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Sample records for gestational age patient

  1. Gestational age

    Science.gov (United States)

    Fetal age - gestational age; Gestation; Neonatal gestational age; Newborn gestational age ... Gestational age can be determined before or after birth. Before birth, your health care provider will use ultrasound to ...

  2. Small for Gestational Age (SGA)

    Science.gov (United States)

    ... Throat (ENT) Dental/Orthodontics Urology Orthopedics Child Development Psychology Special Education Services DO WE NEED TO IMPROVE ... continued research and education about Small for Gestational Age and Russell-Silver syndrome by ... our closed SGA Facebook group for parents. After you request to join, please ...

  3. The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies : an individual patient level meta-analysis

    NARCIS (Netherlands)

    Kindinger, L M; Poon, L C; Cacciatore, S; MacIntyre, D A; Fox, N S; Schuit, E; Mol, B W; Liem, S; Lim, A C; Serra, V; Perales, A; Hermans, F; Darzi, A; Bennett, P; Nicolaides, K H; Teoh, T G

    2016-01-01

    OBJECTIVE: To assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DESIGN: Individual patient data (IPD) meta-analysis. SETTING: International multicentre study. POPULATION:

  4. The Gestational Age Pattern of Human Mortality

    DEFF Research Database (Denmark)

    Schöley, Jonas; Vaupel, James W.; Jacobsen, Rune

    of a "birth hump" peaking week 38. The absolute rate of decline slows down over age. The observed gestational age pattern of the force of mortality is consistent with three hypotheses concerning the causes for ontogenescense: 1) Adaptation: as the organism growths it becomes more resilient towards death, 2...

  5. [Effects of growth hormone treatment on anthropometrics, metabolic risk, and body composition variables in small for gestational age patients].

    Science.gov (United States)

    Aurensanz Clemente, Esther; Samper Villagrasa, Pilar; Ayerza Casas, Ariadna; Ruiz Frontera, Pablo; Bueno Lozano, Olga; Moreno Aznar, Luis Alberto; Bueno Lozano, Gloria

    2017-05-01

    Small for gestational age (SGA) children without catch-up growth can benefit from treatment with growth hormone (rhGH). However, they should be monitored very closely because they are at increased risk of metabolic syndrome. A group of 28 SGA children with a mean age of 8.79 years and undergoing treatment with rhGH were selected for evaluation. Over the course of 4 years, an annual evaluation was performed on the anthropometric variables (weight, height, body mass index [BMI], growth rate, blood pressure and waist perimeter), metabolic risk variables (glycaemia, glycosylated haemoglobin, cholesterol ratio, insulinaemia, insulin-like growth factor 1[IGF1], IGF binding protein-3 [IGFBP-3], IGF1/IGFBP3 ratio, and HOMA index), and body composition variables. Treatment with rhGH was associated with a significant increase in height (-2.76±.11 SD to -1.53±.17 SD, P=.000), weight (-1.50±.09 SD to -1.21±.13 SD; P=.016), and growth rate (-1.43±.35 SD to .41±.41 SD; P=.009), without a corresponding change in the BMI. Insulinaemia (9.33±1.93mU/ml to 16.55±1.72mU/ml; P=.044) and the HOMA index (3.63±.76 to 6.43±.67; P=.042) increased, approaching insulin resistance levels. No changes were observed in the lipid profile. Body composition changes were observed, with a significant increase in lean mass (73.19±1.26 to 78.74±1.31; P=.037), and a reduction of fat mass (26.81±1.26 to 21.26±1.31; P=.021). Treatment with rhGH is effective for improving anthropometric variables in SGA patients who have not experienced a catch-up growth. It also produces changes in body composition, which may lead to a reduction in risk of metabolic syndrome. However, some insulin resistance was observed. It is important to follow up this patient group in order to find out whether these changes persist into adulthood. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Correlation between self-reported gestational age and ultrasound measurements

    DEFF Research Database (Denmark)

    Olesen, Annette Wind; Westergaard, Jes Grabow; Thomsen, Sten Grove

    2004-01-01

    BACKGROUND: We studied the agreement between different measurements of gestational age, i.e. self-reported gestational age in the Danish National Birth Cohort Study, ultrasound-estimated gestational age from the medical records in one Danish county and gestational age from the Danish National...... and the gestational ages based on corrected last menstrual period did not differ significantly. CONCLUSION: The self-reported gestational age in The Danish National Birth Cohort is in good concordance both with data from the National Hospital Discharge Register and with ultrasound-estimated gestational age....

  7. Birth Weight, Gestational Age, and Infantile Colic

    DEFF Research Database (Denmark)

    Milidou, Ioanna; Søndregaard, Charlotte; Jensen, Morten Søndergaard

    Background Infantile colic is a condition of unknown origin characterized by paroxysms of crying during the first months of life. A few studies have identified low birth weight (BW) as a risk factor among infants born at term, while the association between gestational age (GA) and infantile colic...... has not been studied. Aim We aimed to investigate the association between BW, GA, and infantile colic. Methods We studied 62,785 singletons enrolled in the Danish National Birth Cohort. Information on infantile colic symptoms and possible confounders was collected by computer-assisted telephone......, low BW was associated with infantile colic only in infants born at term (gestational weeks 37-41), but not in pre- or post-term infants. Conclusion The results indicate that low birth weight and preterm birth are independently associated with infantile colic. After adjusting for gestational age, low...

  8. Gestational Age and Autism Spectrum Disorder

    DEFF Research Database (Denmark)

    Atladóttir, H Ó; Schendel, D.E.; Henriksen, T B

    2016-01-01

    Autism Spectrum Disorder (ASD) is a serious neurodevelopmental disorder. Several previous studies have identified pre-term birth as a risk factor for ASD but none has studied whether the association between gestational age and ASD has changed over time. This is a Danish population-based follow...

  9. Relationship between 17-hydroxyprogesterone caproate concentrations and gestational age at delivery in twin gestation.

    LENUS (Irish Health Repository)

    Caritis, Steve N

    2012-11-01

    We sought to evaluate in women with twin gestation the relationship between 17-hydroxyprogesterone caproate (17-OHPC) concentration and gestational age at delivery and select biomarkers of potential pathways of drug action.

  10. Gestational diabetes mellitus results in a higher prevalence of small for gestational age babies

    LENUS (Irish Health Repository)

    Avalos, G

    2011-09-01

    Background and aims: Gestational Diabetes Mellitus (GDM) is associated with increased foetal and maternal morbidity and mortality. Previous studies have shown that babies of diabetic mothers are more likely to be large for gestational age (LGA). This retrospective study aimed to assess whether the converse may also be true, that there may also a higher rate of small for gestational age (SGA) amongst babies of mothers with GDM.\\r\

  11. Time domain parameters of heart rate variability in children born as small-for-gestational age.

    Science.gov (United States)

    Zamecznik, Agata; Stańczyk, Jerzy; Wosiak, Agnieszka; Niewiadomska-Jarosik, Katarzyna

    2017-05-01

    According to metabolic programming theory, small-for-gestational age patients are at high risk of cardiovascular diseases also because of the possible malfunction of the autonomic nervous system. Autonomic disorders can be assessed by heart rate variability. The aims of this study were to compare time domain parameters of heart rate variability in children born as small-for-gestational age and appropriate-for-gestational age and to assess the correlation of the postnatal and current somatic parameters with the time domain parameters. The small-for-gestational age group consisted of 68 children aged 5-10 years who were born with birth weight below the 10th percentile. The appropriate-for-gestational age group consisted of 30 healthy peers, matched in terms of gender and age. On the basis of Holter monitoring, slightly higher average heart rate was observed in the small-for-gestational age group than in the appropriate-for-gestational age group. It was found that all the time domain parameters (SDNN, SDNNi, SDANNi, rMSSD, pNN50) were lower in the small-for-gestational age group than in the appropriate-for-gestational age group. In the small-for-gestational age group, girls had lower heart rate and some of the heart rate variability parameters (SDNN, SDNNi, SDANNi) in comparison with boys. Children born as small-for-gestational age have impaired function of the autonomic nervous system. Moreover, in the small-for-gestational age group, autonomic balance moved towards the sympathetic component, which was evidenced by higher heart rate. Children with faster heart rate and lower heart rate variability parameters may be at risk of cardiovascular disease.

  12. Gestational outcomes in patients with neuropsychiatric systemic lupus erythematosus.

    Science.gov (United States)

    de Jesus, G R; Rodrigues, B C; Lacerda, M I; Dos Santos, F C; de Jesus, N R; Klumb, E M; Levy, R A

    2017-04-01

    This study analyzed maternal and fetal outcomes of pregnancies of neuropsychiatric systemic lupus erythematosus patients followed in a reference unit. This retrospective cohort study included 26 pregnancies of patients seen between 2011 and 2015 included with history and/or active neuropsychiatric systemic lupus erythematosus among 135 pregnancies. Three patients had active neuropsychiatric systemic lupus erythematosus at conception, but only one remained with neurological activity during gestation, characteristically related to the inadvertent suspension of medications. Twenty six percent of the newborns were small for gestational age and 40% of live births were premature, with no neonatal death or early complications of prematurity. Preeclampsia was diagnosed in nine pregnancies, with two cases of early severe form that resulted in intrauterine fetal death. Patients with neuropsychiatric systemic lupus erythematosus had more prematurity and preeclampsia compared to patients without neuropsychiatric disease. However, when concomitant lupus nephritis was excluded, the gestational results of neuropsychiatric systemic lupus erythematosus patients were more favorable.

  13. Secular trends in gestational age and birthweight in twins.

    Science.gov (United States)

    Gielen, M; van Beijsterveldt, C E M; Derom, C; Vlietinck, R; Nijhuis, J G; Zeegers, M P A; Boomsma, D I

    2010-09-01

    In recent decades, the overall rate of preterm births has increased. The aim of the present study was to examine whether this trend is also seen for multiple gestations. More specifically, we examined if there has been a decrease in gestational age for live born monozygotic (MZ) and dizygotic (DZ) twins and if there has been a simultaneous change in birthweight. The contributions of fertility treatments and Caesarean sections were taken into consideration. All analyses were carried out in two large European twin cohorts. Cross-sectional study of 6310 live born twin pairs, born between 1964-2007, from the Belgian East Flanders Prospective Twin Survey and 14,712 twin pairs, born between 1990-2006, from the Netherlands Twin Register. Multiple regression analyses were performed with gestational age as outcome variable, and multilevel analysis with birthweight as outcome variable. All analyses were performed with and without adjustment for zygosity, parity, maternal age, mode of conception and delivery and, for the analyses of birthweight, gestational age. Gestational age decreased in a linear fashion from 1964 to 2007 with a decrease of 0.25 days per year in a similar way for MZ and DZ twins. Changes in birthweight depended on gestational age: up to 32 weeks, birthweight decreased and after 32 weeks birthweight increased. The frequency of infertility treatment and Caesarean sections, primiparity and advanced maternal age increased over the years, but none of these factors influenced the secular trends in gestational age and birthweight. The decrease in gestational age and change in birthweight in twins are sources of concern, especially for very preterm twins, for whom birthweight decreased. For twins born after 32 weeks, an increase in birthweight was observed and this is very likely the explanation for the decrease in gestational age.

  14. Secular trends in gestational age and birthweight in twins

    NARCIS (Netherlands)

    Gielen, M.; van Beijsterveldt, C.E.M.; Derom, C.A.; Vlietinck, R; Nijhuis, J.G.; Zeegers, M.P.A.; Boomsma, D.I.

    2010-01-01

    Background: In recent decades, the overall rate of preterm births has increased. The aim of the present study was to examine whether this trend is also seen for multiple gestations. More specifically, we examined if there has been a decrease in gestational age for live born monozygotic (MZ) and

  15. Estimation of gestational age from gall-bladder length.

    Science.gov (United States)

    Udaykumar, K; Udaykumar, Padmaja; Nagesh, K R

    2016-01-01

    Establishing a precise duration of gestation is vital in situations such as infanticide and criminal abortions. The present study attempted to estimate the gestational age of the foetus from gall-bladder length. Foetuses of various gestational age groups were dissected, and the length of the gall bladder was measured. The results were analysed, and a substantial degree of correlation was statistically confirmed. This novel method is helpful when the foetus is fragmented, putrefied or eviscerated, where this method can be used as an additional parameter to improve the accuracy of foetal age estimation. © The Author(s) 2015.

  16. Gestational age, birth weight, and the risk of hyperkinetic disorder

    DEFF Research Database (Denmark)

    Linnet, Karen M; Wisborg, Kirsten; Agerbo, Esben

    2006-01-01

    for socioeconomic status of the parents, family history of psychiatric disorders, conduct disorders, comorbidity, and maternal smoking during pregnancy. Results related to birth weight were unchanged after adjusting for differences in gestational age. CONCLUSIONS: Children born preterm, also close to term......AIMS: To study the association between gestational age and birth weight and the risk of clinically verified hyperkinetic disorder. METHODS: Nested case-control study of 834 cases and 20 100 controls with incidence density sampling. RESULTS: Compared with children born at term, children born...... with gestational ages of 34-36 completed weeks had a 70% increased risk of hyperkinetic disorder (rate ratio (RR) 1.7, 95% confidence interval (CI) 1.2 to 2.5). Children with gestational ages below 34 completed weeks had an almost threefold increased risk (RR 2.7, 95% CI 1.8 to 4.1). Children born at term...

  17. Caesarean section and risk of autism across gestational age

    DEFF Research Database (Denmark)

    Yip, Benjamin Hon Kei; Leonard, Helen; Stock, Sarah

    2017-01-01

    BACKGROUND: 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...

  18. Assessment of Gestational Age in the Third Trimester of Pregnancy ...

    African Journals Online (AJOL)

    SFH) with ultrasonic measurement of biparietal diameter (BPD) and femur length (FL) in assessing gestational age in the third trimester of pregnancy. Subjects and Methods:Women carrying singleton uncomplicated pregnancies in the third ...

  19. Diagnostic value of newborn foot length to predict gestational age

    Directory of Open Access Journals (Sweden)

    Mutia Farah Fawziah

    2017-08-01

    Full Text Available Background  Identification of gestational age, especially within 48 hours of birth, is crucial for newborns, as the earlier preterm status is detected, the earlier the child can receive optimal management. Newborn foot length is an anthropometric measurement which is easy to perform, inexpensive, and potentially efficient for predicting gestational age. Objective  To analyze the diagnostic value of newborn foot length in predicting gestational age. Methods  This diagnostic study was performed between October 2016 and February 2017 in the High Care Unit of Neonates at Dr. Moewardi General Hospital, Surakarta. A total of 152 newborns were consecutively selected and underwent right foot length measurements before 96 hours of age. The correlation between newborn foot length to classify as full term and gestational age was analyzed with Spearman’s correlation test because of non-normal data distribution. The cut-off point of newborn foot length was calculated by receiver operating characteristic (ROC curve and diagnostic values of newborn foot length were analyzed by 2 x 2 table with SPSS 21.0 software. Results There were no significant differences between male and female newborns in terms of gestational age, birth weight, choronological age, and newborn foot length (P>0.05. Newborn foot length and gestational age had a significant correlation (r=0.53; P=0.000. The optimal cut-off newborn foot length to predict full term status was 7.1 cm. Newborn foot length below 7.1 cm had sensitivity 75%, specificity 98%, positive predictive value 94.3%, negative predictive value 90.6%, positive likelihood ratio 40.5, negative likelihood ratio 0.25, and post-test probability 94.29%, to predict preterm status in newborns. Conclusion  Newborn foot length can be used to predict gestational age, especially for the purpose of differentiating between preterm and full term newborns.

  20. [Chinese neonatal birth weight curve for different gestational age].

    Science.gov (United States)

    Zhu, Li; Zhang, Rong; Zhang, Shulian; Shi, Wenjing; Yan, Weili; Wang, Xiaoli; Lyu, Qin; Liu, Ling; Zhou, Qin; Qiu, Quanfang; Li, Xiaoying; He, Haiying; Wang, Jimei; Li, Ruichun; Lu, Jiarong; Yin, Zhaoqing; Su, Ping; Lin, Xinzhu; Guo, Fang; Zhang, Hui; Li, Shujun; Xin, Hua; Han, Yanqing; Wang, Hongyun; Chen, Dongmei; Li, Zhankui; Wang, Huiqin; Qiu, Yinping; Liu, Huayan; Yang, Jie; Yang, Xiaoli; Li, Mingxia; Li, Wenjing; Han, Shuping; Cao, Bei; Yi, Bin; Zhang, Yihui; Chen, Chao

    2015-02-01

    Since 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve. A nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system. the growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1. A total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method. Using GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.

  1. Association between small-for-gestational age and neurocognitive impairment at two years of corrected age among infants born at preterm gestational ages: a cohort study.

    Science.gov (United States)

    Girsen, A I; Do, S C; El-Sayed, Y Y; Hintz, S R; Blumenfeld, Y J

    2017-08-01

    To investigate the association between small-for-gestational age (SGA) and neurocognitive impairment at 2 years of corrected age among infants born at preterm gestational ages. A secondary analysis of a prospectively conducted NICHD/Maternal-Fetal Medicine Units BEAM trial. Non-anomalous pregnancies delivered before 37 weeks of gestation were included in the analysis. Neurocognitive outcomes at 2 years of corrected age were compared between infants who were SGA (years of corrected age among survivors, defined as either mental (MDI) or psychomotor (PDI) developmental index score years of corrected age, SGA and AGA survivors had similar rates of neurocognitive impairment (MDI two years of corrected age among surviving infants.

  2. Determination of gestational age through trans-abdominal scan of ...

    African Journals Online (AJOL)

    The usefulness of placentome diameter measurement for the determination of gestational age in Nigerian breed of sheep and goats was investigated in two experiments. In the first experiment, cross-sectional design was used and placentome diameters were measured in 18 Yankasa/Uda crossbred ewes and 20 Sahel ...

  3. Placental thickness: A sonographic indicator of gestational age in ...

    African Journals Online (AJOL)

    The study is aimed to investigate placental thickness as a parameter for estimating gestational age in normal singleton pregnancies in. Nigerian women. 730 Nigerian women with normal singleton pregnancies who were attending antenatal clinic at Federal Medical Centre, Makurdi, Nigeria were studied by transabdominal ...

  4. Fetal Habituation Performance: Gestational Age and Sex Effects

    Science.gov (United States)

    McCorry, Noleen K.; Hepper, Peter G.

    2007-01-01

    Habituation is the decrement in response to repeated stimulation. Fetal habituation performance may reflect the functioning of the central nervous system (CNS) prenatally. However, basic characteristics of the prenatal habituation phenomena remain unclear, such as the relationship with gestational age (GA) and fetal sex. The current study…

  5. Gestational Age At First Antenatal Attendance In Sagamu, Western ...

    African Journals Online (AJOL)

    This study was a carried out to determine to the gestation age first antenatal attendance at our centre and find out factors that influence it, with the aim of making suggestions that will encourage early booking for ANC Subjects and Methods: A cross – sectional study was carried out amongst pregnant women that came to ...

  6. Birth weights and gestational ages of Malawian newborns at Queen ...

    African Journals Online (AJOL)

    Objective: To determine the distributions of birth weight (BW) and gestational age (GA) and calculate rates of still birth (SB) of four years delivery in the Queen Elizabeth Central Hospital( QECH). Methods: Retrospective analysis was carried out on data of deliveries conducted between January 2000 and December 2003.

  7. The current pattern of gestational age-related anthropometric ...

    African Journals Online (AJOL)

    The current pattern of gestational age-related anthropometric parameters of term Nigerian neonates. O Oluwafemi,1 FWACP; F Njokanma,2 FWACP; E Disu,2 ... Weight and length at birth reflect the quality of intra-uterine growth and exert a strong influence on postnatal survival. ..... Neonatal anthropometry: The thin-fat.

  8. Clinical and radiological correlations in patients with gestational trophoblastic disease

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Lana de Lourdes Aguiar; Parente, Raphael Camara Medeiros; Amim Junior, Joffre; Rezende Filho, Jorge Fonte de; Montenegro, Carlos Antonio Barbosa; Braga, Antonio, E-mail: lanalima@hotmail.com [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); Maesta, Izildinha [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina

    2016-07-15

    Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging. (author)

  9. Clinical and radiological correlations in patients with gestational trophoblastic disease

    Directory of Open Access Journals (Sweden)

    Lana de Lourdes Aguiar Lima

    Full Text Available Abstract Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging.

  10. Clinical and radiological correlations in patients with gestational trophoblastic disease

    International Nuclear Information System (INIS)

    Lima, Lana de Lourdes Aguiar; Parente, Raphael Camara Medeiros; Amim Junior, Joffre; Rezende Filho, Jorge Fonte de; Montenegro, Carlos Antonio Barbosa; Braga, Antonio; Maesta, Izildinha

    2016-01-01

    Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging. (author)

  11. Gestational age, birth weight, and the risk of hyperkinetic disorder

    DEFF Research Database (Denmark)

    Linnet, K. M.; Wisborg, K; Agerbo, E

    2006-01-01

    for socioeconomic status of the parents, family history of psychiatric disorders, conduct disorders, comorbidity, and maternal smoking during pregnancy. Results related to birth weight were unchanged after adjusting for differences in gestational age. CONCLUSIONS: Children born preterm, also close to term......AIMS: To study the association between gestational age and birth weight and the risk of clinically verified hyperkinetic disorder. METHODS: Nested case-control study of 834 cases and 20 100 controls with incidence density sampling. RESULTS: Compared with children born at term, children born...... with birth weights of 1500-2499 g had a 90% increased risk of hyperkinetic disorder (RR 1.9, 95% CI 1.2 to 2.9), and children with birth weights of 2500-2999 g had a 50% increased risk (RR 1.5, 95% CI 1.2 to 1.8) compared with children born at term with birth weights above 2999 g. The results were adjusted...

  12. Gestational, perinatal and family findings of patients with Patau syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Fabiano M. Rosa

    2013-12-01

    Full Text Available OBJECTIVE: To describe gestational, perinatal and family findings of patients with Patau syndrome (PS. METHODS: The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. RESULTS: The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%. Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%; multiparous mothers (92.6%; vaginal delivery (77%; preterm birth (34.6%; birth weight <2500g (33.3%, and Apgar scores <7 in the 1st (75% and in the 5th minute (42.9%. About half of them (53% died during the first month of life. CONCLUSIONS: The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.

  13. Gestational, perinatal and family findings of patients with Patau syndrome.

    Science.gov (United States)

    Rosa, Rafael Fabiano M; Sarmento, Melina Vaz; Polli, Janaina Borges; Groff, Daniela de Paoli; Petry, Patrícia; Mattos, Vinícius Freitas de; Rosa, Rosana Cardoso M; Trevisan, Patrícia; Zen, Paulo Ricardo G

    2013-12-01

    To describe gestational, perinatal and family findings of patients with Patau syndrome (PS). The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, being significant p<0.05. The sample was composed of 27 patients, 63% were male, with a median age of nine days at the first evaluation. Full trisomy of chromosome 13 was the main cytogenetic finding (74%). Only six patients were submitted to obstetric ultrasound and none had prenatal diagnosis of PS. The patients' demographic characteristics, compared to born alive infants in the same Brazilian state showed a higher frequency of: mothers with 35 years old or more (37.5%); multiparous mothers (92.6%); vaginal delivery (77%); preterm birth (34.6%); birth weight <2500g (33.3%), and Apgar scores <7 in the 1st (75%) and in the 5th minute (42.9%). About half of them (53%) died during the first month of life. The understanding of the PS patients' gestational, perinatal and family findings has important implications, especially on the decision about the actions to be taken in relation to the management of these patients.

  14. Correlation between Umbilical Cord Diameter and Cross Sectional Area with Gestational Age and Foetal Anthropometric Parameters.

    Science.gov (United States)

    Begum, K; Ahmed, M U; Rahman, M M; Hossain, M M; Begum, M; Sarkar, S K; Reza, M T; Hoshneara, M; Beg, A; Sultana, F; Begum, F; Akter, F A

    2016-04-01

    The objective of the study was to find out correlation between umbilical cord diameter, cross sectional area with gestational age and foetal anthropometric parameters. This cross sectional study was conducted among healthy women between the 24(th) and 40(th) completed weeks of a normal pregnancy in the Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh during the study period, from July 2009 to June 2011. A total of 230 consecutive normal pregnancy patients were included in the study. The diameter & cross-sectional area of the umbilical cord were measured on a plane adjacent to the junction of the umbilical cord and the fetal abdomen, in cross-section, with maximum magnification of the image. The cord was manually circled, and it's cross sectional areas was automatically calculated by the ultrasonograph. The mean±SD age was 24.3±4.7 years with range from 19 to 36 years. The mean gestational age was 32.1±4.5 weeks and more than a half (56.4%) of the pregnant women were nulliparas. A positive significant (pumbilical cord diameter with bi-parietal diameter (r=0.548); head circumference (r=0.411); abdominal circumference (r=0.444); femur length (r=0.366) and gestational age gestation age (r=0.643). Similarly, a significant (pumbilical cord diameter than cross sectional area with foetal anthropometric parameters.

  15. Estimation of fetal gestational age from ultrasound images

    Science.gov (United States)

    Salari, Valiollah

    1992-06-01

    Estimation of fetal gestational age, weight, and determination of fetal growth from the measurements of certain parameters of fetal head, abdomen, and femur have been well established in prenatal sonography. The measurements are made from the two dimensional, B- mode, ultrasound images of the fetus. The most common parameters measured are, biparietal diameter, occipital frontal diameter, head circumference, femur diaphysis length, and abdominal circumference. Since the fetal head has an elliptical shape and the femur has a linear shape, fitting the ellipse on the image of the fetal head, a line on the image of the femur are the tasks of image processing which are discussed in this paper.

  16. Oral health of children born small for gestational age.

    LENUS (Irish Health Repository)

    O'Connell, A C

    2010-10-01

    We sought to evaluate the oral health status of children born small for gestational age (SGA). Children now aged 4-8 years who were born SGA (birth weight < -2 SDS) were examined using standardised criteria. The parents completed a structured oral health questionnaire. Twenty females and 25 males, mean age 72.1 months, and mean birth weight 2.1 kg, participated in the study. Poor appetite was a concern; 32 (71%) children snacked between meals and 14 (30%) used carbonated beverages more than 3 times daily. Erosion was present in 9 (20%) children. Dental decay occurred in 22 (47%) children with 92% being untreated. Eight children had more than 5 decayed teeth. It is essential that clinicians working with children born SGA include oral health within the general health surveillance and refer these children for a dental assessment within the first 2 years to support parents in establishing safe feeding patterns for their children.

  17. Outcomes of small for gestational age infants born at <27 weeks' gestation.

    Science.gov (United States)

    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

    2013-07-01

    To determine whether small for gestational age (SGA) infants born at impairment at 18-22 months corrected age. 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 impairment was defined as any of the following: cognitive score blindness (bilateral vision impairment. The SGA group comprised 385 infants; the non-SGA group, 2586 infants. Compared with mothers of non-SGA infants, mothers of SGA infants were more likely to have a high school education, prenatal care, cesarean delivery, pregnancy-induced hypertension, and antenatal corticosteroid exposure. Compared with non-SGA infants, SGA infants had higher mortality and were more likely to have postnatal growth failure, prolonged mechanical ventilation, and postnatal steroid use. SGA status was associated with increased risk of death or neurodevelopmental impairment (OR, 3.91; 95% CI, 2.91-5.25; P impairment at 18-22 months corrected age. Copyright © 2013. Published by Mosby, Inc.

  18. Kidney growth in twin children born small for gestational age.

    Science.gov (United States)

    Giapros, Vasileios; Drougia, Aikaterini; Hotoura, Efthalia; Argyropoulou, Maria; Papadopoulou, Frederica; Andronikou, Styliani

    2010-11-01

    Low birth weight (LBW) is associated with adult-onset diseases, including hypertension and renal disease; altered renal development after intrauterine growth restriction (IUGR) may underlie related prenatal programming. No data are available on longitudinal renal growth in twin infants born small for gestational age (SGA). The aim of this prospective longitudinal study was to estimate the renal size during the first 2 years of life in SGA twin infants. The study included 613 children, of which 145 were SGA twins, 141 twins appropriate for gestational age (AGA), 148 matched AGA singletons and 179 matched SGA singletons, classified according to GA into two groups (28-36 and >36 weeks). The SGA children were also classified according to the degree of IUGR: birth weight (BW) kidney length (KL) measurement was performed at the ages of 36 and 40 weeks corrected age (CA) and 3, 6, 12 and 24 months of age, and KL was related to other anthropometric indices. Twin data were examined both as individuals and as members of twin pairs. A total of 2317 measurements were performed. KL was lower at 40 weeks CA in all the SGA twin subgroups. In the SGA twins with GA >36 weeks, KL increased thereafter and became similar to AGA twins and single AGA control subjects. Among pre-term infants of GA <36 weeks, only those with BW 3rd-10th percentile experienced catch-up in KL, while in those with BW <3rd percentile, KL remained lower than in AGA infants throughout the study period, both in absolute terms and relative to other anthropometric indices. No differences in KL were found between twin SGA and singleton SGA or between twin AGA and singleton AGA infants. Intrapair BW differences were correlated with the intrapair differences in KL. Twin SGA infants born prematurely with BW <3rd percentile are unable to achieve catch-up in KL in the first 24 months of life, and long-term follow-up is recommended.

  19. Ultrasound determination of gestational age using placental thickness in female dogs: an experimental study.

    Science.gov (United States)

    Maldonado, André Luiz Louzada; Araujo Júnior, Edward; Mendonça, Débora Sartori; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes; Ajzen, Sérgio Aron

    2012-01-01

    Objective. To verify if the placental thickness allows determining the gestational age, evaluating the correlation between the referred gestational age with the studied one, and the accuracy of the placental thickness measurement (biometry) with fetal morphologic parameters in bitches. Methods. The placental thickness of 336 bitches of diverse breeds was evaluated. Bitches were divided in three groups by body weight: small, medium, and big large size. The gestations pregnancies were evaluated by ultrasound from the third week of gestation. An analysis was performed between the mean values of the gestational age obtained of placental thickness by adjustment of curves and the reported gestational age. Student's t-test was applied to compare the mean of reported and placental thickness gestational age. Significance was defined as P < 0.05. Results. A positive and statistically significant correlation exists between the placental thickness and gestational age. The expression that presents the best correlation coefficient and explanation was thickness of placenta = 0.021x gestational age -0.314. Conclusion. It is possible to determine the gestational age in relation to the placental thickness measured by ultrasound in bitches with a satisfactory accuracy in relation to fetal morphologic parameters as gestational vesicle, ribs, or kidneys.

  20. Ultrasound Determination of Gestational Age Using Placental Thickness in Female Dogs: An Experimental Study

    Directory of Open Access Journals (Sweden)

    André Luiz Louzada Maldonado

    2012-01-01

    Full Text Available Objective. To verify if the placental thickness allows determining the gestational age, evaluating the correlation between the referred gestational age with the studied one, and the accuracy of the placental thickness measurement (biometry with fetal morphologic parameters in bitches. Methods. The placental thickness of 336 bitches of diverse breeds was evaluated. Bitches were divided in three groups by body weight: small, medium, and big large size. The gestations pregnancies were evaluated by ultrasound from the third week of gestation. An analysis was performed between the mean values of the gestational age obtained of placental thickness by adjustment of curves and the reported gestational age. Student's t-test was applied to compare the mean of reported and placental thickness gestational age. Significance was defined as P<0.05. Results. A positive and statistically significant correlation exists between the placental thickness and gestational age. The expression that presents the best correlation coefficient and explanation was thickness of placenta = 0.021x gestational age −0.314. Conclusion. It is possible to determine the gestational age in relation to the placental thickness measured by ultrasound in bitches with a satisfactory accuracy in relation to fetal morphologic parameters as gestational vesicle, ribs, or kidneys.

  1. Optimizing postpartum care for the patient with gestational diabetes mellitus.

    Science.gov (United States)

    Martinez, Noelle G; Niznik, Charlotte M; Yee, Lynn M

    2017-09-01

    Gestational diabetes mellitus poses well-established risks to both the mother and infant. As >50% of women with gestational diabetes mellitus will develop type 2 diabetes mellitus in their lifetime, performing postpartum oral glucose tolerance testing is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with gestational diabetes mellitus is estimated to be diabetes mellitus. Based on existing evidence, we propose best practices for the postpartum care of women with gestational diabetes mellitus: (1) enhanced patient support for identifying long-term health care providers, (2) patient-centered medical home utilization when possible, (3) patient and provider test reminders, and (4) formalized obstetrician-primary care provider hand offs using the Situation Background Assessment Recommendation (SBAR) mnemonic. These strategies deserve future investigation to solidify a multilevel approach for identifying and preventing the continuum of diabetes. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Maternal age, parity and gestational age on the size of the newborn ...

    African Journals Online (AJOL)

    Objective: To assess birthweight, length and head circumference of live births, and to examine the effect of maternal age, parity and gestational age on birth sizes of the live births. Design: A prospective study. Setting: Tikur Anbessa, Zewditu, Gandhi memorial and St. Pauls hospitals, in Addis Ababa, Ethiopia. Subjects: Four ...

  3. Risk of hearing loss in small for gestational age neonates

    Directory of Open Access Journals (Sweden)

    Melani Rakhmi Mantu

    2011-02-01

    Full Text Available Background Small for gestational age (SGA neonates often have intrauterine growth restriction due to placental insufficiency and chronic hypoxia. These conditions may cause developmental impairment, psychosocial disabilities, or metabolic dysfunction in later life. Previous studies have shown greater incidence of speech and language disabilities, learning impairment, and neuromotor dysfunction in term SGA infants compared to term appropriate for gestational age (AGA infants. Objective To compare hearing loss in SGA and AGA neonates using otoocoustic emission (OAE tests and to study correlations between maternal risk factors and hearing loss in SGA neonates. Methods A cross-sectional study was performed in St. Borromeus Hospital, Limijati Hospital, and Melinda Hospital in Bandung from February to May 2010. Study subjects consisted of full-term neonates born in these three hospitals. A retrospective medical record review was performed for this study. Statistical analysis was done by multivariable logistic-regression. Results There was a total of 4279 subjects in our study, including 100 SGA neonates and 4179 AGA neonates. We observed a greater percentage of OAE 'refer' (indicating abnormal OAE results in the SGA group compared to the AGA group (P<0.001, Z=13.247. For suhjects with OAE 'refer' results, we also analyzed the correlation to the following maternal risk factors: smoking, hypertension, diabetes mellitus and asthma. We also found significant differences between  those with and without each of the four maternal risk factors studied (P< 0.001. By using multivariant analysis to compare SGA and AGA neonates, we found the odds ratio (OR to he 4.34 (95% CI 2.52 to 7.49, P=0.001, meaning the SGA group had a 4.34 times higher risk of hearing loss than the AGA group. Conclusion SGA neonates had a higher risk of hearing loss than AGA neonates. In addition, maternal smoking, hypertension, diabetes mellitus and asthma significantly correlated to

  4. Screening gestational diabetes mellitus: The role of maternal age.

    Directory of Open Access Journals (Sweden)

    Chun-Heng Kuo

    Full Text Available Using a specific cutoff of fasting plasma glucose (FPG to screen gestational diabetes mellitus (GDM can reduce the use of oral glucose tolerance tests (OGTT. Since the prevalence of GDM increases with age, this screening method may not be appropriate in healthcare systems where women become pregnant at older ages. Therefore, we aimed to develop a screening algorithm for GDM that takes maternal age into consideration.We included 945 pregnant women without history of GDM who received 75g OGTT to diagnose GDM in 2011. Screening algorithms using FPG with or without age were developed. Another 362 pregnant women were recruited in 2013-2015 as the validation cohort.Using FPG criteria alone, more GDM diagnoses were missed in women ≥35 years than in women <35 years (13.2% vs. 5.8%, p <0.001. Among GDM women ≥35 years, 63.6% had FPG <92 mg/dL (5.1 mmol/L. Use of the algorithm with an "age plus FPG" cutoff could reduce the use of OGTT (OGTT% from 77.6% to 62.9%, while maintaining good sensitivity (from 91.9% to 90.2% and specificity (from 100% to 100%. Similar reduction in OGTT% was found in the validation cohort (from 86.4% to 76.8%. In the simulation, if the percentage of women ≥35 years were 40% or more, the screening algorithm with an "age plus FPG" cutoff could further reduce OGTT% by 11.0%-18.8%.A screening algorithm for GDM that takes maternal age into consideration can reduce the use of OGTT when women become pregnant at older ages.

  5. [Risk factors for fetal macrosomia in patients without gestational diabetes mellitus].

    Science.gov (United States)

    García-De la Torre, J I; Rodríguez-Valdez, A; Delgado-Rosas, A

    2016-03-01

    Fetal macrosomia is birth weight of 4,000 grams or more, regardless of gestational age, in Mexico representing about 5.4%. Associated with multiple demographic, physiological, metabolic and genetic factors of each population. Determine the risk factors associated with the development of fetal macrosomia in patients without gestational diabetes mellitus. Retrospective, descriptive and comparative study of patients who came to delivery from January 2012 to June 2014, 88 patients, 23 patients with diagnosis of macrosomia, and 65 patients without macrosomia without gestational diabetes mellitus were included. An incidence of fetal macrosomia of 18.6%. Risk factors such as parity, history of fetal macrosomia, maternal age, maternal height more to 1.70 meters showed no difference, the percentage of overweight 105% showed 69% vs 52% on the control group and gestational diabetes screening altered that present 30.4 vs 20%. Increased incidence of macrosomia was demonstrated in patients with metabolic factors such as the percentage of overweight and screening altered gestational diabetes mellitus, as they showed higher prevalence in the study group, all modifiable with preconception nutritional management and during pregnancy, to reduce initial weight and weight gain, improved fasting and postprandial blood glucose in patients with positive screening and negative tolerance curve carbohydrates to maintain fetal growth curve with in the percentiles.

  6. Relative Effects of Age, Race, and Stage on Mortality in Gestational Choriocarcinoma.

    Science.gov (United States)

    Tarney, Christopher M; Tian, Chunqiao; Craig, Eric R; Crothers, Barbara A; Chan, John K; Gist, Glenn D; Bateman, Nicholas W; Conrads, Thomas P; Hamilton, Chad A; Larry Maxwell, George; Darcy, Kathleen M

    2018-02-01

    Gestational choriocarcinoma is a malignant form of gestational trophoblastic disease that usually arises after a molar pregnancy, but may follow any antecedent pregnancy. Investigations in this rare cancer are limited. We evaluated the prognostic effects of age, race, and stage in choriocarcinomas diagnosed for 4 decades. Patients diagnosed as having gestational choriocarcinoma between 1973 and 2014 from the Surveillance, Epidemiology, and End Results program were eligible. Relationships with overall survival and cancer-specific survival were evaluated using log-rank testing and Cox modeling. Multivariate analyses included adjustments for age, race, and stage. There were 947 patients with choriocarcinoma including 403 non-Hispanic white (NHW) patients, 473 with distant stage, and 142 who died. Median age at diagnosis was 25 years for non-Hispanic black (NHB) patients and 35 years for Asian/Pacific Islanders (API) compared with 29 years for NHW patients (P = 0.0001). Five-year overall survival varied between 82% and 92% when diagnosed at the age of at least 40 years compared with less than 20 years (P < 0.0001), and from 85% to 95% in patients with distant vs local disease (P < 0.0001), respectively. Multivariate analysis demonstrated that age, race, and stage were independent predictors of mortality. Risk of death increased incrementally in patients diagnosed at 20 to 39 years of age (adjusted hazard ratio [aHR], 3.87; 95% confidence interval [CI], 1.69-8.86; P = 0.001) and at least 40 years of age (aHR, 7.18; 95% CI, 2.95-17.49; P < 0.0001) compared with 20 years or younger. Non-Hispanic black patients were the only racial group at higher risk of death compared with NHW patients (aHR, 1.86; 95% CI, 1.22-2.82; P < 0.004). Distant vs local disease added an additional risk of death (aHR, 2.43; 95% CI, 1.57-3.75; P < 0.0001) over that attributable to age at diagnosis and NHB race. Similar relationships to cancer-specific survival were also observed (P < 0.05). Most

  7. Enamel defect of deciduous teeth in small gestational age children

    Directory of Open Access Journals (Sweden)

    Willyanti S Syarif

    2010-06-01

    Full Text Available Background: Enamel defect could be caused by genetic and environmental factors in prenatal period. Meanwhile, prenatal malnutrition could also cause small gestational age (SGA. Small Gestational Age is the term used for a neonatal baby with birthweight below the -2SD normal value or 10th percentile on the intrauterine Lubchenco curve. This condition is due to intra-uterine growth restriction, and eventually ends up with several developmental defects of organs, including teeth. In fact, deciduous tooth development has a critical phase within this development period. Purpose: The aim of this study is not only to find out the incidence of enamel defect in SGA children, but also to know the percentage of SGA risk factor to develop enamel defect. Method: This was a epidemiology research with consecutive admission technique. It consisted of 153 SGA children aged 9–48 months. Next, the Ponderal index was used to assign SGA types, symmetrical or asymmetrical one-in this study 59 and 94 respectively. On the other hand, three hundred and ninety Appropriate for Gestational Age (AGA children aged 4–48 months were also included in the study as a control group. Enamel defect then was determined by intraoral examination, classified into hypoplasia and hypocalcifications. Chi-square test was finally used to determine the relative risk ratio between the SGA and the control AGA children. Result: The result of this research showed that incidence of enamel defect in SGA children was 86.92%, meanwhile, that in AGA children was 23.08%, 66.00% of which were commonly suffered from hypocalcification. With p<0.05 it is also known that SGA children has the risk of enamel defect with hypocalcification, about 79% higher than AGA children. Conclusion: It could be concluded that 79% of SGA children had the risk of deciduous tooth enamel defect with hypocalcification as the most.Latar belakang: Defek email dapat terjadi karena faktor genetik dan lingkungan sistemik yang

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

    Science.gov (United States)

    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…

  9. Growth Patterns of Large for Gestational Age Children up to Age 4 Years

    NARCIS (Netherlands)

    Bocca-Tjeertes, Inger F. A.; Kerstjens, Jorien M.; Reijneveld, Sijmen A.; Veldman, Karin; Bos, Arend F.; de Winter, Andrea F.

    OBJECTIVE:To determine how growth of large for gestational age (LGA) preterm (PT) children was affected by their PT birth and their LGA status.METHODS:This is a community-based cohort study of 1302 PT and 489 full-term (FT) children, born 2002 and 2003.RESULTS:We found that growth in height, weight,

  10. Pregnant Women's Knowledge and Beliefs about the Safety and Outcomes of Delivery at Various Gestational Ages.

    Science.gov (United States)

    Baldwin, Melody A; Swamy, Geeta K; Wheeler, Sarahn M

    2018-01-01

    Objectives  Despite the morbidity associated with late preterm and early-term births, there is limited data on pregnant women's perception of neonatal risk based on gestational age (GA). Therefore, our objective was to determine pregnant women's perception of neonatal risks at varying GAs. Method  Through an anonymous 24-question survey, pregnant women were asked to designate the GA at delivery that is desirable, safe, and defined as full term. Responses were compared based on race, history of preterm birth, and medical comorbidities. Results  Among the 233 survey respondents, the majority (62.9%) desired delivery at 36 to 39 weeks' gestation. Black women were more likely to desire delivery at 28 to 35 weeks compared with other racial/ethnic groups ( p  = 0.005). Women with a history of preterm birth or medical complications were less likely to desire delivery at 40 weeks. More than 40% of respondents thought delivery at 8 months of pregnancy was safe and 40.3% responded that 37 weeks' gestation is considered term. Conclusion  Misconceptions surrounding the definition of a term pregnancy are pervasive and vary by race, obstetric history, and medical comorbidities. Our findings highlight the need for patient education about appropriate gestational length, especially in minority and high-risk populations.

  11. Risk of hearing loss in small for gestational age neonates

    Directory of Open Access Journals (Sweden)

    Melani Rakhmi Mantu

    2011-01-01

    Full Text Available Background Small for gestational age (SGA neonates often have intrauterine growth restriction due to placental insufficiency and chronic hypoxia. These conditions may cause developmental impairment, psychosocial disabilities, or metabolic dysfunction in later life. Previous studies have shown greater incidence of speech and language disabilities, learning impairment, and ncuromotor dysfunction in term SGA infants compared to term appropriate for gestational age (AGA infants. Objective To compare hearing loss in SGA and AGA neonates using otoacoustic emission (OAE tests and to study correlations between maternal risk factors and hearing loss in SGA neonates. Methods A cross-sectional study was performed in St. Borromeus Hospital, Limijati Hospital, and Melinda Hospital in Bandung from February to May 2010. Study subjects consisted of full-term neonates born in these three hospitals. A retrospective medical record review was performed for this Study. Statistical analysis was done by multivariable logistic-regression. Results There was a total of 4279 subjects in our study, including 100 SGA neonates and 4179 AGA neonates. We observed a greater percentage of OAE 'refer' (indicating abnormal OAE results in the SGA group compared to the AGA group (P<0.001, Z=1.3.247. For subjects with OAE ,refer' results, we also analyzed the correlation to the following maternal risk factors: smoking, hypertension, diabetes mellitus and asthma. We also found significant differences between those with and without each of the four maternal risk factors studied (P<0.001. By using multivariant analysis to compare SGA and AGA neonates, we found the odds ratio (OR to be 4.34 (95% CI 2.52 to'7.49, P = 0.001, meaning the SGA group had a 4.34 times higher risk of hearing loss than the AGA group. Conclusion SGA neonates had a higher risk of hearing loss than A(3A neonates. In addition, maternal smoking, hypertension, diabetes mellitus and asthma significantly correlated to

  12. Functional Outcomes at Age 7 Years of Moderate Preterm and Full Term Children Born Small for Gestational Age

    NARCIS (Netherlands)

    Tanis, Jozien C; van Braeckel, Koenraad N J A; Kerstjens, Jorien M; Bocca-Tjeertes, Inger F A; Reijneveld, Sijmen A; Bos, Arend F

    OBJECTIVE: To compare functional outcomes of 7-year-old (school-age) children born small for gestational age (SGA; ie, a birth weight z score ≤ -1 SD), with appropriate for gestational age (AGA) peers, born moderately preterm or full term. STUDY DESIGN: Data were collected as part of the

  13. Are gestational age and endometrial thickness alternatives for serum human chorionic gonadotropin as criteria for the diagnosis of ectopic pregnancy?

    NARCIS (Netherlands)

    Mol, B. W.; Hajenius, P. J.; Engelsbel, S.; Ankum, W. M.; van der Veen, F.; Hemrika, D. J.; Bossuyt, P. M.

    1999-01-01

    OBJECTIVE: To compare gestational age and endometrial stripe thickness measurement with serum hCG measurement as criteria for the diagnosis of ectopic pregnancy (EP). DESIGN: Prospective study. SETTING: Two large teaching hospitals in Amsterdam, The Netherlands. PATIENT(S): Three hundred fifty-four

  14. Pain behaviours in Extremely Low Gestational Age infants.

    Science.gov (United States)

    Gibbins, Sharyn; Stevens, Bonnie; Beyene, Joseph; Chan, P C; Bagg, Marie; Asztalos, Elizabeth

    2008-07-01

    To date, there are over 40 infant pain measures. Despite this plethora of measures, only 8 have included preterm infants and only 2 have included Extremely Low Gestational Age (ELGA; infants eye squeeze, nasolabial furrow, vertical mouth stretch) increased immediately following the heel lance. There were no specific changes in physiological, body movement or cortisol indicators following the heel lance. ELGA infants demonstrated greater body movements during the diaper change, which may reflect immature motor coordination. No differences in pain responses were found for infants born between 23-25 6/7 weeks GA and those between 26-28 weeks GA. Similarly, no gender differences were found. Changes in 4 facial actions were the most sensitive indicators of pain in ELGA infants. This finding is consistent with existing measures where facial actions are the most prominent pain indicators. Specific body movements such as those included in NIDCAP, may provide more information about pain in ELGA infants. Movements such as hand-on-face, finger splaying, fisting, arching or yawning need to be examined in future research.

  15. [Definitions: small for gestational age and intrauterine growth retardation].

    Science.gov (United States)

    Ego, A

    2013-12-01

    Screening for intrauterine growth restriction (IUGR) is a major component of antenatal care, but the debate about the choice of birthweight standards is longstanding. The objective of this first chapter is to provide guidelines about optimal definition of IUGR. Literature review about available birthweight curves to define IUGR, including the analysis of their diagnosis accuracy and their relevance to identify babies at risk of poor perinatal outcomes. Intrauterine growth curves are more suitable for "normal" growth modeling than birth weight curves, and fetal growth is influenced by individual characteristics, fetal gender being the most important among them (EL2). Infants with a low birth weight are either constitutionally small babies or babies with pathological fetal growth failure. Use of "SGA" for all Small for Gestational Age infants is now recommended, "IUGR" being appropriate only for infants with pathological growth restriction (Professional consensus). Depending on reference curves, identified SGA babies and pregnancy outcomes may be different. Customized birth weight standards are based on an intrauterine growth modeling adjusted for fetal gender, maternal height, weight and parity, and appear to be the most accurate to identify SGA births at risk (EL3). However, their benefit on perinatal morbidity and mortality has not been demonstrated by prospective studies. Benefits and drawbacks of customized birth weight curves seem in favor of their use. Their application in ante and postnatal investigations is a real opportunity to standardize clinical practice and make information provided to parents more consistent. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Gestational age at initiation of antenatal care in a tertiary hospital ...

    African Journals Online (AJOL)

    Gestational age at initiation of antenatal care in a tertiary hospital, Southwestern Nigeria. ... care is still prevalent in our environment. Therefore, pregnant women should be adequately informed about the concept of early antenatal registration. Keywords: Antenatal care, gestational age, initiation, Nigeria, Southwestern ...

  17. The influence of parity on the gestational age at booking among ...

    African Journals Online (AJOL)

    Antenatal care utilization is influenced by several factors. Due to our peculiar socioeconomic and cultural circumstances, gestational age at booking may be affected by certain variables. The aim of this study was to determine the influence of parity and other socio demographic factors on gestational age at booking amongst ...

  18. New insights in factors influencing growth in children born small for gestational age

    NARCIS (Netherlands)

    J.S. Renes (Judith)

    2013-01-01

    markdownabstract__Abstract__ Small for gestational age (SGA) refers to the size of an infant at birth. It is defined as a birth weight and/ or birth length of at least two standard deviation scores (SDS) below the mean for gestational age (1, 2). SGA children can be born full-term or premature.

  19. Interrelationships of Maternal Serum Leptin, Body Mass Index and Gestational Age

    Directory of Open Access Journals (Sweden)

    Ming-Jie Yang

    2005-10-01

    Conclusion: Maternal serum leptin concentration was significantly related to gestational age (except in the first trimester and BMI in the 3 trimesters and throughout pregnancy. Serum leptin concentration peaked during the early third trimester and declined significantly thereafter. Maternal BMI was related to gestational age in the second trimester and the whole pregnancy.

  20. Trends in All-Cause Mortality across Gestational Age in Days for Children Born at Term

    Science.gov (United States)

    Wu, Chun Sen; Sun, Yuelian; Nohr, Ellen Aagaard; Olsen, Jørn

    2015-01-01

    Background Term birth is a gestational age from 259 days to 293 days. However trends in mortality according to gestational ages in days have not yet been described in this time period. Methods and Findings Based on nation-wide registries, we conducted a population-based cohort study among all children born at term in Denmark from 1997 to 2004 to estimate differences in mortality across gestational ages in days among singletons born at term. We studied early-neonatal mortality, neonatal mortality, infant mortality, and five-year mortality. Children were followed from birth up to the last day of the defined mortality period or December 31, 2009. A total of 360,375 singletons born between 259 and 293 days of gestation were included in the study. Mortality decreased with increasing gestational age in days and the highest mortality was observed among children born at 37 week of gestation. A similar pattern was observed when analyses were restricted to children born to by mothers without pregnancy complications. Conclusions This study demonstrates heterogeneity in mortality rates even among singletons born at term. The highest mortality was observed among children born 37 weeks of gestation, which call for cautions when inducing labor in term pregnancies just reaching 37 weeks of gestation. The findings support that 37 weeks of gestation should be defined as early term. PMID:26656842

  1. Perinatal outcomes of polyhydramnios without associated congenital fetal anomalies after the gestational age of 20 weeks.

    Science.gov (United States)

    Chen, Kuang-Chao; Liou, Jui-Der; Hung, Tai-Ho; Kuo, Dong-Ming; Hsu, Jenn-Jeih; Hsieh, Ching-Chang; Hsieh, Tsang-Tang

    2005-04-01

    Polyhydramnios carries a high rate of complications during pregnancy and adverse perinatal outcomes. We could find no studies of this condition in a large Asian population. The aim of this investigation was to evaluate the risks of adverse perinatal outcomes in a large study population with polyhydramnios without associated fetal anomalies after the gestational age of 20 weeks in Taiwan. We retrospectively reviewed the computerized records of women who had babies without associated fetal anomalies after the gestational age of 20 weeks at Chang Gung Memorial Hospital from July 1990 to December 2001. Possible confounding factors that could affect the occurrence of polyhydramnios were analyzed. We then investigated the relative risks of these events to adverse perinatal outcome by adjusting the variants. Significantly higher incidences of preeclampsia, placental abruption, placenta accreta, past history of fetal death or preterm delivery, multiple pregnancy, bodyweight gain > or = 20kg during pregnancy and primiparity were noted in patients with polyhydramnios than in patients without this condition. The presence of polyhydramnios significantly increased the rate of preterm delivery, low birth weight or very low birth weight, low one- and five-minute Apgar scores, fetal death, large for gestational age babies, meconium-stained amniotic fluid, Cesarean section, fetal distress in labor, NICU transfer and neonatal death. Polyhydramnios carried a higher incidence of adverse perinatal outcomes, such as low Apgar scores, fetal death, fetal distress in labor, NICU transfer and neonatal death, despite exclusion of congenital anomalies from the study population. Detailed antepartum fetal well-being surveillance, intensive intrapartum monitoring and further attention postpartum are warranted in patients with this condition.

  2. Gestational, perinatal and family findings of patients with Patau syndrome

    OpenAIRE

    Rosa, Rafael Fabiano M.; Sarmento, Melina Vaz; Polli, Janaina Borges; Groff, Daniela de Paoli; Petry, Patrícia; de Mattos, Vinícius Freitas; Rosa, Rosana Cardoso M.; Trevisan, Patrícia; Zen, Paulo Ricardo G.

    2013-01-01

    OBJECTIVE: To describe gestational, perinatal and family findings of patients with Patau syndrome (PS). METHODS: The study enrolled patients with PS consecutively evaluated during 38 years in a Clinical Genetics Service of a pediatric referral hospital in Southern Brazil. The clinical data and the results of cytogenetic analysis were collected from the medical records. For statistical analysis, the two-tailed Fisher's exact test and the chi-square test with Yates' correction were used, b...

  3. Evaluating the Agreement of Risk Categorization for Fetal Down Syndrome Screening between Ultrasound-Based Gestational Age and Menstrual-Based Gestational Age by Maternal Serum Markers.

    Science.gov (United States)

    Chaksuwat, Pakorn; Sirichotiyakul, Supatra; Luewan, Suchaya; Tongsong, Theera

    2018-01-01

    To evaluate the agreement of risk categorization for Down syndrome screening between ultrasound scan-based gestational age (GA) and last menstrual period-based gestational age in both first and second trimesters by maternal serum markers. Data comprising 4,055 and 4,016 cases of first and second trimester screening were used. The maternal serum markers were analyzed using the ultrasound-based GA and menstrual age. The subjects whose menstrual age and ultrasound-based GA fell in different trimesters were excluded because the risk could not be calculated due to the different serum markers used in each trimester. The agreement of risk categorization for fetal Down syndrome was evaluated. The agreement of Down syndrome screening in the first and the second trimesters were 92.7% and 89%, respectively. The study found a good agreement of risk categorization by Kappa index, which was 0.615 for the overall screening. The menstrual age had a slight decrease in the detection rate and a lower false-positive rate. Menstrual age is acceptable in cases of accurate last menstrual period. However, in places where ultrasonography is not readily available, gestational age estimation by menstrual age along with clinical examination that corresponds to the gestational age can be reliable.

  4. [Family doctor clinical aptitude confronting gestational diabetes patients].

