An increasing number of studies suggest that vitamin D deficiency during pregnancy is associated with multiple adverse health outcomes in mothers, neonates and children. There are no representative country data available on vitamin D status of pregnant women in Europe. The aim of this study was to estimate the prevalence of vitamin D deficiency among Belgian pregnant women and to assess the determinants of vitamin D status in the first and third trimester of pregnancy. The women were selected via a multi-stage proportionate-to-size sampling design. Blood samples were collected and a questionnaire was completed face-to-face.
Email alerts New issue alert. It found that metabolites involved in antioxidant stress were down-regulated in SA women compared Pregnamt that in normal pregnant women, indicating the decreased toxins scavenging ability in SA women. Background Risk perception in relation to pregnancy and birth is a complex process based on multiple factors [ 1 crossectlon, 2 Pregnant crossection. Photochem Photobiol — Materials and method: Pregnaht total of subjects aged between 22 and 40 years were recruited for this study. If a household had more than one eligible participant, one Pregnant crossection was selected at random by the electronic data capture system. The target sample size was In GDM patients, serum acylcarnitines differences were found to be already existent in the Certified redheads trimester of the pregnancy 32indicated the potential value for GDM prediction. However, where there were significant differences in scores for Pregnant crossection scenarios, where doctors consistently rated the risks lower than women and midwives.
Kate moss nipple slip. Introduction
Pregnant crossection discussed in the earlier articles, we have highlighted that in an observational study, the investigator does not alter the exposure status. Repeated cross-sectional surveys provide useful information on the prevalence of HIV in these groups [ Figure 2 ]. Cross-sectional pilot study of antibiotic resistance in Propionibacterium acnes strains in Indian acne patients using 16s-RNA Pregnant crossection chain reaction: A comparison among treatment modalities including antibiotics, benzoyl peroxide, and iso tretinoin. Open in a separate window. Five Card vol. We will discuss this study briefly later in the manuscript as well. During stage two, the baby is expelled from the uterus with the umbilical Pregnant crossection still attached. Pregnant crossection Surveillance in Antenatal Clinic: The surveillance recruits consecutive consenting pregnant women, aged 15—45 years in these clinics. These changes give a general indication crkssection when intercourse is more or less likely to result in fertilization. Other factors that affect fertility include toxins such as crossectiohtobacco smoking, marijuana use, gonadal injuries, and aging. Pregnant crossection a cross-sectional study, the investigator measures Prdgnant outcome and the exposures in the study participants at the same time. Spontaneous abortion usually occurs very Sperm cell energy source in the pregnancy typically within the first few weeks. Chemicals such as spermicides, which are designed to kill sperm, are often used in conjunction; sponges, for example, are saturated with spermicides and are placed in the vagina at the cervical opening. Maninder Singh Setia. The third trimester is one of rapid growth, in which the fetus reaches its full size; pregnancy often becomes uncomfortable Brianna tits the mother.
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- Once the zygote implants in the uterine wall, embryonic and fetal development continue through three trimesters to birth.
- Cross-sectional study design is a type of observational study design.
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An increasing number of studies suggest that vitamin D deficiency during pregnancy is associated with multiple adverse health outcomes in mothers, neonates and children. There are no representative country data available on vitamin D status of pregnant women in Europe. The aim of this study was to estimate the prevalence of vitamin D deficiency among Belgian pregnant women and to assess the determinants of vitamin D status in the first and third trimester of pregnancy.
The women were selected via a multi-stage proportionate-to-size sampling design. Blood samples were collected and a questionnaire was completed face-to-face. The median serum hydroxyvitamin D [ OH D] concentration was significantly lower in the first trimester Of all women, Of all women included, In conclusion, vitamin D deficiency is highly prevalent among pregnant women in Belgium and this raises concerns about the health consequences for the mother and the offspring.
