IMMUNOGLOBULIN G AND COMPLEMENT C 3 LEVELS IN PREGNANCY INDUCED HYPERTENSION

IMMUNOGLOBULIN G AND
Pre-eclampsia has remained a 'dis-
COMPLEMENT C
ease of theories' and the possibility that
3 LEVELS IN
PREGNANCY INDUCED
immunological as well as endocrine and
genetic mechanisms are involved in the
HYPERTENSION
genesis of pre-eclampsia is intriguing.
Immunologic factors may play an
important role in the development of
pre-eclampsia. The phenomena in pre-
eclampsia include absence of blocking
antibodies, decreased cell-mediated im-
G.R. Ramdenee
mune responses, activation of neutro-
M. Matah
phils and involvement of cytokines(l).
B.D. Bhatia
Immunofluorescent studies have locali-
M.R. Sen
zed deposits of immunoglobulin and
S. Swain
complement in the glomeruli of pa-
tients. There also appears to be a certain
degree of hyperactivity in pre-eclamptic
patients, but it is not clear how this is
related to the etiology, severity or prog-
nosis of the disease. Several reports
ABSTRACT
describe the level of activity of various
immunoglobulins and complement fac-
The immunoglobulin G (IgG) and comple-
tors in pre-eclampsia but the findings
ment C3 (C}) were measured in the maternal as
are conflicnng(2). The present study
well cord Hood sera of 30 cases of pregnancy
was an endeavour to estimate IgG and
induced hypertension (PIH) as well as 9 controls
C
with nortnotensive pregnancy. A depression of
3 levels in maternal and cord serum in
IgG as well as C
cases with pregnancy induced hyperten-
3 level was observed in the
maternal as well as cord sera of the mothers with
sion (PIH) with particular reference to
PIH. These findings suggest decreased immuno-
gestation and intrauterine growth status
logical status of both mother and her offspring in
of offsprings, severity of hypertension
PIH, irrespective of the gestation and intraute-
and presence of convulsions.
rine growth status.
Material and Methods
Key words: Immunoglobulin, Complement,
Toxemia of pregnancy, Pregnancy
Thirty consecutive cases with PIH
induced hypertension.
without any other complication and
nine normotensive uncomplicated preg-
From the Departments of Obstetrics and Gyne-
cology. Pediatrics and Microbiology, Insti-
nancy controls were recruited from the
tute of Medical Sciences, Banaras Hindu
Labor Ward of the University Hospitals,
University, Varanasi 221 005.
Banaras Hindu University, Varanasi.
Reprint requests: Dr. Sahadev Swain, Assistant
The newborns having congenital
Professor, Department of Obstetrics and
Gynecology, J1PMER, Pondicherry 605 006.
malformation, intrauterine infection or
intrauterine death were excluded from
Received for publication: October 25, 1993;
Accepted: May 12,1994
the study. The gestation was calculated

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RAMDENEE ET AL.
IgG&C3IN PIH
by enquiring into the first day of induced hypertension which included
mother's last menstrual period and was
11 cases of pre-eclampsia and 19 cases
confirmed subsequently by Dubowitz's
with eclampsia. With respect to intra-
criteria(3). The newborns were classified
uterine growth status of newborns, 15
as regards their intrauterine growth were Term-Appropriate for gestational
status using the standard curve for the
age (Term-AGA: between 10th to 90th
local population(4). Paired cord and percentile), 8 Term-Intrauterine Growth
maternal blood samples were collected
Retarded (Term-IUGR: less than 10th
aseptically in sterile test tubes and percentile) and 7 were preterm (less
allowed to clot at room temperature for
than 37 weeks) gestation. The nine
30 minutes. The serum was separated
uncomplicated pregnant women and
by centrifuging at 1500 rpm for 3 minu-
their normal offsprings at term and ap-
tes. All sera were stored at —20°C after
propriate for gestational age constituted
adding 0.1 ml of 0.1% sodium azide.
the controls.
The Solugen plates (obtained from
Immunodiag-nostic Pvt. Ltd., New Immunoglobulin G Levels
Delhi) were used for estimation of IgG
The levels of mean immunoglobulin
and C
G and complements C
3. The reference standard for IgG
3 in the maternal
was 14.5 mg/ml and the same for C
and cord sera in cases with PIH as well
3
was 0.9 mg/ml. Estimation of serum im-
as normotensive pregnant women who
munoglobulin G (IgG) and C
delivered term appropriate for gesta-
3 comple-
ment were carried out by Mancini's tional age newborns are depicted in
(modified by Fahey) radial diffusion Table I. The IgG level in both maternal
method(7,8).
and cord sera were lower in the cases
complicated with PIH when compared
Results
to normotensive controls.
There were 30 cases with pregnancy
As it is evident from the data in Table

