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Review
. 2023 Oct 17;15(10):e47220.
doi: 10.7759/cureus.47220. eCollection 2023 Oct.

Association of Reduced Maternal Plasma Cholinesterase Activity With Preeclampsia: A Meta-Analysis

Fouad K Mohammad  1 , Ammar A Mohammed  2 , Hishyar M Garmavy  2 , Hussein M Rashid  2
Affiliations
Review

Association of Reduced Maternal Plasma Cholinesterase Activity With Preeclampsia: A Meta-Analysis

Fouad K Mohammad et al. Cureus. .

Abstract

Blood butyrylcholinesterase (BChE) activity has been found to decrease during pregnancy and reportedly decrease even more in preeclampsia (PE). The purpose of the present meta-analysis was to answer a specific question of whether BChE activity (in the plasma, serum, or whole blood) is reduced in pregnant women suffering from PE compared to those with normal pregnancy. The meta-analysis included 15 studies with 20 records of BChE activity in 608 women compared to 569 healthy pregnant (control) ones. The studies were subjected to quality assessment using the Newcastle-Ottawa Scale (NOS). Using the Meta-Essentials software program 1.5, the one-group random effects model and forest plot revealed that the percentage of BChE activity in pregnant women with PE was 84.84% of the control value, with a standard error of 4.09 and 95% C.I. of 76.28, 93.41, indicating a significant 15.16% reduction in BChE activity in comparison to healthy pregnancy. No significant heterogeneity was seen in the analyzed data and the funnel plot did show publication bias. Subgroup (mild, severe, and unclassified PE) forest plot analysis revealed that the % BChE activities in PE compared to respective healthy pregnancies were 96.28%, 97.08%, and 76.62%, respectively with no heterogeneity. The median NOS score of the 15 studies included in the meta-analysis was 7, ranging from 5 to 8 (medium to high quality), and the forest plot showed an effect size of 0.735. This meta-analysis shows that BChE activity is reduced in PE compared with normal pregnancy and its value as a biomarker warrants further clinical studies.

Keywords: biomarker; butyrylcholinesterase; cholinesterase; preeclampsia; pregnancy hypertension.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram of databases searching, screening and including studies that reported butyrylcholinesterase activity in women with preeclampsia in comparison with healthy pregnancy.
Figure 2
Figure 2. Forest plot of %butyrylcholinesterase activity in pregnant women with preeclampsia compared to healthy pregnant controls (15 studies, 20 records).
Figure 3
Figure 3. Galbraith (A) and quantile (B) plots of %butyrylcholinesterase activity in pregnant women with preeclampsia compared to healthy pregnant controls in 20 records from 15 studies.
Figure 4
Figure 4. The funnel plot (publication bias) of %butyrylcholinesterase activity in pregnant women with preeclampsia compared to healthy pregnant controls in 20 records from 15 studies. The trim-and-fill analysis which included the number of the imputed points also indicated no missing studies.
Figure 5
Figure 5. Subgroup analysis and related forest plots to identify the cause of heterogeneity of the reports of %butyrylcholinesterase activity in pregnant women with preeclampsia (mild, severe and unclassified, respectively) compared to healthy pregnant controls in 20 records from 15 studies.
Figure 6
Figure 6. Forest plot of Newcastle–Ottawa Scale scores of the studies
See this image and copyright information in PMC

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