Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 2  |  Page : 152-155  

Study of ionic calcium in maternal and cord blood and baby's blood at 48-h age


Department of Pediatrics, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Web Publication4-Feb-2014

Correspondence Address:
Neelam Deshpande
Navpinnac Kanchanganga Co-Op. Hsg. Society, H-102, D. P. Road, Aundh, Pune - 411 007, Maharashtra
India
Login to access the Email id

Source of Support: Padmashree Dr. D. Y. Patil University, Pimpri, Pune., Conflict of Interest: None


DOI: 10.4103/0975-2870.126321

Rights and Permissions
  Abstract 

Background: Newborns undergo a physiological nadir in serum calcium levels by 24-48 h of age. We have compared the ionic calcium levels in serum of normal as well as high-risk pregnant mothers before delivery, in cord blood of newborns and in neonates at 48 h of age. Materials and Methods: This is a prospective study of 500 pregnant women. One hundred and twenty-two pregnant women did not receive any calcium supplementation antenatally while 378 pregnant women received calcium supplementation antenatally. Results: A statistically significant correlation was found between ionic calcium levels in mothers and in cord blood in the study population and preterm and term babies (coefficient of correlation, r = 0.83, 0.86 and 0.83, respectively). Ionic calcium in baby's blood at 48-h age better correlated with cord blood (r = 0.67) than with maternal blood (r = 0.51). With calcium supplementation antenatally, the mean values for serum calcium of maternal blood, cord blood and baby's blood at 48 h of age were higher than those without antenatal calcium supplementation. Conclusions: Antenatal calcium supplementation may prevent hypocalcemia in the newborn thus preventing neonatal morbidity.

Keywords: Antenatal calcium supplementation, ionic calcium, neonatal hypocalcaemia


How to cite this article:
Deshpande N, Patil L, Deshpande S, Chavan S. Study of ionic calcium in maternal and cord blood and baby's blood at 48-h age. Med J DY Patil Univ 2014;7:152-5

How to cite this URL:
Deshpande N, Patil L, Deshpande S, Chavan S. Study of ionic calcium in maternal and cord blood and baby's blood at 48-h age. Med J DY Patil Univ [serial online] 2014 [cited 2019 Jul 17];7:152-5. Available from: http://www.mjdrdypu.org/text.asp?2014/7/2/152/126321


  Introduction Top


Calcium is the fifth most common element and the most prevalent cation found in the body. [1] Calcium is an important intracellular second messenger. Calcium is also involved in the action of other intracellular messengers, such as cyclic adenosine monophosphate (cAMP) and inositol 1, 4, 5-triphosphate, and thus mediates the cellular response to numerous hormones, including epinephrine, glucagon, ADH, secretin and cholecystokinin. [2] Calcium plays a key role in skeletal, smooth and cardiac muscle contraction. Calcium is the major component of bones and cartilages. Calcium takes part in nerve impulse transmission. Calcium is one of the clotting factors that is essential for clotting. Magnesium, calcium and sodium derangements are a frequent finding in asphyxiated infants, and these abnormalities are significantly associated with poor outcome. [1],[2] For a better outcome prediction, the routine determination of ionic calcium in asphyxiated infants is recommended. The serum ionic calcium concentrations shortly after birth are significantly lower in neonates with hypoxic ischemic encephalopathy who have a poor outcome. Low concentrations may reflect multiple organ damage, particularly involving the brain. [3],[4]

Healthy term babies undergo a physiological nadir in serum Calcium levels by 24-48 h of age. [5],[6],[7] Hypocalcemia is defined as a total serum calcium concentration of less than 2 mmol/L (8 mg/dL) in term neonates and less than 1.75 mmol/L (7 mg/dL) in preterm neonates. [8],[9]

Hypocalcemia is often asymptomatic in neonates. Hypocalcemia may present as lethargy, poor feeding, vomiting and abdominal distension, which can mimic like sepsis. Severe hypocalcemia may present as seizures.