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II, no statistically significant difference
pre-eclamptics (1150 mg/dl and 306
was observed in the mean maternal IgG
mg/dl, respectively).
levels in relation to severity of the PIH
as judged by increasing diastolic blood
Complement C3 Levels
pressure. The cord serum IgG levels
The means for maternal C
was lower if diastolic blood pressure
3 levels
were lower in PIH as compared to the
was more than 110 mm Hg, but this dif-
controls in mothers delivering fullterm
ference was not statistically significant.
appropriate for gestational age. Though
When the maternal and cord sera
the means for cord C3 levels were higher
IgG values were compared between the
in PIH cases as compared to controls the
cases of pre-eclampsia and eclampsia at
difference was not statistically signifi-
various intrauterine growth status of
cant (Table I). There was no differences
the neonates it was observed that there
in the means of maternal C3 levels in
was no statistically significant difference
relation to increasing diastolic blood
in relation to presence of convulsion in
pressure in mothers with pregnancy in-
Term-AGA and Term-IUGR subgroups.
duced hypertension. However, cord se-
However, in preterm groups the mater-
rum C3 levels was significantly low if
nal and cord IgG levels were lower in
the maternal diastolic blood pressure
eclamptic mothers (682.5 mg/dl and 975
was more than 110 mm Hg compared to
mg/dl, respectively) when compared to
the other two groups (Table IT).
181

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RAMDENEE ET AL.
IgG & C3, IN PIH
When maternal and cord C3 serum serum IgG levels have been attributed
levels were compared in relation to to very selective active transplacental
eclamptic and pre-eclamptic mothers, process called pinocytosis involving
there was no significant difference in the
the Fc fragment of IgG mole-
Term-AGA group. But in the Term-
cule(8,12,13).
IUGR groups and preterm groups there
It was further noted that in
was a significant rise in the maternal C3
eclamptic patients, cord serum IgG
serum levels of the eclamptic mothers,
levels did not differ significantly in
when compared to non-eclamptics. fullterm appropriate for gestational age
Similarly, there was no statistically sig-
and fullterm intrauterine growth retar-
nificant difference in the cord serum C3
dation. However, in preterm babies the
levels of the babies born to mothers with
maternal and cord IgG serum levels
eclampsia and pre-eclampsia in relation
were significantly low amongst
to any of the three subgroups of intra-
eclamptic mothers. However, it has
uterine growth status. However, the been reported by earlier studies that
maternal C3 level was higher in there is a significant lower level of IgG
eclamptic mothers in the term-IUGR
in the cord blood of preterm babies and
and preterm subgroups (66.3 mg/dl and
the possible explanation could be imma-
59.2 mg/dl, respectively) when com-
ture liver functions in preterms and in-
pared to the pre-eclamptic mothers (60.0
adequate transfer of IgG across the pla-
mg/dl and 54.5 mg/dl, respectively).
centa(16,17).
Discussion
Complement levels in toxemia of
The observation in the present study
pregnancy have been studied by many
clearly demonstrated decrease in mater-
investigators but no consistent results
nal and cord IgG serum levels in PIH
have been obtained. Some showed de-
when compared to mothers without creased complement, others could not
toxemia of pregnancy. Similar observa-
demonstrate the difference(7,11). In the
tions have been reported by earlier present study, a decrease was observed
studies(7-ll). The lower levels of mater-
in maternal serum C3'levels in term-
nal serum IgG in PIH probably suggests
AGA and term-IUGR as well as in
associated immunosuppression or could
preterm baby groups as compared to
be due to increased urinary losses of im-
the controls. On the other hand, the
munoglobulin specially the intermediate
cord serum C3 levels were higher in
group of macroglobulins or due to de-
fullterm appropriate gestational age and
pression of IgG synthesis or formations
preterm baby group of toxemia of preg-
of immune complexes(7,10,12,13).
nancy. However, there was no change in
fullterm intrauterine growth retardation
The cord serum IgG levels were low
group. No suitable explanation for the
as compared to maternal serum IgG lev-
above can be offered at this stage. The
els even in normotensive controls. Most
possible explanation could be that the
of the workers have reported higher chronic stress in toxemia of pregnancy
cord serum IgG levels as compared to
may stimulate fetal liver to synthesise
maternal serum IgG levels(14,15). High
more of the complement. Like the IgG
182

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INDIAN PEDIATRICS
VOLUME 32-FEBRUARY 1995
levels in relation to increase maternal
8. Bazaz-Malik G. Yadav R, Seghal H.
diastolic blood pressure levels, no sig-
Serum proteins and immunoglobulin
nificant alteration have been observed
in infancy and childhood. Indian J
in the C
Med Res 1980, 72: 860-863.
3 level. Similarly, in relation to
convulsions no significant changes were
9. Burdash NM," Blake JM, Hosier LL.
Immunoglobulin levels and liver func-
observed in the C3 level.
tion tests in normal and toxemic preg-
Thus, the findings of the present
nancies. Am J Obstet Gynecol 1975,
study clearly suggest decreased immu-
116: 827-830.

nological status of both mother and her
10. Studd JWW. Immunoglobulins in nor-
offspring in PIH, irrespective of the ges-
mal pregnancy, pre-eclampsia and
tation and intrauterine growth status
pregnancy complicated by the
nephrotic syndrome. J Obstet Gynecol
and hence need special attention.
Br CWlth 1971, 78: 786-790.
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