1.1 Introduction
Biochemical parameters refer to measurable indicators of biological processes within the body, including substances such as glucose, lipids, and renal function markers. These parameters are critical for assessing metabolic and physiological states, particularly in high-risk populations like pregnant women (Kumar et al., 2019). In pregnancy, biochemical changes are a natural occurrence due to the physiological adjustments the body undergoes to support fetal development. However, in the presence of comorbidities such as diabetes and hypertension, these changes can become more pronounced, potentially endangering both maternal and fetal health. Diabetes and hypertension, which are among the most common complications during pregnancy, have been associated with adverse outcomes, including pre-eclampsia, premature delivery, and increased risk of stillbirth. These conditions can alter critical biochemical parameters, including blood glucose levels, lipid profiles, and kidney function markers, which are essential in monitoring maternal health during pregnancy.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
In Nigeria, awareness of the impact of maternal conditions such as hypertension and diabetes on pregnancy outcomes grew as healthcare infrastructure improved, particularly with the establishment of referral hospitals in urban centers like Enugu State. These hospitals became critical centers for managing high-risk pregnancies, allowing for more focused research on the biochemical changes occurring in affected patients. The early 2000s saw an increase in studies aimed at understanding the metabolic and biochemical alterations associated with hypertensive disorders and diabetes in pregnant women in the Nigerian context (Anumba et al., 2001). These studies highlighted the need for routine biochemical monitoring, particularly in cases where both conditions were present, as the interaction between diabetes and hypertension significantly elevated the risk of complications.
In recent years, research has become more focused on specific biochemical markers, such as lipid profiles, renal function tests, and glucose metabolism, which are crucial for understanding the pathophysiology of these conditions in pregnancy. In Enugu State, several referral hospitals have served as important sites for studies aimed at determining the relationship between these biochemical parameters and pregnancy outcomes. The increased use of advanced diagnostic tools and biochemical assays has provided more precise data, contributing to the development of evidence-based guidelines for managing pregnant women with diabetes and hypertension (Eze, 2016).
Pregnancy is a complex physiological state that places significant demands on a woman's body, particularly in terms of metabolic, cardiovascular, and renal functions. In normal pregnancy, these physiological systems adapt to meet the increased needs of both the mother and the developing fetus. However, when conditions such as diabetes and hypertension are present, these adaptations can become dysregulated, leading to adverse maternal and fetal outcomes. Hypertensive disorders, including preeclampsia, affect up to 10% of pregnancies worldwide, while gestational diabetes mellitus (GDM) complicates around 7% of all pregnancies, making them significant public health concerns (American Diabetes Association, 2021).
Diabetes in pregnancy, particularly gestational diabetes and preexisting type 2 diabetes, alters glucose metabolism and insulin sensitivity, which can lead to hyperglycemia. This condition not only poses a risk to the mother but also increases the likelihood of fetal macrosomia, birth injuries, and neonatal hypoglycemia. On the other hand, hypertensive disorders, especially chronic hypertension and preeclampsia, are linked to placental dysfunction, restricted fetal growth, and increased risk of preterm birth (Kattah & Garovic, 2022). The combination of diabetes and hypertension further exacerbates these risks, emphasizing the need for careful monitoring of biochemical parameters in affected pregnancies.
Several biochemical markers are crucial in monitoring the health of diabetic and hypertensive pregnant women. These include blood glucose levels, renal function markers, lipid profiles, and electrolyte balance. Monitoring these parameters allows healthcare providers to assess the severity of the conditions and make informed decisions regarding treatment and management (Oyelese & Smulian, 2020). in the context of Enugu State, referral hospitals play a critical role in managing high-risk pregnancies, offering specialized care for women with diabetes and hypertension.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to determine some biochemical parameters in diabetic and hypertensive pregnant subjects in some referral hospitals.
1.3 Statement of Problems
Investigation revealed that the prevalence of diabetes and hypertension among pregnant women in Nigeria, particularly in Enugu State, is a significant public health concern. These conditions pose substantial risks to both maternal and fetal health, often leading to complications such as preeclampsia, preterm birth, and fetal growth restriction. Despite the known dangers, there is often insufficient monitoring and evaluation of key biochemical parameters in diabetic and hypertensive pregnant women. The lack of regular assessment is leading to delayed diagnosis and suboptimal management of these conditions, resulting in preventable adverse outcomes (Ezugwu et al., 2018).
Additionally, inadequate resources and the absence of standardized protocols for biochemical monitoring in referral hospitals is a barrier to effective healthcare delivery. These hospitals, which cater to high-risk pregnancies, often face challenges in consistently evaluating biochemical markers such as blood glucose, lipid profiles, and renal function. This insufficiency is contributing to the worsening of maternal and fetal health, as healthcare providers are unable to make timely interventions based on biochemical data (Ikechebelu & Okeke, 2020).
Furthermore, the interaction between diabetes and hypertension in pregnancy is poorly understood in the local context, particularly in how it influences biochemical changes and pregnancy outcomes. There is a gap in localized research that examines how these conditions affect pregnant women in Enugu State, where environmental and genetic factors might influence the progression of disease and response to treatment. Without detailed knowledge of these biochemical parameters, it is challenging to develop appropriate management strategies that could mitigate the risks associated with these conditions (Okafor et al., 2021). It is against the backdrop that this study seeks to address these problems by evaluating the some biochemical parameters in diabetic and hypertensive pregnant subjects.
