Nitric oxide and pre-eclampsia: A comparative study in Ghana

  • Open Access Macedonian Journal of Medical Sciences, Volume 6, No. 6, Year 2018

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Study Justification:
– Preeclampsia is a leading cause of fetal and maternal mortality and morbidity.
– The etiology of preeclampsia is still unknown, with various theories lacking conclusive evidence.
– Recent studies suggest a possible involvement of nitric oxide and vascular endothelial dysfunction in preeclampsia.
– This study aims to compare plasma nitric oxide levels in pre-eclamptic and healthy pregnant women in Ghana.
Study Highlights:
– Case-control study conducted at Korle-Bu Teaching Hospital in Ghana.
– 30 pre-eclamptic and 30 healthy pregnant women aged 18-35 years with over 30 weeks’ gestation were recruited.
– Plasma nitric oxide levels were determined using the Griess Reagent system.
– Statistical analysis was performed using SPSS software version 20.0.
– Results showed no statistically significant difference in plasma nitric oxide levels between pre-eclamptic and healthy pregnant women.
– Parity and body mass index (BMI) were similar between the two groups, but blood pressure differed significantly.
Recommendations for Lay Reader and Policy Maker:
– Plasma nitric oxide levels may not play a significant role in the etiology of pre-eclampsia.
– Further research is needed to explore other potential factors contributing to the development of pre-eclampsia.
– Policy makers should consider funding additional studies to investigate alternative mechanisms and risk factors for pre-eclampsia.
– Lay readers should be aware that this study provides valuable insights into the understanding of pre-eclampsia but does not provide definitive answers.
Key Role Players:
– Researchers and scientists specializing in obstetrics and gynecology.
– Medical professionals, including doctors, nurses, and midwives.
– Ethical and Protocol Review Committee of the University of Ghana School of Medicine and Dentistry.
– Management of Korle-Bu Teaching Hospital.
– Head of Obstetrics and Gynecology department at Korle-Bu Teaching Hospital.
Cost Items for Planning Recommendations:
– Research funding for additional studies.
– Salaries and wages for researchers, doctors, nurses, and midwives involved in the research.
– Laboratory equipment and supplies for conducting the study.
– Data analysis software and tools.
– Ethical approval and protocol review processes.
– Administrative and logistical support for managing the study.
– Publication and dissemination of research findings.

The strength of evidence for this abstract is 6 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is a case-control study, which is generally considered to provide moderate evidence. The sample size is relatively small, with only 30 pre-eclamptic and 30 healthy pregnant women included in the study. Additionally, the study only compares plasma nitric oxide levels between the two groups and does not investigate other potential factors contributing to pre-eclampsia. To improve the strength of the evidence, a larger sample size could be used to increase statistical power. Additionally, including a control group of non-pregnant women or women with other pregnancy complications could provide a better comparison. Finally, conducting a multivariate analysis to control for potential confounding factors would strengthen the findings.

BACKGROUND: Preeclampsia is one of the commonest aetiologies of foetal and maternal mortality and morbidity. Though common, the aetiology of preeclampsia has remained unknown with several inconclusive theories surrounding the disease. Recent studies have implicated vascular endothelial dysfunction and possibly nitric oxide in preeclampsia. AIM: To compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in a large tertiary hospital in Ghana. METHODS: This was a case-control study conducted among pre-eclampsia and healthy pregnant women in Korle-Bu Teaching Hospital over a four-month period. Thirty (30) pre-eclamptic and 30 healthy pregnant women aged 18-35 years with over 30 weeks’ gestation were consecutively recruited into the study after obtaining informed consent. Plasma nitric oxide levels were determined using the Griess Reagent system. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and results were compared using the independent t-test. A P-value of ≤ 0.05 was considered statistically significant. RESULTS: The parity and body mass index (BMI) of the participants were similar. There was a significant difference in the blood pressure of the pre-eclamptic compared to healthy pregnant women. There was no statistically significant difference (P-value = 0.160) in the plasma levels of nitric oxide in pre-eclamptic (Mean = 1178.78; SD = 89.70 nM) compared to healthy pregnant women (Mean = 1365.43; SD = 95.46 nM). CONCLUSION: Plasma nitric oxide levels may not play a significant role in the aetiology of pre-eclampsia.

