Calcium and Magnesium Metabolism in Pre-Eclampsia

Preeclampsia is a multisystem disorder associated with high maternal and perinatal mortality and morbidity. The cause of the disorder is largely unknown and its pathogenesis is complex and poorly understood. Calcium and magnesium are divalent ions which may have roles to play in the manifestations of the disease. An understanding of their metabolism in preeclampsia may aid our management of pregnant women who develop the disease.

To determine the plasma and urinary concentrations of calcium, magnesium and parathyroid hormone in women with mild, severe preeclampsia and in normal pregnancy.

This is was a case control study of fifty women with mild preeclampsia, fifty women with severe preeclampsia and fifty women with normal pregnancy as controls, drawn from The Antenatal Clinic at the Lagos University Teaching Hospital, Lagos, Nigeria. The women were consecutively recruited after signing an informed consent form. Ethical approval was obtained from the medical ethics committee of the hospital.

The three groups of women were similar in their socio demographic characteristics. Plasma calcium was low in mild and severe preeclampsia compared to normal pregnancy controls (p=0.021). Urine calcium/creatinine ratio was lower in mild and severe preeclampsia compared to normal pregnancy controls (p= 0.030). Fractional excretion of calcium and levels of parathyroid hormone were similar across all three subgroups of women. Plasma magnesium was higher in mild and severe preeclampsia compared to normal pregnancy controls (p=0.011) and showed a positive correlation with plasma creatinine (r=0.48, p=0.045). Parathyroid hormone levels were similar across the study groups.

Preeclampsia is associated with significant changes in calcium and magnesium metabolism. This study noted significant hypocalcaemia in mild and severe preeclampsia with significantly low urine calcium/creatinine levels. Calcium supplementation may have a place in patient's management. Hypermagnesemia was observed in mild and severe preeclampsia and appeared related to renal function.