Universa Medicina

Juli-September 2006, Vol.25 No.3

The relationship between maternal blood zinc level

and the size of newborn baby
Widagdo a*, Harmon Mawardi* , Firda Fairuza*, Meiharty B. Zulkifli**,
Tjahaya Bangun**, Augustine Matatula***, and Slamet Zaeny****
*Department of Child Health, Medical Faculty Trisakti University, **Department of Child
Health, ***Department of Clinical Pathology, and **** Department of Obstetric and
Gynecology, Budhi Asih Provincial General Hospital Jakarta, Indonesia

ABSTRACT
The high incidence of low birth weight is the major problem in Indonesia. The effects of zinc to fetal growth
were reported with different results. The objective of this study is to investigate the relationship between maternal
zinc level and the newborn size. A cross-sectional design was conducted involving the parturient at Budhi Asih
Hospital, Jakarta. Serum zinc level (mol/L) was measured with Cobas Mira Plus Colorimeter (1997) using 5-BRPAPS. Eighty-eight mothers attending the hospital seeking for delivery assistance were enrolled into the study.
This study showed that the serum zinc level of mothers was 8.96 7.45 mol / L (range 0.15 - 53.22 mol/L) and
48% of them had the level < 8.15 mol/L. The weight of the newborn was 3064 450 g and incidence of LBW was
9.3%. There correlation between maternal zinc with newborn size (birth weight, height and head circumference)
was not significant (p >0.05). The evidence of preterm and low birth weight babies each in low and normal zinc
were also not significant (p>0.05). This study documented a limited role of zinc on newborn size.
Keywords: Maternal zinc serum, brithweight, height, head circumference

Hubungan antara kadar seng darah ibu dan besar bayi baru lahir
ABSTRAK
Angka kejadian bayi berat lahir rendah di Indonesia adalah tinggi. Laporan penelitian tentang pengaruh
seng terhadap janin masih tidak konsisten. Penelitian ini bertujuan untuk menyelidiki hubungan antara kadar seng
ibu dan besar bayi. Sebuah studi potong silang dilakukan dengan melibatkan ibu melahirkan di Rumah Sakit Budhi
Asih Jakarta. Kadar seng serum (mol/L) diperiksa dengan Colorimeter Cobas Mira Plus (1997) dan reagensia 5BR-PAPS. Sebanyak 88 ibu hamil ikut serta dalam penelitian ini. Hasil peneltian menunjukkan kadar zinc serum
ibu besarnya 8,96 7,45 mol/L (rentang antara 0,15 53,22 mol/L) dan 48% di antaranya mempunyai kadar
seng < 8,15 mol/L. Berat lahir bayi besarnya 3064 450 g dan insidens dari bayi berat lahir rendah adalah 9,3%.
Hubungan antara kadar seng serum ibu dan besar bayi (berat badan, panjang badan, dan lingkar kepala) tidak
bermakna secara statistik (p > 0,05). Sedang jumlah bayi prematur dan bayi berat lahir rendah pada ibu kadar seng
rendah juga tidak berbeda bermakna dengan pada ibu kadar seng cukup (p > 0,05). Penelitian ini belum berhasil
membuktikan adanya hubungan yang bermakna antara kadar seng serum ibu dan besar bayi yang dilahirkan.
Kata kunci: Seng serum ibu, berat bayi, panjang, lingkar kepala

Korespondensi : a Widagdo
Bagian Anak
Fakultas Kedokteran, Universitas Trisakti
Jl. Kyai Tapa No.260, Grogol Jakarta 11440
Tel. 021-5672731 eks. 2307, Fax. 021-5660706
E-Mail : widiant@centrin.net.id

