Serum Magnesium in Pre-eclampsia and Eclampsia

Bangladesh J Obstet Gynaecol, 2010; Vol. 25(1) : 15-19 Serum Magnesium in Pre-eclampsia and Eclampsia NAHAR K, YASMIN H, SHAMSUDDIN L Abstract Objective: To assess the serum magnesium level of pregnant women with pre-eclampsia and eclampsia in Mymensingh Medical College & Hospital (MMCH). Materials and Methods: This descriptive cross-sectional study was carried out in the department of Obstetrics and Gynaecology of Mymensingh Medical College & Hospital (MMCH) and “ Prof. Muhammed Hossain Central Laboratory” of Bangladesh Agricultural University (BAU). The serum magnesium level were estimated in 60 study subjects who were pregnant women with pre-eclampsia & eclampsia and of 60 control subjects who were the normotensive pregnant women by photometric test using xylidyl blue. Results: The mean (±SD) serum magnesium of the control and study group were (2.29 ± 0.28 mg/dl) & (1.84 ±0.26 mg/dl) respectively. The difference in serum magnesium level between the two groups was statistically highly significant (p=<0.001). In the study group the mean (±SD) serum magnesium level of the pre-eclamptic & eclamptic groups were (1.9150 ± 0.26 mg/dl) & (1.8063 ±0.25 mg/dl) respectively and the difference between them was also statistically significant (p=<0.05). Conclusion: From the result it could be concluded that hypomagnesaemia can be said to be one of the etiological factors in pre-eclampsia and eclampsia. Hence by estimating serum magnesium during antenatal period pre-eclampsia can be predicted and eclampsia can be prevented early. Key words: Pre-eclampsia, Eclampsia, Serum magnesium. occasionally hyporeflexia5. Serum magnesium level is tightly regulated in a narrow range of approximately 0.7 to 1.0 m mol / L because only 1% of the total body content of magnesium is extracelluler. Magnesium deficiency is identified when serum ionized magnesium level falls below 0.7 m mol / L although patients remain asymptomatic. Symptoms appear when level falls below 0.5 m mol/ L2. Introduction: Hypertension complicates as many as 5-8% of all pregnancy. Among the hypertensive disorders of pregnancy the highest risks are associated with preeclampsia & eclampsia.1 They are one of the most common causes of maternal & fetal mortality & morbidity. But the exact etiology of pre-eclampsia & eclampsia is still unknown. Now-a-days eclampsia is considered as malnutrition related disease. In Bangladesh eclampsia accounts 5% of total obstetric admission in our health facilities & 16% of maternal death.2 Serum magnesium progressively declined during pregnancy reaching a nadir at 34 weeks and then rises up to term6. Statistically significant fall in serum magnesium has been observed in pre-eclampsia & eclampsia. In eclampsia serum magnesium was markedly reduced than in pre-eclampsia. Administration of magnesium sulfate to these patients were beneficial in relieving severity of the disease7. One study showed that abnormally low concentration of ionized magnesium in the serum is responsible for eclamptic convulsion2. It has been demonstrated that magnesium is essential for life3. Magnesium is the second most abundant intracellular cation & the fourth most abundant cation in the body. Over 300 enzymes are dependent on magnesium4. The principal clinical features attributed to magnesium deficiency are irritability, tetany, hyperreflexia, & 1 2. 3. Associate Professor, Department of Obs. & Gynae, Mymensingh Medical College Consultant, Department of Obs. & Gynae, Sherpur Professor, Department of Obs. & Gynae, Enam Medical College . Bangladesh J Obstet Gynaecol Vol. 25, No. 1 Magnesium has been established as an essential element for fetal well-being. Its deficiency during pregnancy has been reported to be associated with eclampsia, pre-eclampsia, preterm birth, increased maternal hospitalization, incidence of low birth weight & small for gestational age infants.8 So there is a relation between the low level of serum magnesium of pregnant women & the development of pre-eclampsia & eclampsia. Supplementation of these elements to diet may be of value to prevent preeclampsia & eclampsia. Oral magnesium supplementation during pregnancy improves the maternal morbidity & mortality & also improves the fetal outcome 8. Materials and Methods: This descriptive cross sectional study was carried out from July 2009 to June 2010 in the Department of Obstetrics & Gynaecology, Mymensingh Medical college Hospital & Prof. Muhammed Hussain Central Laboratory”, BAU. Among the admitted patient total 120 was taken with proper selection criteria. Of which 60 were the study subjects (pregnant women with pre-eclampsia & eclampsia) and 60 were control subjects (the normotensive pregnant women). Assessment of serum magnesium is done in this study by photometric test using xylidyl blue. Patients were diagnosed as case and control by history, appropriate clinical examination and urine albumin test by heat coagulation test. In each case, information about the patients were recorded in structured questionnaire after obtaining written consent of the patients/guardians in the consent form. 5 ml of venous blood was collected from each subject (both study and control group) with all aseptic precautions using sterile disposable plastic syringe by anticubital venipuncture and poured into a clean glass test tube. The collected blood was allowed to clot at room temperature. Fluid was separated by centrifugation for 10 minutes. The sera obtained by centrifuging were kept in eppendrofs tube after proper labeling. Maternal serum magnesium level was categorized into three groups- one group having serum magnesium level of < 1.8 mg/dl. Next group having serum magnesium level of 1.8 mg/dl & another group having serum magnesium level of > 1.8 mg/dl. Calculated data were arranged in systemic manner, presented in various tables and figures. Statistical analysis was made to evaluate the objectives of this study with the help of Statistical Package for Social Science (SPSS, Version 11.5). Level of significance was expressed as P value. P value <0.05 was considered as significant. Results The patient characteristics as mean maternal age, parity, mean gestational age and mean economic status are shown in table I. The result showed that statistically very significant (P<0.01) difference in case of antenatal care status between the two groups in table II. The highest (82%) of study group have no antenatal care. Only 67% of control group have regular antenatal care. Highest number of patient was observed having systolic BP (140-160 mm of Hg) and diastolic BP (90-100 mm of Hg). Second highest number 23% having systolic BP (161-200mm of Hg) and about 17% having diastolic BP above 110 mm of Hg (figure I). Table-1 Patient characteristics of the case & the control group: Variables Case (n=60) Control (n=60) (Mean ±SD) (Mean ±SD) Age (years) 25.35 ± 6.19 25.33 ±4.27 0.985517 Monthly income 3500.00 ±95.00 7500.00±250.00 0.415 Parity 1.22±1.40 0.85±1.17 (...truncated)