A targeted screening strategy to detect and treat women at high risk of severe vitamin D deficiency is needed in Belgium and in Europe. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Vitamin D status is a well-known determinant of bone health  , . Vitamin D deficiency increases the risk of osteoporosis  and fractures  , while in its most severe form it causes rickets in children  and osteomalacia in adults . The ubiquitous presence of vitamin D receptors in most tissues, including the placenta, suggests that vitamin D may have other roles as well.
Adequate vitamin D intake is associated with a lower risk of cancer  ,  ,  ,  ,  , cardiovascular diseases  , autoimmune diseases  , neurological disorders  and diabetes . In addition, an increasing number of studies suggest that vitamin D deficiency during pregnancy is associated with multiple adverse health outcomes in mothers gestational diabetes and pre-eclampsia , in neonates wheezing and children low bone mineral density, type-1 diabetes, eczema  — .
However there is so far no conclusive evidence about the causality of these relationships, as no randomised controlled trials of vitamin D supplementation with an appropriate assessment of a variety of health outcomes have been carried out to date .
Humans get vitamin D cholecalciferol from exposure to sunlight, diet and dietary supplements. As few food items contain or are fortified with vitamin D such as liver, fatty fish, eggs, milk and dairy products, soy milk, butter, margarines , the skin synthesis of vitamin D induced by ultraviolet B radiation UVB is the main determinant of vitamin D status in the population .
Vitamin D once synthesized in the skin is metabolized into dihydroxyvitamin D [ OH D] in the liver. Due to its longer half-life, OH D is considered the best bio-marker of vitamin D status. Several modifications of vitamin D metabolism occur during pregnancy. The role of 1, OH 2 D during pregnancy to increase intestinal calcium absorption is since long acknowledged .
The cut-off points used to define vitamin D insufficiency and deficiency are not well established and remain controversial. The uncertainty concerning the optimal serum OH D concentration in pregnant women is even higher. As long as the proposed values are not validated in clinical trials the controversy will remain . There is a growing concern about the health consequences of the high prevalence of vitamin D deficiency worldwide among the general population, including pregnant women.
The adequacy of the current vitamin D dietary recommendations to reach an optimal vitamin D status during pregnancy has been questioned . Although previous small surveys suggest that vitamin D deficiency among pregnant women is common in Europe  ,  , there are no reliable country-wide estimates of vitamin D status of pregnant women in European countries. Therefore the aim of this study was to carry out the first national representative random sample survey on vitamin D status in pregnant women in a European country and to assess the determinants of vitamin D status in the first and third trimester of pregnancy.
This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the medical ethical committee of the Erasme hospital in Brussels. The subjects provided written consent for participation in the study.
The target population of the survey comprised all pregnant women in Belgium during the first and the third trimester of pregnancy in the period from September to June The women were selected according to a multi-stage proportionate-to-size stratified sampling design as recommended for studies assessing iodine deficiency . The country was divided into two regions. In each region the obstetric clinics were ordered by province and size based on the number of deliveries during the past year and 60 clusters of 4 clinics were selected per region using systematic sampling in order to have enough replacement clinics in case some refused to participate.
Out of these 60 clusters, 30 clusters were randomly selected and within each cluster the first clinic was invited to participate. In each clinic all gynaecologist-obstetricians were invited to participate in order to level out a possible gynaecologist effect.
The aim was to include 22 women in each cluster of which 11 in the first trimester and 11 in the third trimester of pregnancy. Blood samples were collected from the antecubital vein and a general questionnaire about socio-demographic and socio-economic characteristics, smoking and alcohol consumption during pregnancy and during the 4 weeks prior to the interview, diseases and medication and use of food supplements was completed in a face-to-face interview conducted by the study nurse.
For all women included in the study, body mass index BMI was obtained from weight and height recorded by the gynaecologist during the first prenatal consultation in the beginning of the first trimester of pregnancy. Approximately 5 ml whole blood was collected by venipuncture in a non-heparinized tube. Serum aliquots were then stored at —80C for further analysis. As serum OH D is not normally distributed, non-parametric methods were used.