    Science.gov (United States)

    Pivaral, Carlos Enrique Cabrera; Clara, Elizabeth Rivera; Peña, Luz María Adriana Balderas; Centeno, Mayari Cabrera; Reynoso, Carlos Alonso

    2008-02-01

    Gestational diabetes mellitus complicates 7% of all pregnancies. Recognizing and treating this entity result in a diminished number of materno-fetal complications; this study explores the family physician clinical aptitude to identify risk factors, to diagnose and treat gestational diabetes. Identify clinical aptitude level of family physician to the treatment of diabetes gestational patients. Transversal study to describe the level of clinical aptitude in 85 family physicians working in Guadalajara. Were studied: speciality, genre, work condition, working years, working hours, and place of work. The evaluation instrument was designed to this specific purpose and validated by an expert group; were evaluated four indicators: 1) identification of risk factors, 2) diagnosis, 3) use of therapeutic resources and 4) use of paraclinic resources. Confidence coefficient to the assessment instrument was (21 formula from Kuder-Richardson) 0.92 in global evaluation. The global clinical aptitude in the four family medicine units studied was less than 21 points in 41% of physician population and very low (22 a 40 points) in 38% of the evaluated physicians. The clinical aptitude from family physician in gestational diabetes is low, this situation represents an urgent need to design a system to provide to these groups of health providers specialized continuous education to enhance the attention quality to this group of patients in family medicine units.

  5. Use of fetal biometry in the assessment of gestational age in South ...

    African Journals Online (AJOL)

    Results: The nomogram for the femur length (FL) and biparietal diameter (BPD) for the different weeks of gestation (from 13th to the 40th week) were established. Correlation coefficients between gestational age and the various fetal parameters were also reported. Growth charts using both FL and BPD were plotted.

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

    Science.gov (United States)

    Studies on infants/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/children affect white matter development, which was evaluated in this study. Using d...

  7. Donor age and gestational age influence on growth factor levels in human amniotic membrane.

    Science.gov (United States)

    López-Valladares, Maria J; Teresa Rodríguez-Ares, M; Touriño, Rosario; Gude, Francisco; Teresa Silva, M; Couceiro, Jose

    2010-09-01

    Amniotic membrane (AM) is used as a biomaterial for reconstruction in ocular surface surgery. This study investigated the influence of interdonor variations and processing and preservation procedures applied to the AM on growth factors and protein levels.  Samples of human AM from thirteen donors were analysed. Collected donor data were age, parity and gestational age. Total protein amount was measured in extracts of intact AM nonpreserved, lyophilized and cryopreserved, at -80°C and in liquid nitrogen. An enzyme-linked immunosorbent assay (ELISA) was used to assay growth factors protein levels for epidermal growth factor, basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), keratinocyte growth factor (KGF), transforming growth factor beta1 (TFG-β(1) ) and nerve growth factor (NGF). Univariate and multivariate statistical analyses were used to study the influence of the preservation method applied and interdonor variations on growth factors levels. We detected important variations in growth factors and protein concentrations between samples from different donors. Total protein amount, bFGF, HGF, KGF and TGF-β(1) showed lower levels in samples from donors with higher gestational ages and donor ages, for all groups. The variability in the biochemical composition of AM from different donors is considerable, and it is related with donor factors as donor age and gestational age. As AM biochemical composition has a role in its therapeutic effects, these variations could affect the clinical results of amniotic membrane transplantation and must be taken into account in donor selection processes. © 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.

  8. Determination of gestational age by ultrasonography - wrong, wrong and wrong again?

    International Nuclear Information System (INIS)

    Bratlid, D.

    1991-01-01

    The article is a critical review of principal weaknesses in the current use of ultrasonography for determination of gestational age and discusses the fact that the method in its practical use disregards any biological variation in biparietal diameter. It is concluded that second trimester determination of gestational age by ultrasonography has an accuracy no greater than ±1.5 weeks. This is comparable to the accuracy of the clinical assessment of maturation in the newborn baby. Ultrasonography as the main indicator of gestational age should be used only when the pregnant woman's own menstrual history is obviously incorrect. 6 refs., 1 fig

  9. Trends in All-Cause Mortality across Gestational Age in Days for Children Born at Term

    DEFF Research Database (Denmark)

    Wu, Chun Sen; Sun, Yuelian; Nohr, Ellen Aagaard

    2015-01-01

    BACKGROUND: Term birth is a gestational age from 259 days to 293 days. However trends in mortality according to gestational ages in days have not yet been described in this time period. METHODS AND FINDINGS: Based on nation-wide registries, we conducted a population-based cohort study among all...... children born at term in Denmark from 1997 to 2004 to estimate differences in mortality across gestational ages in days among singletons born at term. We studied early-neonatal mortality, neonatal mortality, infant mortality, and five-year mortality. Children were followed from birth up to the last day...

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

    Science.gov (United States)

    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.

  11. Comparison Of Late Second-Trimester Non-stress Test Characteristics Between Small For Gestational Age And Appropriate For Gestational Age Fetuses

    Directory of Open Access Journals (Sweden)

    Beigy A

    2004-07-01

    Full Text Available Background: The purpose of this study was to compare electronic fetal heart rate monitoring (EFM characteristics between Appropriate for Gestational Age (AGA and Small for Gestational Age (SGA fetuses and to determine whether SGA fetuses have specific abnormalities. Materials and Methods: Among children born from Apr 2002 to Mar 2003 in Arash hospital, we identified 300 singleton infants born after 36 weeks' gestation of uncomplicated pregnancies in whom second-trimester (24-27 weeks' gestation EFM records were obtained. Individual components of fetal heart rate (FHR pattern; baseline rate, baseline FHR variability, presence of acceleration and periodic and episodic deceleration , and birth characteristics were compared between AGA and SGA infants or between pregnancies with or without second-trimester decelerations. Statistical analysis was performed using Student t, Chi square and Fisher exact test. Results: Among 300 infants, 261 (87% were AGA and 39 (13% were SGA; 65 had and 235 did not have second-trimester decelerations. Baseline FHR variability, second- trimester decelerations and intrapartum FHR decelerations were significantly higher in SGA fetuses than in AGA fetuses (P<0.05. Birth weight and gestational age were significantly lower in SGA fetuses than in AGA fetuses (P<0.05. There were no significant differences in baseline rate and acceleration ,maternal age and parity, Apgar score in 1 minute, meconium staining, mode of delivery, NICU admission, between SGA and AGA infants. Small for Gestational Age infants were more frequent in pregnancies with second-trimester decelerations compared with those without second-trimester deceleration (P<0.05. Baseline FHR variability in pregnancies with second-trimester decelerations was significantly higher than in pregnancies without second-trimester deceleration (P<0.05. Conclusion: Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were

  12. Weight gain in pregnancy, maternal age and gestational age in relation to fetal macrosomia.

    Science.gov (United States)

    Li, Yi; Liu, Qi-Fei; Zhang, Dan; Shen, Ying; Ye, Kui; Lai, Han-Lin; Wang, Hai-Qing; Hu, Chuan-Lai; Zhao, Qi-Hong; Li, Li

    2015-04-01

    To investigate the possible risk factors related to macrosomia. Pregnant women and their newborns (n = 1041) were recruited from a cohort study in Maternal and Child Care Center of Hefei from January 2011 to July 2012. Questionnaires were applied to collect the demographic data besides the medical records. Detailed health records of the entire pregnancy were obtained using retrospective study. Meanwhile the data of neonatal outcomes was prospectively tracked. Associations between exposure risk factors and macrosomia were analyzed using Pearson's chi squared test. Logistic regression models were used to assess the independent association between these potential predictors and macrosomia. The incidence of macrosomia of this cohort was 11.24% of which male: female = 2.55:1. Male incidence (8.07%) of macrosomia was higher than female (3.17%), p macrosomia; multiple logistic regression analysis indicated that macrosomia was mainly independently associated with weight gain in pregnancy (OR=1.14, 95% CI [1.10-1.19]), maternal age (OR = 1.09, 95% CI [1.03-1.15]) and gestational age (OR = 1.62, 95% CI [1.31-1.99]), respectively. Our findings indicate that weight gain in pregnancy, maternal age and gestational age should be considered as independent risk factors for macrosomia.

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

    Science.gov (United States)

    ... the National Technical Information Service NCHS Changes in Cesarean Delivery Rates by Gestational Age: United States, 1996– ... origin, National Vital Statistics System The singleton birth cesarean delivery rate increased from 1998 to 2009 but ...

  14. Gestational Thrombocytopenic Patients in Our Center: Analysis of the Patients and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Emel Ebru Özçimen

    2016-02-01

    Full Text Available OBJECTIVE: Gestational thrombocytopenia is the most common cause of the thrombocytopenia in pregnancy. The aim of this study was to determine the prevalence of gestational thrombocytopenia (GT among pregnant women in our center. STUDY DESIGN: Platelet count was analyzed in 452 pregnant women. The patients were divided according to severity of thrombocytopenia. RESULTS: Forty-five patients were thrombocytopenic. Six patients were severe, 16 patients were moderate and 23 patients were mild thrombocytopenic. The prevalence of GT was found 9.9 %. CONCLUSION: Gestational thrombocytopenia is usually observed as mild form.

  15. Small for Gestational Age and Magnesium: Intrauterine magnesium deficiency may induce metabolic syndrome in later life

    OpenAIRE

    Junji Takaya

    2015-01-01

    Magnesium deficiency during pregnancy as a result of insufficient or low intake of magnesium is common in developing and developed countries. Previous reports have shown that intracellular magnesium of cord blood platelets is lower among small for gestational age (SGA) groups than that of appropriate for gestational age (AGA) groups, suggesting that intrauterine magnesium deficiency may result in SGA. Additionally, the risk of adult-onset diseases such as insulin resistance syndrome is greate...

  16. [Short-term outcome and small for gestational age newborn management].

    Science.gov (United States)

    Flamant, C; Gascoin, G

    2013-12-01

    To describe early complications and management of the small for gestational age (SGA) neonate. This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations. Words included in the search mainly were: small for gestational age, intrauterine growth restriction, fetal growth restriction, very low birth weight infants, neonatal management, neonatal outcome, neonatal morbidity, neonatal mortality Neonatal mortality relative risk among SGA infants is 2-4 times higher than adapted for gestational age (AGA) newborn infants, at any gestational age. SGA infants had an increased risk for perinatal asphyxia, hypothermia and hypoglycaemia during their first days of life. In the SGA preterm population, bronchopulmonary dysplasia, pulmonary hypertension and necrotising enterocolitis are significantly more frequent as compared with AGA population. Periventricular leukomalacia is not significantly different between SGA and AGA infants whereas intraventricular hemorrhage and retinopathy risks are discussed. Adaptive problems require paediatric contact before birth. Early management of the small for gestational age includes intervention to prevent hypothermia, the use of pressure controlled ventilator if needed, and close blood glucose monitoring. SGA infants had excess neonatal mortality and morbidity in comparison with adapted ones for gestational age (AGA) infants, especially for preterm infants. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. The accuracy of gestational age predicted from femur and humerus length in Saanen goats using ultrasonography

    Directory of Open Access Journals (Sweden)

    Mohamed Abdelghafar Rihab

    2012-01-01

    Full Text Available Serial transabdominal ultrasonographic scanning was performed to measure femur and humerus length of foetuses of Saanen goats to establish their gestational stage. Data were obtained from 38 goats that became pregnant after artificial insemination. Animals were restrained in a supine position on a special table designed for this purpose. Humerus and femur length were measured at weekly intervals starting from week 8 of gestation till the end of gestation. Real-time ultrasound scanner equipped with switchable frequency (5-7.5 MHz micro convex probe was used in the present study. Humerus and femur length showed strong positive correlation with gestational age (r2 = 0.95. Measurements of humerus and femur of foetuses are useful indicators to predict gestational age at the 2nd and 3rd trimesters in Saanen goats. Measuring of only one bone length is quite enough. Incorporating of both measurements within a multiple regression equation did not improve predictive capacity of the bones. The results of the study were used to construct reference charts and gestational equations in Saanen goats utilizing humerus and femur measurements. In Sudan, this is the first study utilizing measurements of the femur and humerus and the first study comparing the length of the humerus and femur for predicting gestational age in Saanen goats.

  18. Risk for developmental coordination disorder correlates with gestational age at birth

    DEFF Research Database (Denmark)

    Zhu, Jin Liang; Olsen, Jørn; Olesen, Annette Wind

    2012-01-01

    BACKGROUND: Studies suggest that children born very preterm have a high risk of developmental coordination disorder (DCD). We examined the relation between the larger spectrum of gestational age at birth and the risk of DCD. METHODS:   We used the 7-year follow-up data from 22898 singletons...... in the Danish National Birth Cohort. We calculated a total score from the Developmental Coordination Disorder Questionnaire (DCDQ), incorporated in the 7-year follow-up, and defined children with a score of 46 or below as having probable DCD. Information on gestational age was obtained from the Medical Birth...... of DCD was seen for children born post-term. CONCLUSION: Our data indicate that short gestational age at birth in a range up to gestational week 37 is related to an increased risk of DCD....

  19. Appendectomy and pregnancy: gestational age does not affect the position of the incision.

    Science.gov (United States)

    de Moya, Marc A; Sideris, Antonios C; Choy, Garry; Chang, Yuchiao; Landman, Wendy B; Cropano, Catrina M; Cohn, Stephen M

    2015-03-01

    The position of the base of the appendix during advancing gestational age is based on inadequate data. Therefore, the proper location for an appendectomy incision during pregnancy is highly unclear. This study investigated the location of the appendix during pregnancy to determine the optimal location for an incision in pregnant patients with appendicitis relative to McBurney's point. Magnetic resonance images (MRIs) were reviewed independently by two fellowship-trained abdominal MRI radiologists blinded to the imaging report. The distance of the appendix from anatomic landmarks was measured in a total of 114 pregnant women with an abdominal or pelvic MRI who were admitted between 2001 and 2011 at a Level I trauma center. Patients with a history of appendectomy were excluded. The distance from the base of the appendix to McBurney's point changed over the course of the gestation by only 1.2 cm and which did not amount to a clinically or statistically significant change in position. Our data provide evidence that there is minimal upward or lateral displacement of the appendix during pregnancy, and therefore its distance from the McBurney's point remains essentially unchanged. These findings justify the use of the McBurney's incision for appendectomy during pregnancy regardless of the trimester.

  20. The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants

    Energy Technology Data Exchange (ETDEWEB)

    Dietz, Kelly R. [University of Minnesota, Department of Radiology, Minneapolis, MN (United States); Zhang, Lei [University of Minnesota, Biostatistical Design and Analysis Center, Minneapolis, MN (United States); Seidel, Frank G. [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States)

    2015-08-15

    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. (orig.)

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

    Science.gov (United States)

    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.

  2. An epigenetic clock for gestational age at birth based on blood methylation data

    DEFF Research Database (Denmark)

    Knight, Anna K.; Craig, Jeffrey M; Theda, Christiane

    2016-01-01

    BACKGROUND: Gestational age is often used as a proxy for developmental maturity by clinicians and researchers alike. DNA methylation has previously been shown to be associated with age and has been used to accurately estimate chronological age in children and adults. In the current study, we...

  3. Effect of dietary approaches to stop hypertension diet plan on pregnancy outcome patients with gestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jie Yao

    2015-12-01

    Full Text Available The purpose of this study is to test the effects of Dietary Approaches to Stop Hypertension (DASH diet plan on pregnancy outcomes patients with gestational diabetes mellitus. This randomized controlled clinical trial was performed among 33 women diagnosed with gestational diabetes. These patients were randomly distributed to the control group (n = 16 or DASH diet group (n = 17 for 4 weeks. Whereas 47.1% of women in the DASH diet needed to have a cesarean section, this percentage of mean gestational age in control diet was 81.3% (p<0.01. Approximately 23.5% of women in the DASH diet and 75% of women in control diet needed to commence insulin therapy after intervention (p<0.01. In conclusion, the effect of DASH diet improved pregnancy outcomes patients with gestational diabetes.

  4. Evaluation of the Normal Fetal Kidney Length and Its Correlation with Gestational Age

    OpenAIRE

    Farrokh Seilanian Toosi; Hossein Rezaie-Delui

    2013-01-01

    A true estimation of gestational age (GA) plays an important role in quality maternity care and scheduling the labor date. This study aimed to evaluate the normal fetal kidney length (KL) and its correlation with GA. A cross-sectional study on 92 pregnant women between 8th and 10th week of gestation with normal singleton pregnancy underwent standard ultrasound fetal biometry and kidney length measurement. univariate and multivariate linear regression analysis was used to create a predictive e...

  5. Gender- and Gestational Age-Specific Body Fat Percentage at Birth.

    LENUS (Irish Health Repository)

    Hawkes, Colin P

    2011-08-08

    Background: There is increasing evidence that in utero growth has both immediate and far-reaching influence on health. Birth weight and length are used as surrogate measures of in utero growth. However, these measures poorly reflect neonatal adiposity. Air-displacement plethysmography has been validated for the measurement of body fat in the neonatal population. Objective: The goal of this study was to show the normal reference values of percentage body fat (%BF) in infants during the first 4 days of life. Methods: As part of a large population-based birth cohort study, fat mass, fat-free mass, and %BF were measured within the first 4 days of life using air-displacement plethsymography. Infants were grouped into gestational age and gender categories. Results: Of the 786 enrolled infants, fat mass, fat-free mass, and %BF were measured in 743 (94.5%) infants within the first 4 days of life. %BF increased significantly with gestational age. Mean (SD) %BF at 36 to 37 weeks\\' gestation was 8.9% (3.5%); at 38 to 39 weeks\\' gestation, 10.3% (4%); and at 40 to 41 weeks\\' gestation, 11.2% (4.3%) (P < .001). Female infants had significantly increased mean (SD) %BF at 38 to 39(11.1% [3.9%] vs 9.8% [3.9%]; P = .012) and at 40 to 41 (12.5% [4.4%] vs 10% [3.9%]; P < .001) weeks\\' gestation compared with male infants. Gender- and gestational age-specific centiles were calculated, and a normative table was generated for reference. Conclusion: %BF at birth is influenced by gestational age and gender. We generated accurate %BF centiles from a large population-based cohort.

  6. Universal gestational age effects on cognitive and basic mathematic processing : 2 cohorts in 2 countries

    OpenAIRE

    Wolke, Dieter; Strauss, Vicky Yu-Chun; Johnson, Samantha J.; Gilmore, Camilla; Marlow, Neil; Jaekel, Julia

    2015-01-01

    Objective:\\ud To determine whether general cognitive ability, basic mathematic processing, and mathematic attainment are universally affected by gestation at birth, as well as whether mathematic attainment is more strongly associated with cohort-specific factors such as schooling than basic cognitive and mathematical abilities.\\ud \\ud Study design:\\ud The Bavarian Longitudinal Study (BLS, 1289 children, 27-41 weeks gestational age [GA]) was used to estimate effects of GA on IQ, basic mathemat...

  7. Universal Gestational Age Effects on Cognitive and Basic Mathematic Processing: 2 Cohorts in 2 Countries

    OpenAIRE

    Wolke, Dieter; Strauss, Vicky Yu-Chun; Johnson, Samantha; Gilmore, Camilla; Marlow, Neil; Jaekel, Julia

    2015-01-01

    Objective To determine whether general cognitive ability, basic mathematic processing, and mathematic attainment are universally affected by gestation at birth, as well as whether mathematic attainment is more strongly associated with cohort-specific factors such as schooling than basic cognitive and mathematical abilities. Study design The Bavarian Longitudinal Study (BLS, 1289 children, 27-41?weeks gestational age [GA]) was used to estimate effects of GA on IQ, basic mathematic processing, ...

  8. Maternal education and stillbirth: estimating gestational-age-specific and cause-specific associations.

    Science.gov (United States)

    Auger, Nathalie; Delézire, Pauline; Harper, Sam; Platt, Robert W

    2012-03-01

    Associations between risk factors and perinatal outcomes may be biased at preterm gestational ages, if preterm delivery behaves as an effect modifier due to other unmeasured factors in the causal pathway. We evaluated whether fetuses-at-risk denominators could be used in regression models instead of conventional denominators to obtain less biased estimates of the association between maternal education and stillbirth at preterm gestational intervals. Data included 2,143,134 live-born and 8946 stillborn singletons from 1981 through 2006 in Québec, Canada. Odds ratios and 95% confidence intervals were estimated for the relationship between education and stillbirth according to cause of fetal death, adjusting for maternal age, marital status, home language, parity, and period. We examined associations for 4 gestational intervals (education at all gestational intervals. Using conventional denominators, low education (relative to high education) was more strongly associated with term than preterm stillbirth and was apparently protective at education was more strongly associated with preterm stillbirth than term stillbirth, even at education was most strongly associated with diabetic-related stillbirth at ≥28 weeks (odds ratio = 5.04) relative to high education. Low education is associated with stillbirth throughout gestation, especially diabetic-related stillbirth. Use of fetuses-at-risk denominators in regression models can avoid potentially biased estimates obtained with conventional denominators at preterm gestational ages.

  9. Risks of small-for-gestational-age births in immigrants: a nationwide epidemiological study in Sweden.

    Science.gov (United States)

    Li, Xinjun; Sundquist, Kristina; Sundquist, Jan

    2012-11-01

    To examine if there is an association between country of birth in parents and small-for-gestational-age (defined as a birthweight of more than two standard deviations (SDs) below the mean) in first singletons births. In this follow-up study, national population and healthcare registers were used to identify small-for-gestational-age births in all first singleton births in Sweden between 1 January 1982 and 31 December 2006. Odds ratios, standardised with regard to maternal age at birth, period of birth, marital status, family income, geographical region, employment, maternal height, and smoking history, were estimated by maternal and paternal country of birth. Singletons with both parents born in Sweden were used as reference group. There were 1,060,467 records for first singletons births over the study period, of whom 3.5% were small-for-gestational-age. The rate was higher in newborns with non-Swedish born than in those with Swedish born mothers (4.1 and 3.3%, respectively). Immigrants from Southern European countries, Africa, and Asia had higher risks of small-for-gestational-age in than those in the reference group, and the risks were even higher in compatriot parents. Country of birth affected the risk of small-for-gestational-age. Maternity care should pay a special attention to pregnancies in certain population groups.

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

    Science.gov (United States)

    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.

  11. Neu-Laxova syndrome in an appropriate for gestational age newborn

    Directory of Open Access Journals (Sweden)

    Dilli Dilek

    2008-01-01

    Full Text Available Neu-Laxova syndrome is a rare lethal congenital disorder involving multiple systems. Intrauterine growth retardation, ichthyosis, microcephaly, abnormal facial findings, and limb contractures are its key features. We present a case of Neu-Laxova syndrome in a male appropriate for gestational age (AGA newborn with characteristic features including ichthyosis, microcephaly, severe ectropion, rudimentary ears, eclabion, limb contractures, and hypoplastic genitalia. The patient was born at 38 weeks of gestation to consanguinous Turkish parents. The mother was a 20-year-old primi gravida with lack of prenatal follow-up. Therefore, the case was diagnosed postnatally, and he died 5 days later. Because of the autosomal recessive inheritance of Neu-Laxova syndrome, in countries with high rates of consanguineous marriage, such as Turkey, physicians have to know this syndrome, and serial prenatal ultrasound examinations with genetic counseling should be performed on pregnant women at high risk. To the best of our knowledge, this is the first case described in an AGA newborn.

  12. Adult height of prepubertal short children born small for gestational age treated with GH.

    Science.gov (United States)

    Rosilio, Myriam; Carel, Jean-Claude; Ecosse, Emmanuel; Chaussainon, Jean-Louis

    2005-06-01

    Human GH (hGH) treatment leads to catch-up growth in children with short stature born small for gestational age (SGA). However, long-term efficacy and safety results in this patient group remain scarce. The present study assessed the efficacy and safety of late childhood treatment with biosynthetic hGH (Humatrope) in a group of short children born SGA (height hGH dose of 0.067 mg/kg for 2 years, and then received no treatment for the following 2 years. After the fourth year on study, patients whose height had decreased more than 0.5 SDS but who still showed growth potential based on bone age were allowed to resume treatment until they reached adult height. Height gain SDS was assessed for 11 girls and 24 boys (mean age+/-s.d. 9.6+/-0.9 years) at the end of the 2 years of hGH treatment, during the subsequent 2-year off-treatment period, and upon reaching adult height. At the end of the initial 2-year treatment period, 83% of patients had reached a height within the normal range, with a mean increase in height SDS vs baseline of 1.3+/-0.3 (P Fasting glucose and glycosylated hemoglobin levels were not significantly modified during treatment. High-dose hGH treatment for a minimum of 2 years in short children born SGA was well tolerated and resulted in a significant increase in adolescent and adult height.

  13. Low-Dose Aspirin in Early Gestation for Prevention of Preeclampsia and Small-for-Gestational-Age Neonates: Meta-analysis of Large Randomized Trials.

    Science.gov (United States)

    Roberge, Stéphanie; Sibai, Baha; McCaw-Binns, Affette; Bujold, Emmanuel

    2016-07-01

    Objectives Meta-analyses of small to moderate size randomized controlled trials (RCTs) suggested that aspirin started before 17 weeks' gestation reduces the risk of preeclampsia and small-for-gestational-age (SGA) neonates. We evaluated data from large randomized trials originally excluded from meta-analyses. Methods We performed meta-analyses of RCTs including more than 350 participants that compared aspirin to placebo during pregnancy. Corresponding authors were contacted to obtain data according to gestational age. Outcomes included preeclampsia, severe preeclampsia, and SGA. Relative risks (RRs) with their 95% confidence intervals (CIs) were calculated. Results Data for women recruited before 17 weeks' gestation were obtained for three (50%) of the six eligible trials for a total of 11,949 participants including 3,293 recruited before 17 weeks' gestation with available data. We observed no impact of low-dose aspirin (60 mg) started before 17 weeks' gestation on the risk of preeclampsia (RR: 0.93; 95% CI: 0.75-1.15), severe preeclampsia (RR: 0.96; 95% CI: 0.71-1.28), or SGA (RR: 0.84; 95% CI: 0.56-1.26) and it was not statistically different than when started at or after 17 weeks' gestation. Conclusion Data from large randomized trials do not support greater benefits of low-dose aspirin (at 60 mg daily) when started before 17 weeks' gestation for the prevention of preeclampsia or SGA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Functioning at school age of moderately preterm children born at 32 to 36 weeks' gestational age.

    Science.gov (United States)

    van Baar, Anneloes L; Vermaas, John; Knots, Edwin; de Kleine, Martin J K; Soons, Paul

    2009-07-01

    To study outcome of low-risk moderately preterm birth between 32 and 36/7 weeks' gestation. 377 Moderately preterm children (M: 34.7, SD: 1.2 complete weeks), without need for neonatal intensive care and without dysmaturity or congenital malformations, were compared with 182 term children and assessed at eight years (M: 8.9, SD: 0.54). School situation, IQ, sustained attention, behavior problems, and attention-deficit/hyperactivity characteristics were studied. Special education was attended by 7.7% of the moderately preterm children, more than twice the rate of 2.8% in the general Dutch population of this age. Additional exploration for two preterm subgroups of 32 to 33 versus 34 to 36 weeks' gestation showed a need for special education in 9.7% versus 7.3% and a significant difference in grade retention for 30% versus 17%, respectively. Of the children attending mainstream primary schools, grade retention was found in 19% of the preterm versus 8% of the comparison children. Adjusting for maternal education, a group difference of 3 points was found in IQ. The preterm children needed more time for the sustained attention task. The preterm children had more behavior problems (specifically internalizing problems with 27% scoring above the borderline cut-off), as well as more attention-deficit/hyperactivity disorder characteristics (specifically attention deficits). Cognitive and emotional regulation difficulties affect functioning of moderately preterm children, as school problems, a slightly lower IQ, attention and behavioral problems are found when they are compared with term-born children. Identification and monitoring of precursors of these problems at younger age is needed in view of prevention purposes.

  15. Puberty in growth hormone-treated children born small for gestational age (SGA)

    NARCIS (Netherlands)

    V.H. Boonstra (Venje); Y. van Pareren; P.G.H. Mulder (Paul); A.C.S. Hokken-Koelega (Anita)

    2003-01-01

    textabstractSeventy-five small for gestational age (SGA) children were studied in a randomized, double-blind, dose-response GH trial with either 1 or 2 mg GH/m(2).d. Mean (SD) age at the start of GH therapy was 7.3 (2.2) yr. Data were compared with Dutch reference data. In SGA

  16. Cognitive Functioning in Toddlerhood: The Role of Gestational Age, Attention Capacities, and Maternal Stimulation

    Science.gov (United States)

    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.…

  17. The risk of intrauterine fetal death in the small-for-gestational-age fetus

    Science.gov (United States)

    Pilliod, Rachel A.; Cheng, Yvonne W.; Snowden, Jonathan M.; Doss, Amy E.; Caughey, Aaron B.

    2013-01-01

    OBJECTIVE We sought to evaluate the risk of intrauterine fetal death (IUFD) in small-for-gestational-age (SGA) fetuses. STUDY DESIGN We analyzed a retrospective cohort of all births in the United States in 2005, as recorded in a national database. We calculated the risk of IUFD within 3 sets of SGA threshold categories as well as within non-SGA pregnancies using the number of at-risk fetuses as the denominator. RESULTS The risk of IUFD increased with gestational age and was inversely proportional to percentile of birthweight for gestational age. The risk for IUFD in those <3rd percentile was as high as 58.0 IUFDs per 10,000 at-risk fetuses, 43.9 for <5th percentile, and 26.3 for <10th percentile compared to 5.1 for non-SGA gestations. CONCLUSION There is an increase in the risk of IUFD in SGA fetuses compared to non-SGA fetuses at all gestational ages with the greatest risk demonstrated in the lowest percentile cohort evaluated. PMID:23021697

  18. Executive Functions of Six-Year-Old Boys with Normal Birth Weight and Gestational Age

    Science.gov (United States)

    Phua, Desiree Yee-Ling; Rifkin-Graboi, Anne; Saw, Seang-Mei; Meaney, Michael J.; Qiu, Anqi

    2012-01-01

    Impaired fetal development, reflected by low birth weight or prematurity, predicts an increased risk for psychopathology, especially attention deficit hyperactivity disorder (ADHD). Such effects cut across the normal range of birth weight and gestation. Despite the strength of existing epidemiological data, cognitive pathways that link fetal development to mental health are largely unknown. In this study we examined the relation of birth weight (>2500 g) and gestational age (37–41 weeks) within the normal range with specific executive functions in 195 Singaporean six-year-old boys of Chinese ethnicity. Birth weight adjusted for gestational age was used as indicator of fetal growth while gestational age was indicative of fetal maturity. Linear regression revealed that increased fetal growth within the normal range is associated with an improved ability to learn rules during the intra/extra-dimensional shift task and to retain visual information for short period of time during the delayed matching to sample task. Moreover, faster and consistent reaction times during the stop-signal task were observed among boys born at term, but with higher gestational age. Hence, even among boys born at term with normal birth weight, variations in fetal growth and maturity showed distinct effects on specific executive functions. PMID:22558470

  19. Inflammatory markers in umbilical cord blood from small-for-gestational-age newborns

    DEFF Research Database (Denmark)

    Lausten-Thomsen, Ulrik; Olsen, Marianne; Greisen, Gorm

    2014-01-01

    This study investigates the role of inflammation in intrauterine growth retardation by exploring the levels of inflammatory markers in umbilical cord blood from neonates who were born small-for-gestational-age (SGA) and comparing them to neonates who were born appropriate-for-gestational-age (AGA......). Interleukin 6 (IL-6), Tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were measured by standard methods in term or near-term (gestational age >36 weeks) neonates born SGA (n = 45) and a matched group of neonates born AGA (n = 45). Infants exposed to maternal chronic diseases, diabetes or pre...... of elevated inflammatory markers in the cord blood from SGA infants compared to AGA infants, and consequently the results suggest an inflammatory component in intrauterine growth restriction (IUGR)....

  20. Respiratory morbidity in twins by birth order, gestational age and mode of delivery.

    Science.gov (United States)

    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 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 birth order have a gestational age dependent effect on the incidence of RDS.

  1. Gestational age-specific reference ranges from different laboratories misclassify pregnant women's thyroid status

    DEFF Research Database (Denmark)

    Bliddal, Sofie; Feldt-Rasmussen, Ulla; Boas, Malene

    2014-01-01

    region, the use of gestational-age-specific reference ranges from different laboratories led to misclassification. Up to 100% of maternal FT4 levels fell outside the other cohort's reference range despite similar TSH levels. In clinical practice, thyroid testing of pregnant women without adding method......OBJECTIVES: Correct interpretation of thyroid status during pregnancy is vital to secure fetal development. Pregnancy-related changes in maternal thyroid status necessitate the use of gestational age-specific reference ranges. In this study, we investigated between-laboratory reproducibility...... comparable (P=0.09). Up to 90.3% of the women had FT4 levels outside their laboratory's nonpregnant reference range, and up to 100% outside the other cohort's gestational-age-specific reference ranges. Z-score-based reference ranges markedly improved comparison between cohorts. CONCLUSION: Even in the same...

  2. Socioeconomic disparities in small-for-gestational-age birth and preterm birth.

    Science.gov (United States)

    Bushnik, Tracey; Yang, Seungmi; Kaufman, Jay S; Kramer, Michael S; Wilkins, Russell

    2017-11-15

    Maternal socioeconomic disadvantage has been associated with increased risk of small-for-gestational-age birth and preterm birth. Few studies, however, have considered maternal education and income simultaneously to better understand the mechanisms underlying perinatal health disparities. This analysis examines both maternal education and income and their association with the risk of small-for-gestational-age birth and preterm birth. The study is based on 127,694 singleton live births from the 2006 Canadian Birth-Census Cohort, a national cohort of births registered from May 2004 to May 2006 that were linked to the 2006 long-form Census. Unadjusted rates of small-for-gestational-age birth (sex-specific birth weight below the 10th percentile for gestational age) and preterm birth (before 37 completed weeks of gestation) were estimated across selected maternal characteristics. Logistic regression was used to estimate crude and covariate-adjusted risk ratios of both outcomes according to maternal education and income adequacy quintiles. Small-for-gestational-age birth was associated with both maternal education and income adequacy, while preterm birth was associated with maternal education only. These findings persisted after taking factors including maternal age, ethnicity, and marital status into account. The results suggest that the mechanism by which maternal education is associated with these outcomes is likely not through income, nor does income replace education as a potentially meaningful measure of socioeconomic position. The mechanisms underlying associations between socioeconomic position and perinatal health disparities are complex. The results of this study indicate that more than one socioeconomic factor may play a role.

  3. Does the gestation age of newborn babies influence the ultrasonic assessment of hip condition?

    Directory of Open Access Journals (Sweden)

    Simić Slavica

    2009-01-01

    Full Text Available Introduction. Ultrasound represents a method of examination of hips of newborn babies capable of defining hip condition and distinguishing stable and unstable hips based on morphological elements. It is accepted in a large number of countries as a method of examination of high risk newborns, or as a method of systematic screening. Objective. The objective of this study was to investigate correlation between ultrasonically estimated hip maturity and respective gestation maturity both in premature and term-born babies, and to investigate the influence of different delivery types on hips condition. Methods. In our study 2045 patients, 1141 males and 904 females, were examined in at the Institute of Neonatology over a period of 5 years. The average age was 34.04 gestation weeks. There were significantly more premature (1698 or 83.03% than term-born babies (347 or 16.97%. Ultrasound hip examination, as a screening method, was carried out according to Graf. It was followed by clinical examination. Results were analyzed by appropriate statistical methods (χ2-test, one-way ANOVA, multifactor ANOVA. Results. The overall frequency of unstable hips was 3.2%, 1.88% in males and 4.87% in females (p<0.05. 96.8% babies had stable hips, out of which 35.21% were mature and 61.59% immature. In the study of the breech presentation, out of 183 babies, unstable hips were found in 1.58% of male cases, and in 10.23% of female cases. Conclusion. Clinical screening of developmental dysplasia of the hip is insufficient for early diagnosis and decision about the treatment of premature babies. The high frequency of unstable hip type IIc (risky and IId (decentralized in premature babies requires early diagnosis and therapy. Wide swaddling for prematures should be applied up to eight months of age. Gentle manipulation is necessary while nursing and conducting physiotherapy of a premature baby.

  4. Efficacy of metformin in maintaining euglycemia in patients with gestational diabetes mellitus

    International Nuclear Information System (INIS)

    Amir, Z.E.; Saifuddin, Z.; Tanveer, S.; Khan, S.A.

    2017-01-01

    To determine efficacy of metformin in maintaining euglycemia in patients with GDM among women presenting in our institution. Methodology: It was a prospective study conducted at the department of Obstetrics and Gynecology Railway teaching Hospital IIMCT, Rawalpindi from October 2014 to April 2015 and included 60 patients of 18-45 years of age at 10-32 weeks gestation in singleton pregnancy with fasting blood glucose levels > 6.1 mmol /L and 2 hours Post Prandial levels > 7.8 mml/L Metformin is started at a dose of 500 mg daily and increased up to 2500 mg daily. Aim was to keep fasting sugar level between 3.5 - 5.9 mmol/L and 2 hours post prandial < 7.8 mmol/L. Results: The median daily dose of metformin was 1500 mg. The mean gestational age at delivery was 38.1 weeks. Neonatal hypoglycemia (glucose level < 1.6mmol/L ) was less common. The only adverse effects of metformin was GI upset (13.1 %) The results of postpartum questionnaire assessing acceptability of treatment among women treated with metformin alone, 65.6 % said they would chose metformin in subsequent pregnancy. The efficacy of metformin alone was 85.7%. Conclusion: In women with gestational diabetes mellitus, metformin (alone or with supplemental insulin) is not associated with increased prenatal complications. The women preferred metformin to insulin treatment. (author)

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

    Science.gov (United States)

    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

  6. Effects of gestational age at birth on cognitive performance: a function of cognitive workload demands.

    Directory of Open Access Journals (Sweden)

    Julia Jaekel

    Full Text Available OBJECTIVE: Cognitive deficits have been inconsistently described for late or moderately preterm children but are consistently found in very preterm children. This study investigates the association between cognitive workload demands of tasks and cognitive performance in relation to gestational age at birth. METHODS: Data were collected as part of a prospective geographically defined whole-population study of neonatal at-risk children in Southern Bavaria. At 8;5 years, n = 1326 children (gestation range: 23-41 weeks were assessed with the K-ABC and a Mathematics Test. RESULTS: Cognitive scores of preterm children decreased as cognitive workload demands of tasks increased. The relationship between gestation and task workload was curvilinear and more pronounced the higher the cognitive workload: GA² (quadratic term on low cognitive workload: R²  = .02, p<0.001; moderate cognitive workload: R²  = .09, p<0.001; and high cognitive workload tasks: R²  = .14, p<0.001. Specifically, disproportionally lower scores were found for very (<32 weeks gestation and moderately (32-33 weeks gestation preterm children the higher the cognitive workload of the tasks. Early biological factors such as gestation and neonatal complications explained more of the variance in high (12.5% compared with moderate (8.1% and low cognitive workload tasks (1.7%. CONCLUSIONS: The cognitive workload model may help to explain variations of findings on the relationship of gestational age with cognitive performance in the literature. The findings have implications for routine cognitive follow-up, educational intervention, and basic research into neuro-plasticity and brain reorganization after preterm birth.

  7. Risk profiles of infants ≥32 weeks' gestational age with ...

    African Journals Online (AJOL)

    Increased NICU stay, increased chronological age, problematic breastfeeding and use of tube feeding showed an association with OPD. Three risk factors, namely intrauterine growth restriction, premature rupture of membranes and nutritive sucking difficulties were associated with OD. Conclusion. Risk profiles associated ...

  8. Evaluation of cardiac function in a group of small for gestational age school-age children treated with growth hormone.

    Science.gov (United States)

    Aurensanz Clemente, Esther; Ayerza Casas, Ariadna; Samper Villagrasa, Pilar; Ruiz Frontera, Pablo; Bueno Lozano, Gloria

    2017-02-09

    Small for gestational age (SGA) patients have an increased risk of developing a cardiovascular pathology, as well as a metabolic syndrome. Our objective is to evaluate the cardiac morphology and function of SGA children treated with growth hormone (GH), identifying changes that could potentially have long-term consequences. We selected 23 SGA school-age patients and 23 healthy children. We measured their weight, height, blood pressure and heart rate. Using transthoracic echocardiography, we evaluated cardiac chamber size, ascending and abdominal aortic diameter as well as the systolic and diastolic function of both ventricles. SGA children have a higher systolic and diastolic blood pressure (P<.05) without significant changes in their heart rate. They also have a thicker interventricular septum (SGA Z-score 1.57 vs. 0.89; P=.026) and a worse right ventricular systolic function, with a lower TAPSE (SGA Z-score -0.98 vs. 0.95; P=.000), as well as a lower blood flow rate in the pulmonary artery (SGA 0.85m/s vs. 0.97m/s; P=.045). No significant difference was observed in the patients' left ventricular function. SGA patients' ascending aortic diameter was greater (SGA Z-score -1.09 vs. -1.93; P=.026), whereas the systolic abdominal aortic diameter was smaller (SGA Z-score-0.89 vs. -0.19; P=.015). We found functional and morphological cardiac changes in SGA school-age patients treated with GH. It is important to follow-up this patient group in order to determine if these changes contribute to an increased cardiac morbidity in adulthood. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  9. Glomerulogenesis: Can it predict the gestational age? A study of 176 fetuses

    Directory of Open Access Journals (Sweden)

    Panduranga Chikkannaiah

    2012-01-01

    Full Text Available Background: Accurate assessment of gestational age of fetuses is essential from both clinical and medico-legal point of view. Crown-rump length, crown-heel length, foot length, and the weight of the fetus are the commonly used parameters for fetal age assessment. However, this estimate often lacks accuracy and sometimes is necessary to combine other data. An analysis of the embryological development of nephrons in the kidney can assist in this determination. Objective : To correlate the gestational age with the histological study of sequential development of nephrons in fetal kidney. Materials and Methods: This study included 176 fetuses delivered between June 2009 and June 2011 and aged from 12 to 40 weeks. The number of glomerular generations counted in hematoxylin and eosin-stained microscopic sections of the kidneys were correlated with the reported period of gestation based on obstetrical methods. Regression analysis was used to determine the statistical significance of the correlation. Results: A high degree of statistically significant correlation was observed between the period of gestation and the number of glomerular generations (P value < 0.0001. Conclusion: The histological assessment of the number of glomerular generations in kidney can be used as a reliable method of estimating fetal age.

  10. Haematological Indices in Healthy Appropriate For-Gestational-Age ...

    African Journals Online (AJOL)

    Results: The average value of hemoglobin and hematocrit at birth were 150g/L and 0.46L/L respectively. These values fell progressively to 68g/Land 0.26L/L at 6 weeks of age, with a marginal increase to 89g/Land 0.27L/L respectively at 12 weeks. At birth, the reticulocyte count was 2.2%and at 12 weeks it was 1.3%.

  11. Early gestational age at preeclampsia onset is associated with subclinical atherosclerosis 12 years after delivery.

    Science.gov (United States)

    Christensen, Martin; Kronborg, Camilla Skovhus; Carlsen, Rasmus Kirkeskov; Eldrup, Nikolaj; Knudsen, Ulla Breth

    2017-09-01

    Women with a history of preeclampsia have increased risk of cardiovascular disease later in life. However, it is unclear whether early gestational age at preeclampsia onset is associated with higher cardiovascular disease risk. This study aimed to test the association between gestational age at preeclampsia onset (including the early-onset/late-onset preeclampsia distinction) and subclinical atherosclerosis and arterial stiffness in age-matched women 12 years after index pregnancy. Eligible participants were identified in two Danish registries. Main outcome measures were carotid plaque presence, carotid intima-media thickness, aortic pulse wave velocity, and augmentation index adjusted for heart rate. Twenty-four women with previous early-onset preeclampsia, 24 with previous late-onset preeclampsia and 24 with previous normotensive pregnancies were included after matching on age (±2 years) and time since delivery (±1 year). In all outcome measures, the early-onset group had the highest percentage or mean value. In the adjusted analysis, the early-onset group significantly differed from the late-onset group in all outcome measures except aortic pulse wave velocity. The early-onset group also had significantly higher carotid intima-media thickness (average and left) compared with the normotensive group. Gestational age at preeclampsia onset as a continuous variable was significantly associated to both carotid plaque presence and carotid intima-media thickness (average and right). Gestational age at preeclampsia onset is negatively associated with markers of subclinical atherosclerosis 12 years after delivery. Potentially, gestational age at preeclampsia onset might be helpful in directing cardiovascular disease prevention after preeclampsia. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Defining smallness for gestational age in the early years of the Danish Medical Birth Registry

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Mathiasen, Rene; Greisen, Gorm

    2011-01-01

    Being born small for gestational age (SGA) is associated with decreased insulin sensitivity and increased blood pressure in childhood, but the association with clinical disease in early adulthood is less certain. The Danish Medical Birth Registry has registered all births in Denmark since 1973, b...

  13. Morbility, clinical data and proteomic analysis of IUGR and AGA newborns at different gestational ages

    Directory of Open Access Journals (Sweden)

    M.D. Ruiz-González

    2016-12-01

    Full Text Available The data are related to the proteomic analysis of 43 newborns with intrauterine growth retardation (IUGR and 45 newborns with appropriate weight for gestational age (AGA carried out by separation via 2DE and analyzed by MS–TOF/TOF. All newborns were separated into three gestational age groups, "Very Preterm" 29–32 weeks, "Moderate Preterm" 33–36 weeks, and, "Term" ≥37weeks. From each newborn, blood was drawn three times from birth to 1 month life. High-abundant serum proteins were depleted, and the minority ones were separated by 2DE and analyzed for significant expression differences. The data reflect analytic and clinic variables analyzed globally and categorized by gestational age in relation to IUGR and the optimization of conditions for 2-DE separation. The data from this study are related to the research article entitled "Alterations of Protein Expression in Serum of Infants with Intrauterine Growth Restriction and Different Gestational Ages" (M.D. Ruis-González, M.D. Cañete, J.L. Gómez-Chaparro, N. Abril, R. Cañete, J. López-Barea, 2015 [1]. The present dataset of serum IUGR newborn proteome can be used as a reference for any study involving intrauterine growth restriction during the first month of life.

  14. Nationwide Birth Weight and Gestational Age-specific Neonatal Mortality Rate in Taiwan

    Directory of Open Access Journals (Sweden)

    Shuo-Tse Hsu

    2015-06-01

    Conclusion: We have provided an easy-to-use birth weight/gestational age-specific neonatal mortality rate chart as a reference document that physicians and parents can use to make decisions based on ethical considerations relating to whether to give palliative care or further invasive management. The normative data are crucial for public health policies on neonatal care in Taiwan.

  15. Bloom syndrome in short children born small for gestational age: A challenging diagnosis

    NARCIS (Netherlands)

    J.S. Renes (Judith); R.H. Willemsen (Ruben); A. Wagner (Anja); M.J. Finken (Martijn); A.C.S. Hokken-Koelega (Anita)

    2013-01-01

    textabstractBackground: GH treatment has become a frequently applied growth-promoting therapy in short children born small for gestational age (SGA). In some disorders GH treatment is contraindicated, eg, chromosomal breakage syndromes. Bloom syndrome is a rare chromosomal breakage syndrome

  16. Increased risk of asthma in overweight children born large for gestational age

    NARCIS (Netherlands)

    Pinto, L. A.; Guerra, S.; Anto, J. M.; Postma, D.; Koppelman, G. H.; de Jongste, J. C.; Gehring, U.; Smit, H. A.; Wijga, A. H.

    Background: Being born large for gestational age (LGA) is a marker of increased growth velocity in fetal life and a risk factor for childhood overweight. Both being born LGA and childhood overweight may influence the development of asthma, although the role of overweight in the association between

  17. Birth weight and gestational age on retinopathy of prematurity in discordant twins in China

    Directory of Open Access Journals (Sweden)

    Zong-Hua Wang

    2014-08-01

    Full Text Available AIM:To assess the relative effect of birth weight and gestational age on retinopathy of prematurity (ROP using preterm twin pairs discordant for birth weigh in a tertiary neonatal intensive care unit in China.METHODS: Fifty-six discordant twin pairs of 112 preterm infants were retrospectively analyzed. The twin pairs were divided into two subgroups based on birth weight in each pair. The occurrence of ROP and severe ROP requiring treatment were compared between the lower birth weight infants and their co-twins with the higher birth weight. Some neonatal morbidities related to prematurity and neonatal characteristics were also compared between the twin pairs.RESULTS: Based on the univariate analysis, gestational age and birth weight were significantly associated with the occurrence and progression of ROP. But no significant differences in ROP between larger and smaller infants were observed in the twin-paired analysis. The incidence of neonatal morbidities regarding respiratory distress syndrome (RDS, patent ductus arteriosus (PDA, intraventricular hemorrhage (IVH, sepsis and neonatal characteristics regarding gender distribution, one- and five-minute Apgar score, postnatal steroid treatment, blood transfusion, supplemental oxygen therapy, and mechanical ventilation were not different between the twins. However, gestational age of ≤28wk was significantly associated with significantly higher rates of ROP and severe ROP.CONCLUSION: Gestational age is a better predictor of ROP than birth weight in the twin-paired study.

  18. Using fMRI to Investigate Memory in Young Children Born Small for Gestational Age

    NARCIS (Netherlands)

    de Bie, Henrica M. A.; de Ruiter, Michiel B.; Ouwendijk, Mieke; Oostrom, Kim J.; Wilke, Marko; Boersma, Maria; Veltman, Dick J.; Delemarre-van de Waal, Henriette A.

    2015-01-01

    Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with differences in brain anatomy and impaired cognition. We investigated learning and memory in children born SGA using neuropsychological testing and functional Magnetic

  19. Using fMRI to Investigate Memory in Young Children Born Small for Gestational Age

    NARCIS (Netherlands)

    de Bie, H.M.A.; de Ruiter, M.B.; Ouwendijk, M.; Oostrom, K.J.; Wilke, M.; Boersma, M.; Veltman, D.J.; Delemarre-van de Waal, H.A.

    2015-01-01

    Objectives: Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with differences in brain anatomy and impaired cognition. We investigated learning and memory in children born SGA using neuropsychological testing and functional

  20. Brain Development, Intelligence and Cognitive Outcome in Children Born Small for Gestational Age

    NARCIS (Netherlands)

    de Bie, H.M.A.; Oostrom, K.J.; Delemarre-van d Waal, H.A.

    2010-01-01

    Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with increased neonatal morbidity and mortality as well as short stature, cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia and end-stage renal

  1. The effects of smoking on birthweight-for-gestational-age curves in teenage and adult primigravidae

    NARCIS (Netherlands)

    Dewan, N.; Brabin, B.; Wood, L.; Dramond, S.; Cooper, C.

    2003-01-01

    Objectives. To compare the effect of smoking on the birthweight-for-gestational-age curves of teenage and adult primigravidae. Methods. A retrospective analysis of the perinatal. database at the Liverpool Women's Hospital for the years 1997-1999 for teenage and adult primigravidae. Results. Records

  2. The Influence of Gestational Age on the Loss of Maternal Measles ...

    African Journals Online (AJOL)

    Background: Maternal measles antibodies (MMA) are actively transferred in mother-infant pairs during third trimester of pregnancy. Gestational age (GA) affects the levels of MMA such that longer GA may result in infants starting out with high levels of MMA. Objective: To determine the influence of GA on the loss of MMA in ...

  3. Earliest gestational age for fetal sexing in cell-free maternal plasma

    NARCIS (Netherlands)

    Rijnders, R. J. P.; van der Luijt, R. B.; Peters, E. D. J.; Goeree, J. K.; van der Schoot, C. E.; Ploos van Amstel, J. K.; Christiaens, G. C. M. L.

    2003-01-01

    OBJECTIVES: To evaluate at what gestational age fetal DNA can reliably be detected at the earliest in maternal plasma. METHODS: We performed consecutive blood sampling in the first trimester of pregnancy in 17 women who were pregnant after in vitro fertilization (IVF) or intrauterine insemination

  4. Maternal thyrotropin is independently related to Small for Gestational Age neonates at term

    NARCIS (Netherlands)

    Monen, L.; Kuppens, S.M.; Hasaart, T.H.; Oosterbaan, H.P.; Oei, S.G.; Wijnen, H.; Hutton, E.K.; Vader, H.L.; Pop, V.J.M.

    2015-01-01

    Objective Small for gestational age (SGA) newborns constitute still a major cause of perinatal morbidity and mortality. Overt thyroid disease is a known cause of preterm birth and low birthweight but in its untreated condition it is rare today. In this study, we investigated the possible relation

  5. Neonatal morbidity in term neonates is related to gestational age at birth and level of care

    NARCIS (Netherlands)

    Miltenburg, A.S.; van Elburg, R.M.; Kostense, P.J.; van Geijn, H.P.; Bolte, A.C.

    2011-01-01

    Aims: The objective of this study was to assess whether the incidence of neonatal morbidity of neonates born at term and admitted to a neonatal intensive care unit (NICU) differs by gestational age and level of care. Methods: This is a 5-year retrospective cohort study of singleton term births

  6. Neonatal morbidity in term neonates is related to gestational age at birth and level of care

    NARCIS (Netherlands)

    Miltenburg, Andrea Solnes; van Elburg, Ruurd M.; Kostense, Pieter J.; van Geijn, Herman P.; Bolte, Antoinette C.

    2011-01-01

    The objective of this study was to assess whether the incidence of neonatal morbidity of neonates born at term and admitted to a neonatal intensive care unit (NICU) differs by gestational age and level of care. This is a 5-year retrospective cohort study of singleton term births admitted to the NICU

  7. Functioning of 7-Year-Old Children Born at 32 to 35 Weeks' Gestational Age

    NARCIS (Netherlands)

    Cserjesi, R.; Van Braeckel, K.N.J.A.; Butcher, P.R.; Kerstjens, J.M.; Reijneveld, S.A.; Bouma, A.; Geuze, R.H.; Bos, A.F.

    2012-01-01

    OBJECTIVE: To compare neuropsychological functions in moderately preterm (32-35 weeks' gestation) and full-term children at the age of 7 years and identify gender differences. METHODS: Community-based prospective cohort study of 248 moderately preterm children (138 boys) and 130 full-term children

  8. ASSESSMENT OF GESTATIONAL AGE BASED ON ULTRASONIC FEMUR LENGTH OF FETUS

    Directory of Open Access Journals (Sweden)

    M. Honarvar

    1999-08-01

    Full Text Available The ultrasonic measurement of the fetal femur length is a sensitive and precise variable for estimation of fetal growth and development. Tlte objective of this study was to predict gestational age in fetuses older ttian twenty-four weeks of gestation by ultrasonic measurement of the femur length. In this study, pregnant mothers were identified by the criteria of normality, such as well-known LMP, regular menstrual cycles, no use of oral contraceptive pills for the prior 3 months, no smoking, no history of diabetes. The relation between gestational age and fetal femur length was determined by cross-sectional analysis of 900 normal fetuses (> 25 weeks using real -time ultrasonography. Mathematical modeling of the data demonstrated that the femur growth curve is always linear beyond 24 weeks of gestation. Tlte following regression equation was derived : GA (week = 5.2 FL (cm + 2, SD ±5 days (Honarvar's Formula 2. According to this data, the error in estimation of GA for given FL is less tlian 6 days. Tiiis equation appears to be clinically reliable and easy to use. Previous normal ultrasonic fetal femur length curves for otlicr populations may underestimate or overestimate normal fetal age for Iranian population.

