[Multiple gestation epidemiology--15 years survey].

PubMed

Rodrigues, Carla T; Branco, Miguel R; Ferreira, Isabel D; Nordeste, Ana; Fonseca, Margarida; Taborda, Adelaide; Silva, Isabel S; Almeida, Maria do Céu

2005-01-01

Between January of 1987 and December of 2001 were born 1243 twins related to 609 multiple pregnancies, in Maternidade Bissaya-Barreto. Data were grouped in periods of three years and several parameters were studied. The rate of multiple gestation has increased probably due to the contribution of the assisted conception techniques, and to the increase of the number of multiple fetal pregnancies (two or more) and to the increase of the mother age. These more frequent obstetric problems were preterm birth, gestational hypertension and abnormal sonographic data of fetal growth. The average age of delivery was 34 weeks and the birth weight has decreased. The most important factors for neonatal morbidity were hyaline membranous disease, intraventricular haemorrhage and the twin-twin transfusion syndrome. The neonatal mortality decreased in the last studied period.

The pattern of antenatal visits with emphasis on gestational age at booking in Riyadh Health Centres.

PubMed

al-Shammari, S A; Khoja, T; Jarallah, J S

1994-04-01

1344 expectant mothers were selected by random sampling from the catchment population of 15 health centres in Riyadh. The health centres were taken to represent all areas of urban Riyadh. These mothers were asked to complete a pre-designed questionnaire in Arabic and undergo a structured interview by trained midwives to explore their knowledge, attitude and practice toward antenatal visits. It was found that the average gestational age at booking was 13 weeks. The number of antenatal visits achieved during the current pregnancy was 6. 97% of expectant mothers were aware of the importance of antenatal visits. Various demographic characteristics were studied in relation to the number of antenatal visits achieved and the gestational age at booking. It was found that the level of education of both husband and wife and poor obstetric history significantly affected gestational age at booking, (P-values) were less than 0.03 and 0.002 respectively). However the family income and gestational age at booking affected the number of antenatal visits (P-values were less than 0.0003 and 0.0001 respectively). The respondents' most striking reason for non-compliance was related to accessibility to health centre. 23.3% thought that the health centres were far away from their residence and they needed to involve the husbands in driving them to health centres. Recommendations were given to improve aspects of accessibility and inviting more antenatal visits in addition to improving quality of such service.

[Peruvian newborn fetal growth according to its sex, geographical area, and maternal parity and height].

PubMed

Rendón, Manuel Ticona; Apaza, Diana Huanco

2008-09-01

Birth weight is the most important indicator of fetal growth, fetal development, and nutritional estate of newborn, and several factors affect it. To know the fetal growth of Peruvian newborns according to fetal sex, maternal parity and height, and geographical area. Prospective and cross sectional study. Successive newborn data of 29 hospitals of Ministerio de Salud del Peru was obtained during 2005 year, all of them without intrauterine growth delay. Student ttest was used to compare: male and female, primiparous and multiparous, and coast, mountain, and rainforest newborn average weight (meaningful difference: p < 0.05). Maternal height was related to newborn weight, height, cephalic perimeter, and gestational age. From 50,568 selected alive newborns, male had an average weight from 19 to 41 g higher than female, and multiparous newborns had from 22 to 53 g more than primiparous newborns. Maternal height has a direct connection with newborn weight, height, and cephalic perimeter. Coast newborns had an average weight from 133 to 210 g higher than those from mountain, and from 76 to 142 g higher than those from rainforest; average weight of rainforest newborns was from 19 to 83 g higher to those from mountain. Weight differences due to fetal sex, maternal parity and height, and geographic region were meaningful among 36 to 42 weeks of gestation. Fetal sex, maternal parity and height, and geographical region affect newborn weight. It is recommended to use weight and gestational age as correction factors to appropriately classify Peruvian newborns.

Examining the provisional guidelines for weight gain in twin pregnancies: a retrospective cohort study.

PubMed

Lutsiv, Olha; Hulman, Adam; Woolcott, Christy; Beyene, Joseph; Giglia, Lucy; Armson, B Anthony; Dodds, Linda; Neupane, Binod; McDonald, Sarah D

2017-09-29

Weight gain during pregnancy has an important impact on maternal and neonatal health. Unlike the Institute of Medicine (IOM) recommendations for weight gain in singleton pregnancies, those for twin gestations are termed "provisional", as they are based on limited data. The objectives of this study were to determine the neonatal and maternal outcomes associated with gaining weight below, within and above the IOM provisional guidelines on gestational weight gain in twin pregnancies, and additionally, to explore ranges of gestational weight gain among women who delivered twins at the recommended gestational age and birth weight, and those who did not. A retrospective cohort study of women who gave birth to twins at ≥20 weeks gestation, with a birth weight ≥ 500 g was conducted in Nova Scotia, Canada (2003-2014). Our primary outcome of interest was small for gestational age (<10th percentile). In order to account for gestational age at delivery, weekly rates of 2nd and 3rd trimester weight gain were used to categorize women as gaining below, within, or above guidelines. We performed traditional regression analyses for maternal outcomes, and to account for the correlated nature of the neonatal outcomes in twins, we used generalized estimating equations (GEE). A total of 1482 twins and 741 mothers were included, of whom 27%, 43%, and 30% gained below, within, and above guidelines, respectively. The incidence of small for gestational age in these three groups was 30%, 21%, and 20%, respectively, and relative to gaining within guidelines, the adjusted odds ratios were 1.44 (95% CI 1.01-2.06) for gaining below and 0.92 (95% CI 0.62-1.36) for gaining above. The gestational weight gain in women who delivered twins at 37-42 weeks with average birth weight ≥ 2500 g and those who delivered twins outside of the recommend ranges were comparable to each other and the IOM recommendations. While gestational weight gain below guidelines for twins was associated with some adverse neonatal outcomes, additional research exploring alternate ranges of gestational weight gain in twin pregnancies is warranted, in order to optimize neonatal and maternal outcomes.

Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement erapy.

PubMed

Zayek, Michael M; Eyal, Fabien G; Smith, Robert C

2018-01-01

To compare the pharmacy costs of calfactant (Infasurf, ONY, Inc.) and poractant alfa (Curosurf, Chiesi USA, Inc., Cary, NC). The University of South Alabama Children's and Women's Hospital switched from calfactant to poractant alfa in 2013 and back to calfactant in 2015. Retrospectively, we used deidentified data from pharmacy records that provided type of surfactant administered, gestational age, birth weight, and number of doses on each patient. We examined differences in the number of doses by gestational ages and the differences in costs by birth weight cohorts because cost per dose is based on weight. There were 762 patients who received calfactant and 432 patients who received poractant alfa. The average number of doses required per patient was 1.6 administrations for calfactant-treated patients and 1.7 administrations for poractant alfa-treated patients, p = 0.03. A higher percentage of calfactant patients needed only 1 dose (53%) than poractant alfa patients (47%). The distribution of the number of doses for calfactant-treated patients was significantly lower than for the poractant alfa-patients, p < 0.001. Gestational age had no consistent effect on the number of doses required for either calfactant or poractant alfa. Per patient cost was higher for poractant alfa than for calfactant in all birth weight cohorts. Average per patient cost was $1160.62 for poractant alfa, 38% higher than the average per patient cost for calfactant ($838.34). Using poractant alfa for 22 months is estimated to have cost $202,732.75 more than it would have cost if the hospital had continued using calfactant. Our experience showed a strong pharmacoeconomic advantage for the use of calfactant compared to the use of poractant alfa because of similar average dosing and lower per patient drug costs.

Patterns of gestational weight gain and birthweight outcomes in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons: a prospective study.

PubMed

Pugh, Sarah J; Albert, Paul S; Kim, Sungduk; Grobman, William; Hinkle, Stefanie N; Newman, Roger B; Wing, Deborah A; Grantz, Katherine L

2017-09-01

Inadequate or excessive total gestational weight gain is associated with increased risks of small- and large-for-gestational-age births, respectively, but evidence is sparse regarding overall and trimester-specific patterns of gestational weight gain in relation to these risks. Characterizing the interrelationship between patterns of gestational weight gain across trimesters can reveal whether the trajectory of gestational weight gain in the first trimester sets the path for gestational weight gain in subsequent trimesters, thereby serving as an early marker for at-risk pregnancies. We sought to describe overall trajectories of gestational weight gain across gestation and assess the risk of adverse birthweight outcomes associated with the overall trajectory and whether the timing of gestational weight gain (first vs second/third trimester) is differentially associated with adverse outcomes. We conducted a secondary analysis of a prospective cohort of 2802 singleton pregnancies from 12 US prenatal centers (2009 through 2013). Small and large for gestational age were calculated using sex-specific birthweight references <5th, <10th, or ≥90th percentiles, respectively. At each of the research visits, women's weight was measured following a standardized anthropometric protocol. Maternal weight at antenatal clinical visits was also abstracted from the prenatal records. Semiparametric, group-based, latent class, trajectory models estimated overall gestational weight gain and separate first- and second-/third-trimester trajectories to assess tracking. Robust Poisson regression was used to estimate the relative risk of small- and large-for-gestational-age outcomes by the probability of trajectory membership. We tested whether relationships were modified by prepregnancy body mass index. There were 2779 women with a mean of 15 (SD 5) weights measured across gestation. Four distinct gestational weight gain trajectories were identified based on the lowest Bayesian information criterion value, classifying 10.0%, 41.8%, 39.2%, and 9.0% of the population from lowest to highest weight gain trajectories, with an inflection at 14 weeks. The average rate in each trajectory group from lowest to highest for 0-<14 weeks was -0.20, 0.04, 0.21, and 0.52 kg/wk and for 14-39 weeks was 0.29, 0.48, 0.63, and 0.79 kg/wk, respectively; the second lowest gaining trajectory resembled the Institute of Medicine recommendations and was designated as the reference with the other trajectories classified as low, moderate-high, or high. Accuracy of assignment was assessed and found to be high (median posterior probability 0.99, interquartile range 0.99-1.00). Compared with the referent trajectory, a low overall trajectory, but not other trajectories, was associated with a 1.55-fold (95% confidence interval, 1.06-2.25) and 1.58-fold (95% confidence interval, 0.88-2.82) increased risk of small-for-gestational-age <10th and <5th, respectively, while a moderate-high and high trajectory were associated with a 1.78-fold (95% confidence interval, 1.31-2.41) and 2.45-fold (95% confidence interval, 1.66-3.61) increased risk of large for gestational age, respectively. In a separate analysis investigating whether early (<14 weeks) gestational weight gain tracked with later (≥14 weeks) gestational weight gain, only 49% (n = 127) of women in the low first-trimester trajectory group continued as low in the second/third trimester, and had a 1.59-fold increased risk of small for gestational age; for the other 51% (n = 129) of women without a subsequently low second-/third-trimester gestational weight gain trajectory, there was no increased risk of small for gestational age (relative risk, 0.75; 95% confidence interval, 0.47-1.38). Prepregnancy body mass index did not modify the association between gestational weight gain trajectory and small for gestational age (P = 0.52) or large for gestational age (P = .69). Our findings are reassuring for women who experience weight loss or excessive weight gain in the first trimester; however, the risk of small or large for gestational age is significantly increased if women gain weight below or above the reference trajectory in the second/third trimester. Published by Elsevier Inc.

Maternal and Neonatal Outcome in Mothers with Gestational Diabetes Mellitus.

PubMed

Prakash, G Thiruvikrama; Das, Ashok Kumar; Habeebullah, Syed; Bhat, Vishnu; Shamanna, Suryanarayana Bettadpura

2017-01-01

Gestational diabetes mellitus (GDM) is common and is accompanied with other comorbidities. Challenges to treatment exist at our institute as it serves women with low income. This study assessed the burden of comorbidities and the outcome of GDM. This was a prospective, observational study of women with gestational diabetes attending the obstetrics department from September 2012 to April 2014. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Medical comorbidities were noted, and lipid profile was done. All the women were followed up till delivery, and the complications were recorded. Age- and parity-matched pregnant women with normal oral glucose tolerance test were recruited as controls. One hundred and thirty-nine women were followed up till delivery. The average age was 28 years. Eighteen percent had bad obstetric history. The average body mass index was 28.8. Twenty-five percent had gestational hypertension (HTN), and 6.4% had chronic HTN. Thirty percent had hypothyroidism. 65% women received insulin. The glucose values were within the recommended range in 60% of the women. Maternal hypoglycemia occurred in 7 (5%) women. Forty-four percent of the women required cesarean section and 34% had complications either during pregnancy or labor. Three neonates had macrosomia. Twenty-six neonates (20%) required admission to the Neonatal Intensive Care Unit. Four neonates (3%) died. Newborns of mothers whose GDM optimally treated had less complications. Gestational diabetes is associated with HTN, hypothyroidism, obesity, and lipid abnormalities. The majority of women required insulin for treatment and optimal control of blood glucose resulted in lower neonatal complications.

The Relationship of Parental Knowledge to the Development of Extremely Low Birth Weight Infants.

ERIC Educational Resources Information Center

Dichtelmiller, Margo; And Others

1992-01-01

This study found that mothers (n=40) of extremely high-risk infants (averaging 1000 grams birthweight and 28 weeks gestational age) called upon the same experiences and sources of information as mothers of full-term infants. Infants of mothers with above average knowledge about infancy scored significantly higher on tests of infant development at…

[Dynamic evaluation on body weight gain in premature infants and its significance].

PubMed

Ru, Xi-fang; Feng, Qi; Wang, Ying; Zhang, Xin; Li, Xing; Meng, Jing-wen; Guo, Zai-chen

2010-09-01

To investigate the incidence of intra- and extrauterine growth retardation (EUGR) and growth restriction in premature infants, and to illustrate the growth pattern of them in postnatal and infantile period. All premature infants were admitted to our neonatal intensive care unit (NICU) during the recent 7 years. The criteria for enrollment were (1) gestational age < 37 weeks; (2) single fetus; (3) admitted within the first 24 hours of life; (4) hospitalization period ≥ 14 days; (5) clinical follow-up persisted till ≥ 3 months of corrected gestational age. Intrauterine growth restriction (IUGR), EUGR and growth restriction were defined as having a measured growth value (weight) that was ≤ 10(th) percentile of Chinese infants' growth curve in corrected age on admission, discharge and follow-up period. Results were analyzed by using SPSS 12.0 statistical software package by chi-square test, rank-sum test, and t test. Two hundred and thirty nine infants were involved, 134 were boys and 105 girls. The incidence of IUGR and EUGR assessed by weight was 25.5% and 40.6%, respectively. The lower the birth weight was, the higher the incidence of IUGR and EUGR was. The percentile of body weight in the growth curve at discharge was lower than that at birth (Z = -7.784, P = 0.000). The incidence of growth restriction assessed by weight was 20.5%, 15.0%, 8.8%, 17.0%, 10.4%, 10.1%, 11.9%, 7.0% at corrected gestational age of 38 - 40 weeks, corrected age of 28 d, 61 d, 91 d, 122 d, 152 d, 183 d, and 274 d, respectively. The incidences of growth restriction were stable when the corrected age was older than 91 days. The incidence of growth restriction in female premature infants at 183 days' corrected age was higher than that in male children (χ(2) = 6.181, P = 0.017), the incidence was 19.3% and 3.8% respectively. During the follow-up period, most of the average body weight of premature infants whose gestational age was < 32 weeks or birth weight ≤ 1500 g were lower than the 50(th) percentile of the growth curve except the average body weight of boys whose gestational age < 32 weeks at corrected age of 2 and 4 months. Premature and/or low birth weight infants are at high risk of growth restriction, especially very low birth weight infants. The incidence of growth restriction decreased with growth. Long-term prognosis requires further investigation.

Ethnic Differences in Gestational Weight Gain: A Population-Based Cohort Study in Norway.

PubMed

Kinnunen, Tarja I; Waage, Christin W; Sommer, Christine; Sletner, Line; Raitanen, Jani; Jenum, Anne Karen

2016-07-01

Objectives To explore ethnic differences in gestational weight gain (GWG). Methods This was a population-based cohort study conducted in primary care child health clinics in Groruddalen, Oslo, Norway. Participants were healthy pregnant women (n = 632) categorised to six ethnic groups (43 % were Western European women, the reference group). Body weight was measured at 15 and 28 weeks' gestation on average. Data on pre-pregnancy weight and total GWG until delivery were self-reported. The main method of analysis was linear regression adjusting for age, weeks' gestation, pre-pregnancy body mass index, education and severe nausea. Results No ethnic differences were observed in GWG by 15 weeks' gestation. By 28 weeks' gestation, Eastern European women had gained 2.71 kg (95 % confidence interval, CI 1.10-4.33) and Middle Eastern women 1.32 kg (95 % CI 0.14-2.50) more weight on average than the Western European women in the fully adjusted model. Among Eastern European women, the total adjusted GWG was 3.47 kg (95 % CI 1.33-5.61) above the reference group. Other ethnic groups (South Asian, East Asian and African) did not differ from the reference group. When including non-smokers (n = 522) only, observed between-group differences increased and Middle Eastern women gained more weight than the reference group by all time points. Conclusions Eastern European and Middle Eastern women had higher GWG on average than Western European women, especially among the non-smokers. Although prevention of excessive GWG is important for all pregnant women, these ethnic groups might need special attention during pregnancy.

Does maternal exposure during pregnancy to higher ambient temperature increase the risk of hypospadias?

PubMed

Kilinc, Muhammet Fatih; Cakmak, Sedat; Demir, Demirhan Orsan; Doluoglu, Omer Gokhan; Yildiz, Yildiray; Horasanli, Kaya; Dalkilic, Ayhan

2016-12-01

The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature. The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy. The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias. The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively. In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects.

PubMed

Woo, Irene; Hindoyan, Rita; Landay, Melanie; Ho, Jacqueline; Ingles, Sue Ann; McGinnis, Lynda K; Paulson, Richard J; Chung, Karine

2017-12-01

To study the perinatal outcomes between singleton live births achieved with the use of commissioned versus spontaneously conceived embryos carried by the same gestational surrogate. Retrospective cohort study. Academic in vitro fertilization center. Gestational surrogate. None. Pregnancy outcome, gestational age at birth, birth weight, perinatal complications. We identified 124 gestational surrogates who achieved a total of 494 pregnancies. Pregnancy outcomes for surrogate and spontaneous pregnancies were significantly different (P<.001), with surrogate pregnancies more likely to result in twin pregnancies: 33% vs. 1%. Miscarriage and ectopic rates were similar. Of these pregnancies, there were 352 singleton live births: 103 achieved from commissioned embryos and 249 conceived spontaneously. Surrogate births had lower mean gestational age at delivery (38.8 ± 2.1 vs. 39.7 ± 1.4), higher rates of preterm birth (10.7% vs. 3.1%), and higher rates of low birth weight (7.8% vs. 2.4%). Neonates from surrogacy had birth weights that were, on average, 105 g lower. Surrogate births had significantly higher obstetrical complications, including gestational diabetes, hypertension, use of amniocentesis, placenta previa, antibiotic requirement during labor, and cesarean section. Neonates born from commissioned embryos and carried by gestational surrogates have increased adverse perinatal outcomes, including preterm birth, low birth weight, hypertension, maternal gestational diabetes, and placenta previa, compared with singletons conceived spontaneously and carried by the same woman. Our data suggest that assisted reproductive procedures may potentially affect embryo quality and that its negative impact can not be overcome even with a proven healthy uterine environment. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

[Risk Factors for Healthcare Associated Sepsis in Very Low Birth Weight Infants].

PubMed

Pereira, Helena; Grilo, Ema; Cardoso, Patrícia; Noronha, Natália; Resende, Cristina

2016-04-01

Healthcare associated infections in very low birth weight infants are associated with significant morbidity and mortality and are also a cause of increased length of stay and hospital costs. The objective of this study was to evaluate the rate of healthcare-associated sepsis and associated risk factors in very low birth weight infants. Retrospective observational study including very low birth weight infants hospitalized in a Neonatal Intensive Care Unit during ten years (2005-2014). We evaluated the association between several risk factors and healthcare-associated sepsis. 461 very low birth weight infants were admitted. There were 110 episodes of HS in 104 very low birth weight infants and 53 episodes of sepsis associated with central vascular catheter. The density of the sepsis was 7.5/1 000 days of hospitalization and the density of central vascular catheter - associated sepsis was 22.6/1 000 days of use. The infants with HS had lower average birth weight and gestational age (959 ± 228 g vs 1191 ± 249 g and 27.6 ± 2 vs 29.8 ± 2.2 weeks), p < 0.001. After adjusting for birth weight and gestational age we verified an association between healthcare-associated sepsis and antibiotic therapy in D1, the duration of parenteral nutrition and central vascular catheter. After logistic regression only the gestational age and duration of parenteral nutrition remained as independent significant risk factors for healthcare-associated sepsis. The independent factors for healthcare-associated sepsis are gestational age and duration of parenteral nutrition. For each extra week on gestational age the risk declined in 20% and for each day of NP the risk increased 22%.

Prediction of gestational age based on genome-wide differentially methylated regions.

PubMed

Bohlin, J; Håberg, S E; Magnus, P; Reese, S E; Gjessing, H K; Magnus, M C; Parr, C L; Page, C M; London, S J; Nystad, W

2016-10-07

We explored the association between gestational age and cord blood DNA methylation at birth and whether DNA methylation could be effective in predicting gestational age due to limitations with the presently used methods. We used data from the Norwegian Mother and Child Birth Cohort study (MoBa) with Illumina HumanMethylation450 data measured for 1753 newborns in two batches: MoBa 1, n = 1068; and MoBa 2, n = 685. Gestational age was computed using both ultrasound and the last menstrual period. We evaluated associations between DNA methylation and gestational age and developed a statistical model for predicting gestational age using MoBa 1 for training and MoBa 2 for predictions. The prediction model was additionally used to compare ultrasound and last menstrual period-based gestational age predictions. Furthermore, both CpGs and associated genes detected in the training models were compared to those detected in a published prediction model for chronological age. There were 5474 CpGs associated with ultrasound gestational age after adjustment for a set of covariates, including estimated cell type proportions, and Bonferroni-correction for multiple testing. Our model predicted ultrasound gestational age more accurately than it predicted last menstrual period gestational age. DNA methylation at birth appears to be a good predictor of gestational age. Ultrasound gestational age is more strongly associated with methylation than last menstrual period gestational age. The CpGs linked with our gestational age prediction model, and their associated genes, differed substantially from the corresponding CpGs and genes associated with a chronological age prediction model.

Pregnancy beyond the age of 40 - the influence of parity on perinatal outcome.

PubMed

Wielgos, Aleksandra; Szymusik, Iwona; Bartnik, Pawel; Kacperczyk, Joanna; Kosinska-Kaczynska, Katarzyna; Pietrzak, Bronislawa

2015-01-01

The aim of the study was to compare the pregnancy course and neonatal outcome in women at least 40 years old during conception. Data were collected on the basis of medical records of patients who gave birth between 2009-2014 at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Women enrolled were at least 40 years old at the moment of conception and delivered after 22 completed weeks of gestation - they were also assigned into 2 groups: primiparas and multiparas. Demographic features, pregnancy and delivery complications, mode of delivery and neonatal outcome were analyzed and compared. 9760 women delivered at the Department during the study period, among them 193 met the inclusion criteria for the study: 40 primiparas (average age 40.9 ± 1.14) and 153 multiparas (average age 41.3 ± 1.35). No relation between parity and preterm delivery was observed (5% primiparas vs 11.1% multiparas; p>0.05). However, gestational age at delivery was associated with the number of pregnancies - the higher the pregnancy number, the lower the gestational age (p=0.009; R=-0.188). Primiparity was associated with an increased rate of oligohydramnios (RR=4.78; 95% CI 1.15-20.63) and pregnancy induced hypertension (RR=2.34; 95% CI 0.93-5.58). Primiparas had a significantly greater risk of operative delivery (RR=1.83; 95% CI 1.42-2.12) and unsuccessful labor inductions (RR=3.60; 95% CI 1.04-5.29). They were more often diagnosed with fibroids (RR=3.04; 95%CI 1.15-7.81). No relations between parity and birth weight, fetal abnormalities or Apgar score were observed. Delayed childbearing of a first child seems to increase the risk of perinatal complications, which is important for counseling purposes.

Gestational Age Patterns of Fetal and Neonatal Mortality in Europe: Results from the Euro-Peristat Project

PubMed Central

Mohangoo, Ashna D.; Buitendijk, Simone E.; Szamotulska, Katarzyna; Chalmers, Jim; Irgens, Lorentz M.; Bolumar, Francisco; Nijhuis, Jan G.; Zeitlin, Jennifer

2011-01-01

Background The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6–9.1‰) and neonatal (1.6–5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Methodology/Principal Findings Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22–23 weeks for neonatal mortality and 22–27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28–31 and 32–36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. Conclusions For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries. PMID:22110575

Birth at 22 gestational weeks: case report of cognitive resilience.

PubMed

Hopp, Crista A; Baron, Ida Sue

2017-02-01

Children delivered at the edge of viability are at greatest risk of medical and neuropsychological disability, their adverse outcomes overshadowing extremely preterm survivors with more optimal outcomes. We aimed to describe an exceptionally early-born extremely preterm (EEEP) preschooler whose neurobiological, familial, and socioeconomic factors likely influenced her unexpected cognitive resilience. Baby G was a 3-years 10-months-old, English-speaking, Caucasian, singleton girl born weighing 435 g at 22 5/7  weeks' gestation to well-educated married parents. Neonatal complications of extremely premature birth included sepsis, severe respiratory distress syndrome, patent ductus arteriosus requiring ligation, necrotizing enterocolitis not requiring surgical intervention, and retinopathy of prematurity. Intellectual and neuropsychological testing was administered. Baby G performed age-appropriately in nearly all domains and did not exhibit intellectual deficits. Her general conceptual ability was above average for both her chronological and adjusted ages. She had below average performance on tests of motor function, working memory, and delayed recall of spatial locations. Standardized parental behavioral questionnaires indicated no concern in emotional or attentional functioning except in relation to mental shifting capacity and signs of anxiety. Report of persistent adverse neurodevelopmental/neuropsychological disabilities following EEEP birth is a counterpoint to the more optimal outcomes in some vulnerable EEEP survivors. This case emphasizes that decisions about aggressive resuscitation and prognostication for infants born EEEP may be enhanced by consideration of individual variability, and of pertinent medical, socioeconomic, and sociodemographic variables that may be more predictive of neuropsychological outcomes than birth weight and gestational age.

Length and weight of very low birth weight infants in Germany at 2 years of age: does it matter at what age they start complementary food?

PubMed

Spiegler, J; Eisemann, N; Ehlers, S; Orlikowsky, T; Kannt, O; Herting, E; Göpel, W

2015-06-01

We analysed at what age parents start complementary food in very low birth weight infants, determined risk factors for early introduction of complementary food (post-term age) and analysed whether the age at introduction of complementary food influences height or weight at 2 years of age. Parents of premature infants born in 2009-2011 answered questionnaires regarding introduction of complementary food in the first year of life (N=2262) and were followed up at a post-term age of 2 years (N=981). Length and weight were compared with full-term infants from the KiGGs study. Logistic and linear regression analyses were conducted to study predictors for early introduction of complementary food and the influence of age at introduction of complementary food on later height and weight. Average age at introduction of complementary food was 3.5 months post-term age. The lower the gestational age at birth, the earlier (post-term age) vegetables and meat were introduced. Age at introduction of complementary food was influenced by intrauterine growth restriction, gestational age at birth, maternal education and a developmental delay perceived by the parents. Length and weight at a post-term age of 2 years was not negatively influenced by early introduction of complementary food. VLBW infants are introduced to complementary food on average before a post-term age of 4 months. There was no negative effect of early introduction of complementary food on height and weight at 2 years of age.

Fifteen years experience with an in-vitro fertilization surrogate gestational pregnancy programme.

PubMed

Goldfarb, J M; Austin, C; Peskin, B; Lisbona, H; Desai, N; de Mola, J R

2000-05-01

The purpose of our study was to review and evaluate retrospectively the experience of an in-vitro fertilization (IVF) surrogate gestational programme in a tertiary care and academic centre. In a 15 year period from 1984 to 1999, a total of 180 cycles of IVF surrogate gestational pregnancy was started in 112 couples. On average, the women were 34.4 +/- 4.4 years of age, had 11.1 +/- 0.72 oocytes obtained per retrieval, 7.1 +/- 0.5 oocytes fertilized and 5. 8 +/- 0.4 embryos subsequently cleaved. Sixteen cycles (8.9%) were cancelled due to poor stimulation. Except for six cycles (3.3%) where there were no embryos available, an average of 3.2 +/- 0.1 embryos was transferred to each individual recipient. The overall pregnancy rate per cycle after IVF surrogacy was 24% (38 of 158), with a clinical pregnancy rate of 19% (30 of 158), and a live birth rate of 15.8% (25 of 158). When compared to patients who underwent a hysterectomy, individuals with congenital absence of the uterus had significantly more oocytes retrieved (P < 0.006), fertilized, cleaved and more embryos available for transfer despite being of comparable age. IVF surrogate gestation is an established, yet still controversial, approach to the care of infertile couples. Take-home baby rates are comparable to conventional IVF over the same 15 year span in our programme. Patients with congenital absence of the uterus responded to ovulation induction better than patients who underwent a hysterectomy, perhaps due in part to ovarian compromise from previous surgical procedures.

[Our experience based on Omneo 1 /Nutrilon Comfort 1/ formula-fed of high-risk newborn babies].

PubMed

Rosmanova, R; Simov, V

2007-01-01

To investigate the acceptability and effect of Omneo 1/Nutrilon Comfort/milk formula of high-risk newborn babies. Omneo 1 was given as food to 30 high-risk newborn babies. All of them were prematurely born of an average birth gestation age-33 gestation weeks and of average weight--1757,16 gr. None of the infants was ever fed mother's milk. The intake of Omneo 1 was applied to infants of stabilized health condition and post conceptual age no less than 38 gestation weeks /the average gestation weeks were 38,96/. The following parameters were closely observed: Body weight was measured once a week with the accuracy of +/- 5 gr.; The fecal pH was measured an 20 babies by means of multicolor indication paper Merck Eurolaba GmbH, Darmstadt, Germany; Stool characteristics-consistency and frequency, regurgitation and vomiting were recorded on the basis of mother's and personals interview. Methods used--clinical analysis, inquiry method, laboratory and anthropometric measuring. The survey is prospective. Weight gain was of 800 gr up to 1200 gr per month. Per day was achieved at an average weight gain - 37,60 gr. Decrease fecal pH was observed--at the beginning 7.1 (+/- 0.65) at the end of the study--5.1(+/-). The acidity of the excrements decreased which suppressed the development of pathogenic microorganisms. As regards the public inquiry, parents did not report cases an gastro-intestinal discomfort (regurgitation, constipation, colic). In two of the babies, blood in the excrements was macroscopically traced and "Allergy to cow's milk protein" was diagnosed. One of the infants was hospitalized with a generalized infection. The feeding with Omneo 1 was suspended in the case of these newborn, and they were excluded from the survey. Parents are positive about feeding Omneo 1 despite the higher price of the product. Omneo 1 milk contributes to adequate weight growth of high-risk newborn babies and its intake results in lower fecal pH as an indicator of positive bifidus effect.

Correction of systematic bias in ultrasound dating in studies of small-for-gestational-age birth: an example from the Iowa Health in Pregnancy Study.

PubMed

Harland, Karisa K; Saftlas, Audrey F; Wallis, Anne B; Yankowitz, Jerome; Triche, Elizabeth W; Zimmerman, M Bridget

2012-09-01

The authors examined whether early ultrasound dating (≤20 weeks) of gestational age (GA) in small-for-gestational-age (SGA) fetuses may underestimate gestational duration and therefore the incidence of SGA birth. Within a population-based case-control study (May 2002-June 2005) of Iowa SGA births and preterm deliveries identified from birth records (n = 2,709), the authors illustrate a novel methodological approach with which to assess and correct for systematic underestimation of GA by early ultrasound in women with suspected SGA fetuses. After restricting the analysis to subjects with first-trimester prenatal care, a nonmissing date of the last menstrual period (LMP), and early ultrasound (n = 1,135), SGA subjects' ultrasound GA was 5.5 days less than their LMP GA, on average. Multivariable linear regression was conducted to determine the extent to which ultrasound GA predicted LMP dating and to correct for systematic misclassification that results after applying standard guidelines to adjudicate differences in these measures. In the unadjusted model, SGA subjects required a correction of +1.5 weeks to the ultrasound estimate. With adjustment for maternal age, smoking, and first-trimester vaginal bleeding, standard guidelines for adjudicating differences in ultrasound and LMP dating underestimated SGA birth by 12.9% and overestimated preterm delivery by 8.7%. This methodological approach can be applied by researchers using different study populations in similar research contexts.

[Embryo volume estimated by three-dimensional ultrasonography at seven to ten weeks of pregnancy].

PubMed

Filho, João Bortoletti; Nardozza, Luciano Marcondes Machado; Araujo Júnior, Edward; Rôlo, Líliam Cristine; Nowak, Paulo Martin; Moron, Antonio Fernandes

2008-10-01

to evaluate the embryo's volume (EV) between the seventh and the tenth gestational week, through tridimensional ultrasonography. a transversal study with 63 normal pregnant women between the seventh and the tenth gestational week. The ultrasonographical exams have been performed with a volumetric abdominal transducer. Virtual Organ Computer-aided Analysis (VOCAL) has been used to calculate EV, with a rotation angle of 12 masculine and a delimitation of 15 sequential slides. The average, median, standard deviation and maximum and minimum values have been calculated for the EV in all the gestational ages. A dispersion graphic has been drawn to assess the correlation between EV and the craniogluteal length (CGL), the adjustment being done by the determination coefficient (R(2)). To determine EV's reference intervals as a function of the CGL, the following formula was used: percentile=EV+K versus SD, with K=1.96. CGL has varied from 9.0 to 39.7 mm, with an average of 23.9 mm (+/-7.9 mm), while EV has varied from 0.1 to 7.6 cm(3), with an average of 2.7 cm(3) (+/-3.2 cm(3)). EV was highly correlated to CGL, the best adjustment being obtained with quadratic regression (EV=0.2-0.055 versus CGL+0.005 versus CGL(2); R(2)=0.8). The average EV has varied from 0.1 (-0.3 to 0.5 cm(3)) to 6.7 cm(3) (3.8 to 9.7 cm(3)) within the interval of 9 to 40 mm of CGL. EV has increased 67 times in this interval, while CGL, only 4.4 times. EV is a more sensitive parameter than CGL to evaluate embryo growth between the seventh and the tenth week of gestation.

Gestational age-dependent risk factors for preterm birth: associations with maternal education and age early in gestation.

PubMed

Auger, Nathalie; Abrahamowicz, Michal; Wynant, Willy; Lo, Ernest

2014-05-01

Preterm birth (PTB) before 37 weeks can occur over a wide range of gestational ages, but few studies have assessed if associations between risk factors and PTB vary over the duration of gestation. We sought to evaluate if associations between two major risk factors (maternal education and age) and PTB depend on gestational age at delivery. We estimated hazard ratios of PTB for education and age in a time-to-event analysis using a retrospective cohort of 223,756 live singleton births from the province of Québec, Canada for the years 2001-2005. Differences in hazards of maternal education and age with PTB were assessed over gestational age in a Cox proportional hazards model using linear and nonlinear time interaction terms, adjusting for maternal characteristics. Associations of PTB with lower (vs. higher) education and older (vs. younger) age strengthened progressively at earlier gestational ages, such that the risk of PTB for maternal education and age was not constant over the course of gestation. Associations of PTB with risk factors such as maternal low education and older age may be stronger early in gestation. Models that capture the time-dependent nature of PTB may be useful when the goal is to assess associations at low gestational ages, and to avoid masked or biased associations early in gestation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[The anatomical features of the middle ear exerting the influence on the formation of exudative otitis media in the breast-fed infants of different gestational age].

PubMed

Matroskin, A G; Rakhmanova, I V; Dreval', A A; Kislyakov, A N; Vladimirov, A I

The objective of the present study was to elucidate the anatomical features of the structure of the middle ear and eustachian tube in the breast-fed infants of different gestational age that may be responsible for the formation of exudates (fluids). We have examined 150 temporal bones obtained from the children's cadavers that were allocated to three groups as follows: 50 temporal bones obtained at weeks 26-30 weeks of gestation (group 1), 44 bones 31-36 weeks of gestation (group 2), and 37-40 weeks of gestation (full-term babies, group 3),The analysis of the data obtained on an individual bases revealed either increase or decreases in the selected characteristics of the eustachian tube in comparison with the respective average values as well as the well apparent predominance of a single change or a combination of alteration of several parameters in one case in 26-30 weeks and 31-36 weeks groups. No significant changes were found in group 1. It is concluded that the presence of a single change or a combination of two or three abnormal changes in the parameters of the bone structures of the eustachian tube can affect the development of the secretory process in the middle ear especially in the children born after 36 weeks of pregnancy.

Auditory brainstem response in neonates: influence of gender and weight/gestational age ratio

PubMed Central

Angrisani, Rosanna M. Giaffredo; Bautzer, Ana Paula D.; Matas, Carla Gentile; de Azevedo, Marisa Frasson

2013-01-01

OBJECTIVE: To investigate the influence of gender and weight/gestational age ratio on the Auditory Brainstem Response (ABR) in preterm (PT) and term (T) newborns. METHODS: 176 newborns were evaluated by ABR; 88 were preterm infants - 44 females (22 small and 22 appropriate for gestational age) and 44 males (22 small and 22 appropriate for gestational age). The preterm infants were compared to 88 term infants - 44 females (22 small and 22 appropriate for gestational age) and 44 males (22 small and 22 appropriate for gestational age). All newborns had bilateral presence of transient otoacoustic emissions and type A tympanometry. RESULTS: No interaural differences were found. ABR response did not differentiate newborns regarding weight/gestational age in males and females. Term newborn females showed statistically shorter absolute latencies (except on wave I) than males. This finding did not occur in preterm infants, who had longer latencies than term newborns, regardless of gender. CONCLUSIONS: Gender and gestational age influence term infants' ABR, with lower responses in females. The weight/gestational age ratio did not influence ABR response in either groups. PMID:24473955

Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy.

PubMed

Ferrazzi, Enrico; Stampalija, Tamara; Monasta, Lorenzo; Di Martino, Daniela; Vonck, Sharona; Gyselaers, Wilfried

2018-01-01

The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m 2 ) on maternal hemodynamics was reassessed in the same groups. Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic. Copyright © 2017 Elsevier Inc. All rights reserved.

Prediction of Nine Month Performance from Neonatal and Developmental Criteria.

ERIC Educational Resources Information Center

Sweet, John F., Jr.; And Others

This study investigated the ability of the Neonatal Behavioral Assessment Scale (NBAS), in combination with neonatal histories and developmental assessments, to predict mental and motor performance of 9-month-old infants on the Bayley Scales of Infant Development (BSID). Fourteen normal, full-term infants and 10 average-for-gestational-age,…

Prenatal Exposure to Tetrachloroethylene-Contaminated Drinking Water and the Risk of Adverse Birth Outcomes

PubMed Central

Aschengrau, Ann; Weinberg, Janice; Rogers, Sarah; Gallagher, Lisa; Winter, Michael; Vieira, Veronica; Webster, Thomas; Ozonoff, David

2008-01-01

Background Prior studies of prenatal exposure to tetrachloroethylene (PCE) have shown mixed results regarding its effect on birth weight and gestational age. Objectives In this retrospective cohort study we examined whether PCE contamination of public drinking-water supplies in Massachusetts influenced the birth weight and gestational duration of children whose mothers were exposed before the child’s delivery. Methods The study included 1,353 children whose mothers were exposed to PCE-contaminated drinking water and a comparable group of 772 children of unexposed mothers. Birth records were used to identify subjects and provide information on the outcomes. Mothers completed a questionnaire to gather information on residential histories and confounding variables. PCE exposure was estimated using EPANET water distribution system modeling software that incorporated a fate and transport model. Results We found no meaningful associations between PCE exposure and birth weight or gestational duration. Compared with children whose mothers were unexposed during the year of the last menstrual period (LMP), adjusted mean differences in birth weight were 20.9, 6.2, 30.1, and 15.2 g for children whose mothers’ average monthly exposure during the LMP year ranged from the lowest to highest quartile. Similarly, compared with unexposed children, adjusted mean differences in gestational age were −0.2, 0.1, −0.1, and −0.2 weeks for children whose mothers’ average monthly exposure ranged from the lowest to highest quartile. Similar results were observed for two other measures of prenatal exposure. Conclusions These results suggest that prenatal PCE exposure does not have an adverse effect on these birth outcomes at the exposure levels experienced by this population. PMID:18560539

Climate Change and Fetal Health: The Impacts of Exposure to Extreme Temperatures in New York City

NASA Technical Reports Server (NTRS)

Ngo, Nicole S.; Horton, Radley M.

2015-01-01

Background: Climate change is projected to increase the frequency, intensity, and duration of heat waves while reducing cold extremes, yet few studies have examined the relationship between temperature and fetal health. Objectives: We estimate the impacts of extreme temperatures on birth weight and gestational age in Manhattan, a borough in New York City, and explore differences by socioeconomic status (SES). Methods: We combine average daily temperature from 1985 to 2010 with birth certificate data in Manhattan for the same time period. We then generate 33 downscaled climate model time series to project impacts on fetal health. Results: We find exposure to an extra day where average temperature 25 F and 85 F during pregnancy is associated with a 1.8 and 1.7 g (respectively) reduction in birth weight, but the impact varies by SES, particularly for extreme heat, where teen mothers seem most vulnerable. We find no meaningful, significant effect on gestational age. Using projections of temperature from these climate models, we project average net reductions in birth weight in the 2070- 2099 period of 4.6 g in the business-as-usual scenario. Conclusions: Results suggest that increasing heat events from climate change could adversely impact birth weight and vary by SES.

Last menstrual period provides the best estimate of gestation length for women in rural Guatemala.

PubMed

Neufeld, Lynnette M; Haas, Jere D; Grajéda, Ruben; Martorell, Reynaldo

2006-07-01

The accurate estimation of gestational age in field studies in rural areas of developing countries continues to present difficulties for researchers. Our objective was to determine the best method for gestational age estimation in rural Guatemala. Women of childbearing age from four communities in rural Guatemala were invited to participate in a longitudinal study. Gestational age at birth was determined by an early second trimester measure of biparietal diameter, last menstrual period (LMP), the Capurro neonatal examination and symphysis-fundus height (SFH) for 171 women-infant pairs. Regression modelling was used to determine which method provided the best estimate of gestational age using ultrasound as the reference. Gestational age estimated by LMP was within +/-14 days of the ultrasound estimate for 94% of the sample. LMP-estimated gestational age explained 46% of the variance in gestational age estimated by ultrasound whereas the neonatal examination explained only 20%. The results of this study suggest that, when trained field personnel assist women to recall their date of LMP, this date provides the best estimate of gestational age. SFH measured during the second trimester may provide a reasonable alternative when LMP is unavailable.

Cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers.

PubMed

Vela-Huerta, M; Aguilera-López, A; Alarcón-Santos, S; Amador, N; Aldana-Valenzuela, C; Heredia, A

2007-09-01

To compare cardiopulmonary adaptation in large for gestational age infants of diabetic and nondiabetic mothers. Color Doppler echocardiography was performed in 113 (22 large for gestational age infants of diabetic mothers, 21 of nondiabetic mothers and 70 adequate for gestational age newborns) full-term infants. Pulmonary arterial pressure was significantly higher in infants of diabetic mothers than in those of nondiabetic mothers and normal infants at 24 h (38.5 vs. 32.5, and 35.5 mmHg, respectively). However, slow fall in this parameter was shown in all large for gestational age infants. Open ductus arteriosus was frequent in all large for gestational age infants, but its closure was significantly delayed in infants of diabetic mothers. Septal hypertrophy was higher in infants of diabetic mothers than in large for gestational age infants of nondiabetic mothers. Large for gestational age infants born from nondiabetic mothers showed delayed fall in pulmonary arterial pressure similar to those born from diabetic mothers but showed lower proportion of septal hypertrophy. Patent ductus arteriosus persisted for longer period of time in all large for gestational age infants than in normal infants, but its closure was significantly delayed in infants of diabetic mothers.

Association of Temporal Changes in Gestational Age With Perinatal Mortality in the United States, 2007-2015.

PubMed

Ananth, Cande V; Goldenberg, Robert L; Friedman, Alexander M; Vintzileos, Anthony M

2018-05-14

Whether the changing gestational age distribution in the United States since 2005 has affected perinatal mortality remains unknown. To examine changes in gestational age distribution and gestational age-specific perinatal mortality. This retrospective cohort study examined trends in US perinatal mortality by linking live birth and infant death data among more than 35 million singleton births from January 1, 2007, through December 31, 2015. Year of birth and changes in gestational age distribution. Changes in the proportion of births at gestational ages 20 to 27, 28 to 31, 32 to 33, 34 to 36, 37 to 38, 39 to 40, 41, and 42 to 44 weeks; changes in perinatal mortality (stillbirth at ≥20 weeks, and neonatal deaths at <28 days) rates; and contribution of gestational age changes to perinatal mortality. Trends were estimated from log-linear regression models adjusted for confounders. Among the 34 236 577 singleton live births during the study period, the proportion of births at all gestational ages declined, except at 39 to 40 weeks, which increased (54.5% in 2007 to 60.2% in 2015). Overall perinatal mortality declined from 9.0 to 8.6 per 1000 births (P < .001). Stillbirths declined from 5.7 to 5.6 per 1000 births (P < .001), and neonatal mortality declined from 3.3 to 3.0 per 1000 births (P < .001). Although the proportion of births at gestational ages 34 to 36, 37 to 38, and 42 to 44 weeks declined, perinatal mortality rates at these gestational ages showed annual adjusted relative increases of 1.0% (95% CI, 0.6%-1.4%), 2.3% (95% CI, 1.9%-2.8%), and 4.2% (95% CI, 1.5%-7.0%), respectively. Neonatal mortality rates at gestational ages 34 to 36 and 37 to 38 weeks showed a relative adjusted annual increase of 0.9% (95% CI, 0.2%-1.6%) and 3.1% (95% CI, 2.1%-4.1%), respectively. Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality showed an annual relative adjusted decline of -1.3% (95% CI, -1.8% to -0.9%). The decline in neonatal mortality rate was largely attributable to changes in the gestational age distribution than to gestational age-specific mortality. Although the proportion of births at gestational age 39 to 40 weeks increased, perinatal mortality at this gestational age declined. This finding may be owing to pregnancies delivered at 39 to 40 weeks that previously would have been unnecessarily delivered earlier, leaving fetuses at higher risk for mortality at other gestational ages.

Variation between last-menstrual-period and clinical estimates of gestational age in vital records.

PubMed

Qin, Cheng; Hsia, Jason; Berg, Cynthia J

2008-03-15

An accurate assessment of gestational age is vital to population-based research and surveillance in maternal and infant health. However, the quality of gestational age measurements derived from birth certificates has been in question. Using the 2002 US public-use natality file, the authors examined the agreement between estimates of gestational age based on the last menstrual period (LMP) and clinical estimates in vital records across durations of gestation and US states and explored reasons for disagreement. Agreement between the LMP and the clinical estimate of gestational age varied substantially across gestations and among states. Preterm births were more likely than term births to have disagreement between the two estimates. Maternal age, maternal education, initiation of prenatal care, order of livebirth, and use of ultrasound had significant independent effects on the disagreement between the two measures, regardless of gestational age, but these factors made little difference in the magnitude of gestational age group differences. Information available on birth certificates was not sufficient to understand this disparity. The lowest agreement between the LMP and the clinical estimate was observed among preterm infants born at 28-36 weeks' gestation, who accounted for more than 90% of total preterm births. This finding deserves particular attention and further investigation.

Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study.

PubMed

Quigley, Maria A; Poulsen, Gry; Boyle, Elaine; Wolke, Dieter; Field, David; Alfirevic, Zarko; Kurinczuk, Jennifer J

2012-05-01

To compare school performance at age 5 years in children born at full term (39-41 weeks gestation) with those born at early term (37-38 weeks gestation), late preterm (34-36 weeks gestation), moderately preterm (32-33 weeks gestation) and very preterm (<32 weeks gestation). Population-based cohort (UK Millennium Cohort Study). Seven thousand six hundred and fifty children born in 2000-2001 and attending school in England in 2006. School performance was measured using the foundation stage profile (FSP), a statutory assessment by teachers at the end of the child's first school year. The FSP comprises 13 assessment scales (scored from 1 to 9). Children who achieve an average of 6 points per scale and at least 6 in certain scales are classified as 'reaching a good level of overall achievement'. Fifty-one per cent of full term children had not reached a good level of overall achievement; this proportion increased with prematurity (55% in early term, 59% in late preterm, 63% in moderately preterm and 66% in very preterm children). Compared with full term children, an elevated risk remained after adjustment, even in early term (adjusted RR 1.05, 95% 1.00 to 1.11) and late preterm children (adjusted RR 1.12, 95% CI 1.04 to 1.22). Similar effects were noted for 'not working securely' in mathematical development, physical development and creative development. The effects of late preterm and early term birth were small in comparison with other risk factors. Late preterm and early term birth are associated with an increased risk of poorer educational achievement at age 5 years.

Gestational age estimates from singleton births conceived using assisted reproductive technology.

PubMed

Callaghan, William M; Schieve, Laura A; Dietz, Patricia M

2007-09-01

Information on gestational age for public health research and surveillance in the US is usually obtained from vital records and is primarily based on the first day of the woman's last menstrual period (LMP). However, using LMP as a marker of conception is subject to a variety of errors and results in misclassification of gestational age. Pregnancies conceived through assisted reproductive technology (ART) are unique in that the estimates of gestational age are not based on the LMP, but on the date when fertilisation actually occurred, and thus most gestational age errors are likely to be due to errors introduced in recording and data entry. The purpose of this paper was to examine the birthweight distribution by gestational age for ART singleton livebirths reported to a national ART surveillance system. Gestational age was categorised as 20-27, 28-31, 32-36 and 37-44 weeks; birthweight distributions were plotted for each category. The distributions of very-low-birthweight (VLBW; <1500 g), moderately low-birthweight (1500-2499 g) and normal-birthweight infants for each gestational week were examined. At both 20-27 and 28-31 weeks, there was an extended right tail to the distribution and a small second mode. At 32-36 weeks, there were long tails in either direction and at 37-44 weeks, an extended tail to the left. There was a high proportion of VLBW infants at low gestational ages and a decreasing proportion of VLBW infants with increasing gestational age. However, there was also a fairly constant proportion of normal-birthweight infants at every gestational age below 34 weeks, which suggested misclassification of gestational age. Approximately 12% of ART births classified as 28-31 weeks' gestation had a birthweight in the second mode of the birthweight distribution compared with approximately 29% in national vital statistics data. Even when the birthweight and dates of conception and birth are known, questions remain regarding the residual amount of misclassification and the true nature of the birthweight distributions.

Association between gestational age and bovine fetal characteristics measured by transcutaneous ultrasound over the right flank of the dairy cow.

PubMed

Hunnam, J C; Parkinson, T J; Lopez-Villalobos, N; McDougall, S

2009-09-01

To determine bovine fetal characteristics significantly associated with increasing gestational age as measured via transcutaneous ultrasonography over the right flank. The length of gestation at date of pregnancy diagnosis via transcutaneous and transrectal ultrasonography was determined for 224 dairy cattle by estimation from subsequent calving dates. A separate dataset was created for each measurable fetal characteristic (i.e. thoracic diameter, abdominal diameter, umbilical diameter, placentome length and placentome height) and risk factors significantly associated with gestational age at pregnancy diagnosis within each dataset, including the fetal characteristic, were identified. Abdominal diameter was the most frequently observed fetal characteristic and thoracic diameter was the least. Gestational age at pregnancy diagnosis (d) was significantly associated with fetal thoracic diameter (P < 0.01), abdominal diameter (P < 0.01) and umbilical diameter (P = 0.02) when measured via transcutaneous ultrasound. Within each model, sire breed, dam breed, dam age and/or calf sex were also significantly associated with gestational age. Gestational age at pregnancy diagnosis was not significantly associated with either placentome height or length (P > 0.05). Fetal thoracic diameter, abdominal diameter and umbilical diameter were found to be significantly associated with gestational age between approximate days 73 to 190 of gestation. Transcutaneous ultrasonography may prove a useful method of estimating gestational age in the absence of accurate breeding records.

Growth after late-preterm birth and adult cognitive, academic, and mental health outcomes.

PubMed

Sammallahti, Sara; Heinonen, Kati; Andersson, Sture; Lahti, Marius; Pirkola, Sami; Lahti, Jari; Pesonen, Anu-Katriina; Lano, Aulikki; Wolke, Dieter; Eriksson, Johan G; Kajantie, Eero; Raikkonen, Katri

2017-05-01

Late-preterm birth (at 34 0⁄7 -36 6⁄7 wk gestation) increases the risk of early growth faltering, poorer neurocognitive functioning, and lower socio-economic attainment. Among early-preterm individuals, faster early growth benefits neurodevelopment, but it remains unknown whether these benefits extend to late-preterm individuals. In 108 late-preterm individuals, we examined if weight, head, or length growth between birth, 5 and 20 months' corrected age, and 56 mo, predicted grade point average and special education in comprehensive school, or neurocognitive abilities and psychiatric diagnoses/symptoms at 24-26 y of age. For every 1 SD faster weight and head growth from birth to 5 mo, and head growth from 5 to 20 mo, participants had 0.19-0.41 SD units higher IQ, executive functioning score, and grade point average (95% confidence intervals (CI) 0.002-0.59 SD), and lower odds of special education (odds ratio (OR) = 0.49-0.59, 95% CIs 0.28-0.97), after adjusting for sex, gestational age, follow-up age, and parental education. Faster head growth from 20 to 56 mo was associated with less internalizing problems; otherwise we found no consistent associations with mental health outcomes. Faster growth during the critical early period after late-preterm birth is associated with better adult neurocognitive functioning, but not consistently with mental health outcomes.

Gestational age assessment in malaria pregnancy cohorts: a prospective ultrasound demonstration project in Malawi.

PubMed

Wylie, Blair J; Kalilani-Phiri, Linda; Madanitsa, Mwayi; Membe, Gladys; Nyirenda, Osward; Mawindo, Patricia; Kuyenda, Redson; Malenga, Albert; Masonbrink, Abbey; Makanani, Bonus; Thesing, Phillip; Laufer, Miriam K

2013-06-04

Malaria during pregnancy is associated with an increased risk for low birth weight (<2500 grams). Distinguishing infants that are born premature (< 37 weeks) from those that are growth-restricted (less than the 10th percentile at birth) requires accurate assessment of gestational age. Where ultrasound is accessible, sonographic confirmation of gestational age is more accurate than menstrual dating. The goal was to pilot the feasibility and utility of adding ultrasound to an observational pregnancy malaria cohort. In July 2009, research staff (three mid-level clinical providers, one nurse) from The Blantyre Malaria Project underwent an intensive one-week ultrasound training to perform foetal biometry. Following an additional four months of practice and remote image review, subjects from an ongoing cohort were recruited for ultrasound to determine gestational age. Gestational age at delivery established by ultrasound was compared with postnatal gestational age assessment (Ballard examination). One hundred and seventy-eight women were enrolled. The majority of images were of good quality (94.3%, 509/540) although a learning curve was apparent with 17.5% (24/135) images of unacceptable quality in the first 25% of scans. Ultrasound was used to date 13% of the pregnancies when menstrual dates were unknown and changed the estimated gestational age for an additional 25%. There was poor agreement between the gestational age at delivery as established by the ultrasound protocol compared to that determined by the Ballard examination (bias 0.8 weeks, limits of agreement -3.5 weeks to 5.1 weeks). The distribution of gestational ages by Ballard suggested a clustering of gestational age around the mean with 87% of the values falling between 39 and 41 weeks. The distribution of gestational age by ultrasound confirmed menstrual dates was more typical. Using ultrasound confirmed dates as the gold standard, 78.5% of preterm infants were misclassified as term and 26.8% of small-for gestational age infants misclassified as appropriately grown by Ballard. Ultrasound should be strongly considered in prospective malaria studies with obstetric endpoints to confirm gestational age and avoid misclassification of infants as premature or growth-restricted. The use of ultrasound does require a significant investment of time to maintain quality image acquisition.

Accuracy of gestational age estimation from last menstrual period among women seeking abortion in South Africa, with a view to task sharing: a mixed methods study.

PubMed

Constant, Deborah; Harries, Jane; Moodley, Jennifer; Myer, Landon

2017-08-22

The requirement for ultrasound to establish gestational age among women seeking abortion can be a barrier to access. Last menstrual period dating without clinical examination should be a reasonable alternative among selected women, and if reliable, can be task-shared with non-clinicians. This study determines the accuracy of gestational age estimation using last menstrual period (LMP) assessed by community health care workers (CHWs), and explores providers' and CHWs' perspectives on task sharing this activity. The study purpose is to expand access to early medical abortion services. We conducted a multi-center cross-sectional study at four urban non-governmental reproductive health clinics in South Africa. CHWs interviewed women seeking abortion, recorded their LMP and gestational age from a pregnancy wheel if within 63 days. Thereafter, providers performed a standard examination including ultrasound to determine gestational age. Lastly, investigators calculated gestational age for all LMP dates recorded by CHWs. We compared mean gestational age from LMP dates to mean gestational age by ultrasound using t-tests and calculated proportions for those incorrectly assessed as eligible for medical abortion from LMP. In addition, in-depth interviews were conducted with six providers and seven CHWs. Mean gestational age was 5 days (by pregnancy wheel) and 9 days (by LMP calculation) less than ultrasound gestational age. Twelve percent of women were eligible for medical abortion by LMP calculation but ineligible by ultrasound. Uncertainty of LMP date was associated with incorrect assessment of gestational age eligibility for medical abortion (p = 0.015). For women certain their LMP date was within 56 days, 3% had ultrasound gestational ages >70 days. In general, providers and CHWs were in favour of task sharing screening and referral for abortion, but were doubtful that women reported accurate LMP dates. Different perspectives emerged on how to implement task sharing gestational age eligibility for medical abortion. If LMP recall is within 56 days, most women will be eligible for early medical abortion and LMP can substitute for ultrasound dating. Task sharing gestational age estimation is feasible in South Africa, but its implementation should meet women's privacy needs and address healthcare workers' concerns on managing any procedural risk.

Validity of gestational age estimates by last menstrual period and neonatal examination compared to ultrasound in Vietnam.

PubMed

Deputy, Nicholas P; Nguyen, Phuong H; Pham, Hoa; Nguyen, Son; Neufeld, Lynnette; Martorell, Reynaldo; Ramakrishnan, Usha

2017-01-11

Accurate estimation of gestational age is important for both clinical and public health purposes. Estimates of gestational age using fetal ultrasound measurements are considered most accurate but are frequently unavailable in low- and middle-income countries. The objective of this study was to assess the validity of last menstrual period and Farr neonatal examination estimates of gestational age, compared to ultrasound estimates, in a large cohort of women in Vietnam. Data for this analysis come from a randomized, placebo-controlled micronutrient supplementation trial in Vietnam. We analyzed 912 women with ultrasound and prospectively-collected last menstrual period estimates of gestational age and 685 women with ultrasound and Farr estimates of gestational age. We used the Wilcoxon signed rank sum test to assess differences in gestational age estimated by last menstrual period or Farr examination compared to ultrasound and computed the intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) to quantify agreement between methods. We computed the Kappa coefficient (κ) to quantify agreement in preterm, term and post-term classification. The median gestational age estimated by ultrasound was 273.9 days. Gestational age was slightly overestimated by last menstrual period (median 276.0 days, P < 0.001) and more greatly overestimated by Farr examination (median 286.7 days, P < 0.001). Gestational age estimates by last menstrual period and ultrasound were moderately correlated (ICC = 0.78) and concordant (CCC = 0.63), whereas gestational age estimates by Farr examination and ultrasound were weakly correlated (ICC = 0.26) and concordant (CCC = 0.05). Last menstrual period and ultrasound estimates of gestational age were within ± 14 days for 88.4% of women; Farr and ultrasound estimates were within ± 14 days for 55.8% of women. Last menstrual period and ultrasound estimates of gestational age had higher agreement in term classification (κ = 0.41) than Farr and ultrasound (κ = 0.05). In this study of women in Vietnam, we found last menstrual period provided a more accurate estimate of gestational age than the Farr examination when compared to ultrasound. These findings provide useful information about the utility and accuracy of different methods to estimate gestational age and suggest last menstrual period may be preferred over Farr examination in settings where ultrasound is unavailable. The trial was registered at ClinicalTrials.Gov as NCT01665378 on August 13, 2012.

Neonatal Mortality Risk Associated with Preterm Birth in East Africa, Adjusted by Weight for Gestational Age: Individual Participant Level Meta-Analysis

PubMed Central

Marchant, Tanya; Willey, Barbara; Katz, Joanne; Clarke, Siân; Kariuki, Simon; ter Kuile, Feiko; Lusingu, John; Ndyomugyenyi, Richard; Schmiegelow, Christentze; Watson-Jones, Deborah; Armstrong Schellenberg, Joanna

2012-01-01

Background Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age in the high mortality setting of East Africa. Methods and Findings Members and collaborators of the Malaria and the MARCH Centers, at the London School of Hygiene & Tropical Medicine, were contacted and protocols reviewed for East African studies that measured (1) birth weight, (2) gestational age at birth using antenatal ultrasound or neonatal assessment, and (3) neonatal mortality. Ten datasets were identified and four met the inclusion criteria. The four datasets (from Uganda, Kenya, and two from Tanzania) contained 5,727 births recorded between 1999–2010. 4,843 births had complete outcome data and were included in an individual participant level meta-analysis. 99% of 445 low birth weight (<2,500 g) babies were either preterm (<37 weeks gestation) or small for gestational age (below tenth percentile of weight for gestational age). 52% of 87 neonatal deaths occurred in preterm or small for gestational age babies. Babies born <34 weeks gestation had the highest odds of death compared to term babies (odds ratio [OR] 58.7 [95% CI 28.4–121.4]), with little difference when stratified by weight for gestational age. Babies born 34–36 weeks gestation with appropriate weight for gestational age had just three times the likelihood of neonatal death compared to babies born term, (OR 3.2 [95% CI 1.0–10.7]), but the likelihood for babies born 34–36 weeks who were also small for gestational age was 20 times higher (OR 19.8 [95% CI 8.3–47.4]). Only 1% of babies were born moderately premature and small for gestational age, but this group suffered 8% of deaths. Individual level data on newborns are scarce in East Africa; potential biases arising due to the non-systematic selection of the individual studies, or due to the methods applied for estimating gestational age, are discussed. Conclusions Moderately preterm babies who are also small for gestational age experience a considerably increased likelihood of neonatal death in East Africa. Please see later in the article for the Editors' Summary. PMID:22904691

Gestation age dependent transfer of human immunoglobulins across placenta in timed-pregnant guinea pigs.

PubMed

Xu, Yanqun; Ma, Li; Norton, Malgorzata G; Stuart, Christine; Zhao, Zhong; Toibero, Denise; Dahlen, Shelby; Zhong, Lilin; Zhang, Pei; Struble, Evi B

2015-12-01

When administered during pregnancy, antibodies and other biologic drugs that contain the Fc part of the IgG molecule can traverse the placenta. Although it is generally accepted that the FcRn receptor mediates this process, gaps remain in our understanding of underlying details in humans and in common laboratory animal species. We expanded our previous studies in timed-pregnant guinea pigs to both measure the transport of human (h) IgG at earlier gestation ages in vivo and evaluate FcRn function in vitro using Surface Plasmon Resonance (SPR) and Madin-Darby canine kidney cells (MDCK) that express guinea pig (gp) FcRn. In timed-pregnant guinea pigs both the average concentration of hIgG in the fetus and its ratio to maternal hIgG concentration increase exponentially with gestation age. Thus, hIgG fetal:maternal concentration ratios increase from an average of 1% to 3%, 17%, and 76% on GD ∼26, 35, 46, and 54, respectively. In vitro, gpFcRn immobilized on a solid surface can bind hIgG and gpIgG preparations in a similar manner. All engineered human Fc isotype-specific constructs were internalized by MDCK-gpFcRn cells at significant levels. While not significant, their recycling and hIgG transcytosis by this cell line also trend higher than background controls. Pregnant guinea pigs exhibit similarities with humans in the degree and timing of transplacental transfer as well as the ability of their FcRn to bind and internalize hIgG in vitro. Further studies are needed to guide building appropriate systems for the evaluation of FcRn mediated function of human immunoglobulin therapies. Published by Elsevier Ltd.

Impact of obesity on perinatal outcomes among asthmatic women

PubMed Central

Thuot, Meggie; Coursol, Marc-André; Nguyen, Sonia; Lacasse-Guay, Vanessa; Beauchesne, Marie-France; Fillion, Anne; Forget, Amélie; Kettani, Fatima-Zohra; Blais, Lucie

2013-01-01

BACKGROUND: Only one study has investigated the combined effect of maternal asthma and obesity on perinatal outcomes; however, it did not consider small-for-gestational age and large-for-gestational age infants. OBJECTIVES: To examine the impact of obesity on perinatal outcomes among asthmatic women. METHODS: A cohort of 1386 pregnancies from asthmatic women was reconstructed using three of Quebec’s administrative databases and a questionnaire. Women were categorized using their prepregnancy body mass index. Underweight, overweight and obese women were compared with normal weight women. The primary outcome was the birth of a small-for-gestational-age infant, defined as a birth weight below the 10th percentile for gestational age and sex. Secondary outcomes were large-for-gestational-age infants (birth weight >90th percentile for gestational age) and preterm birth (<37 weeks’ gestation). Logistic regression models were used to obtain the ORs of having small-for-gestational-age infants, large-for-gestational-age infants and preterm birth as a function of body mass index. RESULTS: The proportions of underweight, normal weight, overweight and obese women were 10.8%, 53.3%, 19.7% and 16.2%, respectively. Obese asthmatic women were not found to be significantly more at risk for giving birth to small-for-gestational-age infants (OR 0.6 [95% CI 0.4 to 1.1]), large-for-gestational-age infants (OR 1.2 [95% CI 0.7 to 2.2]) or having a preterm delivery (OR 0.7 [95% CI 0.4 to 1.3]) than normal-weight asthmatic women. CONCLUSIONS: No significant negative interaction between maternal asthma and obesity on adverse perinatal outcomes was observed. PMID:23951559

Discordant twins with the smaller baby appropriate for gestational age--unusual manifestation of superfoetation: a case report.

PubMed

Baijal, Noopur; Sahni, Mohit; Verma, Neeraj; Kumar, Amit; Parkhe, Nittin; Puliyel, Jacob M

2007-01-19

Documentation of superfoetation is extremely rare in humans., The younger foetus has invariably been small for gestational age (estimated from the date of the last menstrual bleed) in all the cases reported in the literature. We report a case where the younger twin was of appropriate size for gestation. The first of twins was of 32 weeks gestation and the baby was of appropriate size and development for the gestational age. The second twin was of 36 weeks gestation. Gestational age was estimated with the New Ballard score, x-ray of the lower limbs, dental age on x-ray, and ophthalmic examination. Bleeding on implantation of the first foetus probably helped demarcate the two pregnancies. Dental age and the New Ballard score can be used to diagnose superfoetation in discordant twins, when detailed first trimester ultra-sound data is not available.

Discordant twins with the smaller baby appropriate for gestational age – unusual manifestation of superfoetation: A case report

PubMed Central

Baijal, Noopur; Sahni, Mohit; Verma, Neeraj; Kumar, Amit; Parkhe, Nittin; Puliyel, Jacob M

2007-01-01

Background Documentation of superfoetation is extremely rare in humans., The younger foetus has invariably been small for gestational age (estimated from the date of the last menstrual bleed) in all the cases reported in the literature. We report a case where the younger twin was of appropriate size for gestation. Case Presentation The first of twins was of 32 weeks gestation and the baby was of appropriate size and development for the gestational age. The second twin was of 36 weeks gestation. Gestational age was estimated with the New Ballard score, x-ray of the lower limbs, dental age on x-ray, and ophthalmic examination. Conclusion Bleeding on implantation of the first foetus probably helped demarcate the two pregnancies. Dental age and the New Ballard score can be used to diagnose superfoetation in discordant twins, when detailed first trimester ultra-sound data is not available. PMID:17239246

Comparison of gestational age at birth based on last menstrual period and ultrasound during the first trimester.

PubMed

Hoffman, Caroline S; Messer, Lynne C; Mendola, Pauline; Savitz, David A; Herring, Amy H; Hartmann, Katherine E

2008-11-01

Reported last menstrual period (LMP) is commonly used to estimate gestational age (GA) but may be unreliable. Ultrasound in the first trimester is generally considered a highly accurate method of pregnancy dating. The authors compared first trimester report of LMP and first trimester ultrasound for estimating GA at birth and examined whether disagreement between estimates varied by maternal and infant characteristics. Analyses included 1867 singleton livebirths to women enrolled in a prospective pregnancy cohort. The authors computed the difference between LMP and ultrasound GA estimates (GA difference) and examined the proportion of births within categories of GA difference stratified by maternal and infant characteristics. The proportion of births classified as preterm, term and post-term by pregnancy dating methods was also examined. LMP-based estimates were 0.8 days (standard deviation = 8.0, median = 0) longer on average than ultrasound estimates. LMP classified more births as post-term than ultrasound (4.0% vs. 0.7%). GA difference was greater among young women, non-Hispanic Black and Hispanic women, women of non-optimal body weight and mothers of low-birthweight infants. Results indicate first trimester report of LMP reasonably approximates gestational age obtained from first trimester ultrasound, but the degree of discrepancy between estimates varies by important maternal characteristics.

Determinants of neonatal weight loss in term-infants: specific association with pre-pregnancy maternal body mass index and infant feeding mode.

PubMed

Regnault, Nolwenn; Botton, Jérémie; Blanc, Laurence; Hankard, Régis; Forhan, Anne; Goua, Valérie; Thiebaugeorges, Olivier; Kaminski, Monique; Heude, Barbara; Charles, Marie-Aline

2011-05-01

We aimed to study the determinants of neonatal weight loss measured on the third day of life in term-infants. The EDEN mother-child cohort is a prospective study that recruited 2002 pregnant women before 24 weeks of gestation in two French university hospitals. Neonates were weighed every day until discharge that occurred on average 4.5 days after birth. Altogether, 1557 healthy term neonates with data on weight at day 3 and feeding mode available were included. The outcome variable was weight loss at day 3 (D3WL), expressed as a percentage of birth weight lost in the first 3 days of life. Our main explanatory variables were maternal pre-pregnancy body mass index (BMI), gestational weight gain, gestational diabetes, birth weight, gestational age and feeding mode. Factors associated with greater D3WL, whatever the feeding mode, were: higher birth weight, gestational diabetes and caesarean section; higher gestational age was associated with a reduced D3WL. The association between maternal pre-pregnancy BMI and D3WL differed by feeding mode (interaction p value=0.0002). In breastfed babies, mean D3WL ranged from 4.9% for neonates of underweight mothers to 5.8% for neonates of obese mothers (p trend=0.0005). In formula-fed babies, D3WL was highest for neonates of underweight mothers (4.1%) and lowest for those of obese mothers (2.6%) (p trend=0.01). The lower D3WL in formula-fed neonates, especially in neonates of obese mothers, suggests a relative overfeeding in the early days compared with breastfed neonates, which may potentially have consequences on later health. Overweight and obese mothers may need extra support to prevent early breastfeeding discontinuation.

Estimation of gestational age from hand and foot length.

PubMed

Kumar, G P; Kumar, U K

1994-01-01

Abortion, foeticide and infanticide have been practised from time immemorial by both primitive and civilized societies. Establishing the precise duration of gestation is an important point in the total medical evidentiary picture of infanticide. In this study, an attempt has been made to establish the gestational age of the foetus using foot and hand length. This study will be of help in establishing the gestational age when the foetus is fragmented. Results obtained were significant in establishing the gestational age.

A comparison of foetal and infant mortality in the United States and Canada.

PubMed

Ananth, Cande V; Liu, Shiliang; Joseph, K S; Kramer, Michael S

2009-04-01

Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries. Stillbirth and infant mortality rates were compared for singleton births at >or=22 weeks and newborns weighing>or=500 g in the United States and Canada (1996-2000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach. The overall stillbirth rate in the United States (37.9 per 10,000 births) was similar to that in Canada (38.2 per 10,000 births), while the overall infant mortality rate was 23% (95% CI 19-26%) higher (50.8 vs 41.4 per 10,000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0%, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10,000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively. Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two neighbouring countries.

A comparison of LMP-based and ultrasound-based estimates of gestational age using linked California livebirth and prenatal screening records.

PubMed

Dietz, Patricia M; England, Lucinda J; Callaghan, William M; Pearl, Michelle; Wier, Megan L; Kharrazi, Martin

2007-09-01

Although early ultrasound (<20 weeks' gestation) systematically underestimates the gestational age of smaller fetuses by approximately 1-2 days, this bias is relatively small compared with the large error introduced by last menstrual period (LMP) estimates of gestation, as evidenced by the number of implausible birthweight-for-gestational age. To characterise this misclassification, we compared gestational age estimates based on LMP from California birth certificates with those based on early ultrasound from a California linked Statewide Expanded Alpha-fetoprotein Screening Program (XAFP). The final sample comprised 165 908 women. Birthweight distributions were plotted by gestational age; sensitivity and positive predictive value for preterm rates according to LMP were calculated using ultrasound as the 'gold standard'. For gestational ages 20-27 and 28-31 weeks, the LMP-based birthweight distributions were bimodal, whereas the ultrasound-based distributions were unimodal, but had long right tails. At 32-36 weeks, the LMP distribution was wider, flatter, and shifted to the right, compared with the ultrasound distribution. LMP vs. ultrasound estimates were, respectively, 8.7% vs. 7.9% preterm (<37 weeks), 81.2% vs. 91.0% term (37-41 weeks), and 10.1% vs. 1.1% post-term (>or=42 weeks). The sensitivity of the LMP-based preterm birth estimate was 64.3%, and the positive predictive value was 58.7%. Overall, 17.2% of the records had estimates with an absolute difference of >14 days. The groups most likely to have inconsistent gestational age estimates included African American and Hispanic women, younger and less-educated women, and those who entered prenatal care after the second month of pregnancy. In conclusion, we found substantial misclassification of LMP-based gestational age. The 2003 revised US Standard Certificate of Live Birth includes a new gestational age item, the obstetric estimate. It will be important to assess whether this estimate addresses the problems presented by LMP-based gestational age.

Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life.

PubMed

Claesson, Ing-Marie; Sydsjö, Gunilla; Olhager, Elisabeth; Oldin, Carin; Josefsson, Ann

2016-06-01

Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children's BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offspring's WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

Menstrual versus clinical estimate of gestational age dating in the United States: temporal trends and variability in indices of perinatal outcomes.

PubMed

Ananth, Cande V

2007-09-01

Accurate estimation of gestational age early in pregnancy is paramount for obstetric care decisions and for determining fetal growth and other conditions that may necessitate timing the iatrogenic intervention or delivery. We sought to examine temporal changes in the distributions of two measures of gestational age, namely, those based on menstrual dating and a clinical estimate. We further sought to evaluate relative comparisons and variability in indices of perinatal outcomes. We utilised the Natality data files in the US, 1990-2002 comprising women that delivered a singleton livebirth between 22 and 44 weeks gestation (n = 42 689 603). Changes were shown in the distributions of gestational age based on menstrual vs. clinical estimate between 1990 and 2002, as well as changes in the proportions of preterm (<37, <32 and <28 weeks) and post-term (>or=42 weeks) birth, and small- (SGA; <10th percentile) and large-for-gestational-age (LGA; birthweight >90th percentile) births. While the absolute rates of preterm birth <37 weeks, SGA and LGA births were lower based on the clinical estimate of gestational age relative to that based on menstrual dating, the increases in preterm birth rate between 1990 and 2002 were fairly similar between the two measures of gestational dating. However, the decline in post-term births was larger, based on the clinical estimate (-73.8%), than on the menstrual estimate (-36.6%) between 1990 and 2002. While the clinical estimate of gestational age appears to provide a reasonably good approximation to the menstrual estimate, disregarding the clinical estimate of gestational age may ignore the advantages of gestational age assessment in modern obstetrics.

Acculturation and Adverse Birth Outcomes in a Predominantly Puerto Rican Population.

PubMed

Barcelona de Mendoza, Veronica; Harville, Emily; Theall, Katherine; Buekens, Pierre; Chasan-Taber, Lisa

2016-06-01

Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominantly Puerto Rican population. Methods We conducted a secondary analysis of Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011. A convenience sample of pregnant Latina women were recruited from a tertiary care hospital in Massachusetts. Acculturation was measured in early pregnancy; directly via the Psychological Acculturation Scale, and via proxies of language preference and generation in the United States. Birth outcomes (gestational age and birthweight) were abstracted from medical records (n = 1362). Results After adjustment, psychological acculturation, language preference, and generation was not associated with odds of preterm birth. However, every unit increase in psychological acculturation score was associated with an increase in gestational age of 0.22 weeks (SE = 0.1, p = 0.04) among all births. Women who preferred to speak Spanish (β = -0.39, SE = 0.2, p = 0.02) and who were first generation in the US (β = -0.33, SE = 0.1, p = 0.02) had significantly lower gestational ages than women who preferred English or who were later generation, respectively. Similarly, women who were first generation had babies who weighed 76.11 g less (SE = 35.2, p = 0.03) than women who were later generation. Discussion We observed a small, but statistically significant adverse impact of low acculturation on gestational age and birthweight in this predominantly Puerto Rican population.

Use of cell-free DNA in the investigation of intrauterine fetal demise and miscarriage.

PubMed

Clark-Ganheart, Cecily A; Fries, Melissa H; Leifheit, Kathryn M; Jensen, Taylor J; Moreno-Ruiz, Nilda L; Ye, Peggy P; Jennings, Jacky M; Driggers, Rita W

2015-06-01

To estimate whether cell-free DNA is present in nonviable pregnancies and thus can be used in diagnostic evaluation in this setting. We conducted a prospective cohort study of 50 participants at MedStar Washington Hospital Center, Washington, DC, between June 2013 and January 2014. Included were women with pregnancies complicated by missed abortion or fetal demise. All gestational ages were considered for study participation. Participants with fetal demise were offered the standard workup for fetal death per the American College of Obstetricians and Gynecologists. Maternal blood samples were processed to determine the presence of cell-free DNA, the corresponding fetal fractions, and genetic abnormalities. Fifty samples from nonviable pregnancies were analyzed. The average clinical gestational age was 16.9 weeks (standard deviation 9.2). The mean maternal body mass index was 30.3 (standard deviation 9.1). Seventy-six percent (38/50) of samples yielded cell-free DNA results, that is, had fetal fractions within the detectable range of 3.7-65%. Among the 38, 76% (29) were classified as euploid, 21% (8) as trisomies, and 3% (1) as microdeletion. A cell-free DNA result was obtained more frequently at ultrasonographic gestational ages of 8 weeks or greater compared with less than 8 weeks (87.9% [n=29/33, 95% confidence interval (CI) 72.7-95.2; and 52.9%, n=9/17, 95% CI 31.0-73.8] of the time, respectively, P=.012). Time from demise was not associated with obtaining a result. Among nonviable pregnancies, cell-free DNA is present in the maternal plasma with fetal fractions greater than 3.7% in more than three fourths of cases after an ultrasonographic gestational age of 8 weeks. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01916928. III.

Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets.

PubMed

Lee, Anne Cc; Kozuki, Naoko; Cousens, Simon; Stevens, Gretchen A; Blencowe, Hannah; Silveira, Mariangela F; Sania, Ayesha; Rosen, Heather E; Schmiegelow, Christentze; Adair, Linda S; Baqui, Abdullah H; Barros, Fernando C; Bhutta, Zulfiqar A; Caulfield, Laura E; Christian, Parul; Clarke, Siân E; Fawzi, Wafaie; Gonzalez, Rogelio; Humphrey, Jean; Huybregts, Lieven; Kariuki, Simon; Kolsteren, Patrick; Lusingu, John; Manandhar, Dharma; Mongkolchati, Aroonsri; Mullany, Luke C; Ndyomugyenyi, Richard; Nien, Jyh Kae; Roberfroid, Dominique; Saville, Naomi; Terlouw, Dianne J; Tielsch, James M; Victora, Cesar G; Velaphi, Sithembiso C; Watson-Jones, Deborah; Willey, Barbara A; Ezzati, Majid; Lawn, Joy E; Black, Robert E; Katz, Joanne

2017-08-17

Objectives  To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21 st birth weight standard. Design  Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21 st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting  CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures  In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results  In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700). Conclusions  In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets

PubMed Central

Kozuki, Naoko; Cousens, Simon; Stevens, Gretchen A; Blencowe, Hannah; Silveira, Mariangela F; Sania, Ayesha; Rosen, Heather E; Schmiegelow, Christentze; Adair, Linda S; Baqui, Abdullah H; Barros, Fernando C; Bhutta, Zulfiqar A; Caulfield, Laura E; Christian, Parul; Clarke, Siân E; Fawzi, Wafaie; Gonzalez, Rogelio; Humphrey, Jean; Huybregts, Lieven; Kariuki, Simon; Kolsteren, Patrick; Lusingu, John; Manandhar, Dharma; Mongkolchati, Aroonsri; Mullany, Luke C; Ndyomugyenyi, Richard; Nien, Jyh Kae; Roberfroid, Dominique; Saville, Naomi; Terlouw, Dianne J; Tielsch, James M; Victora, Cesar G; Velaphi, Sithembiso C; Watson-Jones, Deborah; Willey, Barbara A; Ezzati, Majid; Lawn, Joy E; Black, Robert E; Katz, Joanne

2017-01-01

Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard. Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. With available national level data, prevalence of small for gestational age and population attributable fractions of neonatal mortality attributable to small for gestational age were estimated. Setting CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small for gestational age; the number and proportion of neonatal deaths that could be prevented by reducing the prevalence of small for gestational age to 10%. Results In 2012, an estimated 23.3 million infants (uncertainty range 17.6 to 31.9; 19.3% of live births) were born small for gestational age in low and middle income countries. Among these, 11.2 million (0.8 to 15.8) were term and not low birth weight (≥2500 g), 10.7 million (7.6 to 15.0) were term and low birth weight (<2500 g) and 1.5 million (0.9 to 2.6) were preterm. In low and middle income countries, an estimated 606 500 (495 000 to 773 000) neonatal deaths were attributable to infants born small for gestational age, 21.9% of all neonatal deaths. The largest burden was in South Asia, where the prevalence was the highest (34%); about 26% of neonatal deaths were attributable to infants born small for gestational age. Reduction of the prevalence of small for gestational age from 19.3% to 10.0% in these countries could reduce neonatal deaths by 9.2% (254 600 neonatal deaths; 164 800 to 449 700). Conclusions In low and middle income countries, about one in five infants are born small for gestational age, and one in four neonatal deaths are among such infants. Increased efforts are required to improve the quality of care for and survival of these high risk infants in low and middle income countries PMID:28819030

Appropriate for gestational age (AGA)

MedlinePlus

Fetal age; Gestation; Development - AGA; Growth - AGA; Neonatal care - AGA; Newborn care - AGA ... Gestational age is the common term used during pregnancy to describe how far along the pregnancy is. It is ...

Formation of alveoli in rats: postnatal effect of prenatal dexamethasone.

PubMed

Massaro, G D; Massaro, D

1992-07-01

We administered a glucocorticosteroid (dexamethasone) or its diluent to pregnant rats on gestation days 17, 18, and 19. In male offspring we determined the lung's gas exchange surface area (S(a)), the average volume (v) of gas exchange saccules at age 2 days and alveoli at age 14 days, and their number (N) on these days. S(a), v, and N at 2 days and v at 14 days were not affected by the prenatal administration of dexamethasone. However, S(a) and N were lower in 14-day-old pups from dexamethasone-treated dams than in pups from diluent-treated dams. In separate experiments we found the responsiveness to prenatal dexamethasone, as a depressor of the postnatal increase in S(a), appeared earlier in female than male fetuses; it was present in female but not in male fetuses on days 16-18 and was found in male fetuses on days 17-19. We conclude 1) prenatal administration of dexamethasone diminishes the postnatal increase in S(a), 2) responsiveness to this action of dexamethasone occurs earlier in gestation in female than in male fetuses, and 3) prenatal dexamethasone does not effect the postnatal volume of an average alveolus but diminishes their number in male pups.

Gestational age assessment in malaria pregnancy cohorts: a prospective ultrasound demonstration project in Malawi

PubMed Central

2013-01-01

Background Malaria during pregnancy is associated with an increased risk for low birth weight (<2500 grams). Distinguishing infants that are born premature (< 37 weeks) from those that are growth-restricted (less than the 10th percentile at birth) requires accurate assessment of gestational age. Where ultrasound is accessible, sonographic confirmation of gestational age is more accurate than menstrual dating. The goal was to pilot the feasibility and utility of adding ultrasound to an observational pregnancy malaria cohort. Methods In July 2009, research staff (three mid-level clinical providers, one nurse) from The Blantyre Malaria Project underwent an intensive one-week ultrasound training to perform foetal biometry. Following an additional four months of practice and remote image review, subjects from an ongoing cohort were recruited for ultrasound to determine gestational age. Gestational age at delivery established by ultrasound was compared with postnatal gestational age assessment (Ballard examination). Results One hundred and seventy-eight women were enrolled. The majority of images were of good quality (94.3%, 509/540) although a learning curve was apparent with 17.5% (24/135) images of unacceptable quality in the first 25% of scans. Ultrasound was used to date 13% of the pregnancies when menstrual dates were unknown and changed the estimated gestational age for an additional 25%. There was poor agreement between the gestational age at delivery as established by the ultrasound protocol compared to that determined by the Ballard examination (bias 0.8 weeks, limits of agreement -3.5 weeks to 5.1 weeks). The distribution of gestational ages by Ballard suggested a clustering of gestational age around the mean with 87% of the values falling between 39 and 41 weeks. The distribution of gestational age by ultrasound confirmed menstrual dates was more typical. Using ultrasound confirmed dates as the gold standard, 78.5% of preterm infants were misclassified as term and 26.8% of small-for gestational age infants misclassified as appropriately grown by Ballard. Conclusion Ultrasound should be strongly considered in prospective malaria studies with obstetric endpoints to confirm gestational age and avoid misclassification of infants as premature or growth-restricted. The use of ultrasound does require a significant investment of time to maintain quality image acquisition. PMID:23734718

Long-term Cognitive and Health Outcomes of School-Aged Children Who Were Born Late-Term vs Full-Term.

PubMed

Figlio, David N; Guryan, Jonathan; Karbownik, Krzysztof; Roth, Jeffrey

2016-08-01

Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomes may influence physician and patient decisions regarding optimal pregnancy length. To compare the cognitive and physical outcomes of school-aged children who were born full term or late term. We analyzed Florida birth certificates from 1994 to 2002 linked to Florida public school records from 1998 to 2013 and found 1 442 590 singleton births with 37 to 41 weeks' gestation in the Florida Bureau of Vital Statistics. Of these, 1 153 716 children (80.0%) were subsequently located in Florida public schools. Linear and logistic regression models were used to assess the association of gestational age with cognitive and physical outcomes at school age. Data analysis took place between April 2013 and January 2016. Late-term (born at 41 weeks) vs full-term (born at 39 or 40 weeks) gestation. There were a number of measures used, including the average Florida Comprehensive Assessment Test mathematics and reading scores at ages 8 through 15 years; whether a child was classified as gifted, defined as a student with superior intellectual development and capable of high performance; poor cognitive outcome, defined as a child scoring in the fifth percentile of test takers or having a disability that exempted him or her from taking the Florida Comprehensive Assessment Test; and Exceptional Student Education placement owing to orthopedic, speech, or sensory impairment or being hospitalbound or homebound. Of 1 536 482 children born in Florida from singleton births from 1994 to 2002 with complete demographic information, 787 105 (51.2%) were male; 338 894 (22.1%) of mothers were black and 999 684 (65.1%) were married at time of birth, and the mean (SD) age for mothers at time of birth was 27.2 (6.2) years. Late-term infants had 0.7% of an SD (95% CI, 0.001-0.013; P = .02) higher average test scores in elementary and middle school, 2.8% (95% CI, 0.4-5.2; P = .02) higher probability of being gifted, and 3.1% (95% CI, 0.0-6.1; P = .05) reduced probability of poor cognitive outcomes compared with full-term infants. These cognitive benefits appeared strongest for children with disadvantaged family background characteristics. Late-term infants were also 2.1% (95% CI, -0.3 to 4.5; P = .08) more likely to be physically impaired. There appears to be a tradeoff between cognitive and physical outcomes associated with late-term gestation. Children born late-term performed better on 3 measures of school-based cognitive functioning but worse on 1 measure of physical functioning relative to children born full term. Our findings provide longer-run information for expectant parents and physicians who are considering delivery at full term vs late term. These findings are most relevant to uncomplicated, low-risk pregnancies.

Association between placentome size, measured using transrectal ultrasonography, and gestational age in cattle.

PubMed

Adeyinka, F D; Laven, R A; Lawrence, K E; van Den Bosch, M; Blankenvoorde, G; Parkinson, T J

2014-03-01

The aim of this study was to estimate whether fetal age could be accurately estimated using placentome size. Fifty-eight cows with confirmed conception dates in two herds were used for the study. The length of the long axis and cross-sectional area of placentomes close to the cervix were measured once every 10 days between approximately 60-130 days of gestation and once every 15 days between 130-160 days of gestation. Four to six placentomes were measured using transrectal ultrasonography in each uterine horn. A linear mixed model was used to establish the factors that were significantly associated with log mean placentome length and to create an equation to predict gestational age from mean placentome length. Limits of agreement analysis was then used to evaluate whether the predictions were sufficiently accurate for mean placentome length to be used, in practice, as a method of determining gestational age. Only age of gestation (p<0.001) and uterine horn (p=0.048) were found to have a significant effect on log mean placentome length. From the three models used to predict gestational age the one that used log mean placentome length of all placentomes, adjusting for the effect of horn, had the smallest 95% limits of agreement; ±33 days. That is, predicted gestational age had a 95% chance of being between 33 days greater and 33.7 days less than actual age. This is approximately twice that reported in studies using measurement of fetal size. Measurement of placentomes near to the cervix using transrectal ultrasonography was easily achieved. There was a significant association between placentome size and gestational age, but between-cow variation in placentome size and growth resulted in poor agreement between placentome size and gestational age. Although placentomes can be easily visualised during diagnosis of pregnancy using transrectal ultrasonography, mean placentome size should not be used to estimate gestational age.

Large for gestational age (LGA)

MedlinePlus

... gov/ency/article/002248.htm Large for gestational age (LGA) To use the sharing features on this page, please enable JavaScript. Large for gestational age means that a fetus or infant is larger ...

Small for gestational age (SGA)

MedlinePlus

... this page: //medlineplus.gov/ency/article/002302.htm Small for gestational age (SGA) To use the sharing features on this page, please enable JavaScript. Small for gestational age means that a fetus or ...

Estimation of Gestational Age: Implications for Developmental Research.

ERIC Educational Resources Information Center

DiPietro, Janet A.; Allen, Marilee C.

1991-01-01

Reviews prenatal and postnatal methods of gestational age estimation and evaluates implementation of this information in research. Recommendations concerning the assignment of gestational age in the perinatal period and the use of age correction for preterm infants are offered. (Author/BC)

Fetal and neonatal outcomes of preterm infants born before 32 weeks of gestation according to antenatal vs postnatal assessments of restricted growth.

