|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 10
| Issue : 1 | Page : 19-23 |
|
Cord blood lipid profile at delivery and association with birth weight among term babies
Osaretin James Agbonlahor, Ishola Ayomide, Mathias Abiodun Emokpae
Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City; Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
| Date of Submission | 02-Dec-2021 |
| Date of Decision | 16-Mar-2022 |
| Date of Acceptance | 21-Mar-2022 |
| Date of Web Publication | 01-Jul-2022 |
Correspondence Address:
Prof. Mathias Abiodun Emokpae
Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/njecp.njecp_43_21
Background: Abnormal birth weight is a leading risk factor for neonatal morbidity and mortality, abnormal lipid profile levels may be involved. Aim: The aim of this study was to evaluate the relationship between cord blood lipid profile levels and neonatal birth weight of babies. Materials and Methods: Two hundred apparently healthy pregnant women attending antenatal clinics a Specialist Hospital in Benin City were recruited into the study. Five (5 mL) milliliters of cord blood was collected from the umbilical vein into plain bottle. The serum levels of total cholesterol, triglycerides, and high-density lipoprotein (HDL) were determined using spectrophotometric techniques. The low-density lipoprotein (LDL) was calculated using Friedewald's equation, while anthropometric measurements were done using standard techniques. Data were analyzed using Student's t-test and Pearson correlation coefficient. Results: The birth weight (2.34 ± 0.3 versus 3.47 ± 0.4; P < 0.01), head circumference (32.3 ± 1.3 versus 34.4 ± 2.8; P < 0.04), recumbent length (50.2 ± 0.5 versus 54.6 ± 0.2; P < 0.04), and Ponderal Index (2.14 ± 0.5 versus 24.5 ± 0.2; P < 0.02) were significantly lower in babies with small for gestational age (SGA) than appropriate gestational age. The total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol were significantly lower (P < 0.001) in SGA than appropriate for gestational age (AGA) babies. Total cholesterol (r = 0.21; P < 0.004) and triglycerides (r = 0.31; P < 0.001) correlated positively with the weight of babies. Conclusion: AGA babies had significantly higher lipid profile levels compared to SGA babies.
Keywords: Body weight, cord blood, lipid
How to cite this article:
Agbonlahor OJ, Ayomide I, Emokpae MA. Cord blood lipid profile at delivery and association with birth weight among term babies. Niger J Exp Clin Biosci 2022;10:19-23 |
How to cite this URL:
Agbonlahor OJ, Ayomide I, Emokpae MA. Cord blood lipid profile at delivery and association with birth weight among term babies. Niger J Exp Clin Biosci [serial online] 2022 [cited 2023 May 29];10:19-23. Available from: https://www.njecbonline.org/text.asp?2022/10/1/19/349563 |
| Introduction | |  |
Abnormal lipid profile levels have been recognized as a risk factor for cardiovascular diseases (CVDs), the process is considered to begin in early life and progresses without notice for several years.[1] Even though the lipid profile levels have been widely investigated and reference ranges established for both adults and neonates in developed countries,[2],[3],[4] there appears to be paucity of information on lipid profile levels among neonates with small for gestational age (SGA) and appropriate for gestational age (AGA) babies in our setting. Moreover, lipid profiles from different countries and regions showed variations in concentrations indicating that genetic, age, and environmental factors could play some roles in their physiology.[5],[6]
CVD is the most common cause of disability and death in adults worldwide.[7] Besides genetic tendency, an increased risk of CVD is associated with lifestyle and various medical conditions, such as hypercholesterolemia, hypertension, smoking, obesity, and inadequate physical activity.[8],[9] The effect of intrauterine factors on the emergence of these risk factors also has been suggested.[10] Moreover, several maternal and fetal factors, such as hypertension, diabetes, obesity, and low or high birth weight, can influence fetal plasma lipids.[11]
Low birth weight (LBW) is associated with increased incidence of CVD, hypertension, and type II diabetes.[12] Changes in blood lipids in LBW newborns with relative insulin intolerance can increase the risk of CVD in adulthood. LBW is a risk of later atherosclerotic diseases that is equal to smoking or hypertension at puberty.[11],[13] Therefore, it seems that a relation exists between birth weight and mortality from CVD in adulthood.[14] On the other hand, high birth weight is associated with increased insulin-like growth factor-1 (IGF-1) that could change lipoprotein composition and concentration at birth and could increase the risk of CVD.[15] Therefore, it is of public health importance to know whether association exists between umbilical cord lipids and birth weight of newborn. It was against this background that this study investigated the association between cord blood lipid profile and neonatal birth weight in term babies.
