Main Article Content

Authors


Background:


Multiple infections, nutrient deficiencies and inflammation (MINDI) occur in indigenous communities, but their associations with perinatal outcomes have not been described.




Objective:


To assess maternal and cord blood micronutrient and inflammation status in peripartum mothers from the Ngäbe-Buglé comarca in Panama, and their associations with placental and infant outcomes.




Methods:


In 34 mother-newborn dyads, placental weight and diameter were measured, and maternal and cord blood were processed for complete cell counts, serum C-reactive protein, ferritin, serum transferrin receptor (sTfR), vitamins A and D. Blood volumes were calculated using Nadler’s formula.




Results:


Mothers had low plasma volume (<2.8 L, 96%), vitamin A (52.9%), vitamin D (29.4%), iron (58.8%) and hemoglobin (23.5%), but high hematocrit (>40%, 17.6%) and inflammation (C-reactive protein >8.1 mg/L, 85.3%). Birthweights were normal, but the low placental weight (35.3%), low head circumference Z-scores (17.6%), and low cord hemoglobin (5.9%), iron (79.4%), vitamin A (14.7%) and vitamin D (82.3%) were identified. Maternal and cord vitamin D were highly correlated. Higher maternal plasma volume was associated with heavier placentae (β= 0.57), and higher cord D (β= 0.43) and eosinophils (β= 0.43) with larger placentae. Hemoconcentration (higher cord hematocrit) was associated with lower newborn weight (β= -0.48) and head circumference (β= -0.56). Inflammation [higher maternal neutrophils (β= -0.50), and cord platelets (β= -0.32)] was associated with the lower newborn length and head circumference.




Conclusion:


Maternal-newborn hemoconcentration, subclinical inflammation and multiple nutrient deficiencies, particularly neonatal vitamin D deficiency, were identified as potential targets for interventions to improve pregnancy outcomes in vulnerable communities.


Doris González-Fernández, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada

orcid_id14.png https://orcid.org/0000-0002-1485-9313

Yining An, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada

orcid_id14.png https://orcid.org/0000-0001-7720-5002

Hugues Plourde, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada

orcid_id14.png https://orcid.org/0000-0001-9635-373X

Emérita del Carmen Pons, Ministerio de Salud, Departamento de Salud Nutricional, Ciudad de Panamá, Panamá

orcid_id14.png https://orcid.org/0000-0002-0271-1864

Odalis Teresa Sinisterra, Ministerio de Salud, Región de Salud “Panamá Norte”, Ciudad de Panamá, Panamá

orcid_id14.png https://orcid.org/0000-0001-8150-6158

Delfina Rueda, Ministerio de Salud, Región de Salud “Comarca Ngäbe-Buglé” San Félix, provincia de Chiriquí, Panamá

orcid_id14.png https://orcid.org/0000-0002-5408-9480

Enrique Murillo, Universidad de Panamá, Departamento de Bioquímica, Ciudad de Panamá, Panamá

orcid_id14.png https://orcid.org/0000-0002-6056-6220

Marilyn E Scott, McGill University (Macdonald Campus), Institute of Parasitology, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada

orcid_id14.png https://orcid.org/0000-0002-3553-4550

Kristine G Koski, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada

orcid_id14.png https://orcid.org/0000-0002-2088-2931

González-Fernández, D., An, Y., Plourde, H., Pons, E. del C., Sinisterra, O. T., Rueda, D., Murillo, E., Scott, M. E., & Koski, K. G. (2024). Maternal and cord blood parameters are associated with placental and newborn outcomes in indigenous mothers: A case study in the MINDI cohort. Colombia Medica, 52(3), e2054600. https://doi.org/10.25100/cm.v52i3.4600 (Original work published June 28, 2021)

Hoover E, Cook K, Plain R, et al. Indigenous peoples of North America: environmental exposures y reproductive justice. Environmental health perspectives. 2012;120(12):1645-9. https://doi.org/10.1289/ehp.1205422

Wurtz H. Indigenous Women of Latin America: Unintended pregnancy, unsafe abortion, y reproductive health outcomes. Pimatisiwin. 2012;10(3):271-82.

Anderson I, Robson B, Connolly M, et al. Indigenous y tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study. Lancet. 2016 Jul 9;388(10040):131-57. https://doi.org/10.1016/S0140-6736(16)32465-5

Sheppard AJ, Shapiro GD, Bushnik T, et al. Birth outcomes among First Nations, Inuit y Metis populations. Health Rep. 2017 Nov 15;28(11):11-6.

