Atherogenic index of plasma as a marker of severity in pre-eclampsia

Abstract

Background: Pre-eclampsia is a major hypertensive disorder of pregnancy associated with endothelial dysfunction, metabolic disturbance and adverse maternal-perinatal outcomes. The atherogenic index of plasma (AIP), derived from fasting triglyceride and high-density lipoprotein cholesterol values, may provide an integrated measure of atherogenic burden.

Methods: This hospital-based comparative cross-sectional study included 312 third-trimester pregnant women: 156 with pre-eclampsia and 156 normotensive pregnant women. Clinical parameters, biochemical markers, fasting lipid profile, AIP and fetomaternal outcomes were compared. AIP was categorized as low (<0.10), intermediate (0.10-0.24) and high risk (>0.24), and its associations with severity and delivery/neonatal outcomes were evaluated among women with pre-eclampsia.

Results: Women with pre-eclampsia had significantly higher BMI, blood pressure, random blood sugar, serum creatinine, LDH, total cholesterol, triglycerides and LDL-C, with lower HDL-C (all p<0.001, except gestational age). Mean AIP was higher in pre-eclampsia (0.39±0.13 versus 0.15±0.14; p<0.001), with high-risk AIP in 84.0% versus 23.7% of controls. High-risk AIP occurred in 98.2% of severe and 76.2% of mild pre-eclampsia (p=0.001). AIP correlated inversely with birth weight (ρ=-0.759) and 5-minute Apgar score (ρ=-0.699), while adverse outcomes were concentrated in the high-risk category.

Conclusions: Third-trimester pre-eclampsia was associated with higher AIP, greater disease severity and less favourable fetomaternal outcomes. AIP may serve as a low-cost adjunct marker for severity and short-term risk stratification, although prospective multivariable validation is required.