Assessment of Variations in Oxidative Stress in Newborns from Caesarian and Normal Delivery Based on Apgar Score

Fetal distress seems to be strongly related to fetal hypoxia, which is known to cause derangement of the balance between pro-oxidant and anti-oxidant factors by depleting the antioxidant reserve and increasing oxidative stress. Reduced Apgar score signify the fetal distress in postpartum period. The current study explores the severity of oxidative stress and nitrosative stress markers along with the antioxidant status in the cord blood of the newborns with low Apgar score (Group 1), fairly low Apgar score (Group 2) and normal Apgar score (Group 3) in both categories born by Cesarean section (CS) and Normal delivery (ND). Cord blood was collected from eighty full terms, mature neonates of both sexes; forty born via ND and 40 delivered by CS. Apgar scores were recorded and they were grouped based on the different levels of the score. Methemoglobin (HbM), RBC glucose-6-phosphate dehydrogenase (G6PD), RBC reduced glutathione (GSH) were measured as markers of oxidative stress, whereas serum nitrate and nitrite levels were assayed as markers of nitrosative stress. The data obtained were analyzed for the level of significance between study variables. One way ANOVA revealed statistically significant difference between the means of HbM (1.48±0.52, 1.03±0.4 and 0.69±0.31 for Group 1, 2 and 3 respectively, p<0.001), RBC G6PD (15.62±1.99, 18.16±2.47, 21.93±3.91) RBC GSH (7.7±1.55, 10.75±2.31, 16±6.10), serum nitrate (63.18±17.14, 49.29±14.39, 40.86±8.83) serum nitrite (4.89±1.8, 4.64±1.04, 3.69±0.72) between the three groups of ND neonates. The results were almost similar in CS neonates (HbM - 2.17±0.95, 1.45±0.62, 0.8±0.3; G6PD - 12.54±2.31, 14.31±2.17, 18.1±3.13; GSH - 7.6±2.23, 9±2.11, 12.78±2.83) except serum nitrate and nitrite where no significant difference was found between means among the different Apgar groups. The results suggest that lowest Apgar score ND neonates are exposed to highest oxidative, nitrosative stress and have the poorest antioxidant defense. The CS neonates have the similar fate except the insignificant difference between the nitrosative stresses among the three Apgar score groups signifying that they are better protected against the nitrosative stress than their ND counterparts.