Adipsin as a marker of preeclampsia in a Ghanaian community

Adipsin as a marker of preeclampsia in a Ghanaian community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adipsin as a marker of preeclampsia in a Ghanaian community Ahmed Tijani Bawah, Hawawu Hussein, Robert Kuganab-Lem, Tamimu Yakubu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3885548/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: This study was aimed at determining the levels of serum adipsin and lipids during the first trimester in pregnant women and to evaluate the relationship between these biochemical markers and preeclampsia (PE). Available data suggest that changes in the levels of adipsin is linked to the development of PE hence this study examined the potential of using this biomarker and adiposity in the prediction of the disease. Methods: This was a prospective case-control study which examined first trimester serum adipsin lipids and anthropometric parameters in pregnant women who later developed PE and those who did not. Urine protein and blood pressure were determined after 20 th week of pregnancy and the values used to diagnose PE using the guidelines of the American Heart Association. Results: There were significant differences (p < 0.05) in the body mass index (BMI), coronary risk, lipids and adipsin between the PE group and the normotensive group. Analyses of risk factors for PE revealed that family history of hypertension, overweight, and history of cesarean operation are strong predictors of the disease. Conclusion: Our results suggest that adipsin may be involved in pregnancy related metabolic changes and these changes could be linked to the pathophysiology of PE. Preeclampsia adipsin coronary risk lipids Figures Figure 1 Introduction Preeclampsia (PE), a condition unique to pregnancy, is characterized by newly diagnosed hypertension and proteinuria, which usually appear after 20 weeks of gestation. The disorder aggravates and becomes eclampsia (E) if adequate attention is not given to it. PE complicates 2–8% of all pregnancies globally and continues to be one of the main causes of maternal and perinatal mortality and morbidity, especially in developing nations [ 1 ]. The world Health Organization estimates that about 16% of maternal mortalities in low resource settings are attributable to PE and E [ 2 ]. PE is one of the main causes of maternal and perinatal morbidity and mortality accounting for about 60,000 maternal death per year [ 2 ]. Notwithstanding the fact that scientists have conducted in-depth research into this pregnancy disorder, its indefinable pathology makes it a complex disease. However, a number of markers such as misfolded protein [ 3 ], adipsin [ 4 ] and inositol phosphoglycans P-type [ 5 ] have been proposed to play a role in pathophysiology of the disease. Adipose tissue expresses and secretes a serine protease called adipsin in large amounts [ 6 ]. When associated with C3b, this serine protease cleaves Factor B (FB), forming the C3bBb complex (C3 convertase), which is part of the alternate pathway of complement activation [ 7 ] and eventually cleaves C3 into its active components C3a and C3b2. Furthermore, the acylation-stimulating protein (C3adesArg/ASP) is produced when carboxypeptidase B (CbB) cleaves the terminal arginine of C3a in the circulatory system [ 8 ] and triglyceride (TG) synthesis is stimulated in cultured adipocytes by interactions between C3a and ASP and the receptor C5L2 [ 9 ]. There are varied reports on the relationship between lipids and PE. While some researchers reported no significant relationship between first trimester lipids and PE [ 10 ] others reported significant difference in the major lipid fractions between those with normal pregnancies and those with PE [ 11 ], [ 12 ]. Despite the fact that a strong correlation between elevated adipsin and PE has been demonstrated in a recent study which also revealed the promising value of this protein as a diagnostic tool for PE [ 13 ] to date, no relationship between adipsin and PE has been reported among pregnant women in a Ghanaian community. We therefore explored the relationship between adipsin, lipids, coronary risk, socio-demographic factors and pre-eclampsia and evaluated the effectiveness and accuracy of these markers in the prediction of PE Materials and methods Study site and design This was a case control study conducted at the Tamale Technical University Hospital in the Sagnarigu District, Tamale, Ghana from October, 2021 to September, 2022. Selection of participants Pregnant women over the age of 18 with or without hypertension (cases and controls, respectively) were included in the study. Pregnant women with blood pressure less than 140/90 mmHg and no dipstick proteinuria were enrolled as controls, while those who also had proteinuria and hypertension were entered as cases. Pregnant people with renal disease, diabetes, malignancies and pre-gestational hypertension were excluded. Study population This was a prospective case control study from which we selected 70 pregnant women with PE (cases) and 70 normotensive pregnant women (controls) in the Sagnarigu District in the Northern region. We took records of medical history and maternal characteristics at 11 ± 2 weeks of gestation. Anthropometric measurements The participants were made to stand on a bathroom scale (Zhongshan Camry Electronic Co. Ltd., Guangdong, China) with their footwear off while wearing light clothing and their weights measured to the nearest 0.1kg.The participants were then asked to stand upright with heels put together and the head in a horizontal plane. Their heights were measured with a stadiometer to the nearest 0.5 cm. BMI was calculated as weight/height squared (Kg/m 2 ). Blood Pressure Measurement Each participant was instructed to sit on a comfortable seat, extend their left arm on a nearby table, and then wait for 10 minutes. A mercury sphygmomanometer and stethoscope were used to measure blood pressure. In accordance with the American Heart Association's recommendations [ 14 ], measurements were obtained from the participants' left upper arm after at least five minutes of rest. The mean blood pressure was recorded to the closest 2.0 mmHg using three separate readings with at least a 5-minute interval between each. Samples collection and preservation During the first trimester, between the hours of 7:00 and 8:00 am, 5 milliliters of blood were also drawn, placed in serum separator tubes, and immediately placed on cold packs. For a subsequent biochemical examination, serum samples were separated within 1 hours and kept in multiple aliquots