Assesment of polyunsaturated fatty acids in cord

　　作者：Galila M Mokhar， Soha M Abd El Dayem， Nermine H Sayed， Sohair abd El Maksod， Manal El Shamaa， Hani M El Mikaty]

【摘要】 Objective:To assess whether infants of diabetic mothers [pre pregnancy diabetics (PPD) and gestational diabetics mellitus (GDM)] have compromised arachidonic and docosahexaenoic acids in their plasma and the relationship with deficiency of the same compounds in their mothers.Methods: This study was conducted on 30 diabetic mothers (both PPD and GDM) and their infants. Twenty healthy infants and their mothers with age and sex matched were included as controls.All infant (of diabetic and non diabetic mothers) were subjected to assessment of APGAR Scoring， thorough history taking and anthropometric measures. Lipid profile components as well as polyunsaturated fatty acids(PUFA) were assessed in diabetic GDM and PPD and non diabetic mothers as well as in their babies.Results: Highdensity lipoproteir(HDL) level was found to be significantly lower in diabetic mothers (specially those with PPD) compared to non diabetic ones， whereas no significant difference was found between babies of the two groups. Also， the current study revealed that diabetic mothers (GDM and PPD) and their babies had significantly higher levels of PUFA precursors linoleic acids(LA) and alpha linoleic acids(ALA). PUFA arachidonic acid(AA) and docosahexaenoic acids(DHA) were found to be significantly lower in diabetic mothers (GDM and PPD) compared to non diabetic mothers， and same results were found in the babies of the two groups.Conclusion: Neonates with diabetic mothers (both GDM and PPD) have highly compromised plasma levels of AA and DHA PUFA， which affects the child well being by far， and produces hazardous multisystem complications on the long run.

【关键词】 Polyunsaturated fatty acid; Arachidonic acid; Docosahexaenoic acid; Diabetic; Infant; Mother

　　 INTRODUCTION

　　Longchain polyunsaturated fatty acids (PUFA) [arachidonic acid (AA) and docosahexaenoic acids (DHA)] are essential for optimum fetal growth and development. They represent major components of the developing central nervous system， and are essential for cognitive and visual functions[1]. Their consumption may reduce the risk for a variety of diseases， including cardiovascular， neurological and immunological disorders， diabetes and cancer[2]. There is increased demand for these fatty acids during pregnancy， and maternal supplies of AA and DHA are likely the major source of longchain PUFA， determining fetal essential fatty acid and longchain PUFA accretion[3].

　　Diabetes impairs the synthesis of both AA and DHA[4，5]. In poorly controlled maternal diabetes， it is conceivable that the relative insufficiency of AA and DHA may exacerbate speech and reading impairments， behavioral disorders， suboptimal performance on developmental tests， and lower IQ， which have been reported in some children born to mothers with type 1 diabetes mellitus[6]. Moreover， compromised levels of PUFA in infants of diabetic mothers may be severe enough to be a risk for congenital malformations[7]. This is to be added to the known fact that in infants of diabetic mothers， congenital anomalies occur about twothree times as often as in normal population[8].

　　We are aiming to assess whether infants of diabetic mothers [prepregnancy diabetics (PPD) and gestational diabetics (GD)] have compromised arachidonic and docosahexaenoic acids in their plasma and whether this could be related (if present) to deficiency of the same compounds in their mothers.

　　MATERIALS AND METHODS

　　It is a cross sectional study. Consent was taken from all mothers before starting the study. This study was conducted on 30 diabetic mothers (both pre pregnancy and gestational diabetes mellitus) and their infants. 20 healthy infants and their mothers with age and sex matched were included as controls. This study was conducted on 30 infants of diabetic mothers (pre pregnancy DM n=17， 56.6%; gestational DM n=13， 43.3%) and 20 babies as control group in addition to their mothers. The mean age of diabetic mothers was (25±2.4) years (2130 years) and Duration of diabetes ranged from 2 weeks to 10 years [(35.4±36.7) yrs]. All babies were full term ( 37 weeks)， with good general conditions at birth after smooth resuscitation， all were singletons and had no congenital anomalies and their entire mother had controlled diabetes.

　　All infant (of diabetic and non diabetic mothers) were subjected to APGAR Scoring， thorough history taking and anthropometrics measures (head circumference， length && birth weight).

　　3-5mL arterial cord blood samples were withdrawn from the babies immediately after birth under aseptic conditions and peripherally from the mothers perinatally. The blood samples were collected in heparinized plastic tubes and immediately centrifuged. Plasma was separated， and BHT was added into plasma to prevent fatty acid oxidation at concentration of 20μ:1 mL.

　　Lipid profile components [cholesterol， triglycerides (TG)， low density lipoproteins (LDL) and high density lipoproteins (HDL)] as well as PUFA [AA， DHA and their precursors linoleic acids(LA) and alpha linolenic acids (ALA)] were assessed in diabetic (GDM and PPD) and non diabetic mothers as well as in their babies.

　　Lipid profile assessment was done by using Automated Olympus AU400 (Olympus chemistry analyzer， AU400， Olympus Optical Co.， Ltd.)〔9〕.

　　Determination of long chain PUFA was employed as following: free fatty acid methyl esters (FFAMEs) were prepared by specific methylation of plasma nonesterified fatty acids in a onestep reaction. Analysis of the FFAMEs was done by Gas chromatograph/mass spectrometry (GC/MS)〔10〕.

　　Statistical analysis

　　Analysis of data was done using statistical program for social science (SPSS) version 9.0 as follows:

　　 Unpaired ttest was used to compare two independent quantitative variables (symmetrically distributed). While non parametric (Mann Whitney U) test was used for analysis of non symmetrically distributed variables;

　　 One way ANOVA test was used to compare more than two quantitative variables， followed by post HOCC test for detection of significant;

　　 Wilcoxon Rank Sum test was also done for comparison between more than 2 quantitative not symmetrically distributed variables;

　　 Pearson's correlation was also done to detect the relation between different variables;

　　Pvalue is consider significant if &< 0.05.

参考文献

HDL， AA && DHA levels were significantly lower while ALA and LA levels were significantly higher in diabetic pregnant mothers (all diabetics， gestational and pre pregnacy diabetes) compared to nondiabetic group (Table 1， 2).

　　Head circumference， length， birth weight， LDL ， ALA && LA levels were significantly higher while Apgar score's， AA && DHA levels were significantly lower in infants of diabetic mothers (IDMs) compared to non diabetics (Table 3).

　　Head circumference， length， LDL， ALA && LA levels were significantly higher while Apgar score 1 minute， AA && DHA levels were significantly lower in infants of diabetic mothers (gestational and pre pregnancy diabetes) compared to non diabetics (Table 4).

　　Macrosomic infants of diabetic mothers had lower HDL and DHA levels compared to IDMs born with appropriate birth weight (Table 5).

　　Head circumference and birth weigh was significantly higher in infant of diabetics receiving insulin during pregnancy (Table 6).

　　DHA showed a significant negative correlation between birth weight and length of IDMs， duration of diabetes and gestaional age (Fig 1～4).