Relationship between prepregnancy BMI and the concentrations of iron, calcium, and magnesium in serum and hair during the first trimester of pregnancy in women.

BACKGROUND: In women of childbearing age, a low dietary supply of iron, calcium, and magnesium is often observed. Minerals deficiency in pregnant women is often associated with abnormal body weight and may impact fetal development disorders. The aim of this study is to determine the relationship between prepregnancy body mass index (BMI) and the dietary intake of iron, calcium and magnesium and their concentrations in serum and hair in pregnant women. METHOD: The study involved 97 Caucasian/white low-risk pregnant women at 12 weeks of gestation. The analysis of minerals in serum and hair samples was performed using atomic absorption spectrometry. Pre-pregnancy BMI was calculated based on self-reported weight. The study used a validated questionnaire and a 24-h recall nutrition interview, which were analyzed using Aliant software. RESULTS: It was found that overweight and obese women exhibited higher magnesium concentration in serum, while iron content in serum and hair was markedly lower compared to women with normal body weight. The average total supply of iron was below the recommendation in pregnant women. Moreover, an inverse significant relationship was observed between BMI and iron concentration in hair and serum in the whole population. CONCLUSION: In conclusion, being overweight or obese before pregnancy is associated with low dietary iron intake and low iron concentration in serum and hair during the first trimester of pregnancy in women.

Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women.

The most common association related to alpha-fetoprotein (AFP) is fetal neural tube defect (NTD), and indeed, this is where the international career of this protein began. In times when ultrasonography was not yet technically advanced, the detection of high levels of AFP in maternal serum (MS-AFP) and amniotic fluid was the basis for suspecting neural tube defects. In cases where there was no confirmation of NTD, other causes were sought. It has been established that high titers of MS-AFP could originate in other defects or diseases, such as (1) increased proteinuria in severe fetal kidney diseases; (2) pathological overproduction in liver diseases; (3) penetration through the membranes of gastrointestinal organs exposed to amniotic fluid; (4) passage through the walls of skin vessels; and as a side effect of (5) hepatic hematopoiesis and increased transfer through the edematous placenta in fetal anemia. This article provides a review of the current literature on congenital defects and genetic diseases in the fetus where an elevated level of MS-AFP may serve as the initial diagnostic clue for their detection.

Role of Alpha-Fetoprotein (AFP) in Diagnosing Childhood Cancers and Genetic-Related Chronic Diseases.

Alpha-fetoprotein (AFP) is a protein commonly found during fetal development, but its role extends beyond birth. Throughout the first year of life, AFP levels can remain high, which can potentially mask various conditions from the neurological, metabolic, hematological, endocrine, and early childhood cancer groups. Although AFP reference values and clinical utility have been established in adults, evaluating AFP levels in children during the diagnostic process, treatment, and post-treatment surveillance is still associated with numerous diagnostic pitfalls. These challenges arise from the presence of physiologically elevated AFP levels, inconsistent data obtained from different laboratory tests, and the limited population of children with oncologic diseases that have been studied. To address these issues, it is essential to establish updated reference ranges for AFP in this specific age group. A population-based study involving a statistically representative group of patients could serve as a valuable solution for this purpose.

Nutrient Intake among Pregnant Women in Spain and Poland: A Comparative Analysis.

Prenatal nutrition plays a crucial role in maternal and child health. This study aims to compare nutrient intake and its adequacy to recommendations among pregnant women in Spain and Poland. The ECLIPSES study in Spain utilized a self-administered food frequency questionnaire, while the PREDISH study in Poland employed a 3-day interview method. We assessed energy and nutrient intake against recommended dietary allowances. The analysis included 583 participants in the first trimester and 465 participants in the third trimester from both countries. Our findings revealed insufficient intake of iron, vitamin D, and vitamin B9 among pregnant women in both Spain and Poland. Significant differences were observed in the intake of energy, carbohydrates, fiber, calcium, iron, and vitamins D, E, C, B6, B9, and B12. Notably, 81.6% and 21.5% of participants did not meet the recommended minimum carbohydrate intake, while 99.8% and 43.8% exceeded the limit for total fat, particularly monounsaturated fatty acids (MUFAs). Tailored dietary guidance based on regional differences is crucial for pregnant women. Although variations in dietary intake were observed, both Spain and Poland faced similar risks of nutritional deficiencies, particularly for iron, vitamin D, and vitamin B9. These findings emphasize the need for enhanced efforts in preventing these deficiencies and promoting optimal prenatal nutrition.

