E W et al confirmed that preeclamptic women had lower serum ionized calcium levels than normotensive, third trimester, pregnant women (1.20 +/- 0.01 vs. 1.26 +/- 0.01 mmol/L, P less than 0.02). They also found that preeclamptic and normotensive pregnant women had equivalent levels of 25-hydroxyvitamin D [25(OH)D]; however, preeclamptics had significantly lower 1,25-dihydroxyvitamin D [1,25-(OH)2D] levels (172.1 +/- 18.5 vs. 219.6 +/- 12.7 pmol/L, P less than 0.05). Thus, lower 1,25-(OH)2D levels may contribute to the suboptimal intestinal absorption of calcium during a time of increased calcium demand, thus resulting in lower ionized calcium levels, increased PTH, and hypocalciuria in preeclampsia. Abnormalities in calcium homeostasis may contribute to the increased vascular sensitivity which is documented in preeclampsia (8). Calcium metabolism is under strain during pregnancy. Expectant mothers need to store about 30-50 gm of calcium during the course of pregnancy, of which 25gms are needed by the foetus. Eighty percent of the total foetal calcium is deposited during the third trimester. The transport of ionized calcium from the mother to the foetus increases from about 50 mg/day at 20 weeks of gestation to a maximum of about 350 mg/day at 35 weeks of gestation (9). Decreased serum calcium levels lead to an increase in the parathyroid hormone levels, thereby increasing the intracellular calcium levels, which leads to an increase in the vascular smooth muscle contraction and thus, an increase in the blood pressure. Despite the low circulating calcium levels, the intracellular level of calcium ions is high, which leads to hypertension (1). Some researchers (10) have also shown an increased, intracellular, ionised calcium concentration and an increased sensitivity of these cells to angiotensin II in women with preeclampsia. Belizan hypothesized that a low calcium intake results in high parathyroid hormone levels and increased membrane permeability. As a result, calcium is released from the mitochondria and it enters the cytoplasm, thus resulting in increased intracellular free calcium levels and decreased serum calcium levels. The elevation of cytoplasmic calcium levels triggers smooth muscle contraction, thus resulting in vascular constriction and increased blood pressure (1).
Several studies have examined the effects of calcium supplementation on blood pressure during pregnancy, thus investigating the role of calcium supplementation and its effects on blood pressure. (11),(12) There has been a near-unanimity in the observed phenomenon that calcium supplementation of approximately 2 g of elemental calcium (5 g calcium carbonate) per day, results in an overall lowering of blood pressure and an overall reduction in the incidence of the hypertensive disorders of pregnancy. The mechanism is the same as that for blood pressure reduction, that is, an overall shift of intracellular ionized calcium to the extracellular space, resulting in smooth muscle relaxation.
Bucher HC (13) et al conducted a meta-analysis of randomized controlled trials on the effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia. The pooled analysis showed a reduction in systolic blood pressure of -5.40 mm Hg (95% confidence interval [CI], -7.81 to -3.00 mm Hg; P<.001) and in diastolic blood pressure of -3.44 mm Hg (95% CI, -5.20 to -1.68 mm Hg; P<.001). The odds ratio for preeclampsia in women with calcium supplementation compared with placebo was 0.38 (95% CI, 0.22 to 0.65). Hence, they concluded that calcium supplementation during pregnancy leads to an important reduction in systolic and diastolic blood pressure and preeclampsia.
(Table/Fig 2) shows the proposed mechanism whereby calcium supplementation may reduce blood pressure (14).
