# Evaluation of Oxidative Stress and Urinary Calcium Creatinine Ratio in Pregnancy Induced Hypertension Dr. Babli Yadav ? , Dr. Sangita Paneri ? & Dr. Sumitra Yadav ? Abstract-The present study has been undertaken to evaluate oxidative stress and urinary calcium creatinine ratio in pregnancy induced hypertension. Study was carried out in M.Y. hospital and M.G.M. medical college during 2012 to 2013. Study comprised 250 subjects 125 normal pregnant women without any complications were taken as control and 125 pregnant women with PIH were taken study cases. Normal Gynaecological examination & history based informations were taken from each subject. Fasting blood sample and morning urine samples were collected from each subject and blood samples were analyzed for free radical estimations and urine sample analyzed for calcium and creatinine. Our study shows a significant change in free radical level and siginificant fall in urine calcium creatinine ratio as compared to control study concluded that PIH can be result of increased oxidative stress. In this condition change in urinary calcium creatinine ratio indicate its relation to renal system. Study conclude that by improving oxidative stress with proper antioxidant diet or therapy we can decrease or minimize the risk associated with PIH. # Introduction regnancy induced hypertension (PIH) still continues to be one of the most common complication of pregnancy 1,2,3 ,. Despite of so much research and changes in management it is still a leading cause of maternal morbidity and mortality 4,5,6 . Though the exact cause of PIH is unknown. A number of modalities of treatment are being tried to decrease the progress of PIH 7,8,9 . In pregnancy induced hypertension endothelial cell dysfunction is a key event and this endothelial cell dysfunction may be associated with oxidative stress and addition to that calcium and creatinine ratio is as important aspect of maternal and fetal physiology during gestation so in order to evaluate oxidative stress and urinary calcium creatinine ratio in pregnancy induced hypertension was planned. # II. # Material and Methods The study was conducted on total 250 patients who have been admitted in the Department of Obstetrics and Gynecology MGM Medical College and associate MY hospital Indore from July 2012 to may 2013. 125 normal pregnant women were taken as control and 125 pregnancy induced hypertensive women taken as study cases. A detailed history about age, residence, literacy, occupation etc. was noted with general physical and obstetric examination. Blood samples and spot urine were collected from each subject. Blood samples were analyzed for free radicals levels by Thiobarbituric acid reactive substance estimation urine samples were analyzed for calcium and creatinine levels by fully automated biochemistry analyzer. # Table 1 : Comparison of urinary calcium to creatinine ratio between normotensive pregnant women and PIH patients # Parameters Control n=125 # PIH cases n=125 p value Urinary calcium/creatinine ratio 0.0618±0.0084 0.0370±0.0064 <0.001 # Results The result of this study presented in the table-1 and table-2. The significant decrease in urinary calcium IV. # Discussion Pregnancy induced hypertension is a multifaceted syndrome with involvement of several important organs 10,11 . PIH is also associated with endothelial dysfunction 12,13,14 . Our study revealed that there was significant increase in MDA levels was observed there is reasonable evidence to suggest that circulating neutrophils of patient with preeclampsia release an excess of reactive oxygen species 15,16,17 , present study revealed decrease calcium creatinine ratio observed in PIH women. Different studies concluded that calcium homoeostasis is an important aspect of maternal and fetal physiology during gestation 18,19,20,21 . A certain calcium level is required for production of endothelial derived releasing factor which maintains vasodilation in normal pregnancy. Alteration of calcium metabolism has been implicated in pathogenesis of hypertension during pregnancy. Study concluded that the pregnancy induced hypertension is associated with increased oxidative stress and disturb calcium creatinine ratio so addition antioxidant in treatment of PIH we can minimize the risk associated with PIH. 2ParameterControlPIH casesp valuen=125n=125Plasma MDA2.8±0.485.2±0.92<0.001Nmol/mlIII. * AmericanCollege Of Obstetrician Gynecologist Hypertension in Pregnancy 19 Jan. 1996 Technical Bulletin * Should the definition of Preeclampsia include a rise in diastolic BP ? 15 mm of Hg RLevin Am. J. Obstet. Gynecol 182 225 * Evaluation of definition of Preeclampsia R ANorth RTaylor British Journal of Obstetrics Gynecology 106 1999 * LChesley Diagnosis of Preeclampsia. J. Obstetrics Gynecology 65 423 1985 * Serum proteins in patients with toxemic glomerular lesion McCartney C PSchumacher G F B Am. J. Obstetrics Gynecology 111 197 * Risk factor for preeclampsia, abruptio placentae, and adverse neonatal outcome among women with chronic hypertension B MSibai MLindheimor JHauth N. Eng. J. Med 339 667 1998 * Lie RT (2002) the interval between pregnancies and the risk of preeclampsia RSkjaerven AJWilcox N Engl J Med 346 * The importance of genetic and environmental effects for pre-eclampsia and gestational hypertension: a family study ENilsson HSalonen Ros SCnattingius PLichtenstein BJOG 111 2004 * Preeclampsia from epidemiological observation to molecular mechanism. Braz PLopez-Jaramillo J PCasas NSerrano J. Med. Bio. Res 34 10 2001 * Correlation between placental bed biopsy findings, vascular cell adhesion molecule and fibronectin levels in preeclampsia RMadazil EBudak ZCalay MAksu Br. J. Obstet. Gynecol 107 14 2000 * M GMarlettini ACassani MorselliLabate Clin. Exp. Hypertension S. A 11 8 1989 * Hypocalcemia in preeclampsia RAvendano J GRodiguez BInzinza Rev. Chil. Obstet. Clinicol 58 6 1993 * The use of urinary albumincreatinine ratio and Ca/ Cr ratio as screening test for PIH P NBaker GHackett Obstet. Gynecol 83 may 1994 * Urinary calcium to creatinine ratio for predicting preeclampsia TOzcan BKaleli MOzren CTuran Am. J. Perinatal 12 5 Sep 1995 * Calcium/ Creatinine ratio and microalbuminuria in the prediction of preeclampsia M HRodriguez D IMasaki JMestman DKumar Int. J. Obstet. Gynecol 159 6 Dec 1988 * Calciuria in symptom free primigravidae women remote from term: is the response to an oral calcium challenge predictable? V RSuarez J MMiyahira D AGuinn S GFisher Am. J. Obstetrics & Gynecology 180 6P+1 Jun 1999 * Hamzenezadis: Calcium/ Creatinine ratio in a spot sample of urine for early prediction of preeclampsia TKazerooni Int. J. Obstetrics & Gynecology 80 3 Mar 2003 * Role of urinary calcium/ creatinine ratio in prediction of pregnancy induced hypertension JKar Srivastava RMishra The J of Obstetrics & Gynecology of India 52 2 Mar 2002 * Calciuria and preeclampsia-a case control study VenditelliSzmidt Adjide Vallerie DavidFrancoise Sandra Eur. J. Obstet. Gynecol. Reprod. Boil 125 2 2006 * Evaluation of the value of calcium to creatinine ratio for predicting of pre-eclampsia MVahdat MKashanian ESariri MMehdinia doi: 10.3109/ 14767058.2012.712561 J Matern Fetal Neonatal Med 25 12 2012 Dec. 2012 Aug 7. 21 Mansooreh * MaryamKashanian * Mehrnoosh Evaluation of the value of calcium to creatinine ratio for predicting of pre-eclampsia Elaheh;Sariri Mehdinia Journal of Maternal-Fetal and Neonatal Medicine 25 12 December 2012