| Materials and Methods | | |
Study area
This study will be conducted at the Stella Obasanjo Hospital, Benin City, Edo State, Nigeria.
Study population
This is a cross-sectional study of 200 apparently healthy pregnant women attending antenatal clinics at the Departments of Obstetrics and Gynecology, Stella Obasanjo Hospital, Benin City. They were consecutively enrolled for the study during pregnancy and later admitted with the onset of confirmed labor for deliveries in the same facility. The gestational age was calculated by counting in weeks from the 1st day of the last menstrual period. Demographic and clinical information were obtained using structured questionnaires.
Inclusion criteria
All apparently healthy pregnant women of 18 years and above expecting singleton, who were attending antenatal clinic throughout the pregnancy and also report for delivery were included in the study. Furthermore, pregnant women who carried their pregnancy to full term and delivered either by vaginal or cesarean were rerolled.
Exclusion criteria
Pregnant women with complications such as diabetes mellitus, CVDs, and those who had parity more than four (4) were excluded. Obstetric conditions that could cause SGA babies such as preterm deliveries, bad obstetric history, abruption placenta previa and congenital anomalies of the baby, pregnancy-induced hypertension, polyhydramnios, endocrine disorders, or other severe maternal illnesses, clinical signs of infection, benign tumors, and malignancies were also excluded from the study.
Ethical consideration
Ethical approval for this study was sought and obtained from the Ethics and Research Committee of the Edo State Hospitals Management Board, Benin City, Nigeria (Reference: A.926/438 dated January 5, 2018). Individual informed consent was obtained during the antenatal follow-up within the pregnancy.
Sample size determination
The sample size for this study was determined using the sample size determination for health studies formula by Lwanga and Lemeshow.[16]
N = Z2pq/d2
Where:
N is the desired sample size
Z is the standard deviation set at 1.96.
P is the prevalence of SGA in Nigeria put at 14%.[17]
q is (1 − p) = (1 − 0.14) =0.86
d is precision in proportion of one, set at 5% = 0.05
Then, N = 1.962 × 0.14 × 0.86/0.0025 = 185
Therefore, 200 subjects will be recruited for this study.
Sample preparation
The pregnant women were admitted at the onset of labor, and immediately after delivery, the cord was clamped at both ends and cut. Five (5 mL) milliliters of cord blood was be collected from the umbilical vein into plain tube container and labeled appropriately. The blood was allowed to cloth and spun at 3000 rpm for 15 min after cloth retraction to obtain serum. The serum was stored at −20°C until analysis for lipid profile within 2 weeks.
Anthropometric measurements
Birth weight of the neonates, head circumference, and recumbent length were measured by digital infant scale, flexible metal tape measure, and Seca 416 portable Infantometer, respectively, the attending nurses. The Ponderal Index (PI) was calculated as birth weight (gr)/body length (cm) 3 × 100, to assess the fetal growth pattern.
Estimation of lipid profile parameters
Total cholesterol, triglycerides, and high-density lipoprotein (HDL) were determined by Beckman Coulter (Au5811 analyzer) using Randox reagents with strict adherence to the outlined protocols in each kit, whereas low-density lipoprotein (LDL) cholesterol was calculated using the Friedewald formula.
Quality control
Control sera were used to monitor the performance of assay procedures: SPINTROL H Normal and Pathologic (Ref. 1002120 and 1002210). If control values are outside the defined range, the instrument, reagents, and calibrators were checked for problems.