Simonet F, Wilkins R, Luo ZC. Temporal trends in Inuit, First Nations y non-Aboriginal birth outcomes in rural y northern Quebec. Int J Circumpolar Health. 2012;71. https://doi.org/10.3402/ijch.v71i0.18791

Luo ZC, Wilkins R. Degree of rural isolation y birth outcomes. Paediatr Perinat Epidemiol. 2008 Jul;22(4):341-9. https://doi.org/10.1111/j.1365-3016.2008.00938.x

O'Brien CM, Arbuckle S, Thomas S, Rode J, Turner R, Jeffery HE. Placental inflammation is associated with rural y remote residence in the Northern Territory, Australia: a cross-sectional study. BMC Pregnancy Childbirth. 2015 Feb 14;15:32. https://doi.org/10.1186/s12884-015-0458-7

Morgan HG. Placental malaria y low birthweight neonates in urban Sierra Leone. Ann Trop Med Parasitol. 1994 Dec;88(6):575-80. https://doi.org/10.1080/00034983.1994.11812907

Moffatt ME. Current status of nutritional deficiencies in Canadian aboriginal people. Can J Physiol Pharmacol. 1995 Jun;73(6):754-8. https://doi.org/10.1139/y95-100

Godel JC, Basu TK, Pabst HF, Hodges RS, Hodges PE, Ng ML. Perinatal vitamina A (retinol) status of northern Canadian madres y their infants. Biol Neonate. 1996;69(3):133-9. https://doi.org/10.1159/000244288

Dallaire F, Dewailly E, Shademani R, et al. Vitamin A concentration in umbilical cord blood of infants from three separate regions of the province of Quebec (Canada). Can J Public Health. 2003 Sep-Oct;94(5):386-90. https://doi.org/10.1007/BF03403568

Rosique G J, Restrepo C MT, Manjarrés C LM, Gálvez A A, Santa M J. Estado nutricional y hábitos alimentarios en indígenas Embera de Colombia. Rev Chil Nutr. 2010;37:270-80. https://doi.org/10.4067/S0717-75182010000300002

Mokdad AH, Colson KE, Zuniga-Brenes P, et al. Salud Mesoamerica 2015 Initiative: design, implementation, y baseline findings. Popul Health Metr. 2015;13(1):3. https://doi.org/10.1186/s12963-015-0034-4

Egely GM, Johnson-Down L, Cao ZR, Sheikh N, Weiler H. Food insecurity y nutrition transition combine to affect nutrient intakes in Canadian arctic communities. J Nutr. 2011 Sep;141(9):1746-53. https://doi.org/10.3945/jn.111.139006

Grant CC, Wall CR, Yates R, Crengle S. Nutrition y indigenous health in New Zealy. J Paediatr Child Health. 2010 Sep;46(9):479-82. https://doi.org/10.1111/j.1440-1754.2010.01842.x

Longvah T, Khutsoh B, Meshram, II, et al. Mother y child nutrition among the Chakhesang tribe in the state of Nagaly, North-East India. Matern Child Nutr. 2017 Nov;13 Suppl 3(Suppl 3). https://doi.org/10.1111/mcn.12558

Hirschler V, Molinari C, Maccallini G, Intersimone P, Gonzalez CD. Vitamin D levels y cardiometabolic markers in indigenous Argentinean children living at different altitudes. Glob Pediatr Health. 2019;6:2333794x18821942. https://doi.org/10.1177/2333794X18821942

Mansuri S, Badawi A, Kayaniyil S, et al. Traditional foods y 25(OH)D concentrations in a subarctic First Nations community. Int J Circumpolar Health. 2016 Jan;75(1):31956. https://doi.org/10.3402/ijch.v75.31956

Black RE, Victora CG, Walker SP, et al. Maternal y child undernutrition y overweight in low-income y middle-income countries. Lancet. 2013 Aug 3;382(9890):427-51. https://doi.org/10.1016/S0140-6736(13)60937-X

Gerny AD, Schulze KJ, Stewart CP, West KP, Jr., Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects y prevention. Nat Rev Endocrinol. 2016 May;12(5):274-89. https://doi.org/10.1038/nrendo.2016.37

Rees WD. Interactions between nutrients in the maternal diet y the implications for the long-term health of the offspring. Proc Nutr Soc. 2019 Feb;78(1):88-96. https://doi.org/10.1017/S0029665118002537

