Gebelikteki çinko eksikliği ile kötü obstetrik sonuçlar arasında bir bağlantı var mı?

Yıl 2022, Cilt: 19 Sayı: 3, 1424 - 1430, 30.09.2022

Uğur Değer , Gökçe Turan , Nurullah Peker

https://doi.org/10.38136/jgon.1117596

Cited By: 1

Öz

Amaç: Bu çalışmanın amacı gebelikteki çinko eksikliğinin maternal ve fetal sonuçları üzerindeki etkisini araştırmaktır.

Yöntem: Bu çalışma Ocak 2020 ile Aralık 2020 tarihleri arasında ikinci basamak bir hastanede yapıldı. Tüm hastaların demografik verileri, doğum sırasındaki çinko, hemoglobin (Hb), hematokrit (Hct) düzeyleri, oligohidramnios, preterm doğum, preeklampsi, preterm prematür membran rüptürü (PPROM), intrauterin gelişme geriliği (IUGR) gibi kötü gebelik sonuçları kaydedildi. Maternal serum çinko değeri <56 μg/dL çinko eksikliği olarak kabul edilirken, maternal serum çinko düzeyi ≥56 μg/dL normal olarak kabul edildi. Çinko eksikliği olan grup ile çinko düzeyi yeterli olan grubun, maternal ve neonatal sonuçları karşılaştırıldı.

Bulgular: Bu hastaların 36’sında (%35,2) çinko eksikliği bulundu. Çinko seviyesi yeterli olan grubun ortalama çinko düzeyi 74 μg/dL (56-120), çinko düzeyi eksik olan grubun ortalama çinko düzeyi 50 μg/dL (36-55) (p:0.000) idi. Çinko eksikliği olan grupta PPROM ve preterm doğum oranları anlamlı olarak daha fazla bulundu (sırasıyla p=0,031, p=0,039). Çinko eksikliği olan grubun 1.ve 5. dakika APGAR skorları ise anlamlı olarak daha düşüktü (sırasıyla p=0,002 ve p=0,001). Çinko eksikliği PPROM riskini 1,7 kat, preterm doğumu 0,479 kat anlamlı olarak artırıyordu (sırasıyla; OR=1.713, %95 CI=0.662-0.824, p=0.043; OR=0.479, %95 CI=0.209-0.095, p=0.041).

Sonuç: Özetle, bu çalışma gebelerdeki çinko seviyesinin maternal ve neonatal sonuçlarını araştırdı ve çinko eksikliği olan gebelerde preterm doğum ve PPROM görülme oranı daha fazla idi. Sonuç olarak, gebelere özellikle gebeliğin üçüncü trimesterinde verilen çinko takviyesi çinko eksikliğine bağlı olumsuz perinatal sonuçları azaltacaktır.

Anahtar Kelimeler

Maternal serum, Çinko, Preterm doğum, Gebelik

Is there any connection between zinc deficiency and poor obstetric outcomes in pregnancy?

Öz

Aim: The present study aims to examine the effects of zinc deficiency on maternal and fetal outcomes during pregnancy.
Material-method: The study was carried out in a secondary care hospital between 2020 January and 2020 December. Demographic data of all patients, zinc, hemoglobin (Hb), hematocrit (Hct) levels at birth and adverse pregnancy outcomes such as oligohydramnios, preterm delivery, preeclampsia, preterm premature rupture of membranes (PPROM), intrauterine growth retardation (IUGR) were recorded. Maternal serum zinc levels of <56 μg/dL were considered deficient, whereas maternal serum zinc levels of ≥56 μg/dL were considered normal. Maternal and neonatal outcomes of the zinc-deficient group and the zinc-deficient group were compared.
Results: Zinc deficiency was found in 36(35.2%) of these patients. The group with sufficient zinc levels had a mean zinc level of 74 μg/dL (56-120), while the group with zinc deficiency had a mean zinc level of 50 μg/dL (36-55) (p:0.000). The rates of PPROM and preterm delivery were significantly higher in the zinc-deficient group (p=0.03,p=0.039, respectively). The zinc-deficient group had significantly lower 1st and 5th minute APGAR scores (p=0.002, p=0.001, respectively). Zinc deficiency significantly increased the risk of PPROM by 1.7 times and preterm birth by 0.479 times (OR=1.713, 95% CI=0.662-0.824, p=0.043; OR=0.479, 95% CI=0.209-0.095, p=0.041, respectively).
Conclusion: The results of this research indicate that pregnant women who were zinc deficient had a higher rate of preterm delivery and PPROM. In conclusion, zinc supplements given to pregnant women, particularly during the third trimester of pregnancy, will reduce the negative perinatal outcomes associated with zinc deficiency.