  9. Adaptive responses of cardiac function to fetal postural change as gestational age increases

    Science.gov (United States)

    Kim, Woo Jin; Choi, Hye Jin; Yang, Sun Young; Koo, Boo Hae; Ahn, Ki Hoon; Hong, Soon Cheol; Oh, Min-Jeong; Kim, Hai-Joong

    2016-01-01

    Objective The cardiovascular system maintains homeostasis through a series of adaptive responses to physiological requirements. However, little is known about the adaptation of fetal cardiac function to gravity, according to gestational age. In the present study, we aimed to evaluate the adaptive responses of cardiac function to postural changes, using Tei index measurements. Methods Fetal echocardiography and Doppler examination were performed on 114 women with vertex singleton pregnancies at 19 to 40 weeks' gestation. Participants were placed in an upright seated position, and the Tei index for fetal left ventricular cardiac function was measured. The women were then moved into a supine position and the Tei index was re-measured. Results The mean Tei index when measured in an upright seated position was significantly lower than that measured in a supine positioning for all fetuses (0.528±0.103 vs. 0.555±0.106, P=0.014, respectively). This difference was also noted in fetuses with a gestational age of 28–40 weeks (0.539±0.107 vs. 0.574±0.102, P=0.011, respectively). However, there was no difference in the Tei index between an upright seated and a supine position among fetuses with a gestational age of Postural changes from an upright seated to a supine position result in an increased Tei index after a gestational age of 28 weeks. This appears to reflect maturation in the adaptive responses of the fetal cardiovascular system to postural changes. PMID:27896244

  10. Gestational age at initiation of 17-alpha hydroxyprogesterone caproate and recurrent preterm birth.

    Science.gov (United States)

    Ning, Angela; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Goodnight, William H; Manuck, Tracy A

    2017-09-01

    Preterm birth is the leading cause of neonatal morbidity and mortality in nonanomalous neonates in the United States. Women with a previous early spontaneous preterm birth are at highest risk for recurrence. Weekly intramuscular 17-alpha hydroxyprogesterone caproate reduces the risk of recurrent prematurity. Although current guidelines recommend 17-alpha hydroxyprogesterone caproate initiation between 16 and 20 weeks, in clinical practice, 17-alpha hydroxyprogesterone caproate is started across a spectrum of gestational ages. The objective of the study was to examine the relationship between the gestational age at 17-alpha hydroxyprogesterone caproate initiation and recurrent preterm birth among women with a prior spontaneous preterm birth 16-28 weeks' gestation. This was a retrospective cohort study of women from a single tertiary care center, 2005-2016. All women with ≥1 singleton preterm births because of a spontaneous onset of contractions, preterm prelabor rupture of membranes, or painless cervical dilation between 16 and 28 weeks followed by a subsequent singleton pregnancy treated with 17-alpha hydroxyprogesterone caproate were included. Women were grouped based on quartiles of gestational age of 17-alpha hydroxyprogesterone caproate initiation (quartile 1, 14 0/7 to 16 1/7 ; quartile 2, 16 2/7 to 17 0/7 ; quartile 3, 17 1/7 to 18 6/7 ; and quartile 4, 19 0/7 to 27 5/7 ). Women with a gestational age of 17-alpha hydroxyprogesterone caproate initiation in quartiles 1 and 2 were considered to have early-start 17-alpha hydroxyprogesterone caproate; those in quartiles 3 and 4 were considered to have late-start 17-alpha hydroxyprogesterone caproate. The primary outcome was recurrent preterm birth preterm birth preterm birth preterm birth preterm birth preterm birth preterm birth among women with a prior spontaneous preterm birth 16-28 weeks are high. Women beginning 17-alpha

  11. Pituitary-gonadal function in adolescent males born appropriate or small for gestational age with or without intrauterine growth restriction

    DEFF Research Database (Denmark)

    Jensen, Rikke Beck; Vielwerth, Signe; Larsen, Torben Kjeldgaard

    2007-01-01

    Being born small for gestational age (SGA) is suggested to influence female pituitary-gonadal axis, but only a few studies have focused on male pituitary-gonadal function.......Being born small for gestational age (SGA) is suggested to influence female pituitary-gonadal axis, but only a few studies have focused on male pituitary-gonadal function....

  12. [Association between neontal morbidity, gestational age and developmental delays in moderate to late preterm children].

    Science.gov (United States)

    Schonhaut, Luisa; Pérez, Marcela; Muñoz, Sergio

    2015-01-01

    There is evidence that children born moderate-to-late preterm (MLP) have a higher risk of hospitalisation, neonatal morbidity, and developmental delay (DD). To determine the association between DD, gestational age, and neonatal morbidity in MLP children. A case control study design nested in a cohort of MLP children born between 2006 and 2009 at a private hospital located in the Metropolitan area of Santiago. The children were assessed with the Bayley-III Scales of Infant Development at 8 or 18 months corrected age, or at 30 months of chronological age. Neonatal records were retrospectively reviewed. A multivariate analysis was performed to determine the effect of neonatal morbidity on development. A total of 130 MLP children, 25 cases and 105 controls, were studied. Most of them (83.8%) were hospitalised during the neonatal period. Significant differences between cases and controls regarding maternal age and symptomatic hypoglycaemia were observed (crude OR 3.5, adjusted OR 8.18). It was concluded that the variables that negatively affect the rate of development are male gender, being a twin, and gestational age. Symptomatic hypoglycaemia is the main risk factor for DD, while being a twin, male gender, and gestational age influenced the total development rate obtained. It is essential to develop strategies for prevention, screening, and early management of this metabolic disorder to prevent future DD. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. [Growth hormone treatment in small for gestational age children in Spain].

    Science.gov (United States)

    Rial Rodríguez, José Manuel; de Arriba Muñoz, Antonio; Bosch Muñoz, Jordi; Cabanas Rodríguez, Paloma; Cañete Estrada, Ramón; Díez López, Ignacio; Hawkins Solís, María Magdalena; Martínez-Aedo Ollero, María José; Rodríguez Dehli, Ana Cristina; Ibáñez Toda, Lourdes

    2017-05-01

    Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice. Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions). Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2±2.8 years (mean±SD). The mean patient height at start was -3.1±0.8 SD. They gained 0.7±0.2 SD in the first year, and 1.2±0.8 SD after two years. Final height was attained by 8% of the sample, reaching -1.4±0.7 SD. These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Association of newborn diseases with weight/length ratio and the adequacy of weight for gestational age

    Directory of Open Access Journals (Sweden)

    José Ricardo Dias Bertagnon

    2011-09-01

    Full Text Available Objective: To compare the frequencies of newborn diseases in thosenewborns classified according to a weight/length rate and thoseclassified by the adequacy weight for gestational age. Methods: Aretrospective cross-sectional study by record assessment was carriedout enclosing all the live newborns at Hospital Geral do Grajaú, fromSeptember to December, 2009 (n =577 classified according to therate weight/length and also to the adequacy weight for gestationalage. The 10 and 90 percentiles of the weight/length distribution, nowdesignated as “indices” were calculated leading to the followingclassification: low index, for newborns below 54.8 g/cm; high index,for those over 75.8 g/cm; and average index, for the remainingnewborns. According to the adequacy weight for gestational age thenewborns were designated as pre-term for gestational age; term smallfor gestational age; appropriate term and large term. In this samplethere were no small and large pre-term or post-term newborns. Majordiseases were related to the index and adequacy extracts by the χ2test for a contingency table. Results: A significant association wasfound among low index, pre-term for gestational age newborns andterm small for gestational age; between average index and appropriatefor gestational age term newborns; and high index with large termappropriate for gestational age newborns (p< 0.001. Hypoglycemia(3.4% was associated to both low and high indices, to appropriatefor gestational age preterm newborns and to small for gestational ageterm newborns. Sepsis (3.1% was associated to both low index andpre-term appropriate for gestational age newborns. The respiratorydistress syndrome (1.3% was associated to low index and pre-termappropriate for gestational age newborns. Other respiratory distresssyndromes (3.8% were associated to low and high indices but notto the adequacy for gestational age classification. Jaundice (14.9%was not associated to the studied classifications

  15. Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center

    OpenAIRE

    Kim, Woo Jeng; Han, Young Sin; Ko, Hyun Sun; Park, In Yang; Shin, Jong Chul; Wie, Jeong Ha

    2017-01-01

    Objective This study investigated the effect of an antenatal corticosteroid (ACS) in preterm small-for-gestational-age (SGA) neonate. Methods This study was a retrospective cohort study. We compared women who received ACS with unexposed controls and evaluated neonatal complications among those having a singleton SGA neonate born between 29 and 34 complete gestational weeks. The neonates born after 32 weeks of gestation were divided into subgroups. Multivariable logistic regression analysis wa...

  16. Small for gestational age as a predictor of behavioral and learning problems in twins.

    Science.gov (United States)

    Rooney, Rosanna; Hay, David; Levy, Florence

    2003-02-01

    The study examines the effects of being born small for gestational age (SGA) on rates of behavioral problems in twins and siblings, utilising data from the Australian Twin Study of disruptive behavior disorders in twins and their siblings. Participants were 3944 twins and their siblings who were assessed at two intervals three years apart. At the first assessment (1991), they ranged between 4 and 12 years of age. Items assessing Attention Deficit/Hyperactivity Disorder were based on DSM-III-R criteria (Time 1) and DSM-IV criteria (Time 2). Other measures included history of speech and reading therapy, demographic information and obstetric and neonatal history. Results indicated that both male and female twins, who were extremely growth restricted (small for gestational age up to the third percentile-WGA3) showed more inattention, and poorer speech and reading scores. The effects were greater for males. Male twins who were small for gestation age, up to the 10th percentile, were more likely to have a DSM-IV diagnosis of Inattention. Implications of these results included WGA3 male twins being at a "triple disadvantage" for subsequent behavioral and learning problems, in that being male, being a twin and being small for gestational age are all significant factors. Recommendations are made for early intervention for low birthweight male twins. The study is consistent with recent follow-up studies of very-low-birthweight singletons, indicating male disadvantage in cognitive outcome. While there is some genetic component to SGA, it does constitute a potentially major contribution to common environmental effects that must be considered in twin-based genetic analyses.

  17. Universal gestational age effects on cognitive and basic mathematic processing: 2 cohorts in 2 countries.

    Science.gov (United States)

    Wolke, Dieter; Strauss, Vicky Yu-Chun; Johnson, Samantha; Gilmore, Camilla; Marlow, Neil; Jaekel, Julia

    2015-06-01

    To determine whether general cognitive ability, basic mathematic processing, and mathematic attainment are universally affected by gestation at birth, as well as whether mathematic attainment is more strongly associated with cohort-specific factors such as schooling than basic cognitive and mathematical abilities. The Bavarian Longitudinal Study (BLS, 1289 children, 27-41 weeks gestational age [GA]) was used to estimate effects of GA on IQ, basic mathematic processing, and mathematic attainment. These estimations were used to predict IQ, mathematic processing, and mathematic attainment in the EPICure Study (171 children mathematic attainment scores by 2.34 (95% CI: -2.99, -1.70) and 2.76 (95% CI: -3.40, -2.11) points, respectively. There were no differences among children born 34-41 weeks GA. Similarly, for children born mathematic processing scores decreased by 1.77 (95% CI: -2.20, -1.34) points with each lower GA week. The prediction function generated using BLS data accurately predicted the effect of GA on IQ and mathematic processing among EPICure children. However, these children had better attainment than predicted by BLS. Prematurity has adverse effects on basic mathematic processing following birth at all gestations mathematic attainment mathematic processing scores from one cohort to another among children cared for in different eras and countries suggests that universal neurodevelopmental factors may explain the effects of gestation at birth. In contrast, mathematic attainment may be improved by schooling. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  18. Gestational age at biochemical sampling in first trimester screening for trisomy 18 and 13

    DEFF Research Database (Denmark)

    Petersen, Olav Bjørn; Ekelund, Charlotte; Kirkegaard, Ida

    Objective: To determine if gestational age at serum sampling affect the discriminative value of PAPP-A and free β hCG in relation to trisomy 18 (T18) and trisomy 13 (T13). Methods: We retrospectively searched for T18 and T13 cases in the Astraia database at two large Fetal Medicne Centres......, 39 pregnancies with trisomy 18 and 26 pregnancies with trisomy 13 was identified. We found that PAPP-A MoM levels in trisomy 18 pregnancies are less discriminatory (P = 0.0004) at earlier gestations than they are at later gestations. They decrease from an estimated median MoM of 0.54 (95% CI: 0.......16 to 0.30) at the middle of week 12. For trisomy 13 pregnancies we also found a trend, though not statistically significant, towards poorer discrimination at early gestations. In the prospective, two sample data, a total of 5 T18 and 3 T13 cases was identified. The within-case MoM-variation showed...

  19. Evaluation of the normal fetal kidney length and its correlation with gestational age.

    Science.gov (United States)

    Seilanian Toosi, Farrokh; Rezaie-Delui, Hossein

    2013-05-30

    A true estimation of gestational age (GA) plays an important role in quality maternity care and scheduling the labor date. This study aimed to evaluate the normal fetal kidney length (KL) and its correlation with GA. A cross-sectional study on 92 pregnant women between 8th and 10th week of gestation with normal singleton pregnancy underwent standard ultrasound fetal biometry and kidney length measurement. univariate and multivariate linear regression analysis was used to create a predictive equation to estimate GA on the KL and fetobiometry parameters. A significant correlation was found between GA and KL (r=0.83, P<0.002). The best GA predictor was obtained by combining head circumference, fetal biparietal diameter, femur length and KL with a standard error (SE) about 14.2 days. Our findings showed that KL measurements combination with other fetal biometric parameters could predict age of pregnancy with a better precision.

  20. Evaluation of the Normal Fetal Kidney Length and Its Correlation with Gestational Age

    Directory of Open Access Journals (Sweden)

    Farrokh Seilanian Toosi

    2013-05-01

    Full Text Available A true estimation of gestational age (GA plays an important role in quality maternity care and scheduling the labor date. This study aimed to evaluate the normal fetal kidney length (KL and its correlation with GA. A cross-sectional study on 92 pregnant women between 8th and 10th week of gestation with normal singleton pregnancy underwent standard ultrasound fetal biometry and kidney length measurement. univariate and multivariate linear regression analysis was used to create a predictive equation to estimate GA on the KL and fetobiometry parameters. A significant correlation was found between GA and KL (r=0.83, P<0.002. The best GA predictor was obtained by combining head circumference, fetal biparietal diameter, femur length and KL with a standard error (SE about 14.2 days. Our findings showed that KL measurements combination with other fetal biometric parameters could predict age of pregnancy with a better precision.

  1. Standards of Birth Weight According to Gestational Age in the Northwestern Regions of Ukraine

    Directory of Open Access Journals (Sweden)

    Rodych O.

    2015-05-01

    Full Text Available An analysis of the neonatal registry for 2001-2010 years in Rivne and Volyn regions of Ukraine as well as 2006-2011 years of Khmelnytsky region was carried out. General information was available about body weight of 366 607 newborns, among which 188 687 were boys and 177 920 girls. Based on the analysis we developed local standards of birth body weight in relation to gestational age separately for boys and girls. Procedure for processing local standards met international standards that have been developed by the WHO. Availability of processed local standards depending on gestational age will enable neonatologists, pediatricians and researchers to clearly identify anomalies in the health of newborns in the northwestern regions of Ukraine. Therefore, identification of newborns with low or high birth weight will enable adequate and timely steps to improve their health.

  2. Term small-for-gestational-age infants from low risk women are at significantly greater risk of adverse neonatal outcomes.

    Science.gov (United States)

    Madden, Jessie V; Flatley, Christopher J; Kumar, Sailesh

    2018-02-17

    Small-for-gestational age (SGA) infants (birthweight 37 weeks gestation). This is compounded by the fact that late pregnancy ultrasound is not the norm in many jurisdictions for this cohort of women. We thus investigated the relationship between birthweight age (AGA) (birthweight 10 th - 90 th centile) group at term. This was retrospective analysis of data from the Mater Mother's Hospital in Brisbane, Australia for women who birthed between January 2000 and December 2015. Women with multiple pregnancy, diabetes mellitus, hypertension, pre-term birth, major congenital anomalies and large for gestational age infants (>90 th centile for gestational age) were excluded. SGA infants were subdivided into 2 cohorts - infants with birthweights 5 th - age groups than controls. After stratification for gestational age at birth, the composite outcome remained significantly higher in both small-for-gestational-age cohorts and was highest in the ages in infants <5 th centile for birthweight, it is highest at early term gestation. Our findings highlight that early term birth does not necessarily improve outcomes and emphasize the importance of identifying this cohort of infants. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Does a History-Indicated Cerclage Affect Gestational Age at Delivery in Women with Evidence of Recurrent Cervical Insufficiency?

    Science.gov (United States)

    Ginsberg, Norman A; Miller, Emily; Gerber, Sue; Dungan, Jeffery S; Shulman, Lee P

    2015-01-01

    To determine whether women with recurrent evidence of cervical insufficiency (CI) and with a history-indicated cerclage (HIC) placed at the beginning of the second trimester will deliver later than the index case. Retrospective case-control study of singleton pregnancy with history-consistent CI. Patients had a cerclage placed between 12 and 16 weeks of gestation. Transvaginal cervical measurement was done between 18 and 24 weeks. Those with a cervical measurement 25 mm were considered to have recurrent CI (Group A). Gestational age at delivery of the index case (Group C) and the cerclage patients (Groups A and B), which are the same patients as Group C, was compared using Student's t test. They have the same genetics and anatomy. A total of 124 women had an HIC. Sixteen (13%) had recurrent CI (Group A). Comparing cases, the proximate average age at delivery was 22 weeks as compared with 33 weeks and 3 days for those with a cerclage (p 25 mm (Group B), 96 (89%) had a term delivery. In the index cases 64% delivered at 22 weeks or less (Group C). Cerclage in those patients with recurrent CI has a significantly improved outcome as compared with the index case. This minimizes pregnancy loss.

  4. Pregnant Women's Knowledge and Beliefs about the Safety and Outcomes of Delivery at Various Gestational Ages

    OpenAIRE

    Baldwin, Melody A.; Swamy, Geeta K.; Wheeler, Sarahn M.

    2018-01-01

    Objectives  Despite the morbidity associated with late preterm and early-term births, there is limited data on pregnant women's perception of neonatal risk based on gestational age (GA). Therefore, our objective was to determine pregnant women's perception of neonatal risks at varying GAs. Method  Through an anonymous 24-question survey, pregnant women were asked to designate the GA at delivery that is desirable, safe, and defined as full term. Responses were compared based on race, history o...

  5. Prevalence of hypospadias in Italy according to severity, gestational age and birthweight: an epidemiological study

    Directory of Open Access Journals (Sweden)

    Magnani Cinzia

    2009-06-01

    Full Text Available Abstract Background Hypospadias is a congenital displacement of the urethral meatus in male newborns, being either an isolated defect at birth or a sign of sexual development disorders. The aim of this study was to assess the prevalence rate of hypospadias in different Districts of Italy, in order to make a comparison with other countries all over the world. Methods We reviewed all the newborns file records (years 2001–2004 in 15 Italian Hospitals. Results We found an overall hypospadias prevalence rate of 3.066 ± 0.99 per 1000 live births (82.48% mild hypospadias, 17.52% moderate-severe. In newborns Small for Gestational Age (birthweight th percentile of any gestational age the prevalence rate of hypospadias was 6.25 per 1000 live births. Performing multivariate logistic regression analysis for different degrees of hypospadias according to severity, being born SGA remained the only risk factor for moderate-severe hypospadias (p = 0.00898 but not for mild forms (p > 0.1. Conclusion In our sample the prevalence of hypospadias results as high as reported in previous European and American studies (3–4 per 1000 live births. Pathogenesis of isolated hypospadias is multifactorial (genetic, endocrine and environmental factors: however, the prevalence rate of hypospadias is higher in infants born small for gestational age than in newborns with normal birth weight.

  6. Body composition of women with newborns who are small for gestational age.

    Science.gov (United States)

    Levario-Carrillo, Margarita; Rodríguez, Nora; Tufiño-Olivares, Edith; Jiménez, María del Refugio; Delgado-Monge, Martha Cecilia; Reza-López, Sandra

    2009-01-01

    The relationship between maternal and placental hemodynamic disorders and fetal growth is well known, but few studies have evaluated a link between maternal extracellular water (EW) and newborn birth weight. To identify the characteristics of body composition (BC) of women with small for gestational age (SGA) newborns, and to determine the relationship between maternal EW and birth weight of the baby. We studied maternal BC using multifrequency bioelectric impedance in the second and third trimesters of pregnancy. Newborns with weight below the 10th percentile were classified as SGA; those with weights between the 10th and 90th percentiles as appropriate for gestational age (AGA), and large for gestational age (LGA) were those with weights above the 90th percentile. We studied 460 women and their BC varied depending on whether their newborns were SGA, AGA or LGA. EW was lower in the mothers of SGA (11 +/- 2 l) compared to AGA (12 +/- 3 l) newborns (p relationship (p maternal EW in the second trimester and the weight of the newborn, beta = 43 (95% CI 27-58). BC of women whose newborns are SGA differs significantly from that of women whose newborns are AGA, a result which suggests that the mothers of SGA infants may have a disordered hemodynamic state during the second trimester of pregnancy. (c) 2008 S. Karger AG, Basel.

  7. Relationship between sonographic umbilical cord size and gestational age among pregnant women in Enugu, Nigeria.

    Science.gov (United States)

    Eze, Charles; Ugwuja, Mabel; Eze, Cletus; Ugwu, George; Agwuna, Kennedy; Ituk-Ozalla

    2014-06-01

    Common fetal parameters for gestational age (GA) estimation have pitfalls especially in advanced pregnancy and pregnancy complicated by fetal structural anomaly. To assess the relationship between umbilical cord size and gestational age of the fetus. A sonographic cross sectional study involving 300 pregnant women with GA between 14 weeks to 40 weeks was done in Enugu, Nigeria. Gestational ages were first estimated by use of Naegele's formula for GA estimation based on the date of onset of each subject's last menstrual period. Fetal parameters such as biparietal diameter, femur length, head circumference and abdominal circumference were measured and also used to estimate GA. Umbilical cord diameters were measured and used to compute the umbilical cord cross-sectional area. The mean umbilical cord diameter and cross-sectional area were 14.5mm ± 7.2mm and 201.6mm ± 139.5mm(2) respectively. Umbilical cord growth rate of 1.0mm/week was noted between the 14(th) and 35(th) week of pregnancy. There were significant correlations (p umbilical cord size and other fetal parameters for GA estimation. Umbilical cord size had strong linear relationship with common fetal GA estimation parameters and could be used to compliment these parameters for GA estimation.

  8. Catch-up growth in small for gestational age babies: good or bad?

    Science.gov (United States)

    Ong, Ken K

    2007-02-01

    Most small for gestational age infants show rapid early postnatal growth and weight gain. Increasing trends towards childhood overweight and its metabolic consequences, and their epidemiological associations with lower birth weight, have led to critical assessments of the benefits and disadvantages of rapid early growth. In the last 12 months, three systematic reviews have described the consistent association between rapid infancy growth and subsequent obesity risk in childhood and later life. Recent studies have also described the very early development of insulin resistance in small for gestational age children who show catch-up growth, and this insulin resistance may, in turn, adversely affect body composition, growth and puberty. Long-term randomized trials of growth hormone therapy, however, remind us of the persisting short stature and significant adult height deficit in untreated children without early spontaneous catch-up. Even in modern societies with low rates of childhood infection and mortality, the small for gestational age infant may face a dilemma over whether or not to catch up. Current nutritional strategies that promote catch-up growth should include some monitoring of weight-for-length and adiposity, and the concept of 'healthy catch-up growth' should be the goal of future research.

  9. The Effect of Gestational Age at Birth on Post-Term Maturation of Heart Rate Variability

    Science.gov (United States)

    Fyfe, Karinna L.; Yiallourou, Stephanie R.; Wong, Flora Y.; Odoi, Alexsandria; Walker, Adrian M.; Horne, Rosemary S.C.

    2015-01-01

    Study Objective: Preterm birth delays maturation of autonomic cardiovascular control, reflected in reduced heart rate variability (HRV) in preterm compared to term infants at term-equivalent age. It has been suggested that immature cardiovascular control contributes to the increased risk for the sudden infant death syndrome (SIDS) in preterm infants. However, the effects of prone sleeping, the major SIDS risk factor, and of gestational age (GA) at birth on HRV have not been assessed in preterm infants beyond term-equivalent age. Subjects and Methods: Very preterm (n = 21; mean GA 29.4 ± 0.3 weeks), preterm (n = 14; mean GA 33.5 ± 0.3 weeks), and term (n = 17; mean GA 40.1 ± 0.3 weeks) infants were recruited and underwent daytime polysomnography at 2–4 weeks, 2–3 months, and 5–6 months post-term corrected age (CA). Infants slept both supine and prone. HRV was assessed in the low frequency (LF) and high frequency (HF) ranges. Results: There was no effect of prone sleeping on HRV parameters in either preterm group. In term infants LF/HF was significantly elevated in the prone position in AS at 2–4 weeks (P preterm compared to both preterm and term infants at 2–3 months CA. Conclusion: Prone sleeping did not significantly impact on heart rate variability (HRV) in preterm infants. However, reduced maturation of high frequency HRV in very preterm infants resulted in significantly altered sympathovagal balance at 2–3 months corrected age, the age of peak sudden infant death syndrome (SIDS) risk. This may contribute to the increased risk of SIDS in infants born at earlier gestational age. Citation: Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RS. The effect of gestational age at birth on post-term maturation of heart rate variability. SLEEP 2015;38(10):1635–1644. PMID:25902805

  10. On the evaluation of routine ultrasound screening in the third trimester for detection of light for gestational age (LGA) infants

    DEFF Research Database (Denmark)

    Secher, Niels Jørgen; Kern Hansen, P; Lenstrup, C

    1987-01-01

    Based upon 2194 consecutive pregnancies with known gestational age, formulas for weight deviation predicted in the 32nd and 37th gestational week were estimated by multiple linear regression on the measurements of the abdominal diameter (AD) and the biparietal diameter (BPD) of the first 64...

  11. [Neuro-intellectual prognosis at school age for 62 children born with a gestational age of under 32 weeks].

    Science.gov (United States)

    Sizun, J; Le Pommelet, C; Lemoine, M L; Cauvin, J M; Sparfel, O; Louarn, O; Cornec, G; de Parscau, L

    1998-02-01

    The aim of this study was to detail the incidence of cerebral palsy in children born before 32 weeks of gestation and to evaluate the scholastic and intellectual performance in non-handicapped children. The population included 63 survivors hospitalized in 1984-85 (gestational age: 30.06 +/- 1.21 weeks; birth weight: 1386 +/- 267 g; inborn 60%; male: 38.7%; small for gestational age: 4.8%; hyaline membrane disease: 32%; European: 98.4%). Neurodevelopmental assessment was performed by pediatricians and psychologists using Wisc-R, visual screening by Monoyer scale, hearing by audiometry realized by oto-rhinolaryngologists. There were 62 survivors (one child dead by sudden infant death syndrome). Fifty children evaluated at a mean age of 9.3 +/- 0.7 years and written data available for another eight. Twelve children presented with cerebral palsy. Risk factors were ultrasound abnormalities of parenchymal brain and male gender. In children without cerebral palsy, we observed 12 visual and two hearing impairment. Three were in special education, 32 were in an age-appropriate level, nine with one year below. Neonatal events were not associated with the Wisc-R results except for ultrasound abnormalities of parenchymal brain. Wisc-R was strongly correlated with familial economic and education level. School performances in non-handicapped children born before 32 weeks is satisfying. Intellectual performance is mainly correlated with familial economic and education level.

  12. Developmental Scores at 1 Year With Increasing Gestational Age, 37–41 Weeks

    Science.gov (United States)

    Rose, Olga; Blanco, Estela; Martinez, Suzanna M.; Sim, Eastern Kang; Castillo, Marcela; Lozoff, Betsy; Vaucher, Yvonne E.

    2013-01-01

    OBJECTIVE: To examine the relationship between gestational age and mental and psychomotor development scores in healthy infants born between 37 and 41 weeks. METHODS: The cohort included 1562 participants enrolled during infancy in an iron deficiency anemia preventive trial in Santiago, Chile. All participants were healthy, full-term (37–41 weeks) infants who weighed 3 kg or more at birth. Development at 12 months was assessed using the Bayley Scales of Infant Development. Using generalized linear modeling, we analyzed the association between gestational age and 1-year-old developmental status, taking into account potential confounders including birth weight percentile, gender, socioeconomic status, the home environment, iron status, and iron supplementation. RESULTS: For each additional week of gestation, the Mental Development Index increased by 0.8 points (95% confidence interval = 0.2–1.4), and the Psychomotor Development Index increased by 1.4 points (95% confidence interval = 0.6–2.1) controlling for birth weight percentile, gender, socioeconomic status, and home environment. CONCLUSIONS: In a large sample of healthy full-term infants, developmental scores obtained using the Bayley Scales of Infant Development at 12 months increased with gestational age (37–41 weeks). There is increasing evidence that birth at 39 to 41 weeks provides developmental advantages compared with birth at 37 to 38 weeks. Because cesarean deliveries and early-term inductions have increased to 40% of all births, consideration of ongoing brain development during the full-term period is an important medical and policy issue. PMID:23589812

  13. References of birth weights for gestational age and sex from a large cohort of singleton births in cameroon.

    Science.gov (United States)

    Kemfang Ngowa, Jean Dupont; Domkam, Irénée; Ngassam, Anny; Nguefack-Tsague, Georges; Dobgima Pisoh, Walter; Noa, Cyrille; Kasia, Jean Marie

    2014-01-01

    Objective. To establish the percentile charts of birth weights for gestational age and sex within the Cameroonian population. Methods. A review of medical records of infants born between January 2007 and December 2011 at the maternities of two hospitals in Cameroon, Central Africa. Multiple pregnancies, births of HIV infected women, stillbirths, and births with major fetal malformations were excluded. The smooth curves of birth weight for gestational age and sex were created using the Gamlss package under R.3.0.1 software. Results. The birth weights of 12837 live birth singleton infants born to HIV negative women between 28 and 42 weeks of gestation were analyzed to construct the birth weight curves for gestational age and sex. The smoothed percentile curves of birth weights for gestational age and sex of Cameroonian infants have demonstrated an increasing slope until 40 weeks and then a plateau. There was a varied difference of distribution in birth weights for gestational age between Cameroonian, Botswanan, American, and French infants. Conclusion. We established the reference curves of birth weights for gestational age and sex for Cameroonians. The difference in birth weight curves noted between Cameroonian, Botswanan, American, and French infants suggests the importance of establishing the regional birth weight norms.

  14. References of Birth Weights for Gestational Age and Sex from a Large Cohort of Singleton Births in Cameroon

    Directory of Open Access Journals (Sweden)

    Jean Dupont Kemfang Ngowa

    2014-01-01

    Full Text Available Objective. To establish the percentile charts of birth weights for gestational age and sex within the Cameroonian population. Methods. A review of medical records of infants born between January 2007 and December 2011 at the maternities of two hospitals in Cameroon, Central Africa. Multiple pregnancies, births of HIV infected women, stillbirths, and births with major fetal malformations were excluded. The smooth curves of birth weight for gestational age and sex were created using the Gamlss package under R.3.0.1 software. Results. The birth weights of 12837 live birth singleton infants born to HIV negative women between 28 and 42 weeks of gestation were analyzed to construct the birth weight curves for gestational age and sex. The smoothed percentile curves of birth weights for gestational age and sex of Cameroonian infants have demonstrated an increasing slope until 40 weeks and then a plateau. There was a varied difference of distribution in birth weights for gestational age between Cameroonian, Botswanan, American, and French infants. Conclusion. We established the reference curves of birth weights for gestational age and sex for Cameroonians. The difference in birth weight curves noted between Cameroonian, Botswanan, American, and French infants suggests the importance of establishing the regional birth weight norms.

  15. Maternal weight determines the association between Hbalc in second half of pregnancy and risk of large for gestational age babies

    DEFF Research Database (Denmark)

    Nielsen, Gunnar Lauge; Dethlefsen, Claus; Møller, Margrethe

    Aim: To assess the association between maternal glycosylated haemoglobin (HbA1c) in diabetic pregnancies and the risk of delivering large for gestational age babies (LGA) taking into account maternal body mass index (BMI), weight gain, age, White class, and smoking habits.  Method: We identified...... all pregnant diabetic women in a Danish county. HbA1c values after 20th gestational week were collected and offspring was categorized as large, normal or small for gestational age. Logistic regression models we fitted to assess the association between HbA1c and risk of delivering a LGA baby taking...

  16. The effects of gestational age and growth restriction on compensatory kidney growth.

    Science.gov (United States)

    Drougia, Aikaterini; Giapros, Vasileios; Hotoura, Efthalia; Papadopoulou, Frederica; Argyropoulou, Maria; Andronikou, Styliani

    2009-01-01

    Low birth weight is associated with altered renal development, adult onset hypertension and renal disease. The aim of this prospective longitudinal study was to estimate the renal growth during the first 2 years of life in small-for-gestational age (SGA) infants of varied gestational age (GA) and with differing degrees of growth retardation (GR) at birth. Material and methods. The study included 466 children: SGA, n = 243, and appropriate-for-gestational age (AGA), n = 223, classified according to GA into three groups (28-34, 34-36 and >36 weeks, respectively). The SGA children were also classified according to the degree of GR: birth weight kidney length (KL) measurement was performed at the ages of 36 and 40 weeks corrected age and 3, 6, 12 and 24 months of chronological age. The ratios of KL(3) to crown to heel length (CHL), body weight (BW) and body surface area (BSA) were used as estimators of relative kidney length (RKL). A total of 1898 measurements were performed. In the full-term and near-term SGA infants (GA >36 weeks), RKL was similar to or even higher than that in AGA controls (P < 0.05 at 12 and 24 months). In two groups of preterm infants (GA 34-36, 28-34 weeks), RKL was lower than in AGA controls either after the first 6 months (GA 34-36 group, P < 0.05) or throughout the study period (GA 28-34 group, P < 0.05). The absolute KL was more severely affected in the preterm babies (GA <36 weeks) with BW <3rd percentile than in those of GA 3rd-10th percentile. While in full-term and near-term SGA infants RKL is similar to or even higher than that of AGA infants, in smaller preterm babies (<36 weeks of GA) the RKL is impaired up to the second year of life.

  17. Kidney development in the first year of life in small-for-gestational-age preterm infants

    Energy Technology Data Exchange (ETDEWEB)

    Hotoura, Efthalia; Giapros, Vasilios; Drougia, Aikaterini [University Hospital of Ioannina, Neonatal Intensive Care Unit, Ioannina (Greece); Argyropoulou, Maria; Papadopoulou, Frederica; Nikolopoulos, Panayiotis [University Hospital of Ioannina, Radiology Department, Ioannina (Greece); Andronikou, Styliani [University Hospital of Ioannina, Neonatal Intensive Care Unit, Ioannina (Greece); University of Ioannina Medical School, Child Health Department, Ioannina (Greece)

    2005-10-01

    Small-for-gestational-age (SGA) infants have been reported to have a significantly reduced number of nephrons that could be a risk factor for development of hypertension later in life. To evaluate kidney size prospectively in relation to other anthropometric parameters during the first year of life in SGA babies. The babies in the study were 31-36 weeks' gestational age (GA) at birth and were matched with control preterm infants of similar GA, but appropriate for gestational age (AGA). The SGA infants were further classified as symmetrical and asymmetrical according to the anthropometric parameters. The total number of measurements in symmetrical SGA preterm infants was 324, in asymmetrical SGA preterm infants 295, and in AGA infants 536. In symmetrical SGA preterm infants (31-36 weeks' GA) mean kidney length ({+-} SD) of 56{+-}4 mm was significantly different from the controls (58.9{+-}4.6 mm) up to 6 months' chronological age (P < 0.05). In the asymmetrical SGA preterm infants, mean kidney length (45.3{+-}4.0 mm) was significantly different from the controls (48.2{+-}4.4 mm) up to 40 weeks' corrected age. At 1 year chronological age, all preterm infants (symmetrical and asymmetrical SGA and AGA) had similar mean kidney length (61.6{+-}4.6, 62.8{+-}4.3, and 62.3{+-}4.0 mm, respectively). The ratio of kidney length to crown-to-heel length was similar in all preterm groups. Kidney length in preterm SGA infants (symmetrical and asymmetrical) follows closely the other auxological parameters during the first year of life. (orig.)

  18. [Study on growth hormone treatment in small for gestational age children].

    Science.gov (United States)

    Sánchez Zahonero, Julia; López García, María José

    2017-02-01

    To analyse the effectiveness of growth hormone (GH) therapy in short-stature children born small for gestational age (SGA) without catch-up growth (height at the beginning of treatment<-2.5 SDS), in Valencia (Spain), between 01/01/2003 and 12/31/2013; and to compare our findings with previously published data. Anthropometric data from the SGA children were obtained from the database of the «Ministry of Health of Valencia». These data were retrospectively reviewed. A total of 115 SGA children, with a mean age of 8.10±2.75 years and height of -3.14±0.59 SDS started treatment (dose: 0.035±0.004mg/kg/day) between January 1st, 2003 and March 31st, 2013. After 2 years of therapy (n=115, age: 10.50±2.72 years) the height SDS was -2.11±0.66; and after 4 years (n = 96, age: 12.65±2.46 years) of -1.76±0.75 SDS. This latest improvement in stature matches ages at which the growth spurt usually occurs. Only 35 out of 115 children reached adult height, although impaired (-2.22±0.86 SDS), and failed to achieve their target height (-1.72 ±0.75 SDS). However, this sub-group grew to near the height of the shorter parent (-1.95 ±1.28 SDS), and 42,9% of these 35 cases increased their stature by more than 1 SDS. The studied sample did not achieve satisfactory growth results, as in other published series. Our findings might be improved by starting treatment earlier, and with doses individualised according to patient characteristics. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Pregnancy Weight Gain by Gestational Age in Women with Uncomplicated Dichorionic Twin Pregnancies.

    Science.gov (United States)

    Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Braxter, Betty J; Eckhardt, Cara L; Himes, Katherine P; Bodnar, Lisa M

    2018-01-29

    Twin pregnancies are at increased risk for adverse outcomes and are associated with greater gestational weight gain compared to singleton pregnancies. Studies that disentangle the relationship between gestational duration, weight gain and adverse outcomes are needed to inform weight gain guidelines. We created charts of the mean, standard deviation and select percentiles of maternal weight gain-for-gestational age in twin pregnancies and compared them to singleton curves. We abstracted serial prenatal weight measurements of women delivering uncomplicated twin pregnancies at Magee-Womens Hospital (Pittsburgh, PA, 1998-2013) and merged them with the hospital's perinatal database. Hierarchical linear regression was used to express pregnancy weight gain as a smoothed function of gestational age according to pre-pregnancy BMI category. Charts of week- and day-specific values for the mean, standard deviation, and percentiles of maternal weight gain were created. Prenatal weight measurements (median: 11 [interquartile range: 9, 13] per woman) were available for 1109 women (573 normal weight, 287 overweight, and 249 obese). The slope of weight gain was most pronounced in normal weight women and flattened with increasing pre-pregnancy BMI (e.g. 50th percentiles of 6.8, 5.7, and 3.6 kg at 20 weeks and 19.8, 18.1, and 14.4 at 37 weeks in normal weight, overweight, and obese women, respectively). Weight gain patterns in twins diverged from singletons after 17-19 weeks. Our charts provide a tool for the classification of maternal weight gain in twin pregnancies. Future work is needed to identify the range of weight gain associated with optimal pregnancy health outcomes. © 2018 John Wiley & Sons Ltd.

  20. The C in TORCH: a cost-effective alternative to screening small-for-gestational-age infants.

    Science.gov (United States)

    Wei, Daniel; Sardesai, Smeeta R; Barton, Lorayne

    2014-01-01

    Infants born with birth weights under the 10th percentile for their gestational age are classified as small for gestational age (SGA). TORCH infections are reported to be associated with SGA infants. With the low incidence of infections, screening is likely to be expensive and of low utility. The objective of this study was to determine the utility and cost-effectiveness of screening SGA infants with TORCH serology titers, urine cytomegalovirus (CMV) cultures and cranial ultrasounds. A retrospective review was conducted on all infants admitted to the neonatal intensive care unit (NICU) at Los Angeles County and University of Southern California (LAC+USC) Medical Center from January 2003 to December 2011 with a diagnosis of SGA or intrauterine growth restriction. Birth characteristics such as birth weight, length, head circumference and gestational age were recorded. TORCH titer results, urine CMV results and cranial ultrasound findings were collected. Between 2003 and 2011, 232 SGA infants were admitted to the NICU at LAC+USC Medical Center. Of these, 117 infants (50%) had TORCH titer testing performed; there was only 1 positive CMV IgM and 1 positive HSV IgM result. Repeat urine CMV testing was performed on 109 infants (47%), with a total of 296 urine CMV samples collected from these infants; 6 infants had positive results, of whom 3 had repeat positive urine CMV samples. Overall, 149 of the infants had a cranial ultrasound done, none of which were positive for calcifications. TORCH titer testing, urine CMV screening and cranial ultrasound screening are of low yield in screening clinically asymptomatic SGA infants for TORCH infections. Given the low number of positive results, a cost-effective alternative of selective TORCH testing may be limited to infants with additional clinical findings. This study serves as a reminder to periodically examine testing practices and patient population to maximize cost-effectiveness.

  1. Prediction of parturition in dogs and cats: accuracy at different gestational ages.

    Science.gov (United States)

    Beccaglia, M; Luvoni, G C

    2012-12-01

    In bitches and queens, the ultrasonographic measurement of extrafoetal and foetal structures allows the evaluation of gestational age and the prediction of the parturition term for an extended period of time. The aim of this study was to investigate whether the accuracy of parturition date prediction is affected by the week of pregnancy when the ultrasonographic examination is performed. The results were obtained by retrospective analysis on the gestational period basis (from week 4 to week 9 of pregnancy) in 495 ultrasonographic examinations of pregnant bitches (small and medium size) and 60 of pregnant queens. They demonstrated that a similar accuracy (p > 0.05) was obtained by the measurement of inner chorionic cavity at week 4 and 5 of pregnancy (± 1 day, 81% vs 67.7%; ± 2 days, 93.1% vs 85.9%). Accuracy (± 1 day) based on biparietal (BP) measurement was similar at week 5 and 6 of pregnancy (78.6% vs 78.9%; p > 0.05), whereas a significant decrease (p parturition term is highly consistent for 6 and 8 weeks of gestation, respectively. © 2012 Blackwell Verlag GmbH.

  2. On the evaluation of routine ultrasound screening in the third trimester for detection of light for gestational age (LGA) infants

    DEFF Research Database (Denmark)

    Secher, Niels Jørgen; Kern Hansen, P; Lenstrup, C

    1987-01-01

    % of the pregnancies. The usefulness of the screening was evaluated on the remaining 36%. An attempt to diagnose light for gestational age (LGA) infants resulted in either a low sensitivity or a low predictive value of a positive test. The late third trimester screening was more sensitive than the early, indicating......Based upon 2194 consecutive pregnancies with known gestational age, formulas for weight deviation predicted in the 32nd and 37th gestational week were estimated by multiple linear regression on the measurements of the abdominal diameter (AD) and the biparietal diameter (BPD) of the first 64...

  3. [Body composition and metabolic risk in small for gestational age children treated with growth hormone].

    Science.gov (United States)

    Aurensanz Clemente, Esther; Samper Villagrasa, Pilar; Ayerza Casas, Ariadna; Ruiz Frontera, Pablo; Moreno Aznar, Luis Alberto; Bueno Lozano, Gloria

    2016-09-16

    Small for gestational age (SGA) children are at increased risk of metabolic syndrome. Our objective is to evaluate changes in body composition produced by growth hormone (GH) treatment. A group of 28 SGA children without catch-up growth and undergoing treatment with GH was selected for evaluation. Over the course of 3 years from the beginning of the treatment with GH, the children's body composition variables (bone mineral density [BMD], fat and lean body mass proportion) were evaluated annually with dual-energy X-ray absorptiometry. A study of correlation between metabolic and body composition variables was also made. Treatment with GH produces a reduction in fat mass proportion in relation to lean body mass, decreasing from 25.94±6.09 to 22.88±5.38% (P=.034). In the abdominal regions we observe an increase in lean mass, from 1,356,91±426,71 to 2,570,96±814,36g (P=.000) and a tendency for visceral fat deposits to decrease. BMD in lumbar vertebrae improved from -1.55±0.68 to -0.90±0.79Z (P=.019). Treatment with GH produces changes in body composition, improving BMD and increasing the proportion of lean body mass with a reduction in fat mass. If these changes persisted into adulthood, they may cause a reduction in the metabolic and cardiovascular risk in this group of patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  4. Perinatal factors affecting growth and development at age 3 years in extremely low birth weight infants born small for gestational age.

    Science.gov (United States)

    Matsuda, Nozomi; Taki, Atsuko; Tsuji, Atsumi; Nakajima, Keisuke; Takasawa, Kei; Morioka, Chikako; Minosaki, Yoshihiro; Oku, Kikuko; Kashimada, Kenichi; Morio, Tomohiro

    2018-01-01

    Factors affecting growth and development in extremely low birth weight infants (ELBWIs) born small for gestational age (SGA) have not been precisely elucidated. We performed a retrospective analysis of ELBWIs born SGA who were treated in the neonatal intensive care unit of Kawaguchi Municipal Medical Centre, Japan. A total 244 ELBWIs were born from 2003 to 2010, and 31 were born with weight and height below the 10th percentile for their gestational age. Among the 31 ELBWIs born SGA, we excluded 9 who died before they reached 3 yr of age or who had severe developmental retardation. A total of 16 patients (weight, 510-998 g; GA, 28w0d-32w5d) who were followed until age 3 yr were eligible for our study. At age 3 yr, 94% and 88% of ELBWIs were above the -2 standard deviation (SD) for height and weight, respectively. A history of mechanical ventilation was associated with height. The average score of the full developmental quotient (DQ) was 85, and 63% (10/16) of ELBWIs scored more than 85. Lower Apgar score (≤ 7) was a risk factor for lower DQ scores in motor development and full development. Our study revealed that most ELBWIs born SGA were more than -2 SD below the mean for height and body weight.

  5. Etiological Subgroups of Small-for-Gestational-Age: Differential Neurodevelopmental Outcomes.

    Directory of Open Access Journals (Sweden)

    Xiuhong Li

    Full Text Available It remains unclear why substantial variations in neurodevelopmental outcomes exist within small-for-gestational-age (SGA children. We prospectively compared 5-y neurodevelopmental outcomes across SGA etiological subgroups.Children born SGA (N = 1050 from U.S. Early Childhood Longitudinal Study-Birth Cohort (2001-2007 was divided into etiological subgroups by each of 7 well-established prenatal risk factors. We fit linear regression models to compare 5-y reading, math, gross motor and fine motor scores across SGA subgroups, adjusting for socio-demographic confounders.Compared to singleton SGA subgroup, multiple-birth SGA subgroup had lower mean reading (adjusted mean difference, -4.08 [95% confidence interval, -6.10, -2.06] and math (-2.22 [-3.61, -0.84] scores. These disadvantages in reading and math existed only among multiple-birth SGA subgroup without ovulation stimulation (reading, -4.50 [-6.64, -2.36]; math, -2.91 [-4.37, -1.44], but not among those with ovulation stimulation (reading, -2.33 [-6.24, 1.57]; math 0.63 [-1.86, 3.12]. Compared to singleton SGA subgroup without maternal smoking and inadequate gestational weight gain, singleton SGA subgroup with co-occurrence of maternal smoking and inadequate gestational weight gain (GWG had lower mean reading (-4.81 [-8.50, -1.12] and math (-2.95 [-5.51, -0.38] scores. These differences were not mediated by Apgar score.Multiple-birth SGA subgroups (vs. singleton SGA or singleton SGA subgroup with co-occurrence of smoking and inadequate GWG (vs. singleton SGA subgroup without maternal smoking and inadequate gestational weight gain have poorer cognitive development up to 5 y.

  6. Dependence of malformation upon gestational age and exposed dose of gamma radiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung-Ho; Lee, Jong-Hwan; Oh, Heon; Kim, Se-Ra [Chonnam National Univ., Kwangju (Korea, Republic of). Coll. of Veterinary Medicine; Lee, Cha-Soo; Jo, Sung-Kee; Kim, Tae-Hwan; Lee, Yun-Sil

    2001-09-01

    In order to evaluate the importance of gestational age and the dose-incidence relationship by gamma radiation, pregnant ICR mice at gestational days from 2.5 to 15.5 days post-coitus (p.c.) were exposed to a single dose of 2.0 Gy and also at day 11.5 after conception, which was the most sensitive stage for the induction of major congenital malformations. The animals were sacrificed on day 18 of gestation and the fetuses were examined for mortality, growth retardation, changes in head size and other morphological abnormalities. The only demonstrable effect of irradiation during the pre-implantation period was an increase in prenatal mortality. Resorptions were maximal on exposure at day 2.5 after conception. The pre-implantation irradiated embryos which survived did not show any major fetal abnormalities. A small head, growth retardation, a cleft palate, dilatation of the cerebral ventricle, a renal pelvis, and abnormalities of the extremities and tail after exposure were prominent during the organogenesis period, especially on day 11.5 of gestation. As for the dose-incidence relationship, the incidence of a small head, growth-retarded fetuses, a cleft palate, dilatation of cerebral ventricle and abnormalities of the extremities in live fetuses rose as the radiation dose increased. The result indicated that the late period of organogenesis in the development of the brain, skull and extremities of a mouse was a particularly sensitive phase. The threshold doses of radiation that induced a cleft palate and dilatation of the cerebral ventricle, and abnormal extremities were between 1.0 and 2.0 Gy, and between 0.5 and 1.0 Gy, respectively. (author)

  7. Dependence of malformation upon gestational age and exposed dose of gamma radiation

    International Nuclear Information System (INIS)

    Kim, Sung-Ho; Lee, Jong-Hwan; Oh, Heon; Kim, Se-Ra; Lee, Cha-Soo; Jo, Sung-Kee; Kim, Tae-Hwan; Lee, Yun-Sil

    2001-01-01

    In order to evaluate the importance of gestational age and the dose-incidence relationship by gamma radiation, pregnant ICR mice at gestational days from 2.5 to 15.5 days post-coitus (p.c.) were exposed to a single dose of 2.0 Gy and also at day 11.5 after conception, which was the most sensitive stage for the induction of major congenital malformations. The animals were sacrificed on day 18 of gestation and the fetuses were examined for mortality, growth retardation, changes in head size and other morphological abnormalities. The only demonstrable effect of irradiation during the pre-implantation period was an increase in prenatal mortality. Resorptions were maximal on exposure at day 2.5 after conception. The pre-implantation irradiated embryos which survived did not show any major fetal abnormalities. A small head, growth retardation, a cleft palate, dilatation of the cerebral ventricle, a renal pelvis, and abnormalities of the extremities and tail after exposure were prominent during the organogenesis period, especially on day 11.5 of gestation. As for the dose-incidence relationship, the incidence of a small head, growth-retarded fetuses, a cleft palate, dilatation of cerebral ventricle and abnormalities of the extremities in live fetuses rose as the radiation dose increased. The result indicated that the late period of organogenesis in the development of the brain, skull and extremities of a mouse was a particularly sensitive phase. The threshold doses of radiation that induced a cleft palate and dilatation of the cerebral ventricle, and abnormal extremities were between 1.0 and 2.0 Gy, and between 0.5 and 1.0 Gy, respectively. (author)

  8. Estimating recurrence and incidence of preterm birth subject to measurement error in gestational age: A hidden Markov modeling approach.

    Science.gov (United States)

    Albert, Paul S

    2018-02-21

    Prediction of preterm birth as well as characterizing the etiological factors affecting both the recurrence and incidence of preterm birth (defined as gestational age at birth ≤ 37 wk) are important problems in obstetrics. The National Institute of Child Health and Human Development (NICHD) consecutive pregnancy study recently examined this question by collecting data on a cohort of women with at least 2 pregnancies over a fixed time interval. Unfortunately, measurement error due to the dating of conception may induce sizable error in computing gestational age at birth. This article proposes a flexible approach that accounts for measurement error in gestational age when making inference. The proposed approach is a hidden Markov model that accounts for measurement error in gestational age by exploiting the relationship between gestational age at birth and birth weight. We initially model the measurement error as being normally distributed, followed by a mixture of normals that has been proposed on the basis of biological considerations. We examine the asymptotic bias of the proposed approach when measurement error is ignored and also compare the efficiency of this approach to a simpler hidden Markov model formulation where only gestational age and not birth weight is incorporated. The proposed model is compared with alternative models for estimating important covariate effects on the risk of subsequent preterm birth using a unique set of data from the NICHD consecutive pregnancy study. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

  9. [The relationship between metabolic disorders and small for gestational age with idiopathic premature adrenarche].

    Science.gov (United States)

    Mejorado Molano, Francisco Javier; Andrés Zallo, Laura; Fornos Rodríguez, Marta; Pérez Segura, Pilar; Gavela Pérez, Teresa; Sanz Calvo, María Luisa; Soriano Guillén, Leandro

    2017-11-01

    There is still controversy on the relationship between idiopathic premature adrenarche (IPA) and a history of small for gestational age, as well as the concomitant presence of obesity and other metabolic disturbances. An attempt is made to study these potential associations in a cohort of girls with IPA from our hospital. A descriptive cross-sectional study was conducted that included girls with a diagnosis of IPA from the Paediatric Department of the Fundación Jiménez Díaz (Madrid, Spain) between January 2007 and May 2015. A record was made of family and personal history with perinatal data, as well as anthropometric data and biochemical values at the time of diagnosis. Out of a total of 76 girls with IPA, 2.7% had a history of small for gestational age. When body mass index was analysed according to modified criteria of WHO 2007/Cole 2000, 11.8% were overweight, and 11.8% were obese at diagnosis. Using the criteria set by the Spanish Ministry of Health, 6.6% were overweight and 18.4% obese, with 21.2% of the girls being insulin resistance, and 13.95% having dyslipidaemia. None of them had hypertension. From a comparative analysis between normal and overweight and obesity IPA girls, the latter had significantly higher levels of triglycerides and insulin, a higher HOMA index, and lower levels of HDL cholesterol. IPA girls included in the study do not have a higher prevalence of small for gestational age compared to the general population. Prevalence of overweight and obesity in girls with IPA is not higher than the prevalence in the normal population. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Induced abortion and risk of small-for-gestational-age birth.

    Science.gov (United States)

    Parazzini, F; Cipriani, S; Chiaffarino, F; Sandretti, F; Bortolus, R; Chiantera, V

    2007-11-01

    To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant. Case-control study. General and university hospitals. Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal characteristics and habits, gynaecological and obstetric history, general anamnesis, family history of obstetric and gynaecological diseases, and the age of the father of the child. Further information on current pregnancy and delivery was also collected. We used conditional multiple logistic regression (with age as the matching variable), with maximum likelihood fitting, to obtain odds ratios and their corresponding 95% CIs. Included in the regression equations were terms for education, plus terms significantly associated in this data set with the risk of SGA birth (smoking in pregnancy, history of SGA, gestational hypertension and parity). Women admitted to a general and a university hospital. No significant increase in the risk of SGA birth was observed in women with a previous induced abortion [odds ratio (OR) 1.0; 95% CI 0.6-1.7]. The OR for SGA birth was 1.2 (95% CI 0.7-2.1) for preterm and 1.0 (95% CI 0.7-1.4) for term SGA births. This study found no association between risk of SGA birth and induced abortion.

  11. Effect of low lead exposure on gestational age, birth weight and premature rupture of the membrane.

    Science.gov (United States)

    Mirghani, Zein

    2010-12-01

    To find out the effect of prenatal exposure to low lead from cosmetics on gestational age, premature rupture of the membrane and birth weight. The study was carried out in the mountainous Aseer region, Southwest of Saudi Arabia where the air is thought to be clean and free of lead pollution due to the absence of petroleum smelting and other heavy industries. The region is famous as a holiday resort for tourists from Arabia and the gulf countries. All 176 pregnant women included in the study were of singleton pregnancies of gestational age 27 weeks or more who attended the antenatal outpatient clinic of the main maternity hospital. On the day of delivery 4 milliliters of venous blood from each singleton parturient was placed in a heparinized non-silica containing tube and stored at -20 degrees C prior to analysis. Ninety-four (70.1%) women out of 134 had maternal blood lead concentration 200 microg/L. The mean difference in gestational age was 10.5 days, showing a non significant difference (P=0.152). Ninety-three women (72.7%) out of a total of 128 who had blood lead concentration 200 microg/L gave birth to infants weighing an average of 2.99 kg. The mean difference was 0.12 kg which is non-significant (P=0.261). Regarding premature.rupture of the membrane a total of 127 women with maternal blood lead levels above 200 microg/L showed no significant differences (P=0.64). The Chi-square test of the relationship between the birth weight (kg) and the levels of blood lead below 150 microg/L was not significant while the relationship between the birth weight (kg) and the levels of blood lead above 200 microg/L resulted in very slight differences in the values of infants' birth weight. The detected low lead exposures from cosmetics does not produce statistically significant effects on the three pregnancy outcomes; gestational age, premature rupture of the membrane or birth weight. However, the importance of low lead exposure from the 100% lead sulfide eye cosmetic "kohl

  12. Effect of low lead exposure on gestational age, birth weight and premature rupture of the membrane

    International Nuclear Information System (INIS)

    Mirghani, Z.