127

Widagdo, Mawardi, Fairuza, et al

INTRODUCTION
National Health Survey conducted by
Ministry of Health Republic of Indonesia
(2001), found that the incidence of LBW baby
was still high. (1) The prevalence of LBW infants
in Indonesia is in a range of 7-14%, even reach
16% in some districts. (2)
As the causes of LBW could be fetal,
placental, uterine or maternal aspects. (3) One
of the common maternal cause is malnutrition
in which usually associated with zinc
deficiency, and infants with LBW have higher
rates of morbidity and mortality because of
infectious diseases and impaired immunity. And
LBW estimated to account about a third of all
deaths in the first year of life in less-developed
countries. (4,5)
Zinc is essential for normal embryogenesis
and fetal growth, and in humans, a firm
concensus has never been reached whether there
is a positive association between maternal zinc
nutriture and pregnancy outcome. Several
studies showed that pregnant women with zinc
deficiency gave birth to small babies. (6,7) On the
other hand, other studies stated that there were
no significant relation between birth weight and
maternal zinc deficiency. (8-10) Considering the
inconsistency in findings of various research
groups, we were interested in assessing the
relationship between maternal blood zinc level
and the size of the baby in terms of weight,
height, and head circumference.
METHODS
Research design
The study was a cross-sectional design,
and carried out at the Department of Obstetrics
and Gynecology and Department of Child
Health, Budhi Asih Provincial General Hospital
at East Jakarta in June 2004 until August 2004.
128

Maternal blood zinc level and size of newborn

Population and sample

The study population involved the
parturient mothers seeking help for delivery at
the hospital. The samples were taken randomly
from the mothers who agreed to sign the
informed consent after receiving the
explanations. The criteria of inclusion were the
mothers not in a high risk conditions such as
diabetes mellitus, severe hypertension,
eclampsia, and carrying singleton fetus.
Data collection
The data will be collected from mother
includes name, age, education, income, weight,
height, first day of last menstruation, and blood
zinc, and from newborn is gender, weight,
height, head circumference, and physical sign
if any. Newborn anthropometry measurement
was done within 72 hours after delivery. The
gestational age was determined from the first
day of last menstruation, or physical and
neurological criteria. Low birth weight means
the baby with birth weight of 2500 gram or less,
and preterm denotes the gestational age of less
than 37 weeks.
Zinc measurement
For the purpose of the zinc level
measurement in mother, the blood specimen was
taken from mothers peripheral vein on the time
prior to delivery at hospital. The specimen of
each participant was directly transferred to the
Laboratory Division of Budhi Asih General
Hospital for further measurement using Cobas
Mira Plus Colorimeter (1997) with 5-BR-PAPS
solution. Serum zinc is low if the level is less
than 8.15 mol/L as the cutoff point, and the
level of and above 8.15 mol/L is categorized
as normal or adequate level.
Statistical analysis
All data were recorded on the prepared
form for the study, and the statistical analysis

Universa Medicina

Juli-September 2006, Vol.25 No.3

was done using z test, chi square test, and

Pearson correlation coefficient test, wherever
needed. The statistical difference of respective
variables was stated as significant at 95%
degree of confidence and p<0,05.
Ethical clearance
The study was approved by the Committee
of Research Ethics of Faculty of Medicine
Trisakti University. Written informed consent
was obtained from the mother (if possible)
before beginning detailed examinations.
RESULTS
During 3 moths of study (June - August
2004) there were 88 mothers attending the
hospital seeking for delivery assistance and the

mean age was 30 7 y. Characteristics of

mothers and newborn, and zinc levels of the
mothers are presented in Table 1. The serum
zinc level of mothers was 8.96 7.45 mol/L
(range 0.15 - 53.22 mol/L) and 48% of them
had the level of less than 8.15 mol/L. The
weight of the newborn was 3064 450 g and
incidence of LBW was 9.3%. The data
presented in Table 2 illustrate that the maternal
zinc levels was not significant related to
newborn size. The correlation coefficient for
maternal zinc levels and birth weight was r 0.18
and p>0.05, height (r=0.20; p=>0.05), and head
circumference (r=0.17; p>0.05). The incidence
of preterm and low birth weight babies in the
mothers with low zinc level was not
significantly different as compared to the
mothers of normal level of zinc with p>0.05
(Table 3 and 4).

