Birth by cesarean section is associated with elevated neonatal plasma levels of dimethylarginines
Article first published online: 19 APR 2012
© 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society
Volume 54, Issue 4, pages 476–479, August 2012
How to Cite
Vida, G., Sulyok, E., Ertl, T., Martens-Lobenhoffer, J. and Bode-Böger, S. M. (2012), Birth by cesarean section is associated with elevated neonatal plasma levels of dimethylarginines. Pediatrics International, 54: 476–479. doi: 10.1111/j.1442-200X.2012.03605.x
- Issue published online: 26 JUL 2012
- Article first published online: 19 APR 2012
- Accepted manuscript online: 29 FEB 2012 08:03AM EST
- Received 28 September 2011; revised 10 February 2012; accepted 15 February 2012.
- cesarean section;
- vaginal delivery
Background: This study was undertaken to compare the effects of vaginal delivery and cesarean section on the l-arginine-nitric oxide system by measuring levels of l-arginine, an endogenous nitric oxide synthase antagonist asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in the cord blood and postnatally.
Methods: Plasma samples were obtained from the umbilical vein and artery at birth and from peripheral venous blood on the second postnatal day in 30 full-term newborn infants: 10 born vaginally and 20 born by cesarean section.
Results: After vaginal delivery, ADMA concentration was higher in the umbilical vein than in the umbilical artery (mean 1.06 vs 0.90 µmol/L [P= 0.027]); and ADMA level fell after birth to 0.66 µmol/L on the second postnatal day (P= 0.007 vs umbilical artery). Newborns born by cesarean section had similar ADMA levels in umbilical arterial and venous blood, 1.19 and 1.18 µmol/L, and the ADMA level fell to 0.84 µmol/L by the second postnatal day (P < 0.001). Vaginal birth induced neither significant umbilical venoarterial difference nor a postnatal fall in SDMA. After cesarean section, SDMA was essentially the same in umbilical vein, umbilical artery and postnatal peripheral vein samples. At 2 days of age, both ADMA and SDMA levels stayed higher in infants born by cesarean section than in vaginally born infants.
Conclusions: ADMA level falls after both vaginal and cesarean birth, whereas SDMA level does not. The higher ADMA level after cesarean birth compared with vaginal birth may contribute to decreased nitric oxide production and bioavailability in neonatal vascular beds.