at -80°C. Each participant received a clean, dry, wide-mouth, leak-proof container after the 20th week of pregnancy in order to collect about 5ml of urine sample. Biochemical and urine analysis Adipsin levels in both cases and the controls were analysed by sandwich enzyme-linked immunosorbent assay technique (Elabscience Biotechnology Co. Ltd., Wu Han, People’s Republic of China) while the lipid Profile was determined using the Selectra Pro S (Vital Scientific B.V. Van Rensselaerwweg 4, NL 6956 AV Spankeren, The Netherlands) automated chemistry analyzer using the procedure outlined for the equipment. Repeated thawing and freezing of samples was avoided. Urine protein was determined using dipstick urinalysis test (Urit Medical Electronic Co., Ltd., Guangxi,People’s Republic of China following manufacturer’s instructions Proteinuria was defined as the presence of urine protein with concentration of at least + [ 15 ] Study variables and outcome measurement The outcome variable was PE (Yes/No). An experienced obstetrician/gynecologist diagnosed the PE based on systolic and diastolic blood pressure readings of 140 mmHg or higher and 90 mmHg or higher, respectively, on two occasions at least four hours apart and proteinuria of + or more. Statistical analysis Data analysis was performed with the SPSS software, version 20 and Stata version 13. Analysis by the Kolmogorov-Smirnov test for normality revealed that the data for adipsin was non-normal at (p < 0001). Thus, the Mann-Whitney test was adopted for the independent variables with two groups for adipsin, while the t test was used for independent variables for BMI TC, TG, HDL, LDL, VLDL, and C. RISK which was found to be normal. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the accuracy of a test/marker (Adipsin) in predicting PE. In a univariate analysis, potential confounders were added into the multiple logistic regression model, any variable that predicted PE was retained in the multiple logistic regression, significance was set at α = 0.05 for all the analyses. Results The baseline demographics and the biochemical markers were compared among those with PE and those without PE (Table 1 ). Participants with PE were significantly older than those without PE (30.9 vs 28.8 years; p = 0.023). Similarly, those with PE had significantly higher BMI than the controls (27.5 vs 25.6 Kg/m 2 ; p = 0.004) (Table 1 ). The biochemical parameters including adipsin and the lipids with the exception of HDL cholesterol all showed significantly higher values in the preeclamptic women compared to their counterparts without PE (p < 0.001). HDL cholesterol was significantly lower in the PEs than the controls (0.88 vs 1.49 mmol/L, p < 0. 001) (Table 1 ). Furthermore, coronary risk ratio was higher in the PEs compared to those without PE. Table 1 Mann Whitney U and T test for biochemical parameters in preeclampsia Variable Age (Years) Adipsin (ng/ml) BMI (Kg/m 2 ) TC (mmol/L) TG (mmol/L) HDL (mmol/L) LDL (mmol/L) VLDL (mmol/L) CR PE No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes Min 16.0 16.0 1291 1380 18.9 20.3 2.4 3.1 0.42 0.51 0.07 0.04 0.2 2.2 .019 0.23 0.8 1.0 Max 40 45 2561 2800 35.3 37.3 8.3 9.7 3.34 3.26 3.42 3.18 6.7 8.2 1.52 1.48 85.9 198 Mean 28.8 30.9 1829.2 2266.8 25.6 27.5 5.3 8.3 1.53 2.53 1.49 0.88 3.5 5.9 0.7 1.2 8.9 34.9 LB 27.6 29.5 1722.1 2155.9 24.6 26.6 4.9 7.8 1.4 2.4 1.26 0.68 3.1 5.5 0.62 1.07 4.9 22.6 UB 30.0 32.5 1936.3 2377.8 26.4 28.5 5.7 8.7 1.7 2.7 1.72 1.06 3.8 6.4 0.75 1.23 12.8 47.1 P Value 0.023 < 0.001 0.004 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 PE: preeclampsia, BMI: body mass index, TC: total cholesterol, TG: triglycerides, HDL: high density lipoprotein, LDL: low density lipoprotein, VLDL: very low density lipoprotein, CR: coronary risk Analysis of the multiple logistic regression of PE and risk factors revealed that obese women had 2.5 higher risk of developing PE (p < 0.042) compared to those with healthy weight (Table 2 ). Participants with family history of hypertension showed 4.8 times higher risk of developing PE as compared those with no family history of hypertension (OR 4.8; CI 95% 1.3–17.6; p = 0.017) (Table 2 ). Women with previous cesarean operation had higher risk of developing PE as compared with women with normal spontaneous vaginal deliveries (OR 24.2; CI 95% 4.4-133.8; p 0.05) (Table 2 ). Table 2 Multiple logistic regression of PE and Risk factors PE Crude OR (CI) P value Adj OR”**” P value Age (Years) 16–25 1 1 26–35 1.14 (0.49–2.57) 0.762 1.05 (0.3–3.3) 0.930 36–45 2.26(0.71–7.19) 0.169 2.8 (0.6–14.4) 0.217 BMI (Kg/m 2 ) Healthy 1 1 Obese 2.36 (1.17–4.75) 0.060 2.5 (1.0-6.6) 0.006 RWH No 1 1 Yes 2.11 (0.83–5.37) 0.115 4.8 (1.3–17.6) 0.017 Parity No pregnancy 1 1 1 pregnancy 2.39 (1.2–4.9) 0.016 0.5 (0.1–3.2) 0.468 2 or more 1.30*10 07 0.986 8.10*10 11 0.984 CS No 1 1 Yes 5.6 (2.11–14.70) 0.001 24.2 (4.4-133.8) < 0.001 MC No 1 1 Yes 1.61 (0.95–2.62) 0.077 1.8 (0.4–7.9) 0.419 SB No Yes 2.29 (0.93–5.67) 0.071 3.9 (0.7–22.4) 0.468 Gravidity 1 1 1 2 2.9 (1.2–7.4) 0.021 1.9 (0.3–12.2) 0.640 3 or more 3 (1.3–7.2) 0.014 7.8 (0.4-155.7) 0.180 BMI: body mass index, RWH: relatives with hypertension, CS: cesarean section, MC: miscarriage, SB: stillbirth Performance of adipsin as screening tool for PE is presented in Fig. 1 . The area under the receiver operating characteristic (ROC) curve (AUC) was 0.767. A cut off point of 1513.11ng/ml with sensitivity of 0.929 and specificity of 0.614 is suggested to positively predict PE. Discussions This study was aimed at determining the level of adipsin and lipids during the first trimester and to evaluate the usefulness of these biochemical markers in addition to the maternal characteristics to explicate pregnancies that are likely to develop PE. This study revealed that adipsin was significantly higher in those who developed PE compared to the controls. This is similar to an earlier study which reported a significant rise in adipsin levels in pregnant women with preeclampsia before delivery [ 16 ]. Another study by Poveda et at (2016), reported an elevated adipsin levels in late pregnancy of PE compared to normotensive pregnant women [ 17 ]. However, in another study plasma adipsin concentration was only slightly higher in patients with preeclampsia compared to the controls although the urinary concentration was significantly increased [ 4 ]. This suggests that the increase of adipsin in urine of patients with preeclampsia may not have originated from differences in the concentration of this protein in plasma [ 4 ]. Pregnancy-related metabolic alterations and the pathophysiology of