Abstract
BackgroundAbnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Although their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. This study aimed to determine hematological, coagulation and cytokine profiles in hypertensive as compared to normotensive pregnancy and to identify correlations between these profiles.MethodsThis was a hospital-based comparative cross-sectional study conducted from September 2017 to February 2018. There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women admitted to the maternity block of the same hospital. Hematological and cytokine parameters were compared between the hypertensive and the normotensive group. We analyzed the data using Student’s independent t-test when the data were normally distributed; and the Mann–Whitney U-test when the data were not normally distributed. Kruskal Wallis with Dunn’s multiple comparison tests was run for subgroup analysis and correlation studies were done using Spearman ranking.ResultsHemoglobin levels were slightly but significantly lower, (P < 0.01) in women with HDP compared to normotensive (N) women; the same was true for platelet counts (P < 0.001). The red cell distribution width (RDW) was slightly but significantly higher in HDP than in N. Neutrophil counts and Interleukin 6 (IL-6) levels were significantly (P < 0.001) higher in HDP than in N; and within HDP IL-6 levels increased with increasing severity of HDP. A novel remarkable finding was that eosinophil counts, normal in N, were lower and lower with increasing severity of HDP, to the point that they were nearly absent in women with eclampsia.ConclusionThere are significant changes in hematological, cytokine and coagulation parameters in pregnant women with hypertensive disorders compared to normotensive pregnant women. The picture that emerges is that of an inflammatory state associated with hypertensive disorders of pregnancy.
Highlights
Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies
There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women with confirmed diagnosis of gestational hypertension (GH) (n = 14), preeclampsia (PE) (n = 44), or eclampsia (E)(n = 18) who were admitted to the maternity block of the same hospital
Canzoneri et al [31]].We suggest that increased neutrophil counts in HDP are a sign of inflammation, and they may be caused by increased Interleukin 6 (IL-6) [32]: neutrophil counts correlated positively with IL-6 and IL-10 (Table 3)
Summary
Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. Hypertensive disorders of pregnancy (HDP) affect up to 10% of all pregnancies globally [1]. These multi-system disorders comprise gestational hypertension (GH), preeclampsia (PE) and eclampsia (E). Hypertensive disorders of pregnancy are a common cause of morbidity and mortality in pregnant women: they can affect the fetus and the newborn. Maternal complications include the HELLP syndrome (hemolyisis, elevated liver enzymes, low platelets), pulmonary edema, acute liver/renal failure, disseminated intravascular coagulopathy, adult respiratory distress syndrome, sepsis and liver hemorrhage [2]
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