J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://jcgo.elmerpub.com

Original Article

Volume 15, Number 3, September 2026, pages 114-125

Serum Lactate Dehydrogenase Levels as a Prognostic Marker for Maternal and Neonatal Outcomes in Hypertensive Pregnancy Complication: A Systematic Review and Meta-Analysis

↓ Figure 2. Meta-analysis results (forest plot) for maternal outcomes: (a) placental abruption, (b) eclampsia, (c) FGR, and (d) maternal death in LDH ≥ 600 IU/L compared to control groups. FGR: fetal growth restriction; LDH: lactate dehydrogenase.

↓ Figure 3. Meta-analysis results (forest plot) for neonatal outcomes: (a) low birth weight, (b) NICU admission, (c) IUFD, and (d) preterm in LDH ≥ 600 IU/L compared to control groups. IUFD: intrauterine fetal death; LDH: lactate dehydrogenase; NICU: neonatal intensive care unit.

↓ **Table 1.** Study Characteristics
No.	Author, publication year, country	Study design	Participants demographics	Inclusion/exclusion criteria of participants	Outcome of interest
CAD: coronary artery disease; DIC: disseminated intravascular coagulation;DM: diabetes mellitus; FGR: fetal growth restriction; HDP: hypertensive disorders of pregnancy; IUFD: intrauterine fetal death; LBW: low birth weight; NICU: neonatal intensive care unit; SOL: space-occupying lesion.
1	Hak et al, 2015, India [9]	Case–control study	36 (36%)	64 (64%)	N/A	N/A	Inclusion: third trimester (28 weeks onwards); normotensive, preeclampsia, eclampsia Exclusion: history of chronic hypertension, renal disease, pre-existing DM, liver disorder, epileptic disorder, hemolytic anemia, trauma, bone fracture, muscle injury; on drug, such as aspirin, fluoride, narcotics	Maternal outcome: placental abruption Neonatal outcome: -
2	Umasatyasri et al, 2015, India [10]	Prospective comparative case–control	115 (76.7%)	35 (23.3%)	37.60 ± 2.76 weeks	36.60 ± 2.90 weeks	Inclusion criteria: singleton pregnancy; age 18–30; no previous history of hypertension; third trimester of pregnancy; blood pressure normal during first 20 weeks Exclusion criteria: history of liver, diabetes, renal failure, hemolytic anemia, stroke, CAD, chronic lung disease, DIC, seizure, chronic hypertension, gestational diabetes; multiple pregnancy; smoking and alcoholism; hepatotoxic drugs	Maternal outcome: - Neonatal outcome: IUFD
3	Mary et al, 2017, India [11]	Case-control study	32 (40.5%)	47 (59.4%)	N/A	N/A	Inclusion criteria: singleton pregnancy; age 20–30; preeclamptic women whose BP was normal during first 20 weeks of gestation; no previous history of hypertension Exclusion criteria: history of diabetes, renal failure, hemolytic anemias, chronic hypertension, gestational diabetes, liver disease, CAD, chronic lung disease, connective tissue disorder, DIC, seizure; multiple pregnancy; smoking and alcoholism; hepatotoxic drugs	Maternal outcome: eclampsia; placental abruption Neonatal outcome: -
4	Gaddi et al, 2018, India [12]	Prospective case–control	92 (46%)	108 (54%)	38.5 ± 2.14 weeks	36.79 ± 3.3 weeks	Inclusion: normal pregnancy; mild preeclampsia, severe preeclampsia, eclampsia Exclusion: history of pre-existing DM, thyroid disorder, renal disease, epileptic disorder, liver disorder	Maternal outcome: placental abruption; maternal death Neonatal outcome: NICU admission; FGR
5	Singh et al, 2018, India [13]	Prospective case–control study	123 (41%)	177 (59%)	N/A	N/A	Inclusion criteria: 28 weeks of gestation; with HDP Exclusion criteria: chronic hypertension; history of diabetes, liver renal disease, epilepsy, thyroid disease, hyperuricemia; smoking, alcohol, and drug intake; symptomatic infectious disease; multiple gestation	Maternal outcome: placental abruption; eclampsia Neonatal outcome: low birth weight; IUFD; preterm
