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Research Article | DOI: https://doi.org/10.31579/2690-1919/490
1Department of Haematology and Blood Transfusion, Federal Medical Centre, Umuahia, Abia State, Nigeria.
2Department of Haematology and Blood Transfusion, Abia State University, Uturu, Nigeria.
3Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu State, Nigeria.
4Department of Haematology and Blood Transfusion, University of Abuja, Gwagwalada, Nigeria.
5Department of Biochemistry, Lead City University, Ibadan, Oyo State, Nigeria.
6Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu State, Nigeria.
*Corresponding Author: Chikezie Kelecchi, Department of Haematology and Blood Transfusion, Federal Medical Centre, Umuahia, Abia State, Nigeria.
Citation: Chikezie K, Uche CL, Ocheni S, Ugwu AO, Nwabuko CO, et al, (2025), Examining Blood Group Antigens as Potential Predictors of Preeclampsia Among Pregnant Women, J Clinical Research and Reports, 18(5); DOI:10.31579/2690-1919/490
Copyright: © 2025, Chikezie Kelecchi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 February 2025 | Accepted: 17 February 2025 | Published: 25 February 2025
Keywords: preeclampsia; red cell antigens; abo blood group; rh blood group
Background: Preeclampsia is a significant cause of maternal and perinatal morbidity and mortality worldwide. While its etiology remains multifactorial, emerging evidence suggests a possible association between red cell antigens and susceptibility to preeclampsia. This study aimed to determine the distribution of ABO, Rh, Kell, Kidd, and Duffy blood group antigens among preeclamptic and non-preeclamptic pregnant women in South-eastern Nigeria, and to assess any potential association with preeclampsia.
Materials and Methods: This cross-sectional analytical study was conducted at the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (ESUTH). The study population included pregnant women diagnosed with preeclampsia (n=78) and healthy pregnant controls (n=78) at ≥20 weeks gestation. Blood samples were collected, and red cell antigen typing was performed using standard serological methods. Statistical analyses, including chi-square tests and binary logistic regression, were conducted using SPSS version 21, with significance set at p<0.05.
Results: No statistically significant differences were observed in the distribution of Kell (p=0.32), Kidd (p=0.56), and Duffy (p=0.16) antigens between the two groups. Regression analysis indicated no significant predictive association between blood group antigens and preeclampsia (p>0.05).
Conclusion: The study found no significant association between ABO, Rh, Kell, Kidd, or Duffy blood group antigens and preeclampsia in the study population. These findings suggest that red cell antigens are unlikely to serve as independent predictors of preeclampsia among pregnant women in Enugu, Nigeria. Further large-scale and multi-center studies may provide additional insights into potential immunogenetic influences on preeclampsia.
Preeclampsia is a hypertensive disorder unique to pregnancy, characterized by the onset of elevated blood pressure and proteinuria after 20 weeks of gestation [1]. It remains a leading cause of maternal and perinatal morbidity and mortality worldwide, particularly in low- and middle-income countries like Nigeria. The aetiology of preeclampsia is multifactorial, involving genetic, immunological, and environmental factors. Recent studies have explored the potential association between maternal blood group antigens and the risk of developing preeclampsia, suggesting that certain blood groups may predispose individuals to this condition.
The ABO blood group system, first described by Karl Landsteiner in 1901, classifies human blood into four main types: A, B, AB, and O, based on the presence or absence of specific antigens on the surface of red blood cells [2]. These antigens are oligosaccharides expressed not only on erythrocytes but also on various epithelial and endothelial cells throughout the body. The distribution of ABO blood groups varies among different populations and has been implicated in susceptibility to various diseases, including cardiovascular disorders and certain infections.
Several studies have investigated the relationship between ABO blood groups and the risk of preeclampsia. A systematic review and meta-analysis by Alpoim et al. [2] concluded that non-O blood groups, particularly AB, are associated with an increased risk of developing preeclampsia. Similarly, a study conducted in India by Ainani et al. [3] found that women with AB blood group had the highest risk, while those with O blood group had the lowest risk for preeclampsia. These findings suggest a potential link between ABO blood group antigens and the pathogenesis of preeclampsia, possibly through mechanisms involving coagulation and immune response.
In Nigeria, preeclampsia and eclampsia contribute significantly to maternal and perinatal morbidity and mortality. A systematic review and meta-analysis by Kokori et al. [4] reported a prevalence of preeclampsia/eclampsia among pregnant women in Nigeria, highlighting the substantial health burden posed by these conditions. Specifically, in Enugu, South-Eastern Nigeria, studies have documented the prevalence and outcomes of severe preeclampsia. Ugwu et al. [5] reported a prevalence of 3.3% for severe preeclampsia at the University of Nigeria Teaching Hospital, with significant maternal and perinatal complications observed.
