Preeclampsia is a taking cause of maternal and neonatal mortality and morbidity. It is a complex syndrome of undetermined etiologic beginning, normally diagnosed during 2nd half of gestation. Elevated degrees of oxidative lipid derived functions and decreased antioxidants in the circulation of preeclamptics may lend to endothelial harm. There is good grounds for a important addition in the degrees of plasma and red blood cells. Group I: Normotensive nonpregnant adult females ( control ) , Group II: Pregnant adult females with normal blood force per unit area, Group III: Preeclamptic ( pretreatment ) , adult females Preeclamptic adult females were subdivided into Group IIIA: Pre eclamptic adult females supplemented with Vitamin E ( n=20 ) , Group IIIB: Preeclamptic adult females supplemented with Omega 3 Fatty Acid, Group IIIC: Preeclamptic adult females supplemented with Vitamin E 400mg + Omega 3 Fatty Acid. Serum SOD, MDA, GPx, GSH degrees was measured in all groups and compared with pre intervention and station interventions consequence by utilizing the one manner ANOVA followed by the Tukey – HSD process. Our consequences showed that supplementation of Vitamin E, Omega 3 fatty acid entirely and in combination has significantly increased antioxidant enzyme position and significantly decreased oxidative emphasis when compared to unsupplemented patients ( P & lt ; 0.001 ) .
Keywords: Preeclampsia, Vitamin E, Omega 3 fatty acids, SOD, MDA, GPx, GSH
Pre-eclampsia is a taking cause of maternal and neonatal mortality and morbidity. It is a complex syndrome of undetermined etiologic beginning, normally diagnosed during 2nd half of gestation. The hypertensive upsets in gestation are common complications of gestation and organize one of the great three of complications that continued to be responsible for the bulk of maternal deceases. How gestation per Se incites or aggravates hypertensive vascular disease remain unresolved despite decennaries of intensive research. Diffuse vascular endothelial break is believed to play a major function in the pathophysiologic mechanisms of pre eclampsia. Therefore, coiling arterias display an abnormally high vascular opposition with decreased uteroplacental perfusion as confirmed by Doppler flow velocimetry studies1.
Pre-eclampsia is a multi organ system upset that occurs after the twentieth hebdomad of gestation and is characterized by: 1. Hypertension i.e. Blood force per unit area & gt ; 140/90 mm/Hg 2. Proteinuria ( urine protein & gt ; 0.3 g/24 hours ) with or without 3.Abnormal hydrops ( Beaulieu MD, 1994 ) When the diastolic blood force per unit area becomes above 110 millimeter Hg and protein above 3 milligrams per twenty-four hours the status is called terrible pre-eclampsia2 and if the happenings of ictuss are superimposed on preeclampsia the status is referred to as eclampsia3
Elevated degrees of oxidative lipid derived functions and decreased antioxidants in the circulation of preeclamptics may lend to endothelial harm. There is good grounds for a important addition in the degrees of plasma and erythrocytesmalondialdehyde ( MDA ) , a marker of lipid peroxidation in normotensive pregnant adult females, which were further increased in adult females with pregnancy-induced hypertension4. Evidence of increased oxidative lipid derived functions in the decidual eutherian tissues was observed in adult females with established preelampsia5. Elevated degrees of oxidative lipid derived functions, conjugated dienes and decreased antioxidant capacity in the maternal circulation have besides been reported6.
The free extremist scavenging mechanisms include enzymatic antioxidants like Superoxide dismutase ( SOD ) , Glutathione peroxidase ( GPx ) , Glutathione reductase ( GSH ) and Catalase, which limit the cellular concentration of free groups and prevent inordinate oxidative harm.
Until late, the informations back uping the efficaciousness of supplementation with vitamin C and vitamin Tocopherol for the bar of pre-eclampsia have been limited. 7Vitamin E, a powerful lipid soluble antioxidant is considered as the most reactive antioxidant8. The most of import map of vitamin E in the organic structure is to protect the polyunsaturated fatty acid from oxidization 9
Although omega-3 fatty acids have been known as indispensable to normal growing and wellness since the 1930s, consciousness of their wellness benefits has dramatically increased in the past few old ages. New versions of ethyl esterized omega-3 fatty acids, such as E-EPA and combinations of E-EPA and E-DHA, have drawn attending as a extremely purified and more effectual merchandise than the traditional 1s. Furthermore, n -3 LCPUFA have a broad scope of biological effects, including benei¬?cial consequence on lipoprotein metamorphosis, thrombocyte map, endothelial map, vascular responsiveness, cytokine production and coagulation10
Supplement with Omega 3 Fatty Acid during gestation lowers the hazard of premature birth and can increase the length of gestation and birth weight by changing the balance of eicosanoids involved in labor and advance foetal growing by bettering placental blood flow.
