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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 3  |  Page : 367-371

Association between zinc level and prelabour rupture of membranes


1 Department of Obstetrics and Gynecology, Al-Imamain Al-Kadhmain Medical City, Baghdad, Iraq
2 Department of Obstetrics and Gynecology, College of Medicine, Al-Nahrain University, Baghdad, Iraq

Date of Submission04-Mar-2022
Date of Acceptance28-Mar-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Huda Mohamed Mahmood
Department of Obstetrics and Gynecology, Al-Imamain Al-Kadhmain Medical City, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_41_22

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  Abstract 

Background: Assessment of micronutrients in pregnant women particularly ZINC and whether its concentration is different between term and preterm birth is important to optimize the normal pregnancy and to reduce the incidence of pregnancy complications, especialy preterm labour and pre labour rupture of membrane. Objectives: Assessment of correlation between maternal serum ZINC level and the prelabour rupture of membrane in both preterm and term pregnant women. Study Design: Case control study. Materials and Methods: A case control study performed in Al-Imamain Al- Kadhumain Medical City/Obstetrics and Gynecology department from 1st of February to 1st of November 2019, Including 400 pregnant women their gestational age ranged between (24 to 42) divided in to 4 group: group A, group B, group C, group D which all undergo serum Zinc level measurement. Result: The mean ± SD of serum ZINC in group A which include the preterm prom, which is less than the control group (B) preterm intact membranes which, and the mean ± SD of serum zinc of group (C) which include the term prelabour rupture of membranes which is less than group (D) which is the control group of group (C) term intact membranes. This study shows significant relationship between ZINC deficiency and prelabour rupture of membrane in both term and preterm pregnant women at a P value< 0.001 and <0.001 respectively, also this study show inverse relationship between serum zinc and increasing parity, maternal age, vaginal infection, and BMI. Conclusion: Pregnant women with prelabour rupture of membranes wether term or preterm tend to have lower Zinc level. Increasing maternal age, increasing parity, high BMI, vaginal infection are associated with low Zinc.

Keywords: Premature preterm rupture of membrane, preterm labor, s.zinc


How to cite this article:
Mahmood HM, Al-Moayad HA. Association between zinc level and prelabour rupture of membranes. Med J Babylon 2022;19:367-71

How to cite this URL:
Mahmood HM, Al-Moayad HA. Association between zinc level and prelabour rupture of membranes. Med J Babylon [serial online] 2022 [cited 2022 Dec 7];19:367-71. Available from: https://www.medjbabylon.org/text.asp?2022/19/3/367/357258




  Introduction Top


Pre labour premature rapture of membranes is important cause of preterm deliveries, perinatal and neonatal mortality which is account one-third of preterm births. Preterm newborns contribute to only 8- 10% of live births but responsible for 90% of neonatal mortality.[1]

Preterm infants are mainly complicated with difficult respiration, poor feeding, impaired body temperature regulation and increase risk of infection.[1],[2]

Preterm premature rupture of membranes (PPROM) is a subtypes of preterm labour which affects 3- 4.5% of all pregnancies globally and between 60% - 80% of the affected pregnant will deliver within 7 days and 75% within 2 weeks of PPROM[3]

Cause of prelabour rupture of membranes may lead to physiologic weak of the membranes associated with uterine contractions and Intra amniotic infection is commonly associated with PPROM[4]

The risk factors for PPROM include a history Of PPROM, cervical incompetance, antepartum homarrage, multiple pregnencies, connective tissue disorders, poor education, smoking, and illicit drug use.[5]

Reduction in the intake of nutrients, such as thiamin, riboflavin, vitamin A, C, and E, copper, and zinc, is associated with preterm birth and higher risk of PPROM.[6] This results from nutrient-deficiency problem that predispose women to develop abnormal collagen structure.[7]

By gaining the knowledge about the exact role of micronutrients in the pregnancy, better nutrient approach of pregnancy would be achieved to optimize the normal pregnancy and to decrease the pregnancy complications, in particular the preterm labour and prelabour rupture of membranes. Since preterm fetal membranes are very strong, the PPROM should be a result of an internal pathology and/or external factors[5]

According to the recent studies, rupture membranes is related to biochemical collagen distruption in the extracellular matrix of the chorion and amnion with apoptosis in thr membranes.

