The Association of Maternal Social Factors and Antenatal Care with ...

African Journal of Biomedical Research, Vol. 11 (2008); 297 - 303
ISSN 1119 – 5096 © Ibadan Biomedical Communications Group
Full Length Research Article
The Association of Maternal Social Factors
and Antenatal Care with Cord Serum Zinc
in Full – Term Neonates

Lasisi A. O, Kuti M.O., Adekunle A.O.

Departments of Otorhinolaryngology, Chemical Pathology and Obstetrics

and Gynecology, University of Ibadan, Ibadan, Nigeria
Full-text available at
http://www.ajbrui.com

http://www.bioline.br/md

http://www.ajol.com

ABSTRACT

Zinc is a crucial micronutrient in early childhood survival and the development of
innate and acquired immunity. The objective is to determine the relationship between

of maternal social class and antenatal care to serum zinc level in newborns in a

tertiary and a rural hospital. It is prospective study using questionnaires on

consecutive mothers with normal pregnancy(excluding sepsis and chronic illneses)
and cord serum level of Zinc estimation in newborns using flame atomic absorption

spectrophotometry. There were 106 mothers and neonates; were made up of 57

females and 49 males. The ages of the mother ranged between 21 years to 39 years,
with a mean of 26 years; while the gestational age of the neonates ranged between 30

weeks and 45 weeks with a mean of 37.3. The range of the serum Zinc was 0.14µg/L

– 0.92µg/L, with a mean of 0.64µg/L (SD=0.17) and median value of 0.63µg/L. The

social classes of the mothers were low 66, middle 23 and high 17 with mean neonatal
serum zinc of 0.62µg/L, 0.68µg/L and 0.72µg/L. The mean serum Zinc in 17/86
Received:
neonates of mothers with inadequate tetanus vaccination was 0.53µg/L, (below the
February 2008
median value) compared to 0.66µg/L in 89/106 neonates of mothers with complete

vaccination. The serum zinc in the neonates of mothers <25 years of age was
Accepted (Revised):
0.68µg/L compared to 0.61µg/L in the neonates of mothers >25years. Fever in
June 2008
pregnancy was seen in 31/106; with mean neonatal serum Zinc of 0.63µg/L compared

with those without fever 0.65µg/L. There were 94 neonates with normal weight
Published
(>2.5kg) and 12 low birth weight (<2.5kg) with mean serum Zinc of 0.69µg/L and
September 2008
0.66µg/L respectively. Antenatal care was complete in 81 and incomplete in 25 with

mean neonatal serum Zinc of 0.66µg/L and 0.56µg/L respectively. Univariate analysis

revealed significant correlation between the mean serum Zinc and the socioeconomic
class (P = 0.022), but there was no correlation with maternal age (P=0.327), sex

(P=0.566), gestational age (P=0.100), birth weight (P=0.365), vaccination (P=0.954),

malaria fever (P=0.875) and antenatal care (P=0.97), We concluded that low social

status of the mothers and inadequate vaccination in pregnancy were major factors
associated with low neonatal serum zinc. The control of these factors may impact on

optimal neonatal nutrition.

(Afr. J. Biomed. Res. 11: 297 - 303)


Key word: neonates, serum zinc, maternal social classes, antenatal care, association




*Address for Correspondence: akeemlasisi@gmail.com; +234 805 536 9593

Abstracted by:
African Index Medicus (WHO), CAB Abstracts, Index Copernicus, Global Health Abstracts, Asian Science Index, Index
Veterinarius, Bioline International , African Journals online

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African Journal of Biomedical Research 2008 (Vol. 11) / Lasisi, Kuti and Adekunle


INTRODUCTION
University College Hospital and the Bilal Mission
There is increasing recognition that micronutrients
Hospital Ibadan. Using oral interview and
deficiencies
are
important
determinants
of
confirmation in the hospital record chart, the detail
infection and infant mortality rate which is high in
of the tetanus vaccination, fever, and antenatal
most developing countries despite advances in
care in pregnancy were documented.
child health care (Lind et al, 2003; Jeswani and

