INTRODUCTION AND LETERATURE REVIEW

1.1 INTRODUCTION

Preeclampsia is a serious complication of pregnancy characterized by high blood pressure and

signs of damage to other organ systems, most commonly the liver and kidneys. If not diagnosed

and treated promptly, it can have adverse effects on both mother and baby. Recent studies have

shown that bicarbonate and potassium levels in the blood can serve as biomarkers for pre-

eclampsia, providing valuable information for early detection and monitoring of the condition

(Lassey & Wilson, Citation1998). Theories of the pathophysiology of preeclampsia involve both

maternal and fetal factors. Although the cause of preeclampsia remains unclear, many theories

suggest that abnormal placental implantation and abnormal trophoblast invasion may be the cause

(Smith & Kenny, 2006). It has been hypothesized that fluctuations in maternal serum bicarbonate

are responsible for the elevated blood pressure seen in patients with preeclampsia (cited in

Sidahmed & Abubaker, 2017; cited in Tabassum, Al-Jameil, Ali, Khan, & Al-Rahed, 2015).

1.2.1: DEFINITION OF PREECLAMPSIA

Formerly known as toxemia, preeclampsia is a hypertensive syndrome that usually occurs during

pregnancy after 20 weeks gestation and is one of the hypertensive disorders of pregnancy

responsible for maternal as well as perinatal mortalities worldwide (Sukonpan & Phupong, 2005).

The syndrome consists of persistent hypertension accompanied by one or more of the following:

proteinuria, evidence of systemic involvement, liver involvement, neurologic complications, fetal

growth restriction, and hematologic complications (Felman & Liberto, 2017).

1.2.2: PATHOGENESIS OF PREECLAMPSIA

Preeclampsia is a serious complication that can occur during pregnancy and is characterized by

high blood pressure and damage to organs such as the kidneys and liver. The pathogenesis of

preeclampsia is not fully understood, but it is believed to involve abnormalities in the placenta
 (Smith & Kenny, 2006). The placenta plays a crucial role in supplying the fetus with nutrients and

oxygen, and in preeclampsia, there is thought to be inadequate blood flow to the placenta, leading

to placental hypoxia and release of factors that trigger the maternal symptoms of preeclampsia.

The pathogenesis of preeclampsia and its subsequent effects on the mother and fetus (Sukonpan

& Phupong, 2005). The failure of trophoblast uterine interactions in the first trimester leads to a

stress response in the placenta. This may affect the growth and development of the velvet tree and

the delivery of oxygen and nutrients to the fetus. The stress to the syncytiotrophoblast leads to the

shedding of a range of factors into the systemic circulation. These factors disrupt the homeostatic

functions of the maternal endothelium, including regulation of coagulation, fluid shifts, and blood

pressure, thereby inducing a systemic inflammatory response ( Ahmed A.2021).

1.2.2: CAUSES OF PREECLAMPSIA

Preeclampsia is a serious medical condition that can occur during pregnancy, typically after 20

weeks gestation. It is characterized by high blood pressure and damage to the liver and kidneys.

While the exact cause of preeclampsia is not fully understood, there are several risk factors and

possible causes that have been identified through research.

One of the main risk factors for developing preeclampsia is a history of high blood pressure or

preeclampsia in a previous pregnancy. Other risk factors include being pregnant for the first time,

being over the age of 40, carrying multiple babies, having a family history of preeclampsia, and

certain medical conditions such as obesity, diabetes, and kidney disease. These risk factors can

increase a woman's chances of developing preeclampsia, although the exact cause of the

condition is still unknown (Chesley, Annitto, & Cosgrove,1976).

Researchers believe that preeclampsia may be caused by problems with the placenta, the organ

that nourishes the growing fetus during pregnancy. In a normal pregnancy, blood vessels in the
 placenta widen to allow for increased blood flow to the fetus. However, in women who develop

preeclampsia, these blood vessels may not widen as they should, leading to restricted blood flow

and high blood pressure. This can result in damage to the mother's organs and potentially harm

the developing baby. Further research is needed to fully understand the causes of preeclampsia

and develop effective treatments to prevent and manage the condition.

1.2 BIOMARKER IN PREECLAMPSIA

Preeclampsia is a serious and potentially life-threatening condition that can affect pregnant

women. It is characterized by high blood pressure and damage to organs such as the kidneys and

liver. Biomarkers are becoming increasingly important in the diagnosis and management of

preeclampsia (Lassey & Wilson,1998). These biomarkers are substances that can be measured in

the blood or urine that indicate the presence of the condition. One of the most commonly studied

biomarkers in preeclampsia is placental growth factor (PlGF). PlGF is produced by the placenta

and plays a key role in the growth and development of blood vessels. In preeclampsia, levels of

PlGF are often reduced, which can be a strong indicator of the condition. Monitoring PlGF levels

in pregnant women can help identify those at risk of developing preeclampsia and allow for early

intervention to prevent potentially serious complications.