PubMed

Monier, Isabelle; Ancel, Pierre-Yves; Ego, Anne; Jarreau, Pierre-Henri; Lebeaux, Cécile; Kaminski, Monique; Goffinet, François; Zeitlin, Jennifer

2017-05-01

Fetal growth restriction is defined using ultrasound parameters during pregnancy or as a low birthweight for gestational age after birth, but these definitions are not always concordant. The purpose of this study was to investigate fetal and neonatal outcomes based on antenatal vs postnatal assessments of growth restriction. From the EPIPAGE 2 population-based prospective study of very preterm births in France in 2011, we included 2919 singleton nonanomalous infants 24-31 weeks gestational age. We constituted 4 groups based on whether the infant was suspected with fetal growth restriction during pregnancy and/or was small for gestational age with a birthweight <10th percentile of intrauterine norms by sex: 1) suspected with fetal growth restriction/small for gestational age 2) not suspected with fetal growth restriction/small for gestational age 3) suspected with fetal growth restriction/not small for gestational age and 4) not suspected with fetal growth restriction/not small for gestational age. We estimated relative risks of perinatal mortality and morbidity for these groups adjusting for maternal and neonatal characteristics. We found that 22.2% of infants were suspected with fetal growth restriction/small for gestational age, that 11.4% infants were not suspected with fetal growth restriction/small for gestational age, that 3.0% infants were suspected with fetal growth restriction/not small for gestational age, and that 63.4% infants were not suspected with fetal growth restriction/not small for gestational age. Compared with infants who were not suspected with fetal growth restriction/not small-for-gestational-age infants, small-for-gestational-age infants suspected and not suspected with fetal growth restriction had higher risks of stillbirth or termination of pregnancy (adjusted relative risk, 2.0 [95% confidence interval, 1.6-2.5] and adjusted relative risk, 2.8 [95% confidence interval, 2.2-3.4], respectively), in-hospital death (adjusted relative risk, 2.8 [95% confidence interval, 2.0-3.7] and adjusted relative risk, 2.0 [95% confidence interval, 1.5-2.8], respectively), and bronchopulmonary dysplasia (adjusted relative risk, 1.3 [95% confidence interval, 1.2-1.4] and adjusted relative risk, 1.3 [95% confidence interval, 1.1-1.4], respectively), but not severe brain lesions. Risks were not increased for infants suspected with fetal growth restriction but not small-for-gestational-age. Antenatal and postnatal assessments of fetal growth restriction were not concordant for 14% of very preterm infants. In these cases, birthweight appears to be the more relevant parameter for the identification of infants with higher risks of adverse short-term outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Serial betamethasone administration: effect on maternal salivary estriol levels.

PubMed

Hendershott, C M; Dullien, V; Goodwin, T M

1999-01-01

Maternal salivary estriol levels are an indirect measure of fetal adrenal activity, which may be affected by administration of betamethasone. The objective was to compare sequential salivary estriol levels in patients receiving serial betamethasone therapy with those of healthy pregnant patients. Ten patients at high risk for preterm delivery were asked to obtain salivary specimens before and 1 to 2 days after each administration of weekly betamethasone treatments between 24 and 32 weeks' gestation. These values were compared with those of specimens obtained throughout gestation in healthy women who were not delivered preterm. Unconjugated salivary estriol was measured with a sensitive and specific enzyme-linked immunoassay (Biex, Inc, Dublin, Calif). The effect of betamethasone on salivary estriol levels did not change with time, showing an average of 23.1% drop from pretreatment to posttreatment levels but rebounding to the same starting level before the next dose. When weekly pretreatment values were looked at across time, the geometric mean of the individual patients' slopes did not differ significantly from no change. The same was true of the posttreatment values. The rate of change with advancing gestation was compared between 182 control subjects and the 10 study subjects. The average change was +8.8% per week in the control subjects and -1.3% per week in the study patients (P =.003). Maternal administration of betamethasone significantly suppressed salivary estriol levels. These levels returned to pretreatment values each week before the next dose; however, the rise normally associated with advancing gestational age was not observed.

Comparative Study of Abdominal Versus Transvaginal Ultrasound for Uterine Artery Doppler Velocimetry at 11 to 13 Weeks.

PubMed

Demers, Marie-Elaine; Dubé, Samuel; Bourdages, Mélodie; Gasse, Cedric; Boutin, Amélie; Girard, Mario; Bujold, Emmanuel; Demers, Suzanne

2018-01-10

To compare the first-trimester uterine artery pulsatility index (PI) measured by abdominal and transvaginal ultrasound (US). We performed a prospective study of singleton pregnant women recruited at 11 to 13 weeks' gestation. The mean uterine artery PI was obtained by abdominal followed by transvaginal US. The mean of the left and right uterine artery PIs was used, and differences between approaches were computed. The intraclass correlation coefficient and a Bland-Altman plot were used to compare the two approaches. Data were available for 940 participants, including 928 (99%) with uterine artery PIs obtained on both uterine sides. The mean uterine artery PI decreased with gestational age in both approaches (P < .001). We observed a moderate correlation between abdominal and transvaginal mean uterine artery PIs (intraclass correlation coefficient, 0.72; 95% confidence interval, 0.69 to 0.75). Values obtained by abdominal US (median, 1.70, interquartile range, 1.35 to 2.09) were greater than those obtained by transvaginal US (median, 1.65; interquartile range, 1.37 to 1.99). There was a significant increase in differences as average measurements became higher (P < .01). The first-trimester mean uterine artery PI decreases with gestational age in both approaches. Abdominal US could be associated with greater uterine artery PI values than transvaginal US, especially at higher measurements. The first-trimester uterine artery PI for prediction of adverse perinatal outcomes should be adjusted for gestational age and possibly for the US approach. © 2018 by the American Institute of Ultrasound in Medicine.

Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial.

PubMed

Lutenbacher, Melanie; Gabbe, Patricia Temple; Karp, Sharon M; Dietrich, Mary S; Narrigan, Deborah; Carpenter, Lavenia; Walsh, William

2014-07-01

Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-<37 weeks gestation; <24 weeks gestation at enrollment; spoke and read English; received care at regional medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.

Preconception Cardiovascular Risk Factor Differences Between Gestational Hypertension and Preeclampsia

PubMed Central

Klungsøyr, Kari; Øyen, Nina; Tell, Grethe S.; Næss, Øyvind; Skjærven, Rolv

2016-01-01

Preconception predictors of gestational hypertension and preeclampsia may identify opportunities for early detection and improve our understanding of the pathogenesis and life course epidemiology of these conditions. Female participants in community-based Cohort Norway health surveys, 1994 to 2003, were prospectively followed through 2012 via record linkages to Medical Birth Registry of Norway. Analyses included 13 217 singleton pregnancies (average of 1.59 births to 8321 women) without preexisting hypertension. Outcomes were gestational hypertension without proteinuria (n=237) and preeclampsia (n=429). Mean age (SD) at baseline was 27.9 years (4.5), and median follow-up was 4.8 years (interquartile range 2.6–7.8). Gestational hypertension and preeclampsia shared several baseline risk factors: family history of diabetes mellitus, pregravid diabetes mellitus, a high total cholesterol/high-density lipoprotein cholesterol ratio (>5), overweight and obesity, and elevated blood pressure status. For preeclampsia, a family history of myocardial infarction before 60 years of age and elevated triglyceride levels (≥1.7 mmol/L) also predicted risk while physical activity was protective. Preterm preeclampsia was predicted by past-year binge drinking (≥5 drinks on one occasion) with an adjusted odds ratio of 3.7 (95% confidence interval 1.3–10.8) and by past-year physical activity of ≥3 hours per week with an adjusted odds ratio of 0.5 (95% confidence interval 0.3–0.8). The results suggest similarities and important differences between gestational hypertension, preeclampsia, and preterm preeclampsia. Modifiable risk factors could be targeted for improving pregnancy outcomes and the short- and long-term sequelae for mothers and offspring. PMID:27113053

Association of first-trimester maternal lipid profiles and triglyceride-glucose index with the risk of gestational diabetes mellitus and large for gestational age newborn.

PubMed

Pazhohan, Azar; Rezaee Moradali, Monireh; Pazhohan, Nahideh

2017-11-20

To evaluate the association of maternal first-trimester plasma lipid profiles, fasting plasma glucose (FPG), and triglyceride (TyG) index with the risk of gestational diabetes mellitus (GDM) and large for gestational age (LGA) infant in Iranian mothers. Nine hundred and fifty-four healthy pregnant women were prospectively followed till after delivery. Maternal fasting lipids and glucose concentration were measured at nine-week gestation on average. We used generalized linear models to calculate the relative risks and 95% confidence intervals. The incidence of GDM and LGA infants among our participants was 18.4% and 26.1%, respectively. There was a significant correlation between the increase in FPG, triglyceride, TG/HDL-C ratio, as well as TyG index with the risk of GDM and LGA infant. After adjusting for potential confounders, the relative risk of GDM in women in the top tertile of FPG, triglyceride (TG), triglyceride/high-density lipoprotein-cholesterol (TG/HDL-C) and TyG index was 4.2-, 4.2-, 3.9-, and 4.9-folds of its risk in women in the bottom tertile, respectively. Also after adjusting for GDM, the relative risk of LGA infants in women in the top tertile of FPG, TG, TG/HDL-C ratio and TyG index was 3.9-, 4.3-, 4.8-, and 5.3-folds of its risk in women in the bottom tertile, respectively. Based on our findings, TyG index is more robust early predictors of GDM and LGA in Iranian women.

Trends in gestational age at time of surgical abortion for fetal aneuploidy and structural abnormalities.

PubMed

Davis, Anne R; Horvath, Sarah K; Castaño, Paula M

2017-03-01

Screening for fetal aneuploidy has evolved over the past 2 decades. Whether these advances impact gestational age at abortion has received little study. We sought to describe trends in the gestational age at the time of abortion by fetal diagnosis over an 11-year study period. We hypothesized that gestational age at time of abortion would decrease for fetal aneuploidy but remain unchanged for structural abnormalities. We conducted a retrospective case series of all women undergoing surgical abortion for fetal aneuploidy or structural abnormalities up to 24 weeks' gestation from 2004 through 2014 in a hospital operating room setting at a single, urban medical center. We excluded labor induction abortions (<1% of abortions at our medical center) and suction aspirations performed in the office practice. We performed suction aspiration up to 14 weeks and dilation and evacuation after that gestational age. We describe the median gestational age at abortion by fetal indication and year. For women undergoing abortion for fetal aneuploidy (n = 392), the median gestational age at time of abortion decreased from 19.0 weeks (interquartile range 18.0-21.0) in 2004 to 14.0 weeks (interquartile range 13.0-17.0) in 2014 (Kruskal-Wallis P < .0001). For women undergoing abortion for fetal structural abnormalities (n = 586), the median gestational age was ≥20 weeks for each year during the study interval (P = .1). As gestational age decreased in the fetal aneuploidy group, fewer women underwent dilation and evacuation and more became eligible for suction aspiration (<14 weeks). In 2004, >90% of women underwent dilation and evacuation for either indication. By 2014, 31% of women with fetal aneuploidy were eligible for suction aspiration compared to 11% of those with structural anomalies. Gestational age at the time of abortion for fetal aneuploidy decreased substantially from 2004 through 2014; earlier abortion is safer for women. In contrast, women seeking abortion for fetal structural abnormalities did not experience a change in timing. Legislation restricting gestational age at the time of abortion could disproportionately affect women with fetal structural abnormalities. Copyright © 2016 Elsevier Inc. All rights reserved.

Gestational age estimation on United States livebirth certificates: a historical overview.

PubMed

Wier, Megan L; Pearl, Michelle; Kharrazi, Martin

2007-09-01

Gestational age on the birth certificate is the most common source of population-based gestational age data that informs public health policy and practice in the US. Last menstrual period is one of the oldest methods of gestational age estimation and has been on the US Standard Certificate of Live Birth since 1968. The 'clinical estimate of gestation', added to the standard certificate in 1989 to address missing or erroneous last menstrual period data, was replaced by the 'obstetric estimate of gestation' on the 2003 revision, which specifically precludes neonatal assessments. We discuss the strengths and weaknesses of these measures, potential research implications and challenges accompanying the transition to the obstetric estimate.

[Dynamic changes of lung function in infant of different gestational ages].

PubMed

Qi, Li-feng; Yu, Jia-lin; Liu, Xiao-hong; Wei, Min-chao

2013-06-25

To explore the dynamic changes of lung function in infants born at different gestational ages without respiratory complications. A total of 110 cases of hospitalized neonatal patients were retrospectively recruited and analyzed at Shenzhen Children's Hospital from July 2010 to August 2012. By gestational age they were divided into 3 groups of full term (37-40 weeks, n = 55, 29 males and 26 females) with an average birth weight (3.1 ± 0.3) kg, late preterm group (34- < 37 weeks, n = 30, 18 males and 12 females) with an average birth weight (2.1 ± 0.3) kg and early preterm (<34 weeks, n = 25, 16 males and 9 females )with an average birth weight (1.4 ± 0.3) kg. At Days 1, 14 and 28, lung function parameters of functional residual capacity (FRC) and lung clear index (LCI) were measured by multiple breath washouts with an ultrasonic flow meter and tidal breathing. One-way ANOVA was used for each index. Tidal expiratory flow 75% remaining tidal volume (TEF75), tidal expiratory flow 50% remaining tidal volume (TEF50) and tidal expiratory flow 25% remaining tidal volume (TEF25) gradually increased at Days 1, 14 and 28 in 3 groups. However respiratory rate (RR) gradually decreased. Compared with full term and late preterm, the early preterm infants had lower TEF75, TEF50 and TEF25, lower the ratios of time to peak expiratory flow and expiratory time (TPTEF/TE), lower ratios of volume to peak expiratory flow and expiratory volume (VPEF/VE) ((71 ± 21) and (66 ± 16) vs (55 ± 19)ml/s, (70 ± 20) and (62 ± 17) vs (51 ± 16)ml/s, (54 ± 17) and (51 ± 13) vs (38 ± 10)ml/s, 37% ± 8% and 34% ± 9% vs 29% ± 6%, 38% ± 6% and 33% ± 8% vs 28% ± 7%, F = 5.82, 8.74, 11.30, 7.72, 16.40, all P < 0.01), higher RR and LCI at Day 28((49 ± 6) and (51 ± 8) vs (56 ± 7)/min, 8.6 ± 2.7 and 8.9 ± 2.2 vs 10.8 ± 2.0,F = 10.09, 7.15, both P < 0.05). At a matched post-menstrual age of 40 weeks, compared with full term and late preterm, the early preterm group had lower TEF50, TEF25, TPTEF/TE, VPEF/VE ((65 ± 21) and (62 ± 12) vs (50 ± 17)ml/s,(51 ± 13) and (47 ± 10) vs (39 ± 10)ml/s, 36% ± 8% and 31% ± 7% vs 30% ± 6%, 37% ± 10% and 32% ± 8% vs 29% ± 6%,F = 4.41, 8.23, 9.08, 7.35, all P < 0.05). Lung function improves with the elongation of days. The parameters of lung function in early infants are worse than those in full and late-preterm counterparts. At a corrected gestational age of 40 weeks, early preterm infants fail to achieve catch-up growth in lung function. Dynamic monitoring of lung function in preterm infants of different gestational ages is of vital importance for gauging respiratory maturity and assessing lung development especially for preterm infants.

The relationship of birth weight, gestational age, and postmenstrual age with ocular biometry parameters in premature infants.

PubMed

Ozdemir, Ozdemir; Tunay, Zuhal Ozen; Acar, Damla Erginturk; Erol, Muhammet Kazım; Sener, Ender; Acar, Ugur

2015-01-01

To analyze ocular biometry parameters and evaluate their relationship with gestational age, birth weight, and postmenstrual age in prematurely born infants. The right eyes of 361 premature infants born before the 36th gestational week were evaluated. Birth weight, gestational week, and gender were recorded. An A-scan Biometer was used for obtaining axial measurements, including anterior chamber depth, lens thickness, vitreous length, and total axial length. Gestational age and birth weight values ranged from 23 to 36 weeks and from 560 to 2,670 g, respectively. The mean gestational age and birth weight were 30.8 ± 2.8 weeks and 1,497.9 ± 483.6 g, respectively. During the first examination (4-5 weeks of postnatal age), birth weight and gestational age of the infants correlated significantly and positively with lens thickness, vitreous length, and axial length (r>0.5, p<0.001), but not with anterior chamber depth (r<0.5). Increased vitreous and axial lengths correlated significantly with increasing postmenstrual age of the infants (r=0.669, p<0.001; r=0.845, p<0.001, respectively). Lens thickness, vitreous length, and axial length, but not anterior chamber depth, were significantly correlated with birth weight and gestational age. All four parameters increased with increasing postmenstrual age, with higher correlations for vitreous and axial lengths than for anterior chamber depth and lens thickness. It was concluded that axial elongation resulted primarily from increasing posterior chamber length.

Postmenstrual age correlates to indices of protein metabolism in very low birth weight infants.

PubMed

Boehm, G; Räihä, N C

1993-04-01

In 14 infants who were normal in weight for gestational age and 14 infants who were small for gestational age, the plasma essential amino acid profiles and serum urea concentrations were studied between the 30th and 46th weeks of postmenstrual age. All infants were of very low birth weight (< 1,500 g) and were fed with fresh human milk fortified with 6 g freeze-dried human milk per 100 ml (mean protein intake 3.1 g/kg/day, mean energy intake 130 kcal/kg/day). With the exception of threonine, all measured plasma essential amino acid concentrations increased significantly with increasing postmenstrual age (appropriate for gestational age infants: r = 0.861, p < 0.01; small for gestational age infants: r = 0.772, p < 0.001). No differences in this increase could be found between the infants who were small or appropriate for gestational age. The serum urea concentrations also increased with increasing postmenstrual age without differences between the study groups (appropriate for gestational age infants: r = 0.658, p < 0.01; small for gestational age infants: r = 0.604, p < 0.05). The results indicate that very low birth weight infants of similar weights may have very different protein requirements, depending on their postmenstrual ages. Thus, postmenstrual age is of greater importance than birth weight when protein nutrition is planned for very low birth weight infants.

Foetal haemoglobin concentration at postmenstrual age is unaffected by gestational age at birth.

PubMed

Watanabe, Yuki; Osawa, Kayo; Sato, Itsuko; Iwatani, Sota; Kono, Ruri; Hayakawa, Ikuyo; Hayashi, Nobuhide; Iijima, Kazumoto; Saegusa, Jun; Morioka, Ichiro

2018-05-01

Background Our aim was to determine whether the postnatal age or postmenstrual age is a more appropriate criterion for evaluating foetal haemoglobin concentrations. Methods Blood samples ( n = 1095) were obtained from 394 infants and were divided into two groups based on gestational age at birth: <37 weeks ( n = 491) and ≥37 weeks ( n = 604). (1) Foetal haemoglobin concentrations divided by one month at age after birth were compared between the groups. (2) Foetal haemoglobin concentrations divided into ≤9 months from last menstruation and one month thereafter were compared between the groups. Results In samples from infants ≥37 weeks' gestational age at birth, the median foetal haemoglobin concentrations were 69.5%, 21.4% and 3.6% at 0-1 month, 2-3 months and ≥5 months after birth, respectively. The median foetal haemoglobin concentrations in infants <37 weeks' gestational age at birth were 75.5%, 62.7% and 5.1% at 0-1 month, 2-3 months and ≥5 months after birth, respectively. The median foetal haemoglobin concentrations in infants <37 weeks' gestational age at birth were significantly higher than that in infants ≥37 weeks' gestational age at birth at all postnatal age points. (2) There was no significant difference between the groups at all age points after nine months of postmenstrual age: 72.5 and 75.3% at 9-10 months, 25.1 and 26.6% at 11-12 months and 5.5 and 4.6% at >13 months after last menstruation in infants ≥37 and <37 weeks' gestational age at birth, respectively. Conclusions Evaluation of foetal haemoglobin concentrations at postmenstrual age is unaffected by gestational age at birth.

Longitudinal changes in maternal and neonatal anthropometrics: a case study of the Helsinki Birth Cohort, 1934-1944.

PubMed

Moltchanova, E; Eriksson, J G

2015-08-01

Changes in anthropometrics often reflect changes in living conditions, and one's characteristics at birth may be associated with future health. The aim of this study was to investigate the secular trends in maternal and neonatal anthropometrics in the Helsinki Birth Cohort Study. The study participants, thus, comprised all 13,345 live births recorded in Helsinki, Finland, between 1934 and 1944. Adult characteristics of the clinical subsample comprised of 2003 individuals, alive during 2003, were also analyzed. Linear Regression analysis with seasonal terms was applied to see whether clinically and statistically significant trends can be found in maternal age, height and body mass index (BMI) at pregnancy; gestational age, birth weight, ponderal index and sex ratio; and adult height, BMI and fat percentage. Statistically significant trends were found in maternal age and maternal BMI with abrupt changes between 1941 and 1944. Gestational age increased by an average of 0.11% per year (P<0.0001), and the proportion of premature births dropped from 7.9% in 1934 to 4.5% in 1944 (P<0.0001). In the clinical sample, a statistically significant, although small, average annual increase of 0.1% in adult heights was detected (P=0.0012 for men and P=0.0035 for women). In conclusion, although no significant changes were found in either neonatal or adult anthropometrics of babies born in Helsinki between 1934 and 1944, there were abrupt changes in the characteristics of their mothers.

Hospital volume and mortality due to preterm patent ductus arteriosus.

PubMed

Michihata, Nobuaki; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

2016-11-01

Preterm patent ductus arteriosus (PDA) requires neonatal intensive care. The relationship between hospital volume and mortality of PDA remains poorly understood. This was a retrospective observational study, using a national inpatient database in Japan. We identified patients who were diagnosed with PDA; exclusion criteria were as follows: (i) other cardiac complications; (ii) mild PDA treated without oral/i.v. indomethacin, surgery, or catheter intervention; (iii) age >1 year at admission; (iv) gestational age ≥32 weeks; (v) death within 3 days of admission; and (vi) transferal to other hospitals. Information was collected using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013. Hospital volume was defined as the average annual number of neonates with gestational age <32 weeks at each hospital. The outcome measure was in-hospital mortality. A total of 2437 eligible patients treated at 199 hospitals were included. Low, medium, and high volume were defined as average annual number of preterm infants <34, 34-65, and >65, respectively. There were no significant differences in in-hospital mortality according to hospital volume. In-hospital mortality was identical in patients who received indomethacin alone, surgical or catheter intervention, or both after adjustment for patient background. There was no significant relationship between hospital volume and in-hospital mortality due to preterm PDA. Centralization of patients with this condition may not be necessary. © 2016 Japan Pediatric Society.

Estimating Gestational Age From Ultrasound Fetal Biometrics.

PubMed

Skupski, Daniel W; Owen, John; Kim, Sungduk; Fuchs, Karin M; Albert, Paul S; Grantz, Katherine L

2017-08-01

To compare the accuracy of a new formula with one developed in 1984 (and still in common use) and to develop and compare racial and ethnic-specific and racial and ethnic-neutral formulas. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons was a prospective cohort study that recruited women in four self-reported racial-ethnic groups-non-Hispanic black, Hispanic, non-Hispanic white, and Asian-with singleton gestations from 12 U.S. centers (2009-2013). Women with a certain last menstrual period confirmed by first-trimester ultrasonogram had longitudinal fetal measurements by credentialed study ultrasonographers blinded to the gestational age at their five follow-up visits. Regression analyses were performed with linear mixed models to develop gestational age estimating formulas. Repeated cross-validation was used for validation. The estimation error was defined as the mean squared difference between the estimated and observed gestational age and was used to compare the formulas' accuracy. The new formula estimated the gestational age (±2 SD) within ±7 days from 14 to 20 weeks of gestation, ±10 days from 21 to 27 weeks of gestation, and ±17 days from 28 to 40 weeks of gestation. The new formula performed significantly better than a formula developed in 1984 with an estimation error of 10.4 compared with 11.2 days from 21 to 27 weeks of gestation and 17.0 compared with 19.8 days at 28-40 weeks of gestation, respectively. Racial and ethnic-specific formulas did not outperform the racial and ethnic-neutral formula. The NICHD gestational age estimation formula is associated with smaller errors than a well-established historical formula. Racial and ethnic-specific formulas are not superior to a racial-ethnic-neutral one.

Postdischarge growth and development in a predominantly Hispanic, very low birth weight population.

PubMed

Powers, George C; Ramamurthy, Rajam; Schoolfield, John; Matula, Kathleen

2008-12-01

The goals were to assess postdischarge growth and developmental progress of very low birth weight (birth weight: <1500 g) premature infants in a predominantly Hispanic population and to identify predictors for neurodevelopmental impairment at 3 years of age. A cohort of 135 very low birth weight infants (gestational age: 23 to 35 weeks) were monitored to 3 years of age. Maternal and neonatal characteristics, anthropometric z scores, and developmental performance (using corrected age until 24 months) were analyzed collectively and according to gestational age groups. Specific criteria for failure to thrive and microcephaly were used. A characteristic pattern of poor weight gain in the first 12 months was followed by accelerated weight gain starting at 18 months, whereas head growth decreased at 18 months, with recovery beginning at 30 months of age. Infants born at gestational age of or=27 weeks achieved catch-up growth by 30 months of age. Mean developmental scores also decreased in infancy, with improvements in motor development emerging at 18 months and cognitive skills at 30 months. Growth z scores, particularly for head growth, correlated with developmental scores. Infants born at gestational age of

Brain metabolite alterations in infants born preterm with intrauterine growth restriction: association with structural changes and neurodevelopmental outcome.

PubMed

Simões, Rui V; Muñoz-Moreno, Emma; Cruz-Lemini, Mónica; Eixarch, Elisenda; Bargalló, Núria; Sanz-Cortés, Magdalena; Gratacós, Eduard

2017-01-01

Intrauterine growth restriction and premature birth represent 2 independent problems that may occur simultaneously and contribute to impaired neurodevelopment. The objective of the study was to assess changes in the frontal lobe metabolic profiles of 1 year old intrauterine growth restriction infants born prematurely and adequate-for-gestational-age controls, both premature and term adequate for gestational age and their association with brain structural and biophysical parameters and neurodevelopmental outcome at 2 years. A total of 26 prematurely born intrauterine growth restriction infants (birthweight <10th centile for gestational age), 22 prematurely born but adequate for gestational age controls, and 26 term adequate-for-gestational-age infants underwent brain magnetic resonance imaging and magnetic resonance spectroscopy at 1 year of age during natural sleep, on a 3 Tesla scanner. All brain T1-weighted and diffusion-weighted images were acquired along with short echo time single-voxel proton spectra from the frontal lobe. Magnetic resonance imaging/magnetic resonance spectroscopy data were processed to derive structural, biophysical, and metabolic information, respectively. Neurodevelopment was evaluated at 2 years of age using the Bayley Scales 3rd edition, assessing cognitive, language, motor, socioemotional, and adaptive behavior. Prematurely born intrauterine growth restriction infants had slightly smaller brain volumes and increased frontal lobe white matter mean diffusivity compared with both prematurely born but adequate for gestational age and term adequate for gestational age controls. Frontal lobe N-acetylaspartate levels were significantly lower in prematurely born intrauterine growth restriction than in prematurely born but adequate for gestational age infants but increased in prematurely born but adequate for gestational age compared with term adequate-for-gestational-age infants. The prematurely born intrauterine growth restriction group also showed slightly lower choline compounds, borderline decrements of estimated glutathione levels, and increased myoinositol to choline ratios, compared with prematurely born but adequate for gestational age controls. These specific metabolite changes were locally correlated to lower gray matter content and increased mean diffusivity and reduced white matter fraction and fractional anisotropy. Prematurely born intrauterine growth restriction infants also showed a tendency for poorer neurodevelopmental outcome at 2 years, associated with lower levels of frontal lobe N-acetylaspartate at 1 year within the preterm subset. Preterm intrauterine growth restriction infants showed altered brain metabolite profiles during a critical stage of brain maturation, which correlate with brain structural and biophysical parameters and neurodevelopmental outcome. Our results suggest altered neurodevelopmental trajectories in preterm intrauterine growth restriction and adequate-for-gestational-age infants, compared with term adequate-for-gestational-age infants, which require further characterization. Copyright © 2016 Elsevier Inc. All rights reserved.

Predictors of response to 17-alpha hydroxyprogesterone caproate for prevention of recurrent spontaneous preterm birth.

PubMed

Manuck, Tracy A; Esplin, M Sean; Biggio, Joseph; Bukowski, Radek; Parry, Samuel; Zhang, Heping; Huang, Hao; Varner, Michael W; Andrews, William; Saade, George; Sadovsky, Yoel; Reddy, Uma M; Ilekis, John

2016-03-01

Prematurity is the leading cause of neonatal morbidity and death among nonanomalous neonates in the United States. Intramuscular 17-alpha hydroxyprogesterone caproate injections reduce the risk of recurrent prematurity by approximately one third. Unfortunately, prophylactic 17-alpha hydroxyprogesterone caproate is not always effective, and one-third of high-risk women will have a recurrent preterm birth, despite 17-alpha hydroxyprogesterone caproate therapy. The reasons for this variability in response are unknown. Previous investigators have examined the influence of a variety of factors on 17-alpha hydroxyprogesterone caproate response but have analyzed data that used a fixed outcome of term delivery to define progesterone response. We hypothesized that the demographics, history, and pregnancy course among women who deliver at a similar gestational age with 17-alpha hydroxyprogesterone caproate for recurrent spontaneous preterm birth prevention differs when compared with those women who deliver later with 17-alpha hydroxyprogesterone caproate and that these associations could be refined by the use of a contemporary definition of 17-alpha hydroxyprogesterone caproate "responder." This was a planned secondary analysis of a prospective, multicenter, longitudinal study of women with ≥1 previous documented singleton spontaneous preterm birth at <37 weeks gestation. Data were collected at 3 prespecified gestational age epochs during pregnancy. All women who were included in this analysis received 17-alpha hydroxyprogesterone caproate during the studied pregnancy. We classified women as a 17-alpha hydroxyprogesterone caproate responder or nonresponder by calculating the difference in delivery gestational age between the 17-alpha hydroxyprogesterone caproate-treated pregnancy and her earliest spontaneous preterm birth. Responders were defined as those with pregnancy that extended ≥3 weeks later with 17-alpha hydroxyprogesterone caproate, compared with the delivery gestational age of their earliest previous spontaneous preterm birth. Data were analyzed with the use of chi-square test, t-test, and logistic regression. One hundred fifty-five women met the inclusion criteria. The 118 responders delivered later on average (37.7 weeks gestation) than the 37 nonresponders (33.5 weeks gestation; P < .001). Among responders, 32% (38/118 women) had a recurrent spontaneous preterm birth. Demographics (age, race/ethnicity, education, and parity) were similar between groups. In the regression model, the gestational age of the previous spontaneous preterm birth (odds ratio, 0.68; 95% confidence interval, 0.56-0.82; P < .001), vaginal bleeding/abruption in the current pregnancy (odds ratio, 0.24; 95% confidence interval, 0.06-0.88; P = .031), and first-degree family history of spontaneous preterm birth (odds ratio, 0.37; 95% confidence interval, 0.15-0.88; P = .024) were associated with response to 17-alpha hydroxyprogesterone caproate. Because women with a penultimate preterm pregnancy were more likely to be 17-alpha hydroxyprogesterone caproate nonresponders, we performed an additional limited analysis examining only the 130 women whose penultimate pregnancy was preterm. In regression models, the results were similar to those in the main cohort. Several historic and current pregnancy characteristics define women who are at risk for recurrent preterm birth at a similar gestational age, despite 17-alpha hydroxyprogesterone caproate therapy. These data should be studied prospectively in larger cohorts and combined with genetic and environmental data to identify women who are most likely to benefit from this intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

Intrauterine hematomas in the second and third trimesters associated with adverse pregnancy outcomes: a retrospective study.

PubMed

Ji, Wanqing; Li, Weidong; Mei, Shanshan; He, Ping

2017-09-01

To carry out a retrospective study of the clinical features of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors for poor pregnancy outcomes. A total of 398 patients who underwent routine examination in our hospital from January 2011 to December 2015 were classified into normal pregnancy (NP) group (N = 265) and adverse pregnancy (AP) group (N = 133), according to their pregnancy outcomes. Maternal clinical demographics, gestational age, location of hematoma, volume of hematoma, and accompanying contraction and vaginal bleeding were recorded. The average age of pregnant women in the NP and AP groups was 28.25 ± 4.06 and 29.5 ± 5.06 years, respectively (p = 0.007). Gestational age at first detection of hematoma was 15.11 ± 5.13 weeks in the NP group compared with 21.22 ± 8.25 weeks in the AP group (p < 0.001). In the AP group, the incidence of retroplacental hematoma (54.1%) and palpable contractions (62.8%) was significantly higher than in the NP group (25.7% and 12.1%, respectively; p < 0.01). However, similar maternal parity or history of delivery, volume of hematoma and incidence of vaginal bleeding were found. Intrauterine hematoma in the second and third trimesters is a sign of pathological pregnancy, resulting in adverse outcomes. Maternal age, gestational age at first diagnosis, location of hematoma and accompanying contraction are risk factors for poor pregnancy outcomes.

Parenting and Cognitive and Psychomotor Delay Due to Small-for-Gestational-Age Birth

ERIC Educational Resources Information Center

Li, Xiuhong; Eiden, Rina D.; Epstein, Leonard H.; Shenassa, Edmond D.; Xie, Chuanbo; Wen, Xiaozhong

2017-01-01

Background: To examine whether different dimensions of parenting at different ages help small-for-gestational-age (SGA) children "catch-up" the normal children in cognition and psychomotor. Methods: We analyzed data of 800 children born SGA and 3,000 children born appropriate-for-gestational-age (AGA) from the Early Childhood…

Self-assessment of eligibility for early medical abortion using m-Health to calculate gestational age in Cape Town, South Africa: a feasibility pilot study.

PubMed

Momberg, Mariette; Harries, Jane; Constant, Deborah

2016-04-16

Although abortion is legally available in South Africa, barriers to access exist. Early medical abortion is available to women with a gestational age up to 63 days and timely access is essential. This study aimed to determine women's acceptability and ability to self-assess eligibility for early medical abortion using an online gestational age calculator. Women's acceptability, views and preferences of using mobile technology for gestational age (GA) determination were explored. No previous studies to ascertain the accuracy of online self-administered calculators in a non-clinical setting have been conducted. A convenience sample of abortion seekers were recruited from two health care clinics in Cape Town, South Africa in 2014. Seventy-eight women were enrolled and tasked with completing an online self-assessment by entering the first day of their last menstrual period (LMP) onto a website which calculated their GA. A short survey explored the feasibility and acceptability of employing m-Health technology in abortion services. Self-calculated GA was compared with ultrasound gestational age obtained from clinical records. Participant mean age was 28 (SD 6.8), 41% (32/78) had completed high school and 73% (57/78) reported owning a smart/feature phone. Internet searches for abortion information prior to clinic visit were undertaken by 19/78 (24%) women. Most participants found the online GA calculator easy to use (91%; 71/78); thought the calculation was accurate (86%; 67/78) and that it would be helpful when considering an abortion (94%; 73/78). Eighty-three percent (65/78) reported regular periods and recalled their LMP (71%; 55/78). On average women overestimated GA by 0.5 days (SD 14.5) and first sought an abortion 10 days (SD 14.3) after pregnancy confirmation. Timely access to information is an essential component of effective abortion services. Advances in the availability of mobile technology represent an opportunity to provide accurate and safe abortion information and services. Our findings indicate that an online GA calculator would be accurate and helpful. GA could be calculated based on LMP recall within an error of 0.5 days, which is not considered clinically significant. An online GA calculator could potentially act as an enabler for women to access safe abortion services sooner.

Quantitative susceptibility map analysis in preterm neonates with germinal matrix-intraventricular hemorrhage.

PubMed

Tortora, Domenico; Severino, Mariasavina; Sedlacik, Jan; Toselli, Benedetta; Malova, Mariya; Parodi, Alessandro; Morana, Giovanni; Fato, Marco Massimo; Ramenghi, Luca Antonio; Rossi, Andrea

2018-05-10

Germinal matrix-intraventricular hemorrhage (GMH-IVH) is a common form of intracranial hemorrhage occurring in preterm neonates that may affect normal brain development. Although the primary lesion is easily identified on MRI by the presence of blood products, its exact extent may not be recognizable with conventional sequences. Quantitative susceptibility mapping (QSM) quantify the spatial distribution of magnetic susceptibility within biological tissues, including blood degradation products. To evaluate magnetic susceptibility of normal-appearing white (WM) and gray matter regions in preterm neonates with and without GMH-IVH. Retrospective case-control. A total of 127 preterm neonates studied at term equivalent age: 20 had mild GMH-IVH (average gestational age 28.7 ± 2.1 weeks), 15 had severe GMH-IVH (average gestational age 29.3 ± 1.8 weeks), and 92 had normal brain MRI (average gestational age 29.8 ± 1.8 weeks). QSM at 1.5 Tesla. QSM analysis was performed for each brain hemisphere with a region of interest-based approach including five WM regions (centrum semiovale, frontal, parietal, temporal, and cerebellum), and a subcortical gray matter region (basal ganglia/thalami). Changes in magnetic susceptibility were explored using a one-way analysis of covariance, according to GMH-IVH severity (P < 0.05). In preterm neonates with normal brain MRI, all white and subcortical gray matter regions had negative magnetic susceptibility values (diamagnetic). Neonates with severe GMH-IVH showed higher positive magnetic susceptibility values (i.e. paramagnetic) in the centrum semiovale (0.0019 versus -0.0014 ppm; P < 0.001), temporal WM (0.0011 versus -0.0012 ppm; P = 0.037), and parietal WM (0.0005 versus -0.0001 ppm; P = 0.002) compared with controls. No differences in magnetic susceptibility were observed between neonates with mild GMH-IVH and controls (P = 0.236). Paramagnetic susceptibility changes occur in several normal-appearing WM regions of neonates with severe GMH-IVH, likely related to the accumulation of hemosiderin/ferritin iron secondary to diffusion of extracellular hemoglobin from the ventricle into the periventricular WM. 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

The rate of preterm birth in the United States is affected by the method of gestational age assignment.

PubMed

Duryea, Elaine L; McIntire, Donald D; Leveno, Kenneth J

2015-08-01

The objective of the study was to examine the rate of preterm birth in the United States using 2 different methods of gestational age assignment and determine which method more closely correlates with the known morbidities associated with preterm birth. Using National Center for Health Statistics data from 2012 United States birth certificates, we computed the rate of preterm birth defined as a birth at 36 or fewer completed weeks with gestational age assigned using the obstetric estimate as specified in the revised birth certificate. This rate was then compared with the rate when gestational age is calculated using the last menstrual period alone. The rates of neonatal morbidities associated with preterm birth were examined for each method of assigning gestational age. The rate of preterm birth was 9.7% when the obstetric estimate is used to calculate gestational age, which is significantly different from the rate of 11.5% when gestational age is calculated using the last menstrual period alone. In addition, the neonates identified as preterm by obstetric estimate were more likely to qualify as low birthweight (54% vs 42%; P < .001) and suffer morbidities such as need for assisted ventilation and surfactant use than those identified with the last menstrual period alone. That is to say obstetric estimate is more sensitive and specific for preterm birth by all available markers of prematurity. The preterm birth rate is 9.7% vs 11.5% and more closely correlates with adverse neonatal outcomes associated with preterm birth when gestational age is assigned using the obstetric estimate. This method of gestational age assignment is currently used by most industrialized nations and should be considered for future reporting of US outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

A description of externally recorded womb sounds in human subjects during gestation

PubMed Central

Daland, Robert; Kesavan, Kalpashri; Macey, Paul M.; Zeltzer, Lonnie; Harper, Ronald M.

2018-01-01

Objective Reducing environmental noise benefits premature infants in neonatal intensive care units (NICU), but excessive reduction may lead to sensory deprivation, compromising development. Instead of minimal noise levels, environments that mimic intrauterine soundscapes may facilitate infant development by providing a sound environment reflecting fetal life. This soundscape may support autonomic and emotional development in preterm infants. We aimed to assess the efficacy and feasibility of external non-invasive recordings in pregnant women, endeavoring to capture intra-abdominal or womb sounds during pregnancy with electronic stethoscopes and build a womb sound library to assess sound trends with gestational development. We also compared these sounds to popular commercial womb sounds marketed to new parents. Study design Intra-abdominal sounds from 50 mothers in their second and third trimester (13 to 40 weeks) of pregnancy were recorded for 6 minutes in a quiet clinic room with 4 electronic stethoscopes, placed in the right upper and lower quadrants, and left upper and lower quadrants of the abdomen. These recording were partitioned into 2-minute intervals in three different positions: standing, sitting and lying supine. Maternal and gestational age, Body Mass Index (BMI) and time since last meal were collected during recordings. Recordings were analyzed using long-term average spectral and waveform analysis, and compared to sounds from non-pregnant abdomens and commercially-marketed womb sounds selected for their availability, popularity, and claims they mimic the intrauterine environment. Results Maternal sounds shared certain common characteristics, but varied with gestational age. With fetal development, the maternal abdomen filtered high (500–5,000 Hz) and mid-frequency (100–500 Hz) energy bands, but no change appeared in contributions from low-frequency signals (10–100 Hz) with gestational age. Variation appeared between mothers, suggesting a resonant chamber role for intra-abdominal space. Compared to commercially-marketed sounds, womb signals were dominated by bowel sounds, were of lower frequency, and showed more variation in intensity. Conclusions High-fidelity intra-abdominal or womb sounds during pregnancy can be recorded non-invasively. Recordings vary with gestational age, and show a predominance of low frequency noise and bowel sounds which are distinct from popular commercial products. Such recordings may be utilized to determine whether sounds influence preterm infant development in the NICU. PMID:29746604

A description of externally recorded womb sounds in human subjects during gestation.

PubMed

Parga, Joanna J; Daland, Robert; Kesavan, Kalpashri; Macey, Paul M; Zeltzer, Lonnie; Harper, Ronald M

2018-01-01

Reducing environmental noise benefits premature infants in neonatal intensive care units (NICU), but excessive reduction may lead to sensory deprivation, compromising development. Instead of minimal noise levels, environments that mimic intrauterine soundscapes may facilitate infant development by providing a sound environment reflecting fetal life. This soundscape may support autonomic and emotional development in preterm infants. We aimed to assess the efficacy and feasibility of external non-invasive recordings in pregnant women, endeavoring to capture intra-abdominal or womb sounds during pregnancy with electronic stethoscopes and build a womb sound library to assess sound trends with gestational development. We also compared these sounds to popular commercial womb sounds marketed to new parents. Intra-abdominal sounds from 50 mothers in their second and third trimester (13 to 40 weeks) of pregnancy were recorded for 6 minutes in a quiet clinic room with 4 electronic stethoscopes, placed in the right upper and lower quadrants, and left upper and lower quadrants of the abdomen. These recording were partitioned into 2-minute intervals in three different positions: standing, sitting and lying supine. Maternal and gestational age, Body Mass Index (BMI) and time since last meal were collected during recordings. Recordings were analyzed using long-term average spectral and waveform analysis, and compared to sounds from non-pregnant abdomens and commercially-marketed womb sounds selected for their availability, popularity, and claims they mimic the intrauterine environment. Maternal sounds shared certain common characteristics, but varied with gestational age. With fetal development, the maternal abdomen filtered high (500-5,000 Hz) and mid-frequency (100-500 Hz) energy bands, but no change appeared in contributions from low-frequency signals (10-100 Hz) with gestational age. Variation appeared between mothers, suggesting a resonant chamber role for intra-abdominal space. Compared to commercially-marketed sounds, womb signals were dominated by bowel sounds, were of lower frequency, and showed more variation in intensity. High-fidelity intra-abdominal or womb sounds during pregnancy can be recorded non-invasively. Recordings vary with gestational age, and show a predominance of low frequency noise and bowel sounds which are distinct from popular commercial products. Such recordings may be utilized to determine whether sounds influence preterm infant development in the NICU.

Distinguishing pathological from constitutional small for gestational age births in population-based studies.

PubMed

Ananth, Cande V; Vintzileos, Anthony M

2009-10-01

Small for gestational age (SGA) can occur following a pathological process or may represent constitutionally small fetuses. However, distinguishing these processes is often difficult, especially in large studies, where the term SGA is often used as a proxy for restricted fetal growth. Since biologic variation in fetal size is largely a third trimester phenomenon, we hypothesized that the definition of SGA at term may include a sizeable proportion of constitutionally small fetuses. In contrast, since biologic variation in fetal size is not fully expressed in (early) preterm gestations, it is plausible that SGA in early preterm gestations would comprise a large proportion of growth restricted fetuses. We compared mortality and morbidity rates between SGA and appropriate for gestational age (AGA) babies. A population-based study of over 19million non-malformed, singleton births (1995-04) in the United States was performed. Gestational age (24-44weeks) was based on a clinical estimate. SGA and AGA were defined as sex-specific birthweight <10th and 25-74th centiles, respectively, for gestational age. All analyses were adjusted for a variety of confounding factors. Excess mortality risk in SGA and AGA babies. On an additive scale, stillbirth and neonatal mortality rates were higher at every preterm gestation among SGA than AGA births, and similar at term gestations. An inverse relationship between gestational age and excess deaths between SGA and AGA babies delivered at <37weeks was evident. In early preterm gestations, the definition of SGA may well be justified as a proxy for IUGR. In contrast, SGA babies that are delivered at term are likely to be constitutionally small.

A two-component Bayesian mixture model to identify implausible gestational age.

PubMed

Mohammadian-Khoshnoud, Maryam; Moghimbeigi, Abbas; Faradmal, Javad; Yavangi, Mahnaz

2016-01-01

Background: Birth weight and gestational age are two important variables in obstetric research. The primary measure of gestational age is based on a mother's recall of her last menstrual period. This recall may cause random or systematic errors. Therefore, the objective of this study is to utilize Bayesian mixture model in order to identify implausible gestational age. Methods: In this cross-sectional study, medical documents of 502 preterm infants born and hospitalized in Hamadan Fatemieh Hospital from 2009 to 2013 were gathered. Preterm infants were classified to less than 28 weeks and 28 to 31 weeks. A two-component Bayesian mixture model was utilized to identify implausible gestational age; the first component shows the probability of correct and the second one shows the probability of incorrect classification of gestational ages. The data were analyzed through OpenBUGS 3.2.2 and 'coda' package of R 3.1.1. Results: The mean (SD) of the second component of less than 28 weeks and 28 to 31 weeks were 1179 (0.0123) and 1620 (0.0074), respectively. These values were larger than the mean of the first component for both groups which were 815.9 (0.0123) and 1061 (0.0074), respectively. Conclusion: Errors occurred in recording the gestational ages of these two groups of preterm infants included recording the gestational age less than the actual value at birth. Therefore, developing scientific methods to correct these errors is essential to providing desirable health services and adjusting accurate health indicators.

Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan.

PubMed

Hydery, Tasmina; Price, Mylissa K; Greenwood, Bonnie C; Takeshita, Mito; Kunte, Parag S; Mauro, Rose P; Lenz, Kimberly; Jeffrey, Paul L

2017-10-01

Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by a third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care with a prior preterm pregnancy. This retrospective cohort study used medical claims, pharmacy claims, and prior authorization (PA) request data for MassHealth members who had a PA submitted for progesterone between January 1, 2011, and March 31, 2015. Members were excluded due to breaks in coverage, progesterone was not indicated for prevention of PTB, and if current gestational week or date of delivery was unavailable. A total of 418 members were screened for inclusion of whom 190 met criteria and 169 filled progesterone. Mean age was 29.2 years (SD = 5.23), and clinical comorbidities were identified in 90.5% of members. Consistent with clinical trials on progesterone effectiveness, 62.1% of members had a term delivery (37 wks of gestation). Among members with prior gestational age at delivery available, the average difference in gestational age between pregnancies was 8.25 weeks (SD = 6.11). In addition, 66.3% of members were adherent to progesterone based on proportion of days covered (PDC) of 0.8 or higher. The overall mean PDC was 0.79 (SD = 0.26). Despite similar birth outcomes in clinical trials and national trends, medication adherence is low in this state Medicaid program. Therefore, members may benefit from adherence support. © 2017 Pharmacotherapy Publications, Inc.

Retrospective cohort study on risk factors for development of gestational diabetes among mothers attending antenatal clinics in Nairobi County.

PubMed

Adoyo, Maureen Atieno; Mbakaya, Charles; Nyambati, Venny; Kombe, Yeri

2016-01-01

World Health Organization estimates that deaths resulting from diabetes will rise above 50% by the year 2020; hence urgent action is needed to reverse the trend notably through nutrition and lifestyle intervention among populations at risks. Studies have established that nutritional environment and physiology of the mother affects neonate's health at infancy and later in life thus this study sought to investigate the risk factors for development of gestational diabetes focusing age, weight, family history and pre-existing medical condition which could be modified to improve population health. A retrospective cohort study design was used. Subjects were sampled from selected maternity facilities in Nairobi and were subjected to oral glucose test to ascertain Gestational Diabetes mellitus (GDM) status. A questionnaire was administered to a sample of 238 respondents. Quantitative data was then analyzed as descriptive statistic, univariate and multivariate regression. Average age for mothers with GDM was high with a mean of 33.06 (95% C.I: 31.59-34.52) compared to a mean of 27.9 (95% C.I: 27.01-28.78) for non-GDM mothers. Weight before pregnancy was high with mean of 74.04 (95% C.I: 70.82-77.30) among mothers with GDM compared to mean of 60.27 (95% C.I:58.59-61.96) among non-GDM mothers. Mothers with diabetic history in the family had twice the risk of developing GDM (OR= 2.27; 95% C.I: 1.23-4.17) compared to those who did not observe diabetic history in the family. Gestational diabetes cases are relatively high. Age advancement; high weight and diabetic history in family are determining factors for development of diabetes among pregnant women.

The puzzling association between smoking and hypertension during pregnancy.

PubMed

Zhang, J; Klebanoff, M A; Levine, R J; Puri, M; Moyer, P

1999-12-01

The object of this study was to examine the association between maternal smoking and hypertension during pregnancy. We used data from the Collaborative Perinatal Project, a large prospective cohort study that collected detailed information on blood pressure, proteinuria, smoking, and placental morphologic and histologic characteristics. A total of 9651 healthy primigravid women without chronic hypertension who had been enrolled in the study at the first or second trimester (average 18 weeks' gestation) and had had >/=3 prenatal visits were included. Gestational hypertension was defined as diastolic blood pressure >/=90 mm Hg on 2 occasions from 24 weeks' gestation to 2 weeks post partum. Preeclampsia was defined as gestational hypertension plus >/=2 urine samples containing >/=1+ protein according to dipstick measurement during the same gestational period. After we controlled for prepregnancy body mass, age, socioeconomic status, and race, both past smoking and smoking during pregnancy were associated in a dose-response pattern with reduced risks of gestational hypertension and preeclampsia. For women who smoked >/=10 cigarettes/d the relative risks with respect to women who had never smoked were 0.6 (95% confidence interval, 0.4-0.9) for gestational hypertension and 0.5 (95% confidence interval, 0.4-0.7) for preeclampsia. This protective effect was observed both for mild and severe gestational hypertension and for preeclampsia. The more and the longer a woman had smoked previously, the lower was her risk of development of hypertension during pregnancy. This association could not be explained by confounding factors, by changes in placental morphologic or histopathologic characteristics, by maternal net weight gain, or by elevated liver enzyme bioactivity. Smoking is associated with a reduced risk of hypertension during pregnancy. The protective effect appears to continue even after cessation of smoking. Further basic research on this issue is warranted.

[Risk factors of small for the gestational age neonates in a hospital of Lima, Peru].

PubMed

Tejeda-Mariaca, J Eduardo; Pizango-Mallqui, Orion; Alburquerque-Duglio, Miguel; Mayta-Tristán, Percy

2015-01-01

Identify risk factors for at-term small for gestational age newborns. Retrospective cohort study using data from the Maternal Perinatal Information System of the Maria Auxiliadora Hospital of Lima, from the period 2000-2010. Maternal age, parity, education level, marital status, pregestational body mass index, number of prenatal care visits, presence of conditions such as preeclampsia, eclampsia, urinary tract infection and gestational diabetes as risk factors in small for gestational age newborns were evaluated. The weight for gestational age was calculated based on Peruvian percentiles. Crude relative risk (RR) and adjusted (ARR) were calculated with confidence intervals of 95% using log-binomial generalized linear models. 64,670 pregnant women were included. The incidence for small for gestational age was 7.2%. Preeclampsia (ARR 2.0, 95% CI: 1.86 to 2.15), eclampsia (ARR 3.22, 95% CI: 2.38 to 4.35), low maternal weight (ARR 1.38; 95% CI: 1.23 to 1.54), nulliparity (ARR 1.32, 95% CI: 1.23 to 1.42), age ≥35 years (ARR 1.16, 95% CI: 1.04 -1.29), having prenatal care visits from 0 to 2 (ARR 1.43, 95% CI: 1.32 to 1.55) and 3 to 5 (ARR 1.22, 95% CI: 1.14 to 1.32) were risk factors for small for gestational age. It is necessary to identify pregnant women with risk factors such as those found to decrease the condition of small for gestational age. Actions should emphasize modifiable factors, such as the frequency of prenatal care visits.

Cellular Components, Including Stem-Like Cells, of Preterm Mother's Mature Milk as Compared with Those in Her Colostrum: A Pilot Study.

PubMed

Kaingade, Pankaj; Somasundaram, Indumathi; Sharma, Akshita; Patel, Darshan; Marappagounder, Dhanasekaran

2017-09-01

Whether the preterm mothers' mature milk retains the same cellular components as those in colostrum including stem-like cell, cell adhesion molecules, and immune cells. A total of five preterm mothers were recruited for the study having an average age of 30.2 years and gestational age of 29.8 weeks from the Pristine Women's Hospital, Kolhapur. Colostrum milk was collected within 2-5 days and matured milk was collected 20-30 days after delivery from the same mothers. Integral cellular components of 22 markers including stem cells, immune cells, and cell adhesion molecules were measured using flowcytometry. Preterm mature milk was found to possess higher expressions of hematopoietic stem cells, mesenchymal stem-like cells, immune cells, few cell adhesion molecules, and side population cells than colostrum. The increased level of these different cell components in mature milk may be important in the long-term preterm baby's health growth. Further similar research in a larger population of various gestational ages and lactation stages of preterm mothers is warranted to support these pilot findings.

The role of prenatal nutrition assistance on the prevalence of night blindness in pregnant adults.

PubMed

Ribeiro Neves, Paulo Augusto; Ramalho, Andrea; De Carvalho Padilha, Patricia; Saunders, Cláudia

2014-05-01

In developing countries, night blindness is a very common public health problem among pregnant women. Evaluate the effect of the changes occurred on prenatal care concerning prenatal nutritional care on the occurrence of night blindness (XN) in adult pregnant women in public maternity hospital in Rio de Janeiro between 1999-2001 and between 2007-2008. Two cross-sectional studies were conducted, been the first one conducted between 1999-2001 and the second one between 2007-2008. Were studied 402 puerperal women, 225 between 1999-2001 (GI) and 177 between 2007-2008 (GII). The gestational XN was investigated during the immediate puerperium (GI) and during the prenatal/puerperium (GII), diagnosed by the World Health Organization. The study collected sociodemographic, clinical, obstetric, anthropometric and prenatal care information. It verified significant reduce of prevalence of gestational XN (GI = 18.7% e GII = 0.6%, p < 0.001). The occurrence of gestational XN was associated to sanitary conditions, education level, more than six prenatal consultations, miscarriage at last pregnancy, higher average number of deliveries, average number of prenatal care consultations and prenatal nutritional (p < 0.05). There was no association between gestational XN and marital status, skin color, pre-gestational nutritional status, adequacy of gain of total gestational weight, gestational anaemia and average number of pregnancies (p > 0.05). The inclusion of nutritional care in routine prenatal care may have contributed to the reduction of gestational XN. Studies to assess the nutritional intervention in the prevention and treatment of gestational XN at regions at greatest risk are suggested. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Changes in Birth Weight between 2002 and 2012 in Guangzhou, China

PubMed Central

Xia, Xiao-Yan; Mo, Wei-Jian; Wang, Ping; Feng, Qiong; Larson, Charles P.; Xia, Hui-Min; Qiu, Xiu

2014-01-01

Background Recent surveillance data suggest that mean birth weight has begun to decline in several developed countries. The aim of this study is to examine the changes in birth weight among singleton live births from 2002 to 2012 in Guangzhou, one of the most rapidly developed cities in China. Methods We used data from the Guangzhou Perinatal Health Care and Delivery Surveillance System for 34108 and 54575 singleton live births with 28–41 weeks of gestation, who were born to local mothers, in 2002 and 2012, respectively. The trends in birth weight, small (SGA) and large (LGA) for gestational age and gestational length were explored in the overall population and gestational age subgroups. Results The mean birth weight decreased from 3162 g in 2002 to 3137 g in 2012 (crude mean difference, −25 g; 95% CI, −30 to −19). The adjusted change in mean birth weight appeared to be slight (−6 g from 2002 to 2012) after controlling for maternal age, gestational age, educational level, parity, newborn's gender and delivery mode. The percentages of SGA and LGA in 2012 were 0.6% and 1.5% lower than those in 2002, respectively. The mean gestational age dropped from 39.2 weeks in 2002 to 38.9 weeks in 2012. In the stratified analysis, we observed the changes in birth weight differed among gestational age groups. The mean birth weight decreased among very preterm births (28–31 weeks), while remained relatively stable among other gestational age subcategories. Conclusions Among local population in Guangzhou from 2002 to 2012, birth weight appeared to slightly decrease. The percentage of SGA and LGA also simultaneously dropped, indicating that newborns might gain a healthier weight for gestational age. PMID:25531295

Trends in Serial Measurements of Ultrasound Markers in Second and Third Trimester Down Syndrome Fetuses.

PubMed

Vos, F I; De Jong-Pleij, E A P; Bakker, M; Tromp, E; Bilardo, C M

2015-01-01

To evaluate trends of nasal bone length (NBL), prenasal thickness (PT), nuchal fold (NF), prenasal thickness to nasal bone length (PT-NBL) ratio, and prefrontal space ratio (PFSR), measured serially in second- and third-trimester Down syndrome (DS) fetuses. Prenatal databases were searched for cases of continuing DS pregnancies with serial measurements, taken at least two weeks apart. Trends were plotted on previously reported normal ranges. Serial measurements were available in 25 Down syndrome fetuses. Median gestational age (GA) was 25 weeks; average number of visits per case was 2.44, with a median interval of 39 days between investigations. In DS fetuses, NBL and PT showed fairly stable trends with gestation. PFSR, but especially NF, had a more unpredictable trend. The PT-NBL ratio was the most stable marker, remaining unchanged in 95% of cases. NBL, PT, and NF showed more deviance from the normal range with advancing gestation, but MoM values remained stable. All but two fetuses had ultrasound markers or structural anomalies, especially heart defects. The PT-NBL ratio is the most constant DS marker throughout gestation, following a predictable trend. © 2015 S. Karger AG, Basel.

Size for Gestational Age and Neonatal Temperament.

ERIC Educational Resources Information Center

Riese, Marilyn L.

The appropriate-for-gestational-age (AGA) and small-for-gestational-age (SGA) infants from 30 pairs of full-term and 15 pairs of preterm same-sex twins were compared for neonatal temperament. The evaluation of neonatal temperament included ratings of irritability, resistance to soothing, activity level, reactivity, and reinforcement value. Results…

Determinants and consequences of discrepancies in menstrual and ultrasonographic gestational age estimates.

PubMed

Morin, Isabelle; Morin, Lucie; Zhang, Xun; Platt, Robert W; Blondel, Béatrice; Bréart, Gérard; Usher, Robert; Kramer, Michael S

2005-02-01

To assess the association between maternal and fetal characteristics and discrepancy between last normal menstrual period and early (<20 weeks) ultrasound-based gestational age and the association between discrepancies and pregnancy outcomes. Hospital-based cohort study. Montreal, Canada. A total of 46,514 women with both menstrual- and early ultrasound-based gestational age estimates. Positive (last normal menstrual period > early ultrasound, i.e. menstrual-based gestational age is higher than early ultrasound-based gestational age, so that the expected date of delivery is earlier with the menstrual-based gestational age) discrepancies > or =+7 days, mean birthweight, low birthweight, stillbirth and in-hospital neonatal death. Multiparous mothers and those with diabetes, small stature or high pre-pregnancy body mass index were more likely to have positive discrepancies. The proportion of women with discrepancies > or =+7 days was significantly higher among chromosomally malformed and female fetuses. The mean birthweight declined with increasingly positive differences. The risk of low birthweight was significantly higher for positive differences. Associations with fetal growth measures were more plausible with early ultrasound estimates. Although most discrepancies between last normal menstrual period- and early ultrasound-based gestational age are attributable to errors in menstrual dating, our results suggest that some positive differences reflect early growth restriction.

Effect of weight and adiposity at conception and wide variations in gestational dietary intake on pregnancy outcome and early postnatal performance in young adolescent sheep.

PubMed

Wallace, Jacqueline M; Milne, John S; Aitken, Raymond P

2010-02-01

Nutritional backgrounds prior to pregnancy may interact with subsequent gestational intake to influence pregnancy outcome, particularly in young, growing adolescents. To investigate this interaction, singleton pregnancies were established in two groups of adolescent sheep of identical age but different initial weight and adiposity score, classified as good (G) and poor (P) body mass index (BMI). Thereafter, ewes were offered either an optimal control (C) intake to maintain adiposity throughout pregnancy, undernourished (UN) to maintain weight at conception but deplete maternal body reserves, or overnourished (ON) to promote rapid maternal growth and adiposity, resulting in a 2 x 3 factorial design. Gestation length was independent of BMI and reduced in ON dams. Average placental and lamb birth weights were influenced by initial BMI (G > P) and gestational intake (C > UN > ON), with the highest incidence of growth restriction in ON groups. Metabolic challenges at two thirds of gestation revealed enhanced insulin insensitivity in ON dams (higher glucose postinsulin challenge and higher insulin postglucose challenge), but nevertheless fetal growth was constrained. Initial colostrum yield, total IgG, and nutrient supply were reduced in ON groups, but these low-birth-weight lambs exhibited rapid catch-up growth to weaning. Thus, both maternal BMI at conception and gestational intake have a profound influence on pregnancy outcome in young, putatively growing adolescent sheep and may have implications for the nutritional management of pregnant adolescent humans.

Risk factors for classical hysterotomy by gestational age.

PubMed

Osmundson, Sarah S; Garabedian, Matthew J; Lyell, Deirdre J

2013-10-01

To examine the likelihood of classical hysterotomy across preterm gestational ages and to identify factors that increase its occurrence. This is a secondary analysis of a prospective observational cohort collected by the Maternal-Fetal Medicine Network of all women with singleton gestations who underwent a cesarean delivery with a known hysterotomy. Comparisons were made based on gestational age. Factors thought to influence hysterotomy type were studied, including maternal age, body mass index, parity, birth weight, small for gestational age (SGA) status, fetal presentation, labor preceding delivery, and emergent delivery. Approximately 36,000 women were eligible for analysis, of whom 34,454 (95.7%) underwent low transverse hysterotomy and 1,562 (4.3%) underwent classical hysterotomy. The median gestational age of women undergoing a classical hysterotomy was 32 weeks and the incidence peaked between 24 0/7 weeks and 25 6/7 weeks (53.2%), declining with each additional week of gestation thereafter (P for trend <.001). In multivariable regression, the likelihood of classical hysterotomy was increased with SGA (n=258; odds ratio [OR] 2.71; confidence interval [CI] 1.78-4.13), birth weight 1,000 g or less (n=467; OR 1.51; CI 1.03-2.24), and noncephalic presentation (n=783; OR 2.03; CI 1.52-2.72). The likelihood of classical hysterotomy was decreased between 23 0/7 and 27 6/7 weeks of gestation and after 32 weeks of gestation when labor preceded delivery, and increased between 28 0/7 and 31 6/7 weeks of gestation and after 32 weeks of gestation by multiparity and previous cesarean delivery. Emergent delivery did not predict classical hysterotomy. Fifty percent of women at 23-26 weeks of gestation who undergo cesarean delivery have a classical hysterotomy, and the risk declines steadily thereafter. This likelihood is increased by fetal factors, especially SGA and noncephalic presentation. : II.

Human placental growth hormone is increased in maternal serum at 20 weeks of gestation in pregnancies with large-for-gestational-age babies.

PubMed

Liao, Shutan; Vickers, Mark H; Taylor, Rennae S; Jones, Beatrix; Fraser, Mhoyra; McCowan, Lesley M E; Baker, Philip N; Perry, Jo K

2016-12-01

To investigate the relationship between maternal serum concentrations of placental growth hormone (GH-V), insulin-like growth factor (IGF)-1 and 2, IGF binding proteins (IGFBP)-1 and 3 and birth weight in appropriate-for-gestational-age (AGA), large-for-gestational-age (LGA) and small-for-gestational-age (SGA) cases in a nested case-control study. Maternal serum samples were selected from the Screening for Pregnancy Endpoints (SCOPE) biobank in Auckland, New Zealand. Serum hormone concentrations were determined by ELISA. We found that maternal serum GH-V concentrations at 20 weeks of gestation in LGA pregnancies were significantly higher than in AGA and SGA pregnancies. Maternal GH-V concentrations were positively correlated to birth weights and customized birth weight centiles, while IGFBP-1 concentrations were inversely related to birth weights and customized birth weight centiles. Our findings suggest that maternal serum GH-V and IGFBP-1 concentrations at 20 weeks' gestation are associated with fetal growth.

Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy.

PubMed

McCowan, Lesley M; Figueras, Francesc; Anderson, Ngaire H

2018-02-01

Small for gestational age is usually defined as an infant with a birthweight <10th centile for a population or customized standard. Fetal growth restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth. Improved identification, accompanied by surveillance and timely delivery, is associated with reduction in small-for-gestational-age stillbirths. Internationally and regionally, detection of small for gestational age and management of fetal growth problems vary considerably. The aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines; and identify future research priorities in this field. A search of MEDLINE, Google, and the International Guideline Library identified 6 national guidelines on management of pregnancies complicated by fetal growth restriction/small for gestational age published from 2010 onwards. There is general consensus between guidelines (at least 4 of 6 guidelines in agreement) in early pregnancy risk selection, and use of low-dose aspirin for women with major risk factors for placental insufficiency. All highlight the importance of smoking cessation to prevent small for gestational age. While there is consensus in recommending fundal height measurement in the third trimester, 3 specify the use of a customized growth chart, while 2 recommend McDonald rule. Routine third-trimester scanning is not recommended for small-for-gestational-age screening, while women with major risk factors should have serial scanning in the third trimester. Umbilical artery Doppler studies in suspected small-for-gestational-age pregnancies are universally advised, however there is inconsistency in the recommended frequency for growth scans after diagnosis of small for gestational age/fetal growth restriction (2-4 weekly). In late-onset fetal growth restriction (≥32 weeks) general consensus is to use cerebral Doppler studies to influence surveillance and/or delivery timing. Fetal surveillance methods (most recommend cardiotocography) and recommended timing of delivery vary. There is universal agreement on the use of corticosteroids before birth at <34 weeks, and general consensus on the use of magnesium sulfate for neuroprotection in early-onset fetal growth restriction (<32 weeks). Most guidelines advise using cardiotocography surveillance to plan delivery in fetal growth restriction <32 weeks. The recommended gestation at delivery for fetal growth restriction with absent and reversed end-diastolic velocity varies from 32 to ≥34 weeks and 30 to ≥34 weeks, respectively. Overall, where there is high-quality evidence from randomized controlled trials and meta-analyses, eg, use of umbilical artery Doppler and corticosteroids for delivery <34 weeks, there is a high degree of consistency between national small-for-gestational-age guidelines. This review discusses areas where there is potential for convergence between small-for-gestational-age guidelines based on existing randomized controlled trials of management of small-for-gestational-age pregnancies, and areas of controversy. Research priorities include assessing the utility of late third-trimester scanning to prevent major morbidity and mortality and to investigate the optimum timing of delivery in fetuses with late-onset fetal growth restriction and abnormal Doppler parameters. Prospective studies are needed to compare new international population ultrasound standards with those in current use. Copyright © 2017. Published by Elsevier Inc.

Birth weight standardized to gestational age and intelligence in young adulthood: a register-based birth cohort study of male siblings.

PubMed

Eriksen, Willy; Sundet, Jon M; Tambs, Kristian

2010-09-01

The authors aimed to determine the relation between birth-weight variations within the normal range and intelligence in young adulthood. A historical birth cohort study was conducted. Data from the Medical Birth Register of Norway were linked with register data from the Norwegian National Conscript Service. The sample comprised 52,408 sibships of full brothers who were born singletons at 37-41 completed weeks' gestation during 1967-1984 in Norway and were intelligence-tested at the time of mandatory military conscription. Generalized estimating equations were used to fit population-averaged panel data models. The analyses showed that in men with birth weights within the 10th-90th percentile range, a within-family difference of 1 standard deviation in birth weight standardized to gestational age was associated with a within-family difference of 0.07 standard deviation (99% confidence interval: 0.03, 0.09) in intelligence score, after adjustment for a range of background factors. There was no significant between-family association after adjustment for background factors. In Norwegian males, normal variations in intrauterine growth are associated with differences in intelligence in young adulthood. This association is probably not due to confounding by familial and parental characteristics.

Extremely preterm infants small for gestational age are at risk for motor impairment at 3 years corrected age.

PubMed

Kato, Takeshi; Mandai, Tsurue; Iwatani, Sota; Koda, Tsubasa; Nagasaka, Miwako; Fujita, Kaori; Kurokawa, Daisuke; Yamana, Keiji; Nishida, Kosuke; Taniguchi-Ikeda, Mariko; Tanimura, Kenji; Deguchi, Masashi; Yamada, Hideto; Iijima, Kazumoto; Morioka, Ichiro

2016-02-01

Few studies have targeted psychomotor development and associated perinatal risk factors in Japanese very low birth weight (VLBW) infants who are severely small for gestational age (SGA). A single-center study was conducted in 104 Japanese VLBW infants who were born preterm, due to maternal, umbilical cord, or placental abnormalities, between 2000 and 2007. Psychomotor development as a developmental quotient (DQ) was assessed using the Kyoto Scale of Psychological Development at 3 years corrected age. Severely SGA was defined as birth weight or length below -2 standard deviation values of the mean values at the same gestation. VLBW infants were divided into 2 subgroups based on gestational age at birth: ⩾28 weeks (n=64) and <28 weeks (n=40). DQs of infants with severe SGA were compared with those of infants who were appropriate for gestational age (AGA). Factors associated with developmental disabilities in VLBW infants with severe SGA (n=23) were determined. In the group born at ⩾28 weeks gestation, infants with severe SGA had normal DQ values and did not significantly differ from those with AGA. However, in the group born at <28 weeks gestation, severe SGA infants had significantly lower postural-motor DQ values than AGA infants. Gestational age <28 weeks was an independent factor for low postural-motor DQ, regardless of the cause of severe SGA or pregnancy termination. Extremely preterm newborns with severe SGA are at risk of motor developmental disability at age 3 years. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

New Korean reference for birth weight by gestational age and sex: data from the Korean Statistical Information Service (2008-2012).

PubMed

Lim, Jung Sub; Lim, Se Won; Ahn, Ju Hyun; Song, Bong Sub; Shim, Kye Shik; Hwang, Il Tae

2014-09-01

To construct new Korean reference curves for birth weight by sex and gestational age using contemporary Korean birth weight data and to compare them with the Lubchenco and the 2010 United States (US) intrauterine growth curves. Data of 2,336,727 newborns by the Korean Statistical Information Service (2008-2012) were used. Smoothed percentile curves were created by the Lambda Mu Sigma method using subsample of singleton. The new Korean reference curves were compared with the Lubchenco and the 2010 US intrauterine growth curves. Reference of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles birth weight by gestational age were made using 2,249,804 (male, 1,159,070) singleton newborns with gestational age 23-43 weeks. Separate birth weight curves were constructed for male and female. The Korean reference curves are similar to the 2010 US intrauterine growth curves. However, the cutoff values for small for gestational age (<10th percentile) of the new Korean curves differed from those of the Lubchenco curves for each gestational age. The Lubchenco curves underestimated the percentage of infants who were born small for gestational age. The new Korean reference curves for birth weight show a different pattern from the Lubchenco curves, which were made from white neonates more than 60 years ago. Further research on short-term and long-term health outcomes of small for gestational age babies based on the new Korean reference data is needed.

Gestational age and birth weight centiles of singleton babies delivered normally following spontaneous labor, in Southern Sri Lanka

PubMed

Attanayake, K; Munasinghe, S; Goonewardene, M; Widanapathirana, P; Sandeepani, I; Sanjeewa, L

2018-03-31

To estimate the gestational age and birth weight centiles of babies delivered normally, without any obstetric intervention, in women with uncomplicated singleton pregnancies establishing spontaneous onset of labour. Consecutive women with uncomplicated singleton pregnancies, attending the Academic Obstetrics and Gynecology Unit of the Teaching Hospital Mahamodara Galle, Sri Lanka, with confirmed dates and establishing spontaneous onset of labor and delivering vaginally between gestational age of 34 - 41 weeks, without any obstetric intervention , during the period September 2013 to February 2014 were studied. The gestational age at spontaneous onset of labor and vaginal delivery and the birth weights of the babies were recorded. There were 3294 consecutive deliveries during this period, and of them 1602 (48.6%) met the inclusion criteria. Median gestational age at delivery was 275 days (range 238-291 days, IQR 269 to 280 days) and the median birth weight was 3000 g (range1700g - 4350g; IQR 2750-3250g). The 10th, 50th and 90th birth weight centiles of the babies delivered at a gestational age of 275 days were approximately 2570g, 3050g and 3550g respectively. The median gestational age among women with uncomplicated singleton pregnancies who established spontaneous onset of labor and delivered vaginally, without any obstetric intervention, was approximately five days shorter than the traditionally accepted 280 days. At a gestational age of 275 days, the mean birth weight was approximately 3038g and the 50th centile of the birth weight of the babies delivered was approximately 3050g.

Early rescue administration of surfactant and nasal continuous positive airway pressure in preterm infants <32 weeks gestation.

PubMed

Tsakalidis, Christos; Kourti, Maria; Karagianni, Paraskevi; Rallis, Dimitris; Porpodi, Maria; Nikolaidis, Nikolaos

2011-08-01

This study reports our institutional experience on the outcome after prophylactic and early rescue endotracheal instillation of surfactant within 20 minutes of birth, followed by extubation and nasal continuous positive airway pressure (NCPAP) in preterm infants <32 weeks gestational age. A total of 142 infants were prospectively studied (42, gestational age from 23 to 27 and 100, from 28 up to 32 weeks). All infants were electively intubated for administration of 200 mg/kg porcine isolated surfactant (Curosurf, Chiesi Farmaceutici SPA, Parma, Italy) as soon as practicably possible (within 20 min after birth) and NCPAP was then initiated. Extubation and switch to NCPAP at 6 h was successful in 6/42 (14.3%) infants less than 28 weeks gestational age and 75/100 (75%) infants 28-32 weeks gestational age. Out of 81 infants that were successfully extubated, 76 (93.83%) never required re-ventilation. At 96 h of age, need for continuing intubation and ventilation was required by 6/38 (15.8%) alive infants <28 weeks gestational age and 8/100 (8%) infants 28-32 weeks gestational age. Mean duration of NCPAP post-extubation was 38±20 hours for infants 23-27 wks and 29±15 hours for infants 28-32 wks gestational age. The mortality rate was 2.81% (4/142). Implementation of prophylactic or early rescue administration of surfactant with NCPAP in infants at high risk for developing RDS in neonatal ICU is a safe modality of respiratory support in preterm infants.

[Evaluation of pre-pregnancy weight and gestational weight gain among urban and rural women from southwestern China].

PubMed

Dai, Zhengyan; Li, Ming; Rui, Li; Sun, Xiaohong; Pang, Xuehong; Zhou, Lan; Zeng, Guo

2014-07-01

To evaluate the situation of pre-pregnancy weight and gestational weight gain (GWG) of women in the urban and rural areas of southwest of China. Total 3391 women whose infants and young children aged 6 - 24 months were selected from urban and rural areas of Kunming, Guiyang and Chengdu cities by stratified cluster random sampling. Data of pre-pregnancy height and weight, prenatal weight and pregnancy age for subjects was obtained using a questionnaire. Pre-pregnancy BMI and GWG were calculated. According to the BMI standard for adults from WHO and GWG Guidelines from IOM (2009), the status of pre-pregnancy weight and GWG were assessed. Average BMI of pre-pregnancy for them is (20.3 +/- 2.4). Percentage of normal weight, underweight, and overweight/obesity of pre-pregnancy were 72.7%, 24.1% and 3.2% respectively. The average GWG was (14.9 +/- 6.0) kg, and there was a significant difference between urban and rural group (P < 0.05). Percentage of normal, insufficient and excessive GWG were 35.3%, 31.1% and 33.3% respectively. The rate of excessive GWG in urban group was higher than rural group (P < 0.05), but the rate of insufficient GWG was lower (P < 0.05). The rate of insufficient GWG was higher in women aged below 23 years old (P < 0.05), and the rate of excessive GWG was higher in women aged 24 - 34 years old (P < 0.05). It should be pay more attention to improve the underweight of pre-pregnancy and abnormal GWG among women in the southwest of China.

Estimating Gestational Age With Sonography: Regression-Derived Formula Versus the Fetal Biometric Average.

PubMed

Cawyer, Chase R; Anderson, Sarah B; Szychowski, Jeff M; Neely, Cherry; Owen, John

2018-03-01

To compare the accuracy of a new regression-derived formula developed from the National Fetal Growth Studies data to the common alternative method that uses the average of the gestational ages (GAs) calculated for each fetal biometric measurement (biparietal diameter, head circumference, abdominal circumference, and femur length). This retrospective cross-sectional study identified nonanomalous singleton pregnancies that had a crown-rump length plus at least 1 additional sonographic examination with complete fetal biometric measurements. With the use of the crown-rump length to establish the referent estimated date of delivery, each method's (National Institute of Child Health and Human Development regression versus Hadlock average [Radiology 1984; 152:497-501]), error at every examination was computed. Error, defined as the difference between the crown-rump length-derived GA and each method's predicted GA (weeks), was compared in 3 GA intervals: 1 (14 weeks-20 weeks 6 days), 2 (21 weeks-28 weeks 6 days), and 3 (≥29 weeks). In addition, the proportion of each method's examinations that had errors outside prespecified (±) day ranges was computed by using odds ratios. A total of 16,904 sonograms were identified. The overall and prespecified GA range subset mean errors were significantly smaller for the regression compared to the average (P < .01), and the regression had significantly lower odds of observing examinations outside the specified range of error in GA intervals 2 (odds ratio, 1.15; 95% confidence interval, 1.01-1.31) and 3 (odds ratio, 1.24; 95% confidence interval, 1.17-1.32) than the average method. In a contemporary unselected population of women dated by a crown-rump length-derived GA, the National Institute of Child Health and Human Development regression formula produced fewer estimates outside a prespecified margin of error than the commonly used Hadlock average; the differences were most pronounced for GA estimates at 29 weeks and later. © 2017 by the American Institute of Ultrasound in Medicine.

Neuropsychological Impairment in School-Aged Children Born to Mothers With Gestational Diabetes.

PubMed

Bolaños, Lourdes; Matute, Esmeralda; Ramírez-Dueñas, María de Lourdes; Zarabozo, Daniel

2015-10-01

The aim of this study was to determine whether school-aged children born to mothers with gestational diabetes show delays in their neuropsychological development. Several key neuropsychological characteristics of 32 children aged 7 to 9 years born to mothers with gestational diabetes were examined by comparing their performance on cognitive tasks to that of 28 children aged 8 to 10 years whose mothers had glucose levels within normal limits during pregnancy. The gestational diabetes group showed low performance on graphic, spatial, and bimanual skills and a higher presence of soft neurologic signs. Lower scores for general intellectual level and the working memory index were also evident. Our results suggest that gestational diabetes is associated with mild cognitive impairment. © The Author(s) 2015.

Presentation to delivery interval in women with early preterm delivery presenting with preterm labor: the effect of gestational age.

PubMed

Ashwal, Eran; Shinar, Shiri; Wertheimer, Avital; Reina, Luciena; Miremberg, Hadas; Aviram, Amir; Yogev, Yariv; Hiersch, Liran

2017-10-01

To evaluate the association between gestational age at presentation and interval to delivery in women with early spontaneous preterm delivery (PTD). A retrospective cohort study of women who presented with threatened preterm labor (tPTL) and intact membranes and had a spontaneous PTD <34 weeks in a university-affiliated hospital (2009-2015). The interval from presentation to delivery was compared between different gestational age subgroups. Of 67 550 deliveries during the study period, 252 met inclusion criteria. This cohort was divided to three gestational age subgroups at presentation: 24-28 6/7 weeks (n = 83), 29-31 6/7 weeks (n = 61) and 32-33 6/7 weeks (n = 108). Median time from presentation to delivery was 24.5 h. An inverse relation was observed between gestational age at presentation and admission-delivery interval (group A: 74.7 h, group B: 21.0 h, group C: 14.0 h, p < 0.001). Gestational age at presentation is inversely related to admission-delivery interval in women with tPTL and intact membranes.

Gestational Age and Neonatal Brain Microstructure in Term Born Infants: A Birth Cohort Study

PubMed Central

Broekman, Birit F. P.; Wang, Changqing; Li, Yue; Rifkin-Graboi, Anne; Saw, Seang Mei; Chong, Yap-Seng; Kwek, Kenneth; Gluckman, Peter D.; Fortier, Marielle V.; Meaney, Michael J.; Qiu, Anqi

2014-01-01

Objective Understanding healthy brain development in utero is crucial in order to detect abnormal developmental trajectories due to developmental disorders. However, in most studies neuroimaging was done after a significant postnatal period, and in those studies that performed neuroimaging on fetuses, the quality of data has been affected due to complications of scanning during pregnancy. To understand healthy brain development between 37–41 weeks of gestational age, our study assessed the in utero growth of the brain in healthy term born babies with DTI scanning soon after birth. Methods A cohort of 93 infants recruited from maternity hospitals in Singapore underwent diffusion tensor imaging between 5 to 17 days after birth. We did a cross-sectional examination of white matter microstructure of the brain among healthy term infants as a function of gestational age via voxel-based analysis on fractional anisotropy. Results Greater gestational age at birth in term infants was associated with larger fractional anisotropy values in early developing brain regions, when corrected for age at scan. Specifically, it was associated with a cluster located at the corpus callosum (corrected p<0.001), as well as another cluster spanning areas of the anterior corona radiata, anterior limb of internal capsule, and external capsule (corrected p<0.001). Conclusions Our findings show variation in brain maturation associated with gestational age amongst ‘term’ infants, with increased brain maturation when born with a relatively higher gestational age in comparison to those infants born with a relatively younger gestational age. Future studies should explore if these differences in brain maturation between 37 and 41 weeks of gestational age will persist over time due to development outside the womb. PMID:25535959

Gestational Age at Birth and Brain White Matter Development in Term-Born Infants and Children.

PubMed

Ou, X; Glasier, C M; Ramakrishnaiah, R H; Kanfi, A; Rowell, A C; Pivik, R T; Andres, A; Cleves, M A; Badger, T M

2017-12-01

Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study. Using DTI tract-based spatial statistics methods, we evaluated white matter microstructures in 2 groups of term-born (≥37 weeks of gestation) healthy subjects: 2-week-old infants ( n = 44) and 8-year-old children ( n = 63). DTI parameters including fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity were calculated by voxelwise and ROI methods and were correlated with gestational age at birth, with potential confounding factors such as postnatal age and sex controlled. Fractional anisotropy values, which are markers for white matter microstructural integrity, positively correlated ( P < .05, corrected) with gestational age at birth in most major white matter tracts/regions for the term infants. Mean diffusivity values, which are measures of water diffusivities in the brain, and axial and radial diffusivity values, which are markers for axonal growth and myelination, respectively, negatively correlated ( P < .05, corrected) with gestational age at birth in all major white matter tracts/regions excluding the body and splenium of the corpus callosum for the term infants. No significant correlations with gestational age were observed for any tracts/regions for the term-born 8-year-old children. Our results indicate that longer gestation during the normal term period is associated with significantly greater infant white matter development (as reflected by higher fractional anisotropy and lower mean diffusivity, axial diffusivity, and radial diffusivity values); however, similar associations were not observable in later childhood. © 2017 by American Journal of Neuroradiology.

Effects of lactation on postpartum blood pressure among women with gestational hypertension and preeclampsia.

PubMed

Countouris, Malamo E; Schwarz, Eleanor B; Rossiter, Brianna C; Althouse, Andrew D; Berlacher, Kathryn L; Jeyabalan, Arun; Catov, Janet M

2016-08-01

Women with a history of hypertensive disorders of pregnancy are at an increased risk of hypertension and cardiovascular disease in later life. Lactation has been associated with a reduced risk of maternal hypertension, both in the postpartum period and later life. However, little is known about whether lactation is also cardioprotective in women with hypertensive disorders of pregnancy such as preeclampsia or gestational hypertension. This study aimed to characterize the relationship between lactation and postpartum blood pressure among women with preeclampsia and gestational hypertension. Data were obtained from women who participated in the Prenatal Exposures and Preeclampsia Prevention study (n = 379; 66% African American; 85% overweight or obese). Women enrolled during pregnancy and attended a postpartum visit (on average, 9.1 months after delivery) during which data on lactation duration and blood pressure were collected. The significance of the associations between postpartum blood pressure and lactation among women who remained normotensive during pregnancy, developed gestational hypertension, or developed preeclampsia were assessed with an analysis of variance. Linear regression models were used to adjust for maternal age, race, education, prepregnancy weight, and time since delivery. Gestational hypertension affected 42 subjects (11%) and preeclampsia affected 33 (9%). Lactation was reported by 217 (57%) with 78 (21%) reporting ≥ 6 months of lactation. Women who lactated were somewhat older, more educated, and had higher socioeconomic status. Among women who had gestational hypertension, lactation was associated with lower systolic blood pressure (P = .02) and diastolic blood pressure (P = .02). This association persisted after adjustment for age, race, education, prepregnancy weight, and time since delivery. However, for women who had preeclampsia and women who remained normotensive during pregnancy, lactation was not associated with postpartum blood pressure in either bivariate or multivariate analyses. This study found that lactation is associated with lower postpartum blood pressure among overweight women who develop gestational hypertension but not among women who develop preeclampsia. Future studies are needed to explore the association of lactation and blood pressure in later life for women with hypertensive disorders of pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

Determining gestational age and preterm birth in rural Guatemala: A comparison of methods.

PubMed

Weinstein, John R; Thompson, Lisa M; Díaz Artiga, Anaité; Bryan, Joe P; Arriaga, William E; Omer, Saad B; McCracken, John P

2018-01-01

Preterm birth is the leading cause of death among children <5 years of age. Accurate determination of prematurity is necessary to provide appropriate neonatal care and guide preventive measures. To estimate the most accurate method to identify infants at risk for adverse outcomes, we assessed the validity of two widely available methods-last menstrual period (LMP) and the New Ballard (NB) neonatal assessment-against ultrasound in determining gestational age and preterm birth in highland Guatemala. Pregnant women (n = 188) were recruited with a gestational age <20 weeks and followed until delivery. Ultrasound was performed by trained physicians and LMP was collected during recruitment. NB was performed on infants within 96 hours of birth by trained study nurses. LMP and NB accuracy at determining gestational age and identifying prematurity was assessed by comparing them to ultrasound. By ultrasound, infant mean gestational age at birth was 38.3 weeks (SD = 1.6) with 16% born at less than 37 gestation. LMP was more accurate than NB (mean difference of +0.13 weeks for LMP and +0.61 weeks for NB). However, LMP and NB estimates had low agreement with ultrasound-determined gestational age (Lin's concordance<0.48 for both methods) and preterm birth (κ<0.29 for both methods). By LMP, 18% were judged premature compared with 6% by NB. LMP underestimated gestational age among women presenting later to prenatal care (0.18 weeks for each additional week). Gestational age for preterm infants was overestimated by nearly one week using LMP and nearly two weeks using NB. New Ballard neuromuscular measurements were more predictive of preterm birth than those measuring physical criteria. In an indigenous population in highland Guatemala, LMP overestimated prematurity by 2% and NB underestimated prematurity by 10% compared with ultrasound estimates. New, simple and accurate methods are needed to identify preterm birth in resource-limited settings worldwide.

Determining gestational age and preterm birth in rural Guatemala: A comparison of methods

PubMed Central

Thompson, Lisa M.; Díaz Artiga, Anaité; Bryan, Joe P.; Arriaga, William E.; Omer, Saad B.; McCracken, John P.

2018-01-01

Background Preterm birth is the leading cause of death among children <5 years of age. Accurate determination of prematurity is necessary to provide appropriate neonatal care and guide preventive measures. To estimate the most accurate method to identify infants at risk for adverse outcomes, we assessed the validity of two widely available methods—last menstrual period (LMP) and the New Ballard (NB) neonatal assessment—against ultrasound in determining gestational age and preterm birth in highland Guatemala. Methods Pregnant women (n = 188) were recruited with a gestational age <20 weeks and followed until delivery. Ultrasound was performed by trained physicians and LMP was collected during recruitment. NB was performed on infants within 96 hours of birth by trained study nurses. LMP and NB accuracy at determining gestational age and identifying prematurity was assessed by comparing them to ultrasound. Results By ultrasound, infant mean gestational age at birth was 38.3 weeks (SD = 1.6) with 16% born at less than 37 gestation. LMP was more accurate than NB (mean difference of +0.13 weeks for LMP and +0.61 weeks for NB). However, LMP and NB estimates had low agreement with ultrasound-determined gestational age (Lin’s concordance<0.48 for both methods) and preterm birth (κ<0.29 for both methods). By LMP, 18% were judged premature compared with 6% by NB. LMP underestimated gestational age among women presenting later to prenatal care (0.18 weeks for each additional week). Gestational age for preterm infants was overestimated by nearly one week using LMP and nearly two weeks using NB. New Ballard neuromuscular measurements were more predictive of preterm birth than those measuring physical criteria. Conclusion In an indigenous population in highland Guatemala, LMP overestimated prematurity by 2% and NB underestimated prematurity by 10% compared with ultrasound estimates. New, simple and accurate methods are needed to identify preterm birth in resource-limited settings worldwide. PMID:29554145

Cord blood calcium, phosphate, magnesium, and alkaline phosphatase gestational age-specific reference intervals for preterm infants.

PubMed

Fenton, Tanis R; Lyon, Andrew W; Rose, M Sarah

2011-08-31

The objective was to determine the influence of gestational age, maternal, and neonatal variables on reference intervals for cord blood bone minerals (calcium, phosphate, magnesium) and related laboratory tests (alkaline phosphatase, and albumin-adjusted calcium), and to develop gestational age specific reference intervals based on infants without influential pathological conditions. Cross-sectional study. 702 babies were identified as candidates for this study in a regional referral neonatal unit. After exclusions (for anomalies, asphyxia, maternal magnesium sulfate administration, and death), relationships were examined between cord blood serum laboratory analytes (calcium, phosphate, magnesium, alkaline phosphatase, and albumin-adjusted calcium) with gestation age and also with maternal and neonatal variables using multiple linear regression. Infants with influential pathological conditions were omitted from the development of gestational age specific reference intervals for the following categories: 23-27, 28-31, 32-34, 35-36 and > 36 weeks. Among the 506 preterm and 54 terms infants included in the sample. Phosphate, magnesium, and alkaline phosphatase in cord blood serum decreased with gestational age, calcium increased with gestational age. Those who were triplets, small for gestational age, and those whose mother had pregnancy-induced hypertension were influential for most of the analytes. The reference ranges for the preterm infants ≥ 36 weeks were: phosphate 1.5 to 2.6 mmol/L (4.5 to 8.0 mg/dL), calcium: 2.1 to 3.1 mmol/L (8.3 to 12.4 mg/dL); albumin-adjusted calcium: 2.3 to 3.2 mmol/L (9.1 to 12.9 mg/dL); magnesium 0.6 to 1.0 mmol/L (1.4 to 2.3 mg/dL), and alkaline phosphatase 60 to 301 units/L. These data suggest that gestational age, as well as potentially pathogenic maternal and neonatal variables should be considered in the development of reference intervals for preterm infants.

Maternal-fetal disposition of glyburide in pregnant mice is dependent on gestational age.