    2010-01-01

    Objective: To find out the effect of prenatal exposure to low lead from cosmetics on gestational age, premature rupture of the membrane and birth weight. Methods: The study was carried out in the mountainous Aseer region, Southwest of Saudi Arabia where the air is thought to be clean and free of lead pollution due to the absence of petroleum smelting and other heavy industries. The region is famous as a holiday resort for tourists from Arabia and the gulf countries. All 176 pregnant women included in the study were of singleton pregnancies of gestational age 27 weeks or more who attended the antenatal outpatient clinic of the main maternity hospital. On the day of delivery 4 milliliters of venous blood from each singleton parturient was placed in a heparinized non-silica containing tube and stored at -20 deg. C prior to analysis. Results: Ninety-four (70.1%) women out of 134 had maternal blood lead concentration 200 mu g/L. The mean difference in gestational age was 10.5 days, showing a non significant difference (P=0.152). Ninety-three women (72.7%) out of a total of 128 who had blood lead concentration 200 mu g/L gave birth to infants weighing an average of 2.99 kg. The mean difference was 0.12 kg which is non-significant (P=0.261). Regarding premature rupture of the membrane a total of 127 women with maternal blood lead levels above 200 mu g/L showed no significant differences (P=0.64). The Chi-square test of the relationship between the birth weight (kg) and the levels of blood lead below 150 mu g/L was not significant while the relationship between the birth weight (kg) and the levels of blood lead above 200 mu g/L resulted in very slight differences in the values of infants' birth weight. Conclusion: The detected low lead exposures from cosmetics does not produce statistically significant effects on the three pregnancy outcomes; gestational age, premature rupture of the membrane or birth weight. However, the importance of low lead exposure from the 100% lead

  13. Accuracy and correlates of maternal recall of birthweight and gestational age

    DEFF Research Database (Denmark)

    Adegboye, A R A; Heitmann, Berit Lilienthal

    2008-01-01

    OBJECTIVE: To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates. DESIGN: Comparison of data from the DBR...... agreement between recalled and registered BW (MD =-0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression...

  14. Maternal obesity, gestational diabetes, breastfeeding and childhood overweight at age 2 years.

    Science.gov (United States)

    Bider-Canfield, Z; Martinez, M P; Wang, X; Yu, W; Bautista, M P; Brookey, J; Page, K A; Buchanan, T A; Xiang, A H

    2017-04-01

    Maternal obesity, excessive gestational weight gain (EGWG), gestational diabetes mellitus (GDM) and breastfeeding are four important factors associated with childhood obesity. The objective of the study was to assess the interplay among these four factors and their independent contributions to childhood overweight in a cohort with standard clinical care. The cohort included 15 710 mother-offspring pairs delivered in 2011. Logistic regression was used to assess associations between maternal exposures and childhood overweight (body mass index >85th percentile) at age 2 years. Mothers with pre-pregnancy obesity or overweight were more likely to have EGWG, GDM and less likely to breastfeed ≥6 months. Mothers with GDM had 40-49% lower EGWG rates and similar breastfeeding rates compared with mothers without GDM. Analysis adjusted for exposures and covariates revealed an adjusted odds ratio (95% confidence interval) associated with childhood overweight at age 2 years of 2.34 (2.09-2.62), 1.50 (1.34-1.68), 1.23 (1.12-1.35), 0.95 (0.83-1.10) and 0.76 (0.69-0.83) for maternal obesity, overweight, EGWG, GDM and breastfeeding ≥6 months vs. obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years. © 2016 World Obesity Federation.

  15. Mental health of small children for normal gestational age: a cohort study from Southeastern Brazil

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    Adriana Martins Saur

    2015-03-01

    Full Text Available The aim of this study is to investigate mental health problems in children born small for gestational age (SGA and those born appropriate for gestational age (AGA and to assess the association of these problems with child and family characteristics. Six hundred and seventy-seven children, belonging to a birth cohort from 1994 in Ribeirão Preto/SP (southeastern Brazil, were evaluated (140 SGA and 537 AGA. They were later reevaluated at school age (2004/2005 by means of the Strengths and Difficulties Questionnaire for mental health assessment (parent report. Results showed that children born SGA presented greater frequency of behavioral problems and emotional symptoms compared to children born AGA. Variables associated with mental health problems in the univariate model were: male sex, children born SGA, low educational level of parents, socioeconomic disadvantage, and belonging to families with many members. However, in multivariate analysis, two factors - being born SGA and father's low educational level - lost their statistical significance, and the other sociodemographic variables remained significant (male sex, low-level of maternal education, low socioeconomic level, families with many members. It has been concluded that being born SGA was not independently associated with mental health problems, but sociodemographic factors proved to be the predictors of this type of problem in the cohort studied.

  16. Very early feeding in stable small for gestational age preterm infants: a randomized clinical trial.

    Science.gov (United States)

    Arnon, Shmuel; Sulam, Daniella; Konikoff, Fred; Regev, Rivka H; Litmanovitz, Ita; Naftali, Timna

    2013-01-01

    To examine the effect of initiating very early feeding on time-to-reach full feeding in stable, small for gestational age (SGA) preterm infants. Preterm infants with gestational age below 37 weeks and birth weight below the 10(th) percentile were randomly allocated to a very early (within 24 hours of birth) feeding regimen or delayed (after 24 hours of birth) feeding. All infants had in utero evidence of absent or reverse diastolic flow. Infants unable to start early feeding were excluded. Time-to-reach full feeding, feeding progression, and related morbidity were compared. Electrogastrography (EGG) was used to measure pre- and postprandial gastric motility on the second and seventh day after feeding initiation. Sixty infants were included in the study, 30 in each group. Infants included in the very early feeding regimen achieved full enteral feeding sooner than controls (98±80-157 vs. 172±123-261 hours of age, respectively; p= 0.004) and were discharged home earlier (p=0.04). No necrotizing enterocolitis (NEC) was documented in both study groups. Gastric motility was improved at day seven after feeding initiation in both study groups, with no difference between groups. Stable SGA preterm infants on a very early feeding regimen achieved full enteral feeding and were discharged home significantly earlier than those on a delayed regimen, with no excess morbidity. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  17. The Effect of Gestational Age on Axial Length of the Eyes of Premature Infants

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    Mehmet Ali Sekeroglu

    2016-01-01

    Full Text Available Aim: The aim of the present study is to evaluate the axial length of the eyes of premature infants without retinopathy of prematurity and to document the relationship with gestational age and changes as infants grew-up. Material and Method: The axial length of the eyes were measured by using a mobile A-scan ultrasonographic biometry device just before the first retinopathy of prematurity screening examination and 4-weeks thereafter. Results: One-hundred and thirty-six infants with a mean gestational age of 31,7±2,7 weeks and a birth-weight of 1561.0±379.3 g were included in the study. Axial length measurements were done at a mean postconceptional age of 35.8 ±2.6 (31-40 and 39.8±2.7 (35-44 weeks, consecutively. The mean axial length at first and second visits were 16.43±0.42 mm (15.28-17.13 and 16.69±0.41 mm (15.60-17.70, consecutively (p

  18. Learning-based prediction of gestational age from ultrasound images of the fetal brain.

    Science.gov (United States)

    Namburete, Ana I L; Stebbing, Richard V; Kemp, Bryn; Yaqub, Mohammad; Papageorghiou, Aris T; Alison Noble, J

    2015-04-01

    We propose an automated framework for predicting gestational age (GA) and neurodevelopmental maturation of a fetus based on 3D ultrasound (US) brain image appearance. Our method capitalizes on age-related sonographic image patterns in conjunction with clinical measurements to develop, for the first time, a predictive age model which improves on the GA-prediction potential of US images. The framework benefits from a manifold surface representation of the fetal head which delineates the inner skull boundary and serves as a common coordinate system based on cranial position. This allows for fast and efficient sampling of anatomically-corresponding brain regions to achieve like-for-like structural comparison of different developmental stages. We develop bespoke features which capture neurosonographic patterns in 3D images, and using a regression forest classifier, we characterize structural brain development both spatially and temporally to capture the natural variation existing in a healthy population (N=447) over an age range of active brain maturation (18-34weeks). On a routine clinical dataset (N=187) our age prediction results strongly correlate with true GA (r=0.98,accurate within±6.10days), confirming the link between maturational progression and neurosonographic activity observable across gestation. Our model also outperforms current clinical methods by ±4.57 days in the third trimester-a period complicated by biological variations in the fetal population. Through feature selection, the model successfully identified the most age-discriminating anatomies over this age range as being the Sylvian fissure, cingulate, and callosal sulci. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Maternal selenium, copper and zinc concentrations in pregnancy associated with small-for-gestational-age infants.

    Science.gov (United States)

    Mistry, Hiten D; Kurlak, Lesia O; Young, Scott D; Briley, Annette L; Pipkin, Fiona Broughton; Baker, Philip N; Poston, Lucilla

    2014-07-01

    Pregnancy during adolescence increases the risk of adverse pregnancy outcome, especially small-for-gestational-age (SGA) birth, which has been linked to micronutrient deficiencies. Smoking has been shown to be related to lower micronutrient concentrations. Different ethnicities have not been examined. We used a subset from a prospective observational study, the About Teenage Eating study consisting of 126 pregnant adolescents (14-18-year-olds) between 28 and 32 weeks gestation. Micronutrient status was assessed by inductively coupled mass spectrometry. Smoking was assessed by self-report and plasma cotinine, and SGA was defined as infants born selenium, copper and zinc concentrations in adolescent mothers giving birth to SGA vs. appropriate-for-gestational-age (AGA) infants; and (2) comparison of micronutrient concentrations between women of different ethnicities and smoking habits. The plasma selenium {mean ± standard deviation (SD) [95% confidence interval (CI)]} concentration was lower in the SGA [n = 19: 49.4 ± 7.3 (CI: 45.9, 52.9) µg L(-1)] compared with the AGA [n = 107: 65.1 ± 12.5 (CI: 62.7, 67.5) µg L(-1); P selenium concentration compared with non-smokers (P = 0.01) and Afro-Caribbean women had higher selenium concentrations compared with White Europeans (P = 0.02). Neither copper nor zinc concentrations varied between groups. Low plasma selenium concentration in adolescent mothers could contribute to the risk of delivering an SGA infant, possibly through lowering placental antioxidant defence, thus directly affecting fetal growth. Differences in plasma selenium between ethnicities may relate to variation in nutritional intake, requiring further investigation. © 2012 John Wiley & Sons Ltd.

  20. Temporal Trends in Chorioamnionitis by Maternal Race/Ethnicity and Gestational Age (1995–2010

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    Michael J. Fassett

    2013-01-01

    Full Text Available Objective. To characterize trends in chorioamnionitis (CAM by maternal race/ethnicity and gestational age. Study Design. We examined trends in CAM from 1995–2010 among singleton births in all Kaiser Permanente Southern California hospitals (. Data were extracted from Perinatal Service System and clinical utilization records. Gestational age- and race/ethnicity-specific biannual diagnosis rates were estimated using the Poisson regression after adjusting for potential confounding factors. Results. Overall diagnosis rates of CAM increased from 2.7% in 1995-1996 to 6.0% in 2009-2010 with a relative increase of 126% (95% confidence intervals [CI] 113%–149%. From 1995-1996 to 2009-2010, CAM increased among the Whites (1.8% to 4.3%, -value for trend <.001, Blacks (2.2% to 3.7%, -value for trend <.001, Hispanics (2.4% to 5.8%, -value for trend <.001, and Asian/Pacific Islanders (3.6% to 9.0%, -value for trend <.001. The adjusted relative percentage change in CAM from 1995-1996 to 2009-2010 was for Whites [preterm 21% (9%–78%, term 138% (108%–173%], for Blacks [preterm 24% (−9%–81%, term 62% (30%–101%], for Hispanics [preterm 31% (3%–66%, term 135% (114%–159%], and for Asian/Pacific Islanders [preterm 44% (9%–127%, term 145% (109%–188%]. Conclusion. The findings suggest that CAM diagnosis rate has increased for all race/ethnic groups. This increase is primarily due to increased diagnosis at term gestation.

  1. Resting-state oscillatory activity in children born small for gestational age: a magnetoencephalographic study

    Directory of Open Access Journals (Sweden)

    Maria eBoersma

    2013-09-01

    Full Text Available Growth restriction in utero during a period that is critical for normal growth of the brain, has previously been associated with deviations in cognitive abilities and brain anatomical and functional changes. We measured magnetoencephalography (MEG in 4-7 year old children to test if children born small for gestational age (SGA show deviations in resting-state brain oscillatory activity. Children born SGA children with postnatally spontaneous catch-up growth (SGA+; 6 boys, 7 girls; mean age 6.3 y (SD=0.9 and children born appropriate for gestational age (AGA; 7 boys, 3 girls; mean age 6.0 y (SD=1.2 participated in a resting-state MEG study. We calculated absolute and relative power spectra and used nonparametric statistics to test for group differences. SGA+ and AGA born children showed no significant differences in absolute and relative power except for reduced absolute gamma band power in SGA children. At time of MEG investigation, SGA+ children showed was significantly lower head circumference (HC and a trend toward lower IQ, however there was no association of HC or IQ with absolute or relative power. Except for reduced absolute gamma band power, our findings suggest normal brain activity patterns at school age in a group of children born SGA in which spontaneous catch-up growth of bodily length after birth occurred. Although previous findings suggest that being born SGA alters brain oscillatory activity early in neonatal life, we show that these neonatal alterations do not persist at early school age when spontaneous postnatal catch-up growth occurs after birth.

  2. Trends in the distribution of gestational age and contribution of planned births in New South Wales, Australia.

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    Natasha Nassar

    Full Text Available BACKGROUND: There is concern that the rate of planned births (by pre-labour caesarean section or induction of labour is increasing and that the gestation at which they are being conducted is decreasing. The aim of this study was to describe trends in the distribution of gestational age, and assess the contribution of planned birth to any such changes. METHODS: We utilised the New South Wales (NSW Perinatal Data Collection to undertake a population-based study of all births in NSW, Australia 1994-2009. Trends in gestational age were determined by year, labour onset and plurality of birth. RESULTS: From 1994-2009, there was a gradual and steady left-shift in overall distribution of gestational age at birth, with a decline in the modal gestational age from 40 to 39 weeks. For singletons, there was a steady but significant reduction in the proportion of spontaneous births. Labour inductions increased in the proportion performed, with a gradual and changing shift in the distribution from a majority at 40 weeks to an increase at both 37-39 weeks and 41 weeks gestation. The proportion of pre-labour caesareans also increased steadily at each gestational age and doubled since 1994, with most performed at 39 weeks in 2009 compared with 38 weeks up to 2001. CONCLUSIONS: Findings suggest a changing pattern towards births at earlier gestations, fewer births commencing spontaneously and increasing planned births. Factors associated with changing clinical practice and long-term implications on the health and well-being of mothers and babies should be assessed.

  3. Gestational age-specific perinatal mortality rates for assisted reproductive technology (ART) and other births.

    Science.gov (United States)

    Chughtai, Abrar A; Wang, Alex Y; Hilder, Lisa; Li, Zhuoyang; Lui, Kei; Farquhar, Cindy; Sullivan, Elizabeth A

    2018-02-01

    Is perinatal mortality rate higher among births born following assisted reproductive technology (ART) compared to non-ART births? Overall perinatal mortality rates in ART births was higher compared to non-ART births, but gestational age-specific perinatal mortality rate of ART births was lower for very preterm and moderate to late preterm births. Births born following ART are reported to have higher risk of adverse perinatal outcomes compared to non-ART births. This population-based retrospective cohort study included 407 368 babies (391 952 non-ART and 15 416 ART)-393 491 singletons and 10 877 twins or high order multiples. All births (≥20 weeks of gestation and/or ≥400 g of birthweight) in five states and territories in Australia during the period 2007-2009 were included in the study, using National Perinatal Data Collection (NPDC). Primary outcome measures were rates of stillbirth, neonatal and perinatal deaths. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate the likelihood of perinatal death. Rates of multiple birth and low birthweight were significantly higher in ART group compared to the non-ART group (P ART births (16.5 per 1000 births, 95% CI 14.5-18.6), compared to non-ART births (11.3 per 1000 births, 95% CI 11.0-11.6) (AOR 1.45, 95% CI 1.26-1.68). However, gestational age-specific perinatal mortality rate of ART births (including both singletons and multiples) was lower for very preterm (ART births. Congenital abnormality and spontaneous preterm were the most common causes of neonatal deaths in both ART and non-ART group. Due to different cut-off limit for perinatal period in Australia, the results of this study should be interpreted with cautions for other countries. Australian definition of perinatal period commences at 20 completed weeks (140 days) of gestation and ends 27 completed days after birth which is different from the definition by World Health Organisation (commences at 22 completed weeks (154 days) of

  4. Disparities in Birth Weight and Gestational Age by Ethnic Ancestry in South American countries

    Science.gov (United States)

    Wehby, George L.; Gili, Juan A.; Pawluk, Mariela; Castilla, Eduardo E.; López-Camelo, Jorge S.

    2015-01-01

    Objective We examine disparities in birth weight and gestational age by ethnic ancestry in 2000–2011 in eight South American countries. Methods The sample included 60480 singleton live-births. Regression models were estimated to evaluate differences in birth outcomes by ethnic ancestry controlling for time trends. Results Significant disparities were found in seven countries. In four countries – Brazil, Ecuador, Uruguay, and Venezuela – we found significant disparities in both low birth weight and preterm birth. Disparities in preterm birth alone were observed in Argentina, Bolivia, and Colombia. Several differences in continuous birth weight, gestational age, and fetal growth rate were also observed. There were no systematic patterns of disparities between the evaluated ethnic ancestry groups across the study countries, in that no racial/ethnic group consistently had the best or worst outcomes in all countries. Conclusions Racial/ethnic disparities in infant health are common in several South American countries. Differences across countries suggest that racial/ethnic disparities are driven by social and economic mechanisms. Researchers and policymakers should acknowledge these disparities and develop research and policy programs to effectively target them. PMID:25542227

  5. Sonographic Biometry of Fetal Interorbital Distance as a Predictor of Gestational Age in Enugu, Southeast Nigeria.

    Science.gov (United States)

    Nwadike, U I; Agwu, K K; Eze, C U; Okpala, O C; Onu, A O

    2015-05-13

    The objective of this study was to develop a sonographic technique for the measurement of fetal interorbital distance (IOD) for gestational age (GA) determination and to establish a normogram of IOD for the local population. The fronto-transverse sonographic technique was established as a feasible and reproducible technique for IOD measurement. Two independent and experienced sonographers tested the technique and had a coefficient of variation of 17.64% and 19.72%, respectively, which is statistically insignificant. The established technique was used to measure the IOD of 320 fetuses from the 13 th week to 40 th week GA, while standard technique was used to measure biparietal diameter (BPD), head circumference (HC) and femur length (FL) of the fetuses. The data obtained were used to determine the regression equation GA = 6.24 + 4.89 IOD for the prediction of the gestational age. There was good correlation between IOD, BPD, HC and FL. The predicted normogram of IOD was compared with normogram of the Caucasian population. The result showed that there was no statistical difference between them (p < 0.05). Results from the study suggest that the fronto-transverse technique is a feasible and reproducible technique for IOD measurement and the established normogram of IOD can be a veritable statistic for GA prediction in our locality.

  6. Using fMRI to Investigate Memory in Young Children Born Small for Gestational Age.

    Science.gov (United States)

    de Bie, Henrica M A; de Ruiter, Michiel B; Ouwendijk, Mieke; Oostrom, Kim J; Wilke, Marko; Boersma, Maria; Veltman, Dick J; Delemarre-van de Waal, Henriette A

    2015-01-01

    Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with differences in brain anatomy and impaired cognition. We investigated learning and memory in children born SGA using neuropsychological testing and functional Magnetic Resonance Imaging (fMRI). 18 children born appropriate for gestational age (AGA) and 34 SGA born children (18 with and 16 without postnatal catch-up growth) participated in this study. All children were between 4 and 7 years old. Cognitive functioning was assessed by IQ and memory testing (Digit/Word Span and Location Learning). A newly developed fMRI picture encoding task was completed by all children in order to assess brain regions involved in memory processes. Neuropsychological testing demonstrated that SGA children had IQ's within the normal range but lower than in AGA and poorer performances across measures of memory. Using fMRI, we observed memory related activity in posterior parahippocampal gyrus as well as the hippocampus proper. Additionally, activation was seen bilaterally in the prefrontal gyrus. Children born SGA showed less activation in the left parahippocampal region compared to AGA. This is the first fMRI study demonstrating different brain activation patterns in 4-7 year old children born SGA, suggesting that intrauterine growth restriction continues to affect neural functioning in children later-on.

  7. Maternal hypertension and neonatal outcome among small for gestational age infants.

    Science.gov (United States)

    von Dadelszen, Peter; Magee, Laura Ann; Taylor, Elizabeth L; Muir, Jennifer C; Stewart, Shawn D; Sherman, Paul; Lee, Shoo K

    2005-08-01

    To determine whether maternal hypertension might improve perinatal outcome among small for gestational age (SGA) infants (neonatal intensive care units (NICUs) and 3,244 SGA singletons. Multivariable regression was used to analyze the relation between maternal hypertension and each of the following: SNAP-II (Score of Neonatal Acute Physiology; ordinal regression) and neonatal survival and survival without severe intraventricular hemorrhage (logistic regression), adjusting for potential confounders. There were 698 (21.5%) neonates born to hypertensive mothers. Inversely associated with lower SNAP-II scores (healthier infant) were antenatal steroids (complete course: odds ratio [OR] 0.67, 95% confidence interval [CI] 0.54-0.83; incomplete: OR 0.71, 95% CI 0.56-0.88), lower gestational age (neonatal survival (93.0% versus 91.2%, and adjusted OR 1.9, 95% CI 1.2-3.0), but not survival without severe intraventricular hemorrhage (91.4% versus 87.0%, and adjusted OR 1.4, 95% CI 1.0-2.0), respectively. Among SGA neonates in NICU, maternal hypertension is associated with improved admission neonatal physiology and survival.

  8. Small for Gestational Age and Magnesium: Intrauterine magnesium deficiency may induce metabolic syndrome in later life

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    Junji Takaya

    2015-12-01

    Full Text Available Magnesium deficiency during pregnancy as a result of insufficient or low intake of magnesium is common in developing and developed countries. Previous reports have shown that intracellular magnesium of cord blood platelets is lower among small for gestational age (SGA groups than that of appropriate for gestational age (AGA groups, suggesting that intrauterine magnesium deficiency may result in SGA. Additionally, the risk of adult-onset diseases such as insulin resistance syndrome is greater among children whose mothers were malnourished during pregnancy, and who consequently had a low birth weight. In a number of animal models, poor nutrition during pregnancy leads to offspring that exhibit pathophysiological changes similar to human diseases. The offspring of pregnant rats fed a magensium restricted diet have developed hypermethylation in the hepatic 11β-hydroxysteroid dehydrogenase-2 promoter. These findings indicate that maternal magnesium deficiencies during pregnancy influence regulation of non-imprinted genes by altering the epigenetic regulation of gene expression, thereby inducing different metabolic phenotypes. Magnesium deficiency during pregnancy may be responsible for not only maternal and fetal nutritional problems, but also lifelong consequences that affect the offspring throughout their life. Epidemiological, clinical, and basic research on the effects of magnesium deficiency now indicates underlying mechanisms, especially epigenetic processes.

  9. [Comparative analysis of risk factors for preterm and small-for-gestational-age births].

    Science.gov (United States)

    Zhong, Xin-Qi; Cui, Qi-Liang

    2014-12-01

    To compare the risk factors between preterm and small-for-gestational-age (SGA) births. A total of 1 270 newborns who had no obstetric risk factors or maternal diseases were enrolled in this study. Their mothers' stature, body weight, passive smoking, and history of abnormal pregnancy were investigated using the self-designed questionnaire. The infants were divided into four groups: preterm, appropriate-for-gestational-age (AGA), SGA, and term infants. Multivariate logistic regression analysis was performed to compare the risk factors between preterm and SGA births. A weight gain less than 9 kg during pregnancy increased the risks of preterm (OR=1.63, 95% CI: 1.12-2.07) and SGA (OR=1.92, 95% CI: 1.56-2.58). The histories of abortion (OR=1.46, 95% CI: 1.09-1.93) and preterm birth (OR=2.63, 95% CI: 1.81-3.92) were independent risk factors for preterm births, while low pre-pregnancy body mass index (births. Due to different risk factors between preterm and SGA births, specific preventive measures should be taken pertinently to reduce the incidence of the two bad pregnancy outcomes.

  10. Gestational age at birth and risk of intellectual disability without a common genetic cause.

    Science.gov (United States)

    Heuvelman, Hein; Abel, Kathryn; Wicks, Susanne; Gardner, Renee; Johnstone, Edward; Lee, Brian; Magnusson, Cecilia; Dalman, Christina; Rai, Dheeraj

    2017-12-06

    Preterm birth is linked to intellectual disability and there is evidence to suggest post-term birth may also incur risk. However, these associations have not yet been investigated in the absence of common genetic causes of intellectual disability, where risk associated with late delivery may be preventable. We therefore aimed to examine risk of intellectual disability without a common genetic cause across the entire range of gestation, using a matched-sibling design to account for unmeasured confounding by shared familial factors. We conducted a population-based retrospective study using data from the Stockholm Youth Cohort (n = 499,621) and examined associations in a nested cohort of matched outcome-discordant siblings (n = 8034). Risk of intellectual disability was greatest among those born extremely early (adjusted OR 24 weeks  = 14.54 [95% CI 11.46-18.44]), lessening with advancing gestational age toward term (aOR 32 weeks  = 3.59 [3.22-4.01]; aOR 37 weeks  = 1.50 [1.38-1.63]); aOR 38 weeks  = 1.26 [1.16-1.37]; aOR 39 weeks = 1.10 [1.04-1.17]) and increasing with advancing gestational age post-term (aOR 42 weeks  = 1.16 [1.08-1.25]; aOR 43 weeks  = 1.41 [1.21-1.64]; aOR 44 weeks  = 1.71 [1.34-2.18]; aOR 45 weeks  = 2.07 [1.47-2.92]). Associations persisted in a cohort of matched siblings suggesting they were robust against confounding by shared familial traits. Risk of intellectual disability was greatest among children showing evidence of fetal growth restriction, especially when birth occurred before or after term. Birth at non-optimal gestational duration may be linked causally with greater risk of intellectual disability. The mechanisms underlying these associations need to be elucidated as they are relevant to clinical practice concerning elective delivery around term and mitigation of risk in post-term children.

  11. Second-trimester maternal distress increases the risk of small for gestational age.

    Science.gov (United States)

    Khashan, A S; Everard, C; McCowan, L M E; Dekker, G; Moss-Morris, R; Baker, P N; Poston, L; Walker, J J; Kenny, L C

    2014-10-01

    The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations. The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 ± 1 and 20 ± 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise. The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07-1.71], moderate (aOR 1.26, 95% CI 1.06-1.49), high (aOR 1.45, 95% CI 1.08-1.95) and very high stress scores (aOR 1.56, 95% CI 1.03-2.37); very high anxiety score (aOR 1.45, 95% CI 1.13-1.86); and very high depression score (aOR 1.14, 95% CI 1.05-1.24) at 20 ± 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females. These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

  12. Mothers, places and small for gestational age births: a cohort study.

    Science.gov (United States)

    Sundquist, Jan; Sundquist, Kristina; Johansson, Sven-Erik; Li, Xinjun; Winkleby, Marilyn

    2011-04-01

    This study examines whether neighbourhood deprivation increases the risk of giving birth to a small for gestational age (SGA) infant, after accounting for individual-level maternal socioeconomic characteristics. An open cohort of women, aged 20-44 years, was followed from 1 January 1992 through 31 December 2004 for first singleton births. The women's residential addresses during the two consecutive years preceding the birth of their infants were geocoded and classified into three levels of neighbourhood deprivation. Gestational age was confirmed by ultrasound examinations. Multilevel logistic regression models were used in the statistical analysis. Sweden. During the study period, women gave birth to 720 357 infants, of whom 20 487 (2.8%) were SGA. Age-adjusted incidence rates of SGA births increased with increasing level of neighbourhood deprivation. In the total population, 2.5% of births in the least deprived neighbourhoods and 3.5% of births in the most deprived neighbourhoods were SGA. A similar pattern of higher incidence with increasing level of neighbourhood-level deprivation was observed across all individual-level sociodemographic categories, including maternal age, marital status, family income, educational attainment, employment, mobility and urban/rural status. High neighbourhood-level deprivation remained significantly associated with SGA risk after adjusting for maternal sociodemographic characteristics (OR 1.28, 95% CI 1.22 to 1.34). This study is the largest to date of the influence of neighbourhood on SGA birth, with SGA confirmed by ultrasound examination. Results suggest that the characteristics of a mother's neighbourhood affect the risk of delivering an SGA infant independently of maternal sociodemographic characteristics.

  13. Gestational Age and Child Development at Age Five in a Population-Based Cohort of Australian Aboriginal and Non-Aboriginal Children.

    Science.gov (United States)

    Hanly, Mark; Falster, Kathleen; Chambers, Georgina; Lynch, John; Banks, Emily; Homaira, Nusrat; Brownell, Marni; Eades, Sandra; Jorm, Louisa

    2018-01-01

    Preterm birth and developmental vulnerability are more common in Australian Aboriginal compared with non-Aboriginal children. We quantified how gestational age relates to developmental vulnerability in both populations. Perinatal datasets were linked to the Australian Early Development Census (AEDC), which collects data on five domains, including physical, social, emotional, language/cognitive, and general knowledge/communication development. We quantified the risk of developmental vulnerability on ≥1 domains at age 5, according to gestational age and Aboriginality, for 97 989 children born in New South Wales, Australia, who started school in 2009 or 2012. Seven thousand and seventy-nine children (7%) were Aboriginal. Compared with non-Aboriginal children, Aboriginal children were more likely to be preterm (5% vs. 9%), and developmentally vulnerable on ≥1 domains (20% vs. 36%). Overall, the proportion of developmentally vulnerable children decreased with increasing gestational age, from 44% at ≤27 weeks to 20% at 40 weeks. Aboriginal children had higher risks than non-Aboriginal children across the gestational age range, peaking among early term children (risk difference [RD] 19.0, 95% confidence interval [CI] 16.3, 21.7; relative risk [RR] 1.91, 95% CI 1.77, 2.06). The relation of gestational age to developmental outcomes was the same in Aboriginal and non-Aboriginal children, and adjustment for socio-economic disadvantage attenuated the risk differences and risk ratios across the gestational age range. Although the relation of gestational age to developmental vulnerability was similar in Aboriginal and non-Aboriginal children, Aboriginal children had a higher risk of developmental vulnerability at all gestational ages, which was largely accounted for by socio-economic disadvantage. © 2017 John Wiley & Sons Ltd.

  14. 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.

    Science.gov (United States)

    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.

  15. Gestational Age at Birth and 'Body-Mind' Health at 5 Years of Age: A Population Based Cohort Study.

    LENUS (Irish Health Repository)

    Cronin, Frances M

    2016-01-01

    Numerous studies have identified the effects of prematurity on the neonate\\'s physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000-2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children\\'s general health and severity of behavior problems. The association between parent\\'s general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor\\/fair health and\\/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32-36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%-6.2%), compared to 1% (0.2-2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.

  16. Gestational Age at Birth and 'Body-Mind' Health at 5 Years of Age: A Population Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Frances M Cronin

    Full Text Available Numerous studies have identified the effects of prematurity on the neonate's physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000-2002 in the United Kingdom was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children's general health and severity of behavior problems. The association between parent's general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764 rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems, suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32-36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%-6.2%, compared to 1% (0.2-2.3 for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.

  17. Relationship between ultrasound estimated fetal gestational age and cerebellar appearance in healthy pregnant Nigerian women.

    Science.gov (United States)

    Adeyekun, Ademola A; Orji, Michael O

    2015-01-01

    Fetal biometry by ultrasound provides reliable and important information about fetal growth and wellbeing. Evaluation of the fetal posterior fossa is useful in the assessment of neural tube-defects. Studies on normal ultrasound fetal cerebellar appearance and diameter across gestational age (GA) are scanty in the Nigerian medical literature. This study was carried out to study normal fetal cerebellar appearance and diameter at various GAs among healthy pregnant Nigerian Africans. This was a prospective study of 450 healthy singleton pregnant women between 13 and 42 weeks gestation. A curvilinear probe with a 3.5 MHz transducer of a SonoAce X6 (Medison Inc., Korea 2010) scanner was used to assess fetal transcerebellar diameter (TCD) and appearance. GA was also determined using fetal biometric parameters such as the biparietal diameter, femur length, and abdominal circumference. Fetal cerebellar appearance was correlated against GA. The cerebellar appearance was graded into: Grade I: 164 fetuses (36.4%), Grade II; 102 fetuses (22.7%) and Grade III: 184 fetuses (40.9%). Mean GA and TCD was 21 weeks and 21.2 mm for Grade I; 28 weeks and 32.6 mm for Grade II; and 35 weeks and 47.1 mm for Grade III. There was significance difference among the cerebellar grades at the GA groups and transverse cerebellar diameter (P < 0.000). There is a gradual and steady change in ultrasonographic appearance of the fetal cerebellar and diameter appearance with advancing gestation. The changes ranged from anechoic, "pair of eye glass" appearance at second trimester to relatively echogenic, "dumb-bell" appearance at early third trimester, and solid, "fan-shape" in late third trimester.

  18. Working memory mediates the effects of gestational age at birth on expressive language development in children.

    Science.gov (United States)

    Riva, Valentina; Cantiani, Chiara; Dionne, Ginette; Marini, Andrea; Mascheretti, Sara; Molteni, Massimo; Marino, Cecilia

    2017-07-01

    This study tested the role of temporary memory, measured by phonological short-term memory (pSTM) and verbal working memory (vWM), as a mediator of the effect of 3 putative risk factors (i.e., socioeconomic status, home literacy environment, birth gestational age) upon expressive and receptive language. A community-based sample of 646 Italian children aged 6-11 years was assessed with a comprehensive battery of language and cognitive tests. A mediation analysis was used to examine whether memory mediates environmental/biological effects on language. The results demonstrated a developmental cascade of effects, whereby the duration of pregnancy drives vWM functioning that, in turn, may affect expressive linguistic outcome Conclusion: Treatments focused on vWM, specifically to preterm children, may improve their language development, with enduring consequences on educational and psychosocial outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Visfatin levels in prepubertal children born small or large for gestational age.

    Science.gov (United States)

    Giapros, V I; Kiortsis, D N; Evagelidou, E N; Challa, A S; Cholevas, V K; Siomou, E C; Bairaktari, E T; Andronikou, S K

    2012-02-01

    Children born small (SGA) or large (LGA) for gestational age are prone to develop insulin resistance (IR) during childhood. Visfatin, a hormone with insulin-mimetic actions, has been associated with IR. This study was designed to examine whether serum level of visfatin is correlated with metabolic indices of IR, in prepuberty in association with the intrauterine growth pattern. The following parameters were evaluated at a mean age of 6.5±1.2 years in 155 prepubertal children born appropriate for the gestational age (AGA) (n=63), or SGA (n=42), or LGA (n=50): serum levels of visfatin, adiponectin, leptin, fasting glucose (G(F)) and insulin (I(F)), the homeostasis model assessment IR index (HOMA-IR), plasma lipids, anthropometric indices at birth and the time of evaluation, and obesity indices [waist circumference (WC), body mass index (BMI) and skinfold thickness]. The mean serum level of visfatin was lower in the SGA than in the AGA and the LGA children (9±5.2 vs. 11.8±5.1 and 12.7±5.6 ng/ml, respectively, pt=2.56, beta=0.24, pt=2.46, beta=0.22, p=0.014), independent of age, gender, maternal weight before pregnancy, maternal weight gain during pregnancy, BMI z-score, WC z-score, serum leptin and adiponectin, and HOMA-IR. In conclusion serum visfatin level was lower in prepubertal SGA children but not correlated with IR indices. Low birth weight was an independent predictor of visfatin level. © Georg Thieme Verlag KG Stuttgart · New York.

  20. There is an association between disease location and gestational age at birth in newborns submitted to surgery due to necrotizing enterocolitis.

    Science.gov (United States)

    Feldens, Letícia; Souza, João C K de; Fraga, José C

    2017-08-30

    To evaluate if there are differences regarding disease location and mortality of necrotizing enterocolitis, according to the gestational age at birth, in newborns submitted to surgery due to enterocolite. A historical cohort study of 198 newborns submitted to surgery due to necrotizing enterecolitis in a tertiary hospital, from November 1991 to December 2012. The newborns were divided into different categories according to gestational age (<30 weeks, 30-33 weeks and 6 days, 34-36 weeks and 6 days, and ≥37 weeks), and were followed for 60 days after surgery. The inclusion criterion was the presence of histological findings of necrotizing enterocolitis in the pathology. Patients with single intestinal perforation were excluded. The jejunum was the most commonly affected site in extremely premature infants (p=0.01), whereas the ileum was the most commonly affected site in premature infants (p=0.002), and the colon in infants born at term (p<0.001). With the increasing gestational age, it was observed that intestinal involvement decreased for the ileum and the jejunum (decreasing from 45% to 0% and from 5% to 0%, respectively), with a progressive increase in colon involvement (0% to 84%). Total mortality rate was 45.5%, and no statistical difference was observed in the mortality at different gestational ages (p=0.287). In newborns submitted to surgery due to necrotizing enterocolitis, the disease in extremely preterm infants was more common in the jejunum, whereas in preterm infants, the most affected site was the ileum, and in newborns born close to term, it was the colon. No difference in mortality was observed according to the gestational age at birth. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  1. Effect of correcting for gestational age at birth on population prevalence of early childhood undernutrition.

    Science.gov (United States)

    Perumal, Nandita; Roth, Daniel E; Perdrizet, Johnna; Barros, Aluísio J D; Santos, Iná S; Matijasevich, Alicia; Bassani, Diego G

    2018-01-01

    Postmenstrual and/or gestational age-corrected age (CA) is required to apply child growth standards to children born preterm (age). Yet, CA is rarely used in epidemiologic studies in low- and middle-income countries (LMICs), which may bias population estimates of childhood undernutrition. To evaluate the effect of accounting for GA in the application of growth standards, we used GA-specific standards at birth (INTERGROWTH-21st newborn size standards) in conjunction with CA for preterm-born children in the application of World Health Organization Child Growth Standards postnatally (referred to as 'CA' strategy) versus postnatal age for all children, to estimate mean length-for-age (LAZ) and weight-for-age (WAZ) z scores at 0, 3, 12, 24, and 48-months of age in the 2004 Pelotas (Brazil) Birth Cohort. At birth (n = 4066), mean LAZ was higher and the prevalence of stunting (LAZ age (mean ± SD): - 0.36 ± 1.19 versus - 0.67 ± 1.32; and 8.3 versus 11.6%, respectively. Odds ratio (OR) and population attributable risk (PAR) of stunting due to preterm birth were attenuated and changed inferences using CA versus postnatal age at birth [OR, 95% confidence interval (CI): 1.32 (95% CI 0.95, 1.82) vs 14.7 (95% CI 11.7, 18.4); PAR 3.1 vs 42.9%]; differences in inferences persisted at 3-months. At 12, 24, and 48-months, preterm birth was associated with stunting, but ORs/PARs remained attenuated using CA compared to postnatal age. Findings were similar for weight-for-age z scores. Population-based epidemiologic studies in LMICs in which GA is unused or unavailable may overestimate the prevalence of early childhood undernutrition and inflate the fraction of undernutrition attributable to preterm birth.

  2. THE INFLUENCE OF GESTATIONAL AGE AND BIRTH WEIGHT OF THE NEWBORN ON TOOTH ERUPTION

    Science.gov (United States)

    Ramos, Sandra Regina Piovezani; Gugisch, Renato Cordeiro; Fraiz, Fabian Calixto

    2006-01-01

    Objective: The aim of the present study was to compare the beginning of eruption of the first deciduous tooth in preterm infants (eruption. Methods: The neonatal records and the moment of eruption of the first deciduous tooth of 146 infants - 77 preterm infants and 69 full-term infants, ranging from 5 to 36 months old, of both genders – were recorded. All of them were under care at the Pediatric Ambulatory of Hospital Universitário Evangélico at Curitiba – Parana. Data were analyzed considering biological age and post-conception, or corrected, age – which is the gestational age plus the infant's chronological age at the month of eruption of the first deciduous tooth. Results: Results showed that when chronological age is considered, tooth eruption in preterm and very low birth weight infants is importantly delayed. However, when corrected age is considered, no statistically significant differences were found among groups. Conclusion: The delayed eruption may be related to the premature birth and not to a delay in dental development. PMID:19089267

  3. Gestational age-specific reference intervals for 15 biochemical measurands during normal pregnancy in China.

    Science.gov (United States)

    Dai, Yanpeng; Liu, Junjie; Yuan, Enwu; Li, Yushan; Wang, Quanxian; Jia, Liting; Wang, Linkai; Su, Yanhua

    2017-01-01

    Aims Physiological changes that occur during pregnancy can influence biochemical parameters. Therefore, using reference intervals based on specimens from non-pregnant women to interpret laboratory results during pregnancy may be inappropriate. This study aimed to establish the essential reference intervals for a range of analytes during pregnancy. Methods A cross-sectional study was performed in 13,656 healthy pregnant and 2634 non-pregnant women. Fifteen biochemical measurands relating to renal and hepatic function were analysed using an Olympus AU5400 analyzer (Olympus, Tokyo, Japan). All the laboratory results were checked for outliers using Dixon's test. Reference intervals were established using a non-parametric method. Results Alanine aminotransferase, aspartate aminotransferase, albumin, cholinesterase, creatinine, direct bilirubin, gamma-glutamyl transpeptidase, total bilirubin, total bile acid and total protein showed a decrease during the whole gestational period, while alkaline phosphatase and uric acid increased. Urea nitrogen, β 2 -microglobulin and cystatin-C fell significantly during the first trimester and then remained relatively stable until third trimester. Reference intervals of all the measurands during normal pregnancy have been established. Conclusions The reference intervals established here can be adopted in other clinical laboratories after appropriate validation. We verified the importance, for some measurands, of partitioning by gestational age when establishing reference intervals during pregnancy.

  4. Gestational age in relation to marine n-3 fatty acids in maternal erythrocytes

    DEFF Research Database (Denmark)

    Olsen, S.F.; Hansen, Harald S.; Sommer, S.

    1991-01-01

    randomly selected groups of 62 Faroese and 37 Danish women with an assessable gestational age. Average ratio of long-chain n-3 fatty acids to arachidonic acid [(3/6) ratio] was 0.73 (SD = 0.11) in Faroese women and 0.61 (SD = 0.12) in Danish women (p ...Gestation is longer in Faroese than Danish women, possibly because of the high intake of marine long-chain n-3 fatty acids that down regulates formation of prostaglandins from arachidonic acid. Polyunsaturated fatty acids were quantified in erythrocytes obtained within 2 days of delivery from......-3 fatty acids in the Faroes. A 20% increase in the (3/6) ratio was associated with an increase in pregnancy duration of 5.7 days in Danish women (95% confidence interval, 1.4 to 10.1 days; p = 0.02) and 0.7 days in Faroese women (95% confidence interval, -2.0 to 3.3; p = 0.6). The hypothesized...

  5. The effects of maternal obesity on perinatal outcomes among those born small for gestational age.

    Science.gov (United States)

    Yao, Ruofan; Park, Bo Y; Caughey, Aaron B

    2017-06-01

    Maternal obesity has been associated with higher birth weight. Small for gestational age (SGA) neonates born to obese women may be associated with pathological growth with increased neonatal complications. This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2011. Analyses were limited to births between 34 and 42 weeks gestation with birth weight ≤10th percentile. Results were stratified by maternal pre-pregnancy BMI class. The risk for stillbirth, neonatal death, neonatal intensive care unit (NICU) admission and five minute Apgar scores <7 were estimated for each obesity class and compared to the normal weight group. Multivariable logistic regression analyses were performed to control for potential confounding variables. The rate of stillbirth was 1.4/1000 births for normal weight women, and 2.9/1000 among obese women (p < 0.001, aOR: 1.83 [1.43, 2.34]). The rate of neonatal deaths among normal weight women was 4.3/1000 births, whereas among obese women it was 4.7/1000 (p = 0.94, aOR: 1.10 [0.92, 1.30]). A dose-dependent relationship between maternal obesity and stillbirths was seen, but not for other neonatal outcomes. Among SGA neonates, maternal pre-pregnancy obesity was associated with increased risks for stillbirth, NICU admission and low Apgar scores but not neonatal death.

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

    Science.gov (United States)

    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.

  7. Correction of first trimester biochemical aneuploidy screening markers for smoking status: influence of gestational age, maternal ethnicity and cigarette dosage.

    Science.gov (United States)

    Spencer, Kevin; Cowans, Nicholas J

    2013-02-01

    To examine the gestational age, maternal ethnicity and cigarette dosage effects of the reduction of maternal serum pregnancy-associated plasma protein A (PAPP-A) and free-β human chorionic gonadotrophin (free hCGβ) in smokers. Maternal serum PAPP-A and free hCGβ corrected for confounders, excluding smoking, in first trimester smokers and nonsmokers were compared by gestational age, maternal ethnicity and cigarette dosage. A small set of second trimester smokers and nonsmoker controls were analysed for PAPP-A along with free hCGβ and assessed for gestational age effects of smoking. Pregnancy-associated plasma protein A reduction by smoking in the first trimester was not influenced by gestational age, however free hCGβ levels were only significantly reduced in weeks 12 and 13 in smokers. Ethnicity and cigarette dosage were also found to influence the reduction of both makers in smokers in the first trimester. In second trimester smokers, PAPP-A was found to be reduced by less and free hCGβ reduced by more than in the first trimester, although no second trimester gestational age effect on smoking was found. Current methods of correcting for smoking status may be an oversimplification of a more complex subject. © 2012 John Wiley & Sons, Ltd.

  8. Chronic Lung Disease and Developmental Delay at 2 Years of Age in Children Born Before 28 Weeks' Gestation

    Science.gov (United States)

    Laughon, Matthew; O'Shea, Michael T.; Allred, Elizabeth N.; Bose, Carl; Kuban, Karl; Van Marter, Linda J.; Ehrenkranz, Richard A.; Leviton, Alan

    2009-01-01

    Introduction Extremely low gestational age newborns (ELGANs) are at increased risk of chronic lung disease (CLD) and of developmental delay. Some studies have suggested that CLD contributes to developmental delay. Patients and Methods We examined data collected prospectively on 915 infants born before the 28th week of gestation in 2002–2004 who were assessed at 24 months of age with the Bayley Scales of Infant Development-2nd Edition or the Vineland Adaptive Behavior Scales. We excluded infants who were not able to walk independently (Gross Motor Function Classification System score mechanical ventilation (MV) (CLD without MV) or receiving MV (CLD with MV). Results Forty-nine percent of ELGANs had CLD; of these, 14% were receiving MV at 36 weeks' postmenstrual age. ELGANs without CLD had the lowest risk of a Mental Developmental Index (MDI) or a Psychomotor Developmental Index (PDI) of <55, followed by ELGANs with CLD not receiving MV, and ELGANs with CLD receiving MV (9%, 12%, and 18% for the MDI and 7%, 10%, and 20% for the PDI, respectively). In time-oriented multivariate models, the risk of an MDI of <55 was associated with the following variables: gestational age of <25 weeks; single mother; late bacteremia; pneumothorax; and necrotizing enterocolitis. The risk of a PDI of <55 was associated with variables such as single mother, a complete course of antenatal corticosteroids, early and persistent pulmonary dysfunction, pulmonary deterioration during the second postnatal week, pneumothorax, and pulmonary interstitial emphysema. CLD, without or with MV, was not associated with the risk of either a low MDI or a low PDI. However, CLD with MV approached, but did not achieve, nominal statistical significance (odds ratio: 1.9 [95% confidence interval: 0.97–3.9]) for the association with a PDI of <55. Conclusions Among children without severe gross motor delays, risk factors for CLD account for the association between CLD and developmental delay. Once those

  9. Birth weight by gestational age and congenital malformations in Northern Ethiopia.

    Science.gov (United States)

    Mekonen, Hayelom K; Nigatu, Balkachew; Lamers, Wouter H

    2015-03-29

    Studies on birth weight and congenital anomalies in sub-Saharan regions are scarce. Data on child variables (gestational age, birth weight, sex, and congenital malformations) and maternal variables (gravidity, parity, antenatal care, previous abortions, maternal illness, age, medication, and malformation history) were collected for all neonates delivered at Ayder referral and Mekelle hospitals (Northern Ehthiopia) in a prospective study between 01-12-2011 and 01-05-2012. The total number of deliveries was 1516. More female (54%) than male neonates were born. Birth weights were 700-1,000 grams between 26 and 36 weeks of pregnancy and then increased linearly to 3,500-4,000 grams at 40 weeks. Thirty-five and 54% of neonates were very-low and low birth weight, respectively, without sex difference. Very-low birth-weight prevalence was not affected by parity. Male and female neonates from parity-2 and parity-2-4 mothers, respectively, were least frequently under weight. Sixty percent of newborns to parity -3 mothers weighed less than 2,500 grams, without sex difference. The percentage male neonates dropped from ~50% in parity-1-3 mothers to ~20% in parity-6 mothers. Diagnosed congenital malformations (~2%) were 2-fold more frequent in boys than girls. The commonest malformations were in the central nervous system (CNS; ~1.5% of newborns). Parity, low birth weight, gestational age less than 35 weeks, male sex, and lack of antenatal care were the most significant risk factors for congenital anomalies. The high prevalence of neonates with low birth weight and CNS anomalies in Northern Ethiopia was very high. The findings may reflect the harsh conditions in the past 2 decades and suggest environmental and/or nutritional causes. Male sex and parity affected the outcome of pregnancy negatively.

  10. Genetic factors associated with small for gestational age birth and the use of human growth hormone in treating the disorder

    Directory of Open Access Journals (Sweden)

    Saenger Paul

    2012-05-01

    Full Text Available Abstract The term small for gestational age (SGA refers to infants whose birth weights and/or lengths are at least two standard deviation (SD units less than the mean for gestational age. This condition affects approximately 3%–10% of newborns. Causes for SGA birth include environmental factors, placental factors such as abnormal uteroplacental blood flow, and inherited genetic mutations. In the past two decades, an enhanced understanding of genetics has identified several potential causes for SGA. These include mutations that affect the growth hormone (GH/insulin-like growth factor (IGF-1 axis, including mutations in the IGF-1 gene and acid-labile subunit (ALS deficiency. In addition, select polymorphisms observed in patients with SGA include those involved in genes associated with obesity, type 2 diabetes, hypertension, ischemic heart disease and deletion of exon 3 growth hormone receptor (d3-GHR polymorphism. Uniparental disomy (UPD and imprinting effects may also underlie some of the phenotypes observed in SGA individuals. The variety of genetic mutations associated with SGA births helps explain the diversity of phenotype characteristics, such as impaired motor or mental development, present in individuals with this disorder. Predicting the effectiveness of recombinant human GH (hGH therapy for each type of mutation remains challenging. Factors affecting response to hGH therapy include the dose and method of hGH administration as well as the age of initiation of hGH therapy. This article reviews the results of these studies and summarizes the success of hGH therapy in treating this difficult and genetically heterogenous disorder.

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

    Science.gov (United States)

    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.

  12. Socioeconomic inequality in birth weight and gestational age in Denmark 1996-2007

    DEFF Research Database (Denmark)

    Mortensen, Laust Hvas

    2013-01-01

    were siblings but were different in terms of socioeconomic position. Data consisted of 471,215 live born singletons born in Denmark 1997-2007 with at least one sibling or one first cousin. We examined parental educational attainment and household income in relation to preterm birth and small......A large body of literature has reported associations between socioeconomic position and adverse pregnancy outcomes even in affluent egalitarian welfare states. This study explored the nature of this relationship by examining women who changed socioeconomic position between pregnancies and women who...... for gestational age using Cox regression. Household income was only weakly related to these outcomes. Paternal education was strongly associated with the outcomes only in the cohort analyses. Maternal education was inversely associated with preterm birth only in the cohort analyses, where the least educated women...

  13. Brain development, intelligence and cognitive outcome in children born small for gestational age.

    Science.gov (United States)

    de Bie, H M A; Oostrom, K J; Delemarre-van de Waal, H A

    2010-01-01

    Intrauterine growth restriction (IUGR) can lead to infants being born small for gestational age (SGA). SGA is associated with increased neonatal morbidity and mortality as well as short stature, cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia and end-stage renal disease in adulthood. In addition, SGA children have decreased levels of intelligence and cognition, although the effects are mostly subtle. The overall outcome of each child is the result of a complex interaction between intrauterine and extrauterine factors. Animal and human studies show structural alterations in the brains of individuals with IUGR/SGA. The presence of growth hormone (GH) receptors in the brain implies that the brain is also a target for GH. Exogenous GH theoretically has the ability to act on the brain. This is exemplified by the effects of GH on cognition in GH-deficient adults. In SGA children, data on the effect of exogenous GH on intelligence and cognition are scant and contradictory.

  14. Ovarian morphology and function during growth hormone therapy of short girls born small for gestational age

    DEFF Research Database (Denmark)

    Tinggaard, Jeanette; Jensen, Rikke; Sundberg, Karin

    2014-01-01

    OBJECTIVE: To study the effect of growth hormone (GH) treatment on ovarian and uterine morphology and function in short, prepubertal small-for-gestational-age (SGA) girls.DESIGN: A multinational, randomized controlled trial on safety and efficacy of GH therapy in short, prepubertal children born...... multicystic ovaries.CONCLUSION(S): GH treatment was associated with statistically significant growth of the internal genitalia, but remained within the normal range. As altered pubertal development and ovarian morphology were found in 2 of 18 girls, monitoring of puberty and ovarian function during GH therapy......(S): Data on anthropometrics, reproductive hormones, and ultrasonographic examination of the internal genitalia were collected during 36 months of GH treatment.RESULT(S): Uterine and ovarian volume increased significantly during 3 years of treatment (64% and 110%, respectively) but remained low within...

  15. Accuracy and correlates of maternal recall of birthweight and gestational age

    DEFF Research Database (Denmark)

    Adegboye, Amanda Rodrigues Amorim; Heitmann, B.

    2008-01-01

    OBJECTIVE: To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates. DESIGN: Comparison of data from the DBR...... the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland-Altman's plots. The misclassification of the various BW and GA categories were also estimated. MAIN OUTCOME MEASURES: Differences between recalled and registered BW and GA. RESULTS: There was high...... agreement between recalled and registered BW (MD =-0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression...

  16. Factors affecting vocabulary acquisition at age 2 in children born between 23 and 28 weeks' gestation.

    Science.gov (United States)

    Marston, Louise; Peacock, Janet L; Calvert, Sandra A; Greenough, Anne; Marlow, Neil

    2007-08-01

    Language development is often slower in preterm children compared with their term peers. We investigated factors associated with vocabulary acquisition at 2 years in a cohort of children born at 28 weeks' gestation or less. For children entered into the United Kingdom Oscillation Study, language development was evaluated by using the MacArthur-Bates Communicative Development Inventories score, completed by parents as part of a developmental questionnaire. The effect of demographic, neonatal, socioeconomic factors, growth, and disability were investigated using multifactorial random effects modelling. Questionnaires were returned by 288 participants (148 males, 140 females). The mean number of words vocalized was 42 (SD 29). Multifactorial analysis showed only four factors were significantly associated with vocabulary acquisition. These were: (1) level of disability (mean words: no disability, 45; other disability, 38; severe disability, 30 [severe disability is defined as at least one extreme response in one of the following clinical domains: neuromotor, vision, hearing, communication, or other physical disabilities]; 95% confidence interval [CI] for the difference between no and severe disability 7- 23); (2) sex (39 males, 44 females; 95% CI 0.4-11); (3) length of hospital stay (lower quartile, 47; upper quartile, 38; 95% CI -12 to -4); and (4) weight SD score at 12 months (lower quartile, 39; upper quartile, 44; 95% CI 1-9). There was no significant association between gestational age and vocabulary after multifactorial analysis. There was no significant effect of any socioeconomic factor on vocabulary acquisition. We conclude that clinical factors, particularly indicators of severe morbidity, dominate the correlates of vocabulary acquisition at age 2 in children born very preterm.

  17. Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage.

    Science.gov (United States)

    Goldstein, R F; Cotten, C M; Shankaran, S; Gantz, M G; Poole, W K

    2013-01-01

    To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants. Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort. Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt. GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI.