Intake of Omega 3 Fatty Acid during gestation and breastfeeding may ease the kid ‘s encephalon development. There is besides some grounds that supplementation with Omega 3 Fatty Acid might assist to forestall pre-eclampsia, postpartum depression, menopausal jobs, postmenopausal osteoporosis, and chest malignant neoplastic disease. Accustomed ingestion of modest sums of fish and other seafood has been associated with a decrease in the hazard of bosom disease11
MATERIALS AND METHODS
The topics for this survey were from the Obstetrics and Gynaecology Department of Meenakshi Medical College Hospital and Research Institute, Kancheepuram, Tamil Nadu, India. After inscribing in the survey, a elaborate obstetric history and the informed consent were obtained. A thorough account of the process of this long term survey was explained in item and blood samples were obtained basally. The survey protocol was approved by an Institutional Human Ethical Committee of Meenakshi University
Grouping: The patients were divided into three groups:
Group I: Normotensive nonpregnant adult females -control ( n = 42 ) , Group II: Pregnant adult females with normal blood force per unit area ( n = 50 ) , Group III: Pre eclamptic adult females ( n = 60 )
Preeclamptic adult females were subdivided into Group IIIA: Pre eclamptic adult females supplemented with Vitamin E ( n=20 ) , Group IIIB: Pre eclamptic adult females supplemented with Omega 3 Fatty Acid ( n=20 ) , Group IIIC: Pre eclamptic adult females supplemented with Vitamin E 400mg + Omega 3 Fatty Acid ( n=20 )
The addendums were Vitamin E 400mg, Omega 3 Fatty Acid ( DHA 120mg and EPA 180 milligram ) , Vitamin E 400mg + Omega 3 Fatty Acid one time daily from 22 – 24 hebdomads for eight hebdomads. The three above mentioned drugs were obtained from Merck Pharmaceutical India after acquiring official permission to be used on human topics and after complete standardization. The survey groups were asked to devour their normal accustomed diet, but they were asked to follow the recommendations for pregnant adult females.
Blood sample aggregation was done between 22-24 hebdomads of gestation and after 8 hebdomads of supplementation of antioxidants along with the regular antihypertensive agents. The patients were requested to be on nightlong fasting. Blood samples were collected between 8.00 AM and 10.00 AM. In each instance, 10 milliliter fasting venous blood were drawn into a Na Lipo-Hepin vacutainer tubing for dividing plasma and stored at 4A°C, until processed. All samples were processed within 20 hours of trying. All the pregnant adult females were encouraged to book and to go to regular prenatal medical examination.
The blood samples were centrifuged at 1000g for 15 min at 4A°C ; the stray ruddy cells were washed 4 – 5 times with 0.154 M NaCl to take plasma and buffy coat. After the concluding wash, required packed ruddy cells were lysed by hypotonic stock solution and different dilutions were used as Hemolysates.
Malondialdehyde ( MDA ) 12: The assaywas estimated harmonizing to the method of Nadiger et Al ( 1986 ) . On the reaction of malondialdehyde ( MDA ) with thiobarbituric acid ( TBA ) ; organizing a MDA-TBA2 adduct that absorbs strongly at 532 nanometer. The MDA content in plasma was expressed as nmol / milliliter.
Superoxide dismutase ( SOD ) 13: Superoxide dismutase activity was estimated harmonizing to the method of Hartzet Al 1983. The assay process is based on the autoxidation of SOD reagent to an adrenochrome at alkalic pH by measuring of alterations in the soaking up at a wavelength of 480 nanometers. Superoxide dismutase activity is evaluated and expressed as IU/gHb
Glutathione peroxidase ( GPx ) 14: Glutathione peroxidase activity was determined by the nonenzymatic method byPaglia and Valentine ( 1967 ) . Glutathione peroxidase enzymes, catalyses the decrease of H2O2 and organic peroxides to H2O and the corresponding stable intoxicant therefore suppressing the formation of free groups. Enzyme activity can be decreased by negative feedback from extra substrate or from harm by oxidative alteration.