Anahtar Kelimeler

Maternal serum, Zinc, Preterm birth, Pregnancy

Kaynakça

• 1. Hirano T, Murakami M, Fukada T, Nishida K, Yamasaki S, Suzuki T: Roles of Zinc and Zinc Signaling in Immunity: Zinc as an Intracellular Signaling Molecule. Adv Immunol. 2008; 97:149–76.
• 2. Osendarp SJM, West CE, Black RE: The need for maternal zinc supplementation in developing countries: An unresolved issue. J Nutr. 2003; 133.
• 3. Mistry HD, Kurlak LO, Young SD, Briley AL, Broughton Pipkin F, Baker PN, et al.: Maternal selenium, copper and zinc concentrations in pregnancy associated with small-for-gestational-age infants. Matern Child Nutr. 2014; 10:327–34.
• 4. Tamura T, Goldenberg RL, Johnston KE, DuBard M: Maternal plasma zinc concentrations and pregnancy outcome. Am J Clin Nutr. 2000; 71:109–13.
• 5. Shah D, Sachdev HPS: Effect of gestational zinc deficiency on pregnancy outcomes: summary of observation studies and zinc supplementation trials. Br J Nutr. 2001; 85:S101–08.
• 6. Khadem N, Mohammadzadeh A, Farhat AS, Valaee L, Khajedaluee M, Parizadeh SMR: Relationship between low birth weight neonate and maternal serum zinc concentration. Iran Red Crescent Med J. 2012; 14:240–44.
• 7. Ota E, Mori R, Middleton P, Tobe-Gai R, Mahomed K, Miyazaki C, et al.: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2015; 2015.
• 8. Caulfield L, Zavaleta N, Figueroa A, Leon Z: Maternal zinc supplementation does not affect size at birth or pregnancy duration in Peru. Journal of Nutrition. 1999;129:1563-68
• 9. Wang H, Hu Y-F, Hao J-H, Chen Y-H, Su P-Y, Wang Y, et al.: Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study OPEN. Nat Publ Gr. 2015.
• 10. Mori R, Ota E, Middleton P, Tobe-Gai R, Mahomed K, Bhutta ZA: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2012.
• 11. Mahomed K, Bhutta Z, Middleton P: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2007.
• 12. Zhang C, Xu YY, Tao FB, Xu DX: Maternal serum zinc concentration during pregnancy is inversely associated with risk of preterm birth in a Chinese population. J Nutr. 2016; 146:509–15.
• 13. Lim Y, Levy M, Bray TM: Dietary Zinc Alters Early Inflammatory Responses during Cutaneous Wound Healing in Weanling CD-1 Mice. J Nutr. 2004; 134:811–16.
• 14. Defranco EA, Jacobs TS, Plunkett J, Chaudhari BP, Huettner PC, Muglia LJ: Placental pathologic aberrations in cases of familial idiopathic spontaneous preterm birth. Placenta. 2011; 32:386–90.
• 15. Andrews WW, Goldenberg RL, Faye-Petersen O, Cliver S, Goepfert AR, Hauth JC: The Alabama Preterm Birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23- to 32-week preterm newborn infants. Am J Obstet Gynecol. 2006; 195:803–08.
• 16. Chen Y-H, Zhao M, Chen X, Zhang Y, Wang H, Huang Y-Y, et al.: Zinc Supplementation during Pregnancy Protects against Lipopolysaccharide-Induced Fetal Growth Restriction and Demise through Its Anti-inflammatory Effect. J Immunol. 2012; 189:454–63.
• 17. Mesdaghinia E, Naderi F, Bahmani F, Chamani M, Ghaderi A, Asemi Z: The effects of zinc supplementation on clinical response and metabolic profiles in pregnant women at risk for intrauterine growth restriction: a randomized, double-blind, placebo-controlled trial. J Matern Neonatal Med. 2021; 34:1382–88.
• 18. Carducci B, Keats EC, Bhutta ZA: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2021; 2021.
• 19. Higashi A, Tajiri A, Matsukura M, Matsuda I: A prospective survey of serial maternal serum zinc levels and pregnancy outcome. J Pediatr Gastroenterol Nutr. 1988; 7:430–33.
• 20. Lao TT, Chin RKH, Mak YT, Swaminathan R, Lam YM: Plasma and erythrocyte zinc and birth weight in pre-eclamptic pregnancies. Arch Gynecol Obstet. 1990; 247:167–71.
• 21. Mukherjee MD, Sandstead HH, Ratnaparkhi M V., Johnson LK, Milne DB, Stelling HP: Maternal zinc, iron, folic acid, and protein nutriture and outcome of human pregnancy. Am J Clin Nutr. 1984; 40:496–507.
• 22. Yasodhara P, Ramaraju LA, Raman L: Trace minerals in pregnancy 1. Copper and zinc. Nutr Res. 1991; 11:15–21.
• 23. Demir ME, Ulas T, Dal MS, Eren MA, Aydogan H, Yalcin S, et al.: Oxidative stress parameters and ceruloplasmin levels in patients with severe preeclampsia. Clin Ter. 2013; 164.
• 24. Dey M, Arora D, Narayan N, Kumar R: Serum cholesterol and ceruloplasmin levels in second trimester can predict development of pre-eclampsia. N Am J Med Sci. 2013; 5:41–46.
• 25. Carmichael S, Yang W, Shaw G: Maternal dietary nutrient intake and risk of preterm delivery. Am J Perinatol. 2013; 30:579–88.
• 26. Noor S, Nazar AF, Bashir R, Sultana R: Prevalance of PPROM and its outcome. J Ayub Med Coll Abbottabad. 2007; 19:14–17.
• 27. Rahmanian M, Jahed FS, Yousefi B, Ghorbani R: Maternal serum copper and zinc levels and premature rupture of the foetal membranes. J Pak Med Assoc. 2014; 64:770–74.
• 28. Shahnazi M, Khalili AF, Azimi S: Effect of zinc supplement on prevention of PPROM and improvement of some pregnancy outcomes in pregnant women with a history of PPROM: A randomized double-blind controlled trial. Iran Red Crescent Med J. 2017; 19:41931.
• 29. Aminisani N, Ehdaivand F, Shamshirgaran SM, Mohajery M, Pourfarzi F, Sadeghiyeh Ahari MD: Zinc supplementation during pregnancy: A randomized controlled trial. Iran J Pharmacol Ther. 2009; 8:67–71.