Statistical analysis
The data were analyzed using the Statistical Package for Social Science Program (SPSS) Version 21.0 (Chicago, IL, USA). The values obtained in this study are represented as mean ± standard deviation. Student's t-test, Chi-square, and analysis of variance (ANOVA) were used to compare means, while the correlation was done by linear regression analysis. The P < 0.05 was considered statistically significant.
| Results | | |
A total of 200 healthy pregnant women were randomly enrolled in the study during pregnancy and later admitted at the onset of confirmed labor for deliveries. The neonatal body weight was categorized into SGA (<2.5 kg) and AGA (>2.5 kg). [Table 1] shows the comparison of anthropometric measurements of babies based on neonatal birth weight. The birth weight (P < 0.01), head circumference (P < 0.04), recumbent length (P < 0.04), and PI (P < 0.02) were significantly lower in babies with SGA than AGA. | Table 1: Comparison of anthropometric measurements of babies based on neonatal birth weight
Click here to view |
[Table 2] shows the comparison of the lipid profile levels in cord blood samples based on the birth weight of babies. The total cholesterol, triglycerides, HDL-c, and LDL-c were significantly lower (P < 0.001) in SGA than AGA babies. | Table 2: Comparison of the levels of measured parameters in cord blood samples based on birth weight (mean±standard deviation)
Click here to view |
[Table 3] shows that total cholesterol (r = 0.21; P < 0.004) and triglycerides (r = 0.31; P < 0.001) correlated positively with weight weight of babies, whereas HDL-c (r = 0.096; P < 0.186) correlated negatively with birth weight of babies, but correlation was not statistically significant. | Table 3: Correlation of lipid profile parameters in cord blood with birth weight of neonates
Click here to view |
| Discussion | | |
In this study, it was observed that the mean values of birth weight, head circumference, recumbent length, and PI were significantly lower in babies with SGA than AGA. Anthropometric indices represent diagnostic criteria which are useful in assessing the risk for conditions such as CVD, hypertension, diabetes mellitus, and many more in children.[18] This aligns with reports from previous studies, where lower anthropometric parameters were documented in babies with SGA.[19] This is scientifically reasonable because SGA has been defined as a birth weight of <10th percentile for gestational age,[20] and anthropometric measurements most, especially the birth weight and the recumbent length, are noted to be reduced in SGA.[21] The causes of SGA are diverse in nature; however, maternal and placental factors are the most common underlying etiologies. Maternal factors such as chronic medical conditions (hypertension, renal disease, and collagen vascular diseases), infections (toxoplasmosis, rubella, cytomegalovirus, malaria, trypanosomiasis, and HIV), nutritional status, and substance use (cigarette smoking, alcohol, illicit drugs, and medications) are all implicated in SGA. Other factors contributing SGA include placental factors such as a single umbilical artery, placental hemangiomas, placenta previa, low-lying placenta, and chronic placental abruption.[22] Thus, the data from this study depicts a remarkable decrease in the anthropometric indices of SGA babies.
Cord lipid profile is a reflection of lipid metabolism during fetal life and at birth because most fetal lipids are synthesized de novo through conversion of glucose to various fatty acid-containing compounds.[1] Only part of it is derived from placental circulation. In this study, total cholesterol, triglycerides, HDL-c, and LDL-c were significantly lower in SGA than AGA babies. The possible reason may be due to the abnormal intrauterine environment created by maternal changes during gestation which may have impacted on lipid metabolism in neonates. This also may have accounted for their differences in both lipid profile and anthropometry at birth.[15] On the contrary, some authors reported that the mean total cholesterol, triglycerides, LDL, and VLDL levels were significantly elevated with SGA babies as compared to AGA babies.[1],[23] The reason for the differences in results may be attributed to sample selection. These authors included preterm babies among the SGA babies. For example, Shenoy et al.[23] reported that LBW babies born prematurely, whether or not they have intrauterine growth retardation, may be susceptible to CVDs such as the adults. The long-term effects of the elevated cord blood cholesterol observed among premature newborns regarding fatty streak formation are still debated. Although the atherogenic process is recognized as a pediatric problem, the reversibility of the injuries in this early phase of life is still been debated. Some described aortic fatty streak formation in the fetuses, which was attributed to maternal and/or fetal hypercholesterolemia.[24] Furthermore, the existence of lipid accumulation in the extracranial arteries of aborted fetuses and preterm newborns was demonstrated by the same authors.[25]
Other authors reported no significant differences in HDL-c and LDL-c between SGA and AGA babies.[26],[27],[28],[29] It was explained that because of lack of glucose as a fuel, SGA babies use an alternate source such as amino acids and lipids and generate glucose by gluconeogenesis. There is increased hepatic generation of lipids, particularly LDL, VLDL, and chylomicrons, coupled with decreased peripheral utilization of lipids due to decreased activity of lipoprotein lipase.[30],[31]
Total cholesterol and triglycerides correlated positively with birth weight of babies, whereas HDL-c correlated negatively with birth weight of babies. On the contrary, findings by Pardo et al.[28] reported that the birth weight of the newborns correlated inversely with total cholesterol, LDL-cholesterol, and total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol index, confirming the difference in lipid distribution between preterm and term infants.