preeclampsia may be influenced by the elevated level of adipsin found in pregnant women with PE [ 17 ]. As a result, the rise in adipsin levels in preeclamptic patients may control alterations in downstream products and contribute to vascular endothelial damage. Adipsin may be involved in the development of preeclampsia and might therefore be utilized as a possible marker given that the plasma adipsin levels increased from the first trimester. Our results also showed significant differences in triglycerides (TG), total cholesterol (TC), Low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and coronary risk ration (C. Risk) between the PEs and the controls. These results corroborates previous findings in which most of the lipid fractions, with the exception of high density lipoprotein (HDL) cholesterol were significantly raised in women with pregnancy induced hypertension including PE [ 18 ]. A similar study reported significantly lower HDL cholesterol among women with PE compared to the controls in consonance with this present study [ 19 ]. This suggests that dyslipidemia may be linked to hypertensive disorders of pregnancy by contributing to endothelial dysfunction and the expression of PE [ 20 ] as was reported in another study which concluded that early pregnancy dyslipidemia was related to an increased risk of preeclampsia [ 21 ]. This association may be important in comprehending the pathogenesis of PE and may aid in developing policies for the early diagnosis of the disease and prevention of its devastating consequences. Increased plasma lipids and lipoproteins may stimulate endothelia dysfunction consequent to oxidative stress and may also impair trophoblast invasion leading to series of events culminating in PE [ 22 ]. Obese women were also found to have greater risk of developing PE in line with previous studies which associated obesity to the possibility of developing PE [ 23 ], [ 24 ]. Our study also revealed that poor previous obstetric outcome like cesarean section (CS) had relationship with PE in consonance with a previous study which stated that regardless of parity or gestational age, cesarean deliveries were more common in preeclamptic women who had labor induction than in non-preeclamptics [ 25 ], [ 26 ]. Compared to the normotensives, those with family history of hypertension had higher risk of developing PE in line with a similar study done in Kumasi, Ghana [ 25 ]. Our study did not find significant relationship between parity, gravidity, stillbirth, miscarriages and PE though many studies have linked these factors to the onset of PE. Strengthen and limitations There are limitations to this study. An issue with this study is that some of the data was collected through participant self-reporting. Moreover, data were only collected in the Sagnarigu District in Northern Region of Ghana, therefore the conclusions may not apply to other groups. Despite this, our study contributes to our understanding of the interactions between risk factors for PE and a few biochemical markers in the pathophysiology of PE among women in the Northern Region of Ghana. Conclusions This study has demonstrated significant rise in adipsin during the first trimester among pregnant women with PE, and this biomarker contributes significantly to the prediction of PE in pregnant women. Dyslipidemia, family history of hypertension and obesity have also been demonstrated to be significant predictors of PE. More research is still needed to determine the precise mechanism underlying preeclamptic pathophysiology and whether elevated plasma adipsin levels and dyslipidemia are the direct causes. Abbreviations ASP Acylation-stimulating protein CbB carboxypeptidase B HDL High Density Lipoprotein LDL Low Density Lipoprotein VLDL Very Low Density Lipoprotein TC Total Cholesterol. TG:Triglyceride Declarations Acknowledgments The researchers express sincere gratitude to the maternity and laboratory departments of the Tamale Technical University Hospital Tamale, Ghana, for granting them permission to carry out the project in the facility. Authors’ contribution ATB, KKB and HH were involved in the conception, design, analysis, interpretation, report writing and manuscript writing. RKL and TY have been involved in the design, analysis, and critically reviewing the manuscript. All authors read and approved the final manuscript. Funding Authors received no funding for this project Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interest The authors declare that they have no conflict of interest Ethics approval and consent to participate The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. It was reviewed and approved by the Ethics Sub-Committee of Tamale Technical University, Tamale, Ghana under file number ID: FAHSEC/AP01/23. The study’s aims and risks were explained to all participants, and their written informed consent was obtained before starting the study. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests, either financial or non-financial. References Duley L (2009) The global impact of pre-eclampsia and eclampsia, in Seminars in perinatology , vol. 33, no. 3, pp. 130–137 Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066–1074 Rood KM et al (2019) Congo red dot paper test for antenatal triage and rapid identification of preeclampsia. EClinicalMedicine 8:47–56 Wang T et al (2014) Elevation of urinary adipsin in preeclampsia: correlation with urine protein concentration and the potential use for a rapid diagnostic test. Hypertension 64(4):846–851 Williams PJ, Gumaa K, Scioscia M, Redman CW, Rademacher TW (2007) Inositol phosphoglycan P-type in preeclampsia: a novel marker? Hypertension 49(1):84–89 White RT et al (1992) Human adipsin is identical to complement factor D and is expressed at high levels in adipose tissue. J Biol Chem 267(13):9210–9213 Choy LN, Rosen BS, Spiegelman BM (1992) Adipsin and an endogenous pathway of complement from adipose cells. J Biol Chem 267(18):12736–12741 Cianflone K, Xia Z, Chen LY (2003) Critical review of acylation-stimulating protein physiology in humans and rodents. Biochim Biophys Acta (BBA)-Biomembranes 1609(2):127–143 Richani K et al (2005) Normal pregnancy is characterized by systemic activation of the complement system. J Matern Neonatal Med 17(4):239–245 Bawah AT, Bawah A-M, Zorro RI (2022) Pathophysiology of Preeclampsia: The Role of Adiposity and Serum Adipokines, in Cardiovascular Diseases , IntechOpen, Ephraim RKD, Doe PA, Amoah S, Antoh EO (2014) Lipid profile and high maternal body mass index is associated with preeclampsia: a case-control study of the Cape Coast Metropolis. 