European Journal of Cardiovascular Medicine

The lipid profile test measures the levels of cholesterol and its related substances in the body as well as different indicators of heart disease risk. [1] Dyslipidemia can lead to problems like stroke kidney failure heart disease and atherosclerosis. Dyslipidemia becomes more common as people get older. Fetal malnutrition and being born prematurely can affect the levels of different types of lipoproteins in a baby's cord blood. [2] The chances of getting heart disease (CVD) are going up in kids and teens because of things like being overweight and having high levels of fats in the blood. [3, 4]   Many things like high blood pressure diabetes being overweight and having a baby that is too small or too big can affect the fats in a baby's blood. [7-10] Low birth weight (LBW) is linked to higher chances of getting heart disease high blood pressure and type II diabetes. [11] All of these factors lead to cardiovascular disease by causing a buildup of plaque in the arteries. [12] Finding out the levels of fat in cord blood can help identify babies who are at a higher risk of having abnormal fat levels compared to healthy newborns. [14-16] Low birth weight newborns who have trouble processing insulin may experience changes in their blood fats which can lead to a higher chance of heart disease when they grow up. LBW increases the chances of getting heart diseases later in life just like smoking or high blood pressure during puberty. [17-19] Therefore it appears that there is a connection between a person's birth weight and their risk of dying from cardiovascular disease when they are older. [20] Babies born early are more likely to have trouble learning problems with movement trouble with their senses and breathing issues compared to babies born on time. Being born too early increases the chances of having heart disease and other serious health problems later in life. .[21] A higher birth weight is linked to more insulin-like growth factor-1 (IGF-1) which can alter the types and amounts of fats in the blood at birth. This could raise the chances of getting heart diseases.[22] This research looked at how the fats in a baby's umbilical cord may be linked to the risk of heart diseases in adulthood. The study analyzed the levels of fats in the umbilical cord blood of newborns with different birth weights and gestational ages.

This cross-sectional study was carried out from April 2017 to March 2019, involving 3,157 newborns at a government maternity hospital, specifically the Institute of Pregnant Women, located in South India. The research received approval from the Institutional Ethics Committee (IEC) of Sri Venkateswara Medical College, and written informed consent was obtained from all participating parents. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. The study included all preterm, term, and post-term infants delivered via both vaginal and cesarean methods. Exclusion criteria encompassed stillborn infants, those with intrauterine death (IUD), newborns with congenital anomalies, and infants whose mothers had a history of hypertension, hyperlipidemia, cardiovascular disease, diabetes (either pre-gestational or gestational), drug use during or prior to pregnancy (excluding vitamins, folic acid, and iron), or smoking. Birth weight was recorded using an electronic scale (Seca Medical Scales and Measurement Systems, Birmingham, United Kingdom). Newborns were categorized into five groups based on their birth weight: extremely low birth weight (≤1000 g; group 1), very low birth weight (≤1500 g; group 2), low birth weight (1500-2500 g; group 3), normal birth weight (2500-4000 g; group 4), and high birth weight (>4000 g; group 5). Additionally, the newborns were classified into term, preterm, and post-term groups. A sample of 3 ml of cord blood was collected from the placental end of the umbilical vein, and serum was separated through centrifugation. The serum lipid profiles were analyzed using an enzymatic method on an auto-analyzer (A25 biochemistry analyzer, Bio systems, Spain), which included measurements of total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) was calculated.[18]

This study has the large sample size, recruited 3157 newborns. Out of them, 1681 (53.2%) were boys and 1476 (46.76%) were girls.  In 1681 male babies, 113 (3.6%) babies are Preterm babies delivered before 37 weeks of gestation, 43 (1.4%) babies are Post-term babies delivered after 42 weeks of gestation, and 1525 (48.3%) babies are Term babies delivered between 38 to 41 weeks of gestation. In 1476 female babies, 108 (3.4%) babies are Preterm babies delivered before 37 weeks of gestation, 39 (1.2%) babies are Post-term babies delivered after 42 weeks of gestation, 1329 (42.1%) babies are term babies delivered between 38 to 41 weeks of gestation. Both male and female babies with Preterm are 221 (7.0%), Post-term are 82 (2.6%) and Term are 2854 (90.4%) Tab. 1 , Fig.1 .