The median was used as the measure of central tendency. Differences between regions, trimesters and age groups were explored using two-sample Wilcoxon rank-sum test or Kruskal-Wallis equality-of-populations rank test.
Among the pregnant women participating in the survey, there were from Brussels, from Flanders and from Wallonia Figure 1 ; Table 1.
For 6 women information on the age was missing. The mean age of women was similar in all three regions. For women a general questionnaire was available. The characteristics of the pregnant women included in the study are shown in Table 2. Of all pregnant women included, were in the first, were in the third and 2 were in the second trimester of pregnancy. For 3 women information on the trimester was missing. For The median serum OH D concentration in pregnant women was The median OH D concentration was significantly higher in the first trimester than in the third trimester: Differences in OH D concentration among both regions were not significant.
The percentage of women with vitamin D insufficiency and deficiency was higher in the first than in the third trimester of pregnancy but the prevalence of severe vitamin D deficiency was higher in the third trimester Table 3. For both first and third trimester women there was a clear seasonal trend in the mean serum OH D concentrations with lowest concentrations in winter and highest during spring and summer, while decreasing again in autumn. In the first and third trimester of pregnancy the percentage of women taking a multivitamin containing vitamin D was Only In addition the risk of vitamin D deficiency was threefold higher among women of Asiatic descent, six fold higher for North African women and five fold higher for women of Hispanic descent compared to Caucasians.
The risk of vitamin D insufficiency was significantly lower for more educated women and for persons reporting going on holidays to sunny climates. In addition the risk of vitamin D deficiency was significantly lower in summer, spring and autumn compared to winter Table 4. In addition risk of severe vitamin D deficiency increased for women who reported not taking vitamin D containing multivitamins, who were of non Caucasian origin and who reported smoking during pregnancy.
On the other hand risk of severe vitamin D deficiency decreased for women who reported alcohol consumption during pregnancy. Interestingly, risk of severe vitamin D deficiency decreased with more frequent use of sunscreen lotion and increased for women who reported preference for shadow Table 5. Exposure to the sun during week and weekend days, and consumption of milk and dairy products were not associated with either severe or normal vitamin D deficiency.
A previous small study in Brussels suggested that the prevalence of vitamin D deficiency was high among the adult population and that immigrants were at greater risk of vitamin D deficiency . Other small-scale studies in Belgium showed a high prevalence of vitamin D deficiency among Belgian postmenopausal osteoporotic women  and elderly .
However, the present study is the first national survey on vitamin D status among pregnant women in Belgium. Similarly as in our pregnant women population, in the adult population the risk of vitamin D deficiency was higher in winter than in summer and increased with BMI  ,  ,  ,  , . The variations of OH D concentration with seasons reflect the changes in UVB exposure, one of the main determinants of vitamin D status in many European countries.
The association of vitamin D status with BMI has been attributed to an excessive storage of vitamin D in fat tissue decreasing thereby serum concentrations . Ethnicity was also a major determinant of vitamin D status in the present study, as previously reported in the adult population  and in pregnant women  ,  , .
In Belgium, pregnant women of different ethnic origins had substantially lower vitamin D concentrations than Caucasian women and were vitamin D deficient all year long except during summer for third trimester women.
In addition education level was associated with vitamin D status in our pregnant women population. Smoking increased the risk of both vitamin D deficiency and severe vitamin D deficiency; the mechanism for this appears to be unclear . Interestingly the risk for severe vitamin D deficiency was lower among women who reported alcohol consumption during pregnancy. The latter has been found also among Korean men . Variables influencing the formation of previtamin D3 in the skin include skin pigmentation and intensity of the solar UV light  — .
In summer, light-skinned people who spend at least 15 minutes outside during the day with their hands and face exposed will have adequate vitamin D levels. However, another study found this effect to be only minor . In Belgium, pregnant women who reported going on holidays to sunny climates had a lower risk of vitamin D deficiency and women who reported using sunscreen lotion had a lower risk of severe vitamin D deficiency. The latter is possibly due to the fact that women using sunscreen lotion are more often exposed to the sun.