Oh C, Keats EC, Bhutta ZA. Vitamin y mineral supplementation during pregnancy on maternal, birth, child health y development outcomes in low- y middle-income countries: a systematic review y meta-analysis. Nutrients. 2020 Feb 14;12(2). https://doi.org/10.3390/nu12020491

Gonzalez-Fernyez D, Koski KG, Sinisterra OT, Del Carmen Pons E, Murillo E, Scott ME. Interactions among urogenital, intestinal, skin, y oral infections in pregnant y lactating Panamanian Ngabe women: a neglected public health challenge. Am J Trop Med Hyg. 2015 Mar 30;92(6):1100-10. https://doi.org/10.4269/ajtmh.14-0547

Gonzalez-Fernyez D, Pons EDC, Rueda D, et al. C-reactive protein is differentially modulated by co-existing infections, vitamina deficiencies y maternal factors in pregnant y lactating indigenous Panamanian women. Infect Dis Poverty. 2017 Jun 02;6(1):94. https://doi.org/10.1186/s40249-017-0307-1

González-Fernández D, Pons EdC, Rueda D, et al. Identification of high-risk pregnancies in a remote setting using ambulatory blood pressure: the MINDI Cohort. Front Public Health. 2020 2020-March-24;8(86). https://doi.org/10.3389/fpubh.2020.00086

Malik AY, Foster C. The revised Declaration of Helsinki: cosmetic or real change? J R Soc Med. 2016 May;109(5):184-9. https://doi.org/10.1177/0141076816643332

Panamanian Ministry of Health. [Statistical Bulletin 2010]. 2011; Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwi2ju2s3rDoAhX4g3IEHXIiBZsQFjAAegQIAhAB&url=http%3A%2F%2Fwww.minsa.gob.pa%2Fsites%2Fdefault%2Ffiles%2Fpublicacion-general%2Fanuario2010.pdf&usg=AOvVaw0Zs6zTNvI_3LG8Drrhaoma

Klabunde RE. Vascular Function. In: Taylor C, ed. Cardiovascular Physiology Concepts. Second ed. Philadelphia: Wolters Kluwer | Lippincott Williams & Wilkins, 2012:97-8.

Ayala DE, Hermida RC. Ambulatory blood pressure monitoring for the early identification of hypertension in pregnancy. Chronobiol Int. 2013 Mar;30(1-2):233-59. https://doi.org/10.3109/07420528.2012.714687

WHEC (Women's Health y Education Center). Obstetrics: Normal values in pregnancy. 2009; Available from: http://www.womenshealthsection.com/content/obs/obs025.php3

Almog B, Shehata F, Aljabri S, Levin I, Shalom-Paz E, Shrim A. Placenta weight percentile curves for singleton y twins deliveries. Placenta. 2011 Jan;32(1):58-62. https://doi.org/10.1016/j.placenta.2010.10.008

Villar J, Cheikh Ismail L, Victora CG, et al. International styards for newborn weight, length, y head circumference by gestational age y sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):857-68. https://doi.org/10.1016/S0140-6736(14)60932-6

WHO, CDC. Health Topics: Nutrition. Assessing the Iron Status of Populations. Available from: apps.who.int/iris/bitstream/10665/75368/1/9789241596107_eng.pdf?ua=1&ua=1.

Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy y laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009 Dec;114(6):1326-31. https://doi.org/10.1097/AOG.0b013e3181c2bde8

Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume y platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb). 2016;26(2):178-93. https://doi.org/10.11613/BM.2016.020

Glasser L, Sutton N, Schmeling M, Machan JT. A comprehensive study of umbilical cord blood cell developmental changes y reference ranges by gestation, gender y mode of delivery. J Perinatol. 2015 Jul;35(7):469-75. https://doi.org/10.1038/jp.2014.241

Basu S, Kumar N, Srivastava R, Kumar A. Effect of severe maternal iron deficiency anemia on neonatal platelet indices. Indian J Pediatr. 2015 Dec;82(12):1091-6. https://doi.org/10.1007/s12098-015-1775-6

Hay G, Refsum H, Whitelaw A, Melbye EL, Haug E, Borch-Iohnsen B. Predictors of serum ferritin y serum soluble transferrin receptor in newborns y their associations with iron status during the first 2 y of life. Am J Clin Nutr. 2007 Jul;86(1):64-73. https://doi.org/10.1093/ajcn/86.1.64

Kitano T, Takagi K, Arai I, et al. Elevated C-reactive protein in umbilical cord blood: Neonatal case review. Pediatr Int. 2019 Jun;61(6):583-6. https://doi.org/10.1111/ped.13866

Wiseman EM, Bar-El Dadon S, Reifen R. The vicious cycle of vitamina A deficiency: A review. Crit Rev Food Sci Nutr. 2016 Apr 29:0.

