Plasma Proteins in Toxemias of Pregnancy - Book Report/Review Example

? PLASMA PROTEINS IN TOXEMIAS OF PREGNANCY (A Journal Article Review) PSY 256 of (affiliation) Date of Submission: Introduction This paper is an article review of a research study conducted by Mack et al. that further investigated the possible causal relationship between disturbances in protein metabolism during late pregnancy (usually at the last trimester) that manifests as toxemias and evidenced by onset of pre-eclampsia and eclampsia because of derangements in blood protein composition. Results of their study entitled as “Plasma Proteins in Toxemias of Pregnancy” was first published in the prestigious peer-reviewed The Journal of Clinical Investigation on April 2, 1951. Based on their results, it is not very clear yet whether protein deficiency is the real cause of toxemia or if there are still other unidentified and elusive “toxic factors” such as higher tissue requirements for the proteins during pregnancy or interference with the absorption and uptake of protein intake. Their hypothesis was to determine the possible or probable factors of toxemia, and its manifestations in pregnant women, by studying the blood proteins of normal pregnant women and those of pregnant women who suffered mild eclampsia, severe pre-eclampsia, and eclampsia prior to actual delivery. The difficulty in the research study was how to separate various factors which could possibly be contributory to toxemia and eclampsia in some pregnant women while others did not suffer the same symptoms and manifestations. The main method utilized for this blood proteins analysis was electrophoresis, which is the process of using an electric field to look at the motion behavior of dispersed particles within a fluid, depending on their electric charge (if positively- or negatively-charged). The researchers chose to conduct their experiment with their expectations of separating the confounding factors associated with toxemia and eclampsia, as the serious ailment of eclampsia has been attributed to a good number of conflicting theories. Discussion The researchers utilized the blood samples of 29 private clinic patients using the newer electrophoresis techniques; all the members of that sampling were selected due to development of toxemia during their last trimester of pregnancy. Patient history, physical examination results, and blood protein samples were analyzed for the purpose of comparing the results with another control group, which are pregnant women who did not develop toxemia or eclampsia, and also with another control group, which are women who were not pregnant (Mack et al., 1951, p. 610). Women who had toxemias during pregnancy were studied up to eight weeks postpartum. The laboratory results obtained indicated the mean concentrations of total proteins in the blood plasma including that of albumin, beta and gamma globulins of the women who developed pre-eclampsia and eclampsia tended to be lower when compared to values in a normal pregnancy (ibid. p. 611) but the other globulin fractions in blood plasma tended to be higher instead. This is contrasted with the mean values of fibrinogen for normal pregnancy in the third trimester, where these values were found to be much higher than the average for non-pregnant women. Both chemical analysis and electrophoresis determination indicated that a rising toxemic level is associated with a decline in the fibrin levels, a leading indicator of eclampsia. However, these results are somewhat confusing, because like in the case of three patients who developed a severe case of pre-eclampsia, their plasma fibrinogen levels were found to be lower compared to women who had normal pregnancies, but still this lowered level is still not significantly lower to mean values. These three exceptional cases led to premature placental separation (or spontaneous abortion) pointing to increased hypo-proteinemia as a possible cause for toxemic pregnancies. In the study, the dependent variable is the level of toxemia in pre-eclampsia and also in eclampsia cases of some pregnant women (especially those in primigravida or first pregnancies), while the independent variables are the various blood proteins found in plasma. With the results obtained so far in their study, the correlation could be considered as the weak type, because there is no definitive, conclusive evidence to show what causes toxemia based on blood protein levels. This was shown in the mean levels wherein some women who had normal pregnancies showed no significant variations compared to those women who had complicated toxemic pregnancies. The results of the study were inconclusive at best, because what the results indicated are only the indications of lowered protein levels were precursors to pre-eclampsia and eclampsia, but not the real physiologic processes which are actually contributory or causes of the conditions. In other words, what the study showed was only how lower blood plasma proteins tend to cause toxemia, which in turn can lead to pre-eclampsia and eclampsia, but not the actual explanation of how this occurs in terms of physiologic, biological, or chemical processes within the body. This could be partly due to the failure of the researchers to isolate certain factors to be designated as the independent variables, plus the relatively small size of their sample group (29 only). The study authors themselves had acknowledged how other conditions such as diabetes, renal diseases, liver ailments, hypertension, obesity, heart conditions, etc. can affect significantly the blood plasma protein levels in patients who have normal or complicated pregnancies. Even a review of extant medical literature will indicate an established relationship between toxemia and disturbed or abnormal protein metabolism but not directly linked to pre-eclampsia and eclampsia while a toxic type of protein (an atypical euglobulin) had been suspected but not proven yet. The researchers specifically studied the mean values and ranges of concentrations in the total protein and protein fractions in the blood plasma before delivery, during birth, and in then in the postpartum period of up to eight weeks. Data obtained is considered as devoid or lacking in any undue influence caused by any medication or therapy prior to the