Preterm delivery and low maternal serum cholesterol level: any correlation?
Keywords:
Hypocholesterolaemia, Physiologic hypercholesterolaemia, Preterm birth, preterm delivery, Perinatal mortalityAbstract
Background: Preterm birth is a major challenge in perinatal health care with prematurity accounting for 40-60% of all perinatal deaths in Nigeria. The physiologic hypercholesterolaemia of later pregnancy suggests an adaptive function for pregnancy maintenance or fetal growth. Decreased levels of maternal total cholesterol and low-density lipoprotein cholesterol have been reported in association with preterm delivery.
Methods: This was a prospective observational cohort study designed to assess whether low maternal serum cholesterol during early pregnancy is associated with preterm delivery in these women. Eligible participants were enrolled for the study at gestational age of 14 to 20 weeks over a period of 12 months. Blood samples were obtained to measure total serum cholesterol concentrations and the sera were then analyzed enzymatically by the Cholesterol Oxidase: p-Aminophenazone (CHOD PAP) method.
Results: The study showed an incidence of 5.0% for preterm delivery in the low risk study patients. Preterm birth was 4.83-times more common with low total maternal cholesterol than with midrange total cholesterol (11.8% versus 2.2%, P = 0.024).
Conclusions: We can infer from the study that the low maternal serum cholesterol (hypocholesterolaemia) is associated with preterm delivery. We can therefore recommend on this basis that the concept of an optimal range for maternal serum cholesterol during pregnancy may have merit and pregnant women should be encouraged to follow a healthy, balanced diet and ensure regular antenatal visit to their healthcare provider.
References
Ezechukwu CC, Ugochukwu EF, Egbuonu I, Chukwuka JO. Risk factors for neonatal mortality in a regional tertiary hospital in Nigeria. Nig J Clin Pract. 2004;7:50-2.
Kierse MJNC. New perspectives for the effective treatment of preterm labour. Am J Obstet Gynaecol. 1995;173:618-28.
Chike-Obi U. Preterm delivery in Ilorin; multiple and teenage pregnancies major aetiologic factors. West Afr J Med. 1993;12:228-30.
Njokanma OF, Olanrewaju DM. A study of neonatal deaths at the Ogun State University teaching hospital, Sagamu, Nigeria. J Trop Paediatr. 1995;98:155-60.
Njokanma OF, Sule Odu OA, Akesode FA. Perinatal mortality at the Ogun State University teaching hospital, Sagamu, Nigeria. J Trop Paediatr. 1994;40:78-81.
Azikeh ME. Preterm labour and delivery. In: Okpere E, eds. Clinical Obstetrics. 1st ed. Benin City: University of Benin Press; 2003: 203-209.
Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371:75–84.
Arius F. Preterm labour. In: Arius F, eds. Practical Guide to High Risk Pregnancy and Delivery. 2nd ed. USA: Mosby-Year Book, Mosby, Mo; 1993: 71-99.
Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R & Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. J Am Med Assoc. 1990;284:843-9.
McCormick M. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985;312:82-90.
Page JM, Schneeweiss S, Whyte HEA, Harvey P. Ocular sequelae in premature infants. Paediatr. 1993;92:787-90.
Stewart AL, Rifkin L, Amess PN, Kirkbride V, Townsend JP, Miller DH, Lewis SW, Kingsley DP, Moseley IF, Foster O, Murray RM. Brain structure and neurocognitive and behavioural function in adolescents who were born very preterm. Lancet. 1999;353:1653-7.
Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992-1995. Arch Pediatr Adolesc Med. 2000;154:725-31.
Adinma JI, Agbai AO. Pattern of twin births in Nigerian Igbo woman. West Afr J Med. 1994;13(4):234-6.
Moutquin JM. Effectiveness and safety of the oxytocin antagonist atosiban vs. beta-adrenergic agonist in the treatment of preterm labour. Br J Obstet Gynaecol. 2001;108:133-42.
Lumley J. Defining the problem: the epidemiology of preterm birth. Br J Obstet Gynaecol. 2003;110:3-7.
Woollett LA. The origins and roles of cholesterol and fatty acids in the fetus. Curr Opin Lipidol. 2001;12:305-12.
Tuckey RC. Progesterone synthesis by the human placenta. Placenta. 2005;26:273-81.
Henson MC, Shi W, Greene SJ, Reggio BC. Effects of pregnant human, non-pregnant human and fetal bovine sera on human chorionic gonadotropin, estradiol, and progesterone release by cultured human trophoblast cells. Endocrinol. 1996;13:2067-74.
Knopp RH, Warth MR, Charles D et al. Lipoprotein metabolism in pregnancy, fat transport to the fetus, and the effects of diabetes. Biol Neonate. 1986;50:297-317.
Woollett LA. Maternal cholesterol in fetal development: transport of cholesterol from the maternal to the fetal circulation. Am J Clin Nutr. 2005;82:1155-61.
Sen A, Ghosh PK, Mukherjea M. Changes in lipid composition and fluidity of human placental basal membrane and modulation of bilayer protein functions with progress of gestation. Mol Cell Biochem. 1998;187:183-90.
Winkler K, Wetzka B, Hoffmann MM et al. Low density lipoprotein (LDL) subfractions during pregnancy: accumulation of buoyant LDL with advancing gestation. J Clin Endocrinol Metab. 2000;85:4543-50.
Brizzi P, Tonolo G, Esposito F, et al. Lipoprotein metabolism during normal pregnancy. Am J Obstet Gynaecol. 1999;181:430-4.
Tranquilli AL, Cester N, Giannubilo SR, Corradetti A, Nanetti L, Mazzanti L. Plasma lipids and physicochemical properties of the erythrocyte plasma membrane throughout pregnancy. Acta Obstet Gynaecol Scand. 2004;83:443-8.
Schlesselman JJ. Sample size requirements in Cohort and Case Control studies of disease. Am J Epid. 1974;99(6):381-4.
Oyedeji GA. Socioeconomic status and cultural background of hospitalized children in Ilesa. Nig J Paediatr. 1985;12(4):111-7.
Tietz NW. Serum Cholesterol. In: Tietz NW, eds. Clinical Guide To Laboratory Test. 4th ed. Philadelphia, PA: W. B. Saunders; 2006; 244-249.
The SPSS System for Windows [computer program]. Version 17, Cary, NC: SPSS Institute Inc; 2008. Available at: http://247pearsoned.custhelp.com/app/answers/detail/a_id/8142/~/spss-17%3A-system-requirements.
Scholl TO. Iron status during pregnancy: setting the stage for mother and infant. Am J Clin Nutr. 2005;81:1218S-22S.
Edison RJ, Berg K, Remaley A et al. Adverse birth outcome among mothers with low serum cholesterol. Paediatr. 2007;120:723-33.