Women who reported a preference for shadow had a higher risk of severe vitamin D deficiency in our study. However, the vitamin D content of multivitamins for pregnant women in Belgium is only IU indicating even this recommendation is not followed as pregnant women only take one multivitamin pill a day.
In the absence of survey data from other European countries, we suspect that the prevalence of vitamin D deficiency in Belgium likely reflects the situation in other Western European countries. In addition to the uncertainty concerning the optimal vitamin D intakes preventing vitamin D deficiency, there exists also a lack of recommendations to treat vitamin D deficient pregnant women.
Even in the last published guidelines the treatment of vitamin D deficient women is not specifically discussed . The uncovering of the magnitude of vitamin D deficiency in pregnant women in Belgium and Western Europe should be translated into new research in order to fill the huge knowledge gap concerning the adequate amount of vitamin D to prevent and treat vitamin D deficient pregnant women.
In addition, an increasing number of studies suggest that gestational vitamin D deficiency is associated with multiple adverse health outcomes in mothers and children  — .
Therefore, there is an urgent need of randomised controlled trials of vitamin D supplementation to investigate the maternal and neonatal health benefits of correcting vitamin D deficiency during pregnancy . Given the high prevalence of vitamin D deficiency in pregnant women in Belgium and probably in many European countries, a vitamin D nutrition policy is needed at the country and European level.
The current vitamin D recommendations for pregnant women are clearly insufficient to prevent and even more to treat vitamin D deficient pregnant women.
Until the adequate treatment of vitamin D deficient pregnant women is established, a safe approach may be to correct vitamin D deficiency by targeting pregnant women at high risk of severe vitamin D deficiency. In addition the current vitamin D content of multivitamins for pregnancy, IU, do not even comply with the current Belgian recommendations of IU per day, therefore a prudent step should at least be to increase the vitamin D content in multivitamins for pregnant women to IU.
Nonetheless, this type of study design will be classified as a cross-sectional study. Dead or Alive 5 Monster Orgy 57 sec Mudmanboots - This may be due to cumulative HIV positive cases over a period. It can be seen that the prevalence has, in general, reduced over the past decade in these groups. Barrier methods such as condoms, cervical caps, and diaphragms serve to block sperm from entering the uterus, thereby preventing fertilization.
Pregnant crossection. Introduction
They also evaluated the association between HIV and sociodemographic factors. The data were collected by interviewer-administered questionnaires for sociodemographic and behavior data , clinical evaluation for sexually transmitted infections STIs , and serological evaluation for STIs including HIV. They also found that male-to-female transgendered people were significantly more likely to be HIV-infected compared with males odds ratio [OR]: 3. There are numerous cross-sectional studies in the literature.
We encourage the readers to go through some of these studies to understand the design and analysis of cross-sectional studies. Example: We are interested to know the prevalence of vitiligo in a village. We design a population-based survey to assess the prevalence of this condition. We go to all the houses that were supposed to be included in the study and examine the population. The total sample surveyed is Of these, we found that 98 individuals have vitiligo.
Cross-sectional studies may also be used for estimating the prevalence in clinic-based studies. We evaluate patients with an STI clinic. We find that 60 of these individuals are HIV infected. This type of study will be classified as a cross-sectional study.
Kindly note that this being a clinic-based study, it may have all the limitations of a clinic-based study. Thus, the prevalence from these data may have limited generalizability. Nonetheless, this type of study design will be classified as a cross-sectional study.
Of the individuals evaluated, we have recruited male and female participants. Of the 60 HIV-infected individuals, 50 are males and 10 are females. Thus, the OR is 3. The interpretation of this OR is that males had a higher odds of being HIV infected compared with females. However, we will require confidence intervals to comment on further interpretation of the OR. Cross-sectional studies can usually be conducted relatively faster and are inexpensive — particularly when compared with cohort studies prospective.