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Int J Womens Health, pp. 449–454, Bodnar LM, Ness RB, Markovic N, Roberts JM (2005) The risk of preeclampsia rises with increasing prepregnancy body mass index. Ann Epidemiol 15(7):475–482 Fondjo LA, Amoah B, Tashie W, Annan JJ (2022) Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case–control study in Ghana. Women’s Heal 18:17455057221109362 Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB (2010) Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced? J Matern Neonatal Med 23(5):383–388 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3885548","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":268447769,"identity":"d47d6178-206c-47e8-8b3f-dde1b0dca7ba","order_by":0,"name":"Ahmed Tijani Bawah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYDACCSDmMbBhZpBgPsDA2EC0loo0dgYJtgRStJw5zM8gwWNAnBb+2d2JD962MUvLR/d8k/i5w0aOgf3w0Q14LblzdrPh3DY2Y8M7Z7dJ9p5JM2bgSUu7gdeaG7nbpHnbeJINZ+Ruk+BtO5zYIMFjhleL/I3c7b952yTqN87IeSb5lxgtBkBbmHnOGDDLS+SwSRNli+GN3M2ScyoSmA0k0oytZdvSjNkI+UXuRu7GD28M/jPLz0h+ePNtm40cP/vhY/i9D3fhAQYWUBwxsBGlHATkGxiYPxCtehSMglEwCkYUAACooU0dg7JZTwAAAABJRU5ErkJggg==","orcid":"","institution":"Tamale Technical University","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"Tijani","lastName":"Bawah","suffix":""},{"id":268447770,"identity":"ad53039b-b7b4-4e7e-809f-b73746cc455f","order_by":1,"name":"Hawawu Hussein","email":"","orcid":"","institution":"Tamale Technical University","correspondingAuthor":false,"prefix":"","firstName":"Hawawu","middleName":"","lastName":"Hussein","suffix":""},{"id":268447771,"identity":"dc8d29c1-da62-4fb7-b9c9-bad07dea164d","order_by":2,"name":"Robert Kuganab-Lem","email":"","orcid":"","institution":"Tamale Technical University","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Kuganab-Lem","suffix":""},{"id":268447772,"identity":"dbb2a12b-2af4-49b0-a929-d3bf3ea6d7ec","order_by":3,"name":"Tamimu Yakubu","email":"","orcid":"","institution":"Tamale Technical University","correspondingAuthor":false,"prefix":"","firstName":"Tamimu","middleName":"","lastName":"Yakubu","suffix":""},{"id":268447773,"identity":"f8a13245-4478-47e9-a283-da89bc036633","order_by":4,"name":"Khadija Kande Bawa","email":"","orcid":"","institution":"Yendi College of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Khadija","middleName":"Kande","lastName":"Bawa","suffix":""}],"badges":[],"createdAt":"2024-01-21 18:46:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3885548/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3885548/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50050454,"identity":"6408aff7-be5b-4072-b130-3566e061f16d","added_by":"auto","created_at":"2024-01-23 16:37:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41653,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic curve for Adipsin and PE\u003c/p\u003e\n\u003cp\u003eAUC = 0.767, sensitivity = 0.929 specificity = 0.614, threshold point \u0026gt; 1513.11ng/ml\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3885548/v1/28c6ba4c4fc1c7e1e13899c3.png"},{"id":50274516,"identity":"52225ede-d4f9-44cc-aebd-ba049c587d73","added_by":"auto","created_at":"2024-01-28 23:07:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":505738,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3885548/v1/fbcb1013-16a0-45bf-9ea1-c8b90616bcdd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adipsin as a marker of preeclampsia in a Ghanaian community","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePreeclampsia (PE), a condition unique to pregnancy, is characterized by newly diagnosed hypertension and proteinuria, which usually appear after 20 weeks of gestation. The disorder aggravates and becomes eclampsia (E) if adequate attention is not given to it. PE complicates 2\u0026ndash;8% of all pregnancies globally and continues to be one of the main causes of maternal and perinatal mortality and morbidity, especially in developing nations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The world Health Organization estimates that about 16% of maternal mortalities in low resource settings are attributable to PE and E [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. PE is one of the main causes of maternal and perinatal morbidity and mortality accounting for about 60,000 maternal death per year [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Notwithstanding the fact that scientists have conducted in-depth research into this pregnancy disorder, its indefinable pathology makes it a complex disease. However, a number of markers such as misfolded protein [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], adipsin [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and inositol phosphoglycans P-type [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] have been proposed to play a role in pathophysiology of the disease. Adipose tissue expresses and secretes a serine protease called adipsin in large amounts [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. When associated with C3b, this serine protease cleaves Factor B (FB), forming the C3bBb complex (C3 convertase), which is part of the alternate pathway of complement activation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and eventually cleaves C3 into its active components C3a and C3b2. Furthermore, the acylation-stimulating protein (C3adesArg/ASP) is produced when carboxypeptidase B (CbB) cleaves the terminal arginine of C3a in the circulatory system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and triglyceride (TG) synthesis is stimulated in cultured adipocytes by interactions between C3a and ASP and the receptor C5L2 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There are varied reports on the relationship between lipids and PE. While some researchers reported no significant relationship between first trimester lipids and PE [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] others reported significant difference in the major lipid fractions between those with normal pregnancies and those with PE [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Despite the fact that a strong correlation between elevated adipsin and PE has been demonstrated in a recent study which also revealed the promising value of this protein as a diagnostic tool for PE [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] to date, no relationship between adipsin and PE has been reported among pregnant women in a Ghanaian community. We therefore explored the relationship between adipsin, lipids, coronary risk, socio-demographic factors and pre-eclampsia and evaluated the effectiveness and