Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 319196

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : BC24 - BC27 Full Version

Comparison of Serum C-reactive Protein, Parathyroid Hormone, and Calcitonin Levels between Pregnant and Non Pregnant Women from Rural North Gujarat: A Case-control Study


Published: August 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56115.16770
Viral Gopalbhai Solanki, Kinjal Prahaladbhai Patel, Sandip Sanabhai Sendhav, Harshili Rameshbhai Tale, Vinay Patke, Chirag Kanubhai Pandya, Prasad Vitthalrao Khodke

1. Assistant Professor, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 2. Assistant Professor, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 3. Associate Professor, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 4. Third Year Student, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 5. Professor and Head, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 6. Assistant Professor, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India. 7. Tutor, Department of Biochemistry, Nootan Medical College and Research Centre, Visnagar, Gujarat, India.

Correspondence Address :
Viral Gopalbhai Solanki,
Biochemistry Department, Nootan Medical College and Research Centre, Sankalchand Patel University, Kamana Char Rasta, Visnagar-384315, Gujarat, India.
E-mail: dr.viralsolanki@gmail.com

Abstract

Introduction: Pregnancy requires women to provide calcium to foetus in amounts that may exceed their daily intake. C-reactive protein (CRP) is a susceptible marker of systemic inflammation. Parathyroid hormone (PTH) regulates foeto-placental mineral homeostasis and skeletal development and stimulates placental calcium transfer. The increase in calcitonin and calcitriol levels are significant in the transport of maternal calcium to the fetus and in the anticipation, and revival of maternal bone loss. These changes have direct implications on calcium metabolism and cause decreased albumin level, inflammation, increase in extracellular fluid volume, increase in renal function, and placental calcium transfer.

Aim: To assess the serum levels of CRP, calcitonin, and PTH in the first, second, and third trimester of pregnancy and also to compare these parameters with non pregnant women.

Materials and Methods: The present case-control study was conducted in the Department of Biochemistry of Nootan Medical College and Research Centre, Visnagar, Gujarat, from June 2021 to October 2021. A total of 150 subjects (75 age-and sex-matched apparently healthy well-nourished non pregnant females, and 75 pregnant females) were included. CRP, PTH, and calcitonin were measured. Statistical analysis was performed using Independent t-test, and Pearson’s correlation coefficient (r).

Results: Mean age of participants in case group was 32.16±10.97 (mean±SD). The mean age of control was 30.54±6.63. Serum CRP level of cases was significantly higher 3.2±2.2 than the level in controls 2.3±1.8 (p=0.003). Serum PTH level of cases 31.6±10.4 was significantly lower (p=0.0012) than the level in controls 45.9±9.8. Serum calcitonin level of cases 281±143 was significantly higher (p<0.001) than the level in controls 103±46.

Conclusion: There was a significant increase in serum CRP level and serum calcitonin level in cases as compared with controls while there is decrease in serum PTH levels between these two groups.

Keywords

Inflammation, Maternal calcium, Placental transfer, Trimester

Numerous biochemical and metabolic modifications occur during pregnancy. During pregnancy, women provides calcium to the foetus in amounts that may exceed their daily intake (1). As a result, hormones involved in calcium homeostasis work together to congregate the mineral requirements (2). In order to counteract the increased intestinal absorption of calcium, the requirement for calcitriol is likewise raised (3). It helps to sustain maternal calcium homeostasis (4). High CRP level in pregnancy can be caused by a variety of inflammatory and infectious diseases (5).

CRP is a susceptible marker of systemic inflammation. CRP accompanies both acute and chronic inflammatory disorders (6). Serum concentrations of CRP in pregnancy are greater beyond non pregnant standards, and the variation being detected as early as four weeks gestation (7). Although the direct synthesis of CRP by trophoblast may play a role, the specific aetiology of this increase is uncertain. Elevated concentrations of CRP in the first trimester have been related with preterm delivery (7). CRP levels in pregnant women who have preterm labour and early rupture of membranes have been calculated as a tool for identifying subclinical infection (7).

PTH is an exceptionally essential hormone in calcium homeostasis (8). It has a short half-life of five min and is prejudiced by slight changes in serum calcium levels. The need for calcium increases during pregnancy (9). Maternal PTH levels are optimistically allied with birth weight, fetal upper arm, and calf circumferences (10). PTH is responsible for the foeto-placental mineral homeostasis, skeletal development, and stimulates placental calcium transfer (11).

