Association of Urinary Strontium Levels with Pregnancy-induced Hypertension

Abstract

Pregnancy-induced hypertension (PIH), including gestational hypertension and preeclampsia, accounts for the majority of maternal and perinatal morbidity and mortality. Strontium (Sr) has been recently associated with preeclampsia in a small group of women; however, the role of Sr in PIH is not fully understood and warrants further investigation. In this study, we examined the association between urinary Sr levels and PIH, and assessed the effect of maternal age on the association. Urinary Sr concentrations were measured in 5423 pregnant women before delivery by inductively coupled plasma mass spectrometry (ICP-MS). Logistic regression analysis adjusting for potential confounders was applied to explore the association between Sr and PIH, and to evaluate the Sr-PIH relationship stratified by maternal age. Among the participants, 200 (3.83%) women were diagnosed with PIH. Compared with non-PIH women, women who developed PIH had lower urinary Sr concentrations (131.26 vs. 174.98 μg/L creatinine, P<0.01). With the natural log-transformed urinary creatinine-standardized Sr concentrations increasing, the risk of PIH decreased significantly [adjusted OR=0.60 (95%CI: 0.51, 0.72)]. Furthermore, the significant association of Sr with PIH was found among women under 35 years (P<0.01). Our finding suggested that Sr may play a potential protective role in the pathogenesis of PIH, especially among young pregnant women under 35 years old.

Keywords

strontium / pregnancy / hypertension / maternal age / trace elements

References

[1] SavitzDA, DanilackVA, EngelSM, et al.. Descriptive Epidemiology of Chronic Hypertension, Gestational Hypertension, and Preeclampsia in New York State, 1995–2004. Matern Child Health J, 2014, 18(4): 829-838

[2] HelewaME, BurrowsRF, SmithJ, et al.. Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy. CMAJ, 1997, 157(6): 715-725

[3] MolBJ, RobertsCT, ThangaratinamS, et al.. Preeclampsia. Lancet, 2016, 387(10022): 999-1011

[4] AnanthCV, BassoO. Impact of pregnancy-induced hypertension on stillbirth and neonatal mortality. Epidemiology, 2010, 21(1): 118-123

[5] VeerbeekJHW, HermesW, BreimerAY, et al.. Cardiovascular Disease Risk Factors After Early-Onset Preeclampsia, Late-Onset Preeclampsia, and Pregnancy-Induced Hypertension. Hypertension, 2015, 65(3): 600-606

[6] AlsnesIV, VattenLJ, FraserA, et al.. Hypertension in Pregnancy and Offspring Cardiovascular Risk in Young Adulthood: Prospective and Sibling Studies in the HUNT Study (Nord-TrOndelag Health Study) in Norway. Hypertension, 2017, 69(4): 591-598

[7] BakkerR, SteegersEA, HofmanA, et al.. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study. Am J Epidemiol, 2011, 174(7): 797-806

[8] LeonLJ, McCarthyFP, DirekK, et al.. Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study. Circulation, 2019, 140(13): 1050-1060

[9] ClaussonB, CnattingiusS, AxelssonO. Preterm and term births of small for gestational age infants: a population-based study of risk factors among nulliparous women. Br J Obstet Gynaecol, 1998, 105(9): 1011-1017

[10] KintirakiE, PapakatsikaS, KotronisG, et al.. Pregnancy-Induced hypertension. Hormones (Athens), 2015, 14(2): 211-223

[11] HilaliN, KocyigitA, DemirM, et al.. DNA damage and oxidative stress in patients with mild preeclampsia and offspring. Eur J Obstet Gynecol Reprod Biol, 2013, 170(2): 377-380

[12] LinLT, TsuiKH, ChengJT, et al.. Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension: A Nationwide Population-Based Retrospective Cohort Study. Medicine, 2016, 95(20): e3732

[13] NegiR, PandeD, KarkiK, et al.. Trace elements and antioxidant enzymes associated with oxidative stress in the pre-eclamptic/eclamptic mothers during fetal circulation. Clin Nutr, 2012, 31(6): 946-950

[14] MbofungCMF, AtinmoT, OmololuA. Neonatal, maternal, and intrapartum factors and their relationship to cord-and maternal-plasma trace-element concentration. Biological Trace Element Research, 1986, 9(4): 209-219

[15] EvansP, HalliwellB. Micronutrients: oxidant/antioxidant status. Br J Nutr, 2007, 85(S2): S67

[16] NielsenSP. The biological role of strontium. Bone, 2004, 35(3): 583-588

[17] DahlSG, AllainP, MariePJ, et al.. Incorporation and distribution of strontium in bone. Bone, 2001, 28(4): 446-453

[18] El-MegharbelSM, HamzaRZ, RefatMS. Synthesis, spectroscopic and thermal studies of Mg(II), Ca(II), Sr(II) and Ba(II) diclofenac sodium complexes as anti-inflammatory drug and their protective effects on renal functions impairment and oxidative stress. Spectrochim Acta A Mol Biomol Spectrosc, 2015, 135: 915-928

[19] LlurbaE, GratacosE, Martin-GallanP, et al.. A comprehensive study of oxidative stress and antioxidant status in preeclampsia and normal pregnancy. Free Radic Biol Med, 2004, 37(4): 557-570