At delivery, the duration of labour, fetal
Vani, 1991). Zinc is a crucial micronutrient as it
weight and gestational age were noted and the
influences various aspects of the immune system
cord blood of the neonate was taken from the
starting with its effects on the barrier, modulation
umbilical vein using a 21G needle and 5 ml
of the host resistance to several pathogens and
syringe, and introduced into a non – heparinized
various components of innate and acquired
bottle. This was centrifuged at 1500 x g for 10
immunity (Prasad, 2000; Brown et al, 2002). In
minutes. After clot extraction, the serum was
addition, severe bacterial illnesses also lead to zinc
separated and stored at -80◦C. The sample were
redistribution (Mahalanabis and Bhan, 2001;
analysed for Zinc.
Cousins and Lienart, 1988).


Supplementation
with
zinc
has
been
Determination of Plasma Zinc: Serum was
documented to provide protection against common
deproteinised 1 ml to 9 mL of 10% trichloroacetic
childhood infections like diarrhea and pneumonia
acid in 0.1% lanthanum solution. Zinc levels were
in older children (Zlotkin et al, 2003; Dijkhuizen
determined in the resultant supernatant using
et al, 2001). However, there is limited data on
flame
atomic
absorption
spectrophotometry
therapeutic effect of zinc supplementation on
(Model 205 Buck Scientfic, East Norwalk CT,
severe infections in young infants less than 4
USA 06855). All reagents and materials used for
months of age (Herman et al, 2002; Froozani and
the analysis were free of zinc contamination and
Parsam, 1983). This is an initial report of the
the plastics used for the analysis were previously
serum zinc level in full - term neonates. The
washed with Hydrochloric acid.
objective is to document how the cord serum zinc

level of these neonates is affected by the social
Statistics: The main outcome variables were the
status of the mothers and other antenatal events.
serum levels of retinol in the neonates. Tetanus

vaccination was judged adequate if there were 2
MATERIALS AND METHOD
doses within 4 weeks to delivery, inadequate if

less or none. We depended on self report of fever
Participants Recruitment
by the mother, this was assessed as malaria fever if
Inclusion Criteria: Consecutive mothers with
confirmed by the doctor or self - treatment with
normal pregnancy as judged by the obstetrician.
antimalaria was followed by resolution. Antenatal
Exclusion Criteria: Pregnant women with history
care was judged adequate if there was no default
of sepsis, chorioamnionitis and other chronic
by the pregnant mother. The socioeconomic class
medical illneses such as asthma, allergy, diabetes,
was defined as high (I and II), middle (III) and low
and hypertension.
(IV and V) based on occupation, income earning

and education of the parents11, 12.
Subjects: Participants were recruited into the

The data was initially explored using the stata
study following ethical approval by the University
software, variables were analysed by unpaired t-
of Ibadan/University College Hospital, Ibadan
test both for equal and unequal variance using the
Ethical Committee (UI/IRC/07/023). Consecutive
variance ratio function of the Stata software to
eligible and consented pregnant mothers in the last
determine
the
appropriate
use
of
the
trimester of pregnancy were counselled. The
Satterthwaite’s correction for the degrees of
participants were pregnant women who had
freedom. Level of statistical significance was set at
antenatal care, labour and delivery at the
p< 0.05 for all the analyses.
Growth Values in Nigerian Adolescents
298

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African Journal of Biomedical Research 2008 (Vol. 11) / Lasisi, Kuti and Adekunle

RESULTS
0.66µg/L while it was incomplete in 17/86, with
mean of 0.53µg/L. There were 31/106 mothers
The study included 106 neonates and mothers. The
who had fever in pregnancy, with mean neonatal
neonates were made up of 57 females and 49
serum Zinc of 0.63µg/L compared with those
males. The ages of the mother at pregnancy ranged
without fever 0.65µg/L.
between 21 years to 39 years, with a mean of 26