The Role of Alpha-Fetoprotein (AFP) in Contemporary Oncology: The Path from a Diagnostic Biomarker to an Anticancer Drug.

This article presents contemporary opinion on the role of alpha-fetoprotein in oncologic diagnostics and treatment. This role stretches far beyond the already known one-that of the biomarker of hepatocellular carcinoma. The turn of the 20th and 21st centuries saw a significant increase in knowledge about the fundamental role of AFP in the neoplastic processes, and in the induction of features of malignance and drug resistance of hepatocellular carcinoma. The impact of AFP on the creation of an immunosuppressive environment for the developing tumor was identified, giving rise to attempts at immunotherapy. The paper presents current and prospective therapies using AFP and its derivatives and the gene therapy options. We directed our attention to both the benefits and risks associated with the use of AFP in oncologic therapy.

Influence of selected factors on serum AFP levels in pregnant women in terms of prenatal screening accuracy - literature review.

Alpha-fetoprotein (AFP) is one of the biochemical components of the triple (T-3) and quadruple (T-4) test used so far in prenatal screening mainly for trisomy 21 (T21) and neural tube defects (NTDs). Based on many years of experience and data collected during these studies, a variety of factors have been identified that can affect a pregnant woman's serum AFP level, and thus the risk assessment of trisomy 21 (T21) and neural tube defects. These include both unaccounted for purely medical data (e.g., from baseline information about the patient, assisted reproduction methods used, comorbidities and emerging pregnancy pathologies) and errors made during statistical analysis. Since the triple or quadruple test is usually performed between 15 and 20 weeks of pregnancy, most scientific studies are based solely on results from this period of pregnancy - limited data are available for the first and third trimesters of pregnancy. In the era of new improved screening tests, AFP has the potential to become an independent marker for pregnancy well-being evaluation.

Association between the Concentrations of Essential and Toxic Elements in Mid-Trimester Amniotic Fluid and Fetal Chromosomal Abnormalities in Pregnant Polish Women.

The present study aimed to investigate the relationship between the concentrations of essential and toxic elements present in the amniotic fluid (AF) and fetal chromosomal abnormalities in pregnant women. A total of 156 pregnant white Polish women aged between 20 and 43 years and screened to detect high risk for chromosomal defects in the first trimester were included in the study. AF samples were collected from these women during routine diagnostic and treatment procedures at mid-gestation (15-22 weeks of their pregnancies). The concentrations of various minerals in the AF were determined by inductively coupled plasma mass spectrometry. Genomic hybridization and cytogenetic karyotyping were performed to detect chromosomal aberrations in the fetuses. The genetic analysis revealed chromosomal aberrations in 19 fetuses (over 12% of all the evaluated women). The major abnormalities identified were trisomy 21 (N = 11), trisomy 18 (N = 2), and triploidy (N = 2). Fetuses with chromosomal abnormalities more frequently showed lower manganese concentration in the AF in the second trimester as compared to those with normal karyotype. A coincidence was observed between high iron levels in the AF and a higher risk of chromosomal abnormalities in the fetuses.

Alpha-fetoprotein (AFP) - new aspects of a well-known marker in perinatology.

Alpha-fetoprotein (AFP) is a serum protein, which is characteristic of the fetal development period and a well-known oncological marker. The predominance of AFP among serum proteins is common in fetal life, whereas after birthing its functions are gradually taken over by albumins. An understanding of the mechanism of AFP transfer between fetus and mother has led to the development of screening tests for identifying neural tube defects and Down's syndrome. Currently, the knowledge on patophysiology and the possible importance of AFP in perinatology and fetal medicine extends far beyond those 2 disease states. Throughout the 50 years of research on AFP, there has been dynamic progress of diagnostic techniques, from the qualitative ones that are used solely for scientific studies to the widely used radioimmunoassays and immunoenzymatic assays (enzyme-linked immunosorbent assay, chemiluminescence immunoassay, time-resolved fluorescence immunoassay). Some genetic mutations cause complete inhibition of AFP production by the fetus. This affects the results of screening tests during pregnancy, and also leads to constantly high levels of AFP in adults, which are not linked to oncogenesis.

The Presence of Mycotoxins in Human Amniotic Fluid.