Glutathione reductase ( GSH ) 15: Glutathione Reductase activity was measured harmonizing to the method ofGoldberg et al 1983. Glutathione Reductase catalyses the decrease of glutathione in the presence of NADPH, which is oxidised to NADP+ . The lessening in optical density at 340nm is measured.
Statisticss: In statistics informations was analayzed one manner ANOVA ( Analysis of discrepancy ) followed by the Tukey – HSD process. The SPSS package bundle version 17 was used to prove the significance of the experiment performed.. In the present survey Group II is compared with Group I ( i.e. , compared pregnant adult females with normal adult females ) . Group III compared with Group II to happen out the consequence of the pre-eclampsia consequence on antioxidant position. Group IIIA, Group IIIB, Group IIIC are compared with Group III ( i.e. , comparing between pre and station intervention ) .
The consequences were shown in Figures 1 and 2. On comparing, the average values of lipid peroxidation merchandise malondialdehyde and the enzymatic antioxidants superoxide dismutase, glutathione peroxidase and glutathione reductase are among the three groups was important. In add-on, the average value of gestation induced high blood pressure ( Group III ) was statistically more important ( P & lt ; 0.001 ) .
Table.1: Comparison Of Lipid Peroxidation Product and Antioxidant Enzymes in Group I, Group II & A ; Group III.
[ n=42 ]
[ n=50 ]
[ n=60 ] Pretreatment
MDA ( nmol/L )
SOD ( IU/gmHb )
GPx ( IU/gmHb )
GSH ( IU/gmHb )
Table.2: Comparisons of Lipid Peroxidation Product and Antioxidant Enzymes among Subgroups Group III A, Group III B, Group III C with Group III ( Pre – Rx )
[ n=60 ]
Post intervention ( N=20 in each group )
Group III A
Group III B
Omega 3 Fatty acids
Group III C
Omega 3 Fatty acids+Vit Tocopherol
MDA ( nmol/L )
SOD ( IU/gmHb )
GPx ( IU/gmHb )
23.68 A± 0.9
22.00 A± 1.4
24.8 A± 0.93
GSH ( IU/gmHb )
7.86 A± 0.6
6.59 A± 0.88
8.87 A± 0.53
Our consequences showed that supplementation of Vitamin E, Omega 3 fatty acid entirely and in combination has significantly increased antioxidant enzyme position and significantly decreased oxidative emphasis when compared to unsupplemented patients ( P & lt ; 0.001 ) .
In preeclampsia the oxidant/antioxidant balance is tipped in favour of oxidizers at the disbursal of antioxidants, because in plasma, elevated degrees of maternal lipid peroxides were measured 16Antioxidant enzymes like Superoxide Dismutase, Glutathione Peroxidase, and Glutathione Reductase organize the first line of defence against ROS and the lessening in their activities contributes to the oxidant assault on the cells. Dismutase converts superoxide O into Hydrogen Peroxide and in preeclamptic oxidative emphasis conditions oxidative balance system is disturbed. During normal gestation there is an addition in oxidative emphasis and therefore a parallel addition in antioxidant activity is seen. The findings implicate oxidative emphasis in the disease and mention the biochemical principle for clinical tests of antioxidants to forestall and handle gestation induced high blood pressure. Supplement of antioxidants along with polyunsaturated fatty acids, peculiarly omega-3 fatty acids, may be utile in the direction of pre-eclampsia.
Based on the consequences of the present survey, it is clear that in PIH there is an altered oxidizer position and decreased antioxidant enzyme position proposing that there is an indirect grounds for the presence of oxidative emphasis in pre eclampsia.In decision Vitamin E and Omega 3 Fatty acid, entirely or its combination protects the human placenta against the hurtful effects of reactive O species. Our informations support this hypothesis that, over coevals of free groups at the initial phase is quickly scavenged by supplementation with vitamin E and Omega 3 fatty acids thereby reenforcing placental opposition to oxidative hurt. The function of antioxidants in the bar of pre-eclampsia is controversial. From our survey it was found that, supplementing adult females with antioxidants, combination of Vitamin E with Omega 3 fatty acids ( eicosapentanoic acid and docosohexanoic acid ) during pre-eclampsia may assist to antagonize oxidative emphasis and thereby prevent or detain the oncoming of pre-eclampsia and hence, better the wellness of the female parent and babe.