PubMed

Shuster, Diana L; Risler, Linda J; Liang, Chao-Kang J; Rice, Kenneth M; Shen, Danny D; Hebert, Mary F; Thummel, Kenneth E; Mao, Qingcheng

2014-08-01

Gestational diabetes mellitus is a major complication of human pregnancy. The oral clearance (CL) of glyburide, an oral antidiabetic drug, increases 2-fold in pregnant women during late gestation versus nonpregnant controls. In this study, we examined gestational age-dependent changes in maternal-fetal pharmacokinetics (PK) of glyburide and metabolites in a pregnant mouse model. Nonpregnant and pregnant FVB mice were given glyburide by retro-orbital injection. Maternal plasma was collected over 240 minutes on gestation days (gd) 0, 7.5, 10, 15, and 19; fetuses were collected on gd 15 and 19. Glyburide and metabolites were quantified using high-performance liquid chromatography-mass spectrometry, and PK analyses were performed using a pooled data bootstrap approach. Maternal CL of glyburide increased approximately 2-fold on gd 10, 15, and 19 compared with nonpregnant controls. Intrinsic CL of glyburide in maternal liver microsomes also increased as gestation progressed. Maternal metabolite/glyburide area under the curve ratios were generally unchanged or slightly decreased throughout gestation. Total fetal exposure to glyburide was <5% of maternal plasma exposure, and was doubled on gd 19 versus gd 15. Fetal metabolite concentrations were below the limit of assay detection. This is the first evidence of gestational age-dependent changes in glyburide PK. Increased maternal glyburide clearance during gestation is attributable to increased hepatic metabolism. Metabolite elimination may also increase during pregnancy. In the mouse model, fetal exposure to glyburide is gestational age-dependent and low compared with maternal plasma exposure. These results indicate that maternal glyburide therapeutic strategies may require adjustments in a gestational age-dependent manner if these same changes occur in humans. Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics.

Trends in Timing of Pregnancy Awareness Among US Women.

PubMed

Branum, Amy M; Ahrens, Katherine A

2017-04-01

Objectives Early pregnancy detection is important for improving pregnancy outcomes as the first trimester is a critical window of fetal development; however, there has been no description of trends in timing of pregnancy awareness among US women. Methods We examined data from the 1995, 2002, 2006-2010 and 2011-2013 National Survey of Family Growth on self-reported timing of pregnancy awareness among women aged 15-44 years who reported at least one pregnancy in the 4 or 5 years prior to interview that did not result in induced abortion or adoption (n = 17, 406). We examined the associations between maternal characteristics and late pregnancy awareness (≥7 weeks' gestation) using adjusted prevalence ratios from logistic regression models. Gestational age at time of pregnancy awareness (continuous) was regressed over year of pregnancy conception (1990-2012) in a linear model. Results Among all pregnancies reported, gestational age at time of pregnancy awareness was 5.5 weeks (standard error = 0.04) and the prevalence of late pregnancy awareness was 23 % (standard error = 1 %). Late pregnancy awareness decreased with maternal age, was more prevalent among non-Hispanic black and Hispanic women compared to non-Hispanic white women, and for unintended pregnancies versus those that were intended (p < 0.01). Mean time of pregnancy awareness did not change linearly over a 23-year time period after adjustment for maternal age at the time of conception (p < 0.16). Conclusions for Practice On average, timing of pregnancy awareness did not change linearly during 1990-2012 among US women and occurs later among certain groups of women who are at higher risk of adverse birth outcomes.

Trends in Timing of Pregnancy Awareness Among US Women

PubMed Central

2017-01-01

Objectives Early pregnancy detection is important for improving pregnancy outcomes as the first trimester is a critical window of fetal development; however, there has been no description of trends in timing of pregnancy awareness among US women. Methods We examined data from the 1995, 2002, 2006–2010 and 2011–2013 National Survey of Family Growth on self-reported timing of pregnancy awareness among women aged 15–44 years who reported at least one pregnancy in the 4 or 5 years prior to interview that did not result in induced abortion or adoption (n = 17, 406). We examined the associations between maternal characteristics and late pregnancy awareness (≥7 weeks’ gestation) using adjusted prevalence ratios from logistic regression models. Gestational age at time of pregnancy awareness (continuous) was regressed over year of pregnancy conception (1990–2012) in a linear model. Results Among all pregnancies reported, gestational age at time of pregnancy awareness was 5.5 weeks (standard error = 0.04) and the prevalence of late pregnancy awareness was 23 % (standard error = 1 %). Late pregnancy awareness decreased with maternal age, was more prevalent among non-Hispanic black and Hispanic women compared to non-Hispanic white women, and for unintended pregnancies versus those that were intended (p < 0.01). Mean time of pregnancy awareness did not change linearly over a 23-year time period after adjustment for maternal age at the time of conception (p < 0.16). Conclusions for Practice On average, timing of pregnancy awareness did not change linearly during 1990–2012 among US women and occurs later among certain groups of women who are at higher risk of adverse birth outcomes. PMID:27449777

Prematurity and Low Birth Weight did not Correlate with Anti-Toxoplasma gondii Maternal Serum Profiles – a Brazilian Report

PubMed Central

Spegiorin, Lígia Cosentino Junqueira Franco; Vaz-Oliani, Denise Cristina Mós; Galão, Eloisa Aparecida; Oliani, Antonio Hélio; de Mattos, Luiz Carlos; de Mattos, Cinara Cássia Brandão

2015-01-01

Gestational Toxoplasma gondii infection is considered a major risk factor for miscarriage, prematurity and low birth weight in animals. However, studies focusing on this topic in humans are scarce. The objective of this study is to determine whether anti-Toxoplasma gondii maternal serum profiles correlate prematurity and low birth weight in humans. The study examined 213 pregnant women seen at the High-Risk Pregnancy Hospital de Base, São José do Rio Preto, São Paulo, Brazil. All serological profiles (IgM-/IgG+; IgM-/IgG-; IgM+/IgG+) were determined by ELISA commercial kits. Maternal age, gestational age and weight of the newborn at birth were collected and recorded in the Statement of Live Birth. Prematurity was defined as gestational age <37 weeks and low birth weight ≤ 2499 grams. The t-test was used to compare values (p < 0.05). The mean maternal age was 27.6±6.6 years. Overall, 56.3% (120/213) of the women studied were IgM-/IgG+, 36.2% (77/213) were IgM-/IgG- and 7.5% (16/213) were IgM+/IgG+. The average age of the women with serological profile IgM+/IgG+ (22.3±3.9 years) was different from women with the profile IgM-/IgG+ (27.9±6.7 years, p = 0.0011) and IgM-/IgG- (27.9±6.4 years, p = 0.0012). There was no statistically significant difference between the different serological profiles in relation to prematurity (p = 0.6742) and low birth weight (p = 0.7186). The results showed that prematurity and low birth weight did not correlate with anti-Toxoplasma gondii maternal serum profiles. PMID:26192182

Cardiorespiratory parameters and their relation with gestational age and level of oral feeding skills in preterm infants.

PubMed

Yamamoto, Raquel Coube de Carvalho; Prade, Leila Sauer; Berwig, Luana Cristina; Weinmann, Angela Regina Maciel; Keske-Soares, Márcia

2016-01-01

To correlate cardiorespiratory parameters with gestational age and level of oral feeding skills in the first oral feeding in preterm infants. Study participants were 37 clinically stable preterm infants. Cardiorespiratory rate was assessed before and after introduction of oral feeding. The newborns were divided into three strata according to gestational age at birth. Oral skill was classified into four levels: I - low oral skill and low resistance to feeding; II - low oral skill and high resistance to feeding; III - high oral skill and low resistance to feeding; IV - high oral skill and high resistance to feeding. No difference was observed in heart and respiratory rate between the strata of gestational age at birth and between the levels of oral skill. Comparison between pre- and post-cardiorespiratory rates within each level of oral skill and stratum of gestational age showed difference between heart rate in the strata of gestational ages of 30 to 33 weeks and of 34 to 36 weeks, as well as between oral skill of levels I, II, and IV. With regard to the comparison between pre- and post- respiratory rates, difference was found in the oral skill of level I. Differences were observed between pre- and post-prandial cardiorespiratory rates regarding the first oral feeding, as well as between strata of gestational age at birth and levels of oral feeding skills.

The early infant gut microbiome varies in association with a maternal high-fat diet.

PubMed

Chu, Derrick M; Antony, Kathleen M; Ma, Jun; Prince, Amanda L; Showalter, Lori; Moller, Michelle; Aagaard, Kjersti M

2016-08-09

Emerging evidence suggests that the in utero environment is not sterile as once presumed. Work in the mouse demonstrated transmission of commensal bacteria from mother to fetus during gestation, though it is unclear what modulates this process. We have previously shown in the nonhuman primate that, independent of obesity, a maternal high-fat diet during gestation and lactation persistently shapes the juvenile gut microbiome. We therefore sought to interrogate in a population-based human longitudinal cohort whether a maternal high-fat diet similarly alters the neonatal and infant gut microbiome in early life. A representative cohort was prospectively enrolled either in the early third trimester or intrapartum (n = 163), with a subset consented to longitudinal sampling through the postpartum interval (n = 81). Multiple body site samples, including stool and meconium, were collected from neonates at delivery and by 6 weeks of age. A rapid dietary questionnaire was administered to estimate intake of fat, added sugars, and fiber over the past month (National Health and Examination Survey). DNA was extracted from each infant meconium/stool sample (MoBio) and subjected to 16S rRNA gene sequencing and analysis. On average, the maternal dietary intake of fat ranged from 14.0 to 55.2 %, with an average intake of 33.1 % (σ = 6.1 %). Mothers whose diets significantly differed from the mean (±1 standard deviation) were separated into two distinct groups, a control group (n = 13, μ = 24.4 %) and a high-fat group (n = 13, μ = 43.1 %). Principal coordinate analysis revealed that the microbiome of the neonatal stool at birth (meconium) clustered differently by virtue of maternal gestational diet (PERMANOVA p = 0.001). LEfSe feature selection identified several taxa that discriminated the groups, with a notable relative depletion of Bacteroides in the neonates exposed to a maternal high-fat gestational diet (Student's t-test, p < 0.05) that persisted to 6 weeks of age. Similar to the primate, independent of maternal body mass index, a maternal high-fat diet is associated with distinct changes in the neonatal gut microbiome at birth which persist through 4-6 weeks of age. Our findings underscore the importance of counseling pregnant mothers on macronutrient consumption during pregnancy and lactation.

Predictors of preterm birth in patients with mild systemic lupus erythematosus.

PubMed

Clowse, Megan E B; Wallace, Daniel J; Weisman, Michael; James, Andra; Criscione-Schreiber, Lisa G; Pisetsky, David S

2013-09-01

While increased disease activity is the best predictor of preterm birth in women with systemic lupus erythematosus (SLE), even women with low disease activity are at increased risk of this complication. Biomarkers that would identify at-risk pregnancies could allow interventions to prevent preterm birth. Measures of SLE activity, inflammation, placental health and renal function between 20 and 28 weeks gestation (mid-gestation) were correlated to preterm birth and gestational age at delivery in a prospective cohort of pregnant women with SLE. Of the 40 pregnancies in 39 women, all with mild-moderate SLE disease, 9 (23.7%) of the 38 live births were delivered preterm. Low C4 was the only marker of SLE activity associated with younger gestational age at delivery. Elevated ferritin and lower oestradiol correlated with younger gestational age at delivery. Renal function remained normal during all pregnancies at mid-gestation and did not correlate with preterm birth. Higher serum uric acid, however, correlated with younger gestational age at delivery. In women with SLE with mild-moderate disease activity, ferritin, oestradiol and uric acid levels at mid-gestation may predict preterm birth. These markers may prove to be clinically useful in identifying pregnancies at particularly high risk for adverse outcomes.

2009 IOM guidelines for gestational weight gain: how well do they predict outcomes across ethnic groups?

PubMed

Khanolkar, Amal R; Hanley, Gillian E; Koupil, Ilona; Janssen, Patricia A

2017-11-13

To determine whether the Institute Of Medicine's (IOM) 2009 guidelines for weight-gain during pregnancy are predictive of maternal and infant outcomes in ethnic minority populations. We designed a population-based study using administrative data on 181,948 women who delivered live singleton births in Washington State between 2006-2008. We examined risks of gestational hypertension, preeclampsia/eclampsia, cesarean delivery, and extended hospital stay in White, Black, Native-American, East-Asian, Hispanic, South-Asian and Hawaiian/Pacific islander women according to whether they gained more or less weight during pregnancy than recommended by IOM guidelines. We also examined risks of neonatal outcomes including Apgar score <7 at 5 min, admission to NICU, requirement for ventilation, and a diagnosis of small or large for gestational age at birth. Gaining too much weight was associated with increased odds for gestational hypertension (adjusted OR (aOR) ranged between 1.53-2.22), preeclampsia/eclampsia (aOR 1.44-1.81), cesarean delivery (aOR 1.07-1.38) and extended hospital stay (aOR 1.06-1.28) in all ethnic groups. Gaining too little weight was associated with decreased odds for gestational hypertension and delivery by cesarean section in Whites, Blacks and Hispanics. Gaining less weight or more weight than recommended was associated with increased odds for small for gestational age and large for gestational age infants respectively, in all ethnic groups. Adherence to the 2009 IOM guidelines for weight gain during pregnancy reduces risk for various adverse maternal outcomes in all ethnic groups studied. However, the guidelines were less predictive of infant outcomes with the exception of small and large for gestational age. GWG: Gestational weight gain; IOM/NRC; Institute of Medicine and National Research Council; NICU: Neonatal intensive care need for ventilation; SGA: Small for gestational age; LGA: Large for gestational age; BERD: Birth Events Records Database; CHARS: Comprehensive Hospital Discharge Abstract Reporting System; ICD: International Classification of Disease; LMP: Last menstrual period; OR: Odds ratio.

Newborn Plasma Glucose Concentration Nadirs by Gestational-Age Group.

PubMed

Kaiser, Jeffrey R; Bai, Shasha; Rozance, Paul J

2018-01-01

The glucose concentrations and times to nadir for newborns of all gestational ages when intrapartum glucose-containing solutions are not routinely provided are unknown. To characterize and compare patterns of initial glucose concentration nadirs by gestational-age groups. A cross-sectional cohort study of 1,366 newborns born in 1998 at the University of Arkansas for Medical Sciences, appropriate for gestational age, nonasphyxiated, nonpolycythemic, and not infants of diabetic mothers, were included. Initial plasma glucose concentrations, before intravenous fluids or feedings, were plotted against time after birth for 4 gestational-age groups (full term [FT], ≥37-42 weeks; late preterm [LPT], ≥34 and < 37 weeks; preterm [PT], ≥28 and < 34 weeks; and extremely low gestational age newborns [ELGAN], 23 and < 28 weeks of gestation). ELGAN had the earliest nadir at 61 ± 4 min, followed by PT newborns (71 ± 2 min), and then LPT and FT newborns at 92-93 min. The time to nadir for ELGAN and PT newborns was significantly earlier than for FT newborns. Glucose nadir concentrations for ELGAN, PT, and LPT newborns were significantly lower than for FT newborns. LPT newborns' pattern of glucose paralleled those of FT newborns, with values approximately 5-6 mg/dL lower during the first 3 h. Plasma glucose nadirs occurred at different times among gestational-age groups during the early postnatal period as follows: ELGAN < PT < LPT ≈ FT. In order to potentially prevent low glucose concentrations at the time of the nadir, exogenous glucose should be provided to all newborns as soon as possible after birth. © 2018 S. Karger AG, Basel.

Birth weight centiles by gestational age for twins born in south India.

PubMed

Premkumar, Prasanna; Antonisamy, Belavendra; Mathews, Jiji; Benjamin, Santhosh; Regi, Annie; Jose, Ruby; Kuruvilla, Anil; Mathai, Mathews

2016-03-24

Birth weight centile curves are commonly used as a screening tool and to assess the position of a newborn on a given reference distribution. Birth weight of twins are known to be less than those of comparable singletons and twin-specific birth weight centile curves are recommended for use. In this study, we aim to construct gestational age specific birth weight centile curves for twins born in south India. The study was conducted at the Christian Medical College, Vellore, south India. The birth records of all consecutive pregnancies resulting in twin births between 1991 and 2005 were reviewed. Only live twin births between 24 and 42 weeks of gestation were included. Birth weight centiles for gestational age were obtained using the methodology of generalized additive models for location, scale and shape (GAMLSS). Centiles curves were obtained separately for monochorionic and dichorionic twins. Of 1530 twin pregnancies delivered during the study period (1991-2005), 1304 were included in the analysis. The median gestational age at birth was 36 weeks (1st quartile 34, 3rd quartile 38 weeks). Smoothed percentile curves for birth weight by gestational age increased progressively till 38 weeks and levels off thereafter. Compared with dichorionic twins, monochorionic twins had lower birth weight for gestational age from after 27 weeks. We provide centile values of birth weight at 24 to 42 completed weeks of gestation for twins born in south India. These charts could be used both in routine clinical assessments and epidemiological studies.

Factors affecting pregnancy length and phases of parturition in Martina Franca jennies.

PubMed

Carluccio, Augusto; Gloria, Alessia; Veronesi, Maria Cristina; De Amicis, Ippolito; Noto, Federico; Contri, Alberto

2015-09-01

The knowledge of normal pregnancy length, duration of parturition stages, and neonatal early adaptation is mandatory for a rationale management of birth, especially in monotocous species with long gestations. This study reports data obtained from a large number of Martina Franca jennies with normal healthy pregnancies and spontaneous eutocic delivery of a mature, healthy, and viable donkey foal. Pregnancy lasts, on average, 371 days, and only the fetal gender significantly determines pregnancy length, with longer gestations observed in jennies bearing male fetuses. Other factors such as the year of foaling, month of ovulation, month of parturition, birth weight of the foal, and age of the jenny did not influence pregnancy length. The first stage of foaling lasted on average 65 minutes, the second stage 19 minutes, and the third stage 58 minutes. The umbilical cord ruptured on average within 16 minutes after birth; the foal stood up in 61 minutes and suckled the colostrum for the first time within 10 minutes after birth and again after 143 minutes of birth; meconium passage occurred, on average, 86 minutes after birth. Although times reported for the process of foaling are similar to data reported for the horse, the times for early neonatal donkey foal adaptation are longer as compared to the horse foal. Copyright © 2015 Elsevier Inc. All rights reserved.

Variability in Antibiotic Regimens for Surgical Necrotizing Enterocolitis Highlights the Need for New Guidelines.

PubMed

Blackwood, Brian P; Hunter, Catherine J; Grabowski, Julia

Necrotizing enterocolitis or NEC is the most common gastrointestinal emergency in the newborn. The etiology of NEC remains unknown, and treatment consists of antibiotic therapy and supportive care with the addition of surgical intervention as necessary. Unlike most surgical diseases, clear guidelines for the type and duration of peri-operative antibiotic therapy have not been established. Our aim was to review the antibiotic regimen(s) applied to surgical patients with NEC within a single neonatal intensive care unit (NICU) and to evaluate outcomes and help develop guidelines for antibiotic administration in this patient population. A single-center retrospective review was performed of all patients who underwent surgical intervention for NEC from August 1, 2005 through August 1, 2015. Relevant data were extracted including gestational age, age at diagnosis, gender, pre-operative antibiotic treatment, post-operative antibiotic treatment, development of stricture, and mortality. Patients were excluded if there was incomplete data documentation. A total of 90 patients were identified who met inclusion criteria. There were 56 male patients and 34 female patients. The average gestational age was 30 5/7 wks and average age of diagnosis 16.7 d. A total of 22 different pre-operative antibiotic regimens were identified with an average duration of 10.6 d. The most common pre-operative regimen was ampicillin, gentamicin, and metronidazole for 14 d. A total of 15 different post-operative antibiotic regimens were identified with an average duration of 6.6 d. The most common post-operative regimen was ampicillin, gentamicin, and metronidazole for two days. There were 26 strictures and 15 deaths. No regimen or duration proved superior. We found that there is a high degree of variability in the antibiotic regimen for the treatment of NEC, even within a single NICU, with no regimen appearing superior over another. As data emerge that demonstrate the adverse effects of antibiotic overuse, our findings highlight the need for guidelines in the antibiotic treatment of NEC and suggest that an abbreviated course of post-operative antibiotics may be safe.

Serum YKL-40 and uterine artery Doppler -- a prospective cohort study, with focus on preeclampsia and small-for-gestational-age.

PubMed

Gybel-Brask, Dorte; Høgdall, Estrid; Johansen, Julia; Christensen, Ib Jarle; Skibsted, Lillian

2014-08-01

To test if serum YKL-40 is increased in women developing preeclampsia or small-for-gestational age fetuses. We also assessed the association between uterine artery pulsatility index, notching and serum YKL-40 levels. Prospective cohort study. A primary referral unit for obstetric ultrasound. A total of 1214 unselected pregnant women enrolled at nuchal translucency examination between 11(+3) and 13(+6)  weeks of gestation. All women had ultrasound and blood sample collection at the nuchal translucency scan, a 20-week malformation scan and 25-week and 32-week fetal growth examinations. Uterine artery Doppler was assessed and outcome was registered from medical records. Preeclampsia, hypertension, small-for-gestational age. Serum YKL-40 was associated with increasing maternal age (p < 0.0001), body mass index (p = 0.0002), primiparity (p = 0.0003), and hypertension (p = 0.015). Serum YKL-40 increased from 12 to 20 weeks and decreased from 20-25 and 25-32 weeks of gestation. No association was found between preeclampsia and serum YKL-40. Small-for-gestational-age at birth was significantly associated with a 5.4% increase in serum YKL-40 at 32 weeks of gestation (95% CI 1.5-9.3, p = 0.005). An association was found between uterine artery pulsatility index at 32 weeks and small-for-gestational age (p = 0.0015) but not between YKL-40 and uterine artery notching (p = 0.83). Serum YKL-40 was not associated with preeclampsia. Increasing serum YKL-40 was related to maternal age, body mass index and small-for-gestational age and may reflect an exaggerated inflammatory response. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

Two-year neurodevelopmental outcomes of extremely preterm infants treated with early hydrocortisone: treatment effect according to gestational age at birth.

PubMed

Baud, Olivier; Trousson, Clémence; Biran, Valérie; Leroy, Emilie; Mohamed, Damir; Alberti, Corinne

2018-01-10

To determine whether early hydrocortisone treatment in extremely preterm infants affects neurodevelopmental outcomes at 2 years of age according to gestational age at birth. This is an exploratory analysis of neurodevelopmental outcomes by gestational age strata from the PREMILOC trial, in which patients were randomly assigned to receive either placebo or low-dose hydrocortisone and randomisation was stratified by gestational age groups (24-25 and 26-27 weeks of gestation). Neurodevelopmental impairment (NDI) was assessed using a standardised neurological examination and the revised Brunet-Lézine scale at 22 months of corrected age. A total of 379 of 406 survivors were evaluated, 96/98 in the gestational age group of 24-25 weeks and 283/308 in the gestational age group of 26-27 weeks. Among surviving infants born at 24-25 weeks, significant improvement in global neurological assessment was observed in the hydrocortisone group compared with the placebo group (P=0.02) with a risk of moderate-to-severe NDI of 2% and 18%, respectively (risk difference 16 (95% CI -28% to -5%)). In contrast, no statistically significant difference between treatment groups was observed in infants born at 26-27 weeks (P=0.95) with a similar risk of moderate-to-severe NDI of 9% in both groups. The incidence of cerebral palsy or other major neurological impairments were found similar between treatment groups in each gestational group. In an exploratory analysis of neurodevelopmental outcomes from the PREMILOC trial, early low-dose hydrocortisone was associated with a statistically significant improvement in neurodevelopmental outcomes in infants born at 24 and 25 weeks of gestation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Neonatal outcomes according to different therapies for gestational diabetes mellitus.

PubMed

Silva, Amanda L da; Amaral, Augusto R do; Oliveira, Daniela S de; Martins, Lisiane; Silva, Mariana R E; Silva, Jean Carl

To compare different neonatal outcomes according to the different types of treatments used in the management of gestational diabetes mellitus. This was a retrospective cohort study. The study population comprised pregnant women with gestational diabetes treated at a public maternity hospital from July 2010 to August 2014. The study included women aged at least 18 years, with a singleton pregnancy, who met the criteria for gestational diabetes mellitus. Blood glucose levels, fetal abdominal circumference, body mass index and gestational age were considered for treatment decision-making. The evaluated neonatal outcomes were: type of delivery, prematurity, weight in relation to gestational age, Apgar at 1 and 5min, and need for intensive care unit admission. The sample consisted of 705 pregnant women. The neonatal outcomes were analyzed based on the treatment received. Women treated with metformin were less likely to have children who were small for gestational age (95% CI: 0.09-0.66) and more likely to have a newborn adequate for gestational age (95% CI: 1.12-3.94). Those women treated with insulin had a lower chance of having a preterm child (95% CI: 0.02-0.78). The combined treatment with insulin and metformin resulted in higher chance for a neonate to be born large for gestational age (95% CI: 1.14-11.15) and lower chance to be born preterm (95% CI: 0.01-0.71). The type of treatment did not affect the mode of delivery, Apgar score, and intensive care unit admission. The pediatrician in the delivery room can expect different outcomes for diabetic mothers based on the treatment received. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Risk of ultrasound-detected neonatal brain abnormalities in intrauterine growth-restricted fetuses born between 28 and 34 weeks' gestation: relationship with gestational age at birth and fetal Doppler parameters.

PubMed

Cruz-Martinez, R; Tenorio, V; Padilla, N; Crispi, F; Figueras, F; Gratacos, E

2015-10-01

To estimate the value of gestational age at birth and fetal Doppler parameters in predicting the risk of neonatal cranial abnormalities in intrauterine growth-restricted (IUGR) fetuses born between 28 and 34 weeks' gestation. Fetal Doppler parameters including umbilical artery (UA), middle cerebral artery (MCA), aortic isthmus, ductus venosus and myocardial performance index were evaluated in a cohort of 90 IUGR fetuses with abnormal UA Doppler delivered between 28 and 34 weeks' gestation and in 90 control fetuses matched for gestational age. The value of gestational age at birth and fetal Doppler parameters in predicting the risk of ultrasound-detected cranial abnormalities (CUA), including intraventricular hemorrhage, periventricular leukomalacia and basal ganglia lesions, was analyzed. Overall, IUGR fetuses showed a significantly higher incidence of CUA than did control fetuses (40.0% vs 12.2%, respectively; P < 0.001). Within the IUGR group, all predictive variables were associated individually with the risk of CUA, but fetal Doppler parameters rather than gestational age at birth were identified as the best predictor. MCA Doppler distinguished two groups with different degrees of risk of CUA (48.5% vs 13.6%, respectively; P < 0.01). In the subgroup with MCA vasodilation, presence of aortic isthmus retrograde net blood flow, compared to antegrade flow, allowed identification of a subgroup of cases with the highest risk of CUA (66.7% vs 38.6%, respectively; P < 0.05). Evaluation of fetal Doppler parameters, rather than gestational age at birth, allows identification of IUGR preterm fetuses at risk of neonatal brain abnormalities. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Development and validation of a simplified algorithm for neonatal gestational age assessment – protocol for the Alliance for Maternal Newborn Health Improvement (AMANHI) prospective cohort study

PubMed Central

Baqui, Abdullah; Ahmed, Parvez; Dasgupta, Sushil Kanta; Begum, Nazma; Rahman, Mahmoodur; Islam, Nasreen; Quaiyum, Mohammad; Kirkwood, Betty; Edmond, Karen; Shannon, Caitlin; Newton, Samuel; Hurt, Lisa; Jehan, Fyezah; Nisar, Imran; Hussain, Atiya; Nadeem, Naila; Ilyas, Muhammad; Zaidi, Anita; Sazawal, Sunil; Deb, Saikat; Dutta, Arup; Dhingra, Usha; Ali, Said Moh’d; Hamer, Davidson H.; Semrau, Katherine EA; Straszak–Suri, Marina; Grogan, Caroline; Bemba, Godfrey; Lee, Anne CC; Wylie, Blair J; Manu, Alexander; Yoshida, Sachiyo; Bahl, Rajiv

2017-01-01

Objective The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population–based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub–Saharan African sites. Methods This study used on–going population–based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio–demographic and morbidity data during the pregnancy. When they deliver, trained research assistants visit women within 72 hours to assess the baby for gestational maturity. They assess for neuromuscular and physical characteristics selected from the Ballard and Dubowitz maturation assessment scales. They also measure newborn anthropometry and assess feeding maturity of the babies. Computer machine learning techniques will be used to identify the most parsimonious group of signs that correctly predict gestational age compared to the early ultrasound date (the gold standard). This gestational age will be used to categorize babies into term, late preterm and early preterm groups. Further, the ultrasound–based gestational age will be used to calculate population–based rates of preterm birth. Importance of the study The AMANHI gestational age study will make substantial contribution to improve identification of preterm babies by frontline health workers in low– and middle– income countries using simple evaluations. The study will provide accurate preterm birth estimates. This new information will be crucial to planning and delivery of interventions for improving preterm birth outcomes, particularly in South Asia and sub–Saharan Africa. PMID:29163937

Development and validation of a simplified algorithm for neonatal gestational age assessment - protocol for the Alliance for Maternal Newborn Health Improvement (AMANHI) prospective cohort study.

PubMed

Baqui, Abdullah; Ahmed, Parvez; Dasgupta, Sushil Kanta; Begum, Nazma; Rahman, Mahmoodur; Islam, Nasreen; Quaiyum, Mohammad; Kirkwood, Betty; Edmond, Karen; Shannon, Caitlin; Newton, Samuel; Hurt, Lisa; Jehan, Fyezah; Nisar, Imran; Hussain, Atiya; Nadeem, Naila; Ilyas, Muhammad; Zaidi, Anita; Sazawal, Sunil; Deb, Saikat; Dutta, Arup; Dhingra, Usha; Ali, Said Moh'd; Hamer, Davidson H; Semrau, Katherine Ea; Straszak-Suri, Marina; Grogan, Caroline; Bemba, Godfrey; Lee, Anne Cc; Wylie, Blair J; Manu, Alexander; Yoshida, Sachiyo; Bahl, Rajiv

2017-12-01

The objective of the Alliance for Maternal and Newborn Health Improvement (AMANHI) gestational age study is to develop and validate a programmatically feasible and simple approach to accurately assess gestational age of babies after they are born. The study will provide accurate, population-based rates of preterm birth in different settings and quantify the risks of neonatal mortality and morbidity by gestational age and birth weight in five South Asian and sub-Saharan African sites. This study used on-going population-based cohort studies to recruit pregnant women early in pregnancy (<20 weeks) for a dating ultrasound scan. Implementation is harmonised across sites in Ghana, Tanzania, Zambia, Bangladesh and Pakistan with uniform protocols and standard operating procedures. Women whose pregnancies are confirmed to be between 8 to 19 completed weeks of gestation are enrolled into the study. These women are followed up to collect socio-demographic and morbidity data during the pregnancy. When they deliver, trained research assistants visit women within 72 hours to assess the baby for gestational maturity. They assess for neuromuscular and physical characteristics selected from the Ballard and Dubowitz maturation assessment scales. They also measure newborn anthropometry and assess feeding maturity of the babies. Computer machine learning techniques will be used to identify the most parsimonious group of signs that correctly predict gestational age compared to the early ultrasound date (the gold standard). This gestational age will be used to categorize babies into term, late preterm and early preterm groups. Further, the ultrasound-based gestational age will be used to calculate population-based rates of preterm birth. The AMANHI gestational age study will make substantial contribution to improve identification of preterm babies by frontline health workers in low- and middle- income countries using simple evaluations. The study will provide accurate preterm birth estimates. This new information will be crucial to planning and delivery of interventions for improving preterm birth outcomes, particularly in South Asia and sub-Saharan Africa.

Women Born Preterm or with Inappropriate Weight for Gestational Age Are at Risk of Subsequent Gestational Diabetes and Pre-Eclampsia

PubMed Central

á Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter; Greisen, Gorm

2012-01-01

Introduction Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain. Methods Through nation-wide registries we identified all Danish mothers in the years 1989–2007. Two separate cohorts consisting mothers born 1974–1977 (n = 84219) and 1978–1981 (n = 32376) were studied, due to different methods of registering birthweight and gestational age in the two periods. Data was linked with information on GDM, pre-eclampsia and education. Results In a multivariate logistic regression model the odds of developing GDM was increased by 5–7% for each week the mother was born before term (p = 0.018 for 1974–1977, p = 0.048 for 1978–1981), while the odds were increased by 13–17% for each standard deviation (SD) reduction in birthweight for gestational age for those who were small or normal for gestational age (p<0.0001 and p = 0.035) and increased by 118–122% for each SD increase above the normal range (p<0.0001 and p = 0.024). The odds of pre-eclampsia was increased by 3–5% for each week the mother was born before term (p = 0.064 and p = 0.04), while the odds were increased 11–12% for each SD reduction in birthweight for gestational age (p<0.0001 and p = 0.0002). Conclusion In this cohort of young Danish mothers, being born premature or with increasingly low birthweight for gestational age was associated with an increased risk of GDM and pre-eclampsia in adulthood, while increasingly high birthweight for gestational age was associated with an increased risk of GDM and a decreased risk of pre-eclampsia. Inappropriate weight for gestational age was a more important risk factor than prematurity. PMID:22479500

Fetal kidney length as a useful adjunct parameter for better determination of gestational age.

PubMed

Ugur, Mete G; Mustafa, Aynur; Ozcan, Huseyin C; Tepe, Neslihan B; Kurt, Huseyin; Akcil, Emre; Gunduz, Reyhan

2016-05-01

To determine the validity of fetal kidney length and amniotic fluid index (AFI) in labor dating.  This prospective study included 180 pregnant women followed up in the outpatient clinic at the Department of Obstetrics and Gynecology, Gaziantep University, Turkey, between January 2014 and January 2015. The gestational age (GA) was estimated by early fetal ultrasound measures and last menstrual period. Routine fetal biometric parameters, fetal kidney length, and amniotic fluid index were measured. We studied the correlation between fetal kidney length, amniotic fluid index, and gestational age.  The mean gestational age depending on last menstrual period and early ultrasound was 31.98±4.29 (24-39 weeks). The mean kidney length was 35.66±6.61 (19-49 mm). There was a significant correlation between gestational age and fetal kidney length (r=0.947, p=0.001). However, there was a moderate negative correlation between GA and AFI. Adding fetal kidney length to the routine biometrics improved the effectiveness of the model used to estimate GA (R2=0.965 to R2=0.987).  Gestational age can be better predicted by adding fetal kidney length to other routine parameters.

Analyzing risks of adverse pregnancy outcomes.

PubMed

Kramer, Michael S; Zhang, Xun; Platt, Robert W

2014-02-01

Approaches for analyzing the risks of adverse pregnancy outcomes have been the source of much debate and many publications. Much of the problem, in our view, is the conflation of time at risk with gestational age at birth (or birth weight, a proxy for gestational age). We consider the causal questions underlying such analyses with the help of a generic directed acyclic graph. We discuss competing risks and populations at risk in the context of appropriate numerators and denominators, respectively. We summarize 3 different approaches to quantifying risks with respect to gestational age, each of which addresses a distinct etiological or prognostic question (i.e., cumulative risk, prospective risk, or instantaneous risk (hazard)) and suggest the appropriate denominators for each. We show how the gestational age-specific risk of perinatal death (PND) can be decomposed as the product of the gestational age-specific risk of birth and the risk of PND conditional on birth at a given gestational age. Finally, we demonstrate how failure to consider the first of these 2 risks leads to selection bias. This selection bias creates the well-known crossover paradox, thus obviating the need to posit common causes of early birth and PND other than the study exposure.

Effects of gestational age on brain volume and cognitive functions in generally healthy very preterm born children during school-age: A voxel-based morphometry study.

PubMed

Lemola, Sakari; Oser, Nadine; Urfer-Maurer, Natalie; Brand, Serge; Holsboer-Trachsler, Edith; Bechtel, Nina; Grob, Alexander; Weber, Peter; Datta, Alexandre N

2017-01-01

To determine whether the relationship of gestational age (GA) with brain volumes and cognitive functions is linear or whether it follows a threshold model in preterm and term born children during school-age. We studied 106 children (M = 10 years 1 month, SD = 16 months; 40 females) enrolled in primary school: 57 were healthy very preterm children (10 children born 24-27 completed weeks' gestation (extremely preterm), 14 children born 28-29 completed weeks' gestation, 19 children born 30-31 completed weeks' gestation (very preterm), and 14 born 32 completed weeks' gestation (moderately preterm)) all born appropriate for GA (AGA) and 49 term-born children. Neuroimaging involved voxel-based morphometry with the statistical parametric mapping software. Cognitive functions were assessed with the WISC-IV. General Linear Models and multiple regressions were conducted controlling age, sex, and maternal education. Compared to groups of children born 30 completed weeks' gestation and later, children born <28 completed weeks' gestation had less gray matter volume (GMV) and white matter volume (WMV) and poorer cognitive functions including decreased full scale IQ, and processing speed. Differences in GMV partially mediated the relationship between GA and full scale IQ in preterm born children. In preterm children who are born AGA and without major complications GA is associated with brain volume and cognitive functions. In particular, decreased brain volume becomes evident in the extremely preterm group (born <28 completed weeks' gestation). In preterm children born 30 completed weeks' gestation and later the relationship of GA with brain volume and cognitive functions may be less strong as previously thought.

[Prophylactic CPAP versus therapeutic CPAP in preterm newborns of 28-32 gestational weeks].

PubMed

Zaharie, Gabriela; Ion, Daniela Adriana; Schmidt, Nadia; Popa, Monica; Kudor-Szabadi, Liana; Zaharie, Toader

2008-01-01

Strategies in ventilation and in exposure to the oxygen that minimise lung injury improved the prognosis of the extremely low weight newborns. Avoiding intubation can prevent the reduction of mucociliary flow, injury of the mucosa and infection. Using early CPAP isn't unanimous; there are differences between studies in what are concerned: the beginning of the treatment, gestational age, methods. CPAP is used in the treatment of respiratory arrest of infants since 1971, initially endotracheal, than with different nasal instruments. The studies evaluate the benefits of prophylactic or curative CPAP. To compare the necessity for mechanical ventilation and surfactant administration, complications and the period of hospitalisation in VLBW and ELBW, that were under prophylactic or curative CPAP. We made a prospective study on 90 newborns, during january 2004 and june 2006, that were not intubated in the delivery room with no major malformations. Preventive CPAP was applied in the first half an hour after birth. therapeutical CPAP was applied only in infants with the necessity in oxygen over 40%, to maintain the saturation between 90 - 95%. Group A (curative CPAP) - 25 cases, the average for gestational age 30,30+/-2,45 weeks and for birth weight 1588,00+/-573,05. For group B the averages were: 30,08+/-2,30 weeks and 1508,50+/-400,83 grams. Surfactant was necessary in 40% of group A, over 23% in group B (p = 0,269). Mechanical ventilation in first 72 hours of life was necessary in 18 cases (72%) - A and in 35 cases (53,84%) - B. The necessity for CPAP in hours: 92,15+/-3,85 in group A, over 112,25+/-5,75 group B (p = 0,044). Complications we considered: PDA and cerebral hemorrhage. We had 8 cases (38%) of group A with PDA, significantly different of group B: 5 cases (7,69%). Cerebral hemorrhage was absent in 40% of group A and in 73,84% in group B (p = 0,11). CPAP is a non invasive method with benefits in the treatment of the respiratory arrest in preterm newborn of 28 - 32 gestational weeks. Using early CPAP may reduce: necessity for surfactant, mechanical ventilation and PDA.

Fetal environment and early age at natural menopause in a British birth cohort study

PubMed Central

Tom, Sarah E.; Cooper, Rachel; Kuh, Diana; Guralnik, Jack M.; Hardy, Rebecca; Power, Chris

2010-01-01

BACKGROUND Early life development may influence the timing of natural menopause through association with size of the initial follicle pool or early follicular loss. This study examines the relationships of birthweight, gestational age and birthweight standardized by gestational age with early menopause in the 1958 British birth cohort study. METHODS Study participants were over 2900 women with data on birthweight, gestational age (obtained at birth), menopausal status at age 44–45 years and potential confounding factors. Logistic regression was used to study relationships of birthweight, gestational age and birthweight standardized by gestational age with post-menopausal status by 44–45 years, with and without adjustments for confounding factors. RESULTS There was a U-shaped association between birthweight and menopausal status at 44–45 years: women at either extremes of birthweight (<2.5 and ≥4.0 kg) had increased odds of post-menopausal status compared with those weighing 3.0–3.49 kg [odds ratio (OR) = 1.91, 95% confidence interval (CI) 1.08, 3.38; 1.81, 95% CI 1.11, 2.97, respectively]. Women with higher birthweight standardized by gestational age (which indicates faster fetal growth rate) also had increased odds of being post-menopausal by 44–45 years (OR for fastest quarter versus second fastest quarter = 1.80; 95% CI 1.16, 2.81). These associations persisted after adjustment for socioeconomic position at birth, adult smoking status and use of oral contraceptives. CONCLUSIONS These findings suggest that variations in fetal environment may be associated with the timing of menopause. Given that extremes of birthweight and higher birthweight standardized by gestational age were associated with earlier age at menopause, mechanisms related to these characteristics that also regulate ovarian function should be investigated further. PMID:20047935

Quantitative Analysis of the Cervical Texture by Ultrasound and Correlation with Gestational Age.

PubMed

Baños, Núria; Perez-Moreno, Alvaro; Migliorelli, Federico; Triginer, Laura; Cobo, Teresa; Bonet-Carne, Elisenda; Gratacos, Eduard; Palacio, Montse

2017-01-01

Quantitative texture analysis has been proposed to extract robust features from the ultrasound image to detect subtle changes in the textures of the images. The aim of this study was to evaluate the feasibility of quantitative cervical texture analysis to assess cervical tissue changes throughout pregnancy. This was a cross-sectional study including singleton pregnancies between 20.0 and 41.6 weeks of gestation from women who delivered at term. Cervical length was measured, and a selected region of interest in the cervix was delineated. A model to predict gestational age based on features extracted from cervical images was developed following three steps: data splitting, feature transformation, and regression model computation. Seven hundred images, 30 per gestational week, were included for analysis. There was a strong correlation between the gestational age at which the images were obtained and the estimated gestational age by quantitative analysis of the cervical texture (R = 0.88). This study provides evidence that quantitative analysis of cervical texture can extract features from cervical ultrasound images which correlate with gestational age. Further research is needed to evaluate its applicability as a biomarker of the risk of spontaneous preterm birth, as well as its role in cervical assessment in other clinical situations in which cervical evaluation might be relevant. © 2016 S. Karger AG, Basel.

Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations.

PubMed

Blomberg, Marie

2011-05-01

To estimate whether weight loss or low gestational weight gain in class I-III obese women is associated with adverse maternal and neonatal outcomes compared with gestational weight gain within the new Institute of Medicine recommendations. This was a population-based cohort study, which included 32,991 obesity class I, 10,068 obesity class II, and 3,536 obesity class III women who were divided into four gestational weight gain categories. Women with low (0-4.9 kg) or no gestational weight gain were compared with women gaining the recommended 5-9 kg concerning obstetric and neonatal outcome after suitable adjustments. Women in obesity class III who lost weight during pregnancy had a decreased risk of cesarean delivery (24.4%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.60-0.99), large-for-gestational-age births (11.2%, OR 0.64, 95% CI 0.46-0.90), and no significantly increased risk for pre-eclampsia, excessive bleeding during delivery, instrumental delivery, low Apgar score, or fetal distress compared with obese (class III) women gaining within the Institute of Medicine recommendations. There was an increased risk for small for gestational age, 3.7% (OR 2.34, 95% CI 1.15-4.76) among women in obesity class III losing weight, but there was no significantly increased risk of small for gestational age in the same group with low weight gain. Obese women (class II and III) who lose weight during pregnancy seem to have a decreased or unaffected risk for cesarean delivery, large for gestational age, pre-eclampsia, excessive postpartum bleeding, instrumental delivery, low Apgar score, and fetal distress. The twofold increased risk of small for gestational age in obesity class III and weight loss (3.7%) is slightly above the overall prevalence of small-for-gestational-age births in Sweden (3.6%).

Socioeconomic inequity in survival for deliveries at 22-24 weeks of gestation.

PubMed

Morisaki, Naho; Isayama, Tetsuya; Samura, Osamu; Wada, Kazuko; Kusuda, Satoshi

2018-05-01

Guidelines recommend individual decision making on resuscitating infants of 22-24 weeks' gestational age (GA) at birth. When the decision not to resuscitate is made, infants would likely die soon after delivery, and under some circumstances such neonatal deaths may be registered as stillbirths occurring during delivery (intrapartum stillbirth). Thus we assessed whether socioeconomic factors are associated with peridelivery deaths (during or within 1 hour of delivery) of infants delivered at 22-24 weeks' gestation. We analysed 14 726 singletons of 22-24 weeks' GA using the 2003-2011 Japanese vital statistics, and assessed how maternal characteristics influence risk of peridelivery death as well as intrauterine fetal death (IUFD) and death after 1 hour of age until 40 weeks postmenstrual age. Living in a municipality with low-average income (lowest tertile (risk ratio 1.32, 95% CI 1.20 to 1.44), middle tertile (risk ratio 1.08, 95% CI 0.98 to 1.19)), younger maternal age (age <20 (risk ratio 1.43, 95% CI 1.17 to 1.75), age 20-34 (risk ratio 1.14, 95% CI 1.03 to 1.27)) and having previous live births (risk ratio 1.08, 95% CI 1.01 to 1.17) increased risk of peridelivery deaths, but did not increase risk of IUFD or deaths after 1 hour of age. Peridelivery death was twice as likely to occur in births to multiparous teenage mothers in a low-income municipality, compared with those of older primiparous mothers in a wealthier municipality. Socioeconomic factors substantially influence whether births of 22-24 weeks' GA survive delivery and the first hour of life. Such disparities may reflect the impact of socioeconomic situations on decision making for resuscitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Obstetric prognostic factors of newborn infants with very low birth weight (< or = 1,500 gram) with reference to survival rate and early childhood development].

PubMed

Hamm, W; Göhring, U J; Günther, M; Kribs, A; Neuhaus, W; Roth, B; Bolte, A

1995-03-01

Prognostic factors influencing survival in 235 very low birthweight prematures (< or = 1500 g) born between 1986 and 15.11. 1993 at the Department of Obstetrics and Gynaecology, University Hospital of Cologne, were retrospectively evaluated. Chromosomal anomalies and severe congenital malformations were excluded. Of 180 singletons 84 were classified as appropriate-for-gestational-age (AGA) and 96 as small-for-gestational-age (SGA). By interrogating the attending paediatricians data regarding the early development of 62/65 surviving singletons born between 1986 to 1990 were recorded (follow-up rate 95%). Survival was significantly correlated to singleton pregnancy (p < 0.05), female sex (p = 0.001) and in the AGA-prematures to prenatal corticoid prophylaxis. With similar mean birthweight SGA-singletons showed a three weeks higher mean gestational age; the mortality showed an inverse correlation to birthweight and gestational age being 11% higher in the AGA-group compared with the SGA-group (32% versus 21%). At the age of between 11 months and 6 years severe handicaps and developmental retardations were found more often in previous AGA-prematures (6/26) than in previous SGA-prematures (4/36); type and degree of later handicap were not correlated to birthweight. According to our results survival rates of very low birthweight prematures are strongly influenced by singleton pregnancy, by fetal sex, by gestational age and in the AGA-group by prenatal corticoid prophylaxis; mortality shows an inverted correlation to birthweight and gestational age, whereas the later prognosis of survivors does not seem to be influenced by birthweight or gestational age.

Customized vs INTERGROWTH-21st standards for the assessment of birthweight and stillbirth risk at term.

PubMed

Francis, Andre; Hugh, Oliver; Gardosi, Jason

2018-02-01

Fetal growth abnormalities are linked to stillbirth and other adverse pregnancy outcomes, and use of the correct birthweight standard is essential for accurate assessment of growth status and perinatal risk. Two competing, conceptually opposite birthweight standards are currently being implemented internationally: customized gestation-related optimal weight (GROW) and INTERGROWTH-21 st . We wanted to compare their performance when applied to a multiethnic international cohort, and evaluate their usefulness in the assessment of stillbirth risk at term. We analyzed routinely collected maternity data from 10 countries with a total of 1.25 million term pregnancies in their respective main ethnic groups. The 2 standards were applied to determine small for gestational age (SGA) and large for gestational age (LGA) rates, with associated relative risk and population-attributable risk of stillbirth. The customized standard (GROW) was based on the term optimal weight adjusted for maternal height, weight, parity, and ethnic origin, while INTERGROWTH-21 st was a fixed standard derived from a multiethnic cohort of low-risk pregnancies. The customized standard showed an average SGA rate of 10.5% (range 10.1-12.7) and LGA rate of 9.5% (range 7.3-9.9) for the set of cohorts. In contrast, there was a wide variation in SGA and LGA rates with INTERGROWTH-21 st , with an average SGA rate of 4.4% (range 3.1-16.8) and LGA rate of 20.6% (range 5.1-27.5). This variation in INTERGROWTH-21 st SGA and LGA rates was correlated closely (R = ±0.98) to the birthweights predicted for the 10 country cohorts by the customized method to derive term optimal weight, suggesting that they were mostly due to physiological variation in birthweight. Of the 10.5% of cases defined as SGA according to the customized standard, 4.3% were also SGA by INTERGROWTH-21 st and had a relative risk of 3.5 (95% confidence interval, 3.1-4.1) for stillbirth. A further 6.3% (60% of the whole customized SGA) were not SGA by INTERGROWTH-21 st , and had a relative risk of 1.9 (95% confidence interval, 3.1-4.1) for stillbirth. An additional 0.2% of cases were SGA by INTERGROWTH-21 st only, and had no increased risk of stillbirth. At the other end, customized assessment classified 9.5% of births as large for gestational age, most of which (9.0%) were also LGA by the INTERGROWTH-21 st standard. INTERGROWTH-21 st identified a further 11.6% as LGA, which, however, had a reduced risk of stillbirth (relative risk, 0.6; 95% confidence interval, 0.5-0.7). Customized assessment resulted in increased identification of small for gestational age and stillbirth risk, while the wide variation in SGA rates using the INTERGROWTH-21 st standard appeared to mostly reflect differences in physiological pregnancy characteristics in the 10 maternity populations. Copyright © 2018 Elsevier Inc. All rights reserved.

Development of Emotional and Behavioral Regulation in Children Born Extremely Preterm and Very Preterm: Biological and Social Influences

ERIC Educational Resources Information Center

Clark, Caron A. C.; Woodward, Lianne J.; Horwood, L. John; Moor, Stephanie

2008-01-01

This study describes the development of emotional and behavioral regulation in a regional cohort of children born extremely preterm (less than 28 weeks gestational age, n = 39), very preterm (less than 34 weeks gestational age, n = 56), and full term (n = 103). At 2 and 4 years, children born at younger gestational ages demonstrated poorer…

Gestational age

MedlinePlus

... looking at the baby's weight, length, head circumference , vital signs, reflexes, muscle tone, posture, and the condition of the skin and hair. If the baby's gestational age findings after birth match the calendar age, the baby ...

Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial.

PubMed

Pron, Gaylene; Mocarski, Eva; Bennett, John; Vilos, George; Common, Andrew; Vanderburgh, Leslie

2005-01-01

To report on pregnancies and deliveries occurring in a large cohort of women who underwent uterine artery embolization instead of surgery for symptomatic leiomyomata. A total of 555 women underwent uterine embolization in a multicenter clinical trial. The primary embolic agent was 355-500 microm polyvinyl alcohol particles with treatment end-point as bilateral stasis in the uterine arteries. Women desiring pregnancy were informed of the uncertain effect of embolization on fertility and pregnancy. Average age at embolization was 43 years (range 18-59 years). Thirty-one percent were younger than age 40 years. Women were followed up prospectively by telephone, and obstetric records of the women who conceived were reviewed. Twenty-one women of average age 34 years (range 27-42 years) conceived, (3 of these twice), and 13 women were nulliparous. Twenty-three of the 24 pregnancies were conceived spontaneously (1 woman had in vitro fertilization). There were 4 spontaneous abortions (16.7%, 95% confidence interval 5.4-41.9%) and 2 elective pregnancy terminations. Fourteen of the 18 live births were full term and 4 were preterm. There were 9 vaginal deliveries and 9 cesarean deliveries, 4 of which were elective. Abnormal placentation occurred in 3 cases, all nulliparas (12.5% 95% confidence interval 3.1-36.3%). Two cases developed placenta previa (1 had a clinical partial accreta) and the third developed a placenta membranacea with accreta resulting in cesarean hysterectomy. Three postpartum hemorrhages all secondary to placental abnormalities occurred. Four newborns were small for gestational age (< or = 5th percentile); 2 of these pregnancies were complicated by gestational hypertension. Women are able to achieve pregnancies after uterine artery embolization, and most resulted in term deliveries and appropriately grown newborns. Close monitoring of placental status, however, is recommended.

Ultrasound during mid-gestation: Agreement with physical foetal and placental measurements and use in predicting gestational age in sheep.

PubMed

Jones, A K; Gately, R E; McFadden, K K; Hoffman, M L; Pillai, S M; Zinn, S A; Govoni, K E; Reed, S A

2017-08-01

To determine the effects of poor maternal nutrition and litter size on foetal growth during mid-gestation, pregnant ewes (n = 82) were fed 100%, 60% or 140% of NRC TDN beginning at day 30.2 ± 0.2 of gestation. Transabdominal ultrasound was performed weekly between day 46.0 ± 0.4 and 86.0 ± 0.7 to monitor foetal heart width (HW), umbilical diameter (UMB), rib width (RW) and placentome outer (OD) and inner diameter (ID). Data were analysed with repeated-measures using the mixed procedure for effects of maternal diet, litter size and gestation, and equations predictive of gestational age were generated using the regression procedure. To determine the agreement of ultrasound measurement and actual size, ewes (n = 20-21) were euthanized at day 45 or 90 to obtain corresponding postmortem measurements for Bland-Altman analysis. The HW, UMB and placentome OD and ID increased with gestation (p < .0001) but were unaffected by maternal diet or litter size (p ≥ .12). Ultrasound underestimated postmortem measurements of HW (14.8%), UMB (7.3%), placentome OD (4.5%) and ID (37.3%) at day 90 of gestation. Ultrasound underestimated RW at day 45 (7.7%) but overestimated RW (23.8%) at day 90, indicating inconsistent bias when reporting RW by ultrasound. Combining the HW, UMB, RW and placentome OD generated the strongest equation predictive of gestational age (R 2  = .91). These findings indicate that during mid-gestation, maternal diet or litter size did not affect HW, UMB or placentome diameters and these factors can be used to estimate gestational age. © 2017 Blackwell Verlag GmbH.

Birth weight and other perinatal characteristics and childhood leukemia in California.

PubMed

Oksuzyan, S; Crespi, C M; Cockburn, M; Mezei, G; Kheifets, L

2012-12-01

We conducted a large registry-based study in California to investigate the association of perinatal factors and childhood leukemia with analysis of two major subtypes, acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML). We linked California cancer and birth registries to obtain information on 5788 cases and 5788 controls matched on age and sex (1:1). We examined the association of birth weight, gestational age, birth and pregnancy order, parental ages, and specific conditions during pregnancy and risk of total leukemia, ALL and AML using conditional logistic regression, with adjustment for potential confounders. The odds ratio (OR) per 1000 g increase in birth weight was 1.11 for both total leukemia and ALL. The OR were highest for babies weighing ≥ 4500 g with reference < 2500 g: 1.59 (95% CI: 1.05-2.40) and 1.70 (95% CI: 1.08-2.68) for total leukemia and ALL, respectively. For AML, increase in risk was also observed but the estimate was imprecise due to small numbers. Compared to average-for-gestational age (AGA), large-for-gestational age (LGA) babies were at slightly increased risk of total childhood leukemia (OR = 1.10) and both ALL and AML (OR = 1.07 and OR = 1.13, respectively) but estimates were imprecise. Being small-for-gestational age (SGA) was associated with reduced risk of childhood leukemia (OR = 0.81, 95% CI: 0.67-0.97) and ALL (OR = 0.77, 95% CI: 0.63-0.94), but not AML. Being first-born was associated with decreased risk of AML only (OR = 0.70; 95% CI: 0.53-0.93). Compared to children with paternal age <25 years, children with paternal age between 35 and 45 years were at increased risk of total childhood leukemia (OR = 1.12; 95% CI: 1.04-1.40) and ALL (OR = 1.23; 95% CI: 1.04-1.47). None of conditions during pregnancy examined or maternal age were associated with increased risk of childhood leukemia or its subtypes. Our results suggest that high birth weight and LGA were associated with increased risk and SGA with decreased risk of total childhood leukemia and ALL, being first-born was associated with decreased risk of AML, and advanced paternal age was associated with increased risk of ALL. These findings suggest that associations of childhood leukemia and perinatal factors depend highly on subtype of leukemia. Copyright © 2012 Elsevier Ltd. All rights reserved.

Neuromotor Development of Children Aged 6 and 7 Years Born before the 30th Week Gestation.

PubMed

Majewska, Joanna; Zajkiewicz, Katarzyna; Wacław-Abdul, Kamila; Baran, Joanna; Szymczyk, Daniel

2018-01-01

The aim of this study was to evaluate and compare the level of neuromotor function and somatic development in 6- and 7-year-old children born before the 30th week gestation with that in full-term children at the same age, as well as the correlation between prematurity and motor development. The study group consisted of prematurely born 40 children. Their mean gestational age at birth was 27.8 ± 1.6 weeks (range 24-30 weeks). The control group consisted of 40 healthy children born with normal birth weight (>2500 g). The neuromotor function was assessed using Touwen neurological examination criteria. During the examination, the attention was focused on the hand preference, laterality, synkinesis, and asymmetry. In addition, children's weight, height, and BMI index were measured. Premature children showed much worse results than full-term ones in hand function ( p < 0,001). They obtained the best results in paper tearing while crossing the body midline turned out to be the most difficult. Considering the quality of walking, the biggest difficulty for the premature children was to walk backwards along the straight line while during normal walking they showed the best results. The results for the muscle tone subcategory in the study group were also significantly worse than those in control group ( p < 0,001), as well as the total outcome for the movement coordination and diadochokinesis subcategories ( p < 0,001). The nondisabled, prematurely born children have significantly lower average outcomes regarding hand function, quality of walking, muscle tone, coordination, and diadochokinesis at age of six to seven, compared to the full-term peers.

Neonatal Maturation of Paracetamol (Acetaminophen) Glucuronidation, Sulfation, and Oxidation Based on a Parent-Metabolite Population Pharmacokinetic Model

PubMed Central

Cook, Sarah F.; Stockmann, Chris; Samiee-Zafarghandy, Samira; King, Amber D.; Deutsch, Nina; Williams, Elaine F.; Wilkins, Diana G.; van den Anker, John N.

2017-01-01

Objectives This study aimed to model the population pharmacokinetics of intravenous paracetamol and its major metabolites in neonates and to identify influential patient characteristics, especially those affecting the formation clearance (CLformation) of oxidative pathway metabolites. Methods Neonates with a clinical indication for intravenous analgesia received five 15-mg/kg doses of paracetamol at 12-h intervals (<28 weeks’ gestation) or seven 15-mg/kg doses at 8-h intervals (≥28 weeks’ gestation). Plasma and urine were sampled throughout the 72-h study period. Concentration-time data for paracetamol, paracetamol-glucuronide, paracetamol-sulfate, and the combined oxidative pathway metabolites (paracetamol-cysteine and paracetamol-N-acetylcysteine) were simultaneously modeled in NONMEM 7.2. Results The model incorporated 259 plasma and 350 urine samples from 35 neonates with a mean gestational age of 33.6 weeks (standard deviation 6.6). CLformation for all metabolites increased with weight; CLformation for glucuronidation and oxidation also increased with postnatal age. At the mean weight (2.3 kg) and postnatal age (7.5 days), CLformation estimates (bootstrap 95% confidence interval; between-subject variability) were 0.049 L/h (0.038–0.062; 62 %) for glucuronidation, 0.21 L/h (0.17–0.24; 33 %) for sulfation, and 0.058 L/h (0.044–0.078; 72 %) for oxidation. Expression of individual oxidation CLformation as a fraction of total individual paracetamol clearance showed that, on average, fractional oxidation CLformation increased <15 % when plotted against weight or postnatal age. Conclusions The parent-metabolite model successfully characterized the pharmacokinetics of intravenous paracetamol and its metabolites in neonates. Maturational changes in the fraction of paracetamol undergoing oxidation were small relative to between-subject variability. PMID:27209292

Neonatal Maturation of Paracetamol (Acetaminophen) Glucuronidation, Sulfation, and Oxidation Based on a Parent-Metabolite Population Pharmacokinetic Model.

PubMed

Cook, Sarah F; Stockmann, Chris; Samiee-Zafarghandy, Samira; King, Amber D; Deutsch, Nina; Williams, Elaine F; Wilkins, Diana G; Sherwin, Catherine M T; van den Anker, John N

2016-11-01

This study aimed to model the population pharmacokinetics of intravenous paracetamol and its major metabolites in neonates and to identify influential patient characteristics, especially those affecting the formation clearance (CL formation ) of oxidative pathway metabolites. Neonates with a clinical indication for intravenous analgesia received five 15-mg/kg doses of paracetamol at 12-h intervals (<28 weeks' gestation) or seven 15-mg/kg doses at 8-h intervals (≥28 weeks' gestation). Plasma and urine were sampled throughout the 72-h study period. Concentration-time data for paracetamol, paracetamol-glucuronide, paracetamol-sulfate, and the combined oxidative pathway metabolites (paracetamol-cysteine and paracetamol-N-acetylcysteine) were simultaneously modeled in NONMEM 7.2. The model incorporated 259 plasma and 350 urine samples from 35 neonates with a mean gestational age of 33.6 weeks (standard deviation 6.6). CL formation for all metabolites increased with weight; CL formation for glucuronidation and oxidation also increased with postnatal age. At the mean weight (2.3 kg) and postnatal age (7.5 days), CL formation estimates (bootstrap 95% confidence interval; between-subject variability) were 0.049 L/h (0.038-0.062; 62 %) for glucuronidation, 0.21 L/h (0.17-0.24; 33 %) for sulfation, and 0.058 L/h (0.044-0.078; 72 %) for oxidation. Expression of individual oxidation CL formation as a fraction of total individual paracetamol clearance showed that, on average, fractional oxidation CL formation increased <15 % when plotted against weight or postnatal age. The parent-metabolite model successfully characterized the pharmacokinetics of intravenous paracetamol and its metabolites in neonates. Maturational changes in the fraction of paracetamol undergoing oxidation were small relative to between-subject variability.

[Follow-up of infants with birth weight under 1,500 g].

PubMed

Weldt, E; Valenzuela, B; Angulo, G; Muñoz, E; Gómez, S; Levy, M L; Rosselot, S; Norambuena, N

1989-01-01

A prospective study of 199 children with birth weight less than 1,500 g was done. 86 boys and 113 girls, 141 (71%) adequate for gestational age and 58 (29%) small for gestational age. At follow-up 43 (21.6%) infants were lost to control, 17 (7%) moved to other places and 7 (3.5%) died in the first year of life. In the first year of life, infants whose birthweights were adequate for gestational age had been hospitalized more frequently and the small for dates showed higher percentage of undernutrition. After the second year of life, it was possible to know the impairment. It was found 7.4% of cerebral palsy, 2.9% of hipoacusia and 2.2% of retinopathy of prematurity, these diagnosis were most frequent in children that were adequate for gestational age. We concluded that small for dates infants are at risk of undernutrition and that those adequate for gestational age are at risk of permanent sequelae.

Impact of antenatal steroids on intraventricular hemorrhage in very-low-birth weight infants.

PubMed

Wei, J C; Catalano, R; Profit, J; Gould, J B; Lee, H C

2016-05-01

To determine the association between antenatal steroids administration and intraventricular hemorrhage rates. We used cross-sectional data from the California Perinatal Quality Care Collaborative during 2007 to 2013 for infants ⩽32 weeks gestational age. Using multivariable logistic regression, we evaluated the effect of antenatal steroids on intraventricular hemorrhage, stratified by gestational age. In 25 979 very-low-birth weight infants, antenatal steroid use was associated with a reduction in incidence of any grade of intraventricular hemorrhage (odds ratio=0.68, 95% confidence interval: 0.62, 0.75) and a reduction in incidence of severe intraventricular hemorrhage (odds ratio=0.51, 95% confidence interval: 0.45, 0.58). This association was seen across gestational ages ranging from 22 to 29 weeks. Although current guidelines recommend coverage for preterm birth at 24 to 34 weeks gestation, our results suggest that treatment with antenatal steroids may be beneficial even before 24 weeks of gestational age.

Income inequality, parental socioeconomic status, and birth outcomes in Japan.

PubMed

Fujiwara, Takeo; Ito, Jun; Kawachi, Ichiro

2013-05-15

The purpose of this study was to investigate the impact of income inequality and parental socioeconomic status on several birth outcomes in Japan. Data were collected on birth outcomes and parental socioeconomic status by questionnaire from Japanese parents nationwide (n = 41,499) and then linked to Gini coefficients at the prefectural level in 2001. In multilevel analysis, z scores of birth weight for gestational age decreased by 0.018 (95% confidence interval (CI): -0.029, -0.006) per 1-standard-deviation (0.018-unit) increase in the Gini coefficient, while gestational age at delivery was not associated with the Gini coefficient. For dichotomous outcomes, mothers living in prefectures with middle and high Gini coefficients were 1.24 (95% CI: 1.05, 1.47) and 1.23 (95% CI: 1.02, 1.48) times more likely, respectively, to deliver a small-for-gestational-age infant than mothers living in more egalitarian prefectures (low Gini coefficients), although preterm births were not significantly associated with income distribution. Parental educational level, but not household income, was significantly associated with the z score of birth weight for gestational age and small-for-gestational-age status. Higher income inequality at the prefectural level and parental educational level, rather than household income, were associated with intrauterine growth but not with shorter gestational age at delivery.

Congenital heart disease infant death rates decrease as gestational age advances from 34 to 40 weeks.

PubMed

Cnota, James F; Gupta, Resmi; Michelfelder, Erik C; Ittenbach, Richard F

2011-11-01

To describe congenital heart disease death rates in infants born between 34 and 40 weeks, estimate the relationship between gestational age and congenital heart disease infant death rates, and compare congenital heart disease death rates across 1- and 2-week intervals in gestational age. The 2000 to 2003 national linked birth/infant death cohort datasets were obtained. Congenital heart disease deaths were identified by using International Statistical Classification of Diseases, 10th Revision codes. Proportional death rates were calculated by using congenital heart disease deaths and all live births. The relationship between congenital heart disease death rates and gestational age was determined. Death rates were compared across intervals. A total of 14.9 million records were analyzed. Congenital heart disease deaths occurred in 4736 infants (0.04%) born between 34 and 40 weeks. There was a significant, negative linear relationship between congenital heart disease death rate and gestational age (R(2) = 0.97). Comparisons across 1-week intervals varied (P = .02-.23). All 2-week intervals were statistically significant (P < .01). Congenital heart disease death rates decrease as gestational age approaches 40 weeks. These results should be considered before elective delivery for the sole indication of prenatally diagnosed congenital heart disease. Copyright © 2011 Mosby, Inc. All rights reserved.

The FL/AC ratio for prediction of shoulder dystocia in women with gestational diabetes.

PubMed

Duryea, Elaine L; Casey, Brian M; McIntire, Donald D; Twickler, Diane M

2017-10-01

To determine if sonographic variables, including fetal femur length to abdominal circumference (FL/AC) ratio, are associated with shoulder dystocia in women with gestational diabetes. This was a retrospective cohort study of women with gestational diabetes who delivered singleton infants at Parkland Hospital from 1997 to 2015. Diagnosis and treatment of gestational diabetes were uniform including sonography at 32-36 weeks. Biometric calculations were evaluated for correlation with shoulder dystocia. During the study period, 6952 women with gestational diabetes underwent a sonogram at a mean gestation of 34.8 ± 1.8 weeks. Of 4183 vaginal deliveries, 66 experienced shoulder dystocia (16/1000). The FL/AC was associated with shoulder dystocia (p < 0.001) with an AUC of 0.70 (95% CI: 0.64-0.77). This was similar to age-adjusted AC and head circumference to AC ratio (HC/AC) (both with an AUC of 0.72). All other measurements, including estimated fetal weight, were inferior. When examining the 257 women with multiple sonograms after 32 weeks' gestation, FL/AC was stable with advancing gestational age (p = 0.54) whereas age-adjusted AC and HC/AC were not (p < 0.001). The FL/AC is associated with shoulder dystocia in women with gestational diabetes. Additionally, it is a simple ratio that is independent of the reference used and remains stable, unlike age-adjusted AC and HC/AC ratio.

Sonographic Measurement of Fetal Ear Length in Turkish Women with a Normal Pregnancy

PubMed Central

Özdemir, Mucize Eriç; Uzun, Işıl; Karahasanoğlu, Ayşe; Aygün, Mehmet; Akın, Hale; Yazıcıoğlu, Fehmi

2014-01-01

Background: Abnormal fetal ear length is a feature of chromosomal disorders. Fetal ear length measurement is a simple measurement that can be obtained during ultrasonographic examinations. Aims: To develop a nomogram for fetal ear length measurements in our population and investigate the correlation between fetal ear length, gestational age, and other standard fetal biometric measurements. Study Design: Cohort study. Methods: Ear lengths of the fetuses were measured in normal singleton pregnancies. The relationship between gestational age and fetal ear length in millimetres was analysed by simple linear regression. In addition, the correlation of fetal ear length measurements with biparietal diameter, head circumference, abdominal circumference, and femur length were evaluated.Ear length measurements were obtained from fetuses in 389 normal singleton pregnancies ranging between 16 and 28 weeks of gestation. Results: A nomogram was developed by linear regression analysis of the parameters ear length and gestational age. Fetal ear length (mm) = y = (1.348 X gestational age)−12.265), where gestational ages is in weeks. A high correlation was found between fetal ear length and gestational age, and a significant correlation was also found between fetal ear length and the biparietal diameter (r=0.962; p<0.001). Similar correlations were found between fetal ear length and head circumference, and fetal ear length and femur length. Conclusion: The results of this study provide a nomogram for fetal ear length. The study also demonstrates the relationship between ear length and other biometric measurements. PMID:25667783

Efficacy of surfactant at different gestational ages for infants with respiratory distress syndrome

PubMed Central

Wang, Li; Chen, Long; Li, Renjun; Zhao, Jinning; Wu, Xiushuang; Li, Xue; Shi, Yuan

2015-01-01

Since exogenous surfactant replacement therapy was first used to prevent respiratory distress syndrome (RDS), it has become the main method for treatment of RDS. However, in some infants, death is inevitable despite intensive care and surfactant replacement therapy, especially in near-term and term infants. The main purpose of this study was to compare the therapeutic effect of pulmonary surfactant for infants at different gestational ages and to investigate whether exogenous surfactant replacement therapy is effective for all newborns with RDS. Data on surfactant replacement therapy, including blood gas, oxygenation function parameters and therapy results, were collected from 135 infants who were diagnosed with RDS during three years at a tertiary neonatal intensive care unit. According to gestational age, the subjects were classified into three groups as follows: group 1: gestational age <35 weeks (n=54); group 2: 35 weeks ≤ gestational age <37 weeks (n=35); group 3: gestational age ≥37 weeks (n=46). Six hours after surfactant was given, there were significantly better blood gas results in group 1 and worse results in groups 2 and 3. Similar oxygenation function parameter results were observed in the three groups. In addition, there was a trend toward an increased rate of repeated surfactant administration with increasing gestational age. For near-term and term infants, the efficacy of surfactant therapy was not as good as it was for preterm infants. The causes of RDS in near-term and term infants might be different from those in preterm infants and should be studied further. PMID:26550326

Body Mass Index, Overweight, and Obesity in Swedish Women Born Post-term.

PubMed

Derraik, José G B; Lundgren, Maria; Cutfield, Wayne S; Ahlsson, Fredrik

2016-07-01

There is increasing evidence that post-term birth (≥42 weeks of gestation) is associated with adverse long-term outcomes. We assessed whether women born post-term displayed increased risk of overweight and obesity in adulthood. Data were collected at first antenatal visit (~10-12 weeks of gestation) on singleton Swedish women aged ≥18 years in 1991-2009 (mean age 26.1 years), who were born post-term (n = 27 153) or at term (37-41 weeks of gestation; n = 184 245). Study outcomes were evaluated for continuous associations with gestational age. Stratified analyses were carried out comparing women born post-term or at term. Analyses were also run with a 2-week buffer between groups to account for possible errors in gestational age estimation, comparing women born very post-term (≥43 weeks of gestation; n = 5761) to those born within a narrower term window (38-40 weeks of gestation; n = 130 110). Increasing gestational age was associated with greater adult weight and body mass index (BMI). Stratified analyses showed that women born post-term were 0.5 kg heavier and had BMI 0.2 kg/m(2) greater than those born at term. Differences were more marked between women born very post-term (≥43 weeks) vs. a narrower term group (38-40 weeks): 1.0 kg and 0.3 kg/m(2) . The adjusted relative risks of overweight/obesity and obesity in women born very post-term were 1.13 and 1.12 times higher, respectively, than in those born at term. Post-term birth is associated with greater BMI and increased risk of overweight and obesity in adulthood, particularly among women born ≥43 weeks of gestation. © 2016 John Wiley & Sons Ltd.

Mediators of the association between pre-eclampsia and cerebral palsy: population based cohort study

PubMed Central

Heimstad, Runa; Iversen, Ann-Charlotte; Austgulen, Rigmor; Lydersen, Stian; Andersen, Guro L; Irgens, Lorentz M; Vik, Torstein

2013-01-01

Objective To test the hypothesis that pre-eclampsia is a risk factor for cerebral palsy mediated through preterm birth and being born small for gestational age. Design Population based cohort study. Setting Clinical data from the Norwegian Cerebral Palsy Registry were linked with perinatal data prospectively recorded by the Medical Birth Registry of Norway. Participants All singleton babies who survived the neonatal period during 1996-2006 (849 children with cerebral palsy and 616 658 control children). Main outcome measures Cerebral palsy and cerebral palsy subtypes. Results Children exposed to pre-eclampsia had an excess risk of cerebral palsy (unadjusted odds ratio 2.5, 95% confidence interval 2.0 to 3.2) compared with unexposed children. Among children born at term (≥37 weeks), exposure to pre-eclampsia was not associated with an excess risk of cerebral palsy in babies not born small for gestational age (1.2, 0.7 to 2.0), whereas children exposed to pre-eclampsia and born small for gestational age had a significantly increased risk of cerebral palsy (3.2, 1.5 to 6.7). Non-small for gestational age babies born very preterm (<32 weeks) and exposed to pre-eclampsia had a reduced risk of cerebral palsy compared with unexposed children born at the same gestational age (0.5, 0.3 to 0.8), although the risk was not statistically significantly reduced among children exposed to pre-eclampsia and born small for gestational age (0.7, 0.4 to 1.3). Exposure to pre-eclampsia was not associated with a specific cerebral palsy subtype. Conclusions Exposure to pre-eclampsia was associated with an increased risk of cerebral palsy, and this association was mediated through the children being born preterm or small for gestational age, or both. Among children born at term, pre-eclampsia was a risk factor for cerebral palsy only when the children were small for gestational age. PMID:23838554

Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods

PubMed Central

van der Waal, Zelda; Rushton, Steven; Rankin, Judith

2018-01-01

Objectives To determine whether introduction or withdrawal of a maternal financial incentive was associated with changes in timing of first attendance for antenatal care (‘booking’), or incidence of small for gestational age. Design A natural experimental evaluation using interrupted time series analysis. Setting A hospital-based maternity unit in the north of England. Participants 34 589 women (and their live-born babies) who delivered at the study hospital and completed the 25th week of pregnancy in the 75 months before (January 2003 to March 2009), 21 months during (April 2009 to December 2010) and 36 months after (January 2011 to December 2013) the incentive was available. Intervention The Health in Pregnancy Grant was a financial incentive of £190 ($235; €211) payable to pregnant women in the UK from the 25th week of pregnancy, contingent on them receiving routine antenatal care. Primary and secondary outcome measures The primary outcome was mean gestational age at booking. Secondary outcomes were proportion of women booking by 10, 18 and 25 weeks’ gestation; and proportion of babies that were small for gestational age. Results By 21 months after introduction of the grant (ie, immediately prior to withdrawal), compared with what was predicted given prior trends, there was an reduction in mean gestational age at booking of 4.8 days (95% CI 2.3 to 8.2). The comparable figure for 24 months after withdrawal was an increase of 14.0 days (95% CI 2.8 to 16.8). No changes in incidence of small for gestational age babies were seen. Conclusions The introduction of a universal financial incentive for timely attendance at antenatal care was associated with a reduction in mean gestational age at first attendance, but not the proportion of babies that were small for gestational age. Future research should explore the effects of incentives offered at different times in pregnancy and of differing values; and how stakeholders view such incentives. PMID:29391362

Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods.

PubMed

Adams, Jean; van der Waal, Zelda; Rushton, Steven; Rankin, Judith

2018-01-31

To determine whether introduction or withdrawal of a maternal financial incentive was associated with changes in timing of first attendance for antenatal care ('booking'), or incidence of small for gestational age. A natural experimental evaluation using interrupted time series analysis. A hospital-based maternity unit in the north of England. 34 589 women (and their live-born babies) who delivered at the study hospital and completed the 25th week of pregnancy in the 75 months before (January 2003 to March 2009), 21 months during (April 2009 to December 2010) and 36 months after (January 2011 to December 2013) the incentive was available. The Health in Pregnancy Grant was a financial incentive of £190 ($235; €211) payable to pregnant women in the UK from the 25th week of pregnancy, contingent on them receiving routine antenatal care. The primary outcome was mean gestational age at booking. Secondary outcomes were proportion of women booking by 10, 18 and 25 weeks' gestation; and proportion of babies that were small for gestational age. By 21 months after introduction of the grant (ie, immediately prior to withdrawal), compared with what was predicted given prior trends, there was an reduction in mean gestational age at booking of 4.8 days (95% CI 2.3 to 8.2). The comparable figure for 24 months after withdrawal was an increase of 14.0 days (95% CI 2.8 to 16.8). No changes in incidence of small for gestational age babies were seen. The introduction of a universal financial incentive for timely attendance at antenatal care was associated with a reduction in mean gestational age at first attendance, but not the proportion of babies that were small for gestational age. Future research should explore the effects of incentives offered at different times in pregnancy and of differing values; and how stakeholders view such incentives. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Estimation of Gestational Age, Using Neonatal Anthropometry: A Cross-sectional Study in India

PubMed Central

Thawani, Rajat; Faridi, M.M.A.; Arora, Shilpa Khanna; Kumar, Rajeev

2013-01-01

Prematurity is a significant contributor to neonatal mortality in India. Conventionally, assessment of gestational age of newborns is based on New Ballard Technique, for which a paediatric specialist is needed. Anthropometry of the newborn, especially birthweight, has been used in the past to predict the gestational age of the neonate in peripheral health facilities where a trained paediatrician is often not available. We aimed to determine if neonatal anthropometric parameters, viz. birthweight, crown heel-length, head-circumference, mid-upper arm-circumference, lower segment-length, foot-length, umbilical nipple distance, calf-circumference, intermammary distance, and hand-length, can reliably predict the gestational age. The study also aimed to derive an equation for the same. We also assessed if these neonatal anthropometric parameters had a better prediction of gestational age when used in combination compared to individual parameters. We evaluated 1,000 newborns in a cross-sectional study conducted in Guru Teg Bahadur Hospital in Delhi. Detailed anthropometric estimation of the neonates was done within 48 hours after birth, using standard techniques. Gestational age was estimated using New Ballard Scoring. Out of 1,250 consecutive neonates, 1,000 were included in the study. Of them, 800 randomly-selected newborns were used in devising the model, and the remaining 200 newborns were used in validating the final model. Quadratic regression analysis using stepwise selection was used in building the predictive model. Birthweight (R=0.72), head-circumference (R=0.60), and mid-upper arm-circumference (R=0.67) were found highly correlated with gestation. The final equation to assess gestational age was as follows: Gestational age (weeks)=5.437×W–0.781×W2+2.815×HC–0.041×HC2+0.285×MUAC–22.745 where W=Weight, HC=Head-circumference and MUAC=Mid-upper arm-circumference; Adjusted R=0.76. On validation, the predictability of this equation is 46% (±1 week), 75.5% (+2 weeks), and 91.5% (+3 weeks). This mathematical model may be used in identifying preterm neonates. PMID:24592594

Cerebral palsy rates by birth weight, gestation and severity in North of England, 1991-2000 singleton births.

PubMed

Glinianaia, Svetlana V; Rankin, Judith; Colver, Allan

2011-02-01

To investigate changes in rates of cerebral palsy (CP) by birth weight, gestational age, severity of disability, clinical subtype and maternal age in the North of England, 1991-2000. Data on 908 cases of CP (816 singletons, 92 multiples) were analysed from the prospective population-based North of England Collaborative Cerebral Palsy Survey. Severity of disability, measured as a Lifestyle Assessment Score (LAS), was derived from the lifestyle assessment questionnaire. CP rates by birth weight, gestational age, birth weight standardised for gestational age and sex, severity of disability and maternal age were compared between 1991-1995 and 1996-2000 using rate ratios (RR). The prevalence of CP in singletons was 2.46 (95% CI 2.29 to 2.63) per 1000 neonatal survivors compared to 11.06 per 1000 (95% CI 8.81 to 13.3) in multiples (RR 4.49, 95% CI 3.62 to 5.57), with no significant change between quinquennia. The singleton CP rates were higher for lower birth weight groups than birth weight ≥2500 g; and there were no significant changes for any birth weight group between quinquennia. There were also no changes in rates of more severe disability (LAS≥30%) by birth weight, gestation or clinical subtype. For preterm and term births the patterns of Z-score of birth weight-for-gestation are similar, with CP rates increasing as Z-score deviates from the optimal weight-for-gestation, which is about 1 SD above the mean. In contrast to increasing rates in previous years, rates of CP and more severe CP were stable by birth weight, gestational age and clinical subtype for 1991-2000.

Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study).

PubMed

Pels, Anouk; Mol, Ben Willem J; Singer, Joel; Lee, Terry; von Dadelszen, Peter; Ganzevoort, Wessel; Asztalos, Elizabeth; Magee, Laura A

2018-06-01

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile ( P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. URL: https://www.isrctn.com. Unique identifier: ISRCTN71416914. © 2018 The Authors.

Body Weight, Length and Head Circumference at Birth in a Cohort of Turkish Newborns

PubMed Central

Kurtoğlu, Selim; Hatipoğlu, Nihal; Mazıcıoğlu, Mustafa Mümtaz; Akın, Mustafa Ali; Çoban, Dilek; Gökoğlu, Sonay; Baştuğ, Osman

2012-01-01

Objective: Intrauterine growth references are primarily useful indicators in the assessment of the general health status of newborn infants. Although Lubchenco’s references are still used in many neonatal care units, we believe that there is a need for up-to-date intrauterine growth references specific for different populations. To develop gestational age-and gender-specific national references for birth weight, birth length and head circumference. Methods: Data were collected from neonatal records of perinatology services of eleven hospitals from January to December 2009. The anthropometry of a total of 4750 singleton live births born between 28 and 41 weeks of gestation were recorded. Means and standard deviations were calculated, and percentiles for each gender and gestational week were produced using the LMS program. The results were compared with US infants and also with local data. Results: Gestational age- and gender-specific 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentile values were produced. Comparison of the 10th, 50th and 90th percentile values showed that the boys were heavier and longer than the girls. Head circumference values were also higher in the boys. Proportions of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) infants in the sample were 10.1%, 79.1% and 10.8%, respectively. Conclusion: These gender- and gestational age-specific references will be of use in clinical practice and also for research purposes until more comprehensive, reliable and accessible national data pertaining to the intrauterine growth of Turkish infants are produced. Conflict of interest:None declared. PMID:22664362

Gestational age at birth and brain white matter development in term-born infants and children

USDA-ARS?s Scientific Manuscript database

Studies on infants and children born preterm have shown that adequate gestational length is critical for brain white matter development. Less is known regarding how variations in gestational age at birth in term infants and children affect white matter development, which was evaluated in this study....

Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.

PubMed

Moore, Tamanna; Hennessy, Enid M; Myles, Jonathan; Johnson, Samantha J; Draper, Elizabeth S; Costeloe, Kate L; Marlow, Neil

2012-12-04

To determine outcomes at age 3 years in babies born before 27 completed weeks' gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation. Prospective national cohort studies, EPICure and EPICure 2. Hospital and home based evaluations, England. 1031 surviving babies born in 2006 before 27 completed weeks' gestation. Outcomes for 584 babies born at 22-25 weeks' gestation were compared with those of 260 surviving babies of the same gestational age born in 1995. Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort. Of the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks' gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%). Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks' gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks.

Pre-Pregnancy Dating Violence and Birth Outcomes Among Adolescent Mothers in a National Sample.

PubMed

Madkour, Aubrey Spriggs; Xie, Yiqiong; Harville, Emily W

2014-07-01

Although infants born to adolescent mothers are at increased risk of adverse birth outcomes, little is known about contributors to birth outcomes in this group. Given past research linking partner abuse to adverse birth outcomes among adult mothers, we explored associations between pre-pregnancy verbal and physical dating violence and the birth weight and gestational age of infants born to adolescent mothers. Data from the National Longitudinal Study of Adolescent Health Waves I (1995/1996), II (1996), and IV (2007/2008) were analyzed. Girls whose first singleton live births occurred after Wave II interview and before age 20 (N = 558) self-reported infants' birth weight and gestational age at Wave IV. Dating violence victimization (verbal and physical) in the 18 months prior to Wave II interview was self-reported. Controls included Wave I age, parent education, age at pregnancy, time between reporting abuse and birth, and childhood physical and sexual abuse. Weighted multivariable regression models were performed separately by race (Black/non-Black).On average, births occurred 2 years after Wave II interview. Almost one in four mothers reported verbal dating violence victimization (23.6%), and 10.1% reported physical victimization. Birth weight and prevalence of verbal dating violence victimization were significantly lower in Black compared with non-Black teen mothers. In multivariable analyses, negative associations between physical dating abuse and birth outcomes became stronger as time increased for Black mothers. For example, pre-pregnancy physical dating abuse was associated with 0.79 kilograms lower birth weight (p< .001) and 4.72 fewer weeks gestational age (p< .01) for Black mothers who gave birth 2 years post-reporting abuse. Physical dating abuse was unassociated with birth outcomes among non-Black mothers, and verbal abuse was unassociated with birth outcomes for all mothers. Reducing physical dating violence in adolescent relationships prior to pregnancy may improve Black adolescent mothers' birth outcomes. Intervening on long-term violence may be particularly important. © The Author(s) 2013.

Pre-pregnancy Dating Violence and Birth Outcomes among Adolescent Mothers in a National Sample

PubMed Central

Madkour, Aubrey Spriggs; Xie, Yiqiong; Harville, Emily W.

2015-01-01

Background Although infants born to adolescent mothers are at increased risk of adverse birth outcomes, little is known about contributors to birth outcomes in this group. Given past research linking partner abuse to adverse birth outcomes among adult mothers, we explored associations between pre-pregnancy verbal and physical dating violence and the birthweight and gestational age of infants born to adolescent mothers. Methods Data from the National Longitudinal Study of Adolescent Health Waves I (1995/96), II (1996), and IV (2007/08) were analyzed. Girls whose first singleton live births occurred after Wave II interview and before age 20 (n=558) self-reported infants’ birth weight and gestational age at Wave IV. Dating violence victimization (verbal and physical) in the 18 months prior to Wave II interview was self-reported. Controls included Wave I age; parent education; age at pregnancy; time between reporting abuse and birth; and childhood physical and sexual abuse. Weighted multivariable regression models were performed separately by race (Black/non-Black). Results On average, births occurred two years after Wave II interview. Almost one in four mothers reported verbal dating violence victimization (23.6%), and 10.1% reported physical victimization. Birthweight and prevalence of verbal dating violence victimization were significantly lower in Black compared to non-Black teen mothers. In multivariable analyses, negative associations between physical dating abuse and birth outcomes became stronger as time increased for Black mothers. For example, pre-pregnancy physical dating abuse was associated with 0.79 kilograms lower birthweight (p<.001) and 4.72 fewer weeks gestational age (p<0.01) for Black mothers who gave birth two years post-reporting abuse. Physical dating abuse was unassociated with birth outcomes among non-Black mothers, and verbal abuse was unassociated with birth outcomes for all mothers. Conclusions Reducing physical dating violence in adolescent relationships prior to pregnancy may improve Black adolescent mothers’ birth outcomes. Intervening on long-term violence may be particularly important. PMID:24366966

[Nutritional status of women with gestational diabetes and characteristics of newborn].

PubMed

González Stäger, Maria Angelica; Rodríguez Fernández, Alejandra; Ortega Quintana, Victoria; Oliveras Vega, Leslie

2012-12-01

The objective was to determine the relationship between the mother's nutritional status and the newborn's gestational characteristics. A sample of 149 women with gestational diabetes was controlled in the High Risk Obstetric Unit of the Medical Specialties Public Health Center before delivery in the maternity ward of the Hospital Clinico Herminda Martín de Chillán, Chile in 2010. Data were obtained from the perinatal clinical history and the newborn's chart. The variables recorded for the mother were nutritional status, type of delivery, number of pregnancies, and metabolic control. Data for the newborn were weight, length, head circumference, and gestational diagnosis. These data were analyzed by ANOVA, Chi-square test, and Multiple Correspondence. Women with a normal nutritional status were multiparous with natural childbirth; the newborn had an adequate gestational age and normal head circumference. On the other hand, maternal obesity was related to a Cesarean; the newborn was large for gestational age and had a larger head circumference. Overweight women were primiparous and the newborn was small for gestational age with a smaller head circumference (p < 0.01). It was concluded that obesity in women with gestational diabetes explains variables such as type of delivery, number of gestations, and the newborn's diagnosis.

Fetal nasal bone length during the second trimester of pregnancy in a Turkish population.

PubMed

Goynumer, G; Arisoy, R; Yayla, M; Erdogdu, E; Ergin, N

2014-05-01

To determine the distribution of fetal nasal bone length (NBL) according to gestational age during the second trimester of pregnancy in a Turkish population. Fetal NBL and other routine biometric measurements were evaluated retrospectively in 2327 fetuses between 15 and 24 weeks of gestation. The measurements were obtained via transabdominal ultrasound. The distribution of fetal NBL between 15 and 24 weeks of gestation was established, and percentiles were calculated. Relationships between fetal NBL and other parameters were assessed using regression analysis. Mean (±standard deviation) fetal NBL ranged from 2.95±0.52 at 15 weeks of gestation to 6.26±0.77mm at 24 weeks of gestation. The fifth percentile for fetal NBL was 2.1mm at 15 weeks of gestation and 5.0mm at 24 weeks of gestation. A significant positive correlation was noted between fetal NBL and gestational age (NBL=gestational age×0.37-2.55; R(2)=0.59; p<0.01) and between fetal NBL and biparietal diameter (BPD) (NBL=BPD×0.11-0.33; R(2)=0.61; p<0.01). Fetal NBL is less in Turkish subjects compared with non-Turkish subjects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Preterm Induction of Labor: Predictors of Vaginal Delivery and Labor Curves

PubMed Central

Feghali, Maisa; Timofeev, Julia; Huang, Chun-Chih; Driggers, Rita; Miodovnik, Menachem; Landy, Helain J.; Umans, Jason G.

2014-01-01

Objective To evaluate the labor curves of patients undergoing preterm induction of labor (IOL) and assess possible predictors of vaginal delivery (VD). Study Design Data from the NICHD Consortium on Safe Labor were analyzed. A total of 6,555 women undergoing medically-indicated IOL before 37 weeks gestational age (GA) were included in this analysis. Patients were divided into four groups based on gestational age: A: 24-27+6, B: 28-30+6, C: 31-33+6, and D: 34-36+6 weeks. Pregnant women with a contraindication to VD, IOL at or after 37 weeks and those without data from cervical exam on admission were excluded. ANOVA was used to assess differences between GA groups. Multiple logistic regression was used to assess predictors of VD. A repeated measures analysis was used to determine average labor curves. Results Rates of vaginal live births increased with GA, from 35% (Group A) to 76% (Group D). Parous women [odds ratio (OR)=6.78, 95% confidence interval (CI) 6.38-7.21] and those with a favorable cervix at the start of IOL (OR=2.35, 95% CI 2.23-2.48) were more likely to deliver vaginally. Analysis of labor curves in nulliparous women showed shorter duration of labor with increasing GA; the active phase of labor was, however, similar across all GA. Conclusion The majority of women undergoing medically-indicated preterm IOL between 24 and 36+6 weeks’ GA deliver vaginally. The strongest predictor of VD was parity. Preterm IOL had a limited influence on estimated labor curves across gestational age. PMID:25068566

Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort

PubMed Central

Aris, Izzuddin M; Bernard, Jonathan Y; Chen, Ling-Wei; Tint, Mya Thway; Pang, Wei Wei; Lim, Wai Yee; Soh, Shu E; Saw, Seang-Mei; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap-Seng; Yap, Fabian; Kramer, Michael S; Lee, Yung Seng

2017-01-01

Abstract Background: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. Methods: We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child’s BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. Results: Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m2, 16.5 (5.3) mm and 3.8 (1.3) kg/m2, respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m2 and pre-peak velocity of 0.7 (0.3) kg/m2/month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [–0.45 kg/m2 (–0.69, –0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12–1.62) for age; 1.89 (1.60–2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. Conclusions: Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations. PMID:27649801

Infant body mass index peak and early childhood cardio-metabolic risk markers in a multi-ethnic Asian birth cohort.