Mycotoxin exposure assessments through biomonitoring studies, based on the analysis of amniotic fluid, provides useful information about potential exposure of mothers and fetuses to ubiquitous toxic metabolites that are routinely found in food and the environment. In this study, amniotic fluid samples (n = 86) were collected via abdominal amniocentesis at 15-22 weeks of gestation from pregnant women with a high risk of chromosomal anomalies or genetic fetal defects detected during 1st trimester prenatal screening. These samples were analyzed for the presence of the most typical Aspergillus, Penicillium and Fusarium mycotoxins, with a focus on aflatoxins, ochratoxins and trichothecenes, using the LC-FLD/DAD method. The results showed that the toxin was present in over 75% of all the tested samples and in 73% of amniotic fluid samples from fetuses with genetic defects. The most frequently identified toxins were nivalenol (33.7%) ranging from

Effect of Iron and Folic Acid Supplementation on the Level of Essential and Toxic Elements in Young Women.

Although simultaneous supplementation of iron and folic acid is justified, the potential interactions between these micronutrients and other elements are poorly known. In this study, we aimed to investigate the effect of iron and folic acid supplementation on the levels of selected essential and toxic elements in the serum of micronutrient-deficient young women. A total of 40 women participated in this study and were divided into two groups: study group (n = 23) (with iron and folate deficiency) and control group (n = 17). The study group received iron and folic acid supplements for 3 months. Blood samples were collected at baseline and after the completion of the study period. Women completed a 3-day food intake record. We calculated the body mass index (BMI) of all the participants. Cellular morphology was analyzed in whole blood, and biochemical parameters were determined in serum. Elements were measured in serum by inductively coupled plasma mass spectrometry (ICP-MS). According to our results, in the case of the study group, the supplementation of iron and folic acid restored their levels; however, it caused a significant decrease in the level of zinc, calcium, and magnesium. In the case of the control group, at the end of the study period, there was a marked decrease in the level of iron. Interestingly, there was an increase in the level of arsenic and vanadium in both groups. In conclusion, simultaneous supplementation of iron and folic acid impairs the level of zinc, calcium, and magnesium in women of childbearing age.

A new procedure for the determination of 21 macro- and trace elements in human fetal urine using an inductively coupled plasma mass spectrometry with dynamic reaction cell (ICP-DRC-MS) equipped with a micro-flow nebulizer.

The procedure for determination of 21 macro- and trace elements - Li, Na, Mg, Al, K, Ca, V, Cr, Mn, Fe, Co, Cu, Zn, Se, Sr, As, Cd, Sb, Ba, Pb and U - in human fetal urine by inductively coupled plasma mass spectrometry (ICP-MS) was developed and validated. The application of a micronebulizer and a dynamic reaction cell (DRC) allowed to perform a full analysis of small volumes (200 µL) of urine collected from human fetuses without the need for sample digestion with closed microwave systems. The procedure and ICP-MS instrument was thoroughly optimized in order to reliably determine both macroelements and ultra-trace concentrations of elements. The internal standard method (Ge, Rh and Tb) was applied in order to encompass signal drift and non-spectral interferences. The rules of metrology were used in order to ensure the quality of the results: (1) the procedure was validated, (2) the uncertainty of the measurement results was estimated and (3) the traceability of the measurement result was established by using the certified reference material with matching matrix (Seronorm Trace Elements Urine L-1). Also, the analyte addition method to the artificial urine was employed for additional confirmation of trueness of the procedure. The selected parameters of the procedure were as follows: (a) limits of detection - (0.00023-53 µg L-1) for U and Ca, respectively, (b) recoveries of the reference value - 81%-136% for Mn and Cd, respectively (c) linearity expressed as R - greater than 0.999, and (d) expanded relative uncertainties (k = 2) - 13%-66% for Sr and Cd, respectively. The developed and validated procedure was applied to 58 samples of urine collected from human fetuses. The samples were diluted with nitric acid and analyzed without further treatment. The procedure allowed to reliably determine both macro- and trace elements in very low volume of sample in a single analytical run.

Evaluation of folate concentration in amniotic fluid and maternal and umbilical cord blood during labor.

