Background: The intrauterine foetal environment is crucial for its survival and long term health. Intrauterine growth retardation of the foetus is a pregnancy specific disorder which involves the restriction in the physical and or mental growth of the foetus during the course of the pregnancy. Lactate dehydrogenase is an intracellular enzyme that converts lactic acid to pyruvic acid. It has been proposed as an important marker for liver diseases, myocardial, renal, and pulmonary infarction. Very few studies have been carried out to establish its significance in various disorders of pregnancy and placentation. Intrauterine growth retardation with its complications carry a high maternal morbidity and foetal morbidity and mortality. Predictors for the prognosis of the disease are desperately needed for the effective management. Total serum lactic acid dehydrogenase activity has been found to be elevated in severe pre-eclampsia. Studies have showed increased levels of foetal lactate dehydrogenase in IUGR, but there are very few studies in which maternal serum levels are studied.
Objectives: i) To analyse lactic acid dehydrogenase as a predictor of IUGR and ii) to study the diagnostic efficiency of LDH levels in prediction foetal outcome in IUGR infants.
Methods: This prospective case control study was done between a period from July 2007 to December 2014 at QMH KGMU, and Department of M&RH, SGPGIMS, Lucknow. 490 women attending the antenatal clinics were recruited between 32 and 36 weeks for the analysis for serum lactic dehydrogenase levels in triplicate. Maternal and foetal outcome was noted. The statistical analysis included ANOVA, χ2 test, and Students t-test. ROC curve was used to attain the sensitivity and specificity of the test. Keeping CI at 95%, significance was determined if P value was <0.005.
Results: Out of the patients recruited, 226 cases and 180 controls could be followed for outcome, rest of them defaulted for various reasons. The mean serum LDH in mothers was 296.334 IU/ml in the control arm whereas the mean was 456.36 IU/ml in the study group (F test=0.000002; P=0.0024). At the cut off of 315 IU/m, the sensitivity was 72.5% and specificity was 60.5%.
Conclusions: Maternal serum LDH is a good prognostic marker to predict for maternal and foetal outcome. It can be used in regular risk scoring systems for methodological analysis of the prognosis of outcome at delivery.