Table 1. Characteristics of mothers (n=88) and newborns (n=79)

Data are expressed as mean standard deviation or n (%)

Table 2. Correlations coefficients for maternal serum zinc levels and newborn size

129

Widagdo, Mawardi, Fairuza, et al

Maternal blood zinc level and size of newborn

Table 3. The association between preterm baby and maternal serum zinc level

DISCUSSION
The result of study obviously showed that
maternal blood zinc level were not significantly
correlated with newborn size. The prevalence
of maternal zinc deficiency was very high
(48%). Zinc serum deficiency in pregnant
women is suspected to increase the risk of
obstetric complication and the risk of congenital
lip and palate deformities. This finding is also
consistent with a study in East Nusa Tenggara
revealed an average of 71% pregnant women
suffer from zinc serum deficiency. Another
study in Central Java also showed the
prevalence of zinc serum deficiency around 7090%. (11)
Pearson correlation coeficient showed no
significant correlation between maternal zinc
levels and birth weight, height and head
circumference (p>0.05). This result is
consistent with a study in Kuwait,which
observed no corrrelation between maternal zinc
levels and birth weight. (12)
There was also no significant difference in
the occurrence of LBW in low and normal
maternal zinc level. Significant declining of
serum zinc level in mothers during pregnancy
and the correlation of maternal zinc level with

the size of newborn which was not significant,

were also reported by Meadows, (7) Caulfield, (10)
Ozendarp, (13) and Kapil. (14) In several studies,
maternal blood zinc levels did nor correlate
significantly with birth weight. The birth weight
in our study ranged between 1800 and 4450 g,
and the absence of a correlation of zinc levels
and birthweight leads us to conclude that levels
of zinc in maternal blood is not useful indicator
for the assessment of fetal growth. The findings
is in agreement with those of other groups, who
observed no effect on infant growth when
mothers received zinc supplementation.
Hamadani ( 1 5 ) also showed that zinc
supplementation during pregnancy had no
significant effect on mental and behavior
development or growth. Tamura (16) in his study
of 3448 women also reported that maternal zinc
concentration declined as gestation progressed,
and they were not significantly associated with
any measure of pregnancy outcomes or neonatal
conditions. Christian (17) reported the study of
4926 pregnant that antenatal supplementation of
folic acid alone had no significant effect on birth
size, combination of folic acid and iron increased
mean birth weight by 37g, but a triple
combination of folic acid-iron-zinc had no effect
on birth size compared with control group.

Table 4. The association of birth weight and maternal serum zinc level

130

Universa Medicina

However, the result of study involving 81

cases and 84 control performed in Tanzania (18)
disclosed that there was significant relationship
between infant birth weight and maternal and
infant zinc level (p = 0.002). A year study in
Pakistan (2002-2003) involving 242 subjects
receiving zinc supplement and the control group
concluded that there was no significant
difference in the birth weight and other
anthropometric measures between zinc
supplemented and placebo group. (19)
It seems that the different result of the
studies of effect of zinc in pregnant women on
the gestational age and baby size were possibly
related to the method of study in term of using
serum or tissue in assessing zinc level,
nutritional status, age, and gender of the
subjects.
CONCLUSION
The correlation coefficient between the
size of newborn in terms of weight, height, and
head circumference, each with maternal zinc
level were not significant. The incidence of
preterm and low birth weight babies in the
mothers with low and normal zinc level were
also not significant different. The further study
in the broader scope could be suggested to find
the definitive and valuable result to share in
improving of the perinatal life.
ACKNOWLEDGMENTS
The authors wish to extend their utmost
a p p r e c i a t i o n t o t h e R e c t o r o f Tr i s a k t i
University for the generous support to this
program. The authors also address their thanks
to the Dean of Faculty of Medicine Trisakti
University for the kind support and guidance
in finishing this study. We also thank the
Director and the staff of the Budhi Asih
Provincial General Hospital for the permission

Juli-September 2006, Vol.25 No.3

and support given in performing the study at

the hospital. Our sincere thank especially
addressed to all mothers and babies for their
honorable participation.
References
1.