Most of the transplacental transport of calcium takes place late during pregnancy. Therefore, premature babies have deficient stores of calcium but, in contrast, small for date term newborns have normal calcium stores. [10],[11]

The present study measured ionic calcium levels in normal and high risk mothers before delivery, estimated its levels in cord blood as well in neonatal serum at 48 h age with a view to compare the levels in pregnant mothers with their new born babies. It also correlated alteration in the ionic calcium levels in the new born babies born to high risk pregnant mothers.


  Materials and Methods Top


This is a prospective study approved by the Ethical and Scientific Committee of Dr. D. Y. Patil University, Pimpri, Pune. The study was carried out in Padmashri Dr. D. Y. Patil Hospital and Research Center, Pimpri, Pune, for a duration of 2 years from March 2006 to April 2008.

ANC history, birth history and status of the newborn up to 48 h were noted in a predesigned proforma. Five hundred pregnant women andfive hundred newborns were included in the study, adhering to the following inclusion criteria:

  1. The gestational age at the time of delivery is a minimum of 34 weeks and a maximum of 42 weeks
  2. Age at the time of enrollment between 18 and 39 years
  3. Availability of previous gynecological and obstetric records
  4. Apparently healthy newborn on clinical examination


The exclusion criteria that were followed during the enrollment in the study were:

  1. Pregnancy complicated by toxemia of pregnancy or hypertension or diabetes
  2. Twin pregnancy
  3. Non-availability of previous gynecological and obstetric records
  4. Newborn with clinical examination not within normal limits


Out of 500 pregnant women, 212 used to include meat and/or eggs in their diet occasionally, whereas 288 pregnant women used to have a purely vegetarian diet with milk occasionally. As all the women were from same the socioeconomical class and were staying in the same geographical area, their diet did not vary much in terms of its calcium content. Out of 500 pregnant women, 122 did not receive any calcium supplementation during pregnancy whereas the remaining 378 received calcium supplementation during pregnancy (500 mg twice a day daily throughout the pregnancy). Out of 500 mothers enrolled in the study, 102 mothers had high-risk pregnancy due to any of the following reasons: Preterm delivery, i.e. gestational age <37 weeks (n = 72), H/o at least one abortion (n = 24) and maternal age >35 years (n = 6). Out of the 500 newborns included in the study, 247 were female and 253 were male. The mean birth weight of the newborns was 2.74 kg (range 1.3-3.8 kg).

Determination of the ionic calcium levels in pregnant women in labor, in cord blood and in neonates at 48 h of age was carried out. For estimation of ionic calcium, anaerobic collection of blood is most important. [4] This was achieved by collecting the blood in the 2 mL vacutte provided with a lid. After collecting blood, the vacutte was closed immediately. Samples obtained were transported immediately to the laboratory with a 9180 electrolyte analyzer.

The ionic calcium levels were compared between term (n = 428) and preterm (n = 72) deliveries, between mothers who received calcium supplements antenatally (n = 378) and those who did not receive calcium supplements antenatally (n = 122).


  Results Top


A statistically significant correlation was found between maternal and cord blood ionic calcium in the overall study population [Figure 1] and preterm and term babies (coefficient of correlation, r = 0.83, 0.86 and 0.83, respectively). A statistically significant correlation was also found between ionic calcium in cord blood and baby's blood collected at 48 h of age (r = 0.67) in the overall study population [Figure 2]. Serum ionic calcium in babies at 48 h of age is related with the calcium levels in maternal serum (r = 0.51), although less strongly than that with cord blood ionic calcium (r = 0.67). The mean values of ionic calcium (maximum - minimum) in the overall study population in maternal and cord blood and baby's blood at 48 h of age were 1.11 (1.99-0.31), 1.11 (1.99-0.32) and 1.0 (1.88-0.32) mmol/L, respectively. Despite biochemical hypocalcemia, no symptomatic hypocalcemia was observed in our study. The serum ionic calcium levels in preterm and term babies were compared. The mean values of ionic calcium in preterm babies (n = 72) in maternal blood and cord blood and baby's blood at 48 h of age were 1.07, 1.11 and 1.00 mmol/L, respectively. The mean values of ionic calcium in term babies (n = 428) in maternal blood and cord blood and baby's blood at 48 h of age were 1.11, 1.10 and 1.00 mmol/L, respectively.
Figure 1: Correlation between maternal and cord blood calcium (n = 500)

