Relation between Serum Ferritin and Iron Parameters with Preeclampsia
AbstractObjective: Preeclampsia is one of the most important complications of pregnancy that is associated with increased morbidity and mortality. The aim of this study was to investigate the relation between serum iron status and ferritin with pre-eclampsia.Materials and Methods: This case control study evaluated 33 preeclamptic patients and 33 normal pregnant women before parturition in Imam Hossein hospital, from March 2003 till March 2004. Anemia, diabetes and multiple pregnancies were excluded from the study. Blood samples were taken before delivery and patients with HELLP syndrome were considered separately. Data were analyzed using the SPSS software and P value <0.05 was considered statistically significant. T-test, chi-square and Fisher exact test were used.Results: The mean of serum iron level in case and control group was 79.9±32.4µg/dl and 88.6±40.8 µg/dl, respectively (NS). TIBC was 443.4±55.0 µmol/l and 383.7±63.6 µmol/l in normal patients and preeclamptics respectively (P = 0.002). Mean serum ferritin was 32.1±16.2 ng/dl in control group and 123.8±46.1 ng/dl in preeclamptics (P<0.001). No meaningful relation was observed between hematocrit, ferritin and iron.Conclusions: Ferritin increases and TIBC decreases in preeclampsia regardless of hepatic function. It seems that elevated serum ferritin (as an oxidative stress) can accelerate vascular damage. So, routine iron supplementation in preeclamptic women is questationable.
Hauth JC, Ewell MG , Levine RJ, Esterlitz JR, Sibai B, Curet LB, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Prevention Study Group. Obstet Gynecol 2000; 95(1): 24-28.
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap L, Wenstrom KD. Williams obstetrics. 22th edition.McGRAWHILL:Medical publishing division,2005.
Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM. Births: Final data for 1998. Natl Vital Stat Rep 2000;48(3): 1-100.
Berg CJ,Atrash HK, Koonin LM, Tucker M. Pregnancy related mortality in the united states(1987-1990) .Obstet Gynecol 1996; 88:161.
Lindhiemer MD, Woodruff TK. Activin A, Inhibin A, and preeclampsia. Lancet 1997;349(9061):1266-1267.
Stamilio DM, Sehdev HM, Morgam MA, Propert K, Macones GA. Can antenatal clinical and biochemical markers predict the development of severe preeclampsia? Am J Obstet Gynecol 2000;182(3):589.
Entman SS, Kambam JR, Bradley CA, Cousar JB .Increased levels of carboxyhemoglobin and serum iron as an indicator of increased red cell turnover in preeclampsia. Am J Obstet Gynecol 1987;156(5):1169-73.
Entman SS, Richardson LD,Killam AP. Elevated serum ferritin in the altered ferrokinetikes of toxemia of pregnancy. Am J Obstet Gynecol 1982; 144: 418-22.
Hubel CA, Kozlov AV, Kagan VE, Evans RW, Davidge ST, McLaughlin MK, et al. Decreased transferrin and increased transferrin saturation in sera of women with preeclampsia: implications for oxidative stress. Am J Obstet Gynecol 1996;175: 692-700.
Rayman MP, Barlis J, Evans RW, Redman CW, King LJ. Abnormal iron parameters in the pregnancy syndrome pre-eclampsia. Am J Obstet Gynecol 2002;187(2):412-8.
Hubel CA, Roberts JM, Taylor RN, Musci TJ, Rodgers GM, mclaughlin MK. Lipid preoxidation in pregnancy: new perspectives on preeclampsia. Am J Obstet Gynecol 1989;161(4):1025-1034.
Walsh SC. Lipid peroxidation in pregnancy. Hypertens pre 1994;13:1.
Hubel CA. Dyslipidemia, iron, and oxidative stress in preeclampsia: assessment of maternal and feto-placental interactions. Semin Reprod Endocrinol 1998;16(1):75-92.
Raman L, Pawashe AB, Yasodhara P. Hyperferritinemia in pregnancy induced hypertension and eclampsia. J Postgrad Med 1992;38:65-7.
Vitoratos N, Salamalekis E, Dalamaga N, Kassanos D, Creatsas G. Defective antioxidant mechanisms via changes in serum ceruloplasmin and total iron binding capacity of serum in women with pre- eclampsia. Eur J Obstet Gynecol Reprod Biol 1999;84(1):63-7.
Konjin AM. Iron metabolism in inflammation. Bailliiers clin Haemato 1994;7(4): 829-849.
Means RT, Krantz SB.Progress in understanding of the anemia of chronic disease. Blood 1992;80:1639-1643.
Milman N, Sengel V, H and Dombernowsky P. Iron status markers in patients with small cell carcinoma of the lung. Relation to survival. Br J Cancer 1991;64:895-898.
Cavill I. Iron metabolism and and erythropoiesis in chronic disease states. Erythropoiesis . New Dimens Treat anemia 1996; 7: 98-101.
Cook JD, Skikne BS. Iron deficiency. Definition and diagnosis. J Intern Med 1989; 226(5): 349-355.
Milman N, Pedersen NS,Visfeldt j. Serum ferritin in healthy Danes: relation to bone marrow haemosiderin iron. Dan Med Bull 1983;30:115-120.
Pepper JR, Mumby S, Gutteriadge JM. Sequential oxidative damage, and changes in iron binding and iron oxidisingplasma antioxidants during cardiopulmonary bypass surgery. Free Radical Res 1994;21(6):377-85.
Walters GO, Miller FM and Worwood M. Serum ferritin concentration and iron stores in normal subjects. J clin Pathol 1973;26:770-772.
Worwood M, Serum ferritnin . In: Iron in biochemistry and medicine II. Jacobs and Worwood M.(eds). London: Academic Press. 1980; 204-244.
Finch.CA, Belloti.V, Stray S, lipschitz DA, Cook JD,Pippard MJ, et al. Plasma ferritin determination as a diagnostic tool. West J Med 1986;145:657-63.
Worwood M, Cragg SJ, Wag staff M, Jacobs A. Binding of human serum ferritin to concavalin. Clin Sci 1979;56:83-7.
Halliwel B, Gutteriadge JM. Role of free radicals and catalytic metal ions in human disease: an overview. Methods Enzymol 1990;186:1-85.
Adam B, Malatyalioglu E, Alvur M, Talu C: Magnesium, zinc and iron levels in pre-eclampsia. J Matern Fetal Med 2001; 10(4): 246-50.
Lao TT, Tam KF, Chan LY. Third trimester iron status and pregnancy outcome in non-anemic women; pregnancy unfavourably affected by maternal iron excess. Hum Reprod 2000;15(8):1843-8.
Halliwel B, Gutteriadge JMC. The antioxidants of human extracellular fluids. Arch biochem: Biophys 1990; 280(1):1-8.
Guttariadge JMC, quinlan GJ. Antioxidants protection agonists organ and inorganic oxygen radicals by normal human plasma:The important primary role of iron-binding and iron –oxidising proteins. Biochim biophys Acta 1993;1156(2):144-50.
Hubel CA, bodnar LM, Many A. Nonglycosilated ferritin predominates in the circulation of women with pre-eclampsia but not intrauterine growth restriction. Clin Chem 2004;50(5):948-951.