Plasma Aldosterone and Angiotensin 1-7 Levels with Early Preeclampsia Without Comorbidities at the Obstetrics and Gynecology Polyclinic of Universitas Airlangga Hospital
DOI:
https://doi.org/10.52783/jns.v14.4100Keywords:
Preeclampsia, Angiotensin (1-7), Aldosterone, Renin-Angiotensin-Aldosterone System (RAAS)Abstract
Dysfunction of the Renin-Angiotensin-Aldosterone System (RAAS) is thought to play an important role in the pathogenesis of preeclampsia. Further research is needed to improve understanding of the underlying mechanisms of this disease and to investigate safer and more effective diagnostic and therapeutic options for pregnant women. Objective: to determine the correlation between plasma aldosterone and angiotensin 1-7 levels with the incidence of preeclampsia, especially early preeclampsia. Methods: A cross-sectional study using a total sampling of pregnant patients with a gestational age of more than 20 weeks and a single live baby who underwent antenatal examination at the RSUA Polyclinic from May to June 2023. Exclusion criteria included pregnant patients with multiple comorbidities. The immunoassay method took venous blood samples (5 cc) for aldosterone and angiotensin (1-7) measurements. Statistical analysis was performed using SPSS 26.1 software with the ANOVA statistical method and Tukey's post hoc test. Further statistical approaches included subgroup analysis of early preeclampsia and subgroup analysis of late preeclampsia. Results: 114 patients were included in this study, consisting of 21 preeclamptic patients and 93 non-preeclamptic patients. Statistical analysis showed that both angiotensin (1-7) and aldosterone levels did not significantly correlate with the incidence of preeclampsia (p = 0.852; p = 0.419, respectively). However, in the subgroup analysis of early preeclampsia (n = 11), aldosterone levels were significantly higher than in non-preeclamptic cases (p = 0.024). Conclusion: The correlation of aldosterone levels with early preeclampsia cases indicates a specific role of aldosterone. Increased aldosterone levels protect the placental angiogenesis-branching system, with the mechanism of volume retention and sodium levels in early preeclampsia.
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Basyiar, A., Mamlukah, M., Iswarawanti, D. and Wahyuniar, L., 2021. Faktor Risiko Yang Berhubungan Dengan Kejadian Preeklamsia Pada Ibu Hamil Trimester II Dan III di Puskesmas Cibeureum Kabupaten Kuningan Tahun 2019. Journal of Public Health Innovation, 2(1), pp.50-60.
Sole, K., Staff, A., Räisänen, S. and Laine, K., 2022. Substantial decrease in preeclampsia prevalence and risk over two decades: A population-based study of 1,153,227 deliveries in Norway. Pregnancy Hypertension, 28, pp.21-27
Belay, A. and Wudad, T., 2019. Prevalence and associated factors of pre-eclampsia among pregnant women attending anti-natal care at Mettu Karl referal hospital, Ethiopia: cross-sectional study. Clinical Hypertension, 25(1).
World Health Organization, 2018. WHO recommendations: drug treatment for severe hypertension in pregnancy. [online] WHO. Available at: <https://apps.who.int/iris/handle/10665/277234> [Accessed 28 September 2022].
Fitriani, H., Setya R, A. and Keni, M., 2021. Risk Factors Of Preeclampsia Among Pregnant Women In Indonesia. KnE Life Sciences, pp.836-841.
Kementerian Kesehatan, 2021. Profil Kesehatan Indonesia Tahun 2020. Jakarta: Kementerian Kesehatan RI
Dinas Kesehatan Kota Surabaya, 2021. Profil Kesehatan Kota Surabaya Tahun 2020. Surabaya: Dinas Kesehatan Kota Surabaya
Lumbers, E., Delforce, S., Arthurs, A. and Pringle, K., 2019. Causes and Consequences of the Dysregulated Maternal Renin-Angiotensin System in Preeclampsia. Frontiers in Endocrinology, 10
Leaños-Miranda, A., Inova Campos-Galicia, Méndez-Aguilar, F., Molina-Pérez, C., Ramírez-Valenzuela, K., Sillas-Pardo, L., Uraga-Camacho, N., Isordia-Salas, I. and Berumen-Lechuga, M., 2018. Lower circulating angiotensin II levels are related to the severity of preeclampsia and its risk as disclosed by a specific bioassay. Medicine, 97(39), p.e12498
Junus, K., Björk Ragnarsdóttir, I., Nordlöf Callbo, P., Bergman, L., Lager, S. and Wikström, A., 2022. Elevated mid-pregnancy plasma levels of angiotensin-converting enzyme 2 in women prior to the development of preeclampsia. Scientific Reports, 12(1)
Velloso, E., Vieira, R., Cabral, A., Kalapothakis, E. and Santos, R., 2007. Reduced plasma levels of angiotensin-(1-7) and renin activity in preeclamptic patients are associated with the angiotensin I- converting enzyme deletion/deletion genotype. Brazilian Journal of Medical and Biological Research, 40(4), pp.583-590.