There was a significant decrease in the serum magnesium levels in the normal pregnancy cases as compared to those in the non-pregnant controls and this significantly decreased further in PIH. Our findings are consistent with the reports of some researchers, (15),(16). Magnesium affects the cardiac and smooth muscle cells by altering the transport of calcium and its binding to the membrane and organ cells. Magnesium acts peripherally to produce peripheral vasodilatation and a fall in blood pressure. Thus, low levels of magnesium predispose to an increase in the arterial pressure(17). Magnesium is known to increase the prostacycline release from the endothelial cells of the blood vessels, which acts as a potent vasodilator. In addition, magnesium depletion increases the vasoconstrictor effect of angiotensin II and nor-adrenaline. Magnesium also has a substantial beneficial effect in preeclampsia for the prevention and treatment of convulsions. Therapeutic magnesium sulphate which is used in PIH inhibits phosphatidyl inositol-4, 5-bisphosphate specific phospholipase C activity and subsequent calcium release in the cells, thus leading to decreased intracellular calcium levels and a decrease in blood pressure (18). Hypomagnesaemia and a negative magnesium balance have been found in primary aldosteronism. Aldosterone increases the urinary excretion of magnesium. PIH has been shown to have secondary aldosteronism. The tendency of the depletion of magnesium might be because of the aldosterone effect.
We also found the serum sodium levels to be significantly decreased in the PIH cases as compared to that in the non-pregnant controls and in the normal primigravida. Our findings are in accordance with those reported by other authors, (19),(20). Sodium transport is altered across the cell membrane and this leads to the accumulation of sodium in the extravascular spaces and a decrease in the plasma sodium levels. The serum sodium levels tend to decline in cases of preeclampsia as the disorder increases in severity (19). The intrarenal production of cyclic GMP, endothelin and PGE2 are all decreased in preeclampsia and this may have implications in the sodium retention, hypertension, intrarenal thrombosis and the vasospasm of preeclamptic pregnancy (21). One proposal which was derived from a number of experimental evidences, suggests that an excessive intake of sodium chloride leads to sodium and water retention, the expansion of ECF and intravascular volume, increased venous return and an elevated cardiac index. As elevated blood flow to the tissue continues, whole body autoregulation takes place, with a subsequent increase in the total peripheral resistance and the eventual development of hypertension (22). The “peripheral arterial vasodilation hypothesis” of sodium and water retention in pregnancy and its implications for the pathogenesis of preeclampsia-eclampsia explain that with increased endothelial damage, sodium retention and increased sensitivity to angiotensin lead to hypertension, oedema and proteinuria, the diagnostic triad of preeclampsia-eclampsia (23).
(Table/Fig 3) shows that endothelial damage attenuates the vasodilation of pregnancy and leads to pathophysiologic events that characterize preeclampsia-eclampsia (23).
EDRF= endothelial-derived relaxing factor; PG=Prostaglandin; GFR= Glomerular filteration rate; RBF= Renal blood flow; HELLP= hemolysis, elevated liver enzymes, low platelets
Though there was a decrease in the potassium levels in the normal pregnancy cases and PIH as compared to the controls, there was no significant difference in the potassium levels in PIH as compared to those in the normal primigravida. In erythrocytes, the extrusion of the cellular sodium load is accomplished by the Na/K pump and by the Na/K co-transport. An abnormal low rate of net sodium extrusion by the Na/K co-transport was observed in the PIH patients. PIH may be an early sign of abnormality in the transport of sodium and potassium across the vascular smooth-muscle cell membrane, which is responsible for the maintenance of blood pressure (24),(25).