This was a case-control study undertaken at the Korle-Bu Teaching Hospital (KBTH), Ghana between March and June 2016. The study was conducted at the Korle-Bu Teaching Hospital, the premiere Teaching Hospital and the largest tertiary hospital affiliated with the University of Ghana School of Medicine and Dentistry. The 2000 bed capacity hospital has a 350 bed capacity with 3 operating theatre suites obstetrics and gynaecology department. The department has 65 doctors, 200 nurses and midwives, with a daily antenatal attendance of 100 patients, and a total annual delivery of between 10,000 and 12,000. Ethical Approval for the study was obtained from the Ethical and Protocol Review Committee of University of Ghana School of Medicine and Dentistry (Protocol Identification Number: CHS-Et/M.4-P4.5/2015-2016). Clearance was also received from the Management of the Korle-Bu Teaching Hospital and Head of Obstetrics and Gynaecology department where the study was conducted. The study population included third-trimester healthy pregnant women and pre-eclamptics aged 18-35 years attending the obstetrics and gynaecology clinic at the Korle-Bu Teaching Hospital. Patients not eligible for inclusion were: Pre-eclampsia was diagnosed using the onset of hypertension after 20 weeks of gestation with blood pressure > 140/90 mmHg measured on two separate occasions with the coexistence of proteinuria of at least 2+ on dipstick [13]. The plasma nitric oxide level for healthy pregnant women and pre-eclamptics has been found to be 63.8 and 73.3 μmol/l respectively [14], with a mean difference (d) of 9.5 μmol/l. Using the formula by Charan and Biswas [15], sixty (60) pregnant women in their third trimester (gestation > 30 weeks), consisting of 30 pre-eclamptic as cases and 30 healthy pregnant women as controls were recruited consecutively into the study after obtaining informed consent. The participants were interviewed using a structured questionnaire to obtain their demographic characteristics after signing an informed consent form. The information collected included their age, parity and gestational age. Participants subsequently had their weight and height measured using mechanical patient weighing scale with height rod (Product: 6003, Italy). Three ml of blood was drawn from the cubital vein using a sterile 19G hypodermic needle fixed on a 5 ml syringe after cleansing the site to be punctured with methylated spirit. Aseptic conditions were adhered to. The blood sample was transferred into a sodium ethylenediamine tetraacetate (Na EDTA) test tube and prevented from clotting by gently inverting the tube 4 times manually. Nitric oxide levels were assessed in the plasma samples using the Griess Reagent system (Promega, Madison, USA). The assay relies on a diazotisation reaction that was originally described by Griess in 1879. Patients’ age, weight, height, parity, BMI and plasma nitric oxide levels were entered into Microsoft® Access database 2010 (Microsoft® USA), and analysis was done using statistical package for social science (SPSS®) software version 20.0. The age, BMI and parity of participants, were presented as means (standard deviations) in a tabular form. The plasma nitric oxide levels between the two groups were presented in a bar chart. Independent t-test was employed to compare the difference between the mean plasma nitric oxide level of pre-eclamptic and healthy pregnant women. A p-value ≤ 0.05 was considered statistically significant.

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Based on the information provided, it appears that the study aimed to compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in Ghana. The study found no statistically significant difference in the plasma levels of nitric oxide between the two groups.

In terms of potential innovations to improve access to maternal health, here are a few recommendations:

1. Telemedicine: Implementing telemedicine services can help improve access to maternal health by allowing pregnant women in remote or underserved areas to consult with healthcare professionals remotely. This can help overcome geographical barriers and provide timely medical advice and support.

2. Mobile health (mHealth) applications: Developing mobile applications specifically designed for maternal health can provide pregnant women with access to important information, resources, and tools. These apps can offer features such as tracking pregnancy progress, providing educational content, and sending reminders for prenatal care appointments.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services and education in underserved areas can help improve access to care. These workers can conduct prenatal visits, provide health education, and assist with referrals to higher-level healthcare facilities when necessary.