Table. 1 Distribution of neonates with Gender v/s Gestational age

Table.2 Chi-Square Test for Gender and Gestational age of the baby

The Pearson Chi-Square significance is 0.795 which shows there is no significant difference between the gender and gestational age of the babies shown in Tab.2.

Table.3 Distribution of newborns with birth weights and gestational age (Extreme low birth weight (<1000gms) and N=18, Very low birth weight (>1000 – 1500gms) and N=38, Low birth weight (>1500 – 2500gms) and N=817, Normal weight (>2500 – 4000gms) and N=2275, Overweight (>4000gms) and N=9).

Total 18 neonates were Extreme low birth weight (<1000 gms), in that 16 (0.5%) are Preterm, 0 (0.0%) are Post-term, 2 (0.1%) are term babies. Total 38 neonates were low birth weight (>1000 – 1500) babies, in that 30 (1.0%) are Preterm, 0 (0.0%) are Post-term, 8 (0.3%) are term babies. Total 817 neonates were low birth weight (>1500-2500) babies, in that 138 (4.4%) are Preterm, 16 (0.5%) are Post-term, 663 (21.0%) are term babies. Total 2275 neonates were normal birth weight (>2500 – 4000) babies, in that 35 (1.2 %) are Preterm, 65 (2.1%) are Post-term, 2173 (68.8 %) are term babies. Total 9 neonates were over birth weight (>4000) babies, in that 0 (0.0 %) are Preterm, 1 (0.0 %) are Post-term, 8 (0.3 %) are Term babies. Tab.3, Fig.2

Table. 4 Chi-Square Test for Birth Weight and gestational age of the baby

The Pearson Chi-Square significance is 0.000 which shows there is a significant difference between the Birth Weight and gestational age of the babies. Tab.4.

Table.5 Statistics (Mean, Standard Deviation and Standard Error) of 3157 neonates Birth weight, Gestational age and Lipid Profiles.

One way ANOVA: The average mean birth weights of Preterm neonates were 2.8869 with standard deviation of 0.76328 and standard error 0.05134. For Post-term neonates, mean value was 3.8171 with standard deviation of 0.41952 and standard error 0.04633. For term neonates, mean value was 3.7628 with standard deviation of 0.44320 and standard error 0.00830.The average mean value of cholesterol in Preterm neonates was 81.1222 with standard deviation of 32.43271 and standard error 2.18166. For Post-term neonates, mean value was 70.7439 with standard deviation of 21.17873 and standard error 2.33880.For term neonates, mean value was 75.2754 with standard deviation of 27.66184 and standard error 0.51779. The average mean value of Triglycerides (TGL) in Preterm neonates was 89.1041 with standard deviation of 172.16750 and standard error 11.58124. For Post-term neonates, mean value was 61.9634 with standard deviation of 40.09970 and standard error 4.42827. For term neonates, mean value was 68.4509 with standard deviation of 78.72423 and standard error 1.47361. The average mean values of High Density Lipoproteins (HDL) in Preterm neonates were 24.4425 with standard deviation of 16.16246 and standard error 1.08720. For Post-term neonates, mean value was 21.4695 with standard deviation of 14.46316 and standard error 1.59719. For term neonates, mean value was 22.9379 with standard deviation of 13.16955 and standard error 0.24652. The average mean value of Low Density Lipoproteins (LDL) in Preterm neonates was 38.8588 with standard deviation of 37.02789 and standard error 2.49077. For Post-term neonates, mean value was 36.8817 with standard deviation of 24.62004 and standard error 2.71883. For term babies, mean value is 38.6510 with standard deviation of 26.25809 and standard error 0.49151. The average mean value of Very Low Density Lipoproteins (VLDL) in Preterm babies is 17.8208 with standard deviation of 34.43350 and standard error 2.31625. For Post-term babies, mean value is 12.3927 with standard deviation of 8.01994 and standard error 0.88565. For

term babies, mean value is 13.6902 with standard deviation of 15.74485 and standard error 0.29472 in Tab.5, Fig.3.

Tab.6 Chi-Square Test for cord blood lipid profile and gestational age of the baby Test of Homogeneity of Variances

Test of homogeneity of variances indicates there is no significant difference between the gender and gestational age of the baby where as in accordance with birth weight and cord-blood lipids, it shows a significant difference among the groups in Tab.6.