Click here to view
Figure 2: Correlation between cord blood calcium and baby's calcium at 48 h of age (n = 500)

Click here to view


It is observed that with calcium supplementation antenatally, the mean values for ionic calcium in maternal blood, cord blood and baby's blood at 48 h of age are higher than those without antenatal calcium supplementation. The results are summarized in [Table 1].
Table 1: Effect of calcium supplementation on ionic calcium values

Click here to view



  Discussion Top


Although antenatal calcium supplementation is a standard protocol followed by obstreticians, the main reason thought behind this practice is to supplement calcium to the mother as her calcium is drained by the fetus. We have shown in this study that antenatal calcium supplementation is needed not only to replete maternal the calcium status but also that fetal outcomes are dependent on antenatal calcium supplementation. A statistically significant correlation was found between ionic calcium in maternal and cord blood in the overall population (coefficient of correlation, r = 0.83). As seen in [Figure 1], the relationship between ionic calcium in maternal and cord blood in the overall population is almost linear. A statistically significant linear correlation is noted between ionic calcium in maternal and cord blood in preterm (r = 0.86) as well as term (r = 0.83) babies. It is clear from [Table 1] that ionic calcium values are higher when calcium is supplemented antenatally. As we have already discussed, calcium derangements are a frequent finding in asphyxiated infants, and these abnormalities are significantly associated with poor outcome. [1],[2] The serum ionic calcium concentrations shortly after birth are significantly lower in neonates with hypoxic ischemic encephalopathy who have a poor outcome. Low concentrations may reflect multiple organ damage, particularly involving the brain. [3],[4] Thus, antenatal Ca supplementation may improve prognosis in neonatal birth asphyxia.

The more diffuse distribution in [Figure 2] than in [Figure 1] suggests that ionic calcium in maternal and cord blood are more strongly related than ionic calcium in cord blood and baby's blood at 48 h of age. Along with the initial serum ionic calcium level at birth, baby's ionic calcium level at 48 h of age also depends on hormonal interactions in newborns. [5] Because of the involvement of multiple factors, ionic calcium in cord blood and baby's blood at 48 h of age are less strongly related than ionic calcium in maternal and cord blood [Figure 1] and [Figure 2]. As expected, ionic calcium in baby's blood at 48 h of age is related with that in maternal blood (r = 0.51), although less strongly than that in cord blood (r = 0.67).

In our study, the mean values of ionic calcium in preterm babies in maternal blood and cord blood and baby's blood at 48 h of age were 1.07, 1.11 and 1.00 mmol/L, respectively. The mean values of ionic calcium in term babies in maternal blood, cord blood and baby's blood at 48 h of age were 1.11, 1.10 and 1.00 mmol/L, respectively. It can be seen that, in our study, the values of ionic calcium in maternal blood and cord blood and baby's blood at 48 h of age do not differ significantly in the term and preterm groups and in the overall study population (as evident from [Table 1]). This could be because the number of preterm babies (n = 72) in the study is disproportionately smaller than the number of term babies (n = 428) in the study. Moreover, the preterm babies were not very preterm as one of the inclusion criteria was that gestational age at the time of delivery would be a minimum of 34 weeks.