INTRODUCTION: Folate is required for fetal, placental and maternal tissue growth during pregnancy. A decline in maternal circulating folate concentrations and an increase in total homocysteine (a non-specific indicator of folate deficiency) have been observed with the progression of pregnancy. However, the role of folate in the third trimester of pregnancy is not clear and folate status in late pregnancy has not so far been widely analyzed. The main aim of this retrospective cross-sectional study was to determine the folate concentrations in amniotic fluid and in maternal and umbilical cord blood serum derived during delivery. MATERIAL AND METHODS: This study was conducted on 175 pregnant Polish women (white/Caucasian) aged between 17 and 42 years. Only pregnancies without birth defects were included in this study. Amniotic fluid, maternal serum, and umbilical cord blood samples were collected during vaginal delivery or cesarean section. Folate concentration was determined using a microbiological assay. RESULTS: Strong correlations were observed between the concentrations of folate in amniotic fluid and maternal serum (rho = 0.67, p < 0.001) and amniotic fluid and cord blood serum (rho = 0.49, p < 0.001) and between maternal serum and cord blood serum (rho = 0.67, p < 0.001). Folate concentrations in amniotic fluid were significantly associated with maternal age (rho = 0.19, p < 0.05). Pre-pregnancy body mass index and maternal weight/neonatal birth weight ratio were independent predictors of folate concentrations in maternal serum (ß = 0.33, p < 0.05; ß = -0.19, p < 0.05) and amniotic fluid (ß = 0.28, p < 0.05; ß = -0.19, p < 0.05) in late pregnancy. CONCLUSIONS: Folate concentrations in amniotic fluid are associated with maternal and neonatal folate status peripartum in healthy women.

Relationship between pre-pregnancy body mass index and mineral concentrations in serum and amniotic fluid in pregnant women during labor.

The aim of the study was to determine the correlations between body mass index (BMI) values before pregnancy and the concentrations of selected elements (Mg, Co, Cu, Zn, Sr, Cd, Ba, Pb, U, Ca, Cr, Al, Mn, V, Fe) in blood serum and amniotic fluid (AF) in pregnant women. Elemental analysis of serum and amniotic fluid in 225 Polish women (Caucasian/white) showed a relationship between the concentration of minerals in the above-mentioned samples and the pre-pregnancy BMI. Analysis of blood serum was performed by using ICP-MS and it demonstrated that iron concentration was significantly lower in overweight and obese women. Being underweight in pregnant women was associated with a significantly lower concentration of magnesium and cobalt in the blood serum. Both underweight and overweight women were associated with significantly lower concentrations of calcium and strontium in the blood serum. The concentration of cobalt was significantly higher in underweight women. The concentration of lead in the blood serum of overweight and obese women was significantly higher than in other groups. Analysis of the AF showed that the concentration of copper was significantly lower in overweight and obese women, and the concentration of manganese and vanadium significantly higher than in other groups of women. A deficiency in essential minerals and an excess of heavy metals in women may be associated with abnormal body weight and this is important in the etiopathogenesis of pregnancy and fetal development disorders.

Associations between the Level of Trace Elements and Minerals and Folate in Maternal Serum and Amniotic Fluid and Congenital Abnormalities.

Congenital birth defects may result in a critical condition affecting the baby, including severe fetal/neonatal handicap and mortality. Several studies have shown that genetic, nutritional, and environmental factors may have an impact on fetal development and neonatal health. The relevance of essential and toxic elements on fetal development has not yet been fully investigated, and the results of recent research indicate that these elements may be crucial in the assessment of the risk of malformations in neonates. We determined the association between essential and toxic elements and the level of folate in maternal serum (MS) and amniotic fluid (AF), along with neonatal abnormalities. A total of 258 pregnant Polish women in the age group of 17⁻42 years participated in this study. AF and MS were collected during vaginal delivery or during cesarean section. An inductively coupled plasma mass spectrometry technique was used to determine the levels of various elements in AF and MS. The results of this exploratory study indicate that the levels of essential and toxic elements are associated with fetal and newborn anatomical abnormalities and growth disorders.

Evaluation of Essential and Toxic Elements in Amniotic Fluid and Maternal Serum at Birth.

