Cord Blood Serum Zinc Levels and the Intrauterine Growth Status in Preterm Neonates

Annisa Trie  Anna; Ema  Alasiry; A. Dwi Bahagia  Febriani; Setia  Budi; Martira  Maddepungeng; Ratna Dewi  Artati

doi:10.6000/1929-4247.2024.13.03.5

Authors

Annisa Trie Anna Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia https://orcid.org/0009-0005-9998-4402
Ema Alasiry Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia; DR Wahidin Sudirohusodo Hospital, Makassar, Indonesia and Division of Neonatology, Department of Pediatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
A. Dwi Bahagia Febriani Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia; DR Wahidin Sudirohusodo Hospital, Makassar, Indonesia and Division of Neonatology, Department of Pediatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Setia Budi Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia; DR Wahidin Sudirohusodo Hospital, Makassar, Indonesia and Division of Gastroenterohepatology, Department of Pediatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Martira Maddepungeng Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia; DR Wahidin Sudirohusodo Hospital, Makassar, Indonesia and Division of Growth, developmental and Social Pediatrics, Department of Pediatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Ratna Dewi Artati Department of Pediatrics, Faculty of Medicine, Hasanuddin University, South Sulawesi, Indonesia; DR Wahidin Sudirohusodo Hospital, Makassar, Indonesia and Division of Endocrinology, Department of Pediatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

DOI:

https://doi.org/10.6000/1929-4247.2024.13.03.5

Keywords:

Preterm, newborn, intrauterine growth, cord blood zinc

Abstract

Background: The risk of death is higher if the SGA baby is accompanied by prematurity. Intrauterine growth is considered to have an important role in the occurrence of premature birth and SGA, so many recent studies are trying to find that can support intrauterine growth, one of which is research on the role of the micronutrient zinc, which is a trace element that the body cannot produce. Zinc is an essential micronutrient for organ development and growth. Zinc plays a role in DNA synthesis and the signaling pathway of the IGF-1 receptor. Umbilical cord blood serum zinc levels can reflect intrauterine zinc status, indicating maternal zinc supply to the fetus.

Objectives: To assess the relationship between cord blood serum zinc levels and intrauterine growth status in pretermneonates.

Methods: This research is an observational study with a cross-sectional approach. The sample for this study was 85 pretermneonates, consisting of 53 neonates with AGA (appropriate for gestational age) and 32 neonates with SGA (small for gestational age). A cord blood sample was collected immediately after birth, and zinc levels were determined by the atomic absorption spectrophotometer method.

Results: The median serum zinc levels of the SGA and AGA groups were 41.87 µg/dl (20.43 - 56.04 µg/dl) and 52.12 µg/dl (35.54 - 62.46 µg/dl), respectively, and the difference between the two groups was found to be statistically significant.

Conclusion: There was a relationship between cord blood serum zinc levels and the intrauterine growth status of pretermneonates.

References

Liu L, Johnson HL, Perin J, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet, 2012; 379: 2151-2161. https://doi.org/10.1016/S0140-6736(12)60560-1 DOI: https://doi.org/10.1016/S0140-6736(12)60560-1

Lakshmanan, et al. 2017. The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit. Health and Quality of Life Outcomes 2017; 15: 38. https://doi.org/10.1186/s12955-017-0602-3 DOI: https://doi.org/10.1186/s12955-017-0602-3

Gomella. Gestational Age and Birthweight Classification Neonatology. Management, Procedures, On-Call Problems, Diseases, and Drugs 7th Edition. McGrawhill 2013; pp. 98-100.

Haksari EL, Hakimi M, Ismail D. Neonatal mortality in small for gestational age infants based on reference local newborn curve at secondary and tertiary hospitals in Indonesia. BMC Pediatr 2023; 23: 21. https://doi.org/10.1186/s12887-023-04023-z DOI: https://doi.org/10.1186/s12887-023-04023-z

Gidi NW. et al. Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia. BMJ Paediatr Open 2020; 4(1): e000740. https://doi.org/10.1136/bmjpo-2020-000740 DOI: https://doi.org/10.1136/bmjpo-2020-000740

Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet 2013; 382: 417-25. https://doi.org/10.1016/S0140-6736(13)60993-9 DOI: https://doi.org/10.1016/S0140-6736(13)60993-9