| Conclusion | | |
Data presented in this study indicate that there is a close relationship between lipid profile parameters and anthropometry at birth of neonates. AGA babies had significantly higher lipid profile parameters compared with SGA babies.
Acknowledgments
We appreciate the contributions of Medical and Nursing staff of Stella Obasanjo Women and Children Hospital, Benin City toward the success of this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Gora A, Dev D, Gupta P, Gupta ML. Correlation of maternal lipid profile with newborn's lipid profile. Int J Contemp Pediatr 2018;5:1523-6.  |
| 2. | Barnes K, Nestel PJ, Pryke ES, Whyte HM. Neonatal plasma lipids. Med J Aust 1972;2:1002-5. |
| 3. | Neal WA, John CC. Disorders of lipoprotein metabolism and transport. In: Kliegman RM, Stanton BF, St. Game JW, Schor NF, editors. Nelson Textbook of Pediatrics. 20 th ed., Vol. 1. Philadelphia: Elsevier; 2016. p. 691-715. |
| 4. | Umar LW, Aliyu IS, Akuyam SA. Evaluation of lipid profile in cord blood of full-term Nigerian newborn infants. Sub Saharan Afr J Med 2017;4:9-14. |
| 5. | El-Hazmi MA, Warsy AS. Evaluation of serum cholesterol and triglyceride levels in 1-6-year-old Saudi children. J Trop Pediatr 2001;47:181-5. |
| 6. | Akuyam SA, Isah HS, Ogala WN. Evaluation of serum lipid profile of under-five Nigerian children. Ann Afr Med 2007;6:119-23. [ PUBMED] [Full text] |
| 7. | Santosa S, Hensrud DD, Votruba SB, Jensen MD. The influence of sex and obesity phenotype on meal fatty acid metabolism before and after weight loss. Am J Clin Nutr 2008;88:1134-41. |
| 8. | Mago P, Bharatwaj RS, Verma M, Chatwal J. Cord blood lipid profile at birth among normal Indian newborns and its relation to gestational maturity and birth weight − A cross sectional study. Indian J Res 2013;2:215-8. |
| 9. | Kelishadi R, Poursafa P. A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease. Curr Probl Pediatr Adolesc Health Care 2014;44:54-72. |
| 10. | Aletayeb SM, Dehdashtian M, Aminzadeh M, Moghaddam AE, Mortazavi M, Malamiri RA, et al. Correlation between umbilical cord blood lipid profile and neonatal birth weight. Pediatr Pol 2013;88:521-5. |
| 11. | Mól N, Zasada M, Klimek M, Kwinta P. Somatic development and some indices of lipid metabolism in 11-year-old children born with extremely low birth weight (<1000 G) (long-term cohort study). Dev Period Med 2017;XXI: 4. |
| 12. | Ramaraj SM, Bharath AP, Sanjay KM. Lipid profile in neonates and its relation with birth weight and gestational age. Indian J Pediatr 2015;82:375-7. |
| 13. | Molina M, Casanueva V, Cid X, Ferrada MC, Pérez R, Dios G, et al. Lipid profile in newborns with intrauterine growth retardation. Rev Med Chil 2000;128:741-8. |
| 14. | Belbasis L, Savvidou MD, Kanu C, Evangelou E, Tzoulaki I. Birth weight in relation to health and disease in later life: An umbrella review of systematic reviews and meta-analyses. BMC Med 2016;14:147. |
| 15. | Nayak CD, Agarwal V, Nayak DM. Correlation of cord blood lipid heterogeneity in neonates with their anthropometry at birth. Indian J Clin Biochem 2013;28:152-7. |