accuracy of these markers in the prediction of PE\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy site and design\u003c/h2\u003e \u003cp\u003eThis was a case control study conducted at the Tamale Technical University Hospital in the Sagnarigu District, Tamale, Ghana from October, 2021 to September, 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSelection of participants\u003c/h2\u003e \u003cp\u003ePregnant women over the age of 18 with or without hypertension (cases and controls, respectively) were included in the study. Pregnant women with blood pressure less than 140/90 mmHg and no dipstick proteinuria were enrolled as controls, while those who also had proteinuria and hypertension were entered as cases. Pregnant people with renal disease, diabetes, malignancies and pre-gestational hypertension were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis was a prospective case control study from which we selected 70 pregnant women with PE (cases) and 70 normotensive pregnant women (controls) in the Sagnarigu District in the Northern region. We took records of medical history and maternal characteristics at 11\u0026thinsp;\u0026plusmn;\u0026thinsp;2 weeks of gestation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric measurements\u003c/h2\u003e \u003cp\u003eThe participants were made to stand on a bathroom scale (Zhongshan Camry Electronic Co. Ltd.,\u003c/p\u003e \u003cp\u003eGuangdong, China) with their footwear off while wearing light clothing and their weights measured to the nearest 0.1kg.The participants were then asked to stand upright with heels put together and the head in a horizontal plane. Their heights were measured with a stadiometer to the nearest 0.5 cm. BMI was calculated as weight/height squared (Kg/m \u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eBlood Pressure Measurement\u003c/h2\u003e \u003cp\u003eEach participant was instructed to sit on a comfortable seat, extend their left arm on a nearby table, and then wait for 10 minutes. A mercury sphygmomanometer and stethoscope were used to measure blood pressure. In accordance with the American Heart Association's recommendations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], measurements were obtained from the participants' left upper arm after at least five minutes of rest. The mean blood pressure was recorded to the closest 2.0 mmHg using three separate readings with at least a 5-minute interval between each.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eSamples collection and preservation\u003c/h2\u003e \u003cp\u003eDuring the first trimester, between the hours of 7:00 and 8:00 am, 5 milliliters of blood were also drawn, placed in serum separator tubes, and immediately placed on cold packs. For a subsequent biochemical examination, serum samples were separated within 1 hours and kept in multiple aliquots at -80\u0026deg;C. Each participant received a clean, dry, wide-mouth, leak-proof container after the 20th week of pregnancy in order to collect about 5ml of urine sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eBiochemical and urine analysis\u003c/h2\u003e \u003cp\u003eAdipsin levels in both cases and the controls were analysed by sandwich enzyme-linked immunosorbent assay technique (Elabscience Biotechnology Co. Ltd., Wu Han, People\u0026rsquo;s Republic of China) while the lipid Profile was determined using the Selectra Pro S (Vital Scientific B.V. Van Rensselaerwweg 4, NL 6956 AV Spankeren, The Netherlands) automated chemistry analyzer using the procedure outlined for the equipment. Repeated thawing and freezing of samples was avoided. Urine protein was determined using dipstick urinalysis test (Urit Medical Electronic Co., Ltd., Guangxi,People\u0026rsquo;s Republic of China following manufacturer\u0026rsquo;s instructions Proteinuria was defined as the presence of urine protein with concentration of at least + [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eStudy variables and outcome measurement\u003c/h2\u003e \u003cp\u003eThe outcome variable was PE (Yes/No). An experienced obstetrician/gynecologist diagnosed the PE based on systolic and diastolic blood pressure readings of 140 mmHg or higher and 90 mmHg or higher, respectively, on two occasions at least four hours apart and proteinuria of +\u0026thinsp;or more.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed with the SPSS software, version 20 and Stata version 13. Analysis by the Kolmogorov-Smirnov test for normality revealed that the data for adipsin was non-normal at (p\u0026thinsp;\u0026lt;\u0026thinsp;0001). Thus, the Mann-Whitney test was adopted for the independent variables with two groups for adipsin, while the t test was used for independent variables for BMI TC, TG, HDL, LDL, VLDL, and C. RISK which was found to be normal. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the accuracy of a test/marker (Adipsin) in predicting PE. In a univariate analysis, potential confounders were added into the multiple logistic regression model, any variable that predicted PE was retained in the multiple logistic regression, significance was set at α\u0026thinsp;=\u0026thinsp;0.05 for all the analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe baseline demographics and the biochemical markers were compared among those with PE and those without PE (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Participants with PE were significantly older than those without PE (30.9 vs 28.8 years; p\u0026thinsp;=\u0026thinsp;0.023). Similarly, those with PE had significantly higher BMI than the controls (27.5 vs 25.6 Kg/m\u003csup\u003e2\u003c/sup\u003e; p\u0026thinsp;=\u0026thinsp;0.004) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The biochemical parameters including adipsin and the lipids with the exception of HDL cholesterol all showed significantly higher values in the preeclamptic women compared to their counterparts without PE (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). HDL cholesterol was significantly lower in the PEs than the controls (0.88 vs 1.49 mmol/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0. 001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Furthermore, coronary risk ratio was higher in the PEs compared to those without PE.