Despite the recognized burden of preeclampsia in Nigeria, there is a paucity of research examining the association between ABO blood group antigens and the risk of preeclampsia among Nigerian women. Understanding this relationship could provide insights into the pathophysiology of preeclampsia and inform strategies for risk assessment and management in this population.
This study aims to investigate the association between ABO blood group antigens and the occurrence of preeclampsia among pregnant women attending teaching hospitals in Enugu, Nigeria. By conducting a cross-sectional analysis, we seek to determine whether specific blood groups are associated with an increased risk of preeclampsia in this population. The findings of this study could have implications for prenatal care, including the potential for blood group screening to identify women at higher risk for preeclampsia, thereby facilitating early interventions to improve maternal and fetal outcomes.
Study Design
The study was a cross-sectional analytical study involving pregnant women and 24-48 hours post-delivery women with preeclampsia (cases) and those without the disease (controls) receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (ESUTH), Enugu.
Study Area
The study was conducted in the Obstetrics and Gynaecology Departments of the UNTH Ituku-Ozala, and ESUTH Park lane, GRA, both in Enugu state. These are the two Teaching Hospitals in Enugu state, Nigeria. The participants’ blood samples were analysed in the Haematology laboratory and the blood bank unit of UNTH, Enugu.
Study Population
Participants were pregnant women diagnosed of preeclampsia as defined by WHO25 (BP ≥ 140/90mmhg and proteinuria of ≥ 2+ in pregnant women of 20 weeks gestation and above as well as those 24-48 hours post-delivery) and those with normal pregnancy recruited at the antenatal clinics and wards (antenatal, postnatal and labour wards) of UNTH and ESUTH.
Inclusion Criteria
Women who were pregnant or 24-48 hours post-delivery with an established diagnosis of preeclampsia were recruited as the study group, while women who did not have preeclampsia or any other hypertensive and medical diseases, and who were above 20 weeks of gestation or 24-48 hours post-delivery were recruited as the control group.
Exclusion Criteria
Pregnant women with hypertensive disorders of pregnancy other than preeclampsia or other diagnosed morbidities and pregnant women below 20 weeks of gestation were excluded from the study. Previously transfused pregnant women were also excluded from the study.
Sampling Method
The cases and controls were recruited in a non-randomized fashion after confirming from the participants that they had not been earlier recruited for this study. The preeclamptic group was first recruited, and subsequently, the non-preeclamptic group was recruited. The non-preeclamptic group was matched with the preeclamptic group for the age range and parity group.
Sample Size Determination
The sample size was determined using the formula for comparison of two proportions:57
n= 2(Zα/2+ Zβ)2 P(1-P)/(P1-P2)2, where:
n= minimum sample size
Zα/2 = critical value of the normal distribution at α/2
Zβ = critical value of the normal distribution at β
P= pooled prevalence (prevalence in case group, P1 + prevalence in control group, P2)
P1-P2 = difference in the proportion of events in two groups
To calculate the sample size (using the Z table), Zα/2 = 1.64 at 90% confidence interval and Zβ = 0.84 for a power of 80%. Taking P1 to be 28% (0.28) and P2 to be 12% (0.12) from the findings of Mital et al. [6] on the presence of AB blood group among preeclamptic (case) and non-preeclamptic (control) pregnant women in India, the sample size is calculated thus:
n= 2(1.64 + 0.84)2 0.2(1-0.2)/(0.16)2
n= 12.3 x 0.16/0.0256 = 76.88
The calculated minimum sample size was approximately 77 for each group of the study.
Clinical and Demographic Data
Detailed clinical, pertinent personal history and other relevant information were collected by the researcher/assistant from clinical/ward records and from the patients or their caregivers using a well-structured questionnaire specifically designed for this study.
Biological Specimen Collection and Analyses
Five millilitres (5mls) of venous whole blood samples were collected from the study and control groups at recruitment. This was collected in EDTA-containing test tubes labelled with the subject’s identification number and placed in racks for storage in the refrigerator at 4 oC, for the serologic analysis of the red cell antigens (ABO, Rh, Kell, Kidd and Duffy) in batches at the Blood Bank/Blood Transfusion Unit of the Department of Haematology and Immunology, UNTH, Enugu.
