CORRELATION BETWEEN MATERNAL BODY

MASS INDEX AND NEONATAL BIRTH WEIGHT

WITH INSULIN LIKE GROWTH FACTOR-1 (IGF-1)
LEVELS OF BREAST MILK

Dian Maharani, Bayu K, Prasetya I, Anik Puryatni

Nutrition and Metabolic Diseases Division-

Paediatric Department, Medicine Faculty of Brawijaya University
Saiful Anwar General Hospital Malang, East Java, 65141, Indonesia

1
 BACKGROUND

MATERNAL FACTORS

MATERNAL BODY HUMAN NEONATAL BIRTH

MASS INDEX BREAST MILK WEIGHT

? ?
IGF - 1
 …background

Human milk is uniquely suited to the human infant, both in its nutritional
composition and in the non-nutritive bioactive factors that promote
survival and healthy development.
Oftedal OT. The evolution of milk secretion and its ancient origins.
Animal : an international journal of animal bioscience. 2012; 6(3):355–368

Breast milk contain bioactive substances that support immune system

maturity, organ system development, and normal flora colonization in
neonates
(Boyd et al., 2006; Sullivan et al., 2010; Walker 2010)
 …background

• Cells
• Immunoglobulins
• Cytokines
• Chemokines
• Growth Factors
• Hormones
• Anti microbials
• Metabolic hormones
• Oligosacharides and glycans
• Mucin
• Probiotics
 …background
INSULIN-LIKE GROWTH FACTORS

IGF-I and IGF-II, as well as IGF binding proteins and IGF-specific proteases,
are found in human milk.
(Burrin, 1997; Blum & Baumrucker, 2002; Phillip et al., 2002)

Levels are highest in colostrum, and steadily decline over the course of
lactation
(Posser, 1996; Milsom et al., 2008)

There are no significant differences between preterm and term milk, with
the exception of IGF binding protein-2, which is higher in preterm milk
(Blum & Baumrucker, 2002; Elmlinger et al., 2007)
 …background

Maternal serum IGF-1 was the main source of IGF-1 in breast milk.
(Tavakkol et al., 1988; Posser et al., 1987)

Composition of protein, immune factors, growth factors and cytokines in

breast milk affected by multi-factors such as maternal age, delivery
methods, lactation phase, smoking, parity and maternal infection
(Lucas & Cole, 1990; Bishara et al., 2009; Bachour et al., 2012; Hassiotou et al., 2013, Dizdar et al., 2014)

Reduced maternal IGF-1 has been described in cases of IUGR

Murphy VE, Smith R, Giles WB, Clifton VL. Endocrine regulation of human fetal growth: the role of the mother, placenta, and fetus.
Endocr Rev 2006;27:141– 69
 …background

Aim of this study

To determine correlation between maternal body mass index and

neonatal birth weight with IGF-1 levels of breast milk
 METHODS

This study was designed as a cross sectional study

Twenty four pairs of mothers-neonates collected in November to December 2017

Maternal body mass index was measured and neonatal birth weight was obtained soon after delivery

IGF-1 levels of breast milk was measured at third day after by ELISA method

Data was analyzed Pearson correlation with significant value p<0.05

 Inclussion and Exclusion Criteria

• Maternal-neonatal pair admitted in Saiful Anwar Hospital

Neonatology ward and fully fed with breast milk
• Sample of beast milk collected in third day after delivery
• The patient parents allowed her baby to be included in the
study after being briefed (informed consent)
• Neonates with multiple congenital anomaly or
malformation of gastrointestinal system were rule out
from this study
• Neonates with neonatal infection also ruled out from this
study
 RESULT
Sample characteristics Frequency
Maternal Age
• < 17 years old -
• 17 – 35 years old 21/24
• > 35 years old 3/24
Maternal Body Mass Index
• < 18.5 -
• 18.5 – 24.9 12/24
• 25 – 29.9 7/24
• > 30 5/24
Parity
• Primiparity 4/24
• Multiparity 20/24
Delivery methods
• Spontaneous delivery 9/24
• Cesarean section 15/24
Gestational Age (weeks), median (min-max) 33 (24 – 40)
Neonatal Birth Weight (grams), mean (SD)
• 37 – 42 weeks 3296.00 (± 454.35)
• 32 - < 37 weeks 2179.63 (± 181.70)
• 28 - < 32 weeks 1264.57 (± 135.99)
• < 28 weeks 899.33 (± 86.03)
• Total 2031.79 (± 911.965)
IGF-1 levels of breast milk (ng/ml), mean (SD) 2.62 (0.87)
 …result

Correlation with IGF – 1 levels of breast milk

Parameters
r p-value
Maternal Age -0.237 0.265
Maternal Body Mass Index 0.593 0.003*
Parity 0.237 0.264
Delivery Method 0.274 0.195
Gestational Age 0.029 0.084
Neonatal Birth Weight 0.426 0.038*
 …result

• Results showed that there was significant

correlation between IGF-1 levels of breast milk with
maternal body mass index (r=0.593; p=0.003) and
neonatal birth weight (r=0.426; p=0.038)
DISCUSSION
 DISCUSSION

MATERNAL IGF – 1 LEVELS OF

BODY MASS INDEX BREAST MILK

GH
IGFPB

Jahnson et al. Maternal hormones linking
maternal body mass index and dietary intake
to birth weight.
Am J Clin Nutr. 2008:87:1743-9
(Bajpal and Menon, 2006)
DISCUSSION
Levels of IGF1, IGF2 and
IGFBP3 correlate best with
spontaneous GH secretion
(Bajpal and Menon, 2006
GH and nutrition are the
major factors that regulate
hepatic IGF-I expression, as
well as in other organs
(Daughaday & Rotwein, 1989; Clemmons, 1991
Undernutrition of either
protein or energy intake
)
substantially lowers IGF-1
levels
(Thissen et al., 1994)
Overconsumption may
)
increase IGF-1, but excess
calories are not nearly as
strong a stimulus as
nutritional restriction.
(Thissen et al., 1994)
 DISCUSSION

Puche and Castilla-Cortázar Journal of Translational Medicine 2012, 10:224

Overexpression of IGFBP-1 Biological action of IGF-1

caused growth and depends on target cell
developmental retardation respon modulated by
under normoxia condition IGFBP and hormonal
expression
(Kajimura et al., 2005)
(Sara & Hall, 1990)

(Bajpal and Menon, 2006)

DISCUSSION
DISCUSSION
 CONCLUSION

• The IGF-1 levels of breast milk are positively

correlate to maternal body mass index and
neonatal birth weight.
Thank you