The disruption of collagen is primarily a result of successive activities of a number of matrix metalloproteinase (MMPs) and tissue- specific inhibitors.

The MMPs have been identified within human and some other species. They belong to a large multi gene family of zinc-dependent, photolytic enzymes with more than 26 known species, and specific structure and several properties.[8]

Zinc is found to be an essential trace mineral second to iron, it has a vital role in protein synthesis and metabolism, DNA metabolism, and cell membrane stabilization.[9]

Zinc play role in cell division, differentiation, DNA synthesis, regulation of gene expression, activity of insulin-like growth factors, regulation of apoptosis and promoting normal embryogenesis[10]

Oysters, Red meat, poultry, beans, nuts, certain seafood, whole grains, fortified breakfast cereals, and dairy products are rich with Zinc while vegetable, fruits, tea, coffee, rice, and bread have iow Zinc.

Zinc requirements for pregnant women have been estimated from the amount of zinc accumulated in maternal and embryonic/fetal tissues.[11]

100 mg of total zinc in pregnant women are devided to: 57% in the fetus, 6.5% to placenta, <1% to the amniotic fluid, 24% to the uterus, 5% to the mammary tissue, and 6.5% to the maternal blood volume. This additional zinc gained for pregnancy represents 5%–7% of the whole body zinc in non-pregnant woman.[12],[13] The aim of study is to assessment of correlation between maternal serum ZINC level and the prelabour rupture of membrane in both preterm and term pregnant women.


  Materials and Methods Top


It is a case control prospective study include 400 pregnant women with singleton viable emberyo, the gestational age range from 24 - 42 weeks of gestation according to last menstrual period and early ultrasound (11_14) weeks, their age ranged (16_40) years old. this study conducted at outpatient clinic at Al. Imammain Al Kathumaainm Medical CITY, verbal consent was obtained from all laydes included in the study.

The study began in February 2019 and concluded towards the end of October 2019, the Iraqi Board and council of Obstetrics and Gynecology approved the study. In 15-1-2019, no. 112

All patient sent for, Complete blood count (WBC), CRP to exclude chorioamnionites, GUE with exclusion of patient who had urinary tract infection, and vaginal swab for detection of vaginal infection including bacterial vaginosis. Obstetric ultrasound done to all patient for viability, gestational age, amniotic fluid index. Finally, all patient sent for serum ZINC, and comparism done between the four groups. 2.5. Sample Collection and Preparation of Blood Samples of ZINC Measurement: The test were done in Al-Imamain Medical City laprotory, all specimens labeled by the name along with date and time of collection. A 5 millimeters of blood obtained from the forearm vein using disposable plastic syringe, the delivered blood kept in plastic tube without anticoagulant, the sample left at room temperature for 15 minutes, then the Sample centrifuged to obtain the serum which stored by freezing it at 20C.

Zinc assay kit was Rodex. The samples thawed at room temperature when all collected, then they were diluted with deionized water, by using atomic absorption spectrophotometer.

Exclusion criteria

  1. Polyhydramnios.


  2. BMI under 20 kg \m2


  3. Medical disease including diabetes mellitus, connective tissue disorders


  4. Chorioamnionitis.


  5. Urinary tract infection.


  6. Uterine congenital anomalies.


  7. Inflammatory bowel disease, malabsorption.


  8. Vaginal bleeding


  9. Smokers


  10. Patient in labour (with positive uterine contraction, or cervical dilatation).


Ethical consideration

The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with patients verbal and analytical approval before sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee according to the document number 1232 dated 5/1/2019 to get this approval.


  Results Top


[Table 1] shows no significant difference between group A and group B regarding age, parity, BMI, and gestational age. [Table 2] shows significantly lower Zinc level in group of women with prelabour rupture of membranes whether term or preterm compared with those with intact membrane since the P value <0.001*. [Table 3] shows that 1 shows that there is no significant difference between group C and group D regarding age, parity, BM, and gestational age. [Table 4] shows no significant difference in presence and absence of infection by bacterial vaginosis between group with prelabour rupture of membrane whether term or preterm as the P value 0.137 and 0.657, respectively. [Table 5] shows comparism of maternal characteristic and serum zinc between the 4 groups included in the study.
Table 1: Significant difference between group A and group B regarding age, parity, BMI and gestational age

