33 4 08-Dr Golmahammad Lou

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IJMS

Vol 33, No 4, December 2008

Iran J Med SciDecember 2008; Vol 33 No 4231

Evaluation of Serum Calcium, Magnesium,Copper, and Zinc Levels in Women with

Pre-eclampsia

Abstract

Background: Pre-eclampsia along with its complicationsseems to be one of the major causes of maternal morbidity andmortality. Despite numerous studies, the etiology of pre-

eclampsia has not yet been fully elucidated. According to re-cent studies changes in the level of blood trace elements canbe an adverse event in human and animal pregnancy. The pre-

sent study determines whether maternal serum levels of cal-cium, magnesium, copper, and zinc in patients with pre-eclampsia are lower than matched control subjects.

Methods: Serum calcium, magnesium, copper, and zinc levelswere measured in 52 women with pre-eclampsia in their thirdtrimester of pregnancy as patients group, and in 52 healthy

normotensive pregnant women as control group with similarmaternal and gestational ages. All women were primigravidawith singleton pregnancy. Data on body mass index (BMI),maternal and gestational ages, serum calcium, magnesium,copper, and zinc levels were collected and compared between

the two groups.

Results: There were no significant differences between thetwo groups in body mass index and maternal and gestational

ages. Serum calcium, magnesium, copper, and zinc levelswere 8.970.49, versus 8.700.58 (P=0.27), 1.900.24 versus

1.900.26 (P=0.75), 212.60 versus 212.32 (P=0.47), and13.073.20 versus 12.913.01 (P=0.78) for control and pa-

tients groups respectively.

Conclusion: The mean serum levels of calcium, magnesium,copper and zinc between the two groups were not significantly

different. It seems that these trace elements are not involved inthe pathogenesis of pre-eclampsia.

Iran J Med Sci 2008; 33(4): 231-234.

KeywordsPreeclampsia calcium magnesium copperzinc

Introduction

re-eclampsia is a transient but potentially dangerouscomplication of pregnancy that affects 3-5% of preg-nancies.

1,2Pre-eclampsia has been dubbed the dis-

ease of theories because of the multiple hypotheses have

P

S. Golmohammad lou, A. Amirabi,M. Yazdian, N. Pashapour

1

Department of Gynecology,1Neonatology,Faculty of Medicine,Uromiyeh University of Medical Sciences,Uromiyeh, Iran.Correspondence:Sariyeh Golmohammad lou MD,Department of Gynecology,Faculty of Medicine,Uromiyeh University of Medical Sciences,Uromiyeh, Iran.Tel: +98 441 3466400Fax: +98 441 2780801Email: [email protected]: 20 April 2008Revised: 16 August 2008

Accepted: 2 November 2008

Original Article
mailto:[email protected]:[email protected]


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S. Golmohammad lou, A. Amirabi, M. Yazdian, N. Pashapour


been proposed to explain its occurrence.3

In spite of numerous studies, the etiology ofpre-eclampsia has not been fully elucidated.Some studies have concluded that changes inlevels of blood metals observed in pre-eclamptic patients may implicate the patho-

genesis of pre-eclampsia.4,5

Whereas, otherstudies have failed to show an association be-tween the serum concentrations of these ele-ments and occurrence of pre-eclampsia.

6,7

High rate of pre-eclampsia in developingcountries have forced some authors to con-clude that malnutrition is a risk factor in theetiology of pre-eclampsia and implicate it bydeficit intake of calcium and zinc.

8

On the basis of some studies claim thatblood calcium and magnesium have a relaxanteffect on the blood vessels of pregnantwomen,

1we tried to find out whether there is a

correlation between pre-eclampsia and theserum levels of calcium, magnesium, and cop-per in pregnant women. This was done bymeasuring the blood concentrations of calcium,magnesium, copper, and zinc in primigravidpre-eclamptic women and comparing themwith matched normotensive pregnant women.This is the first study that measures serumconcentrations of four elements simultaneouslyin pre-eclamptic women.

Patients and Methods

The present study was approved by EthicalCommittee of Uromiyeh University of MedicalSciences. The study population was one hun-dred and four primigravida women, in theirthird trimester with singleton pregnancies, ad-mitted to Kosar Obstetetrics hospital affiliatedto Uromiyeh University of Medical Sciences. Awritten informed consent was obtained fromthe participants in the study. Pre-eclampsiawas defined as new onset of hypertension after20 weeks of gestation with high systolic ( 140mmHg) and diastolic blood pressures (90mmHg) and proteinuria (300mg/24 h).

1Accord-

ing to previous studies that reported serummagnesium level of 0.670.05 and 0.70 0.06mmol/l for pre-eclampsia and normotensivegroups respectively, and consideringpower=80% and significant level=95%, 52pregnant women with pre-eclampsia and 52healthy normotensive pregnant women wereenrolled in the study. Inclusion criteria, basedon the maternal chronological age or gesta-tional age were; negative history of hyperten-sion or other diseases associated with hyper-tension and no taking diuretic or magnesium orother metal containing medications. At the timeof admission to the hospital, venous blood

samples were collected and their sera wereisolated by centrifugation and stored at 4-8Cuntil analysis.

Serum levels of calcium and magnesiumwere measured with Pars Azmoon kit usingauto analyser (Arsenazo method) and Chim

Azmoon kit using photometric (Xylidl bluemethod) respectively. Serum concentrations ofzinc and copper were measured by colorimet-ric method using Randox kit (Randox, UK).