Vashevnik S, Walker S, Permezel M. Stillbirths and neonatal deaths in appropriate, small and large birthweight for gestational age fetuses. Aust N Z J Obstet Gynaecol 2007; 47: 302-6. https://doi.org/10.1111/j.1479-828X.2007.00742.x DOI: https://doi.org/10.1111/j.1479-828X.2007.00742.x

Abdellatif M, Elhawary IM, Mahmoud MM. et al. Cord levels of zinc and copper in relation to maternal serum levels in different gestational ages. Egypt Pediatric Association Gaz 2021; 69: 11. https://doi.org/10.1186/s43054-021-00059-x DOI: https://doi.org/10.1186/s43054-021-00059-x

Beyersmann D, Haase H. Functions of zinc in signaling, proliferation, and differentiation of mammalian cells. BioMetals 2001; 14(3-4): 331-341. https://doi.org/10.1023/A:1012905406548 DOI: https://doi.org/10.1023/A:1012905406548

Gernand AD, Schulze KJ, Stewart CP, West Jr KP, Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nature Reviews Endocrinology 2016; 12(5): 274-289. https://doi.org/10.1038/nrendo.2016.37 DOI: https://doi.org/10.1038/nrendo.2016.37

Cano-Ibáñez N, et al. Maternal dietary diversity and risk of small for gestational age newborn: Findings from a case-control study. Clinical Nutrition 2020; 39(6): 1943-1950 https://doi.org/10.1016/j.clnu.2019.08.019 DOI: https://doi.org/10.1016/j.clnu.2019.08.019

Farias PM, et al. Minerals in Pregnancy and Their Impact on Child Growth and Development. Molecules 2020; 25(23): 5630. https://doi.org/10.3390/molecules25235630 DOI: https://doi.org/10.3390/molecules25235630

Shenkin A. Micronutrients in health and disease. Postgrad Med J 2006; 82(971): 559-67. https://doi.org/10.1136/pgmj.2006.047670 DOI: https://doi.org/10.1136/pgmj.2006.047670

Maxfield L, Shukla S, Crane JS. Zinc Deficiency. [Updated 2023 Jun 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493231/

Hess SY, Lönnerdal B, Hotz C, Rivera J, Brown KH. Recent advances in knowledge on zinc nutrition and human health. Food Nutr Bull 2009; 30(1 suppl): S5-S11. https://doi.org/10.1177/15648265090301S102 DOI: https://doi.org/10.1177/15648265090301S102

Chaffee BW, King JC. Effect of zinc supplementation on pregnancy and infant outcomes: a systematic review. Paediatr Perinat Epidemiol 2012; 26(suppl 1): 118-137. https://doi.org/10.1111/j.1365-3016.2012.01289.x DOI: https://doi.org/10.1111/j.1365-3016.2012.01289.x

GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396(10258): 1223-49. https://doi.org/10.1016/S0140-6736(20)30752-2 DOI: https://doi.org/10.1016/S0140-6736(20)30752-2

Bailey R, L West Jr. K, P, Black R, E. The Epidemiology of Global Micronutrient Deficiencies Ann Nutr Metab 2015; 66(suppl 2): 22-3310. https://doi.org/10.1159/000371618 DOI: https://doi.org/10.1159/000371618

Yu X, et al. Effects of maternal mild zinc deficiency and different ways of zinc supplementation for offspring on learning and memory. Food and Nutrition Research 2016; 60. https://doi.org/10.3402/fnr.v60.29467 DOI: https://doi.org/10.3402/fnr.v60.29467

Darnton-Hill I, Mkparu UC. Micronutrients in Pregnancy in Low- and Middle-Income Countries. Nutrients 2015; 7(3): 1744-1768. https://doi.org/10.3390/nu7031744 DOI: https://doi.org/10.3390/nu7031744

Kumera G, Awoke T, Melese T. et al. Prevalence of zinc deficiency and its association with dietary, serum albumin, and intestinal parasitic infection among pregnant women attending antenatal care at the University of Gondar Hospital, Gondar, Northwest Ethiopia. BMC Nutr 2015; 1: 31. https://doi.org/10.1186/s40795-015-0026-6 DOI: https://doi.org/10.1186/s40795-015-0026-6

