This study was carried out to determine the levels of proteins, bilirubin and lipid profile of pre-eclamptic patients attending Imo state specialist hospital, Umuguma. Sixty(60) subjects aged 25-40 years were recruited for the study and they were divided into two groups of thirty(30) pre-eclamptic women and thirty(30) apparently healthy pregnant women. The sample was collected using a standard clean venipuncture technique and the statistical analysis was carried out using statistical package for social sciences(SPSS). The result obtained showed a  significant decrease in total protein and albumin in pre-eclampsia women with mean values of 60.02±3.07g/l and 30.67±3.3g/l when compared with apparently healthy pregnant women with mean values of 65.69±4.9g/l and 36.30±2.9g/l at P<0.05. In the bilirubin, both Total Bilirubin and Conjugated Bilirubin showed a significant increase in pre-eclamptic women with mean values of 0.7±0.15mg/dl and 0.22±0.097mg/dl when compared with the apparently healthy pregnant women with mean values 0.57±0.20mg/dl and 0.10±0.04mg/dl at P<0.05. For lipid profile, Total Cholesterol(Tc), Triglyceride(Tg) and Low Density Lipoprotein(LDL) showed a significant increase in Pre-eclamptic women with mean values of 231.34±18.59mg/dl, 162.32±25.40mg/dl and 176.65±27.26mg/dl when compared with the apparently healthy pregnant women with mean values of 201.79±16.63mg/dl, 84.47±8.69mg/dl and 54.18±4.49 mg/dl at P<0.05 while High Density Lipoprotein(HDL) shows a significant decrease in pre-eclamptic women with mean values of 44.27±4.11mg/dl when compared with the apparently healthy pregnant women with mean values of 49.50±7.25mg/dl at P<0.05.This findings shows that pre-eclampsia is associated with hypoproteinaemia, hypoalbuminaemia, hyperbilirubinaemia and hyperlipidaemia Hence could probably serve as a biochemical marker in pre-eclampsia.





Title page                                                                                                                              i

Certification                                                                                                                         ii

Dedication                                                                                                                           iii

Acknowledgement                                                                                                              iv

Abstract                                                                                                                               v

Table of content                                                                                                                  vi

List of figures                                                                                                                      x

List of tables                                                                                                                       xi


  • Introduction                                                                                                                1

1.1      Justification                                                                                                                  4

1.3      Aims and objective                                                                                                      5


2.1      Definition of preeclampsia                                                                                           6

2.1.1    Etiology and pathophysiology of preeclampsia                                                          6

2.1.2    Signs, symptoms and causes of preeclampsia                                                             9

2.1.3    Risk factors for preeclampsia                                                                                      10

2.1.4    Diagnosis, prevention and treatment                                                                          11

2.2       Serum proteins                                                                                                            13

2.2.1    Structural components and polypeptide chains

Of proteins                                                                                                                    13

2.2.2     Structure of protein                                                                                                     16

2.2.3     Classification of proteins                                                                                            17

2.2.4      Digestion of proteins                                                                                                 19

2.2.5     Absorption of proteins                                                                                                20

2.2.6     Functions of proteins                                                                                                  20

2.2.7     Clinical significance of protein                                                                                   22

2.3        Serum albumin                                                                                                            22

2.3.1     Functions of albumin                                                                                                  23

2.3.2   Clinical significance of albumin                                                                                    24

2.3.3   Protein and preeclampsia                                                                                              25

2.4      Bilirubin                                                                                                                        26

2.4.1   Bilirubin metabolism                                                                                                     29

2.4.2   Disorders of bilirubin metabolism                                                                                 32

2.4.3   Bilirubin and preeclampsia                                                                                            33

2.5      Lipid                                                                                                                             34

2.5.1   Digestion, absorption and transport of lipids                                                               34

2.5.2   Biological functions of lipids                                                                                        35

2.5.3   Classification of lipids                                                                                                  36

2.5.4   Serum lipid profile                                                                                                        37

2.5.5   Serum triglyceride                                                                                                        38

2.5.6   Serum total cholesterol                                                                                                39

2.5.7   Lipoproteins                                                                                                                 42

2.5.8   Metabolism of lipoproteins                                                                                          44

2.5.9   Lipid profile and preeclampsia                                                                                    47


3.1     Study area                                                                                                                     49

3.2     Advocacy, mobilization and pre-survey contacts                                                         49

3.3    Study population                                                                                                           50

3.4    Selection criteria                                                                                                            51

3.5    Sample collection                                                                                                           52

3.6    Method of assay                                                                                                            53

3.6.1 Serum total protein estimation                                                                                       53

3.6.2 Serum albumin estimation                                                                                  55

3.6.3 Serum bilirubin estimation                                                                                             56

3.6.4 Serum lipid profile estimation                                                                                        59

3.7   Statistical analysis                                                                                                           65


4.0   Result                                                                                                                              66


5.1  Discussion                                                                                                                        71

5.2  Conclusion                                                                                                                       72

5.3   Recommendation for further research                                                                            73

REFERENCES                                                                                                                    74

APPENDICES                                                                                                                      81

















1.0                                               INTRODUCTION

  • Introduction

Pre-eclampsia is defined as the presence of systolic blood pressure (SBP) greater than or equal to 140mmHg and diastolic blood pressure(DBP)greater than or equal to 90mmHg (Jameil et al., 2014). Pre-eclampsia is a multisystem disorder affecting several organs and maternal systems including the vascular system, liver, kidney and brain (Steegers et al., 2010). It is a complication of pregnancy that contribute to both maternal and fetal problems.