[20] Barneo-CaragolC, Martínez-MorilloE, Rodriguez-GonzalezS, et al.. Strontium and its role in preeclampsia. J Trace Elem Med Biol, 2018, 47: 37-44

[21] Barneo-CaragolC, Martinez-MorilloE, Rodriguez-GonzalezS, et al.. Strontium and oxidative stress in normal pregnancy. J Trace Elem Med Biol, 2018, 45: 57-63

[22] ShaginaNB, FellTP, TolstykhEI, et al.. Strontium biokinetic model for the pregnant woman and fetus: application to Techa River studies. J Radiol Prot, 2015, 35(3): 659-667

[23] DietlA, FarthmannJ. Gestational hypertension and advanced maternal age. Lancet, 2015, 386(10004): 1627-1628

[24] YangJ, HuoWQ, ZhangB, et al.. Maternal urinary cadmium concentrations in relation to preterm birth in the Healthy Baby Cohort Study in China. Environ Int, 2016, 94: 300-306

[25] VardavasCI, HohmannC, PatelarouE, et al.. The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children. Eur Respir J, 2016, 48(1): 115-124

[26] YazbeckC, ThiebaugeorgesO, MoreauT, et al.. Maternal blood lead levels and the risk of pregnancy-induced hypertension: the EDEN cohort study. Environ Health Perspect, 2009, 117(10): 1526-1530

[27] GaillardR, SteegersEA, HofmanA, et al.. Associations of maternal obesity with blood pressure and the risks of gestational hypertensive disorders. The Generation R Study. J Hypertens, 2011, 29(5): 937-944

[28] Macdonald-WallisC, TillingK, FraserA, et al.. Associations of blood pressure change in pregnancy with fetal growth and gestational age at delivery: findings from a prospective cohort. Hypertension, 2014, 64(1): 36-44

[29] Macdonald-WallisC, TillingK, FraserA, et al.. Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol, 2013, 209(4): 327.e1-327.e17

[30] VikseBE, IrgensLM, LeivestadT, et al.. Preeclampsia and the risk of end-stage renal disease. N Engl J Med, 2008, 359(8): 800-809

[31] RetnakaranR, WenSW, TanHZ, et al.. Maternal Blood Pressure Before Pregnancy and Sex of the Baby: A Prospective Preconception Cohort Study. Am J Hypertens, 2017, 30(4): 382-388

[32] Cupul-UicabLA, SkjaervenR, HaugK, et al.. In Utero Exposure to Maternal Tobacco Smoke and Subsequent Obesity, Hypertension, and Gestational Diabetes Among Women in the MoBa Cohort. Environ Health Perspect, 2012, 120(3): 355-360

[33] LiuH, XiaW, XuS, et al.. Cadmium body burden and pregnancy-induced hypertension. Int J Hyg Environ Health, 2018, 221(2): 246-251

[34] RezendeVB, BarbosaF, PaleiAC, et al.. Correlations among antiangiogenic factors and trace elements in hypertensive disorders of pregnancy. J Trace Elem Med Biol, 2015, 29: 130-135

[35] RadzkiRP, BienkoM, FilipR, et al.. Effect of Strontium Ranelate on Femur Densitometry and Antioxidative/Oxidative Status in Castrated Male Rats. Scand J Lab Anim Sci, 2009, 36(2): 193-201

[36] RondonLJ, MarcanoE, RodriguezF, et al.. Blood pressure, magnesium and other mineral balance in two rat models of salt-sensitive, induced hypertension: effects of a non-peptide angiotensin II receptor type 1 antagonist. Magnes Res, 2014, 27(3): 113-130

[37] KurodaI. Strontium-89 for prostate cancer with bone metastases: the potential of cancer control and improvement of overall survival. Ann Nucl Med, 2014, 28(1): 11-16

[38] BaiYS, FengW, WangSH, et al.. Essential Metals Zinc, Selenium, and Strontium Protect against Chromosome Damage Caused by Polycyclic Aromatic Hydrocarbons Exposure. Environ Sci Technol, 2016, 50(2): 951-960

[39] GimouMM, PouillotR, CharrondiereUR, et al.. Dietary exposure and health risk assessment for 14 toxic and essential trace elements in Yaounde: the Cameroonian total diet study. Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2014, 31(6): 1064-1080

[40] ChenLJ, TangLY, HeJR, et al.. Urinary strontium and the risk of breast cancer: A case-control study in Guangzhou, China. Environ Res, 2012, 112: 212-217

[41] UsudaK, KonoK, DoteT, et al.. An overview of boron, lithium, and strontium in human health and profiles of these elements in urine of Japanese. Environ Health Prev Med, 2007, 12(6): 231-237

[42] ShaginaNB, BougrovNG, DegtevaMO, et al.. An application of in vivo whole body counting technique for studying strontium metabolism and internal dose reconstruction for the Techa River population. J Phys, 2006, 41: 433-440

[43] van der TuukK, KoopmansCM, GroenH, et al.. Prediction of progression to a high risk situation in women with gestational hypertension or mild pre-eclampsia at term. Aust N Z J Obstet Gynaecol, 2011, 51(4): 339-346