  18. Early psychomotor development of low-risk preterm infants: Influence of gestational age and gender.

    Science.gov (United States)

    Romeo, Domenico M; Brogna, Claudia; Sini, Francesca; Romeo, Mario G; Cota, Francesco; Ricci, Daniela

    2016-07-01

    The influence of gestational age and gender in the neurodevelopment of infants during the first year of age is not yet fully elucidated. The purpose of this study was to identify the early occurrence of neurodevelopmental differences, between very preterm, late preterm and term born infants and the possible influence of the gender on the neurodevelopment in early infancy. A total of 188 low-risk infants, 69 very preterms, 71 late-preterms, and 48 term infants were assessed at 3, 6, 9, 12 months corrected age using the Hammersmith Infant Neurological Examination (HINE). At two years of age infants performed the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development. The main results indicate that both very preterms and late-preterms showed significant lower global scores than term born infants at each evaluation (p development of infants assessed during the first 2 years of life. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  19. Relationship between blood pressure and insulin resistance in patients with gestational diabetes

    International Nuclear Information System (INIS)

    Kan Shujuan; Zhang Sujuan

    2008-01-01

    Objective: To study the relationship existe between blood pressure level and degree of insulin resistance in patients with gestational diabetes. Methods: Ninety-five cases of gestational diabetes were diagnosed among 350 pregnant women. Of them, 55 were found to be hypertensive and 40 were normotensive. Fasting, 1,2, 3h post-prandial (75g glucose) blood sugar (with peroxidase method) levels and fasting insulin (with RIA) levels were measured in these patients and 85 normal pregnant women (as control). Results: Fasting, 1, 2, 3h post 75g glucose blood sugar and fasting insulin levels in the 55 hypertensive diabetics were significantly higher than those in the normotensives and controls (P<0.05). The calculated insulin sensitivity indices were significantly lower (P also < 0.05). Conclusion: A higher insulin resistance existed in hypertensive gestational diabetics which might be a risk factor of developing hypertension. (authors)

  20. Feasibility and reproducibility of fetal lung texture analysis by Automatic Quantitative Ultrasound Analysis and correlation with gestational age.

    Science.gov (United States)

    Cobo, Teresa; Bonet-Carne, Elisenda; Martínez-Terrón, Mónica; Perez-Moreno, Alvaro; Elías, Núria; Luque, Jordi; Amat-Roldan, Ivan; Palacio, Montse

    2012-01-01

    To evaluate the feasibility and reproducibility of fetal lung texture analysis using a novel automatic quantitative ultrasound analysis and to assess its correlation with gestational age. Prospective cross-sectional observational study. To evaluate texture features, 957 left and right lung images in a 2D four-cardiac-chamber view plane were previously delineated from fetuses between 20 and 41 weeks of gestation. Quantification of lung texture was performed by the Automatic Quantitative Ultrasound Analysis (AQUA) software to extract image features. A standard learning approach composed of feature transformation and a regression model was used to evaluate the association between texture features and gestational age. The association between weeks of gestation and fetal lung texture quantified by the AQUA software presented a Pearson correlation of 0.97. The association was not influenced by delineation parameters such as region of interest (ROI) localization, ROI size, right/left lung selected or sonographic parameters such as ultrasound equipment or transducer used. Fetal lung texture analysis measured by the AQUA software demonstrated a strong correlation with gestational age. This supports further research to explore the use of this technology to the noninvasive prediction of fetal lung maturity. Copyright © 2012 S. Karger AG, Basel.

  1. Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center.

    Science.gov (United States)

    Kim, Woo Jeng; Han, Young Sin; Ko, Hyun Sun; Park, In Yang; Shin, Jong Chul; Wie, Jeong Ha

    2018-01-01

    This study investigated the effect of an antenatal corticosteroid (ACS) in preterm small-for-gestational-age (SGA) neonate. This study was a retrospective cohort study. We compared women who received ACS with unexposed controls and evaluated neonatal complications among those having a singleton SGA neonate born between 29 and 34 complete gestational weeks. The neonates born after 32 weeks of gestation were divided into subgroups. Multivariable logistic regression analysis was performed. A total 82 of the preterm infants met inclusion criteria; 57 (69.5%) were born after 32 weeks of gestation. There were no significant differences in terms of mechanical ventilation, seizure, intracranial hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, feeding difficulty, and neonatal mortality between infants whose mothers received ACS ant those whose mothers did not (all P >0.05). However, newborns whose mothers received ACS exhibited a significantly increased risk of developing respiratory distress syndrome (RDS) (adjusted odds ratio [aOR], 3.271; 95% confidence interval [CI], 1.038-10.305; P =0.043). In case of neonates born beyond 32 weeks of gestation, the risk of neonatal hypoglycemia was significantly higher in women receiving ACS after controlling for confounding factors (aOR, 5.832; 95% CI, 1.096-31.031; P =0.039). ACS did not improve neonatal morbidities, in SGA neonates delivered between 29 and 34 gestational weeks. Rather, ACS could increase the risk of RDS. In cases of SGA neonate delivered between 32 and 34 complete gestational weeks, the risk of hypoglycemia was significantly increased. The use of ACS in women with preterm SGA infants needs to be evaluated further, especially after 32 weeks' gestation.

  2. Atypical sensory processing is common in extremely low gestational age children.

    Science.gov (United States)

    Rahkonen, Petri; Lano, Aulikki; Pesonen, Anu-Katriina; Heinonen, Kati; Räikkönen, Katri; Vanhatalo, Sampsa; Autti, Taina; Valanne, Leena; Andersson, Sture; Metsäranta, Marjo

    2015-05-01

    Atypical sensory processing is common in children born extremely prematurely. We investigated sensory processing abilities in extremely low gestational age (ELGA) children and analysed associated neonatal risk factors, neuroanatomical findings and neurodevelopmental outcome. We carried out a prospective study of 44 ELGA children, including 42 who had undergone brain magnetic resonance imaging (MRI) at term-equivalent age, when they were 2 years of corrected age. Their sensory processing abilities were assessed with the Infant/Toddler Sensory Profile questionnaire and their neurodevelopmental with a structured Hempel neurological examination, Griffiths Mental Developmental Scales and Bayley Scales of Infant and Toddler Development Third Edition. Sensory profiles were definitely or probably atypical (sensory processing was associated with surgical closure of the patent ductus arteriosus (p = 0.02, adjusted p sensory processing in ELGA children was common, and children with neonatal neuroanatomical lesions tended to present specific behavioural responses to sensory stimuli. Surgical closure of the patent ductus arteriosus may predispose infants to feeding problems due to atypical oral sensory processing. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  3. Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain.

    Science.gov (United States)

    Kallak, Theodora Kunovac; Hellgren, Charlotte; Skalkidou, Alkistis; Sandelin-Francke, Lotta; Ubhayasekhera, Kumari; Bergquist, Jonas; Axelsson, Ove; Comasco, Erika; Campbell, Rebecca E; Sundström Poromaa, Inger

    2017-10-01

    Prenatal androgen exposure has been suggested to play a role in polycystic ovary syndrome. Given the limited information on what maternal characteristics influence maternal testosterone levels, and the even less explored routes by which female fetus androgen exposure would occur, the aim of this study was to investigate the impact of maternal age, BMI, weight gain, depressed mood and aromatase SNPs on testosterone levels in maternal serum and amniotic fluid of female fetuses. Blood samples from pregnant women ( n  = 216) obtained in gestational weeks 35-39, and pre-labor amniotic fluid samples from female fetuses ( n  = 56), taken at planned Caesarean section or in conjunction with amniotomy for induction of labor, were analyzed. Maternal serum testosterone and amniotic fluid testosterone and cortisol were measured by tandem mass spectrometry. Multiparity (β = -0.28, P  testosterone levels. Maternal age (β = -0.34, P  testosterone in female fetuses, explaining 64.3% of the variability in amniotic fluid testosterone. Young maternal age and excessive maternal weight gain may increase the prenatal androgen exposure of female fetuses. Further studies are needed to explore this finding. © 2017 The authors.

  4. Nutritional requirements and feeding recommendations for small for gestational age infants.

    Science.gov (United States)

    Tudehope, David; Vento, Maximo; Bhutta, Zulfiqar; Pachi, Paulo

    2013-03-01

    We define the small for gestational age (SGA) infant as an infant born ≥ 35 weeks' gestation and milk for SGA infants because it meets most of their nutritional requirements and provides short- and long-term benefits. Several distinct patterns of intrauterine growth restriction are identified among the heterogeneous grouping of SGA infants; each varies with regard to neonatal morbidities, requirements for neonatal management, postnatal growth velocities, neurodevelopmental progress, and adult health outcomes. There is much we do not know about nutritional management of the SGA infant. We need to identify and define: infants who have "true" growth restriction and are at high risk for adverse metabolic outcomes in later life; optimal growth velocity and "catch-up" growth rates that are conducive with life-long health and well being; global approaches to management of hypoglycemia; and an optimal model for postdischarge care. Large, rigorously conducted trials are required to determine whether aggressive feeding of SGA infants results in improved nutritional rehabilitation, growth, and neurodevelopmental outcomes. Before birth, maternal supplementation with specific nutrients reduces the rate and severity of growth restriction and may prevent nutrient deficiency states if infants are born SGA. After birth, the generally accepted goal is to provide enough nutrients to achieve postnatal growth similar to that of a normal fetus. In addition, we recommend SGA infants be allowed to "room in" with their mothers to promote breastfeeding, mother-infant attachment, and skin-to-skin contact to assist with thermoregulation. Crown Copyright © 2013. Published by Mosby, Inc. All rights reserved.

  5. Impact on obstetric outcome of third-trimester screening for small-for-gestational-age fetuses.

    Science.gov (United States)

    Callec, R; Lamy, C; Perdriolle-Galet, E; Patte, C; Heude, B; Morel, O

    2015-08-01

    To evaluate the performance of screening for small-for-gestational-age (SGA) fetuses by ultrasound biometry at 30-35 weeks' gestation, and to determine the impact of screening on obstetric and neonatal outcomes. For this prospective cohort study, pregnant women were recruited from two French university maternity centers between 2003 and 2006. Performance measures of third-trimester biometry for the prediction of SGA, defined as estimated fetal weight third-trimester ultrasound had a sensitivity of 29.0% (95% CI, 22.5-36.6%) and specificity of 94.2% (95% CI, 93.0-95.2%). Positive and negative predictive values were 30.8% (95% CI, 23.9-38.7%) and 93.7% (95% CI, 92.5-94.8%), respectively. One hundred and ten SGA neonates went undiagnosed at ultrasound. Compared to the TN neonates considered as of normal weight at ultrasound, planned preterm delivery (before 37 weeks) and elective Cesarean section for a fetal growth indication were 2.4 (P = 0.01) and 2.85 (P = 0.003) times more likely to occur, respectively, in the FP group of non-SGA neonates, diagnosed incorrectly as SGA during the antenatal period. There was no statistically significant difference in 5-min Apgar score third-trimester ultrasound screening for SGA seems poor, as it misses the diagnosis of a large number of SGA neonates. The consequences of routine screening for SGA in a low-risk population may lead to unnecessary planned preterm deliveries and elective Cesarean sections in FP pregnancies, without improved neonatal outcome in the FN pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  6. Expectant management of severe preeclampsia at 27(0/7) to 33(6/7) weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management.

    Science.gov (United States)

    Bombrys, Annette E; Barton, John R; Habli, Mounira; Sibai, Baha M

    2009-06-01

    We sought to determine perinatal outcome and maternal morbidities based on gestational age (GA) at onset of expectant management in severe preeclampsia (PE) between 27(0/7) and 33 (6/7) weeks. In this retrospective analysis of outcome in patients with severe preeclampsia, we studied 66 patients (71 fetuses) with severe PE at 27 (0)/ (7) to 33(6/ 7). All patients received corticosteroids. Perinatal and maternal complications were analyzed. Five patients had twin gestations. Median for days of prolongation was 5 days (range, 3 to 35). Birth weights of 19 (27%) were or= grade ?). Rate of abruption was significantly higher at 27 to 28 weeks as compared with > 28 weeks (25% vs 6%, p = 0.05). There was no eclampsia, and two had transient renal insufficiency at 27 weeks. Four of 11 (36%) patients with expectant management at >or= 32 weeks had pulmonary edema or hemolytic anemia, elevated liver enzymes, and low platelet count. During expectant management, rate of respiratory distress syndrome and other serious neonatal complications decrease with increasing GA, supporting a role for such management in early severe preeclampsia. Because there is significant maternal morbidity at >or= 32 weeks with minimal neonatal benefit, consideration should be given for delivery of these pregnancies following corticosteroid administration.

  7. Association of Maternal Age to Development and Progression of Retinopathy of Prematurity in Infants of Gestational Age under 33 Weeks

    Directory of Open Access Journals (Sweden)

    Atsuro Uchida

    2014-01-01

    Full Text Available Aim. To find predictive and indicative markers of risk for development of retinopathy of prematurity (ROP and its progression to the stage requiring laser treatment, in premature infants whose gestational age (GA was under 33 weeks. Methods. We retrospectively reviewed medical records of 197 premature infants born in 2005–2010 whose GA<33 weeks and underwent eye screening at Keio University Hospital. The association between candidate risk factors and development or progression of ROP was assessed. Results. Among the 182 eligible infants (median GA, 29.1 weeks; median birth weight (BW, 1028 g, 84 (46% developed any stage of ROP, of which 45 (25% required laser treatment. Multivariate analysis using a stepwise method showed that GA (P=0.002; 95% confidence interval (CI, 0.508–0.858, BW (P<0.001; 95% CI, 0.994–0.998, and lower maternal age (P=0.032; 95% CI, 0.819–0.991 were the risk factors for ROP development and GA (P<0.001; 95% CI, 0.387–0.609 and lower maternal age (P=0.012; 95% CI, 0.795–0.973 were for laser treatment. The odds ratio of requiring laser treatment was 3.3 when the maternal age was <33 years. Conclusion. ROP was more likely to be developed and progressed in infants born from younger mother and low GA.

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

    Science.gov (United States)

    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

  9. Cholecystectomy under segmental thoracic epidural block in a patient with twin gestation

    Directory of Open Access Journals (Sweden)

    R Barani Selvan

    2012-01-01

    Full Text Available Cholecystectomy represents the second most common surgery during pregnancy. Both general and regional anesthetic techniques have been successfully used for cholecystectomy in pregnant patients. Authors present here a case of a pregnant patient carrying twin gestation who underwent cholecystectomy, which is not frequently encountered by the anesthesiologists. This report enumerates the perioperative issues relating to anesthesia given to a pregnant patient in addition to emphasizing the importance of multidisciplinary approach when such a case is encountered.

  10. Use of Paliperidone Palmitate Throughout a Schizoaffective Disorder Patient's Gestation Period.

    Science.gov (United States)

    Zamora Rodríguez, F J; Benítez Vega, C; Sánchez-Waisen Hernández, M R; Guisado Macías, J A; Vaz Leal, F J

    2017-01-01

    Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. Case report: An analysis is made of the safety and tolerability of paliperidone palmitate treatment throughout the gestation period in a 34-year-old patient diagnosed with schizoaffective disorder. Discussion: Paliperidone palmitate treatment throughout the gestation period was safe and well tolerated by both mother and foetus, there being no malformations or other perinatal complications in the newborn to date. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Pequenos para idade gestacional: fator de risco para mortalidade neonatal Small for gestational age

    Directory of Open Access Journals (Sweden)

    Márcia Furquim de Almeida

    1998-06-01

    Full Text Available OBJETIVO: Estudar as variáveis contempladas na Declaração de Nascimento (DN como possíveis fatores de risco para nascimentos pequenos para a idade gestacional (PIG e o retardo de crescimento intra-uterino como fator de risco para a mortalidade neonatal. MATERIAL E MÉTODO: As variáveis existentes na DN foram obtidas diretamente de prontuários hospitalares. Os dados referem-se a uma coorte de nascimentos obtida por meio da vinculação das declarações de nascimento e óbito, correspondendo a 2.251 nascimentos vivos hospitalares, de mães residentes, ocorridos no Município de Santo André, Região Metropolitana de São Paulo, no período de l/1 a 30/6/1992, e aos óbitos neonatais verificados nessa coorte. RESULTADOS: Obteve-se a proporção de 4,3% de nascimentos PIG, significativamente maior entre os recém-nascidos de pré-termo e pós-termo, entre os nascimentos cujas mães tinham mais de 35 anos de idade e grau de instrução inferior ao primeiro grau completo. Os recém-nascidos PIG apresentam maior risco de morte neonatal que aqueles que não apresentavam sinais de retardo de crescimento intra-uterino. CONCLUSÕES: Em áreas com menor freqüência de baixo peso ao nascer, é importante investigar a presença de retardo de crescimento intra-uterino entre os nascimentos prematuros e não apenas nos nascimentos de termo. O registro da data da última menstruação (ou da idade gestacional em semanas não agregadas na DN facilitaria a detecção de PIGs na população de recém-nascidos.INTRODUCTION: Variables of birth certificates were analysed as risk factors of SGA (Small for Gestational Age infantis, and with a view to discovering if retarded intra-uterine growth was a risk factor neonatal mortality. MATERIAL AND METHOD: Data were obtained directly from 11 hospital medical records. A cohort of 2.251 hospital live births was obtained. Linkage of the death and birth certificates was undertaken to identify the neonatal deaths. The

  12. Proteinuria in aging rats due to low-protein diet during mid-gestation

    NARCIS (Netherlands)

    Joles, J. A.; Sculley, D. V.; Langley-Evans, S. C.

    Nephrogenesis in the rat starts mid-gestation and continues into lactation. Maternal low protein (LP) intake leads to renal injury in rats and associates with mild renal injury in humans. We hypothesized that LP during early nephrogenesis or throughout gestation would induce more renal injury in rat

  13. Postnatal growth and development in the preterm and small for gestational age infant.

    Science.gov (United States)

    Cooke, Richard J

    2010-01-01

    A clear relationship exists between undernutrition, poorer growth and poor development in term and preterm infants. However, preterm infants are at greater risk than term infants. Undernutrition is more common and 'programmed' growth rates are almost six times faster. Thus, even short periods of nutritional deprivation may have significant effects. Recent advances have led to an improvement in early growth but very low birthweight infants remain small for gestational age at hospital discharge. Studies suggest that a 'window of opportunity' exists after hospital discharge, in that better growth between discharge and 2-3 months corrected age is paralleled by better development, and poorer growth is associated with poorer development. However, interventions aimed at improving growth and development have yielded varying results. This may partly be related to differences in study design as well as the composition of the nutrient-enriched formulas. Irrespective, one point is concerning, i.e. infant boys appear to be at a developmental disadvantage when fed a term infant formula after discharge. A single study has also suggested that dietary intervention can improve brain growth in term and preterm infants with perinatal brain injury. However, concern has been expressed about rapid 'catch-up' growth in preterm infants and the development of insulin resistance and visceral adiposity. Data from our group do not support the idea of increased or altered adiposity in preterm infants fed a nutrient-enriched formula after hospital discharge. Copyright (c) 2010 S. Karger AG, Basel.

  14. Prediction model for adult height of small for gestational age children at the start of growth hormone treatment

    NARCIS (Netherlands)

    M.A.J. de Ridder (Maria); Th. Stijnen (Theo); A.C.S. Hokken-Koelega (Anita)

    2008-01-01

    textabstractContext: GH treatment is approved for short children born small for gestational age (SGA). The optimal dose is not yet established. Objective: Our objective was to develop a model for prediction of height at the onset of puberty and of adult height (AH). Design and Setting: Two GH

  15. Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants

    NARCIS (Netherlands)

    Zeitlin, Jennifer; Bonamy, Anna Karin Edstedt; Piedvache, Aurelie; Cuttini, Marina; Barros, Henrique; Van Reempts, Patrick; Mazela, Jan; Jarreau, Pierre Henri; Gortner, Ludwig; Draper, Elizabeth S.; Maier, Rolf F.; Martens, E.; Martens, Guy; Boerch, Klaus; Hasselager, Asbjoern; Huusom, Lene; Pryds, Ole; Weber, Tom; Toome, Liis; Varendi, Heili; Ancel, Pierre Yves; Blondel, Beatrice; Burguet, Antoine; Truffert, P.; Misselwitz, Bjoern; Schmidt, S.; Baronciani, Dante; Gargano, G.; Agostino, Rocco; DiLallo, D.; Franco, Francesco; Carnielli, Virgilio; Koopman-Esseboom, C.|info:eu-repo/dai/nl/14117739X; van Heijst, A.; Nijman, J.; Gadzinowski, Janusz; Graça, Luis M.; Ceu Machado, Maria; Carrapato, M. R.G.; Ribeiro-Rodrigues, Teresa; Norman, Mikael; Wilson, E.; Boyle, Elaine M.; Manktelow, B. N.; Fenton, A. C.; Milligan, David W A; Marques-Bonet, T.

    2017-01-01

    Aim: This study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references. Methods: We generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's

  16. Serum dehydroepiandrosterone sulfate levels and pubarche in short children born small for gestational age before and during growth hormone treatment

    NARCIS (Netherlands)

    V.H. Boonstra (Venje); F.H. de Jong (Frank); A.C.S. Hokken-Koelega (Anita); P.G.H. Mulder (Paul)

    2004-01-01

    textabstractIt has been suggested that the programming of the endocrine axes occurs during critical phases of fetal development and will be affected by intrauterine growth retardation. As a result, children born small for gestational age (SGA) might have several hormonal

  17. Prediction model for adult height of small for gestational age children at the start of growth hormone treatment

    NARCIS (Netherlands)

    de Ridder, Maria A. J.; Stijnen, Theo; Hokken-Koelega, Anita C. S.

    Context: GH treatment is approved for short children born small for gestational age (SGA). The optimal dose is not yet established. Objective: Our objective was to develop a model for prediction of height at the onset of puberty and of adult height (AH). Design and Setting: Two GH studies were

  18. Early rapid growth : no association with later cognitive functions in children born not small for gestational age

    NARCIS (Netherlands)

    Beyerlein, Andreas; Ness, Andrew R.; Streuling, Ina; Hadders-Algra, Mijna; von Kries, Ruediger

    Background: There is an association between rapid growth in early life and overweight in childhood. This adverse association needs to be balanced against potential beneficial effects on cognitive functioning observed in children who are born small for gestational age (SGA). Objective: We examined

  19. Adiponectin levels measured in dried blood spot samples from neonates born small and appropriate for gestational age

    DEFF Research Database (Denmark)

    Klamer, A; Skogstrand, Kristin; Hougaard, D M

    2007-01-01

    Adiponectin levels measured in neonatal dried blood spot samples (DBSS) might be affected by both prematurity and being born small for gestational age (SGA). The aim of the study was to measure adiponectin levels in routinely collected neonatal DBSS taken on day 5 (range 3-12) postnatal from...

  20. Association of Prenatal Ibuprofen Exposure with Birth Weight and Gestational Age: A Population-Based Sibling Study.

    Science.gov (United States)

    Nezvalová-Henriksen, Kateřina; Wood, Mollie; Spigset, Olav; Nordeng, Hedvig

    2016-01-01

    Three studies so far have investigated the effect of prenatal non-steroidal anti-inflammatory drug (NSAID) exposure on birth weight and gestational age. The aim in this study was to evaluate the association of prenatal ibuprofen with birth weight and gestational age at birth, using a sibling design in an attempt to adjust for the possibility of familial confounding. Using data from the Norwegian Mother and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN), we identified 28 597 siblings, of whom 1080 were prenatally exposed to ibuprofen and 26 824 were not exposed to any NSAID. Random and fixed effects models with propensity score adjustment were used to evaluate the effects of ibuprofen exposure on birth weight and gestational age. Ibuprofen exposure during the first trimester was associated with a decrease in birth weight of 79 grams (95% confidence interval -133 to -25 grams). In contrast, second and/or third trimester exposure, and duration of exposure had no impact on the effect estimates. We found no association between ibuprofen exposure and gestational age at birth. Our results suggest that prenatal exposure to ibuprofen during the first trimester is associated with a slight decrease in birth weight. The association does not seem to be attributable to shared genetics and family environment, and could be explained by either exposure to ibuprofen, or to non-shared confounding between pregnancies.

  1. Preterm infants under 27 weeks gestational age: outcomes in a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Maria Isabel Sá

    2016-02-01

    Full Text Available Introduction: Over the last decades, survival of extremely preterm infants improved but there´s still significant morbidity among this group. We pretend to evaluate if specific attitudes/characteristics are associated with higher survival or survival without severe disabilities and elaborate predicting outcome models. Material and Methods: Observational descriptive study, including the 205 liveborn/stillborn infants -gestational age 22w0d-26w6d- born at an Obstetrics Unit or transferred to a Neonatology Unit of a Level III Hospital, from January-2000 to December-2009. We collected variables related to management in the prenatal/neonatal period, neonate performances and psychomotor development(18-24 months. Significant associations between variables/outcomes were identified by chi-square test or t-test; multivariate logistic regression models were used to describe and predict mortality/morbidity. Results: Advanced Gestational Age (GA (p=0.001, antenatal corticotherapy(p=0.001, cesarean section(p=0.001, inborn delivery(p=0.021 and increased weight(p=0.001 were associated with survival. Absence of Intraventricular Hemorrhage (IVH grade 3-4(p=0.001 and absence of Periventricular Leukomalacia (PVL (p=0.005 were associated with survival without severe neurossensorial deficit. According to multivariable models, advanced GA (OR=0.353,CI95% 0.208-0.599, increased weight (OR=0.996,CI95% 0.993-0.999 and antenatal corticotherapy (OR=0.150,CI95% 0.044-0.510 were associated with lower mortality risk. Rupture of membranes less than 12 h duration was associated with higher mortality risk (OR=3.88,CI95% 1.406-10.680. IVH grades 3-4 was associated with higher morbidity risk (OR=16.931,CI95% 2.744-104.452. Mortality and severe morbidity models predicted correctly the outcome in 78.1% and 85.7% of the cases, respectively. Conclusions: Mortality/morbidity models might be valuable tools providing insight in the prediction of the outcome of these neonates and helping

  2. Assessment of MRI-Based Automated Fetal Cerebral Cortical Folding Measures in Prediction of Gestational Age in the Third Trimester.

    Science.gov (United States)

    Wu, J; Awate, S P; Licht, D J; Clouchoux, C; du Plessis, A J; Avants, B B; Vossough, A; Gee, J C; Limperopoulos, C

    2015-07-01

    Traditional methods of dating a pregnancy based on history or sonographic assessment have a large variation in the third trimester. We aimed to assess the ability of various quantitative measures of brain cortical folding on MR imaging in determining fetal gestational age in the third trimester. We evaluated 8 different quantitative cortical folding measures to predict gestational age in 33 healthy fetuses by using T2-weighted fetal MR imaging. We compared the accuracy of the prediction of gestational age by these cortical folding measures with the accuracy of prediction by brain volume measurement and by a previously reported semiquantitative visual scale of brain maturity. Regression models were constructed, and measurement biases and variances were determined via a cross-validation procedure. The cortical folding measures are accurate in the estimation and prediction of gestational age (mean of the absolute error, 0.43 ± 0.45 weeks) and perform better than (P = .024) brain volume (mean of the absolute error, 0.72 ± 0.61 weeks) or sonography measures (SDs approximately 1.5 weeks, as reported in literature). Prediction accuracy is comparable with that of the semiquantitative visual assessment score (mean, 0.57 ± 0.41 weeks). Quantitative cortical folding measures such as global average curvedness can be an accurate and reliable estimator of gestational age and brain maturity for healthy fetuses in the third trimester and have the potential to be an indicator of brain-growth delays for at-risk fetuses and preterm neonates. © 2015 by American Journal of Neuroradiology.

  3. Placenta previa and the risk of delivering a small-for-gestational-age newborn.

    Science.gov (United States)

    Räisänen, Sari; Kancherla, Vijaya; Kramer, Michael R; Gissler, Mika; Heinonen, Seppo

    2014-08-01

    To evaluate whether there is an association between placenta previa and delivery of a small-for-gestational-age (SGA) newborn and to quantify the contribution of individual risk factors for SGA that are associated with placenta previa stratified by maternal parity. A cross-sectional study using the Finnish Medical Birth Register during 2000-2010. All singleton births (N=596,562) were included; major congenital anomalies were excluded. An association between SGA (less than 2 standard deviations below the mean) and placenta previa was modeled by parity-specific unadjusted and adjusted statistical models. Placenta previa complicated 625 of 249,476 singleton births among nulliparous women (2.50/1,000) and 915 of 347,086 singleton births among multiparous women (2.64/1,000). Among nulliparous women, the most common risk factor for placenta previa was in vitro fertilization; placenta previa was not associated with an increased prevalence of SGA controlling for maternal age, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.57-1.17). Among multiparous women, placenta previa was associated with a twofold increased risk of SGA controlling for maternal age, parity, prior preterm birth, prior caesarean delivery, prior SGA newborn, prior preeclampsia, smoking, in vitro fertilization, socioeconomic status, and preeclampsia (adjusted OR 2.08, 95% CI 1.50-2.89). Furthermore, only one-fourth of the association between SGA and placenta previa could be explained by controlling for risk factors clustering with placenta previa among multiparous women. Placenta previa is associated with impaired fetal growth in multiparous but not nulliparous women. II.

  4. Slow fetal growth between first and early second trimester ultrasound scans and risk of small for gestational age (SGA birth.

    Directory of Open Access Journals (Sweden)

    Marija Simic

    Full Text Available To investigate the association between fetal growth between first and early second trimester ultrasound scan and the risk of severe small for gestational age (SGA birth.This cohort study included 69 550 singleton pregnancies with first trimester dating and an early second trimester growth scan in Stockholm and Gotland Counties, Sweden between 2008 and 2014. Exposure was difference in biparietal diameter growth between observed and expected at the second trimester scan, calculated by z-scores. Risk of birth of a severe SGA infant (birth weight for gestational age by fetal sex less than the 3rd centile was calculated using multivariable logistic regression analysis and presented as adjusted odds ratio (aOR.Parietal growth less than 2.5 percentile between first and second trimester ultrasound examination was associated with elevated risk of being born severe SGA. (aOR 1.67; 95% Confidence Interval 1.28-2.18. The risks of preterm severe SGA (birth before 37 weeks and term severe SGA (birth 37 weeks or later were at similar levels, and risk of severe SGA were also elevated in the absence of preeclampsia, hypertensive diseases or gestational diabetes.Fetuses with slow growth of biparietal diameter at ultrasound examination in early second trimester exhibit increased risk of being born SGA independent of gestational age at birth and presence of maternal hypertensive diseases or diabetes mellitus.

  5. Slow fetal growth between first and early second trimester ultrasound scans and risk of small for gestational age (SGA) birth.

    Science.gov (United States)

    Simic, Marija; Stephansson, Olof; Petersson, Gunnar; Cnattingius, Sven; Wikström, Anna-Karin

    2017-01-01

    To investigate the association between fetal growth between first and early second trimester ultrasound scan and the risk of severe small for gestational age (SGA) birth. This cohort study included 69 550 singleton pregnancies with first trimester dating and an early second trimester growth scan in Stockholm and Gotland Counties, Sweden between 2008 and 2014. Exposure was difference in biparietal diameter growth between observed and expected at the second trimester scan, calculated by z-scores. Risk of birth of a severe SGA infant (birth weight for gestational age by fetal sex less than the 3rd centile) was calculated using multivariable logistic regression analysis and presented as adjusted odds ratio (aOR). Parietal growth less than 2.5 percentile between first and second trimester ultrasound examination was associated with elevated risk of being born severe SGA. (aOR 1.67; 95% Confidence Interval 1.28-2.18). The risks of preterm severe SGA (birth before 37 weeks) and term severe SGA (birth 37 weeks or later) were at similar levels, and risk of severe SGA were also elevated in the absence of preeclampsia, hypertensive diseases or gestational diabetes. Fetuses with slow growth of biparietal diameter at ultrasound examination in early second trimester exhibit increased risk of being born SGA independent of gestational age at birth and presence of maternal hypertensive diseases or diabetes mellitus.

  6. Intrauterine nicotine exposure, birth weight, gestational age and the risk of infantile colic

    DEFF Research Database (Denmark)

    Milidou, Ioanna; Søndergaard, Charlotte; Jensen, Morten Søndergaard

    Background and aim: Infantile colic is characterised by crying bouts in a healthy infant during the first months. Smoking in pregnancy and low birth weight (BW) have been previously identified as risk factors for infantile colic. Nicotine acts as a neurotransmitter and is known to affect the intr......Background and aim: Infantile colic is characterised by crying bouts in a healthy infant during the first months. Smoking in pregnancy and low birth weight (BW) have been previously identified as risk factors for infantile colic. Nicotine acts as a neurotransmitter and is known to affect...... the intrauterine central nervous system development, while low BW and premature birth have both been related to adverse neurodevelopmental outcomes. We investigated the association between intrauterine nicotine exposure, BW, gestational age (GA) and infantile colic in a large cohort study. Materials and methods......: We used data from the Danish National Birth Cohort. The study on nicotine exposure included 63,128 infants and the study on BW and GA included 62, 785 infants with complete data. Infantile colic was defined according to the modified Wessel’s criteria based on maternal interview 6 months postpartum...

  7. Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth.

    Science.gov (United States)

    Wikström, Anna-Karin; Gunnarsdottir, Johanna; Nelander, Maria; Simic, Marija; Stephansson, Olof; Cnattingius, Sven

    2016-03-01

    It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (≥37 weeks) singleton births (n=157 446). Using normotensive (diastolic blood pressure [DBP] risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51-1.90) and 1.70 (1.16-2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5-2.8) per each mm Hg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth. © 2016 American Heart Association, Inc.

  8. Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates?

    Science.gov (United States)

    van der Weiden, S; de Jong, E P; Te Pas, A B; Middeldorp, J M; Vossen, A C T M; Rijken, M; Walther, F J; Lopriore, E

    2011-02-01

    congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA). to determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture. we performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed. TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative. the co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures. 2010 Elsevier Ltd. All rights reserved.

  9. Living in violence: Neighborhood domestic violence and small for gestational age births.

    Science.gov (United States)

    Felker-Kantor, Erica; Wallace, Maeve; Theall, Katherine

    2017-07-01

    To determine the association between neighborhood domestic violence and small-for-gestational-age (SGA) birth and to examine if there is a differential impact of neighborhood domestic violence on SGA births by race in a high crime community. This analysis includes all birth records issued in New Orleans, Louisiana from 2011 to 2012 geocoded by census tract (N=177 census tracts, N=8322 women). Hierarchical modeling and ecologic spatial analysis were used to examine the area-effect of neighborhood domestic violence on SGA births, independent of individual-level predictors and accounting for the propensity to live in high domestic violence neighborhoods. Tests for spatial autocorrelation reveled area-level clustering and overlap of SGA and domestic violent rates. Pregnant women living in high domestic violence areas were more likely to give birth to an SGA infant compared to women in low-domestic violence areas (OR=1.04, 95%CI: 1.01, 1.08), net of the effects of individual-level factors and propensity scores. Neighborhood-level attributes including rates of domestic violence may increase women's risk for SGA birth, highlighting a policy-relevant and potentially amenable exposure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Childbirth expense support and small-for-gestational-age infants in Japan.

    Science.gov (United States)

    Tsuchiya, Sayaka; Ohashi, Kazutomo

    2015-10-01

    Poor nutritional status during the fetal period could cause perinatal and lifelong health disadvantages in neonates. The aim of this study was to investigate the background of pregnant women receiving childbirth expense support (CES), pregnancy outcome, and neonatal anthropometric data. A retrospective cohort study was conducted using 823 antenatal and delivery records in a perinatal center located in one of the poorest areas in Japan. Neonates who were small for gestational age (SGA) were compared between the CES and the non-CES groups. The incidences of low birthweight (LBW) and SGA were significantly higher in the group receiving CES (14.6% and 14.6%, respectively). The adjusted OR of CES was 2.78 (95%CI: 1.32-5.87) and the adjusted OR of maternal smoking was 5.03 (95%CI: 2.74-9.21), indicating that CES and maternal smoking were directly associated with SGA. CES recipients had a higher prevalence of SGA infants. CES was independently associated with SGA. Previous studies have shown that smoking is a major risk factor for SGA. Further studies are needed to identify risk factors of SGA specific to CES recipients. © 2015 Japan Pediatric Society.

  11. Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth

    Science.gov (United States)

    Wallace, Maeve E.; Liu, Danping; Grantz, Katherine L.

    2015-01-01

    Objectives. We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth. Methods. Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor’s or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. Results. Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. Conclusions. High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur. PMID:26066964

  12. Metabolic profiling uncovers a phenotypic signature of small for gestational age in early pregnancy.

    LENUS (Irish Health Repository)

    Horgan, Richard P

    2012-01-31

    Being born small for gestational age (SGA) confers increased risks of perinatal morbidity and mortality and increases the risk of cardiovascular complications and diabetes in later life. Accumulating evidence suggests that the etiology of SGA is usually associated with poor placental vascular development in early pregnancy. We examined metabolomic profiles using ultra performance liquid chromatography-mass spectrometry (UPLC-MS) in three independent studies: (a) venous cord plasma from normal and SGA babies, (b) plasma from a rat model of placental insufficiency and controls, and (c) early pregnancy peripheral plasma samples from women who subsequently delivered a SGA baby and controls. Multivariate analysis by cross-validated Partial Least Squares Discriminant Analysis (PLS-DA) of all 3 studies showed a comprehensive and similar disruption of plasma metabolism. A multivariate predictive model combining 19 metabolites produced by a Genetic Algorithm-based search program gave an Odds Ratio for developing SGA of 44, with an area under the Receiver Operator Characteristic curve of 0.9. Sphingolipids, phospholipids, carnitines, and fatty acids were among this panel of metabolites. The finding of a consistent discriminatory metabolite signature in early pregnancy plasma preceding the onset of SGA offers insight into disease pathogenesis and offers the promise of a robust presymptomatic screening test.

  13. Joint Effects of Structural Racism and Income Inequality on Small-for-Gestational-Age Birth.

    Science.gov (United States)

    Wallace, Maeve E; Mendola, Pauline; Liu, Danping; Grantz, Katherine L

    2015-08-01

    We examined potential synergistic effects of racial and socioeconomic inequality associated with small-for-gestational-age (SGA) birth. Electronic medical records from singleton births to White and Black women in 10 US states and the District of Columbia (n = 121 758) were linked to state-level indicators of structural racism, including the ratios of Blacks to Whites who were employed, were incarcerated, and had a bachelor's or higher degree. We used state-level Gini coefficients to assess income inequality. Generalized estimating equations models were used to quantify the adjusted odds of SGA birth associated with each indicator and the joint effects of structural racism and income inequality. Structural racism indicators were associated with higher odds of SGA birth, and similar effects were observed for both races. The joint effects of racial and income inequality were significantly associated with SGA birth only when levels of both were high; in areas with high inequality levels, adjusted odds ratios ranged from 1.81 to 2.11 for the 3 structural racism indicators. High levels of racial inequality and socioeconomic inequality appear to increase the risk of SGA birth, particularly when they co-occur.

  14. Smoking Ban and Small-For-Gestational Age Births in Ireland

    Science.gov (United States)

    Kabir, Zubair; Daly, Sean; Clarke, Vanessa; Keogan, Sheila; Clancy, Luke

    2013-01-01

    Background Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births. Methods and Findings We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5th percentile) and very SGA (vSGA - BW<3rd percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ∼2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(−5.3%; 95% CI −5.43% to −5.17%, p<0.0001) and (−0.45%; 95% CI: −0.7% to −0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, −0.6% (p<0.0001) and −0.02% (p<0.0001), respectively. Conclusions A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful

  15. Association between maternal vascular murmur and the small-for-gestational-age fetus with abnormal umbilical artery Doppler flow

    DEFF Research Database (Denmark)

    Riknagel, Diana; Farlie, Richard; Hedegaard, Morten

    2017-01-01

    OBJECTIVE: To investigate the association between maternal vascular murmurs (MVMs) and fetal growth restriction (defined as small-for-gestational-age [SGA] fetus) and abnormal Doppler pulsatility index (PI) of the uterine and/or umbilical arteries. METHODS: A cross-sectional study of women aged 18...... participants had MVMs. There was a clear association between MVMs and a composite of SGA and an abnormal PI of the uterine and/or the umbilical artery (P

  16. Chronic hypertension: first-trimester blood pressure control and likelihood of severe hypertension, preeclampsia, and small for gestational age.

    Science.gov (United States)

    Nzelu, Diane; Dumitrascu-Biris, Dan; Nicolaides, Kypros H; Kametas, Nikos A

    2018-03-01

    There is extensive evidence that prepregnancy chronic hypertension is associated with a high risk of development of severe hypertension and preeclampsia and birth of small-for-gestational-age neonates. However, previous studies have not reported whether antihypertensive use, blood pressure control, or normalization of blood pressure during early pregnancy influences the rates of these pregnancy complications. The purpose of this study was to stratify women with prepregnancy chronic hypertension according to the use of antihypertensive medications and level of blood pressure control at the first hospital visit during the first trimester of pregnancy and to examine the rates of severe hypertension, preeclampsia, and birth of small-for-gestational-age neonates according to such stratification. We conducted a prospective study of 586 women with prepregnancy chronic hypertension, in the absence of renal or liver disease, that was booked at a dedicated clinic for the management of hypertension in pregnancy. The patients had singleton pregnancies and were subdivided according to findings in their first visit: group 1 (n=199), blood pressure age neonates (birthweight age). The incidence of these complications was compared in the 3 strata. The median gestational age at presentation was 10.0 weeks (interquartile range, 9.1-11.0 weeks). In groups 2 and 3, compared with group 1, there was a significantly higher body mass index, incidence of black racial origin, and history of preeclampsia in a previous pregnancy. There was a significant increase from group 1 to group 3 in the incidence of severe hypertension (10.6%, 22.2%, and 52.1%), preterm preeclampsia with onset at age (13.1%, 17.7%, and 21.1%), but not term preeclampsia with onset at ≥37 weeks of gestation (9.5%, 9.1%, and 6.6%). In women with prepregnancy chronic hypertension, the rates of development of severe hypertension, preterm preeclampsia, and small for gestational age are related to the use of antihypertensive

  17. Longitudinal study of aortic isthmus Doppler in appropriately grown and small-for-gestational-age fetuses with normal and abnormal umbilical artery Doppler.

    LENUS (Irish Health Repository)

    Kennelly, M M

    2012-04-01

    To establish reference ranges using longitudinal data for aortic isthmus (AoI) Doppler indices in appropriate-for-gestational-age (AGA) fetuses and to document the longitudinal trends in a cohort of small-for-gestational-age (SGA) fetuses with normal umbilical artery Doppler and in fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler.

  18. Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Riitta Luoto

    2011-05-01

    Full Text Available BACKGROUND: Our objective was to examine whether gestational diabetes mellitus (GDM or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. METHOD AND FINDINGS: We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT at 8-12 wk gestation. Euglycemic (n = 399 women with at least one GDM risk factor (body mass index [BMI] ≥ 25 kg/m(2, glucose intolerance or newborn's macrosomia (≥ 4,500 g in any earlier pregnancy, family history of diabetes, age ≥ 40 y were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome and newborns' birthweight adjusted for gestational age (neonatal outcome. Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET minutes and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber. Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216 of women in the intervention group and 12.4% (22/179 in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71-2.62, p = 0.36. Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size -133 g, 95% CI -231 to -35, p = 0.008 as was proportion of large-for-gestational-age (LGA newborns (26/216, 12.1% versus 34/179, 19.7%, p = 0.042. Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30-3.25, p = 0.023 and

  19. [46-OR] : Early and late onset preeclampsia versus small for gestational age risks in subsequent pregnancies

    NARCIS (Netherlands)

    Bernardes, Thomas P; Mol, Ben W; Ravelli, Anita C; van den Berg, Paul P; Stolk, Ronald P; Groen, Henk

    OBJECTIVES: Current literature suggests that early and late onset preeclampsia should be treated as distinct entities and that early onset preeclampsia shares pathophysiology aspects with intrauterine growth restriction. Our objective was to investigate whether 5th percentile small for gestational

  20. Impact of ambient air pollution on gestational age is modified by season in Sydney, Australia

    Directory of Open Access Journals (Sweden)

    Lincoln Doug

    2007-06-01

    Full Text Available Abstract Background The effect of individual pollutants and the period(s during pregnancy when pollutant levels are likely to have most impact on preterm birth is not clear. We evaluated the effect of prenatal exposure to six common urban air pollutants in the Sydney metropolitan area on preterm birth. Methods We obtained information on all births in metropolitan Sydney between January 1, 1998 and December 31, 2000. For each birth, exposure to each air pollutant was estimated for the first trimester, the three months preceding birth, the first month after the estimated date of conception and the month prior to delivery. Gestational age was analysed as a categorical variable in logistic regression models. Results There were 123 840 singleton births in Sydney in 1998–2000 and 4.9% were preterm. Preterm birth was significantly associated with maternal age, maternal smoking, male infant, indigenous status and first pregnancy. Air pollutant levels in the month and three months preceding birth had no significant effect on preterm birth after adjusting for maternal and infant covariates. Ozone levels in the first trimester of pregnancy and spring months of conception and sulphur dioxide were associated with increased risks for preterm births. Nitrogen dioxide was associated with a decreased risk of preterm births. Conclusion We found more protective than harmful associations between ambient air pollutants and preterm births with most associations non-significant. In view of these inconsistent associations, it is important to interpret the harmful effects with caution. If our results are confirmed by future studies then it will be imperative to reduce Sydney's already low air pollution levels even further.

  1. Association between prenatal care and small for gestational age birth: an ecological study in Quebec, Canada

    Directory of Open Access Journals (Sweden)

    N. Savard

    2016-07-01

    Full Text Available Background: In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA birth (weight o 10th percentile on the Canadian scale. Methods: In this ecological study, births were identified from Quebec’s registry of demographic events between 2006 and 2008 (n ¼ 156 404; 134 areas. Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same territory. Potential confounders included sedentary behaviour and cigarette smoking. The odds ratios (ORs were adjusted for mother’s age, marital status, parity, program coverage and mean income in the area. Results: Mothers eligible for the programs remain at a higher odds of SGA than noneligible mothers (OR ¼ 1.40; 95% confidence interval [CI]: 1.30–1.51. Further, areas that provide more visits to eligible mothers (4–6 food supplementation visits seem more successful at reducing the frequency of SGA birth than those that provide 1–2 or 3 visits (OR ¼ 0.86; 95% CI: 0.75–0.99. Conclusions: Further studies that validate whether an increase in the number of prenatal care interventions reduces the odds of SGA birth in different populations and evaluate other potential benefits for the children should be done.

  2. Gestational Weight Gain and Overweight in Children Aged 3–6 Years

    Science.gov (United States)

    Guo, Lianhong; Liu, Jufen; Ye, Rongwei; Liu, Jianmeng; Zhuang, Zhixiong; Ren, Aiguo

    2015-01-01

    Objective To determine whether gestational weight gain (GWG) was associated with increased odds of childhood overweight after accounting for pre-pregnancy BMI. Methods In a prospective cohort study based on a premarital and perinatal health care system in China, data of 100 612 mother-child pairs were obtained. The main exposure was GWG as both a continuous and categorical variable. The outcome measure was overweight, defined by age- and sex-specific cutoff values for body mass index (BMI) in children aged 3–6 years. Results A 1-kg increase in maternal GWG was associated with an increase of 0.009 (95% confidence interval [CI]: 0.007–0.010, P children’s mean BMI; in the subgroup of pre-pregnancy overweight/obese mothers, the increase in children’s BMI was 0.028 (95% CI, 0.017–0.039, P overweight when adequate GWG was used as the reference, with an odds ratio (OR) of 1.21 (95% CI, 1.12–1.29). The risk was highest (OR 2.22; 95% CI, 1.79–2.76) in the children of mothers who were overweight/obese before pregnancy and gained excessive weight during pregnancy. Conclusions Greater maternal GWG was associated with greater offspring BMI, and the risk of overweight was doubled in children whose mothers were overweight/obese before pregnancy and gained excessive weight during pregnancy. As a result, maintenance of appropriate weight gain during pregnancy and prophylaxis of maternal overweight/obesity before pregnancy should be a strategy for preventing childhood overweight/obesity. PMID:26119288

  3. Gestational age and birth weight in relation to school performance of 10-year-old children: a follow-up study of children born after 32 completed weeks

    DEFF Research Database (Denmark)

    Kirkegaard, Ida; Obel, Carsten; Hedegaard, Morten

    2006-01-01

    after adjustment for potential cofounders and when the analyses were restricted to children born at term (39-40 weeks of gestation), suggesting that the association could not be explained by a low gestational age. Compared with children born at term, reading and spelling difficulties were more often...... the children were between 9 and 11 years of age, we gathered information about their school performance (reading, spelling, and arithmetic) from questionnaires completed by the parents and the children's primary school teachers. RESULTS: The association between birth weight and reading, as well as spelling...... found among children born at gestational age 33 to 36 weeks and 37 to 38 weeks, whereas there was no relation between gestational age and arithmetic difficulties. CONCLUSIONS: Gestational age and birth weight were associated with school performance in the 10-year-old child and the association extended...

  4. Kidney transplantation fails to provide adequate growth in children with chronic kidney disease born small for gestational age.

    Science.gov (United States)

    Franke, Doris; Steffens, Rena; Thomas, Lena; Pavičić, Leo; Ahlenstiel, Thurid; Pape, Lars; Gellermann, Jutta; Müller, Dominik; Querfeld, Uwe; Haffner, Dieter; Živičnjak, Miroslav

    2017-03-01

    Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx). Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with (n = 94) and without (n = 228) an SGA history were evaluated by the use of linear mixed-effects models. Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients (p growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only. In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients.

  5. Serum triglycerides and cholesterol status in patients with and without gestational diabetes mellitus

    International Nuclear Information System (INIS)

    Khan, S.H.; Tabassum, H.; Shahzad, S.

    2017-01-01

    To measure the differences of lipids including total cholesterol and triglycerides among subjects with or without GDM. Study Design: Cross sectional comparative study. Place and duration of study: This study was carried out between Dec 2010 to Jun 2012 at the department of gynecology and obstetrics Pakistan Naval Ship (PNS) Shifa and department of pathology, PNS Rahat. Material and Methods: Pregnant women who presented in outpatient department of gynaecology between 24-34 weeks of gestation were randomly selected, and were requested to undergo 100 Gm oral glucose tolerance test for diagnosis of gestational diabetes mellitus (GDM). A total of 93 pregnant women were included in the study. Afterwards they were divided in 2 groups on basis of presence and absence of GDM. Later all the patients were analyzed for total cholesterol and triglycerides. Results of triglycerides and total cholesterol were compared among subjects with or without GDM. Results: The differences for serum triglycerides and total cholesterol were not found to be significant among subject with or without gestational diabetes mellitus, where 0.05 was considered significant. Conclusion: There was no difference between serum triglyceride and total cholesterol levels among subjects with or without gestational diabetes mellitus. (author)

  6. Evaluating the Role of Birth Weight and Gestational Age on Acute Lymphoblastic Leukemia Risk Among Those of Hispanic Ethnicity.

    Science.gov (United States)

    Barahmani, Nadia; Dorak, M Tevfik; Forman, Michele R; Sprehe, Michael R; Scheurer, Michael E; Bondy, Melissa L; Okcu, M Fatih; Lupo, Philip J

    2015-01-01

    High birth weight is an established risk factor for childhood acute lymphoblastic leukemia (ALL), especially in children younger than 5 years of age at diagnosis. The goal of this study was to explore the association between being born large for gestational age and the risk for ALL by race/ethnicity to determine if the role of this risk factor differed by these characteristics. The authors compared birth certificate data of 575 children diagnosed with ALL who were younger than 5 years and included in the Texas Cancer Registry, Texas Department of Health, between the years 1995 and 2003 with 11,379 controls matched by birth year. Stratified odds ratios were calculated for risk of ALL by birth weight for gestational age, categorized in 3 groups, small, appropriate, and large for gestational age (SGA, AGA, and LGA, respectively), for each race/ethnicity group. The risk of developing ALL was higher among Hispanics who were LGA (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.34-2.68) compared with LGA non-Hispanic whites (OR = 1.27, 95% CI: 0.87-1.86) after adjusting for infant gender, year of birth, maternal age, birth order, and presence of Down syndrome. However, the difference was not statistically significant. These results suggest that there may be differences in the association between higher growth in utero and risk of childhood ALL among Hispanics versus non-Hispanic whites.

  7. Preterm or not--an evaluation of estimates of gestational age in a cohort of women from Rural Papua New Guinea.

    Directory of Open Access Journals (Sweden)

    Stephan Karl

    Full Text Available Knowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate.In a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (<25 gestational weeks using correlation, regression and Bland-Altman analyses and ranked for their capability to predict preterm birth using the harmonic mean of recall and precision (F-measure.Average bias between reference ultrasound and clinical methods ranged from 0-11 days (95% confidence levels: 14-42 days. Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72, and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17. The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35. A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58.Estimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable

  8. Newborn skin reflection: Proof of concept for a new approach for predicting gestational age at birth. A cross-sectional study.

    Science.gov (United States)

    Reis, Zilma Silveira Nogueira; Vitral, Gabriela Luiza Nogueira; de Souza, Ingrid Michelle Fonseca; Rego, Maria Albertina Santiago; Guimaraes, Rodney Nascimento

    2017-01-01

    Current methods to assess the gestational age during prenatal care or at birth are a global challenge. Disadvantages, such as low accessibility, high costs, and imprecision of clinical tests and ultrasonography measurements, may compromise health decisions at birth, based on the gestational age. Newborns' organs and tissues can indirectly indicate their physical maturity, and we hypothesized that evolutionary changes in their skin, detected using an optoelectronic device meter, may aid in estimating the gestational age. This study analyzed the feasibility of using newborn skin reflectance to estimate the gestational age at birth noninvasively. A cross-sectional study evaluated the skin reflectance of selected infants, preferably premature, at birth. The first-trimester ultrasound was the reference for gestational age. A prototype of a new noninvasive optoelectronic device measured the backscattering of light from the skin, using a light emitting diode at wavelengths of 470 nm, 575 nm, and 630 nm. Univariate and multivariate regression analysis models were employed to predict gestational age, combining skin reflectance with clinical variables for gestational age estimation. The gestational age at birth of 115 newborns from 24.1 to 41.8 weeks of gestation correlated with the light at 630 nm wavelength reflectance 3.3 mm/6.5 mm ratio distant of the sensor, at the forearm and sole (Pearson's correlation = 0.505, P skin reflectance at wavelengths of 630 nm and 470 nm in combination with birth weight, phototherapy, and adjusted to include incubator stay, and sex (R2 = 0.828, P skin reflectometer device, in combination with clinical variables, was able to predict the gestational age and could be useful when the information is in doubt or is unknown. Multivariable predictive models associated the skin reflectance with easy to obtain clinical parameters, at the birth scenario. External validation needs to be proven in an actual population with the real incidence of

  9. Differential effect of assisted reproductive technology and small-for-gestational age on fetal cardiac remodeling.

    Science.gov (United States)

    Valenzuela-Alcaraz, B; Crispi, F; Cruz-Lemini, M; Bijnens, B; García-Otero, L; Sitges, M; Balasch, J; Gratacós, E

    2017-07-01

    Fetuses conceived by assisted reproductive technology (ART) and those that are small-for-gestational age (SGA) show cardiovascular remodeling in utero; however, these two conditions are often associated. We aimed to evaluate the differential effect of ART and SGA on fetal cardiac remodeling. This was a prospective cohort study of term singleton pregnancies seen at our department between April 2011 and September 2013. The cohort was divided according to fetal growth and mode of conception into the following four groups: 102 appropriate-for-gestational-age (AGA) fetuses conceived spontaneously (controls), 72 AGA fetuses conceived by ART (ART-AGA), 31 SGA fetuses conceived by ART (ART-SGA) and 28 SGA fetuses conceived naturally (Spont-SGA). SGA was defined as birth weight Fetal echocardiography was performed at 28-32 weeks to assess cardiac dimensions, geometry and function. ART fetuses had dilated atria (mean left atrium-to-heart area ratio: controls, 15 ± 2.7%; ART-AGA, 18 ± 4.1%; Spont-SGA, 14 ± 3.7%) and more globular ventricles (left ventricular sphericity index: controls, 1.77 ± 0.2; ART-AGA, 1.68 ± 0.2; Spont-SGA, 1.72 ± 0.2), with normally sized hearts. In contrast, SGA fetuses had enlarged hearts (cardiothoracic ratio: controls, 24 ± 3%; ART-AGA, 24 ± 4%; Spont-SGA, 29 ± 6%), preserved atrial size, more globular and concentric hypertrophic ventricles (left ventricle relative wall thickness: controls, 0.48 ± 0.17; ART-AGA, 0.54 ± 0.13; Spont-SGA, 0.63 ± 0.23). Both ART and SGA fetuses had decreased longitudinal motion (tricuspid annular ring displacement: controls, 6.5 ± 0.8 mm; ART-AGA, 5.5 ± 0.7 mm; Spont-SGA, 5.9 ± 0.6 mm) and impaired relaxation (left isovolumetric relaxation time: controls, 47.0 ± 7.3 ms; ART-AGA, 50.0 ± 7.9 ms; Spont-SGA, 49.5 ± 9.3 ms). ART-SGA fetuses presented a combination of features from both ART and SGA groups. SGA and conception with ART

  10. Blood glucose levels within 7 days after birth in preterm infants according to gestational age

    Directory of Open Access Journals (Sweden)

    Ju Young Yoon

    2015-12-01

    Full Text Available PurposeThis study investigated blood glucose levels in preterm babies according to gestational age (GA.MethodsSubjects were 141 preterm infants with a GA180 mg/dL.ResultsDuring the 7 days after birth, hypo- and hyperglycemia occurred in 29 (29 of 141, 20.6% and 42 (42 of 141, 29.8% neonates, respectively. During the first 2 hours, 18 neonates (12.8% exhibited hypoglycemia, and only 2 (2 of 141, 1.4% developed hyperglycemia. From 6 to 24 hours, hypo- and hyperglycemia were observed in 0 and 9 (9 of 141, 6.4% neonates, respectively. Infants small for their GA (SGA were at risk for hypoglycemia both within 24 hours (odds ratio [OR], 2.718; P=0.045 and during days 2 to 7 (OR, 4.454; P=0.006, and hyperglycemia during days 2 to 7 (OR, 3.200; P=0.005. Low 1-minite Apgar score was risk factor for both hypo- and hyperglycemia during days 2 to 7 (OR, 0.756; P=0.035 for hypoglycemia and OR, 0.789; P=0.016 for hyperglycemia. Both hypo- and hyperglycemia within 24 hours were less common in those who started feeding (OR, 0.294; P=0.013 for hypoglycemia and OR, 0.162; P=0.011 for hyperglycemia.ConclusionCareful blood glucose level monitoring is required in preterm infants, especially SGA infants or those with low Apgar score. Early feeding could be beneficial for maintaining euglycemia.