The objective of this study was to determine the concentration and the reference ranges of essential and toxic elements in amniotic fluid (AF) and maternal serum (MS) at birth. This study was conducted among 175 healthy pregnant Caucasian European women aged 18-42. AF and maternal blood samples were collected during delivery. An inductively coupled plasma mass spectrometry (ICP-MS) technique was used to determine the levels of Mg, Co, Cu, Zn, Sr, Cd, Ba, Pb, U, Ca, Cr, Al, Mn, V, Fe, As, Se and Sb in AF and MS. The range of reference values was calculated for all analyzed elements in the serum and AF. The mean concentrations of elements, except Pb, were generally higher in MS than in AF. Multiple regression analysis showed that the maternal/newborn body mass (MBM/NBM) ratio was a strong negative predictor (among maternal age and gravidity) of Mg concentration in amniotic fluid. In the serum, MBN/NBM ratio was a strong positive predictor of Cu concentration. Moreover, regression analysis showed that maternal age was an independent positive predictor of the Se level in maternal serum. The reference value ranges of 18 essential and toxic elements were established in AF and MS among a population of healthy pregnant Polish women at delivery. The level of Mg, Co, Cu, Ca and Se in AF and MS can be determined by maternal age and MBM/NBM ratio. These results can be useful in counseling individuals with pregnancies affected by exposure to one of the parameters under investigation.

Assessment of dietary intake and mineral status in pregnant women.

PURPOSE: To evaluate the dietary intake of pregnant women and their nutritional status of Ca, Mg, Fe, Zn, and Cu, as the nutritional status of pregnant women is an important factor for the proper progression of a pregnancy and the development and health of the foetus. METHODS: The study was conducted on 108 pregnant women ages 18-42, at 6-32 weeks of gestation. We used a questionnaire and a 24-h recall nutrition interview. Hair samples were taken for testing and the level of each mineral was assessed using atomic absorption spectrometry. The results were analysed using the Dietetyk and Statistica 10 software. RESULTS: Low levels of Fe, Zn, Ca, Mg, vitamin D, and folic acid intake were seen in the pregnant women, with the use of dietary supplements significantly increasing their intake of Fe, Zn, and folic acid. The concentration of zinc and magnesium in the women's hair was shown to be affected by their age and, in the case of magnesium, by the week of pregnancy. CONCLUSIONS: It was observed that the diet of pregnant women is characterised by low levels of Fe, Zn, Ca, Mg, vitamin D, and folic acid. Dietary supplementation with vitamins and minerals significantly increases the daily Fe and folic acid intake in pregnant women. The concentration of Zn and Mg in hair depends on the age of pregnant women and Mg level in the hair of women decreases during pregnancy.

Evaluation of Mineral Concentrations in Maternal Serum Before and After Birth and in Newborn Cord Blood Postpartum-Preliminary Study.

The mineral levels in maternal serum change during pregnancy and may be correlated with those of newborn cord blood. The aim of this study was to evaluate the concentrations of calcium (Ca), magnesium (Mg), zinc (Zn), iron (Fe), and copper (Cu) in maternal blood before and after delivery and in umbilical cord vein and artery serum. The study was carried out in 64 Caucasian pregnant women who delivered in a district hospital in Greater Poland region, aged 28.1 ± 5.4 years, with a mean gestational age of 39.2 ± 1.3 weeks. Blood samples were taken from women 2-8 h before delivery and immediately after childbirth. The umbilical cord artery and vein blood of newborns was obtained immediately after childbirth. The levels of minerals in serum were determined by flame atomic absorption spectrometry. A significant drop in the concentrations of Mg (17.71 ± 1.51 vs 17.07 ± 1.61 µg/ml; p < 0.007), Fe (1.08 ± 0.46 vs 0.82 ± 0.35 µg/ml; p < 0.0004), and Zn (0.63 ± 0.17 vs 0.46 ± 0.16; p < 0.0001) in maternal serum was found after delivery. Moreover, higher levels of Ca, Fe, and Zn and lower levels of Cu were observed in the umbilical vein (Ca: 102.80 ± 7.80 µg/ml; p < 0.0001, Fe: 1.96 ± 0.43 µg/ml; p < 0.0001, Zn: 0.65 ± 0.16 µg/ml; p < 0.0001, Cu: 0.36 ± 0.09 µg/ml; p < 0.0001) and in the umbilical artery cord blood (Ca: 98.07 ± 8.18 µg/ml; p < 0.0001, Fe: 1.63 ± 0.30 µg/ml; p < 0.0001, Zn: 0.65 ± 0.15 µg/ml; p < 0.0001, and Cu: 0.36 ± 0.10 µg/ml; p < 0.0001) compared to the maternal serum (Ca: 85.05 ± 10.76 µg/ml, Fe: 0.82 ± 0.35 µg/ml, Zn: 0.46 ± 0.16 µg/ml, and Cu: 1.90 ± 0.35 µg/ml). Fe levels in the cord artery serum negatively correlated with blood loss during delivery (R = -0.48; p = 0.01), while the Ca concentration in the maternal serum after birth decreased with the age of the women (R = -0.25; p = 0.03). In conclusion, it seems that the process of birth alters the mineral levels in pregnant women's blood. Moreover, it was found that blood loss and the age of the mother are associated with mineral concentrations in the maternal serum and cord artery blood.