1.3.1: DEFINITION OF BICARBONATE

Bicarbonate is a base, that the body needs to help keep a normal acid-base (pH) balance. This

balance prevents your body from becoming too acidic, which can cause many health problems.

The lungs and kidneys keep a normal blood pH by removing excess acid. Serum bicarbonate

mostly travels throughout the body as carbon dioxide (CO2), a gas dissolved in the blood

(Manjareeka, M., & Nanda, S. 2012). That's why the amount of CO2 in your blood is used to

measure serum bicarbonate (base) and to therefore check your acid-base balance. If CO2 is too

low in your blood, then that means serum bicarbonate (base) is low, and your body has too much

acid. Too much acid in the body is called metabolic acidosis (Manjareeka, M., & Nanda, S. 2012).
1.3.2 CHANGES IN BICARBONATE LEVEL DURING PREGNANCY

During pregnancy, there are a number of physiological changes that occur in a woman’s body,

including alterations in her bicarbonate levels. Bicarbonate is an important buffer in the body that

helps maintain the pH balance of blood and other bodily fluids. During pregnancy, the demand

for bicarbonate increases due to the metabolic changes that occur as the fetus grows. As a result,

pregnant women may experience a slight increase in their bicarbonate levels, which can help to

compensate for the increased production of metabolic acids.

However, it is important to note that changes in bicarbonate levels during pregnancy can also be

influenced by other factors, such as diet, hydration status, and kidney function. Some pregnant

women may experience elevated bicarbonate levels as a result of their body’s response to changes

in acid-base balance, while others may experience lower levels due to factors such as vomiting or

kidney disease (Lassey & Wilson,1998). Overall, monitoring bicarbonate levels during pregnancy

is essential in order to ensure the health and well-being of both the mother and the developing

fetus, and healthcare providers should take these changes into consideration when managing the

care of pregnant women (Smith & Kenny, 2006).

1.3.2: USE OF BICARBONATE AS BIOMAKER IN PREECLAMPSIA

Bicarbonate is an important component of the body’s buffering system, helping to maintain the

pH balance in the blood. Abnormal levels of bicarbonate have been found in women with the

preeclampsia, suggesting a disruption in the body’s ability to regulate acid-base balance

(Manjareeka, M., & Nanda, S. 2012). Low levels of bicarbonate may indicate metabolic acidosis,

a condition often seen in patients with preeclampsia due to decreased kidney function and

compromised blood flow to vital organs. Monitoring bicarbonate levels in pregnant women with

the suspected preeclampsia can aid in early diagnosis and management of the condition.
 Bicarbonate levels have been identified as a potential biomarker for preeclampsia. Preeclampsia

is characterized by abnormal placental function and systemic endothelial dysfunction (Smith &

Kenny, 2006). This can lead to disturbances in acid-base balance, including alterations in

bicarbonate levels. Monitoring bicarbonate levels can provide valuable clinical information for

the diagnosis and treatment of preeclampsia. However, it's important to note that the use of

bicarbonate levels as a biomarker for preeclampsia may require further validation through clinical

studies and research.

1.4: POTASSIUM

Potassium is important in body functions such as the regulation of blood pressure and of water

content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

Low levels of potassium can affect these important functions in your body. Over time, low

potassium levels in the body can lead to effects such as heart arrhythmias, muscle weakness, and

even paralysis. Low potassium levels can also affect your kidneys, causing excessive urination

(polyuria) and excessive thirst (polydipsia) (Lassey & Wilson,1998). This is because potassium

helps kidneys balance body's fluid and electrolyte levels. However, bicarbonate and potassium

levels may serve as biomarkers for preeclampsia. In preeclampsia, there is a disruption in the

maternal endothelium's homeostatic functions, which can lead to imbalances in various

electrolytes and biomolecules. Monitoring bicarbonate and potassium levels may provide

valuable insights into the physiological changes that occur in pre-eclampsia and may aid in the

diagnosis and treatment of the condition (Manjareeka, M., & Nanda, S. 2012).