Conclusion

From the above study, though calcium and magnesium deficiencies cannot be pin pointed as the sole factors for the aetiology of PIH, their relationship with PIH cannot be denied. Both magnesium and sodium are known to decrease the intracellular calcium by different mechanisms, thus leading to smooth muscle contraction and an elevation in blood pressure. The recommended daily allowance of calcium for a pregnant woman is 1200 mg. One cup of yogurt provides the same amount of calcium as one cup of milk (302 mg). Other dairy products providing a significant amount of calcium include Swiss cheese (260 mg per ounce), jack cheese (210 mg per ounce), cottage cheese (115 mg per ½ cup), and ice cream (176 mg per cup). Non-dairy foods which contain calcium include collard leaves (270 mg per ¾ cup), broccoli (160 mg per stalk), okra (150 mg per cup), and acorn squash (108 mg per cup). Thus, along with a dietary restriction of sodium, a dietary supplementation of calcium and magnesium in the form of milk, cheese, soybean products, leafy vegetables, etc. during pregnancy, could result in a reduction in the incidence of PIH.

References

1.
Belizan J.M., Villar. J., Repke J. The relationship between calcium intake and pregnancy induced hypertension: up-to-date evidence. Am. J. Obstet. Gynecol. 1988; 158: 898-902.
2.
Ambwani S.R. M K Desai, A O Girdhar, U H Shah, A K Mathur Role of serum electrolytes (Magnesium and Calcium) in Essential Hypertension. Indian J. Cardiol. 1999; 1-4: 30-32.
3.
Giteman H J. An improved procedure for the determination of calcium in biochemical specimens. Anal Biochem 1967; 18:521-531.
4.
John G T. Ionized calcium by Ion-Selective electrode. In: Pesce A J and Kaplan L A. Methods in Clinical Chemistry, Philadelphia:The C.V. Mosby Company.1987:1010-1020.
5.
Gindler E M and Heth D A. Colorimetric determination with bound “Calmagite” of Magnesium in human blood serum. Clin Chem 1971; 17:662.
6.
Mohieldein A H, Dokem A A, Osman YHM et al. Serum Calcium level as a marker of Pregnancy induced Hypertension. Sudan J med Sci 2007;2:245-248.
7.
Punthumapol C and Kittichotpanich B. Serum Calcium, Magnesium and Uric acid in preeclampsia and normal pregnancy. J Med assoc Thai 2008;91:968-73.
8.
Seely EW, Wood RJ, Brown EM, Graves SW. Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia J Clin Endocrinol Metab. 1992 Jun;74(6):1436-40
9.
Forkes GB. Calcium accumulation by the human fetus. Paediatrics 1976; 57:976.
10.
Haller H, Oeney T, Hauck U, Distler A, Philipp T. Increased intracellular free calcium and sensitivity to angiotensin II in platelets of preeclamptic women. Am. J. Hypertens., 1989; 2: 238- 43.
11.
Crowther CA, Hiller JE, Pridmore B., et al, "Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, pre-eclampsia and preterm birth: an Australian randomized trial. FRACOG and the ACT study group". Aust. N. Z. J. Obstet. Gynaecol. 1999; 39: 12-8.
12.
Herrera JA, Arevalo-Herrara M, Herrera S. "Prevention of pre-eclampsia by linoleic acid and calcium supplementation: A randomized controlled trial". Obstet. Gynaecol 1998; 91: 585-90.
13.
Bucher H.C., Guyatt G.H., Cook R.J. et al, "Effect of calcium supplementation on pregnancy induced hypertension and pre-eclampsia. A Meta-analysis of randomized controlled trials". JAMA 1996; 275: 1113-7.
14.
Repke J.T. "Calcium and vitamin-D" Clinical Obstetrics and Gynecology, Sept. 1994; 37(3): 550-557pp.
15.
Seydoux J, Luc Paunier EG, Beguin F. Serum and intracellular magnesium during normal pregnancy and in patients with preeclampsia. Br. J. Obstet. Gynaecol. 1992; 99 : 207-11.
16.
Standley CA, Whitty JE,Mason BA et al. Serum ionized magnesium levels in normal and pre-eclamptic gestation". Obstet Gynecol. 1997; 89: 24-27.
17.
Resnick LM, Gupta RK, Gruenspan H, et al. Hypertension and peripheral insulin resistant-possible mediating role of intracellular free magnesium. Am. J. Hypertens. 1990; 3: 373.
18.
Hurd WW, Fomin VP, Natarajan V. et al. Magnesium sulfate inhibits the oxytocin-induced production of inositol 1,4,5-tris phosphate in cultured human myometrial cells. Am. J. Obstet. Gynecol. 2002; 187: 419-24.
19.
Searcy R.L., Diagnostic Biochemistry, New York: McGraw-Hill Book Company, 1969, 469pp, 476pp.
20.
Pitkin R.M. et al. Maternal nutrition: A selective review of clinical topics. Obstet. Gynecol. 1972; 40: 7730-785.
21.
Clarke S.L. et al Ed. Critical care obstetrics, 3rd edition, USA: Black Well Science Ltd. 1997, 251-256pp.
22.
Sullivan C.A. and Martin J.N. Jr. Sodium and Pregnancy. In Clinical Obstetrics and Gynaecology, Pitkin R.M., Scott J.R. Philadelphia: J.B. Lippincott Co. 1994; 37(3) : 558-573pp.
23.
Schrier R Wand Briner V A Clinical Commentary -Pheripheral arterial vasodilation hypothesis of sodium and water retention in pregnancy: Implications for pathogenesis of preeclampsia-Eclampsia. Obstetrics and Gynecology, April 1991; 77(4) : 632-639.
24.
Arumanayagam M. and Rogers M. Platelet sodium pump and Na+/ K+ co-transport activity in non-pregnant, normotensive and hypertensive pregnant women. Hypertens Pregnancy 1999; 18(1): 35-44.
25.
Ulrich-S, Von-Tempelhoff-GF, Heilmann-L. The Na+/K+ co-transporter of the erythrocyte membrane in PIH. Zentralbl-Gynakol 1994; 116(3): 164-8.

DOI and Others

JCDR/2011/1153

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com