PubMed

Aris, Izzuddin M; Bernard, Jonathan Y; Chen, Ling-Wei; Tint, Mya Thway; Pang, Wei Wei; Lim, Wai Yee; Soh, Shu E; Saw, Seang-Mei; Godfrey, Keith M; Gluckman, Peter D; Chong, Yap-Seng; Yap, Fabian; Kramer, Michael S; Lee, Yung Seng

2017-04-01

: Infant body mass index (BMI) peak has received much interest recently as a potential predictor of future obesity and metabolic risk. No studies, however, have examined infant BMI peak in Asian populations, in whom the risk of metabolic disease is higher. : We utilized data among 1020 infants from a mother-offspring cohort, who were Singapore citizens or permanent residents of Chinese, Malay or Indian ethnicity with homogeneous parental ethnic backgrounds, and did not receive chemotherapy, psychotropic drugs or have diabetes mellitus. Ethnicity was self-reported at recruitment and later confirmed using genotype analysis. Subject-specific BMI curves were fitted to infant BMI data using natural cubic splines with random coefficients to account for repeated measures in each child. We estimated characteristics of the child's BMI peak [age and magnitude at peak, average pre-peak velocity (aPPV)]. Systolic (SBP) and diastolic blood pressure (DBP), BMI, sum of skinfolds (SSF) and fat-mass index (FMI) were measured during a follow-up visit at age 48 months. Weighted multivariable linear regression was used to assess the predictors (maternal BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational age and breastfeeding duration) of infant BMI peak and its associations with outcomes at 48 months. Comparisons between ethnicities were tested using Bonferroni post-hoc correction. : Of 1020 infants, 80.5% were followed up at the 48-month visit. Mean (SD) BMI, SSF and FMI at 48 months were 15.6 (1.8) kg/m 2 , 16.5 (5.3) mm and 3.8 (1.3) kg/m 2 , respectively. Mean (SD) age at peak BMI was 6.0 (1.6) months, with a magnitude of 17.2 (1.4) kg/m 2 and pre-peak velocity of 0.7 (0.3) kg/m 2 /month. Compared with Chinese infants, the peak occurred later in Malay {B [95% confidence interval (CI): 0.64 mo (0.36, 0.92)]} and Indian infants [1.11 mo (0.76, 1.46)] and was lower in magnitude in Indian infants [-0.45 kg/m 2 (-0.69, -0.20)]. Adjusting for maternal education, BMI, gestational weight gain, ethnicity, infant sex, gestational age, birthweight-for-gestational-age and breastfeeding duration, higher peak and aPPV were associated with greater BMI, SSF and FMI at 48 months. Age at peak was positively associated with BMI at 48 months [0.15 units (0.09, 0.22)], whereas peak magnitude was associated with SBP [0.17 units (0.05, 0.30)] and DBP at 48 months [0.10 units (0.01, 0.22)]. Older age and higher magnitude at peak were associated with increased risk of overweight at 48 months [Relative Risk (95% CI): 1.35 (1.12-1.62) for age; 1.89 (1.60-2.24) for magnitude]. The associations of BMI peak with BMI and SSF at 48 months were stronger in Malay and Indian children than in Chinese children. : Ethnic-specific differences in BMI peak characteristics, and associations of BMI peak with early childhood cardio-metabolic markers, suggest an important impact of early BMI development on later metabolic outcomes in Asian populations. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Adverse effects of small for gestational age differ by gestational week among very preterm infants.

PubMed

Jensen, Erik A; Foglia, Elizabeth E; Dysart, Kevin C; Simmons, Rebecca A; Aghai, Zubair H; Cook, Alison; Greenspan, Jay S; DeMauro, Sara B

2018-05-05

To characterise the excess risk for death, grade 3-4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3-5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation. Retrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs). Of 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3-4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2-3 weeks less mature. The excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Relationship between birth weight, maternal smoking during pregnancy and childhood and adolescent lung function: A path analysis.

PubMed

Balte, Pallavi; Karmaus, Wilfried; Roberts, Graham; Kurukulaaratchy, Ramesh; Mitchell, Frances; Arshad, Hasan

2016-12-01

Low birth weight and gestational maternal smoking have been linked with reduced lung function in children in many cross sectional studies. However, these associations have not yet been assessed with repeated measurements of lung function. Our aim was to investigate the effects of birth weight, gestational age, and gestational maternal smoking on lung function in children at age 10 and 18 years. In the Isle of Wight birth cohort spirometry was performed at age 10 and 18 years. Information on birth weight and gestational age were obtained from hospital records. Mothers were asked about smoking during pregnancy. We employed linear mixed models to estimate the effect of these risk factors on repeated measurements of lung function. We considered maternal asthma, sex, neonatal intensive care unit admission, height, socio-economic status, personal smoking in participants at age 18, body mass index and environmental tobacco smoke exposure as potential confounders. Finally, we used path analysis to determine links between birth weight, gestational age and gestational maternal smoking on lung function at age 10 and 18 years. Linear mixed models showed that with every 1 kg increase in birth weight, Forced expiratory volume in one second (FEV 1 ) increased by 42.6 ± 17.2 mL and Forced expiratory flow between 25% and 75% (FEF 25-75 ) of Forced vital capacity (FVC) increased by 95.5 ± 41.2 mL at age 18 years after adjusting for potential confounders. Path analysis suggested that birth weight had positive direct effects on FEV 1 and FEF 25-75 and positive indirect effect on FVC at 10 years which were carried forward to 18 years. Additionally, results also suggested a positive association between gestational age and FEV 1 , FVC and FEF 25-75  at ages 10 and 18 years and an inverse association between gestational smoke exposure and FEV 1 /FVC ratio and FEF 25-75  at age 18 years. Higher birth weight and gestational age were associated with higher FEV 1 , FVC and FEF 25-75 and maternal smoking during pregnancy was associated with reduced FEV 1 /FVC ratio and FEF 25-75 . The use of path analysis can improve our understanding of underlying "causal" pathways among different prenatal and childhood factors that affect lung function in both pre-adolescent and adolescent periods. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The impact of environmental temperature on the diagnosis of gestational diabetes mellitus.

PubMed

Vasileiou, Vasiliki; Kyratzoglou, Eleni; Paschou, Stavroula A; Kyprianou, Miltiades; Anastasiou, Eleni

2018-03-01

To investigate a probable impact of seasons on the diagnosis of GDM, as well as the specific effect of the environmental temperature on the diagnosis of this clinical entity. Two observational studies, one retrospective and one prospective, were conducted in a referral center. Study A included retrospectively 7618 pregnant women who underwent a 3-h 100 g OGTT during the 3rd trimester of gestation. Study B prospectively included 768 pregnant women tested in the 3rd trimester of gestation with a 75 g OGTT. Temperature was recorded every day at 09:00 h. Retrospective Study A: GDM prevalence differed significantly by season: winter = 28.1%, summer = 39.2%, spring = 32.4% and autumn = 32.4% ( P  < 0.0001). The odds ratio for being diagnosed with GDM was much higher during summer 1.65 (95% CI: 1.43-1.90), with spring and autumn following with 1.23 (95% CI: 1.08-1.39) compared to winter. Glucose levels during OGTT were measured: significantly increased blood glucose values were observed at 60, 120 and 180 min in summer, which remained significant after adjustment for age, gestational age, BMI, weight gain during pregnancy and blood pressure. Prospective Study B: At temperatures above 25°C, the average glucose 60-min and 120-min levels were increased. The relative risk for abnormal glucose values at 60 min, when the environmental temperature increased over 25°C, was 2.2 (1.5-3.3). GDM prevalence in Greece presents seasonal variation, with higher risk during summer due to post glucose load level variations. These variations could be attributed to differences in environmental temperature. © 2018 European Society of Endocrinology.

Changes in resting and walking energy expenditure and walking speed during pregnancy in obese women.

PubMed

Byrne, Nuala M; Groves, Ainsley M; McIntyre, H David; Callaway, Leonie K

2011-09-01

Energy-conserving processes reported in undernourished women during pregnancy are a recognized strategy for providing the energy required to support fetal development. Women who are obese before conceiving arguably have sufficient fat stores to support the energy demands of pregnancy without the need to provoke energy-conserving mechanisms. We tested the hypothesis that obese women would show behavioral adaptation [ie, a decrease in self-selected walking (SSW) speed] but not metabolic compensation [ie, a decrease in resting metabolic rate (RMR) or the metabolic cost of walking] during gestation. RMR, SSW speed, metabolic cost of walking, and anthropometric variables were measured in 23 women aged 31 ± 4 y with a BMI (in kg/m(2)) of 33.6 ± 2.5 (mean ± SD) at ≈15 and 30 wk of gestation. RMR was also measured in 2 cohorts of nonpregnant control subjects matched for the age, weight, and height of the pregnant cohort at 15 (n = 23) and 30 (n = 23) wk. Gestational weight gain varied widely (11.3 ± 5.4 kg), and 52% of the women gained more weight than is recommended. RMR increased significantly by an average of 177 ± 176 kcal/d (11 ± 12%; P < 0.0001); however, the within-group variability was large. Both the metabolic cost of walking and SSW speed decreased significantly (P < 0.01). Whereas RMR increased in >80% of the cohort, the net oxygen cost of walking decreased in the same proportion of women. Although the increase in RMR was greater than that explained by weight gain, evidence of both behavioral and biological compensation in the metabolic cost of walking was observed in obese women during gestation. The trial is registered with the Australian Clinical Trials Registry as ACTRN012606000271505.

Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012-2014).

PubMed

Tamayo, T; Tamayo, M; Rathmann, W; Potthoff, P

2016-05-01

Information on the prevalence of gestational diabetes mellitus is scarce on national and international level. On July 1st, 2013, a general two-step screening was implemented in Germany harmonizing gestational diabetes diagnoses. We aim to provide prevalence estimates for gestational diabetes and pregnancy-related complications for the large region of North Rhine for the 12 months before and after introduction of the general screening. Routine care data covering all outpatient diagnoses of more than 150,000 pregnancies per 12-month period in women aged 15-55 years was used to determine cases of gestational diabetes. Gestational diabetes diagnosis and pregnancy-related complications were assessed according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Relative Risks for pregnancy-related complications were calculated in pregnancies with and without gestational diabetes. Before the screening, diagnosis of gestational diabetes was made in 6.02% of pregnancies and in 6.81% after this date (other types of diabetes mellitus: 1.67% and 1.76% respectively). The prevalence of GDM increased with age and was highest at age 36-40 years (8.45%). The relative increase in prevalence after introduction of the screening was highest in the age group≤25 years (24.9%). The frequency of pregnancy-related complications such as hypertension, pre-eclampsia, cesarean section was increased in pregnancies with gestational diabetes in comparison to those without independent of observation period. We found a high prevalence of gestational diabetes, which has relatively increased by 13.12% after the introduction of the general screening. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring.

PubMed

Nahum Sacks, Kira; Friger, Michael; Shoham-Vardi, Ilana; Abokaf, Hanaa; Spiegel, Efrat; Sergienko, Ruslan; Landau, Daniella; Sheiner, Eyal

2016-09-01

The reported rates of gestational diabetes mellitus are constantly escalating and little is known about long-term complications in the offspring. Evidence from the field of epigenetics strongly advocates the need for research on the neuropsychiatric complications in offspring prenatally exposed to gestational diabetes mellitus. We sought to assess whether in utero exposure to gestational diabetes mellitus increases the risk of long-term neuropsychiatric morbidity in the offspring. A population-based cohort study compared the incidence of hospitalizations due to neuropsychiatric disease between singletons exposed and unexposed to gestational diabetes mellitus. Deliveries occurred in the years 1991 through 2014 in a regional tertiary medical center. Perinatal deaths, multiple gestations, mothers with pregestational diabetes or lack of prenatal care, and children with congenital malformations were excluded from the study. A multivariate generalized estimating equation logistic regression model analysis was used to control for confounders and for maternal clusters. During the study period 231,271 deliveries met the inclusion criteria; 5.4% of the births were to mothers diagnosed with gestational diabetes mellitus (n = 12,642), of these 4.3% had gestational diabetes type A1 (n = 10,076) and 1.1% had gestational diabetes type A2 (n = 2566). During the follow-up period, a significant linear association was noted between the severity of the gestational diabetes (no gestational diabetes, gestational diabetes mellitus A1, gestational diabetes mellitus A2) and neuropsychiatric disease of the offspring (1.02% vs 1.36% vs 1.68%, respectively, P < .001). A Kaplan-Meier curve demonstrated that children born to women with gestational diabetes mellitus had higher cumulative incidence of neuropsychiatric morbidity. Using a generalized estimating equation multivariable logistic regression model, controlling for time-to-event, maternal age, gestational age at delivery, maternal obesity, maternal preeclampsia and fertility treatments, maternal gestational diabetes mellitus was found to be an independent risk factor for long-term neuropsychiatric disease of the offspring (gestational diabetes mellitus A1 [adjusted odds ratio, 1.83; 95% confidence interval, 1.53-2.19] and gestational diabetes mellitus A2 [adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.27]). Within the limits of our database, our findings also point to a possible association between in utero exposure to gestational diabetes mellitus and autistic spectrum disorder of the offspring (adjusted odds ratio, 4.44; 95% confidence interval, 1.55-12.69), which was found significant also after controlling for time-to-event, maternal age, gestational age at delivery, and offspring weight at birth. Exposure to maternal gestational diabetes mellitus is an independent risk factor for long-term neuropsychiatric morbidity in the offspring. Copyright © 2016 Elsevier Inc. All rights reserved.

[Influence of maternal nutritional status, weight gain and energy intake on fetal growth in high-risk pregnancies].

PubMed

Nomura, Roseli Mieko Yamamoto; Paiva, Letícia Vieira; Costa, Verbênia Nunes; Liao, Adolfo Wenjaw; Zugaib, Marcelo

2012-03-01

To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.

The sensitivity of length of pregnancy using clinical estimate of gestation versus last menstrual period: an example with particulate matter and preterm birth

EPA Science Inventory

Estimating gestational age is usually based on last menstrual period date (LMP) or clinical estimation (CGA); both approaches introduce error and potential bias. Differences in the two methods of gestational age assignment may lead to misclassification and differences in risk est...

4D ultrasound study of fetal facial expressions in the third trimester of pregnancy.

PubMed

AboEllail, Mohamed Ahmed Mostafa; Kanenishi, Kenji; Mori, Nobuhiro; Mohamed, Osman Abdel Kareem; Hata, Toshiyuki

2018-07-01

To evaluate the frequencies of fetal facial expressions in the third trimester of pregnancy, when fetal brain maturation and development are progressing in normal healthy fetuses. Four-dimensional (4 D) ultrasound was used to examine the facial expressions of 111 healthy fetuses between 30 and 40 weeks of gestation. The frequencies of seven facial expressions (mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking) during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30-31 weeks, 43 at 32-35 weeks, and 43 at ≥36 weeks). Comparison of facial expressions among the three gestational age groups was performed to determine their changes with advancing gestation. Mouthing was the most frequent facial expression at 30-40 weeks of gestation, followed by blinking. Both facial expressions were significantly more frequent than the other expressions (p < .05). The frequency of yawning decreased with the gestational age after 30 weeks of gestation (p = .031). Other facial expressions did not change between 30 and 40 weeks. The frequency of yawning at 30-31 weeks was significantly higher than that at 36-40 weeks (p < .05). There were no significant differences in the other facial expressions among the three gestational age groups. Our results suggest that 4D ultrasound assessment of fetal facial expressions may be a useful modality for evaluating fetal brain maturation and development. The decreasing frequency of fetal yawning after 30 weeks of gestation may explain the emergence of distinct states of arousal.

Gestational age and newborn size according to parental social mobility: an intergenerational cohort study.

PubMed

Gigante, Denise P; Horta, Bernardo L; Matijasevich, Alicia; Mola, Christian Loret de; Barros, Aluisio J D; Santos, Ina S; Barros, Fernando C; Victora, Cesar G

2015-10-01

We examined the associations between socioeconomic trajectories from birth to adulthood and gestational age and birth size in the next generation, using linked data from two population-based birth cohorts carried out in a Brazilian city. By comparing socioeconomic trajectories of mothers and fathers, we attempted to identify-specific effects of maternal and paternal socioeconomic trajectory on offspring birth weight, birth length, head circumference and gestational age at birth. 2 population-based birth cohort studies were carried out in 1982 and 2004 in Pelotas (Brazil); 156 mothers and 110 fathers from the earlier cohort had children in 2004. Gestational age and birth length, weight and head circumference were measured. Analyses were carried out separately for mothers and fathers. Mediation analyses assessed the role of birth weight and adult body mass index (BMI). Among mothers, but not for fathers, childhood poverty was strongly associated with smaller size in the next generation (about 400 g in weight and 1.5 cm in height) and shorter gestations (about 2 weeks). Adult poverty did not play a role. For mothers, the associations with gestational age, birth length and weight-but not with head circumference-persisted after adjusting for maternal birth weight and for the height and weight of the grandmother. Maternal birth weight did not mediate the observed associations, but high maternal BMI in adulthood was partly responsible for the association with gestational age. Strong effects of early poverty on gestational age and birth size in the next generation were observed among mothers, but not among fathers. These findings suggest a specific maternal effect of socioeconomic trajectory, and in particular of early poverty on offspring size and duration of pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Nationwide singleton birth weight percentiles by gestational age in Taiwan, 1998-2002.

PubMed

Hsieh, Wu-Shiun; Wu, Hui-Chen; Jeng, Suh-Fang; Liao, Hua-Fang; Su, Yi-Ning; Lin, Shio-Jean; Hsieh, Chia-Jung; Chen, Pau-Chung

2006-01-01

There are limited nationwide population-based data about birth weight percentiles by gestational age in Taiwan. The purpose of this study was to develop updated intrauterine growth charts that are population based and contain the information of birth weight percentiles by gestational age for singleton newborns in Taiwan. We abstracted and analyzed the birth registration database from the Ministry of the Interior in Taiwan during the period of 1998-2002 that consisted of over one million singleton births. Percentiles of birth weight for each increment of gestational week from 21 to 44 weeks were estimated using smoothed means and standard deviations. The analyses revealed that birth weight rose with advancing gestational age, with greater slopes during the third trimester and then leveled off beyond 40 weeks of gestational age. The male to female ratio ranged from 1.088 to 1.096. The mean birth weights during the period of 1998-2002 were higher than those previously reported for the period of 1945-1967; while the birth weight distribution and percentile during the period of 1998-2002 were similar to those reported for the period of 1979-1989. The 10th, 50th, and 90th percentiles of birth weigh at 40th gestational age among the male newborns were 2914, 3374, and 3890 g respectively; and for the female newborns 2816, 3250, and 3747 g. At the gestational age of 37 weeks, the 10th, 50th, and 90th percentiles of birth weigh among the male newborns were 2499, 2941, and 3433 g respectively; and for the female newborns 2391, 2832, and 3334 g. From 1998 to 2002, there was a gradual increase in the prevalence of low birth weight and preterm birth together with the percentage of infants born to foreign-born mothers. This study provides the first nationwide singleton intrauterine growth charts in Taiwan that are population-based and gender-specific. The normative data are particularly useful for the investigation of predictors and outcomes of altered fetal growth.

A randomised controlled trial evaluating IGF1 titration in contrast to current GH dosing strategies in children born small for gestational age: the North European Small-for-Gestational-Age Study.

PubMed

Jensen, Rikke Beck; Thankamony, Ajay; O'Connell, Susan M; Kirk, Jeremy; Donaldson, Malcolm; Ivarsson, Sten-A; Söder, Olle; Roche, Edna; Hoey, Hilary; Dunger, David B; Juul, Anders

2014-10-01

Short children born small for gestational age (SGA) are treated with a GH dose based on body size, but treatment may lead to high levels of IGF1. The objective was to evaluate IGF1 titration of GH dose in contrast to current dosing strategies. In the North European Small-for-Gestational-Age Study (NESGAS), 92 short pre-pubertal children born SGA were randomised after 1 year of high-dose GH treatment (67 μg/kg per day) to three different regimens: high dose (67 μg/kg per day), low dose (35 μg/kg per day) or IGF1 titration. The average dose during the second year of the randomised trial did not differ between the IGF1 titration group (38 μg/kg per day, s.d. 0.019) and the low-dose group (35 μg/kg per day, s.d. 0.002; P=0.46), but there was a wide variation in the IGF1 titration group (range 10-80 μg/kg per day). The IGF1 titration group had significantly lower height gain (0.17 SDS, s.d. 0.18) during the second year of the randomised trial compared with the high-dose group (0.46 SDS, s.d. 0.25), but not significantly lower than the low-dose group (0.23 SDS, s.d. 0.15; P=0.17). The IGF1 titration group had lower IGF1 levels after 2 years of the trial (mean 1.16, s.d. 1.24) compared with both the low-dose (mean 1.76, s.d. 1.48) and the high-dose (mean 2.97, s.d. 1.63) groups. IGF1 titration of GH dose in SGA children proved less effective than current dosing strategies. IGF1 titration resulted in physiological IGF1 levels with a wide range of GH dose and a poorer growth response, which indicates the role of IGF1 resistance and highlights the heterogeneity of short SGA children. © 2014 European Society of Endocrinology.

Neonatal survival rates in 860 singleton live births at 24 and 25 weeks gestational age. A Canadian multicentre study.

PubMed

Effer, Sidney B; Moutquin, Jean-Marie; Farine, Dan; Saigal, Saroj; Nimrod, Carl; Kelly, Edmond; Niyonsenga, Theophile

2002-07-01

To determine the current survival rate of singleton living newborns born at gestational age of 24 and 25 weeks, using obstetric factors available to the physician before birth. Retrospective study of all live births in 13 of 17 Canadian tertiary centres. Population All singleton live births without congenital abnormalities. During the years 1991-1996, data were abstracted from clinical databases and charts of 860 live births, in 13 of the 17 tertiary centres in Canada, all with major neonatal intensive care units. Newborn survival was defined as alive at discharge from neonatal intensive care unit. Abstracted elements included gestational age, maternal antenatal corticosteroid treatment, birthweight, gender, fetal presentation and mode of delivery. Average survival rates increased from 56.1% at 24 weeks (n = 406) to 68.0% at 25 weeks (n = 454). Survival rates ranged from 53.1% at day 168 to 81.6% at day 181 (r = 0.802, P < 0.05). Steroid administration improved the survival rates at 24 and 25 weeks compared with that of unexposed fetuses, respectively (58.9% vs 41.8%; OR 1.70; 95% CI 1.03-2.08 and 74.2% vs 56.8%; OR 2.19; 95% CI 1.41-3.38). Caesarean delivery for breech presentation improved survival compared with vaginal delivery, both at 24 and 25 weeks (56.1% vs 36.0%; OR 2.19; 95% CI 1.10-4.34, and 68.7% vs 55.2% OR 1.78; 95% CI 0.093-3.43). Female neonates displayed better survival rates (59.6% vs 52.1% OR 1.36; 95% CI 0.92-2.01, and 72.6% vs 63.1% OR 1.51; 95% CI 1.02-2.25) at 24 and 25 weeks, respectively. Explanatory regression model confirmed these factors as prognostic variables associated with survival. This extensive collaborative study confirms that several prognostic factors, known before birth, including gestational age in days, steroid treatment, mode of presentation and fetal sex may help obstetricians, neonatologists and parents in their decision-making process at 24 and 25 weeks of pregnancy.

[Effects of postnatal growth retardation on early neurodevelopment in premature infants with intrauterine growth retardation].

PubMed

Cai, Yue-Ju; Song, Yan-Yan; Huang, Zhi-Jian; Li, Jian; Qi, Jun-Ye; Xiao, Xu-Wen; Wang, Lan-Xiu

2015-09-01

To study the effects of postnatal growth retardation on early neurodevelopment in premature infants with intrauterine growth retardation (IUGR). A retrospective analysis was performed on the clinical data of 171 premature infants who were born between May 2008 and May 2012 and were followed up until a corrected gestational age of 6 months. These infants were classified into two groups: IUGR group (n=40) and appropriate for gestational age (AGA) group (n=131). The growth retardation rates at the corrected gestational ages of 40 weeks, 3 months, and 6 months, as well as the neurodevelopmental outcome (evaluated by Gesell Developmental Scale) at corrected gestational ages of 3 and 6 months, were compared between the two groups. The growth retardation rate in the IUGR group was significantly higher than in the AGA group at the corrected gestational ages of 40 weeks, 3 months, and 6 months. All five developmental quotients evaluated by Gesell Developmental Scale (gross motor, fine motor, language, adaptability and individuality) in the IUGR group were significantly lower than in the AGA group at the corrected gestational ages of 3 months. At the corrected gestational age of 6 months, the developmental quotients of fine motor and language in the IUGR group were significantly lower than in the AGA group, however, there were no significant differences in the developmental quotients of gross motor, adaptability and individuality between the two groups. All five developmental quotients in IUGR infants with catch-up lag in weight were significantly lower than in IUGR and AGA infants who had caught up well. Growth retardation at early postnatal stages may adversely affect the early neurodevelopment in infants with IUGR.

A home calendar and recall method of last menstrual period for estimating gestational age in rural Bangladesh: a validation study.

PubMed

Gernand, Alison D; Paul, Rina Rani; Ullah, Barkat; Taher, Muhammad A; Witter, Frank R; Wu, Lee; Labrique, Alain B; West, Keith P; Christian, Parul

2016-10-21

The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound. As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births. LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity. Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials. ClinicalTrials.gov NCT00860470.

Preterm birth-associated cost of early intervention services: an analysis by gestational age.

PubMed

Clements, Karen M; Barfield, Wanda D; Ayadi, M Femi; Wilber, Nancy

2007-04-01

Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for children's first 3 years also were examined. Overall, 14,033 of 76,901 surviving infants received early intervention services. Program costs totaled almost $66 million, with mean cost per surviving infant of $857. Mean cost per infant was highest for children who were 24 to 31 weeks' gestational age ($5393) and higher for infants who were 32 to 36 weeks' gestational age ($1578) compared with those who were born at term ($725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants. Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.

Reexamining the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality

PubMed Central

Ananth, Cande V; Platt, Robert W

2004-01-01

Background Low birth weight (<2,500 g) is a strong predictor of infant mortality. Yet low birth weight, in isolation, is uninformative since it is comprised of two intertwined components: preterm delivery and reduced fetal growth. Through nonparametric logistic regression models, we examine the effects of gestational age, fetal growth, and maternal smoking on neonatal mortality. Methods We derived data on over 10 million singleton live births delivered at ≥ 24 weeks from the 1998–2000 U.S. natality data files. Nonparametric multivariable logistic regression based on generalized additive models was used to examine neonatal mortality (deaths within the first 28 days) in relation to fetal growth (gestational age-specific standardized birth weight), gestational age, and number of cigarettes smoked per day. All analyses were further adjusted for the confounding effects due to maternal age and gravidity. Results The relationship between standardized birth weight and neonatal mortality is nonlinear; mortality is high at low z-score birth weights, drops precipitously with increasing z-score birth weight, and begins to flatten for heavier infants. Gestational age is also strongly associated with mortality, with patterns similar to those of z-score birth weight. Although the direct effect of smoking on neonatal mortality is weak, its effects (on mortality) appear to be largely mediated through reduced fetal growth and, to a lesser extent, through shortened gestation. In fact, the association between smoking and reduced fetal growth gets stronger as pregnancies approach term. Conclusions Our study provides important insights regarding the combined effects of fetal growth, gestational age, and smoking on neonatal mortality. The findings suggest that the effect of maternal smoking on neonatal mortality is largely mediated through reduced fetal growth. PMID:15574192

Maternal folate status, but not that of vitamins B-12 or B-6, is associated with gestational age and preterm birth risk in a multiethnic Asian population.

PubMed

Chen, Ling-Wei; Lim, Ai Lin; Colega, Marjorelee; Tint, Mya-Thway; Aris, Izzuddin M; Tan, Chuen Seng; Chong, Yap-Seng; Gluckman, Peter D; Godfrey, Keith M; Kwek, Kenneth; Saw, Seang-Mei; Yap, Fabian; Lee, Yung Seng; Chong, Mary Foong-Fong; van Dam, Rob M

2015-01-01

Maternal folate, vitamin B-12, and vitamin B-6 concentrations during pregnancy have been shown to influence birth outcomes, but the evidence is inconclusive. We aimed to examine the associations of maternal B-vitamin status with gestational age, birth weight, and length in a birth cohort study in Singapore. Maternal blood samples (n = 999) collected during weeks 26-28 of gestation were assayed for plasma folate, vitamin B-12, and vitamin B-6 concentrations. Birth weight and gestational age data were obtained from hospital records, and other anthropometric variables were measured within 72 h after birth. Relations between B-vitamin status and birth outcomes were assessed by linear or logistic regression with adjustment for potential confounders. Median (IQR) plasma concentrations were 34.4 (24.5-44.6) nmol/L for folate, 209 (167-258) pmol/L for vitamin B-12, and 61.8 (25.9-113) nmol/L for vitamin B-6. We found that higher plasma folate concentrations were associated with a longer gestational age (0.12 wk per SD increase in folate; 95% CI: 0.02, 0.21) and tended to be associated with lower risk of all preterm birth (delivery at <37 wk of gestation; OR: 0.79; 95% CI: 0.63, 1.00) and spontaneous preterm birth (OR: 0.76; 95% CI: 0.56, 1.04). Overall, concentrations of maternal folate, vitamin B-12, and vitamin B-6 were not independently associated with birth weight or being born small for gestational age (SGA; birth weight <10th percentile for gestational age). Higher maternal folate concentrations during late pregnancy were associated with longer gestational age and tended to be associated with a lower risk of preterm birth in this multiethnic Asian population. In contrast, the results of our study suggested little or no benefit of higher folate concentrations for reducing the risk of SGA or of higher vitamin B-6 and vitamin B-12 concentrations for reducing the risk of preterm birth or SGA. © 2015 American Society for Nutrition.

Gestational age specific neonatal survival in the State of Qatar (2003-2008) - a comparative study with international benchmarks.

PubMed

Rahman, Sajjad; Salameh, Khalil; Al-Rifai, Hilal; Masoud, Ahmed; Lutfi, Samawal; Salama, Husam; Abdoh, Ghassan; Omar, Fahmi; Bener, Abdulbari

2011-09-01

To analyze and compare the current gestational age specific neonatal survival rates between Qatar and international benchmarks. An analytical comparative study. Women's Hospital, Hamad Medical Corporation, Doha, Qatar, from 2003-2008. Six year's (2003-2008) gestational age specific neonatal mortality data was stratified for each completed week of gestation at birth from 24 weeks till term. The data from World Health Statistics by WHO (2010), Vermont Oxford Network (VON, 2007) and National Statistics United Kingdom (2006) were used as international benchmarks for comparative analysis. A total of 82,002 babies were born during the study period. Qatar's neonatal mortality rate (NMR) dropped from 6/1000 in 2003 to 4.3/1000 in 2008 (p < 0.05). The overall and gestational age specific neonatal mortality rates of Qatar were comparable with international benchmarks. The survival of < 27 weeks and term babies was better in Qatar (p=0.01 and p < 0.001 respectively) as compared to VON. The survival of > 32 weeks babies was better in UK (p=0.01) as compared to Qatar. The relative risk (RR) of death decreased with increasing gestational age (p < 0.0001). Preterm babies (45%) followed by lethal chromosomal and congenital anomalies (26.5%) were the two leading causes of neonatal deaths in Qatar. The current total and gestational age specific neonatal survival rates in the State of Qatar are comparable with international benchmarks. In Qatar, persistently high rates of low birth weight and lethal chromosomal and congenital anomalies significantly contribute towards neonatal mortality.

Pregnancy outcomes in women aged 35 years or older with gestational diabetes - a registry-based study in Finland.

PubMed

Lamminpää, Reeta; Vehviläinen-Julkunen, Katri; Gissler, Mika; Selander, Tuomas; Heinonen, Seppo

2016-01-01

To compare pregnancy outcomes of women ≥ 35 years to women <35 years with and without gestational diabetes. The data include 230,003 women <35 years and 53,321 women ≥ 35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28-31 and 32-36 weeks' gestation), Apgar scores <7 at 5 min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA). In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30-1.88), admission to the NICU (OR 3.30, CI 2.94-3.69) and shoulder dystocia (OR 2.12, CI 1.05-4.30) were highest in insulin-treated women ≥ 35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73-3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant. GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia.

Mediation analysis of gestational age, congenital heart defects, and infant birth-weight.

PubMed

Wogu, Adane F; Loffredo, Christopher A; Bebu, Ionut; Luta, George

2014-12-17

In this study we assessed the mediation role of the gestational age on the effect of the infant's congenital heart defects (CHD) on birth-weight. We used secondary data from the Baltimore-Washington Infant Study (1981-1989). Mediation analysis was employed to investigate whether gestational age acted as a mediator of the association between CHD and reduced birth-weight. We estimated the mediated effect, the mediation proportion, and their corresponding 95% confidence intervals (CI) using several methods. There were 3362 CHD cases and 3564 controls in the dataset with mean birth-weight of 3071 (SD = 729) and 3353 (SD = 603) grams, respectively; the mean gestational age was 38.9 (SD = 2.7) and 39.6 (SD = 2.2) weeks, respectively. After adjusting for covariates, the estimated mediated effect by gestational age was 113.5 grams (95% CI, 92.4-134.2) and the mediation proportion was 40.7% (95% CI, 34.7%-46.6%), using the bootstrap approach. Gestational age may account for about 41% of the overall effect of heart defects on reduced infant birth-weight. Improved prenatal care and other public health efforts that promote full term delivery, particularly targeting high-risk families and mothers known to be carrying a fetus with CHD, may therefore be expected to improve the birth-weight of these infants and their long term health.

A cost analysis of first-line chemotherapy for low-risk gestational trophoblastic neoplasia.

PubMed

Shah, Neel T; Barroilhet, Lisa; Berkowitz, Ross S; Goldstein, Donald P; Horowitz, Neil

2012-01-01

To determine the optimal approach to first-line treatment for low-risk gestational trophoblastic neoplasia (GTN) using a cost analysis of 3 commonly used regimens. A decision tree of the 3 most commonly used first-line low-risk GTN treatment strategies was created, accounting for toxicities, response rates and need for second- or third-line therapy. These strategies included 8-day methotrexate (MTX)/folinic acid, weekly MTX, and pulsed actinomycin-D (act-D). Response rates, average number of cycles needed for remission, and toxicities were determined by review of the literature. Costs of each strategy were examined from a societal perspective, including the direct total treatment costs as well as the indirect lost labor production costs from work absences. Sensitivity analysis on these costs was performed using both deterministic and probabilistic cost-minimization models with the aid of decision tree software (TreeAge Pro 2011, TreeAge Inc., Williamstown, Massachusetts). We found that 8-day MTX/folinic acid is the least expensive to society, followed by pulsed act-D ($4,867 vs. $6,111 average societal cost per cure, respectively), with act-D becoming more favorable only with act-D per-cycle cost <$231, or response rate to first-line therapy > 99%. Weekly MTX is the most expensive first-line treatment strategy to society ($9,089 average cost per cure), despite being least expensive to administer per cycle, based on lower first-line response rate. Absolute societal cost of each strategy is driven by the probability of needing expensive third-line multiagent chemotherapy, however relative cost differences are robust to sensitivity analysis over the reported range of cycle number and response rate for all therapies. Based on similar efficacy and lower societal cost, we recommend 8-day MTX/folinic acid for first-line treatment of low-risk GTN.

Developmental assessment of preterm infants: Chronological or corrected age?

PubMed

Harel-Gadassi, Ayelet; Friedlander, Edwa; Yaari, Maya; Bar-Oz, Benjamin; Eventov-Friedman, Smadar; Mankuta, David; Yirmiya, Nurit

2018-06-12

The aim of this study is to examine the effect of age correction on the developmental assessment scores of preterm infants, using for the first time, the Mullen scales of early learning (MSEL) test. Participants included 110 preterm infants (born at a gestational age of ≤ 34 weeks) at ages 1, 4, 8, 12, 18, 24 and 36 months. The corrected age-based MSEL composite score and each of the five MSEL scale scores were significantly higher than chronological age-based scores at all ages. These corrected scores were significantly higher than the chronological scores regardless of gestational age whether weight was, or adequate or small for gestational age. Larger differences between corrected and chronological age-based scores significantly correlated with earlier gestational age and with lower birth weight between 1 and 24 months but not at 36 months. Using chronological age-based scores yielded significantly more infants identified with developmental delays than using corrected age-based scores. The findings indicate that clinicians and researchers, as well as family members, should be aware of and acknowledge the distinction between corrected and chronological ages when evaluating preterm infants in research and clinical practices. Copyright © 2018. Published by Elsevier Ltd.

A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy.

PubMed

Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Himes, Katherine P; Simhan, Hyagriv N; Bodnar, Lisa M

2013-05-01

To establish the unbiased relation between maternal weight gain in pregnancy and perinatal health, a classification for maternal weight gain is needed that is uncorrelated with gestational age. The goal of this study was to create a weight-gain-for-gestational-age percentile and z score chart to describe the mean, SD, and selected percentiles of maternal weight gain throughout pregnancy in a contemporary cohort of US women. The study population was drawn from normal-weight women with uncomplicated, singleton pregnancies who delivered at the Magee-Womens Hospital in Pittsburgh, PA, 1998-2008. Analyses were based on a randomly selected subset of 648 women for whom serial prenatal weight measurements were available through medical chart record abstraction (6727 weight measurements). The pattern of maternal weight gain throughout gestation was estimated by using a random-effects regression model. The estimates were used to create a chart with the smoothed means, percentiles, and SDs of gestational weight gain for each week of pregnancy. This chart allows researchers to express total weight gain as an age-standardized z score, which can be used in epidemiologic analyses to study the association between pregnancy weight gain and adverse or physiologic pregnancy outcomes independent of gestational age.

The risk of prematurity and small-for-gestational-age birth in Mexico City: the effects of working conditions and antenatal leave.

PubMed Central

Cerón-Mireles, P; Harlow, S D; Sánchez-Carrillo, C I

1996-01-01

OBJECTIVES: This study examined the effect of working conditions, occupational stress, and antenatal leave on risk of small-for-gestational age and premature births in Mexico City. METHODS: Over a 3-month period, 2663 (96.2%) of 2767 women who gave birth at three major hospitals and worked at least 3 months during pregnancy were interviewed shortly after delivery. After the exclusion of multiple gestations and birth defects, 261 (10.0%) small-for-gestational-age and 288 (11.0%) preterm births were identified. RESULTS: For small-for-gestational-age births, working more than 50 hours a week (odds ratio [OR] = 1.59), standing more than 7 hours a day (OR = 1.40), and no antenatal leave (OR = 1.55) were associated with an increased risk. Women with no antenatal leave were also much more likely to give birth prematurely (OR = 3.04). CONCLUSIONS: In this study, arduous working conditions and lack of antenatal leave benefits were found to increase the risk of poor birth outcome in Mexican women. Enforcement of existing antenatal leave laws and provision of comparable benefits for the uninsured may reduce the incidence of small-for-gestational-age births and prematurity. PMID:8659657

Modeling Fetal Weight for Gestational Age: A Comparison of a Flexible Multi-level Spline-based Model with Other Approaches

PubMed Central

Villandré, Luc; Hutcheon, Jennifer A; Perez Trejo, Maria Esther; Abenhaim, Haim; Jacobsen, Geir; Platt, Robert W

2011-01-01

We present a model for longitudinal measures of fetal weight as a function of gestational age. We use a linear mixed model, with a Box-Cox transformation of fetal weight values, and restricted cubic splines, in order to flexibly but parsimoniously model median fetal weight. We systematically compare our model to other proposed approaches. All proposed methods are shown to yield similar median estimates, as evidenced by overlapping pointwise confidence bands, except after 40 completed weeks, where our method seems to produce estimates more consistent with observed data. Sex-based stratification affects the estimates of the random effects variance-covariance structure, without significantly changing sex-specific fitted median values. We illustrate the benefits of including sex-gestational age interaction terms in the model over stratification. The comparison leads to the conclusion that the selection of a model for fetal weight for gestational age can be based on the specific goals and configuration of a given study without affecting the precision or value of median estimates for most gestational ages of interest. PMID:21931571

The relation of birth weight and gestational age to biological, occupational and socioeconomic factors.

PubMed

Velonakis, E G; Maghiorakos, P; Tzonou, A; Barrat, J; Proteau, J; Ladopoulos, I

1997-01-01

The data of the 2,040 single births, born during 1987 at the "Saint Antoine" Hospital in Paris, were analysed in order to identify the impact of various biological, occupational, and socioeconomic factors on gestational age and birth weight. Birth weight is associated with the height of the mother and the weight gained during pregnancy. It is lower for mothers with preeclampsia during the current or previous pregnancies or with urogenital infections during the current pregnancy and for mothers with one or more induced abortions. Girls weigh less than boys. Parity has a positive relation to the baby's weight, while manual work seems to have a negative one. APGAR score and duration of the pregnancy are associated with the birth weight. Placenta previa, preeclampsia and urinary infections affect the gestational age. A short pause period in work is related to a shorter gestational age. Weight gain is associated with a prolonged duration of the pregnancy. Gestational age and birth weight are associated with the nationality of the mother, especially in some ethnic groups, and with marital status.

PREDICTIVE ACCURACY OF TRANSCEREBELLAR DIAMETER IN COMPARISON WITH OTHER FOETAL BIOMETRIC PARAMETERS FOR GESTATIONAL AGE ESTIMATION AMONG PREGNANT NIGERIAN WOMEN.

PubMed

Adeyekun, A A; Orji, M O

2014-04-01

To compare the predictive accuracy of foetal trans-cerebellar diameter (TCD) with those of other biometric parameters in the estimation of gestational age (GA). A cross-sectional study. The University of Benin Teaching Hospital, Nigeria. Four hundred and fifty healthy singleton pregnant women, between 14-42 weeks gestation. Trans-cerebellar diameter (TCD), biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) values across the gestational age range studied. Correlation and predictive values of TCD compared to those of other biometric parameters. The range of values for TCD was 11.9 - 59.7mm (mean = 34.2 ± 14.1mm). TCD correlated more significantly with menstrual age compared with other biometric parameters (r = 0.984, p = 0.000). TCD had a higher predictive accuracy of 96.9% ± 12 days), BPD (93.8% ± 14.1 days). AC (92.7% ± 15.3 days). TCD has a stronger predictive accuracy for gestational age compared to other routinely used foetal biometric parameters among Nigerian Africans.

Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes.

PubMed

Zhang, Cui Hong; Liu, Xiang Yu; Zhan, Yi Wei; Zhang, Long; Huang, Yan Jie; Zhou, Hong

2015-09-01

To investigate the single and joint effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, electronic medical records of 14,196 women who delivered singleton live infant at a maternal and child health hospital in Beijing, China, in 2012 were reviewed. Logistic regression was used to assess the associations, adjusting for maternal age, height, education, parity, and offspring sex. Women of high prepregnancy BMI or excessive GWG had higher risks of gestational diabetes mellitus, hypertensive disorders in pregnancy, postpartum hemorrhage, caesarean delivery, macrosomia, and large for gestational age infant, while women of inadequate GWG had higher risks of preterm delivery, low birth weight, and small for gestational age infant. Findings suggest that antenatal care providers should help pregnant women control their GWG to normal. © 2015 APJPH.

[Renal response to intravenous administration of sodium bicarbonate in newborn infants of different gestational ages].

PubMed

Jasso-Gutiérrez, L; Araujo, B; Fuse-Moteji, R; del Castillo, E D

1976-01-01

The study comprised a series of 16 neonates made up of 5 patients of 33 weeks of gestation, 5 infants of 35 weeks and 6 more of 40 weeks of gestation. Blood pH, PaCO2 and HCO3- were measured together with bicarbonate, ammonium, titrable acidity and hydrogen ions in urine before and after intravenous infusion of sodium bicarbonate. Before infusion of bicarbonate, titrable acidity, ammonium and net acidity in urine were higher in accordance with a greater gestational age. As the administration of bicarbonate elapsed, titrable acidity, ammonium and net acidity dropped with increase in concentration of bicarbonate. A hypothesis is set forth that the differences found in the factors evaluated in urine before administration of bicarbonate depend on the physiologic characteristics set in the newborn by gestational age.

Are gestational age, birth weight, and birth length indicators of favorable fetal growth conditions? A structural equation analysis of Filipino infants.

PubMed

Bollen, Kenneth A; Noble, Mark D; Adair, Linda S

2013-07-30

The fetal origins hypothesis emphasizes the life-long health impacts of prenatal conditions. Birth weight, birth length, and gestational age are indicators of the fetal environment. However, these variables often have missing data and are subject to random and systematic errors caused by delays in measurement, differences in measurement instruments, and human error. With data from the Cebu (Philippines) Longitudinal Health and Nutrition Survey, we use structural equation models, to explore random and systematic errors in these birth outcome measures, to analyze how maternal characteristics relate to birth outcomes, and to take account of missing data. We assess whether birth weight, birth length, and gestational age are influenced by a single latent variable that we call favorable fetal growth conditions (FFGC) and if so, which variable is most closely related to FFGC. We find that a model with FFGC as a latent variable fits as well as a less parsimonious model that has birth weight, birth length, and gestational age as distinct individual variables. We also demonstrate that birth weight is more reliably measured than is gestational age. FFGCs were significantly influenced by taller maternal stature, better nutritional stores indexed by maternal arm fat and muscle area during pregnancy, higher birth order, avoidance of smoking, and maternal age 20-35 years. Effects of maternal characteristics on newborn weight, length, and gestational age were largely indirect, operating through FFGC. Copyright © 2013 John Wiley & Sons, Ltd.

Epidemiology of Apnea and Bradycardia Resolution in Premature Infants

PubMed Central

Srinivasan, Lakshmi; Escobar, Gabriel J.

2011-01-01

BACKGROUND: There is little epidemiologic evidence to assess the maturation of respiratory control in premature infants. OBJECTIVE: To measure the success rate or the percentage of infants who have no additional events of various apnea- or bradycardia-free intervals after correcting for gestational age, postmenstrual age of the last apnea or bradycardia event, and the severity of the event. METHODS: This was a retrospective cohort study of infants born at 34 weeks' gestational age or earlier at 1 of 5 Kaiser Permanente Medical Care Program hospitals between 1998 and 2001. The success rates of various apnea- or bradycardia-free intervals were calculated after stratifying according to gestational age, postmenstrual age of the last event, or event severity. RESULTS: Among the 1403 infants identified in this study, 84.2% did not have an apnea event and 78.5% did not have a bradycardia event after they were otherwise ready for discharge. For the entire cohort, a 95% success rate was statistically reached, with a 7-day apnea- or bradycardia-free interval. Infants with a gestational age of 30 weeks or less had a 5% to 15% lower success rate than infants with a gestational age more than 30 weeks for any given apnea- or bradycardia-free interval. The success rate was reduced by an additional 5% to 10% if the last apnea or bradycardia event occurred at a postmenstrual age of more than 36 weeks. Including only the most severe events slightly improved the success rate of a given interval. CONCLUSIONS: The risk of recurrence for apnea or bradycardia differs depending on the gestational age of the infant and the postmenstrual age of the last apnea or bradycardia event. PMID:21746726

Visual perceptual skills in children born with very low birth weights.

PubMed

Davis, Deborah Winders; Burns, Barbara M; Wilkerson, Shirley A; Steichen, Jean J

2005-01-01

A disproportionate number of very low birth weight (VLBW; < or =1500 g) children require special education services and have school-related problems even when they are free from major disabilities and have average intelligence quotient scores. Visual-perceptual problems have been suggested as contributors to deficits in academic performance, but few data are available describing specific visual-perceptual problems. This study was designed to identify specific visual-perceptual skills in VLBW children. Participants were 92 VLBW children aged 4 through 5 years who were free from major disability and appropriate for gestational age at birth. The Test of Visual-Perceptual Skills (non-motor)-Revised was used. Despite intelligent quotient scores in the average range, the majority (63% to 78.3%) of the children performed below age level on all seven subscales of a normed assessment of visual perceptual skills. Results suggest that visual perceptual screening should be considered as a part of routine evaluations of preschool-aged children born prematurely. Early identification of specific deficits could lead to interventions to improve achievement trajectories for these high-risk children.

Impact of Antenatal Steroids on Intraventricular Hemorrhage in Very Low Birth Weight Infants

PubMed Central

Wei, Julia C.; Catalano, Ralph; Profit, Jochen; Gould, Jeffrey B.; Lee, Henry C.

2016-01-01

Objective To determine the association between antenatal steroids administration and intraventricular hemorrhage rates. Methods We used cross-sectional data from the California Perinatal Quality Care Collaborative during 2007-2013 for infants ≤ 32 weeks gestational age. Using multivariable logistic regression, we evaluated the effect of antenatal steroids on intraventricular hemorrhage, stratified by gestational age. Results In 25,979 very low birth weight infants, antenatal steroid use was associated with a reduction in incidence of any grade of intraventricular hemorrhage (odds ratio = 0.51, 95% confidence interval: 0.45, 0.58) and a reduction in incidence of severe intraventricular hemorrhage (odds ratio = 0.62, 95% confidence interval: 0.57, 0.67). This association was seen across gestational ages ranging from 22 to 29 weeks. Conclusions While current guidelines recommend coverage for preterm birth at 24 to 34 weeks gestation, our results suggest that treatment with antenatal steroids may be beneficial even before 24 weeks of gestational age. PMID:27010109

Normal reference ranges for left ventricular dimensions in preterm infants.

PubMed

Abushaban, Lulu; Vel, Mariappa Thinakar; Rathinasamy, Jebaraj; Sharma, Prem N

2014-09-01

To establish normal reference ranges for the left ventricular dimensions in preterm infants and their correlation with gestational age, body weight and chronological age. In a prospective study, 268 preterm babies, who fulfilled the criteria for inclusion, were examined in Kuwait during the years (2008-2010). Echocardiograms were performed to measure the left ventricular dimensions on 0-6 day(s) of life and at weekly intervals until they reached 36 weeks. The gestational age was grouped into three: 24-27, 28-31 and 32-35 weeks, and body weight into five: ⩽999, 1,000-1,499, 1,500-1,999, 2,000-2,499 and ≥2,500 grams. The overall group differences were compared for each period of life: 0-6 days, 1-2, 3-4 and ≥5 weeks. The mean gestational age was 29.8 (± 2.38 SD) weeks, ranging between 24 and 35, and the mean body weight 1,479 (± 413 SD) grams, ranging between 588 and 3380. At the first scan (0-6 days of life), all the left ventricular measurements correlated well (P < 0.001) with body weight, and the same was observed with gestational age, except for left ventricular posterior wall thickness at end-systole and end-diastole. A significant gradual increase was noticed in all the dimensions with body weight during each period of life. However, with respect to gestational age, an increase was observed in all the dimensions during first four weeks, but the rate of increase became less after 5 weeks of life. Overall, a progressive and significant increase in all left ventricle measurements was observed during the first nine weeks of life. The left ventricular dimension measurements were found to have significant correlation with both gestational age and body weight. The study also provides reference data, which can be used as normal reference tool for left ventricular dimensions for preterm infants against the gestational age, body weight and chronological age.

Maternal anthropometrics are associated with fetal size in different periods of pregnancy and at birth. The Generation R Study.

PubMed

Ay, L; Kruithof, C J; Bakker, R; Steegers, E A P; Witteman, J C M; Moll, H A; Hofman, A; Mackenbach, J P; Hokken-Koelega, A C S; Jaddoe, V W V

2009-06-01

We aimed to examine the associations of maternal anthropometrics with fetal weight measured in different periods of pregnancy and with birth outcomes. Population-based birth cohort study. Data of pregnant women and their children in Rotterdam, the Netherlands. In 8541 mothers, height, prepregnancy body mass index (BMI) and gestational weight gain were available. Fetal growth was measured by ultrasound in mid- and late pregnancy. Regression analyses were used to assess the impact of maternal anthropometrics on fetal weight and birth outcomes. Fetal weight and birth outcomes: weight (grams) and the risks of small (<5th percentile) and large (>95th percentile) size for gestational age at birth. Maternal BMI in pregnancy was positively associated with estimated fetal weight during pregnancy. The effect estimates increased with advancing gestational age. All maternal anthropometrics were positively associated with fetal size (P-values for trend <0.01). Mothers with both their prepregnancy BMI and gestational weight gain quartile in the lowest and highest quartiles showed the highest risks of having a small and large size for gestational age child at birth, respectively. The effect of prepregnancy BMI was strongly modified by gestational weight gain. Fetal growth is positively affected by maternal BMI during pregnancy. Maternal height, prepregnancy BMI and gestational weight gain are all associated with increased risks of small and large size for gestational age at birth in the offspring, with an increased effect when combined.

LBW and IUGR temporal trend in 4 population-based birth cohorts: the role of economic inequality.

PubMed

Sadovsky, Ana D I; Matijasevich, Alicia; Santos, Iná S; Barros, Fernando C; Miranda, Angelica E; Silveira, Mariangela F

2016-07-29

Low/medium income countries, with health inequalities present high rates of neonates having low birthweight and/or are small for the gestational age. This study aims to analyze the absolute and relative income inequality in the occurrence of low birthweight and small size for gestational age among neonates in four birth cohorts from southern Brazil in 1982, 1993, 2004, and 2011. The main exhibit was monthly family income. The outcomes were birth with low birthweight or small for the gestational age. The inequalities were calculated using the Slope Index of Inequality and the Relative Index of Inequality adjusted for maternal skin color, schooling, age, and marital status. In all birth cohorts, poorer mothers were at greater odds of having neonates with low birthweight or small for the gestational age. There was a tendency to decrease the prevalence of small for gestational age in poorer families associated with the reduction of inequalities over the past decades, which was not observed regarding low birthweight. Economic inequalities occurred in neonates with low birthweight and with intrauterine growth restriction in the four studies, with a higher incidence of inadequate neonatal outcomes in the poorer families.

Gestational Age at First Antenatal Care Visit in Malawi.

PubMed

Mkandawire, Paul

2015-11-01

This paper examines the gestational age at first antenatal care (ANC) visit and factors associated with timely initiation of ANC in Malawi in a context where maternal and child health services are generally provided for free. Lognormal survival models are applied to Demographic and Health Survey data from a nationally representative sample of women (n = 13,588) of child-bearing age. The findings of this study show that less than 30 % of pregnant women initiate ANC within the World Health Organization recommended gestational timeframe of 16 weeks or earlier. The hazard analysis shows a gradient in the initiation of ANC by maternal education level, with least educated mothers most likely to delay their first ANC visit. However, after adjusting for variables capturing intimate partner violence in the multivariate models, the effect of maternal education attenuated and lost statistical significance. Other significant predictors of gestational age at first ANC include media exposure, perceived distance from health facility, age, and birth order. The findings of the study link domestic violence directly with the gestational age at which mothers initiate ANC, suggesting that gender-based violence may operate through delayed initiation of ANC to undermine maternal and child health outcomes.

Perinatal mortality by gestational week and size at birth in singleton pregnancies at and beyond term: a nationwide population-based cohort study.

PubMed

Morken, Nils-Halvdan; Klungsøyr, Kari; Skjaerven, Rolv

2014-05-22

Whether gestational age per se increases perinatal mortality in post-term pregnancy is unclear. We aimed at assessing gestational week specific perinatal mortality in small-for-gestational-age (SGA) and non-SGA term and post-term gestations, and specifically to evaluate whether the relation between post-term gestation and perinatal mortality differed before and after ultrasound was introduced as the standard method of gestational age estimation. A population-based cohort study, using data from the Medical Birth Registry of Norway (MBRN), 1967-2006, was designed. Singleton births at 37 through 44 gestational weeks (n = 1 855 682), excluding preeclampsia, diabetes and fetal anomalies, were included. Odds ratios (OR) with 95% confidence intervals (CI) for perinatal mortality and stillbirth in SGA and non-SGA births by gestational week were calculated. SGA infants judged post-term by LMP had significantly higher perinatal mortality than post-term non-SGA infants at 40 weeks, independent of time period (highest during 1999-2006 [OR 9.8, 95% CI: 5.7-17.0]). When comparing years before (1967-1986) versus after (1987-2006) ultrasound was introduced, there was no decrease in the excess mortality for post-term SGA versus non-SGA births (ORs from 6.1 [95% CI: 5.2-7.1] to 6.7 [5.2-8.5]), while mortality at 40 weeks decreased significantly (ORs from 4.6, [4.0-5.3] to 3.2 [2.5-3.9]). When assessing stillbirth risk (1999-2006), more than 40% of SGA stillbirths (11/26) judged to be ≥41 weeks by LMP were shifted to lower gestational ages using ultrasound estimation. Mortality risk in post-term infants was strongly associated with growth restriction. Such infants may erroneously be judged younger than they are when using ultrasound estimation, so that the routine assessment for fetal wellbeing in the prolonged gestation may be given too late.

Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children.

PubMed

Sonnenschein-van der Voort, Agnes M M; Arends, Lidia R; de Jongste, Johan C; Annesi-Maesano, Isabella; Arshad, S Hasan; Barros, Henrique; Basterrechea, Mikel; Bisgaard, Hans; Chatzi, Leda; Corpeleijn, Eva; Correia, Sofia; Craig, Leone C; Devereux, Graham; Dogaru, Cristian; Dostal, Miroslav; Duchen, Karel; Eggesbø, Merete; van der Ent, C Kors; Fantini, Maria P; Forastiere, Francesco; Frey, Urs; Gehring, Ulrike; Gori, Davide; van der Gugten, Anne C; Hanke, Wojciech; Henderson, A John; Heude, Barbara; Iñiguez, Carmen; Inskip, Hazel M; Keil, Thomas; Kelleher, Cecily C; Kogevinas, Manolis; Kreiner-Møller, Eskil; Kuehni, Claudia E; Küpers, Leanne K; Lancz, Kinga; Larsen, Pernille S; Lau, Susanne; Ludvigsson, Johnny; Mommers, Monique; Nybo Andersen, Anne-Marie; Palkovicova, Lubica; Pike, Katharine C; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Roberts, Graham; Schmidt, Anne; Sram, Radim J; Sunyer, Jordi; Thijs, Carel; Torrent, Maties; Viljoen, Karien; Wijga, Alet H; Vrijheid, Martine; Jaddoe, Vincent W V; Duijts, Liesbeth

2014-05-01

Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years). First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes. Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27). Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children

PubMed Central

Sonnenschein-van der Voort, Agnes M.M.; Arends, Lidia R.; de Jongste, Johan C.; Annesi-Maesano, Isabella; Arshad, S. Hasan; Barros, Henrique; Basterrechea, Mikel; Bisgaard, Hans; Chatzi, Leda; Corpeleijn, Eva; Correia, Sofia; Craig, Leone C.; Devereux, Graham; Dogaru, Cristian; Dostal, Miroslav; Duchen, Karel; Eggesbø, Merete; van der Ent, C. Kors; Fantini, Maria P.; Forastiere, Francesco; Frey, Urs; Gehring, Ulrike; Gori, Davide; van der Gugten, Anne C.; Hanke, Wojciech; Henderson, A. John; Heude, Barbara; Iñiguez, Carmen; Inskip, Hazel M.; Keil, Thomas; Kelleher, Cecily C.; Kogevinas, Manolis; Kreiner-Møller, Eskil; Kuehni, Claudia E.; Küpers, Leanne K.; Lancz, Kinga; Larsen, Pernille S.; Lau, Susanne; Ludvigsson, Johnny; Mommers, Monique; Nybo Andersen, Anne-Marie; Palkovicova, Lubica; Pike, Katharine C.; Pizzi, Costanza; Polanska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Roberts, Graham; Schmidt, Anne; Sram, Radim J.; Sunyer, Jordi; Thijs, Carel; Torrent, Maties; Viljoen, Karien; Wijga, Alet H.; Vrijheid, Martine; Jaddoe, Vincent W.V.; Duijts, Liesbeth

2014-01-01

Background Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results. Objectives We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years). Methods First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes. Results Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27). Conclusion Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth. PMID:24529685

Metabolic health of young adults who were born small for gestational age and treated with growth hormone, after cessation of growth hormone treatment: a 5-year longitudinal study.

PubMed

van der Steen, Manouk; Smeets, Carolina C J; Kerkhof, Gerthe F; Hokken-Koelega, Anita C S

2017-02-01

Growth hormone treatment reduces fat mass and insulin sensitivity and increases lean body mass. Data are only available for short-term longitudinal changes after cessation of growth hormone treatment in young adults born small for gestational age. We aimed to assess long-term changes over a 5-year period following cessation of growth hormone treatment. We did a longitudinal study of young adults born small for gestational age and previously treated with growth hormone. Individuals were followed up for 5 years after attainment of adult height, when growth hormone treatment was discontinued: assessments were done at cessation of growth hormone treatment and at 6 months, 2 years, and 5 years thereafter. Data 5 years after cessation of growth hormone were compared with untreated age-matched controls. We used dual-energy x-ray absorptiometry to assess body composition, and did frequently sampled intravenous glucose tolerance tests to assess insulin sensitivity, acute insulin response, and the disposition index (a measure of β-cell function). This study is registered with ISRCTN, numbers ISRCTN96883876 and ISRCTN65230311. Between April, 2004, and April, 2016, we followed up 199 young adults born small for gestational age and previously treated with growth hormone, during the 5 years after cessation of growth hormone treatment. Data at 5 years for these individuals were compared with those for 51 untreated adults born small for gestational age with short stature, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age and unexposed to growth hormone treatment. In young adults born small for gestational age and previously treated with growth hormone, 5 years after cessation of growth hormone treatment, there were increases in fat mass (estimated marginal mean 10·73 kg [95% CI 9·95-11·50] at cessation of treatment vs 16·12 kg [14·77-17·46] at 5 years; p<0·0001), trunk fat (5·34 kg [4·94-5·73] vs 7·86 kg [7·12-8·60]; p<0·0001), and limb fat (4·87 kg [4·49-5·25] vs 7·41 kg [6·78-8·05]; p<0·0001); furthermore, lean body mass had decreased (42·41 kg [95% CI 41·09-43·73] at cessation of treatment vs 41·42 kg [40·17-42·66] at 5 years; p=0·0013). Insulin sensitivity increased within 6 months of cessation and was sustained 5 years after treatment cessation (estimated marginal mean 4·14 mU/L [95% CI 3·79-4·53] at cessation of treatment vs 6·15 mU/L [5·21-7·24] at 5 years; p<0·0001), and acute insulin response was diminished at 6 months, which persisted at 5 year follow-up (597·63 mU/L [539·62-661·86] vs 393·69 mU/L [337·56-459·15]; p<0·0001). The disposition index was increased 6 months after treatment but values at 5 years were similar to those at cessation of treatment (2483·94 [95% CI 2233·43-2762·54] at cessation of treatment vs 2367·83 [2033·43-2757·22] at 5 years; p=0·49). 5 years after cessation of growth hormone treatment, adults born small for gestational age and previously treated with growth hormone had fat mass, insulin sensitivity, and disposition index similar to those of untreated adults born small for gestational age with short stature, but lean body mass (adjusted for sex and height) was lower (46·47 kg [44·95-48·00] in those born small for gestational age with short stature vs 44·32 kg [43·35-45·30] in those born small for gestational age and treated with growth hormone; p=0·007). In adults previously treated with growth hormone born small for gestational age, at 5 years after cessation of growth hormone treatment, compared with adults born small for gestational age with spontaneous catch-up growth and adults born appropriate for gestational age, lean body mass was lower and results from frequently sampled intravenous glucose tolerance tests were similar. Significant changes in body composition and insulin sensitivity were recorded 5 years after cessation of growth hormone treatment in adults born small for gestational age, reflecting a loss of pharmacological effects of growth hormone. 5 years after cessation of treatment, fat mass, insulin sensitivity, and β-cell function of previously treated adults were similar to untreated adults born small for gestational age with short stature, indicating that long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on metabolic health in early adulthood. Novo Nordisk Farma BV (Netherlands). Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of day of gestation and feeding regimen in Holstein × Gyr cows: I. Apparent total-tract digestibility, nitrogen balance, and fat deposition.

PubMed

Rotta, P P; Filho, S C Valadares; Gionbelli, T R S; Costa E Silva, L F; Engle, T E; Marcondes, M I; Machado, F S; Villadiego, F A C; Silva, L H R

2015-05-01

This study investigated how feeding regimen (FR) alters apparent total-tract digestibility, performance, N balance, excretion of purine derivatives, and fat deposition in Holstein × Gyr cows at different days of gestation (DG). Forty-four pregnant multiparous Holstein × Gyr cows with an average initial body weight of 480±10.1 kg and an initial age of 5±0.5 yr old were allocated to 1 of 2 FR: ad libitum (AL; n=20) and maintenance level (ML; n=24). Maintenance level was considered to be 1.15% of body weight on a dry matter (DM) basis and met 100% of the energy requirements, whereas AL provided 190% of total net energy requirements. Data for hot and cold carcass dressing, fat deposition, average daily gain, empty body gain, and average daily gain without the gravid uterus were analyzed as a 4×2 factorial design. Intake, apparent total-tract digestibility, N balance, urinary concentration of urea, and purine derivatives data were analyzed as repeated measurements taken over the 28-d period (122, 150, 178, 206, 234, and 262 d of gestation). Cows were individually fed a corn silage-concentrate based diet composed of 93% roughage and 7% concentrate (DM basis) as a total mixed ration. Pregnant cows were slaughtered on 4 different DG: 139 (n=11), 199 (n=11), 241 (n=11), and 268 d (n=11). Overall, DM intake decreased as DG increased. This decrease observed in DM intake may be associated with the reduction in ruminal volume caused by the rapid increase in fetal size during late gestation. We observed an interaction for DM and organic matter apparent total-tract digestibility between FR and DG; at 150, 178, and 206 d of gestation, ML-fed cows had greater DM and organic matter apparent total-tract digestibility values than AL-fed cows. Rib fat thickness, mesentery, and kidney, pelvic, and heart fat were greater in AL-fed than in ML-fed cows at all DG, with the exception of rib fat thickness on d 139. Ad libitum-fed cows excreted more N in their feces and urine compared with ML-fed cows. Pregnant cows that were fed at maintenance had greater digestibility during some DG, excreted less N in feces and less N and urea in urine, and deposited less fat in the body. We therefore recommend ML (1.15% of body weight with 93% of roughage) as a FR for pregnant dry cows; however, during the last month of gestation, AL seems to be the most appropriate FR to avoid loss of body weight. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Large for Gestational Age Newborns from Mothers Without Diabetes Mellitus Tend to Become Tall and Lean Toddlers.

PubMed

de Zegher, Francis; Pérez-Cruz, Miriam; Sebastiani, Giorgia; Díaz, Marta; López-Bermejo, Abel; Ibáñez, Lourdes

2016-11-01

A longitudinal study with dual x-ray absorptiometry disclosed that infants born large for gestational age from mothers without diabetes mellitus and without excessive gestational weight gain tend to be long with increased adipose tissue as newborns and tall and lean as toddlers. Copyright © 2016 Elsevier Inc. All rights reserved.

Meteorological factors and timing of the initiating event of human parturition

NASA Astrophysics Data System (ADS)

Hirsch, Emmet; Lim, Courtney; Dobrez, Deborah; Adams, Marci G.; Noble, William

2011-03-01

The aim of this study was to determine whether meteorological factors are associated with the timing of either onset of labor with intact membranes or rupture of membranes prior to labor—together referred to as `the initiating event' of parturition. All patients delivering at Evanston Hospital after spontaneous labor or rupture of membranes at ≥20 weeks of gestation over a 6-month period were studied. Logistic regression models of the initiating event of parturition using clinical variables (maternal age, gestational age, parity, multiple gestation and intrauterine infection) with and without the addition of meteorological variables (barometric pressure, temperature and humidity) were compared. A total of 1,088 patients met the inclusion criteria. Gestational age, multiple gestation and chorioamnionitis were associated with timing of initiation of parturition ( P < 0.01). The addition of meteorological to clinical variables generated a statistically significant improvement in prediction of the initiating event; however, the magnitude of this improvement was small (less than 2% difference in receiver-operating characteristic score). These observations held regardless of parity, fetal number and gestational age. Meteorological factors are associated with the timing of parturition, but the magnitude of this association is small.

Small for gestational age and perinatal mortality at term: An audit in a Dutch national cohort study.

PubMed

Eskes, Martine; Waelput, Adja J M; Scherjon, Sicco A; Bergman, Klasien A; Abu-Hanna, Ameen; Ravelli, Anita C J

2017-08-01

To assess the underlying risk factors for perinatal mortality in term born small for gestational age infants. We performed a population based nationwide cohort study in the Netherlands of 465,532 term born infants from January 2010 to January 2013. Logistic regression analyses were performed. Also audit results were studied for detailed care information. We studied 162 small for gestational age infants who died in the perinatal period. Risk factors were: gestational age at 37completed weeks (adjusted Odds Ratio (aOR) 2.6, 95% Confidence Interval (CI) 1.6-4.3), male gender (aOR 1.4, 95% CI 1.01-1.9), South Asian ethnicity (aOR 3.6, 95% CI 1.6-8.4), African (aOR 3.5, 95% CI 1.9-6.5) and other non-Western ethnicity (aOR 1.9, CI 1.2-3.1). At 37 completed weeks gestation audit results showed that 26% of the women smoked, 91% were boys and in all but one case death occurred before birth. In 61% of all deceased SGA infants born at 37 completed weeks gestation referral from primary care by independent midwives to the obstetrician took place because of antepartum death before labor. Gestational age of 37 completed weeks, male gender, South Asian, African or other non-Western ethnicity and smoking are associated with perinatal mortality in SGA infants. These risk factors concern the complete term population starting at 37 weeks or even earlier. Therefore, it is of utmost importance to develop accurate diagnostic tests to screen for SGA before 36 weeks gestation to prevent perinatal mortality at term in SGA infants. Copyright © 2017 Elsevier B.V. All rights reserved.

Gestational age specific stillbirth risk among Indigenous and non-Indigenous women in Queensland, Australia: a population based study.

PubMed

Ibiebele, Ibinabo; Coory, Michael; Smith, Gordon C S; Boyle, Frances M; Vlack, Susan; Middleton, Philippa; Roe, Yvette; Flenady, Vicki

2016-07-15

In Australia, significant disparity persists in stillbirth rates between Aboriginal and Torres Strait Islander (Indigenous Australian) and non-Indigenous women. Diabetes, hypertension, antepartum haemorrhage and small-for-gestational age (SGA) have been identified as important contributors to higher rates among Indigenous women. The objective of this study was to examine gestational age specific risk of stillbirth associated with these conditions among Indigenous and non-Indigenous women. Retrospective population-based study of all singleton births of at least 20 weeks gestation or at least 400 grams birthweight in Queensland between July 2005 and December 2011 using data from the Queensland Perinatal Data Collection, which is a routinely-maintained database that collects data on all births in Queensland. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95 % confidence intervals, adjusting for maternal demographic and pregnancy factors. Of 360987 births analysed, 20273 (5.6 %) were to Indigenous women and 340714 (94.4 %) were to non-Indigenous women. Stillbirth rates were 7.9 (95 % CI 6.8-9.2) and 4.1 (95 % CI 3.9-4.3) per 1000 births, respectively. For both Indigenous and non-Indigenous women across most gestational age groups, antepartum haemorrhage, SGA, pre-existing diabetes and pre-existing hypertension were associated with increased risk of stillbirth. There were mixed results for pre-eclampsia and eclampsia and a consistently raised risk of stillbirth was not seen for gestational diabetes. This study highlights gestational age specific stillbirth risk for Indigenous and non-Indigenous women; and disparity in risk at term gestations. Improving access to and utilisation of appropriate and responsive healthcare may help to address disparities in stillbirth risk for Indigenous women.

Outcomes of Small for Gestational Age Infants < 27 Weeks’ Gestation

PubMed Central

De Jesus, Lilia C.; Pappas, Athina; Shankaran, Seetha; Li, Lei; Das, Abhik; Bell, Edward F.; Stoll, Barbara J.; Laptook, Abbot R.; Walsh, Michele C.; Hale, Ellen C.; Newman, Nancy S.; Bara, Rebecca; Higgins, Rosemary D.

2014-01-01

Objective To determine whether small for gestational age (SGA) infants <27 weeks gestation is associated with mortality, morbidity, growth and neurodevelopmental impairment at 18–22 months’ corrected age (CA). Study design This was a retrospective cohort study from National Institute of Child Health and Human Development Neonatal Research Network’s Generic Database and Follow-up Studies. Infants born at <27 weeks’ gestation from January 2006 to July 2008 were included. SGA was defined as birth weight <10th percentile for gestational age by the Olsen growth curves. Infants with birth weight ≥10th percentile for gestational age were classified as non-SGA. Maternal and infant characteristics, neonatal outcomes and neurodevelopmental data were compared between the groups. Neurodevelopmental impairment was defined as any of the following: cognitive score <70 on BSID III, moderate or severe cerebral palsy, bilateral hearing loss (+/− amplification) or blindness (vision <20/200). Logistic regression analysis evaluated the association between SGA status and death or neurodevelopmental impairment. Results There were 385 SGA and 2586 non-SGA infants. Compared with the non-SGA group, mothers of SGA infants were more likely to have higher level of education, prenatal care, cesarean delivery, pregnancy-induced hypertension and antenatal corticosteroid exposure. SGA infants were more likely to have postnatal growth failure, a higher mortality and to have received prolonged mechanical ventilation and postnatal steroids. SGA status was associated with higher odds of death or neurodevelopmental impairment [OR 3.91 (95% CI: 2.91–5.25), P<0.001]. Conclusion SGA status among infants <27 weeks’ gestation was associated with an increased risk for postnatal steroid use, mortality, growth failure and neurodevelopmental impairment at 18–22 months’ CA. PMID:23415614

Dynamics of lipoprotein level in blood plasma of pregnant women as a function of gestational age according to FTIR spectroscopy

NASA Astrophysics Data System (ADS)

Korolik, E. V.; Korolenko, E. A.; Tretinnikov, O. N.; Kozlyakova, O. V.; Korolik, A. K.; Kirkovskiy, V. V.

2013-01-01

Results of an IR spectroscopic investigation of films of blood plasma taken from women of reproductive age, pregnant women with positive and negative Rh factors, and Rh-immunized women were presented as a function of gestational age. It was found that the lipoprotein content in blood plasma of all groups of pregnant women increased during the early stages of pregnancy (17-23 weeks) irrespective of the Rh factor and attained its peak value by weeks 30-35. It was shown that the lipoprotein level in blood plasma as a function of gestational age was quantitatively the same for pregnant women with positive and negative Rh factors. It was established for the first time that this dependence for Rh-immunized women featured a considerable increase of lipoprotein content at gestational age 30-32 weeks and declined acutely by week 36.

Cognitive functioning in toddlerhood: The role of gestational age, attention capacities, and maternal stimulation.

PubMed

de Jong, Marjanneke; Verhoeven, Marjolein; Hooge, Ignace T C; Maingay-Visser, Arnoldina P G F; Spanjerberg, Louise; van Baar, Anneloes L

2018-04-01

Why do many preterm children show delays in development? An integrated model of biological risk, children's capacities, and maternal stimulation was investigated in relation to cognitive functioning at toddler age. Participants were 200 Dutch children (gestational age = 32-41 weeks); 51% boys, 96% Dutch nationality, 71.5% highly educated mothers. At 18 months, attention capacities were measured using eye-tracking, and maternal attention-directing behavior was observed. Cognitive functioning was measured at 24 months using the Bayley-III-NL. Cognitive functioning was directly predicted by children's attention capacities and maternal attention-maintaining behavior. Gestational age was indirectly related to cognitive functioning through children's attention capacities and through maternal attention-redirecting behavior. In this way, a combination of gestational age, children's attention capacities, and maternal stimulation was associated with early cognitive development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Natural cycle IVF reduces the risk of low birthweight infants compared with conventional stimulated IVF.

PubMed

Mak, Winifred; Kondapalli, Laxmi A; Celia, Gerard; Gordon, John; DiMattina, Michael; Payson, Mark

2016-04-01

Are perinatal outcomes improved in singleton pregnancies resulting from fresh embryo transfers performed following unstimulated/natural cycle IVF (NCIVF) compared with stimulated IVF? Infants conceived by unstimulated/NCIVF have a lower risk of being low birthweight than infants conceived by stimulated IVF; however, this risk did not remain significant after adjusting for gestation age. Previous studies have shown that infants born after modified NCIVF have a higher average birthweight and are less likely to be low birthweight than those infants conceived with conventional stimulated IVF. Retrospective cohort study of singleton live births in non-smoking women undergoing fresh IVF-embryo transfer cycles from 2007 to 2013 in a single IVF center. The women were stratified by stimulated (n = 174) or unstimulated (n = 190) IVF exposure status. Unstimulated/NCIVF is defined as IVF without the use of exogenous gonadotrophins, and only includes the use of HCG to time oocyte retrieval. Demographic data including maternal age, BMI, infertility diagnosis and IVF cycle characteristics were collected. The perinatal outcomes used for comparison between the two study groups were length of gestation, birthweight, preterm delivery, very preterm delivery, low birthweight, small for gestational age and large for gestational age. Although women in the NCIVF group were older than those in the stimulated group (35.0 versus 34.2 years, P < 0.05), parity and history of prior ART cycles were comparable between the groups. The mean birthweight was significantly higher in the NCIVF group by 163 g than in the stimulated group (3436 ± 420 g versus 3273 ± 574 g, P < 0.05). Consistent with this finding, there were also less low birthweight (<2500 g) infants in the NCIVF group versus stimulated group (1 versus 8.6%, P < 0.005). The reduction in risk for low birthweight in the NCIVF group remained significant after adjustment for maternal age, infertility diagnosis, ICSI, number of embryos transferred and blastocyst transfer (odds ratio (OR) 0.07; 95% CI 0.014-0.35). As NCIVF group had less preterm infants, additional adjustment for gestational age was performed and this showed a tendency towards lower risk of low birthweight in NCIVF (OR 0.11; 95% CI 0.01-1.0). While gestational age at delivery was comparable between the groups, both preterm births (<37 weeks gestation) (31 versus 42%, P < 0.05) and very preterm births (<32 weeks gestation) (0.52 versus 6.3%, P < 0.005) were significantly reduced in the NCIVF group. However, after adjustment for potential confounders, the reduction in risk of preterm and very preterm delivery associated with the NCIVF group was no longer significant (OR 1.1; 95% CI 0.48-2.5). Limitations of this study are the retrospective nature of the data collection and the lack of information about parental characteristics associated with birthweight. The improved perinatal outcomes following successful unstimulated/NCIVF suggest that this treatment should be considered as a viable option for infertile couples. NCIVF could reduce potential adverse perinatal outcomes such as low birthweight related to fresh embryo transfers performed following ovarian stimulation. The etiology of the improved perinatal outcomes following NCIVF needs to be explored further to determine if the improvement is derived from endometrial factors versus follicular/oocyte factors. The study was supported by the following grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, NICHD K12HD047018 (W.M.), NICHD K12HD001271 (L.A.K.). The authors have no competing interests. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Twins' risk of childhood asthma mediated by gestational age and birthweight.

PubMed

Ullemar, V; Lundholm, C; Almqvist, C

2015-08-01

Children born with low gestational age (GA) or low birthweight (BW) are at increased risk of asthma. Twins as compared to singletons are on average more likely to be born with lower GA and BW and have been hypothesized to comprise a high-risk population for asthma. Many previous studies have not accounted for potential confounders or mediators. To investigate the association between twinship and childhood asthma or early life wheeze and identify potential mediators, such as GA/BW. The study population consisted of two cohorts including all children born in Sweden from 1 January 1993 to 1 June 2001 (n = 756,363 singletons, n = 22,478 twins) and 1 July 2005 to 31 December 2009 (n = 456,239 singletons, n = 12,872 twins). Asthma was defined using validated register-based outcomes of diagnosis or medication. The data were analysed using logistic (older cohort) and Cox regression (younger cohort). Adjusted models incorporated potential confounding or mediating factors including gestational age and birthweight. In the younger cohort, the crude hazard ratio (HR) of asthma medication after 1.5 years of age was 1.12 (95% CI 1.01-1.23), and fully adjusted HR was 0.80, 95% CI 0.72-0.89. Crude HR of asthma diagnosis in the same age group was 1.14 (95% CI 0.99-1.30), fully adjusted 0.78 (0.68-0.98). Adjusted analyses in the older group yielded similar results. Twins were at significantly higher unadjusted risk of asthma or early life wheeze compared to singletons in the younger, but not in the older cohort. Associations attenuated following adjustment for GA/BW, suggesting that GA/BW mediates the effect of twinship on asthma risk. After adjustments, twins were at lower risk of asthma outcomes, possibly due to unmeasured confounding. © 2015 John Wiley & Sons Ltd.

Refractive errors and refractive development in premature infants.

PubMed

Ozdemir, O; Tunay, Z Ozen; Acar, D Erginturk; Acar, U

2015-12-01

To examine refractive errors and refractive development in premature infants. Premature infants in the retinopathy of prematurity (ROP) screening program were recruited and examined longitudinally between 28 and 58 weeks postmenstrual age. For performing cycloplegic retinoscopy, 1% tropicamide was administered, two drops with a 10-minute interval, in order to paralyze accommodation and to achieve cycloplegia. Birth weight, gestational age, gender and acute ROP disease were recorded. The relationship between spherical equivalent, astigmatism and postmenstrual age was evaluated. A total of 798 readings were obtained from 258 infants (131 females, 127 males) between 28 and 58 weeks postmenstrual age. The median number of examinations was 3 (minimum 1, maximum 7). In the comparisons of birth weight, gestational age, spherical equivalent and astigmatism between genders, there were no statistically significant differences (P>0.05). Gestational age (regression analysis, r(2)=0.30, P<0.01) and birth weight (regression analysis, r(2)=0.22, P<0.01) had a significant effect on refractive error development. Preterm babies with lower birth weight and those born more prematurely had lower spherical equivalent. The spherical equivalent of the eyes correlated significantly with the postmenstrual age of the infants (r=0.512, P<0.01). Infants with low gestational age and low birth weight also had low spherical equivalent. Moreover, spherical equivalent correlated with increasing postmenstrual age. However, astigmatism did not correlate with postmenstrual age and did not associate with gestational age or birth weight. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Preterm premature rupture of membranes at 22-25 weeks' gestation: perinatal and 2-year outcomes within a national population-based study (EPIPAGE-2).

PubMed

Lorthe, Elsa; Torchin, Héloïse; Delorme, Pierre; Ancel, Pierre-Yves; Marchand-Martin, Laetitia; Foix-L'helias, Laurence; Benhammou, Valérie; Gire, Catherine; D'Ercole, Claude; Winer, Norbert; Sentilhes, Loïc; Subtil, Damien; Goffinet, François; Kayem, Gilles

2018-05-28

Most clinical guidelines state that with early preterm premature rupture of membranes, obstetric and pediatric teams must share a realistic and individualized appraisal of neonatal outcomes with parents and consider their wishes for all decisions. However, we currently lack reliable and relevant data, according to gestational age at rupture of membranes, to adequately counsel parents during pregnancy and to reflect on our policies of care at these extreme gestational ages. To describe both perinatal and 2-year outcomes of preterm infants born after preterm premature rupture of membranes at 22-25 weeks' gestation. EPIPAGE-2 is a French national prospective population-based cohort of preterm infants born in 546 maternity units in 2011. Inclusion criteria in this analysis were women diagnosed with preterm premature rupture of membranes at 22-25 weeks' gestation and singleton or twin gestations with fetus(es) alive at rupture of membranes. Latency duration, antenatal management, and outcomes (survival at discharge, survival at discharge without severe morbidity, and survival at 2 years' corrected age without cerebral palsy) were described and compared by gestational age at preterm premature rupture of membranes. Among the 1435 women with a diagnosis of preterm premature rupture of membranes, 379 were at 22-25 weeks' gestation, with 427 fetuses (331 singletons and 96 twins). Median GA at preterm premature rupture of membranes and at birth were 24 (interquartile range 23-25) and 25 (24-27) weeks, respectively. For each gestational age at preterm premature rupture of membranes, nearly half of the fetuses were born within the week after the rupture of membranes. Among the 427 fetuses, 51.7% were survivors at discharge (14.1%, 39.5%, 66.8% and 75.8% with preterm premature rupture of membranes at 22, 23, 24 and 25 weeks, respectively), 38.8% were survivors at discharge without severe morbidity and 46.4% were survivors at 2 years without cerebral palsy, with wide variations by gestational age at preterm premature rupture of membranes. Survival at 2 years without cerebral palsy was low with preterm premature rupture of membranes at 22 and 23 weeks but reached approximately 60% and 70% with preterm premature rupture of membranes at 24 and 25 weeks. Preterm premature rupture of membranes at 22-25 weeks is associated with high incidence of mortality and morbidity, with wide variations by gestational age at preterm premature rupture of membranes. However, a non-negligible proportion of children survive without severe morbidity both at discharge and at 2-years' corrected age. Copyright © 2018 Elsevier Inc. All rights reserved.

Postnatal Brain Growth Assessed by Sequential Cranial Ultrasonography in Infants Born <30 Weeks' Gestational Age.

PubMed

Cuzzilla, R; Spittle, A J; Lee, K J; Rogerson, S; Cowan, F M; Doyle, L W; Cheong, J L Y

2018-06-01

Brain growth in the early postnatal period following preterm birth has not been well described. This study of infants born at <30 weeks' gestational age and without major brain injury aimed to accomplish the following: 1) assess the reproducibility of linear measures made from cranial ultrasonography, 2) evaluate brain growth using sequential cranial ultrasonography linear measures from birth to term-equivalent age, and 3) explore perinatal predictors of postnatal brain growth. Participants comprised 144 infants born at <30 weeks' gestational age at a single center between January 2011 and December 2013. Infants with major brain injury seen on cranial ultrasonography or congenital or chromosomal abnormalities were excluded. Brain tissue and fluid spaces were measured from cranial ultrasonography performed as part of routine clinical care. Brain growth was assessed in 3 time intervals: <7, 7-27, and >27 days' postnatal age. Data were analyzed using intraclass correlation coefficients and mixed-effects regression. A total of 429 scans were assessed for 144 infants. Several linear measures showed excellent reproducibility. All measures of brain tissue increased with postnatal age, except for the biparietal diameter, which decreased within the first postnatal week and increased thereafter. Gestational age of ≥28 weeks at birth was associated with slower growth of the biparietal diameter and ventricular width compared with gestational age of <28 weeks. Postnatal corticosteroid administration was associated with slower growth of the corpus callosum length, transcerebellar diameter, and vermis height. Sepsis and necrotizing enterocolitis were associated with slower growth of the transcerebellar diameter. Postnatal brain growth in infants born at <30 weeks' gestational age can be evaluated using sequential linear measures made from routine cranial ultrasonography and is associated with perinatal predictors of long-term development. © 2018 by American Journal of Neuroradiology.

Continuum of neurobehaviour and its associations with brain MRI in infants born preterm

PubMed Central

Eeles, Abbey L; Walsh, Jennifer M; Olsen, Joy E; Cuzzilla, Rocco; Thompson, Deanne K; Anderson, Peter J; Doyle, Lex W; Cheong, Jeanie L Y; Spittle, Alicia J

2017-01-01

Background Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks’ gestational age (PT<30); MLPT (32–36 weeks’ gestational age) and term age (≥37 weeks’ gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age. Methods Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl’s Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI. Results Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants. Conclusions There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants. PMID:29637152

Pregnancy Complications as Markers for Subsequent Maternal Cardiovascular Disease: Validation of a Maternal Recall Questionnaire.

PubMed

Carter, Ebony Boyce; Stuart, Jennifer J; Farland, Leslie V; Rich-Edwards, Janet W; Zera, Chloe A; McElrath, Thomas F; Seely, Ellen W

2015-09-01

We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r=0.95), and gestation length (r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease.

Refractive Status at Birth: Its Relation to Newborn Physical Parameters at Birth and Gestational Age

PubMed Central

Varghese, Raji Mathew; Sreenivas, Vishnubhatla; Puliyel, Jacob Mammen; Varughese, Sara

2009-01-01

Background Refractive status at birth is related to gestational age. Preterm babies have myopia which decreases as gestational age increases and term babies are known to be hypermetropic. This study looked at the correlation of refractive status with birth weight in term and preterm babies, and with physical indicators of intra-uterine growth such as the head circumference and length of the baby at birth. Methods All babies delivered at St. Stephens Hospital and admitted in the nursery were eligible for the study. Refraction was performed within the first week of life. 0.8% tropicamide with 0.5% phenylephrine was used to achieve cycloplegia and paralysis of accommodation. 599 newborn babies participated in the study. Data pertaining to the right eye is utilized for all the analyses except that for anisometropia where the two eyes were compared. Growth parameters were measured soon after birth. Simple linear regression analysis was performed to see the association of refractive status, (mean spherical equivalent (MSE), astigmatism and anisometropia) with each of the study variables, namely gestation, length, weight and head circumference. Subsequently, multiple linear regression was carried out to identify the independent predictors for each of the outcome parameters. Results Simple linear regression showed a significant relation between all 4 study variables and refractive error but in multiple regression only gestational age and weight were related to refractive error. The partial correlation of weight with MSE adjusted for gestation was 0.28 and that of gestation with MSE adjusted for weight was 0.10. Birth weight had a higher correlation to MSE than gestational age. Conclusion This is the first study to look at refractive error against all these growth parameters, in preterm and term babies at birth. It would appear from this study that birth weight rather than gestation should be used as criteria for screening for refractive error, especially in developing countries where the incidence of intrauterine malnutrition is higher. PMID:19214228

Postnatal growth outcomes and influence of maternal gestational weight gain: a prospective cohort study in rural Vietnam.

PubMed

Hanieh, Sarah; Ha, Tran T; Simpson, Julie A; Thuy, Tran T; Khuong, Nguyen C; Thoang, Dang D; Tran, Thach D; Tuan, Tran; Fisher, Jane; Biggs, Beverley-Ann

2014-09-30

Suboptimal weight gain during pregnancy may result in adverse outcomes for both the mother and child, including increased risk of pre-eclampsia and gestational diabetes, delivery of low birth weight and small-for-gestational age (SGA) infants, and preterm delivery. The objectives of this study were to identify maternal predictors of rate of weight gain in pregnancy, and to evaluate the association of gestational weight gain with infant postnatal growth outcomes. We conducted a prospective cohort study of infants born to women who had previously participated in a double-blind cluster randomized controlled trial of antenatal micronutrient supplementation, in Ha Nam province, Vietnam. Pregnant women (n = 1258) were seen at enrolment and 32 weeks gestation, and infants (n = 965) were followed until 6 months of age. Primary outcome was infant anthropometric indicators at 6 months of age (weight for age, length for age, weight for height z scores), and infant weight gain velocity during the first 6 months of life. Low body mass index (<18.5 kg/m2) was present in 26% of women, and rate of gestational weight gain was 0.4 kg per week [SD 0.12]. Rate of weight gain during pregnancy was significantly associated with infant weight-for-age (MD 1.13, 95% CI 0.58 to 1.68), length-for-age (MD 1.11, 95% CI 0.66 to 1.55), weight-for-length z scores (MD 0.63, 95% CI 0.07 to 1.19), and infant weight gain velocity during the first 6 months of life (MD 93.6 g per month, 95% CI 8.2 to 179.0). Rate of gestational weight gain is predictive of postnatal growth at six months of age in this setting. Public health programs should be targeted towards improving body mass index and weight gain in pregnant women in rural Vietnam.

Study of plasma adrenomedullin level in normal pregnancy and preclampsia.