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Table 2: Shows Significantly lower Zinc level in group of women with prelabour rupture of membranes wether term or preterm compared with those with intact membrane since the P value <0.001*

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Table 3: Shows that 1 shows that there is no significant difference between group C and group D regarding age, parity, BMI and gestational age

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Table 4: Shows no significant difference in presence and absence of infection by bacterial vaginosis between group with prelabour rupture of membrane wethere term or preterm as the P value 0.137 and 0.657 respectivly

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Table 5: Comparism of maternal characteristic and serum zinc between the 4 groups included in the study

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The study show that low level of zinc was more in patient more than 40 years also show that zinc deficiency is more in those with BMI more than 30, significant decrease in the mean Zinc level in women with parity ≥4 in all subgroups. There is significantly lower level of Zinc in patient with vaginal infection by bacterial vaginosis compared to absence in all subgroup. And gestational age there is a negative correlation between the gestational age and mean serum Zinc in all subgroups


  Discussion Top


In this study evaluation of the correlation of maternal serum Zinc status and prelabour rupture of membranes at preterm and term pregnancy has been under taken, demonstration a significant relationship between ZINC deficiency and prelabour rupture of membranes in both preterm and term pregnant women as Mean±SD in Preterm ruptured membrane, in Preterm intact membrane, in term ruptured membrane, in term intact membrane with significant association, and there was no significant difference between both preterm prom and term promas the mean and SD of preterm prom, and the mean and SD of term prom were virtually the same.

The study of (Bakhshandeh Nosrat Dr, et al.,-2005)[14] they noticed a significant relationship between decreased plasma Zinc and premature rupture of membranes in both term and preterm pregnancies this agreed with current results.

The study of (Muh. Nadir Abdullah, Moh. Fauzi, et al., 2010)[15] found that pregnant women at term who had prelabour rupture of membranes, had significantly lower serum zinc in comparison to their control group, this finding support our data

Mojgan Rahmanian, (et al., 2014)[16] found lower serum zinc levels in premature rupture of membranes in the study group more than the control group, but the deficiency was not statistically significant, and this deficiency was physiological, meaning that it is not a cause of prom. this particular result is inconsistent with this study

In this study there was lower serum zinc presenting by the age of 40 in all study groups, but this deficiency is statistically significant as the P value were (0.030,0.023,0.007,0.009) in group

A,B,C,D respectively. but this result is not supported by the result of Kaliki Hymavathi Reddy, (et..al, 2015)[17] who demonstrate maternal age is of no significance in zinc deficiency

Regarding parity in this study a statistcaly significant lower zinc values are found by increasing parity in preterm prom, preterm not prom and term prom at a P values <0.001, <0.001,

<0.001, <0.001 respectively, and this result is agreed upon by Kaliki Hymavathi Reddy, et..al, 2015, in his study, becauase of increase Zinc consumption. And in Sikorski R, (et..al, 1990)[18] who studied the zinc status in premature rupture of membranes at term pregnancy.

This study observed that zinc levels were significantly lower in prelabour ROM. The study of Ian Darnton- Hill, 2013[19] shows that zinc supplementation reduced the incidence or severity of maternal infections, which are known risk factors for premature birth.

Regarding BMI, there was a significant zinc deficiency in all Study group patients who had high BMI and this result is supported by Rebecca L. Wilson, ect….2018[20] who conclude maternal trace mineral early in pregnancy associated with pregnancy outcome, and there is association between decrease Zinc and increase BMI, and this advocatet our finding.

Our study showed that there is significant zinc deficiency, which is consistent with Taiwo Olagoke Dunsin 2016[21] notice that an increase in BMI resulted in lower ZINC levels.