Table.7 Comparison of our study with different studies with respect of gender.

Table.8 Comparison of our study with different studies with respect to birth weights.

Tab.9 Comparison of our study with different studies with respect to Gestational age.

Lipid profiles are recognized as significant risk factors for cerebrovascular accidents (CVA) and strokes, demonstrating a direct relationship between lipid profile abnormalities and the incidence of cardiovascular morbidity and mortality. The plasma lipid profile present in cord blood serves as an indicator of the lipid metabolism occurring in the infant at birth. The majority of lipids are synthesized de novo through the conversion of glucose into various fatty acids, with only a portion derived from placental circulation. Therefore, assessing the lipid profile in cord blood provides a reliable measure of lipid metabolism in newborns. [1] The current study revealed that preterm infants exhibited the highest concentrations of cord blood lipid profiles.

Donegá et al. reported that the levels of total cholesterol, LDL-C, and HDL-C in cord blood were significantly elevated in preterm infants, while triglyceride levels were lower in this group. [23] Some results from the present study align with previous research indicating that cord blood cholesterol levels are higher in preterm infants compared to term infants. [24] Pardo et al. also found that total cholesterol, LDL-C, and HDL-C levels in cord blood were greater in preterm neonates than in term neonates, with statistically significant differences noted for total cholesterol and LDL-C, although the difference for HDL-C was not significant.[25] This phenomenon may be attributed to reduced activity of lipoprotein lipase, hepatic lipase, and lecithin cholesterol acyltransferase enzymes in preterm newborns, which could lead to increased lipoprotein concentrations compared to term infants. [26] These findings should be taken into account when considering infant nutrition and preventive health measures in Tab.7,8,9.

Statistical analysis: Data were analyzed with MS Excel and SPSS Version 23.0 (IBM Corp. Released 2015.IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp) Results were expressed as mean± SD. The Chi square and p-values were calculated to make statistical comparisons. P value < 0.005 was considered statistically significant

As per the above mentioned results of term neonates (n= 2854), the study conclude that the standard cord-blood lipid profile of term (>37 to 41 weeks) babies were cholesterol 75.2754. TGL 68.4509, HDL 22.9379, LDL 38.6510 VLDL 13.6902 (Tab.5). The study conclude that the standard cord-blood lipid profile of normal birth weight ( ≥ 2500 gms to 4000 gms) were cholesterol 75.03385, TGL 64.71051, HDL 23.16602, LDL 38.93034VLDL 12.9421011 (Tab.7) The study also showed the fluctuations of lipid profile in Preterm and Post-term neonates (Fig no - 3) indicates the risk of obesity and CVDs in comparison with literatures. The study urges the preventive measures to minimize the low birth weight labor/Preterm with adequate nutritional supplementations to the mothers during the gestational age and life style modifications of mothers. This also base for the long cohort studies to be observe the life style of preterm, term and Post-term neonates for next 20 years to prone for various morbidities.

Acknowledgment

We acknowledge the support of the admitted babies and the parents for making this study successful. We also acknowledge all the nurses and other paramedical staffs in the Govt maternity hospital and Govt.General Hospital for helping in data collection and giving the inputs. We are thankful to DHR; GOVT of India provided MRU facility to our Institution.

1.       Shrikant Hemant Joshi1 , Manjunath G M2*, Lakshmi L3, A comparative study to assess the umbilical cord-blood lipid profile between normal and low birth weight babies in a tertiary care hospital, MedPulse International Journal of Pediatrics, Print ISSN: 2579-0897, Online ISSN: 2636-4662, Volume 20, Issue 1, October 2021 pp 05-08

2.       SedighehGhaemi, RaziyehNajafi, and Roya Kelishadi, Cord-blood lipoprotein profile in term,Preterm, and Post-term newborns.J Res Med Sci. 2014 Nov; 19(11): 1038–1040.

3.       Kelishadi R, Pour MH, Sarrafzadegan NS, Kahbazi M, Sadry G, Amani A, et al. Dietary fat intake and lipid profiles of Iranian adolescents: Isfahan Healthy Heart Program- Heart Health Promotion from Childhood. Prev Med 2004;39:760–766.