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMann Whitney U and T test for biochemical parameters in preeclampsia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"19\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAge (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAdipsin (ng/ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBMI (Kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eTC (mmol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003eHDL (mmol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eLDL (mmol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003eVLDL (mmol/L)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" 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colname=\"c8\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e85.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1829.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2266.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1722.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2155.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e22.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1936.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2377.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c18\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c19\"\u003e \u003cp\u003e47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c19\" namest=\"c18\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"19\"\u003ePE: preeclampsia, BMI: body mass index, TC: total cholesterol, TG: triglycerides, HDL: high density lipoprotein, LDL: low density lipoprotein, VLDL: very low density lipoprotein, CR: coronary risk\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAnalysis of the multiple logistic regression of PE and risk factors revealed that obese women had 2.5 higher risk of developing PE (p\u0026thinsp;\u0026lt;\u0026thinsp;0.042) compared to those with healthy weight (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants with family history of hypertension showed 4.8 times higher risk of developing PE as compared those with no family history of hypertension (OR 4.8; CI 95% 1.3\u0026ndash;17.6; p\u0026thinsp;=\u0026thinsp;0.017) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Women with previous cesarean operation had higher risk of developing PE as compared with women with normal spontaneous vaginal deliveries (OR 24.2; CI 95% 4.4-133.8; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, other maternal characteristics like age, parity, gravidity, previous miscarriages, and stillbirths did not show significant differences among the PEs and the non PEs (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple logistic regression of PE and Risk factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrude OR (CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdj OR\u0026rdquo;**\u0026rdquo;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.14 (0.49\u0026ndash;2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.3\u0026ndash;3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.26(0.71\u0026ndash;7.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8 (0.6\u0026ndash;14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (Kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.36 (1.17\u0026ndash;4.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5 (1.0-6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRWH\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.11 (0.83\u0026ndash;5.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8 (1.3\u0026ndash;17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.39 (1.2\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5 (0.1\u0026ndash;3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 or more\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30*10\u003csup\u003e07\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.10*10\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.6 (2.11\u0026ndash;14.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2 (4.4-133.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61 (0.95\u0026ndash;2.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8 (0.4\u0026ndash;7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.29 (0.93\u0026ndash;5.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9 (0.7\u0026ndash;22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (1.2\u0026ndash;7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9 (0.3\u0026ndash;12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.3\u0026ndash;7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8 (0.4-155.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eBMI: body mass index, RWH: relatives with hypertension, CS: cesarean section, MC: miscarriage, SB: stillbirth\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePerformance of adipsin as screening tool for PE is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.767. A cut off point of 1513.11ng/ml with sensitivity of 0.929 and specificity of 0.614 is suggested to positively predict PE.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis study was aimed at determining the level of adipsin and lipids during the first trimester and to evaluate the usefulness of these biochemical markers in addition to the maternal characteristics to explicate pregnancies that are likely to develop PE.\u003c/p\u003e \u003cp\u003eThis study revealed that adipsin was significantly higher in those who developed PE compared to the controls. This is similar to an earlier study which reported a significant rise in adipsin levels in pregnant women with preeclampsia before delivery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Another study by Poveda \u003cem\u003eet at\u003c/em\u003e (2016), reported an elevated adipsin levels in late pregnancy of PE compared to normotensive pregnant women [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, in another study plasma adipsin concentration was only slightly higher in patients with preeclampsia compared to the controls although the urinary concentration was significantly increased [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This suggests that the increase of adipsin in urine of patients with preeclampsia may not have originated from differences in the concentration of this protein in plasma [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Pregnancy-related metabolic alterations and the pathophysiology of preeclampsia may be influenced by the elevated level of adipsin found in pregnant women with PE [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. As a result, the rise in adipsin levels in preeclamptic patients may control alterations in downstream products and contribute to vascular endothelial damage. Adipsin may be involved in the development of preeclampsia and might therefore be utilized as a possible marker given that the plasma adipsin levels increased from the first trimester.