Background: Preterm birth (PTB) and fetal growth restriction (FGR) contribute to high hospital costs. An imbalance in the concentration of the four trace elements (i.e., copper, zinc, iron, and calcium) was shown to be associated with complications during pregnancy. This study aimed to analyze the role of these trace elements in the occurrence of PTB and FGR.
Methods: A search was conducted in PubMed, Cochrane Library, and Ovid. The articles were filtered based on the inclusion and exclusion criteria, and further screening was based on the association of articles with the clinical question. The risk of bias in each of the studies was assessed using the Cochrane risk of bias table. Forrest plots were created and analyzed using Review Manager 5.3e.
Results: Three studies were included in the risk of bias assessment and meta-analysis. Maternal serum levels of copper and iron were lower in the FGR group (p < 0.05), while copper, zinc, iron, and calcium were lower in the PTB group (p < 0.05). The included studies had a low degree of homogeneity (I2 < 50%).
Conclusion: Maternal iron deficiency was associated with FGR, while low levels of the trace elements copper, zinc, iron, and calcium were associated with PTB.
1. Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol. 2017;41:387–91.
2. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Sci. 2014;345:760–5.
3. Ream MA, Lehwald L. Neurologic Consequences of Preterm Birth. Curr Neurol Neurosci Rep. 2018;18:48.
4. Beck S, Wojdyla D, Say L, Bertran AP, Meraldi M, Requejo JH, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88:31–8.
5. Sungkar A, Fattah ANA, Surya R, Santoso BI, Zalud I. High preterm birth at Cipto Mangunkusumo Hospital as a national referral hospital in Indonesia. Med J Indones. 2017;26:198–203.
6. Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention-PubMed-NCBI [Internet]. [cited 2019 Feb 11]. Available from: https://www.ncbi.n lm.nih.gov/pubmed/20669423.
7. Lim G, Tracey J, Boom N, Karmakar S, Wang J, Berthelot J-M, et al. CIHI Survey: Hospital Costs for Preterm and Small-for-Gestational Age Babies in Canada. Healthc Q. 2009;12:20–4.
8. Manning F. General principles and applications of ultrasonography. Matern-Fetal Med 4th Ed Phila WB Saunders Co. 1999;169–206.
9. Taylor HG, Margevicius S, Schluchter M, Andreias L, Hack M. Persisting Behavior Problems in Extremely Low Birth Weight Adolescents. J Dev Behav Pediatr JDBP. 2015;36:178–87.
10. Dahl LB, Kaaresen PI, Tunby J, Handegård BH, Kvernmo S, Rønning JA. Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight. Pediatrics. 2006;118:e449–59.
11. Ergaz Z, Shoshani-Dror D, Guillemin C, Neeman-azulay M, Fudim L, Weksler-Zangen S, et al. The effect of copper deficiency on fetal growth and liver anti-oxidant capacity in the Cohen diabetic rat model. Toxicol Appl Pharmacol. 2012;265:209–20.
12. Kashanian M, Hadizadeh H, Faghankhani M, Nazemi M, Sheikhansari N. Evaluating the effects of copper supplement during pregnancy on premature rupture of membranes and pregnancy outcome. J Matern Fetal Neonatal Med. 2018;31:39–46.
13. Dickinson N, Gulliver J, MacPherson G, Atkinson J, Rankin J, Cummings M, et al. A framework to explore micronutrient deficiency in maternal and child health in Malawi, Southern Africa. Environ Health Glob Access Sci Source. 2009;8:S13.
14. Chaffee BW, King JC. Effect of Zinc Supplementation on Pregnancy and Infant Outcomes: A Systematic Review. Paediatr Perinat Epidemiol. 2012;26:118–37.
15. Esteban-Vasallo MD, Aragonés N, Pollan M, López-Abente G, Perez-Gomez B. Mercury, cadmium, and lead levels in human placenta: A systematic review. Environ Health Perspect. 2012;120:1369–77.
16. Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018;10:CD001059.
17. Kumar A, Kaur S. Calcium: A Nutrient in pregnancy. J Obstet Gynaecol India. 2017;67:313–8.
18. Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child’s health. Saudi Med J. 2015;36:146–9.
19. Suryanarayana R, Chandrappa M, Santhuram AN, Prathima S, Sheela SR. Prospective study on prevalence of anemia of pregnant women and its outcome: A community based study. J Fam Med Prim Care. 2017;6:739–43.
20. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48:333–9.
21. Osada H, Watanabe Y, Nishimura Y, Yukawa M, Seki K, Sekiya S. Profile of trace element concentrations in the feto-placental unit in relation to fetal growth. Acta Obstet Gynecol Scand. 2002;81:931–7.
22. Kiilholma P, Grönroos M, Erkkola R, Pakarinen P, Näntö V. The role of calcium, copper, iron and zinc in preterm delivery and premature rupture of fetal membranes. Gynecol Obstet Invest. 1984;17:194–201.
23. Lewicka I, Kocyłowski R, Grzesiak M, Gaj Z, Oszukowski P, Suliburska J. Selected trace elements concentrations in pregnancy and their possible role-literature review. Ginekol Pol. 2017;88:509–14.
24. Goel R, Misra PK. Plasma copper in foetal malnutrition. Acta Paediatr Scand. 1982;71:421–3.
25. Plećas D, Plesinac S, Kontić Vucinić O. Nutrition in pregnancy: basic principles and recommendations. Srp Arh Celok Lek. 2014;142:125–30.
26. Shen P-J, Gong B, Xu F-Y, Luo Y. Four trace elements in pregnant women and their relationships with adverse pregnancy outcomes. Eur Rev Med Pharmacol Sci. 2015;19:4690–7.
27. Alwan NA, Cade JE, McArdle HJ, Greenwood DC, Hayes HE, Simpson NAB. Maternal iron status in early pregnancy and birth outcomes: insights from the Baby’s Vascular health and Iron in Pregnancy study. Br J Nutr. 2015;113:1985–92.
28. Symington EA, Baumgartner J, Malan L, Wise AJ, Ricci C, Zandberg L, et al. Maternal iron-deficiency is associated with premature birth and higher birth weight despite routine antenatal iron supplementation in an urban South African setting: The NuPED prospective study. PLOS ONE. 2019;14:e0221299.
29. Rahmati S, Azami M, Badfar G, Parizad N, Sayehmiri K. The relationship between maternal anemia during pregnancy with preterm birth: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2019:1–11.
Irwinda R, Sungkar A, Surya R, Guinto VT. Trace elements in maternal serum and their relationships with preterm birth and fetal growth restriction. Makara J Health Res. 2020;24.