  Conclusions Top


  1. A statistically significant correlation exists between maternal ionic calcium and cord blood ionic calcium, cord blood ionic calcium and baby's ionic calcium at 48 h of age, maternal ionic calcium and baby's ionic calcium at 48 h of age.
  2. Baby's ionic calcium at 48 h of age is lower than maternal ionic calcium and cord blood ionic calcium levels.
  3. Antenatal calcium supplementation increases the ionic calcium levels in maternal ionic calcium, cord blood ionic calcium and baby's ionic calcium at 48 h of age.


Recommendations

Antenatal calcium supplementation may prevent subclinical and clinical hypocalcemia in the newborn thus preventing neonatal morbidity.


  Acknowledgments Top


The authors thank Dr. P. D. Patil, Chancellor, and Dr. B. S. Mane,(former Registrar), for sanctioning the funds for the research project. Dr. Amarjeet Singh, Dean, and Dr. D. Y. Patil Medical College is acknowledged for encouragement to carry out the study. The authors would also like to thank Dr. Hemant Deshpande, Prof and Head, Department of Obstetrics and Gynaecology, Dr. Mrs. Sontakke, Prof and Head, Department of Biochemistry, and Dr. J S Bhawalkar, Prof and Head, Department of Community Medicine, Dr. D. Y. Patil Medical College for their help in collecting data, necessary investigations and follow-up. They also thank Dr. S. R. Agarkhedkar, Prof and Head, Department of Pediatrics for guidance and help.

 
  References Top

1.Jain A, Agarwal R, Sankar MJ, Deorari AK, Paul VK. Hypocalcemia in the newborn, Indian J Pediatr 2008;75:165-9.  Back to cited text no. 1
    
2.Wandrup J. Critical analytical and clinical aspects of ionic calcium in neonates. Clin Chem 1989;35:2027-33.   Back to cited text no. 2
    
3.Pitkin RM. Calcium metabolism in pregnancy and the perinatal period: A review. Am J Obstet Gynecol 1985;151:99-109.  Back to cited text no. 3
    
4.Schanberger CW, Pitkin RM. Maternal - perinatal calcium relationships. Obstet Gynecol 1979;53:74-6.  Back to cited text no. 4
    
5.Koo WW, Tsang RC Calcium, magnesium, phosphorus and vitamin D. In: Tsang RC, (Editor), Nutritional Needs of the Preterm Infant: Scientific Basis and Practical Guidelines. Baltimore: Williams and Wilkins; 1993. p. 135.  Back to cited text no. 5
    
6.Reitz RE, Daane TA, Woods JR, Weinstein RL. Calcium, magnesium, phosphorus and parathyroid hormone interrelationships in pregnancy and newborn infants. Obstet Gynecol 1977;50:701-5.  Back to cited text no. 6
    
7.Rubin LP, Posillico JT, Anast CS, Brown EM. Circulating levels of biologically active and immunoreactive intact parathyroid hormone in human newborns. Pediatr Res 1991;29:201-7.  Back to cited text no. 7
    
8.Wandrup J , Kroner J, Pryds O, Kastrup KW Age-related reference values for ionic calcium in the first week of life in premature and full-term neonates. Scand J Clin Lab Invest 1988;48:240-55.  Back to cited text no. 8
    
9.Specker BL, Tsang RC, Ho ML, Landi TM, Gratton TL Low serum calcium and high parathyroid hormone levels in neonates fed humanized cow s milk based formula. Am L Dis Child 1991;145:941-5.  Back to cited text no. 9
    
10.Salle BL, Delvin EE, Lapillanne A, Bishop NJ, Gloreux FH. Perinatal metabolism of vitamin D. Am J Clin Nutr 2000;71:1317-24.  Back to cited text no. 10
    
11.Pitkin RM, Cruikshank DP, Schauberger CW, Reynolds WA, Williams GA, Hargis GK. Fetal calcitropic hormones and neonatal calcium homeostasis. Pediatrics 1980;66:77-82.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
Acknowledgments
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1666    
    Printed34    
    Emailed0    
    PDF Downloaded174    
    Comments [Add]    

Recommend this journal