PubMed

Senna, Azza Abo; Zedan, Magda; el-Salam, Gamal E Abd; el-Mashad, Ashraf I

2008-02-06

The aim of this study was to evaluate whether maternal circulating adrenomedullin (AM) values in patients with preeclampsia are different from those in normotensive pregnant women at different gestational ages. In a prospective clinical study, 90 women aged 17 to 40 years old, were divided into 4 main groups: group I (45 women): Normotensive pregnant women at first trimester (15 women), second trimester (15 women), and third trimester (15 women) of pregnancies. Group II (15 women): Pregnant women with preeclampsia at 25 to 38 weeks of gestation. Group III (15 women): Normotensive healthy nonpregnant women. Group IV (15 women): Hypertensive nonpregnant women. The plasma AM concentration was measured in all women by using enzyme immunoassay kits. Plasma AM levels in pregnant women with normal blood pressure at different gestational ages (first, second, and third trimesters) were statistically significantly higher than those detected in nonpregnant normotensive women and significantly increased with increasing gestational age (P < .001). Moreover, there was significant positive correlation between plasma AM levels and increasing gestational age (r = 0.915, P < .001). Preeclamptic patients had the highest mean plasma AM levels compared with all other groups, which is statistically significant (P < .001) and there was a significant positive correlation between plasma AM levels and systolic blood pressure, diastolic blood pressure, severity of preeclampsia, and proteinuria in pregnant patients with preeclampsia. Maternal plasma AM concentration increases throughout pregnancy and increases as gestational age progresses. AM production starts very early in gestation, suggesting that it may have an important role in human reproduction, from implantation to delivery. Maternal plasma AM level in preeclampsia appears to be higher than that in normal pregnancy.

Study of Plasma Adrenomedullin Level In Normal Pregnancy and Preclampsia

PubMed Central

Senna, Azza Abo; Zedan, Magda; Abd El Salam, Gamal E.; El Mashad, Ashraf I.

2008-01-01

Aim The aim of this study was to evaluate whether maternal circulating adrenomedullin (AM) values in patients with preeclampsia are different from those in normotensive pregnant women at different gestational ages. Subjects and Methods In a prospective clinical study, 90 women aged 17 to 40 years old, were divided into 4 main groups: group I (45 women): Normotensive pregnant women at first trimester (15 women), second trimester (15 women), and third trimester (15 women) of pregnancies. Group II (15 women): Pregnant women with preeclampsia at 25 to 38 weeks of gestation. Group III (15 women): Normotensive healthy nonpregnant women. Group IV (15 women): Hypertensive nonpregnant women. The plasma AM concentration was measured in all women by using enzyme immunoassay kits. Results Plasma AM levels in pregnant women with normal blood pressure at different gestational ages (first, second, and third trimesters) were statistically significantly higher than those detected in nonpregnant normotensive women and significantly increased with increasing gestational age (P < .001). Moreover, there was significant positive correlation between plasma AM levels and increasing gestational age (r = 0.915, P < .001). Preeclamptic patients had the highest mean plasma AM levels compared with all other groups, which is statistically significant (P < .001) and there was a significant positive correlation between plasma AM levels and systolic blood pressure, diastolic blood pressure, severity of preeclampsia, and proteinuria in pregnant patients with preeclampsia. Conclusion Maternal plasma AM concentration increases throughout pregnancy and increases as gestational age progresses. AM production starts very early in gestation, suggesting that it may have an important role in human reproduction, from implantation to delivery. Maternal plasma AM level in preeclampsia appears to be higher than that in normal pregnancy. PMID:18382699

Gestational age, gender and parity specific centile charts for placental weight for singleton deliveries in Aberdeen, UK.

PubMed

Wallace, J M; Bhattacharya, S; Horgan, G W

2013-03-01

The weight of the placenta is a crude but useful proxy for its function in vivo. Accordingly extremes of placental weight are associated with adverse pregnancy outcomes while even normal variations in placental size may impact lifelong health. Centile charts of placental weight for gestational age and gender are used to identify placental weight extremes but none report the effect of parity. Thus the objective was to produce gender and gestational age specific centile charts for placental weight in nulliparous and multiparous women. Data was extracted from the Aberdeen Maternity and Neonatal Databank for all women delivering singleton babies in Aberdeen city and district after 24 weeks gestation. Gestational age specific centile charts for placental weight by gender and parity grouping (n = 88,649 deliveries over a 30 year period) were constructed using the LMS method after exclusion of outliers (0.63% of deliveries meeting study inclusion criteria). Tables and figures are presented for placental weight centiles according to gestational age, gender and parity grouping. Tables are additionally presented for the birth weight to placental weight ratio by gender. Placental weight and the fetal:placental weight ratio were higher in male versus female deliveries. Placental weight was greater in multiparous compared with nulliparous women. We present strong evidence that both gender and parity grouping influence placental weight centiles. The differences at any given gestational age are small and the effects of parity are greater overall than those of gender. In contrast the birth weight to placental weight ratio differs by gender only. These UK population specific centile charts may be useful in studies investigating the role of the placenta in mediating pregnancy outcome and lifelong health. Copyright © 2012 Elsevier Ltd. All rights reserved.

Prenatal factors associated with birth weight and length and current nutritional status of hospitalized children aged 4-24 months.

PubMed

Mariante Giesta, Juliana; Ramón da Rosa, Suélen; Moura Pessoa, Juliana Salino; Lúcia Bosa, Vera

2015-06-01

The objective of the present study was to investigate the associations of prenatal factors with birth weight and length, as well as current nutritional status, of children hospitalized in southern Brazil. We conducted a cross-sectional study of 300 child-mother pairs. Children were between 4 and 24 months old. They were at the inpatient unit or pediatric emergency department of the Hospital de Clínicas de Porto Alegre. Anthropometric data were collected, and a questionnaire on gestational data was answered by the children's mothers. Maternal variables of interest were: prepregnancy body mass index (BMI), gestational weight gain, smoking and/or use of alcohol, use of illicit drugs, gestational diabetes and/ or high blood pressure. Children's variables of interest were: sex, gestational age, birth weight (BW) and birth length (BL), and current anthropometric data [body mass index for age (BMI/A), height for age (H/A), and weight for age (W/A)]. The gestational weight gain and smoking were associated with BW. We also found that H/A was associated with BW and BL, W/A was associated with BW, and BMI/A was associated with BL. The gestational weight gain was associated with BL, diabetes was associated with BW and BL, and high blood pressure was associated with low height in the first two years of life. We concluded that prenatal factors may have an influence on both BW and BL, causing the birth of small and large for gestational age children, and thus affecting their growth rate during the first years of life. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Measurement of frontal lobe volume and thalamic volume in fetuses with congenital heart disease at different gestational weeks using three dimensional ultra sonography and its clinical value.

PubMed

Li-Fei, Zhu; Hong-Xiong, Liu; Ying, H E

2016-11-01

Our study aimed to investigate the measurement of frontal lobe volume and thalamic volume in fetuses with congenital heart disease (CHD) at different gestational weeks using three dimensional (3-D) ultrasonography and its clinical value. Then, 238 pregnant women who received obstetric ultrasonography in ultrasound department of Internal Medicine of our hospital were enrolled between March 2013 to April 2014. In this study, 85 fetuses were diagnosed to develop CHD by prenatal fetal echocardiography, and the other 153 fetuses were normal. Frontal lobe volume, thalamic volume and cerebral blood flow was determined by color Doppler ultrasonic diagnostic apparatus (type: GE Voluson E8). The level of MCA-PI and CPR in CHD fetus group performed significantly lower than that in normal fetus group (P<0.05), but the level of UA-PI performed significantly higher than that in normal fetus group (P<0.05). When gestational age <30 weeks, there was no significant difference in thalamic volume and frontal lobe volume between the two groups (P<0.05); when gestational age <30 weeks, the level of CHD fetus group performed significantly lower thalamic volume and frontal lobe volume than that in normal fetus group (P<0.05). When gestational age <30 weeks, there was no significant difference in BPD, HC, and GA between the two groups (P<0.05); when gestational age <30 weeks, the level of BPD, HC and GA in CHD fetus group performed significantly lower than that in normal fetus group (P<0.05). If gestational age <30 weeks, CHD performed a small impact on fetal frontal lobe volume and thalamic volume; if gestational age <30 weeks, the level of frontal lobe volume and thalamic volume in fetuses with CHD performed significantly lower than that in normal fetuses.

Population-based birth weight reference percentiles for Chinese twins.

PubMed

Dai, Li; Deng, Changfei; Li, Yanhua; Yi, Ling; Li, Xiaohong; Mu, Yi; Li, Qi; Yao, Qiang; Wang, Yanping

2017-09-01

Birth weight percentiles by gestational age are important for assessing prenatal growth and predicting postnatal outcomes of newborns. Several countries have developed nation-specific birth weight references for twins, but China still lacks such references. Birth weight data for twins born between October 2006 and September 2015 were abstracted from the China National Population-based Birth Defects Surveillance System. A total of 54,786 live twin births aged ≥28 weeks of gestation without birth defects were included in the analysis. The LMS method was adopted to generate gestational age-specific birth weight percentiles and curves for male and female twins separately. Significant differences were observed between the current reference and other references developed for Chinese or non-Chinese twins. The neonatal mortality rate in this cohort was 12.3‰, and much higher rates at very early gestation weeks were identified in small-for-gestational-age twins grouped by the newly developed reference cutoffs. The established birth weight centiles represent the first birth weight norm for contemporary Chinese twins and can be a useful tool to assess growth of twins in clinical and research settings. Key Messages There have been no population-based birth weight percentiles for Chinese twins prior to this study. The established birth weight centiles for female and male twins are markedly lower than those for Chinese singletons. Twin-specific curves should be used for determining inappropriate for gestational age in twins rather than using existing singleton reference. The birth weight percentiles for twins differed significantly from those for non-Chinese twins. In addition to ethnic influences, the observed differences could be ascribed to variations in prenatal care, fetal or maternal nutrition status or other environmental factors. Neonatal mortality rates varied considerably among twins grouped by the newly developed reference percentiles. Small-for-gestational-age twins had much higher mortality than did appropriate-for-gestational-age twins, highlighting the need to reduce postnatal mortality by improving perinatal health care for twins.

Resistance training during pregnancy and perinatal outcomes.

PubMed

White, Erin; Pivarnik, Jim; Pfeiffer, Karin

2014-08-01

Approximately 10% of women engage in resistance training during pregnancy; however there is limited research on this activity. The purpose of this study was to examine associations between resistance training and adverse outcomes. Women completed an online survey and recalled their exercise habits during each trimester of their most recent pregnancy within the previous 5 years. Women also reported pregnancy and birth outcomes. Participants were then categorized into 3 groups based on leisure-time exercise: 1) Resistance + aerobic training (RTAE), 2) Aerobic exercise only (AE), and 3) no exercise (NE). 284 women completed the survey. Women in the RTAE group resistance trained on average 2.9 days/ week for 27.3 minutes/session. The prevalences of hypertensive disorders (HD) and gestational diabetes mellitus (GDM) were significantly lower in the RTAE group when compared with the grouping of AE + NE women. Prepregnancy body mass index (BMI) was the strongest factor related to both GDM and HD. There was no difference in the risk of preterm labor, mode of delivery, or gestational age at delivery by exercise status. Our results suggest that women can safely engage in aerobic exercise and resistance training for muscular endurance 3 days/week for 30 minutes throughout gestation.

Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996-2011

MedlinePlus

... cesarean delivery rate : Number of births in multiple pregnancies delivered by cesarean per 100 multiple births. Gestational age categories Early preterm : Births prior to 34 completed weeks of ...

Comparison of the Screening Tests for Gestational Diabetes Mellitus between "One-Step" and "Two-Step" Methods among Thai Pregnant Women.

PubMed

Luewan, Suchaya; Bootchaingam, Phenphan; Tongsong, Theera

2018-01-01

To compare the prevalence and pregnancy outcomes of GDM between those screened by the "one-step" (75 gm GTT) and "two-step" (100 gm GTT) methods. A prospective study was conducted on singleton pregnancies at low or average risk of GDM. All were screened between 24 and 28 weeks, using the one-step or two-step method based on patients' preference. The primary outcome was prevalence of GDM, and secondary outcomes included birthweight, gestational age, rates of preterm birth, small/large-for-gestational age, low Apgar scores, cesarean section, and pregnancy-induced hypertension. A total of 648 women were screened: 278 in the one-step group and 370 in the two-step group. The prevalence of GDM was significantly higher in the one-step group; 32.0% versus 10.3%. Baseline characteristics and pregnancy outcomes in both groups were comparable. However, mean birthweight was significantly higher among pregnancies with GDM diagnosed by the two-step approach (3204 ± 555 versus 3009 ± 666 g; p =0.022). Likewise, the rate of large-for-date tended to be higher in the two-step group, but was not significant. The one-step approach is associated with very high prevalence of GDM among Thai population, without clear evidence of better outcomes. Thus, this approach may not be appropriate for screening in a busy antenatal care clinic like our setting or other centers in developing countries.

Centile charts for birthweight for gestational age for Scottish singleton births

PubMed Central

Bonellie, Sandra; Chalmers, James; Gray, Ron; Greer, Ian; Jarvis, Stephen; Williams, Claire

2008-01-01

Background Centile charts of birthweight for gestational age are used to identify low birthweight babies. The charts currently used in Scotland are based on data from the 1970s and require updating given changes in birthweight and in the measurement of gestational age since then. Methods Routinely collected data of 100,133 singleton births occurring in Scotland from 1998–2003 were used to construct new centile charts using the LMS method. Results Centile charts for birthweight for sex and parity groupings were constructed for singleton birth and compared to existing charts used in Scottish hospitals. Conclusion Mean birthweight has been shown to have increased over recent decades. The differences shown between the new and currently used centiles confirm the need for more up-to-date centiles for birthweight for gestational age. PMID:18298810

The Probability of Neonatal Respiratory Distress Syndrome as a Function of Gestational Age and Lecithin/Sphingomyelin Ratio

PubMed Central

St. Clair, Caryn; Norwitz, Errol R.; Woensdregt, Karlijn; Cackovic, Michael; Shaw, Julia A.; Malkus, Herbert; Ehrenkranz, Richard A.; Illuzzi, Jessica L.

2011-01-01

We sought to define the risk of neonatal respiratory distress syndrome (RDS) as a function of both lecithin/sphingomyelin (L/S) ratio and gestational age. Amniotic fluid L/S ratio data were collected from consecutive women undergoing amniocentesis for fetal lung maturity at Yale-New Haven Hospital from January 1998 to December 2004. Women were included in the study if they delivered a live-born, singleton, nonanomalous infant within 72 hours of amniocentesis. The probability of RDS was modeled using multivariate logistic regression with L/S ratio and gestational age as predictors. A total of 210 mother-neonate pairs (8 RDS, 202 non-RDS) met criteria for analysis. Both gestational age and L/S ratio were independent predictors of RDS. A probability of RDS of 3% or less was noted at an L/S ratio cutoff of ≥3.4 at 34 weeks, ≥2.6 at 36 weeks, ≥1.6 at 38 weeks, and ≥1.2 at term. Under 34 weeks of gestation, the prevalence of RDS was so high that a probability of 3% or less was not observed by this model. These data describe a means of stratifying the probability of neonatal RDS using both gestational age and the L/S ratio and may aid in clinical decision making concerning the timing of delivery. PMID:18773379

Multi-dose vitamin d supplementation in stable very preterm infants: Prospective randomized trial response to three different vitamin D supplementation doses.

PubMed

Bozkurt, Ozlem; Uras, Nurdan; Sari, Fatma Nur; Atay, Funda Yavanoglu; Sahin, Suzan; Alkan, Ayse Dogan; Canpolat, Fuat Emre; Oguz, Serife Suna

2017-09-01

Preterm newborns are born with lower vitamin D stores. Although vitamin D supplementation is recommended there is no consensus regarding the adequate dose of supplementation for preterm infants. To assess the effect of three different doses of vitamin D supplementation (400, 800 and 1000IU/d) in preterm infants ≤32weeks gestation on the prevalence of vitamin D deficiency and 25(OH) D levels at 36weeks postmenstrual age (PMA). Prospective randomized trial. 121 preterm infants with gestational age of 24-32weeks were randomly allocated to receive 400, 800 or 1000IU/d vitamin D. Serum concentration of 25(OH) D and the prevalence of vitamin D deficiency at 36weeks PMA. Vitamin D deficiency was defined as serum 25(OH) D concentrations <20ng/ml. Of the 121 infants 72% had deficient vitamin D levels before supplementation. The average 25(OH) vitamin D concentrations at 36weeks PMA were significantly higher in 800IU (40±21.4ng/ml) and 1000IU group (43±18.9ng/ml) when compared to 400IU group (29.4±13ng/ml). The prevalence of vitamin D deficiency (2.5 vs 22.5; RR: 0.09; CI:0.01-0.74) and insufficiency (30 vs 57.5; RR:0.32; CI:0.13-0.80) was significantly lower in 1000IU group when compared to 400IU group at 36weeks PMA. 1000IU/d of vitamin D supplementation in preterm infants ≤32weeks gestation age effectively decreases the prevalence of vitamin D deficiency and leads to higher concentrations of 25(OH) vitamin D at 36weeks PMA TRIAL REGISTRATION: Clinical Trials.gov: NCT02941185. Copyright © 2017. Published by Elsevier B.V.

Small for gestational age and exposure to particulate air pollution in the early-life environment of twins.

PubMed

Bijnens, Esmée M; Derom, Catherine; Gielen, Marij; Winckelmans, Ellen; Fierens, Frans; Vlietinck, Robert; Zeegers, Maurice P; Nawrot, Tim S

2016-07-01

Several studies in singletons have shown that maternal exposure to ambient air pollutants is associated with restricted fetal growth. About half of twins have low birth weight compared with six percent in singletons. So far, no studies have investigated maternal air pollution exposure in association with birth weight and small for gestational age in twins. We examined 4760 twins of the East Flanders Prospective Twins Survey (2002-2013), to study the association between in utero exposure to air pollution with birth weight and small for gestational age. Maternal particulate air pollution (PM10) and nitric dioxide (NO2) exposure was estimated using a spatial temporal interpolation method over various time windows during pregnancy. In the total group of twins, we observed that higher PM10 and NO2 exposure during the third trimester was significantly associated with a lower birth weight and higher risk of small for gestational age. However, the association was driven by moderate to late preterm twins (32-36 weeks of gestation). In these twins born between 32 and 36 weeks of gestation, birth weight decreased by 40.2g (95% CI: -69.0 to -11.3; p=0.006) and by 27.3g (95% CI: -52.9 to -1.7; p=0.04) in association for each 10µg/m³ increment in PM10 and NO2 concentration during the third trimester. The corresponding odds ratio for small for gestational age were 1.68 (95% CI: 1.27-2.33; p=0.0003) and 1.51 (95% CI: 1.18-1.95; p=0.001) for PM10 or NO2, respectively. No associations between air pollution and birth weight or small for gestational age were observed among term born twins. Finally, in all twins, we found that for each 10µg/m³ increase in PM10 during the last month of pregnancy the within-pair birth weight difference increased by 19.6g (95% CI: 3.7-35.4; p=0.02). Assuming causality, an achievement of a 10µg/m³ decrease of particulate air pollution may account for a reduction by 40% in small for gestational age, in twins born moderate to late preterm. Copyright © 2016 Elsevier Inc. All rights reserved.

Renal function and size at young adult age after intrauterine growth restriction and very premature birth.

PubMed

Keijzer-Veen, Mandy G; Kleinveld, Hilda A; Lequin, Maarten H; Dekker, Friedo W; Nauta, Jeroen; de Rijke, Yolanda B; van der Heijden, Bert J

2007-10-01

Premature birth and intrauterine growth restriction may increase the risk of developing renal disease at adult age. Renal function may already be impaired at young adult age. Cross-sectional study. Very premature individuals (gestational age < 32 weeks) recruited from Project on Premature and Small for Gestational Age Infants and full-term-born controls (37 to 42 weeks) recruited from a children's hospital in Rotterdam, The Netherlands. All individuals were 20 years of age at the time of study. Gestational age and birth weight: premature and small for gestational age (SGA; n = 23), premature and appropriate for gestational age (n = 29), and controls (n = 30). Glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and filtration fraction before and after renal stimulation with low-dose dopamine infusion and oral amino-acid intake. Urine albumin and renal ultrasound. Height, weight, kidney length and volume, GFR, and ERPF were significantly lower in the SGA group than in controls. After adjustment for body surface area, GFR did not differ significantly among groups. Mean ERPF was 71 mL/min/1.73 m(2) (95% confidence interval [CI], 3 to 139) less, but filtration fraction was only 1.3% (95% CI, -0.3 to 3.0) greater, in the SGA group than controls. Renal stimulation significantly increased GFR and ERPF and decreased filtration fraction in all groups. After renal stimulation, ERPF was 130 mL/min/1.73 m(2) (95% CI, 21 to 238) greater in the SGA group than controls, but GFR and filtration fraction did not differ significantly among groups. Microalbuminuria was present in 2 patients (8.7%) in the SGA group, but none in the appropriate-for-gestational-age group or controls. Renal function correlated with renal size. Small sample size. Our findings do not fully support the hypothesis that preterm birth in combination with intrauterine growth restriction contributes to renal function alterations at young adult age. Larger studies are needed to evaluate this hypothesis.

Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants?

PubMed

Lee, J; Spinazzola, R M; Kohn, N; Perrin, M; Milanaik, R L

2016-07-01

To assess the association between gestational age versus corrected age at the time of hip ultrasound with findings for developmental dysplasia of the hip (DDH) in preterm breech infants. A retrospective medical chart review was conducted to examine hip ultrasounds of 318 premature breech infants for findings associated with DDH. Positive findings for DDH occurred in 3/135 (2%) of infants <32 weeks gestational age and 17/183 (9%) of infants 32 to <37 weeks gestational age (odds ratio: 0.22, 95% CI: 0.04 to 0.79, P<0.015). No infants born <32 weeks gestational age had abnormal findings for DDH upon follow-up ultrasound. Infants <40 weeks corrected age at the time of hip ultrasound were more likely to have DDH findings compared with infants ⩾44 weeks corrected age (odds ratio: 7.83, 95% CI: 2.20 to 29.65, P<0.001). Current hip ultrasonography policies that include screening of premature breech infants may need to be revised.

Effect of gestating sow body condition, feed refusals, and group housing on growth and feed intake in grower-finishing pigs.

PubMed

Sell-Kubiak, E; van der Waaij, E H; Bijma, P

2013-08-01

The main focus of this study was to identify sow gestation features that affect growth rate (GR) and feed intake (FI) of their offspring during grower-finishing stage. Because the sow provides a specific environment to her offspring during gestation, certain features (e.g., BW of the sow), feed refusals or gestation group, may affect her ability to deliver and feed a healthy litter. Data on 17,743 grower-finishing pigs, coming from 604 sires and 681 crossbred sows, were obtained from the Institute for Pigs Genetics. Sow gestation features were collected during multiple gestations and divided into 3 clusters describing i) sow body condition (i.e., BW, backfat, and gestation length), ii) sow feed refusals (FR), the difference between offered and eaten feed during 3 periods of gestation: 1 to 28, 25 to 50, 45 to 80 d, and iii) sow group features (i.e., number of sows, and average parity). Sow gestation features were added to the base model 1 at a time to study their effect on GR and FI. Significant gestation features (P < 0.1) were fitted simultaneously in animal model to investigate whether they could explain common litter and permanent sow effects. Gestation length had effect on GR [1.4 (g/d)/d; P = 0.04] and FI [6.8 (g/d)/d; P = 0.007]. Body weights of the sow at insemination [0.07 (g/d)/kg; P = 0.08], at farrowing [0.14 (g/d)/kg; P < 0.0001], and after lactation [0.1 (g/d)/kg; P = 0.003] had effect on GR. Sow parturition-lactation loss in backfat thickness and weight were not significant for GR and FI. Days with FR during 25 to 50 and 45 to 80 d of gestation and average FR during 45 to 80 d of gestation had negative effect on GR and when substantially increased had also a positive effect on FI. Sow FR from 1 to 28 d of gestation were not significant. Number of sows in gestation group had effect on FI [-9 (g/d)/group member; P = 0.04] and day sow entered group had an effect on GR [-0.9 (g/d)/day; P = 0.04]. Sow gestation features explained 1 to 3% of the total variance in grower-finishing pigs. Gestation features did explain phenotypic variance due to permanent sow and part of phenotypic variance due to common litter effects for FI but not for GR.

Investigating maternal risk factors as potential targets of intervention to reduce socioeconomic inequality in small for gestational age: a population-based study.

PubMed

Hayward, Irene; Malcoe, Lorraine Halinka; Cleathero, Lesley A; Janssen, Patricia A; Lanphear, Bruce P; Hayes, Michael V; Mattman, Andre; Pampalon, Robert; Venners, Scott A

2012-06-13

The major aim of this study was to investigate whether maternal risk factors associated with socioeconomic status and small for gestational age (SGA) might be viable targets of interventions to reduce differential risk of SGA by socioeconomic status (socioeconomic SGA inequality) in the metropolitan area of Vancouver, Canada. This study included 59,039 live, singleton births in the Vancouver Census Metropolitan Area (Vancouver) from January 1, 2006 to September 17, 2009. To identify an indicator of socioeconomic SGA inequality, we used hierarchical logistic regression to model SGA by area-level variables from the Canadian census. We then modelled SGA by area-level average income plus established maternal risk factors for SGA and calculated population attributable SGA risk percentages (PAR%) for each variable. Associations of maternal risk factors for SGA with average income were investigated to identify those that might contribute to SGA inequality. Finally, we estimated crude reductions in the percentage and absolute differences in SGA risks between highest and lowest average income quintiles that would result if interventions on maternal risk factors successfully equalized them across income levels or eliminated them altogether. Average income produced the most linear and statistically significant indicator of socioeconomic SGA inequality with 8.9% prevalence of SGA in the lowest income quintile compared to 5.6% in the highest. The adjusted PAR% of SGA for variables were: bottom four quintiles of height (51%), first birth (32%), bottom four quintiles of average income (14%), oligohydramnios (7%), underweight or hypertension, (6% each), smoking (3%) and placental disorder (1%). Shorter height, underweight and smoking during pregnancy had higher prevalence in lower income groups. Crude models assuming equalization of risk factors across income levels or elimination altogether indicated little potential change in relative socioeconomic SGA inequality and reduction in absolute SGA inequality for shorter height only. Our findings regarding maternal height may indicate trans-generational aetiology for socioeconomic SGA inequalities and/or that adult height influences social mobility. Conditions affecting foetal and childhood growth might be viable targets to reduce absolute socioeconomic SGA inequality in future generations, but more research is needed to determine whether such an approach is appropriate.

Gestational syphilis and stillbirth in Latin America and the Caribbean.

PubMed

Arnesen, Lauren; Martínez, Gerardo; Mainero, Luis; Serruya, Suzanne; Durán, Pablo

2015-03-01

To measure the association between gestational syphilis and stillbirth in Latin America and the Caribbean. In a retrospective study, data on stillbirth and gestational syphilis extracted from the Sistema Informático Perinatal database were analyzed for deliveries in 11 countries between January 1, 2009, and December 31, 2012. Potential confounders were examined, and binary logistic regression analysis was performed to assess the association between gestational syphilis and stillbirth. Among 368 151 deliveries, 3875 (1.1%) were by women with a positive syphilis test, and 1461 (0.4%) were stillbirths. Among the stillbirths, 29 (2.0%) were delivered by women with a positive syphilis test. After controlling for country, congenital anomalies, gestational age at labor, maternal age, and previous stillbirth, gestational syphilis was significantly associated with stillbirth (odds ratio 1.88, 95% confidence interval 1.25-2.83; P=0.002). Gestational syphilis contributes to stillbirth in Latin America and the Caribbean. Interventions targeting gestational syphilis are highly cost-effective and should be implemented across the region. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Recent Declines in Induction of Labor by Gestational Age

MedlinePlus

... Individual live birth in a singleton (one fetus) pregnancy. Singleton induction rate : Number of labor inductions for singleton births per 100 singleton births. Gestational age categories : Early preterm: Births prior to 34 completed weeks of ...

Perinatal mortality by gestational week and size at birth in singleton pregnancies at and beyond term: a nationwide population-based cohort study

PubMed Central

2014-01-01

Background Whether gestational age per se increases perinatal mortality in post-term pregnancy is unclear. We aimed at assessing gestational week specific perinatal mortality in small-for-gestational-age (SGA) and non-SGA term and post-term gestations, and specifically to evaluate whether the relation between post-term gestation and perinatal mortality differed before and after ultrasound was introduced as the standard method of gestational age estimation. Methods A population-based cohort study, using data from the Medical Birth Registry of Norway (MBRN), 1967–2006, was designed. Singleton births at 37 through 44 gestational weeks (n = 1 855 682), excluding preeclampsia, diabetes and fetal anomalies, were included. Odds ratios (OR) with 95% confidence intervals (CI) for perinatal mortality and stillbirth in SGA and non-SGA births by gestational week were calculated. Results SGA infants judged post-term by LMP had significantly higher perinatal mortality than post-term non-SGA infants at 40 weeks, independent of time period (highest during 1999–2006 [OR 9.8, 95% CI: 5.7-17.0]). When comparing years before (1967–1986) versus after (1987–2006) ultrasound was introduced, there was no decrease in the excess mortality for post-term SGA versus non-SGA births (ORs from 6.1 [95% CI: 5.2-7.1] to 6.7 [5.2-8.5]), while mortality at 40 weeks decreased significantly (ORs from 4.6, [4.0-5.3] to 3.2 [2.5-3.9]). When assessing stillbirth risk (1999–2006), more than 40% of SGA stillbirths (11/26) judged to be ≥41 weeks by LMP were shifted to lower gestational ages using ultrasound estimation. Conclusions Mortality risk in post-term infants was strongly associated with growth restriction. Such infants may erroneously be judged younger than they are when using ultrasound estimation, so that the routine assessment for fetal wellbeing in the prolonged gestation may be given too late. PMID:24885576

Nonresponse to 17-alpha hydroxyprogesterone caproate for recurrent spontaneous preterm birth prevention: clinical prediction and generation of a risk scoring system.

PubMed

Manuck, Tracy A; Stoddard, Gregory J; Fry, Rebecca C; Esplin, M Sean; Varner, Michael W

2016-11-01

Spontaneous preterm birth remains a leading cause of neonatal morbidity and mortality among nonanomalous neonates in the United States. Spontaneous preterm birth tends to recur at similar gestational ages. Intramuscular 17-alpha hydroxyprogesterone caproate reduces the risk of recurrent spontaneous preterm birth. Unfortunately, one-third of high-risk women will have a recurrent spontaneous preterm birth despite 17-alpha hydroxyprogesterone caproate therapy; the reasons for this variability in response are unknown. We hypothesized that clinical factors among women treated with 17-alpha hydroxyprogesterone caproate who suffer recurrent spontaneous preterm birth at a similar gestational age differ from women who deliver later, and that these associations could be used to generate a clinical scoring system to predict 17-alpha hydroxyprogesterone caproate response. Secondary analysis of a prospective, multicenter, randomized controlled trial enrolling women with ≥1 previous singleton spontaneous preterm birth <37 weeks' gestation. Participants received daily omega-3 supplementation or placebo for the prevention of recurrent preterm birth; all were provided 17-alpha hydroxyprogesterone caproate. Women were classified as a 17-alpha hydroxyprogesterone caproate responder or nonresponder by calculating the difference in delivery gestational age between the 17-alpha hydroxyprogesterone caproate-treated pregnancy and her earliest previous spontaneous preterm birth. Responders were women with pregnancy extending ≥3 weeks later compared with the delivery gestational age of their earliest previous preterm birth; nonresponders delivered earlier or within 3 weeks of the gestational age of their earliest previous preterm birth. A risk score for nonresponse to 17-alpha hydroxyprogesterone caproate was generated from regression models via the use of clinical predictors and was validated in an independent population. Data were analyzed with multivariable logistic regression. A total of 754 women met inclusion criteria; 159 (21%) were nonresponders. Responders delivered later on average (37.7±2.5 weeks) than nonresponders (31.5±5.3 weeks), P<.001. Among responders, 27% had a recurrent spontaneous preterm birth (vs 100% of nonresponders). Demographic characteristics were similar between responders and nonresponders. In a multivariable logistic regression model, independent risk factors for nonresponse to 17-alpha hydroxyprogesterone caproate were each additional week of gestation of the earliest previous preterm birth (odds ratio, 1.23; 95% confidence interval, 1.17-1.30, P<.001), placental abruption or significant vaginal bleeding (odds ratio, 5.60; 95% confidence interval, 2.46-12.71, P<.001), gonorrhea and/or chlamydia in the current pregnancy (odds ratio, 3.59; 95% confidence interval, 1.36-9.48, P=.010), carriage of a male fetus (odds ratio, 1.51; 95% confidence interval, 1.02-2.24, P=.040), and a penultimate preterm birth (odds ratio, 2.10; 95% confidence interval, 1.03-4.25, P=.041). These clinical factors were used to generate a risk score for nonresponse to 17-alpha hydroxyprogesterone caproate as follows: black +1, male fetus +1, penultimate preterm birth +2, gonorrhea/chlamydia +4, placental abruption +5, earliest previous preterm birth was 32-36 weeks +5. A total risk score >6 was 78% sensitive and 60% specific for predicting nonresponse to 17-alpha hydroxyprogesterone caproate (area under the curve=0.69). This scoring system was validated in an independent population of 287 women; in the validation set, a total risk score >6 performed similarly with a 65% sensitivity, 67% specificity and area under the curve of 0.66. Several clinical characteristics define women at risk for recurrent preterm birth at a similar gestational age despite 17-alpha hydroxyprogesterone caproate therapy and can be used to generate a clinical risk predictor score. These data should be refined and confirmed in other cohorts, and women at high risk for nonresponse should be targets for novel therapeutic intervention studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Association between hyperglycaemia and adverse perinatal outcomes in south Asian and white British women: analysis of data from the Born in Bradford cohort.

PubMed

Farrar, Diane; Fairley, Lesley; Santorelli, Gillian; Tuffnell, Derek; Sheldon, Trevor A; Wright, John; van Overveld, Lydia; Lawlor, Debbie A

2015-10-01

Diagnosis of gestational diabetes predicts risk of infants who are large for gestational age (LGA) and with high adiposity, which in turn aims to predict a future risk of obesity in the offspring. South Asian women have higher risk of gestational diabetes, lower risk of LGA, and on average give birth to infants with greater adiposity than do white European women. Whether the same diagnostic criteria for gestational diabetes should apply to both groups of women is unclear. We aimed to assess the association between maternal glucose and adverse perinatal outcomes to ascertain whether thresholds used to diagnose gestational diabetes should differ between south Asian and white British women. We also aimed to assess whether ethnic origin affected prevalence of gestational diabetes irrespective of criteria used. We used data (including results of a 26-28 week gestation oral glucose tolerance test) of women from the Born in Bradford study, a prospective study that recruited women attending the antenatal clinic at the Bradford Royal Infirmary, UK, between 2007 and 2011 and who intended to give birth to their infant in that hospital. We studied the association between fasting and 2 h post-load glucose and three primary outcomes (LGA [defined as birthweight >90th percentile for gestational age], high infant adiposity [sum of skinfolds >90th percentile for gestational age], and caesarean section). We calculated adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) for a 1 SD increase in fasting and post-load glucose. We established fasting and post-load glucose thresholds that equated to an OR of 1·75 for LGA and high infant adiposity in each group of women to identify ethnic-specific criteria for diagnosis of gestational diabetes. Of 13,773 pregnancies, 3420 were excluded from analyses. Of 10,353 eligible pregnancies, 4088 women were white British, 5408 were south Asian, and 857 were of other ethnic origin. The adjusted ORs of LGA per 1 SD fasting glucose were 1·22 (95% CI 1·08-1·38) in white British women and 1·43 (1·23-1·67) in south Asian women (pinteraction with ethnicity = 0·39). Results for high infant adiposity were 1·35 (1·23-1·49) and 1·35 (1·18-1·54; pinteraction with ethnicity=0·98), and for caesarean section they were 1·06 (0·97-1·16) and 1·11 (1·02-1·20; pinteraction with ethnicity=0·47). Associations between post-load glucose and the three primary outcomes were weaker than for fasting glucose. A fasting glucose concentration of 5·4 mmol/L or a 2 h post-load level of 7·5 mmol/L identified white British women with 75% or higher relative risk of LGA or high infant adiposity; in south Asian women, the cutoffs were 5·2 mmol/L or 7·2 mml/L; in the whole cohort, the cutoffs were 5·3 mmol/L or 7·5 mml/L. The prevalence of gestational diabetes in our cohort ranged from 1·2% to 8·7% in white British women and 4% to 24% in south Asian women using six different criteria. Compared with the application of our whole-cohort criteria, use of our ethnic-specific criteria increased the prevalence of gestational diabetes in south Asian women from 17·4% (95% CI 16·4-18·4) to 24·2% (23·1-25·3). Our data support the use of lower fasting and post-load glucose thresholds to diagnose gestational diabetes in south Asian than white British women. They also suggest that diagnostic criteria for gestational diabetes recommended by UK NICE might underestimate the prevalence of gestational diabetes compared with our criteria or those recommended by the International Association of Diabetes and Pregnancy Study Groups and WHO, especially in south Asian women. The National Institute for Health Research. Copyright © 2015 Farrar et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Association between hyperglycaemia and adverse perinatal outcomes in south Asian and white British women: analysis of data from the Born in Bradford cohort

PubMed Central

Farrar, Diane; Fairley, Lesley; Santorelli, Gillian; Tuffnell, Derek; Sheldon, Trevor A; Wright, John; van Overveld, Lydia; Lawlor, Debbie A

2015-01-01

Summary Background Diagnosis of gestational diabetes predicts risk of infants who are large for gestational age (LGA) and with high adiposity, which in turn aims to predict a future risk of obesity in the offspring. South Asian women have higher risk of gestational diabetes, lower risk of LGA, and on average give birth to infants with greater adiposity than do white European women. Whether the same diagnostic criteria for gestational diabetes should apply to both groups of women is unclear. We aimed to assess the association between maternal glucose and adverse perinatal outcomes to ascertain whether thresholds used to diagnose gestational diabetes should differ between south Asian and white British women. We also aimed to assess whether ethnic origin affected prevalence of gestational diabetes irrespective of criteria used. Methods We used data (including results of a 26–28 week gestation oral glucose tolerance test) of women from the Born in Bradford study, a prospective study that recruited women attending the antenatal clinic at the Bradford Royal Infirmary, UK, between 2007 and 2011 and who intended to give birth to their infant in that hospital. We studied the association between fasting and 2 h post-load glucose and three primary outcomes (LGA [defined as birthweight >90th percentile for gestational age], high infant adiposity [sum of skinfolds >90th percentile for gestational age], and caesarean section). We calculated adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) for a 1 SD increase in fasting and post-load glucose. We established fasting and post-load glucose thresholds that equated to an OR of 1·75 for LGA and high infant adiposity in each group of women to identify ethnic-specific criteria for diagnosis of gestational diabetes. Findings Of 13 773 pregnancies, 3420 were excluded from analyses. Of 10 353 eligible pregnancies, 4088 women were white British, 5408 were south Asian, and 857 were of other ethnic origin. The adjusted ORs of LGA per 1 SD fasting glucose were 1·22 (95% CI 1·08–1·38) in white British women and 1·43 (1·23–1·67) in south Asian women (pinteraction with ethnicity = 0·39). Results for high infant adiposity were 1·35 (1·23–1·49) and 1·35 (1·18–1·54; pinteraction with ethnicity=0·98), and for caesarean section they were 1·06 (0·97–1·16) and 1·11 (1·02–1·20; pinteraction with ethnicity=0·47). Associations between post-load glucose and the three primary outcomes were weaker than for fasting glucose. A fasting glucose concentration of 5·4 mmol/L or a 2 h post-load level of 7·5 mmol/L identified white British women with 75% or higher relative risk of LGA or high infant adiposity; in south Asian women, the cutoffs were 5·2 mmol/L or 7·2 mml/L; in the whole cohort, the cutoffs were 5·3 mmol/L or 7·5 mml/L. The prevalence of gestational diabetes in our cohort ranged from 1·2% to 8·7% in white British women and 4% to 24% in south Asian women using six different criteria. Compared with the application of our whole-cohort criteria, use of our ethnic-specific criteria increased the prevalence of gestational diabetes in south Asian women from 17·4% (95% CI 16·4–18·4) to 24·2% (23·1–25·3). Interpretation Our data support the use of lower fasting and post-load glucose thresholds to diagnose gestational diabetes in south Asian than white British women. They also suggest that diagnostic criteria for gestational diabetes recommended by UK NICE might underestimate the prevalence of gestational diabetes compared with our criteria or those recommended by the International Association of Diabetes and Pregnancy Study Groups and WHO, especially in south Asian women. Funding The National Institute for Health Research. PMID:26355010

Cardiovascular risk factors and carotid intima media thickness in young adults born small for gestational age after cessation of growth hormone treatment: a 5-year longitudinal study.

PubMed

van der Steen, Manouk; Kerkhof, Gerthe F; Smeets, Carolina C J; Hokken-Koelega, Anita C S

2017-12-01

Growth hormone treatment reduces blood pressure and lipid concentrations. We assessed long-term changes in blood pressure, lipid concentrations, and carotid intima media thickness over a 5-year period after cessation of growth hormone treatment in adults born small for gestational age. We did a longitudinal observational study at a medical centre in the Netherlands between April 1, 2004, and April 1, 2016. We included adults born small for gestational age who were treated with growth hormone (1 mg/m 2 per day); treatment started during childhood until adult height. Participants were evaluated at cessation of treatment, and 6 months, 2 years, and 5 years later. We compared cardiovascular risk factors with untreated controls from the PROGRAM study. We included 199 participants born small for gestational age and treated with growth hormone along with 285 controls: 51 untreated short adults born small for gestational age, 92 untreated adults born small for gestational age with spontaneous catch-up growth, and 142 adults born appropriate for gestational age. In the 6 months after treatment cessation, systolic blood pressure increased temporarily from 113·00 mm Hg (95% CI 111·18-114·82) to 116·92 mm Hg (115·07 to 118·77; p<0·001) and diastolic blood pressure increased temporarily from 62·19 mm Hg (60·99-63·38) to 66·51 mm Hg (65·14-67·89; p<0·001). At 5 years after treatment cessation, mean systolic blood pressure was 109·2 mm Hg (105·5-113·0) and mean diastolic blood pressure was 63·4 mm Hg (60·9-65·9), similar to the values at cessation. Lipid concentrations were non-significantly higher 5 years after treatment cessation (p values 0·09-0·21) than at treatment cessation. Cessation of growth hormone had no effect on carotid intima media thickness. At 5 years after cessation, total cholesterol was lower in adults treated with growth hormone (mean 4·21 mmol/L, 95% CI 4·04-4·38) than in untreated short adults born small for gestational age (4·66 mmol/L, 4·42-4·92; p=0·0030), as was mean LDL cholesterol (2·28 mmol/L, 2·14-2·43 vs 2·85 mmol/L, 2·62-3·10; p<0·0001); blood pressure and carotid intima media thickness did not differ between these two groups (p values >0·12). At 5 years after cessation, systolic blood pressure, diastolic blood pressure, lipid concentrations, and carotid intima media thickness of adults treated with growth hormone were not different to those in adults born small for gestational age who had spontaneous catch-up growth or adults born appropriate for gestational age. Long-term growth hormone treatment in children born small for gestational age has no unfavourable effects on cardiovascular health in early adulthood and improves lipid profiles. Novo Nordisk (Netherlands). Copyright © 2017 Elsevier Ltd. All rights reserved.

Relationship between hyperemesis gravidarum and small-for-gestational-age in the Japanese population: the Japan Environment and Children's Study (JECS).

PubMed

Morokuma, Seiichi; Shimokawa, Mototsugu; Kato, Kiyoko; Sanefuji, Masafumi; Shibata, Eiji; Tsuji, Mayumi; Senju, Ayako; Kawamoto, Toshihiro; Kusuhara, Koichi

2016-08-26

Small-for-gestational-age in infancy is a known risk factor not only for short-term prognosis but also for several long-term outcomes, such as neurological and metabolic disorders in adulthood. Previous research has shown that severe nausea and vomiting in early pregnancy (NVP) and hyperemesis gravidarum, which is an extreme form of NVP, represent risk factors for small-for-gestational-age birth. However, there is no clear consensus on this association. Thus, in the present study, we investigated the correlation between hyperemesis gravidarum and NVP on the one hand, and infant birth weight on the other, using data from the Japan Environment and Children's Study (JECS). The data utilized in the present study were obtained from the JECS, an ongoing cohort study that began in January 2011. Our sample size was 8635 parent-child pairs. The presence or absence of severe NVP, hyperemesis gravidarum, and potential confounding factors were noted. A multivariable regression analysis was used to estimate risks for small-for-gestational-age birth, and the results were expressed as risk ratios and 95 % confidence intervals. The risk ratios of small-for-gestational-age birth (95 % confidence interval) for mothers with severe NVP and those with hyperemesis gravidarum were 0.86 (0.62-1.19) and 0.81 (0.39-1.66), respectively, which represents a non-significant result. In our analysis of JECS data, neither severe NVP nor hyperemesis gravidarum was associated with increased risk for small-for-gestational-age birth.

Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth.

PubMed

Suri, Rita; Altshuler, Lori; Hellemann, Gerhard; Burt, Vivien K; Aquino, Ana; Mintz, Jim

2007-08-01

The authors evaluated the effects of prenatal antidepressant exposure and maternal depression on infant gestational age at birth and risk of preterm birth. Ninety women were followed in a prospective, naturalistic design through pregnancy with monthly assessments of symptoms of depression and anxiety using the Structured Clinical Interview for DSM-IV mood module for depression, the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Perceived Stress Scale. Participants included 49 women with major depressive disorder who were treated with antidepressants during pregnancy (group 1), 22 women with major depressive disorder who were either not treated with antidepressants or had limited exposure to them during pregnancy (group 2), and 19 healthy comparison subjects (group 3). The primary outcome variables were the infants' gestational age at birth, birth weight, 1- and 5-minute Apgar scores, and admission to the special care nursery. Groups 1, 2, and 3 differed significantly in gestational age at birth (38.5 weeks, 39.4 weeks, 39.7 weeks, respectively), rates of preterm birth (14.3%, 0%, 5.3%, respectively), and rates of admission to the special care nursery (21%, 9%, 0%, respectively). Birth weight and Apgar scores did not differ significantly between groups. Mild to moderate depression during pregnancy did not affect outcome measures. Prenatal antidepressant use was associated with lower gestational age at birth and an increased risk of preterm birth. Presence of depressive symptoms was not associated with this risk. These results suggest that medication status, rather than depression, is a predictor of gestational age at birth.

Natural progress of blood glucose in full-term low-grade low-birthweight infants.

PubMed

Ishikawa, Norio

2002-12-01

Although various authors have suggested the risk of hypoglycemia in practical medicine for low-birthweight infants is exaggerated, convincing evidence using recent definitions of hypoglycemia is not documented. To evaluate the risk of hypoglycemia in low grade low-birthweight infants (LGLBWI) (2100 g < birthweight < 2500 g) whose only abnormality is low-birthweight, whole blood glucose (BGw) was measured five times (0, 0.5, 1, and 4 h after birth and just before the first bottle feeding) in 49 LGLBWI and 38 normal birthweight infants. Whole blood glucose was not lower in LGLBWI with a gestational age of 38-40 weeks (GT38LGLBWI) than in normal birthweight individuals with a gestational age of 38-40 weeks at each of the five measuring times. No case of GT38LGLBWI, not even in small for gestational age infants, required treatment for hypoglycemia. The BGw was significantly lower in 37-week gestational age LGLBWI than in GT38LGLBWI at 0.5 h and 1 h after birth (P < 0.05). However, in all cases with low BGw value (below 30 mg/dL at 1 h after birth), BGw value increased naturally to the normal level 1.5 h after birth. No symptoms of hypoglycemia were observed. In the care of hypoglycemia in LGLBWI, attention should be paid first to gestational age, namely, tendency to prematurity. In this study, however, no hypoglycemia that required treatment was found among full-term normal LGLBWI, even those who were small for gestational age. Frequent blood glucose measurement for those infants is therefore unnecessary.

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Ganchimeg, Togoobaatar; Nagata, Chie; Vogel, Joshua P; Morisaki, Naho; Pileggi-Castro, Cynthia; Ortiz-Panozo, Eduardo; Jayaratne, Kapila; Mittal, Suneeta; Ota, Erika; Souza, João Paulo; Mori, Rintaro

2016-01-01

To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries. Secondary analysis of a cross-sectional study. Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health. 29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour. We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age. Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality. Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age. Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.

Mortality of mothers from cardiovascular and non-cardiovascular causes following pregnancy complications in first delivery.

PubMed

Lykke, Jacob A; Langhoff-Roos, Jens; Lockwood, Charles J; Triche, Elizabeth W; Paidas, Michael J

2010-07-01

The combined effects of preterm delivery, small-for-gestational-age offspring, hypertensive disorders of pregnancy, placental abruption and stillbirth on early maternal death from cardiovascular causes have not previously been described in a large cohort. We investigated the effects of pregnancy complications on early maternal death in a registry-based retrospective cohort study of 782 287 women with a first singleton delivery in Denmark 1978-2007, followed for a median of 14.8 years (range 0.25-30.2) accruing 11.6 million person-years. We employed Cox proportional hazard models of early death from cardiovascular and non-cardiovascular causes following preterm delivery, small-for-gestational-age offspring and hypertensive disorders of pregnancy. We found that preterm delivery and small-for-gestational-age were both associated with subsequent death of mothers from cardiovascular and non-cardiovascular causes. Severe pre-eclampsia was associated with death from cardiovascular causes only. There was a less than additive effect on cardiovascular mortality hazard ratios with increasing number of pregnancy complications: preterm delivery 1.90 [95% confidence intervals 1.49, 2.43]; preterm delivery and small-for-gestational-age offspring 3.30 [2.25, 4.84]; preterm delivery, small-for-gestational-age offspring and pre-eclampsia 3.85 [2.07, 7.19]. Thus, we conclude that, separately and combined, preterm delivery and small-for-gestational-age are strong markers of early maternal death from both cardiovascular and non-cardiovascular causes, while hypertensive disorders of pregnancy are markers of early death of mothers from cardiovascular causes.

Cell population data in neonates: differences by age group and associations with perinatal factors.

PubMed

Lee, J; Kim, S Y; Lee, W; Han, K; Sung, I K

2015-10-01

Cell population data (CPD) describe physical parameters of white blood cell subpopulations and are reported to be of some value in the diagnosis of sepsis in neonates. Before using the CPD for diagnosing sepsis, the baseline features of the CPD distribution in healthy neonates should be clarified. The aim of this study was to compare the CPD distributions of healthy neonates and other age groups and to identify perinatal factors that are associated with changes in the CPD distribution of healthy neonates. The CPD distribution of 69 samples from term neonates was compared with adolescents and adults. The CPD distribution of 163 samples from healthy neonates was analyzed in association with perinatal factors, including gestational age, chronologic age, birthweight, delivery mode, premature rupture of membranes, diabetes, and pregnancy-induced hypertension. The CPD distribution for term neonates was significantly different from those in adolescents and adults. The mean lymphocyte volume showed a negative correlation with gestational age at birth (r = -0.305; P < 0.01). The mean neutrophil volume was smaller in the cesarean section group than in the normal delivery group. The small for gestational age (SGA) group had smaller mean neutrophil volume and mean monocyte volume than the appropriate for gestational age group. The CPD distribution of healthy neonates differed from those of adolescents or adults, and the differences were associated with gestational age, delivery mode, and being SGA. © 2015 John Wiley & Sons Ltd.

Birth weight and gestational age characteristics of children with autism, including a comparison with other developmental disabilities.

PubMed

Schendel, Diana; Bhasin, Tanya Karapurkar

2008-06-01

The objectives of this study were to compare the birth weight and gestational age distributions and prevalence rates of autism with those of other developmental disabilities and to estimate the birth weight-and gestational age-specific risks for autism. For the first objective, a retrospective cohort of children born in Atlanta, Georgia, in 1981-1993 who survived to 3 years of age was identified through vital records. Children in the cohort who had developmental disabilities (autism, mental retardation, cerebral palsy, hearing loss, or vision impairment) and were still residing in metropolitan Atlanta at 3 to 10 years of age were identified through the Metropolitan Atlanta Developmental Disabilities Surveillance Program. A nested case-control sample from the cohort was used for the second objective; all cohort children identified with autism were case participants, and control participants were cohort children who were not identified as having developmental disabilities or receiving special education services. The prevalence of autism in low birth weight or preterm children was markedly lower than those of other developmental disabilities. In multivariate analyses, birth weight of <2500 g and preterm birth at <33 weeks' gestation were associated with an approximately twofold increased risk for autism, although the magnitude of risk from these factors varied according to gender (higher in girls) and autism subgroup (higher for autism accompanied by other developmental disabilities). For example, a significant fourfold increased risk was observed in low birth weight girls for autism accompanied by mental retardation, whereas there was no significantly increased risk observed in low birth weight boys for autism alone. Gender and autism subgroup differences in birth weight and gestational age, resulting in lower gender ratios with declining birth weight or gestational age across all autism subgroups, might be markers for etiologic heterogeneity in autism.

Sonographic study of the development of fetal corpus callosum in a Chinese population.

PubMed

Zhang, Hai-chun; Yang, Jie; Chen, Zhong-ping; Ma, Xiao-yan

2009-02-01

The observation of fetal corpus callosum (CC) is important for the prenatal sonographic assessment of fetal central nervous system development. The aim of this study was to investigate the development of normal Chinese fetal CC. CC measurements were performed using high-resolution transabdominal sonography on 622 Chinese fetuses between 16 and 39 weeks' gestation. The correlation between CC size and gestational age was investigated. The fetal CC length increased in a linear fashion during pregnancy. The length of the CC as a function of gestational age was expressed by the following regression equation: length (mm) = -9.567 + 1.495 x gestational age (weeks) (r = 0.932, p < 0.001). Knowledge of normal CC appearance may help identify developmental anomalies and enable accurate prenatal counseling. (c) 2008 Wiley Periodicals, Inc.

Trends and differentials in higher-birthweight infants at 28-31 weeks of gestation, by race and Hispanic origin, United States, 1990-2002.

PubMed

Kirmeyer, Sharon E W; Martin, Joyce A

2007-09-01

Birth certificate gestational age data based on the date of the mother's last menstrual period (LMP) are considered problematic. Of particular concern are birthweight distributions for infants reported on the birth certificate as having been delivered at 28-31 weeks' gestation; these distributions have been shown to be distinctly bimodal. The 'second curve' of the birthweight distribution at 28-31 weeks includes implausible birthweight/gestational age combinations and, thus, has been hypothesised to represent erroneous gestational ages due to misidentification of the date of LMP. It has been suggested that such 'misclassification' has declined in recent years and that this change can affect trends in preterm birth rates (<37 weeks' gestation), particularly rates among non-Hispanic black infants. This present study used primarily simple and multivariable analyses to review trends and differentials in birthweight distributions at 28-31 weeks by race and Hispanic origin of the mother. It aggregated data for the years 1990-92 and 2000-02 from the US vital statistics Natality files. Over the decade, the percentage of births in the second curve declined for all births and for each racial and Hispanic origin group studied. The largest decline was observed for non-Hispanic blacks; the smallest for Hispanic births. Later initiation of prenatal care, younger maternal age, lower educational attainment, higher birth order and vaginal and singleton delivery were positively associated with a larger second curve, suggesting misclassification of gestational age. Declines in the second curve over the study period were suggested to contribute significantly to the observed decrease in overall preterm birth rates for non-Hispanic black births. Further analysis is needed to estimate the influence of reporting error on preterm birth rates by race and Hispanic origin.

Maternal and placental risk factors for light-for-gestational-age births.

PubMed

Aoyama, Keiko; Endo, Toshiaki; Saito, Tsuyoshi; Izumi, Hisako; Asakura, Sumiyo; Mori, Mitsuru

2016-07-01

We conducted a cross-sectional study to investigate risk factors for births of light-for-gestational-age (LGA) infants. A survey was conducted at the Department of Obstetrics and Gynecology at Sapporo Medical University Hospital in Sapporo, Japan from 2013 to 2014. LGA and appropriate for gestational age (AGA) are defined as having a birthweight below the 10th percentile and between the 10th percentile and 90th percentile for gestational age at birth in the population standard of gestational age, sex, and parity, respectively. An odds ratio (OR) and its 95% confidence interval (95%CI) for LGA were calculated by analysis using the logistic regression model. In total, 307 inpatients (94.2%) participated in the study out of 326 consecutive post-partum inpatients. Among them, 37 infants and 237 infants were classified into the LGA and AGA groups, respectively. As a result of multivariable analysis, prevalence of gestational hypertension (OR = 8.96, 95%CI 1.81-44.35) and the presence of placental infarction (OR = 9.65, 95%CI 1.76-53.01) were significantly associated with an increased risk of LGA. Placentas weighing 510-603 g and ≥604 g were significantly associated with reduced risk of LGA (OR = 0.04, 95%CI 0.01-0.29 and OR = 0.03, 95%CI 0.01-0.32, respectively), and higher placental weights were significantly observed in the trend for reduced LGA risk (P for trend < 0.001). We found that the prevalence of gestational hypertension, lower placental weight, and the presence of placental infarctions were all independently associated with the risk of LGA. Placental abnormalities may be etiologically important for LGA risk, though further research is necessary. © 2016 Japan Society of Obstetrics and Gynecology.

Paracervical block for pain control in first-trimester surgical abortion: a randomized controlled trial.

PubMed

Renner, Regina-Maria; Nichols, Mark D; Jensen, Jeffrey T; Li, Hong; Edelman, Alison B

2012-05-01

Despite lack of efficacy data, the majority of first-trimester surgical abortions are performed with a paracervical block. Women may be unnecessarily exposed to a painful injection and potentially noxious medication. Our objective was to estimate the effect of a paracervical block and the effect of gestational age on patient pain perception. This was a randomized, single-blind trial of patients undergoing abortion receiving paracervical block or sham stratified by gestational age (early: less than 8 weeks of gestation, n=60; late: 8-10 6/7 weeks of gestation, n=60). Premedicated with ibuprofen and lorazepam, all participants received 2 mL 1% buffered lidocaine injected at the tenaculum site followed by a slow, deep injection of 18 mL at four sites (block) or no injection (sham) with a 3-minute wait. The primary outcome was dilation pain (100-mm visual analog scale). Secondary outcomes included pain at additional time points, satisfaction, need for more analgesics, and adverse events. Full enrollment occurred (n=120). We used intent-to-treat analysis. Demographics did not differ between groups. Paracervical block administration was painful (mean 55 mm compared with sham 30 mm, P<.001) but decreased dilation pain (42 mm compared with 79 mm, P<.001) and aspiration pain (63mm compared with 89 mm, P<.001). These results were consistent for both gestational age strata; however, paracervical block benefit was greater at an earlier gestation. Satisfaction scores with pain control and the procedure were significantly higher in the block group. Although paracervical block is painful, it reduces first-trimester abortion pain regardless of gestational age, but the benefit on dilation pain was greater at earlier gestations. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094366. I.

Caesarean section and risk of autism across gestational age: a multi-national cohort study of 5 million births.

PubMed

Yip, Benjamin Hon Kei; Leonard, Helen; Stock, Sarah; Stoltenberg, Camilla; Francis, Richard W; Gissler, Mika; Gross, Raz; Schendel, Diana; Sandin, Sven

2017-04-01

The positive association between caesarean section (CS) and autism spectrum disorder (ASD) may be attributed to preterm delivery. However, due to lack of statistical power, no previous study thoroughly examined this association across gestational age. Moreover, most studies did not differentiate between emergency and planned CS. Using population-based registries of four Nordic countries and Western Australia, our study population included 4 987 390 singletons surviving their first year of life, which included 671 646 CS deliveries and 31 073 ASD children. We used logistic regression to estimate odds ratios (OR) and their 95% confidence intervals (CI) for CS, adjusted for gestational age, site, maternal age and birth year. Stratified analyses were conducted by both gestational age subgroups and by week of gestation. We compared emergency versus planned CS to investigate their potential difference in the risk of ASD. Compared with vaginal delivery, the overall adjusted OR for ASD in CS delivery was 1.26 (95% CI 1.22-1.30). Stratified ORs were 1.25 (1.15-1.37), 1.16 (1.09-1.23), 1.34 (1.28-1.40) and 1.17 (1.04-1.30) for subgroups of gestational weeks 26-36, 37-38, 39-41 and 42-44, respectively. CS was significantly associated with risk of ASD for each week of gestation, from week 36 to 42, consistently across study sites (OR ranged 1.16-1.38). There was no statistically significant difference between emergency and planned CS in the risk of ASD. Across the five countries, emergency or planned CS is consistently associated with a modest increased risk of ASD from gestational weeks 36 to 42 when compared with vaginal delivery. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Translating HbA1c measurements into estimated average glucose values in pregnant women with diabetes.

PubMed

Law, Graham R; Gilthorpe, Mark S; Secher, Anna L; Temple, Rosemary; Bilous, Rudolf; Mathiesen, Elisabeth R; Murphy, Helen R; Scott, Eleanor M

2017-04-01

This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA 1c levels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA 1c measurements are applicable to pregnant women with diabetes. CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed. Average glucose levels were calculated from 5-7 day CGM profiles (mean 1275 glucose values per profile) and paired with a corresponding (±1 week) HbA 1c measure. In total, 688 average glucose-HbA 1c pairs were obtained across pregnancy (mean six pairs per participant). Average glucose level was used as the dependent variable in a regression model. Covariates were gestational week, study centre and HbA 1c . There was a strong association between HbA 1c and average glucose values in pregnancy (coefficient 0.67 [95% CI 0.57, 0.78]), i.e. a 1% (11 mmol/mol) difference in HbA 1c corresponded to a 0.67 mmol/l difference in average glucose. The random effects model that included gestational week as a curvilinear (quadratic) covariate fitted best, allowing calculation of a pregnancy-specific eAG (PeAG). This showed that an HbA 1c of 8.0% (64 mmol/mol) gave a PeAG of 7.4-7.7 mmol/l (depending on gestational week), compared with a standard eAG of 10.2 mmol/l. The PeAG associated with maintaining an HbA 1c level of 6.0% (42 mmol/mol) during pregnancy was between 6.4 and 6.7 mmol/l, depending on gestational week. The HbA 1c -average glucose relationship is altered by pregnancy. Routinely generated standard eAG values do not account for this difference between pregnant and non-pregnant individuals and, thus, should not be used during pregnancy. Instead, the PeAG values deduced in the current study are recommended for antenatal clinical care.

Predictive factors for birth weight of newborns of mothers with gestational diabetes mellitus.

PubMed

Silva, Sara de Oliveira Corrêa da; Saunders, Cláudia; Zajdenverg, Lenita; Moreira, Luciana Novaes; Heidelmann, Sonaly Petronilho; Pereira, Ariane Cristine Dos Santos; Padilha, Patricia de Carvalho

2018-04-01

To evaluate the predictive factors of birth weight (BW) of newborns of women with gestational diabetes mellitus (GDM). A cross-sectional study was performed among pregnant women with GDM treated in a public maternity unit, Brazil. We selected 283 pregnant women, with nutritional follow-up initiated till the 28th gestational week, singleton pregnancy, without chronic diseases and with birth weight information of the newborns. The predictive factors of BW were identified by multivariate linear regression. Mean maternal age was 31.2 ± 5.8 years; 64.4% were non-white; 70.1% were pre-gestational overweight or obese. Mean BW was 3234.3 ± 478.8 g. An increase of 1 kg of weight in the first and third trimesters increased BW by 21 g (p = 0.01) and 27 g (p = 0.03), respectively. Similarly, the other predictive factors of BW were pre-gestational body mass index (β = 17.16, p = 0.02) and postprandial plasma glucose in the third trimester (β = 4.14, p = 0.008), in the model adjusted by gestational age at delivery (β = 194.68, p < 0.001). The best predictors of BW were gestational age at birth, and maternal pre-gestational and gestational anthropometric characteristics. Maternal glycaemic levels may also influence BW. The results may contribute to a review of prenatal routines for pregnant women with GDM. Copyright © 2018 Elsevier B.V. All rights reserved.

A randomized clinical trial on the effects of remote intercessory prayer in the adverse outcomes of pregnancies.

PubMed

da Rosa, Maria Inês; Silva, Fabio Rosa; Silva, Bruno Rosa; Costa, Luciana Carvalho; Bergamo, Angela Mendes; Silva, Napoleão Chiaramonte; Medeiros, Lidia Rosi de Freitas; Battisti, Iara Denise Endruweit; Azevedo, Rafael

2013-08-01

The scope of this article was to investigate whether intercessory prayer (IP) influences the adverse outcomes of pregnancies. A double-blind, randomized clinical trial was conducted with 564 pregnant women attending a prenatal public health care service. The women were randomly assigned to an IP group or to a control group (n = 289 per group). They were simultaneously and randomly assigned to practice prayer off-site or not. The following parameters were evaluated: Apgar scores, type of delivery and birth weight. The mean age of the women was 25.1 years of age (± 7.4), and the average gestational age was 23.4 weeks (± 8.1). The average number of years of schooling for the women was 8.1 years (± 3.1). The women in the IP and control groups presented a similar number of adverse medical events with non-significant p. No significant differences were detected in the frequency of adverse outcomes in pregnant women who practiced IP and those in the control group.

Prenatal exposure to perfluoroalkyl substances and birth outcomes in a Spanish birth cohort.

PubMed

Manzano-Salgado, Cyntia B; Casas, Maribel; Lopez-Espinosa, Maria-Jose; Ballester, Ferran; Iñiguez, Carmen; Martinez, David; Costa, Olga; Santa-Marina, Loreto; Pereda-Pereda, Eva; Schettgen, Thomas; Sunyer, Jordi; Vrijheid, Martine

2017-11-01

Prenatal perfluorooctanoate (PFOA) exposure has been associated with reduced birth weight but maternal glomerular filtration rate (GFR) may attenuate this association. Further, this association remains unclear for other perfluoroalkyl substances (PFAS), such as perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA). We estimated associations between prenatal PFAS exposure and birth outcomes, and the influence of GFR, in a Spanish birth cohort. We measured PFHxS, PFOS, PFOA, and PFNA in 1st-trimester maternal plasma (years: 2003-2008) in 1202 mother-child pairs. Continuous birth outcomes included standardized weight, length, head circumference, and gestational age. Binary outcomes included low birth weight (LBW), small-for-gestational-age, and preterm birth. We calculated maternal GFR from plasma-creatinine measurements in the 1st-trimester of pregnancy (n=765) using the Cockcroft-Gault formula. We used mixed-effects linear and logistic models with region of residence as random effect and adjustment for maternal age, parity, pre-pregnancy BMI, and fish intake during pregnancy. Newborns in this study weighted on average 3263g and had a median gestational age of 39.8weeks. The most abundant PFAS were PFOS and PFOA (median: 6.05 and 2.35ng/mL, respectively). Overall, PFAS concentrations were not significantly associated to birth outcomes. PFOA, PFHxS, and PFNA showed weak, non-statistically significant associations with reduced birth weights ranging from 8.6g to 10.3g per doubling of exposure. Higher PFOS exposure was associated with an OR of 1.90 (95% CI: 0.98, 3.68) for LBW (similar in births-at-term) in boys. Maternal GFR did not confound the associations. In this study, PFAS showed little association with birth outcomes. Higher PFHxS, PFOA, and PFNA concentrations were non-significantly associated with reduced birth weight. The association between PFOS and LBW seemed to be sex-specific. Finally, maternal GFR measured early during pregnancy had little influence on the estimated associations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Population Pharmacokinetics of Metronidazole Evaluated Using Scavenged Samples from Preterm Infants

PubMed Central

Ouellet, Daniele; Smith, P. Brian; James, Laura P.; Ross, Ashley; Sullivan, Janice E.; Walsh, Michele C.; Zadell, Arlene; Newman, Nancy; White, Nicole R.; Kashuba, Angela D. M.; Benjamin, Daniel K.

2012-01-01

Pharmacokinetic (PK) studies in preterm infants are rarely conducted due to the research challenges posed by this population. To overcome these challenges, minimal-risk methods such as scavenged sampling can be used to evaluate the PK of commonly used drugs in this population. We evaluated the population PK of metronidazole using targeted sparse sampling and scavenged samples from infants that were ≤32 weeks of gestational age at birth and <120 postnatal days. A 5-center study was performed. A population PK model using nonlinear mixed-effect modeling (NONMEM) was developed. Covariate effects were evaluated based on estimated precision and clinical significance. Using the individual Bayesian PK estimates from the final population PK model and the dosing regimen used for each subject, the proportion of subjects achieving the therapeutic target of trough concentrations >8 mg/liter was calculated. Monte Carlo simulations were performed to evaluate the adequacy of different dosing recommendations per gestational age group. Thirty-two preterm infants were enrolled: the median (range) gestational age at birth was 27 (22 to 32) weeks, postnatal age was 41 (0 to 97) days, postmenstrual age (PMA) was 32 (24 to 43) weeks, and weight was 1,495 (678 to 3,850) g. The final PK data set contained 116 samples; 104/116 (90%) were scavenged from discarded clinical specimens. Metronidazole population PK was best described by a 1-compartment model. The population mean clearance (CL; liter/h) was determined as 0.0397 × (weight/1.5) × (PMA/32)2.49 using a volume of distribution (V) (liter) of 1.07 × (weight/1.5). The relative standard errors around parameter estimates ranged between 11% and 30%. On average, metronidazole concentrations in scavenged samples were 30% lower than those measured in scheduled blood draws. The majority of infants (>70%) met predefined pharmacodynamic efficacy targets. A new, simplified, postmenstrual-age-based dosing regimen is recommended for this population. Minimal-risk methods such as scavenged PK sampling provided meaningful information related to development of metronidazole PK models and dosing recommendations. PMID:22252819

Hyperemesis gravidarum and pregnancy outcomes in the Norwegian Mother and Child Cohort - a cohort study.

PubMed

Vikanes, Åse V; Støer, Nathalie C; Magnus, Per; Grjibovski, Andrej M

2013-09-03

Hyperemesis gravidarum (HG) characterized by excessive nausea and vomiting in early pregnancy, is reported to be associated with increased risks for low birthweight (LBW), preterm birth (PTB), small-for-gestational-age (SGA) and perinatal death. Conflicting results in previous studies underline the necessity to study HG's potential effect on pregnancy outcomes using large cohorts with valid data on exposure and outcome measures, as well as potential confounders. This study aims to investigate associations between HG and adverse pregnancy outcomes using the Norwegian Mother and Child Cohort Study (MoBa). All singleton pregnancies in MoBa from 1998 to 2008 were included. Multivariable regression was used to estimate relative risks, approximated by odds ratios, for PTB, LBW, SGA and perinatal death. Linear regression was applied to assess differences in birthweight and gestational age for children born to women with and without HG. Potential confounders were adjusted for. Altogether, 814 out of 71,468 women (or 1.1%) had HG. In MoBa HG was not associated with PTB, LBW or SGA. Babies born to women with HG were born on average 1 day earlier than those born to women without HG; (-0.97 day (95% confidence intervals (CI): -1.80 - -0.15). There was no difference in birthweight when maternal weight gain was adjusted for; (23.42 grams (95% CI: -56.71 - 9.86). Babies born by women with HG had lower risk for having Apgar score < 7 after 1 minute (crude odds ratio was 0.64 (95% CI: 0.43 - 0.95)). No differences between the groups for Apgar score < 7 after 5 minutes were observed. Time-point for hospitalisation slightly increased differences in gestational age according to maternal HG status. HG was not associated with adverse pregnancy outcomes. Pregnancies complicated with HG had a slightly shorter gestational length. There was no difference in birth weight according to maternal HG-status. HG was associated with an almost 40% reduced risk for having Apgar score < 7 after 1 minute, but not after 5 minutes. The clinical importance of these statistically significant findings is, however, rather limited.

Timing of umbilical cord clamping among infants born at 22 through 27 weeks' gestation.

PubMed

Backes, C H; Huang, H; Iams, J D; Bauer, J A; Giannone, P J

2016-01-01

To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with immediate cord clamping (ICC) at delivery among infants born at 22 to 27 weeks' gestation. This was a pilot, randomized, controlled trial in which women in labor with singleton pregnancies at 22 to 27 weeks' gestation were randomly assigned to ICC (cord clamped at 5 to 10 s) or DCC (30 to 45 s). Forty mother-infant pairs were randomized. Infants in the ICC and DCC groups had mean gestational ages (GA) of 24.6 and 24.4 weeks, respectively. No differences were observed between the groups across all available safety measures, although infants in the DCC group had higher admission temperatures than infants in the ICC group (97.4 vs. 96.2 °F, P=0.04). During the first 24 h of life, blood pressures were lower in the ICC group than in the DCC group (P<0.05), despite a threefold greater incidence of treatment for hypotension (45% vs. 12%, P<0.01). Infants in the ICC group had increased numbers of red blood transfusions (in first 28 days of life) than infants in DCC group (4.1±3.9 vs. 2.8±2.2, P=0.04). Among infants born at an average GA of 24 weeks', DCC appears safe, logistically feasible, and offers hematological and circulatory advantages compared with ICC. A more comprehensive appraisal of this practice is needed.

Pregnancy Complications as Markers for Subsequent Maternal Cardiovascular Disease: Validation of a Maternal Recall Questionnaire

PubMed Central

Stuart, Jennifer J.; Farland, Leslie V.; Rich-Edwards, Janet W.; Zera, Chloe A.; McElrath, Thomas F.; Seely, Ellen W.

2015-01-01

Abstract Background: We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. Methods: A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. Results: A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r=0.95), and gestation length (r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). Conclusions: This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease. PMID:26061196

Effects of mares' age and day of gestation on efficacy of transvaginal ultrasound-guided twin reduction.

PubMed

Rau, Janina; Tiedemann, Daniela; Sielhorst, Jutta; Tönissen, Anna; Burger, Dominik; Martinsson, Gunilla; Rohn, Karl; Oldenhof, Harriette; Sieme, Harald

2018-06-01

Transvaginal ultrasound-guided aspiration (TUA) is a procedure which can be used for the reduction of twins post-fixation in the mare. The aim of this study was to evaluate the effect of the age of mares and the day of gestation on the outcome of TUA treatment. In 88 mares, diagnosed pregnant with twins, TUA of the yolk sac or allantoic fluid was performed between day 30 and 62 of gestation. Mares were aged 3-22 years. Ultrasonographic examination for a viable singleton pregnancy was performed by referring veterinarians 5-7 days and 4 weeks after TUA. Based on reported findings, effects of age and day of gestation on pregnancy rates were evaluated. Four weeks after TUA, 67% of the cases resulted in a viable singleton pregnancy. Five to 7 days after TUA treatment, the success rate was 74%. The gestational period did not affect the outcome, irrespective of the age of the mare. In contrast, success rates decreased with increasing age of the mares (84% ≤ 7 years vs. 67% 8-14 years vs. 57% ≥ 15 years). In mares aged 8-14 years, a decrease in singleton pregnancies was observed, if TUA was performed after day 35 of gestation. Success rates were slightly higher, if twin vesicles were localized within separate uterine horns (73%) as compared to the same horn (66%). Differences in singleton pregnancy rates were not statistically significant (p > 0.05). TUA was found to be an effective procedure for reduction of twin pregnancies performed at days 30-62 of gestation. Success rates for singleton pregnancies were high for young mares ≤ 7 years old (84%) and middle aged mares treated before day 36 of pregnancy (74%). Duration of pregnancy at the time of TUA did not have a major impact on the outcome. Nevertheless, the procedure should optimally be performed around days 32-35 of pregnancy to allow for the possibility of natural reduction before treatment and rebreeding in case of a total pregnancy loss after TUA. Schattauer GmbH.

Gestational Age is Dimensionally Associated with Structural Brain Network Abnormalities Across Development.

PubMed

Nassar, Rula; Kaczkurkin, Antonia N; Xia, Cedric Huchuan; Sotiras, Aristeidis; Pehlivanova, Marieta; Moore, Tyler M; Garcia de La Garza, Angel; Roalf, David R; Rosen, Adon F G; Lorch, Scott A; Ruparel, Kosha; Shinohara, Russell T; Davatzikos, Christos; Gur, Ruben C; Gur, Raquel E; Satterthwaite, Theodore D

2018-04-21

Prematurity is associated with diverse developmental abnormalities, yet few studies relate cognitive and neurostructural deficits to a dimensional measure of prematurity. Leveraging a large sample of children, adolescents, and young adults (age 8-22 years) studied as part of the Philadelphia Neurodevelopmental Cohort, we examined how variation in gestational age impacted cognition and brain structure later in development. Participants included 72 preterm youth born before 37 weeks' gestation and 206 youth who were born at term (37 weeks or later). Using a previously-validated factor analysis, cognitive performance was assessed in three domains: (1) executive function and complex reasoning, (2) social cognition, and (3) episodic memory. All participants completed T1-weighted neuroimaging at 3 T to measure brain volume. Structural covariance networks were delineated using non-negative matrix factorization, an advanced multivariate analysis technique. Lower gestational age was associated with both deficits in executive function and reduced volume within 11 of 26 structural covariance networks, which included orbitofrontal, temporal, and parietal cortices as well as subcortical regions including the hippocampus. Notably, the relationship between lower gestational age and executive dysfunction was accounted for in part by structural network deficits. Together, these findings emphasize the durable impact of prematurity on cognition and brain structure, which persists across development.

Delivery room triage of large for gestational age infants of diabetic mothers.

PubMed

Cordero, Leandro; Rath, Krista; Zheng, Katherine; Landon, Mark B; Nankervis, Craig A

2014-01-01

To review our 4-year experience (2008-2011) with delivery room triage of large for gestational age infants of diabetic mothers. Retrospective cohort investigation of 311 large for gestational age infants of diabetic mothers (White's Class A1 (77), A2 (87), B (77), and C-R (70)). Of 311 women, 31% delivered at 34-36 weeks gestational age and 69% at term. While 70% were delivered by cesarean, 30% were vaginal deliveries. A total of 160 asymptomatic infants were triaged from the delivery room to the well baby nursery. Of these, 55 (34%) developed hypoglycemia. In 43 cases, the hypoglycemia was corrected by early feedings; in the remaining 12, intravenous dextrose treatment was required. A total of 151 infants were triaged from the delivery room to the neonatal intensive care unit. Admission diagnoses included respiratory distress (51%), prevention of hypoglycemia (27%), prematurity (21%), and asphyxia (1%). Hypoglycemia affected 66 (44%) of all neonatal intensive care unit infants. Safe triage of asymptomatic large for gestational age infants of diabetic mothers from the delivery room to well baby nursery can be accomplished in the majority of cases. Those infants in need of specialized care can be accurately identified and effectively treated in the neonatal intensive care unit setting.

Maternal Exposure to Polybrominated and Polychlorinated Biphenyls: Infant Birth Weight and Gestational Age

PubMed Central

Givens, Marjory L.; Small, Chanley M.; Terrell, Metrecia L.; Cameron, Lorraine L.; Blanck, Heidi Michels; Tolbert, Paige E.; Rubin, Carol; Henderson, Alden K.; Marcus, Michele

2007-01-01

Understanding the influence of maternal exposures on gestational age and birth weight is essential given that pre-term and/or low birth weight infants are at risk for increased mortality and morbidity. We performed a retrospective analysis of a cohort exposed to polybrominated biphenyls (PBB) through accidental contamination of cattle feed and polychlorinated biphenyls (PCB) through residual contamination in the geographic region. Our study population consisted of 444 mothers and their 899 infants born between 1975 and 1997. Using restricted maximum likelihood estimation, no significant association was found between estimated maternal serum PBB at conception or enrollment PCB levels and gestational age or infant birth weight in unadjusted models or in models that adjusted for maternal age, smoking, parity, infant gender, and decade of birth. For enrollment maternal serum PBB, no association was observed for gestational age. However, a negative association with high levels of enrollment maternal serum PBB and birth weight was suggested. We also examined the birth weight and gestational age among offspring of women with the highest (10%) PBB or PCB exposure, and observed no significant association. Because brominated compounds are currently used in consumer products and therefore, are increasingly prevalent in the environment, additional research is needed to better understand the potential relationship between in utero exposure to brominated compounds and adverse health outcomes. PMID:17617441

JOURNAL CLUB: Quantification of Fetal Dose Reduction if Abdominal CT Is Limited to the Top of the Iliac Crests in Pregnant Patients With Trauma.

PubMed

Corwin, Michael T; Seibert, J Anthony; Fananapazir, Ghaneh; Lamba, Ramit; Boone, John M

2016-04-01

The purposes of this study were to correlate fetal z-axis location within the maternal abdomen on CT with gestational age and estimate fetal dose reduction of a study limited to the abdomen only, with its lower aspect at the top of the iliac crests, compared with full abdominopelvic CT in pregnant trauma patients. We performed a study of pregnant patients who underwent CT of the abdomen and pelvis for trauma at a single institution over a 10-year period. The inferior aspect of maternal liver, spleen, gallbladder, pancreas, adrenals, and kidneys was recorded as above or below the iliac crests. The distance from the iliac crest to the top of the fetus or gestational sac was determined. The CT images of the limited and full scanning studies were independently reviewed by two blinded radiologists to identify traumatic injuries. Fetal dose profiles, including both scatter and primary radiation, were computed analytically along the central axis of the patient to estimate fetal dose reduction. Linear regression analysis was performed between gestational age and distance of the fetus to the iliac crests. Thirty-five patients were included (mean age, 26.2 years). Gestational age ranged from 5 to 38 weeks, with 5, 19, and 11 gestations in the first, second, and third trimesters, respectively. All solid organs were above the iliac crests in all patients. In three of six patients, traumatic findings in the pelvis would have been missed with the limited study. There was high correlation between gestational age and distance of the fetus to the iliac crests (R(2) = 0.84). The mean gestational age at which the top of the fetus was at the iliac crest was 17.3 weeks. Using the limited scanning study, fetuses at 5, 20, and 40 weeks of gestation would receive an estimated 4.3%, 26.2%, and 59.9% of the dose, respectively, compared with the dose for the full scanning study. In pregnant patients in our series with a history of trauma, CT of the abdomen only was an effective technique to reduce fetal radiation exposure compared with full abdomen and pelvis CT.

Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring.

PubMed

Sujan, Ayesha C; Rickert, Martin E; Öberg, A Sara; Quinn, Patrick D; Hernández-Díaz, Sonia; Almqvist, Catarina; Lichtenstein, Paul; Larsson, Henrik; D'Onofrio, Brian M

2017-04-18

Prenatal antidepressant exposure has been associated with adverse outcomes. Previous studies, however, may not have adequately accounted for confounding. To evaluate alternative hypotheses for associations between first-trimester antidepressant exposure and birth and neurodevelopmental problems. This retrospective cohort study included Swedish offspring born between 1996 and 2012 and followed up through 2013 or censored by death or emigration. Analyses controlling for pregnancy, maternal and paternal covariates, as well as sibling comparisons, timing of exposure comparisons, and paternal comparisons, were used to examine the associations. Maternal self-reported first-trimester antidepressant use and first-trimester antidepressant dispensations. Preterm birth (<37 gestational weeks), small for gestational age (birth weight <2 SDs below the mean for gestational age), and first inpatient or outpatient clinical diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder in offspring. Among 1 580 629 offspring (mean gestational age, 279 days; 48.6% female; 1.4% [n = 22 544] with maternal first-trimester self-reported antidepressant use) born to 943 776 mothers (mean age at childbirth, 30 years), 6.98% of exposed vs 4.78% of unexposed offspring were preterm, 2.54% of exposed vs 2.19% of unexposed were small for gestational age, 5.28% of exposed vs 2.14% of unexposed were diagnosed with autism spectrum disorder by age 15 years, and 12.63% of exposed vs 5.46% of unexposed were diagnosed with attention-deficit/hyperactivity disorder by age 15 years. At the population level, first-trimester exposure was associated with all outcomes compared with unexposed offspring (preterm birth odds ratio [OR], 1.47 [95% CI, 1.40-1.55]; small for gestational age OR, 1.15 [95% CI, 1.06-1.25]; autism spectrum disorder hazard ratio [HR], 2.02 [95% CI, 1.80-2.26]; attention-deficit/hyperactivity disorder HR, 2.21 [95% CI, 2.04-2.39]). However, in models that compared siblings while adjusting for pregnancy, maternal, and paternal traits, first-trimester antidepressant exposure was associated with preterm birth (OR, 1.34 [95% CI, 1.18-1.52]) but not with small for gestational age (OR, 1.01 [95% CI, 0.81-1.25]), autism spectrum disorder (HR, 0.83 [95% CI, 0.62-1.13]), or attention-deficit/hyperactivity disorder (HR, 0.99 [95% CI, 0.79-1.25]). Results from analyses assessing associations with maternal dispensations before pregnancy and with paternal first-trimester dispensations were consistent with findings from the sibling comparisons. Among offspring born in Sweden, after accounting for confounding factors, first-trimester exposure to antidepressants, compared with no exposure, was associated with a small increased risk of preterm birth but no increased risk of small for gestational age, autism spectrum disorder, or attention-deficit/hyperactivity disorder.

Birth Weight by Gestational Age for 76,710 Twins Born in the United States as a Result of In Vitro Fertilization: 2006 to 2010.

PubMed

Dickey, Richard P; Pridjian, Gabriella; Xiong, Xu; Klempel, Monica C

2017-01-01

Objective  The objective of this study was to establish twin-specific birth weight percentiles by gestational age using U.S. twin births resulting from in vitro fertilization (IVF). Study Design  A retrospective analysis of birth weight by completed weeks of gestation for 76,710 twin IVF births reported to the Society for Assisted Reproductive Technologies from 2006 to 2010. Mean and median birth weights and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated by completed week of gestation and infant sex. Results  IVF twin birth weight accelerates until term and then declines. The deceleration in twin birth weight occurs at 39 completed weeks of gestation for larger twins, those at or above the 50th percentile in weight. For smaller twins, the growth deceleration occurs earlier, at 38 weeks of gestation. IVF female and male twin birth weights for gestational age were similar to all IVF twins, showing similar decelerations near term. Conclusion  Using U.S. IVF twin-specific growth charts, with known date of conception, twins demonstrate a deceleration in birth weight near term. Larger twins demonstrate a deceleration in birth weight by 39 completed weeks of gestation; smaller twins show a deceleration at 38 weeks. These data may assist in the clinical management of twins near term. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical diagnosis of gestational diabetes.

PubMed

Ryan, Edmond A

2013-12-01

Gestational diabetes mellitus (GDM) diagnosis remains controversial. ACOG criteria are based on the long-term risk of maternal diabetes. ADA recently suggested diagnosing GDM with 1 elevated value on an oral glucose tolerance test based on a 1.75-fold risk of large-for-gestational age infants resulting in a 17.8% rate of GDM. Given the lack of neonatal-based outcomes for the traditional position and problems of reproducibility and benefit/harm balance of the ADA approach, an alternative is presented herein based on a 2-fold risk of a large-for-gestational age baby, requiring 2 separate abnormalities to reduce false positives giving a more balanced benefit/harm ratio (10% GDM rate).

Nutrient deficiency and obstetrical outcomes in pregnant women following Roux-en-Y gastric bypass: A retrospective Danish cohort study with a matched comparison group.

PubMed

Hammeken, Lianna Hede; Betsagoo, Ramsina; Jensen, Ann Nygaard; Sørensen, Anne Nødgaard; Overgaard, Charlotte

2017-09-01

Roux-en-Y gastric bypass surgery and small-for-gestational-age births are known to be associated although the etiology is not fully understood. This study aimed to investigate pregnancy outcomes and maternal nutritional status among pregnant women with a history of Roux-en-Y gastric bypass using maternal anemia and gestational weight gain as indicators of micronutrient and macronutrient deficiency in pregnancy. The study was designed as a retrospective matched cohort study. All Roux-en-Y-gastric-bypass-operated pregnant women (n=151) who were followed in the outpatient obstetric clinic at Aalborg University Hospital in Denmark and gave birth between 1 January 2010 and 31 December 2013 were included. Each Roux-en-Y-gastric-bypass-operated woman was closely matched with a non-Roux-en-Y-gastric-bypass-operated woman. Primary outcomes were small-for-gestational-age birth, maternal anemia and gestational weight gain. The two groups (matched 1:1) were compared by paired tests on all measures, conditional logistic regression for paired binary data and the paired t-test or Wilcoxon signed-rank test for paired continuous data. The risk of small-for-gestational-age birth (odds ratio (OR)=2.67, 95% confidence interval (CI); 1.04-6.82) and maternal anemia (OR=3.0, 95% CI; 1.09-8.25) were significantly increased for the Roux-en-Y gastric bypass group compared to the non-Roux-en-Y gastric bypass group. No significant difference was found in gestational weight gain (p=0.169) between women with a history of Roux-en-Y gastric bypass (11.51kg±8.97 standard deviation (SD)) and non- Roux-en-Y-gastric-bypass-operated women (12.18kg±6.28 SD). A history of Roux-en-Y gastric bypass surgery increases the risk of small-for-gestational-age birth and anemia, while a finding of differences in gestational weight gain is uncorroborated. Our findings suggest a role of micronutrient deficiency rather than reduced gestational weight gain in the etiology of small-for-gestational-age birth among women with a history of Roux-en-Y gastric bypass surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

[Turner's syndrome: subjects with a normal body mass at birth grow taller than born small for gestational age].

PubMed

Wiśniewski, Andrzej; Stupnicki, Romuald; Milde, Katarzyna; Szufladowicz-Woźniak, Jolanta

2006-01-01

Body mass deficit at birth is one of the characteristic features observed in Turner's syndrome (TS). Body mass is lower than expected for gestational age in about 90% of TS-babies, and is below -2 SD (i.e. "small for gestational age") in about 20% of patients. The aim of the study was to compare the growth courses of TS-girls born with normal and deficient body mass. A group of 157 TS-girls, delivered at term (> or =38 weeks of gestation), were studied. Body mass of 80 girls ranged from -0.5 to +0.5 SD and body length was above -2 SD (AGA group); another 54 girls had body mass below -2 SD and body length above -2 SD (disproportional SGA group), and 23 girls had both body mass and length below -2 SD (proportional SGA group). Turner's syndrome was confirmed by chromosome analysis. Body mass at birth (BMB) was related to the norms for gestational age (GA) designed by Usher and McLean. Newborns, whose BMB was lower than -2 SD for GA, were considered small for gestational age (SGA). Postnatal body height and mass values were related to Polish norms for females with Turner's syndrome and to the norms for healthy female population. In the spontaneously growing TS-girls from the AGA group, a total of 275 measurements of body mass and height were carried out, the respective numbers for DSGA and PSGA groups were 176 and 100. Mean differences between the actual and expected body height for the AGA, DSGA and PSGA groups amounted to 0.40+/- 1.02, -0.21+/-0.88 and -0.95+/-0.80 SD TS, respectively, all means differing highly significantly (p<0.001) from each other. It may be concluded that spontaneously growing girls with Turner's syndrome, who had a normal (for gestational age) body mass at birth, attain a higher stature than girls with body mass deficit.

Mid-pregnancy maternal leptin levels, birthweight for gestational age and preterm delivery

PubMed Central

Shroff, M.R.; Holzman, C.; Tian, Y.; Evans, R. W.; Sikorskii, A.

2014-01-01

Summary Objective Maternal blood leptin levels are positively associated with adiposity. Recent studies suggest that leptin is also abundantly produced by the placenta and may function as a regulator of fetal growth. Our goal was to examine mid-pregnancy levels of leptin in maternal blood in relation to birthweight for gestational age (BW/GA) and timing of delivery after accounting for maternal pre-pregnancy body mass index (prepreg-BMI) and pregnancy complications. Patients Data were from 1,304 sub-cohort mother/infant pairs who participated in the Pregnancy Outcomes and Community Health (POUCH) Study (1998–2004). Measurements Leptin levels, measured at 16–27 weeks’ gestation, were log-transformed. Geometric mean (GMean) leptin levels were estimated by weighted linear regression with gestational age at blood draw as a covariate. GMean was re-transformed to the original scale for reporting. Results Using the GMeans leptin in mothers of term appropriate-for-gestational age (AGA) neonates as the referent (25.2 μg/L), we observed lower levels in mothers of preterm AGA (21.9 μg/L), term small-for-gestational age (SGA) (20.3 μg/L), and preterm SGA neonates (21.7 μg/L). Results were largely unchanged after adjustment for prepreg-BMI. Leptin levels were higher in mothers who delivered large-for-gestational age (LGA) neonates, both preterm (33.6 μg/L) and term (29.1 μg/L), but the GMeans were markedly attenuated after adjustment for prepreg-BMI. Conclusion The association between BW/GA and maternal leptin levels after adjustment for prepreg-BMI may represent: 1) a residual effect of maternal adiposity that is not fully captured by BMI; and/or 2) variation in placental leptin levels entering the maternal circulation. In conclusion, mid-pregnancy maternal blood leptin levels may be an early indicator of fetal growth status. PMID:22934578

Mid-pregnancy maternal leptin levels, birthweight for gestational age and preterm delivery.