taking of blood samples. The data pertains to the 29 women in the sample group, and then this was compared to women who had normal pregnancies and also to women who were not pregnant at all. In particular, their data on blood protein levels during toxemias in pregnancies focused on two trends observed in an altered physiological functioning: to that of women who had uncomplicated or normal pregnancies and to healthy and normal women who are presently not pregnant at all. This particular research study is merely an approximation or proxy of the suspected or other causative factors inducing toxemia and hypoproteinemia, because most previous studies on the same subject did not properly classify toxemia in terms of clinical types nor their level of the toxemia observed. In short, it is hard to make a direct comparison of the study results with that of previous studies on the same medical issue, although a rough approximation could be made. This is evidenced by the observation that a return to normalcy is attained by most women who had an uncomplicated pregnancy between six to eight weeks after giving birth when compared to levels of blood plasma proteins in women who were healthy but not pregnant (ibid.) but this compares to an entirely different observation for women who had toxemia while pregnant, in which their observed blood protein levels returned only to normal after a period extending beyond the eight weeks observation period in the study (ibid. p. 615). The shorter observation period affects study results, in the sense that adequacy of control data obtained was not very reliable or credible. What caught my interest in this journal article is that eclampsia affects a lot of pregnant women, and very little is understood about this life-threatening and acute condition despite all the efforts made towards its prevention. It is characterized by hypertension and proteinuria (the medical term for an abnormal level of proteins in the urine, making it foamy in appearance) prior to the onset of actual eclampsia, which is in turn characterized by seizures and convulsions. This condition threatens not only the expectant mother but also compromises the fetus because it can lead to fetal distress, placental bleeding, and if not controlled immediately, eventual abortion. What makes this unusual condition interesting is it affects only some pregnant women, usually in the last trimester (with a predilection for primigravida) while some women are quite normal. It puzzles the mind why this is so, with a number of possible pathophysiological theories being put forward to explain it and perhaps offer probable solutions and preventive measures. Pre-eclampsia and eclampsia show the signs and symptoms of toxemia, such as hypertension, renal dysfunction, pulmonary edema, hepatic malfunction, and cerebral dysfunction leading to coma. In some instances, women who have eclamptogenic conditions suffer temporary blindness and a coma could occur without any warning of the aforementioned signs whatsoever. Although there is a familial or genetic link to eclampsia, other risk factors include that of a history of hypertension, obesity, poor nutrition, high proportion of body fat, and poor blood flow to uterus and placenta (Nihira, 2012, para. 5) in addition to diabetes, rheumatoid arthritis and kidney disease. There is no known cure for eclampsia because its etiology or exact causes are unknown; if detected early enough, it can be managed by the use of magnesium sulfate. The best chance for mother and fetus is to seek immediate professional help if symptoms show up. Due to advances in medical knowledge, pre-eclampsia and eclampsia now happen most often during the postpartum period (usually within 48 hours but can develop even up to the sixth week postpartum), because it is managed by the use of magnesium sulfate and other medications during labor and delivery (Hayes, 2013, para. 7). An only known “remedy or cure” for eclampsia is delivery, if the baby is already full term (at 37 weeks of gestation) or it can delivered caesarian section if premature but viable. If not, then bed rest and steroids are highly recommended. Conclusion The research study is significant because eclampsia (previously known as toxemia) can be a silent killer, because there are cases where no symptoms or manifestations show up but the pregnant woman suddenly suffers seizures and convulsions, leading to brain damage, stroke, or even coma and death. It is therefore very important to have regular check ups in both urine and blood pressure to detect early if there are unusual protein concentrations in the urine or blood. It is not very surprising the research findings are not conclusive, because eclampsia has refused to yield its secrets pertaining to its etiology despite several decades of meticulous research. A promising avenue is genetic research, because it offers the best possible way to find out the genetic causes of eclampsia, through differentially expressed genes, which is essentially a pregnancy-related ailment or disorder but not related to any known preexisting organic origins. A meta-study of 1,068 previous research studies that performed gene expression analyses of tissues in the placenta indicated some 40 annotated genes which could identify a specific protein in the placental tissue which can serve as a good diagnostic bio-marker of eclampsia (Kleinrouweler et al., 2013, para. 4); this approach is similar to cancer research in the search for a genetic cure. References Hayes, A. (2013, January 29). “Eclampsia: 5 things you need to know.” CNN. Retrieved on July 23, 2013 from http://edition.cnn.com/2013/01/28/health/eclampsia-5-things Kleinrouweler, C. E., van Uitert, M., Moerland, P. D., Ris-Stalpers, C., van der Post, J. A., & Afink, G. B. (2013, July 12). Differentially-expressed genes in the pre-eclamptic placenta: A systematic review and meta-analysis. PLoS One, 8(7). doi: 10.1371/journal.pone.0068991. Mack, H. C., Robinson, A. R., Wiseman, M. E., Schoeb, E. J., & Macy, I G. (1951, April 2). Plasma proteins in toxemias of pregnancy. The Journal of Clinical Investigation, 609-615. Nihira, M. A. (2012, August 19). “Health and pregnancy: Pre-eclampsia and eclampsia.” WebMD. Retrieved on July 22, 2013 from http://www.webmd.com/baby/guide/preeclampsia-eclampsia Read More