Sarah Mudzamiri

Leukocyte selenium, zinc, and copper concentrations in preeclamptic and normotensive pregnant women

Preeclampsia is an important cause of maternal and perinatal mortality worldwide. The etiology of this relatively common medical complication of pregnancy, however, remains unknown. We studied the relationship between maternal leukocyte selenium, zinc, and copper concentrations and the risk of preeclampsia in a large hospital-based case-control study. One hundred seventy-one women with proteinuric pregnancy-induced hypertension (with or without seizures) comprised the case group. Controls were 184 normotensive pregnant women. Leukocytes were separated from blood samples collected during the patients’ postpartum labor and delivery admission. Leukocyte concentrations for the three cations were measured by inductively coupled plasma-mass spectrometry (ICP-MS). Concentrations for each cation were reported as micrograms per gram of total protein. Women with preeclampsia had significantly higher median leukocyte selenium concentrations than normotensive controls (3.23 vs 2.80 µg/g total protein, p<0.0001). Median leukocyte zinc concentrations were 31% higher in preeclamptics as compared with controls (179.15 vs 136.44 µg/g total protein, p<0.0001). Although median leukocyte copper concentrations were slightly higher for cases than controls, this difference did not reach statistical significance (17.72 vs 17.00 µg/g total protein, p=0.468). There was evidence of a linear increase in risk of preeclampsia with increasing concentrations of selenium and zinc. The relative risk for preeclampsia was 3.38 (adjusted odds ratio [OR]=3.38, 95% confidence interval [CI]=1.53–7.54) among women in the highest quartile of the control selenium distribution compared with women in the lowest quartile. The corresponding relative risk and 95% CI for preeclampsia was 5.30 (2.45–11.44) for women in the highest quartile of the control zinc distribution compared with women in the lowest quartile. There was no clear pattern of a linear trend in risk with increasing concentration of leukocyte copper concentrations (adjusted for linear trend in risk =0.299). Our results are consistent with some previous reports. Prospective studies are needed to determine whether observed alterations in selenium and zinc concentrations precede preeclampsia or whether the differences may be attributed to preeclampsia-related alterations in maternal and fetal-placental trace metal metabolism.

Plasma tumor necrosis factor-α soluble receptor p55 (sTNFp55) concentrations in eclamptic, preeclamptic and normotensive pregnant Zimbabwean women

We sought to examine the relationship between excessive tumor necrosis factor-alpha (TNF-alpha) release (as measured by sTNFp55 plasma concentrations) and risk of eclampsia and preeclampsia, respectively, among sub-Saharan African women delivering at Harare Maternity Hospital, Zimbabwe. In total, 33 pregnant women with eclampsia, 138 women with preeclampsia and 185 normotensive women were included in a case-control study conducted during the period, June 1995 through April 1996. Postpartum plasma sTNFp55 was measured by enzyme linked immunosorbent assay. Women with eclampsia had significantly higher sTNFp55 than normotensive controls (1.87 vs 1.35 ng/ml, P<0.001). Similarly, women with preeclampsia had sTNFp55 concentrations higher than normotensive controls (1.69 vs 1.35 ng/ml, P < 0.001). The odds ratio for eclampsia was 5.00 (adjusted odds ratio (OR) 5.00, 95% confidence interval (CI) 1.20-20.92) among women in the highest quartile of the control sTNFp55 distribution compared with women in the lowest quartile. The corresponding odds ratio and 95% CI for preeclampsia was 2.37 (1.11-5.06). Postpartum plasma sTNFp55 concentrations are increased among Zimbabwean women with eclampsia and preeclampsia as compared with their normotensive counterparts. These findings are consistent with the hypothesized role of cytokines in mediating endothelial dysfunction and the pathogenesis of preeclampsia/eclampsia. Additional work is needed to identify modifiable risk factors for the excessive synthesis and release of TNF-alpha in pregnancy; and to assess whether measurements of sTNFp55 early in pregnancy may be used to identify women likely to benefit from anti-inflammatory therapy.

Maternal mid-arm circumference and other anthropometric measures of adiposity in relation to infant birth size among Zimbabwean women

Background. To examine relationships between maternal anthropometric measures in Zimbabwean women and indices of infant birth size. Methods. We conducted a cross‐sectional study of pregnant women admitted for labor and delivery at the Harare Maternity Hospital from July 1998 to March 1999. The study population was comprised of 498 participants who delivered singleton infants. Anthropometric measures (height, weight, and mid‐arm circumference) were taken during participants’ postpartum hospital stay. Logistic regression and least‐squares regression procedures were used to assess the association of maternal measures with infant size. Results. Women in the highest weight quartile (>67 kg) were 58% less likely to have a low‐birth‐weight infant when compared to women in the lowest quartile (<57 kg) (OR = 0.42, 95% CI 0.19–0.90). Women in the highest body mass index quartile were 75% less likely to have a low‐birth‐weight infant compared to women in the lowest quartile (>27 versus <23 kg/m2: OR = 0.25, 95%CI 0.10–0.60). Similar trends were seen for risk of low birth weight in relation to mid‐arm circumference. Maternal mid‐arm circumference was most strongly related with the four infant size indices measured. Each unit increase in maternal mid‐arm circumference resulted in a 36.1‐g increase in infant birth weight (p<0.001). In general, women who were heavier at the time of delivery were less likely to have a low‐birth‐weight infant than women who were lighter. Conclusions. In areas where food security is a public health concern, as it is in most parts of the developing world, pregnant women may not be meeting their own nutritional needs and those of their fetus.

Maternal height–how high is the risk of short stature?

SummaryIn 1992, maternal height was measured in 698 black primigravidae in Harare. Mean height was 159 cm; 45 women (6–4 per cent) were ⩽150 cm tall. The latter group was associated with an increased risk for caesarean section, after controlling for maternal age, educational level, duration of labour and the birth weight of the baby. There was an increased need for neonatal unit care for the babies of women ⩽ 150 cm high. Short stature is in itself a risk factor for caesarean section.