Calcitonin stimulate renal 1,25(OH)2 vitamin D (1,25D) production in the proximal tubule (12). During pregnancy and lactation, both calcitonin and calcitriol are increased. Elevated calcitonin and calcitriol levels may have a role in the delivery of maternal calcium to the fetus/infant, as well as the prevention and restoration of maternal bone loss (13).

Calcitonin is the hypocalcemic, hypophosphatemic polypeptide of C cell origin, and it has been reported to increase in pregnant women at the time of delivery. In a study, high levels of this hormone was determined by radioimmunoassay in pregnant women in all trimesters (14). Several studies have found that levels were also higher for the first two days after delivery (14),(15). Few researches reported that except in the first trimester, when the calcitonin hormone's level was inversely related to blood phosphate, calcitonin levels were not linked to serum calcium or phosphate (14),(15). Possibly, pregnancy-induced hypercalcitonemia protects the mother's skeleton while allowing the foetus to accumulate calcium (14).

During the course of the pregnancy, an extraordinary series of physiologic changes occur, intended at preserving maternal homeostasis while at the same time providing for fetal growth and development (16). Most of the studies mainly focussed to measure the parameters in normal pregnancy and to associate them with some risk factors (17),(18). Hence, present study was conducted to measure the CRP, PTH, and calcitonin levels in all the three trimesters, and also compared their levels with non pregnant women.

Material and Methods

The case-control study was conducted in the Department of Biochemistry of Nootan Medical College and Research Centre, Visnagar, Gujarat, from June 2021 to October 2021. Ethical clearance was obtained by institution’s Human Research Ethics Committee. (Ref: IEC/NMCRCAPPROVAL/44/2021)

Inclusion criteria: Women aged between 21 to 45 years, recalling the exact date of the last menstrual period, whose gestational age was appropriate according to trimester in the first visit, and BMI ranging between 26 to 30 kg/m2 were included in the study. Age-matched, non pregnant, and healthy controls were recruited from those who reported for the health check-up scheme of the hospital.

Exclusion criteria: Participants having any systemic disease, endocrine disorder or infections and any history of complicated pregnancy were excluded.

Sample size calculation: Sample size was calculated using Cochran’s formula;

Sample size=Z2×SD2/Precision2

Power of study was 80% (19). Using SD & Precision of other studies on pregnant woman (20),(21), sample size arrived was 40 and 59, respectively.

Altogether 150 participants were enrolled in this study. 75 were recruited as case and 75 as controls.

In the case group, participants were divided into 1st, 2nd and 3rd trimesters with 25 participants in each trimesters. In the control group (n=75), participant were divided into 3 groups of 25 participants each, where each control group was compared with individual case group. Age and sex were matched for all 3 groups.

Study Procedure

Five mL of blood samples were collected and allowed to clot, and then centrifuged at 3400 RPM for 15 min at 20-22°C to obtain the serum. Parameters like serum CRP, PTH, and calcitonin were evaluated and compared between the cases and controls.

Serum CRP was measured by antigen-antibody reaction by the end-point method using Erba EM 200 fully auto analyser. PTH concentration in human serum was determined using an immunoenzymatic colorimetric technique. Calcitonin concentration in human serum was determined using an immunoenzymatic colorimetric technique. Serum PTH and serum calcitonin were analysed using ELISA machine. Reference range for CRP is 0-10 mg/L, (22) for PTH 9-94 pg/mL, (23) and for calcitonin is <11 pg/mL (24).

Statistical Analysis

Analysis was performed using the commercially available Statistical Software STATA (14.2), and Microsoft Excel 2016. The p-value of less than 0.05 was considered statistically significant. All of the parameters were analysed by applying Independent t-test and Pearson’s correlation coefficient (r).

Results

Mean age of participants in case group was 32.16±10.97 yrs and that in the control group was 30.54±6.63 yrs. The mean BMI for cases and controls were 31.66±1.5 kg/m2 and 23.88±1.8 kg/m2, respectively (Table/Fig 1).