Facchinetti F, et al. Intra-uterine growth retardation is associated with increased levels of magnesium in amniotic fluid. In European Journal of Obstetrics & Gynecology and Reproductive Biology 1989; 32. https://doi.org/10.1016/0028-2243(89)90040-3 DOI: https://doi.org/10.1016/0028-2243(89)90040-3

Yang, et al. A placental growth factor is silenced in mouse embryos by the zinc finger protein ZFP568. Science 2017; 356(6339): 757-759. https://doi.org/10.1126/science.aah6895 DOI: https://doi.org/10.1126/science.aah6895

Finken MJJ, et al. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. In Endocrine Reviews 2018; 39(6): 851-894. Oxford University Press. https://doi.org/10.1210/er.2018-00083 DOI: https://doi.org/10.1210/er.2018-00083

Scheplyagina LA. Impact of the mother's zinc deficiency on the woman's and newborn's health status. J Trace Elem Med Biol 2005; 19(1): 29-35. https://doi.org/10.1016/j.jtemb.2005.07.008 DOI: https://doi.org/10.1016/j.jtemb.2005.07.008

Macdonald RS. Zinc and Health: Current Status and Future Directions The Role of Zinc in Growth and Cell Proliferation 2000; 1: 2. https://doi.org/10.1093/jn/130.5.1500S DOI: https://doi.org/10.1093/jn/130.5.1500S

Bayomy, et al. Cord Serum Zinc Level and Its Impact on Birth Weight, Length, and Growth Velocity in the First Three Months of Life. American Journal of Medicine and Medical Sciences 2021; 7: 47-54.

Gupta N, Bansal S, Gupta M, Nadda A. A comparative study of serum zinc levels in small for gestational-age babies and appropriate for gestational-age babies in a Tertiary Hospital, Punjab. J Family Med Prim Care 2020; 9(2): 933-937. https://doi.org/10.4103/jfmpc.jfmpc_814_19 DOI: https://doi.org/10.4103/jfmpc.jfmpc_814_19

Youssof AL, et al. Zinc Content in Cord Blood Is Associated with Maternal Age and Parity. Biological Trace Element Research 2017; 175(1): 17-26. https://doi.org/10.1007/s12011-016-0760-x DOI: https://doi.org/10.1007/s12011-016-0760-x

Bahl L, Chaudhuri LS, Pathak RM. Study of serum zinc in neonates and their mothers in Shimla hills (Himachal Pradesh) Indian J Pediatr 1994; 61: 571-5. https://doi.org/10.1007/BF02751721 DOI: https://doi.org/10.1007/BF02751721

Iqbal AS, et al. Serum zinc and copper levels in the maternal blood and cord blood of neonates. Indian J Pediatr 2001; 68: 523-6. https://doi.org/10.1007/BF02723246 DOI: https://doi.org/10.1007/BF02723246

Akdaz S, Yazihan N. Cord blood zinc status effects on pregnancy outcomes and its relation with maternal serum zinc levels: a systematic review and meta-analysis. World Journal of Pediatrics 2020; 16(4): 366-376. https://doi.org/10.1007/s12519-019-00305-8 DOI: https://doi.org/10.1007/s12519-019-00305-8

Martadiansyah, et al. Zinc Serum Maternal Levels as a Risk Factor for Preeclampsia. Bioscientia Medicina: Journal of Biomedicine & Translational Research 2021; pp. 693-701. https://doi.org/10.32539/bsm.v5i7.390 DOI: https://doi.org/10.32539/bsm.v5i7.390

Abregu FMG, Caniffi C, Arranz CT, Tomat AL, et al. Impact of Zinc Deficiency During Prenatal and/or Postnatal Life on Cardiovascular And Metabolic Diseases: Experimental and Clinical Evidence. Adv Nutr 2022; pii: 6528912.

Wang H, et al. Maternal Serum Zinc Concentration during Pregnancy Is Inversely Associated with Risk of Preterm Birth in a Chinese Population. J Nutr 2016; 146(3): 509-15. https://doi.org/10.3945/jn.115.220632 DOI: https://doi.org/10.3945/jn.115.220632