Maternal and Fetal Leptin Level Correlation with Fetal Macrosomia

Background:Leptin seems to be a critical factor for overall fetal development. Macrosomia may place the mother and fetus or neonate at risk for adverse outcomes. Aim: to test if leptin level is implicated in macrosomia. Method: The sample comprised25 cases delivered full term normal weight infants, and 25 cases delivered full term macrosomicinfants. Maternal serum samples and fetal cord samples were withdrawn immediately after birth of the full term infants. Results: Fetal leptin level was higher in macrosomic infants than normal weight infants. No difference in maternal leptin level between both groups was observed. Conclusion: Leptin levels related directly to quantity of body fat tissue in fetal macrosomia as there is leptinresistence causing elevated leptin levels.


INTRODUCTION
Leptin is a 16-kD protein produced predominantly in white adipose tissue and, to a lesser extent, in the placenta, skeletal muscle, and stomach fundus in rats.Leptin has a myriad of functions in carbohydrate, bone, and reproductive metabolism that are still being unraveled, but its role in body weight regulation is the main reason it came to prominence.(1)(2)(3) The major role of leptin in body-weight regulation is to signal satiety to the hypothalamus and, thus, reduce dietary intake and fat storage while modulating energy expenditure and carbohydrate metabolism to prevent further weight gain. (4-6)Unlike the Ob/Ob mouse model in which this peptide was first characterized, most humans who are obese are not leptin deficient but rather leptin resistant.

Aim of the study:
The aim of this studywas toinvestigate thecorrelation between the circulating levels of leptin hormone in the maternal and cord serum and macrosomia of the full term newborns, in medically free mothers.with the ultimate goal to know if leptin level is implicated in macrosomia.

MATERIALS AND METHODS
This study which is a case control studywas conducted on a group of 50 medically free pregnant women having antenatal care in the obstetrics unit of the hospital El shatby University of Alexandria and had delivery at the hospital.

Allparticipants werefully counseledabout thestudy and an informed consent
wasobtainedprior to participation in the study.

INCLUSION CRITERIA:
-Medically free mothers having full term macrosomic infants.
-Medically free mothers having full term normal weight infants.
-Any type of delivery whether cesarean or normal vaginal delivery.
-Any type of anesthesia during delivery.

EXCLUSION CRITERIA:
-Other medical causes of macrosomia of the infants, e.g.(DM).
-RH incompatibility. -Preeclampsia The selected patients were subdivided in two groups: We didn't find a statistically significant difference between the two groups of mothers, so maternal leptin level is not related to fetal birth weight, this is consistent with what was proved in previous studies. (18) A significant correlation was found between high gravidity and high parity and fetal macrosomia, that means that high gravidity and high parity is a risk factor for macrosomia as proved in previous studies. (18,19) A significant correlation was found between macrosomia and cesarean type of delivery as 84% of macrosomic babies had cesarean delivery this is consistent with what was proved byCombs (1993). (20) A significant correlation was found between maternal age and fetal macrosomia as older mothers had macrosomic babies .thisproves that high maternal age is a risk factor for macrosomia as proved in previous study. (21)

CONCLUSION
From this study we concluded that: 1-A significant correlation was found between fetal cord leptin level and fetal macrosomia.

RECOMMENDATIONS
-Fetal leptin level is related to fetal weight and can be depended upon for diagnosing fetal macrosomia.
-Maternal weight before pregnancy is related to fetal weight so maternal weight control is beneficial for fetal weight control.

Swelemet al., 81 2 - 3 -
No significant correlation was found between maternal serum leptin level and fetal weight.No correlation was found between maternal and fetal leptin level that is consistent with non-communicatory two compartment feto-placental circulation.