| 16. | Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies; a Practical Manual. Switzerland: IRIS, World Health Organization; 1991. |
| 17. | UNICEF-WHO. Low Birth Weight Babies (% of births)-Nigeria, World Bank Data; 2014. Available from: http://www.data.unicef.org. [Last accessed on 2020 Nov 20]. |
| 18. | Sipola-Leppänen M, Vääräsmäki M, Tikanmäki M, Matinolli HM, Miettola S, Hovi P, et al. Cardiometabolic risk factors in young adults who were born preterm. Am J Epidemiol 2015;181:861-73. |
| 19. | Yildiz B, Ucar B, Aksit A, Aydogdu SD, Colak O, Colak E. Diagnostic values of lipid and lipoprotein levels in late onset neonatal sepsis. Scand J Infect Dis 2009;41:263-7. |
| 20. | Harder T, Rodekamp E, Schellong K, Dudenhausen JW, Plagemann A. Birth weight and subsequent risk of type 2 diabetes: A meta-analysis. Am J Epidemiol 2007;165:849-57. |
| 21. | Araújo de França GV, Restrepo-Méndez MC, Loret de Mola C, Victora CG. Size at birth and abdominal adiposity in adults: A systematic review and meta-analysis. Obes Rev 2014;15:77-91. |
| 22. | Samaras TT, Elrick H, Storms LH. Birthweight, rapid growth, cancer, and longevity: A review. J Natl Med Assoc 2003;95:1170-83. |
| 23. | Shenoy J, Reddy V, Baliga KN. Serum lipid profile in preterm and term appropriate for gestational age Indian newborns: A hospital based comparative study. J Neonatal Biol 2014;3:156. |
| 24. | Napoli C, D'Armiento FP, Mancini FP, Postiglione A, Witztum JL, Palumbo G, et al. Fatty streak formation occurs in human fetal aortas and is greatly enhanced by maternal hypercholesterolemia. Intimal accumulation of low density lipoprotein and its oxidation precede monocyte recruitment into early atherosclerotic lesions. J Clin Invest 1997;100:2680-90. |
| 25. | Napoli C, Witztum JL, de Nigris F, Palumbo G, D'Armiento FP, Palinski W. Intracranial arteries of human fetuses are more resistant to hypercholesterolemia-induced fatty streak formation than extracranial arteries. Circulation 1999;99:2003-10. |
| 26. | Jones JN, Gercel-Taylor C, Taylor DD. Altered cord serum lipid levels associated with small for gestational age infants. Obstet Gynecol 1999;93:527-31. |
| 27. | Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF, et al. Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention. Vasc Health Risk Manag 2009;5:757-65. |
| 28. | Pardo IM, Geloneze B, Tambascia MA, Barros-Filho AA. Atherogenic lipid profile of Brazilian near-term newborns. Braz J Med Biol Res 2005;38:755-60. |
| 29. | Wang C, Zhu W, Wei Y, Su R, Feng H, Hadar E, et al. The associations between early pregnancy lipid profiles and pregnancy outcomes. J Perinatol 2017;37:127-33. |
| 30. | Davey Smith G, Hyppönen E, Power C, Lawlor DA. Offspring birth weight and parental mortality: Prospective observational study and meta-analysis. Am J Epidemiol 2007;166:160-9. |
| 31. | Kazemi SA, Sadeghzadeh M. Lipid profile of cord blood in term newborns. J Comp Pediatr 2014;5:1-6. |
[Table 1], [Table 2], [Table 3]
|
Search Pubmed for