1.4 Aim and Objectives of Study
The aim of the study is to determine specific biochemical parameters in diabetic and hypertensive pregnant subjects in selected referral hospitals in Enugu State. In achieving this aim, the following specific objectives were laid out as follows:
- To assess the blood glucose levels in diabetic and hypertensive pregnant women attending referral hospitals in Enugu State.
- To evaluate renal function markers, such as creatinine and urea levels, in diabetic and hypertensive pregnant women.
- To determine the lipid profiles of pregnant women diagnosed with diabetes and hypertension.
- To investigate the relationship between these biochemical parameters and pregnancy outcomes, including preeclampsia, preterm birth, and fetal growth restriction.
- To provide recommendations for the clinical management of diabetic and hypertensive pregnancies based on the observed biochemical changes.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What are the typical blood glucose levels in diabetic and hypertensive pregnant women attending referral hospitals in Enugu State?
- How do renal function markers, such as creatinine and urea, differ in diabetic and hypertensive pregnant women compared to non-complicated pregnancies?
- What are the variations in lipid profiles among pregnant women diagnosed with diabetes and hypertension?
- How do the identified biochemical parameters correlate with pregnancy outcomes like preeclampsia, preterm birth, and fetal growth restriction?
- What clinical recommendations can be made based on the observed biochemical changes in diabetic and hypertensive pregnant women?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- Null Hypothesis (H₀): There is no significant difference in the biochemical parameters (blood glucose levels, renal function markers, and lipid profiles) between diabetic and hypertensive pregnant women and non-complicated pregnancies in the referral hospitals in Enugu State.
- Alternative Hypothesis (H₁): There is a significant difference in the biochemical parameters (blood glucose levels, renal function markers, and lipid profiles) between diabetic and hypertensive pregnant women and non-complicated pregnancies in the referral hospitals in Enugu State.
Hypothesis Two
- Null Hypothesis (H0): Diabetic and hypertensive pregnant women in Enugu State do not exhibit abnormal lipid profiles compared to healthy pregnant women.
- Alternative Hypothesis (H1): Diabetic and hypertensive pregnant women in Enugu State exhibit abnormal lipid profiles compared to healthy pregnant women.
1.7 Significance of Study
The significance of this study will be far-reaching in improving maternal and neonatal healthcare in Enugu State. It will provide valuable insights into the biochemical changes occurring in diabetic and hypertensive pregnant women, offering healthcare providers a better understanding of how these parameters influence pregnancy outcomes.
The findings of this research will also contribute to the body of knowledge necessary for developing standardized clinical guidelines tailored to the local context. It will enhance the capacity of referral hospitals to effectively manage high-risk pregnancies.
Furthermore, the data generated will guide public health interventions, informing policies aimed at reducing maternal and fetal morbidity and mortality in Nigeria. In addition, this study will serve as a foundation for future research on maternal health, particularly in understanding the interplay between diabetes, hypertension, and biochemical changes during pregnancy.
1.8 Scope of Study
The scope of the research is focused on the determination of some biochemical parameters in diabetic and hypertensive pregnant subjects in some referral hospitals in Enugu State.
1.9 Limitations of the Study
The limitations of this study were primarily related to several logistical and practical challenges.
- Delay from respondents, particularly pregnant women attending antenatal care, was another constraint. Many participants were unable to provide timely responses due to personal or medical reasons, which affected the smooth progression of data collection.
- Financial constraints also posed a limitation, as the resources required for comprehensive biochemical testing and data collection were beyond the initial budget, restricting the number of participants and hospitals involved in the study.
- Time constraints limited the duration of the research study, reducing the opportunity for long-term follow-up with the subjects to observe outcomes post-delivery. These challenges were collectively impacted the overall depth and breadth of the study's findings.
1.10 Definition of Terms
Biochemical Parameters: Biochemical parameters refer to measurable indicators of biological processes within the body, including substances such as glucose, lipids, and renal function markers (e.g., creatinine and urea). These parameters are critical for assessing metabolic and physiological states, particularly in high-risk populations like pregnant women (Kumar et al., 2019).
Diabetes Mellitus: Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels due to insufficient insulin production or ineffective use of insulin by the body. In pregnancy, gestational diabetes can arise, complicating the maternal and fetal health (American Diabetes Association, 2020).
Hypertension: Hypertension is defined as persistently high blood pressure, commonly categorized as systolic blood pressure greater than 130 mmHg or diastolic blood pressure exceeding 80 mmHg. In pregnant women, hypertension can lead to serious complications, such as preeclampsia and eclampsia, necessitating careful monitoring (Duley et al., 2003).
Preeclampsia: Preeclampsia is a pregnancy-specific condition characterized by the onset of hypertension and proteinuria after 20 weeks of gestation. It poses significant risks to both the mother and the fetus, including the possibility of premature birth and long-term health issues (Roberts et al., 2010).
Referral Hospitals: Referral hospitals are specialized healthcare facilities that provide advanced medical care and manage high-risk pregnancies. These hospitals typically offer comprehensive maternal-fetal medicine services and serve as a resource for primary care facilities, ensuring better health outcomes for pregnant women (Nwachukwu et al., 2018).
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