PubMed

Shroff, Monal R; Holzman, Claudia; Tian, Yan; Evans, Rhobert W; Sikorskii, Alla

2013-04-01

Maternal blood leptin levels are positively associated with adiposity. Recent studies suggest that leptin is also abundantly produced by the placenta and may function as a regulator of foetal growth. Our goal was to examine mid-pregnancy levels of leptin in maternal blood in relation to birthweight for gestational age (BW/GA) and timing of delivery after accounting for maternal prepregnancy body mass index (prepreg-BMI) and pregnancy complications. Data were from 1304 subcohort mother/infant pairs who participated in the Pregnancy Outcomes and Community Health (POUCH) Study (1998-2004). Leptin levels, measured at 16-27 weeks' gestation, were log-transformed. Geometric mean (GMean) leptin levels were estimated by weighted linear regression with gestational age at blood draw as a covariate. GMean was re-transformed to the original scale for reporting. Using the GMeans leptin in mothers of term appropriate-for-gestational age (AGA) neonates as the referent (25·2 μg/l), we observed lower levels in mothers of preterm-AGA (21·9 μg/l), term small-for-gestational age (SGA) (20·3 μg/l) and preterm-SGA neonates (21·7 μg/l). Results were largely unchanged after adjustment for prepreg-BMI. Leptin levels were higher in mothers who delivered large-for-gestational age (LGA) neonates, both preterm (33·6 μg/l) and term (29·1 μg/l), but the GMeans were markedly attenuated after adjustment for prepreg-BMI. The association between BW/GA and maternal leptin levels after adjustment for prepreg-BMI may represent: (i) a residual effect of maternal adiposity that is not fully captured by BMI; and/or (ii) variation in placental leptin levels entering the maternal circulation. In conclusion, mid-pregnancy maternal blood leptin levels may be an early indicator of foetal growth status. © 2012 Blackwell Publishing Ltd.

GDM Women’s Pre-Pregnancy Overweight/Obesity and Gestational Weight Gain on Offspring Overweight Status

PubMed Central

Leng, Junhong; Li, Weiqin; Zhang, Shuang; Liu, Huikun; Wang, Leishen; Liu, Gongshu; Li, Nan; Redman, Leanne M.; Baccarelli, Andrea A.; Hou, Lifang; Hu, Gang

2015-01-01

Objectives To examine the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM). Methods We performed a retrospective cohort study in 1263 GDM mother-child pairs. General linear models and Logistic regression models were used to assess the single and joint associations of maternal pre-pregnancy BMI (normal weight, overweight, and obesity) and GWG (inadequate, adequate and excessive GWG) with anthropometry and overweight status in the offspring from birth to 1-5 years old. Results Maternal pre-pregnancy BMI and GWG were positively associated with birth weight for gestational age Z score and birth weight for length for gestational age Z score at birth, and weight for age Z score, length/height for age Z score, and weight for length/height Z score at of 1-5 years old offspring. Maternal pre-pregnancy overweight, obesity, and excessive GWG were associated with increased risks of large for gestational age [ORs 95% CIs = 1.87 (1.37-2.55), 2.98 (1.89-4.69), and 2.93 (2.07-4.13), respectively] and macrosomia [ORs 95% CIs = 2.06 (1.50-2.84), 2.89 (1.78-4.70), and 2.84 (1.98-4.06), respectively] at birth and childhood overweight at 1-5 years old [ORs 95% CIs = 1.26 (0.92-1.73), 1.96 (1.24-3.09), and 1.59 (1.15-2.21), respectively]. Conclusions Offspring born to GDM mothers with pre-pregnancy overweight/obesity or excessive GWG were associated with increased risks of large for gestational age and macrosomia at birth, and childhood overweight at 1-5 years old, compared with those born to GDM mothers with pre-pregnancy normal weight and adequate GWG. PMID:26098307

Newborn hearing screening in Queensland 2009-2011: Comparison of hearing screening and diagnostic audiological assessment between term and preterm infants.

PubMed

Calcutt, Trent L; Dornan, Dimity; Beswick, Rachael; Tudehope, David I

2016-08-13

This study compares rates and timing of newborn hearing screening outcomes, audiological assessment and hearing loss diagnosis between infants of different gestational age groups. Early identification and management of sensorineural hearing loss (SNHL), ideally by 3-6 months of age, facilitates speech and language optimisation. Literature stratifying hearing screening and diagnostic audiology assessment by gestational age groups is lacking. Subjects were infants with recorded gestational ages receiving newborn hearing screening in Queensland between 2009 and 2011. Data were provided through the Queensland Healthy Hearing database. Infants were analysed in <34 weeks, 34-36 +6 weeks, 37-38 +6 weeks and ≥39 weeks gestational age groups. Infants (175 911) were eligible for analysis, 7.9% being preterm. Per 1000 infants analysed, bilateral SNHL of >40 dB occurred in 2.4 for <34, 1.4 for 34-36 +6 , 0.7 for 37-38 +6 and 0.7 for ≥39 weeks gestation. Diagnoses attributable to newborn hearing screening direct referral were 93.1% for bilateral >40 dB SNHL and 88.2% for other hearing loss. Relative to term, preterm infants had a higher incidence of direct and targeted surveillance referrals, audiology assessment and hearing loss diagnosis. Preterm infants were screened later after birth. Specific hearing screening and diagnosis characteristics differed between preterm infants <34 and 34-36 +6 weeks gestation, and term infants. Consideration of unique gestational age strata characteristics supports care individualisation. Preterm infants represent a diagnostic challenge, with higher rates of bilateral >40 dB SNHL than term but correspondingly higher false positive results on screening, justifying vigilant monitoring. Focused research into specific risk factors in preterm infants is warranted. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Maternal medical conditions during pregnancy and gross motor development up to age 24 months in the Upstate KIDS Study

PubMed Central

Ghassabian, Akhgar; Sundaram, Rajeshwari; Wylie, Amanda; Bell, Erin; Bello, Scott C.; Yeung, Edwina

2015-01-01

Aims We examined whether children of mothers with a medical condition diagnosed before or during pregnancy took longer to achieve gross motor milestones up to age 24 months. Methods We obtained information on medical conditions using self-reports, birth certificates, and hospital records in 4909 mothers participating in Upstate KIDS, a population-based birth cohort. Mothers reported on their children’s motor milestone achievement at 4, 8, 12, 18, and 24 months of age. Results After adjustment for covariates (including prepregnancy body mass index), children of mothers with gestational diabetes took longer to achieve sitting without support [Hazard Ratio (HR)=0.84, 95%CI:0.75-0.93), walking with assistance (HR=0.88, 95%CI:0.77-0.98) and walking alone (HR=0.88, 95%CI:0.77-0.99) than children of women with no gestational diabetes. Similar findings emerged for maternal diabetes. Gestational hypertension was associated with a longer time to achieve walking with assistance. These associations did not change after adjustment for gestational age or birth weight. Severe hypertensive disorders of pregnancy were related to a longer time to achieve milestones, but not after adjustment for perinatal factors. Interpretation Children exposed to maternal diabetes, gestational or pre-gestational, may take longer to achieve motor milestones than non-exposed children, independent of maternal obesity. PMID:26502927

Effect of surfactant and partial liquid ventilation treatment on gas exchange and lung mechanics in immature lambs: influence of gestational age.

PubMed

Rey-Santano, Carmen; Mielgo, Victoria; Gastiasoro, Elena; Valls-i-Soler, Adolfo; Murgia, Xabier

2013-01-01

Surfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. Prospective, randomized study using sealed envelopes. 36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h. Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.

Risk of cesarean delivery when second-trimester ultrasound dating disagrees with definite last menstrual period.

PubMed

Grewal, Jagteshwar; Zhang, Jun; Mikolajczyk, Rafael T; Ford, Jessie

2010-08-01

Estimates of gestational age based on early second-trimester ultrasound often differ from that based on the last menstrual period (LMP) even when a woman is certain about her LMP. Discrepancies in these gestational age estimates may be associated with an increased risk of cesarean section and low birth weight. We analyzed 7228 singleton, low-risk, white women from The Routine Antenatal Diagnostic Imaging with Ultrasound trial. The women were recruited at less than 14 weeks of gestation and received ultrasound exams between 15 and 22 weeks. Our results indicate that among nulliparous women, the risk of cesarean section increased from 10% when the ultrasound-based gestational age exceeded the LMP-based estimate by 4 days to 60% when the discrepancy increased to 21 days. Moreover, for each additional day the ultrasound-based estimate exceeded the LMP-based estimate, birth weight was higher by 9.6 g. Our findings indicate that a positive discrepancy (i.e., ultrasound-based estimate exceeds LMP-based estimate) in gestational age is associated with an increased risk of cesarean section. A negative discrepancy, by contrast, may reflect early intrauterine growth restriction and an increased risk of low birth weight. Copyright Thieme Medical Publishers.

Gestational age and dose influence on placental transfer of 63Ni in rats.

PubMed

Wang, X-W; Gu, J-Y; Li, Z; Song, Y-F; Wu, W-S; Hou, Y-P

2010-04-01

The effects of gestational age and dose of nickel exposure on regulating and influencing placental transfer were investigated. Pregnant rats on gestational day (GD) 12, 15 or 20 were injected intraperitoneally with saline, 64,320 or 640 kBq/kg body weight of (63)Ni. Twenty-four hours after administration, samples were harvested from each for measurement of radioactivity by liquid scintillation counting and for autoradiography. In placenta, amniotic fluid and fetal membrane, (63)Ni concentrations increased with increasing doses and gestational age. In fetus, (63)Ni concentrations reached a maximum on GD 15 and then declined on GD 20 although they maintained a dose-dependency for each GD group. In fetal blood on GD 20, (63)Ni concentration increased dose-dependently and was higher than in maternal blood. The autoradiographs demonstrated that (63)Ni radioactivity was located within placental basal lamina, fetal bones and most organs. These findings suggest that the nickel uptake, retention and transport in placenta increase dose- and gestation age-dependently, and nickel transfer through placental barrier is primarily from mother into the fetus, but hardly from fetus to mother. Copyright 2010 Elsevier Ltd. All rights reserved.

Cognitive Functioning in Toddlerhood: The Role of Gestational Age, Attention Capacities, and Maternal Stimulation

ERIC Educational Resources Information Center

de Jong, Marjanneke; Verhoeven, Marjolein; Hooge, Ignace T. C.; Maingay-Visser, Arnoldina P. G. F.; Spanjerberg, Louise; van Baar, Anneloes L.

2018-01-01

Why do many preterm children show delays in development? An integrated model of biological risk, children's capacities, and maternal stimulation was investigated in relation to cognitive functioning at toddler age. Participants were 200 Dutch children (gestational age = 32-41 weeks); 51% boys, 96% Dutch nationality, 71.5% highly educated mothers.…

[Effect of gestational diabetes on adiposity indicators during the first 18 years of life; systematic review].

PubMed

Jiménez Cruz, Arturo; Ortega Cisneros, Armando; Bacardí Gascón, Montserrat

2014-02-01

Gestational diabetes has been associated with obesity later in life. However, reported results have not been consistent and the methods used have shown weakness. To analize prospective and retrospective cohort studies that assess the gestational diabetes effects on adiposity indicators in the offspring during their first 18 years. A search was made for prospective or retrospective cohort studies registered in Medline/ Pubmed database, from January 2011 to September 2013 that evaluated the gestational diabetes effects on adiposity indicators at birth or after birth. Eleven studies met the inclusion criteria. A total of 472,959 pairs of mother and child were studied. Children age at the moment of evaluation ranged from birth to 18 years. In nine out of eleven articles an association between gestational diabetes and adiposity indicators was observed. In seven studies adjustments for potential confounders (pre gestational BMI, maternal age) were made. In five of those an association between gestational diabetes and adiposity was found. The results of this review indicate that the evidence showing that gestational diabetes increase adiposity indicators later in life is moderate. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants.

PubMed

Dietz, Kelly R; Zhang, Lei; Seidel, Frank G

2015-08-01

Prior to digital radiography it was possible for a radiologist to easily estimate the size of a patient on an analog film. Because variable magnification may be applied at the time of processing an image, it is now more difficult to visually estimate an infant's size on the monitor. Since gestational age and weight significantly impact the differential diagnosis of neonatal diseases and determine the expected size of kidneys or appearance of the brain by MRI or US, this information is useful to a pediatric radiologist. Although this information may be present in the electronic medical record, it is frequently not readily available to the pediatric radiologist at the time of image interpretation. To determine if there was a correlation between gestational age and weight of a premature infant with their transverse chest diameter (rib to rib) on admission chest radiographs. This retrospective study was approved by the institutional review board, which waived informed consent. The maximum transverse chest diameter outer rib to outer rib was measured on admission portable chest radiographs of 464 patients admitted to the neonatal intensive care unit (NICU) during the 2010 calendar year. Regression analysis was used to investigate the association between chest diameter and gestational age/birth weight. Quadratic term of chest diameter was used in the regression model. Chest diameter was statistically significantly associated with both gestational age (P < 0.0001) and birth weight (P < 0.0001). An infant's gestational age and birth weight can be reliably estimated by comparing a simple measurement of the transverse chest diameter on digital chest radiograph with the tables and graphs in our study.

Neonatal Arterial Morphology Is Related to Body Size in Abnormal Human Fetal Growth.

PubMed

Olander, Rasmus F W; Sundholm, Johnny K M; Ojala, Tiina H; Andersson, Sture; Sarkola, Taisto

2016-09-01

Restriction in fetal growth is associated with cardiovascular disease in adulthood. It is unclear whether abnormal intrauterine growth influences arterial morphology during the fetal or neonatal stage. The objective was to study the regional arterial morphology with respect to gestational age and abnormal fetal body size. We studied body anthropometrics and arterial morphology and physiology in 174 neonates born between 31 and 42 weeks of gestation, including neonates with birth weights appropriate, small, and large for age, with very high resolution vascular ultrasound (35-55 MHz). In simple linear regressions, parameters of body size (body weight, body surface area, and organ circumference) and gestational age were statistically significantly associated with common carotid, brachial, femoral arterial parameters (lumen diameter [LD], wall layer thickness [intima-media thickness and intima-media-adventitia thickness], and carotid artery wall stress [CAWS]). Male sex was statistically significantly associated with LD and CAWS. In multiple linear regression models, body size, gestational age, and sex explained a large proportion of the arterial variance (R( 2) range, 0.37-0.47 for LD; 0.09-0.35 for intima-media thickness; 0.21-0.41 for intima-media-adventitia thickness; and 0.23 for CAWS; all models P<0.001). Arterial wall layer thickness, LDs, and CAWS were independently and strongly predicted by body size, and no effect of maternal disease was observed when added to the models. Gestational age and male sex were also independently but more weakly associated with arterial LDs and CAWS (P<0.01), but not with arterial wall layers. These results indicate that the intrauterine growth of fetal arterial LD and wall layer thickness are primarily attributed to body growth overall. LD and CAWS show weaker association with gestational age and sex. © 2016 American Heart Association, Inc.

Placental telomere length decreases with gestational age and is influenced by parity: a study of third trimester live-born twins.

PubMed

Gielen, M; Hageman, G; Pachen, D; Derom, C; Vlietinck, R; Zeegers, M P

2014-10-01

In contrast to the postnatal period, little is known about telomere length (TL) during prenatal life. The decrease in placental TL remains unknown, although intra uterine growth retardation and preeclampsia are associated with shorter placental TL. The aim of this study is to assess the decrease of placental TL during the third trimester of gestation and to explore the role of potential "growth influencing factors". The study sample consisted of 329 live-born twins from the East Flanders Prospective Twin Survey. TL was determined using a multiplex quantitative PCR method. Gestational age, sex, birth order, placental characteristics, parity, maternal and paternal age, diabetes, hypertension, smoking, alcohol use, and socio economic status (SES) were considered "growth influencing factors". Bivariable multilevel regression analysis with "growth influencing factors" was performed. Placental TL ranged from 4.3 kbp to 84.4 kbp with a median of 10.8 kbp. Ln(TL) decreased in a linear fashion with an estimated TL decreasing from 13.98 kbp at 28 weeks to 10.56 kbp at 42 weeks. The regression coefficient of gestational age became smaller if considered together with SES (b = -0.017; p = 0.08) or diabetes (b = -0.018; p = 0.07) and bigger if considered together with parity (b = -0.022; p = 0.02), indicating that part of the association between gestational age and telomere length is explained by these three confounding factors. Placental TL decreases during the third trimester of gestation of live-born twins with approximately 25% indicating that telomere shortening may play a role in aging of the placenta. Copyright © 2014 Elsevier Ltd. All rights reserved.

Prenatal and post-natal cost of small for gestational age infants: a national study.

PubMed

Marzouk, Alicia; Filipovic-Pierucci, Antoine; Baud, Olivier; Tsatsaris, Vassilis; Ego, Anne; Charles, Marie-Aline; Goffinet, François; Evain-Brion, Danièle; Durand-Zaleski, Isabelle

2017-03-21

Small for gestational age (SGA) infants are at increased risk for preterm birth morbidities as well as a range of adverse perinatal outcomes that result in part from associated premature birth. We sought to evaluate the costs of SGA versus appropriate for gestational age (AGA) infants in France from pregnancy through the first year of life and separate the contributions of prematurity from the contribution of foetal growth on costs. This is a cross-sectional population-based study using national hospital discharge data from French public and private hospitals. SGA infants were defined as newborns with a birth weight below the 10th percentile of French intrauterine growth curves adjusted for foetal sex. AGA infants were defined as newborns with a birth weight between the 25th and the 75th. All births were selected between January 1st, 2011 and December 31st, 2011. Costs were calculated from the hospital perspective for both mothers and children using their diagnostic related group and the French national cost study. Hospital outcomes were extracted from the database and compared by gestational age and mode of delivery. Of 777,720 total births in 2011, 84,688 SGA births (10.9%) and 395,760 AGA births (50.8%) were identified. After adjustment for gestational age, the cost for an SGA infant was €2,783 higher than for an AGA infant. The total maternal and infant hospital cost of SGA in France was estimated at 23% the total cost for deliveries. The high cost is explained by higher complication rates, more frequent hospital readmissions and longer lengths of stay. Being small for gestational age is an independent contributor to 1-year hospital costs for both mothers and infants.

Consumption of low-moderate level arsenic contaminated water does not increase spontaneous pregnancy loss: a case control study.

PubMed

Bloom, Michael S; Neamtiu, Iulia A; Surdu, Simona; Pop, Cristian; Lupsa, Ioana Rodica; Anastasiu, Doru; Fitzgerald, Edward F; Gurzau, Eugen S

2014-10-13

Previous work suggests an increased risk for spontaneous pregnancy loss linked to high levels of inorganic arsenic (iAs) in drinking water sources (>10 μg/L). However, there has been little focus to date on the impact of low-moderate levels of iAs in drinking water (<10 μg/L). To address this data gap we conducted a hospital-based case-control study in Timis County, Romania. We recruited women with incident spontaneous pregnancy loss of 5-20 weeks completed gestation as cases (n = 150), and women with ongoing pregnancies matched by gestational age (±1 week) as controls (n = 150). Participants completed a physician-administered questionnaire and we collected water samples from residential drinking sources. We reconstructed residential drinking water exposure histories using questionnaire data weighted by iAs determined using hydride generation-atomic absorption spectrometry (HG-AAS). Logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) for associations between iAs exposure and loss, conditioned on gestational age and adjusted for maternal age, cigarette smoking, education and prenatal vitamin use. We explored potential interactions in a second set of models. Drinking water arsenic concentrations ranged from 0.0 to 175.1 μg/L, with median 0.4 μg/L and 90th%tile 9.4 μg/L. There were no statistically significant associations between loss and average or peak drinking water iAs concentrations (OR 0.98, 95% CI 0.96-1.01), or for daily iAs intake (OR 1.00, 95% CI 0.98-1.02). We detected modest evidence for an interaction between average iAs concentration and cigarette smoking during pregnancy (P = 0.057) and for daily iAs exposure and prenatal vitamin use (P = 0.085). These results suggest no increased risk for spontaneous pregnancy loss in association with low to moderate level drinking water iAs exposure. Though imprecise, our data also raise the possibility for increased risk among cigarette smokers. Given the low exposures overall, these data should reassure pregnant women and policy makers with regard to the potential effect of drinking water iAs on early pregnancy, though a larger more definitive study to investigate the potential risk increase in conjunction with cigarette smoking is merited.

Effects of different data-editing methods on trends in race-specific preterm delivery rates, United States, 1990-2002.

PubMed

Qin, Cheng; Dietz, Patricia M; England, Lucinda J; Martin, Joyce A; Callaghan, William M

2007-09-01

In recent years, national vital statistics data indicate that the US preterm delivery rate has decreased among African Americans and increased among whites. These trends in preterm delivery rates may have been affected, in part, by improvements in the accuracy of gestational age reporting on birth certificates. Several data-editing methods have been developed with the intention of reducing the percentage of records with misclassified gestational age. We explored whether three data-editing methods yielded different trends in preterm delivery for years 1990-2002 among US non-Hispanic white and non-Hispanic African American singleton livebirths. Using National Center for Health Statistics (NCHS) public-use data, we assessed two published methods for editing gestational age, one by Alexander et al. and the other by Zhang and Bowes (Zhang/Bowes). We also assessed a third method that substitutes the clinical estimate (CE) of gestational age when the NCHS last menstrual period (LMP)-based estimate differs from the CE by more than 2 weeks (the LMP/CE method). The percentage of records excluded and/or reclassified by each method was calculated for years 1990, 1996 and 2002. Gestational age-specific birthweight distributions were plotted by race for each method. Preterm delivery rates were calculated and compared by method of editing over time. The percentage of records excluded or reclassified declined from 1990 to 2002 regardless of the method applied. For infants at 28-33 weeks' gestation using the NCHS edited data, birthweight distributions were bimodal, with the second (right-sided) mode showing a mean birthweight consistent with that of term infants. The second mode was less pronounced using the Alexander et al. and the Zhang/Bowes methods, and was not present when the LMP/CE method was used. From 1990 to 2002, preterm delivery rates increased for non-Hispanic whites regardless of method (range 21.3-31.3%). Preterm delivery rates increased slightly for non-Hispanic African Americans with the LMP/CE method (1.8%), and decreased with the other methods (range 6.7-10.8%). Different approaches to editing gestational age from vital records can result in variation in preterm delivery rates and trends. Uncertainty persists around the true trends in preterm delivery, especially among African Americans. Additional research is needed to identify the approach that results in the most accurate classification of gestational age.

Rat gestation during space flight: outcomes for dams and their offspring born after return to Earth.

PubMed

Wong, A M; DeSantis, M

1997-01-01

Sprague-Dawley rats were studied to learn whether gestation in the near-zero gravity, high radiation environment of space impacts selected mammalian postnatal events. Ten rats spent days nine to twenty of pregnancy aboard the space shuttle orbiter Atlantis (STS-66). Their movement was studied shortly after return to Earth; subsequently, several of their offspring were cross-fostered and examined through postnatal day 81 (P81) for whole body growth and somatic motor development. Values for the flight animals were compared to ground-based control groups. Relative to controls, the pregnant flight rats showed a marked paucity of locomotion during the first few hours after returning to Earth. There was greater likelihood of perinatal morbidity for the offspring of flight dams when compared to the control groups. Whole body weight of surviving offspring, averaged for each group separately, showed typical sigmoidal growth curves when plotted against postnatal age. The flight group for our study had a larger ratio of female to male pups, and that was sufficient to account for the lower average daily weight gained by the flight animals when compared to the control groups. Walking was universally achieved by P13 and preceded eye opening, which was complete in all pups by P17. Thus, both of these developmental horizons were attained on schedule in the flight as well as the control rats. Characteristic changes were observed in hind limb step length and gait width as the pups grew. These patterns occurred at the same time in each group of rats. Therefore, prenatal space flight from days nine to twenty of gestation did not interfere with the establishment of normal patterns for hind paw placement during walking.

Rat Gestation During Space Flight: Outcomes for Dams and Their Offspring Born After Return to Earth

NASA Technical Reports Server (NTRS)

Wong, Andre M.; DeSantis, Mark

1997-01-01

Sprague-Dawley rats were studied to learn whether gestation in the near-zero gravity, high radiation environment of space impacts selected mammalian postnatal events. Ten rats spent days nine to twenty of pregnancy aboard the space shuttle orbiter Atlantis (STS-66). Their movement was studied shortly after return to Earth; subsequently, several of their offspring were cross-fostered and examined through postnatal day 81 (P81) for whole body growth and somatic motor development. Values for the flight animals were compared to ground-based control groups. Relative to controls, the pregnant flight rats showed a marked paucity of locomotion during the first few hours after returning to Earth. There was greater likelihood of perinatal morbidity for the offspring of flight dams when compared to the control groups. Whole body weight of surviving offspring, averaged for each group separately, showed typical sigmoidal growth curves when plotted against postnatal age. The flight group for our study had a larger ratio of female to male pups, and that was sufficient to account for the lower average daily weight gained by the flight animals when compared to the control groups. Walking was universally achieved by P13 and preceded eye opening, which was complete in all pups by P17. Thus, both of these developmental horizons were attained on schedule in the flight as well as the control rats. Characteristic changes were observed in hind limb step length and gait width as the pups grew. These patterns occurred at the same time in each group of rats. Therefore, prenatal space flight from days nine to twenty of gestation did not interfere with the establishment of normal patterns for hind paw placement during walking.

Caspase dependent and independent mechanisms of apoptosis across gestation in a sheep model of placental insufficiency and intrauterine growth restriction.

PubMed

Monson, Troy; Wright, Tanner; Galan, Henry L; Reynolds, Paul R; Arroyo, Juan A

2017-05-01

Increased placental apoptosis is a hallmark of intrauterine growth restricted (IUGR). Several molecules have been shown to be involved in the control of apoptosis during this disease. Our objective was to determine the expression of Bcl2, Bax, phospho XIAP, AIF, caspase 3 and 9, and telomerase activity across gestation in an ovine hyperthermia-induced model of IUGR. Pregnant sheep were placed in hyperthermic (HT) conditions to induce IUGR along with age-matched controls. Placental tissues were collected at 55 (early), 95 (mid-gestation) and 130 (near-term) days of gestational age (dGA) to determine the expression of apoptotic molecules during the development of IUGR. Compared to the control placenta, IGUR pregnancies showed: significantly reduced placental Bcl2 in early gestation (55 dGA) with a significant increase observed at mid gestation (95 dGA); decreased placental pXIAP at both mid and near term gestational days (95 and 130 dGA); placental AIF increased only at 55 dGA (early gestation); active caspase 3 increased at both mid and near term gestational days (95 and 130 dGA); caspase 9 only increased at mid gestation (95 dGA) and decreased Telomerase activity near term. Placental apoptosis, mediated in part by the apoptosis related molecule, participates in the development of IUGR. Findings from this study suggest a caspase-independent apoptotic pathway during early gestation and caspase-dependent apoptosis at mid and near term gestation. The data also implicate decreased activation of XIAP as a plausible factor involved in the control of placental apoptosis during IUGR.

Gestational diabetes mellitus screening and outcomes.

PubMed

Aktün, Hale Lebriz; Uyan, Derya; Yorgunlar, Betül; Acet, Mustafa

2015-01-01

To verify the usefulness of the World Health Organization criteria for the diagnosis of gestational diabetes mellitus in pregnant women and its effectiveness in the prevention of maternal and neonatal adverse results in women younger than 35 years without apparent risk factors for gestational diabetes mellitus. This is a retrospective study based on population involving 1360 pregnant women who delivered and who were followed-up in a university hospital in Istanbul. All women underwent the 75-g oral glucose tolerance test screening, usually in between the 24(th)-28(th) weeks of pregnancy. In all cases, the identification of gestational diabetes mellitus was determined in accordance with the World Health Organization criteria. Approximately 28% of the pregnant women aged younger than 35 years with no risk factors for gestational diabetes mellitus were diagnosed with the oral glucose tolerance test in this study. In the gestational diabetes mellitus group, the primary cesarean section rate was importantly higher than that in the non-gestational diabetes mellitus group. Preterm delivery was also associated with gestational diabetes mellitus. The diagnosis of gestational diabetes mellitus was strongly associated with admittance to the neonatal intensive care unit. Neonatal respiratory problems didn't showed any significant deviation between the groups. There was a moderate association between gestational diabetes mellitus and metabolic complications. Pregnant women with no obvious risk factors were diagnosed with gestational diabetes mellitus using the World Health Organization criteria. The treatment of these women potentially reduced their risk of adverse maternal and neonatal hyperglycemia-related events, such as cesarean section, polyhydramnios, preterm delivery, admission to neonatal intensive care unit, large for gestational age, and higher neonatal weight.

Quantifying the Interactions between Maternal and Fetal Heart Rates by Transfer Entropy.

PubMed

Marzbanrad, Faezeh; Kimura, Yoshitaka; Palaniswami, Marimuthu; Khandoker, Ahsan H

2015-01-01

Evidence of the short term relationship between maternal and fetal heart rates has been found in previous studies. However there is still limited knowledge about underlying mechanisms and patterns of the coupling throughout gestation. In this study, Transfer Entropy (TE) was used to quantify directed interactions between maternal and fetal heart rates at various time delays and gestational ages. Experimental results using maternal and fetal electrocardiograms showed significant coupling for 63 out of 65 fetuses, by statistically validating against surrogate pairs. Analysis of TE showed a decrease in transfer of information from fetus to the mother with gestational age, alongside the maturation of the fetus. On the other hand, maternal to fetal TE was significantly greater in mid (26-31 weeks) and late (32-41 weeks) gestation compared to early (16-25 weeks) gestation (Mann Whitney Wilcoxon (MWW) p<0.05). TE further increased from mid to late, for the fetuses with RMSSD of fetal heart rate being larger than 4 msec in the late gestation. This difference was not observed for the fetuses with smaller RMSSD, which could be associated with the quiet sleep state. Delay in the information transfer from mother to fetus significantly decreased (p = 0.03) from mid to late gestation, implying a decrease in fetal response time. These changes occur concomitant with the maturation of the fetal sensory and autonomic nervous systems with advancing gestational age. The effect of maternal respiratory rate derived from maternal ECG was also investigated and no significant relationship was found between breathing rate and TE at any lag. In conclusion, the application of TE with delays revealed detailed information on the fetal-maternal heart rate coupling strength and latency throughout gestation, which could provide novel clinical markers of fetal development and well-being.

Quantifying the Interactions between Maternal and Fetal Heart Rates by Transfer Entropy

PubMed Central

Marzbanrad, Faezeh; Kimura, Yoshitaka; Palaniswami, Marimuthu; Khandoker, Ahsan H.

2015-01-01

Evidence of the short term relationship between maternal and fetal heart rates has been found in previous studies. However there is still limited knowledge about underlying mechanisms and patterns of the coupling throughout gestation. In this study, Transfer Entropy (TE) was used to quantify directed interactions between maternal and fetal heart rates at various time delays and gestational ages. Experimental results using maternal and fetal electrocardiograms showed significant coupling for 63 out of 65 fetuses, by statistically validating against surrogate pairs. Analysis of TE showed a decrease in transfer of information from fetus to the mother with gestational age, alongside the maturation of the fetus. On the other hand, maternal to fetal TE was significantly greater in mid (26–31 weeks) and late (32–41 weeks) gestation compared to early (16–25 weeks) gestation (Mann Whitney Wilcoxon (MWW) p<0.05). TE further increased from mid to late, for the fetuses with RMSSD of fetal heart rate being larger than 4 msec in the late gestation. This difference was not observed for the fetuses with smaller RMSSD, which could be associated with the quiet sleep state. Delay in the information transfer from mother to fetus significantly decreased (p = 0.03) from mid to late gestation, implying a decrease in fetal response time. These changes occur concomitant with the maturation of the fetal sensory and autonomic nervous systems with advancing gestational age. The effect of maternal respiratory rate derived from maternal ECG was also investigated and no significant relationship was found between breathing rate and TE at any lag. In conclusion, the application of TE with delays revealed detailed information on the fetal-maternal heart rate coupling strength and latency throughout gestation, which could provide novel clinical markers of fetal development and well-being. PMID:26701122

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study.

PubMed

Kinomoto-Kondo, Satoko; Umehara, Nagayoshi; Sato, Shiori; Ogawa, Kohei; Fujiwara, Takeo; Arata, Naoko; Sago, Haruhiko

2017-01-01

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes. This case-control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery. Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02). GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

Abortion-Related Mortality in the United States 1998–2010

PubMed Central

Zane, Suzanne; Creanga, Andreea A.; Berg, Cynthia J.; Pazol, Karen; Suchdev, Danielle B.; Jamieson, Denise J.; Callaghan, William M.

2015-01-01

OBJECTIVE To examine characteristics and causes of legal induced abortion–related deaths in the United States between 1998 and 2010. METHODS Abortion-related deaths were identified through the national Pregnancy Mortality Surveillance System with enhanced case-finding. We calculated the abortion mortality rate by race, maternal age, and gestational age and the distribution of causes of death by gestational age and procedure. RESULTS During the period from 1998–2010, of approximately 16.1 million abortion procedures, 108 women died, for a mortality rate of 0.7 deaths per 100,000 procedures overall, 0.4 deaths for non-Hispanic white women, 0.5 deaths for Hispanic women, and 1.1 deaths for black women. The mortality rate increased with gestational age, from 0.3 to 6.7 deaths for procedures performed at 8 weeks or less and at 18 weeks or greater, respectively. A majority of abortion-related deaths at 13 weeks of gestation or less were associated with anesthesia complications and infection, whereas a majority of abortion-related deaths at more than 13 weeks of gestation were associated with infection and hemorrhage. In 20 of the 108 cases, the abortion was performed as a result of a severe medical condition where continuation of the pregnancy threatened the woman’s life. CONCLUSION Deaths associated with legal induced abortion continue to be rare events—less than 1 per 100,000 procedures. Primary prevention of unintended pregnancy, including those in women with serious pre-existing medical conditions, and increased access to abortion services at early gestational ages may help to further decrease abortion-related mortality in the United States. PMID:26241413

Sports and leisure-time physical activity in pregnancy and birth weight: a population-based study.

PubMed

Hegaard, H K; Petersson, K; Hedegaard, M; Ottesen, B; Dykes, A K; Henriksen, T B; Damm, P

2010-02-01

We examined the association between sports and other leisure-time physical activities during pregnancy and birth weight of babies born after 37 completed weeks of gestation. All Danish-speaking pregnant women attending routine antenatal care at the Department of Obstetrics, Aarhus University Hospital, Denmark, from August 1989 to September 1991 were invited to participate in the study. A total of 4458 healthy women who delivered after 37 completed gestational weeks participated in this study. The associations between sports (0, 1-2, 3+ h/week) or leisure-time physical activity (sedentary, light, and moderate to heavy) and birth weight were examined by linear and logistic regression and adjusted for potential confounding factors such as smoking, parity, schooling, pre-pregnancy body mass index and gestational age. The results showed that pregnant women who practiced sports or were moderate to heavy leisure-time physical active during the early second or the early third trimester gave birth to infants with a similar birth weight as inactive women. The proportion of newborns with a low (<2500 g) or a high birth weight (>/=4500 g) was also unchanged. In conclusion, in this large population-based study, we found no association between sports and leisure-time physical activity and low-birth weight, high-birth weight, or average-birth weight.

Screening for gestational diabetes mellitus and its prevalence in Bangladesh.

PubMed

Jesmin, Subrina; Akter, Shamima; Akashi, Hidechika; Al-Mamun, Abdullah; Rahman, Md Arifur; Islam, Md Majedul; Sohael, Farzana; Okazaki, Osamu; Moroi, Masao; Kawano, Satoru; Mizutani, Taro

2014-01-01

The prevalence of gestational diabetes mellitus (GDM) has important health complications for both mother and child and is increasing all over the world. Although prevalence estimates for GDM are not new in developed and many developing countries, data are lacking for many low-income countries like Bangladesh. To evaluate the prevalence of GDM in Bangladesh. This cross-sectional study included 3447 women who consecutively visited the antenatal clinics with an average gestation age of 26 weeks. GDM was defined according to WHO criteria (fasting plasma glucose [FPG] ≥7.0 mmol/L or 2-h ≥7.8 mmol/L) and the new ADA criteria (FPG ≥5.3 mmol/L or 2-h ≥8.6 mmol/L OGTT). We also calculated overt diabetes as FPG ≥7.0 mmol/L. Prevalence of GDM was 9.7% according to the WHO criteria and 12.9% according to the ADA criteria in this study population. Prevalence of overt diabetes was 1.8%. Women with GDM were older, higher educated, had higher household income, higher parity, parental history of diabetes, and more hypertensive, compared with non-GDM women. This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help to formulate new policies to prevent and manage diabetes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Association between gestational weight gain and perinatal outcomes in women with chronic hypertension.

PubMed

Yee, Lynn M; Caughey, Aaron B; Cheng, Yvonne W

2017-09-01

Gestational weight gain above or below the 2009 National Academy of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. The objective of this study was to examine the relationship between gestational weight gain above and below National Academy of Medicine guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension. This is a population-based retrospective cohort study of women with chronic hypertension who had term, singleton, vertex births in the United States from 2012 through 2014. Prepregnancy body mass index was calculated using self-reported prepregnancy weight and height. Women were categorized into 4 groups based on gestational weight gain and prepregnancy body mass index: (1) weight gain less than, (2) weight gain within, (3) weight gain 1-19 lb in excess of, and (4) weight gain ≥20 lb in excess of the National Academy of Medicine guidelines. The χ 2 tests and multivariable logistic regression analysis were used for statistical comparisons. Stratified analyses by body mass index category were additionally performed. In this large birth cohort, 101,259 women met criteria for inclusion. Compared to hypertensive women who had gestational weight gain within guidelines, hypertensive women with weight gain ≥20 lb over National Academy of Medicine guidelines were more likely to have eclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54-2.42) and cesarean delivery (adjusted odds ratio, 1.60; 95% confidence interval, 1.50-1.70). Excess weight gain ≥20 lb over National Academy of Medicine guidelines was also associated with increased odds of 5-minute Apgar <7 (adjusted odds ratio, 1.29; 95% confidence interval, 1.13-1.47), neonatal intensive care unit admission (adjusted odds ratio, 1.23; 95% confidence interval, 1.14-1.33), and large-for-gestational-age neonates (adjusted odds ratio, 2.41; 95% confidence interval, 2.27-2.56) as well as decreased odds of small-for-gestational-age status (adjusted odds ratio, 0.52; 95% confidence interval, 0.46-0.58). Weight gain 1-19 lb over guidelines was associated with similar fetal growth outcomes although with a smaller effect size. In contrast, weight gain less than National Academy of Medicine guidelines was not associated with adverse maternal outcomes but was associated with increased odds of small for gestational age (adjusted odds ratio, 1.31; 95% confidence interval, 1.21-1.52) and decreased odds of large-for-gestational-age status (adjusted odds ratio, 0.86; 95% confidence interval, 0.81-0.92). Analysis of maternal and neonatal outcomes stratified by body mass index demonstrated similar findings. Women with chronic hypertension who gain less weight than National Academy of Medicine guidelines experience increased odds of small-for-gestational-age neonates, whereas excess weight gain ≥20 lb over National Academy of Medicine guidelines is associated with cesarean delivery, eclampsia, 5-minute Apgar <7, neonatal intensive care unit admission, and large-for-gestational-age neonates. Copyright © 2017 Elsevier Inc. All rights reserved.

Performance of a postnatal metabolic gestational age algorithm: a retrospective validation study among ethnic subgroups in Canada

PubMed Central

Hawken, Steven; Ducharme, Robin; Murphy, Malia S Q; Atkinson, Katherine M; Potter, Beth K; Chakraborty, Pranesh; Wilson, Kumanan

2017-01-01

Objectives Biological modelling of routinely collected newborn screening data has emerged as a novel method for deriving postnatal gestational age estimates. Validation of published models has previously been limited to cohorts largely consisting of infants of white Caucasian ethnicity. In this study, we sought to determine the validity of a published gestational age estimation algorithm among recent immigrants to Canada, where maternal landed immigrant status was used as a surrogate measure of infant ethnicity. Design We conducted a retrospective validation study in infants born in Ontario between April 2009 and September 2011. Setting Provincial data from Ontario, Canada were obtained from the Institute for Clinical Evaluative Sciences. Participants The dataset included 230 034 infants born to non-landed immigrants and 70 098 infants born to immigrant mothers. The five most common countries of maternal origin were India (n=10 038), China (n=7468), Pakistan (n=5824), The Philippines (n=5441) and Vietnam (n=1408). Maternal country of origin was obtained from Citizenship and Immigration Canada’s Landed Immigrant Database. Primary and secondary outcome measures Performance of a postnatal gestational age algorithm was evaluated across non-immigrant and immigrant populations. Results Root mean squared error (RMSE) of 1.05 weeks was observed for infants born to non-immigrant mothers, whereas RMSE ranged from 0.98 to 1.15 weeks among infants born to immigrant mothers. Area under the receiver operating characteristic curve for distinguishing term versus preterm infants (≥37 vs <37 weeks gestational age or >34 vs ≤34 weeks gestational age) was 0.958 and 0.986, respectively, in the non-immigrant subgroup and ranged from 0.927 to 0.964 and 0.966 to 0.99 in the immigrant subgroups. Conclusions Algorithms for postnatal determination of gestational age may be further refined by development and validation of region or ethnicity-specific models. However, our results provide reassurance that an algorithm developed from Ontario-born infant cohorts performs well across a range of ethnicities and maternal countries of origin without modification. PMID:28871012

Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda.

PubMed

Kisuule, Ivan; Kaye, Dan K; Najjuka, Florence; Ssematimba, Stephen K; Arinda, Anita; Nakitende, Gloria; Otim, Lawrence

2013-05-25

Mothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming. The study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late. Four hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit. Pregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care.

Risk of adverse outcomes among infants of immigrant women according to birth-weight curves tailored to maternal world region of origin.

PubMed

Urquia, Marcelo L; Berger, Howard; Ray, Joel G

2015-01-06

Infants of immigrant women in Western nations generally have lower birth weights than infants of native-born women. Whether this difference is physiologic or pathological is unclear. We determined whether the use of birth-weight curves tailored to maternal world region of origin would discriminate adverse neonatal and obstetric outcomes more accurately than a single birth-weight curve based on infants of Canadian-born women. We performed a retrospective cohort study of in-hospital singleton live births (328,387 to immigrant women, 761,260 to nonimmigrant women) in Ontario between 2002 and 2012 using population health services data linked to the national immigration database. We classified infants as small for gestational age (<10th percentile) or large for gestational age (≥90th percentile) using both Canadian and world region-specific birth-weight curves and compared associations with adverse neonatal and obstetric outcomes. Compared with world region-specific birth-weight curves, the Canadian curve classified 20 431 (6.2%) additional newborns of immigrant women as small for gestational age, of whom 15,467 (75.7%) were of East or South Asian descent. The odds of neonatal death were lower among small-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on the Canadian birth-weight curve (adjusted odds ratio [OR] 0.83, 95% confidence interval [CI] 0.72-0.95), but higher when small for gestational age was defined by the world region-specific curves (adjusted OR 1.24, 95% CI 1.08-1.42). Conversely, the odds of some adverse outcomes were lower among large-for-gestational-age infants of immigrant women than among those of nonimmigrant women based on world region-specific birth-weight curves, but were similar based on the Canadian curve. World region-specific birth-weight curves seemed to be more appropriate than a single Canadian population-based curve for assessing the risk of adverse neonatal and obstetric outcomes among small- and large-for-gestational-age infants born to immigrant women, especially those from the East and South Asian regions. © 2015 Canadian Medical Association or its licensors.

Performance of a postnatal metabolic gestational age algorithm: a retrospective validation study among ethnic subgroups in Canada.

PubMed

Hawken, Steven; Ducharme, Robin; Murphy, Malia S Q; Atkinson, Katherine M; Potter, Beth K; Chakraborty, Pranesh; Wilson, Kumanan

2017-09-03

Biological modelling of routinely collected newborn screening data has emerged as a novel method for deriving postnatal gestational age estimates. Validation of published models has previously been limited to cohorts largely consisting of infants of white Caucasian ethnicity. In this study, we sought to determine the validity of a published gestational age estimation algorithm among recent immigrants to Canada, where maternal landed immigrant status was used as a surrogate measure of infant ethnicity. We conducted a retrospective validation study in infants born in Ontario between April 2009 and September 2011. Provincial data from Ontario, Canada were obtained from the Institute for Clinical Evaluative Sciences. The dataset included 230 034 infants born to non-landed immigrants and 70 098 infants born to immigrant mothers. The five most common countries of maternal origin were India (n=10 038), China (n=7468), Pakistan (n=5824), The Philippines (n=5441) and Vietnam (n=1408). Maternal country of origin was obtained from Citizenship and Immigration Canada's Landed Immigrant Database. Performance of a postnatal gestational age algorithm was evaluated across non-immigrant and immigrant populations. Root mean squared error (RMSE) of 1.05 weeks was observed for infants born to non-immigrant mothers, whereas RMSE ranged from 0.98 to 1.15 weeks among infants born to immigrant mothers. Area under the receiver operating characteristic curve for distinguishing term versus preterm infants (≥37 vs <37 weeks gestational age or >34 vs ≤34 weeks gestational age) was 0.958 and 0.986, respectively, in the non-immigrant subgroup and ranged from 0.927 to 0.964 and 0.966 to 0.99 in the immigrant subgroups. Algorithms for postnatal determination of gestational age may be further refined by development and validation of region or ethnicity-specific models. However, our results provide reassurance that an algorithm developed from Ontario-born infant cohorts performs well across a range of ethnicities and maternal countries of origin without modification. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Neck circumference might predict gestational diabetes mellitus in Han Chinese women: A nested case-control study.

PubMed

He, Fang; He, Hua; Liu, Wenqi; Lin, Junyu; Chen, Bingjun; Lin, Yucong; Zhao, Yitao; Tao, Wen; Xia, Xuefeng

2017-03-01

A large neck circumference might be an indicator of metabolic syndrome and its components, and for certain patients is more practical as an index than waist circumference. The demarcation value for neck circumference that suggests metabolic syndrome appears to vary by ethnic group. Gestational diabetes mellitus is considered a component of metabolic syndrome in pregnant women. We investigated whether neck circumference in Han Chinese women is associated with gestational diabetes mellitus in early pregnancy, and determined a predictive demarcation value. A nested case-control study was carried out with 255 women aged 18-35 years. Gestational diabetes mellitus was diagnosed according to the criteria of the American Diabetes Association through a 2-h, 75-g oral glucose tolerance test. Of the total population, 41 (16%) women developed gestational diabetes mellitus by 24-28 weeks of gestation. Neck circumference at gestational week 16 positively correlated with pre-pregnancy waist circumference, bodyweight and body mass index, and maternal age (P = 0.029) and hemoglobin A1c at gestational week 24 (P ≤ 0.001). By binary logistic regression, neck circumference was an independent predictor of gestational diabetes mellitus (odds ratio 1.840, 95% confidence interval 1.040-3.254; P = 0.036). According to the receiver operating characteristic curve, for predicting gestational diabetes mellitus the optimal demarcation for neck circumference at gestational week 16 was 35.15 cm. Neck circumference is a viable tool to screen for gestational diabetes mellitus. In this population of pregnant Han Chinese women, a neck circumference of ≥35.15 cm was a predictor of gestational diabetes mellitus. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Foetal Ureaplasma parvum bacteraemia as a function of gestation-dependent complement insufficiency: Evidence from a sheep model of pregnancy.

PubMed

Kemp, Matthew W; Ahmed, Shatha; Beeton, Michael L; Payne, Matthew S; Saito, Masatoshi; Miura, Yuichiro; Usuda, Haruo; Kallapur, Suhas G; Kramer, Boris W; Stock, Sarah J; Jobe, Alan H; Newnham, John P; Spiller, Owen B

2017-01-01

Complement is a central defence against sepsis, and increasing complement insufficiency in neonates of greater prematurity may predispose to increased sepsis. Ureaplasma spp. are the most frequently cultured bacteria from preterm blood samples. A sheep model of intrauterine Ureaplasma parvum infection was used to examine in vivo Ureaplasma bacteraemia at early and late gestational ages. Complement function and Ureaplasma killing assays were used to determine the correlation between complement potency and bactericidal activity of sera ex vivo. Ureaplasma was cultured from 50% of 95-day gestation lamb cord blood samples compared to 10% of 125-day gestation lambs. Bactericidal activity increased with increased gestational age, and a direct correlation between functional complement activity and bactericidal activity (R 2 =.86; P<.001) was found for 95-day gestational lambs. Ureaplasma bacteraemia in vivo was confined to early preterm lambs with low complement function, but Ureaplasma infection itself did not diminish complement levels. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Elimination of neurons from the rhesus monkey's lateral geniculate nucleus during development.

PubMed

Williams, R W; Rakic, P

1988-06-15

The timing, magnitude, and spatial distribution of neuron elimination was studied in the dorsal lateral geniculate nucleus of 57 rhesus monkeys (Macaca mulatta) ranging in age from the 48th day of gestation to maturity. Normal and degenerating cells were counted in Nissl-stained sections by using video-enhanced differential interference contrast optics and video-overlay microscopy. Before embryonic day 60 (E60), the geniculate nucleus contains 2,200,000 +/- 100,000 neurons. Roughly 800,000 of these neurons are eliminated over a 40- to 50-day period spanning the middle third of gestation. Neurons are lost at an average rate of 300 an hour between E48 and E60, and at an average rate of 800 an hour between E60 and E100. Very few neurons are lost after E100, and as early as E103 the population has fallen to the adult average of 1,400,000 +/- 90,000. Degenerating neurons are far more common in the magnocellular part of the nucleus than in the parvicellular part. In 20 of 29 cases, the number of neurons is greater on the right than on the left side. The right-left asymmetry averages about 8.5% and the difference is statistically significant (phi 2 = 38, p less than .001). The period of cell death occurs before the emergence of cell layers in the geniculate nucleus, before the establishment of geniculocortical connections, and before the formation of ocular dominance columns (Rakic, '76). Most important, the depletion of neurons in the geniculate nucleus begins long before the depletion of retinal axons. The number of geniculate neurons is probably a key factor controlling the number of the retinal cells that survive to maturity.

Fetal eyeball volume: relationship to gestational age and biparietal diameter.

PubMed

Odeh, Marwan; Feldman, Yulia; Degani, Shimon; Grinin, Vitali; Ophir, Ella; Bornstein, Jacob

2009-08-01

To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation. The volume of the fetal eyeball was measured with three-dimensional ultrasound between 14 and 40 weeks of gestation using the VOCAL software.Only singleton pregnancies without fetal growth restriction, diabetes mellitus, hypertension or major fetal malformation were included. Over all, 203 women were studied. In 125 both eyeballs were measured while in 78 only one eyeball was measured. The volume of the eyeball correlated strongly with gestational age (right: R = 0.946, P < 0.001, n = 171. left: R = 0.945, P < 0.001, n = 156), and with the biparietal diameter (BPD) (right: R = 0.949, P < 0.001, n = 171. left: R = 0.953, P < 0.001, n = 156). Using regression analysis the best correlation between eyeball volume and the BPD were: square of right eyeball = -0.180 + 0.187 BPD, square of left eyeball = -0.182 + 0.187 BPD. The volume of the eyeball has strong positive correlations with gestational age and BPD. Our data may be helpful in fetuses suspected of having eye anomalies.

Respiratory morbidity in twins by birth order, gestational age and mode of delivery.

PubMed

Bricelj, Katja; Tul, Natasa; Lasic, Mateja; Bregar, Andreja Trojner; Verdenik, Ivan; Lucovnik, Miha; Blickstein, Isaac

2016-10-01

To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery. All twin deliveries at <37 weeks, registered in a national database, in the period 2003-2012 were classified into four gestational age groups: 33-36, 30-32, 28-29, and <28 weeks. Outcome variables included transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS) and need for assisted ventilation. A total of 1836 twins were born vaginally, and 2142 twins were born by cesarean delivery, for a grand total of 3978 twins. TTN did not appear to be related to birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30-36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2-5.1 and OR 2.0, 95% CI 1.2-3.5 for 33-36 weeks and 30-32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1-13.0 for 28-29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages <30 weeks. Mode of delivery and birth order have a gestational age dependent effect on the incidence of RDS.

Homocysteine in small-for-gestational age and appropriate-for-gestational age preterm neonates from mothers receiving folic acid supplementation.

PubMed

Gomes, Thushari S; Lindner, Ulrike; Tennekoon, Kamani H; Karandagoda, Wimal; Gortner, Ludwig; Obeid, Rima

2010-08-01

Prematurity and small-for-gestational age (SGA) neonates are at risk for postnatal complications. Concentrations of total homocysteine (tHcy) might be related to neonatal outcome. We hypothesized that concentrations of tHcy are not related to growth restriction in neonates from mothers receiving 5 mg/day folic acid. We studied a total of 133 preterm neonates from normotensive mothers; SGA (n=96) and appropriate-for-gestational age (AGA, n=37). Concentrations of tHcy, folate and vitamin B12 were measured in venous umbilical cord plasma. AGA preterm neonates had higher mean birth weight (BW) compared to SGA preterms (2472 g vs. 2007 g; p<0.001) of comparable mean gestational age (GA) (35.1 vs. 35.7 weeks; p=0.059). Concentrations of tHcy (4.86 vs. 4.95 micromol/L), folate (63.3 vs. 55.7 nmol/L), and vitamin B12 (409 vs. 394 pmol/L) were not significantly different between the groups. GA was a strong positive predictor, BW was a significant negative predictor of cord plasma folate. Vitamin B12 concentration was a significant negative predictor of cord tHcy. Concentrations of tHcy did not differ between SGA and AGA preterm neonates born to mothers supplemented with folic acid. This finding argues against a causal role for folate deficiency or increased tHcy in growth restriction.

Trends in induced abortion during the 12 years since legalization in Norway.

PubMed

Skjeldestad, F E; Borgan, J K

1994-01-01

Data on 174,595 Norwegian women aged 15-44 who had an induced abortion between 1979 (when all abortions through 12 weeks of gestation were legalized) and 1990 reveals that the general abortion rate decreased by 12% among married women, while it remained unchanged among unmarried women. Unmarried women had higher abortion rates than did married women among all age-groups except teenagers, increasing from a difference of 11 abortions per 1,000 women in 1979-1981 to a difference of 13 per 1,000 in 1988-1990. Pregnancy terminations occurred at an earlier gestational age during the last three years of the study period, compared with the first three. Abortions beyond 12 gestational weeks, which require the approval of a hospital committee, decreased among unmarried women, while increasing somewhat among married women. A larger proportion of married women than unmarried women terminated pregnancies beyond 18 gestational weeks.

Visual Cortical Function in Very Low Birth Weight Infants without Retinal or Cerebral Pathology

PubMed Central

Hou, Chuan; Norcia, Anthony M.; Madan, Ashima; Tith, Solina; Agarwal, Rashi

2011-01-01

Purpose. Preterm infants are at high risk of visual and neural developmental deficits. However, the development of visual cortical function in preterm infants with no retinal or neurologic morbidity has not been well defined. To determine whether premature birth itself alters visual cortical function, swept parameter visual evoked potential (sVEP) responses of healthy preterm infants were compared with those of term infants. Methods. Fifty-two term infants and 58 very low birth weight (VLBW) infants without significant retinopathy of prematurity or neurologic morbidities were enrolled. Recruited VLBW infants were between 26 and 33 weeks of gestational age, with birth weights of less than 1500 g. Spatial frequency, contrast, and vernier offset sweep VEP tuning functions were measured at 5 to 7 months' corrected age. Acuity and contrast thresholds were derived by extrapolating the tuning functions to 0 amplitude. These thresholds and suprathreshold response amplitudes were compared between groups. Results. Preterm infants showed increased thresholds (indicating decreased sensitivity to visual stimuli) and reductions in amplitudes for all three measures. These changes in cortical responsiveness were larger in the <30 weeks ' gestational age subgroup than in the ≥30 weeks' gestational age subgroup. Conclusions. Preterm infants with VLBW had measurable and significant changes in cortical responsiveness that were correlated with gestational age. These results suggest that premature birth in the absence of identifiable retinal or neurologic abnormalities has a significant effect on visual cortical sensitivity at 5 to 7 months' of corrected age and that gestational age is an important factor in visual development. PMID:22025567

The risk of infant and fetal death by each additional week of expectant management in intrahepatic cholestasis of pregnancy by gestational age.

PubMed

Puljic, Anela; Kim, Elissa; Page, Jessica; Esakoff, Tania; Shaffer, Brian; LaCoursiere, Daphne Y; Caughey, Aaron B

2015-05-01

The objective of the study was to characterize the risk of infant and fetal death by each additional week of expectant management vs immediate delivery in pregnancies complicated by cholestasis. This was a retrospective cohort study of 1,604,386 singleton, nonanomalous pregnancies of women between 34 and 40 weeks' gestation with and without intrahepatic cholestasis of pregnancy (ICP) in the state of California during the years of 2005-2008. International Classification of Diseases, 9th version, codes and linked hospital discharge and vital statistics data were utilized. For each week of gestation, the following outcomes were assessed: the risk of stillbirth, the risk of delivery (represented by the risk of infant death at a given week of gestation), and the composite risk of expectant management for 1 additional week. Composite risk combines the risk of stillbirth at this gestational age week plus the risk of infant death if delivered at the subsequent week of gestation. Among women with ICP, the mortality risk of delivery is lower than the risk of expectant management at 36 weeks' gestation (4.7 vs 19.2 per 10,000). The risk of expectant management remains higher than delivery and continues to rise by week of gestation beyond 36 weeks. The risk of expectant management in women with ICP reaches a nadir at 35 weeks (9.1 per 10,000; 95% confidence interval, 1.4-16.9) and rises at 36 weeks (19.2 per 10,000; 95% confidence interval, 7.6-30.8). Among women with ICP, delivery at 36 weeks' gestation would reduce the perinatal mortality risk as compared with expectant management. For later diagnoses, this would also be true at gestational ages beyond 36 weeks. Timing of delivery must take into account both the reduction in stillbirth risk balanced with the morbidities associated with preterm delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

Influence of exercise intervention on gestational diabetes mellitus: a systematic review and meta-analysis.

PubMed

Zheng, J; Wang, H; Ren, M

2017-10-01

Exercise intervention might be a promising approach to prevent gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of exercise intervention on gestational diabetes mellitus. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of exercise intervention on gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was the incidence of gestational diabetes mellitus, preterm birth, and gestational age at birth. Meta-analysis was performed using random-effect model. Five RCTs involving 1872 patients were included in the meta-analysis. Overall, compared with control intervention, exercise intervention was found to significantly reduce the risk of gestational diabetes mellitus (std. mean difference 0.62; 95% CI 0.43-0.89; P = 0.01), but demonstrated no influence on preterm birth (OR 0.93; 95% CI 0.44-1.99; P = 0.86), gestational age at birth (std. mean difference -0.03; 95% CI -0.12 to 0.07; P = 0.60), glucose 2-h post-OGTT (std. mean difference -1.02; 95% CI -2.75 to 0.71; P = 0.25), birth weight (std. mean difference -0.10; 95% CI -0.25 to 0.04; P = 0.16), Apgar score less than 7 (OR 0.78; 95% CI 0.21-2.91; P = 0.71), and preeclampsia (OR 1.05; 95% CI 0.53-2.07; P = 0.88). Compared to control intervention, exercise intervention was found to significantly reduce the incidence of gestational diabetes mellitus, but had no significant influence on preterm birth, gestational age at birth, glucose 2-h post-OGTT, birth weight, Apgar score less than 7, and preeclampsia.

The association between inadequate gestational weight gain and infant mortality among U.S. infants born in 2002.

PubMed

Davis, Regina R; Hofferth, Sandra L

2012-01-01

The purpose of this study was to determine the relative importance of inadequate gestational weight gain as a cause of infant mortality. Birth and infant death certificate data were obtained from a random sample of 100,000 records from the National Center for Health Statistics (NCHS) 2002 Birth Cohort Linked Birth/Infant Death Data File. Descriptive and proportional hazards regression analyses were used to assess the odds of infant mortality associated with inadequate gestational weight gain compared to normal weight gain. Nearly 30% of women experienced inadequate weight gain. Infants born to women with inadequate gestational weight gain had odds of infant death that were 2.23 times the odds for infants born to women with normal weight gain. Increased odds remained after adjustment for gestational age, low birth weight, maternal age, maternal education, and maternal race. Among racial or ethnic subgroups, African American women were 1.3 times as likely as white women to have an infant die, but they were no more likely to have an infant die than white women if they had inadequate weight gain. There is a substantial and significant association between inadequate gestational weight gain and infant death that does not differ by race, ethnic group membership, or maternal age.

Why do four NICUs using identical RBC transfusion guidelines have different gestational age-adjusted RBC transfusion rates?

PubMed

Henry, E; Christensen, R D; Sheffield, M J; Eggert, L D; Carroll, P D; Minton, S D; Lambert, D K; Ilstrup, S J

2015-02-01

To compare neonatal red blood cell (RBC) transfusion rates in four large Intermountain Healthcare NICUs, all of which adhere to the same RBC transfusion guidelines. This retrospective analysis was part of a transfusion-management quality-improvement project. De-identified data included RBC transfusions, clinical and laboratory findings, the anemia-prevention strategies in place in each NICU, and specific costs and outcomes. Of 2389 NICU RBC transfusions given during the 4-year period studied, 98.9 ± 2.1% (mean ± S.D.) were compliant with our transfusion guidelines, with no difference in compliance between any of the four NICUs. However, RBC transfusion rates varied widely between the four, with averages ranging from 4.6 transfusions/1000 NICU days to 21.7/1000 NICU days (P < 0.00001). Gestational age-adjusted transfusion rates were correspondingly discordant (P < 0.00001). The lower-transfusing NICUs had written anemia-preventing guidelines, such as umbilical cord milking at very low birth weight delivery, use of cord blood for admission laboratory studies, and darbepoetin dosing for selected neonates. Rates of Bell stage ⩾ 2 necrotizing enterocolitis and grade ⩾ 3 intraventricular hemorrhage were lowest in the two lower-transfusing NICUs (P < 0.0002 and P < 0.0016). Average pharmacy costs for darbepoetin were $84/dose, with an average pharmacy cost of $269 per transfusion averted. With a cost of $900/RBC transfusion, the anemia-preventing strategies resulted in an estimated cost savings to Intermountain Healthcare of about $6970 per 1000 NICU days, or about $282,300 annually. Using transfusion guidelines has been shown previously to reduce practice variability, lower transfusion rates and diminish transfusion costs. Based on our present findings, we maintain that even when transfusion guidelines are in place and adhered to rigorously, RBC transfusion rates are reduced further if anemia-preventing strategies are also in place.

Maternal underweight and perinatal outcomes: a restrospective cohort study

PubMed

Vilar Sánchez, Ángel; Fernández Alba, Juan Jesús; González Macías, María Del Carmen; Paublete Herrera, María Del Carmen; Carnicer Fuentes, Concepción; Carral San Laureano, Florentino; Torrejón Cardoso, Rafael; Moreno Corral, Luis Javier

2017-06-05

Introduction: Some studies have linked maternal underweight with adverse perinatal outcomes such as spontaneous abortion, abruptio placentae, small for gestational age newborn, intrauterine growth retardation and preterm birth. Objective: To determine the influence of maternal underweight in the onset of labor, route of delivery, birth weight, Apgar score and preterm birth. Methods: Retrospective cohort study. We included pregnant women from the Hospital Universitario de Puerto Real. Period of study: 2002-2011. Study group: underweight at the beginning of gestation (BMI < 18.5 kg/m2). Control group: pregnant women with normal body mass index (BMI) at the beginning of gestation (18.5-24.9 kg/m2). The risk (OR) of induction of labor, cesarean section, small for gestational age newborn, macrosomia, 5’ Apgar score < 7, and preterm birth was calculated. Results: The prevalence of underweight was 2.5% versus 58.9% of pregnant women who had a normal BMI. We found no significant differences in the rate of induction of labor, fetal macrosomia, Apgar at 5’ < 7 or preterm delivery. Maternal underweight was associated with a decreased risk of caesarean section (adjusted OR 0.45, 95% CI 0.22 to 0.89) and an increased risk of small for gestational age newborn (adjusted OR 1.74; 95% CI 1.05 to 2.90). Conclusions: Maternal underweight at the start of pregnancy is associated with a lower risk of caesarean section and a greater risk of small for gestational age newborns (birth weight < P10).

Newborn regional body composition is influenced by maternal obesity, gestational weight gain and the birthweight standard score.

PubMed

Carlsen, E M; Renault, K M; Nørgaard, K; Nilas, L; Jensen, J E B; Hyldstrup, L; Michaelsen, K F; Cortes, D; Pryds, O

2014-09-01

This study investigated whether newborn body composition is influenced by prepregnancy obesity and gestational weight gain (GWG) and explored any associations between body composition and birthweight standard score (z-score), categorised by size for gestational age. We recruited 231 obese and 80 normal weight mothers and their newborn infants and assessed the babies' body composition using dual-energy X-ray absorptiometry. The total and abdominal fat masses of infants born to mother who were obese before pregnancy were 135 g (p < 0.001) and 18 g (p < 0.001) higher than the offspring of normal weight mothers. The infants' fat mass increased by 11 g (p < 0.001) for every kilogram of GWG. There were no associations between prepregnancy obesity and fat-free mass. The fat percentage was significantly higher in infants who were large for gestational age (15.3%) than small for gestational age (5.2%) and appropriate for gestational age (9.8%) (p < 0.001). Lower birthweight z-score was associated with a higher proportion of abdominal fat mass (p = 0.009). Infants born to obese mothers had higher fat mass at birth, with abdominal fat accumulation. Low birthweight was associated with a lower crude abdominal fat mass, but a higher proportion of total fat mass placed abdominally. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Effects of competition among fertility centers on pregnancy and high-order multiple gestation rates.

PubMed

Steiner, Anne Z; Paulson, Richard J; Hartmann, Katherine E

2005-05-01

To measure the effect of competition among fertility centers on pregnancy and high-order multiple (HOM) gestation rates after IVF. Retrospective cohort study. Four hundred eight fertility clinics registered with the Society for Assisted Reproductive Technology as providing IVF services in 2000. Competition was defined as number of clinics in a geographically defined area. Demand for services was based on the population of reproductive-aged women. Three hundred eighty-one fertility clinics reporting clinical outcomes. Pregnancy rates, HOM gestation rates, population of reproductive-aged women, and number of competing clinics were calculated for each clinic from Society for Assisted Reproductive Technology and census data. The clinic HOM gestation rate (percentage of pregnancies that were HOM) and age-adjusted pregnancy rate. The number of clinics in an area of competition ranged from 1 to 22. The HOM gestation rate per clinic ranged from 0% to 50%. As demand increased, competition increased. As competition increased, the number of HOM pregnancies per clinic decreased. In areas of low competition (1 to 2 clinics) the clinic HOM gestation rate was 8.43%, in areas of intermediate competition (3-7 clinics) 8.39%, and in areas of high competition (8-22 clinics) 8.24%. In areas with intermediate demand, high levels of competition resulted in fewer HOM pregnancies than intermediate competition (relative risk 0.56, 95% confidence interval 0.36-0.89) or low levels of competition (RR 0.57, 95% confidence interval 0.35-0.94). Age-adjusted pregnancy rates did not differ by level of competition. According to these data, the risk of HOM gestation decreases with increasing competition among clinics; however, pregnancy rates are unaffected.

Reference Charts for Fetal Cerebellar Vermis Height: A Prospective Cross-Sectional Study of 10605 Fetuses

PubMed Central

Cignini, Pietro; Giorlandino, Maurizio; Brutti, Pierpaolo; Mangiafico, Lucia; Aloisi, Alessia; Giorlandino, Claudio

2016-01-01

Objective To establish reference charts for fetal cerebellar vermis height in an unselected population. Methods A prospective cross-sectional study between September 2009 and December 2014 was carried out at ALTAMEDICA Fetal–Maternal Medical Centre, Rome, Italy. Of 25203 fetal biometric measurements, 12167 (48%) measurements of the cerebellar vermis were available. After excluding 1562 (12.8%) measurements, a total of 10605 (87.2%) fetuses were considered and analyzed once only. Parametric and nonparametric quantile regression models were used for the statistical analysis. In order to evaluate the robustness of the proposed reference charts regarding various distributional assumptions on the ultrasound measurements at hand, we compared the gestational age-specific reference curves we produced through the statistical methods used. Normal mean height based on parametric and nonparametric methods were defined for each week of gestation and the regression equation expressing the height of the cerebellar vermis as a function of gestational age was calculated. Finally the correlation between dimension/gestation was measured. Results The mean height of the cerebellar vermis was 12.7mm (SD, 1.6mm; 95% confidence interval, 12.7–12.8mm). The regression equation expressing the height of the CV as a function of the gestational age was: height (mm) = -4.85+0.78 x gestational age. The correlation between dimension/gestation was expressed by the coefficient r = 0.87. Conclusion This is the first prospective cross-sectional study on fetal cerebellar vermis biometry with such a large sample size reported in literature. It is a detailed statistical survey and contains new centile-based reference charts for fetal height of cerebellar vermis measurements. PMID:26812238

A cross-cultural exploration of abortion fund patients in the USA and the Republic of Ireland, Northern Ireland and the Isle of Man.

PubMed

Ely, Gretchen E; Hales, Travis W; Jackson, D Lynn

2018-05-01

This paper details results of a study examining administrative case data from 2010-2015 from abortion funds serving the USA and the Republic of Ireland, Northern Ireland and the Isle of Man. Driven by the available data, the researchers compared organisational characteristics, patient characteristics, procedural costs, patient resources and the ratio between patient resources and procedural costs. Independent t-tests were conducted to assess whether differences in characteristics, costs or resources were significant. The number of patients serviced by abortion funds across the two datasets increased yearly from 2010-2015. While patients in the USA had more resources, on average, to contribute to their abortion procedure, Irish, Northern Irish and Manx patients had the resources to pay for a greater percentage of their costs, on average, which was mainly attributable to the differences in gestational age of those helped by the different abortion funds. Patients across all nations were similar in terms of their marital status, average age and number of existing children. Patients across these countries face expensive procedures and a lack of resources that are bridged in part by abortion fund assistance.

Association of Pregnancy Complications and Characteristics with Future Risk of Elevated Blood Pressure: The Västerbotten Intervention Programme

PubMed Central

Parikh, Nisha I.; Norberg, Margareta; Ingelsson, Erik; Cnattingius, Sven; Vasan, Ramachandran S.; Domellöf, Magnus; Jansson, Jan Håkan; Edstedt Bonamy, Anna-Karin

2017-01-01

Pregnancy characteristics are associated with risk of cardiovascular diseases, but their independent associations with hypertension or blood pressure levels remain uncertain. We linked the Swedish Medical Birth Register with Västerbotten Intervention Programme data (Northern Sweden). Using linear and logistic regression, we related pregnancy factors in any prior pregnancy with blood pressure and hypertension at age 40 years in 15,896 parous women free of prepregnancy hypertension. Pregnancy factors included parity, age at first delivery, preeclampsia, gestational diabetes, placental abruption, shortest gestational age small for gestational age baby (SGA; < 3rd percentile for birth weight) or stillbirth. We defined hypertension as systolic BP ≥ 140 and/or DBP ≥ 90 mmHg and/or antihypertensive use. Multivariable models were adjusted for all pregnancy factors and potential lifestyle and sociodemographic confounders. At age 40 years, 1,535 women (9.6%) had hypertension. In multivariable models, lower parity, younger age at first birth, preeclampsia, SGA, and placental abruption were independently associated with higher systolic and/or diastolic blood pressure levels at age 40 years. Younger age at first birth, preeclampsia, gestational age <32 versus ≥ 37 weeks and SGA, were independently associated with hypertension. Our findings raise the possibility that earlier and more frequent BP screening may be desirable in women with these pregnancy characteristics. PMID:28137991

Maternal and fetal outcome of mothers with gestational diabetes mellitus attending BIRDEM Hospital.

PubMed

Sajani, T T; Rahman, M T; Karim, M R

2014-04-01

Gestational diabetes mellitus, most of which progress to type-2 diabetes mellitus is increasing worldwide. Identification of gestational diabetes and control of glucose can reduce such complications and improve maternal and neonatal health. A hospital based cross sectional study was conducted to find out maternal and fetal outcome of gestational diabetes from January to July 2011. Data were collected from 109 gestational diabetes mothers attending Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital for delivery. Study revealed that gestational diabetes was more common among mothers aged >25 years old and multiparaous women. Mean gestational age of diagnosis was 16.82±9.54 weeks. Sixty eight (68%) mothers were diagnosed before 20 weeks of gestation and more than 90% mothers with gestational diabetes delivered by caesarean section. Mean pregnancy weight gain was 6.8±1.18kg. Adverse maternal outcome observed in 24% cases and adverse fetal outcome was present in 34% cases. In univariate analysis weeks of delivery and fasting blood sugar were statistically significantly associated with adverse pregnancy outcome. Babies born to mothers with only diet restriction had less birth weight than mothers with insulin therapy. Pregnancy thought to be the most vulnerable stage of women's life and protecting her health along with her fetus during this period yields a positive impact on the health of future generation. Particular attention should be given during antenatal period to initiate screening programme and treatment protocol for gestational diabetic mothers.

COMPARISON OF GESTATIONAL AGE AT DELIVERY BASED ON LAST MENSTRUAL PERIOD AND EARLY ULTRASOUND

EPA Science Inventory

Reported date of last menstrual period (LMP) is commonly used to estimate gestational age but may be unreliable if recall is inaccurate or time between menstruation and ovulation differs from the presumed 15-day interval. Early ultrasound is generally a more accurate method than ...

Gestational length assignment based on last menstrual period, first trimester crown-rump length, ovulation, and implantation timing.

PubMed

Mahendru, Amita A; Wilhelm-Benartzi, Charlotte S; Wilkinson, Ian B; McEniery, Carmel M; Johnson, Sarah; Lees, Christoph

2016-10-01

Understanding the natural length of human pregnancy is central to clinical care. However, variability in the reference methods to assign gestational age (GA) confound our understanding of pregnancy length. Assignation from ultrasound measurement of fetal crown-rump length (CRL) has superseded that based on last menstrual period (LMP). Our aim was to estimate gestational length based on LMP, ultrasound CRL, and implantation that were known, compared to pregnancy duration assigned by day of ovulation. Prospective study in 143 women trying to conceive. In 71 ongoing pregnancies, gestational length was estimated from LMP, CRL at 10-14 weeks, ovulation, and implantation day. For each method of GA assignment, the distribution in observed gestational length was derived and both agreement and correlation between the methods determined. Median ovulation and implantation days were 16 and 27, respectively. The gestational length based on LMP, CRL, implantation, and ovulation was similar: 279, 278, 276.5 and 276.5 days, respectively. The distributions for observed gestational length were widest where GA was assigned from CRL and LMP and narrowest when assigned from implantation and ovulation day. The strongest correlation for gestational length assessment was between ovulation and implantation (r = 0.98) and weakest between CRL and LMP (r = 0.88). The most accurate method of predicting gestational length is ovulation day, and this agrees closely with implantation day. Prediction of gestational length from CRL and known LMP are both inferior to ovulation and implantation day. This information could have important implications on the routine assignment of gestational age.

Gestational age and school achievement: a population study.

PubMed

Searle, Amelia K; Smithers, Lisa G; Chittleborough, Catherine R; Gregory, Tess A; Lynch, John W

2017-09-01

Academic achievement varies according to gestational age but it is unclear whether achievement varies within 'term' (37-41 weeks gestation) or for 'post-term' births (≥42 weeks). We examined gestational age from preterm to post-term against a national minimum standard for academic achievement in population data. Literacy and numeracy data of 8-year-old South Australian grade 3 children in 2008-2010 were linked to routinely collected perinatal data (N=28 155). Longer gestation from 23 to 45 weeks was associated with lower risk of poor literacy and numeracy. Adjusted relative risks for being at or below national minimum standard ranged from 1.12 (95% CI 1.03 to 1.22) for 'late preterm' (32-36 weeks) for numeracy, to 1.84 (95% CI 1.48 to 2.30) for 'early preterm' (23-31 weeks) for writing. Within term, every additional week of gestational age was associated with small decreased risks of poor literacy and numeracy (eg, relative risks for poor numeracy 1.10, 95% CI 1.01 to 1.20 for 37 weeks). Population-attributable fractions for poor achievement were highest among children born 'early term' (37-39 weeks) due to their higher population prevalence. Shorter gestational age was associated with increased risk of poor literacy/numeracy. While children born 'early term' experience only between 1% and 10% increased risk, they constitute a larger proportion of children with poor educational achievement than preterm children, and thus are important to consider for supportive interventions to improve population-level achievement gains. The seemingly lower risk for post-term children showed large error estimates and warrants further consideration within even larger populations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Features of retinopathy of prematurity in a tertiary care hospital in Lahore.

PubMed

Jamil, Ahmad Zeeshan; Tahir, Muhammad Younis; Ayub, Muhammad Hammad; Mirza, Khurram Azam

2015-02-01

To study the demographic and clinical features of Retinopathy of Prematurity in urban Punjab. The cross-sectional study was performed at Hameed Latif Hospital, Lahore, from April 2010 to October 2013 and comprised neonates born with birth weight less than 2000 g, gestational age less than 37 weeks, or those who were considered high risk for Retinopathy of Prematurity. Variables recorded included history, birth weight, gestational age, oxygen supplementation, development of Retinopathy of Prematurity, and laser treatment. Data was analysed using SPSS 17. There were 285 neonates in the study with a mean birth weight of 1280.34 ± 350.43 g and mean gestational age being 29.38 ± 3.14 weeks. Overall, 167 (58.6%) received supplemental oxygen, 86(30.2%) were anaemic and 44 (15.4%) received blood transfusion. Besides, 47 (16.5%) premature babies were product of multiple gestation, 34 (11.9%) were having respiratory distress, 25 (8.8%) had sepsis and received intravenous antibiotics, 70(24.6%) developed Retinopathy of Prematurity, and 22 (7.7%) developed threshold disease and received laser treatment at mean gestational age of 32.11 ± 2.53 weeks. Screening is key to preventing childhood blindness caused by Retinopathy of Prematurity. Prematurity, low birth weight and supplemental oxygen therapy are significant risk factors for the condition.

Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol.

PubMed

Vitner, Dana; Deutsch, Michael; Paz, Yuri; Khatib, Nizar; Baltiter, Tania; Rosenberg, Shiran; Lowenstein, Lior

2011-06-01

The study was aimed to evaluate the effectiveness, outcome, and pain intensity of the vaginal administration of misoprostol for the induction of abortion between 13 and 24 gestational weeks. A retrospective study was conducted at our tertiary medical center from January 2006 to December 2009 on 122 consecutive women who underwent termination of pregnancy (TOP) in the mid-trimester. They were given 400 mcg of vaginal misoprostol every 6h, up to four doses. The induction-to-abortion interval and the level of pain experienced during the process were assessed. Success was defined by the fetus being expelled within 48 h. Vaginal misoprostol was effective in 84% (98/122) of patients. The median duration of the induction-to-abortion interval was 16 (5-48)h. The induction-to-abortion interval was correlated with gestational age, while inversely correlated with parity. A correlation was also found between gestational age and pain intensity at 12h from induction. Misoprostol is safe and effective in mid-trimester abortion induction. The induction-to-abortion interval is shorter and abortion less painful with lower gestational age. Higher parity is also associated with shorter induction to abortion interval. Copyright © 2011. Published by Elsevier Ireland Ltd.

Efficacy of palivizumab prophylaxis on the frequency of RSV-associated lower respiratory tract infections in preterm infants: determination of the ideal target population for prophylaxis.

PubMed

Cetinkaya, M; Oral, T K; Karatekin, S; Cebeci, B; Babayigit, A; Yesil, Y

2017-09-01

Respiratory syncytial virus (RSV) prophylaxis in high-risk infants is an effective intervention for the prevention of severe disease. The aim of this study was to determine the ideal target preterm population that might benefit from palivizumab prophylaxis by establishing the main risk factors for acute RSV-related infections. Former premature infants born with a gestational age ≤37 weeks and ≤1 year of age at the beginning of the RSV season and admitted with respiratory infection were included. RSV status was evaluated by RSV strip test in all infants. RSV-positive and -negative infants were compared in terms of demographic features, risk factors, requirement of hospitalisation and palivizumab administration. A total of 202 preterm infants under 1 year of age were enrolled. The RSV test was positive in 34 (16.8%) infants. Maternal age was significantly lower in RSV-positive infants compared with RSV-negative infants (p = 0.03). RSV-positive infants were found to be significantly discharged during the RSV season (p = 0.03). RSV-positive infants required significantly higher rates of hospitalisation and need for mechanical ventilation. Of the RSV-positive infants, 28 (82%) had a gestational age ≥29 weeks. Seventeen (77%) RSV-positive infants that required hospitalisation were ≥29 weeks of gestation. All infants with a gestational age ≥29 weeks and without palivizumab prophylaxis developed RSV infection. Palivizumab prophylaxis should be implemented into guidelines to cover preterm infants with a gestational age >29 weeks. Palivizumab prophylaxis should also be considered in high-risk infants ≤6 months of age during the RSV season.

Association between maternal nutritional status of pre pregnancy, gestational weight gain and preterm birth.

PubMed

Xinxo, Sonela; Bimbashi, Astrit; Z Kakarriqi, Eduard; Zaimi, Edmond

2013-01-01

Maternal nutritional status of pre pregnancy and gestational weight gain affects the preterm birth. The association between maternal nutritional status of pre pregnancy and preterm birth appears to be complex and varied by studies from different countries, thus this association between the gestational weight gain and preterm birth is more consolidated. The study aims to determine any association between the pre pregnancy maternal nutritional status, gestational weight gain and the preterm birth rate in the Albanian context. In case control study, we analyzed women who have delivered in obstetric institutions in Tirana during the year 2012. Body mass index and gestational weight gain of 150 women who had a preterm delivery were compared with those of 150 matched control women who had a normal delivery regarding the gestation age. The self-reported pre pregnancy weight, height, gestational weight gain, age, education and parity are collected through a structured questioner. The body mass index and gestational weight gain are categorized based on the Institute of Medicine recommendation. The multiple logistic regression is used to measure the association between the nutritional status of pre pregnancy and gestational weight gain and the preterm birth rate. The women which have a underweight status or obese of pre pregnancy are more likely to have a preterm birth compared to the women of a normal pre-pregnancy nutritional status (respectively OR =2.7 and 4.3 p<0.05). Women who do not reach the recommended gestational weight gain are more likely to have a preterm birth compared to the women which reach this weight (OR=1.8 p< 0.05). Maternal nutritional status and gestational weight gain affects the risk for preterm birth. Pre-pregnancy and gestation nutritional assessments should be part of routine prenatal visits.

[Relationship between air pollution exposure during pregnancy and birth weight of term singleton live-birth newborns].

PubMed

Guo, L Q; Zhang, Q; Zhao, D D; Wang, L L; Chen, Y; Mi, B B; Dang, S N; Yan, H

2017-10-10

Objective: This study explored the association between air pollution exposure and birth weight by using the multilevel linear model, after controlling related meteorological factors and individual differences of both mothers and babies. Methods: Women of childbearing age who were pregnant in Xi'an from 2010 to 2013, were selected as objects of this study. Multistage random sampling method was used to select 4 631 subjects followed by a self-designed questionnaire survey. Data related to quality of air and meteorology were gathered from routine monitoring system. Gestational age and date of birth, together with the average levels of air pollution were calculated for each trimester on each mother, and then the impact of air pollution on birth weight was assessed. A multilevel linear model was employed to investigate the association between the levels of exposure to air pollution by birth weight. Confounding factors were under control. We established three models in this study: Model 1 which involving the variable of air pollution exposure. Model 2 was adjusted for variables in Model 1 plus some other individual differences of both mother and baby. Model 3 was adjusted for variables in Model 2 plus meteorological factors. Results: There were significant differences seen in birth weight within the subgroups of gender, gestational age, mother's reproductive age, maternal education, residential areas and family incomes ( P <0.01) of the infants. However, there was no difference found in Model 1 ( P >0.05). Data from Model 3 indicated that a decrease of 13.3 g(10.9 g in Model 2) and 6.6 g (5.9 g in Model 2) in birth weight that were associated with an increase of 10 μg/m(3) in the average level of NO(2) and PM(10) during the second trimester; A decrease of 13.7 g (9.8 g in Model 2) in birth weight was associated with an increase of 10 μg/m(3) in the average level of NO(2) during the third trimester. Conclusion: After controlling for meteorological factors, the levels of exposure to NO(2) and PM(10) during the second trimester and NO(2) during the third trimester were negatively associated with birth weight.

Effect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center.

PubMed

Gockley, Allison A; Joseph, Naima T; Melamed, Alexander; Sun, Sue Yazaki; Goodwin, Benjamin; Bernstein, Marilyn; Goldstein, Donald P; Berkowitz, Ross S; Horowitz, Neil S

2016-09-01

The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites (P < .001) and Hispanics (P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1-39.2%; P = .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients (P = .006). Median gravidity was 2 for white and 3 for non-white patients (P < .001), and median parity was 0 for white patients and 1 for non-white patients (P = .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia. Hispanic patients with complete molar pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups in terms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients. Copyright © 2016. Published by Elsevier Inc.

Anatomical and echocardiographic correlates of normal cardiac morphology in the late first trimester fetus.

PubMed Central

Allan, L. D.; Santos, R.; Pexieder, T.

1997-01-01

OBJECTIVES: To describe the normal cardiac morphology as seen by transvaginal ultrasound imaging in the first trimester fetus and to compare it with the morphology of the heart as seen by microdissection at the same gestational age. DESIGN: In 53 mothers undergoing early sonography, the fetal heart was examined and the images recorded. The gestational age range was 5-12 weeks of gestation, which represents 21 to 70 days after conception. Images were analysed frame by frame and compared with the anatomy of embryos and fetuses at the same gestational ages. RESULTS: After the 9th week of gestation, four cardiac chambers, the aortic origin, and the pulmonary artery could be identified on cross sectional echocardiography in conjunction with colour flow Doppler. At 9 weeks, the apex pointed anteriorly and the right ventricle and pulmonary artery lay to the right of the midline. By the 11th week of gestation, the apex pointed to the left and the pulmonary artery lay to the left of the midline as in the older fetus. Between 9 and 12 weeks' gestation the aorta was larger than the pulmonary artery. These findings were confirmed in the microdissected hearts. CONCLUSIONS: The current quality of ultrasound images obtained using transvaginal transducers in the first trimester fetus allows the study of fetal cardiac anatomy. Some of the later developmental changes can be demonstrated. As technology improves further the details of earlier cardiac morphogenesis may also become visible. Images PMID:9038698

Analysis of correlation factors and pregnancy outcomes of hypertensive disorders of pregnancy - a secondary analysis of a random sampling in Beijing, China.

PubMed

Zhu, Yu-Chun; Yang, Hui-Xia; Wei, Yu-Mei; Zhu, Wei-Wei; Meng, Wen-Ying; Wang, Yong-Qing; Shang, Li-Xin; Cai, Zhen-Yu; Ji, Li-Ping; Wang, Yun-Feng; Sun, Ying; Liu, Jia-Xiu; Wei, Li; Sun, Yu-Feng; Zhang, Xue-Ying; Luo, Tian-Xia; Chen, Hai-Xia; Yu, Li-Jun

2017-03-01

We aimed to assess the prevalence and risk factors for hypertensive disorders and to study the main pregnancy outcomes in the Beijing area of China. This study randomly sampled 15 hospitals in Beijing from Jun 2013 to Nov 2013 and evaluated 15 194 deliveries. Logistic regression analysis was used to study the association between risk factors and hypertensive disorders. Pregnancy outcomes included preterm birth, cesarean delivery and small for gestational age (SGA). The prevalence of hypertensive disorders, preeclampsia (PE) and severe PE was 4.4, 2.7 and 1.8%, respectively. The risk factors for hypertensive disorders and severe PE were maternal body mass index before pregnancy, gestational weight gain (GWG), gestational diabetes and pre-gestational diabetes, and third trimester cholesterol (CHOL) levels. First trimester high-density lipoprotein was a protective factor for severe PE. The incidence of hypertensive disorders increased with maternal age. Preterm delivery, cesarean delivery and small infant size for gestational age were more prevalent in the severe PE group compared with the non-hypertensive group. In the Beijing area of China, maternal body mass index before pregnancy, GWG, maternal complications of gestational diabetes and pre-gestational diabetes, and third trimester CHOL levels are risk factors for both hypertensive disorders of pregnancy and severe PE. First trimester high-density lipoprotein is a protective factor for severe PE. Severe preeclampsia leads to a higher incidence of preterm delivery, cesarean delivery and SGA infants.

Maternal height and length of gestation: does this impact on preterm labour in Asian women?

PubMed

Chan, Ben Chong-Pun; Lao, Terence Tzu-Hsi

2009-08-01

Both maternal height and ethnicity may influence the gestation length, but their independent effect is unclear. This study was performed to examine the relationship between maternal height and gestational length in women with singleton pregnancies in a Chinese and southeast Asian population. A retrospective cohort study was performed on women carrying singleton pregnancies with spontaneous labour in a 48-month period managed under our department to determine the relationship between maternal height, expressed in quartiles, with the mean gestational age and incidence of preterm labour. Of the 16 384 women who delivered within this period, the 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm and 160 cm respectively. Excluded from analysis were 6597 women because of multifetal pregnancy, teenage pregnancy (maternal age < or = 19 years old), induction of labour or elective caesarean section, or incomplete data due to no antenatal booking in our hospital. Significant differences were found in the maternal weight and body mass index, incidences of multiparity and smokers, gestational age and birthweight among the four quartiles. There was significantly increased incidence of preterm birth between 32 and 37 weeks gestation in women with shorter stature. In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at > 32 to < 37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention.

[Neonatal morbidity after conservative management followed by systematic delivery at thirty-four weeks of gestation in preterm rupture of membranes].

PubMed

Accoceberry, M; Carbonnier, M; Boeuf, B; Ughetto, S; Sapin, V; Vendittelli, F; Houlle, C; Laurichesse, H; Lémery, D; Gallot, D

2005-09-01

To evaluate the neonatal morbidity and its risks factors in case of uncomplicated preterm rupture of membranes managed conservatively with subsequent planned delivery at 34 weeks of gestation. We studied retrospectively 42 consecutive neonates systematically delivered at 34 weeks of gestation after more than 48 hours of conservative management for uncomplicated preterm rupture of membranes. Conservative management was conducted in a single tertiary care center and consisted in corticotherapy and in antibiotherapy (amoxycilline during 7 days). We evaluated the neonatal mortality rate, the incidence of infection, respiratory distress, neurological disorders, and we looked for their prenatal risks factors. Forty-two neonates were included. The median gestational age at rupture was 31.1 weeks of gestation (from 25 to 33.9 weeks). The median duration of expectant management was 20 days (from 2.4 to 65 days). We observed 7 cases of neonatal infection but no septic failure, 18 cases of respiratory distresses among which 9 required a tracheal intubation for a mean duration of 3.7 days, no perinatal encephalopathy (5 cases of subependymal haemorrhage) and no neonatal death. We isolated one single risk factor that was the lowest gestational age at rupture in case of subsequent respiratory distress (29.6 vs 31.9 weeks; P=0.02). Neonatal morbidity in this population consisted mainly in respiratory distresses with an increased incidence when gestational age at rupture decreased.