6	Mehta et al, 2019, India [14]	Prospective cohort study	56 (18%)	244 (82%)	N/A	N/A	Inclusion criteria: preeclampsia patients Exclusion criteria: hypertensive pregnant women of gestational age < 20 weeks; pregnant women with history of smoking; alcoholism; diabetes mellitus; chronic hypertension; cardiac, liver or lung disease; multiple and molar pregnancy	Maternal outcome: placental abruption; eclampsia; maternal death Neonatal outcome: low birth weight; IUFD; preterm; FGR
7	Bhandari et al, 2019, India [15]	Prospective cohort study	53 (53%)	47 (47%)	N/A	N/A	Inclusion criteria: singleton pregnancy; cephalic presentation; gestational age ≥ 28 weeks Exclusion criteria: chronic hypertension; medical disorders; taking hepatotoxic drugs	Maternal outcome: eclampsia; abruption; mortality Neonatal outcome: LBW; preterm; NICU admission
8	Shivamurthy et al, 2020, India [16]	Case–control study	182 (91%)	18 (4%)	37.6 ± 2.76 weeks	36.7 ± 2.96 weeks	Inclusion: gestational age ≥ 20 weeks Exclusion: essential hypertension or hypertension < 20 weeks gestation, pre-existing diabetes mellitus, renal disease, liver disorder, thyroid disorder, alcoholic, epilepsy, and urinary tract infection	Maternal outcome: eclampsia; placental abruption Neonatal outcome: LBW; preterm; NICU admission
9	Eleti et al, 2023, India [7]	Prospective comparative case–control	163 (70.8%)	67 (29.1%)	31–40 weeks	28.6–39.6 weeks	Inclusion criteria: gestational age 28–40; singleton pregnancy; normotensive, preeclampsia, eclampsia Exclusion criteria: history of chronic hypertension, pre-existing diabetes mellitus, liver disorder, renal disorder, epileptic disorder, thyroid disorder, heart disease, leukemia, hemolysis, hepatitis, pancreatitis; multiple pregnancy	Maternal outcome: placental abruption; FGR; maternal death Neonatal outcome: preterm; low birth weight; NICU admission; IUFD
10	Kumari et al, 2024, India [8]	Prospective cohort study	74	66	N/A	N/A	Inclusion: singleton pregnancy; after 28 weeks of gestation Exclusion: diabetes; renal failure; previous history of hemolytic anemia; multiple pregnancy; smoking and alcoholism; liver disease; hepatotoxic drug; stroke, coronary artery disease; chronic lung disease connective tissue disorders	Maternal outcome: placental abruption; maternal death Neonatal outcome: FGR; IUFD
11	Vaishnav et al, 2024, India [17]	Prospective cohort study	127	73	N/A	N/A	Inclusion: singleton pregnancy; more than 20 weeks of pregnancy with hypertension; age 18–35 years Exclusion: chronic hypertension; existing liver/renal disease; alcoholism; thyrotoxicosis; pre-existing diabetes; connective tissues disorder; other convulsive disorder; SOL or brain trauma; multiple pregnancy	Maternal outcome: placental abruption; maternal death; pulmonary edema Neonatal outcome: FGR; IUFD
12	Nasir et al, 2025, Iraq [18]	Prospective case–control	25 (25%)	75 (75%)	N/A	N/A	Inclusion: women with singleton pregnancy in their third trimester without history of chronic hypertension, diabetes mellitus, renal, cardiac, and neurological disease Exclusion: -	Maternal outcome: eclampsia Neonatal outcome: FGR; NICU admission

↓ Table 1. Study Characteristics

No.

Author, publication year, country

Study design

Participants demographics

Inclusion/exclusion criteria of participants

Outcome of interest

Gestational age

< 600

≥ 600

< 600

≥ 600

CAD: coronary artery disease; DIC: disseminated intravascular coagulation;DM: diabetes mellitus; FGR: fetal growth restriction; HDP: hypertensive disorders of pregnancy; IUFD: intrauterine fetal death; LBW: low birth weight; NICU: neonatal intensive care unit; SOL: space-occupying lesion.