Merrill, D., Karoly, M., Chen, K., Ferrario, C. and Brosnihan, K., 2002. Angiotensin-(1-7) in Normal and Preeclamptic Pregnancy. Endocrine, 18(3), pp.239-246
K. Bridget Brosnihan, David C. Merrill, Liliya M. Yamaleyeva1, Kai Chen, Liomar Neves, JaNae Joyner, Courtney Givner, Kristy Lanier, Cheryl Moorefield, Brian Westwood1 Endocrine. 2020 August ; 69(2): 410–419. doi:10.1007/s12020-020-02296-3.
Ngwenya, S., 2017. Severe preeclampsia and eclampsia: incidence, complications, and perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe. International Journal of Women's Health, 9, pp.353-357
Damayanti, S., Sulistyowati, S. and Probandari, A., 2019. Maternal Characteristics and the Effects of Early and Late-onset Types of Preeclampsia on Maternal and Perinatal Complications. Indonesian Journal of Medicine, 4(4), pp.329-338
Wu, P., Haththotuwa, R., Kwok, C., Babu, A., Kotronias, R., Rushton, C., Zaman, A., Fryer, A., Kadam, U., Chew-Graham, C. and Mamas, M., 2017. Preeclampsia and Future Cardiovascular Health. Circulation: Cardiovascular Quality and Outcomes, 10(2).
Fan Jiang., Jiamin Yang., et al. 2014. Angiotensin-converting enzyme 2 and angiotensin 1–7: novel therapeutic targets. Nat Rev Cardiol. 11(7): 413–426
Alhenc-Gelas F & Menard J (1986). The Renin-Angiotensin System in Pregnancy and Parturition. Year Book Medical Publishers, Inc., Chicago, IL, USA, 25-33.
Joyner J, Neves LA, Stovall K, Ferrario CM, Brosnihan KB. Angiotensin-(1–7) serves as an aquaretic by increasing water intake and diuresis in association with downregulation of aquaporin-1 during pregnancy in rats. Am J Physiol Regul Integr Comp Physiol 2008;294:R1073–80
Gant, N.F., Daley, G.L., Chand, S., Whalley, P.J., MacDonald, P.C., 1973. A study of angiotensin II pressor response throughout primigravid pregnancy. J. Clin. Invest. 52, 2682–2689.
Herse, F., Dechend, R., Harsem, N.K., Wallukat, G., Janke, J., Qadri, F., Hering, L., Muller, D.N., Luft, F.C., Staff, A.C., 2007. Dysregulation of the circulating and tissue-based renin–angiotensin system in preeclampsia. Hypertension 49, 604–611.
Lew RA, Warner FJ, Hanchapola I & Smith AI (2006). Characterization of angiotensin converting enzyme-2 (ACE2) in human urine. Int J Pept Res Ther 12, 283–289.
Rice GI, Jones AL, Grant PJ, Carter AM, Turner AJ & Hooper NM(2006). Circulating activities of angiotensin-converting enzyme, its homolog, angiotensin-converting enzyme 2, and neprilysin in a family study. Hypertension 48, 914–920.
Kim EH, Lim JH, et all. The Relationship between Aldosterone to Renin Ratio and RI Value of the Uterine Artery in the Preeclamptic Patient vs. Normal Pregnancy. Yonsei Med J 49(1):138- 143, 2008, DOI 10.3349/ymj.2008.49.1.138
Martaadisoebrata D (2013). Obstetrics Pathology Reproductive Health Sciences. Edition 3. Penerbit Buku Kedokteran EGC: Jakarta
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