Oxidative Stress in Women Treated with Atosiban for Impending Preterm Birth.

Preterm birth is defined as delivery before 37 completed weeks of pregnancy, and it is the leading cause of neonatal morbidity and mortality. Oxidative stress is recognized as an important factor in the pathogenesis of premature labor. We conducted this analysis to investigate the safety of administration of the tocolytic drug Atosiban-a reversible, competitive antagonist of the oxytocin receptor in the treatment of preterm birth and its impact on the level of oxidative stress in pregnant women after 48 hours of tocolytic treatment. This prospective study was conducted between March 2016 and August 2017 at the Obstetric Clinic of the Polish Mother's Memorial Hospital Research Institute. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) values as well as 3-nitrotyrosine, carbonyl, and thiol group levels were measured using an ELISA test in serum and plasma of 56 pregnant women before and after 48 hours of continuous administration of Atosiban. We found that TAS levels decreased almost twice after the 48-hour drug administration (0.936 ± 0.360 mmol/L vs. 0.582 ± 0.305 mmol/L, P < 0.001) while TOS increased from 18.217 ± 16.093 µmol/L to 30.442 ± 30.578 µmol/L (P < 0.001). We also found a significant increase in OSI index-almost a threefold increase from 0.022 ± 0.022 to 0.075 ± 0.085, P < 0.001. In addition, statistically significant differences in the level of carbonyl groups were found. It increased from 65.358 ± 31.332 µmol/L to 97.982 ± 38.047 µmol/L (P < 0.001), which indicates increased oxidation of plasma proteins. Furthermore, patients who gave birth prematurely had higher levels of TOS after a 48-hour drug administration than the second group with labor after 37 weeks of pregnancy (42.803 ± 34.683 µmol/L vs. 25.792 ± 27.821 µmol/L, P < 0.031). The obtained results clearly indicate that pregnant women during tocolytic treatment with Atosiban are in a state of increased oxidative stress and occurrence of preterm birth can be associated with this phenomenon. This trial is registered with NCT03570294.

Selected trace elements concentrations in pregnancy and their possible role - literature review.

The aim of this study was to review the role of selected trace elements in pregnancy and fetal development. Citations related to the role of iron (Fe), zinc (Zn), manganese (Mn), copper (Cu) and selenium (Se) during pregnancy were searched in PubMed, Medline, Web of Science, using keywords and MeSH terms. Inadequate supply of trace elements can cause abnormalities of fetal development and predispose a child to disorders later on in life. Trace elements are the key elements of complex enzymes responsible for the modulation of the antioxidant defense system of the organism. It has been suggested that there is a correlation between reduced levels of trace elements essential for antioxidant function in the body of pregnant women, and an increased risk of developing preeclampsia. Trace elements are components of numerous regulatory enzymes and hormones essential to the division and differentiation of fetal cells and their further development. Mineral deficiencies in pregnant women can cause birth defects of the central nervous system, and growth disorders. Future research should be directed to explain the interaction between trace elements, and establish the optimum levels of macro and micronutrients supplementation, as well as determine the reference values for trace elements in the maternal serum, umbilical cord blood and amniotic fluid.

Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth.

BACKGROUND: The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18-38 weeks of gestation, pO(2) is <5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals. AIMS: To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges. STUDY DESIGN: Prospective cohort study, serum of umbilical artery (n=156) and vein (n=180), 599 normal singletons at 37(+0)-42(+0)weeks, neonates with IUGR (n=41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex. OUTCOME MEASURES: Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates. RESULTS: Neonates with IUGR (n=41) had AST values that were not different from the reference group, but had significantly lower ALT (-1.49, 95% CI -1.98 to -1.00 vs 0.14, 95% CI -0.42-0.13), (p<0.001), (Fig. 3). CONCLUSIONS: In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.