Procedure for ABO blood grouping
The forward and reverse grouping methods were employed.
1. Seven clean glass tubes numbered 1-7 and appropriately labelled were placed in the test tube rack and the test sample and reagents were mixed as below:
Tube 1: 1 volume of anti-A antisera + 1 volume of 5% test cell solution (forward grouping)
Tube 2: 1 volume of anti-B antisera + 1 volume of 5% test cell solution (forward grouping)
Tube 3: 1 volume of anti-AB antisera + 1 volume of 5% test cell solution (forward grouping)
Tube 4: 1 volume of test plasma + 1 volume of 5% known A cell solution (reverse grouping)
Tube 5: 1 volume of test plasma + 1 volume of 5% known B cell solution (reverse grouping)
Tube 6: 1 volume of test plasma + 1 volume of 5% known O cell solution (reverse grouping)
Tube 7: 1 volume of test plasma + 1 volume of 5% test cell solution (own serum/auto-control)
2. Each tube was tapped gently at the base to mix the contents. These were left in the rack for 5 minutes at room temperature and then checked for macroscopic agglutination in the absence of which they were centrifuged at 1500rpm for 1 minute.
3. Each tube was tapped gently at the base and examined for macroscopic agglutination or haemolysis.
4. The contents of each tube were then examined for microscopic agglutination or haemolysis in the absence of macroscopic forms using glass slides and a light microscope.
Procedure for Rh Grouping
The forward grouping method was carried out.
1. Four clean glass slides numbered 1-4 and appropriately labelled were placed in the test tube rack and the test samples and reagents were mixed as follows:
Tubes 1-3: 1 volume of anti-D, anti-c and anti-E antisera each per test tube + 1 volume of 5% test cell solution in each test tube.
Tube 4: 1 volume of test plasma + 1 volume of 5% test cell solution (own serum/auto control).
2. The contents of each tube were mixed by gently tapping the base of each tube and then left in the rack for 5 minutes at room temperature and then checked for agglutination macroscopically.
3. In the absence of agglutination above, the test tubes were then centrifuged at 1500rpm for 1 minute and examined for macroscopic and microscopic agglutination or haemolysis following the same protocol as for ABO grouping above.
Procedure for Kell grouping
The forward grouping method was carried out.
1. Three clean glass tubes numbered 1-3 and appropriately labelled were placed in the test tube rack and the test samples and reagents were mixed as follows:
Tubes 1 & 2: 1 volume of anti-K and anti-k antisera each per test tube + 1 volume of 5% test cell solution in each test tube.
Tube 3: 1 volume of test plasma + 1 volume of 5% test cell solution (auto control)
2. The contents of each test tube were mixed by gentle taps at the base of each test tube and incubated in the rack at room temperature for 5 minutes and then checked for macroscopic agglutination.
3. In the absence of agglutination above, the solutions were centrifuged at 1500rpm for 1 minute and then examined for macroscopic and microscopic agglutination or haemolysis following the same protocol as for ABO grouping above.
Procedure for Kidd grouping
The forward grouping method was carried out.
1. Three clean glass tubes numbered 1-3 and appropriately labelled were placed in the test tube rack and the test samples and reagents were mixed as follows:
Tubes 1-2: 1 volume of anti-Jka and anti-Jkb antisera each per test tube + 1 volume of 5% test cell solution in each test tube (forward grouping)
Tube 3: 1 volume of test plasma + 1 volume of 5% test cell solution (auto control)
2. The contents of each test tube were mixed by gentle taps at the base of each test tube and incubated in the rack at room temperature for 5 minutes and then checked for macroscopic agglutination.
3. In the absence of agglutination above, the solutions were centrifuged at 1500g for 1 minute and then examined for macroscopic and microscopic agglutination or haemolysis following the same protocol as for ABO grouping above.
Procedure for Duffy blood grouping
The forward grouping method was carried out.
1. One drop of anti-Fya antisera was placed in a clean labelled glass tube and placed on the test tube rack.
2. One drop of 5% test red cell solution was added to the tube above and incubated at 370C for 30 minutes.
3. 0.3ml of the mixture was mixed with 3mls of saline and centrifuged at 1500rpm for 2-3minutes.
4. The supernatant was discarded and another 3mls of saline was added to the red cell sediment and centrifuged again as above and the supernatant was discarded.
5. The procedure above was repeated once more and one volume of the red cell sediment was mixed with two volumes of AHG in a fresh labelled glass tube.