Hak et al, 2015, India [9]

Case–control study

36 (36%)

64 (64%)

N/A

Inclusion: third trimester (28 weeks onwards); normotensive, preeclampsia, eclampsia
Exclusion: history of chronic hypertension, renal disease, pre-existing DM, liver disorder, epileptic disorder, hemolytic anemia, trauma, bone fracture, muscle injury; on drug, such as aspirin, fluoride, narcotics

Maternal outcome: placental abruption
Neonatal outcome: -

Umasatyasri et al, 2015, India [10]

Prospective comparative case–control

115 (76.7%)

35 (23.3%)

37.60 ± 2.76 weeks

36.60 ± 2.90 weeks

Inclusion criteria: singleton pregnancy; age 18–30; no previous history of hypertension; third trimester of pregnancy; blood pressure normal during first 20 weeks
Exclusion criteria: history of liver, diabetes, renal failure, hemolytic anemia, stroke, CAD, chronic lung disease, DIC, seizure, chronic hypertension, gestational diabetes; multiple pregnancy; smoking and alcoholism; hepatotoxic drugs

Maternal outcome: -
Neonatal outcome: IUFD

Mary et al, 2017, India [11]

Case-control study

32 (40.5%)

47 (59.4%)

N/A

Inclusion criteria: singleton pregnancy; age 20–30; preeclamptic women whose BP was normal during first 20 weeks of gestation; no previous history of hypertension
Exclusion criteria: history of diabetes, renal failure, hemolytic anemias, chronic hypertension, gestational diabetes, liver disease, CAD, chronic lung disease, connective tissue disorder, DIC, seizure; multiple pregnancy; smoking and alcoholism; hepatotoxic drugs

Maternal outcome: eclampsia; placental abruption
Neonatal outcome: -

Gaddi et al, 2018, India [12]

Prospective case–control

92 (46%)

108 (54%)

38.5 ± 2.14 weeks

36.79 ± 3.3 weeks

Inclusion: normal pregnancy; mild preeclampsia, severe preeclampsia, eclampsia
Exclusion: history of pre-existing DM, thyroid disorder, renal disease, epileptic disorder, liver disorder

Maternal outcome: placental abruption; maternal death
Neonatal outcome: NICU admission; FGR

Singh et al, 2018, India [13]

Prospective case–control study

123 (41%)

177 (59%)

N/A

Inclusion criteria: 28 weeks of gestation; with HDP
Exclusion criteria: chronic hypertension; history of diabetes, liver renal disease, epilepsy, thyroid disease, hyperuricemia; smoking, alcohol, and drug intake; symptomatic infectious disease; multiple gestation

Maternal outcome: placental abruption; eclampsia
Neonatal outcome: low birth weight; IUFD; preterm

Mehta et al, 2019, India [14]

Prospective cohort study

56 (18%)

244 (82%)

N/A

Inclusion criteria: preeclampsia patients
Exclusion criteria: hypertensive pregnant women of gestational age < 20 weeks; pregnant women with history of smoking; alcoholism; diabetes mellitus; chronic hypertension; cardiac, liver or lung disease; multiple and molar pregnancy

Maternal outcome: placental abruption; eclampsia; maternal death
Neonatal outcome: low birth weight; IUFD; preterm; FGR

Bhandari et al, 2019, India [15]

Prospective cohort study

53 (53%)

47 (47%)

N/A

Inclusion criteria: singleton pregnancy; cephalic presentation; gestational age ≥ 28 weeks
Exclusion criteria: chronic hypertension; medical disorders; taking hepatotoxic drugs

Maternal outcome: eclampsia; abruption; mortality
Neonatal outcome: LBW; preterm; NICU admission

Shivamurthy et al, 2020, India [16]

Case–control study

182 (91%)

18 (4%)

37.6 ± 2.76 weeks

36.7 ± 2.96 weeks

Inclusion: gestational age ≥ 20 weeks
Exclusion: essential hypertension or hypertension < 20 weeks gestation, pre-existing diabetes mellitus, renal disease, liver disorder, thyroid disorder, alcoholic, epilepsy, and urinary tract infection

Maternal outcome: eclampsia; placental abruption
Neonatal outcome: LBW; preterm; NICU admission

Eleti et al, 2023, India [7]

Prospective comparative case–control

163 (70.8%)

67 (29.1%)