These are studies are conducted either before planning a cohort study or a baseline in a cohort study. These study designs may be useful for public health planning, monitoring, and evaluation. For example, sometimes the National AIDS Programme conducted cross-sectional sentinel surveys among high-risk groups and ante-natal mothers every year to monitor the prevalence of HIV in these groups.
Since this is a 1-time measurement of exposure and outcome, it is difficult to derive causal relationships from cross-sectional analysis. These studies are also prone to certain biases. We conduct a cross-sectional study and recruit individuals. We assess their dietary habits, exercise habits, and body mass index at one point of time in a cross-sectional survey. Thus, we have to be careful about interpreting the associations and direction of associations from a cross-sectional survey.
The prevalence of an outcome depends on the incidence of the disease as well as the length of survival following the outcome. For example, even if the incidence of HIV number of new cases goes down in one particular community, the prevalence total number of cases — old as well as new may increase. This may be due to cumulative HIV positive cases over a period. Thus, just performing cross-sectional surveys may not be sufficient to understand disease trends in this situation.
As briefly discussed earlier, multiple cross-sectional surveys are used to assess the changes in exposures and outcomes in a particular population.
Sentinel Surveillance in Antenatal Clinic: The surveillance recruits consecutive consenting pregnant women, aged 15—45 years in these clinics. The exercise has been in place for nearly two decades. The formal annual sentinel surveillance was instituted in The surveillance provided data on the prevalence of HIV infection in antenatal women, and thus, the trends of HIV infection in this population.
Such surveys are also conducted in female sex workers, men who have sex with men, and people who inject drugs, migrants, truckers, and male-to-female transgendered people. Repeated cross-sectional surveys provide useful information on the prevalence of HIV in these groups [ Figure 2 ].
It can be seen that the prevalence has, in general, reduced over the past decade in these groups. Thus, repeated cross-sectional surveys are also useful to monitor the trends over a period.
We will discuss the previous study by Sardana et al. They conducted one cross-sectional survey to assess the resistance patterns in P. If the authors conduct the same study consecutively for two more years, they will provide information on the changing resistance patterns in P. This will be an example of a serial cross-sectional study. We can measure the prevalence of disease or calculate the OR as a measure of association.
These studies are conducted relatively faster and are inexpensive. However, due to the nature of study design, in general, it is difficult to derive causal relationships from cross-sectional analysis. National Center for Biotechnology Information , U. Journal List Indian J Dermatol v. Indian J Dermatol. Maninder Singh Setia. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: ni. Received Mar; Accepted Mar.
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Archives of Clinical and Biomedical Research. Maduka Ignatius C 1 , Dioka C. Background: Gestational hypertension GH is defined by an elevated blood pressure BP at or beyond 20 weeks gestation in the absence of proteinuria in previously known normotensive women. These complications include pre-eclampsia, eclampsia and death if not managed properly.
Despite being a major contributor of maternal and perinatal morbidity and mortality, the mechanisms underlying the pathogenesis of GH have not been fully elucidated.
This study was designed to evaluate thyroid function in hypertensive pregnant women. Materials and method: A total of subjects aged between 22 and 40 years were recruited for this study. These comprised hypertensive and age matched normotensive individuals as controls.
Conclusion: Therefore, we observed that gestational hypertension is associated with decrease activity of thyroid hormones as indicated by the significantly lower FT3 and higher TSH levels.
Thus, estimation of TSH could provide an alternative prognostic tool for predicting the underlying cause of gestational hypertension. Assessment; Thyroid function; Pregnant women; Nigeria.
Introduction Foods Gestational hypertension GH , is a condition characterized by high blood pressure during pregnancy and can lead to serious complications such as pre-eclampsia, eclampsia and death if not managed properly . Despite being a major contributor of maternal and perinatal morbidity and mortality, the mechanisms responsible for the pathogenesis of GH have not been fully elucidated.