There were 94 neonates with normal weight
years; while the gestational age of the neonates
(>2.5kg) and 12 low birth weight (<2.5kg) with
ranged between 30 weeks and 45 weeks with a
mean serum Zinc of 0.69µg/L and 0.66µg/L
mean of 37.3. The range of the serum Zinc was
respectively. The mothers who had incomplete
0.14µg/L – 0.92µg/L, with a mean of 0.64µg/L
tetanus vaccination were 25/106, with mean serum
(SD=0.17) and median value of 0.63µg/L. The
Zinc of the neonates of 0.56µg/L while 81/106
distribution of the social class of the mothers was
mothers had complete tetanus vaccination with
as follows: Low social class 66, middle 23 and
mean neonatal serum Zinc of 0.66µg/L, figure 2.
high 17 with mean serum zinc of the neonates in
Univariate analysis revealed significant correlation
each social class of 0.62µg/L, 0.68µg/L and
between
the
mean
serum
Zinc
and
the
0.72µg/L respectively, figure 1. The serum zinc in
socioeconomic class (P = 0.022), but there was no
the neonates of mothers <25 years of age was
correlation with maternal age (P=0.327), sex
0.68µg/L compared to 0.61µg/L in the neonates of
(P=0.566), gestational age (P=0.100), birth weight
mothers >25years.
(P=0.365), vaccination (P=0.954), malaria fever

Tetanus vaccination was complete in 89/106
(P=0.875) and antenatal care (P=0.97), tables 1.
mothers with a mean neonatal serum zinc of

TABLE 1:
Univariate analysis showing the association between serum zinc and the variables (n = 106)
Variables
Coefficient
Standard
t
P>|t|
95% Confidence Interval
Error
age
-.003936
.0039548
-1.00
0.327
-.0120018 .0041298
sex
.0204193
.0352108
0.58
0.566
-.0513936 .0922322
gestational age
-.0123186
.0072706
-1.69
0.100
-.027147 .0025098
Birth weight
.029338
.031936
0.92
0.365
-.035796 .094472
maternal vaccination
.0032075
.054663
0.06
0.954
-.1082784 .1146934
fever
.003754
.0235899
0.16
0.875
-.044358 .051866
antenatal care
.0334779
.0478641
0.70
0.489
-.0641415 .1310973
Duration of labour
-.002611
.0037753
-0.69
0.494
-.0103108 .0050888
social status
-.0468393
.0194164
-2.41
0.022
-.0864393 -.0072394


Growth Values in Nigerian Adolescents
299

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Social status
0.74
0.72
Zinc
0.7
0.68
serum 0.66
of
Social status
0.64
0.62
value
0.6
Mean 0.58
0.56
High
Middle
Low

Figure 1: The mean neonatal serum Zinc and the maternal social class

0.8
0.7

Zinc 0.6
m
r
u 0.5
e
s
Yes
0.4

of
s
No
e
l
u 0.3
a

v
n 0.2
a
e
M 0.1
0
Birth weight
Antenatal Care
Fever
Vaccination

Figure 2: Showing graph comparing the mean neonatal serum zinc in those with and without the risk
factors

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African Journal of Biomedical Research 2008 (Vol. 11) / Lasisi, Kuti and Adekunle

DISCUSSION
deficiency exists. There was sufficient data from
animal and human studies of increased host
The main finding in this study was that maternal
susceptibility to infections with zinc deficiency
social status had a significant inverse association
(Marriott et al, 2007; Nasrat et al, 1992; Shah et al,
with neonatal serum retinol. In addition, the
2001). In addition, infection reduces the plasma
neonatal serum zinc was below the median value
zinc concentration, which reflects the severity of
in the neonates of mothers with fever and
the infection and inflammation. This might be
inadequate vaccination in pregnancy, although this
observed early during the illness in organs such as
did not show statistical significance. There were
the skin, thymus, bones and the epithelium which
no previous reports on maternal social status and
also become depleted during this process.
neonatal zinc. However, the work of Froozani and