31–40 weeks

28.6–39.6 weeks

Inclusion criteria: gestational age 28–40; singleton pregnancy; normotensive, preeclampsia, eclampsia
Exclusion criteria: history of chronic hypertension, pre-existing diabetes mellitus, liver disorder, renal disorder, epileptic disorder, thyroid disorder, heart disease, leukemia, hemolysis, hepatitis, pancreatitis; multiple pregnancy

Maternal outcome: placental abruption; FGR; maternal death
Neonatal outcome: preterm; low birth weight; NICU admission; IUFD

Kumari et al, 2024, India [8]

Prospective cohort study

N/A

Inclusion: singleton pregnancy; after 28 weeks of gestation
Exclusion: diabetes; renal failure; previous history of hemolytic anemia; multiple pregnancy; smoking and alcoholism; liver disease; hepatotoxic drug; stroke, coronary artery disease; chronic lung disease connective tissue disorders

Maternal outcome: placental abruption; maternal death
Neonatal outcome: FGR; IUFD

Vaishnav et al, 2024, India [17]

Prospective cohort study

127

N/A

Inclusion: singleton pregnancy; more than 20 weeks of pregnancy with hypertension; age 18–35 years
Exclusion: chronic hypertension; existing liver/renal disease; alcoholism; thyrotoxicosis; pre-existing diabetes; connective tissues disorder; other convulsive disorder; SOL or brain trauma; multiple pregnancy

Maternal outcome: placental abruption; maternal death; pulmonary edema
Neonatal outcome: FGR; IUFD

Nasir et al, 2025, Iraq [18]

Prospective case–control

25 (25%)

75 (75%)

N/A

Inclusion: women with singleton pregnancy in their third trimester without history of chronic hypertension, diabetes mellitus, renal, cardiac, and neurological disease
Exclusion: -

Maternal outcome: eclampsia
Neonatal outcome: FGR; NICU admission

↓ **Table 2.** Results of Study Quality Assessment Using Newcastle–Ottawa Scale (NOS) for Case–Control Study
Study	Selection (max 4)	Comparability (max 2)	Exposure (max 3)	Total score (max 9)
Hak et al, 2015 [9]	★★★★ (1,2,3,4)	★ (1)	★★★ (1,2,3)	8
Umasatyasri et al, 2015 [10]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7
Mary et al, 2017 [11]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7
Gaddi et al, 2018 [12]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7
Singh et al, 2018 [13]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7
Shivamurthy et al, 2020 [16]	★★★ (1,2,4)	★ (1)	★★ (2,3)	6
Eleti et al, 2023 [7]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7
Nasir et al, 2025 [18]	★★★ (1,2,4)	★ (1)	★★★ (1,2,3)	7

↓ Table 2. Results of Study Quality Assessment Using Newcastle–Ottawa Scale (NOS) for Case–Control Study

Study

Selection (max 4)

Comparability (max 2)

Exposure (max 3)

Total score (max 9)

Hak et al, 2015 [9]

★★★★ (1,2,3,4)

★ (1)

★★★ (1,2,3)

Umasatyasri et al, 2015 [10]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

Mary et al, 2017 [11]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

Gaddi et al, 2018 [12]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

Singh et al, 2018 [13]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

Shivamurthy et al, 2020 [16]

★★★ (1,2,4)

★ (1)

★★ (2,3)

Eleti et al, 2023 [7]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

Nasir et al, 2025 [18]

★★★ (1,2,4)

★ (1)

★★★ (1,2,3)

↓ **Table 3.** Results of Study Quality Assessment Using Newcastle–Ottawa Scale (NOS) for Cohort Study
Study	Selection (max 4)	Comparability (max 2)	Exposure (max 3)	Total score (max 9)
Mehta et al, 2019 [14]	★★★★ (1,2,3,4)	★ (1)	★★★ (1,2,3)	8
Bhandari et al, 2019 [15]	★★★★ (1,2,3,4)	★ (1)	★ (1)	6
Kumari et al, 2024 [8]	★★★★ (1,2,3,4)	★ (1)	★★★ (1,2,3)	8
Vaishnav et al, 2024 [17]	★★★★ (1,2,3,4)	★ (1)	★★★ (1,2,3)	8

↓ Table 3. Results of Study Quality Assessment Using Newcastle–Ottawa Scale (NOS) for Cohort Study

Study

Selection (max 4)