6. The mixture was then mixed by a gentle tap at the base of the tube and centrifuged at 1500rpm for 1 minute.
7. The mixture was examined for macroscopic and microscopic agglutination following the same protocols as for the ABO grouping above.
8. The procedure above was repeated with anti-Fyb antisera.
9. An auto-control test was also carried out using the test cells and test plasma following the same protocol as above.
Interpretation of results
For each of the blood grouping procedures, the presence of agglutination or haemolysis signifies a positive reaction, indicating the presence of the tested antigen in the test cells. The absence of agglutination or haemolysis on the other hand indicates a negative reaction and the absence of the tested antigen on the test cells.
All data collected from the study were cleaned, coded, entered into the computer on a pre-designed Excel spreadsheet and analysed using the statistical package for Social Sciences (SPSS) computer software version 21. Also, quantitative data were summarized using mean ± standard deviation (SD), median, mode and range; and outcomes were presented in tables. Quantitative data were presented in proportions. Differences in mean between the cases and the control were analysed using the student t-test, while differences in proportions and test of association were done using the chi-squared test. Binary logistic regression was done to ascertain the blood group that can independently predict preeclampsia. All tests were two-sided and the statistical significance was considered to be at a probability (p) value of <0.05.
The socio-demographic characteristics of pre-eclamptic and non-pre-eclamptic women including age, education, occupation, religion and ethnicity were comparable (Table 1).
Table 2 summarized the ABO blood group distribution, with blood group O being the most prevalent (88.5%), followed by A (5.1%), B (4.5%), and AB (1.9%). No significant association between ABO blood groups and pre-eclampsia was found (p=0.80). Table 3 showed the Rh blood group distribution, where Rh D positive individuals constituted 82.1% of the population, while Rh D negative individuals comprised 17.9%. Although there was a higher proportion of Rh D-negative individuals among pre-eclamptic women (23.1%) compared to non-pre-eclamptic women (12.8%), the association was not statistically significant (p=0.09). However, Rh c negativity was significantly associated with pre-eclampsia (p<0>
Table 4 indicated that the Kell K antigen was found in only one non-pre-eclamptic woman (1.3%), while all other participants were Kell K-negative. All women were Kell k-positive. Similarly, Table 5 showed that all participants were Kidd Jka-negative, while Kidd Jkb-positive individuals constituted 1.9% of the total sample, with no significant difference between the groups (p=0.56). Table 6 showed that Duffy Fya antigen was absent in all non-pre-eclamptic women but present in 2.6% of pre-eclamptic women, though this difference was not statistically significant (p=0.16). All participants were Duffy Fyb-negative.
Table 7 presents the logistic regression results for predicting pre-eclampsia. None of the ABO blood groups showed a significant predictive association with pre-eclampsia (p=0.75-0.98). Similarly, RhD positivity did not significantly predict pre-eclampsia (OR=1.96, p=0.15). RhE (p=0.49), Rhc (p=0.99), and Kidd (p=0.99) blood groups also did not emerge as significant predictors.
| Characteristic | Pre-eclamptic women n=78 (%) | Non-pre-eclamptic women n=78 (%) | All Women
n=156 | χ2 | p-value |
| Age (in years) | |||||
| 21-30 | 34 (43.6) | 34 (43.6) | 68 (43.6) | ||
| 31-40 | 36 (46.2) | 36 (46.2) | 72 (46.2) | 0.00 | 1.00 |
| >40 | 8 (10.3) | 8 (10.3) | 16 (10.3) | ||
| Educational Status | |||||
| None | 2 (2.6) | 1 (1.3) | 3 (1.9) | ||
| Primary | 5 (6.4) | 6 (7.7) | 11 (7.1) | 0.93 | 0.82 |
| Secondary | 26 (33.3) | 22 (28.2) | 48 (30.8) | ||
| Tertiary | 45 (57.7) | 49 (62.8) | 94 (60.3) | ||
| Occupation | |||||
