NEUROENDOCRINE AND INFLAMMATORY BIOMARKER IN IMMEDIATE POST-PARTUM STATE WITH STILL BIRTH AND ITS COMPARISON WITH LIVE BIRTH AS PREGNANCY OUTCOME

Abstract

Objectives: Stillbirth remains a significant contributor to global and perinatal mortality, with a rate of 13.9/1,000 total births worldwide and 11.79/1,000 in India. The contributing factors include hypertensive disorders, diabetes, infections, and congenital anomalies. The immediate postpartum period provides an opportunity to evaluate the maternal physiological and biochemical changes that may be linked to stillbirth. Neuroendocrine and inflammatory biomarkers, such as dehydroepiandrosterone sulfate (DHEA-S) and homocysteine (HCY), are essential in understanding the stress and inflammation associated with adverse pregnancy outcomes, including stillbirth. This study aimed to estimate and compare the levels of DHEA-S and HCY in women with stillbirth and live births to explore their potential association with adverse pregnancy outcomes.

Methods: A case-control study was conducted at a tertiary care center involving 60 women aged 20–35 years. The participants were divided into two groups: 30 women with stillbirth and 30 controls with live births. Detailed demographic, obstetric, and clinical data were collected and venous blood samples were analyzed for DHEA-S and HCY using the enzyme-linked immunosorbent assay and immunoturbidimetric methods, respectively. Data analysis was performed using the Statistical Packages for the Social Sciences v23.0, with statistical significance set at p<0.05.

Results: The mean gestational age was significantly lower in the stillbirth group (34.8±4.8 weeks) compared to the controls (38.7±1.0 weeks, p=0.01). The stillbirth cases exhibited significantly higher levels of DHEA-S (2.74±0.48 μg/mL) and HCY (12.25±5.27 μmoL/L) compared to the controls (0.98±0.45 μg/mL, p=0.01; 8.64±2.28 μmoL/L, p=0.01). Abnormal levels of DHEA-S were observed in all stillbirth cases, while only 50% of controls had abnormal levels (p=0.01). Obstetric complications in the stillbirth group included anemia (13.3%), hypothyroidism (6.7%), intrauterine growth restriction (3.3%), oligohydramnios (3.3%), preeclampsia (3.3%), type 2 diabetes with polyhydramnios (3.3%), and breech presentation (3.3%). Significant differences in physical characteristics such as height and body mass index were noted between the groups.

Conclusion: Elevated levels of DHEA-S and HCY in the stillbirth group suggest distinct pathophysiological responses in the postpartum period, which may indicate the adverse pregnancy outcomes. These biomarkers could potentially serve as useful tools for identifying and managing pregnancies at risk for stillbirth and related complications. Further studies are required to validate their role in predicting and improving the pregnancy outcomes.