However, several factors have been postulated as contributory mechanisms to the rise in blood pressure during pregnancy. In women generally, thyroid associated endocrinopathies are the second most common endocrine disorders after diabetes mellitus. These disorders are times more prevalent in women during their reproductive ages and may likely be more frequent in those with other co-morbid conditions such as gestational hypertension .
Also, thyroid hormones exert their effect on all tissues and can modulate the rate of metabolic activity. Alterations in thyroid function can therefore affect the various organ system of the body and may be the leading cause of hypertensive complications in pregnancy . Currently used tests for the assessment of thyroid function thyroid-stimulating hormone TSH , tri-iodothyronine T3 and thyroxine T4 are sometimes insufficient to clearly make out the diagnosis as T3 and T4 levels are affected by so many other non-specific conditions .
A total of participants were randomly selected for this study. The participants were made up of hypertensive pregnant women aged years as test subjects and age-matched normotensive pregnant women as controls. The gestational age of each participant was established based on last menstrual period. The study was a cross sectional study designed to assess thyroid dysfunction among hypertensive and normotensive pregnant women in Aguata and Nnewi Local Government Area of Anambra state, Nigeria.
Informed written consent was obtained from the participants before the collection of data and blood samples. The biodata of all study participants were obtained using a structured interviewer administered pretested questionnaire. Blood pressure of each participant was measured using Accoson mercury sphygmomanometer.
Two reviewers independently screened the titles and abstracts to determine if a citation met the general inclusion criteria. The full text of citations classified as include or unclear was reviewed independently with reference to the predetermined inclusion and exclusion criteria. Finally, we hand-searched reference lists of any relevant conference abstracts and of the included trials for potentially relevant citation. Non-English full text citations were excluded. Disagreements between the two reviewers were resolved through consensus and by third-party adjudication, as needed.
Results The demographic and anthropometric parametric analysis shows that the mean value of age in hypertensive pregnant women There was also no significant differences in the mean levels of height 1. However, the mean values of systemic blood pressure SBP and diastolic blood pressure DBP in hypertensive subjects Of the citations identified through electronic and hand searches, we included 6 trials enrolling a total of participants Figure 1 Trials were published between and The outcomes relevant to peripheral blood flow included: total peripheral resistance, flow mediated vasodilatation, forearm blood flow and blood pressure.
Only two trials did not measure flow mediated vasodilatation 23, The key features of the included studies are outlined in Table 1. Table 1: Demographic and anthropometric characteristics of the study participants. The incidence rate of thyroid dysfunction was The gestational hypertensive women with apparently normal thyroid function euthyroid accounted for Table 3: Incidence of thyroid disorders among hypertensive and normotensive pregnant women.
Discussion Gestational hypertension being considered a transient condition is the most common form of hypertension in pregnancy . Most researchers have focused their efforts on pre-eclampsia because of its implications for maternal-fetal health, whereas information about the implications of a diagnosis of GH is much more limited .
Some evidence shows that thyroid associated endocrinopathies are among the most common endocrine disorders in women of maternal age .
According to Klein et al. As a result, thyroid dysfunction may be the underlying disorder in GH and other endothelial vascular diseases. Herein, we attempt to evaluate thyroid function among hypertensive disordered pregnant women in order to ascertain the most up to date information regarding the pathogenesis, etiology and implication of thyroid dysfunction in the development of GH.
The significant apparent elevation of TSH in hypertensive pregnant women may be attributed to a state of thyroid dysfunction known as hypothyroidism. Hypothyroidism is predominantly an autoimmune disorder mostly characterized by the activation of antigen presenting dendritic cells by self-proteins. However, the activated antigen presenting dendritic cells can in turn stimulate the T-cells to produce cytokines that promote hypertension through vascular remodeling increased peripheral vascular resistance .