Pre-eclampsia is also characterized by the presence of protein in urine called proteinuria. The disorder affects about 2-4% of pregnancies (Lana et al., 2004). Despite the intensive research in this area, the etiology of pre-eclampsia remains unknown. It seems to have a multifactorial cause and is also known as the “disease of theories”. There are several signs and symptoms which are associated with pre-eclampsia. Although these signs and symptoms are not usually specific for pre-eclampsia, they share almost the same signs and symptoms with pregnancy which are swelling, pitting edema, convulsion, epigastric pain (Jameil et al., 2014). The causes of pre-eclampsia maybe genetic, immune placental and other factors.

Proteins are large molecules made up of Amino acids bonded together by peptide bond (Chatterjea and Rana, 2012). All proteins have carbon, Hydrogen, oxygen, nitrogen and sulphur. These are essential in their structure. There are numerous sources of proteins like milk, egg, beans etc. There are so many classes of proteins. of some proteins include Albumin, globulin, lipoproteins etc. In Pre-eclampsia, there are usually presence of protein in urine. Normally protein being a large molecule is not supposed to be found in urine, because of the damage of the glomeruli of the kidney in a pre-eclamptic patient, there are usually presence of protein in urine. (Neithardt et al., 2002). Therefore in a pre-eclamptic patient, there are usually decreased protein (albumin, globulin and total protein). Also because of the phenomenom of hemodilution and increased demand of the developing fetus, serum albumin decreases during all the trimesters in a pre-eclamptic patient (Harold et al., 2006).

Bilirubin is a product formed from the breakdown of hemoglobin in the Red blood cells of the liver, spleen, bone marrow and reticuloendothelial system (RES). This occurs after 120 days because red blood cells have a life span of 120 days (Nwanjo, 2006). Oxidative stress is involved in the pathogenesis of pre-eclampsia. This is as a result of increased production of oxidizing agents that is not counteracted by antioxidant. Bilirubin is a non-enzymatic antioxidant and it also helps to counteract the ROS (Reactive oxygen species) and RNS (reactive nitrogen species) produced during oxidative stress in pre-eclampsia. Therefore there are usually increased levels of Bilirubin in pre-eclampsia. This is because there is usually increased breakdown of RBC in a pre-eclamptic patient (Raijmakers et al., 2004).

Lipids are large and diverse group of naturally occurring organic compounds that are related by their solubility in non-polar organic solvents (Swapnali et al., 2011). Lipid profile is a blood test done in other to assess the status of fat metabolism in the body and its importance in heart disease. This includes measuring lipids and its derivatives called lipoproteins (HDL, LDL, TG). It is usually performed with a fasting specimen (Zhang et al., 2014). The physiological hyperlipidemia observed in healthy pregnant women is further exacerbated in pre-eclampsia (Ray et al., 2006). Pre-eclampsia is characterized by intense changes of lipid profile. According to Bayhan et al., (2005) there is an increase in TG, LDL-C and total cholesterol but a decrease in HDL-C.





  • Justification

Pre-eclampsia is a pregnancy specific disorder characterized by an impaired blood perfusion of vital organs including the fetal-placental unit. The prevalence of pre-eclampsia although usually reported as 4%-8% presents some variations in the literature particularly for different populations (Sibai et al., 2015; Maynard et al., 2010). Several studies indicate that pre-eclampsia is associated with a higher incidence of newborns with low birth weight (Groom et al., 2007; Duley, 2009; Wu et al., 2009). Some neonatal complications resulting from pre-eclamptic pregnancy are described and are associated with prematurity including Jaundice, respiratory distress, apnea, seizures, hypoglycaemia and prolonged hospitalization (Duley, 2009; Wu et al., 2009).

The changes of total protein, albumin, bilirubin and lipid profile (HDL.C, LDL.C, TC and TG) are worth assessing for in pre-eclamptic patients. Moreover, there is paucity of published work on the aspect of total proteins, albumin, bilirubin and lipid profile in pre-eclamptic patients in Nigeria. However, the intensity of pre-eclampsia, socio-economic and cultural practices vary in various parts of the country. This work is expected to address the paucity of information on the molecular dynamics of pre-eclampsia and  prevention with a view to provoking further research especially in the area of diagnosis, management, and prevention.

  • Aim and specific objectives
  1. Aim

To estimate the levels of Total protein, Albumin, Bilirubin and Lipid profile in pre-eclamptic patients in Imo Specialist Hospital Umuguma,Owerri.

  1. Specific Objectives
  2. To determine the level of proteins (Total protein and albumin) in pre-eclamptic patients.
  3. To determine the level of bilirubin (Total and conjugated) in pre-eclamptic patients
  4. To determine the level of lipid profile (TG, TC, HDL-C and LDL-C) in pre-eclamptic patients
  5. To compare the total protein, albumin, bilirubin and lipid profile values in pre-eclamptic women with that of normal pregnancy.