The implication of this report is to study the
Parsam (1983) appeared similar to our finding.
association of the fetal serum of zinc and other
They compared the serum level of zinc in cord
elements and the risk of development of early
blood of neonates of 194 women at a public and
childhood upper respiratory infections. Soltan and
private Hospitals. Their findings showed that the
Jenkins (1982) found that cord blood zinc
serum zinc levels in cord blood in the case of the
concentrations in congenitally abnormal babies
private group were significantly higher (p < 0.01)
were lower than in the control babies. Hence they
compared to the public group. In addition, a weak
concluded that low plasma zinc may be an
association was observed between umbilical cord
associated factor in the aetiology of fetal
blood Zn levels and anthropometric measurements
abnormality.
of newborns, like birth weight and head

Nasrat et al (1992) reported low level of
circumference, parity, residence and smoking
plasma zinc concentration in 10 fetuses with
habits of mothers (Frkovi et al, 1996; Soltan and
symmetrical growth retardation, but the level was
Jenkins, 1982; Marriott et al, 2007).
not significantly different from that in the normal

Szyszko and Czarnowski (2006) studied the
control fetuses. However, they concluded that in
effect of social habits of mothers comparing
fetuses with symmetrical intrauterine growth
smoking and non-smoking mothers. They found
retardation, a low plasma zinc was probably a
that the ratio of Zinc/Cadmium and Selenium/ lead
parallel phenomenon and not necessarily an
is higher in all tissues of non-smoking than
aetiological factor. Zinc deficiency during fetal
smoking
women,
showing
tobacco
smoke
development was documented to cause intra-
exposure
had
negative
influence
on
the
uterine growth retardation and also impaired
distribution of the micro-elements in the feto-
postnatal immune functions making these babies
placental unit. Inadequate vaccination and fever in
more susceptible to severe infections (Mukherjee
pregnancy may be features of poor access to
et al, 1984; Shankhar and Prasad, 1998; Bhutta et
optimal health care which are features of low
al, 2000). Studies have shown good correlation
social class. In addition, poor immune status may
between
cord
blood
zinc,
maternal
zinc
result in recurrent infection in pregnancy which
concentration and birth weights (Bhutta et al,
may lead to neonatal malnutrition.
1999; Murray and Lopez, 1997). This is critical to
Finding from this study also showed that the
demonstrate because nearly 80% of infant
serum zinc of neonates of younger mothers (< 25
mortality occurs in first 2 months of life (Schultink
years) was higher than those whose age are >25
et al, 1997; Abdulla and Suck, 1998; Brooks et al,
years. Frkovic et al (1996) reported that younger
2005). Any health programme that aims at
mothers (aged ≤ 25 years) also had higher levels
reducing infant mortality rate needs to address
of Zinc in neonatal umbilical cord compared to
mortality in the first two months of life.
those whose age was >25 years. It is difficult to

The predisposition of young infants in
postulate which led to the other between
developing countries to zinc deficiency and
intrauterine infection and low neonatal serum
infections suggest the need for the addition of zinc
Zinc. A vicious cycle of infection and zinc
to standard treatment of serious bacterial
Growth Values in Nigerian Adolescents
301