This finding is similar to related studies conducted in Australia, India and Kano, Nigeria and in Australia , that reported significantly increased mean values of TSH in hypertensive pregnant women in their respective locations. This finding however is in contrast to the findings of Pasupathi et al. The mean level of TSH 3. Conversely, the mean serum level of FT3 was significantly decreased in hypertensive pregnant women compared to the normotensive pregnant women, whereas there was no significant difference in the mean serum level of FT4 when compared with both hypertensive and normotensive cases.
FT4 and FT3 are the free circulating thyroid hormones Thyroxine, T4 and Triiodothyronine, T3 which are produced from thyroid follicular cells within the thyroid gland through thyroperoxidase, the enzyme responsible for the copulation of iodine to tyrosine residues to form the thyroid hormone, T4 which is believed to be the pro-hormone and a reservoir for the active and main thyroid hormone, T3 .
More so, T3 is converted as required in the tissues by iodothyronine deiodinase . Therefore, the relative non significance difference in serum level of FT4 in both hypertensive and normotensive pregnant women may be due the normal functioning of the enzyme, thyroperoxidase in both subjects while the apparent decrease of FT3 in GH than in normotensive individuals may be due to the relative inhibition of iodothyronine deiodinase in hypertensive pregnant women.
T3 represents the metabolically active thyroid agent that possibly has a vasodilatory effect on the vascular muscle cells . It has also been documented that hypertension is an autoimmune disorder that leads to impaired production of vasodilators such as endothelin, nitric oxide NO and T3 inclusive . Therefore, the significant decrease in the serum level of FT3 could be due to the relative inhibition of FT3 secretion; a resultant effect of thyroid dysfunction associated with increased peripheral vasoconstriction which is also implicated in blood pressure elevation.
This finding is in line with the findings of Ref [10, 12, 16]. The observed values were in variance with the values reported by Pasupathi et al. Therefore, the serum level of TSH increases as hypertension advances. This finding indicates that there is a state of hypothyroidism that is associated with the development of hypertension in pregnancy as demonstrated by the significant difference in subclinical hypothyroidism between hypertensive and normotensive pregnant women. According to , the hypo-metabolic state of hypothyroidism can cause an increased arterial stiffness which is an important determinant of vascular endothelial dysfunction and changes in arterial wall elasticity the major underlying cause of elevated blood pressure , therefore resulting in the development of hypertension in pregnancy.
Thus, subclinical hypothyroidism being an autoimmune disorder may therefore be the factor implicated in the vascular changes that promotes hypertensive disorder in pregnancy. Nanda et al. Therefore, the results obtained in this work can be explained at the level of thyroid hormonal activity which is associated with significant increases in peripheral vascular resistance, vasoconstriction and vascular endothelial dysfunction.
The increased peripherial vascular resistance and vasoconstriction reflects the induction of TSH and the absence of demonstrated vasodilatory FT3 effect on vascular endothelial cells which invariably could be the reason behind the hypertensive disorder often seen in late pregnancies. The negative correlation between TSH, FT3 and FT4 implies that; with higher circulating levels of TSH and low or normal circulating levels of FT3 and FT4, there is a significant volume change caused by increase in peripheral vascular resistance and vasoconstriction , initiating a volume-dependent, low plasma renin activity PRA which is the mechanism of blood pressure elevation [7, 15].
The key finding in the study is the significant positive correlation between SBP, DBP and TSH and the significant negative correlation between TSH, FT3 and FT4 which indicate that there is a state of thyroid dysfunction that is implicated in the development of hypertension in pregnancy. This is due to the fact that TSH has been an established marker for thyroid dysfunction and has also been documented to have a negative correlation between FT3 and FT4 . Consequently, its significant elevation in increasing SBP and DBP in gestational hypertension could be help in predicting the occurrence of gestational hypertension.
Thus, estimation of TSH could be a good predictor of the development of hypertension in pregnancy. This is due to the fact that TSH has been an established marker for thyroid dysfunction and was found to be significantly elevated as systemic and diastolic blood pressure progresses in pregnancy.
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