4. Mobile clinics: Establishing mobile clinics that travel to remote or underserved areas can bring essential maternal health services directly to the communities that need them. These clinics can offer prenatal care, screenings, vaccinations, and other necessary interventions.

5. Public-private partnerships: Collaborating with private sector organizations, such as pharmaceutical companies or technology companies, can help leverage resources and expertise to improve access to maternal health. These partnerships can support initiatives such as providing affordable medications, developing innovative technologies, or funding community outreach programs.

It’s important to note that these recommendations are general and may need to be adapted to the specific context and needs of Ghana’s healthcare system.
AI Innovations Description
The study titled “Nitric oxide and pre-eclampsia: A comparative study in Ghana” aimed to compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in a large tertiary hospital in Ghana. The study was conducted at the Korle-Bu Teaching Hospital, which is the largest tertiary hospital affiliated with the University of Ghana School of Medicine and Dentistry.

The study included 30 pre-eclamptic women and 30 healthy pregnant women aged 18-35 years with over 30 weeks’ gestation. Plasma nitric oxide levels were determined using the Griess Reagent system. The results showed that there was no statistically significant difference in the plasma levels of nitric oxide between pre-eclamptic and healthy pregnant women.

Based on the findings of this study, it can be concluded that plasma nitric oxide levels may not play a significant role in the etiology of pre-eclampsia. However, further research is needed to explore other potential factors contributing to the development of pre-eclampsia.

In terms of recommendations for developing innovations to improve access to maternal health, this study provides valuable information that can contribute to the overall understanding of pre-eclampsia. It highlights the need for continued research and exploration of other potential factors involved in the development of pre-eclampsia. This can help in the development of new interventions and strategies to prevent and manage pre-eclampsia, ultimately improving maternal health outcomes.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations for improving access to maternal health:

1. Increase awareness and education: Implement comprehensive education programs to raise awareness about maternal health, including the risk factors and symptoms of conditions like pre-eclampsia. This can be done through community outreach programs, antenatal classes, and partnerships with local healthcare providers.

2. Strengthen healthcare infrastructure: Invest in improving the capacity and resources of healthcare facilities, particularly in rural areas where access to maternal health services may be limited. This can include upgrading equipment, training healthcare professionals, and ensuring the availability of essential medications and supplies.

3. Enhance antenatal care services: Develop and implement standardized protocols for antenatal care that include regular monitoring of blood pressure and proteinuria to detect and manage conditions like pre-eclampsia. This can help in early detection and timely intervention.

4. Improve transportation and referral systems: Establish efficient transportation systems and referral networks to ensure that pregnant women with complications can access higher-level healthcare facilities in a timely manner. This can involve partnerships with local transportation providers and the establishment of clear referral pathways.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the number of women receiving antenatal care, the percentage of women with timely access to emergency obstetric care, or the reduction in maternal mortality rates.

2. Collect baseline data: Gather data on the current state of maternal health access, including the number of women accessing antenatal care, the availability of healthcare facilities, and the transportation infrastructure.

3. Develop a simulation model: Create a simulation model that incorporates the recommendations and their potential impact on the defined indicators. This model can be based on existing data, expert opinions, and evidence from similar interventions.

4. Run simulations: Use the simulation model to run different scenarios, varying the implementation of the recommendations and assessing their impact on the defined indicators. This can help identify the most effective strategies and their potential outcomes.

5. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This can include quantifying the expected changes in the defined indicators and assessing the cost-effectiveness of the interventions.

6. Refine and validate the model: Continuously refine and validate the simulation model based on new data and feedback from stakeholders. This can help improve the accuracy and reliability of the simulations.

7. Communicate findings: Present the findings of the simulation study to relevant stakeholders, including policymakers, healthcare providers, and community members. This can help inform decision-making and facilitate the implementation of the recommendations.

It is important to note that the methodology described above is a general framework and can be adapted based on the specific context and resources available for the simulation study.


Statistics:
Citations: 6
Identifiers:
DOI: 10.3889/oamjms.2018.252
Research Areas:
Health System and Policy, Maternal and Child Health, Noncommunicable Diseases, Sexual and Reproductive Health, Social Determinants, Workforce
Study Countries:
Ghana
Study Design:
Case-Control Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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