  11. Preterm human milk macronutrient concentration is independent of gestational age at birth.

    Science.gov (United States)

    Maly, Jan; Burianova, Iva; Vitkova, Veronika; Ticha, Eva; Navratilova, Martina; Cermakova, Eva

    2018-01-20

    To evaluate the amount of macronutrients in aggregate of human milk samples after preterm delivery during the first 2 months of lactation. Analysis of the donated single milk samples, gained by complete emptying of the whole breast at the same daytime between 24+0 and 35+6 gestational age (GA), was designed as prospective observational cohort trial. Two milk samples were analysed every postnatal week up to the discharge from the hospital, week 9 or loss of lactation. 24-Hour milk collection was not done. Analysis was performed using the MIRIS Human Milk Analyser (MIRIS AB, Uppsala, Sweden). A set of 1917 human milk samples donated by 225 mothers after preterm labour was analysed. Group A (24-30 GA) contains 969 milk samples; group B (31-35 GA) contains 948 milk samples. No difference in milk composition between the groups was identified. Median of true protein content decreased from 1.6 g/dL in group A and 1.5 g/dL in group B in the first week of life, to 1.1 g/dL in both groups at the end of week 3, and then remained stable up to week 9. Content of carbohydrates and fat was stable during the whole observation, with interindividual differences. Human milk does not differ as a function of degree of prematurity. Protein content of preterm human milk is low and decreases during the first 3 weeks of lactation. Recommended daily protein intake cannot be achieved with routine fortification in majority of milk samples. © 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.

  12. Transient bilirubin encephalopathy and apnea of prematurity in 28 to 32 weeks gestational age infants.

    Science.gov (United States)

    Amin, Sanjiv B; Charafeddine, Lama; Guillet, Ronnie

    2005-06-01

    Apnea of prematurity (AoP) is, in part, a reflection of brainstem-mediated respiratory control system maturation. We previously demonstrated changes in brainstem function in relation to hyperbilirubinemia (bilirubin encephalopathy, (BE)) as evaluated by auditory brainstem evoked responses (ABR) in infants 28 to 32 weeks gestational age (GA). We hypothesized that in this population, as bilirubin increases and causes auditory brainstem dysfunction, respiratory control system may also be adversely affected leading to increased frequency of AoP. We studied 100, 28 to 32 weeks GA infants and identified 66 with normal and 34 with abnormal ABR progression in temporal relation to hyperbilirubinemia (BE). The abnormal ABR progression was associated with elevated bilirubin, specifically elevated unbound bilirubin levels. A blinded, retrospective chart review quantified the amount of weekly apnea and bradycardia events during the hospital stay, total duration of methylxanthine treatment, total duration of mechanical ventilation, CPAP, and/or nasal cannula, and risk factors for apnea (sepsis, IVH grade >II, asphyxia). Since mechanical ventilation confounds the identification of apnea, infants requiring mechanical ventilation were excluded from further review (n = 60; 21 with BE and 39 with normal ABR progression). Data from the remaining 40 infants were analyzed. Student's t-test was used to analyze continuous variables if the distribution was normal otherwise Wilcoxon-ranked-sum test was used. chi(2) was used to analyze nominal variables. A p apnea and bradycardia between infants with and without BE was most pronounced during the first week. Premature infants with transient bilirubin encephalopathy as defined by abnormal ABR progression in relation to hyperbilirubinemia have more concurrent apneic events and require more prolonged respiratory support and medications.

  13. Helicobacter pylori colonization and pregnancies complicated by preeclampsia, spontaneous prematurity, and small for gestational age birth.

    Science.gov (United States)

    den Hollander, Wouter J; Schalekamp-Timmermans, Sarah; Holster, I Lisanne; Jaddoe, Vincent W; Hofman, Albert; Moll, Henriëtte A; Perez-Perez, Guillermo I; Blaser, Martin J; Steegers, Eric A P; Kuipers, Ernst J

    2017-04-01

    Preeclampsia (PE), small for gestational age (SGA), and spontaneous preterm birth (PTB) each may be complications of impaired placental function in pregnancy. Although their exact pathogenesis is still unknown, certain infectious agents seem to play a role. Helicobacter pylori (H. pylori) colonization has been associated with increased risk for PE. Our aim was to assess the association between H. pylori colonization and PE, SGA, and PTB. We measured IgG anti-H. pylori and CagA antibodies in serum of pregnant women (median 20.5 weeks, range 16.5-29.4) who participated in a population-based prospective cohort study. Delivery and medical records were assessed. Information on demographics, education, and maternal risk factors was collected by questionnaire. We used multivariate logistic regression analyses to assess associations between H. pylori colonization and PE, SGA, and PTB. In total, 6348 pregnant women were assessed. H. pylori positivity was found in 2915 (46%) women, of whom 1023 (35%) also were CagA-positive. Pregnancy was complicated by PE, SGA, or PTB in 927 (15%) women. H. pylori colonization was associated with PE (aOR 1.51; 95%CI 1.03-2.25). Differentiation according to CagA status revealed the same risk. H. pylori was positively related with SGA, mainly explained by CagA-positive strains (aOR 1.34; 1.04-1.71). No association was observed between H. pylori and PTB. Our data suggest that H. pylori colonization may be a risk factor for PE and SGA. If these associations are confirmed by future studies and shown to be causal, H. pylori eradication may reduce related perinatal morbidity and mortality. © 2016 John Wiley & Sons Ltd.

  14. Ovarian morphology and function during growth hormone therapy of short girls born small for gestational age.

    Science.gov (United States)

    Tinggaard, Jeanette; Jensen, Rikke Beck; Sundberg, Karin; Birkebæk, Niels; Christiansen, Peter; Ellermann, Annie; Holm, Kirsten; Jeppesen, Eva Mosfeldt; Kremke, Britta; Marcinski, Pawel; Pedersen, Carsten; Saurbrey, Nina; Thisted, Ebbe; Main, Katharina M; Juul, Anders

    2014-12-01

    To study the effect of growth hormone (GH) treatment on ovarian and uterine morphology and function in short, prepubertal small-for-gestational-age (SGA) girls. A multinational, randomized controlled trial on safety and efficacy of GH therapy in short, prepubertal children born SGA. Not applicable. A subgroup of 18 Danish girls born SGA included in North European SGA Study (NESGAS). One year of GH treatment (67 μg/kg/day) followed by 2 years of randomized GH treatment (67 μg/kg/day, 35 μg/kg/day, or IGF-I titrated). Data on anthropometrics, reproductive hormones, and ultrasonographic examination of the internal genitalia were collected during 36 months of GH treatment. Uterine and ovarian volume increased significantly during 3 years of treatment (64% and 110%, respectively) but remained low within normal reference ranges. Ovarian follicles became visible in 58% after 1 year compared with 28% before GH therapy. Anti-Müllerian hormone increased significantly during the 3 years of GH therapy but remained within the normal range. Precocious puberty was observed in one girl; another girl developed multicystic ovaries. GH treatment was associated with statistically significant growth of the internal genitalia, but remained within the normal range. As altered pubertal development and ovarian morphology were found in 2 of 18 girls, monitoring of puberty and ovarian function during GH therapy in SGA girls is prudent. Altogether, the findings are reassuring. However, long-term effects of GH treatment on adult reproductive function remain unknown. EudraCT 2005-001507-19. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Pain-Related Reactions among Premature Infants with Gestational Age Less than 26 Weeks: An Observational Cohort Study.

    Science.gov (United States)

    Martakis, Kyriakos; Hünseler, Christoph; Thangavelu, Kruthika; Kribs, Angela; Roth, Bernhard

    2016-01-01

    There is insufficient information regarding acute pain reactions among premature infants with a gestational age of less than 26 weeks and no appropriate scale for pain measurement in this age group. We hypothesized that these infants present specific reactions to a standardized pain stimulus within the first 3 days of life. Mixed-methods, prospective, open-label, single-arm, observational study. Routine capillary or peripheral blood takes were filmed. The model consisting of a baseline, a preparatory, an interventional and a return-to-baseline phase was filmed. After a pilot evaluation, experienced medical and nursing neonatal intensive care unit (NICU) staff analysed the videos. Twenty infants with gestational ages ranging from 22 weeks and 3 days to 26 weeks (mean 24 weeks) were recruited. Nineteen infants showed pain reactions, with a mean latency of 8.3 s (range 2-30). The majority presented eye movements, changes of the breath pattern and a slight increase in the mean SpO2 value. A high degree of interrater and intrarater reliability was found. Premature infants with a gestational age of up to 26 weeks can present a variety of discrete reactions as response to a pain stimulus within the first 72 h of life. Experienced NICU staff can perform a valid and reliable evaluation of these reactions. © 2016 S. Karger AG, Basel.

  16. Low BMI at age 20 years predicts gestational diabetes independent of BMI in early pregnancy in Japan: Tanaka Women's Clinic Study.

    Science.gov (United States)

    Yachi, Y; Tanaka, Y; Nishibata, I; Sugawara, A; Kodama, S; Saito, K; Sone, H

    2013-01-01

    Maternal obesity and weight gain since early adulthood are known predictors of gestational diabetes in Western countries. However, their impact has not been evaluated well in Asia, where mean BMI levels are generally lower than in Western countries. We therefore examined the associations of BMI at age 20 years and BMI change since age 20 years with the risk of gestational diabetes in Japanese pregnant women. Six hundred and twenty-four consecutive pregnant women without recognized diabetes before pregnancy, whose initial obstetric clinic visit was before 13 weeks' gestation, were prospectively observed. Weight at age 20 years was self-reported. Baseline height and weight measurements were obtained at the initial obstetric visit. Multivariate logistic regression analysis estimated the risk of incident gestational diabetes for BMI change since 20 years and BMI at age 20 years. Twenty-eight women developed incident gestational diabetes. By multivariate logistic regression analysis that adjusted for maternal age, parity and baseline BMI, we observed a statistically significant inverse association between BMI at age 20 years and incidence of gestational diabetes (odds ratio 0.68, 95% CI 0.51-0.92). Similarly, when we assessed the association of BMI change since age 20 years, adjusted for maternal age and parity, BMI change was associated with an increased risk of gestational diabetes (odds ratio 1.26, 95% CI 1.03-1.53). When we focused on the threshold of risk of gestational diabetes, women with BMI at 20 years of less than 18 kg/m(2) had a 6.30-fold (2.26-17.59) greater risk than women with both BMI at age 20 years of 18 kg/m(2) or more and BMI change since age 20 years of less than 1.85. Both low BMI at age 20 years and BMI change since age 20 years were significantly associated with increased risk of incident gestational diabetes. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  17. Growth hormone activates hepatic and cerebral cholesterol metabolism in small-for-gestational age children without catch-up growth.

    Science.gov (United States)

    Hirayama, Satoshi; Nagasaka, Hironori; Nakagawa, Saori; Takuwa, Mayuko; Nakacho, Mariko; Yorifuji, Tohru; Kondou, Hiroki; Tsukahara, Hirokazu; Morioka, Ichiro; Ishida, Akihito; Yamato, Susumu; Miida, Takashi

    Growth hormone (GH) replacement therapy improves hypercholesterolemia in patients with GH deficiency, suggesting that GH modulates cholesterol metabolism. We examined GH effects on lipid profiles and cholesterol-related markers reflecting hepatic and cerebral cholesterol metabolism in small-for-gestational age (SGA) children without catch-up growth. This study examined SGA children without catch-up growth (n = 22) and healthy children (controls, n = 11). Based on parents' choice, 11 SGA children received GH at 0.23 to 0.25 mg/kg/d for 6 months, and at 0.34 to 0.36 mg/kg/d for the subsequent 6 months (GH (+) group). The other SGA children received no GH (GH (-) group, n = 11). We ascertained baseline and posttreatment lipid profiles and cholesterol-related markers reflecting hepatic and cerebral cholesterol metabolism. Baseline lipid profiles of SGA children and controls were similar. Serum 24S-hydroxycholesterol (marker for cerebral cholesterol metabolism) concentration was 19% lower in SGA children than in controls (P children without catch-up growth. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  18. 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.

    Science.gov (United States)

    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

  19. Investigation of C-C chemokine receptor type 4 (ccr4 gene polymorphism in patients with Gestational Trophoblastic diseases (GTD

    Directory of Open Access Journals (Sweden)

    S Naeimi

    2011-08-01

    Full Text Available Introduction & Objective: Gestational trophoblastic disease (GTD consists of a spectrum of disorders that are characterized by an abnormal proliferation of trophoblastic tissue, following an abnormal fertilization. CCR4 is one chemo-attractant receptors preferentially expressed on Th2 cells, and therefore, is likely to participate in the recruitment of antigen-specific Th2 cells to sites of allergen exposure. Variations in CCR4 have been reported. In this study we intended to investigate the relationship between polymorphism of this particular gene at the site of 1014 C/T and GTD. Materials & Methods: In the present study, the polymorphisms of the CCR4 gene at the sites of 1014 C/T was investigated in 100 patients at in 2010 with proved GTD and 120 age-sex matched healthy individuals. Polymorphysm of CC chemokine 4 were investigated in these two groups by PCR-RFLP.These two groups were compared in respect their genotypes and alleles. Results: Frequency of genotype TT, CT, CC patients were 34%, 62% and 4% while the frequency of the control group, were 46.7%, 35.8% and 17.5% respectively. A significant difference was seen in genotype prevalence of 1014 C/T in ccr4 gene in the two mentioned groups (P0.05(. Conclusion: Regarding the relationship between The C-C chemokine receptor type 4 and gestational trophoblastic disease (GTD, it might be possible to use this gene as a prognostic marker in identifying the susceptible patients.

  20. Metabolic response to 36 hours of fasting in young men born small vs appropriate for gestational age

    DEFF Research Database (Denmark)

    Jørgensen, Sine W; Brøns, Charlotte; Bluck, Les

    2015-01-01

    AIMS/HYPOTHESIS: Being born small for gestational age (SGA) is associated with an increased risk of type 2 diabetes in an affluent society, but could confer an improved chance of survival during sparse living conditions. We studied whether insulin action and other metabolic responses to prolonged...... fasting differed between 21 young adults born SGA and 18 matched controls born appropriate for gestational age (AGA). METHODS: A frequently sampled IVGTT and indirect calorimetry measurements were performed after a 36 h fast. Endogenous glucose production, insulin sensitivity (SI), first-phase insulin...... individuals displayed a more energy-conserving and energy-conserving cardiometabolic response to 36 h fasting. The role of increased muscle PPARGC1A DNA methylation in mediating this response requires further study....

  1. Gonadotropin levels in urine during early postnatal period in small for gestational age preterm male infants with fetal growth restriction.

    Science.gov (United States)

    Nagai, S; Kawai, M; Myowa-Yamakoshi, M; Morimoto, T; Matsukura, T; Heike, T

    2017-07-01

    The objective of this study was to estimate gonadotropin concentrations in small for gestational age (SGA) male infants with the reactivation of the hypothalamic-pituitary-gonadal axis during the first few months of life that is important for genital development. We prospectively examined 15 SGA and 15 appropriate for gestational age (AGA) preterm male infants between 2013 and 2014 at Kyoto University Hospital. Gonadotropin concentrations (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) were measured in serial urine samples from the postnatal days 7 to 168 and compared between SGA and AGA infants using the Mann-Whitney test. A longitudinal analysis showed that SGA infants had higher LH and lower FSH concentrations (P=0.004 and P=0.006, respectively) than AGA infants. Male infants who are SGA at birth because of fetal growth restriction have gonadotropin secretion abnormalities in the first few months of life.

  2. Birthweight percentiles by gestational age for births following assisted reproductive technology in Australia and New Zealand, 2002-2010.

    Science.gov (United States)

    Li, Zhuoyang; Wang, Yueping A; Ledger, William; Sullivan, Elizabeth A

    2014-08-01

    What is the standard of birthweight for gestational age for babies following assisted reproductive technology (ART) treatment? Birthweight for gestational age percentile charts were developed for singleton births following ART treatment using population-based data. Small for gestational age (SGA) and large for gestational age (LGA) births are at increased risks of perinatal morbidity and mortality. A birthweight percentile chart allows the detection of neonates at high risk, and can help inform the need for special care if required. This population study used data from the Australian and New Zealand Assisted Reproduction Database (ANZARD) for 72 694 live born singletons following ART treatment between January 2002 and December 2010 in Australia and New Zealand. A total of 69 315 births (35 580 males and 33 735 females) following ART treatment were analysed for the birthweight percentile. Exact percentiles of birthweight in grams were calculated for each gestational week between Week 25 and 42 for fresh and thaw cycles by infant sex. Univariate analysis was used to determine the exact birthweight percentile values. Student t-test was used to examine the mean birthweight difference between male and female infants, between single embryo transfer (SET) and double embryo transfer (DET) and between fresh and thaw cycles. Preterm births (birth before 37 completed weeks of gestation) and low birthweight (fetal growth standards but only the weight of live born infants at birth. The comparison of birthweight percentile charts for ART births and general population births provide evidence that the proportion of SGA births following ART treatment was comparable to the general population for SET fresh cycles and significantly lower for thaw cycles. Both fresh and thaw cycles showed better outcomes for singleton births following SET compared with DET. Policies to promote single embryo transfer should be considered in order to minimize the adverse perinatal outcomes associated

  3. Dependency of magnetocardiographically determined fetal cardiac time intervals on gestational age, gender and postnatal biometrics in healthy pregnancies

    Directory of Open Access Journals (Sweden)

    Geue Daniel

    2004-04-01

    Full Text Available Abstract Background Magnetocardiography enables the precise determination of fetal cardiac time intervals (CTI as early as the second trimester of pregnancy. It has been shown that fetal CTI change in course of gestation. The aim of this work was to investigate the dependency of fetal CTI on gestational age, gender and postnatal biometric data in a substantial sample of subjects during normal pregnancy. Methods A total of 230 fetal magnetocardiograms were obtained in 47 healthy fetuses between the 15th and 42nd week of gestation. In each recording, after subtraction of the maternal cardiac artifact and the identification of fetal beats, fetal PQRST courses were signal averaged. On the basis of therein detected wave onsets and ends, the following CTI were determined: P wave, PR interval, PQ interval, QRS complex, ST segment, T wave, QT and QTc interval. Using regression analysis, the dependency of the CTI were examined with respect to gestational age, gender and postnatal biometric data. Results Atrioventricular conduction and ventricular depolarization times could be determined dependably whereas the T wave was often difficult to detect. Linear and nonlinear regression analysis established strong dependency on age for the P wave and QRS complex (r2 = 0.67, p r2 = 0.66, p r2 = 0.21, p r2 = 0.13, p st week onward (p Conclusion We conclude that 1 from approximately the 18th week to term, fetal CTI which quantify depolarization times can be reliably determined using magnetocardiography, 2 the P wave and QRS complex duration show a high dependency on age which to a large part reflects fetal growth and 3 fetal gender plays a role in QRS complex duration in the third trimester. Fetal development is thus in part reflected in the CTI and may be useful in the identification of intrauterine growth retardation.

  4. Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery

    OpenAIRE

    Hazart , J.; Le Guennec , D.; Accoceberry , M.; LEMERY , D.; Mulliez , A.; Farigon , N.; Lahaye , C.; Miolanne-Debouit , M.; Boirie , Yves

    2017-01-01

    The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements inta...

  5. Vitamin A supplementation in extremely low-birth-weight infants: subgroup analysis in small-for-gestational-age infants.

    Science.gov (United States)

    Londhe, Vedang A; Nolen, Tracy L; Das, Abhik; Higgins, Rosemary D; Tyson, Jon E; Oh, William; Devaskar, Sherin U

    2013-10-01

    Preterm infants with intrauterine growth restriction are at increased risk of respiratory distress syndrome and bronchopulmonary dysplasia (BPD). A randomized clinical trial by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network demonstrated that vitamin A supplementation in extremely low-birth-weight (ELBW) preterm infants requiring early respiratory support decreased the risk of developing BPD. A subgroup analysis of small-for-gestational-age (SGA) infants from the original NICHD trial was performed to test the hypothesis that in infants requiring early respiratory support, vitamin A supplementation decreases the relative risk of BPD or death in premature SGA infants to a greater extent than in gestational age-equivalent vitamin A-treated appropriate-for-gestational-age (AGA) infants. Although vitamin A supplementation significantly increased serum retinol concentrations in AGA ELBW infants (median [5th percentile, 95th percentile]: 16.3 [-7.0, 68.8] versus 2.4 [-13.9, 55.1]; p supplementation in preterm SGA infants requiring early respiratory support decreases the relative risk of BPD or death as compared with preterm AGA infants. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Obesity and diabetes genes are associated with being born small for gestational age: Results from the Auckland Birthweight Collaborative study

    Science.gov (United States)

    2010-01-01

    Background Individuals born small for gestational age (SGA) are at increased risk of rapid postnatal weight gain, later obesity and diseases in adulthood such as type 2 diabetes, hypertension and cardiovascular diseases. Environmental risk factors for SGA are well established and include smoking, low pregnancy weight, maternal short stature, maternal diet, ethnic origin of mother and hypertension. However, in a large proportion of SGA, no underlying cause is evident, and these individuals may have a larger genetic contribution. Methods In this study we tested the association between SGA and polymorphisms in genes that have previously been associated with obesity and/or diabetes. We undertook analysis of 54 single nucleotide polymorphisms (SNPs) in 546 samples from the Auckland Birthweight Collaborative (ABC) study. 227 children were born small for gestational age (SGA) and 319 were appropriate for gestational age (AGA). Results and Conclusion The results demonstrated that genetic variation in KCNJ11, BDNF, PFKP, PTER and SEC16B were associated with SGA and support the concept that genetic factors associated with obesity and/or type 2 diabetes are more prevalent in those born SGA compared to those born AGA. We have previously determined that environmental factors are associated with differences in birthweight in the ABC study and now we have demonstrated a significant genetic contribution, suggesting that the interaction between genetics and the environment are important. PMID:20712903

  7. DNA Methylation Patterns in Cord Blood of Neonates Across Gestational Age: Association With Cell-Type Proportions.

    Science.gov (United States)

    Braid, Susan M; Okrah, Kwame; Shetty, Amol; Corrada Bravo, Hector

    A statistical methodology is available to estimate the proportion of cell types (cellular heterogeneity) in adult whole blood specimens used in epigenome-wide association studies (EWAS). However, there is no methodology to estimate the proportion of cell types in umbilical cord blood (also a heterogeneous tissue) used in EWAS. The objectives of this study were to determine whether differences in DNA methylation (DNAm) patterns in umbilical cord blood are the result of blood cell type proportion changes that typically occur across gestational age and to demonstrate the effect of cell type proportion confounding by comparing preterm infants exposed and not exposed to antenatal steroids. We obtained DNAm profiles of cord blood using the Illumina HumanMethylation27k BeadChip array for 385 neonates from the Boston Birth Cohort. We estimated cell type proportions for six cell types using the deconvolution method developed by . The cell type proportion estimates segregated into two groups that were significantly different by gestational age, indicating that gestational age was associated with cell type proportion. Among infants exposed to antenatal steroids, the number of differentially methylated CpGs dropped from 127 to 1 after controlling for cell type proportion. EWAS utilizing cord blood are confounded by cell type proportion. Careful study design including correction for cell type proportion and interpretation of results of EWAS using cord blood are critical.

  8. Ultrasound assessment of placental function: the effectiveness of placental biometry in a low-risk population as a predictor of a small for gestational age neonate.

    LENUS (Irish Health Repository)

    McGinty, Patricia

    2012-07-01

    The aims of the study were to establish reference ranges for placental length and thickness in a low-risk obstetric population and to assess the likelihood of a small for gestational age (SGA) neonate on the basis of placental length at 18-24 weeks\\' gestation.

  9. Adult height after long-term, continuous growth hormone (GH) treatment in short children born small for gestational age: results of a randomized, double-blind, dose-response GH trial

    NARCIS (Netherlands)

    Y. van Pareren; M. Houdijk; M. Jansen (Maarten); M. Reeser; P.G.H. Mulder (Paul); A.C.S. Hokken-Koelega (Anita)

    2003-01-01

    textabstractThe GH dose-response effect of long-term continuous GH treatment on adult height (AH) was evaluated in 54 short children born small for gestational age (SGA) who were participating in a randomized, double-blind, dose-response trial. Patients were randomly and blindly

  10. Sonographic correlation of foetal neck circumference and area with gestational age among pregnant women in Port Harcourt, Nigeria.

    Science.gov (United States)

    Abonyi, Obinna Everistus; Eze, Charles Ugwoke; Onwuzu, Sobechukwu W I

    2017-11-01

    The purpose of this study was to create a reference range nomogram of foetal neck circumference (FNC) and foetal neck area (FNA) in a Nigerian population using polynomial regression models. This cross-sectional study involved 723 pregnant women between 14 and 40 weeks of gestation. Axial measurements of the FNC and FNA were obtained in three measurements and the mean taken as the final value and the 5th, 50th and 95th percentiles for each foetal gestational age (FGA) were calculated. FNC and FNA correlated strongly with FGA, biparietal diameter, abdominal circumference, head circumference, and femoral length. Cubic models fitted the FNC vs FGA, and FNA vs. FGA values, and the mathematical relationships are given as: [Formula: see text] [Formula: see text] [Formula: see text]. Nomograms of FNC and FNA are thus generated. Impact statement The foetal neck circumference (FNC) and foetal neck area (FNA) can serve as predictors of foetal gestational age (FGA) since they correlate strongly and positively with FGA and known biometric parameters. The measurements obtained vary with the population studied. This study provides a nomogram of the FNA and FNC for an African population. The values correlate with that of the Caucasian population up to 32 weeks FGA. Interestingly, FNA and FNC measurements demonstrate high correlation but poor agreement in measurements between sonographers. Even though FNA and FNC could be used as predictors of foetal gestational age, the measurements vary significantly between sonographers. This is attributable to the difficulty in obtaining a satisfactory axial view of foetal neck, which is dependent on foetal presentation.

  11. Being Small for Gestational Age: Does it Matter for the Neurodevelopment of Premature Infants? A Cohort Study.

    Directory of Open Access Journals (Sweden)

    Myriam Bickle Graz

    Full Text Available Whether being small for gestational age (SGA increases the risk of adverse neurodevelopmental outcome in premature infants remains controversial.to study the impact of SGA (birthweight < percentile 10 on cognition, behavior, neurodevelopmental impairment and use of therapy at 5 years old.This population-based prospective cohort included infants born before 32 weeks of gestation. Cognition was evaluated with the K-ABC, and behavior with the Strengths and Difficulties Questionnaire (SDQ. Primary outcomes were cognitive and behavioral scores, as well as neurodevelopmental impairment (cognitive score < 2SD, hearing loss, blindness, or cerebral palsy. The need of therapy, an indirect indicator of neurodevelopmental impairment, was a secondary outcome. Linear and logistic regression models were used to analyze the association of SGA with neurodevelopment.342/515 (76% premature infants were assessed. SGA was significantly associated with hyperactivity scores of the SDQ (coefficient 0.81, p < 0.04, but not with cognitive scores, neurodevelopmental impairment or the need of therapy. Gestational age, socio-economic status, and major brain lesions were associated with cognitive outcome in the univariate and multivariate model, whereas asphyxia, sepsis and bronchopulmonary dysplasia were associated in the univariate model only. Severe impairment was associated with fetal tobacco exposition, asphyxia, gestational age and major brain lesions. Different neonatal factors were associated with the use of single or multiple therapies: children with one therapy were more likely to have suffered birth asphyxia or necrotizing enterocolitis, whereas the need for several therapies was predicted by major brain lesions.In this large cohort of premature infants, assessed at 5 years old with a complete panel of tests, SGA was associated with hyperactive behavior, but not with cognition, neurodevelopmental impairment or use of therapy. Birthweight <10th percentile alone

  12. Being Small for Gestational Age: Does it Matter for the Neurodevelopment of Premature Infants? A Cohort Study.

    Science.gov (United States)

    Bickle Graz, Myriam; Tolsa, Jean-François; Fischer Fumeaux, Céline Julie

    2015-01-01

    Whether being small for gestational age (SGA) increases the risk of adverse neurodevelopmental outcome in premature infants remains controversial. to study the impact of SGA (birthweight cognition, behavior, neurodevelopmental impairment and use of therapy at 5 years old. This population-based prospective cohort included infants born before 32 weeks of gestation. Cognition was evaluated with the K-ABC, and behavior with the Strengths and Difficulties Questionnaire (SDQ). Primary outcomes were cognitive and behavioral scores, as well as neurodevelopmental impairment (cognitive score blindness, or cerebral palsy). The need of therapy, an indirect indicator of neurodevelopmental impairment, was a secondary outcome. Linear and logistic regression models were used to analyze the association of SGA with neurodevelopment. 342/515 (76%) premature infants were assessed. SGA was significantly associated with hyperactivity scores of the SDQ (coefficient 0.81, p cognitive scores, neurodevelopmental impairment or the need of therapy. Gestational age, socio-economic status, and major brain lesions were associated with cognitive outcome in the univariate and multivariate model, whereas asphyxia, sepsis and bronchopulmonary dysplasia were associated in the univariate model only. Severe impairment was associated with fetal tobacco exposition, asphyxia, gestational age and major brain lesions. Different neonatal factors were associated with the use of single or multiple therapies: children with one therapy were more likely to have suffered birth asphyxia or necrotizing enterocolitis, whereas the need for several therapies was predicted by major brain lesions. In this large cohort of premature infants, assessed at 5 years old with a complete panel of tests, SGA was associated with hyperactive behavior, but not with cognition, neurodevelopmental impairment or use of therapy. Birthweight <10th percentile alone does not appear to be an independent risk factor of neurodevelopmental

  13. Effect of dietary approaches to stop hypertension diet plan on pregnancy outcome patients with gestational diabetes mellitus

    OpenAIRE

    Jie Yao; Lin Cong; Benli Zhu; Ting Wang

    2015-01-01

    The purpose of this study is to test the effects of Dietary Approaches to Stop Hypertension (DASH) diet plan on pregnancy outcomes patients with gestational diabetes mellitus. This randomized controlled clinical trial was performed among 33 women diagnosed with gestational diabetes. These patients were randomly distributed to the control group (n = 16) or DASH diet group (n = 17) for 4 weeks. Whereas 47.1% of women in the DASH diet needed to have a cesarean section, this percentage of mean ge...

  14. The Impact of Gestational Age and Birth Weight on the Risk of Strabismus among Premature Infants

    Science.gov (United States)

    Gulati, Shilpa; Andrews, Chris A.; Apkarian, Alexandra O.; Musch, David C.; Lee, Paul P.; Stein, Joshua D.

    2014-01-01

    IMPORTANCE Strabismus causes irreversible vision loss if not detected and treated early. It is unclear whether birth weight (BW) and gestational age (GA) are risk factors for strabismus. OBJECTIVE To estimate the impact of BW and GA on the likelihood of developing strabismus among premature infants. DESIGN In this longitudinal cohort analysis, we followed a group of premature children from birth to determine the proportion which developed strabismus and the timing of first strabismus diagnosis. Multivariable Cox regression analyses assessed the relationships of BW and GA and the development of strabismus. Regression models were adjusted for other known risk factors for strabismus, sociodemographic factors, and ocular comorbidities. SETTING Communities throughout the United States PARTICIPANTS 38055 otherwise healthy children born prematurely who were enrolled for >6 months in a nationwide US managed care network between 2001–2011. EXPOSURE BW strabismus with 95% confidence intervals (CIs) RESULTS Of 38055 otherwise healthy children who were born prematurely, 587 were diagnosed with strabismus later in life. Cumulative incidence of strabismus was 3.0% at 5 years. Controlling for GA and other factors, infants born with BW strabismus. Controlling for BW and other covariates, there was no significant association between strabismus and GA (HR=0.98, [CI, 0.69–1.38]). Among premature infants with BW strabismus relative to those born after 32 weeks (HR=1.27, [CI, 0.86–1.88]). In contrast, among those with GA ≤32 weeks, BW strabismus relative to BW >2000g (HR=14.4, [CI 1.99–104]). CONCLUSIONS AND RELEVANCE Independent of GA, very low BW conferred a large increase in strabismus risk among premature infants. In contrast, independent of BW, GA did not significantly impact the risk of strabismus. Updates to existing guidelines in the pediatric and ophthalmic literature should be considered, highlighting the importance of BW rather than GA and alerting clinicians about

  15. Linear growth patterns in small for gestational age and preterm infants after zinc supplementation

    Directory of Open Access Journals (Sweden)

    Caecilia Nancy Setiawan

    2015-03-01

    Full Text Available Background Low birth weight (LBW infants are at risk for growth disturbances due to intrauterine zinc deficiency. Zinc supplementation is expected to improve the linear growth of LBW babies. Objective To assess the effect of zinc supplementation on linear growth in preterm and small for gestational age (SGA infants. Methods This quasi-experimental study had a pre- and post-test design. Subjects were LBW infants hospitalized in Kariadi Hospital during March-December 2011, consisted of SGA and preterm neonates. All subjects were given 5 mg of zinc syrup daily for 3 months. Subjects’ head circumference, weight, and length were measured monthly. Serum zinc levels were measured before and after supplementation. Data were analyzed with Chi-square test, independent T-test, and general linear model repeated measure. Results A total of 61 subjects were enrolled consisted of 31 preterm and 30 SGA neonates. Mean serum zinc levels in the preterm group were 168.2 (SD 54.5 μg/dL pre-supplementation and 163.6 (SD 50.7 μg/dL post-supplementation (P=0.049, while mean serum zinc levels in the SGA group were 174.8 (SD 46.6 μg/dL pre-supplementation and 167.4 (SD 49.4 μg/dL post-supplementation (P=0.271. Median percentage preterm weight and length increased from 87.3 to 102.4% in the third month (P<0.001 and from 95.8 to 103.9% in the third month (P<0.001, respectively. Median percentage SGA weight and length increased from 73.5 to 98.3% in the third month (P<0.001 and from 94.5 to 102.2% in the third month (P<0.001, respectively. Conclusion Both, the preterm and SGA infants exhibit catch-up growth after three months of zinc supplementation. [

  16. Effect of parents occupational exposures on risk of stillbirth, preterm delivery, and small-for-gestational-age in infants

    International Nuclear Information System (INIS)

    Savitz, D.A.; Whelan, E.A.; Kleckner, R.C.

    1989-01-01

    Epidemiologic research on the effects of parental occupational exposures on fetal development has been limited. The National Natality and Fetal Mortality surveys obtained applicable data of probability samples of live births and fetal deaths which occurred in the US in 1980 among married women. Analyses were conducted for case groups of stillbirths (2,096 mothers, 3,170 fathers), preterm deliveries (<37 weeks completed gestation) (363 mothers, 552 fathers), and small-for gestational-age infants (218 mothers, 371 fathers) compared with controls. Occupational exposures were defined by industry of employment and by imputed exposures based on a job-exposure linkage system. For stillbirth, maternal work in the rubber, plastics, and synthetics industry and lead exposure and paternal employment in the textile industry had the largest odds ratios. Preterm birth was most strongly associated with maternal lead exposure, corroborating previous findings. Twofold increased risk of preterm delivery was found with paternal employment in the glass, clay, and stone; textile; and mining industries. Paternal exposures to x-rays and polyvinyl alcohol were associated with 1.5-fold increase in risk. The occupation of the mother was not associated with delivery of a small-for-gestational-age infant, in contrast to paternal employment in the art and textile industries. Several toxic agents were associated with risk elevation of 1.3 or greater for fathers, most notably benzene

  17. Maternal glycated haemoglobin, pre-gestational weight, pregnancy weight gain and risk of large-for-gestational-age babies: a Danish cohort study of 209 singleton Type 1 diabetic pregnacies

    DEFF Research Database (Denmark)

    Nielsen, G.L.; Dethlefsen, Claus; Møller, M.

    2007-01-01

    Aims To examine the association between maternal glycated haemoglobin in the second half of diabetic pregnancies and the relative risk of delivering large-for-gestational-age (LGA) babies, controlling for maternal body mass index (BMI) before pregnancy, weight gain, age, White class and smoking...... between glycated haemoglobin (HbA1c) and relative risk of delivering an LGA baby was quantified based on logistic regression models and stratified analysis controlling for the five covariates. Results We included 209 singleton pregnancies with assessable HbA1c values of which 59% [95% confidence interval...... habits. Methods We identified all pregnant diabetic women in North Jutland County, Denmark from 1985 to 2003. Data on HbA1c values from the 20th gestational week to term were collected from medical records and the babies were classified as large, normal or small for gestational age. The association...

  18. Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?

    Science.gov (United States)

    Saavedra-Avendano, Biani; Schiavon, Raffaela; Sanhueza, Patricio; Rios-Polanco, Ranulfo; Garcia-Martinez, Laura; Darney, Blair G

    2018-01-01

    To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City's public sector first trimester abortion program. We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007-2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women's characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics. Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12-17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p = 40 years' old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02-4.26% across adult age groups). Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services.

  19. Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?

    Directory of Open Access Journals (Sweden)

    Biani Saavedra-Avendano

    Full Text Available To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA limit (12 weeks, and thus not receiving services, in Mexico City's public sector first trimester abortion program.We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE program, 2007-2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women's characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics.Our sample included 52,391 women, 8.10% (n = 4,246 of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12-17 made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p = 40 years' old respectively. Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02-4.26% across adult age groups.Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services.

  20. Who presents past the gestational age limit for first trimester abortion in the public sector in Mexico City?

    Science.gov (United States)

    Saavedra-Avendano, Biani; Schiavon, Raffaela; Sanhueza, Patricio; Rios-Polanco, Ranulfo; Garcia-Martinez, Laura; Darney, Blair G.

    2018-01-01

    Objective To identify socio-demographic factors associated with presenting for abortion services past the gestational age (GA) limit (12 weeks), and thus not receiving services, in Mexico City’s public sector first trimester abortion program. Methods We used clinical data from four high volume sites in the Interrupción Legal de Embarazo (ILE) program, 2007–2015. We used descriptive statistics to quantify the proportion of women who did not receive an abortion due to presenting past the gestational age limit. We used multivariable logistic regression to identify associations between women’s characteristics and presenting past the GA limit and calculated predicted probabilities of late presentation for key characteristics. Results Our sample included 52,391 women, 8.10% (n = 4,246) of whom did not receive abortion services due to presenting past the GA limit. Adolescents (12–17) made up 8.69% of the total sample and 13.40% of those presenting past the GA limit (p = 40 years’ old respectively). Women living in Mexico City and with higher levels of education had lower odds of presenting past the GA limit, and there was an educational gradient across all age groups. In the multivariable predicted probability models, adolescents at every level of education have significantly higher probabilities of not receiving an abortion due to presenting past the gestational age limit compared with adults (among women with a primary education: 11.75% adolescents vs. 9.02–4.26% across adult age groups). Conclusions Our results suggest that continued efforts are needed to educate women, especially younger and less educated women, about early pregnancy recognition. In addition, all women need information about the availability of first trimester legal abortion to ensure timely access to abortion services. PMID:29414987

  1. Intra- and inter-observer reproducibility study of gestational age estimation using three common foetal biometric parameters: Experienced versus inexperienced sonographer

    International Nuclear Information System (INIS)

    Ohagwu, C.C.; Onoduagu, H.I.; Eze, C.U.; Ochie, K.; Ohagwu, C.I.

    2015-01-01

    Aim: To assess reproducibility of estimating gestational age (GA) of foetus using femur length (FL), biparietal diameter (BPD) and abdominal circumference (AC) within experienced and inexperienced sonographers and between the two. Patients and methods: Two sets of GA estimates each were obtained for FL, BPD and AC by the two observers in 20 normal singleton foetuses. The first estimates for the three biometric parameters were made by the experienced sonographer. Subsequently, the inexperienced sonographer, blind to the estimates of the first observer obtained his own estimates for the same biometric parameters. After a time interval of ten minutes the process was repeated for the second set of GA estimates. All the gestational age estimates were made following standard protocol. Statistical analysis was performed by Pearson's and intraclass correlations, coefficient of variation and Bland–Altman plots. Statistical inferences were drawn at p < 0.05. Results: The Pearson's and intraclass correlations of between GA estimates within and between both observers from measurement of FL, BPD and AC were very high and statistically significant (p < 0.05). Coefficient of variation for duplicate measurements for GA estimates within observers and between observers were quite negligible. Between observers, the first and second GA estimates from FL measurements showed the least variation. Estimates from BPD and AC measurements showed greater degree of variation between the observers. Conclusion: Reproducibility of GA estimation using FL, BPD and AC within experienced and inexperienced sonographers and between the two was excellent. Therefore, a fresh Nigerian radiography graduate with adequate exposure in obstetric ultrasound can correctly determine the gestational age of foetus in routine obstetric ultrasound without supervision

  2. Excessive Gestational Weight Gain and Subsequent Maternal Obesity at Age 40: A Hypothetical Intervention.

    Science.gov (United States)

    Abrams, Barbara; Coyle, Jeremy; Cohen, Alison K; Headen, Irene; Hubbard, Alan; Ritchie, Lorrene; Rehkopf, David H

    2017-09-01

    To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults. We analyzed 3917 women with 1 to 3 pregnancies in the prospective US National Longitudinal Survey of Youth, from 1979 to 2012. We compared the estimated obesity prevalence between 2 scenarios: gestational weight gain as reported and under the scenario of a hypothetical intervention that all women with excessive gestational weight gain instead gained as recommended by the Institute of Medicine (2009). A hypothetical intervention was associated with a significantly reduced estimated prevalence of obesity for first (3.3 percentage points; 95% confidence interval [CI] = 1.0, 5.6) and second (3.0 percentage points; 95% CI = 0.7, 5.2) births, and twice as high in Black as in White mothers, but not significant in Hispanics. The population attributable fraction was 10.7% (95% CI = 3.3%, 18.1%) in first and 9.3% (95% CI = 2.2%, 16.5%) in second births. Development of effective weight-management interventions for childbearing women could lead to meaningful reductions in long-term obesity.

  3. The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles.

    LENUS (Irish Health Repository)

    Grobman, William A

    2013-10-01

    The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate\\/severe cerebral palsy (CP) or death.

  4. The relationship between maternal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGFBP-3 to gestational age and preterm delivery.

    LENUS (Irish Health Repository)

    Cooley, Sharon M

    2010-05-01

    To investigate the relationship between levels of insulin-like growth factors 1 and 2 (IGF-1, IGF-2), and insulin-like growth factor binding protein 3 (IGFBP-3) in antenatal maternal serum and gestational age at delivery.

  5. Placenta mediates the association between maternal second-hand smoke exposure during pregnancy and small for gestational age.

    Science.gov (United States)

    Niu, Z; Xie, C; Wen, X; Tian, F; Ding, P; He, Y; Lin, J; Yuan, S; Guo, X; Jia, D; Chen, W-Q

    2015-08-01

    The causal relationship between maternal second-hand smoke (SHS) exposure during pregnancy and small for gestational-age (SGA) has been affirmed, but the mechanism is still unclear. Previous studies have found that the placenta remarkably affects fetal intrauterine growth and that SHS exposure during pregnancy impairs placental growth and decreases placental weight. Therefore, the placenta may mediate the association between maternal SHS exposure during pregnancy and SGA. This study explores whether and to what extent the association between maternal SHS exposure during pregnancy and SGA is mediated by the placenta. We investigated 562 pregnant women delivering SGA newborns (cases) and 1581 delivering appropriate-for-gestational-age newborns (controls) in this case-control study. Information on maternal SHS exposure during pregnancy, socio-demographic characteristics and obstetric conditions, including placental weight, were collected at the Maternity and Child Health Care Hospitals of Shenzhen and Foshan in Guangdong, China. Linear and hierarchical logistic regression models were fitted to examine the mediation effects of placental weight on the association between maternal SHS exposure during pregnancy and SGA. After controlling for ethnicity, maternal age, educational level, family income, pre-pregnancy body mass index (BMI), parity, gestational age and newborn gender, maternal SHS exposure during pregnancy was associated with a higher SGA risk (adjusted odds ratio (OR) = 1.26; 95% confidence interval (CI) = 1.03-1.55) and lower placental weight (standard deviation (SD) = -0.15, SE = 0.04). Regression models illustrated that placental weight partially mediated (49.6%; 95% CI = 35.9-63.3%) the association between SHS exposure during pregnancy and SGA. Our findings suggest that the placenta plays an intermediary role in how maternal prenatal SHS exposure affects fetal growth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Cervical length and gestational age at admission as predictors of intra-amniotic inflammation in preterm labor with intact membranes.

    Science.gov (United States)

    Palacio, M; Cobo, T; Bosch, J; Filella, X; Navarro-Sastre, A; Ribes, A; Gratacós, E

    2009-10-01

    To evaluate cervical length and gestational age as predictors of intra-amniotic inflammation in patients admitted because of preterm labor and intact membranes. Ninety-three pregnant women with preterm labor and intact membranes were included in our study. Cervical length was measured on admission by transvaginal sonography and transabdominal amniocentesis was performed within the first 48 h following admission. Positive amniotic fluid cultures defined intra-amniotic infection. Levels of intra-amniotic interleukin-6 (IL-6) were measured, and a receiver-operating characteristics (ROC) curve was constructed to determine the best cut-off point of IL-6 for predicting intra-amniotic infection. This value was then used as a basis for determining a cut-off of IL-6 for defining intra-amniotic inflammation. Considering inflammatory status, perinatal outcomes were evaluated and compared. Logistic regression was used to investigate associations of different explanatory variables with inflammatory status. A non-invasive approach for detection of intra-amniotic inflammation in women admitted because of preterm labor with intact membranes was evaluated. Intra-amniotic infection and inflammation rates were 14% and 28%, respectively. ROC curve analysis showed that the best cut-off value for IL-6 was 13.4 ng/mL for predicting intra-amniotic infection, which was comparable to the cut-off of 11.3 ng/mL reported previously by other authors (which we used to define inflammation). Regardless of the intra-amniotic microbial status, perinatal outcomes in women who developed intra-amniotic inflammation were worse than in those who did not. Cervical length or= 28 and membranes.

  7. Gestational age-specific reference intervals for serum thyroid hormone levels in a multi-ethnic population.

    Science.gov (United States)

    Ho, Clement K M; Tan, Edward T H; Ng, Mor Jack; Yeo, George S H; Chern, Bernard; Tee, Nancy W S; Kwek, Kenneth Y C; Tan, Kok Hian

    2017-10-26

    Thyroid disorders are common during pregnancy. To date, a limited number of studies have reported differences in serum thyroid hormone concentrations between different ethnic groups. We sought to establish gestational age-specific reference intervals for serum levels of thyroid hormones in a multi-ethnic population and investigate whether separate reference intervals should be used for different ethnic groups. A total of 926 pregnant women from multiple ethnic groups attended four separate study visits spanning the three trimesters. Venous blood samples were taken at 9 to 14 weeks, 18 to 22 weeks, 28 to 32 weeks, and 34 to 39 weeks of gestation. Serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4), free triiodothyronine (T3), total T4, total T3, thyroid peroxidase antibody and thyroglobulin antibody were measured using Abbott Architect immunoassays. A total of 562 women with singleton pregnancies were found to be negative for both thyroid autoantibodies at all four study visits and thus included in the reference sample group for the establishment of reference intervals (2.5th to 97.5th percentiles). Reference intervals for serum thyroid hormones at 9-14 weeks of gestation derived from the combined group of pregnant women are as follows: TSH, 0.01-2.39 mIU/L; free T4, 11.4-19.5 pmol/L; free T3, 4.23-6.69 pmol/L; total T4, 77.8-182.4 nmol/L; total T3, 1.39-2.97 nmol/L. No differences in the five thyroid parameters' reference intervals are detectable among the ethnic groups except that at study visit 3 (28-32 weeks of gestation), the upper reference limit of total T3 in Malays (3.20 nmol/L; 90% CI, 2.99-3.76 nmol/L) is slightly higher than that in Chinese (2.86 nmol/L; 90% CI, 2.70-2.98 nmol/L). The findings from this study on a multi-ethnic cohort highlight the importance of establishing locally derived and gestational age-specific reference intervals for the five thyroid hormone parameters.

  8. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital.

    Science.gov (United States)

    Teixeira, Marina Parca Cavelagna; Queiroga, Tatiana Peloso Reis; Mesquita, Maria Dos Anjos

    2016-01-01

    To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. Determinar a frequência e os fatores de risco de recém-nascidos pequenos para idade gestacional em uma maternidade de alto risco. Trata-se de um estudo observacional, transversal e caso-controle, realizado em maternidade pública de nível terciário. Foram levantados dados de 998 recém-nascidos e de suas respectivas mães por meio de entrevista e análise de prontuários e de cartões do pré-natal. Algumas placentas foram submetidas à análise anatomopatológica. As variáveis dos recém-nascidos pequenos e não pequenos para idade gestacional e de suas respectivas mães foram comparadas estatisticamente pelo teste paramétrico t de Student, pelo teste exato de Fisher e por odds ratio. O nível de signific

  9. Neonatal outcomes among multiple births ≤ 32 weeks gestational age: Does mode of conception have an impact? A Cohort Study

    Directory of Open Access Journals (Sweden)

    Yoon Woojin

    2011-06-01

    Full Text Available Abstract Background Studies comparing perinatal outcomes in multiples conceived following the use of artificial reproductive technologies (ART vs. spontaneous conception (SC have reported conflicting results in terms of mortality and morbidity. Therefore, the objective of our study was to compare composite outcome of mortality and severe neonatal morbidities amongst preterm multiple births ≤ 32 weeks gestation infant born following ART vs. SC. Methods We conducted a single center cohort study at Mount Sinai Hospital, Toronto, Ontario, Canada. Data on all preterm multiple births (≤ 32 weeks GA discharged between July 2005 and June 2008 were retrospectively collected from a prospective database at our centre. Details regarding mode of conception were collected retrospectively from maternal health records. Preterm multiple births were categorized into those born following ART vs. SC. Composite outcome was defined as combination of death or any of the three neonatal morbidities (grade 3/4 intraventricular hemorrhage or periventricular leukomalacia; retinopathy of prematurity > stage 2 or chronic lung disease. Univariate and multivariate regression analysis were preformed after adjustment of confounders (maternal age, parity, triplets, gestational age, sex, and small for gestational age. Results One hundred and thirty seven neonates were born following use of ART and 233 following SC. The unadjusted composite outcome rate was significantly higher in preterm multiples born following ART vs. SC [43.1% vs. 26.6%, p = 0.001; OR 1.98 (95% CI 1.13, 3.45]; however, when adjusted for confounders the difference between groups was not statistically significant [OR 1.39, 95% CI 0.67, 2.89]. Conclusion In our population of preterm multiple births, the mode of conception had no detectable effect on the adjusted composite neonatal outcome of mortality and/or three neonatal morbidities.

  10. Single and Serial Fetal Biometry to Detect Preterm and Term Small- and Large-for-Gestational-Age Neonates: A Longitudinal Cohort Study

    Science.gov (United States)

    Hernandez-Andrade, Edgar; Ahn, Hyunyoung; Garcia, Maynor; Xu, Zhonghui; Korzeniewski, Steven J.; Saker, Homam; Chaiworapongsa, Tinnakorn; Hassan, Sonia S.; Yeo, Lami; Romero, Roberto

    2016-01-01

    % and 62% vs 52%, respectively; both pscheduled as close as possible to the gestational-age cutoff when a decision regarding the clinical management of the patient needs to be made. Screening performance for SGA is higher for neonates that will be delivered preterm. PMID:27802270

  11. Women born preterm or with inappropriate weight for gestational age are at risk of subsequent gestational diabetes and pre-eclampsia

    DEFF Research Database (Denmark)

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

    2012-01-01

    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....

  12. Evaluation of lipid and glucose metabolism and cortisol and thyroid hormone levels in obese appropriate for gestational age (AGA) born and non-obese small for gestational age (SGA) born prepubertal Slovak children.

    Science.gov (United States)

    Blusková, Zuzana; Koštálová, Ludmila; Celec, Peter; Vitáriušová, Eva; Pribilincová, Zuzana; Maršálková, Marianna; Šemberová, Jana; Kyselová, Tatiana; Hlavatá, Anna; Kovács, László

    2014-07-01

    Obesity is the major determinant of metabolic syndrome. Being born small for gestational age (SGA) may be co-responsible. We aimed at evaluating the association between 1. obesity and 2. being born SGA and the presence of endocrine-metabolic abnormalities in prepubertal Slovak children. The study included 98 children, aged 3-10.9 years: 36 AGA-born obese children (OB), 31 SGA-born children (SGA) and 31 appropriate for gestational age born non-obese children (AGA). Fasting serum levels of glucose, total cholesterol, LDL, HDL, triglycerides, fT4, TSH, cortisol and insulin were determined. HOMA-IR was calculated. Personal data about birth weight and length and family history were collected. Actual anthropometric measurement was done. In every group, high prevalence of positive family history of metabolic disorder was found. In comparison with AGA children, OB children were taller (plevels and homeostasis model assessment for insulin resistance (HOMA-IR) (pcortisol levels (p=0.069) was noted. SGA-born children were shorter (plevels (plevels (p=0.085) and increased fT4 levels (pobese children and twice more metabolic abnormalities were present in SGA-born children in comparison with AGA-born children. SGA-born children are more prone to developing endocrine-metabolic abnormalities than non-obese children born AGA, but they are at less risk than obese AGA-born children. We should provide specialized care for obese children already in prepubertal age and pay attention to SGA-born children.

  13. Insulin aspart in patients with gestational diabetes mellitus and pregestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    M C Deepaklal

    2015-01-01

    Full Text Available Aims: This study was undertaken to assess the effectiveness and safety of insulin aspart in patients with gestational and pregestational diabetes. Settings and Design: An open-label, prospective, nonrandomized, comparative, and observational study conducted at single center in India. Subjects and Methods: A total of 276 patients were in gestational diabetes mellitus (GDM group, 79 were in the pre-GDM group. Patients were started on insulin therapy (insulin aspart ± neutral protamine hagedorn once medical nutrition therapy for 2 weeks failed to achieve control, that is., fasting plasma glucose ≥90 mg/dL and/or 1.0 h postprandial plasma glucose ≥130 mg/dL. Insulin dose was titrated to keep the blood glucose values between 90 and 130 mg/dL. Patients were followed once every 4 weeks until the 28 th week, then once every 2 weeks until 32 nd week, then once every week until delivery, and the final visit was on 60 ± 7 days. The final outcome was assessed in terms of incidence of macrosomia (>3.5 kg body weight between the two groups and episodes of confirmed (blood glucose <56 mg/dL minor or major maternal hypoglycemia. Results: There was no statistically significant difference among the two groups in terms of incidence of macrosomia that is., it was 5.1%, 8.9% in GDM, pre-GDM group, respectively. Conclusions: Insulin aspart was found safe in pregnancy, however, more studies with double-blind, standard controlled studies are required to confirm the findings of this study.