| Civil Servant | 30 (38.5) | 26 (33.3) | 56 (35.9) | ||
| Trader | 16 (20.5) | 20 (25.6) | 36 (23.1) | ||
| Work in private firm | 10 (12.8) | 6 (7.7) | 16 (10.3) | ||
| Farmer | 6 (7.7) | 4 (5.1) | 10 (6.4) | 3.08 | 0.55 |
| Others | 16 (20.5) | 22 (28.2) | 38 (24.4) | ||
| Religion | |||||
| Christian | 72 (92.3) | 74 (94.9) | 146 (93.6) | ||
| Muslim | 6 (7.7) | 4(5.1) | 10 ((6.4) | 0.43 | 0.51 |
| Tribe/ethnicity | |||||
| Igbo | 75 (96.2) | 75 (96.2) | 150 (96.2) | ||
| Hausa | 2 (2.6) | 3 (3.8) | 5 (3.2) | 1.58 | 0.45 |
| Yoruba | 1 (1.3) | 0 (0.0) | 1 (0.6) | df=1 |
Table 1: Sociodemographic Characteristics of the study participants
| Blood group | Pre-eclamptic women n=78 (%) | Non-pre-eclamptic women n=78 (%) | All Women
n=156 (%) | χ2 | p-value |
| A | 5 (6.4) | 3 (3.8) | 8 (5.1) | ||
| AB | 1 (1.3) | 2 (2.6) | 3 (1.9) | ||
| B | 4 (5.1) | 3 (3.8) | 7 (4.5) | 1.01 | 0.80 |
| O | 68 (87.2) | 70 (89.7) | 138 (88.5) |
Table 2: ABO Blood Group Distribution
| Blood group | Pre-eclamptic women n=78 (%) | Non-pre-eclamptic women n=78 (%) | All Women
n=156 (%) | χ2 | p-value |
| Rh D | |||||
| - | 18 (23.1) | 10(12.8) | 28 (17.9) | 2.79 | 0.09 |
| + | 60 (76.9) | 68 (87.2) | 128 (82.1) | ||
| Rh c | |||||
| - | 10 (12.8) | 0 (0.0) | 10 (6.4) | 10.68 | <0> |
| + | 68 (87.2) | 78 (100.0) | 146 (93.6) | ||
| Rh E | |||||
| - | 14 (17.9) | 16 (20.5) | 30(19.2) | 0.17 | 0.69 |
| + | 64 (82.1) | 62 (79.5) | 126 (80.8) |
Table 3: Rh Blood Group Distribution
| Blood group | Pre-eclamptic women n=78 (%) | Non-pre-eclamptic women n=78 (%) | All Women
n=156 (%) | χ2 | p-value |
| Kell K | |||||
| - | 78 (100.0) | 77 (98.7) | 155 (99.4) | 1.01 | 0.32 |
| + | 0 (0.0) | 1 (1.3) | |||
| Kell k | |||||
| - | 78 (100.0) | 78 (100.0) | 156 (100.0) | ||
| + | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Table 4: Kell Blood Group Distribution
| Blood group | Pre-eclamptic women n=78 (%) | Non pre-eclamptic women n=78 (%) | All Women
n=156 (%) | χ2 | p-value |
| Kidd Jka | |||||
| - | 78 (100.0) | 78 (100.0) | 156 (100.0) | ||
| + | 0 (0.0) | 0 (0.0) | 0 (0.0) | ||
| Kidd Jkb | |||||
| - | 77 (98.7) | 76 (97.4) | 153 (98.1) | 0.34 | 0.56 |
| + | 1 (1.3) | 2 (2.6) | 3 (1.9) |
Table 5: Kidd Blood Group Distribution
| Blood Group | Pre-eclamptic women | Non-pre-eclamptic women | All Women | χ2 | p-value |
| Duffy Fya | |||||
| _ | 76 (97.4) | 78 (100.0) | 154 (98.7) | 2.03 | 0.16 |
| + | 2 (2.6) | 0 | 2 (1.3) | ||
| Duffy Fyb | |||||
| - | 78 (100.0) | 78 (100.0) | 156 (100.0) | ||
| + | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Table 6: Duffy Blood Group Distribution
| Predictor | OR (95% CI) | P value |
| ABO | 0.98 | |
| ABO | .84 (0.13-5.24) | 0.85 |
| ABO | .74 (0.06-8.61) | 0.79 |
| ABO | 1.31 (0.25 -6.88) | 0.75 |
| RhD | 1.96 (0.79-4.85) | 0.15 |
| RhE | .73 (0.31-1.76) | 0.49 |
| Rhc | 24.49 x1014 (0.00-0.00) | 0.99 |
| Kidd | 18.20x 108 (0.00-0.00) | 0.99 |
Table 7: Predictors of Preeclampsia
In this cross-sectional analytic study of pregnant women in South-eastern Nigeria, blood group O was predominant, accounting for 89.7% of non-preeclamptic and 87.2% of preeclamptic women. Blood groups A, B, and AB were less prevalent, with no significant differences observed between the two groups. These findings align with a study by Okoye et al. [7] in Nigeria, which reported no significant association between ABO blood types and the risk of preeclampsia. Similarly, a systematic review by Li et al. [8] concluded that there was no effect of ABO blood types on the risk of preeclampsia in several studies, including those conducted in Nigeria and Thailand. However, other studies have reported varying associations. For instance, a meta-analysis by Franchini et al. [9] suggested that non-O blood groups might be associated with an increased risk of preeclampsia, possibly due to their impact on hemostatic balance and thrombus formation. These discrepancies highlight the need for further research to elucidate the relationship between ABO blood groups and preeclampsia.