  Conclusion Top


It can conclude that pregnant women with prelabour rupture of membranes whether term or preterm tend to have lower Zinc level. Also, increasing maternal age, increasing parity, high BMI, and vaginal infection are associated with low Zinc level.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ernita L, Nasrul E, Friadi A The difference of Zinc and matrix levels of metalloproteinase-9 serum between premature rupture of membrane aterm and normal pregnancy. Journal of Midwifery 2019;4:40-50.  Back to cited text no. 1
    
2.
Chandra I, Sun L Third trimester preterm and term premature rupture of membranes: Is there any difference in maternal characteristics and pregnancy outcomes? J Chin Med Assoc 2017;80:657-61.  Back to cited text no. 2
    
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Smith G, Rafuse C, Anand N, Brennan B, Connors G, Crane J, et al. Prevalence, management, and outcomes of preterm prelabour rupture of the membranes of women in Canada. J Obstet Gynaecol Can 2005;27:547-53.  Back to cited text no. 3
    
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Dayal S, Hong PL Premature rupture of membranes. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532888/  Back to cited text no. 4
    
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Mercer B, Goldenberg R, Iams J, Meis P, Moawad A, Das A The preterm prediction study. Analysis of risk factors for preterm premature rupture of the membranes. J Society for Gynecol Investigation 2003;2:350.  Back to cited text no. 5
    
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Carmichael SL, Yang W, Shaw GM; National Birth Defects Prevention Study. Maternal dietary nutrient intake and risk of preterm delivery. Am J Perinatol 2013;30:579-88.  Back to cited text no. 6
    
7.
Noor S, Nazar AF, Bashir R, Sultana R Prevalance of Pprom and its outcome. J Ayub Med Coll Abbottabad 2007;19:14-7.  Back to cited text no. 7
    
8.
Amălinei C, Căruntu ID, Bălan RA Biology of metalloproteinases. Rom J Morphol Embryol 2007;48:323-34.  Back to cited text no. 8
    
9.
Yaqob KS “ZINC” The Friendly and Forgotten Micronutrient. Glob J Ped Neonatol Car 2019;1:2019.  Back to cited text no. 9
    
10.
Scheplyagina LA Impact of the mother’s zinc deficiency on the woman’s and newborn’s health status. J Trace Elem Med Biol 2005;19:29-35.  Back to cited text no. 10
    
11.
Swanson CA, King JC Zinc and pregnancy outcome. Am J Clin Nutr 1987;46:763-71.  Back to cited text no. 11
    
12.
King JC Determinants of maternal zinc status during pregnancy. Am J Clin Nutr 2000;71:1334S-43S.  Back to cited text no. 12
    
13.
Chaffee BW, Kinga JC Effect of Zinc supplementation on pregnancy and infantoutcomes: A systematic review. Paediatr Perinat Epidemiol 2012;26 (Suppl. 1):118-37.  Back to cited text no. 13
    
14.
Nosrat B, Borghei NS, Mansoorian AR, Borghei A Reduced Zinc level in pregnant women with premature rupture of membrane. SJKU 2005;10:19-25.  Back to cited text no. 14
    
15.
Nadir Abdullah M, Fauzi M Comparison of maternal Zinc level in term pregnancy associated with premature rupture of membranes in normal pregnancy. Folia Medica Indonesiana 2010;4:282-5.  Back to cited text no. 15
    
16.
Rahmanian M, Jahed FS, Yousefi B, Ghorbani R. Maternal serum copper and zinc levels and premature rupture of the foetal membranes J Pak Med Assoc 2014;64:770-4.  Back to cited text no. 16
    
17.
Reddy KH, Surekha T, Pavithra D, Suman Dasar VK Role of Micronutrients -“Selenium & Zinc” in Preeclampsia. JMSCR 2015;03:5276-91.  Back to cited text no. 17
    
18.
Sikorski R, Juszkiewicz T, Paszkowski T Zinc status in women with premature rupture of membranes at term. Obstet Gynecol 1990;76:675-7.  Back to cited text no. 18
    
19.
Chaffee BW, King JC Effect of zinc supplementation on pregnancy and infant outcomes: A systematic review. Paediatr Perinat Epidemiol 2012;26(Suppl 1):118-37.  Back to cited text no. 19
    
20.
Wilson RL, Bianco-Miotto T, Leemaqz SY, Grzeskowiak LE, Dekker GA, Roberts CT Early pregnancy maternal trace mineral status and the association with adverse pregnancy outcome in a cohort of Australian women. J Trace Elem Med Biol 2018;46:103-9.  Back to cited text no. 20
    
21.
Dunsin TO Maternal zinc levels and pregnancy outcome in women attending antenatal clinic at University of Benin Teaching Hospital, Benin city, Nigeria. 2016. Available from: https://www.dissertation.npmcn.edu.ng/index.php/fmcog/article/view/1907.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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