A Prospective Cohort Study Protocol on Trimester-Specific G6PD Activity and Oxidative Stress as Predictors of Adverse Fetomaternal Outcomes in Anemic Pregnancy

Abstract

Introduction: Pregnancy is a state of heightened oxidative stress, significantly exacerbated by anemia, which affects 40-60% of pregnancies in India. Glucose-6-phosphate dehydrogenase (G6PD) is critical for maintaining redox homeostasis. The longitudinal interplay between G6PD activity, oxidative stress biomarkers, and anemia across gestation, and its collective impact on pregnancy outcomes, remains poorly characterized and represents a significant research gap, particularly in the Indian population.

Methods and Analysis: This prospective observational cohort study will enroll 300 pregnant women (150 anemic, 150 non-anemic per WHO criteria) at ≤12 weeks gestation from a tertiary care hospital in Wardha, India. Trimester-wise assessments will include spectrophotometric measurement of G6PD activity, serum oxidative stress markers (Malondialdehyde (MDA), Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx)), and urinary F2-isoprostanes (by ELISA, normalized to creatinine). Cord blood hemoglobin and bilirubin will be measured at delivery. Primary outcomes include preeclampsia, preterm birth, intrauterine growth restriction, and low birth weight. Statistical analyses will employ regression models and ROC curves to identify and validate predictive biochemical risk factors. Written informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and national and international conferences.