  14. Altered Maternal Plasma Glycogen Phosphorylase Isoenzyme BB as a Biomarker for Preeclampsia and Small for Gestational Age.

    Science.gov (United States)

    McCarthy, Fergus P; Doyle, Aisling; Khashan, Ali S; Kenny, Louise C

    2016-06-01

    To investigate whether maternal plasma glycogen phosphorylase BB (GPBB) levels were altered in early pregnancy and/or at the time of diagnosis of disease in preeclampsia (term and preterm preeclampsia or SGA were analyzed both from the time of disease presentation and at 15 and 20 weeks' gestation. These were compared with control samples obtained from SCOPE women with healthy uncomplicated pregnancies matched for age, ethnicity, parity, body mass index, and gestational age. Glycogen phosphorylase BB levels were measured using the Diacordon GPBB enzyme-linked immunosorbent assay (Diagenics, Germany). Glycogen phosphorylase BB levels were higher in women with preeclampsia compared with controls at the time of disease (term preeclampsia median [interquartile range (IQR)]: 22.2 [15.1-39.8] ng/mL vs 16.9 [10.4-19.1] ng/mL; P = .04; N = 14 and preterm preeclampsia median [IQR]: 23.1 [11.2-30.9] ng/mL vs 17.2 [9.8-19.1] ng/mL; P = .04; N = 11) and at 20 weeks' gestation (median [IQR]: 23.0 [15.6-31.4] ng/mL vs 17.0 [13.4-23.6] ng/mL; N = 39; P = .04). Glycogen phosphorylase BB levels were also significantly higher in women with SGA compared with normal controls at the time of disease detection (median [IQR]: 22.7 [12.6-25.5] ng/mL vs 17.0 [9.8-18.0] ng/mL; N = 23; P = .03) but significantly less than controls at 15 weeks' gestation prior to disease detection (median [IQR]: 16.0 [12.1-23.2] ng/mL vs 22.2 [17.0-28.9] ng/mL; N = 25; P = .02). Glycogen phosphorylase BB alone has modest predictive abilities for the development of preeclampsia or SGA. Further research may examine its use in combination with other markers. © The Author(s) 2015.

  15. DETERMINATION OF REFERENCE VALUES FOR TREC AND KREC IN DRY BLOOD SPOTS OF NEWBORNS FROM DIFFERENT GESTATION AGES IN SVERDLOVSK REGION

    Directory of Open Access Journals (Sweden)

    S. S. Deryabina

    2018-01-01

    Full Text Available As a preparatory stage for implementation of genetic testing for severe combined immunodeficiency under a neonatal screening program, a study was performed in Sverdlovsk Region which concerned quantitative determination of T and B cell neogenesis markers (TREC and KREC, respectively in blood of conditionally healthy newborns. Archived samples of dry blood spots collected in test-forms for routine neonatal screening were used as biological material for the study of full-term 26 girls and 26 boys who did not exhibit serious illnesses during first year of their life. In addition, we investigated potential effects of foetal gestational age upon the number of TREC and KREC in preterm infants. Blood samples from 55 preterm infants (23 to 36 gestational weeks were also examined. It was shown that the levels of TREC and KREC increased sequentially with the increased gestation terms, but the quantitative changes of markers showed different dynamics. In this respect, the recommended terms of blood sample collection for SCID screening is entirely consistent with timing of blood sampling for routine newborn screening. An alternative result was obtained with a complete absence of TREC or KREC in blood sample of a newborn, irrespectively of prematurity degree (at valid copy numbers of a control gene which should serve as an indication for immediate consulting of the child by immunologist and in-depth immunological examination, because it may be a first prognostic sign of a fatal disease. In order to obtain correct cut-off levels for TREC/KREC, additional studies are needed on a larger sample of newborns (1.000 to 5.000, followed by validation of the obtained reference boundaries in studies involving patients with different forms of primary immunodeficiencies. 

  16. The contribution of attenuated selection in utero to small-for-gestational-age (SGA) among term African American male infants.

    Science.gov (United States)

    Goodman, Julia M; Karasek, Deborah; Anderson, Elizabeth; Catalano, Ralph A

    2013-07-01

    Natural selection conserves mechanisms allowing women to spontaneously abort gestations least likely to yield fit offspring. Small gestational size has been proposed as an indicator of fitness observable by maternal biology. Previous research suggests that exposure to ambient stress in utero results in more "culling" of small fetuses and therefore lower rates of small-for-gestational-age (SGA). However, African American women persistently have higher rates of SGA than non-Hispanic white women, despite experiencing more ambient stress. This paper tests whether attenuation of the stress response among highly stressed African American women, as suggested by the weathering hypothesis, may help to explain this apparent inconsistency. We apply time-series modeling to over 2 million African American and non-Hispanic white male term births in California over the period of January 1989 through December 2010. We test for the parabolic (i.e., "U" shaped) relationship, implied by an attenuated stress response, between unusually strong labor market contraction and the rate of SGA among African American term male infants, and a linear relationship among non-Hispanic whites. We find the hypothesized parabolic relationship among term male African American infants. As expected, we find a linear relationship between unexpected layoffs and the rate of SGA among term male non-Hispanic whites. These results are robust to sensitivity analyses. These results may help to explain the high rates of SGA among term male African American infants, despite greater maternal exposure to ambient stress during pregnancy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. [Progression of gestational hypertension to chronic hypertension].

    Science.gov (United States)

    Romero Gutiérrez, Gustavo; Muro Barragán, Sergio Alejandro; Ponce de León, Ana Lilia Ponce

    2009-09-01

    The gestational hypertension is the most frequent cause of hypertension during the pregnancy. The gestational hypertension is a provisional diagnosis only during the pregnancy; it is unknown the number of women with gestational hypertension who progress to chronic hypertension. To determine the number of women with gestational hypertension who progress to chronic hypertension. A cohort prospective study was carried out; we includedl96 patients with the diagnosis of gestational hypertension at the time of the interruption of the pregnancy; after 12 weeks, a follow up appointment was scheduled in order to measure the blood pressure and to determine how many patients progressed to chronic hypertension. The data were analyzed with arithmetic mean, standard error and percentage values. For the comparison of variables, the Chi2 test and a logistic regression analysis were used; an alpha value was set at 0.05. Thirteen patients (6.6%) with diagnosis of gestational hypertension progressed to chronic hypertension. It was found that advanced age (p = 0.007), high body mass index (p = 0.013) and the antecedent of hypertensive disease in a previous pregnancy (p = 0.048) were significantly associated with the progression to chronic hypertension. The overweight, advanced maternal age and the antecedent of hypertensive disorder in a previous pregnancy are the variables associated with the progression from gestational hypertension to chronic hypertension.

  18. Associations between birthweight, gestational age at birth and subsequent type 1 diabetes in children under 12: a retrospective cohort study in England, 1998-2012.

    Science.gov (United States)

    Goldacre, Raphael R

    2018-03-01

    With genetics thought to explain only 40-50% of the total risk of type 1 diabetes, environmental risk factors in early life have been proposed. Previous findings from studies of type 1 diabetes incidence by birthweight and gestational age at birth have been inconsistent. This study aimed to investigate the relationships between birthweight, gestational age at birth and subsequent type 1 diabetes in England. Data were obtained from a population-based database comprising linked mother-infant pairs using English national Hospital Episode Statistics from 1998 to 2012. In total, 3,834,405 children, categorised by birthweight and gestational age at birth, were followed up through record linkage to compare their incidence of type 1 diabetes through calculation of multivariable-adjusted HRs. Out of 3,834,405 children, 2969 had a subsequent hospital diagnosis of type 1 diabetes in childhood. Children born preterm (age experienced higher incidence of type 1 diabetes than children born at medium birthweight (3000-3499 g) (HR 1.13 [95% CI 1.03, 1.23] and 1.16 [95% CI 1.02, 1.31], respectively), while children at low birthweight (age and low gestational age at birth are both independently associated with subsequent type 1 diabetes. These findings help contextualise the debate about the potential role of gestational and early life environmental risk factors in the pathogenesis of type 1 diabetes, including the potential roles of insulin sensitivity and gut microbiota.

  19. Is a history of preeclampsia associated with an increased risk of a small for gestational age infant in a future pregnancy?

    Science.gov (United States)

    Palatnik, Anna; Grobman, William A; Miller, Emily S

    2016-09-01

    A history of preeclampsia is associated with an increased risk of subsequent preeclampsia, but it is unclear whether women with prior preeclampsia are at increased risk of having a small-for-gestational-age infant in their subsequent pregnancy, even if they do not develop preeclampsia. The objective of this study was to evaluate whether women with preeclampsia in a prior pregnancy are at increased risk of having a pregnancy complicated by a small-for-gestational-age infant, even in the absence of recurrent preeclampsia. This was a secondary analysis of data from 2 multicenter, randomized controlled trials evaluating the role of aspirin in preeclampsia prevention in healthy nulliparas and women at high risk of preeclampsia (ie, with chronic hypertension or a history of preeclampsia). Women who developed preeclampsia in a subsequent pregnancy and women with pregestational diabetes or with a multiple gestation were excluded. The association between a history of preeclampsia and the subsequent birth of a small-for-gestational-age infant was determined in both a univariable and multivariable analysis. A total of 4052 women were included in the analysis: 2972 healthy nulliparas, 499 women with a history of preeclampsia, and 581 women with chronic hypertension. The frequency of delivery of a small-for-gestational-age infant significantly differed by clinical history (5.1% vs 9.2% vs 12.1% in healthy nulliparas, women with a history of preeclampsia, and women with chronic hypertension, respectively, P history of preeclampsia was associated with a significantly increased odds for a small-for-gestational-age infant, even if recurrent preeclampsia did not occur (adjusted odds ratio, 1.48, 95% confidence interval, 1.02-2.17). Even in the absence of recurrent preeclampsia, women with a history of preeclampsia are at a higher risk of delivering a small-for-gestational-age infant in a subsequent pregnancy. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Premature Cardiac Disease and Death in Women Whose Infant Was Preterm and Small for Gestational Age: A Retrospective Cohort Study.

    Science.gov (United States)

    Silverberg, Orli; Park, Alison L; Cohen, Eyal; Fell, Deshayne B; Ray, Joel G

    2018-03-01

    Women with an infant with preterm birth (PTB) or who was severely small for gestational age (SGA) are at higher future risk of premature cardiovascular disease and related death. To determine the risk of cardiac disease or death among women with an infant with both PTB and SGA. This population-based cohort study used electronic health records from the province of Ontario, Canada, where health care is universally available, between April 1, 2002, and March 31, 2016. All singleton live births between 23 to 42 weeks' gestation among 710 501 nulliparous women aged 16 to 50 years without prepregnancy cardiac disease were analyzed. Risk of a composite outcome of heart failure, atrial or ventricular dysrhythmia, or all-cause mortality, starting 30 days after the index birth. Hazard ratios were adjusted for maternal age, income quintile, and preeclampsia/eclampsia (each at the index birth), as well as diabetes, chronic hypertension, obesity, dyslipidemia, drug dependence or smoking, and kidney disease (each within 24 months before the index birth date and time-varying from the birth date onward). Of 710 501 singleton live births, 15 082 mothers (2.1%) were older than age 40 years. Relative to having an infant without PTB or severe SGA (4.1 per 10 000 person-years), the incidence rate of the composite outcome of heart failure, dysrhythmia, or death was 11.3 per 10 000 person-years among mothers with an infant with PTB-SGA (crude hazard ratio, 2.79; 95% CI, 1.85-4.21) (adjusted hazard ratio, 1.66; 95% CI, 1.09-2.52). Women who had an infant with PTB-SGA may be at higher future risk of premature cardiac disease or death.

  1. Motor development from 4 to 8 months corrected age in infants born at or less than 29 weeks' gestation.

    Science.gov (United States)

    Pin, Tamis W; Darrer, Tanya; Eldridge, Bev; Galea, Mary P

    2009-09-01

    Clinically, preterm infants show motor delay and atypical postures compared with their peers born at term. A longitudinal cohort study was designed to describe the motor development of very preterm infants from 4 to 18 months corrected age (CA). The study was also designed to investigate how the atypical postures observed in early infancy in the preterm infants might be related to their later motor development. Here we report the findings in early motor skills from 4 to 8 months CA. Early motor skills were assessed in 62 preterm infants (32 males, 30 females, mean gestation 26.94wks, SD 1.11) and 53 term infants (32 males, 21 females, mean gestation 39.55wks, SD 1.17) using the Alberta Infant Motor Scale (AIMS). The preterm infants demonstrated different motor behaviours from their term peers, with an uneven progression of motor skills in different positions from 4 to 8 months CA. At 8 months CA, 90%of the term infants were able to sit without arm support, but only 56%of the preterm infants could maintain sitting very briefly without arm support. This uneven progression may have been due to an imbalance between the active flexor and extensor strength and hence inadequate postural control in these positions. The AIMS has also been shown to be a valid assessment tool to demonstrate unique characteristics in movement quality in the preterm population.

  2. A Quality Improvement Initiative to Reduce the Need for Mechanical Ventilation in Extremely Low Gestational Age Neonates.

    Science.gov (United States)

    Templin, Ludivine; Grosse, Camille; Andres, Virginie; Robert, Clotilde Des; Fayol, Laurence; Simeoni, Umberto; Boubred, Farid

    2017-07-01

    Objective  Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA). Study Design  This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24 +0 and 26 +6 weeks' gestation before (period 1, n  = 40) and after (period 2, n  = 52) implementing the new protocol. Results  Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, p  = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, p  = 0.002) and during the hospital stay (75 vs. 92.5%, p  < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity. Conclusion  A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  3. An Influence of Birth Weight, Gestational Age, and Apgar Score on Pattern Visual Evoked Potentials in Children with History of Prematurity

    Directory of Open Access Journals (Sweden)

    Marta Michalczuk

    2015-01-01

    Full Text Available Purpose. The objective of our study was to examine a possible influence of gestational age, birth weight, and Apgar score on amplitudes and latencies of P100 wave in preterm born school-age children. Materials and Methods. We examined the following group of school-age children: 28 with history of prematurity (mean age 10.56 ± 1.66 years and 25 born at term (mean age 11.2 ± 1.94 years. The monocular PVEP was performed in all children. Results. The P100 wave amplitudes and latencies significantly differ between preterm born school-age children and those born at term. There was an essential positive linear correlation of the P100 wave amplitudes with birth weight, gestational age, and Apgar score. There were the negative linear correlations of P100 latencies in 15-minute stimulation from O1 and Oz electrode with Apgar score and O1 and O2 electrode with gestational age. Conclusions. PVEP responses vary in preterm born children in comparison to term. Low birth weight, early gestational age, and poor baseline output seem to be the predicting factors for the developmental rate of a brain function in children with history of prematurity. Further investigations are necessary to determine perinatal factors that can affect the modified visual system function in preterm born children.

  4. Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

    Directory of Open Access Journals (Sweden)

    Pearce Mark S

    2012-03-01

    Full Text Available Abstract Background Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows. Methods Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex. Results Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1st (7.4 μg/m3 to the 25th (17.2 μg/m3, 50th (33.8 μg/m3, 75th (108.3 μg/m3, and 90th (180.8 μg/m3 percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05, 62 g (1.63, 98 g (2.26 and 109 g (2.44 respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage. Conclusions The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing

  5. [Association between periconceptional folic acid supplementation and small for gestational age birth based on pre-pregnancy body mass index].

    Science.gov (United States)

    Guo, L L; Shen, J X; Ru, S H; Wang, Y; Li, M; Feng, Y L; Zhang, P; Wu, W W; Wang, S P; Zhang, Y W; Yang, H L

    2017-09-10

    Objective: To investigate the association between periconceptional folic acid supplementation and small for gestational age (SGA) birth based on maternal pre-pregnancy body mass index (BMI) and provide evidence for the development of comprehensive prevention programs on SGA birth. Methods: Between March, 2012 and September, 2016, a total of 8 523 pregnant women delivering in the First Affiliated Hospital of Shanxi Medical University were surveyed to collect the information about their demographic characteristics, folic acid supplementation before and during pregnancy and about their infants. Among their infants, 1 066 were small for gestational age (case group), 7 457 were appropriate for gestational age (AGA) (control group). Unconditional logistic regression model was used to evaluate the association between periconceptional folic acid supplementation and SGA birth in the context of different pre-pregnancy BMI. Results: The overall incidence of SGA birth was 12.51 % (1 066/8 523). After adjusting the confounding factors, pre-pregnancy BMIbirth ( OR =1.22, 95 %CI : 1.01-1.47), pre-pregnancy BMI≥24.0 kg/m(2) was associated with a reduced risk of SGA birth ( OR =0.81, 95 %CI :0.68-0.97). After adjusting confounding factors, periconceptional folic acid supplementation was a protective factor for SGA birth ( OR =0.82, 95 %CI : 0.68-0.98). After stratified by pre-pregnancy BMI, periconceptional folic acid supplementation was associated with the reduced risk of SGA birth in overweight group (24.0 kg/m(2)≤BMIsupplement type, periconceptional single folic acid supplementation (400 μg per tablet) was a protective factor for SGA birth ( OR =0.82, 95 %CI : 0.69-0.99). After stratified by pre-pregnancy BMI, periconceptional single folic acid supplementation (400 μg per tablet) was associated with the reduced risk of SGA birth in overweight groups ( OR =0.56, 95 %CI : 0.36-0.86). No association was observed between periconceptional folic acid containing multivitamin

  6. Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study.

    Science.gov (United States)

    Raynes-Greenow, Camille H; Hadfield, Ruth M; Cistulli, Peter A; Bowen, Jenny; Allen, Hugh; Roberts, Christine L

    2012-11-01

    Investigate the relationship between gestational age and weight for gestational age and sleep apnea diagnosis in a cohort of children aged up to 6 years old. A cohort study, using record linked population health data. New South Wales, Australia. 398,961 children, born between 2000 and 2004, aged 2.5 to 6 years. The primary outcome was sleep apnea diagnosis in childhood, first diagnosed between 1 and 6 years of age. Children with sleep apnea were identified from hospital records with the ICD-10 code G47.3: sleep apnea, central or obstructive. A total of 4,145 (1.0%) children with a first diagnosis of sleep apnea were identified. Mean age at first diagnosis was 44.2 months (SD 13.9). Adenoidectomy, tonsillectomy, or both were common among the children diagnosed with sleep apnea (85.6%). Children born preterm compared to term were significantly more likely to be diagnosed with sleep apnea (apnea compared to children born appropriate for gestational age, hazard ratio 0.95 (95% CI 0.86-1.06). This is the largest study investigating preterm birth and sleep apnea diagnosis and suggests that diagnosis of sleep disordered breathing is more prevalent in children born preterm, but not those who are small for gestational age.

  7. Assessment of cardiorespiratory stability using the infant car seat challenge before discharge in preterm infants (<37 weeks' gestational age).

    Science.gov (United States)

    Narvey, Michael R

    2016-04-01

    Preterm infants younger than 37 weeks corrected gestational age are at increased risk for abnormal control of respiration. The infant car seat challenge has been used as a screening tool to ensure cardiorespiratory stability before discharging preterm infants from many hospitals in Canada. While it is clear that infants placed in a car seat are more likely to experience oxygen desaturation and/or bradycardia than when they are supine, neither positioning predicts an adverse neurodevelopmental outcome or mortality post-discharge. A review of the literature yielded insufficient evidence to recommend routine use of the infant car seat challenge as part of discharge planning for preterm infants. This finding has prompted a change in recommendation from a previous Canadian Paediatric Society position statement published in 2000.

  8. Endodontics and the ageing patient.

    Science.gov (United States)

    Johnstone, M; Parashos, P

    2015-03-01

    Patients are living longer and the rate of edentulism is decreasing. Endodontic treatment is an essential part of maintaining the health and well-being of the elderly. Retention of natural teeth improves the quality of life and the overall health and longevity of ageing patients. Also, teeth that might be otherwise extracted may be strategically valuable to retain a prosthesis, and elderly patients are more likely to have medical complications that may prevent dental extractions from being safely performed. The technical goals of endodontic treatment in the elderly are the same as those for younger patients. However, the pulpo-dentinal complex undergoes calcific changes over time, which may pose challenges for the clinician. The purposes of this review are to discuss age changes in the pulp and the challenges posed by diagnosing, treatment planning and treating the elderly endodontic patient. © 2015 Australian Dental Association.

  9. Measurements using 7.0 T post-mortem magnetic resonance imaging of the scalar dimensions of the fetal brain between 12 and 20 weeks gestational age.

    Science.gov (United States)

    Lin, Xiangtao; Zhang, Zhonghe; Teng, Gaojun; Meng, Haiwei; Yu, Taifei; Hou, Zhongyu; Fang, Fang; Zang, Fengchao; Liu, Shuwei

    2011-12-01

    In this study, scalar values for the fetal brain from 12 to 20 weeks gestational age were obtained. Fifty-two fetal specimens of 12-20 weeks gestational age with an anatomically normal and developmentally appropriate central nervous system (CNS) were scanned using a 7.0 T magnetic resonance imaging (MRI) scanner. The linear biometric measurements of the brain were then determined. All the measurements (except for the interhemispheric distance) were found to increase linearly with gestational age, although each increased at a different growth rates. The 95% confidence interval for each value was obtained. These data may be considered to be a valuable reference for the assessment of normal fetal brain development in clinical settings and as a supplement to post-mortem MRI or anatomical investigations. Copyright © 2011 ISDN. Published by Elsevier Ltd. All rights reserved.

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

    DEFF Research Database (Denmark)

    Gybel-Brask, Dorte; Høgdall, Estrid; Johansen, Julia

    2014-01-01

    -week fetal growth examinations. Uterine artery Doppler was assessed and outcome was registered from medical records. MAIN OUTCOME MEASURES: Preeclampsia, hypertension, small-for-gestational age. RESULTS: Serum YKL-40 was associated with increasing maternal age (p ...OBJECTIVE: 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. DESIGN: Prospective cohort study. SETTING: A primary referral unit...... for obstetric ultrasound. POPULATION: A total of 1214 unselected pregnant women enrolled at nuchal translucency examination between 11(+3) and 13(+6) weeks of gestation. METHODS: All women had ultrasound and blood sample collection at the nuchal translucency scan, a 20-week malformation scan and 25-week and 32...

  11. Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery

    Science.gov (United States)

    Le Guennec, D.; Accoceberry, M.; Lemery, D.; Mulliez, A.; Farigon, N.; Lahaye, C.; Miolanne-Debouit, M.; Boirie, Y.

    2017-01-01

    The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women. PMID:29082043

  12. Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    J. Hazart

    2017-01-01

    Full Text Available The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1: 77.8%, T2: 96.3%, and T3: 100.0%, nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%, D (T1: 33.3%, T2: 26.3%, and T3: 8.3%, C (T1: 66.7%, T2: 41.2%, and T3: 83.3%, B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%, and B9 (T1: 14.3%, T2: 0%, and T3: 9.1% and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%. There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.

  13. Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery.

    Science.gov (United States)

    Hazart, J; Le Guennec, D; Accoceberry, M; Lemery, D; Mulliez, A; Farigon, N; Lahaye, C; Miolanne-Debouit, M; Boirie, Y

    2017-01-01

    The aim is to compare the prevalence of maternal deficiencies in micronutrients, the obstetrical and neonatal complications after bariatric surgery according to surgical techniques, the time between surgery and conception, and BMI at the onset of pregnancy. A retrospective cohort study concerned 57 singleton pregnancies between 2011 and 2016 of 48 adult women who have undergone bariatric surgery. Small-for-gestational-age neonates were identified in 36.0% of pregnancies. With supplements intake (periconceptional period: 56.8%, trimester 1 (T1): 77.8%, T2: 96.3%, and T3: 100.0%), nutritional deficiencies involved vitamins A (T1: 36.4%, T2: 21.1%, and T3: 40.0%), D (T1: 33.3%, T2: 26.3%, and T3: 8.3%), C (T1: 66.7%, T2: 41.2%, and T3: 83.3%), B1 (T1: 45.5%, T2: 15.4%, and T3: 20.0%), and B9 (T1: 14.3%, T2: 0%, and T3: 9.1%) and selenium (T1: 77.8%, T2: 22.2%, and T3: 50.0%). There was no significant difference in the prevalence of nutritional deficiencies and complications according to surgery procedures and in the prevalence of pregnancy issues according to BMI at the beginning of the pregnancy and time between surgery and pregnancy. Prevalence of micronutritional deficiencies and small-for-gestational-age neonates is high in pregnant women following bariatric surgery. Specific nutritional programmes should be recommended for these women.

  14. Association between soluble (Prorenin receptor concentration in cord blood and small for gestational age birth: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Noriyoshi Watanabe

    Full Text Available OBJECTIVE: The (prorenin receptor [(PRR] has been recognized as a multifunctional receptor. The purpose of this study was to assess the association between plasma soluble (PRR [s(PRR] concentration in human cord blood (i.e., neonatal blood at birth and small for gestational age (SGA birth. METHODS: Participants were women with a singleton pregnancy who delivered at the National Center for Child Health and Development between January 2010 and December 2011. Inclusion criteria were availability of maternal pre-pregnancy and paternal body mass index, and the absence of structural anomalies in neonates. s(PRR concentration in cord blood was measured in 621 neonates. The 621 pairs of mothers and neonates were categorized into four groups based on quartiles of s(PRR concentrations in cord blood. SGA was defined as a birth weight below the 10(th percentile for gestational age. Logistic regression analysis was performed to assess the association between cord plasma s(PRR concentration (quartiles and incidence of SGA births. RESULTS: Among 621 neonates, 55 (8.9% were diagnosed as SGA (SGA group and 566 (91.1% were not (non-SGA group. Average s(PRR concentration in cord blood was 66.1±12.6 ng/ml (mean±standard deviation. There were 155 pairs in the first plasma s(PRR concentration quartile (Q1: 73.1 ng/ml. The distribution of SGA births was 18 (11.6% in Q1, 14 (9.2% in Q2, 16 (10.2% in Q3 and 7 (4.5% in Q4, respectively. The odds ratio of SGA births was 0.24 (95% confidence interval: 0.08-0.71 for the fourth quartile compared to the first quartile in multivariate models. The P-value for trend was also significant (P = 0.020. CONCLUSION: High s(PRR concentration is associated with a lower SGA birth likelihood.

  15. Prediction of small-for-gestational-age neonate by third-trimester fetal biometry and impact of ultrasound-delivery interval.

    Science.gov (United States)

    Reboul, Q; Delabaere, A; Luo, Z C; Nuyt, A-M; Wu, Y; Chauleur, C; Fraser, W; Audibert, F

    2017-03-01

    To compare third-trimester ultrasound screening methods to predict small-for-gestational age (SGA), and to evaluate the impact of the ultrasound-delivery interval on screening performance. In this prospective study, data were collected from a multicenter singleton cohort study investigating the links between various exposures during pregnancy with birth outcome and later health in children. We included women, recruited in the first trimester, who had complete outcome data and had undergone third-trimester ultrasound examination. Demographic, clinical and biological variables were also collected from both parents. We compared prediction of delivery of a SGA neonate (birth weight third trimesters (FGVAC). We also assessed the following ultrasound-delivery intervals: ≤ 4 weeks, ≤ 6 weeks and ≤ 10 weeks. Third-trimester ultrasound was performed in 1805 patients with complete outcome data, of whom 158 (8.8%) delivered a SGA neonate. Ultrasound examination was at a median gestational age of 32 (interquartile range, 31-33) weeks. The ultrasound-delivery interval was ≤ 4 weeks in 17.2% of cases, ≤ 6 weeks in 48.1% of cases and ≤ 10 weeks in 97.3% of cases. Areas under the receiver-operating characteristics curve (AUC) were 0.772 for Salomon AC, 0.768 for Hadlock EFW, 0.766 for Hadlock AC, 0.765 for Intergrowth AC, 0.708 for Gardosi EFW and 0.674 for FGVAC (all P Third-trimester ultrasound measurements provide poor to moderate prediction of SGA. A shorter ultrasound-delivery interval provides better prediction than does a longer interval. Further studies are needed to test the effect of including maternal or biological characteristics in SGA screening. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

  16. Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Langejans Marloes

    2008-08-01

    Full Text Available Abstract Background Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age. Methods The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007, hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results. Results Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79 and negative likelihood ratio 0.30 (0.13,0.68 (single study. For small for gestational age it was AFP>2.0MoM to predict birth weight th centile with birth There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals. Conclusion Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.

  17. Association of gestational age with the option of pregnancy termination for fetal abnormalities incompatible with neonatal survival.

    Science.gov (United States)

    Westphal, Flavia; Fustinoni, Suzete Maria; Pinto, Vânia Lopes; Melo, Patrícia de Souza; Abrahão, Anelise Riedel

    2016-01-01

    To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination. This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival. The sample comprised 94 medical records. The Statistical Package for the Social Sciences (SPSS), version 19, was used for the data statistical analysis. The population of the study included young adult women, who had complete or incomplete high school education, employed, with family income of one to three minimum wages, single, nonsmokers, who did not drink alcoholic beverages or used illicit drugs. Women with more advanced gestational age upon fetal diagnosis (p=0.0066) and/or upon admission to the specialized unit (p=0.0018) presented a lower percentage of termination of pregnancy. Due to characteristics different from those classically considered as of high gestational risk, these women might not be easily identified during the classification of gestational risk, what may contribute to a late diagnosis of fetal diseases. Early diagnosis enables access to specialized multiprofessional care in the proper time for couple's counseling on the possibility of requesting legal authorization for pregnancy termination. Identificar o perfil de mulheres atendidas em um serviço de Medicina Fetal, que receberam diagnóstico de anomalia fetal incompatível com a sobrevida neonatal na gestação atual, e verificar a associação da idade gestacional no diagnóstico com a opção pela interrupção da gravidez. Trata-se de um estudo de coorte retrospectivo, realizado no ambulatório de Medicina Fetal de um hospital universitário da cidade de S

  18. Assessing the Risk of Having Small for Gestational Age Newborns Among Lebanese Underweight and Normal Pre-pregnancy Weight Women.

    Science.gov (United States)

    Rafei, Rym El; Abbas, Hussein A; Alameddine, Hind; Bizri, Ayah Al; Melki, Imad; Yunis, Khalid A

    2018-01-01

    Introduction It has been established that underweight women with low gestational weight gain (GWG) are at a higher risk of having Small for Gestational Age (SGA) newborns. However, the association remains poorly studied in Middle Eastern societies exhibiting different ethnic groups, genetic predisposing factors along with differences in nutritional food intake during pregnancy. The aim of this study is to assess the risk of having a SGA newborn among underweight and normal weight BMI women while studying the role of GWG in this association. Methods This is a retrospective cross-sectional study of 62,351 singleton pregnancies from the National Collaborative Perinatal Neonatal Network between 2001 and 2009 from 27 hospitals across Lebanon. Women who had underweight and normal pre-pregnancy BMI were included. Results A total of 8.6% newborns were SGA and 6.6% of women were underweight. Among women with normal and underweight pre-pregnancy BMI, 8.6 and 12.4% had SGA births respectively. Overall, the adjusted OR of having SGA newborns was significantly higher among underweight women (OR = 1.448; 95%CI = 1.287-1.630) compared to normal pre-pregnancy BMI. Below normal weight gain significantly increased the odds of SGA for both normal and underweight pre-pregnancy BMI women, with adjusted ORs of 1.535 (95% CI = 1.418-1.661) and 1.970 (95%CI = 1.515-2.560) respectively. Discussion Higher risks of SGA newborns in underweight and normal BMI women with low GWG were observed. In addition, normal weight gain couldn't protect underweight women of having risk for SGA newborns. Hence, all pregnant women should be encouraged to maintain healthy BMI before pregnancy and attain adequate GWG.

  19. Neurocognitive Correlates of Attention-Deficit Hyperactivity Disorder Symptoms in Children Born at Extremely Low Gestational Age.

    Science.gov (United States)

    Scott, Megan N; Hunter, Scott J; Joseph, Robert M; OʼShea, Thomas Michael; Hooper, Stephen R; Allred, Elizabeth N; Leviton, Alan; Kuban, Karl

    2017-05-01

    Compared with children born near term, those born extremely preterm (EP) are at much higher risk for attention-deficit hyperactivity disorder (ADHD). Little information is available about differences in neuropsychological outcomes among EP children with and without ADHD. Our analyses aimed to evaluate the neuropsychological correlates of ADHD symptoms in extremely low gestational age newborns (ELGANs). We obtained Child Symptom Inventory-4 reports from parents (n = 871) and teachers (n = 634) of 10-year-old children born before the 28th week of gestation. Participants completed standardized assessments of neurocognitive and academic functioning. In the total sample, children who screened positive for ADHD symptoms were at increased risk for neurocognitive limitations. These associations were weaker when the sample was limited to those with intelligence quotient (IQ) ≥70 or ≥85. Even those with IQ ≥85 who screened positive for ADHD symptoms were more likely than their peers to have deficits on the DAS-II Working Memory Cluster and the NEPSY-II Auditory Response subtest. The risks for impaired academic performance (Z ≤ -1) on components of the WIAT-III were 2-to-3 times higher in this group than among ELGANs not classified as having ADHD symptoms. Among children born EP, those with ADHD symptoms are more likely to have global neurocognitive impairment. When IQ is within normal limits, ADHD symptoms are associated with deficits in executive functioning skills. These findings highlight a group at risk for executive functioning deficits and related academic difficulties, even in the absence of intellectual disability.

  20. The effects of maternal depression and use of antidepressants during pregnancy on risk of a child small for gestational age.

    Science.gov (United States)

    Jensen, Hans Mørch; Grøn, Randi; Lidegaard, Ojvind; Pedersen, Lars Henning; Andersen, Per Kragh; Kessing, Lars Vedel

    2013-07-01

    Use of antidepressants during pregnancy has been associated with an increased rate of children small for gestational age (SGA), but it is unclear whether this is due to an effect of the underlying depressive disorder. This study aimed to investigate the effect of antidepressants on SGA in a nationwide sample and to separate the effect of exposure to antidepressants in utero from the effect of maternal depression. A register study was conducted on all pregnant women in Denmark from 1996 to 2006 linking nationwide individualized data from the Medical Birth Register, the Psychiatric Central Register, and a prescription database. The rate of SGA (birth weight below the 10 percentile at given gestational week) was investigated for children exposed in utero to antidepressants or to a maternal psychiatric diagnosis of depression compared to children not prenatally exposed to antidepressants or maternal diagnosis. A total of 673,853 pregnancies were included in the study of which 35.737 women had a diagnosis of depression and/or used antidepressants before end of pregnancy. Antidepressant use during pregnancy was weakly associated with SGA (hazard ratios (HR) = 1.19; 95 % confidence interval (CI), 1.11-1.28), whereas a psychiatric diagnosis before or during pregnancy was not (HR = 1.02; 95 % CI, 0.92-1.13). The association for use during pregnancy was found for selective serotonin reuptake inhibitors and newer antidepressants, but not for older antidepressants. The use of antidepressants during pregnancy slightly increases the rate of SGA. The association seems unrelated to the underlying maternal depressive disorder.

  1. The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity.

    Science.gov (United States)

    Yao, Ruofan; Foster, Sarah E; Caughey, Aaron B

    2018-06-01

    An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies. This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2011. Analysis was limited to births between 34 and 42 weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGA pop ) and another using obese pregnancies (SGA cust ). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation >6 h. Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGA pop, and 1.21 [0.54, 2.74] for SGA cust-pop. The risks for the following neonatal complications were slightly higher for SGA cust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGA pop . Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.

  2. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques.

    Science.gov (United States)

    Ashrafi, M; Gosili, R; Hosseini, R; Arabipoor, A; Ahmadi, J; Chehrazi, M

    2014-05-01

    To compare the incidence of gestational diabetes mellitus (GDM) between pregnancies conceived spontaneously and pregnancies conceived following assisted reproductive technology (ART). This cross-sectional study evaluated the medical records of 215 women who conceived spontaneously and 145 women who conceived following ART from September 2011 to October 2012. Exclusion criteria were: polycystic ovary syndrome, maternal age ≥40 years, family history of diabetes in first-degree relatives, pre-pregnancy diabetes, glucose intolerance treated with hypoglycaemic agent (e.g. metformin), history of GDM, history of stillbirth, recurrent miscarriage, history of baby with birth weight ≥4kg (macrosomia), parity >3, Cushing syndrome, congenital adrenal hyperplasia and hypothyroidism. For better comparison of the incidence of GDM, the ART group was further subdivided into: (i) an in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) group (n=95); and (ii) an intrauterine insemination (IUI) group (n=50). The diagnosis of GDM was based on the criteria of the American Diabetes Association. The incidence of GDM was significantly higher in the IVF/ICSI and IUI groups (43% and 26%, respectively) compared with the spontaneous pregnancy group (10%). Age, pre-pregnancy body mass index (BMI) and weight gain in pregnancy were similar among women with GDM in all three groups. In addition, the incidence of pregnancy-induced hypertension was significantly higher in the IVF/ICSI group (21%) compared with the spontaneous pregnancy group (7%). Logistic regression analysis demonstrated four strong risk factors for GDM: age, BMI, mode of ART and progesterone use during pregnancy. This study indicated that the risk of GDM is two-fold higher in women with singleton pregnancies conceived following ART compared with women who conceived spontaneously. In addition, progesterone use during pregnancy was found to be an important risk factor for GDM. This subject requires further study

  3. 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.

    Science.gov (United States)

    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.

  4. Contraception and postpartum follow-up in patients with gestational diabetes.

    Science.gov (United States)

    Rosenthal, Emily W; Easter, Sarah Rae; Morton-Eggleston, Emma; Dutton, Caryn; Zera, Chloe

    2017-04-01

    We sought to review the effect of immediate provision of postpartum contraception on postpartum follow-up and screening for type 2 diabetes in women with gestational diabetes mellitus (GDM). We performed multivariate logistic regression to identify the association between immediate provision of postpartum contraception and attendance at the 6-week postpartum visit and performance of a 6- to 12-week oral glucose tolerance test, controlling for age, type of insurance, parity and race. Women who received contraception prior to hospital discharge were less likely to attend their postpartum visit [adjusted odds ratio (aOR) 0.59, 95% confidence interval (CI) 0.39-0.88], but just as likely to participate in postpartum diabetes screening (adjusted odds ratio (aOR) 1.27, 95% confidence interval (CI) 0.78-2.06). Attendance at the postpartum visit was associated with private insurance (OR 1.93, 95% CI 1.31-2.99). Receiving contraception while admitted postpartum did not affect follow-up for diabetes screening for women with GDM. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy.

    Science.gov (United States)

    Torche, Florencia; Kleinhaus, Karine

    2012-02-01

    Previous research suggests that maternal exposure to acute stress has a negative impact on the duration of pregnancy, and that this effect may vary by the time of exposure. It has also been proposed that stress exposure reduces the ratio of male-to-female births. To date, no study has jointly examined both outcomes, although they may be strongly related. Using population-level data with no selectivity, we jointly study the sex-specific effect of stress on the duration of pregnancy and the observed sex ratio among pregnant women exposed to a major earthquake in Chile. In a quasi-experimental design, women exposed to the earthquake in different months of gestation were compared with women pregnant 1 year earlier. Estimates from a comparison group of pregnant women living in areas not affected by the earthquake were also examined to rule out confounding trends. Regression models were used to measure the impact of earthquake exposure on gestational age and preterm birth by sex across month of gestation. A counterfactual simulation was implemented to assess the effect of the earthquake on the secondary sex ratio accounting for the differential impact of stress on gestational age by sex. Earthquake exposure in Months 2 and 3 of gestation resulted in a significant decline in gestational age and increase in preterm delivery. Effects varied by sex, and were much larger for female than male pregnancies. Among females, the probability of preterm birth increased by 0.038 [95% confidence interval (CI): 0.005, 0.072] in Month 2 and by 0.039 (95% CI: 0.002, 0.075) in Month 3. Comparable increases for males were insignificant at the conventional P < 0.05 level. After accounting for the sex-specific impact on gestational age, a decline in the male-to-female ratio in Month 3 of exposure was detected [-0.058 (95% CI: -0.113, -0.003)]. Maternal exposure to an exogenous stressor early but not late in the pregnancy affects gestational age and the probability of preterm birth. This

  6. Can a customized standard for large for gestational age identify women at risk of operative delivery and shoulder dystocia?

    Science.gov (United States)

    Cha, Hyun-Hwa; Kim, Ji-Young; Choi, Suk-Joo; Oh, Soo-Young; Roh, Cheong-Rae; Kim, Jong-Hwa

    2012-04-22

    To determine whether a customized standard for large for gestational age (LGA) identifies undiagnosed women at risk of operative delivery and shoulder dystocia. We previously generated customized standards from our institution. We compared the baseline maternal characteristics and neonatal outcomes between LGA and non-LGA births, which were classified by both population-based and customized standards. The risk of operative delivery (vacuum delivery or emergent cesarean section) and shoulder dystocia was compared by logistic regression analysis in LGA pregnancies that were identified by a population-based birth weight standard and a customized standard after adjusting for maternal age, parity, body mass index, and neonatal gender. Multivariable analysis revealed that the pregnancies identified as LGA by a customized standard were associated with an increased risk of emergent cesarean section [odds ratio (OR), 4.09; 95% confidence interval (CI), 3.00-5.74] and shoulder dystocia (OR, 10.56; 95% CI, 5.52-20.19). However, there was no association between an increased risk of vacuum delivery (OR, 1.45; 95% CI, 0.92-2.30) and pregnancies identified as non-LGA, using both standards. In addition, customized LGA infants were at increased risk of admission to neonatal intensive care unit (OR 1.63; 95% CI, 1.09-2.43). A customized standard of LGA is useful in identifying previously unrecognized women at risk of emergent cesarean section and shoulder dystocia.

  7. Infant mortality and morbidity associated with preterm and small-for-gestational-age births in Southern Mozambique: A retrospective cohort study

    NARCIS (Netherlands)

    García-Basteiro, Alberto L.; Quintó, Llorenç; Macete, Eusebio; Bardají, Azucena; González, Raquel; Nhacolo, Arsenio; Sigauque, Betuel; Sacoor, Charfudin; Rupérez, María; Sicuri, Elisa; Bassat, Quique; Sevene, Esperança; Menéndez, Clara

    2017-01-01

    Preterm and small for gestational age (SGA) births have been associated with adverse outcomes during the first stages of life. We evaluated the morbidity and mortality associated with preterm and SGA births during the first year of life in a rural area of Southern Mozambique. This is a retrospective

  8. Prospective population-based cohort study of maternal obesity as a source of error in gestational age estimation at 11-14weeks

    DEFF Research Database (Denmark)

    Bak, Geske S; Sperling, Lene; Källén, Karin

    2016-01-01

    pregnancies who had a known last menstrual period (LMP), a recorded booking of body mass index (BMI), and a late first trimester ultrasound dating scan using crown-rump-length measurement (gestational age 11(+0)-13(+6)weeks). Almost all scans were performed transabdominally. Transvaginal ultrasound was only...

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

    DEFF Research Database (Denmark)

    Lee, Anne Cc; Kozuki, Naoko; Cousens, Simon

    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 bi...

  10. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? results from two large Western-European studies

    NARCIS (Netherlands)

    Pfinder, M.; Kunst, A.E.; Feldmann, R.; van Eijsden, M.; Vrijkotte, T.G.M.

    2013-01-01

    Background: Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure

  11. Preterm birth and small for gestational age in relation to alcohol consumption during pregnancy: stronger associations among vulnerable women? Results from two large Western-European studies

    NARCIS (Netherlands)

    Pfinder, Manuela; Kunst, Anton E.; Feldmann, Reinhold; van Eijsden, Manon; Vrijkotte, Tanja G. M.

    2013-01-01

    Inconsistent data on the association between prenatal alcohol exposure and a range of pregnancy outcomes, such as preterm birth (PTB) and small for gestational age (SGA) raise new questions. This study aimed to assess whether the association between low-moderate prenatal alcohol exposure and PTB and

  12. Serum Screening with Down's Syndrome Markers to Predict Pre-eclampsia and Small for gestational age: Systematic Review and Meta-analysis

    NARCIS (Netherlands)

    Morris, Rachel K.; Cnossen, Jeltsje S.; Langejans, Marloes; Robson, Stephen C.; Kleijnen, Jos; ter Riet, Gerben; Mol, Ben W.; van der Post, Joris A. M.; Khan, Khalid S.

    2008-01-01

    ABSTRACT: BACKGROUND: Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to

  13. Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries

    DEFF Research Database (Denmark)

    Kozuki, Naoko; Katz, Joanne; Lee, Anne Cc

    2015-01-01

    BACKGROUND: Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease. OBJECTIVES: The specific aims of this study were to estimate the association between sh...

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

    DEFF Research Database (Denmark)

    Gybel-Brask, Dorte; Høgdall, Estrid; Johansen, Julia

    2014-01-01

    OBJECTIVE: 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. DESIGN: Prospective cohort study. SETTING: A primary referral unit fo...

  15. Metabolic Health in Short Children Born Small for Gestational Age Treated With Growth Hormone and Gonadotropin-Releasing Hormone Analog : Results of a Randomized, Dose-Response Trial

    NARCIS (Netherlands)

    van der Steen, Manouk; Lem, Annemieke J.; van der Kaay, Danielle C. M.; Bakker-van Waarde, Willie M.; van der Hulst, Flip J. P. C. M.; Neijens, Floor S.; Noordam, Cees; Odink, Roelof J.; Oostdijk, Wilma; Schroor, Eelco J.; Westerlaken, Ciska; Hokken-Koelega, Anita C. S.

    2015-01-01

    Context: Previously we showed that pubertal children born small for gestational age (SGA) with a poor adult height (AH) expectation can benefit from treatment with GH1 mg/m(2) per day (similar to 0.033 mg/kg/d) in combination with 2 years of GnRH analog (GnRHa) and even more so with a double GH

  16. Prenatal exposure to endocrine disrupting chemicals and risk of being born small for gestational age: Pooled analysis of seven European birth cohorts

    NARCIS (Netherlands)

    Govarts, Eva; Iszatt, Nina; Trnovec, Tomas; de Cock, Marijke; Eggesbø, Merete; Palkovicova Murinova, Lubica; van de Bor, Margot; Guxens, Mònica; Chevrier, Cécile; Koppen, Gudrun; Lamoree, Marja; Hertz-Picciotto, Irva; Lopez-Espinosa, Maria Jose; Lertxundi, Aitana; Grimalt, Joan O.; Torrent, Maties; Goñi-Irigoyen, Fernando; Vermeulen, Roel; Legler, Juliette; Schoeters, Greet

    Background and aims: There is evidence that endocrine disrupting chemicals (EDCs) have developmental effects at environmental concentrations. We investigated whether some EDCs are associated with the adverse birth outcome Small for Gestational Age (SGA). Methods: We used PCB 153, p,p’-DDE, HCB, PFOS

  17. IGF1, IGF1R and SHOX mutation analysis in short children born small for gestational age and short children with normal birth size (idiopathic short stature).

    NARCIS (Netherlands)

    Caliebe, J.; Broekman, S.; Boogaard, M.W. van den; Bosch, C.A.; Ruivenkamp, C.A.; Oostdijk, W.; Kant, S.G.; Binder, G.; Ranke, M.B.; Wit, J.M.; Losekoot, M.

    2012-01-01

    BACKGROUND/AIMS: Because the criteria for genetic screening of short children are unknown, we performed genetic analysis of 199 short children born small for gestational age (SGA) or with normal birth size (idiopathic short stature, ISS). METHODS: After selection with a modified scoring system for

  18. Burden of Severe Respiratory Syncytial Virus Disease Among 33-35 Weeks' Gestational Age Infants Born During Multiple Respiratory Syncytial Virus Seasons.

    LENUS (Irish Health Repository)

    Anderson, Evan J

    2017-02-01

    Moderate-late preterm infants, 33-35 weeks\\' gestational age (wGA), are at increased risk for respiratory syncytial virus hospitalization (RSVH). The objective of this study is to quantify the burden of RSVH in moderate-late preterm infants.

  19. CLINICAL AND IMMUNOPATHOLOGIC CHARACTERISTICS OF EARLY NEONATAL SEPSIS IN INFANTS OF DIFFERENT GESTATIONAL AGE AND CLINICAL AND ECONOMICAL EVALUATION OF IMMUNOSUPPORTIVE THERAPY EFFICACY

    Directory of Open Access Journals (Sweden)

    I.G. Soldatova

    2011-01-01

    Full Text Available Study objective — to study clinical and immunopathologic characteristics of early neonatal sepsis in infants of different gestational age and to perform clinical and economical evaluation of immunosupportive therapy with Pentaglobin efficacy in complex treatment of this disease. 79 infants diagnosed with neonatal sepsis were included into prospective study. These patients were divided into 3 subgroups in order to evaluate clinical and economical efficacy of immunosupportive therapy: subgroup A (n = 38 — patients receiving. Pentaglobin as part of basic complex treatment from 3–6 days of life; subgroup B (n = 27 — from 7–10 days of life; subgroup C  (n = 27 — patients treated without Pentaglobin. Proven high clinical and economical efficacy of immunoglobulin preparations as a part of complex treatment of neonatal sepsis allows to recommend this type of therapy for a wide application in neonatology as a part of neonatal sepsis treatment.Key words: early neonatal sepsis, prematurity, extremely low body mass, immunosupportive therapy, intravenous immunoglobines, clinical and economical analysis, neonatal sepsis. (Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (6: 52–61

  20. Does prone or supine position influence pain responses in preterm infants at 32 weeks gestational age?

    Science.gov (United States)

    Grunau, Ruth Eckstein; Linhares, Maria Beatriz Martins; Holsti, Liisa; Oberlander, Tim F; Whitfield, Michael F

    2004-01-01

    The purpose of this study was to examine the influence of prone and supine position in preterm infants during acute pain of blood collection. Level III Neonatal Intensive Care Unit (NICU). Thirty-eight preterm infants (birthweight 1339 [590-2525] g, GA 29 [25- 32] wks) were in 2 groups depending on their position in the isolette prior to and during heel lance at 32 weeks post-conceptional age. The study design was a comparison between groups (Prone, Supine) during 2 events (Baseline, Heel lance). Pain measures were multidimensional, including behavioral (sleep-wake state and facial activity) and physiological (heart rate) responses measured continuously prior to (Baseline) and during blood collection (Lance). Both groups of infants displayed statistically significant shifts in sleep-wake state to greater arousal, and increased facial activity and heart rate, from Baseline to Lance. Prone position was associated with significantly more deep sleep during Baseline, compared with Supine position, but there were no differences in sleep-wake state during Lance. Minor increased facial activity was shown in some time segments of Baseline for infants in Supine compared with Prone, but did not differ overall between positions. Prone and Supine position did not affect heart rate significantly during Baseline or Lance events. Prone position promotes deep sleep in preterm neonates at 32 weeks post-conceptional age when they are undisturbed. However, placement in prone position is not a sufficient environmental comfort intervention for painful invasive procedures such as heel lance for blood sampling in the NICU. Neonates require other environmental supports to promote coping with this stressful event.

  1. Small-for-gestational age prevalence risk factors in central Appalachian states with mountain-top mining.

    Science.gov (United States)

    Ferdosi, Hamid; Lamm, Steve H; Afari-Dwamena, Nana Ama; Dissen, Elisabeth; Chen, Rusan; Li, Ji; Feinleib, Manning

    2018-01-01

    To identify risk factors for small-for-gestational age (SGA) for counties in central Appalachian states (Kentucky (KY), Tennessee (TN), Virginia (VA), and West Virginia (WV)) with varied coal mining activities. Live birth certificate files (1990-2002) were used for obtaining SGA prevalence rates for mothers based on the coal mining activities of their counties of residence, mountain-top mining (MTM) activities, underground mining activities but no mountain-top mining activity (non-MTM), or having no mining activities (non-mining). Co-variable information, including maternal tobacco use, was also obtained from the live birth certificate. Adjusted odds ratios were obtained using multivariable logistic regression comparing SGA prevalence rates for counties with coal mining activities to those without coal mining activities and comparing SGA prevalence rates for counties with coal mining activities for those with and without mountain-top mining activities. Comparisons were also made among those who had reported tobacco use and those who had not. Both tobacco use prevalence and SGA prevalence were significantly greater for mining counties than for non-mining counties and for MTM counties than for non-MTM counties. Adjustment for tobacco use alone explained 50% of the increased SGA risk for mining counties and 75% of the risk for MTM counties, including demographic pre-natal care co-variables that explained 75% of the increased SGA risk for mining counties and 100% of the risk for MTM. The increased risk of SGA was limited to the third trimester births among tobacco users and independent of the mining activities of their counties of residence. This study demonstrates that the increased prevalence of SGA among residents of counties with mining activity was primarily explained by the differences in maternal tobacco use prevalence, an effect that itself was gestational-age dependent. Self-reported tobacco use marked the population at the increased risk for SGA in central

  2. A neonatal piglet model for investigating brain and cognitive development in small for gestational age human infants.

    Directory of Open Access Journals (Sweden)

    Emily C Radlowski

    Full Text Available The piglet was investigated as a potential model for studying brain and cognitive deficits associated with being born small for gestational age (SGA. Naturally farrowed SGA (0.7-1.0 kg BW and average for gestational age (AGA, 1.3-1.6 kg BW piglets were obtained on postnatal day (PD 2, placed in individual cages, and provided a nutritionally adequate milk replacer diet (285 ml/kg/d. Beginning at PD14, performance in a spatial T-maze task was assessed. At PD28, piglets were anesthetized for magnetic resonance (MR imaging to assess brain structure (voxel-based morphometry, connectivity (diffusion-tensor imaging and metabolites in the hippocampus and corpus callosum (proton MR spectroscopy. Piglets born SGA showed compensatory growth such that BW of SGA and AGA piglets was similar (P>0.05, by PD15. Birth weight affected maze performance, with SGA piglets taking longer to reach criterion than AGA piglets (p<0.01. Total brain volume of SGA and AGA piglets was similar (P<0.05, but overall, SGA piglets had less gray matter than AGA piglets (p<0.01 and tended to have a smaller internal capsule (p = 0.07. Group comparisons between SGA and AGA piglets defined 9 areas (≥ 20 clusters where SGA piglets had less white matter (p<0.01; 2 areas where SGA piglets had more white matter (p<0.01; and 3 areas where SGA piglets had more gray matter (p<0.01. The impact of being born SGA on white matter was supported by a lower (p<0.04 fractional anisotropy value for SGA piglets, suggesting reduced white matter development and connectivity. None of the metabolites measured were different between groups. Collectively, the results show that SGA piglets have spatial learning deficits and abnormal development of white matter. As learning deficits and abnormalities in white matter are common in SGA human infants, the piglet is a tractable translational model that can be used to investigate SGA-associated cognitive deficits and potential interventions.

  3. Screening for aneuploidies by maternal age, fetal nuchal translucency and maternal serum biochemistry at 11-13+6 gestational weeks

    Directory of Open Access Journals (Sweden)

    Karadžov-Orlić Nataša

    2012-01-01

    Full Text Available Introduction. Aneuploidies are the major cause of perinatal death and early psychophysical disorders. Objective. In this study, we analyzed detection and false-positive rates of screening for aneuploidies in the first trimester by the combination of maternal age, fetal nuchal translucency (NT thickness and maternal serum free beta-human chorionic gonadotrophin (β-hCG, and pregnancy-associated plasma protein-A (PAPP-A at 11-13+6 weeks of gestation, using the appropriate software developed by the Fetal Medicine Foundation. Methods. Our screening study for aneuploidies analyzed 4172 singleton pregnancies from January 2006 to December 2010. The sensitivities and false-positive rates using the combined aneuploidies determination for the risk cut-off of 1:275 were evaluated. Results. In the trisomy 21 pregnancies, the fetal NT was higher than 95th centile, in 72.8%, serum free b-hCG concentration it was above the 95th centile in 55% and serum PAPP-A was below the 5th centile in 47% of the cases. In the trisomy 18 and 13, the fetal NT was above 95th centile in 66.6% and 44.4% of the cases, respectively. The serum free b-hCG concentration was above the 95th centile in 0 and 10%, but serum PAPP-A was below 5th centile in 80.9% and 88.8% of pregnancies. In the trisomy 21 pregnancies the median free beta-hCG was 2.3 MoM and the median PAPP-A was 0.45 MoM. Chromosomal abnormalities were detected in 169 fetuses: trisomy 21 (97, Turner syndrome (19, trisomy 18 (28, trisomy 13 (11 and others (14. Detection rate of combined screening for aneuploides were 86.0% with false positive rate of 5.3% (mean age 33±4.9 years, >35 years in 35% of pregnancies. Conclusion. Our study suggests that the strategy of first-trimester combined screening of biochemical values and ultrasonographic parameters at 12 gestational weeks identifies higher percentage of aneuploidies with a lower false-positive rate than a single parameter strategy.