Comparability (max 2)

Exposure (max 3)

Total score (max 9)

Mehta et al, 2019 [14]

★★★★ (1,2,3,4)

★ (1)

★★★ (1,2,3)

Bhandari et al, 2019 [15]

★★★★ (1,2,3,4)

★ (1)

Kumari et al, 2024 [8]

★★★★ (1,2,3,4)

★ (1)

★★★ (1,2,3)

Vaishnav et al, 2024 [17]

★★★★ (1,2,3,4)

★ (1)

★★★ (1,2,3)

↓ **Table 4.** GRADE Evidence Profile
Outcome	Number of participants (studies)	Quality assessment	Summary findings
^aEffect estimates come from a small number of studies (no more than 10 studies in each outcome). ^bPotential publication bias was found in each outcome. CI: confidence interval; FGR: fetal growth restriction; IUFD: intrauterine fetal death; LBW: low birth weight; NICU: neonatal intensive care unit.
Placental abruption	< 600: 623 ≥ 600: 861 (10 studies)	Not serious	Not serious	Not serious	Not serious	Not serious	High	4.90	(2.86, 8.40)
Eclampsia	< 600: 371 ≥ 600: 658 (7 studies)	Not serious	Not serious	Not serious	Serious^a	Not serious	Moderate	6.51	(3.36, 12.59)
FGR	< 600: 482 ≥ 600: 573 (6 studies))	Not serious	Not serious	Not serious	Serious^a	Serious^b	Low	4.48	(2.16, 9.29)
Maternal death	< 600: 326 ≥ 600: 529 (5 studies)	Not serious	Not serious	Not serious	Serious^a	Serious^b	Low	2.47	(0.59, 10.25)
LBW	< 600: 262 ≥ 600: 503 (5 studies)	Not serious	Not serious	Not serious	Serious^a	Serious^b	Low	2.27	(1.08, 4.77)
NICU admission	< 600: 298 ≥ 600: 367 (5 studies)	Not serious	Not serious	Not serious	Serious^a	Not serious	Moderate	3.58	(2.12, 6.04)
IUFD	< 600: 385 ≥ 600: 612 (6 studies)	Not serious	Not serious	Not serious	Serious^a	Not serious	Moderate	2.50	(1.21, 5.16)
Preterm	< 600: 262 ≥ 600: 503 (5 studies)	Not serious	Not serious	Not serious	Serious^a	Serious^b	Low	1.63	(0.88, 3.01)

↓ Table 4. GRADE Evidence Profile

Outcome

Number of participants (studies)

Quality assessment

Summary findings

Risk of bias

Inconsistency

Indirectness

Imprecision

Publication bias

Overall quality of evidence

Effect size total

95% CI (lower, upper)

^aEffect estimates come from a small number of studies (no more than 10 studies in each outcome). ^bPotential publication bias was found in each outcome. CI: confidence interval; FGR: fetal growth restriction; IUFD: intrauterine fetal death; LBW: low birth weight; NICU: neonatal intensive care unit.

Placental abruption

< 600: 623
≥ 600: 861
(10 studies)

Not serious

High

4.90

(2.86, 8.40)

Eclampsia

< 600: 371
≥ 600: 658
(7 studies)

Not serious

Serious^a

Not serious

Moderate

6.51

(3.36, 12.59)

FGR

< 600: 482
≥ 600: 573
(6 studies))

Not serious

Serious^a

Serious^b

Low

4.48

(2.16, 9.29)

Maternal death

< 600: 326
≥ 600: 529
(5 studies)

Not serious

Serious^a

Serious^b

Low

2.47

(0.59, 10.25)

LBW

< 600: 262
≥ 600: 503
(5 studies)

Not serious

Serious^a

Serious^b

Low

2.27

(1.08, 4.77)

NICU admission

< 600: 298
≥ 600: 367
(5 studies)

Not serious

Serious^a

Not serious

Moderate

3.58

(2.12, 6.04)

IUFD

< 600: 385
≥ 600: 612
(6 studies)

Not serious

Serious^a

Not serious

Moderate

2.50

(1.21, 5.16)

Preterm

< 600: 262
≥ 600: 503
(5 studies)

Not serious

Serious^a

Serious^b

Low

1.63

(0.88, 3.01)