The Relationship Between Maternal Serum Visfatin Level And Hypertensive Disorders of Pregnancy

Abstract

Background and Objective: Hypertensive disorders of pregnancy are amongst the most common conditions adversely affecting maternal and fetal prognosis, leading to noticeably increased morbidity and mortality in the prenatal period. Pre-eclampsia (PE), in particular, is considered as a cardiovascular complication, having risk factors in common with metabolic syndrome of which insulin resistance and obesity are a part. Visfatin is a recently introduced adipokine with insulin-mimetic properties which is thought to contribute to the components of metabolic syndrome. There have been notions supporting the relationship between level alterations of this novel adipokine and affliction of pregnant women with PE. The current study aims to evaluate the correlation between visfatin quantitative levels and the presence of pregnancy hypertensive disorders including mild PE, severe PE and chronic hypertension (HTN). Moreover, assessment of normal pregnancy visfatin levels as the control is done and the data are compared with those of pregnancies with hypertensive disorders. Materials and methods: This cross-sectional study which recruited cases of mild PE (N=40), severe PE (N=40), chronic HTN (N=40) also included normal pregnant subjects as control (N=60). The cases were of the patients hospitalized at university affiliated centers and the controls consisted of referrals to the outpatient departments (OPD). The subjects were matched for Body Mass Index (BMI), parity, gestational age; they were excluded in case they had gestational diabetes, infectious disease, premature rupture of membrane (PROM), any other medical disease, or in labor phase. Informed consents were signed by all the participants. Then, their fasting blood samples were drawn, kept at -20°c . Enzyme Linked Immune Sorbent Assay (ELIZA) test was performed to determine visfatin level. The data were then analyzed, using Mann-Whitney and Krus-Kal-Wallis statistical methods. Results: The mean of serum level for visfatin was 2.81±0.37ng/ml (mean±SEM) for the pregnant control group while it was 2.66±0.41, 7.99±0.28, and 3.46±0.66ng/ml for the mild PE, severe PE and chronic hypertension cases, respectively. Based on the mean values for circulating visfatin level amongst the groups, visfatin level was significantly higher in the severe PE group as compared with the control (p<.0001), mild PE (p<.0001) and chronic HTN (p<.0001) with correspondent mean differences of 5.1, 5.3 and 4.5, being significant at the 0.05 level. Comparison of the mean visfatin levels of mild PE (P=0.79) and chronic HTN (P=0.29) with the controls revealed no significant difference. Conclusions: Severe PE cases were shown to represent higher circulating visfatin levels compared to the normal pregnant women, mild PE and chronic HTN cases. This may further suggest the potential role of visfatin in pathogenesis of severe PE during pregnancy, leading to proposal of models in prognosis definition, prevention and possibly management of this condition through visfatin level related interventions in the future.