McCauley ME, van den Broek N, Dou L, Othman M. Vitamin A supplementation during pregnancy for maternal y newborn outcomes. Cochrane Database Syst Rev. 2015(10):CD008666. https://doi.org/10.1002/14651858.CD008666.pub3

Balvers MG, Brouwer-Brolsma EM, Endenburg S, de Groot LC, Kok FJ, Gunnewiek JK. Recommended intakes of vitamina D to optimize health, associated circulating 25-hydroxyvitamina D concentrations, y dosing regimens to treat deficiency: workshop report y overview of current literature. J Nutr Sci. 2015;4:e23. https://doi.org/10.1017/jns.2015.10

Ariyawatkul K, Lersbuasin P. Prevalence of vitamina D deficiency in cord blood of newborns y the association with maternal vitamina D status. Eur J Pediatr. 2018 Oct;177(10):1541-5. https://doi.org/10.1007/s00431-018-3210-2

Hauser RG, Kwon RJ, Ryder A, Cheng C, Charifa A, Tormey C. Transfusion medicine equations made internet accessible. Transfus Med Rev. 2020 Jan;34(1):5-9. https://doi.org/10.1016/j.tmrv.2019.10.003

Colavita D, Kim HC, Friedman DF. The sex parameter in estimation of total blood volume for pediatric erythrocytapheresis. J Clin Apher. 2019 Dec;34(6):692-9. https://doi.org/10.1002/jca.21748

Nagano K, Kusaka T, Okubo K, et al. Estimation of circulating blood volume in infants using the pulse dye densitometry method. Paediatr Anaesth. 2005 Feb;15(2):125-30. https://doi.org/10.1111/j.1460-9592.2005.01406.x

Stleglitz E, Huang J. Plasmapheresis Technique. 2018; Available from: https://emedicine.medscape.com/article/1895577-technique

de Haas S, Ghossein-Doha C, van Kuijk SM, van Drongelen J, Spayerman ME. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review y meta-analysis. Ultrasound Obstet Gynecol. 2017 Feb;49(2):177-87. https://doi.org/10.1002/uog.17360

Mannan H. A Practical application of a simple bootstrapping method for assessing predictors selected for epidemiologic risk models using automated variable selection. Int J Stat Appl 2017;7(5):239-49.

Royston P, Sauerbrei W. Multivariable model-building : a pragmatic approach to regression analysis based on fractional polynomials for modelling continuous variables. Chichester, Engly; John Wiley, 2008.

Liu X. Classification accuracy y cut point selection. Stat Med. 2012 Oct 15;31(23):2676-86. https://doi.org/10.1002/sim.4509

Salavati N, Smies M, Ganzevoort W, et al. The possible role of placental morphometry in the detection of fetal growth restriction. Front Physiol. 2019;9:1884-. https://doi.org/10.3389/fphys.2018.01884

Salas SP, Rosso P, Espinoza R, Robert JA, Valdes G, Donoso E. Maternal plasma volume expansion y hormonal changes in women with idiopathic fetal growth retardation. Obstet Gynecol. 1993 Jun;81(6):1029-33.

Salas SP, Rosso P. [Reduced plasma volume y changes in vasoactive hormones in underweight pregnant women]. Rev Med Chil. 1998 May;126(5):504-10.

Roy-Clavel E, Picard S, St-Louis J, Brochu M. Induction of intrauterine growth restriction with a low-sodium diet fed to pregnant rats. Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):608-13. https://doi.org/10.1016/S0002-9378(99)70262-0

Bibeau K, Sicotte B, Bély M, et al. Placental underperfusion in a rat model of intrauterine growth restriction induced by a reduced plasma volume expansion. PLoS One. 2016;11(1):e0145982-e. https://doi.org/10.1371/journal.pone.0145982

Lykkedegn S, Beck-Nielsen SS, Sorensen GL, et al. Vitamin D supplementation, cord 25-hydroxyvitamina D y birth weight: Findings from the Odense Child Cohort. Clin Nutr. 2017 Dec;36(6):1621-7. https://doi.org/10.1016/j.clnu.2016.10.008

Gerny AD, Simhan HN, Klebanoff MA, Bodnar LM. Maternal serum 25-hydroxyvitamina D y measures of newborn y placental weight in a U.S. multicenter cohort study. J Clin Endocrinol Metab. 2013 Jan;98(1):398-404. https://doi.org/10.1210/jc.2012-3275