Serum CRP levels of 1st, 2nd, and 3rd trimesters were 2.5±1.9 mg/L, 3.1±2.1 mg/L, and 3.8±2.4 mg/L, respectively. Serum PTH levels of 1st, 2nd, and 3rd trimesters were 35.5±11.1 pg/mL, 25.5±8.3 pg/mL, and 32.4±10.2 pg/mL, respectively. Serum calcitonin levels of 1st, 2nd, and 3rd trimesters were 225±106 pg/mL, 343±181 pg/mL, and 306±143 pg/mL, respectively (Table/Fig 2).

Serum CRP levels of cases was significantly higher 3.2±2.2 than the level in controls 2.3±1.8 (p=0.003). Serum PTH level of cases 31.6±10.4 was significantly lower (p=0.0012) than the level in controls 45.9±9.8. Serum calcitonin level of cases 281±143 was significantly higher (p<0.001) than the level in controls 103±46 (Table/Fig 3).

CRP level had shown increment as 2.9 mg/L, 3.1 mg/L, 3.4 mg/L, 3.6 mg/L, 3.7 mg/L, 3.7 mg/L, 3.9 mg/L, and 4.3 mg/L according to their gestational age of 16, 20, 24, 28, 32, 36, 38, and 40 weeks, respectively (Table/Fig 4). There was a significant positive correlation between CRP levels and gestational age (r=0.827, p= 0.00015) (Table/Fig 4). Authors had established significant but weak correlation between PTH level and gestational age (r=0.114, p= 0.0118). Authors had established significant positive correlation between calcitonin level and gestational age (r=0.628, p=0.000016) (Table/Fig 4).

Discussion

In this study, a significant increase in the level of serum CRP (3.2±2.2 mg/L) and calcitonin level (281±143 pg/mL) in cases was found, as compared with controls (2.3±1.8 mg/L, 103±46 pg/mL respectively); while there was a decrease in serum PTH level between cases and controls.

Sacks GP et al., provides evidence for maternal inflammatory response with elevated CRP levels as early as four weeks gestation (25). Rebelo I et al., reported that the CRP levels are raised later in the 1st trimester (26) and Teran E et al., reported raised CRP levels later in the 3rd trimester (27). Higher concentration of CRP has been found during 2nd and 3rd trimester in present study. Sacks GP et al., proposed the occurrence of a systemic maternal inflammatory response in the third trimester, which has been widely documented (28). In normal pregnancy, there is evidence of extensive initiation of maternal immune system innate components and these changes comprise the maternal inflammatory response (28).

In a previous cross-sectional investigation employing an identical method for measuring PTH, cases had lower intact PTH concentrations than controls, which supports the findings of the current study (29). Davis OK et al., proposed that Vit D is the primary hormone responsible for maintaining maternal calcium homeostasis throughout pregnancy (29). Vitamin D levels arise during pregnancy (30). Interestingly, previous studies showed a weak positive correlation between PTH level and gestational age (31),(32). Serum PTH levels fell to the 10%–30% of the mean non pregnant value and then increased progressively to a mid-normal range by the term (31),(32), which is consistent with the finding of the present study (31),(32). The mean concentrations of intact PTH in late pregnancy were lower than in nonpregnant women, according to Kaneshapillai A et al., which would support the current study (32).

Konopka P et al., measured the serum calcitonin of nonpregnant and pregnant women using bioassay and observed that 57.4% of pregnant women had elavated values (15). In present study 70% of pregnant women had elevated values of calcitonin. These had concluded some congruent results supporting with present study. The amplification during gestation was statistically noteworthy in the second and third trimester. These authors proposed that hypercalcitonemia may serve to defend the skeleton against demineralisation during pregnancy. Samaan NA et al., initially reported that iCT levels were high in women at delivery that would in support of present study (33).

Some authors were not in agreement with our results, when they found no correlation between serum calcitonin and pregnancy (34). Pitkin RM et al., found no steady change in iCT during a longitudinal study of pregnant subjects (34).

Pregnancy exerts a intense influence upon calcium metabolism, accompanied as it is by osseous formation in the fetus. The human fetus accumulates 20-30 gm of calcium, mostly in the third trimester. Duggin GG et al., found that women have a positive calcium balance during pregnancy, but considerably less so than the amount estimated to be necessary for the fetus (35). The increased levels of iCT during gestation propose that this hormone plays a role in the defense of the maternal skeleton.

The present study was conducted in rural north Gujarat population, which revealed alteration of biochemical marker in pregnancy. Further studies which can reflect correlation of inflammatory markers and calcium homeostasis will illuminate study more deeply.