Statistical AnalysisData were presented as mean SD. Com-

parison of serum levels of the elements be-tween the two groups was performed by Stu-dents t test and P


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Evaluation of calcium, magnesium, copper and zinc levels in pre-eclampsia


BMI.9

However, in the present study, BMI ex-cluded as a cause of pre-eclampsia.

In many studies, decrease in serum magne-sium levels has been considered as the cause ofpathogenesis of pre-eclampsia.

10Serum copper,

zinc, calcium and magnesium levels have beencompared between pre-eclamptic and healthypregnant women in various studies. Some resultsshowed that copper, zinc, and calcium levelswere significantly lower in pre-eclamptic patient,whereas magnesium concentrations showed nosignificant differences between the two groups.

11

Magri et al. did not find a relationship betweenthe serum levels of calcium, magnesium, andzinc and gestational hypertension, therefore, theyproposed that these elements might not clinicallyparticipate in the pathogenesis of the gestationalhypertension.

12

The results of the present study showed nosignificant differences in the serum levels ofcalcium (P=0.27), magnesium (P=0.75), cop-per (0.47), and zinc (P=0.78) between pre-eclampsia group and healthy pregnant indi-viduals, which is compatible with the findings in

another study.

12

Richard et al. showed thatthere was not any difference in the serum levelof ionized calcium between pregnancy-inducedhypertension and normal pregnant women.

13

Magnesium sulfate is used for treatment ofseizure and prophylaxis in women with eclamp-sia and pre-eclampsia worldwide. Magnesiummay act by opposing calcium - dependent arterialconstriction and may also antagonize the in-crease in intracellular calcium concentration.

13

Aali et al. rejected this idea that magnesium ex-erts its effect in pre-eclampsia by modulatingserum level of ionized calcium.

14

Dietary calcium deficiency has been pro-posed as a possible cause of pre-eclampsia. Ina prospective study, researchers administeredtwo grams of elemental calcium in women after13 21 weeks of pregnancy to assess the roleof calcium for preventing preeclampsia. Theresults of that study showed that calcium sup-plementation during pregnancy did not preventpre-eclampsia in healthy nullipara women.

15

Conclusion

The mean serum levels of calcium, magne-

sium, copper and zinc between the two groups

were not significantly different. For defining therole of serum electrolytes in pre-eclampsiamore research is necessary. The results of thepresent study showed that these elements didnot play a prominent role in the pathogenesisof pre-eclampsia.

Acknowledgment

Authors would like to thank Dr. Khalkhali and Dr.Nemati who assisted in all stages of the study.

Conflict of Interest: None declared

References

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3 Solmon CG, Seely EW. Preeclampsia-searching for the cause. N Engl J Med2004; 350: 641-2.

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5 Bringman J, Gibbs C, Ahokas R, et al. Dif-ferences in serum calcium and magnesiumbetween gravidas with severe preeclamp-sia and normotensive controls. AmericanJournal of Obstetrics and Gynecology2006; 195: s148.

6 Gabbe SG, Niebyl JR, Simpson JL. Nor-mal and problem pregnancy. 4ed Philadel-phia, Churchil Liv ingstone 2002. p. 593-4.

7 Cunningham FG, Leveno KJ, Bloom SL,Hauth JC, Gilstrap LC, Wenstrom KD. Textbook of Williams obstetrics at Hypertensivedisorder in pregnancy 22th ed.New york.McGraw-Hill 2005. p. 774.

8 Caughey AB, Stotland NE, WashingtonAE, Escobar GJ. Maternal ethnicity, pater-nal ethnicity, and parental ethnic discor-dance: predictors of preeclampsia. ObstetGynecol2005; 106: 156-61.

9 Pipkin FB. Risk Factors for Preeclampsia.

Table 2: Comparison of the serum concentrations of four elements in pre-eclampsia and control groups.

Patients (n=52) Controls (n=52) P value

Calcium (mg/dl ) 8.700.58 8.970.49 0.27Magnesium (mg/dl) 1.900.26 1.90.24 0.75Copper (mg/dl) 21.402.32 212.60 0.47Zinc (mg/dl) 12.913.01 13.073.20 0.78


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S. Golmohammad lou, A. Amirabi, M. Yazdian, N. Pashapour


N Engl J Med2001; 344: 925-6.10 Adam B, Malatyaliolu E, Alvur M, Talu C.

Magnesium, zinc and iron levels in pre-eclampsia. J Matern Fetal Med 2001; 10:

246-50.11 Kumru S, Aydin S, Simsek M, et al.Com-

parison of serum copper, zinc, calcium,and magnesium levels in preeclamptic andhealthy pregnant women. Biol Trace ElemRes 2003; 94: 105-12.

12 Magri J, Sammut M, Savon C. lead andother metals in gestational hypertension.Int J Gynaecol Obstet2003; 83: 29-36.

13 Richard SR, Nelson DM, Zuspan FP. Cal-cium levels in normal and hypertensivepregnant patients. Am J Obstet Gynecol1984: 149: 168-71.

14 Aali S, Khazaeli P, Ghasemi F, Mehdi-zadeh A. Serum magnesium and calcium

ions in patients with severe preeclamp-sia/eclamsia undergoing magnesium sul-fate therapy. Med Sci Monit 2007; 13:191-4.

15 Levine RJ, Hauth JC, Curet LB, Siabi BM,et al. Trial of calcium to prevent pree-clampsia. N Engl J Med1997; 337: 69-76.

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