Comparison of Birth-and Conception-Based Definitions of Postnatal Age in Developmental and Reproductive Rodent Toxicity Studies: lnfluence of Gestation Length on Measurements of Offspring Body Weight and Puberty in Controls

EPA Science Inventory

Most laboratories conducting developmental and reproductive toxicity studies in rodents assign age by defining postnatal day (PND) 0 or 1 as the day of birth (DOB); i.e., gestation length affects PND and the timing of postnatal measurements. Some laboratories, however, define age...

Abortion surveillance - United States, 2007.

PubMed

Pazol, Karen; Zane, Suzanne; Parker, Wilda Y; Hall, Laura R; Gamble, Sonya B; Hamdan, Saeed; Berg, Cynthia; Cook, Douglas A

2011-02-25

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2007. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2007, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during the preceding decade (1998-2007). Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. A total of 827,609 abortions were reported to CDC for 2007. Among the 45 reporting areas that provided data every year during 1998-2007, a total of 810,582 abortions (97.9% of the total) were reported for 2007; the abortion rate was 16.0 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 231 abortions per 1,000 live births. Compared with 2006, the total number and rate of reported abortions decreased 2%, and the abortion ratio decreased 3%. Reported abortion numbers, rates, and ratios were 6%, 7%, and 14% lower, respectively, in 2007 than in 1998. Women aged 20-29 years accounted for 56.9% of all abortions in 2007 and for the majority of abortions during the entire period of analysis (1998-2007). In 2007, women aged 20-29 years also had the highest abortion rates (29.4 abortions per 1,000 women aged 20-24 years and 21.4 abortions per 1,000 women aged 25-29 years). Adolescents aged 15-19 years accounted for 16.5% of all abortions in 2007 and had an abortion rate of 14.5 abortions per 1,000 adolescents aged 15-19 years; women aged ≥35 years accounted for a smaller percentage (12.0%) of abortions and had lower abortion rates (7.7 abortions per 1,000 women aged 35-39 years and 2.6 abortions per 1,000 women aged ≥40 years). During 1998-2007, the abortion rate increased among women aged ≥35 years but decreased among adolescents aged ≤19 years and among women aged 20-29 years. In contrast to the percentage distribution of abortions and abortion rates, abortion ratios were highest at the extremes of reproductive age, both in 2007 and throughout the entire period of analysis. During 1998-2007 abortion ratios decreased among women in all age groups except for those aged <15 years. In 2007, most (62.3%) abortions were performed at ≤8 weeks' gestation, and 91.5% were performed at ≤13 weeks' gestation. Few abortions (7.2%) were performed at 14-20 weeks' gestation, and 1.3% were performed at ≥21 weeks' gestation. During 1998-2007, the percentage of abortions performed at ≤13 weeks' gestation remained stable; however, abortions performed at ≥16 weeks' gestation decreased by 13%-14%, and among the abortions performed at ≤13 weeks' gestation, the percentage performed at ≤6 weeks' gestation increased 65%. In 2007, 78.1% of abortions were performed by curettage at ≤13 weeks' gestation, and 13.1% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation); 7.9% of abortions were performed by curettage at >13 weeks' gestation. Among the 62.3% of abortions that were performed at ≤8 weeks' gestation, and thus were eligible for early medical abortion, 20.3% were completed by this method. Deaths of women associated with complications from abortions for 2007 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2006, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 1998-2007, the total number, rate, and ratio of reported abortions decreased during 2006-2007. This decrease reversed the increase in reported abortion numbers and rates that occurred during 2005-2006; however, reported abortion numbers and rates for 2007 still were higher than they had been previously in 2005. In 2006, as in previous years, reported deaths related to abortion were rare. Abortion surveillance in the United States continues to provide the data needed to examine trends in the number and characteristics of women obtaining abortions. Policymakers and program planners can use these data to guide and evaluate efforts to prevent unintended pregnancies.

Refractive error at birth and its relation to gestational age.

PubMed

Varughese, Sara; Varghese, Raji Mathew; Gupta, Nidhi; Ojha, Rishikant; Sreenivas, V; Puliyel, Jacob M

2005-06-01

The refractive status of premature infants is not well studied. This study was done to find the norms of refractive error in newborns at different gestational ages. One thousand two hundred three (1203) eyes were examined for refractive error by streak retinoscopy within the first week of life between June 2001 and September 2002. Tropicamide eye drops (0.8%) with phenylephrine 0.5% were used to achieve cycloplegia and mydriasis. The refractive error was measured in the vertical and horizontal meridia in both eyes and was recorded to the nearest dioptre (D). The neonates were grouped in five gestational age groups ranging from 24 weeks to 43 weeks. Extremely preterm babies were found to be myopic with a mean MSE (mean spherical equivalent) of -4.86 D. The MSE was found to progressively decrease (become less myopic) with increasing gestation and was +2.4 D at term. Astigmatism of more than 1 D spherical equivalent was seen in 67.8% of the eyes examined. Among newborns with > 1 D of astigmatism, the astigmatism was with-the-rule (vertical meridian having greater refractive power than horizontal) in 85% and against-the-rule in 15%. Anisometropia of more than 1 D spherical equivalent was seen in 31% babies. Term babies are known to be hypermetropic, and preterm babies with retinopathy of prematurity (ROP) are known to have myopia. This study provides data on the mean spherical equivalent, the degree of astigmatism, and incidence of anisometropia at different gestational ages. This is the largest study in world literature looking at refractive errors at birth against gestational age. It should help understand the norms of refractive errors in preterm babies.

A case-control study to examine the association between breastfeeding during late pregnancy and risk of a small-for-gestational-age birth in Lima, Peru.

PubMed

Pareja, Rossina G; Marquis, Grace S; Penny, Mary E; Dixon, Philip M

2015-04-01

Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥ 28 weeks) and the risk of having a small-for-gestational-age (SGA) newborn, using a matched case-control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non-SGA controls: 50th percentile

Placental Weight Mediates the Effects of Prenatal Factors on Fetal Growth: the Extent Differs by Preterm Status

PubMed Central

Ouyang, Fengxiu; Parker, Margaret; Cerda, Sandra; Pearson, Colleen; Fu, Lingling; Gillman, Matthew W.; Zuckerman, Barry; Wang, Xiaobin

2012-01-01

Elevated pre-pregnancy body mass index (BMI), excessive gestational weight gain (GWG), and gestational diabetes (GDM) are known determinants of fetal growth. The role of placental weight is unclear. We aimed to examine the extent to which placental weight mediates the associations of pre-pregnancy BMI, GWG, and GDM with birthweight-for-gestational age, and whether the relationships differ by preterm status. We examined 1035 mother-infant pairs at birth from the Boston Birth Cohort. Data were collected by questionnaire and clinical measures. Placentas were weighed without membranes or umbilical cords. We performed sequential models excluding and including placental weight, stratified by preterm status. We found that 21% of mothers were obese, 42% had excessive GWG, and 5% had GDM. 41% were preterm. Among term births, after adjustment for sex, gestational age, maternal age, race, parity, education, smoking and stress during pregnancy, birthweight-for-gestational age z-score was 0.55 (0.30, 0.80) units higher for pre-pregnancy obesity vs. normal weight. It was 0.34 (0.13, 0.55) higher for excessive vs. adequate GWG, 0.67 (0.24, 1.10) for GDM vs. no DM, with additional adjustment for pre-pregnancy BMI. Adding placental weight to the models attenuated the estimates for pre-pregnancy obesity by 20%, excessive GWG by 32%, and GDM by 21%. Among preterm infants, GDM was associated with 0.67 (0.34, 1.00) higher birthweight-for-gestational age z-score, but pre-pregnancy obesity and excessive GWG were not. Attenuation by placental weight was 36% for GDM. These results suggest that placental weight partially mediates the effects of pre-pregnancy obesity, GDM and excessive GWG on fetal growth among term infants. PMID:23592670

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period.

PubMed

Pratinidhi, Asha K; Bagade, Abhijit C; Kakade, Satish V; Kale, Hemangi P; Kshirsagar, Vinayak Y; Babar, Rohini; Bagal, Shilpa

2017-03-01

Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.

Hypoglycaemia in the Newborn.

PubMed

Stomnaroska, Orhideja; Petkovska, Elizabeta; Ivanovska, Sanja; Jancevska, Snezana; Danilovski, Dragan

2017-09-01

Severe neonatal hypoglycaemia (HG) leads to neurologic damage, mental retardation, epilepsy, impaired cardiac performance and muscle weakness. The aim was to assess the frequency and severity of HG in a population of newborns. We investigated 739 patients with neonatal hypoglycaemia (HG) (M:F=370:369) born at the University Clinic for Gynaecology and Obstetritics in Skopje in the period 2014-2016 and treated at the neonatal intensive care unit (NICU). 1416 babies were treated in the same period in NICU, and HG was observed in 52.18%. The birth weight was dominated by children with low birth weight: very low birth weight (VLBW)(<1500g) 253 children, (34,23%), low birth weight (1500-2500g) 402 (54.39%), appropriate for gestational age (AGA) 78(10.55%), and high birth weight (>4000g) 6 babies (0.81%). The gestational age was also dominated by children with low gestational age: gestational week (GW) 20-25 four children (0.54%), 26-30 GW 133 babies (17.99%), 31-35 GW472 (63.87%), and 36-40 GW130 neonates (17.59 %). 241 mothers (32.61%) have had an infection during pregnancy, 82 preeclampsia or eclampsia (11.09%), 20 diabetes mellitus (2.70%), 78 placental situations (placenta previa, abruption) (10.55%). In this study 47 babies (6.35%) with HG and co-morbidities died. There was a significant positive correlation between HG birth weight (p<0.01), gestational age (p<0.05), and the lowest Apgar score (p<0.01). Neonatal deaths were significantly correlated with GA (р>0,01), co-morbidities of the mothers (р>0,05) but not with the birth weight (р>0,05). In contrast, a significant positive correlation was found between convulsions and body weight (р<0.05). The lowest Apgar score was positively correlated with the gestational age (0.01), but not with the birth weight (0.05). Low birth weight, low gestational age, maternal risk factors, hypoxic-ischemic encephalopathy and neonatal infections are associated with HG and are a significant factor in overall neonatal mortality. Those results indicate that diminishing the frequency of the neonatal HG and the rates of neonatal mortality requires complex interaction of prenatal and postnatal interventions.

Birthweight outcomes in Bolivia: the role of maternal height, ethnicity, and behavior.

PubMed

Delajara, Marcelo; Wendelspiess Chávez Juárez, Florian

2013-01-01

We identify maternal behavioral factors associated with birthweight in Bolivia using data from the Demographic and Health Survey (DHS) of 2003. We estimate birthweight as a function of maternal behavior and the child's sex and gestational age. We control for maternal height, ethnicity, education, and wealth, and for differences observed across Bolivian regions in educational and health outcomes, demographic indicators, and altitude. We find that maternal age, fertility record, and birth spacing behavior are the main observable behavioral factors associated with birthweight, and that maternal height is associated with gestational age, a main determinant of birthweight. We also find that after controlling for gestational age, both ethnicity and altitude have an insignificant effect on birthweight. Copyright © 2012 Elsevier B.V. All rights reserved.

Assessing the Causal Relationship of Maternal Height on Birth Size and Gestational Age at Birth: A Mendelian Randomization Analysis.

PubMed

Zhang, Ge; Bacelis, Jonas; Lengyel, Candice; Teramo, Kari; Hallman, Mikko; Helgeland, Øyvind; Johansson, Stefan; Myhre, Ronny; Sengpiel, Verena; Njølstad, Pål Rasmus; Jacobsson, Bo; Muglia, Louis

2015-08-01

Observational epidemiological studies indicate that maternal height is associated with gestational age at birth and fetal growth measures (i.e., shorter mothers deliver infants at earlier gestational ages with lower birth weight and birth length). Different mechanisms have been postulated to explain these associations. This study aimed to investigate the casual relationships behind the strong association of maternal height with fetal growth measures (i.e., birth length and birth weight) and gestational age by a Mendelian randomization approach. We conducted a Mendelian randomization analysis using phenotype and genome-wide single nucleotide polymorphism (SNP) data of 3,485 mother/infant pairs from birth cohorts collected from three Nordic countries (Finland, Denmark, and Norway). We constructed a genetic score based on 697 SNPs known to be associated with adult height to index maternal height. To avoid confounding due to genetic sharing between mother and infant, we inferred parental transmission of the height-associated SNPs and utilized the haplotype genetic score derived from nontransmitted alleles as a valid genetic instrument for maternal height. In observational analysis, maternal height was significantly associated with birth length (p = 6.31 × 10-9), birth weight (p = 2.19 × 10-15), and gestational age (p = 1.51 × 10-7). Our parental-specific haplotype score association analysis revealed that birth length and birth weight were significantly associated with the maternal transmitted haplotype score as well as the paternal transmitted haplotype score. Their association with the maternal nontransmitted haplotype score was far less significant, indicating a major fetal genetic influence on these fetal growth measures. In contrast, gestational age was significantly associated with the nontransmitted haplotype score (p = 0.0424) and demonstrated a significant (p = 0.0234) causal effect of every 1 cm increase in maternal height resulting in ~0.4 more gestational d. Limitations of this study include potential influences in causal inference by biological pleiotropy, assortative mating, and the nonrandom sampling of study subjects. Our results demonstrate that the observed association between maternal height and fetal growth measures (i.e., birth length and birth weight) is mainly defined by fetal genetics. In contrast, the association between maternal height and gestational age is more likely to be causal. In addition, our approach that utilizes the genetic score derived from the nontransmitted maternal haplotype as a genetic instrument is a novel extension to the Mendelian randomization methodology in casual inference between parental phenotype (or exposure) and outcomes in offspring.

Assessing the Causal Relationship of Maternal Height on Birth Size and Gestational Age at Birth: A Mendelian Randomization Analysis

PubMed Central

Zhang, Ge; Bacelis, Jonas; Lengyel, Candice; Teramo, Kari; Hallman, Mikko; Helgeland, Øyvind; Johansson, Stefan; Myhre, Ronny; Sengpiel, Verena; Njølstad, Pål Rasmus; Jacobsson, Bo; Muglia, Louis

2015-01-01

Background Observational epidemiological studies indicate that maternal height is associated with gestational age at birth and fetal growth measures (i.e., shorter mothers deliver infants at earlier gestational ages with lower birth weight and birth length). Different mechanisms have been postulated to explain these associations. This study aimed to investigate the casual relationships behind the strong association of maternal height with fetal growth measures (i.e., birth length and birth weight) and gestational age by a Mendelian randomization approach. Methods and Findings We conducted a Mendelian randomization analysis using phenotype and genome-wide single nucleotide polymorphism (SNP) data of 3,485 mother/infant pairs from birth cohorts collected from three Nordic countries (Finland, Denmark, and Norway). We constructed a genetic score based on 697 SNPs known to be associated with adult height to index maternal height. To avoid confounding due to genetic sharing between mother and infant, we inferred parental transmission of the height-associated SNPs and utilized the haplotype genetic score derived from nontransmitted alleles as a valid genetic instrument for maternal height. In observational analysis, maternal height was significantly associated with birth length (p = 6.31 × 10−9), birth weight (p = 2.19 × 10−15), and gestational age (p = 1.51 × 10−7). Our parental-specific haplotype score association analysis revealed that birth length and birth weight were significantly associated with the maternal transmitted haplotype score as well as the paternal transmitted haplotype score. Their association with the maternal nontransmitted haplotype score was far less significant, indicating a major fetal genetic influence on these fetal growth measures. In contrast, gestational age was significantly associated with the nontransmitted haplotype score (p = 0.0424) and demonstrated a significant (p = 0.0234) causal effect of every 1 cm increase in maternal height resulting in ~0.4 more gestational d. Limitations of this study include potential influences in causal inference by biological pleiotropy, assortative mating, and the nonrandom sampling of study subjects. Conclusions Our results demonstrate that the observed association between maternal height and fetal growth measures (i.e., birth length and birth weight) is mainly defined by fetal genetics. In contrast, the association between maternal height and gestational age is more likely to be causal. In addition, our approach that utilizes the genetic score derived from the nontransmitted maternal haplotype as a genetic instrument is a novel extension to the Mendelian randomization methodology in casual inference between parental phenotype (or exposure) and outcomes in offspring. PMID:26284790

Effectiveness of screening for gestational diabetes during the late gestational period among pregnant Turkish women.

PubMed

Kurtbas, Handan; Keskin, H Levent; Avsar, A Filiz

2011-06-01

To assess the incidence of gestational diabetes mellitus (GDM) beyond 30 gestational weeks (GW) in pregnant Turkish women and to determine the criteria for repeating the test during the late period of gestation when the results were normal after the initial screen. Two hundred pregnant women were enrolled. Maternal age, gravidity, parity and presence of other risk factors (family history of diabetes mellitus, habitual abortions, prior fetal macrosomia, obesity, gestational hypertension history) were collected. First, GDM was evaluated between the 24th and 28th GW by screening (50-g glucose challenge test) and diagnostic tests. This protocol was repeated again at least 1 month from the first screen at the 30th-34th GW in all patients, except those diagnosed with GDM due to an abnormal 3-h test. The results were compared with the clinical risk factors. In total, 19.5% of the cases had positive results in the first screening test. Six patients were diagnosed with GDM. Among the remaining 194 pregnancies, another 10 cases were diagnosed as having GDM with repeated tests, and the incidence of newly diagnosed GDM was 5.2%. Only the mean age (34.2 years) (P = 0.010) and a history of delivering a macrosomic infant (P < 0.010) were significantly high in the late-gestation GDM-positive cases. Even when early screening tests are negative, pregnancies with advanced maternal ages and those with a history of delivering a macrosomic infant should be re-evaluated for GDM during the late gestational period with screening and diagnostic tests. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Ultrasonographic measurement of fetal growth parameters over three successive pregnancies in a captive Malayan tapir (Tapirus indicus).

PubMed

Hoyer, M J; van Engeldorp Gastelaars, H M D

2014-01-01

This study was conducted to establish representative curves that allow evaluation of fetal growth and estimation of gestational age from measurement of fetal structures by ultrasound in Malayan tapirs (Tapirus indicus). Three pregnancies (i.e. 3 fetuses) were examined in one female Malayan tapir. Transabdominal ultrasonographic examination was performed without anesthesia from 79 ± 8 days to 281 ± 48 days (mean ± S.D.) post mating. To assess fetal growth attempts were made to measure biparietal diameter (BPD), head length (HL), thorax diameter A (TDA), thorax height A (THA), thorax diameter B (TDB), thorax height B (THB), abdomen diameter (AD), abdomen height (AH), humerus length (HUL) and Crown rump length (CRL). The value of each parameter as an estimator of gestational age was assessed by ease of observation and the length of time the parameter was measurable throughout gestation. The most precise predictors for gestational age in this study were BPD and CRL (weeks 10-20 of gestation), as well as AD and AH (weeks 14-43 of gestation). The parameters TDB, THB and HUL (weeks 15-41 of gestation) gave almost as good predictions. Fetal viability was assessed by identifying a fetal heartbeat and movement. All pregnancies resulted in normal deliveries and healthy offspring. The ultrasound examination was well tolerated by the female. The gestation lengths (399 ± 3 days) were within reported ranges. The serial transabdominal ultrasound, without the need for anesthesia, was an effective method to evaluate fetal growth, development and well being in a Malayan tapir. © 2014 Wiley Periodicals, Inc.

Maternal weight prior and during pregnancy and offspring's BMI and adiposity at 5-6 years in the EDEN mother-child cohort.

PubMed

Jacota, M; Forhan, A; Saldanha-Gomes, C; Charles, M A; Heude, B

2017-08-01

Beyond pre-pregnancy BMI, maternal weight change before and during pregnancy may also affect offspring adiposity. To investigate the relationship between maternal weight history before and during pregnancy with children's adiposity at 5-6 years. In 1069 mother-child dyads from the EDEN Cohort, we examined by linear regression the associations of children's BMI, fat mass and abdominal adiposity at 5-6 years with maternal pre-pregnancy BMI, pre-pregnancy average yearly weight change from age 20 and gestational weight gain. The shapes of relationships were investigated using splines and polynomial functions were tested. Children's BMI and adiposity parameters were positively associated with maternal pre-pregnancy BMI, but these relationships were mainly seen in thin mothers, with no substantial variation for maternal BMI ranging from 22 to 35 kg/m 2 . Gestational weight gain was positively associated with children's BMI Z-score, but again more so in thin mothers. We found no association with pre-pregnancy weight change. Before the adiposity rebound, maternal pre-pregnancy thinness explains most of the relationship with children's BMI. The relationship may emerge at older ages in children of overweight and obese mothers, and this latency may be an obstacle to early prevention. © 2016 World Obesity Federation.

Human milk intake in preterm infants and neurodevelopment at 18 months corrected age.

PubMed

Jacobi-Polishook, Talia; Collins, Carmel T; Sullivan, Thomas R; Simmer, Karen; Gillman, Matthew W; Gibson, Robert A; Makrides, Maria; Belfort, Mandy B

2016-10-01

The effect of human milk intake on neurodevelopment in preterm infants is uncertain. We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes. Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): -0.6, 1.0) or PDI (-0.3 points; 95% CI: -1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: -0.2, 0.3) or PDI (-0.2 points per month; 95% CI: -0.5, 0.01) scores, except in infants born 29-33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6). We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

Abortion surveillance--United States, 2008.

PubMed

Pazol, Karen; Zane, Suzanne B; Parker, Wilda Y; Hall, Laura R; Berg, Cynthia; Cook, Douglas A

2011-11-25

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 1999-2008. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2008, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during 1999-2008. Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. A total of 825,564 abortions were reported to CDC for 2008. Of these, 808,528 abortions (97.9% of the total) were from the 45 reporting areas that provided data every year during 1999-2008. Among these same 45 reporting areas, the abortion rate for 2008 was 16.0 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 234 abortions per 1,000 live births. Compared with 2007, the total number and rate of reported abortions for these 45 reporting areas essentially were unchanged, although the abortion ratio was 1% higher. Reported abortion numbers, rates, and ratios remained 3%, 4%, and 10% lower, respectively, in 2008 than they had been in 1999. Women aged 20-29 years accounted for 57.1% of all abortions reported in 2008 and for the majority of abortions during the entire period of analysis (1999-2008). In 2008, women aged 20-29 years also had the highest abortion rates (29.6 abortions per 1,000 women aged 20-24 years and 21.6 abortions per 1,000 women aged 25-29 years). Adolescents aged 15-19 years accounted for 16.2% of all abortions in 2008 and had an abortion rate of 14.3 abortions per 1,000 adolescents aged 15-19 years; women aged ≥35 years accounted for a smaller percentage (11.9%) of abortions and had lower abortion rates (7.8 abortions per 1,000 women aged 35-39 years and 2.7 abortions per 1,000 women aged ≥40 years). Throughout the period of analysis, abortion rates decreased among adolescents aged ≤19 years, whereas they increased among women aged ≥35 years. Among women aged 20-24 years abortion rates decreased during 1999-2003 and then leveled off during 2004-2008. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2008 and throughout the entire period of analysis were highest among adolescents aged ≤19 years and lowest among women aged 30-39 years. Abortion ratios decreased during 1999-2008 for women in all age groups except for those aged <15 years; however, the steady decrease was interrupted from 2007 to 2008 when abortion ratios increased among women in all age groups except for those aged ≥40 years. In 2008, most (62.8%) abortions were performed at ≤8 weeks' gestation, and 91.4% were performed at ≤13 weeks' gestation. Few abortions (7.3%) were performed at 14-20 weeks' gestation, and even fewer (1.3%) were performed at ≥21 weeks' gestation. During 1999-2008, the percentage of abortions performed at ≤13 weeks' gestation remained stable, whereas abortions performed at ≥16 weeks' gestation decreased 13%-17%. Moreover, among the abortions performed at ≤13 weeks' gestation, the distribution shifted toward earlier gestational ages, with the percentage of abortions performed at ≤6 weeks' gestation increasing 53%. In 2008, 75.9% of abortions were performed by curettage at ≤13 weeks' gestation, and 14.6% were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation); 8.5% of abortions were performed by curettage at >13 weeks' gestation. Among the 62.8% of abortions that were performed at ≤8 weeks' gestation and thus were eligible for early medical abortion, 22.5% were completed by this method. The use of medical abortion increased 17% from 2007 to 2008. Deaths of women associated with complications from abortions for 2008 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2007, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Among the 45 areas that reported data every year during 1999-2008, the total number and rate of reported abortions essentially did not change from 2007 to 2008. This finding is consistent with the recent leveling off from steady decreases that had been observed in the past. In contrast, the abortion ratio increased from 2007 to 2008 after having decreased steadily. In 2007, as in previous years, reported deaths related to abortion were rare. This report provides the data for examining trends in the number and characteristics of women obtaining abortions. This information is needed to better understand the reasons why efforts to reduced unintended pregnancy have stalled and can be used by policymakers and program planners to guide and evaluate efforts to prevent unintended pregnancy.

Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age.

PubMed

Guo, Ting; Winterburn, Julie L; Pipitone, Jon; Duerden, Emma G; Park, Min Tae M; Chau, Vann; Poskitt, Kenneth J; Grunau, Ruth E; Synnes, Anne; Miller, Steven P; Mallar Chakravarty, M

2015-01-01

The hippocampus, a medial temporal lobe structure central to learning and memory, is particularly vulnerable in preterm-born neonates. To date, segmentation of the hippocampus for preterm-born neonates has not yet been performed early-in-life (shortly after birth when clinically stable). The present study focuses on the development and validation of an automatic segmentation protocol that is based on the MAGeT-Brain (Multiple Automatically Generated Templates) algorithm to delineate the hippocampi of preterm neonates on their brain MRIs acquired at not only term-equivalent age but also early-in-life. First, we present a three-step manual segmentation protocol to delineate the hippocampus for preterm neonates and apply this protocol on 22 early-in-life and 22 term images. These manual segmentations are considered the gold standard in assessing the automatic segmentations. MAGeT-Brain, automatic hippocampal segmentation pipeline, requires only a small number of input atlases and reduces the registration and resampling errors by employing an intermediate template library. We assess the segmentation accuracy of MAGeT-Brain in three validation studies, evaluate the hippocampal growth from early-in-life to term-equivalent age, and study the effect of preterm birth on the hippocampal volume. The first experiment thoroughly validates MAGeT-Brain segmentation in three sets of 10-fold Monte Carlo cross-validation (MCCV) analyses with 187 different groups of input atlases and templates. The second experiment segments the neonatal hippocampi on 168 early-in-life and 154 term images and evaluates the hippocampal growth rate of 125 infants from early-in-life to term-equivalent age. The third experiment analyzes the effect of gestational age (GA) at birth on the average hippocampal volume at early-in-life and term-equivalent age using linear regression. The final segmentations demonstrate that MAGeT-Brain consistently provides accurate segmentations in comparison to manually derived gold standards (mean Dice's Kappa > 0.79 and Euclidean distance <1.3 mm between centroids). Using this method, we demonstrate that the average volume of the hippocampus is significantly different (p < 0.0001) in early-in-life (621.8 mm(3)) and term-equivalent age (958.8 mm(3)). Using these differences, we generalize the hippocampal growth rate to 38.3 ± 11.7 mm(3)/week and 40.5 ± 12.9 mm(3)/week for the left and right hippocampi respectively. Not surprisingly, younger gestational age at birth is associated with smaller volumes of the hippocampi (p = 0.001). MAGeT-Brain is capable of segmenting hippocampi accurately in preterm neonates, even at early-in-life. Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images, suggesting that this phenomenon has its onset in the 3rd trimester of gestation. Hippocampal volume assessed at the time of early-in-life and term-equivalent age is linearly associated with GA at birth, whereby smaller volumes are associated with earlier birth.

Automatic segmentation of the hippocampus for preterm neonates from early-in-life to term-equivalent age

PubMed Central

Guo, Ting; Winterburn, Julie L.; Pipitone, Jon; Duerden, Emma G.; Park, Min Tae M.; Chau, Vann; Poskitt, Kenneth J.; Grunau, Ruth E.; Synnes, Anne; Miller, Steven P.; Mallar Chakravarty, M.

2015-01-01

Introduction The hippocampus, a medial temporal lobe structure central to learning and memory, is particularly vulnerable in preterm-born neonates. To date, segmentation of the hippocampus for preterm-born neonates has not yet been performed early-in-life (shortly after birth when clinically stable). The present study focuses on the development and validation of an automatic segmentation protocol that is based on the MAGeT-Brain (Multiple Automatically Generated Templates) algorithm to delineate the hippocampi of preterm neonates on their brain MRIs acquired at not only term-equivalent age but also early-in-life. Methods First, we present a three-step manual segmentation protocol to delineate the hippocampus for preterm neonates and apply this protocol on 22 early-in-life and 22 term images. These manual segmentations are considered the gold standard in assessing the automatic segmentations. MAGeT-Brain, automatic hippocampal segmentation pipeline, requires only a small number of input atlases and reduces the registration and resampling errors by employing an intermediate template library. We assess the segmentation accuracy of MAGeT-Brain in three validation studies, evaluate the hippocampal growth from early-in-life to term-equivalent age, and study the effect of preterm birth on the hippocampal volume. The first experiment thoroughly validates MAGeT-Brain segmentation in three sets of 10-fold Monte Carlo cross-validation (MCCV) analyses with 187 different groups of input atlases and templates. The second experiment segments the neonatal hippocampi on 168 early-in-life and 154 term images and evaluates the hippocampal growth rate of 125 infants from early-in-life to term-equivalent age. The third experiment analyzes the effect of gestational age (GA) at birth on the average hippocampal volume at early-in-life and term-equivalent age using linear regression. Results The final segmentations demonstrate that MAGeT-Brain consistently provides accurate segmentations in comparison to manually derived gold standards (mean Dice's Kappa > 0.79 and Euclidean distance <1.3 mm between centroids). Using this method, we demonstrate that the average volume of the hippocampus is significantly different (p < 0.0001) in early-in-life (621.8 mm3) and term-equivalent age (958.8 mm3). Using these differences, we generalize the hippocampal growth rate to 38.3 ± 11.7 mm3/week and 40.5 ± 12.9 mm3/week for the left and right hippocampi respectively. Not surprisingly, younger gestational age at birth is associated with smaller volumes of the hippocampi (p = 0.001). Conclusions MAGeT-Brain is capable of segmenting hippocampi accurately in preterm neonates, even at early-in-life. Hippocampal asymmetry with a larger right side is demonstrated on early-in-life images, suggesting that this phenomenon has its onset in the 3rd trimester of gestation. Hippocampal volume assessed at the time of early-in-life and term-equivalent age is linearly associated with GA at birth, whereby smaller volumes are associated with earlier birth. PMID:26740912

COMPARISON OF GESTATIONAL AGE AT BIRTH BASED ON LAST MENSTRUAL PERIOD AND ULTRASOUND DURING THE FIRST TRIMESTER

EPA Science Inventory

Reported last menstrual period (LMP) is commonly used to estimate gestational age (GA) but may be unreliable. Ultrasound in the first trimester is generally considered a highly accurate method of pregnancy dating. The authors compared first trimester report of LMP and first trime...

Higher Incidence of Hypospadias in Monochorionic Twins.

PubMed

Visser, Remco; Burger, Nienke C M; van Zwet, Erik W; Hilhorst-Hofstee, Yvonne; Haak, Monique C; van den Hoek, Joop; Oepkes, Dick; Lopriore, Enrico

2015-10-01

Hypospadias is associated with twinning. The incidence of hypospadias in monochorionic and dichorionic male twins is, however, yet to be determined. All medical records of monochorionic and dichorionic twins admitted to our neonatal nursery between January 2004 and August 2013 were reviewed for the presence of hypospadias. A total of 350 monochorionic and 303 dichorionic male twins were included in the study. The incidence of hypospadias in monochorionic and dichorionic groups was 4% (14/350) and 1% (3/303) (p = .016) respectively. In 11 of the 15 twin couples, hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in twin infants small-for-gestational-age group was 10% (6/60) compared with 2% (11/593) in the appropriate-for-gestational-age group (p = .002). In a multivariate analysis, both monochorionicity and small-for-gestational-age were independently associated with hypospadias, odds ratio 4.1 (95% confidence interval (CI): 1.1-14.7) and 6.1 (95% CI: 2.2-17.2) respectively. The incidence of hypospadias is four-fold higher in monochorionic twins compared with dichorionic twins. Hypospadias is also independently associated with small-for-gestational-age.

Auditory maturation in premature infants: a potential pitfall for early cochlear implantation.

PubMed

Hof, Janny R; Stokroos, Robert J; Wix, Eduard; Chenault, Mickey; Gelders, Els; Brokx, Jan

2013-08-01

To describe spontaneous hearing improvement in the first years of life of a number of preterm neonates relative to cochlear implant candidacy. Retrospective case study. Hearing levels of 14 preterm neonates (mean gestational age at birth = 29 weeks) referred after newborn hearing screening were evaluated. Initial hearing thresholds ranged from 40 to 105 dBHL (mean = 85 dBHL). Hearing level improved to normal levels for four neonates and to moderate levels for five, whereas for five neonates, no improvement in hearing thresholds was observed and cochlear implantation was recommended. Three of the four neonates in whom the hearing improved to normal levels were born prior to 28 weeks gestational age. Hearing improvement was mainly observed prior to a gestational age of 80 weeks. Delayed maturation of an immature auditory pathway might be an important reason for referral after newborn hearing screening in premature infants. Caution is advised regarding early cochlear implantation in preterm born infants. Audiological follow-ups until at least 80 weeks gestational age are therefore recommended. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Influence of Gestational Age and Postnatal Age on Speech Sound Processing in NICU infants

PubMed Central

Key, Alexandra P.F.; Lambert, E. Warren; Aschner, Judy L.; Maitre, Nathalie L.

2012-01-01

The study examined the effect of gestational (GA) and postnatal (PNA) age on speech sound perception in infants. Auditory ERPs were recorded in response to speech sounds (CV syllables) in 50 infant NICU patients (born at 24–40 weeks gestation) prior to discharge. Efficiency of speech perception was quantified as absolute difference in mean amplitudes of ERPs in response to vowel (/a/–/u/) and consonant (/b/–/g/, /d/–/g/) contrasts within 150–250, 250–400, 400–700 ms after stimulus onset. Results indicated that both GA and PNA affected speech sound processing. These effects were more pronounced for consonant than vowel contrasts. Increasing PNA was associated with greater sound discrimination in infants born at or after 30 weeks GA, while minimal PNA-related changes were observed for infants with GA less than 30 weeks. Our findings suggest that a certain level of brain maturity at birth is necessary to benefit from postnatal experience in the first 4 months of life, and both gestational and postnatal ages need to be considered when evaluating infant brain responses. PMID:22332725

Frequency of otitis media based on otoendoscopic evaluation in preterm infants.

PubMed

Coticchia, James; Shah, Priyanka; Sachdeva, Livjot; Kwong, Kelvin; Cortez, Josef M; Nation, Javan; Rudd, Tracy; Zidan, Marwan; Cepeda, Eugene; Gonik, Bernard

2014-10-01

This study was conducted to determine the frequency of otitis media in preterm neonates using otoendoscopy and tympanometry. Prospective study. Wayne State University, Hutzel Women's Hospital Neonatal Intensive Care Unit. Eighty-six preterm infants were included (gestational age <36 weeks). Otoendoscopy and tympanometry were performed to detect the presence of otitis media. Kappa statistic and logistic regression were used for statistical analysis. Otoendoscopy was performed in 85 patients. The frequency of otoendoscopy-diagnosed otitis media was 72.9% (62/85). Tympanometry could be performed on 69.76% of the ears. There was 73.5% agreement between the findings of tympanometry and those of otoendoscopy. The association between the presence of otitis media and gestational age at birth was statistically significant. The lower the gestational age, the higher the frequency of otoendoscopy-diagnosed otitis media (P = .001). Otoendoscopically diagnosed otitis media is frequent in preterm neonates. There was agreement between the results of tympanometry and those of otoendoscopy. The frequency of otitis media increased with lower gestational age. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Abortion Surveillance - United States, 2014.

PubMed

Jatlaoui, Tara C; Shah, Jill; Mandel, Michele G; Krashin, Jamie W; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

2017-11-24

Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2014. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2014, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 48 areas that reported data every year during 2005-2014. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women aged 15-44 years) and ratios (number of abortions per 1,000 live births). A total of 652,639 abortions were reported to CDC for 2014. Of these abortions, 98.4% were from the 48 reporting areas that provided data every year during 2005-2014. Among these 48 reporting areas, the abortion rate for 2014 was 12.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 186 abortions per 1,000 live births. From 2013 to 2014, the total number and rate of reported abortions decreased 2%, and the ratio decreased 7%. From 2005 to 2014, the total number, rate, and ratio of reported abortions decreased 21%, 22%, and 21%, respectively. In 2014, all three measures reached their lowest level for the entire period of analysis (2005-2014). In 2014 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2014, women aged 20-24 and 25-29 years accounted for 32.2% and 26.7% of all reported abortions, respectively, and had abortion rates of 21.3 and 18.4 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 17.1%, 9.7%, and 3.6% of all reported abortions, respectively, and had abortion rates of 11.9, 7.2, and 2.6 abortions per 1,000 women aged 30-34 years, 35-39 years, and ≥40 years, respectively. From 2005 to 2014, the abortion rate decreased among women aged 20-24, 25-29, 30-34, and 35-39 years by 27%, 16%, 12%, and 5%, respectively, but increased 4% among women aged ≥40 years. In 2014, adolescents aged <15 and 15-19 years accounted for 0.3% and 10.4% of all reported abortions, respectively, and had abortion rates of 0.5 and 7.5 abortions per 1,000 adolescents aged <15 and 15-19 years, respectively. From 2005 to 2014, the percentage of abortions accounted for by adolescents aged 15-19 years decreased 38%, and their abortion rate decreased 49%. These decreases were greater than the decreases for women in any older age group. In contrast to the percentage distribution of abortions and abortion rates by age, abortion ratios in 2014 and throughout the entire period of analysis were highest among adolescents and lowest among women aged 30-39 years. Abortion ratios decreased from 2005 to 2014 for women in all age groups. In 2014, the majority (67.0%) of abortions were performed at ≤8 weeks' gestation, and nearly all (91.5%) were performed at ≤13 weeks' gestation. Few abortions were performed between 14 and 20 weeks' gestation (7.2%) or at ≥21 weeks' gestation (1.3%). During 2005-2014, the percentage of all abortions performed at ≤13 weeks' gestation remained consistently high (≥91.4%). Among abortions performed at ≤13 weeks' gestation, there was a shift toward earlier gestational ages, as the percentage performed at ≤6 weeks' gestation increased 21%, and the percentage of all other gestational ages at ≤13 weeks' gestation decreased 7%-20%. In 2014, among reporting areas that included medical (nonsurgical) abortion on their reporting form, 22.6% of all abortions were performed by early medical abortion (a nonsurgical abortion at ≤8 weeks' gestation), 67.4% were performed by surgical abortion at ≤13 weeks' gestation, and 8.6% were performed by surgical abortion at >13 weeks' gestation; all other methods were uncommon (<2%). Among abortions performed at ≤8 weeks' gestation that were eligible for early medical abortion on the basis of gestational age, 32.2% were completed by this method. In 2014, women with one or more previous live births accounted for 59.5% of abortions, and women with no previous live births accounted for 40.4%. Women with one or more previous induced abortions accounted for 44.9% of abortions, and women with no previous abortion accounted for 55.1%. Women with three or more previous births accounted for 13.8% of abortions, and women with three or more previous abortions accounted for 8.6% of abortions. Deaths of women associated with complications from abortion for 2014 are being assessed as part of CDC's Pregnancy Mortality Surveillance System. In 2013, the most recent year for which data were available, four women were identified to have died as a result of complications from legal induced abortion. Among the 48 areas that reported data every year during 2005-2014, the decreases in the total number, rate, and ratio of reported abortions that occurred during 2010-2013 continued from 2013 to 2014, resulting in historic lows for all three measures of abortion. The data in this report can help program planners and policymakers identify groups of women with the highest rates of abortion. Unintended pregnancy is the major contributor to induced abortion. Increasing access to and use of effective contraception can reduce unintended pregnancies and further reduce the number of abortions performed in the United States.

Maternal air pollution exposure and preterm birth in Wuxi, China: Effect modification by maternal age.

PubMed

Han, Yingying; Jiang, Panhua; Dong, Tianyu; Ding, Xinliang; Chen, Ting; Villanger, Gro Dehli; Aase, Heidi; Huang, Lu; Xia, Yankai

2018-08-15

Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous. This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age. In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM 10 ), and ozone (O 3 ), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group (< 35 years old) and advanced age group (> = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age < 37 weeks) caused by prenatal air pollution exposure. With adjustment for covariates, the highest level of PM 10 exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM 10 exposure was positively associated with gestational age, whereas O 3 exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM 10 exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM 10 exposure associated with preterm birth was modified by advanced maternal age (OR interaction = 2.00, 95% CI: 1.02, 3.91, P interaction = 0.032). Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution exposure on preterm birth especially in pregnant women with advanced maternal age. Copyright © 2018 Elsevier Inc. All rights reserved.

New formulas for calculating the lung-to-head ratio in healthy fetuses between 20 and 40 weeks' gestation.

PubMed

Kehl, Sven; Eckert, Sven; Berlit, Sebastian; Tuschy, Benjamin; Sütterlin, Marc; Siemer, Jörn

2013-11-01

The purpose of this study was to develop new formulas for the expected fetal lung area-to-head circumference ratio in normal singleton pregnancies between 20 and 40 weeks' gestation. The lung-to-head ratio and complete fetal biometric parameters of 126 fetuses between 20 and 40 weeks' gestation were prospectively measured. The lung-to-head ratio was measured by 3 different methods (longest diameter, anteroposterior diameter, and tracing). Formulas for predicting right and left lung-to-head ratios with regard to gestational age and biometric parameters were derived by stepwise regression analysis. New formulas for calculating right and left lung-to-head ratios by each measurement method were derived. The formulas included gestational age only and no biometric parameters. The new formulas for estimating the expected lung-to-head ratio by the 3 different methods in normal singleton pregnancies up to 40 weeks' gestation may help improve the prognostic power of observed-to-expected lung-to-head ratio assessment in fetuses with congenital diaphragmatic hernias.

Serum levels of fractalkine are associated with markers of insulin resistance in gestational diabetes.

PubMed

Ebert, T; Hindricks, J; Kralisch, S; Lossner, U; Jessnitzer, B; Richter, J; Blüher, M; Stumvoll, M; Fasshauer, M

2014-08-01

Fractalkine has recently been introduced as an adipokine that improves glucose tolerance. Regulation of fractalkine in gestational diabetes, as well as its association with markers of obesity, glucose and lipid metabolism, inflammation and renal function, has not been elucidated. Circulating fractalkine was quantified by enzyme-linked immunosorbent assay in 74 women with gestational diabetes and 74 healthy, pregnant control subjects matched for age, BMI, and gestational age. Median (interquartile range) levels of fractalkine were not significantly different between the two groups [gestational diabetes: 2.24 (2.16) μg/l; control: 2.45 (1.38) μg/l] (P = 0.461). In multivariate linear regression analysis, fractalkine remained independently associated with homeostasis model assessment of insulin resistance (β = -0.253, P = 0.002) and the proinflammatory adipokine progranulin (β = 0.218, P = 0.007). Circulating fractalkine is not different between women with gestational diabetes and control subjects, but the adipokine is independently associated with markers of insulin resistance and proinflammatory progranulin in pregnancy. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

Antenatal antecedents of a small head circumference at age 24-months post-term equivalent in a sample of infants born before the 28th post-menstrual week.

PubMed

Leviton, Alan; Kuban, Karl; Allred, Elizabeth N; Hecht, Jonathan L; Onderdonk, Andrew; O'Shea, T Michael; McElrath, Thomas; Paneth, Nigel

2010-08-01

Little is known about the antecedents of microcephaly in early childhood among children born at extremely low gestational age. To identify some of the antecedents of microcephaly at age two years among children born before the 28th week of gestation. Observational cohort study. 1004 infants born before the 28th week of gestation. Head circumference Z-scores of <-2 and >or=-2, <-1. Risk of microcephaly and a less severely restricted head circumference decreased monotonically with increasing gestational age. After adjusting for gestational age and other potential confounders, the risk of microcephaly at age 2 years was increased if microcephaly was present at birth [odds ratio: 8.8 ((95% confidence interval: 3.7, 21)], alpha hemolytic Streptococci were recovered from the placenta parenchyma [2.9 (1.2, 6.9)], the child was a boy [2.8 (1.6, 4.9)], and the child's mother was not married [2.5 (1.5, 4.3)]. Antecedents associated not with microcephaly, but with a less extreme reduction in head circumference were recovery of Propionibacterium sp from the placenta parenchyma [2.9 (1.5, 5.5)], tobacco exposure [2.0 (1.4, 3.0)], and increased syncytial knots in the placenta [2.0 (1.2, 3.2)]. Although microcephaly at birth predicts a small head circumference at 2 years among children born much before term, pregnancy and maternal characteristics provide supplemental information about the risk of a small head circumference years later. Two findings appear to be novel. Tobacco exposure during pregnancy, and organisms recovered from the placenta predict reduced head circumference at age two years. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Antenatal antecedents of a small head circumference at age 24-months post-term equivalent in a sample of infants born before the 28th post-menstrual week

PubMed Central

Leviton, Alan; Kuban, Karl; Allred, Elizabeth N.; Hecht, Jonathan L.; Onderdonk, Andrew; O'Shea, T. Michael; McElrath, Thomas; Paneth, Nigel

2010-01-01

Background Little is known about the antecedents of microcephaly in early childhood among children born at extremely low gestational age. Aim To identify some of the antecedents of microcephaly at age two years among children born before the 28th week of gestation. Study design Observational cohort study. Subjects 1004 infants born before the 28th week of gestation. Outcome measures Head circumference Z-scores of <−2 and ≥−2, <−1. Results Risk of microcephaly and a less severely restricted head circumference decreased monotonically with increasing gestational age. After adjusting for gestational age and other potential confounders, the risk of microcephaly at age 2 years was increased if microcephaly was present at birth [odds ratio: 8.8 ((95% confidence interval: 3.7, 21)], alpha hemolytic Streptococci were recovered from the placenta parenchyma [2.9 (1.2, 6.9)], the child was a boy [2.8 (1.6, 4.9)], and the child's mother was not married [2.5 (1.5, 4.3)]. Antecedents associated not with microcephaly, but with a less extreme reduction in head circumference were recovery of Propionibacterium sp from the placenta parenchyma [2.9 (1.5, 5.5)], tobacco exposure [2.0 (1.4, 3.0)], and increased syncytial knots in the placenta [2.0 (1.2, 3.2)]. Conclusions Although microcephaly at birth predicts a small head circumference at 2 years among children born much before term, pregnancy and maternal characteristics provide supplemental information about the risk of a small head circumference years later. Two findings appear to be novel. Tobacco exposure during pregnancy, and organisms recovered from the placenta predict reduced head circumference at age two years. PMID:20674197

Two denominators for one numerator: the example of neonatal mortality.

PubMed

Harmon, Quaker E; Basso, Olga; Weinberg, Clarice R; Wilcox, Allen J

2018-06-01

Preterm delivery is one of the strongest predictors of neonatal mortality. A given exposure may increase neonatal mortality directly, or indirectly by increasing the risk of preterm birth. Efforts to assess these direct and indirect effects are complicated by the fact that neonatal mortality arises from two distinct denominators (i.e. two risk sets). One risk set comprises fetuses, susceptible to intrauterine pathologies (such as malformations or infection), which can result in neonatal death. The other risk set comprises live births, who (unlike fetuses) are susceptible to problems of immaturity and complications of delivery. In practice, fetal and neonatal sources of neonatal mortality cannot be separated-not only because of incomplete information, but because risks from both sources can act on the same newborn. We use simulations to assess the repercussions of this structural problem. We first construct a scenario in which fetal and neonatal factors contribute separately to neonatal mortality. We introduce an exposure that increases risk of preterm birth (and thus neonatal mortality) without affecting the two baseline sets of neonatal mortality risk. We then calculate the apparent gestational-age-specific mortality for exposed and unexposed newborns, using as the denominator either fetuses or live births at a given gestational age. If conditioning on gestational age successfully blocked the mediating effect of preterm delivery, then exposure would have no effect on gestational-age-specific risk. Instead, we find apparent exposure effects with either denominator. Except for prediction, neither denominator provides a meaningful way to define gestational-age-specific neonatal mortality.

The Impact of Gender on Anthropometric Measures of Twins.

PubMed

Jahanfar, Shayesteh; Lim, Kenneth

2016-12-01

Literature suggests that male hormones influence fetal growth in singleton pregnancies. We hypothesized that the same phenomenon is seen in twin gestations. (1) to identify the impact of gender associated with fetal birth weight, head circumference, and birth length for twins; (2) to examine the effect of gender on standardized fetal growth at birth, according to gestational age and birth order; (3) to examine the effect of gender on placenta weight and dimensions. This was a population-based retrospective cohort study of twins (4,368 twins, 2,184 pairs) born in British Columbia, Canada from 2000-2010. We excluded twins with stillbirth, congenital anomalies, and those delivered with cesarean section. We also controlled for confounding factors, including birth order, gestational age, maternal anthropometric measures, maternal smoking habits, and obstetric history. A subsample of this population was analyzed from Children and Women Hospital to obtain chorionicity information. Male-male twins were heavier than male-females and female-female twin pairs (p=.01). Within sex-discordant twin pairs, males were also heavier than females (p=.01). Regression analysis suggested that gender affects birth weight independent of birth order and gestational age. Other newborn anthropometric measures were not found to be dependent on gender. In analyzing a subsample with chorionicity data, birth weight was the only anthropometric measure that was both statistically and clinically affected by sex, even after adjustment for gestational age, chorionicity, birth order, and maternal age. Birth weight was affected by gender while head circumference and birth length were not.

Management of small-for-gestational-age twins with absent/reversed end diastolic flow in the umbilical artery: outcome of a policy of daily biophysical profile (BPP).

PubMed

Kennelly, Máiréad M; Sturgiss, Stephen N

2007-01-01

To evaluate a strategy of daily biophysical profile (BPP) for pregnancies with small-for-gestational-age twins and with absent or reversed end diastolic flow (AREDF) in the umbilical artery of one twin and to assess the latency interval between detection and delivery in monochorionic (MC) and dichorionic (DC) twin pregnancy. A search of the Fetal Medicine Database was carried out between 2000 and 2005 at a single tertiary centre to identify all cases with AREDF in the umbilical artery with one small-for-gestational-age twin. Active monitoring with daily BPP was undertaken, once the estimated fetal weights (EFW) was >or= 500 g and at a gestational age of >or= 24 weeks in both twins. Delivery was timed on the basis of an abnormal BPP, two equivocal BPP within 12 h or gestational age of >or= 32(+0) weeks. Twenty-two MC and 17 DC twin pregnancies were identified. There were no fetal losses in the viable actively monitored MC (19) and DC (13) twins. There was a longer latency interval in the MC group at 21.7 days versus 14.4 days in the DC group (p = 0.13). Delivery was indicated for an abnormal BPP (57.8% MC vs 30.8% DC). A strategy of daily BPP can be used to monitor preterm twin fetuses with AREDF, prolonging pregnancy with an acceptable perinatal outcome. Copyright 2007 John Wiley & Sons, Ltd.

The bias in current measures of gestational weight gain

PubMed Central

Hutcheon, Jennifer A; Bodnar, Lisa M; Joseph, KS; Abrams, Barbara; Simhan, Hyagriv N; Platt, Robert W

2014-01-01

Summary Conventional measures of gestational weight gain (GWG), such as average rate of weight gain, are likely correlated with gestational duration. Such correlation could introduce bias to epidemiologic studies of GWG and adverse perinatal outcomes because many perinatal outcomes are also correlated with gestational duration. This study aimed to quantify the extent to which currently-used GWG measures may bias the apparent relation between maternal weight gain and risk of preterm birth. For each woman in a provincial perinatal database registry (British Columbia, Canada, 2000–2009), a total GWG was simulated such that it was uncorrelated with risk of preterm birth. The simulation was based on serial antenatal GWG measurements from a sample of term pregnancies. Simulated GWGs were classified using 3 approaches: total weight gain (kg), average rate of weight gain (kg/week) or adequacy of gestational weight gain in relation to Institute of Medicine recommendations, and their association with preterm birth ≤ 32 weeks was explored using logistic regression. All measures of GWG induced an apparent association between GWG and preterm birth ≤32 weeks even when, by design, none existed. Odds ratios in the lowest fifths of each GWG measure compared with the middle fifths ranged from 4.4 [95% CI 3.6, 5.4] (total weight gain) to 1.6 [95% CI 1.3, 2.0] (Institute of Medicine adequacy ratio). Conventional measures of GWG introduce serious bias to the study of maternal weight gain and preterm birth. A new measure of GWG that is uncorrelated with gestational duration is needed. PMID:22324496

Association between Native American-owned casinos and the prevalence of large-for-gestational-age births.

PubMed

Jones-Smith, Jessica C; Dow, William H; Oddo, Vanessa M

2017-08-01

A small number of studies have used a natural experiment approach to examine the health impacts of increased economic resources stemming from Native American-owned casinos. We build on this work by examining whether casinos are associated with obesity-related health in utero. We examined whether casino openings or expansion (as proxy for increased economic resources) are associated with a decreased likelihood of infants being born large-for-gestational-age (LGA), an important risk factor for childhood overweight/obesity. We used repeated cross-sectional data from California birth records (1987-2011) to assess the prevalence of LGA births among Native Americans (n = 21 011). Using zip code fixed-effect regression models, we compared how prevalence of LGA births changed in association with casino openings or expansions, while controlling for secular trends through the inclusion of a comparison group of Native American newborns in zip codes that were eligible to open or expand casinos, but did not do so. In sensitivity analyses, we evaluated whether there was any change in small-for-gestational-age births (SGA). Average prevalence of LGA births over the period was 11%. Every one slot machine per capita increase was associated with a 0.13 percentage point decrease (95% confidence interval: -0.25, -0.01) in the prevalence of LGA births but was not associated with SGA prevalence. Casino expansion in California is associated with a lower prevalence of LGA births. Interpreted in combination with previous work showing that California casino expansions were associated with a lower body mass index (BMI) among schoolchildren, these results suggest that casinos are associated with improvement in a surrogate marker of excess adiposity. Further studies are needed to elucidate the mechanisms by which casinos might be associated with obesity-related health outcomes among Native Americans. © The Author 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Carotid body size measured by computed tomographic angiography in individuals born prematurely.

PubMed

Bates, Melissa L; Welch, Brian T; Randall, Jess T; Petersen-Jones, Humphrey G; Limberg, Jacqueline K

2018-05-24

We tested the hypothesis that the carotid bodies would be smaller in individuals born prematurely or exposed to perinatal oxygen therapy when compared individuals born full term that did not receive oxygen therapy. A retrospective chart review was conducted on patients who underwent head/neck computed tomography angiography (CTA) at the Mayo Clinic between 10 and 40 years of age (n = 2503). Patients were identified as premature ( < 38 weeks) or receiving perinatal oxygen therapy by physician completion or billing codes (n = 16 premature and n = 7 receiving oxygen). Widest axial measurements of the carotid body images captured during the CTA were performed. Carotid body visualization was possible in 43% of patients and 52% of age, sex, and body mass index (BMI)-matched controls but only 17% of juvenile preterm subjects (p = 0.07). Of the carotid bodies that could be visualized, widest axial measurements of the carotid bodies in individuals born prematurely (n = 7, 34 ± 4 weeks gestation, birth weight: 2460 ± 454 g; average size: 2.5 ± 0.2 cm) or individuals exposed to perinatal oxygen therapy (n = 3, 38 ± 2 weeks gestation, Average size: 2.2 ± 0.1 cm) were not different when compared to controls (2.3 ± 0.2 cm and 2.3 ± 0.2 cm, respectively, p > 0.05). Carotid body size, as measured using CTA, is not smaller in adults born prematurely or exposed to perinatal oxygen therapy when compared to sex, age, and BMI-matched controls. However, carotid body visualization was lower in juvenile premature patients. The decreased ability to visualize the carotid bodies in these individuals may be a result of their prematurity. Copyright © 2018. Published by Elsevier B.V.

Comparison of two measures of gestational age among low income births. The potential impact on health studies, New York, 2005.

PubMed

Lazariu, Victoria; Davis, Christopher F; McNutt, Louise-Anne

2013-01-01

Recently, the National Association for Public Health Statistics and Information Systems considered changing the definition of gestational age from the current definition based on mother's last normal menstrual period (LMP) to the clinical/obstetric estimate determined by the physician (CE).They determined additional information was needed. This study provides additional insight into the comparability of the LMP and CE measures currently used on vital records among births at risk for poor outcomes. The data consisted of all New York State (NYS) (excluding New York City) singleton births in 2005 among mothers enrolled in the NYS Women Infants and Children (WIC) program during pregnancy. Prenatal WIC records were matched to NYS' Statewide Perinatal Data System. The analysis investigates differences between LMP and CE recorded gestations. Relative risks between risk factors and preterm birth were compared for LMP and CE. Exact agreement between gestation measures exists in 49.6% of births. Overall, 6.4% of records indicate discordance in full term/preterm classifications; CE is full term and LMP preterm in 4.9%, with the converse true for 1.5%. Associations between risk factor and preterm birth differed in magnitude based on gestational age measurement. Infants born to mothers with high risk indicators were more likely to have a CE of preterm and LMP full term. Changing the measure of gestational age to CE universally likely would result in overestimation of the importance of some risk factors for preterm birth. Potential overestimation of clinical outcomes associated with preterm birth may occur and should be studied.

Outcomes of infants born at 22 and 23 weeks' gestation.

PubMed

Ishii, Nozomi; Kono, Yumi; Yonemoto, Naohiro; Kusuda, Satoshi; Fujimura, Masanori

2013-07-01

To provide instructive information on death and neurodevelopmental outcomes of infants born at 22 and 23 weeks' gestational age. The study cohort consisted of 1057 infants born at 22 to 25 weeks in the Neonatal Research Network, Japan. Neurodevelopmental impairment (NDI) at 36 to 42 months' chronological age was defined as any of the following: cerebral palsy, hearing impairment, visual impairment, and a developmental quotient <70. A systematic review was performed by using databases of publications of cohort studies with neonatal and neurodevelopmental outcomes at 22 and 23 weeks. Numbers and incidences (%) of infants with death or NDI were 60 (80%) at 22 weeks and 156 (64%) at 23 weeks. In logistic regression analysis, gestational ages of 22 weeks (odds ratio [OR]: 5.40; 95% confidence interval [CI]: 2.48-11.76) and 23 weeks (OR: 2.14; 95% CI: 1.38-3.32) were associated with increased risk of death or NDI compared with 24 weeks, but a gestational age of 25 weeks (OR: 0.65; 95% CI: 0.45-0.95) was associated with decreased risk of death or NDI. In the systematic review, the medians (range) of the incidence of death or NDI in 8 cohorts were 99% (90%-100%) at 22 weeks and 98% (67%-100%) at 23 weeks. Infants born at 22 and 23 weeks' gestation were at higher risk of death or NDI than infants at born at 24 weeks. However, outcomes were improved compared with those in previous studies. There is a need for additional discussions on interventions for infants born at 22 or 23 weeks' gestation.

Estimating Effects of Arsenic Exposure During Pregnancy on Perinatal Outcomes in a Bangladeshi Cohort

PubMed Central

Cardenas, Andres; Rodrigues, Ema; Mazumdar, Maitreyi; Dobson, Christine; Golam, Mostofa; Quamruzzaman, Quazi; Rahman, Mahmudar; Christiani, David C.

2016-01-01

Background: The relationship between arsenic and birth weight is not well understood. The objective was to evaluate the causal relationship between prenatal arsenic exposure and birth weight considering the potential mediation effects of gestational age and maternal weight gain during pregnancy using structural equation models. Methods: A prospectively enrolled cohort of pregnant women was recruited in Bangladesh from 2008 to 2011. Arsenic was measured in personal drinking water at the time of enrollment (gestational age <16 weeks, N = 1,140) and in toenails collected ≤1 month postpartum (N = 624) using inductively coupled plasma mass spectrometry. Structural equation models estimated the direct and indirect effects of arsenic on birth weight with gestational age and maternal weight gain considered as mediating variables. Results: Every unit increase in natural log water arsenic was indirectly associated with decreased birth weight (β = −19.17 g, 95% confidence interval [CI]: −24.64, −13.69) after adjusting for other risk factors. This association was mediated entirely through gestational age (β = −17.37 g, 95% CI: −22.77, −11.98) and maternal weight gain during pregnancy (β = −1.80 g, 95% CI: −3.72, 0.13). When exposure was modeled using toenail arsenic concentrations, similar results were observed. Every increase in natural log toenail arsenic was indirectly associated with decreased birth weight (β = −15.72 g, 95% CI: −24.52, −6.91) which was mediated through gestational age (β = −13.59 g, 95% CI: −22.10, −5.07) and maternal weight gain during pregnancy (β = −2.13 g, 95% CI: −5.24, 0.96). Conclusion: Arsenic exposure during pregnancy was associated with lower birth weight. The effect of arsenic on birth weight appears to be mediated mainly through decreasing gestational age and to a lesser extent by lower maternal weight gain during pregnancy. PMID:26583609

In Preterm Infants, Length Growth below Expected Growth during Hospital Stay Predicts Poor Neurodevelopment at 2 Years.

PubMed

Simon, Laure; Théveniaut, Camille; Flamant, Cyril; Frondas-Chauty, Anne; Darmaun, Dominique; Rozé, Jean-Christophe

2018-05-30

In preterm infants, neonatal weight growth is associated with neurodevelopmental outcome but is a poor indicator of growth quality. The aim of this work was to measure the relationship between neonatal length growth and the 2-year neurological outcome in preterm infants. A total of 2,403 infants enrolled in the LIFT cohort with gestational age less than 34 weeks were studied. Neonatal observed length growth (OLG) was calculated as the change in length Z-score between birth and discharge. Expected length growth (ELG) was estimated based on gestational age, birth weight Z-score, birth length Z-score, gender, and observed neonatal weight growth. The difference between OLG and ELG (∆OLG-ELG) was calculated as OLG - ELG, and infants were ranked into 3 classes depending on their ∆OLG-ELG (≤-0.5, -0.49 to 0.49, ≥0.50 Z-score). We explored the relationship between ∆OLG-ELG and 2-year neurodevelopmental outcome (n = 2,036), and, in a subgroup (n = 85), between ∆OLG-ELG and body composition at discharge. ELG was strongly predicted from the above-mentioned parameters (R2 = 0.73, p = 0.001). OLG correlated closely with gestational age (p = 0.001) but ∆OLG-ELG did not (p = 1.0). OLG was not associated with a 2-year nonoptimal outcome after adjustment for gestational age, but ∆OLG-ELG ≤-0.5 was; the crude and adjusted odds ratios were 1.63 and 1.56, respectively. ∆OLG-ELG correlated negatively with fat mass (R2 = 0.29, p = 0.006) before and after adjustment for gestational age. ∆OLG-ELG is a marker of neonatal growth that does not depend on gestational age, and may reflect quality of growth. A ∆OLG-ELG ≤-0.5 Z-score is associated with a higher risk for 2-year nonoptimal neurodevelopmental outcome. © 2018 S. Karger AG, Basel.

The dietary composition of women who delivered preterm and full-term infants.

PubMed

Waksmańska, Wioletta; Bobiński, Rafał; Ulman-Włodarz, Izabela; Pielesz, Anna; Mikulska, Monika

2017-06-01

Literature data show that excess and primary deficiency in particular nutrients, vitamins and minerals may lead to pre-eclampsia, gestational diabetes, hypertension and neural tube defects in the foetus. The aim of the study was to determine differences in average daily consumption of selected nutrients during pregnancy in women who did not supplement their diet and to evaluate the influence of dietary habits on the occurrence of pre-term delivery and hypertension in pregnant women. Information on the course of pregnancy and the newborn's health status at birth was derived from the Charter of Pregnancy and documents recorded by the hospital. Women's eating habits and dietary composition were analyzed on the basis of a dietary questionnaire. The sample group was divided into four groups: women who delivered neonates appropriate for gestational age (AGA), women with gestosis who delivered AGA neonates by means of caesarean sections, women who delivered pre-term neonates (PTB) and women with gestosis who delivered PTB by means of caesarean sections. In the case of women with vaginal delivery at term the average intake of iodine was always higher than in other groups. Analysis of average daily intake of folates revealed a higher intake in the group of women who gave birth to full-term neonates with proper neonatal weight in comparison with the groups of women with pre-term delivery. P≤0.05. Statistically significant differences in average daily intake of folates, iodine, retinol, magnesium and iron were observed between the group of women with vaginal delivery at term and the groups of women with diagnosed hypertension who delivered preterm. Correlation was demonstrated between average daily intake of iodine and vitamin D and the occurrence of arterial hypertension. Supplementation of the diet of women in the preconception and prenatal period with minerals and vitamins should be considered. Copyright © 2017 Elsevier Inc. All rights reserved.

Influence of pre-pregnancy obesity on the development of macrosomia and large for gestational age in women with or without gestational diabetes mellitus in Chinese population.

PubMed

Wang, L-F; Wang, H-J; Ao, D; Liu, Z; Wang, Y; Yang, H-X

2015-12-01

To determine the effects of gestational diabetes mellitus (GDM) and pre-pregnancy obesity on macrosomia and large for gestational age (LGA). We conducted a prospective cohort study of 587 GDM women and 478 non-GDM women from 2012 to 2013. We collected their data of the pre-pregnancy weight, sociodemographic data, medical histories, clinical treatment, and followed-up the outcomes of delivery including birth weight. Multiple logistic regression models were used to test associations between pre-pregnant obesity and macrosomia/LGA and between GDM and macrosomia/LGA. Of 1065 women we studied, obese women had 4.17 times and 2.27 times increased risk of developing macrosomia (95% CI: 2.52 to 6.91) and LGA (95% CI: 1.60 to 3.21), respectively, than non-obese women after adjustment for maternal age, gestational weeks and GDM. We did not find GDM is a risk factor for macrosomia or LGA after GDM treatment. Pre-pregnancy obesity accounts for a high prevalence of macrosomia. Interventions that focus on pre-pregnancy obesity have the potential to reach far more women at risk of macrosomia.

Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda

PubMed Central

2013-01-01

Background Mothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming. Method The study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late. Results Four hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit. Conclusion Pregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care. PMID:23706142

Reducing perinatal mortality among Indigenous babies in Queensland: should the first priority be better primary health care or better access to hospital care during confinement?

PubMed

Johnston, Trisha; Coory, Michael

2005-05-27

The perinatal mortality rate among Indigenous Australians is still double that of the rest of the community. The aim of our study was to estimate the extent to which increased risk of low birthweight and preterm birth among Indigenous babies in Queensland account for their continuing mortality excess. If a large proportion of excess deaths can be explained by the unfavourable birthweight and gestational age distribution of Indigenous babies, then that would suggest that priority should be given to implementing primary health care interventions to reduce the risk of low birthweight and preterm birth (eg, interventions to reduce maternal smoking or genitourinary infections). Conversely, if only a small proportion is explained by birthweight and gestational age, then other strategies might need to be considered such as improving access to high-quality hospital care around the time of confinement. Population-based, descriptive study of perinatal mortality rates among Indigenous and non-Indigenous babies, in Queensland, stratified by birthweight and gestational age. Indigenous babies are twice as likely to die as their non-Indigenous counterparts (rate ratio1998-2002: 2.01; 95%ci 1.77, 2.28). However, within separate strata of birth weight and gestational age, Indigenous and non-Indigenous rates are similar. The Mantel-Haenszel rate ratio adjusted for birth weight and gestational age was 1.13 (0.99, 1.28). This means that most of the excess mortality in Indigenous babies is largely due to their unfavourable birth weight and gestational-age distributions. If Indigenous babies had the same birth weight and gestational age distribution as their non-Indigenous counterparts, then the relative disparity would be reduced by 87% and 20 fewer Indigenous babies would die in Queensland each year. Our results suggest that Indigenous mothers at high risk of poor outcome (for example those Indigenous mothers in preterm labour) have good access to high quality medical care around the time of confinement. The main reason Indigenous babies have a high risk of death is because they are born too early and too small. Thus, to reduce the relative excess of deaths among Indigenous babies, priority should be given to primary health care initiatives aimed at reducing the prevalence of low birth weight and preterm birth.

Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis.

PubMed

Moore, Kerryn A; Fowkes, Freya J I; Wiladphaingern, Jacher; Wai, Nan San; Paw, Moo Kho; Pimanpanarak, Mupawjay; Carrara, Verena I; Raksuansak, Jathee; Simpson, Julie A; White, Nicholas J; Nosten, François; McGready, Rose

2017-05-10

Malaria in pregnancy is preventable and contributes significantly to the estimated 5.5 million stillbirths and neonatal deaths that occur annually. The contribution of malaria in pregnancy in areas of low transmission has not been quantified, and the roles of maternal anaemia, small-for-gestational-age status, and preterm birth in mediating the effect of malaria in pregnancy on stillbirth and neonatal death are poorly elucidated. We analysed observational data routinely collected at antenatal clinics on the Thai-Myanmar border (1986-2015). We used Cox regression and sequential mediation analysis to determine the effect of falciparum and vivax malaria in pregnancy on antepartum (death in utero) and intrapartum (death during labour) stillbirth and neonatal mortality as well as mediation through maternal anaemia, preterm birth, and small-for-gestational-age status. Of 61,836 women, 9350 (15%) had malaria in pregnancy, and 526 (0.8%) had stillbirths. In a sub-set of 9090 live born singletons followed from birth there were 153 (1.7%) neonatal deaths. The hazard of antepartum stillbirth increased 2.24-fold [95% confidence interval: 1.47, 3.41] following falciparum malaria (42% mediated through small-for-gestational-age status and anaemia), driven by symptomatic falciparum malaria (hazard ratio, HR: 2.99 [1.83, 4.89]) rather than asymptomatic falciparum malaria (HR: 1.35 [0.61, 2.96]). The hazard of antepartum stillbirth increased 2.21-fold [1.12, 4.33] following symptomatic vivax malaria (24% mediated through small-for-gestational-age status and anaemia) but not asymptomatic vivax malaria (HR: 0.54 [0.20, 1.45]). There was no association between falciparum or vivax malaria in pregnancy and intrapartum stillbirth (falciparum HR: 1.03 [0.58, 1.83]; vivax HR: 1.18 [0.66, 2.11]). Falciparum and vivax malaria in pregnancy increased the hazard of neonatal death 2.55-fold [1.54, 4.22] and 1.98-fold [1.10, 3.57], respectively (40% and 50%, respectively, mediated through small-for-gestational-age status and preterm birth). Prevention of malaria in pregnancy, new and existing interventions to prevent small-for-gestational-age status and maternal anaemia, and improved capacity for managing preterm and small-for-gestational-age newborns will reduce the number of malaria-associated stillbirths and neonatal deaths in malaria-endemic areas.

Association of Parasite Load Levels in Amniotic Fluid With Clinical Outcome in Congenital Toxoplasmosis.

PubMed

Yamamoto, Lidia; Targa, Lília S; Sumita, Laura M; Shimokawa, Paulo T; Rodrigues, Jonatas C; Kanunfre, Kelly A; Okay, Thelma S

2017-08-01

To correlate neonatal and infant clinical outcome with parasite load in amniotic fluid (AF). We conducted a retrospective cohort study of 122 children whose mothers had toxoplasmosis during pregnancy. The children were monitored from birth to 12 months old. Stored AF samples were obtained at maternal diagnosis and tested by quantitative polymerase chain reaction. Gestational age at maternal infection, quantitative polymerase chain reaction results, neonatal anti-Toxoplasma gondii immunoglobulin (Ig) M, and clinical outcome at 12 months were correlated. Maternal infection occurred in 18 of 122 (14.7%) and 104 of 122 (85.2%) women in the first and second trimesters, respectively. At birth, IgM was present in 107 of 122 (87.7%) neonates and 36 (29.5%) were symptomatic. Of these, half occurred in the first and the other half in the second trimester and 6 of 36 had severe infections (16.7% of symptomatic, 4.9% of total), all infected in the first trimester. Parasite load levels were highly variable (median 35 parasites/mL, range 2-30,473). Logistic regression correlated symptomatic infection with gestational age (odds ratio [OR] 0.47, CI 0.31-0.73) and parasite load (OR 2.04, CI 1.23-3.37), but not with positive IgM (OR 6.81, CI 0.86-53.9). Negative correlations were found between gestational age and parasite load (rs -0.780, CI -0.843 to -0.696), gestational age and symptoms (rs -0.664, CI -0.755 to -0.547), but not gestational age and IgM (rs -0.136, CI -0.311 to 0.048). Parasite load levels distributed by percentile showed that all symptomatic patients appeared from the 75th percentile and all severe infections from the 95th percentile. Load rankings showed doubled the OR for each 20 parasite/mL increment. Parasite load was associated with symptomatic infections (area under the curve 0.959, CI 0.908-0.987) as well as gestational age (area under the curve 0.918, CI 0.855-0.960) and both parameters combined (area under the curve 0.969, CI 0.920-0.992). Parasite load in AF is associated with the clinical outcome in congenital toxoplasmosis, irrespective of gestational age at maternal infection.

T cell developmental arrest in former premature infants increases risk of respiratory morbidity later in infancy

PubMed Central

Scheible, Kristin M.; Emo, Jason; Laniewski, Nathan; Baran, Andrea M.; Peterson, Derick R.; Bandyopadhyay, Sanjukta; Straw, Andrew G.; Huyck, Heidie; Ashton, John M.; Tripi, Kelly Schooping; Arul, Karan; Werner, Elizabeth; Scalise, Tanya; Maffett, Deanna; Caserta, Mary; Ryan, Rita M.; Reynolds, Anne Marie; Ren, Clement L.; Topham, David J.; Mariani, Thomas J.; Pryhuber, Gloria S.

2018-01-01

The inverse relationship between gestational age at birth and postviral respiratory morbidity suggests that infants born preterm (PT) may miss a critical developmental window of T cell maturation. Despite a continued increase in younger PT survivors with respiratory complications, we have limited understanding of normal human fetal T cell maturation, how ex utero development in premature infants may interrupt normal T cell development, and whether T cell development has an effect on infant outcomes. In our longitudinal cohort of 157 infants born between 23 and 42 weeks of gestation, we identified differences in T cells present at birth that were dependent on gestational age and differences in postnatal T cell development that predicted respiratory outcome at 1 year of age. We show that naive CD4+ T cells shift from a CD31–TNF-α+ bias in mid gestation to a CD31+IL-8+ predominance by term gestation. Former PT infants discharged with CD31+IL8+CD4+ T cells below a range similar to that of full-term born infants were at an over 3.5-fold higher risk for respiratory complications after NICU discharge. This study is the first to our knowledge to identify a pattern of normal functional T cell development in later gestation and to associate abnormal T cell development with health outcomes in infants. PMID:29467329

Morbidity and Mortality in Small for Gestational Age Infants at 22 to 29 Weeks' Gestation.

PubMed

Boghossian, Nansi S; Geraci, Marco; Edwards, Erika M; Horbar, Jeffrey D

2018-02-01

To identify the relative risks of mortality and morbidities for small for gestational age (SGA) infants in comparison with non-SGA infants born at 22 to 29 weeks' gestation. Data were collected (2006-2014) on 156 587 infants from 852 US centers participating in the Vermont Oxford Network. We defined SGA as sex-specific birth weight <10th centile for gestational age (GA) in days. Binomial generalized additive models with a thin plate spline term on GA by SGA were used to calculate the adjusted relative risks and 95% confidence intervals for outcomes by GA. Compared with non-SGA infants, the risk of patent ductus arteriosus decreased for SGA infants in early GA and then increased in later GA. SGA infants were also at increased risks of mortality, respiratory distress syndrome, necrotizing enterocolitis, late-onset sepsis, severe retinopathy of prematurity, and chronic lung disease. These risks of adverse outcomes, however, were not homogeneous across the GA range. Early-onset sepsis was not different between the 2 groups for the majority of GAs, although severe intraventricular hemorrhage was decreased among SGA infants for only gestational week 24 through week 25. SGA was associated with additional risks to mortality and morbidities, but the risks differed across the GA range. Copyright © 2018 by the American Academy of Pediatrics.

Concordance between maternal recall of birth complications and data from obstetrical records.

PubMed

Keenan, Kate; Hipwell, Alison; McAloon, Rose; Hoffmann, Amy; Mohanty, Arpita; Magee, Kelsey

2017-02-01

Prenatal complications are associated with poor outcomes in the offspring. Access to medical records is limited in the United States and investigators often rely on maternal report of prenatal complications. We tested concordance between maternal recall and birth records in a community-based sample of mothers participating in a longitudinal study in order to determine the accuracy of maternal recall of perinatal complications. Participants were 151 biological mothers, who were interviewed about gestational age at birth, birthweight, and the most commonly occurring birth complications: nuchal cord and meconium aspiration when the female child was on average 6years old, and for whom birth records were obtained. Concordance between reports was assessed using one-way random intra-class coefficients for continuous measures and kappa coefficients for dichotomous outcomes. Associations between maternal demographic and psychological factors and discrepancies also were tested. Concordance was excellent for continuously measured birthweight (ICC=0.85, p<0.001) and good for gestational age (ICC=0.68, p<0.001). Agreement was good for low birthweight (<2500g) (kappa=0.67, p<0.001), fair for preterm delivery (<37weeks gestation) (kappa=0.44, p<0.001), and poor for nuchal cord or meconium aspiration. Most discrepancies were characterized by presence according to birth record and absence according to maternal recall. Receipt of public assistance was associated with a decrease in discrepancy in report of nuchal cord. Concordance between maternal retrospective report and medical birth records varies across different types of perinatal events. There was little evidence that demographic or psychological factors increased the risk of discrepancies. Maternal recall based on continuous measures of perinatal factors may yield more valid data than dichotomous outcomes. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Effect of chorioamnionitis on brain development and injury in premature newborns.

PubMed

Chau, Vann; Poskitt, Kenneth J; McFadden, Deborah E; Bowen-Roberts, Tim; Synnes, Anne; Brant, Rollin; Sargent, Michael A; Soulikias, Wendy; Miller, Steven P

2009-08-01

The association of chorioamnionitis and noncystic white matter injury, a common brain injury in premature newborns, remains controversial. Our objectives were to determine the association of chorioamnionitis and postnatal risk factors with white matter injury, and the effects of chorioamnionitis on early brain development, using advanced magnetic resonance imaging. Ninety-two preterm newborns (24-32 weeks gestation) were studied at a median age of 31.9 weeks and again at 40.3 weeks gestation. Histopathological chorioamnionitis and white matter injury were scored using validated systems. Measures of brain metabolism (N-acetylaspartate/choline and lactate/choline) on magnetic resonance spectroscopy, and microstructure (average diffusivity and fractional anisotropy) on diffusion tensor imaging were calculated from predefined brain regions. Thirty-one (34%) newborns were exposed to histopathological chorioamnionitis, and 26 (28%) had white matter injury. Histopathological chorioamnionitis was not associated with an increased risk of white matter injury (relative risk: 1.2; p = 0.6). Newborns with postnatal infections and hypotension requiring therapy were at higher risk of white matter injury (p < 0.03). Adjusting for gestational age at scan and regions of interest, histopathological chorioamnionitis did not significantly affect brain metabolic and microstructural development (p > 0.1). In contrast, white matter injury was associated with lower N-acetylaspartate/choline (-8.9%; p = 0.009) and lower white matter fractional anisotropy (-11.9%; p = 0.01). Histopathological chorioamnionitis does not appear to be associated with an increased risk of white matter injury on magnetic resonance imaging or with abnormalities of brain development. In contrast, postnatal infections and hypotension are associated with an increased risk of white matter injury in the premature newborn.

Screening for chromosomal anomalies in the first trimester: does repeat maternal serum screening improve detection rates?

PubMed

Spencer, Kevin; Cuckle, Howard S

2002-10-01

To assess the within person biological variability of first trimester maternal serum biochemical markers of trisomy 21 across the 10-14 week gestational period. To evaluate whether repeat sampling and testing of free beta-hCG and PAPP-A during this period would result in an improved detection rate. Women presenting at the first trimester OSCAR clinic have blood collected prior to ultrasound dating and nuchal translucency measurement. All samples are analysed for free beta-hCG and PAPP-A before an accurate estimate of gestation is available. In 10% of cases the gestation is prior to the minimum time for NT measurement (11 weeks) and these women are rebooked for a repeat visit to the clinic at the appropriate time. Our fetal database was interrogated to obtain cases in which two maternal blood samples had been collected and analysed in the 10-14 week period. Using data from the marker correlations and statistical modelling, the impact of repeat testing on detection rate for trisomy 21 at a fixed 5% false positive rate, was assessed. 261 pairs of data were available for analysis collected over a 3 year period. The correlation between free beta-hCG in sample 1 and sample 2 was 0.890 and that for PAPP-A was 0.827. The average within person biological variation for free beta-hCG was 21% and 32% for PAPP-A. The increase in detection rate when using both sets of marker data was 3.5% when using serum biochemistry and maternal age, and 1.3% when using nuchal translucency, serum biochemistry and maternal age. Repeat sampling and testing of maternal serum biochemical markers is unlikely to substantially improve first trimester screening performance. Copyright 2002 John Wiley & Sons, Ltd.

Acculturation and gestational weight gain in a predominantly Puerto Rican population.

PubMed

Tovar, Alison; Chasan-Taber, Lisa; Bermudez, Odilia I; Hyatt, Raymond R; Must, Aviva

2012-11-21

Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation (measured via a psychological acculturation scale, generation in the US, place of birth and spoken language preference) was assessed in early pregnancy. Adjusting for age, parity, perceived stress, gestational age, and prepregnancy weight, women who had at least one parent born in Puerto Rico/Dominican Republic (PR/DR) and both grandparents born in PR/DR had a significantly higher mean total gestational weight gain (0.9 kg for at least one parent born in PR/DR and 2.2 kg for grandparents born in PR/DR) and rate of weight gain (0.03 kg/wk for at least one parent born in PR/DR and 0.06 kg/wk for grandparents born in PR/DR) vs. women who were of PR/DR born. Similarly, women born in the US had significantly higher mean total gestational weight gain (1.0 kg) and rate of weight gain (0.03 kg/wk) vs. women who were PR/ DR born. Spoken language preference and psychological acculturation were not significantly associated with total or rate of pregnancy weight gain. We found that psychological acculturation was not associated with gestational weight gain while place of birth and higher generation in the US were significantly associated with higher gestational weight gain. We interpret these findings to suggest the potential importance of the US "obesogenic" environment in influencing unhealthy pregnancy weight gains over specific aspects of psychological acculturation.

Increased uncoupling protein-2 mRNA abundance and glucocorticoid action in adipose tissue in the sheep fetus during late gestation is dependent on plasma cortisol and triiodothyronine

PubMed Central

Gnanalingham, MG; Mostyn, A; Forhead, AJ; Fowden, AL; Symonds, ME; Stephenson, T

2005-01-01

The endocrine regulation of uncoupling protein-2 (UCP2), an inner mitochondrial protein, in fetal adipose tissue remains unclear. The present study aimed to determine if fetal plasma cortisol and triiodothyronine (T3) influenced the mRNA abundance of UCP2, glucocorticoid receptor (GR) and 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) and 2 (11βHSD2) in fetal adipose tissue in the sheep during late gestation. Perirenal–abdominal adipose tissue was sampled from ovine fetuses to which either cortisol (2–3 mg kg−1 day−1) or saline was infused for 5 days up to 127–130 days gestation, or near term fetuses (i.e. 142–145 days gestation) that were either adrenalectomised (AX) or remained intact. Fetal plasma cortisol and T3 concentrations were higher in the cortisol infused animals and lower in AX fetuses compared with their corresponding control group, and increased with gestational age. UCP2 and GR mRNA abundance were significantly lower in AX fetuses compared with age-matched controls, and increased with gestational age and by cortisol infusion. Glucocorticoid action in fetal adipose tissue was augmented by AX and suppressed by cortisol infusion, the latter also preventing the gestational increase in 11βHSD1 mRNA and decrease in 11βHSD2 mRNA. When all treatment groups were combined, both fetal plasma cortisol and T3 concentrations were positively correlated with UCP2, GR and 11βHSD2 mRNA abundance, but negatively correlated with 11βHSD1 mRNA abundance. In conclusion, plasma cortisol and T3 are both required for the late gestation rise in UCP2 mRNA and differentially regulate glucocorticoid action in fetal adipose tissue in the sheep during late gestation. PMID:15961419

Low Socioeconomic Status Negatively Affects Sleep in Pregnant Women

PubMed Central

Okun, Michele L.; Tolge, Madeline; Hall, Martica

2014-01-01

Objective To evaluate the effect of socioeconomic status on measures of sleep quality, continuity, and quantity in a large cohort of pregnant women. Design Prospective, longitudinal study. Participants One hundred seventy (170) pregnant women at 10-20 weeks gestation. Methods Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Sleep duration and continuity (sleep fragmentation index [SFI]) were assessed with actigraphy at 10-12, 14-16, and 18-20 weeks gestation. Since sleep did not significantly differ across time, averages across all three time points were used in analyses. Socioeconomic status (SES) was defined by self-reported annual household income. Linear regression analyses were used to model the independent associations of SES on sleep after adjusting for age, race, parity, marital status, body mass index (BMI), perceived stress, depressive symptoms, and financial strain. Results On average, women reported modestly poor sleep quality (M = 5.4, SD= 2.7), short sleep duration (391 (55.6) min) and fragmented sleep (SFI M = 33.9, SD= 10.4. A household income < $50,000/year was associated with poorer sleep quality (β = -.18, p < .05) and greater sleep fragmentation (β= -.18, p < .05) following covariate adjustment. Conclusions Low SES was associated with poorer sleep quality and fragmented sleep, even after statistical adjustments. Perceived stress and financial strain attenuated SES-sleep associations indicating that psychosocial situations preceding pregnancy are also important to consider. PMID:24617761

Transfer entropy analysis of maternal and fetal heart rate coupling.

PubMed

Marzbanrad, Faezeh; Kimura, Yoshitaka; Endo, Miyuki; Palaniswami, Marimuthu; Khandoker, Ahsan H

2015-01-01

Although evidence of the short term relationship between maternal and fetal heart rates has been found in previous model-based studies, knowledge about the mechanism and patterns of the coupling during gestation is still limited. In this study, a model-free method based on Transfer Entropy (TE) was applied to quantify the maternal-fetal heart rate couplings in both directions. Furthermore, analysis of the lag at which TE was maximum and its changes throughout gestation, provided more information about the mechanism of coupling and its latency. Experimental results based on fetal electrocardiograms (fECGs) and maternal ECG showed the evidence of coupling for 62 out of 65 healthy mothers and fetuses in each direction, by statistically validating against the surrogate pairs. The fetuses were divided into three gestational age groups: early (16-25 weeks), mid (26-31 weeks) and late (32-41 weeks) gestation. The maximum TE from maternal to fetal heart rate significantly increased from early to mid gestation, while the coupling delay on both directions decreased significantly from mid to late gestation. These changes occur concomitant with the maturation of the fetal sensory and autonomic nervous systems with advancing gestational age. In conclusion, the application of TE with delays revealed detailed information about the changes in fetal-maternal heart rate coupling strength and latency throughout gestation, which could provide novel clinical markers of fetal development and well-being.

Labor patterns in twin gestations

PubMed Central

Leftwich, Heidi K.; Zaki, Mary N.; Wilkins, Isabelle; Hibbard, Judith U.

2014-01-01

Objective To compare labor progression in twin vs singleton gestations. Study Design Retrospective review of electronic database created by Consortium on Safe Labor, reflecting labor and delivery information from 12 clinical centers 2002-2008. Women with twin gestations, cephalic presentation of presenting twin, gestational age ≥34 weeks, with ≥2 cervical examinations were included. Exclusion criteria were fetal anomalies or demise. Singleton controls were selected by the same criteria. Categorical variables were analyzed by χ2; continuous by Student t test. Interval censored regression was used to determine distribution for time of cervical dilation in centimeters, or “traverse times,” and controlled for confounding factors. Repeated-measures analysis constructed mean labor curves by parity and number of fetuses. Results A total of 891 twin gestations were compared with 100,513 singleton controls. Twin gestations were more often older, white or African American, earlier gestational age, increased prepregnancy body mass index, and with lower birthweight. There was no difference in number of prior cesarean deliveries, induction, or augmentation, or epidural use. Median traverse times increased at every centimeter interval in nulliparous twins, in both unadjusted and adjusted analysis (P < .01). A similar pattern was noted for multiparas in both analyses. Labor curves demonstrated a delayed inflection point in the labor pattern for nulliparous and multiparous twin gestations. Conclusion Both nulliparous and multiparous women have slower progression of active phase labor with twins even when controlling for confounding factors. PMID:23871795

Changing Survival Rate of Infants Born Before 26 Gestational Weeks: Single-centre study.

PubMed

Rahman, Asad; Abdellatif, Mohamed; Sharef, Sharef W; Fazalullah, Muhammad; Al-Senaidi, Khalfan; Khan, Ashfaq A; Ahmad, Masood; Kripail, Mathew; Abuanza, Mazen; Bataclan, Flordeliza

2015-08-01

This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 ± 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome (100.0%), retinopathy of prematurity (51.9%), bronchopulmonary dysplasia (34.6%), intraventricular haemorrhage (30.9%) and patent ductus arteriosus (28.4%) were the most common morbidities. The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants.

Can a national dataset generate a nomogram for necrotizing enterocolitis onset?

PubMed

Gordon, P V; Clark, R; Swanson, J R; Spitzer, A

2014-10-01

Mother's own milk and donor human milk use is increasing as a means of necrotizing enterocolitis (NEC) prevention. Early onset of enteral feeding has been associated with improvement of many outcomes but has not been shown to reduce the incidence of NEC. Better definition of the window of risk for NEC by gestational strata should improve resource management with respect to donor human milk and enhance our understanding of NEC timing and pathogenesis. Our objective was to establish a NEC dataset of sufficient size and quality, then build a generalizable model of NEC onset from the dataset across gestational strata. We used de-identified data from the Pediatrix national dataset and filtered out all diagnostic confounders that could be identified by either specific diagnoses or logical exclusions (example dual diagnoses), with a specific focus on NEC and spontaneous intestinal perforation (SIP) as the outcomes of interest. The median day of onset was plotted against the gestational age for each of these diagnoses and analyzed for similarities and differences in the day of diagnosis. Onset time of medical NEC was inversely proportional to gestation in a linear relationship across all gestational ages. We found the medical NEC dataset displayed characteristics most consistent with a homogeneous disease entity, whereas there was a skew towards early presentation in the youngest gestation groups of surgical NEC (suggesting probable SIP contamination). Our national dataset demonstrates that NEC onset occurs in an inverse stereotypic, linear relationship with gestational age at birth. Medical NEC is the most reliable sub-cohort for the purpose of determining the temporal window of NEC risk.

Maternal OGTT Glucose Levels at 26–30 Gestational Weeks with Offspring Growth and Development in Early Infancy

PubMed Central

Liu, Gongshu; Li, Nan; Sun, Shurong; Wen, Jing; Lyu, Fengjun; Gao, Wen; Li, Lili; Chen, Fang; Baccarelli, Andrea A.; Hou, Lifang

2014-01-01

Aims. We aim to evaluate the association of maternal gestational oral glucose tolerance test (OGTT) glucose concentrations with anthropometry in the offspring from birth to 12 months in Tianjin, China. Methods. A total of 27,157 pregnant women underwent OGTT during 26–30 weeks gestation, and their children had body weight/length measured from birth to 12 months old. Results. Maternal OGTT glucose concentrations at 26–30 gestational weeks were positively associated with Z-scores for birth length-for-gestational age and birth weight-for-length. Compared with infants born to mothers with normal glucose tolerance, infants born to mothers with gestational diabetes mellitus (impaired glucose tolerance/new diabetes) had higher mean values of Z-scores for birth length-for-gestational age (0.07/0.23; normal group −0.08) and birth weight-for-length (0.27/0.57; normal group −0.001), smaller changes in mean values of Z-scores for length-for-age (0.75/0.62; normal group 0.94) and weight-for-length (0.18/−0.17; normal group 0.37) from birth to month 3, and bigger changes in mean values in Z-scores for weight-for-length (0.07/0.12; normal group 0.02) from month 9 to 12. Conclusions. Abnormal maternal glucose tolerance during pregnancy was associated with higher birth weight and birth length, less weight and length gain in the first 3 months of life, and more weight gain in the months 9–12 of life. PMID:24689042

Natural histroy of trisomy 18 and trisomy 13: I. Growth, physical assessment, medical histories, survival, and recurrence risk

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baty, B.J.; Blackburn, B.L.; Carey, J.C.

