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Factors affecting cord blood leptin levels in a consecutive birth cohort
Rina Fyfe1,2, Alice Burton1, Andrew McLennan1,3
1Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia.
Insights
Umbilical cord leptin levels, influenced by maternal and fetal factors, may help screen newborns. Lower leptin levels in newborns admitted to the neonatal intensive care unit (NICU) suggest potential for early identification of at-risk infants.
Area of Science:
- Perinatal Medicine
- Neonatology
- Endocrinology
Background:
- Fetal growth trajectories impact long-term health outcomes.
- Traditional anthropometric assessments have limitations in diverse populations.
- Umbilical cord blood leptin offers a potential biomarker for fetal growth screening.
Purpose of the Study:
- To report cord blood leptin levels in a large birth cohort.
- To assess the relationship between leptin and neonatal/maternal factors.
- To establish a normal range for cord blood leptin and evaluate its association with neonatal outcomes.
Main Methods:
- Prospective collection of umbilical cord blood samples from 1275 deliveries.
- Measurement of serum leptin levels and collation of maternal/neonatal data.
- Statistical analysis to identify associations and establish normal ranges (multiples of the median).
Main Results:
- Leptin levels correlated significantly with gestational age, birthweight, infant sex, plurality, and maternal BMI.
- Lower mean leptin levels (multiples of the median) were observed in infants admitted to the neonatal intensive care unit (NICU).
- No significant association found between leptin levels and 5-minute Apgar scores.
Conclusions:
- Neonatal cord leptin is influenced by maternal and fetal characteristics.
- Adjusted leptin levels can account for population variations.
- Lower mean leptin multiples of the median in NICU-admitted infants warrant further investigation for potential clinical utility in identifying high-risk fetuses.
Introduction:
The fetus that fails to meet its ideal growth trajectory has increased risks of poor health outcomes throughout life. "Gold standard" methods of anthropometric assessment such as measurement of percentage body fat can be difficult to apply across populations and other biomarkers such as serum concentration of umbilical cord blood leptin may be more effective for screening. This study reports cord blood leptin levels in a large prospective consecutive birth cohort and assesses the relationship between leptin and neonatal and maternal factors.
Methods:
Venous umbilical cord blood samples were collected from a prospective consecutive cohort of pregnancies at the time of delivery. Maternal and neonatal characteristics and details of delivery were collated. Serum leptin levels were measured, associations with demographic features were identified, and a normal range was established. The association between cord leptin level and neonatal outcome was tested.
Results:
Umbilical cord leptin and maternal and neonatal characteristics were collected at 1275 births. The median leptin value was 10.8 ng/ml (IQR: 6.4, 17.8 ng/ml). Log10 leptin was significantly associated with gestation at delivery, birthweight (BWt), infant sex, plurality, and maternal body mass index (BMI) (p < .001). Observed leptin values were expressed as multiples of the median (MoM). The mean leptin MoM was significantly lower in infants admitted to NICU following delivery (0.85; 95% confidence interval [CI]: 0.78-0.91 versus 1.05; 95% CI: 1.03-1.06 (controls), p < .001). There was no significant association between leptin MoM values and 5-min Apgar scores.
Conclusions:
Neonatal cord leptin levels are influenced by a number of maternal and fetal characteristics. Absolute levels can be adjusted to account for normal population variation. Infants requiring admission to NICU have lower mean leptin MoM levels. Further studies are needed to see whether the identification of fetuses with polarized leptin levels (<5th or >95th centile) will benefit from further surveillance or intervention in infancy.
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