4.       Kelishadi R, Hashemipour M, Sarrafzadegan N, Amiri M. Trend of atherosclerosis risk factor in children of Isfahan. Asian CardiovascThorac Ann 2001;9:36–40.

5.       Adami F, VasconcelosFdeA. Childhood and adolescent obesity and adult mortality: a systematic review of cohort studies. Cad SaúdePública 2008;24(Suppl. 4):558–568.

6.       Bridger T. Childhood. Obesity and cardiovascular disease. Paediatr Child Health 2009;14:177–182.

7.       Kherkeulidze P, Johnsson J, Carlson LA. High density lipoprotein particle size distribution in cord-blood. ActaPaediatrScand 1991;80:770–779.

8.       Dolphin PJ, Breckenridge WC, Dolphin MA, Tan MH. The lipoproteins of human umbilical cord-blood apolipoprotein and lipid levels. Atherosclerosis 1984;51:109–122.

9.       Parker Jr CR, Carr BR, Simpson ER, MacDonald PC. Decline in the concentration of low-density lipoprotein-cholesterol in human fetal plasma near term. Metabolism 1983;32: 919–923.

10.    Parker Jr CR, Fortunato SJ, Carr BR, Owen J, Hankins GD, Hauth JC. Apo lipoprotein A-1 in umbilical cord-blood of newborn newborns: relation to gestational age and high-density lipoprotein cholesterol. Pediatr Res 1988;23:348–351.

11.    Baker DJ, Hales CN, Fall CH, Osmond C, Phipps K, Clark PM. Type 2 (non-insulin dependent) diabetes mellitus, hypertension and hyperlipidemia (syndrome X): relation to reduced fetal growth. Diabetologia 1993;36:62–67.

12.    Santos MG, Pegoraro M, Sandrini F, Macuco EC. Risk factors for the development of atherosclerosis in childhood and adolescence. Arq Bras Cardiol 2008;90:276–283.

13.    Goldstein JL, Albers JJ, Schrott HG, Hazzard WR, Bierman EL, Motulsky AG. Plasma lipid levels and coronary heart disease in adult relatives of new borns with normal and elevated cord-blood lipids. Am J Hum Genet. 1974;26:727-35.

14.    Lakhtakia JR, Dogra J, Mathur HC, Mishra SN. Serum lipid in neonatal cord-blood in families with essential hypertension. Indian Pediatr. 1990;27:1101-3.

15.    Low PS, Saha N, Tay JS, Hong S. Ethnic variation of cord plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore. ActaPaediatr. 1996;85:1476-82.

16.    Conathy WJ, Lane DM. Studies on the apolipoproteins and lipoproteins of cord serum. Pediatr Res. 1980;14:757-61.

17.    Mi J, Law C, Zhang KL, Osmond C, Stein C, Barker D. Effects of infant birth weight and maternal body mass index in pregnancy on components of the insulin resistance syndrome in China. Ann Intern Med 2000;132:253–260.

18.    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;128:741–748.

19.    Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischemic heart disease. Lancet 1989;334:577–580.

20.    Klag MJ, Ford DE, Mead LA, He J, Whelton PK, Liang KY, et al. Serum cholesterol in young men and subsequent cardiovascular disease. N Eng J Med 1993;328:313–318.

21.    Tejasree katragadda1, Rajesh shimoga mahabala2, subodh shetty3, ShantharamBaliga Comparison of Cord-blood Lipid Profile inPreterm Small for Gestational Age and Appropriate for Gestational Age Newborns. Journal of Clinical and Diagnostic Research. 2017 Jan, Vol-11(1): SC05-SC07.

22.    Lombardi G, Colao A, Marzullo P, Ferone D, Longobardi S, Esposito V, et al. Is growth hormone bad for your heart? Cardiovascular impact of GH deficiency and of acromegaly. J Endocrinol 1997;155(Suppl. 1):33–37.

23.    Donegá S, Oba J, Maranhão RC. Concentration of serum lipids and apolipoprotein B in newborns. Arq Bras Cardiol 2006;86:419-24.

24.    Tohmaze RM. Cord-blood lipid profile in premature, near-term and term newborn infants. Iran J Neonatol 2014;5:8-10.

25.    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.

26.    Hamosh M. Lipid metabolism in premature infants. Biol Neonate 1987;52:50-64.