1994-01-15

The natural history of trisomy 18 and trisomy 13 was investigated using data derived from parent questionnaires and medical records from 98 families with an index case of trisomy 18 and 32 families with an index case of trisomy 13. Data are presented on pregnancy, delivery, survival, medical complications, immunizations, growth, cause of death, cytogenetics, and recurrence risk. Half of the trisomy 18 babies were delivered by C-section. Fetal distress was a factor in half, and the only reason in a third of C-section deliveries. One minute Apgar scores were significantly lower in C-section and breech deliveries. There were moremore » small-for-gestational-age babies than in the general population, but most of the low-birth-weight newborns were small for gestational age, unlike the general population. Survival in this group of children was better than in other studies due to ascertainment bias. There were more girls than boys at all ages for both conditions, and the sex ratio decreased with time. Growth curves for length, weight, head circumference, and weight vs height are provided. Long-term survival did not appear to be due to mosaicism. There were no adverse reactions attributable to immunizations. At age 1 year there was an average of approximately 2 operations per living child. The authors report the second case of successful major cardiac surgery in a trisomy 18 child. Almost 70% of deaths were attributed to cardiopulmonary arrest. The sibling recurrence risk for trisomy 18 or trisomy 13 was 0.55%. 86 refs., 5 figs., 5 tabs.« less

Long Latency Auditory Evoked Potential in Term and Premature Infants

PubMed Central

Didoné, Dayane Domeneghini; Garcia, Michele Vargas; da Silveira, Aron Ferreira

2013-01-01

Introduction The research in long latency auditory evokes potentials (LLAEP) in newborns is recent because of the cortical structure maturation, but studies note that these potentials may be evidenced at this age and could be considered as indicators of cognitive development. Purpose To research the exogenous potentials in term and premature infants during their first month of life. Materials and Methods The sample consisted of 25 newborns, 15 term and 10 premature infants. The infants with gestational age under 37 weeks were considered premature. To evaluate the cortical potentials, the infants remained in natural sleep. The LLAEPs were researched binaurally, through insertion earphones, with frequent /ba/ and rare /ga/ speech stimuli in the intensity of 80 dB HL (decibel hearing level). The frequent stimuli presented a total of 80% of the presentations, and the rare, 20%. The data were statistically analyzed. Results The average gestational age of the term infants was 38.9 weeks (± 1.3) and for the premature group, 33.9 weeks (± 1.6). It was possible to observe only the potentials P1 and N1 in both groups, but there was no statistically significant difference for the latencies of the components P1 and N1 (p > 0.05) between the groups. Conclusion It was possible to observe the exogenous components P1 and N1 of the cortical potentials in both term and preterm newborns of no more than 1 month of age. However, there was no difference between the groups. PMID:25992057

Maternal age during pregnancy is associated with third trimester blood pressure level: the generation R study.

PubMed

Gaillard, Romy; Bakker, Rachel; Steegers, Eric A P; Hofman, Albert; Jaddoe, Vincent W V

2011-09-01

We hypothesized that hemodynamic adaptations related to pregnancy and ageing might be associated with differences in blood pressure levels during pregnancy between younger and older women. This might partly explain the increased risk of gestational hypertensive disorders with advanced maternal age. We examined the associations of maternal age with systolic and diastolic blood pressure in each trimester of pregnancy and the risks of gestational hypertensive disorders. The study was conducted among 8,623 women participating in a population-based prospective cohort study from early pregnancy onwards. Age was assessed at enrolment. Blood pressure was measured in each trimester. Information about gestational hypertensive disorders was available from medical records. In second and third trimester, older maternal age was associated with lower systolic blood pressure (-0.9 mm Hg (95% confidence interval: -1.4, -0.3) and -0.6 mm Hg (95% confidence interval: -1.1, -0.02) per additional 10 maternal years, respectively). Older maternal age was associated with higher third trimester diastolic blood pressure (0.5 mm Hg (95% confidence interval: 0.04, 0.9) per additional 10 maternal years). Maternal age was associated with pregnancy-induced hypertension among overweight and obese women. Older maternal age is associated with lower second and third trimester systolic blood pressure, but higher third trimester diastolic blood pressure. These blood pressure differences seem to be small and within the physiological range. Maternal age is not consistently associated with the risks of gestational hypertensive disorders. Maternal body mass index might influence the association between maternal age and the risk of pregnancy-induced hypertension.

Low birth weight,very low birth weight rates and gestational age-specific birth weight distribution of korean newborn infants.

PubMed

Shin, Son-Moon; Chang, Young-Pyo; Lee, Eun-Sil; Lee, Young-Ah; Son, Dong-Woo; Kim, Min-Hee; Choi, Young-Ryoon

2005-04-01

To obtain the low birth weight (LBW) rate, the very low birth weight (VLBW) rate, and gestational age (GA)-specific birth weight distribution based on a large population in Korea, we collected and analyzed the birth data of 108,486 live births with GA greater than 23 weeks for 1 yr from 1 January to 31 December 2001, from 75 hospitals and clinics located in Korea. These data included birth weight, GA, gender of the infants, delivery type, maternal age, and the presence of multiple pregnancy. The mean birth weight and GA of a crude population are 3,188 +/-518 g and 38.7+/-2.1 weeks, respectively. The LBW and the VLBW rates are 7.2% and 1.4%, respectively. The preterm birth rate (less than 37 completed weeks of gestation) is 8.4% and the very preterm birth rate (less than 32 completed weeks of gestation) is 0.7%. The mean birth weights for female infants, multiple births, and births delivered by cesarean section were lower than those for male, singletons, and births delivered vaginally. The risk of delivering LBW or VLBW infant was higher for the teenagers and the older women (aged 35 yr and more). We have also obtained the percentile distribution of GA-specific birth weight in infants over 23 weeks of gestation.

Reappraisal of fetal abdominal circumference in an Asian population: analysis of 50,131 records.

PubMed

Lu, Szu-Ching; Chang, Chiung-Hsin; Yu, Chen-Hsiang; Kang, Lin; Tsai, Pei-Ying; Chang, Fong-Ming

2008-03-01

Fetuses from different populations may show different growth patterns. In obstetrics, fetal abdominal circumference (AC) is a very useful index for assessing fetal growth. In this study, we attempted to establish the normal fetal growth curves of AC in an Asian population in South Taiwan. We reviewed our computer ultrasound database of fetal AC records from January 1991 to December 2006. During the study period of 16 years, only the fetuses examined by ultrasonography with gestational age between 14 and 41 weeks were included. We excluded extreme bilateral records after initial analysis. Eventually, 50,131 records of AC were included for final analysis. The observed gestation-specific AC values and the predicted AC values were calculated. The best-fit regression equation of AC versus gestational age is a second-order polynomial equation. In general, fetal AC values in our population showed similar patterns to those in Western populations. Besides, we established a table of the predicted AC values based on specific gestational age, including the 5 th , 10 th , 50 th , 90 th and 95 th centiles, for clinical reference. To the best of our knowledge, our series is the largest sample of AC reported in the medical literature. We believe that the gestational age-specific nomogram of fetal AC is important for further clinical assessment of fetal growth.

Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants.

PubMed

Ogunyemi, D; Friedman, P; Betcher, K; Whitten, A; Sugiyama, N; Qu, L; Kohn, Amitai; Paul, Holtrop

2017-06-01

To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia. Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis. Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR] = 1.61), gestational age (OR = 0.68), gestational diabetes (OR = 0.22), macrosomia (OR = 4.87), small for gestational age neonate [SGA] (OR = 6.83) and admission cervical dilation (OR = 0.79). For intrapartum factors, only cesarean section (OR = 1.57) and last cervical dilation (OR = 0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR = 4.18), gentamycin/clindamycin in labor (OR = 5.35), gestational age (OR = 0.59) and macrosomia (OR = 5.62). Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions. Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.

Estimation of gestational age from study of amniotic fluid and clinical assessment.

PubMed Central

Deshpande, T. V.; Harding, P. G.; Jaco, N. T.

1977-01-01

Study of 108 samples of amniotic fluid obtained between 28 and 42 weeks' gestation from 101 patients revealed that in normal pregnancies the creatinine concentration, lecithin/sphingomyelin (L/S) ratio and percentage of fat cells correlated better with the gestational age of the newborn--assessed by clinical criteria--than did the bilirubin and sodium concentrations. A creatinine concentration of 1.75 mg/dL or more, an L/S ratio of 4 or more and a fat cell percentage of 10 or more correlated significantly with a gestational age of 37 weeks or more. In abnormal pregnancies (those with obstetric or medical complications, or both) the mean creatinine concentration in the amniotic fluid was significantly less than expected for gestational age in fetal dysmaturity and greater than expected when the mother had diabetes. The mean L/S ratio in the amniotic fluid was elevated when the mother had hypertension or smoked and in cases of fetal dysmaturity or long interval between rupture of the membranes and delivery, whereas it was significantly lower than normal when the mother had diabetes. The mean bilirubin concentration in the amniotic fluid was significantly lower than normal when the mother had hypertension. When the mother had diabetes, maturity of the fetal lung, liver, skin and brain appeared to be delayed, according to the values for the amniotic fluid constituents. PMID:912615

[Emergency cervical cerclage during mid-trimester of pregnancy: Experience of Clermont-Ferrand].

PubMed

Delabaere, A; Velemir, L; Ughetto, S; Accoceberry, M; Niro, J; Vendittelli, F; Laurichesse-Delmas, H; Jacquetin, B; Lemery, D; Gallot, D

2011-11-01

The objective of this study was to identify factors associated with favourable perinatal outcome after emergency cervical cerclage during mid-trimester of pregnancy. This is a retrospective study of all cases who underwent emergency cervical cerclage between 16 to 28 weeks of gestation (WG) over a period of 16 years in a University Hospital. Among the 32 cases, the postnatal survival rate (day 28) was 80%. Delivery occurred at a mean gestational age of 33.1 WG [18-41.3 WG] and after 37 WG in 39% of cases. The perinatal outcome was improved by absence of bleeding (P=0.01), unripened cervix (P=0.02), cervical dilatation below 2 cm (P=0.002), no protruding membranes (P=0.02) and more advanced gestational age at the procedure (P=0.005). When no uterine contraction and no maternal blood inflammation were observed at admission, an expectancy of 48 hours before the procedure did not improve significantly perinatal outcome (gestational age at birth and survival rate [P=0.1 and P=0.3 respectively]). Perinatal outcome after emergency cerclage depends on cervical status and gestational age at procedure. It is not influenced by an expectancy of 48 hours before intervention for patients with no uterine contraction and no maternal blood inflammation at admission. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences.

PubMed

Clark, Caron A C; Woodward, Lianne J; Horwood, L John; Moor, Stephanie

2008-01-01

This study describes the development of emotional and behavioral regulation in a regional cohort of children born extremely preterm (<28 weeks gestational age, n = 39), very preterm (<34 weeks gestational age, n = 56), and full term (n = 103). At 2 and 4 years, children born at younger gestational ages demonstrated poorer self-regulation across multiple contexts spanning observed interactions, formal cognitive testing, and parental report of child behavior at home. Among children born preterm, the 2 strongest predictors of impairments in self-regulation were the presence of moderate-to-severe cerebral white matter abnormalities on neonatal magnetic resonance and a less sensitive parenting style when children were aged 2 years. Findings support the importance of early neurological development and parenting for developing regulation in children born very preterm.

Delayed presentation of prolonged hyperinsulinaemic hypoglycaemia in a preterm small-for-gestational age neonate.

PubMed

Chong, Jin Ho; Chandran, Suresh; Agarwal, Prathibha; Rajadurai, Victor Samuel

2013-12-18

Hyperinsulinaemic hypoglycaemia in small-for-gestational age infants usually presents in the first two postnatal days. We present a preterm, small-for-gestational age infant who had hyperinsulinaemic hypoglycaemia on day 13 of life. A female twin infant weighing 1390 g was born at 32(+6) weeks of gestation. Her glycaemic profile was normal till day 13 of life, after which she was noted to be lethargic and hypoglycaemic and had hyperinsulinism, hypoketonaemia and hypofattyacidaemia, requiring high glucose infusion rate to maintain normoglycaemia, while negative for septic markers and metabolic screen. Initially, there was no response to diazoxide and the genetic studies for ABCC8 and KCNJ11 gene mutations were negative. Delayed response to diazoxide was followed by complete resolution of hypoglycaemia in 5 months. This case highlights the importance of glucose monitoring in small-for-date infants for hypoglycaemia till they achieve full feeds and gain weight. Early recognition and appropriate management of hypoglycaemia in this group of infants have important implications for neurodevelopmental outcome.

Neurodevelopmental Outcome in Preterm Infants

ERIC Educational Resources Information Center

Bos, Arend F.; Roze, Elise

2011-01-01

Aim: To determine the distribution of cognitive and motor scores in preterm children, and to establish the influence of brain lesions and decreasing gestational age thereon. Method: One hundred and six very preterm children (63 males, 43 females; gestational age 24.0-31.6wk; birthweight 480-2275g) were assessed for cognition and motor outcome at 6…

Early Childhood Adversity and Pregnancy Outcomes

PubMed Central

Smith, Megan V.; Gotman, Nathan; Yonkers, Kimberly A.

2016-01-01

Objectives To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits. Methods Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators. Results Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age. Conclusions ACEs have an enduring effect on maternal reproductive health, as manifested by mothers’ delivery of offspring that were of reduced birth weight and shorter gestational age. PMID:26762511

A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women.

PubMed

Wang, Chen; Wei, Yumei; Zhang, Xiaoming; Zhang, Yue; Xu, Qianqian; Sun, Yiying; Su, Shiping; Zhang, Li; Liu, Chunhong; Feng, Yaru; Shou, Chong; Guelfi, Kym J; Newnham, John P; Yang, Huixia

2017-04-01

Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women. We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women. This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24≤28 kg/m 2 ) and had an uncomplicated pregnancy at <12 +6 weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus. From December 2014 through July 2016, 300 singleton women at 10 weeks' gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m 2 were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% vs 40.6%; P < .001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 ± 3.02 vs 5.92 ± 2.58 kg; P < .001) and at the end of pregnancy (8.38 ± 3.65 vs 10.47 ± 3.33 kg; P < .001), and reduced insulin resistance levels (2.92 ± 1.27 vs 3.38 ± 2.00; P = .033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25-36 gestational weeks (4.55 ± 2.06 vs 4.59 ± 2.31 kg; P = .9), insulin resistance levels at 36 gestational weeks (3.56 ± 1.89 vs 4.07 ± 2.33; P = .1), hypertensive disorders of pregnancy (17.0% vs 19.3%; odds ratio, 0.854; 95% confidence interval, 0.434-2.683; P = .6), cesarean delivery (except for scar uterus) (29.5% vs 32.5%; odds ratio, 0.869; 95% confidence interval, 0.494-1.529; P = .6), mean gestational age at birth (39.02 ± 1.29 vs 38.89 ± 1.37 weeks' gestation; P = .5); preterm birth (2.7% vs 4.4%, odds ratio, 0.600; 95% confidence interval, 0.140-2.573; P = .5), macrosomia (defined as birthweight >4000 g) (6.3% vs 9.6%; odds ratio, 0.624; 95% confidence interval, 0.233-1.673; P = .3), and large-for-gestational-age infants (14.3% vs 22.8%; odds ratio, 0.564; 95% confidence interval, 0.284-1.121; P = .1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3345.27 ± 397.07 vs 3457.46 ± 446.00 g; P = .049). Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth. Copyright © 2017 Elsevier Inc. All rights reserved.

Correlates of pregnant women's gestational weight gain knowledge.

PubMed

Willcox, Jane Catherine; Ball, Kylie; Campbell, Karen Jane; Crawford, David Andrew; Wilkinson, Shelley Ann

2017-06-01

to investigate correlates of pregnant women's gestational weight gain (GWG) knowledge commensurate with GWG guidelines. cross sectional quantitative study. an Australian tertiary level maternity hospital. pregnant women (n=1032) following their first antenatal visit. survey to assess GWG knowledge and a range of potential correlates of knowledge including socio-economic characteristics, pregnancy characteristics (parity, gestation, pre-pregnancy BMI) and GWG information procurement and GWG attitudinal variables. participants (n=366; 35.4% response) averaged 32.5 years of age with 33% speaking a language other than English. One third of women reported GWG knowledge consistent with guidelines. Women overweight prior to pregnancy were less likely to underestimate appropriate GWG (RRR 0.23, 95% CI=0.09-0.59). Conversely, women in the overweight (RRR 8.80, 95% CI=4.02-19.25) and obese (RRR 19.62, 95% CI=8.03-48.00) categories were more likely to overestimate GWG recommendations, while tertiary educated women were less likely to overestimate GWG (RRR 0.28, 95% CI=0.10-0.79). No associations were found between GWG knowledge and pregnancy, GWG information source or attitudinal variables. the findings highlight women's lack of GWG knowledge and the role of pre-pregnancy body mass index and women's education as correlates of GWG knowledge. Women susceptible to poor GWG knowledge should be a priority target for individual and community-based education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.

PubMed

Feng, Ru; Liu, Lu; Zhang, Yuan-Yuan; Yuan, Zhong-Shang; Gao, Ling; Zuo, Chang-Ting

2018-05-05

Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes. The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses. The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ 2 = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001). Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.

Effects of maternal exposure to phthalates and bisphenol A during pregnancy on gestational age.

PubMed

Weinberger, Barry; Vetrano, Anna M; Archer, Faith E; Marcella, Stephen W; Buckley, Brian; Wartenberg, Daniel; Robson, Mark G; Klim, Jammie; Azhar, Sana; Cavin, Sarah; Wang, Lu; Rich, David Q

2014-03-01

Phthalates and bisphenol A (BPA) are ubiquitous environmental toxicants, present in high concentrations in numerous consumer products. We hypothesized that maternal exposure to phthalates and BPA in pregnancy is associated with shortened gestation. Urinary phthalate and BPA metabolites from 72 pregnant women were measured at the last obstetric clinic visit prior to delivery. Using linear regression models, we estimated the change in gestational age associated with each interquartile range (IQR) increase in phthalate and BPA metabolite concentration. IQR increases in urinary mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) and BPA concentrations were associated with 4.2 and 1.1 d decreases in gestation, respectively. When stratified by gender, these alterations were found only in male infants. We conclude that MEHHP and BPA (free + glucuronide) are associated with reductions in gestation, with effects observed only in males. Our findings are consistent with the idea that these agents induce gender-specific alterations in signaling via PPAR-γ transcription factor, androgen precursors and/or inflammatory mediators during the initiation of labor.

The golden ratio of nasal width to nasal bone length.

PubMed

Goynumer, G; Yayla, M; Durukan, B; Wetherilt, L

2011-01-01

To calculate the ratio of fetal nasal width over nasal bone length at 14-39 weeks' gestation in Caucasian women. Fetal nasal bone length and nasal width at 14-39 weeks' gestation were measured in 532 normal fetuses. The mean and standard deviations of fetal nasal bone length, nasal width and their ratio to one another were calculated in normal fetuses according to the gestational age to establish normal values. A positive and linear correlation was detected between the nasal bone length and the gestational week, as between the nasal width and the gestational week. No linear growth pattern was found between the gestational week and the ratio of nasal width to nasal bone length, nearly equal to phi, throughout gestation. The ratio of nasal width to nasal bone length, approximately equal to phi, can be calculated at 14-38 weeks' gestation. This might be useful in evaluating fetal abnormalities.

Maternal serum placental growth factor at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia.

PubMed

Tsiakkas, A; Cazacu, R; Wright, A; Wright, D; Nicolaides, K H

2016-04-01

To examine the distribution of maternal serum placental growth factor (PlGF) at 12, 22, 32 and 36 weeks' gestation in singleton pregnancies which develop pre-eclampsia (PE) and examine the performance of this biomarker in screening for PE. Serum PlGF was measured in 40 212 cases at 11-13 weeks, in 10 282 cases at 19-24 weeks, in 10 400 at 30-34 weeks and 4043 at 35-37 weeks. Bayes' theorem was used to combine the a-priori risk from maternal characteristics and medical history with serum PlGF. The performance of screening for PE requiring delivery < 32, at 32 + 0 to 36 + 6 and ≥ 37 weeks' gestation was estimated. In pregnancies that developed PE, serum PlGF was decreased and the separation in multiples of the median (MoM) values from normal was greater with earlier, compared to later, gestational age at which delivery for PE became necessary. Additionally, the slope of the regression lines of PlGF MoM with gestational age at delivery in pregnancies that developed PE increased with advancing gestational age at screening. The detection rates (DRs), at a false-positive rate (FPR) of 10%, for PE delivering < 32 weeks were 79% and 97% with screening at 12 and 22 weeks, respectively. The DRs for PE delivering at 32 + 0 to 36 + 6 weeks were 57%, 65% and 90% with screening at 12, 22 and 32 weeks. The DRs for PE delivering ≥ 37 weeks were 40%, 37%, 54% and 64% with screening at 12, 22, 32 and 36 weeks, respectively. The performance of combined screening with maternal factors, medical history and PlGF is superior in screening for early, compared to late, PE and improves with advancing gestational age at screening. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Metabolic effects of growth factors and polycyclic aromatic hydrocarbons on cultured human placental cells of early and late gestation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guyda, H.J.

1991-03-01

The metabolic effects of epidermal growth factor (EGF), insulin, insulin-like growth factor-I (IGF-I), and IGF-II were determined on human placental cells in monolayer culture obtained from early gestation (less than 20 weeks) and late gestation (38-42 weeks). Parameters studied were uptake of aminoisobutyric acid (AIB), uptake of 3-O-methylglucose and (3H)thymidine incorporation into cell protein. Since benzo(alpha)pyrene (BP) inhibits EGF binding and autophosphorylation in cultured human placental cells, particularly in early gestation, we also studied the effect of benzo(alpha)pyrene and other polycyclic aromatic hydrocarbons (PAHs) on EGF-mediated AIB uptake. The metabolic effects of EGF, insulin, and the IGFs in cultured humanmore » placental cells varied with gestational age and the growth factor studied. All three classes of growth factors stimulated AIB uptake in both early and late gestation at concentrations from 10-100 micrograms/L, well within a physiological range. However, insulin stimulation of AIB uptake was maximal at a high concentration in both early and late gestation cells, suggesting an action via type 1 IGF receptors rather than via insulin receptors. EGF stimulated 3-O-methylglucose uptake only in term placental cells. No significant stimulation of (3H)thymidine incorporation by any of the growth factors tested was seen with either early or late gestation cells. The effect of PAHs on AIB uptake by cultured placental cells was variable. BP alone stimulated AIB uptake by both very early and late gestation cells and enhanced EGF-stimulated AIB uptake. alpha-naphthoflavone alone inhibited AIB uptake at all gestational ages and inhibited EGF-stimulated AIB uptake. beta-Naphthoflavone and 3-methylcholanthrene minimally inhibited AIB uptake by early gestation cells and did not modify EGF-stimulated uptake at any gestational period.« less

Serum zinc levels of cord blood: relation to birth weight and gestational period.

PubMed

Gómez, Tahiry; Bequer, Leticia; Mollineda, Angel; González, Olga; Diaz, Mireisy; Fernández, Douglas

2015-04-01

Zn-deficiency has been associated with numerous alterations during pregnancy including low birth weight; however, the research relating neonatal zinc status and birth weight has not produced reliable results. To compare the serum Zn-levels of cord blood in healthy newborns and low birth weight newborns, and to assess a possible relationship between zinc concentration and neonatal birth weight and gestational age. 123 newborns divided in "study group" (n=50) with <2500g birth weight neonates and "control group" (n=73) with ≥2500g birth weight neonates were enrolled. Study group was subdivided according to gestational age in preterm (<37 weeks) and full-term (≥37 weeks). Serum cord blood samples were collected and the Zn-levels were analyzed using flame Atomic Absorption Spectrophotometry method and the result was expressed in μmol/L. The Zn-levels were compared between the groups (Mann-Whitney-U test) and the Zn-levels were correlated with the birth weight and gestational age (Spearman's rank correlations). Statistically significant low positive correlation between Zn-levels and birth weight (ρ=0.283; p=0.005) was found. No statistically significant difference between Zn-levels of study and control groups [17.00±0.43 vs. 18.16±0.32 (p=0.053)] was found. Statistically significant low positive correlation between Zn-levels and gestational age (ρ=0.351; p=0.001) was found. No statistically significant difference between Zn-levels of preterm as compare to full-term newborns [16.33±0.42 vs. 18.43±0.93 (p=0.079)] was found. Zn-level of preterm subgroup was significantly lower compared to control group (p=0.001). Despite low birth weight preterm neonates had significantly lower serum zinc levels of cord blood than healthy term neonates, the correlation between cord blood zinc levels and birth weight and gestational age was lower. The results are not enough to relate the change in cord blood zinc concentration to the birth weight values or gestational period. In relation to complicated pregnancies, further studies regarding zinc levels in blood in our population are required. Copyright © 2015 Elsevier GmbH. All rights reserved.

Magnesium sulphate at 30 to 34 weeks' gestational age: neuroprotection trial (MAGENTA)--study protocol.

PubMed

Crowther, Caroline A; Middleton, Philippa F; Wilkinson, Dominic; Ashwood, Pat; Haslam, Ross

2013-04-09

Magnesium sulphate is currently recommended for neuroprotection of preterm infants for women at risk of preterm birth at less than 30 weeks' gestation, based on high quality evidence of benefit. However there remains uncertainty as to whether these benefits apply at higher gestational ages.The aim of this randomised controlled trial is to assess whether giving magnesium sulphate compared with placebo to women immediately prior to preterm birth between 30 and 34 weeks' gestation reduces the risk of death or cerebral palsy in their children at two years' corrected age. Randomised, multicentre, placebo controlled trial. Women, giving informed consent, at risk of preterm birth between 30 to 34 weeks' gestation, where birth is planned or definitely expected within 24 hours, with a singleton or twin pregnancy and no contraindications to the use of magnesium sulphate.Trial entry & randomisation: Eligible women will be randomly allocated to receive either magnesium sulphate or placebo.Treatment groups: Women in the magnesium sulphate group will be administered 50 ml of a 100 ml infusion bag containing 8 g magnesium sulphate heptahydrate [16 mmol magnesium ions]. Women in the placebo group will be administered 50 ml of a 100 ml infusion bag containing isotonic sodium chloride solution (0.9%). Both treatments will be administered through a dedicated IV infusion line over 30 minutes.Primary study outcome: Death or cerebral palsy measured in children at two years' corrected age. 1676 children are required to detect a decrease in the combined outcome of death or cerebral palsy, from 9.6% with placebo to 5.4% with magnesium sulphate (two-sided alpha 0.05, 80% power, 5% loss to follow up, design effect 1.2). Given the magnitude of the protective effect in the systematic review, the ongoing uncertainty about benefits at later gestational ages, the serious health and cost consequences of cerebral palsy for the child, family and society, a trial of magnesium sulphate for women at risk of preterm birth between 30 to 34 weeks' gestation is both important and relevant for clinical practice globally. Australian New Zealand Clinical Trials Registry - ACTRN12611000491965.

Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study

PubMed Central

2011-01-01

Background Preterm birth (PTB) is a major cause of infant morbidity and mortality, but the relationship between comorbidity and PTB by clinical subtype and severity of gestational age remains poorly understood. We evaluated associations between maternal comorbidities and PTB by clinical subtype and gestational age. Methods We conducted a retrospective cohort study of 1,329,737 singleton births delivered in hospitals in the province of Québec, Canada, 1989-2006. PTB was classified by clinical subtype (medically indicated, preterm premature rupture of membranes (PPROM), spontaneous preterm labour) and gestational age (< 28, 28-31, 32-36 completed weeks). Odds ratios (OR) of PTB by clinical subtype for systemic and localized maternal comorbidities were estimated using polytomous logistic regression, adjusting for maternal age, grand multiparity, and period. Attributable fractions were calculated. Results PTB rates were higher among mothers with comorbidity (10.9%) compared to those without comorbidity (4.7%). Several comorbidities were associated with greater odds of medically indicated PTB compared with no comorbidity, but only comorbidities localized to the reproductive system were associated with spontaneous PTB. Drug dependence and mental disorders were strongly associated with PPROM and spontaneous PTBs across all gestational ages (OR > 2.0). At the population level, several major comorbidities (placental abruption, chorioamnionitis, oliogohydramnios, structural abnormality, cervical incompetence) were key contributors to all clinical subtypes of PTB, especially at < 32 weeks. Major systemic comorbidities (preeclampsia, anemia) were key contributors to PPROM and medically indicated PTBs. Conclusions The relationship between comorbidity and clinical subtypes of PTB depends on gestational age. Prevention of PPROM and spontaneous PTB may benefit from greater attention to preeclampsia, anemia and comorbidities localized to the reproductive system. PMID:21970736

Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study.

PubMed

Auger, Nathalie; Le, Thi Uyen Nhi; Park, Alison L; Luo, Zhong-Cheng

2011-10-04

Preterm birth (PTB) is a major cause of infant morbidity and mortality, but the relationship between comorbidity and PTB by clinical subtype and severity of gestational age remains poorly understood. We evaluated associations between maternal comorbidities and PTB by clinical subtype and gestational age. We conducted a retrospective cohort study of 1,329,737 singleton births delivered in hospitals in the province of Québec, Canada, 1989-2006. PTB was classified by clinical subtype (medically indicated, preterm premature rupture of membranes (PPROM), spontaneous preterm labour) and gestational age (< 28, 28-31, 32-36 completed weeks). Odds ratios (OR) of PTB by clinical subtype for systemic and localized maternal comorbidities were estimated using polytomous logistic regression, adjusting for maternal age, grand multiparity, and period. Attributable fractions were calculated. PTB rates were higher among mothers with comorbidity (10.9%) compared to those without comorbidity (4.7%). Several comorbidities were associated with greater odds of medically indicated PTB compared with no comorbidity, but only comorbidities localized to the reproductive system were associated with spontaneous PTB. Drug dependence and mental disorders were strongly associated with PPROM and spontaneous PTBs across all gestational ages (OR > 2.0). At the population level, several major comorbidities (placental abruption, chorioamnionitis, oliogohydramnios, structural abnormality, cervical incompetence) were key contributors to all clinical subtypes of PTB, especially at < 32 weeks. Major systemic comorbidities (preeclampsia, anemia) were key contributors to PPROM and medically indicated PTBs. The relationship between comorbidity and clinical subtypes of PTB depends on gestational age. Prevention of PPROM and spontaneous PTB may benefit from greater attention to preeclampsia, anemia and comorbidities localized to the reproductive system.

Preliminary evidence for associations between second-trimester human chorionic gonadotropin and unconjugated oestriol levels with pregnancy outcome in Down syndrome pregnancies.

PubMed

Benn, P A

1998-04-01

Fifty-six cases of Down syndrome were identified in a population of women who had undergone maternal serum triple marker screening [alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated oestriol (uE3) analyses]. These affected pregnancies represented all known cases present in the population of 34,368 women screened. Using a 1:270 mid-trimester Down syndrome risk to define the screen-positive group, 42 affected pregnancies were screen-positive (medians: AFP = 0.79 MOM, hCG = 2.13 MOM, uE3 = 0.62 MOM, age 34.6 years) and 14 pregnancies were screen-negative (medians: AFP = 0.82 MOM, hCG = 1.57 MOM, uE3 = 0.92 MOM, age 24.2 years). Four affected pregnancies were associated with in utero death and each of these cases was associated with relatively extreme values of AFP, hCG, and uE3, including the three highest levels of hCG in the entire series of Down syndrome pregnancies. Twenty-nine (15 screen-positive and 14 screen-negative) affected pregnancies resulted in liveborns. Down syndrome pregnancies had a significantly shorter gestational term than controls, and Down syndrome babies were also lighter than controls, even after adjustment for sex and gestational age. In affected pregnancies, a low uE3 level appeared to be associated with a greater chance of a small-for-gestational age baby. No correlations could be demonstrated between AFP or hCG levels and gestational age-adjusted term weight. Based on this small series, it would appear that uE3 may be particularly useful in detecting those Down syndrome cases associated with small-for-gestational age fetuses. A very high hCG value may indicate a higher probability of fetal death.

Hypertensive Disorders of Pregnancy in Women with Gestational Diabetes Mellitus on Overweight Status of Their Children

PubMed Central

Zhang, Shuang; Wang, Leishen; Leng, Junhong; Liu, Huikun; Li, Weiqin; Zhang, Tao; Li, Nan; Li, Wei; Tian, Huiguang; Baccarelli, Andrea A.; Hou, Lifang; Hu, Gang

2017-01-01

Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear. The aim of the present study was to evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM). A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1–5 years old. Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1–5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08–2.79) and macrosomia (OR 2.02, 95%CI 1.23–3.31) at birth and childhood overweight/obesity at 1–5 years old age (OR 1.88, 95%CI 1.16–3.04). For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity, and controlling the maternal hypertension may be more important for preventing large for gestational age babies and childhood obesity. PMID:28300070

Is the metabolic syndrome a "small baby" syndrome?: the bogalusa heart study.

PubMed

Harville, Emily W; Srinivasan, Sathanur; Chen, Wei; Berenson, Gerald S

2012-12-01

Metabolic syndrome has been called a "small baby syndrome," but other analyses suggest that postnatal growth is more important than birthweight, or that large babies are also at risk. The aim of this analysis was to examine whether there was a relationship between both low and high birthweight and metabolic syndrome, using multiple definitions of metabolic syndrome, and to determine whether this relationship varied by body size across the life course. Data from the Bogalusa Heart Study, a study of cardiovascular disease in children and young adults, were linked to birth certificate data. Metabolic syndrome was defined by the National Cholesterol Education Program, the International Diabetes Foundation, and the World Health Organization (WHO) definition. Small-for-gestational-age (SGA) was defined as birthweight <10(th) percentile by sex for gestational age and large-for-gestational-age (LGA) as birthweight >90(th) percentile. Birthweight-for-gestational-age was also examined as a continuous predictor. Chi-squared tests and logistic regression were used to examine the relationship between birth size and metabolic syndrome. Higher birthweight-for-gestational-age was associated with a reduced risk of metabolic syndrome, especially by the WHO definition. After adjustment for body mass index (BMI), categorized birthweight was associated with metabolic syndrome, with the protective associations with LGA being stronger than the positive associations with SGA. Among the individual components of metabolic syndrome, higher waist circumference was associated with both SGA and LGA after BMI was controlled for. Effects of SGA and BMI at any age were largely independent rather than interactive. SGA is associated with some, but not all, components of metabolic syndrome. The relationship between SGA and metabolic syndrome is partially confounded by later BMI.

Maternal serum markers of lipid metabolism in relation to neonatal anthropometry

PubMed Central

Boghossian, Nansi S.; Mendola, Pauline; Liu, Aiyi; Robledo, Candace; Yeung, Edwina H.

2017-01-01

Objective To examine associations between lipids (HDL, LDL, total cholesterol, triglycerides, lipoprotein (a)) measured on average three time-points during pregnancy and neonatal anthropometrics. Study Design Stored samples from a preeclampsia trial measured as part of a case-control study from five US centers (1992-1995) were used. The sample included women without pregnancy complications (n=136), and cases of gestational diabetes (n=93), abnormal glucose tolerance (n=76), gestational hypertension (n=170), and preeclampsia (n=177). Linear regression and linear mixed-effects models estimated adjusted associations between lipids and birth weight z-score, ponderal index, length, and head circumference. Results Among women without complications, cross-sectional associations between total cholesterol measured at different gestational ages increased ponderal index 2.23 to 2.55 kg/m3 per-unit increase in cholesterol. HDL was inversely associated with birth length (β's=-2.21 and -2.56 cm). For gestational hypertension, triglycerides were associated with birth weight z-score (β's=0.24 to 0.31). For preeclampsia, HDL was associated with lower birth weight z-scores (β's=-0.49 and -0.82). Women with gestational diabetes or abnormal glucose tolerance had inconsistent associations. Examining the level changes across pregnancy, each 0.0037 mmol/L increase in HDL was associated with decreased birth weight z-score (β=-0.22), length (β=-0.24 cm), and head circumference (β=-0.24 cm) whereas each 0.028 mmol/L increase in triglycerides was associated with increased birth weight z-score (β=0.13) and head circumference (β=0.19 cm). Conclusion Although associations varied by complications, in general, growth promoting fuels as total cholesterol and triglycerides were associated with increased neonatal size whereas high HDL was associated with smaller size. Maternal HDL that failed to decrease over pregnancy was associated with smaller neonate size. PMID:28333159

Exposure to fine particulate matter during pregnancy and risk of preterm birth among women in New Jersey, Ohio, and Pennsylvania, 2000-2005.

PubMed

Rappazzo, Kristen M; Daniels, Julie L; Messer, Lynne C; Poole, Charles; Lobdell, Danelle T

2014-09-01

Particulate matter ≤ 2.5 μm in aerodynamic diameter (PM2.5) has been variably associated with preterm birth (PTB). We classified PTB into four categories (20-27, 28-31, 32-34, and 35-36 weeks completed gestation) and estimated risk differences (RDs) for each category in association with a 1-μg/m3 increase in PM2.5 exposure during each week of gestation. We assembled a cohort of singleton pregnancies that completed ≥ 20 weeks of gestation during 2000-2005 using live birth certificate data from three states (Pennsylvania, Ohio, and New Jersey) (n = 1,940,213; 8% PTB). We estimated mean PM2.5 exposures for each week of gestation from monitor-corrected Community Multi-Scale Air Quality modeling data. RDs were estimated using modified Poisson linear regression and adjusted for maternal race/ethnicity, marital status, education, age, and ozone. RD estimates varied by exposure window and outcome period. Average PM2.5 exposure during the fourth week of gestation was positively associated with all PTB outcomes, although magnitude varied by PTB category [e.g., for a 1-μg/m3 increase, RD = 11.8 (95% CI: -6, 29.2); RD = 46 (95% CI: 23.2, 68.9); RD = 61.1 (95% CI: 22.6, 99.7); and RD = 28.5 (95% CI: -39, 95.7) for preterm births during 20-27, 28-31, 32-34, and 35-36 weeks, respectively]. Exposures during the week of birth and the 2 weeks before birth also were positively associated with all PTB categories. Exposures beginning around the time of implantation and near birth appeared to be more strongly associated with PTB than exposures during other time periods. Because particulate matter exposure is ubiquitous, evidence of effects of PM2.5 exposure on PTB, even if small in magnitude, is cause for concern.

Approach to infants born at 22 to 24 weeks' gestation: relationship to outcomes of more-mature infants.

PubMed

Smith, P Brian; Ambalavanan, Namasivayam; Li, Lei; Cotten, C Michael; Laughon, Matthew; Walsh, Michele C; Das, Abhik; Bell, Edward F; Carlo, Waldemar A; Stoll, Barbara J; Shankaran, Seetha; Laptook, Abbot R; Higgins, Rosemary D; Goldberg, Ronald N

2012-06-01

We sought to determine if a center's approach to care of premature infants at the youngest gestational ages (22-24 weeks' gestation) is associated with clinical outcomes among infants of older gestational ages (25-27 weeks' gestation). Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks' gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks' gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity. Our study included 3631 infants 22 to 24 weeks' gestation and 5227 infants 25 to 27 weeks' gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants. This study suggests that physicians' willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants.

Patterns of glucose-lowering therapies and neonatal outcomes in the treatment of gestational diabetes in Canada, 2009-2014.

PubMed

Bowker, S L; Savu, A; Yeung, R O; Johnson, J A; Ryan, E A; Kaul, P

2017-09-01

To examine patterns of use of different glycaemic control agents for treating gestational diabetes mellitus. This was a large, retrospective, population-based cohort study of pregnant women with gestational diabetes from Alberta, Canada. We linked data from the Alberta Vital Statistics - Birth database with administrative claims data. Alberta Vital Statistics - Birth data were used to identify births that occurred between 1 January 2009 and 31 December 2014. We used International Classification of Diseases version 9/10 codes to identify women with gestational diabetes, and we excluded women with pre-existing diabetes. Our cohort consisted of 16 857 women with gestational diabetes, with a total of 18 761 birth events between 2009 and 2014. Over the study period, the proportion of women with gestational diabetes who were treated with glycaemic control therapies increased from 25.0% to 31.4% (P<0.0001). The number of pregnancies treated with insulin only increased (from 23.6% to 28.3%; P<0.0001), as did the number treated with metformin, +/- insulin (from 1.4% to 3.2%; P<0.0001). Rates of large-for-gestational-age infants were significantly higher among pregnancies treated with insulin only (17%) or metformin (16.5%) than among pregnancies that did not receive any pharmacological treatment (12.8%). Our findings show increasing use of insulin and metformin in women with gestational diabetes. Rates of large-for-gestational-age infants were similar among pregnant women receiving either pharmacological treatment, and higher than among pregnant women who did not receive any pharmacological treatment. Future research should explore the long-term outcomes and safety of metformin as an alternative for treating gestational diabetes. © 2017 Diabetes UK.

A possible new approach in the prediction of late gestational hypertension: The role of the fetal aortic intima-media thickness.

PubMed

Visentin, Silvia; Londero, Ambrogio P; Camerin, Martina; Grisan, Enrico; Cosmi, Erich

2017-01-01

The aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. This prospective study on singleton pregnancies was conducted at the tertiary center of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, prepregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected. The P value <0.05 was defined significant considering a 2-sided alternative hypothesis. The distribution normality of variables were assessed using Kolmogorov-Smirnoff test. Data were presented by mean (±standard deviation), median and interquartile range, or percentage and absolute values. We considered data from 1381 ultrasound examinations at 29 to 32 weeks' gestation, and in 73 cases late gestational hypertension developed after 34 weeks' gestation. The final multivariate model found that fetal aIMT as well as fetal umbilical artery pulsatility index (PI), maternal age, maternal prepregnacy BMI, parity, and mean PI of maternal UtAs, assessed at ultrasound examination of 29 to 32 weeks' gestation, were significant and independent predictors for the development of gestational hypertension after 34 weeks' gestation. The area under the curve of the model was 81.07% (95% confidence interval, 75.83%-86.32%). A nomogram was developed starting from multivariate logistic regression coefficients. Late-gestational hypertension could be independently predicted by fetal aIMT assessment at 29 to 32 weeks' gestation, ultrasound Doppler waveforms, and maternal clinical parameters.

A possible new approach in the prediction of late gestational hypertension

PubMed Central

Visentin, Silvia; Londero, Ambrogio P.; Camerin, Martina; Grisan, Enrico; Cosmi, Erich

2017-01-01

Abstract The aim was to determine the predictive role of combined screening for late-onset gestational hypertension by fetal ultrasound measurements, third trimester uterine arteries (UtAs) Doppler imaging, and maternal history. This prospective study on singleton pregnancies was conducted at the tertiary center of Maternal and Fetal Medicine of the University of Padua during the period between January 2012 and December 2014. Ultrasound examination (fetal biometry, fetal wellbeing, maternal Doppler study, fetal abdominal aorta intima-media thickness [aIMT], and fetal kidney volumes), clinical data (mother age, prepregnancy body mass index [BMI], and parity), and pregnancy outcomes were collected. The P value <0.05 was defined significant considering a 2-sided alternative hypothesis. The distribution normality of variables were assessed using Kolmogorov–Smirnoff test. Data were presented by mean (±standard deviation), median and interquartile range, or percentage and absolute values. We considered data from 1381 ultrasound examinations at 29 to 32 weeks’ gestation, and in 73 cases late gestational hypertension developed after 34 weeks’ gestation. The final multivariate model found that fetal aIMT as well as fetal umbilical artery pulsatility index (PI), maternal age, maternal prepregnacy BMI, parity, and mean PI of maternal UtAs, assessed at ultrasound examination of 29 to 32 weeks’ gestation, were significant and independent predictors for the development of gestational hypertension after 34 weeks’ gestation. The area under the curve of the model was 81.07% (95% confidence interval, 75.83%–86.32%). A nomogram was developed starting from multivariate logistic regression coefficients. Late-gestational hypertension could be independently predicted by fetal aIMT assessment at 29 to 32 weeks’ gestation, ultrasound Doppler waveforms, and maternal clinical parameters. PMID:28079791

Approach to Infants Born at 22 to 24 Weeks’ Gestation: Relationship to Outcomes of More-Mature Infants

PubMed Central

Ambalavanan, Namasivayam; Li, Lei; Cotten, C. Michael; Laughon, Matthew; Walsh, Michele C.; Das, Abhik; Bell, Edward F.; Carlo, Waldemar A.; Stoll, Barbara J.; Shankaran, Seetha; Laptook, Abbot R.; Higgins, Rosemary D.; Goldberg, Ronald N.

2012-01-01

OBJECTIVE: We sought to determine if a center’s approach to care of premature infants at the youngest gestational ages (22–24 weeks’ gestation) is associated with clinical outcomes among infants of older gestational ages (25–27 weeks’ gestation). METHODS: Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks’ gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks’ gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity. RESULTS: Our study included 3631 infants 22 to 24 weeks’ gestation and 5227 infants 25 to 27 weeks’ gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants. CONCLUSIONS: This study suggests that physicians’ willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants. PMID:22641761

Efficacy of probiotic supplement for gestational diabetes mellitus: a systematic review and meta-analysis.

PubMed

Pan, Jiajia; Pan, Qiangwei; Chen, Yumei; Zhang, Hongping; Zheng, Xiaodong

2017-09-19

Probiotic supplement might be beneficial for gestational diabetes mellitus. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of probiotic supplement in gestational diabetes mellitus. PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of probiotic supplement in gestational diabetes mellitus were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome were fasting serum insulin and fasting plasma glucose. Meta-analysis was performed using the fixed-effect or random-effect model. Six RCTs involving 830 patients were included in the meta-analysis. Overall, compared with control intervention in gestational diabetes mellitus, probiotic supplementation intervention was found to significantly reduce fasting serum insulin (Std. mean difference = -0.95; 95% CI = -1.73 to -0.17; p < .00001) and HOMA-IR (Std. mean difference = -1.12; 95% CI = -2.05 to -0.18; p = .02), but showed no substantial impact on fasting plasma glucose (Std. mean difference = -0.49; 95% CI = -1.05-0.08; p = .09), gestational age (Std. mean difference = 0.07; 95% CI = -0.20-0.34; p = .63), and gestational weight (Std. mean difference = -0.11; 95% CI = -0.38-0.16; p = .43). Compared with control intervention in gestational diabetes mellitus, probiotic supplementation was found to significantly reduce insulin resistance (HOMA-IR) and fasting serum insulin, but had no substantial influence on fasting plasma glucose, gestational age and gestational weight.

Epidemiological investigation of physique situation for birth high-risk children aged 9-15 years in Chengdu, Southwest China.

PubMed

Xiong, F; Yang, F; Huo, T Z; Li, P; Mao, M

2014-01-01

As the intrauterine environment can effect children's growth and development, this study aimed to explore the relationship between birth high-risk and physique situation of 9 to 15-year-old children by cross-sectional investigation, and to provide clues for the monitoring, prevention, and treatment of growth deviation in children. This study recruited 7,194 students aged 9 to 15 years in primary and junior schools. Their parents were asked to complete the birth situation questionnaire. Measurements included height, weight, and body mass index (BMI). Birth high-risk infant was defined according to the gestational age and birth weight. Growth deviation was classified as underweight, short stature, overweight, and obesity. The prevalence of all kinds of growth deviations in preterm, full-term, and post-term birth groups were similar, the same as the physique situation at school age among both sexes. The incidence of small for gestational age (SGA) was 6.23%, when at school age, part of SGA had catch-up growth. However, the prevalence of underweight and short stature for SGA was highest in three groups. The weight and height at school age in SGA group was less than that in appropriate for gestational age (AGA) and large for gestational age (LGA) groups. The prevalence of overweight and obesity for LGA and macrosomia were highest in three groups. At school age, the weight in macrosomia and LGA groups was higher than that in the other groups. Longitudinal height and weight development and growth of children with birth high-risk are different from normal children. In order to improve healthy situation, more attention should be paid to height and weight development of those children with birth high-risk at school age, even in pre-school age. Prevention may already begin during pregnancy.

Gestational age modulates neural correlates of intentional, but not automatic number magnitude processing in children born preterm.

PubMed

Klein, Elise; Moeller, Korbinian; Huber, Stefan; Willmes, Klaus; Kiechl-Kohlendorfer, Ursula; Kaufmann, Liane

2018-04-01

Premature birth is a significant risk factor for learning disabilities in general and mathematics learning difficulties in particular. However, the exact reasons for this relation are still unknown. While typical numerical development is associated with a frontal-to-parietal shift of brain activation with increasing age, influences of gestational age have hardly been considered so far. Therefore, we investigated the influence of gestational age on the neural correlates of number processing in 6- and 7-year-old children born prematurely (n=16). Only the numerical distance effect - as a measure of intentional number magnitude processing - elicited the fronto-parietal activation pattern typically observed for numerical cognition. On the other hand, the size congruity effect - as a measure of automatic number magnitude processing - was associated with activation of brain areas typically attributed to cognitive control. Most importantly, however, we observed that gestational age reliably predicted the frontal-to-parietal shift of activation observed for the numerical distance effect. Our findings seem to indicate that human numerical development may start even before birth and prematurity might hamper neural facilitation of the brain circuitry subserving numerical cognition. In turn, this might contribute to the high risk of premature children to develop mathematical learning difficulties. Copyright © 2017 ISDN. Published by Elsevier Ltd. All rights reserved.

Population Pharmacokinetics of Darbepoetin Alfa in Conjunction with Hypothermia for the Treatment of Neonatal Hypoxic-Ischemic Encephalopathy.

PubMed

Roberts, Jessica K; Stockmann, Chris; Ward, Robert M; Beachy, Joanna; Baserga, Mariana C; Spigarelli, Michael G; Sherwin, Catherine M T

2015-12-01

The aim of this study was to determine the population pharmacokinetics of darbepoetin alfa in hypothermic neonates with hypoxic-ischemic encephalopathy treated with hypothermia. Neonates ≥36 weeks gestation and <12 h postpartum with moderate to severe hypoxic-ischemic encephalopathy who were undergoing hypothermia treatment were recruited in this randomized, multicenter, investigational, new drug pharmacokinetic study. Two intravenous darbepoetin alfa treatment groups were evaluated: 2 and 10 µg/kg. Serum erythropoietin concentrations were measured using an enzyme-linked immunosorbent assay. Monolix 4.3.1 was used to estimate darbepoetin alfa clearance and volume of distribution. Covariates tested included: birthweight, gestational age, postnatal age, postmenstrual age, sex, Sarnat score, and study site. Darbepoetin alfa pharmacokinetics were well described by a one-compartment model with exponential error. Clearance and the volume of distribution were scaled by birthweight (centered on the mean) a priori. Additionally, gestational age (also centered on the mean) significantly affected darbepoetin alfa clearance. Clearance and volume of distribution were estimated as 0.0465 L/h (95% confidence interval 0.0392-0.0537) and 1.58 L (95% confidence interval 1.29-1.87), respectively. A one-compartment model successfully described the pharmacokinetics of darbepoetin alfa among hypothermic neonates treated for hypoxic-ischemic encephalopathy. Clearance decreased with increasing gestational age.

Breast milk fat content of mothers to small-for-gestational-age infants.

PubMed

Domany, K Armoni; Mandel, D; Kedem, M Hausman; Lubetzky, R

2015-06-01

Little is known about the composition of human milk (HM) expressed by mothers of asymmetrically growth-restricted infants. To test the null hypothesis that lactating mothers of small-for-gestational-age (SGA) infants produce milk with fat content similar to that of lactating mothers of infants whose growth is appropriate for gestational age (AGA). Fifty-six lactating mothers of newborns (26 SGA and 30 AGA) were recruited within the first 3 days of delivery. Creamatocrit (CMT) levels in HM were measured at 72 h, 7 days and 14 days postdelivery in capillary tubes after centrifugation at 9000 r.p.m. for 5 min. The groups did not differ in terms of maternal age, body mass index, gestational age (GA), pregnancy weight gain and parity. They differed significantly in terms of infant's birth weight by design. The mean CMT levels at the three time points were similar for the two groups. This remained true when timing of the sample (colostrum, transitional, mature milk) was introduced as a confounder in the analysis of variance (general linear model). Fat content of HM is not affected by fetal growth status. We suggest that mothers of SGA infants may be reassured that their milk contains adequate amount of fat that is appropriate for the growth of their infants.

Impact of aspirin on fetal growth in diabetic pregnancies according to White classification.

PubMed

Adkins, Katlynn; Allshouse, Amanda A; Metz, Torri D; Heyborne, Kent D

2017-10-01

Current US Preventive Services Task Force and other guidelines recommend low-dose aspirin for all pregnant women with pregestational diabetes mellitus to prevent preeclampsia and small-for-gestational-age birth. The Maternal-Fetal Medicine Units High-Risk Aspirin trial did not show a reduction in either preeclampsia or small-for-gestational-age birth in diabetic women. Our objective was to reassess the impact of aspirin on fetal growth in diabetic pregnancies overall and according to White classification. We hypothesized that aspirin improves fetal growth in pregnancies with vascular complications of diabetes at highest risk for poor fetal growth. We conducted secondary analysis of the cohort of diabetic women enrolled in the Maternal-Fetal Medicine Units High-Risk Aspirin trial. The impact of aspirin prophylaxis on birthweight was assessed in the overall cohort and in 2 groups categorized according to White classification as nonvascular (White class B, C, D) or vascular (White class R, F, RF). Birthweight was converted to Z-score normalized for gestational age at delivery and neonatal sex. Difference in birthweight Z-score between aspirin and placebo was tested with a 2-sample t test. The effect of vascular group, aspirin vs placebo randomization, and the interaction of the 2 on normalized birthweight percentile was estimated with linear regression with a multivariable model including covariates body mass index, tobacco use, race, and parity. The percentage of small and large-for-gestational-age newborns born to aspirin- vs placebo-treated women was compared between groups using Pearson exact χ 2 analysis, and an adjusted model was estimated by logistic regression. All 444 women with pregestational diabetes and complete outcome data were included (53 vascular, 391 nonvascular). Aspirin was significantly associated with a higher birthweight Z-score (0.283; 95% confidence interval, 0.023-0.544) in the overall cohort (P = .03). In the adjusted model, the association of aspirin with higher birthweight Z-score was confined to neonates of women with nonvascular diabetes (0.341; 95% confidence interval, 0.677-0.006; P = .044). An opposite but nonsignificant effect was observed among neonates from women with vascular diabetes (-0.416; 95% confidence interval, -1.335 to 0.503; P = .6). This difference in the relationship of aspirin and birthweight Z-score by vascular group was significant at P = .046. Aspirin-randomized women with nonvascular diabetes had more large-for-gestational-age births than those treated with placebo (40.2 vs 26.6%; P = .005). Small-for-gestational-age births occurred at the same frequency with aspirin vs placebo randomization in the overall cohort (8% in each group) and in each vascular group. Inconsistent with our hypothesis, aspirin did not reduce small-for-gestational-age births in the overall cohort or either group. The increased incidence of large-for-gestational-age infants in aspirin-treated diabetic gestations is of potential concern given the known increased maternal and neonatal morbidity associated with macrosomia. Copyright © 2017 Elsevier Inc. All rights reserved.

Short-term costs of preeclampsia to the United States health care system.

PubMed

Stevens, Warren; Shih, Tiffany; Incerti, Devin; Ton, Thanh G N; Lee, Henry C; Peneva, Desi; Macones, George A; Sibai, Baha M; Jena, Anupam B

2017-09-01

Preeclampsia is a leading cause of maternal morbidity and mortality and adverse neonatal outcomes. Little is known about the extent of the health and cost burden of preeclampsia in the United States. This study sought to quantify the annual epidemiological and health care cost burden of preeclampsia to both mothers and infants in the United States in 2012. We used epidemiological and econometric methods to assess the annual cost of preeclampsia in the United States using a combination of population-based and administrative data sets: the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the US Health Care Cost and Utilization Project database, and a commercial claims data set. Preeclampsia increased the probability of an adverse event from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants while lowering gestational age by 1.7 weeks (P < .001). Overall, the total cost burden of preeclampsia during the first 12 months after birth was $1.03 billion for mothers and $1.15 billion for infants. The cost burden per infant is dependent on gestational age, ranging from $150,000 at 26 weeks gestational age to $1311 at 36 weeks gestational age. In 2012, the cost of preeclampsia within the first 12 months of delivery was $2.18 billion in the United States ($1.03 billion for mothers and $1.15 billion for infants), and was disproportionately borne by births of low gestational age. Copyright © 2017 Elsevier Inc. All rights reserved.

Early biometric lag in the prediction of small for gestational age neonates and preeclampsia.

PubMed

Schwartz, Nadav; Pessel, Cara; Coletta, Jaclyn; Krieger, Abba M; Timor-Tritsch, Ilan E

2011-01-01

An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P < .05). The addition of either the estimated fetal weight or abdominal circumference lag to maternal characteristics alone significantly improved the performance of the predictive model, achieving areas under the curve of 0.72 and 0.74, respectively. No significant association was found between the biometric lag variables and the development of preeclampsia. Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes.

The after breakfast 50-g, 1-hour glucose challenge test in urban Mexican pregnant women: its sensitivity and specificity evaluated by three diagnostic criteria for gestational diabetes mellitus.

PubMed

Espinosa de los Monteros, A; Parra, A; Hidalgo, R; Zambrana, M

1999-04-01

To study the sensitivity and specificity of the 50-g, 1-hour gestational glucose challenge test performed 1 to 2 hours after a non-standardized home breakfast in urban Mexican women by using three different gestational diabetes mellitus diagnostic criteria. Four hundred and forty-five consecutive women of 24-28 weeks gestation were studied. The glucose challenge test was performed in the fed state and a week later a fasting 100-g, 3-hours oral glucose tolerance test was carried out in all of them. Duplicate serum glucose concentrations were determined by a glucose-oxidase method. Sensitivity and specificity were calculated using three different diagnostic criteria for gestational diabetes mellitus. The glucose challenge test performed as indicated, with a cutoff of 7.8 mmol/L, had 88-89% sensitivity and 85-87% specificity when using as diagnostic criteria those proposed by the National Diabetes Data Group and by Carpenter & Coustan; by using Sacks et al. criteria, the values were 82% and 88%, respectively. Considering only pregnant women > or = 25 years of age, the sensitivity increased to 92% with the National Diabetes Data Group criteria. Pregnant women < 25 years of age had significantly lower blood glucose values than those with age > or = 25 years during the glucose tolerance test. For the general group the sensitivity of the glucose challenge test performed 1 to 2 hours after breakfast was similar, based on the National Diabetes Data Group and the Carpenter & Coustan's diagnostic criteria for gestational diabetes mellitus. However, when pregnant women > or = 25 years of age were considered, the use of the former criteria yielded a slightly better sensitivity.

Physical activity during pregnancy in obese and normal-weight women as assessed by pedometer.

PubMed

Renault, Kristina; Nørgaard, Kirsten; Andreasen, Kirsten Riis; Secher, Niels Jørgen; Nilas, Lisbeth

2010-07-01

To compare physical activity as assessed by a pedometer in obese and normal-weight pregnant women at different gestational ages. To evaluate the use of a pedometer in pregnancy. Cross-sectional study. Department of obstetrics and gynecology in a university hospital in Copenhagen. 338 pregnant women, 175 normal-weight women with body mass index (BMI) 20-25 kg/m(2) and 163 obese women with BMI > or = 30 kg/m(2). Physical activity was assessed by a pedometer (Yamax Digiwalker SW-700/701) on seven consecutive days in six different groups: normal-weight or obese at gestational ages 11-13, 18-22, and 36-38, and expressed as median number of daily steps during a whole week, working days, and weekends. Relation between BMI and physical activity during pregnancy and compliance with wearing the pedometer. Noncompliance was more frequent in obese than in normal-weight women (19 vs. 10%, p < 0.001). Physical activity was lower in obese women at all gestational ages (6,482, 7,446, 4,626 steps/day in obese vs. 7,558, 8,865, 6,289 steps/day in normal-weight, p < 0.05-0.11). The greatest difference between obese and normal-weight women was seen during weekends. The level of physical activity was higher in both groups at mid-gestation than during earlier and later gestational ages. Physical activity in pregnant women can be assessed by the pedometer and the method was well accepted by the women; however, the compliance was lower in the obese. The level of physical activity differs between different gestational groups and is lower in obese than in normal-weight women, especially during leisure time.

Antenatal Corticosteroids Alter Insulin Signaling Pathways in Fetal Baboon Skeletal Muscle

PubMed Central

BLANCO, Cynthia L.; MOREIRA, Alvaro G.; McGILL, Lisa L.; ANZUETO, Diana G.; NATHANIELSZ, Peter; MUSI, Nicolas

2015-01-01

Objective We hypothesize that prenatal exposure to glucocorticoids (GCs) will negatively alter the insulin signal transduction pathway and has differing effects on the fetus according to gestational age at exposure. Methods Twenty-three fetal baboons were delivered from twenty-three healthy, non-diabetic mothers. Twelve preterm (0.67 gestational age) and eleven near term (0.95 gestational age) baboons were euthanized immediately after delivery. Half of the pregnant baboons at each gestation received two doses of intramuscular betamethasone 24-hours apart (170 μg.kg−1) before delivery, while the other half received no intervention. Vastus lateralis muscle was obtained from postnatal animals to measure protein content and gene expression of insulin receptor (IR)-β, IR-β Tyr 1361 phosphorylation (pIR-β), IR substate-1 (IRS-1), IRS-1 tyrosine phosphorylation (pIRS-1), p85 subunit of PI3-kinase (p85), Akt (Protein Kinase B), phospho-Akt Ser473 (pAkt), Akt-1, Akt-2, and glucose transporters (GLUT1 and GLUT4). Results Skeletal muscle from preterm baboons exposed to glucocorticoids had markedly reduced protein content of Akt and Akt-1 (respectively, 73% and 72% from 0.67 gestational age Control, P<0.001); IR-β and pIR-β were decreased (respectively, 94% and 85%, P<0.01) in the muscle of premature GC exposed fetuses, but not in term fetuses. GLUT1 and GLUT4 tended to increase with GC exposure in preterm animals (P=0.09), while GLUT4 increased 6.0 fold in term animals after GC exposure (P<0.05). Conclusion Exposure to a single course of antenatal GCs during fetal life alters the insulin-signaling pathway in fetal muscle in a manner dependent on the stage of gestation. PMID:24756099

[Risks factors associated with intra-partum foetal mortality in pre-term infants].

PubMed

Zeballos Sarrato, Susana; Villar Castro, Sonia; Ramos Navarro, Cristina; Zeballos Sarrato, Gonzalo; Sánchez Luna, Manuel

2017-03-01

Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). During the study period, the overall foetal mortality was 63.1% (106/168) (≥22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31+6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant's anthropometric measures at birth.

PubMed

Gilles, Maria; Otto, Henrike; Wolf, Isabell A C; Scharnholz, Barbara; Peus, Verena; Schredl, Michael; Sütterlin, Marc W; Witt, Stephanie H; Rietschel, Marcella; Laucht, Manfred; Deuschle, Michael

2018-04-22

Prenatal maternal stress might be a risk for the developing fetus and may have long-lasting effects on child and adult vulnerability to somatic and psychiatric disease. Over-exposure of the unborn to excess glucocorticoids and subsequent alteration of fetal development is hypothesized to be one of the key mechanisms linking prenatal stress with negative child outcome. In this prospective longitudinal study, mothers-to-be (n = 405) in late pregnancy (36.8 ± 1.9 weeks of gestational age) and their singleton neonates were studied. We investigated the impact of different prenatal stress indices derived from six stress variables (perceived stress, specific prenatal worries, negative life events, symptoms of depression, trait anxiety, neuroticism) and diurnal maternal saliva cortisol secretion on gestational age and anthropometric measures at birth. Maternal prenatal distress during late gestation was associated with significant reduction in birth weight (-217 g; p = .005), birth length (-1.2 cm; p = .005) and head circumference (-0.8 cm; p = .001). Prenatal stress was modestly but significantly associated with altered diurnal cortisol pattern (flattened cortisol decline and higher evening cortisol), which in turn was significantly related to reduced length of gestation. No evidence for a profound interaction between maternal cortisol level in late pregnancy and infant's anthropometric measures at birth (i.e., birth weight, length, head circumference) was found. Prenatal stress is associated with flattened circadian saliva cortisol profiles and reduced infant's anthropometric measures at birth. HPA system activity during pregnancy may be related to low gestational age. The effect of prenatal stress might be partly mediated by maternal-placental-fetal neuroendocrine mechanisms especially the dysregulation of diurnal cortisol profile. Copyright © 2018 Elsevier Ltd. All rights reserved.

Goniometric Assessment of Muscle Tone of Preterm Infants and Impact of Gestational Age on Its Maturation in Indian Setting.

PubMed

Farmania, Rajni; Sitaraman, S; Das, Rashmi Ranjan

2017-08-01

The normative data on muscle tone of preterm infants by goniometric assessment in Indian setting are scarce. The aim of this study it to provide a normative objective data of muscle tone of preterm infants by gestation using goniometer. This was a prospective, observational study including preterm infants admitted in a tertiary care hospital from North India. The objective dimension of muscle tone assessment of 204 healthy preterm infants was done; 61 infants completed follow-up till 40 weeks' postconceptional age (PCA) and were compared to term infants. SPSS (version 16.0) was used. The intergroup comparison was done through ANOVA, and the localization of differences between the groups was determined through multiple comparisons by post hoc test. Mean gestational age was 34.3 ± 1.7 weeks. Angles were as follows: adductor = 100.1 ± 8.7, popliteal = 118.9 ± 8.6, dorsiflexion = 39.0 ± 9.0, heel to ear = 121.90 ± 7.90, wrist flexion = 46.0 ± 10.2, and arm recoil = 122.2° ± 16.6°. The evolution of muscle tone as indicated by heel-to-ear angle shows progressive maturation from 32 weeks' gestation while adductor angle, popliteal angle, and arm recoil mature predominantly after 36 weeks' gestation. Comparison of preterm infants to term at 40 weeks' PCA demonstrated significantly less tone in all except posture and heel to ear. Goniometric assessment provides a objective normative data of muscle tone for preterm infants. Maturation of heel to ear and posture evolves from 32 weeks onwards and are the earliest neurologic marker to mature in preterm infants independent of the gestational age at birth.

[Prospective study of prevalence hearing loss in preterm neonates in an intensive care unit].

PubMed

Tomasik, Tomasz

2002-01-01

The risk of hearing loss is higher in prematurely born infants compared with neonates born at term. It is due to unfinished development of auditory path and exposition to many harmful factors related to treatment in a neonatal intensive care unit. Assessment of hearing loss risk factors in preterm babies. 152 newborns with mean birth weight 1408 +/- 551 g and gestational age 30.3 +/- 3.2 weeks. After discharge follow-up (Me = 32 months) study of newborns born before 37 weeks of gestation age. The patients were assigned into two groups: A) with hearing loss (n = 9) and B) without hearing loss (n = 143) according to the results of clinical observation and audiological assessment after 6 months of life. The rate of hearing loss was higher in new-borns born between 24-28 weeks of gestation (6/50, 12%) than in those born between 29-32 (2/52.3%) and 33-36 (1/43, 2%, p = 0.03). Identified risk factors independent of gestational age were: Gram negative sepsis (OR = 6; 95%CI: 1.32-27.33) and hyperbilirubinemia > 340 mumol/l (OR = 40.5; 95%CI: 73.27-503). The other risk factors are: shock (OR = 6.65; 95%CI: 1.44-30.64), hypercarbia (pCO2 > 80 mmHg) (OR = 5.13; 95%CI: 1.29-20.37), severe anemia (Ht < 24%) (OR = 6.0; 95%CI: 1.32-27.33). Prolonged treatment with aminoglicosides (over 10 days) also increased hearing loss risk (OR = 10.4; 95%CI: 1.27-85.75). The risk of hearing loss is highest in the newborn born between 24-28 weeks of gestation. It can be further increased by shock, hypercapnia, severe anemia, prolonged treatment with aminoglicosides. Gestational age independent factors are: hyperbilirubinemia and Gram negative sepsis.

Prevalence, Trend and Determining Factors of Gestational Diabetes in Germany.

PubMed

Huy, C; Loerbroks, A; Hornemann, A; Röhrig, S; Schneider, S

2012-04-01

Purpose: The true prevalence of gestational diabetes in Germany is unknown. Thus, the study's purposes were to estimate the prevalence of gestational diabetes as well as to describe the temporal prevalence trend and to identify determinants. Material and Methods: We calculated prevalence estimates based on two datasets: the register-based German perinatal statistic (n = 650 232) and the maternal self-reports from the German children and youth health survey (KiGGS; n = 15 429). Differences between prevalence estimates were analysed using χ 2 and trend tests, and determinants were identified using logistic regression. Results: According to the perinatal statistic, gestational diabetes was present in 3.7 % of pregnant women in Germany in 2010. The prevalence across the years 2001 to 2006 was estimated at 1.9 % which differed significantly from the prevalence estimate derived from the KiGGS dataset for the same period of time (5.3 %; 95 % confidence interval: 4.6-6.1 %). Both datasets show an increasing trend of gestational diabetes (p < 0.001). The risk for gestational diabetes was mainly associated with age, BMI and social class of pregnant women as well as with multiple pregnancies. Conclusion: The lack of significant screening studies among representative samples hampers a sound estimation of the true prevalence of gestational diabetes in Germany. The increasing trend in gestational diabetes might continue due to the projected increase of important risk factors (e.g., maternal age, obesity). Our analyses support the current consensus recommendations regarding standardised gestational diabetes screening.

Defense Health Care: Activities Related to Past Drinking Water Contamination at Marine Corps Base Camp Lejeune

DTIC Science & Technology

2007-05-01

individuals who were exposed in utero (i.e., as developing fetuses during gestation ) and as infants up to 1 year of age to the contaminated drinking... gestational age.12 In 1999, ATSDR began its current study to determine whether individuals who were exposed in utero and as infants up to 1 year of age to ...functions include developing and enforcing environmental regulations; conducting environmental research; providing financial assistance to states

Key Clinical Factors Predicting Adipokine and Oxidative Stress Marker Concentrations among Normal, Overweight and Obese Pregnant Women Using Artificial Neural Networks.

PubMed

Solis-Paredes, Mario; Estrada-Gutierrez, Guadalupe; Perichart-Perera, Otilia; Montoya-Estrada, Araceli; Guzmán-Huerta, Mario; Borboa-Olivares, Héctor; Bravo-Flores, Eyerahi; Cardona-Pérez, Arturo; Zaga-Clavellina, Veronica; Garcia-Latorre, Ethel; Gonzalez-Perez, Gabriela; Hernández-Pérez, José Alfredo; Irles, Claudine

2017-12-28

Maternal obesity has been related to adverse neonatal outcomes and fetal programming. Oxidative stress and adipokines are potential biomarkers in such pregnancies; thus, the measurement of these molecules has been considered critical. Therefore, we developed artificial neural network (ANN) models based on maternal weight status and clinical data to predict reliable maternal blood concentrations of these biomarkers at the end of pregnancy. Adipokines (adiponectin, leptin, and resistin), and DNA, lipid and protein oxidative markers (8-oxo-2'-deoxyguanosine, malondialdehyde and carbonylated proteins, respectively) were assessed in blood of normal weight, overweight and obese women in the third trimester of pregnancy. A Back-propagation algorithm was used to train ANN models with four input variables (age, pre-gestational body mass index (p-BMI), weight status and gestational age). ANN models were able to accurately predict all biomarkers with regression coefficients greater than R² = 0.945. P-BMI was the most significant variable for estimating adiponectin and carbonylated proteins concentrations (37%), while gestational age was the most relevant variable to predict resistin and malondialdehyde (34%). Age, gestational age and p-BMI had the same significance for leptin values. Finally, for 8-oxo-2'-deoxyguanosine prediction, the most significant variable was age (37%). These models become relevant to improve clinical and nutrition interventions in prenatal care.

The Two-Way Street: Interaction and Development in Small-for-Gestational-Age Infants.

ERIC Educational Resources Information Center

Watt, Jan

Because small for gestational age (SGA) infants are a heterogeneous group known to be at increased risk of learning and behavioral disorders, a study was conducted to replicate and extend findings on developmental patterns of SGA infants in the first year. The study presented, as well, an opportunity to explore the effects, found in a previous…

Maternal sleep and small for gestational age infants in the Japan Environment and Children's Study: a cohort study.

PubMed

Morokuma, Seiichi; Shimokawa, Mototsugu; Kato, Kiyoko; Sanefuji, Masafumi; Shibata, Eiji; Tsuji, Mayumi; Senju, Ayako; Kawamoto, Toshihiro; Kusuhara, Koichi

2017-08-11

Small for gestational age infants have an increased risk of immediate complications, short-term morbidity and mortality, and long-term neurologic and metabolic disorders in adulthood. Previous research has shown that reduced sleep duration is a risk factor for SGA birth. However, only a few studies have evaluated maternal sleep as a risk factor for SGA birth. In the present study, we investigated the relationship between the amount and quality of mothers' sleep and infants' birth weight. This cohort study (n = 8631) used data from the Japan Environment and Children's Study, an ongoing cohort study that began in January 2011. Data on sleep status (sleep duration and one indicator of sleep quality) and potential confounding factors were recorded. A log-binomial regression model was used to estimate the risk of small for gestational age birth, and the results were expressed as risk ratios and their respective 95% confidence interval. No significant results were observed for sleep duration or tiredness upon waking. Neither the amount nor the quality of mothers' sleep was associated with the risk of small for gestational age birth.

Customized versus population-based growth curves: prediction of low body fat percent at term corrected gestational age following preterm birth.

PubMed

Law, Tameeka L; Katikaneni, Lakshmi D; Taylor, Sarah N; Korte, Jeffrey E; Ebeling, Myla D; Wagner, Carol L; Newman, Roger B

2012-07-01

Compare customized versus population-based growth curves for identification of small-for-gestational-age (SGA) and body fat percent (BF%) among preterm infants. Prospective cohort study of 204 preterm infants classified as SGA or appropriate-for-gestational-age (AGA) by population-based and customized growth curves. BF% was determined by air-displacement plethysmography. Differences between groups were compared using bivariable and multivariable linear and logistic regression analyses. Customized curves reclassified 30% of the preterm infants as SGA. SGA infants identified by customized method only had significantly lower BF% (13.8 ± 6.0) than the AGA (16.2 ± 6.3, p = 0.02) infants and similar to the SGA infants classified by both methods (14.6 ± 6.7, p = 0.51). Customized growth curves were a significant predictor of BF% (p = 0.02), whereas population-based growth curves were not a significant independent predictor of BF% (p = 0.50) at term corrected gestational age. Customized growth potential improves the differentiation of SGA infants and low BF% compared with a standard population-based growth curve among a cohort of preterm infants.

Length of day during early gestation as a predictor of risk for severe retinopathy of prematurity.

PubMed

Yang, Michael B; Rao, Sujata; Copenhagen, David R; Lang, Richard A

2013-12-01

Fetal mice require light exposure in utero during early gestation for normal vascular development in the eye. Because angiogenic abnormalities in retinopathy of prematurity (ROP) are manifested in preterm infants, we investigated whether day length during early gestation was associated with severe ROP (SROP). Single-center, retrospective cohort study. We included a total of 343 premature infants (401-1250 g birth weight [BW], from 1998-2002): 684 eyes (1 eye each of 2 patients excluded) with 76 eyes developing SROP, defined as (1) classic threshold ROP in zone I or II, (2) type 1 ROP in zone I, or (3) in a few eyes, type 1 ROP in posterior zone II that was treated. For each infant, average day length (ADL) was calculated during different cumulative time periods and time windows after the estimated date of conception (EDC). Multiple logistic regression analysis (with generalized estimating equations to account for inter-eye correlation) was performed. Association of ADL during early gestation with SROP. In a model evaluating all 684 eyes with 76 eyes developing SROP, BW, gestational age, multiple births, race, per capita income in the mother's residence ZIP code, and ADL during the first 90 days after the EDC were factors associated with the development of SROP. Each additional hour of ADL (90 days) decreased the likelihood of SROP by 28% (P = 0.015; odds ratio [OR], 0.72; 95% confidence interval [CI], 0.55-0.94). In a model evaluating the subset of 146 prethreshold ROP eyes with 76 eyes developing SROP, each additional hour of ADL during the first 105 days after the EDC decreased the likelihood of SROP by 46% (P = 0.001; OR, 0.54; 95% CI, 0.37-0.78). Time windows when ADL was most closely associated with SROP were 31 to 60 days and 61 to 90 days after the EDC for the all eyes and the prethreshold ROP eyes models, respectively. Higher ADL during early gestation was associated with a lower risk for SROP and may imply a role for prophylactic light treatment during early gestation to decrease the risk of SROP. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period

PubMed Central

Pratinidhi, Asha K.; Bagade, Abhijit C.; Kakade, Satish V.; Kale, Hemangi P.; Kshirsagar, Vinayak Y.; Babar, Rohini; Bagal, Shilpa

2017-01-01

Background & objectives: Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers. Methods: This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it. Results: There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants. Interpretation & conclusions: A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly. PMID:28749397

The relationship between gestational age and compliance in human umbilical vein and its possible application in vascular grafting.

PubMed

Li, Wenchun; Huang, Tiezhu; Zeng, Yanjun; Yao, Zhongjun

2006-03-01

The aim of this study was to provide a theoretical basis, using biomechanical properties, for the clinical application of human umbilical vein (HUV) as material for vascular grafting. This was a nonrandomized, non-controlled in vitro study. The experiment was conducted in the Laboratory of Medical Biomechanics, Yunyang Medical College. HUVs of 50 normal fetuses were collected on spontaneous miscarriage or labor with the pregnant women's permission by the Department of Obstetrics and Gynecology, Taihe Hospital, Shiyan, Hubei Province. Gestational aged ranged 24-42 weeks, and parturients were 20-30 years old. The pressure-volume (P-V) relationship of HUV was measured on the biomechanical experiment stand for soft tissues, and then compliance was calculated. The P-V relationship of HUV corresponded to a parabolic curve. The compliance of HUV increased gradually with gestational age [24-27 weeks (2.22+/-0.34) x 10(-4) mL/(kPa * cm), 28-32 weeks (3.65+/-0.46) x 10(-4) mL/(kPa * cm), 33-36 weeks (4.22+/-0.55) x 10(-4) mL/(kPa * cm), 37 weeks (7.63+/-0.48) x 10(-4) mL/(kPa * cm), 38 weeks (8.32+/-0.76) x 10(-4) mL/(kPa * cm)]. However, after 39 weeks of gestation, compliance decreased gradually with gestational age [39 weeks 7.61+/-0.46) x 10(-4) mL/(kPa * cm), 40 weeks (7.53+/-0.72) x 10(-4) mL/(kPa * cm), 41 weeks (4.13+/-0.35) x 10(-4) mL/(kPa * cm), 42 weeks (2.25+/-0.62) x 10(-4) mL/(kPa * cm)]. The compliance of HUVs collected at 37-40 weeks of gestational age was similar. When the HUVs older than 42 weeks or under 28 weeks were compared, there was significant difference in their compliance (F=65.84-86.52, p<0.01). The results of the present study suggest that HUVs collected at 37-40 weeks of gestational age have good compliance, i.e., a good P-V relationship, and therefore may be a suitable material for vascular grafting. HUV is one of several graft materials that may be used when autogenous saphenous vein is absent or inadequate. HUV is very biocompatible and shows promise for use in orthopedic implants.

Linear and nonlinear features of fetal heart rate on the assessment of fetal development in the course of pregnancy and the impact of fetal gender.

PubMed

Spyridou, K; Chouvarda, I; Hadjileontiadis, L; Maglaveras, N

2018-01-30

This work aims to investigate the impact of gestational age and fetal gender on fetal heart rate (FHR) tracings. Different linear and nonlinear parameters indicating correlation or complexity were used to study the influence of fetal age and gender on FHR tracings. The signals were recorded from 99 normal pregnant women in a singleton pregnancy at gestational ages from 28 to 40 weeks, before the onset of labor. There were 56 female fetuses and 43 male. Analysis of FHR shows that the means as well as measures of irregularity of FHR, such as approximate entropy and algorithmic complexity, decrease as gestation progresses. There were also indications that mutual information and multiscale entropy were lower in male fetuses in early pregnancy. Fetal age and gender seem to influence FHR tracings. Taking this into consideration would improve the interpretation of FHR monitoring.

[Maternal diabetes--normalized perinatal mortality, but still high fetal growth].

PubMed

Hellesen, H B; Vikane, E; Lie, R T; Irgens, L M

1996-11-30

Studies suggest that maternal diabetes can cause both placental insufficiency and exaggerated foetal growth. Pregnant mothers with diabetes have suffered high risk of losing their child. Data from the Medical Birth Registry of Norway show a decrease in the still birth rate from 16th week of gestation from 115.7 per 1,000 in 1967-75 to 12.8 in 1986-92 in the diabetes groups. The relative risks were 7.8 and 1.4 respectively for the two time periods. The early neonatal mortality rate decreased correspondingly. The proportion of Caesarean sections in mothers with diabetes, and the proportion of children with low birth weight or born prematurely also increased in the diabetes group. However, children in the diabetes group were on average still as big at gestational age in the most recent period as in the first period. Our data suggest that the improved metabolic control of maternal diabetes has reduced the occurrence and degree of placental insufficiency, with inherent decreases in mortality and risk of complications, but without reducing the foetal growth-stimulating effect of maternal diabetes.

Trajectories of general movements from birth to term-equivalent age in infants born <30 weeks' gestation.

PubMed

Olsen, Joy E; Brown, Nisha C; Eeles, Abbey L; Lee, Katherine J; Anderson, Peter J; Cheong, Jeanie L Y; Doyle, Lex W; Spittle, Alicia J

2015-12-01

General movements (GMs) is an assessment with good predictive validity for neurodevelopmental outcomes in preterm infants. However, there is limited information describing the early GMs of very preterm infants, particularly prior to term. To describe the early GMs trajectory of very preterm infants (born <30weeks' gestation) from birth to term-equivalent age, and to assess the influence of known perinatal risk factors on GMs. Prospective cohort study. 149 very preterm infants born <30weeks' gestation. GMs were recorded weekly from birth until 32weeks' postmenstrual age, and then fortnightly until 38weeks' postmenstrual age. GMs were also assessed at term-equivalent age. Detailed perinatal data were collected. Of 669 GMs assessed, 551 were preterm and 118 were at term-equivalent age. Prior to term, 15% (n=82) of GMs were normal and 85% (n=469) were abnormal, with the proportion of abnormal GMs decreasing with increasing postmenstrual age (p for trend <0.001). By term-equivalent 30% (n=35) of GMs were normal. On univariable analysis, lower gestational age (p<0.001), postnatal infection (p<0.001) and bronchopulmonary dysplasia (p=0.001) were associated with abnormal GMs. Postnatal infection was the only independent perinatal association with abnormal GMs on multivariable analysis. All four infants with grade III/IV intraventricular haemorrhage (IVH) had persistently abnormal GMs. GMs were predominantly abnormal in very preterm infants, with a higher proportion of normal GMs at term-equivalent age than prior to term. Abnormal GMs were associated with postnatal infection and IVH. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Prenatal development in fishers (Martes pennanti)

USGS Publications Warehouse

Frost, H.C.; Krohn, W.B.; Bezembluk, E.A.; Lott, R.; Wallace, C.R.

2005-01-01

We evaluated and quantified prenatal growth of fishers (Martes pennanti) using ultrasonography. Seven females gave birth to 21 kits. The first identifiable embryonic structures were seen 42 d prepartum; these appeared to be unimplanted blastocysts or gestational sacs, which subsequently implanted in the uterine horns. Maternal and fetal heart rates were monitored from first detection to birth. Maternal heart rates did not differ among sampling periods, while fetal hearts rates increased from first detection to birth. Head and body differentiation, visible limbs and skeletal ossification were visible by 30, 23 and 21 d prepartum, respectively. Mean diameter of gestational sacs and crown-rump lengths were linearly related to gestational age (P < 0.001). Biparietal and body diameters were also linearly related to gestational age (P < 0.001) and correctly predicted parturition dates within 1-2 d. ?? 2004 Elsevier Inc. All rights reserved.

Blood Biomarkers of Late Pregnancy Exposure to Trihalomethanes in Drinking Water and Fetal Growth Measures and Gestational Age in a Chinese Cohort

PubMed Central

Cao, Wen-Cheng; Zeng, Qiang; Luo, Yan; Chen, Hai-Xia; Miao, Dong-Yue; Li, Li; Cheng, Ying-Hui; Li, Min; Wang, Fan; You, Ling; Wang, Yi-Xin; Yang, Pan; Lu, Wen-Qing

2015-01-01

Background: Previous studies have suggested that elevated exposure to disinfection by-products (DBPs) in drinking water during gestation may result in adverse birth outcomes. However, the findings of these studies remain inconclusive. Objective: The purpose of our study was to examine the association between blood biomarkers of late pregnancy exposure to trihalomethanes (THMs) in drinking water and fetal growth and gestational age. Methods: We recruited 1,184 pregnant women between 2011 and 2013 in Wuhan and Xiaogan City, Hubei, China. Maternal blood THM concentrations, including chloroform (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (TBM), were measured as exposure biomarkers during late pregnancy. We estimated associations with gestational age and fetal growth indicators [birth weight, birth length, and small for gestational age (SGA)]. Results: Total THMs (TTHMs; sum of TCM, BDCM, DBCM, and TBM) were associated with lower mean birth weight (–60.9 g; 95% CI: –116.2, –5.6 for the highest vs. lowest tertile; p for trend = 0.03), and BDCM and DBCM exposures were associated with smaller birth length (e.g., –0.20 cm; 95% CI: –0.37, –0.04 for the highest vs. lowest tertile of DBCM; p for trend = 0.02). SGA was increased in association with the second and third tertiles of TTHMs (OR = 2.91; 95% CI: 1.32, 6.42 and OR = 2.25; 95% CI: 1.01, 5.03; p for trend = 0.08). Conclusions: Our results suggested that elevated maternal THM exposure may adversely affect fetal growth. Citation: Cao WC, Zeng Q, Luo Y, Chen HX, Miao DY, Li L, Cheng YH, Li M, Wang F, You L, Wang YX, Yang P, Lu WQ. 2016. Blood biomarkers of late pregnancy exposure to trihalomethanes in drinking water and fetal growth measures and gestational age in a Chinese cohort. Environ Health Perspect 124:536–541; http://dx.doi.org/10.1289/ehp.1409234 PMID:26340795

Changing Survival Rate of Infants Born Before 26 Gestational Weeks

PubMed Central

Rahman, Asad; Abdellatif, Mohamed; Sharef, Sharef W.; Fazalullah, Muhammad; Al-Senaidi, Khalfan; Khan, Ashfaq A.; Ahmad, Masood; Kripail, Mathew; Abuanza, Mazen; Bataclan, Flordeliza

2015-01-01

Objectives: This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23–26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. Results: A total of 81 infants between 23–26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 ± 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome (100.0%), retinopathy of prematurity (51.9%), bronchopulmonary dysplasia (34.6%), intraventricular haemorrhage (30.9%) and patent ductus arteriosus (28.4%) were the most common morbidities. Conclusion: The overall survival rate of infants between 23–26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants. PMID:26357555

Preterm induction of labor: predictors of vaginal delivery and labor curves.

PubMed

Feghali, Maisa; Timofeev, Julia; Huang, Chun-Chih; Driggers, Rita; Miodovnik, Menachem; Landy, Helain J; Umans, Jason G

2015-01-01

The purpose of this study was to evaluate the labor curves of patients who undergo preterm induction of labor (IOL) and to assess possible predictors of vaginal delivery (VD). Data from the National Institute of Child Health and Human Development Consortium on Safe Labor were analyzed. A total of 6555 women who underwent medically indicated IOL at <37 weeks of gestation were included in this analysis. Patients were divided into 4 groups based on gestational age (GA): group A, 24-27+6 weeks; B, 28-30+6 weeks; C, 31-33+6 weeks; and D, 34-36+6 weeks. Pregnant women with a contraindication to VD, IOL ≥37 weeks of gestation, and without data from cervical examination on admission were excluded. Analysis of variance was used to assess differences between GA groups. Multiple logistic regression was used to assess predictors of VD. A repeated measures analysis was used to determine average labor curves. Rates of vaginal live births increased with GA, from 35% (group A) to 76% (group D). Parous women (odds ratio, 6.78; 95% confidence interval, 6.38-7.21) and those with a favorable cervix at the start of IOL (odds ratio, 2.35; 95% confidence interval, 2.23-2.48) were more likely to deliver vaginally. Analysis of labor curves in nulliparous women showed shorter duration of labor with increasing GA; the active phase of labor was, however, similar across all GAs. Most women who undergo medically indicated preterm IOL between 24 and 36+6 weeks of gestation deliver vaginally. The strongest predictor of VD was parity. Preterm IOL had a limited influence on estimated labor curves across GAs. Copyright © 2015 Elsevier Inc. All rights reserved.

Comparisons of the oxidative stress biomarkers levels in gestational diabetes mellitus (GDM) and non-GDM among Thai population: cohort study.

PubMed

Rueangdetnarong, Hathairat; Sekararithi, Rattanaporn; Jaiwongkam, Thidarat; Kumfu, Sirinart; Chattipakorn, Nipon; Tongsong, Theera; Jatavan, Phudit

2018-05-01

The primary objective of this study was to compare the levels of oxidative stress biomarkers between pregnancies with gestational diabetes mellitus (GDM) and normoglycemic pregnancies. A prospective study was conducted on pregnant women at average risk for GDM. The participants were screened for GDM with glucose challenge test and confirmed by 100 g, 3-h oral glucose tolerance test and categorized into the control (non-GDM) and GDM groups. Maternal blood was collected from all participants at gestational age (GA) 24-28 weeks and early labor and fetal cord blood was collected for measurements of 8 Isoprostane (8Isop) (oxidative stress marker), TNF-α (inflammatory marker) and IL-10 (anti-inflammatory marker) and were followed up for maternal and neonatal outcomes. A total of 62 women, 30 in GDM and 32 in control group, met the inclusion criteria. At 24-28 weeks of gestation, maternal serum 8Isop and TNF-α levels were significantly higher in GDM group ( P  = 0.032 and P  = 0.047), in spite of good glycemic control. At early labor, maternal 8Isop levels were significantly higher in GDM ( P  = 0.001). The biomarkers in the cord blood as well as maternal and neonatal outcomes in both groups were not significantly different. GDM is significantly associated with inflammatory process when compared to normal pregnancy, as indicated by higher oxidative stress and apoptosis markers. However, such levels were not correlated with the pregnancy outcomes. An increase in oxidative stress could not be prevented by good glycemic control. Cord blood biomarker levels in pregnancy with GDM were not changed, suggesting that the placenta could be the barrier for the oxidative stress and cytokines. © 2018 The authors.

Three-dimensional ultrasonography measurement of fetal nasal bone length during the midtrimester in Taiwanese women.

PubMed

Yang, Pei-Yin; Wu, Joung-Liang; Yeh, Guang-Perng; Tsung-Che Hsieh, Charles

2012-09-01

To evaluate the normal range of the fetal nasal bone length (NBL) in Taiwanese women using three-dimensional (3D) ultrasound, and compare the NBL of normal fetuses with Down syndrome to determine its significance in screening for trisomy 21. A total of 102 consecutive fetuses and another 7 fetuses with trisomy 21, determined by karyotyping at 15-22 weeks' gestation, were evaluated with 3D ultrasound before amniocentesis at Changhua Christian Hospital between November 2003 and April 2004. The normal range for NBL in the second trimester in the Taiwanese population was investigated, and a linear relationship with gestational age was noted. The NBL increased with advancing gestational age (NBL in cm=0.0264×gestational age in weeks -0.042 (R(2)=0.2416). The median of the biparietal diameter/nasal bone length ratio had a stable value which tended to change minimally between 15 and 22 weeks of gestation. Chromosomally normal fetuses had statistically longer nasal bones than fetuses with Down syndrome (p=0.014). We present a reference range for 3D ultrasound measurement of the fetal NBL. A short nasal bone at 15 to 22 weeks is associated with a high risk of trisomy 21. Copyright © 2012. Published by Elsevier B.V.