Small-for-gestational-age versus appropriate-for-gestational-age: Comparison of cord blood lipid profile & insulin levels in term newborns (SAGA-ACT study)

Abstract

Background & objectives:The genesis of atherosclerotic lesions, a major cardiovascular risk factor starts in the early stage of life. If the premature development of cardiovascular risk factors can be anticipated during childhood, cardiovascular events can be prevented effectively by taking appropriate measures. This study was carried out to assess the role of in utero malnutrition in cardiovascular disease development by comparing cord blood lipid profiles and serum insulin levels between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) term newborns.Methods:Consecutive full-term infants who were born between June 20 and August 19, 2013, at the Obstetric Unit of a Hospital at Secunderabad, India, were enrolled in this study. Participating newborns were divided into SGA group (n = 51; test group) and AGA group (n = 52; control group) based on their gestational age and body weight. Cord blood lipid profile and insulin levels were compared between these two groups.Results:As compared to the newborns in AGA group, SGA group of newborns had significantly (P<0.01) higher levels of cholesterol, triglyceride and low-density lipoprotein. No difference was observed between the groups for high-density lipoprotein and insulin levels. Mild and moderate anaemia was observed among mothers of both groups, while severe anaemia was seen in mothers of SGA group only.Interpretation & conclusions:SGA newborns exhibited elevated lipid profiles as compared to AGA newborns. Hence, SGA newborns should be closely monitored for cardiovascular morbidities during childhood, adolescence and early adult life.

Health‐care professionals’ approach in feeding term small‐for‐gestational age infants and its potential implications to later growth outcomes

“…Term small‐for‐gestational age (tSGA) infants are receiving increasing attention in the field of paediatrics as this specific population is at an increased risk for developing metabolic diseases in later childhood/early adulthood . Small for gestational age is defined as infants with a birthweight of less than 10th percentile of birthweight‐for‐gestational age reference chart in any given country as per 1995 World Health Organization (WHO) Expert recommendation .…”

Altered cord blood lipid profile, insulin resistance & growth restriction during the perinatal period & its potential role in the risk of developing cardiovascular disease later in life

“…The theory of a foetal origin for adult chronic diseases is of importance in South Asian countries, such as India, where cardiovascular diseases and diabetes are on the rise, and a large proportion of SGA infants are born due to maternal malnutrition5. The occurrence of heart disease is found to be 14 per cent higher in men and women who are born with birth weights <2.5 kg compared to those born with higher birth weights3.…”

“…Evidence of early cardiovascular and metabolic diseases can be seen in the form of deranged lipid profiles and elevated insulin levels. The SAGA-ACT study5 in this issue was designed to compare the cord blood lipid profile and serum insulin levels of SGA newborns with those of appropriate for gestational age (AGA) newborns. The authors enrolled a sample of healthy newborns, whose mothers were without major pregnancy complications, and who were born during a two month period at a tertiary care hospital in southern India.…”

“…The current SAGA-ACT study5 has an advantage over similar studies in that the lipid and insulin levels were collected from the cord blood, which helps to avoid potential influences from postnatal factors. Since insulin plays a critical role in foetal growth and development, it has been suggested that disorders of glucose and insulin metabolism play an important role in the development of cardiovascular disease and type 2 diabetes in adult life.…”

“…Although several studies including the SAGA-ACT study5 support the hypothesis of a foetal origin for adult diseases, there are several postnatal factors including the velocity of catch-up growth, lifestyle, diet, and smoking that can modulate the risk of developing cardiovascular and metabolic diseases throughout the life of an individual. SGA infants with relatively fast catch-up growth rates have been found to have increased evidence of adiposity and unfavourable lipid profiles as compared with infants unable to catch-up growth15.…”