Increased Levels of Umbilical Cord Blood Interleukin-6 (IL-6) and Serum C-Reactive Protein (CRP) in Premature Infants of Vitamin D Defi cient Mothers

Abstract

Increased Levels of Umbilical Cord Blood Interleukin-6 (IL-6) and Serum C-Reactive Protein (CRP) in Premature Infants of Vitamin D Defi cient Mothers Peningkatan Kadar Interleukin-6 (IL-6) Darah Tali Pusat dan Serum C-Reactive Protein (CRP) pada Bayi Prematur dari Ibu dengan Defi siensi Vitamin D Yuyun Lisnawati, 1 Yesy Marianna, 1 Rinawati Rohsiswatmo 3 1 Department of Obstetrics and Gynecology Faculty of Medicine Universitas Indonesia Persahabatan Hospital 2 Department of Pediatric Faculty of Medicine Universitas Indonesia Dr. Cipto Mangunkusumo General Hospital Jakarta Abstract Abstrak Objective: Increased levels of infl ammatory factors in newborns are often associated with lower maternal vitamin D levels. This study aimed to fi nd out the relationship between maternal and umbilical cord vitamin D serum levels on umbilical cord Interleukin-6 (IL-6) and serum C-Reactive Protein (CRP) levels in premature infants. Tujuan: Peningkatan kadar faktor infl amasi pada bayi baru lahir sering dikaitkan dengan rendahnya kadar vitamin D ibu. Penelitian ini bertujuan untuk mengetahui hubungan kadar serum vitamin D ibu dan tali pusat, dengan kadar IL-6 tali pusat

dan serum C-Reactive Protein (CRP) bayi prematur. Metode: Studi observasional analitik dengan desain potong lintang pada subjek ibu yang mengalami kelahiran prematur di usia 28–34 minggu kehamilan disebabkan ketuban pecah dan bayi yang dilahirkannya, di Rumah Sakit Umum Pusat Methods: The study was an observational analytic, crosssectional design in mothers who underwent preterm birth at 2834 weeks' gestation due to premature rupture of membranes

(PROM) and their infants at Dr. Cipto Mangunkusumo General

Hospital (RSCM), Jakarta and Persahabatan General Hospital,

Jakarta, from January 2017 to August 2018. Levels of serum

vitamin D of the maternal and umbilical cord, umbilical cord IL-6

and serum CRP in premature infants were recorded. Vitamin D

level was divided into defi ciency (<10 ng/mL), insuffi ciency (10– 29 ng/mL), and normal (≥30 ng/mL) groups. The relationship of

vitamin D levels with IL-6 and CRP was carried out using Kruskal

Wallis test. Nasional dr. Cipto Mangunkusumo (RSCM) dan Rumah Sakit Umum Pusat Persahabatan, Jakarta, pada bulan Januari 2017 sampai Agustus 2018. Variabel data adalah kadar serum vitamin D ibu dan tali pusat, kadar serum IL-6 tali pusat dan kadar CRP darah bayi. Kadar vitamin D (25(OH)D) dibagi menjadi defi siensi (<10 ng/mL), insufi siensi (10–29 ng/mL) dan normal (≥30 ng/mL) dan dicari hubungannya dengan kadar IL-6 tali pusat dan serum CRP bayi prematur, menggunakan uji Kruskal Wallis. Results: A total of 70 subjects met the research criteria. Umbilical cord IL-6 and serum CRP levels in premature infants of vitamin D defi cient mothers were higher (20.31 pg/mL and 0.50 mg/L) compared to insuffi cient (3.34 pg/mL and 0.45 mg/L) and normal mothers (3.29 pg/mL and 0.30 mg/L), although not statistically signifi cant (IL-6 p = 0.665, CRP p = 0.89). Referring to the umbilical cord blood vitamin D levels, the results were different and not as expected, in which the umbilical cord IL-6 and serum CRP levels of preterm infants in the defi ciency (3.76 pg/mL and 0.35 mg/L) and insuffi ciency (3.37 pg/mL and 0.40 mg/L) groups were lower (IL-6) and not different (CRP) than the normal group (9.41 pg/mL and 0.40 mg/L). Hasil: Sebanyak 70 subjek telah memenuhi kriteria penelitian. Kadar IL-6 tali pusat dan serum CRP bayi prematur dari kelompok ibu defi siensi vitamin D (20,31 pg/ml dan 0,50 mg/L) lebih tinggi dibandingkan kelompok ibu insufi siensi vitamin D (3,34 pg/mL dan 0,45 mg/L) maupun kelompok ibu normal vitamin D (3,29 pg/mL dan 0,30 mg/L) tetapi perbedaan tersebut tidak bermakna (IL-6 p=0,665 dan CRP p = 0,899). Mengacu pada kadar vitamin D darah tali pusat didapatkan hasil yang berbeda dan tidak sesuai harapan, dimana tali pusat IL-6 dan serum CRP bayi prematur mengalami defi siensi (3,76 pg / mL dan 0,35 mg / L) dan insufi siensi. (3,37 pg / mL dan 0,40 mg / L) kelompok lebih rendah (IL-6) dan tidak berbeda (CRP) dibandingkan kelompok normal (9,41 pg / mL dan 0,40 mg / L). Conclusions: There were atendency for an increase in umbbilical cord IL-6 and serum CRP level in premature infants of Vitamin D defi cient mother although these were not statistically signifi cant. Based on the levels of vitamin D umbilical cord blood, the CRP levels in the serum of premature infants were not different, while the IL-6 levels in the defi ciency and insuffi ciency group were lower than in the normal group. Kesimpulan: Didapat kecenderungan peningkatan kadar IL-6 darah tali pusat dan serum CRP bayi prematur dari ibu dengan defi siensi kadar vitamin D walaupun secara statistik tidak signifi kan. Berdasarkan kelompok vitamin D darah tali pusat, kadar

CRP serum bayi prematur tidak berbeda, sedangkan kadar IL-6

pada kelompok defi siensi dan insufi siensi lebih rendah dibandingkan pada kelompok normal. Keywords: CRP, IL-6, maternal vitamin D, umbilical cord vitamin D. Kata kunci: CRP, IL-6, vitamin D ibu, vitamin D tali pusat.