Limitation(s)

The CRP measurement range was excessively broad, which could lower the study's importance and lead to bias. Another drawback is that CRP is a relatively generic marker that despite tight exclusion criteria, might be positive or high for other reasons, resulting in bias.

Conclusion

In the present study it was found that there was a significant increase in serum CRP level in pregnant women as compared with normal subjects and there was a significant increase in serum calcitonin in pregnant women as compare with normal subjects, while there was decrease in serum PTH level in the cases as compared to control group. In conclusion, regarding the above-mentioned studies, it seems reasonable to perform further studies for determining the predictive value of serum CRP and to try to find an optimum cut-off point. Further studies which can reflect correlation of inflammatory markers and calcium homeostasis will illuminate study more deeply. Further studies are warranted to widen the knowledge about pathophysiological mechanisms linking inflammation and pregnancy complications. More inflammatory and calcium homeostasis markers can be added in future.

References

1.
Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, et al. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr. 1998;67:693-701. [crossref] [PubMed]
2.
Hacker AN, Fung EB, King JC. Role of calcium during pregnancy: Maternal and fetal needs. Nutr Rev. 2012;70(7):397-409. [crossref] [PubMed]
3.
Pitkin RM. Calcium metabolism in pregnancy and the perinatal period: A review. Am J Obstet Gynecol. 1985;151(1):99-109. [crossref]
4.
Belizan JM, Villar J. The relationship between calcium intake and edema, proteinuria, and hypertension-gestosis: An hypothesis. Am J Clin Nutr. 1980;33(10):2202-10. [crossref] [PubMed]
5.
Mitchel EK, Davis JH. Spontaneous births into toilets. J Forensic Sci. 1984;29(2):591-96. [crossref]
6.
Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. William Obstetrics. 21st edn. New York: McGraw-Hill; 2001.
7.
Cottrill HM, Barton JR, O’Brien JM, Rhea DL, Milligan DA. Factors influencing maternal perception of uterine contraction. Am J Obstet Gynecol. 2004;190(5):1455-57. [crossref] [PubMed]
8.
Castell JV, Gomez-Lechon MJ, David M, Fabra R, Trullenque R, Heinrich PC. Acutephase response of human hepatocye: Regulation of acute phase protein synthesis by interleukin-6. Hepatology. 1990;12(5):1179-86. [crossref] [PubMed]
9.
Morley R, Carlin JB, Pasco JA, Wark JD. Maternal 25-hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size. J Clin Endocrinol Metab. 2006;91(3):906-12. [crossref] [PubMed]
10.
Simmonds CS, Karsenty G, Karaplis AC, Kovacs CS. Parathyroid hormone regulates fetal-placental mineral homeostasis. J Bone Miner Res. 2010;25(3):594-605. [crossref] [PubMed]
11.
Cushard WG Jr, Creditor MA, Canterbury JM, Reiss E. Physiologic hyperparathyroidism in pregnancy. J Clin Endocrinol Metab. 1972;34:767-71. [crossref] [PubMed]
12.
Copp DH, Cheney B. Calcitonin-a hormone from the parathyroid which lowers the calcium-level of the blood. Nature. 1962;193:381-82. [crossref] [PubMed]
13.
Copp D, Cameron EC, Cheney BA. Evidence for calcitonin-a new hormone from the parathyroid gland that lowers blood calcium. Endocrinology. 1962;70:638-49. [crossref] [PubMed]
14.
Silva OL, Dillon PT, Becker KL, Snider RH, Moore CF. Increased serum calcitonin in pregnancy. Journal of The National Medical Association. 1981;73(7):649-52.
15.
Konopka P, Klotz HP, Delorme ML. L’etat calcitonique au cours de la gravidite. Nouv Presse Med. 1972;1:253-56.
16.
Pearse AG. The cytochemistry of the thyroid C cells and their relationship to calcitonin. Proc R Soc London B Bio Sci. 1966;164(996):478-87. [crossref] [PubMed]