Departemen Kesehatan R.I. Survei Kesehatan

Rumah Tangga (SKRT) 2001. Jakarta: Badan
Penelitian dan Pengembangan Kesehatan
Departemen Kesehatan Republik Indonesia; 2001.
2. Atmarita. Nutrition problems in Indonesia. An
Integrated International Seminar and Workshop
on Lifestyle Related Diseases. Gajah Mada
University, 19 20 March, 2005.
3. Stoll BJ, Kliegman RM. Prematurity and
intrauterine growth retardation. In: Behrman RE,
Kliegman RM, Jenson HB, editors. Nelson
Textbook
of
Pediatrics.
17 th
ed.
Philadelphia:Saunders; 2004. p. 550-4.
4. Lemons JA, Bauers CR, Oh W. Very low birth
weight outcomes of the National Institute of Child
Health Development. Pediatrics 2001; 107: 11-6.
5. Ferro-Luzzi A, Ashworth A, Martorell R,
Scrimshaw N. Report of the IDECG working group
on effects of IUGR on infants, children and
adolescents : immunocompetence, mortality,
morbidity, body size, body composition and
physical performance. Eur J Clin Nutr 1998; 52:
S97-9.
6. Jameson S. Effects of zinc deficiency in human
reproduction. Acta Med Scand 1976; 593: 561-4.
7. Meadows NJ, Smith MF, Keeling PWN, Ruse W,
Day J, Scopes JW, et al. Zinc and small babies.
The Lancet 1981: 1135-7.
8. Merialdi M, Caulfield L E, Zavaleta N.
Randomized controlled trial of prenatal zinc
supplementation and fetal bone growth. Am J Clin
Nutr 2004; 79: 826-30.
9. Upadhyaya C, Mishra S, Ajmera P, Sharma P.
Serum iron, copper and zinc status in maternal
and cord blood. Indian J Clin Biochem. 2004; 19:
48-52.
10. Caulfield LE, Zavaleta N, Figueroa A, leon Z.
Maternal zinc supplementation does not affect size
at birth or pregnancy duration in Peru. J Nutr 1999;
129: 1563-8.
11. Satoto. Hubungan antara kekurangan seng dengan
tumbuh kembang anak. Majalah Penelitian
Diponegoro 1999; 5: 231-6.

131

Widagdo, Mawardi, Fairuza, et al

12. Al-Saleh E, Nandakumaran N, Al-Shammari M,
Al-Falah F, Al-Harouny A. Assessment of
maternal-fetus status of some essential trace
elements in pregnant women in late gestation:
relationship with birth weight and placental wight.
J Matern Fetal Neonatal Med 2004; 16: 9-14.
13. Osendarp SJM, vaan Raaij JMA, Arifeen SE,
Wahed Ma, Baqui AH, Fuchs GJ. A randomized,
placebo-controlled trial of the effect of zinc
supplementation during pregnancy on pregnancy
outcome in Bangladeshi urban poor. Am J Clin
Nutr 2000; 71: 114-9.
14. Kapil U, Pathak P, Singh P. Zinc and magnesium
nutriture amongst pregnant mothers of urban slum
community in Delhi. Indian Pediatrics 2002; 39:
365-8.
15. Hamadani JD, Fuchs GJ, Osendarp SJM. Zinc
supplementation during pregnancy and effects on
mental development and behavior of infants.
Lancet 2002; 360: 290-4.

132

Maternal blood zinc level and size of newborn

16. Tamura T, Goldenberg RL, Johnston KE, DuBard
M. Maternal plasma zinc concentrations and
pregnancy outcome. Am J Clin Nutr 2000; 71: 10913.
17. Christian P, Khatry SK, Katz J, Pradhan EK,
LeClerq SC, Shresta SR, et al. Effects of alternative
maternal micronutrients supplements on low birth
weight in rural Nepal. BMJ 2003; 326: 571.
18. Rwebembera AAB, Munubhi EKD, Manji KP,
Mpembeni R, Philip J. Relationship between infant
birth weight < 2000 g and maternal zinc level at
Muhimbili National Hospital Dar es Salaam,
Tanzania. 2005. Available at http://trpej.
oxfordjournals.org/cgi/content/abstract/fni077v1.
Accessed June 1, 2006.
19. Hafeez A, Mehmood G, Mazhar F. Oral zinc
supplementation in pregnant women and its effect
on birth weight: a randomized controlled trial.
Arch Dis Child Fetal Neonatal Ed 2005; 90: 170F171.