Budhwar S, Verma P, Verma R, et al. Altered cord serum 25-hydroxyvitamina D signaling y placental inflammation is associated with pre-term birth. Am J Reprod Immunol. 2020 Feb;83(2):e13201. https://doi.org/10.1111/aji.13201

Menon R, Taylor BD. Exploring inflammatory mediators in fetal y maternal compartments during human parturition. Obstet Gynecol. 2019 Oct;134(4):765-73. https://doi.org/10.1097/AOG.0000000000003470

Friis H, Gomo E, Mashange W, et al. The acute phase response to parturition: a cross-sectional study in Zimbabwe. Afr J Reprod Health. 2009 Jun;13(2):61-8.

Kovar IZ, Riches PG. C3 y C4 complement components y acute phase proteins in late pregnancy y parturition. J Clin Pathol. 1988 Jun;41(6):650-2. https://doi.org/10.1136/jcp.41.6.650

Yasuda K, Nakanishi K. Host responses to intestinal nematodes. Int Immunol. 2018 Mar 10;30(3):93-102. https://doi.org/10.1093/intimm/dxy002

Starr LM, Scott ME, Koski KG. Protein deficiency y intestinal nematode infection in pregnant mice differentially impact fetal growth through specific stress hormones, growth factors, y cytokines. J Nutr. 2015 Jan;145(1):41-50. https://doi.org/10.3945/jn.114.202630

Chen YH, Liu ZB, Ma L, et al. Gestational vitamina D deficiency causes placental insufficiency y fetal intrauterine growth restriction partially through inducing placental inflammation. J Steroid Biochem Mol Biol. 2020 Aug 9:105733. https://doi.org/10.1016/j.jsbmb.2020.105733

Morikawa M, Yamada T, Yamada T, et al. Antithrombin activity, platelet count, hemoglobin concentration y hematocrit value determined immediately before vaginal delivery among healthy women. Hokkaido Igaku Zasshi. 2012 Aug;87(4-5):141-6.

Fairlie FM, Lang GD, Lowe GG, Walker JJ. Umbilical artery flow velocity waveforms y cord blood viscosity. Am J Perinatol. 1991 Jul;8(4):239-43. https://doi.org/10.1055/s-2007-999387

Meberg A, Jakobsen E, Halvorsen K. Humoral regulation of erythropoiesis y thrombopoiesis in appropriate y small for gestational age infants. Acta Paediatr Scy. 1982 Sep;71(5):769-73. https://doi.org/10.1111/j.1651-2227.1982.tb09517.x

Vlug RD, Lopriore E, Janssen M, Middeldorp JM, Rath ME, Smits-Wintjens VE. Thrombocytopenia in neonates with polycythemia: incidence, risk factors y clinical outcome. Expert Rev Hematol. 2015 Feb;8(1):123-9. https://doi.org/10.1586/17474086.2015.997705

Dundar B, Dincgez Cakmak B, Ozgen G, Tasgoz FN, Guclu T, Ocakoglu G. Platelet indices in preterm premature rupture of membranes y their relation with adverse neonatal outcomes. J Obstet Gynaecol Res. 2018 Jan;44(1):67-73. https://doi.org/10.1111/jog.13484

Cecinati V, Brescia L, Esposito S. Thrombocytosis y infections in childhood. Pediatr Infect Dis J. 2012;31(1):80-1. https://doi.org/10.1097/INF.0b013e318241f47a

Syed NN, Usman M, Khurshid M. Thrombocytosis: age dependent aetiology y analysis of platelet indices for differential diagnosis. Indian J Pathol Microbiol. 2007 Jul;50(3):628-33.

Solomons NW. Vision of research on human linear growth. Food Nutr Bull. 2019 Dec;40(4):416-31. https://doi.org/10.1177/0379572119885475

Prendergast AJ, Rukobo S, Chasekwa B, et al. Stunting is characterized by chronic inflammation in Zimbabwean infants. PLoS One. 2014;9(2):e86928. https://doi.org/10.1371/journal.pone.0086928

Wren-Atilola HM, Solomons NW, Scott ME, Koski KG. Infant growth faltering linked to subclinical mastitis, maternal faecal-oral contamination, y breastfeeding. Matern Child Nutr. 2019 Jul;15(3):e12756. https://doi.org/10.1111/mcn.12756

Downloads

Download data is not yet available.
Received 2020-10-26
Accepted 2021-05-09
Published 2024-04-18