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African Journal of Biomedical Research 2008 (Vol. 11) / Lasisi, Kuti and Adekunle

infections may lead to significant improvements in
population in Bangladesh: randomised controlled trial.
the outcomes. The infant mortality rates in India
Lancet.; 366(9490): 999-1004.
continued to be in excess of 60 per 1000 live
Brown KH, Peerson JM, Rivera J, Allen LH. (2002):
births. Neonatal mortality contributed to over 64%
Effect of supplemental zinc on the growth and serum
zinc concentrations of prepubertal children: a meta-
of the infant deaths particularly in those who were
analysis of randomized controlled trials. Am J Clin
born low birth weight. Serious systemic infections
Nutr. 75(6):1062-71.
like sepsis and pneumonia constituted 30 - 40% of
Cousins RJ, Leinart AS (1988). Tissue-specific
the causes of mortality Abdulla and Suck, 1998).
regulation of zinc metabolism and metallothionein
This high prevalence of sepsis is likely to suggest
genes by interleukin 1. FASEB J. 1988; 2(13):2884-
an increased requirement for zinc in the young
2890.
infants living in the developing countries. This
Dijkhuizen MA, Wieringa FT, West CE, Martuti S,
will be needed in order to help in sustaining
Muhilal
(2001):
Effects
of
iron
and
zinc
immunity against the recurrent infections and high
supplementation in Indonesian infants on micronutrient
microbial load in the environment.
status and growth. J Nutr. 2001; 131(11):2860-2865.
Frkovi a A, Medugoracb B, Alebi -Jureti A. (1996):

In conclusion, our findings suggested that the
Zinc levels in human milk and umbilical cord blood
low social status of the mothers, and inadequate
Science of The Total Environment Volume 192, Issue
vaccination in pregnancy were major factors
2, 2 December 1996, Pages 207-212.
associated with low serum zinc in newborns.
Froozani MD, Parsam H. (1983): Serum Zinc,
Further studies are needed to correlate the
Copper, Calcium and Phosphorous in Pregnant Women
maternal and neonatal serum zinc status. However,
and their Newborns Journal of Tropical Pediatrics 1983
control of these epidemiological risk factors will
29(3):190-192.
help in achieving optimal neonatal nutrition.
Herman S, Griffin IJ, Suwarti S, Ernawati F,
Permaesih D, Pambudi D, Abrams SA. (2002):
Cofortification of iron-fortified flour with zinc sulfate,
REFERENCES
but not zinc oxide, decreases iron absorption in
Indonesian children. Am J Clin Nutr. 2002;76(4):813-
Abdulla M, Suck C (1998): Blood levels of copper,
817.
iron, zinc, and lead in adults in India and Pakistan and
Jeswani RM, Vani SN. (1991): A study of serum zinc
the effect of oral zinc supplementation for six weeks.
levels in cord blood of neonates and their mothers.
Biol Trace Elem Res.; 61(3):323-331.
Indian J Pediatr. 1991; 58(5):683-686.
Bhutta ZA, Bird SM, Black RE, Brown KH,
Lasisi OA, Sulaiman OA and Afolabi OA (2007):
Gardner JM, Hidayat A, Khatun F, Martorell R,
Socio-Economic Status And Hearing Loss In Chronic
Ninh NX, Penny ME, Rosado JL, Roy SK, Ruel M,
Suppurative Otitis
Media. Annals of Tropical
Sazawal S, Shankar A. (2000): Therapeutic effects of
Paediatrics (2007) 27, 291–296.
oral zinc in acute and persistent diarrhea in children in
Lind T, Lonnerdal B, Stenlund H, Ismail D,
developing countries: pooled analysis of randomized
Seswandhana R, Ekstrom EC, Persson LA. (2003):
controlled trials. Am J Clin Nutr. 2000; 72(6):1516-
community-based randomized controlled trial of iron
1522.
and zinc supplementation in Indonesian infants:
Bhutta ZA, Black RE, Brown KH, Gardner JM,
interactions between iron and zinc. Am J Clin Nutr.
Gore S, Hidayat A, Khatun F, Martorell R, Ninh
77(4):883-890.
NX, Penny ME, Rosado JL, Roy SK, Ruel M,
Mahalanabis D, Bhan MK (2001): Micronutrients as
Sazawal S, Shankar A. (1999): Prevention of diarrhea
adjunct therapy of acute illness in children: impact on
and pneumonia by zinc supplementation in children in
the episode outcome and policy implications of current
developing countries: pooled analysis of randomized
findings. Br J Nutr. 2001; 85 Suppl 2:S151-158.
controlled trials. Zinc Investigators' Collaborative
Marriott LD, Foote KD, Kimber AC, Delves HT,
Group. J Pediatr. 135(6):689-697.
Morgan JB. (2007) Zinc, copper, selenium and
Brooks WA, Santosham M, Naheed A, Goswami D,
manganese blood levels in preterm infants Archives of
Wahed MA, Diener-West M, Faruque AS, Black
Disease in Childhood - Fetal and Neonatal Edition; 92:
RE. (2005): Effect of weekly zinc supplements on
F494-F497.
incidence of pneumonia and diarrhoea in children
Mukherjee MD, Sandstead HH, Ratnaparkhi MV,
younger than 2 years in an urban, low-income
Johnson LK, Milne DB, Stelling HP. (1984):
Growth Values in Nigerian Adolescents
302