\u003c/p\u003e \u003cp\u003eOur results also showed significant differences in triglycerides (TG), total cholesterol (TC), Low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and coronary risk ration (C. Risk) between the PEs and the controls. These results corroborates previous findings in which most of the lipid fractions, with the exception of high density lipoprotein (HDL) cholesterol were significantly raised in women with pregnancy induced hypertension including PE [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A similar study reported significantly lower HDL cholesterol among women with PE compared to the controls in consonance with this present study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This suggests that dyslipidemia may be linked to hypertensive disorders of pregnancy by contributing to endothelial dysfunction and the expression of PE [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] as was reported in another study which concluded that early pregnancy dyslipidemia was related to an increased risk of preeclampsia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This association may be important in comprehending the pathogenesis of PE and may aid in developing policies for the early diagnosis of the disease and prevention of its devastating consequences. Increased plasma lipids and lipoproteins may stimulate endothelia dysfunction consequent to oxidative stress and may also impair trophoblast invasion leading to series of events culminating in PE [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObese women were also found to have greater risk of developing PE in line with previous studies which associated obesity to the possibility of developing PE [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our study also revealed that poor previous obstetric outcome like cesarean section (CS) had relationship with PE in consonance with a previous study which stated that regardless of parity or gestational age, cesarean deliveries were more common in preeclamptic women who had labor induction than in non-preeclamptics [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Compared to the normotensives, those with family history of hypertension had higher risk of developing PE in line with a similar study done in Kumasi, Ghana [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Our study did not find significant relationship between parity, gravidity, stillbirth, miscarriages and PE though many studies have linked these factors to the onset of PE.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengthen and limitations\u003c/h2\u003e \u003cp\u003eThere are limitations to this study. An issue with this study is that some of the data was collected through participant self-reporting. Moreover, data were only collected in the Sagnarigu District in Northern Region of Ghana, therefore the conclusions may not apply to other groups. Despite this, our study contributes to our understanding of the interactions between risk factors for PE and a few biochemical markers in the pathophysiology of PE among women in the Northern Region of Ghana.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study has demonstrated significant rise in adipsin during the first trimester among pregnant women with PE, and this biomarker contributes significantly to the prediction of PE in pregnant women. Dyslipidemia, family history of hypertension and obesity have also been demonstrated to be significant predictors of PE. More research is still needed to determine the precise mechanism underlying preeclamptic pathophysiology and whether elevated plasma adipsin levels and dyslipidemia are the direct causes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcylation-stimulating protein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCbB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecarboxypeptidase B\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh Density Lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow Density Lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVLDL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVery Low Density Lipoprotein\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal Cholesterol. TG:Triglyceride\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers express sincere gratitude to the maternity and laboratory departments of the Tamale Technical University Hospital Tamale, Ghana, for granting them permission to carry out the project in the facility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eATB, KKB and HH were involved in the conception, design, analysis, interpretation, report writing and manuscript writing. RKL and TY have been involved in the design, analysis, and critically reviewing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors received no funding for this project\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. It was reviewed and approved by the Ethics Sub-Committee of Tamale Technical University, Tamale, Ghana under file number ID: FAHSEC/AP01/23.\u003c/p\u003e\n\u003cp\u003eThe study\u0026rsquo;s aims and risks were explained to all participants, and their written informed consent was obtained before starting the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests, either financial or non-financial.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDuley L (2009) The global impact of pre-eclampsia and eclampsia, in \u003cem\u003eSeminars in perinatology\u003c/em\u003e, vol. 33, no. 3, pp. 130\u0026ndash;137\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan KS, Wojdyla D, Say L, G\u0026uuml;lmezoglu AM, Van Look PFA (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367(9516):1066\u0026ndash;1074\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRood KM et al (2019) Congo red dot paper test for antenatal triage and rapid identification of preeclampsia. EClinicalMedicine 8:47\u0026ndash;56\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang T et al (2014) Elevation of urinary adipsin in preeclampsia: correlation with urine protein concentration and the potential use for a rapid diagnostic test. Hypertension 64(4):846\u0026ndash;851\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams PJ, Gumaa K, Scioscia M, Redman CW, Rademacher TW (2007) Inositol phosphoglycan P-type in preeclampsia: a novel marker? Hypertension 49(1):84\u0026ndash;89\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite RT et al (1992) Human adipsin is identical to complement factor D and is expressed at high levels in adipose tissue. J Biol Chem 267(13):9210\u0026ndash;9213\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoy LN, Rosen BS, Spiegelman BM (1992) Adipsin and an