17.
Nikbakht R , Moghadam EK , Nasirkhani Z. Maternal serum levels of C-reactive protein at early pregnancy to predict fetal growth restriction and preterm delivery: A prospective cohort study. Int J Reprod Biomed. 2020;189(3);157-64. [crossref] [PubMed]
18.
Tsourdi E, Athanasios D. Anastasilakis. Parathyroid disease in pregnancy and lactation: A narrative review of the literature. Biomedicines. 2021;9(5):475. [crossref] [PubMed]
19.
Sonal S, Poornima S. Maternal Serum CRP in non-gestation and preeclamptic gestation. Biomedical and Pharmacology Journal. 2013;6(1):107-10. [crossref]
20.
Mohan M, Kusum M, Meena BS, Chitra G. Serum CRP in normal pregnancy and preeclampsia. Int J Clin Obstet Gynaecol. 2019;3(2):141-45. [crossref]
21.
Zaima A, Faraz A, Saima Z, Uzma Z, Ambreen T, Shaheena K. Correlation of CRP levels in third trimester with fetal birth weight in preeclamptic and normotensive pregnant woman. J Coll Physicians Surg Pak. 2015; 25(2):111-14.
22.
CRP kit manual. Erba Mnheim. 2015:N/70/14/C/INT;1-2. Available from: https://erbarus.com/i-files/Reagenty_na_sait/4_Spesific_proteins/CRP/CRP_BLT20009_20010_EN_C1.pdf.
23.
Intact PTH ELISA kit manual. Diametra. DCM157-2; 1-4. Available from: https://eaglebio. com/content/DCM157_Intact_PTH_ELISA_Assay_Kit.pdf.
24.
Calcitonin ELISA assay kit. Eagle Biosciences. DCM181-00; 1-4. Available from: https:// www. eaglebio.com/content/DCM181_Calcitonin_ELISA_Assay_Kit.pdf.
25.
Sacks GP, Seyani L, Lavery S, Trew G. Maternal C-reactive protein levels are raised at 4 weeks. Gestation Human Reproduction. 2004;19(4):1025-30. [crossref] [PubMed]
26.
Rebelo I, Carvalho-Guerra F, Pereira-Leite L, Quintanilha A. Lactoferrin as a sensitive blood marker of neutrophil activation in normal pregnancies. Eur J Obstet Gynecol Reprod Biol. 1995;62(2):189-94. [crossref]
27.
Teran E, Escudero C, Moya W, Flores M, Vallance P, Lopez-Jaramillo P. Elevated C-reactive protein and pro-inflammatory cytokines in Andean women with pre-eclampsia. Int J Gynaecol Obstet. 2001;75(3):243-49. [crossref]
28.
Sacks GP, Sargent IL, Redman CWG. An innate view of human pregnancy. Immunol Today. 1999:20(3):114-18. [crossref]
29.
Davis OK, Hawkins DS, Rubin LP. Serum parathyroid hormone (PTH) in pregnant women determined by an immunoradiometric assay for intact PTH. J Clin Endocrinol Metab. 1988;67(3):850-52. [crossref] [PubMed]
30.
Kumar R, Cohen WR, Silva P. Elevated 1, 25-dihydroxyvitamin D plasma levels in normal human pregnancy and lactation. J Clin Invest. 1979;63(2):342-44. [crossref] [PubMed]
31.
Kovacs CS, El-Hajj Fuleihan G. Calcium and bone disorders during pregnancy and lactation. Endocrinol Metab Clin N Am. 2006;35:21-51. [crossref] [PubMed]
32.
Kaneshapillai A, Hettiaratchi U, Prathapan S, LiyanageI G. Parathyroid hormone in Sri Lankan pregnant women: Vitamin D and other determinants. PLOS ONE. 2021;16(10):e0258381. [crossref] [PubMed]
33.
Samaan NA, Anderson GD, Adam-Mayne M. Immunoreactive calcitonin in the mother, neonate, child, and adult. Am J Obstet Gynecol. 1975;121:622-25. [crossref]
34.
Pitkin RM, Reynolds WA, Williams GA. Calcium metabolism in normal pregnancy: A longitudinal study. Am J Obstet Gynecol. 1979;133(7):781-90. [crossref]
35.
Duggin GG, Lyneham RC, Dale NE. Calcium balance in pregnancy. Lancet. 1974;2(7886):926-27. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/56115.16770

Date of Submission: Mar 05, 2022
Date of Peer Review: Apr 07, 2022
Date of Acceptance: Jun 02, 2022
Date of Publishing: Aug 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 15, 2022
• Manual Googling: May 26, 2022
• iThenticate Software: Jul 30, 2022 (19%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com