The Utility of Serum Total and Placental Alkaline Phosphatase Activity as Predictive Markers for Preeclampsia among Sudanese Pregnant Women

Yusra M  Abdallah; Ghada A Elfadil Elfadil; Maazza Omer Adam Adam; Abdelgadir  Elmugadam; Gad Allah  Modawe

doi:10.52981/smlj.v10i2.2847

Yusra M Abdallah 1. Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
Ghada A Elfadil Elfadil 1. Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
Maazza Omer Adam Adam 1. Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
Abdelgadir Elmugadam 1. Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
Gad Allah Modawe 2. Department of Biochemistry, Faculty of Medicine and Health Sciences, Omdurman, Sudan

DOI: https://doi.org/10.52981/smlj.v10i2.2847

Keywords: Total ALP, PALP, urea, uric acid

Abstract

Background: Serum total alkaline phosphatase (TALP) and placenta alkaline phosphatase (PALP) measurement can afford a simple, reliable and economical adjunctive laboratory parameter in hypertensive disorders of pregnancy.

Objective: To determine the utility of serum TALP and PALP as predictive markers for preeclampsia among Sudanese pregnant females.

Materials and Methods: Cross-sectional comparative hospital-based study conducted in Khartoum state at Omdurman Maternity Hospital from March to June 2022. Hundred Sudanese pregnant women aged ranged between (20 to 45 years), 50 pregnant women with preeclampsia and 50 normal pregnant women as a control group. The serum TALP, and PALP were measured using fully automated analyzer (response® 910), while serum urea, and uric acid were by enzymatic method and creatinine by chemical method. The data obtained were analyzed by using SPSS version (26).

Results: Preeclamptic women showed a significant increase in means of serum uric acid (7.4± 2.3 mg/dL VS 3.6± 1.0 mg/dL), urea (33.8± 4.0 mg/dL Vs 17.5 ± 6.2 mg/dL), PALP (151.5± 76.1IU/L VS 111.1±65.4 IU/L, P-value < 0.05) and the ratio of PALP/TALP (0.66 ±0.2 IU/L VS 0.52±0.1 IU/L, P-value< 0.05) compared to normal pregnant women. The Receiver operating characteristics curve (ROC) showed the optimum cut-off value of PALP >133 IU/L and ratio >0.589 as a predictor of preeclampsia among Sudanese pregnant women.

Conclusion: Sudanese women with preeclampsia had an elevated serum uric acid, urea, PALP and ratio of PALP/TALP. Moreover, PALP and the ratio of PALP/TALP can be used as a predictive marker of preeclampsia in pregnancy.

References

1. Townsend R, O’Brien P and Khalil A. (2016) Current best practice in the management of hypertensive disorders in pregnancy. Integrated Blood Pressure Control.2016. 9:79-94.
2. Kingdom, JCP.; Jauniaux, ERM.; Shaughn, O'Brien PM. The Placenta: Basic Science and Clinical Practice. Vol. Vol.1. London: RCOG-Press; 2000.
3. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31.
4. Brosens JJ, Pijnenborg R, Brosens IA. The myometrial junctional zone spiral arteries in normal and abnormal pregnancies: a review of the literature. Am J Obstet Gynaecol. 2002; 187(5):1416–1423.
5. Marshall WJ, Lapsley M, Day A, Shipman K. Clinical Chemistry.9thed. Elsevier
2021.pp.295-299.
6. Pantegghini M, Bais R, van Solinge WW. Enzymes. In Burtis CA, Ashwood ER, Bruns DE, editors. Tietz text book of clinical chemistry and Molecular Diagnostics. Philadelphia,PA:Elsevier Saunders;2006.pp.597-643.
7. Mangal A, Shrivastava P, Gaur U, Jain A, Goyal U, Rath G. Histochemical Analysis of Placental Alkaline Phosphatase in Hypertensive Disorders complicating Pregnancy. Journal of the Anatomical Society of India. 2005;54(2):2005-12.
8. Mangal A, Gaur U, Jain A, Goyal U, Tripathi R, Rath R. Alkaline phosphatase and placental alkaline phosphatase activity in serum of normal and pregnancy induced hypertensive mothers. JIMSA. 2007;20(2):117-20.
9. Boronkai A, Than NG, Magenheim R, Bellyei S, Szigeti A, Deres P, et al. Extremely high maternal alkaline phosphatase serum concentration with syncytiotrophoblastic origin. J Clin Pathol. 2005;58(1):72–76.
10. Prashant S, Arole V, Mohan Paranjape V, Kishore Bharambe V. Histochemistry of Placental Alkaline Phosphatase in Preeclampsia. International Journal of Biomedical and Advance Research. 2016. 7(7): 323-328.
11. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;1831:S1–22.
12. IFCC primary reference procedure for the measurement of catalytic activity concentration of enzymes at 37c, part of reference procedure for measurement of catalytic concentration of ALP. Clini Chem Lab Med. 2011;49:1439-1446.
13. Bishop M, Fody E, Schoeff L. (2010) Clinical Chemistry (6ₜₕ edͭͪ), Wolter Kluwer, NewYork. 297-299.
14. Burtis C.A, and Burns D.E.(2015) Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics(7ₜₕ ed), Elsevier Saunders, Missouri. 839.
15. Mishra J, Srivastava S, Pandey K. Compromised renal and hepatic functions and unsteady cellular redox state during preeclampsia and gestational diabetes mellitus, Archives of Medical Research .2021,52(6).635-640.
16. Hutchinson E, Brownbill P, Jones N, Abrahams V, Baker P, Sibley C. Utero-Placenta Haemodynamics in the pathogenesis of preeclampsia. Placenta .2009.30(7): 634-641.
17. Rajagambeeram R, Abu Raghavan S, Ghosh S, Basu S, Ramasamy R, and Murugaiyan S.B.(2014) Diagnostic Utility of Heat Stable Alkaline Phosphatase in Hypertensive Disorders of Pregnancy. Journal of Clinical and Dignostic Research (JCDR).8(11):10-13.
18. Bainbridge SA, Roberts JM. Uric acid as a pathogenic factor in preeclampsia. Placenta. 2008;22:S67–S72.
19. Many A, Hubel CA, Fisher SJ, Roberts JM, Zhou Y. Invasive cytotrophoblasts manifest evidence of oxidative stress in preeclampsia. Am J Pathol. 2000;156:321–331.
20. Kang DH, Finch J, Nakagawa T, Karumanchi SA, Kanellis J, Granger J, et al. Uric acid, endothelial dysfunction and pre-eclampsia: searching for a pathogenetic link. J Hypertens. 2004;22(2):229–235.
21. Strevens D, Wide-swensson H, Grubb A, Hansen A, Horn T, Ingemarsson I, Larsen S, Nyengaard JR, Torffvit O, Willner J, Olsen S. Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre-eclamptic pregnancies. BJOG: an international journal of Obstetrics and Gynaecology. 2003 Sep.Vol. 110:825–830.