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Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women

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Abstract

Introduction

Ischemia and oxidative stress leads to generation of hydroxyl free radicals and modification of ‘N-terminus’ of human serum albumin. This modified albumin molecule, known as Ischemia Modified Albumin (IMA), is elevated in early stages of ischemia. It has recently been approved by US Food and Drug Administration (US FDA) for its clinical use, as early marker of myocardial ischemia in cardiology. IMA is a novel marker of ischemia and is elevated in other clinical conditions associated with ischemia like pulmonary embolism, uncontrolled type II diabetes mellitus, acute decompensated heart failure, preeclampsia, recurrent pregnancy losses and IUGR. Role of IMA in birth asphyxia in perinatology is of current interest and needs further research.

Methodology

A prospective case control study was conducted in a tertiary center in North India for one year. Total 80 pregnant women between 34 and 40 weeks were recruited and allocated in two groups. Case group comprised of 40 pre-eclamptic pregnant women and control group comprised of 40 normotensive pregnant women. Comparison and association of maternal serum IMA levels with fetomaternal outcome and number and types of placental histopathological changes was done in two groups.

Results

In preeclampsia group mean serum IMA (115.23 ± 49.51) was significantly higher as compared to the normotensive group (79.21 ± 14.35). The optimum cut off value of IMA to detect a case was 94.5 IU/ml (sensitivity 65%, specificity 87.5%, PPV 83.9%, NPV 71.4% and diagnostic accuracy of 76.3). Pre-eclamptic women, had significantly higher incidence of PTVD, lower fetal birth weight and placental histopathological changes as compared to normotensive group. 83.8% of the women with raised IMA levels were pre-eclamptic. Raised IMA levels were significantly associated with higher incidence of PTVD, birth weight ≤ 2 kg and hypoxic histopathological lesions of chorangiosis, intervillous fibrin and hyalinization.

Conclusion

Determination of maternal serum IMA levels early in pregnancy can predict preeclampsia and avoid future severe preeclampsia related complications. It might be useful to optimize both maternal and fetal/neonatal outcomes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India

    Shyam Pyari Jaiswar, Shikha Verma, Monica Agrawal & Sujata Deo

  2. Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India

    Madhumati Goel

  3. Department of Biochemistry, King George Medical University, Lucknow, Uttar Pradesh, 226003, India

    Abbas Ali Mahdi

Authors
  1. Shyam Pyari Jaiswar
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  2. Shikha Verma
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Correspondence to Monica Agrawal.

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Ethical approval from institutional Ethical Committee KGMU, Lucknow, was taken.

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Informed consent was obtained from all individual participants included in the study.

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Dr. S. P. Jaiswar is Professor at Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India; Dr. Shikha Verma is Senior Resident at Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India; Dr. Monica Agrawal is Associate Professor at Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India; Dr. Sujata Deo is Professor at Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, India; Dr. Madhumati Goel is Professor at Department of Pathology, King George Medical University, Lucknow, India; Dr. Abbas Ali Mahdi is Professor & Head at Department of Biochemistry, King George Medical University, Lucknow, India.

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Jaiswar, S.P., Verma, S., Agrawal, M. et al. Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women. J Obstet Gynecol India 72 (Suppl 1), 166–173 (2022). https://doi.org/10.1007/s13224-021-01614-7

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