endogenous pathway of complement from adipose cells. J Biol Chem 267(18):12736\u0026ndash;12741\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCianflone K, Xia Z, Chen LY (2003) Critical review of acylation-stimulating protein physiology in humans and rodents. Biochim Biophys Acta (BBA)-Biomembranes 1609(2):127\u0026ndash;143\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichani K et al (2005) Normal pregnancy is characterized by systemic activation of the complement system. J Matern Neonatal Med 17(4):239\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBawah AT, Bawah A-M, Zorro RI (2022) Pathophysiology of Preeclampsia: The Role of Adiposity and Serum Adipokines, in \u003cem\u003eCardiovascular Diseases\u003c/em\u003e, IntechOpen,\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEphraim RKD, Doe PA, Amoah S, Antoh EO (2014) Lipid profile and high maternal body mass index is associated with preeclampsia: a case-control study of the Cape Coast Metropolis. Ann Med Health Sci Res 4(5):746\u0026ndash;750\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Lima VJ, de Andrade CR, Ruschi GE, Sass N (2011) Serum lipid levels in pregnancies complicated by preeclampsia. Sao Paulo Med J 129:73\u0026ndash;76\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid M, Moodley J, Naicker T (2021) The function of adipsin and C9 protein in the complement system in HIV-associated preeclampsia. Arch Gynecol Obstet 304(6):1467\u0026ndash;1473\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKIRKENDALL WM, BURTON AC, EPSTEIN FH, FREIS ED (1967) Recommendations for human blood pressure determination by sphygmomanometers. Circulation 36(6):980\u0026ndash;988\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation AD (2010) Diagnosis and classification of diabetes mellitus, \u003cem\u003eDiabetes Care\u003c/em\u003e, vol. 33, no. Supplement_1, pp. S62\u0026ndash;S69,\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIlie I, Gica N, Botezatu R, Peltecu G, Panaitescu AM (2022) Novel biomarkers in the differential diagnosis of preeclampsia and lupus flare in pregnancy. Rom J Rheumatol, vol. 31, no. 2,\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoveda NE et al (2016) Serum adipsin levels throughout normal pregnancy and preeclampsia. Sci Rep 6(1):1\u0026ndash;11\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBawah AT, Tornyi H, Seini MM, Ngambire LT, Yeboah FA (2020) Zonulin as marker of pregnancy induced hypertension: a case control study. Clin Hypertens 26(1):1\u0026ndash;7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBegum Z, Ara I, Shah ABS (2011) Association between lipid profile and Preeclampsia. Ibrahim Card Med J 1(1):41\u0026ndash;44\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSattar N, Bendomir A, Berry C, Shepherd J, Greer IA, Packard CJ (1997) Lipoprotein subfraction concentrations in preeclampsia: pathogenic parallels to atherosclerosis. Obstet Gynecol 89(3):403\u0026ndash;408\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEnquobahrie DA, Williams MA, Butler CL, Frederick IO, Miller RS, Luthy DA (2004) Maternal plasma lipid concentrations in early pregnancy and risk of preeclampsia. Am J Hypertens 17(7):574\u0026ndash;581\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorentzen B, Henriksen T (1998) Plasma lipids and vascular dysfunction in preeclampsia, in \u003cem\u003eSeminars in reproductive endocrinology\u003c/em\u003e, vol. 16, no. 01, pp. 33\u0026ndash;39\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeboah FA et al (2017) Adiposity and hyperleptinemia during the first trimester among pregnant women with preeclampsia. Int J Womens Health, pp. 449\u0026ndash;454,\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBodnar LM, Ness RB, Markovic N, Roberts JM (2005) The risk of preeclampsia rises with increasing prepregnancy body mass index. Ann Epidemiol 15(7):475\u0026ndash;482\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFondjo LA, Amoah B, Tashie W, Annan JJ (2022) Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case\u0026ndash;control study in Ghana. Women\u0026rsquo;s Heal 18:17455057221109362\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB (2010) Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced? J Matern Neonatal Med 23(5):383\u0026ndash;388\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preeclampsia, adipsin, coronary risk, lipids","lastPublishedDoi":"10.21203/rs.3.rs-3885548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3885548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e This study was aimed at determining the levels of serum adipsin and lipids during the first trimester in pregnant women and to evaluate the relationship between these biochemical markers and preeclampsia (PE). Available data suggest that changes in the levels of adipsin is linked to the development of PE hence this study examined the potential of using this biomarker and adiposity in the prediction of the disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a prospective case-control study which examined first trimester serum adipsin lipids and anthropometric parameters in pregnant women who later developed PE and those who did not. Urine protein and blood pressure were determined after 20\u003csup\u003eth\u003c/sup\u003e week of pregnancy and the values used to diagnose PE using the guidelines of the American Heart Association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e There were significant differences (p \u0026lt; 0.05) in the body mass index (BMI), coronary risk, lipids and adipsin between the PE group and the normotensive group. Analyses of risk factors for PE revealed that family history of hypertension, overweight, and history of cesarean operation are strong predictors of the disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eOur results suggest that adipsin may be involved in pregnancy related metabolic changes and these changes could be linked to the pathophysiology of PE.\u003c/p\u003e","manuscriptTitle":"Adipsin as a marker of preeclampsia in a Ghanaian community","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-23 16:37:31","doi":"10.21203/rs.3.rs-3885548/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb036d02-52e1-4a4e-948a-53ee9e51d867","owner":[],"postedDate":"January 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-28T22:59:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-23 16:37:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3885548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3885548","identity":"rs-3885548","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}