1.4.1: ROLE OF POTASSIUM IN PREECLAMPSIA

One mineral that plays a significant role in the development and prevention of preeclampsia is

potassium. Potassium is a crucial mineral that helps regulate blood pressure by balancing the

effects of sodium in the body. In the case of preeclampsia, a woman's blood pressure can become
 elevated due to a lack of potassium, leading to potentially dangerous complications for both the

mother and baby (Schrier & Briner,1991). In pregnant women, maintaining adequate levels of

potassium is essential for preventing preeclampsia. Potassium helps to relax blood vessel walls

and improve blood flow throughout the body, including the placenta. By including potassium-rich

foods in their diet, such as bananas, avocados, and sweet potatoes, pregnant women can help

reduce their risk of developing preeclampsia (Smith & Kenny, 2006). Additionally, healthcare

providers may recommend potassium supplements for pregnant women who are at a higher risk

of developing preeclampsia. Overall, ensuring proper potassium levels is crucial in preventing the

onset of this dangerous pregnancy complication.

1.4.2: POTASSIUM LEVEL IN PREECLAMPSIA.

Preeclampsia is a serious complication that can occur during pregnancy, characterized by high

blood pressure and protein in the urine. Research has shown that women with preeclampsia tend

to have lower levels of potassium in their blood compared to women with normal pregnancies.

Low potassium levels in the blood, also known as hypokalemia, can lead to muscle weakness,

fatigue, and even heart arrhythmias. Therefore, monitoring potassium levels in pregnant women

with preeclampsia is crucial in order to prevent potential complications (Schrier & Briner,1991).

Studies have also found that supplementing with potassium may help improve outcomes for

women with preeclampsia. Increasing potassium intake through diet or supplements has been

shown to reduce blood pressure and improve overall health in pregnant women with preeclampsia

(Sullivan & Martin, 1994). However, it is important to note that too much potassium can also be

harmful, so it is essential for healthcare providers to carefully monitor and adjust potassium levels

in pregnant women with preeclampsia. Overall, research findings on potassium levels in

preeclampsia highlight the importance of proper monitoring and management of this condition in

order to ensure the best possible outcomes for both mother and baby (Delgado,2004).
1.5: AIM AND OBJECTIVES

This project aims to discuss the current understanding of how bicarbonate and potassium can be

used as biomarkers to identify pre-eclampsia, and the adverse health consequences faced by

patients affected by this disease. Recent studies suggest that serum electrolytes may play a role in

preeclampsia because preeclampsia is a disease of the vascular endothelium. Objective: To

compare serum sodium and potassium levels between preeclamptic and normotensive pregnant

women at a tertiary hospital in Ghana.

1.5.1: CLINICAL MANIFESTIONS OF PREECLAMPSIA

Patients with preeclampsia present with some degree of blood pressure elevation. They may have

an unrelenting headache, right upper quadrant pain, or vision changes. Occasionally, patients may

complain of increased lower extremity edema, which, while not diagnostic of preeclampsia,

should certainly raise concern for disease development (Poorolajal, & Jenabi, 2016). In the

absence of symptoms, laboratories drawn for any indication that could be indicative of

developing preeclampsia should alert the clinician’s suspicion. Patients generally have their blood

pressure checked at every appointment, and the blood pressure trend is important as patients who

are diagnosed with preeclampsia often have increased blood pressure during their pregnancy

(Villar, Betran, & Gulmezoglu, Citation2001).

1.5.2: DIAGNOSIS OF PREECLAMPSIA

Preeclampsia is a serious blood pressure condition that can occur during pregnancy. It's diagnosed

when a pregnant woman has high blood pressure (140/90 mm Hg or higher) after 20 weeks of

pregnancy, along with at least one other finding: Protein in the urine (Sullivan & Martin,1994).

Also called proteinuria, this indicates kidney impairment. A 24-hour urine collection can be used

to diagnose preeclampsia if it contains more than 300 mg of protein. A single urine sample can
also be tested for a protein/creatinine ratio of 0.3 or higher, or a dipstick reading of 2+

(Manjareeka, M., & Nanda, S. 2012).

One of the primary methods of diagnosing preeclampsia is through regular blood pressure

monitoring. High blood pressure is a hallmark sign of the condition, and if a pregnant woman

consistently shows elevated blood pressure readings, it may indicate the presence of

preeclampsia. Even more than that, urine tests can be conducted to detect the presence of protein,

which is another key indicator of preeclampsia. These two simple tests are often the first step in

diagnosing the condition and determining the best course of treatment (Searcy,1969).

In some cases, other symptoms may accompany high blood pressure and proteinuria, such as

headaches, blurred vision, and swelling in the hands and face (Manjareeka, M., & Nanda, S.

2012). These additional symptoms can further support the diagnosis of preeclampsia. It is

important for pregnant women to attend all prenatal appointments and communicate any

concerning symptoms to their healthcare providers to ensure early detection and proper

management of preeclampsia. With prompt diagnosis and appropriate treatment, the risks

associated with preeclampsia can be minimized, leading to better outcomes for both the mother

and the baby.