Regarding the Rh blood group system, 87.2% of non-preeclamptic and 76.9% of preeclamptic women were Rh D positive, while 12.8% and 23.1%, respectively, were Rh D negative. The Rh c antigen was universally present in non-preeclamptic women (100%) but less so in preeclamptic women (87.2%), with a statistically significant difference (p<0>
In the present study, we also examined the distribution of specific red cell antigens—namely, Kell, Kidd, and Duffy blood group systems—among preeclamptic and non-preeclamptic pregnant women in teaching hospitals in Enugu, Nigeria. Our findings revealed no statistically significant differences in the distribution of these antigens between the two groups. Specifically, the Kell K antigen was present in 1.3% of non-preeclamptic women and absent in preeclamptic women (χ²=1.01, p=0.32). The Kidd antigen was found in 2.6% of non-preeclamptic women and 1.3% of preeclamptic women (χ²=0.34, p=0.56). The Duffy Fya antigen was absent in non-preeclamptic women but present in 2.6% of preeclamptic women (χ²=2.03, p=0.16).
These results align with several studies that have explored the association between red cell antigens and preeclampsia. For instance, a study conducted in Japan found no significant association between maternal ABO blood group and the risk of preeclampsia, suggesting that ABO blood group antigens may not play a pivotal role in the development of this condition [10]. Similarly, research in Nigeria reported no significant correlation between maternal ABO blood group and preeclampsia risk, reinforcing the notion that these antigens may not be critical determinants in the pathogenesis of preeclampsia [11].
However, contrasting evidence exists. Studies in Finland [12] and Italy [13] reported a higher risk of preeclampsia among women with AB blood type compared to those with O blood type, indicating a potential association between certain ABO blood groups and increased preeclampsia risk. Additionally, research in Thailand found that women with A and AB blood groups had a 1.7-fold higher risk of developing preeclampsia compared to those with O blood group [14]. These discrepancies suggest that the relationship between red cell antigens and preeclampsia may vary across different populations and ethnic groups.
The lack of significant association between Kell, Kidd, and Duffy antigens and preeclampsia in our study may be attributed to several factors. Firstly, the prevalence of these antigens in the studied population may be low, limiting the power to detect significant differences. Secondly, the pathogenesis of preeclampsia is multifactorial, and red cell antigens may play a minor role compared to other genetic, immunological, or environmental factors. Furthermore, variations in study design, sample size, and population characteristics across different studies may contribute to inconsistent findings.
This study's findings indicate no significant association between ABO blood groups and preeclampsia, consistent with some previous studies, while contrasting with others that suggest a potential link between non-O blood groups and increased risk. The significant difference in Rh c antigen distribution between preeclamptic and non-preeclamptic women is a novel finding that requires further research. Further large-scale and multi-center studies may provide additional insights into potential immunogenetic influences on preeclampsia.
Authors’ contributions: KC, TN, SO and EOU conceptualized and designed the study. KC, OA and CJM were involved in data collection/acquisition and statistical analysis. KC, TN, SO, and EOU interpreted the results and together with CLU, AIA, CON and OAU, were involved in the writing and revising of the manuscript for intellectual content. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work. All authors have accepted responsibility for the entire content of this manuscript and consented to its submission to the journal reviewed all the results and approved the final version of the manuscript.
Ethical Considerations: Ethical approval was obtained from the Health Research and Ethics committees of UNTH and ESUTH with reference numbers NHREC/05/01/2008B and ESUTHP/C-MAC/RA/034/vol-2163 respectively.
Informed Consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
Declaration of Helsinki: The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).
Availability of research data: Authors are available and ready to supply the data upon any request through the corresponding author.
The authors did not receive any funding or financial support for this study.
Authors have no conflict of interest to declare.
We acknowledge all the subjects who willingly participated in this study. We also acknowledge the efforts of Dr Ugochukwu Onyeonoro and Dr Ehijie Okoigun in the sample collection and data analysis.
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Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