---

African Journal of Biomedical Research 2008 (Vol. 11) / Lasisi, Kuti and Adekunle

Maternal zinc, iron, folic acid, and protein nutriture and
Shah D, Sachdev HPS (2001):. Effect of gestational
outcome of human pregnancy American Journal of
zinc deficiency on pregnancy outcomes: summary of
Clinical Nutrition, 1984; 40, 496-507.
observation studies and zinc supplementation trials
Murray CJ, Lopez AD (1997): Global mortality,
British Journal of Nutrition 2001; 85, Suppl. 2,
disability, and the contribution of risk factors: Global
S101±S108.
Burden
of
Disease
Study.
Lancet.
1997;
Shankar AH, Prasad AS (1998): Zinc and immune
349(9063):1436-42.
function: the biological basis of altered resistance to
Nasrat H, Bloxam D, Nicolini U, Williams N,
infection. Am J Clin Nutr. 1998; 68(2 Suppl):447S-
Tannirandorn Y, Nicolaides P, Roedeck CH (1992):
463S. Review.
Midpregnancy plasma zinc in normal and growth
Soltan MH, Jenkins DM (1982): Maternal and fetal
retarded fetuses—a preliminary study BJOG: An
plasma zinc concentration and fetal abnormality BJOG:
International Journal of Obstetrics and Gynaecology; 99
An
International
Journal
of
Obstetrics
and
(8): 646–650.
Gynaecology1982; 89 (1): 56–58.
Neggers YH, Goldenberg RL, Tamura T, Cliver SP,
Szyszko M, Czarnowski W (2006):. Smoking
Hoffman HJ. (1997): The relationship between
influence on cadmium, lead, selenium and zinc level in
maternal dietary intake and infant birthweight. Acta
placenta, cord blood and maternal blood of women at
Obstet Gynecol Scand Suppl. 1997;165:71-75.
delivery
from
Gdansk
region
Przegl
Lek.
Prasad AS. (2000) Effects of zinc deficiency on Th1
2006;63(10):993-997.
and Th2 cytokine shifts. J Infect Dis. 2000;182 Suppl
Zlotkin S, Arthur P, Schauer C, Antwi KY, Yeung
1:S62-68.
G, Piekarz A (2003): Home-fortification with iron and
Schultink, W., Merzenich, M, Gross, R, Shrimpton,
zinc sprinkles or iron sprinkles alone successfully treats
R,
Dillon,
D.
(1997):
“Effects
of
iron-zinc
anemia in infants and young children. J Nutr.
supplementation on the iron, zinc, and vitamin A status
2003;133(4):1075-1080.
of anamemic pre-school children. “ Food and Nutrition
Bulletin 1997; 18(4):311-316.

Growth Values in Nigerian Adolescents
303

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