  4. Low Birth Weight, Small for Gestational Age and Preterm Births before and after the Economic Collapse in Iceland: A Population Based Cohort Study

    Science.gov (United States)

    Eiríksdóttir, Védís Helga; Ásgeirsdóttir, Tinna Laufey; Bjarnadóttir, Ragnheiður Ingibjörg; Kaestner, Robert; Cnattingius, Sven; Valdimarsdóttir, Unnur Anna

    2013-01-01

    Objective Infants born small for gestational age (SGA) or preterm have increased rates of perinatal morbidity and mortality. Stressful events have been suggested as potential contributors to preterm birth (PB) and low birth weight (LBW). We studied the effect of the 2008 economic collapse in Iceland on the risks of adverse birth outcomes. Study design The study population constituted all Icelandic women giving birth to live-born singletons from January 1st 2006 to December 31st 2009. LBW infants were defined as those weighing Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation. PMID:24324602

  5. Maternal protein intake in pregnancy and offspring metabolic health at age 9-16 y: results from a Danish cohort of gestational diabetes mellitus pregnancies and controls

    DEFF Research Database (Denmark)

    Maslova, Ekaterina; Hansen, Susanne; Grunnet, Louise Groth

    2017-01-01

    in free-living populations remains limited.Objective: We examined the association of protein intake in pregnancy with offspring metabolic health at age 9-16 y in a longitudinal cohort that oversampled pregnancies with gestational diabetes mellitus (GDM).Design: Six hundred eight women with an index...... pregnancy affected by gestational diabetes mellitus and 626 controls enrolled in the Danish National Birth Cohort were used for the analysis. Protein (total, animal, vegetable) intake was assessed by using a food frequency questionnaire in gestational week 25. The offspring underwent a clinical examination...... including fasting blood samples and a dual-energy X-ray absorptiometry scan (subset of 650) from which metabolic outcomes were derived. Multivariable analyses were conducted applying a 1: 1 substitution of carbohydrates for protein.Results: The mean +/- SD protein intake in pregnancy was 93 +/- 15 g/d (16...

  6. Perinatal mortality in relation to birthweight and gestational age: a registry-based comparison of Northern Norway and Murmansk County, Russia.

    Science.gov (United States)

    Anda, Erik Eik; Nieboer, Evert; Wilsgaard, Tom; Kovalenko, Anton Alexandrovich; Odland, Jon Øyvind

    2011-05-01

    The objective was to explore how perinatal mortality relates to birthweight, gestational age and optimal perinatal survival weight for two Arctic populations employing an existing and a newly established birth registry. A medical birth registry for all births in Murmansk County of North-West Russia became operational on 1st January 2006. Its primary function is to provide useful information for health care officials pertinent to improving perinatal care. The cohort studied consisted of 17,302 births in 2006-07 (Murmansk County) and 16,006 in 2004-06 (Northern Norway). Birthweight probability density functions were analysed, and logistic regression models were employed to calculate gestational-age-specific mortality ratios. The perinatal mortality rate was 10.7/1000 in Murmansk County and 5.7/1000 in Northern Norway. Murmansk County had a higher proportion of preterm deliveries (8.7%) compared to Northern Norway (6.6%). The odds ratio (OR) of risk of mortality (Northern Norway as the reference group) was higher for all gestational ages in Murmansk County, but the largest risk difference occurred among term deliveries (OR 2.45, 95% confidence interval 1.45, 4.14) which hardly changed on adjustment for maternal age, parity and gestation. Proportionately, more babies were born near (± 500 g) the optimal perinatal survival weight in Murmansk County (67.2%) than in Northern Norway (47.6%). The observed perinatal mortality was higher in Murmansk County at all birthweight strata and at gestational ages between weeks 25 and 42, but the adjusted risk difference was most significant for term deliveries. © 2011 Blackwell Publishing Ltd.

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

    Science.gov (United States)

    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.

  8. Development and Evaluation of a Mobile Personalized Blood Glucose Prediction System for Patients With Gestational Diabetes Mellitus.

    Science.gov (United States)

    Pustozerov, Evgenii; Popova, Polina; Tkachuk, Aleksandra; Bolotko, Yana; Yuldashev, Zafar; Grineva, Elena

    2018-01-09

    Personalized blood glucose (BG) prediction for diabetes patients is an important goal that is pursued by many researchers worldwide. Despite many proposals, only a few projects are dedicated to the development of complete recommender system infrastructures that incorporate BG prediction algorithms for diabetes patients. The development and implementation of such a system aided by mobile technology is of particular interest to patients with gestational diabetes mellitus (GDM), especially considering the significant importance of quickly achieving adequate BG control for these patients in a short period (ie, during pregnancy) and a typically higher acceptance rate for mobile health (mHealth) solutions for short- to midterm usage. This study was conducted with the objective of developing infrastructure comprising data processing algorithms, BG prediction models, and an appropriate mobile app for patients' electronic record management to guide BG prediction-based personalized recommendations for patients with GDM. A mobile app for electronic diary management was developed along with data exchange and continuous BG signal processing software. Both components were coupled to obtain the necessary data for use in the personalized BG prediction system. Necessary data on meals, BG measurements, and other events were collected via the implemented mobile app and continuous glucose monitoring (CGM) system processing software. These data were used to tune and evaluate the BG prediction model, which included an algorithm for dynamic coefficients tuning. In the clinical study, 62 participants (GDM: n=49; control: n=13) took part in a 1-week monitoring trial during which they used the mobile app to track their meals and self-measurements of BG and CGM system for continuous BG monitoring. The data on 909 food intakes and corresponding postprandial BG curves as well as the set of patients' characteristics (eg, glycated hemoglobin, body mass index [BMI], age, and lifestyle parameters

  9. Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan

    Directory of Open Access Journals (Sweden)

    Naomi Tamura

    2018-02-01

    Full Text Available From 1985 to 2013, the mean birth weight of infants in Japan decreased from 3120 g to 3000 g, and the low-birth-weight rate among live births increased from 6.3% to 9.6%. No prospective study has elucidated the risk factors for poor fetal growth and preterm birth in recent Japanese parents, such as increased parental age, maternal body figure, assisted reproductive technology (ART, and socioeconomic status. Participants were mother–infant pairs (n = 18,059 enrolled in a prospective birth cohort in Hokkaido, Japan from 2002 to 2013. Parental characteristics were obtained via self-reported questionnaires during pregnancy. Medical records helped identify very-low-birth-weight (VLBW; <1500g, term-small-for-gestational-age (term-SGA, and preterm-birth (PTB; <37 weeks infants. We calculated relative risks (RRs for PTB, VLBW, and term-SGA birth based on parental characteristics. The prevalence of PTB, VLBW, and term-SGA was 4.5%, 0.4%, and 6.5%, respectively. Aged parents and ART were risk factors for PTB and VLBW. Maternal alcohol drinking during pregnancy increased the risk; a parental educational level of ≥16 years reduced risk of term-SGA. Maternal pre-pregnancy BMI of <18.5 kg/m2 increased the risk of PTB and term-SGA. The RR for low BMI was highest among mothers who have low educational level. Among various factors, appropriate nutritional education to maintain normal BMI is important to prevent PTB and term-SGA in Japan.

  10. A fingerprint marker from early gestation associated with diabetes in middle age: The Dutch Hunger Winter Families Study

    Science.gov (United States)

    Kahn, Henry S; Graff, Mariaelisa; Stein, Aryeh D; Lumey, L H

    2009-01-01

    Background Fetal programming of diabetes might originate in early pregnancy when fingerprints are permanently established. The mean dermatoglyphic ridge count difference between fingertips 1 and 5 (‘Md15’) varies with the early prenatal environment. We hypothesized that Md15 would be associated with adult-onset diabetes. Methods We obtained Md15 from 577 Dutch adults (aged 58.9 years, SD 1.1) whose births in 1943–47 were documented in maternity records and from 260 of their same-sex siblings for whom birth weights were not available. Of these 837 participants, complete anthropometry and diabetes status (from history or glucose tolerance test) were obtained for 819. Results After adjustment for age, sex, parental diabetes and adult anthropometry, fingerprint Md15 was associated with prevalent diabetes [odds ratio (OR) = 1.37 per 1 SD (95% confidence interval 1.02–1.84)]. This relationship held [OR = 1.40 (1.03–1.92)] for diabetic cases restricted to those recently diagnosed (within 7 years). In the birth series restricted to recently diagnosed cases, the mutually adjusted ORs were 1.34 (1.00–1.79) per SD of Md15 and 0.83 (0.62–1.10) per SD of birth weight. Further adjustments for maternal smoking, conception season or prenatal famine exposure in 1944–45 did not alter these estimates. Among 42 sibling pairs discordant for diabetes, the diabetic sibling had higher Md15 by 3.5 (0.6–6.3) after multivariable adjustment. Conclusions Diabetes diagnosed at age 50+ years was associated with a fingerprint marker established in early gestation, irrespective of birth weight. Fingerprints may provide a useful tool to investigate prenatal developmental plasticity. PMID:18684786

  11. Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery.

    Science.gov (United States)

    Lee, Yeri; Kim, Hyun-Joo; Choi, Suk-Joo; Oh, Soo-Young; Kim, Jung-Sun; Roh, Cheong-Rae; Kim, Jong-Hwa

    2015-03-01

    To test if there is a stepwise difference in neonatal outcomes according to the stage (or grade) of histological inflammatory response in the chorioamniotic membranes and umbilical cords of preterm premature rupture of membranes (PPROM). This retrospective study included singleton pregnancies diagnosed as PPROM and delivered prior to 34 weeks of gestation (n=339). Acute histological chorioamnionitis and funisitis were subdivided into stages (or grade) as defined by Redline et al. Neonatal composite morbidities and mortality were also monitored. Univariate and multivariate analyses were conducted. Increasing stage (or grade) of acute histological chorioamnionitis and funisitis was significantly associated with an earlier gestational age at membrane rupture and delivery. Among neonatal outcomes, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, retinopathy of prematurity, and composite morbidity showed incremental incidence according to increased stage (or grade) of acute chorioamnionitis, while periventricular leukomalacia and necrotizing enterocolitis did not. Only RDS, BPD, and composite morbidity showed similar incremental incidences associated with severity of funisitis stage. However, the incremental trends of each neonatal outcome were found to be nonsignificant by multivariate analysis adjusting confounding variables including gestational age at delivery. Higher incidences of neonatal morbidity according to increased stage (or grade) of either acute histological chorioamnionitis or funisitis were due to an earlier gestational age at delivery.

  12. Gestational diabetes

    OpenAIRE

    Dragoš, Andreja

    2014-01-01

    Gestational diabetes is diabetes that occurs for the first time during pregnancy. In Slovenia, between 2.8 and 4.5 percent of pregnant women are affected by this disease. The number of women with gestational diabetes is increasing due to unhealthy lifestyle and most of all due to increasing occurrence of obesity. Gestational diabetes is a growing problem in Slovenia, as well as in the world. The purpose of the thesis is to establish the main risk factors for gestational diabetes and determ...

  13. Effect of Macrophage Migration Inhibitory Factor (MIF) in Human Placental Explants Infected with Toxoplasma gondii Depends on Gestational Age

    Science.gov (United States)

    de Oliveira Gomes, Angelica; de Oliveira Silva, Deise Aparecida; Silva, Neide Maria; de Freitas Barbosa, Bellisa; Franco, Priscila Silva; Angeloni, Mariana Bodini; Fermino, Marise Lopes; Roque-Barreira, Maria Cristina; Bechi, Nicoletta; Paulesu, Luana Ricci; dos Santos, Maria Célia; Mineo, José Roberto; Ferro, Eloisa Amália Vieira

    2011-01-01

    Because macrophage migration inhibitory factor (MIF) is a key cytokine in pregnancy and has a role in inflammatory response and pathogen defense, the objective of the present study was to investigate the effects of MIF in first- and third-trimester human placental explants infected with Toxoplasma gondii. Explants were treated with recombinant MIF, IL-12, interferon-γ, transforming growth factor-β1, or IL-10, followed by infection with T. gondii RH strain tachyzoites. Supernatants of cultured explants were assessed for MIF production. Explants were processed for morphologic analysis, immunohistochemistry, and real-time PCR analysis. Comparison of infected and stimulated explants versus noninfected control explants demonstrated a significant increase in MIF release in first-trimester but not third-trimester explants. Tissue parasitism was higher in third- than in first-trimester explants. Moreover, T. gondii DNA content was lower in first-trimester explants treated with MIF compared with untreated explants. However, in third-trimester explants, MIF stimulus decreased T. gondii DNA content only at the highest concentration of the cytokine. In addition, high expression of MIF receptor was observed in first-trimester placental explants, whereas MIF receptor expression was low in third-trimester explants. In conclusion, MIF was up-regulated and demonstrated to be important for control of T. gondii infection in first-trimester explants, whereas lack of MIF up-regulation in third-trimester placentas may be involved in higher susceptibility to infection at this gestational age. PMID:21641401

  14. [Long-term outcome in context of intra uterine growth restriction and/or small for gestational age newborns].

    Science.gov (United States)

    Gascoin, G; Flamant, C

    2013-12-01

    To evaluate long-term outcome after history of intra-uterine growth restriction (IUGR) and/or birth small for gestational age (SGA). This systematic evidence review is based on Pubmed search, Cochrane library and experts recommendations. Neurodevelopmental evaluation at 2 years is lower in those infants, born premature or not. SGA is associated with a high risk of minor cognitive deficiencies, hyperactivity or attention deficit disorders at 5 years or scholar difficulties at 8 years. Those infants are at high risk of metabolic syndrome in adulthood. Most of them will catch up at 6 months for weight and 12 months for height. Even if IUGR is associated with high risk of bronchodysplasia, up to this day, the review of literature did not permit to evaluate respiratory outcome. Adults born SGA have good quality of live and normal professional insertion. One cohort study and more and more animal studies suggest potential trans generational effects. Infants born SGA and/or with history of IUGR are at high risk of minor cognitive deficiencies and scholar difficulties. They are also at high risk of metabolic syndrome in adulthood. However, prematurity seems to have a higher effect than IUGR and/or SGA on long-term outcomes. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Association between gestational age and birth weight on the language development of Brazilian children: a systematic review.

    Science.gov (United States)

    Zerbeto, Amanda B; Cortelo, Fernando M; C Filho, Élio B

    2015-01-01

    To review the literature that addresses the relationship between prematurity, birth weight, and development of language in Brazilian children. A systematic review of studies published between 2003 and 2012 in English and Portuguese and indexed in PubMed, LILACS, and SciELO. The following key words were used in the searches: Prematuro, Prematuridade, Linguagem, Prematurity, Language, Speech-Language Pathology. Fifty-seven articles were retrieved, 13 of which were included in the systematic review. The results showed an association between prematurity, low birth weight, and language development. In studies that made comparisons between preterm and term infants, there was evidence that preterm infants had poorer performance on indicators of language. It was also observed that children born with lower birth weight had a poorer performance on measures of language when compared to children with higher weight and closer to 37 weeks of gestational age. Regarding the type of language assessed, expression proved to be more impaired than reception. Higher parental education and family income were indicated as protective factors for the development of language. Conversely, lower birth weight and higher degree of prematurity emerged as risk factors. Preterm birth and low birth weight poses risks for the language development of children, especially in the first years of life. Therefore, it is essential that pediatricians are aware of the language development of these children to ensure proper treatment. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  16. Measurement of the transverse cerebellar diameter in preterm neonates and its use in assessment of gestational age.

    Science.gov (United States)

    Davies, M W; Swaminathan, M; Betheras, F R

    2001-08-01

    This study aims to confirm the relationship between gestational age (GA) and transverse cerebellar diameter (TCD), to define the prediction of GA by TCD, and assess the reliability of TCD measurements. Infants were included in the study if they had a routine cranial ultrasound scan by day 3, and the TCD was measured. Infants were excluded from the study if the GA was not known, if there was any cranio-spinal malformation or grade 3 or 4 intraventricular haemorrhage (IVH). The GA assessment was an early pregnancy scan or certain dates. Cranial ultrasound scans were done with a LOGIQ 500 scanner (GE Medical Systems, Waukesha, WI, USA) with a 7 MHz curvilinear sector probe (GE LOGIQ-C721; GE Medical Systems). The posterior fossa was scanned using the asterion as the acoustic window with the TCD measured in the coronal plane. Intra- and interobserver reliability were assessed. A total of 221 infants of known GA had their TCD measured. The linear regression for GA versus TCD is: GA(weeks) = (0.470 x TCD(millimetres)) + 13.162 (r = 0.89, r(2) = 0.79, P < 0.001). The 95% confidence interval predicts GA to +/- 2.33 weeks for a given TCD. Intra- and interobserver intraclass correlation coefficients are 0.98 and 0.99, respectively. Transverse cerebellar diameter correlates closely with GA and predicts GA to +/- 2.33 weeks. Measurements of TCD have excellent reproducibility.

  17. 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.

    Science.gov (United States)

    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 gestational age). Between March 2006 and April 2007, project midwives visited daily three government hospitals in Lima, Peru and identified cases and matched controls based on hospital, gestational age, and inter-gestational period. Mothers were interviewed and clinical chart extractions were completed. Factors associated with risk of SGA were assessed by their adjusted odds ratios (aOR) from conditional logistic regression. Exposure to an overlap of breastfeeding during late pregnancy was not associated with an increased risk of having a SGA newborn [aOR=0.58, 95% confidence interval (CI): 0.10-3.30]. However, increased risk was associated with having a previous low-birthweight birth (aOR=6.53; 95% CI: 1.43-29.70) and a low intake of animal source foods (<25th percentile; aOR=2.26; 95% CI: 1.01-5.04), and tended to be associated with being short (<150 cm; aOR=2.05; 95% CI: 0.92-4.54). This study found no evidence to support the hypothesis that breastfeeding during late pregnancy increases the risk for SGA; however, studies with greater statistical power are needed to definitively examine this possible association and clarify whether there are other risks to the new baby, the toddler and the pregnant woman. © 2012 Blackwell Publishing Ltd.

  18. [Blood lactate measurments as a diagnostic and prognostic tool after birth asphyxia in newborn infants with gestational age > or = 34 gestational weeks].

    Science.gov (United States)

    Varkilova, L; Slancheva, B; Emilova, Z; Nikolov, A; Metodieva, V; Hitrova, S; Doicheva, E

    2013-01-01

    Blood lactate at birth as result of activated anaerobic glycolysis is a marker of perinatal asphyxia. To evaluate the dynamics of blood lactate, pH and base excess (BE) as a tool for assessing the severity of fetal hypoxia and predicting neonatal outcome. 79 neonates (> or = 34 gestational weeks) were included and followed up until discharge: 43 with pathologic fetal hearth rate patterns and/or 1-minute Apgar score asphyxia group"); 36 without obstetric or clinical signs of asphyxia (control group). Samples from umbilical artery (u.a.), capillary blood at 2h and 12-24 h after birth were analyzed for blood lactate, pH and BE. Lactate value (u.a.) was significantly higher (5.3 +/- 3.4 mmol/l), pH and BE were lower (7.29 +/- 0.05 and -14.1 +/- 5.9 mmol/l) in the "asphyxia group" compared to the control group (2.7 +/- 1.2 mmol/l, 7.29 +/- 0.05 and -5.9 +/- 3.3 respectively). The 2 h lactate-values increased significantly in infants with asphyxia (6,.7 +/- 4.7) compared to the controls (3.2 +/- 1.1), the 12-24 h values were reduced in the main group (4.6 +/- 1.5) and without changes in the controls (3.2 +/- 0.88). Values of pH and BE at 2 h and 12-24 h increased progressively in both groups without significant differences between them. Hypoxic-ischemic encephalopathy (HIE) stage II-III was observed in infants with u.a. pH asphyxia. Increasing lactate concentration after birth is better predictor of severe HIE.

  19. SPECT of aged backache patients

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Shigehiko; Nishikimi, Junzo; Mizuno, Naokado; Watanabe, Kentaro; Kondo, Masaki; Ozaki, Satoshi; Urasaki, Tetsuya; Muro, Toshiyuki [Prefectural Tajimi Hospital, Gifu (Japan)

    1995-12-01

    Single photon emission computed tomography (SPECT) using {sup 99m}Tc-HMDP was performed on 53 middle-aged or elderly patients (male 20, female, 33; age range, 40-80 years old) with lumbago, i.e., 25 patients with lumbar spondylosis, 15 with lumbar degenerative spondylolisthesis, 4 with spondylolytic spondylolisthesis, 3 with compression fracture, 3 with pulurent spondylitis, 2 with spondylous osteoporosis, and 1 with spinal osteodesmosis. {sup 99m}Tc-HMDP (740 MBq) was intravenously injected and regular SPECT was performed at 3 hours. Gamma camera was performed for about 10 seconds with 5deg intervals, and 36 steps (180deg) of collection was completed after about 6 minutes. The radioisotope accumulation, the presence or absence of sthenia, and its site were evaluated. Forty-seven (88.7%) patients showed excessive accumulation, i.e., 40 (75.5%) in peripheral vertebral osteophyte, 31 (58.5%) in vertebral articulations, and 10 (18.9%) in whole vertebral body. Significantly increased bilateral excessive accumulation was admitted in the vertebral articulations of sliding disc in degenerative spondylolisthesis. SPECT is considered useful in understanding the pathophysiology of degenerative lumber diseases. (S.Y.).

  20. Effect of maternal age and growth on placental nutrient transport: potential mechanisms for teenagers' predisposition to small-for-gestational-age birth?

    Science.gov (United States)

    Hayward, Christina E; Greenwood, Susan L; Sibley, Colin P; Baker, Philip N; Challis, John R G; Jones, Rebecca L

    2012-01-15

    Teenagers have an increased risk of delivering small-for-gestational-age (SGA) infants. Young maternal age and continued skeletal growth have been implicated as causal factors. In growing adolescent sheep, impaired placental development and nutrient transfer cause reduced birth weight. In human pregnancies, SGA is associated with reduced placental amino acid transport. Maternal growth has no effect on placental morphology or cell turnover, but growing teenagers have higher birth weight:placental weight ratios than nongrowing teenagers. We hypothesized that placental nutrient transporter activity would be affected by maternal age and/or growth status. Placentas from teenagers and adults were collected. Teenagers were defined as growing or nongrowing based on knee height measurements. System A amino acid transporter activity was quantified as sodium-dependent uptake of [(14)C]methylaminoisobutyric acid into placental fragments. Teenagers had lower placental system A activity than adults (P teenagers, AGA and SGA infants had lower placental system A activity than AGA infants born to adults (P teenagers than in nongrowing teenagers (P teenagers than in adults (P teenagers. There was no difference in transporter protein expression/localization between cohorts. Teenagers have inherently reduced placental transport, which may underlie their susceptibility to delivering SGA infants. Growing teenagers appear to overcome this susceptibility by stimulating the activity, but not expression, of system A transporters.

  1. Maternal periconceptional and gestational low protein diet affects mouse offspring growth, cardiovascular and adipose phenotype at 1 year of age.

    Directory of Open Access Journals (Sweden)

    Adam J Watkins

    Full Text Available Human and animal studies have revealed a strong association between periconceptional environmental factors, such as poor maternal diet, and an increased propensity for cardiovascular and metabolic disease in adult offspring. Previously, we reported cardiovascular and physiological effects of maternal low protein diet (LPD fed during discrete periods of periconceptional development on 6-month-old mouse offspring. Here, we extend the analysis in 1 year aging offspring, evaluating mechanisms regulating growth and adiposity. Isocaloric LPD (9% casein or normal protein diet (18% casein; NPD was fed to female MF-1 mice either exclusively during oocyte maturation (for 3.5 days prior to mating; Egg-LPD, Egg-NPD, respectively, throughout gestation (LPD, NPD or exclusively during preimplantation development (for 3.5 days post mating; Emb-LPD. LPD and Emb-LPD female offspring were significantly lighter and heavier than NPD females respectively for up to 52 weeks. Egg-LPD, LPD and Emb-LPD offspring displayed significantly elevated systolic blood pressure at 52 weeks compared to respective controls (Egg-NPD, NPD. LPD females had significantly reduced inguinal and retroperitoneal fat pad: body weight ratios compared to NPD females. Expression of the insulin receptor (Insr and insulin-like growth factor I receptor (Igf1r in retroperitoneal fat was significantly elevated in Emb-LPD females (P<0.05, whilst Emb-LPD males displayed significantly decreased expression of the mitochondrial uncoupling protein 1 (Ucp1 gene compared to NPD offspring. LPD females displayed significantly increased expression of Ucp1 in interscapular brown adipose tissue when compared to NPD offspring. Our results demonstrate that aging offspring body weight, cardiovascular and adiposity homeostasis can be programmed by maternal periconceptional nutrition. These adverse outcomes further exemplify the criticality of dietary behaviour around the time of conception on long-term offspring

  2. The effect of a sonographic estimated fetal weight on the risk of cesarean delivery in macrosomic and small for gestational-age infants.

    Science.gov (United States)

    Matthews, Kathy C; Williamson, John; Gupta, Simi; Lam-Rachlin, Jennifer; Saltzman, Daniel H; Rebarber, Andrei; Fox, Nathan S

    2017-05-01

    To assess the association of a sonographic estimated fetal weight (sonoEFW) with the risk of cesarean delivery in women with macrosomic or small for gestational age (SGA) infants. Retrospective cohort of singleton deliveries >24 weeks by one MFM practice from 2005 to 2014. We included all patients who delivered an infant with macrosomia (birth weight ≥4000 g) or SGA (birth weight cesarean delivery between patients who did and did not have a sonoEFW within four weeks of delivery. Regression analysis was performed to control for any differences in baseline characteristics. In patients with macrosomic infants (n = 352), the risk of cesarean delivery was significantly higher in the sonoEFW group (45.3% versus 17.6%, aOR 2.144, 95% CI: 1.06-4.34). When we restricted the analysis to the subgroup of 265 patients who attempted vaginal delivery, our results were similar (22.3% versus 9.1%, aOR 2.73, 95% CI: 1.15-6.48). In patients with an SGA infant (n = 614), the risk of cesarean delivery was not higher in the sonoEFW group (37.4% versus 24.1%, aOR 1.23, 95% CI: 0.80-2.07), nor in those who attempted vaginal delivery (19.8% versus 13.7%, aOR 1.17, 95% CI: 0.62-2.21). A sonoEFW prior to delivery is independently associated with cesarean delivery in women with macrosomic infants, but not those with SGA infants. This should be considered when deciding to obtain a sonoEFW at the end of pregnancy, particularly if not for an accepted indication.

  3. Cerebral MRI findings in very-low-birth-weight and small-for-gestational-age children at 15 years of age

    Energy Technology Data Exchange (ETDEWEB)

    Skranes, Jon S.; Brubakk, Ann-Mari [Norwegian University of Science and Technology, Department of Laboratory Medicine, Children' s and Women' s Health, Trondheim (Norway); Martinussen, Marit; Smevik, Olaug; Myhr, Gunnar [Norwegian University of Science and Technology, Department of Circulation and Imaging, Trondheim (Norway); Indredavik, Marit [Norwegian University of Science and Technology, Department of Neuroscience, Trondheim (Norway); Vik, Torstein [Norwegian University of Science and Technology, Department of Community Medicine and General Practice, Trondheim (Norway)

    2005-08-01

    A high prevalence of abnormal cerebral MRI findings has been reported in low-birth-weight children. To compare MRI findings in very-low-birth-weight (VLBW) and term small-for-gestational-age (SGA) children with controls in early adolescence. Cerebral MRI was used to examine 55 VLBW, 54 SGA and 66 controls at 15 years of age. The MR images were qualitatively assessed, and size of ventricles, white-matter and grey-matter abnormalities were reported. The VLBW teenagers had a higher prevalence of various MRI abnormalities than SGA children and controls. Dilation of the ventricular system, especially of the occipital horns, was found in 82% of the VLBW group, in 19% of the SGA group and in 21% of controls. White-matter reduction was found in 53% of the VLBW, in 6% of the SGA and in 2% of controls. Corpus callosum thinning was found in 47% of the VLBW, in 2% of the SGA and in 6% of controls. Periventricular gliosis was found in 29% of the VLBW, in 4% of the SGA and in 8% of controls. Cerebral MRI pathology in white matter is a common finding in VLBW teenagers. The findings may indicate minor perinatal PVL with resulting loss of white-matter tissue and ventricular dilation. (orig.)

  4. Cerebral MRI findings in very-low-birth-weight and small-for-gestational-age children at 15 years of age

    International Nuclear Information System (INIS)

    Skranes, Jon S.; Brubakk, Ann-Mari; Martinussen, Marit; Smevik, Olaug; Myhr, Gunnar; Indredavik, Marit; Vik, Torstein

    2005-01-01

    A high prevalence of abnormal cerebral MRI findings has been reported in low-birth-weight children. To compare MRI findings in very-low-birth-weight (VLBW) and term small-for-gestational-age (SGA) children with controls in early adolescence. Cerebral MRI was used to examine 55 VLBW, 54 SGA and 66 controls at 15 years of age. The MR images were qualitatively assessed, and size of ventricles, white-matter and grey-matter abnormalities were reported. The VLBW teenagers had a higher prevalence of various MRI abnormalities than SGA children and controls. Dilation of the ventricular system, especially of the occipital horns, was found in 82% of the VLBW group, in 19% of the SGA group and in 21% of controls. White-matter reduction was found in 53% of the VLBW, in 6% of the SGA and in 2% of controls. Corpus callosum thinning was found in 47% of the VLBW, in 2% of the SGA and in 6% of controls. Periventricular gliosis was found in 29% of the VLBW, in 4% of the SGA and in 8% of controls. Cerebral MRI pathology in white matter is a common finding in VLBW teenagers. The findings may indicate minor perinatal PVL with resulting loss of white-matter tissue and ventricular dilation. (orig.)

  5. Psychomotor and intellectual development (Neurocognitive Function) of children born small for gestational age (SGA). Transversal and longitudinal study.

    Science.gov (United States)

    Puga, Beatriz; Puga, Paloma Gil; de Arriba, Antonio; Armendariz, Yolanda; Labarta, Jose I; Longas, Angel Ferrandez

    2009-02-01

    Although much is now known about the effects of intrauterine growth retardation (IUGR) on children born SGA with regard to anthropometric and biochemical parameters and their treatment, there are still many gaps associated with its impact on neurocognitive functions. In our experience published several years ago, IUGR has a negative effect on neurocognitive development, regardless of whether these children showed evidence of catch-up growth or not or of the socio-economic conditions that might contribute to the situation. We have now accumulated a large number of cases, many of whom have been followed longitudinally, some for up to 7 years, many having been treated with GH from the time when this therapy was first approved by the EMA. Apart from the cases mentioned, other confounding factors such as gestational age, Apgar score, neonatal comorbidity and the possible effects of GH treatment have also been included. In addition and using our own reference standards, we now present our experience, which confirms what we had already noted in the past, that IUGR is in itself a condition that often causes psychomotorintellectual impairment, may be extremely severe and tends to worsen. This negative impact of IUGR on neurocognitive development does not depend on how the child grows,spontaneous growth is better and when growth is not altered by GH therapy. Later studies will be able to confirm whether early treatment with GH throughout the 2nd year of life, or an early specific stimulation programme, or the sum of both, can improve the neurocognitive development of these children. IUGR prevention, acting on causal factors that are partly avoidable such as smoking, working conditions and stress during pregnancy (see the corresponding article in this supplement) proves once again to be the best way to stop this negative impact on the IQ of many children born SGA.

  6. The joint influence of marital status, interpregnancy interval, and neighborhood on small for gestational age birth: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Wu Yuquan

    2008-02-01

    Full Text Available Abstract Background Interpregnancy interval (IPI, marital status, and neighborhood are independently associated with birth outcomes. The joint contribution of these exposures has not been evaluated. We tested for effect modification between IPI and marriage, controlling for neighborhood. Methods We analyzed a cohort of 98,330 live births in Montréal, Canada from 1997–2001 to assess IPI and marital status in relation to small for gestational age (SGA birth. Births were categorized as subsequent-born with short (intermediate (12–35 months, or long (36+ months IPI, or as firstborn. The data had a 2-level hierarchical structure, with births nested in 49 neighborhoods. We used multilevel logistic regression to obtain adjusted effect estimates. Results Marital status modified the association between IPI and SGA birth. Being unmarried relative to married was associated with SGA birth for all IPI categories, particularly for subsequent births with short (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31–1.95 and intermediate (OR 1.48, 95% CI 1.26–1.74 IPIs. Subsequent births had a lower likelihood of SGA birth than firstborns. Intermediate IPIs were more protective for married (OR 0.50, 95% CI 0.47–0.54 than unmarried mothers (OR 0.65, 95% CI 0.56–0.76. Conclusion Being unmarried increases the likelihood of SGA birth as the IPI shortens, and the protective effect of intermediate IPIs is reduced in unmarried mothers. Marital status should be considered in recommending particular IPIs as an intervention to improve birth outcomes.

  7. Electroencephalographic activity in response to procedural pain in preterm infants born at 28 and 33 weeks gestational age.

    Science.gov (United States)

    Maimon, Neta; Grunau, Ruth E; Cepeda, Ivan L; Friger, Michael; Selnovik, Leonel; Gilat, Shlomo; Shany, Eilon

    2013-12-01

    Preterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit. Three groups of preterm infants were compared: set 1: group 1 (n=24), born and tested at 28 weeks GA; group 2 (n=22), born at 28 weeks GA and tested at 33 weeks; set 2: group 3 (n=25), born and tested at 33 weeks GA. EEG power was calculated for 30-second artifact-free periods, in standard frequency bandwidths, in 3 phases (baseline, up to 5 min after heel lance, 10 min after heel lance). No significant differences were found in right-left frontal asymmetry, or in ipsilateral or contralateral somatosensory response, across phases. In contrast, the Behavioral Indicators of Infant Pain scores changed across phase (PPain scores (P=0.039). There are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy.

  8. Effect of gestational age and blood glucose on C-peptide excretion rate and clearance in neonates.

    Science.gov (United States)

    Salis, Emma R; Soelbeck, Mikkel K; Reith, David M; Wheeler, Benjamin J; Broadbent, Roland S; Medlicott, Natalie J

    2016-01-01

    The aim of this study was to measure urinary C-peptide concentrations, and then calculate C-peptide clearance (Cl), and excretion rate (UER) in neonates. In addition, the effect of gestational age (GA) and blood glucose levels (BGL) on C-peptide UER were investigated. Insulin concentrations in plasma and C-peptide concentrations were measured in plasma and urine, in 20 neonates. Chemiluminescent immunoassays were used for insulin and C-peptide measurements, with urine diluted to 40% with bovine serum albumin 1% in phosphate buffered saline. Urine volume and time of collection were recorded and used to calculate UER and Cl. The mean Cl of C-peptide was 0.309 ± 0.329 mL/min/kg, and UER was 0.0329 ± 0.0342 pmol/min/kg. Correlations between Cl or UER and GA were not significant (P > 0.05). No significant correlation was shown between Cl or UER and BGL (P > 0.05). Both Cl and UER were highly variable in neonates, but were not correlated with GA. Additionally, BGL did not appear to affect C-peptide UER and Cl. As GA and BGL did not appear to affect Cl and UER, urinary C-peptide may provide a non-invasive method of measuring insulin production in neonates. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  9. Previous cesarean section, gestational age at first delivery and subsequent risk of pre-eclampsia in obese mothers.

    Science.gov (United States)

    Mbah, Alfred K; Sharma, Puza P; Alio, Amina P; Fombo, Doris W; Bruder, Karen; Salihu, Hamisu M

    2012-05-01

    We examine the association between prior C-section and subsequent pre-eclampsia; and describe the effect of gestational age at prior C-section, and obesity status on this association. The study population included women with two subsequent singleton births in Missouri between 1998 and 2005. The risk for pre-eclampsia/eclampsia was assessed among women with and without prior cesarean delivery. The two groups were followed to their second pregnancy and the occurrence of pre-eclampsia was documented. Additionally, the history of pre-eclampsia, prior cesarean at preterm, and obesity status were examined for their differential effects on the risk of pre-eclamsia. Women with prior C-section were 28% more likely to have pre-eclampsia in their subsequent pregnancy [OR = 1.28; 95% CI = 1.20-1.37]. However, this result was not significant when women with pre-eclampsia in their first pregnancy were excluded. After this exclusion, a more than threefold increased risk for subsequent pre-eclampsia was observed in women with prior early C-section [OR = 3.15; 95% CI= 2.43-4.08], while the level of risk did not change in the prior late C-section group [OR = 0.90; 95% CI= 0.82-1.00]. Subgroup analysis suggested that obesity status modified the risk of prior early C-section but did not affect the risk for prior late C-section. Preterm C-section in the first pregnancy may be associated with subsequent pre-eclampsia regardless of prior pre-eclampsia status.

  10. Novel Interpretation of Molecular Diagnosis of Congenital Toxoplasmosis According to Gestational Age at the Time of Maternal Infection

    Science.gov (United States)

    Sterkers, Yvon; Pratlong, Francine; Albaba, Sahar; Loubersac, Julie; Picot, Marie-Christine; Pretet, Vanessa; Issert, Eric; Boulot, Pierre

    2012-01-01

    From a prospective cohort of 344 women who seroconverted for toxoplasmosis during pregnancy, 344 amniotic fluid, 264 placenta, and 216 cord blood samples were tested for diagnosis of congenital toxoplasmosis using the same PCR assay. The sensitivity and negative predictive value of the PCR assay using amniotic fluid were 86.3% and 97.2%, respectively, and both specificity and positive predictive value were 100%. Using placenta and cord blood, sensitivities were 79.5% and 21.2%, and specificities were 92% and 100%, respectively. In addition, the calculation of pretest and posttest probabilities and the use of logistic regression allowed us to obtain curves that give a dynamic interpretation of the risk of congenital toxoplasmosis according to gestational age at maternal infection, as represented by the three sample types (amniotic fluid, placenta, and cord blood). Two examples are cited here: for a maternal infection at 25 weeks of amenorrhea, a negative result of prenatal diagnosis allowed estimation of the probability of congenital toxoplasmosis at 5% instead of an a priori (pretest) risk estimate of 33%. For an infection at 10 weeks of amenorrhea associated with a pretest congenital toxoplasmosis risk of 7%, a positive PCR result using placenta at birth yields a risk increase to 43%, while a negative result damps down the risk to 0.02%. Thus, with a molecular diagnosis performing at a high level, and in spite of the persistence of false negatives, posttest risk curves using both negative and positive results prove highly informative, allowing a better assessment of the actual risk of congenital toxoplasmosis and finally an improved decision guide to treatment. PMID:23035201

  11. Ultrasonographic study of deep portion of diencephalo-telencephalic vesicle for the determination of gestational age of the canine foetus.

    Science.gov (United States)

    Beccaglia, M; Faustini, M; Luvoni, G C

    2008-06-01

    The aim of this study was to evaluate the accuracy of ultrasonographic measurement of the deep portion of diencephalo-telencephalic vesicle (DPTV) in the prediction of delivery date in different size bitches. The effects of litter size and foetal sex ratio on the accuracy were also investigated. For this purpose, the growth curve of DPTV was derived in large size dogs (26-40 kg) and the results of the accuracy of the prediction were compared with those obtained in small (dogs by the application of the equations derived from the growth curve previously described. Ultrasonographic examinations were performed once a week during the second half of pregnancy in seven large size bitches (26-40 kg body weight). A linear regression model was adopted to analyse the relationship between the DPTV mean values and the days remaining to parturition. The results of regression analysis indicated that DPTV measurement in large size dogs is significantly and linearly related to the gestational age. Ultrasonographic measurements of DPTV were also performed during pregnancy in different size bitches with unknown breeding dates. Although the results indicated a similar accuracy of the prediction of the date of parturition in the different sizes of bitches, a higher accuracy was obtained in normal and large litter size compared with small litters. Foetal sex ratio did not affect the accuracy. In conclusion, this study demonstrated that the accuracy of the prediction of parturition day obtained by ultrasonographic evaluation of DPTV growth is reliable when specific formulae for different size dogs are applied. It should be noted that although foetal sex ratio does not affect the accuracy, the prediction could be less accurate when a small litter is present.

  12. Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Erika Aaron

    2012-01-01

    Full Text Available Objectives. To determine rate and factors associated with small-for-gestational-age (SGA births to women with HIV. Methods. Prospective data were collected from 183 pregnant women with HIV in an urban HIV prenatal clinic, 2000–2011. An SGA birth was defined as less than the 10th or 3rd percentile of birth weight distribution based upon cut points developed using national vital record data. Bivariate analysis utilized chi-squared and t-tests, and multiple logistic regression analyses were used. Results. The prevalence of SGA was 31.2% at the 10th and 12.6% at the 3rd percentile. SGA at the 10th (OR 2.77; 95% CI, 1.28–5.97 and 3rd (OR 3.64; 95% CI, 1.12–11.76 percentiles was associated with cigarette smoking. Women with CD4 count >200 cells/mm3 at the first prenatal visit were less likely to have an SGA birth at the 3rd percentile (OR 0.29; 95% CI, 0.10–0.86. Women taking NNRTI were less likely to have an SGA infant at the 10th (OR 0.28; 95% CI, 0.10–0.75 and 3rd (OR 0.16; 95% CI, 0.03–0.91 percentiles compared to those women on PIs. Conclusions. In this cohort with high rates of SGA, severity of HIV disease, not ART, was associated with SGA births after adjusting for sociodemographic, medication, and disease severity.

  13. Patient information comes of age.

    Science.gov (United States)

    Murphy, Jeannette

    2017-12-01

    This virtual issue (VI) has been assembled to coincide with the 8th Annual Patient Information Conference 2013 organised by the UK Patient Information Forum (PiF). The conference theme 'Information and support - a service in its own right' is a response to policy documents and initiatives in both Scotland and England which signal the coming of age of patient/consumer information. The VI consists of a collection of open access articles and addresses the question 'What can health science librarians do to ensure that the public are able to find, appraise and use health information?' This material provides research evidence, and examples of the types of initiatives librarians have undertaken to make information a health and care service in its own right. Two recurrent messages are that health science librarians need to form partnerships with healthcare providers and they have a role to play in improving health literacy skills. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

  14. The relationship between maternal insulin-like growth factors 1 and 2 (IGF-1, IGF-2) and IGFBP-3 to gestational age and preterm delivery.

    LENUS (Irish Health Repository)

    Cooley, Sharon M

    2012-02-01

    AIMS: To investigate the relationship between levels of insulin-like growth factors 1 and 2 (IGF-1, IGF-2), and insulin-like growth factor binding protein 3 (IGFBP-3) in antenatal maternal serum and gestational age at delivery. METHODS: Prospective cohort study of 1650 low-risk Caucasian women in a London University teaching hospital. Maternal IGF-1, IGF-2 and IGFBP-3 were measured in maternal blood at booking and analyzed with respect to gestational age at delivery. RESULTS: There was no significant association between maternal IGF-1 or IGF-2 and preterm birth (PTB). A significant reduction in mean IGFBP-3 levels was noted with delivery <32 completed weeks (P=0.02). CONCLUSION: Maternal mean IGFBP-3 levels are significantly reduced in cases complicated by delivery <32 completed weeks.

  15. [Relationship of plasma ghrelin, IGF-1 and insulin with the growth and development of 2 -7 year-old children with small for gestational age at birth].

    Science.gov (United States)

    Cheng, Yaying; Song, Guangyao; Zhou, Lixia; Cai, Baoping; Zhao, Xiumian; Yin, Jianying

    2012-01-01

    To explore the relationship of Ghrelin, insulin-like growth factor-1 (IGF-1) and insulin with the growth and development of 2 -7 year-old children with small for gestational age (SGA) at birth. The levels of ghrelin, IGF-1, IGFBP-3, insulin and glucose were measured in the children with preterm SGA and term SGA and compared with the children with preterm appropriate for gestational age (AGA) and term AGA. The correlation of ghrelin with IGF-1, IGFBP-3 and insulin was analyzed. Plasma ghrelin in preterm SGA was higher than that in term SGA (P 0.05). Plasma ghrelin in preterm AGA and term SGA was higher than that in term AGA (P development of preterm and SGA children, regardless of the magnitude of their catch up growth. As a re-regulatory factor to insulin, ghrelin regulates the energy metabolism in a form of negative feedback.

  16. A prospective observational study of early fetal growth velocity and its association with birth weight, gestational age at delivery, preeclampsia, and perinatal mortality

    Energy Technology Data Exchange (ETDEWEB)

    Vasudeva, Akhila, E-mail: akhilavasudeva@gmail.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Abraham, Anu Annie, E-mail: anuannieabraham@yahoo.com [Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka State (India); Kamath, Asha, E-mail: aashakamat@gmail.com [Department of Community Medicine, Kasturba Medical College, Manipal, A Constituent College of Manipal University (India)

    2013-08-15

    Objectives: We aimed to measure early fetal growth velocity and to correlate this with the birth weight, gestational age at delivery, and with the incidence of adverse pregnancy outcomes specifically preeclampsia and perinatal mortality. Methods: A data based prospective observational study, wherein sonographic biometry data and specific pregnancy outcome related data were collected from pregnant women's records, starting soon after their first antenatal visit. Early fetal growth velocity was measured using BPD growth between 11 and 14 weeks scan and anomaly scan and standardizing this by Z scoring. Results: Out of 607 fetuses, 41 (6.7%) were slow growing, 531 (87.4%) normally growing, and 35 (5.7%) fast growing (Z scoring <10th{sup ,} 10–90th, and >90th percentiles respectively). As fetal growth velocity increased, the mean birth weight decreased from 2958.7 ± 388.9 (<10th centile), 2742.1 ± 576.6 (10–90th centile), to 2339.3 ± 729.4 (>90th centile); and gestational age at delivery decreased from 38.5 ± 1.3 (<10th centile), 37.5 ± 2.1 (10–90th centile), to 36.4 ± 2.2 (>90th centile), and both these trends were statistically significant (p < 0.001).Faster growing fetuses had a higher risk of preterm delivery(spontaneous + indicated) compared to other 2 groups [OR 4.42 (2.18,8.98)], and slower growing fetuses had a higher risk of postdated deliveries compared to other 2 groups [OR 3.042 (1.44, 6.45)].We found no significant association between early fetal growth velocity and incidence of small for gestational age at birth/low birth weight at term, preeclampsia, and perinatal mortality. Conclusions: Early fetal growth velocity between first and second trimesters, may be one of the important factors influencing ultimate birthweight and gestational age at delivery.

  17. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010

    DEFF Research Database (Denmark)

    Lee, Anne C C; Katz, Joanne; Blencowe, Hannah

    2013-01-01

    birthweight (population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from...... born in India, Pakistan, Nigeria, and Bangladesh. INTERPRETATION: The burden of small-for-gestational-age births is very high in countries of low and middle income and is concentrated in south Asia. Implementation of effective interventions for babies born too small or too soon is an urgent priority...

  18. Association between small for gestational age and low birth weight with attention deficit and impaired executive functions in 3-6 years old children.

    Science.gov (United States)

    Shariat, M; Gharaee, J; Dalili, H; Mohammadzadeh, Y; Ansari, Sh; Farahani, Z

    2017-12-03

    Behavioral disorders and attention deficit hyperactivity disorder (ADHD) symptoms are frequently reported among children with history of small body size at birth and disproportionate intrauterine growth retardation. The current study aimed to investigate some factors like executive functions and attention deficit in children with history of Small for gestational age (SGA) and/or Low Birth Weight (LBW) at birth. A historical cohort study was done and 3-6 years old preschool children (with past history of SGA/LBW) from some kindergartens and health centers were selected. Control group was randomly selected among children with history of normal birth weight and appropriate for gestational age at birth. All children were interviewed by an expert psychologist. Variables related to their attention, development, and executive functions were assessed by ASQ, Conner's, and Wisconsin Card Sorting Test. Completed questionnaires related Attention deficit and indexes of executive functions were evaluated between children in case groups and their counterparts in controls. Based on inclusion criteria, 229 preschool children entered the study. With regard to size for gestational age, 124 cases were categorized in the SGA/LBW group and the rest were assigned in the appropriate for gestational age (AGA) group. In the case group, NPE and Percent Perseverative Errors (PPE) scores were significantly lower than normal birth weight group (p = .0001, p = .015). Scores related B item of Conner's was significantly different between cases and their controls (p = .039, p = .035). Our results indicated that children with past history of some risks at birth may suffer from complications related attention and executive functions in their childhood. Recommendations for further research are strongly suggested.

  19. Risks of Overweight and Abdominal Obesity at Age 16 Years Associated With Prenatal Exposures to Maternal Prepregnancy Overweight and Gestational Diabetes Mellitus

    OpenAIRE

    Pirkola, Jatta; Pouta, Anneli; Bloigu, Aini; Hartikainen, Anna-Liisa; Laitinen, Jaana; Järvelin, Marjo-Riitta; Vääräsmäki, Marja

    2010-01-01

    OBJECTIVE The associations of prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus (GDM) with offspring overweight are controversial. Research estimating risk for offspring overweight due to these exposures, separately and concomitantly, is limited. RESEARCH DESIGN AND METHODS Prevalence of overweight and abdominal obesity at age 16 years and odds ratios (ORs) for prenatal exposures to maternal prepregnancy overweight and GDM were estimated in participants ...

  20. Metals exposure and risk of small-for-gestational age birth in a Canadian birth cohort: The MIREC study

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Shari [Department of Public Health Sciences, Queen’s University, Kingston, Ontario (Canada); Arbuckle, Tye E., E-mail: Tye.Arbuckle@hc-sc.gc.ca [Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa (Canada); Fisher, Mandy [Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa (Canada); Fraser, William D. [Sainte Justine University Hospital Research Center, University of Montreal, Montreal (Canada); Ettinger, Adrienne [Center for Perinatal, Pediatric & Environmental Epidemiology, Yale School of Public Health, New Haven, CT (United States); King, Will [Department of Public Health Sciences, Queen’s University, Kingston, Ontario (Canada)

    2015-07-15

    Background: Lead, mercury, cadmium and arsenic are some of the most common toxic metals to which Canadians are exposed. The effect of exposure to current low levels of toxic metals on fetal growth restriction is unknown. Objective: The aim of this study was to examine relationships between exposure to lead, mercury, cadmium and arsenic during pregnancy, and risk of small for gestational age (SGA) birth. Methods: Lead, mercury, cadmium and arsenic levels were measured in blood samples from the first and third trimesters in 1835 pregnant women from across Canada. Arsenic species in first trimester urine were also assessed. Relative risks and 95% confidence intervals were estimated using log binomial multivariate regression. Important covariates including maternal age, parity, pre-pregnancy BMI, and smoking, were considered in the analysis. An exploratory analysis was performed to examine potential effect modification of these relationships by single nucleotide polymorphisms (SNPs) in GSTP1 and GSTO1 genes. Results: No association was found between blood lead, cadmium or arsenic and risk for SGA. We observed an increased risk for SGA for the highest compared to the lowest tertile of exposure for mercury (>1.6 µg/L, RR=1.56.; 95% CI=1.04–2.58) and arsenobetaine (>2.25 µg/L, RR=1.65; 95% CI=1.10–2.47) after adjustment for the effects of parity and smoking. A statistically significant interaction was observed in the relationship between dimethylarsinic acid (DMA) levels in urinary arsenic and SGA between strata of GSTO1 A104A (p for interaction=0.02). A marginally significant interaction was observed in the relationship between blood lead and SGA between strata of GSTP1 A114V (p for interaction=0.06). Conclusions: These results suggest a small increase in risk for SGA in infants born to women exposed to mercury and arsenic. Given the conflicting evidence in the literature this warrants further investigation in other pregnant populations. - Highlights: • Metals

  1. Metals exposure and risk of small-for-gestational age birth in a Canadian birth cohort: The MIREC study

    International Nuclear Information System (INIS)

    Thomas, Shari; Arbuckle, Tye E.; Fisher, Mandy; Fraser, William D.; Ettinger, Adrienne; King, Will

    2015-01-01

    Background: Lead, mercury, cadmium and arsenic are some of the most common toxic metals to which Canadians are exposed. The effect of exposure to current low levels of toxic metals on fetal growth restriction is unknown. Objective: The aim of this study was to examine relationships between exposure to lead, mercury, cadmium and arsenic during pregnancy, and risk of small for gestational age (SGA) birth. Methods: Lead, mercury, cadmium and arsenic levels were measured in blood samples from the first and third trimesters in 1835 pregnant women from across Canada. Arsenic species in first trimester urine were also assessed. Relative risks and 95% confidence intervals were estimated using log binomial multivariate regression. Important covariates including maternal age, parity, pre-pregnancy BMI, and smoking, were considered in the analysis. An exploratory analysis was performed to examine potential effect modification of these relationships by single nucleotide polymorphisms (SNPs) in GSTP1 and GSTO1 genes. Results: No association was found between blood lead, cadmium or arsenic and risk for SGA. We observed an increased risk for SGA for the highest compared to the lowest tertile of exposure for mercury (>1.6 µg/L, RR=1.56.; 95% CI=1.04–2.58) and arsenobetaine (>2.25 µg/L, RR=1.65; 95% CI=1.10–2.47) after adjustment for the effects of parity and smoking. A statistically significant interaction was observed in the relationship between dimethylarsinic acid (DMA) levels in urinary arsenic and SGA between strata of GSTO1 A104A (p for interaction=0.02). A marginally significant interaction was observed in the relationship between blood lead and SGA between strata of GSTP1 A114V (p for interaction=0.06). Conclusions: These results suggest a small increase in risk for SGA in infants born to women exposed to mercury and arsenic. Given the conflicting evidence in the literature this warrants further investigation in other pregnant populations. - Highlights: • Metals

  2. Gestational diabetes

    Science.gov (United States)

    ... right for you. Low-impact exercises, such as swimming, brisk walking, or using an elliptical machine are ... chap 45. Moyer VA; US Preventive Services Task Force. Screening for gestational diabetes mellitus: US Preventive Services ...

  3. Placental alkaline phosphatase activity and its relation to foetal growth and nutrition in appropriate and small for gestational age newborns at term.

    Science.gov (United States)

    Mosbah, Amira A Abd El-Rahman; Abd-Ellatif, Nahla A Bahgat; Sorour, Ehab Ibrahim; El-Halaby, Alaa F

    2011-12-01

    The placental alkaline phosphatase (PAP) activity progressively rises as pregnancy advances, possibly, because of its increasing synthesis by placental tissue. The present study examined the relationship between placental alkaline phosphatase activity and the biochemical indices of foetal nutrition (cord blood glucose, albumin) and growth (neonatal birth weight). Placental and umbilical cord blood samples were collected from 56 term deliveries 30 of them were appropriate for gestational age (AGA) and 26 were small for gestational age(SGA) and prepared for placental alkaline phosphatase assay, glucose and albumin estimations using standard procedures. The birth weights of the neonates at term were taken and recorded. Correlation analyses of the data obtained show significant positive relationships between PAP and cord blood glucose, albumin and birth weight in AGA newborn (r2 = 0.86, 0.71, 0.68 p<0.05) and (r2 = 0.69, 0.81, 0.73 p<0.05) in SGA newborn but no significant relationship with gestational age, also there was significant statistical difference between both groups in level of PAP, glucose and albumin.

  4. Conservative management of preterm premature rupture of membranes beyond 32 weeks' gestation: is it worthwhile?

    Science.gov (United States)

    Tsafrir, Z; Margolis, G; Cohen, Y; Cohen, A; Laskov, I; Levin, I; Mandel, D; Many, A

    2015-01-01

    We aimed to investigate whether conservative management of preterm premature rupture of membranes (PPROM) at 32-34 weeks' gestation improves outcome. In this retrospective analysis of singleton pregnancies, the study group included patients with PPROM at 28-34 weeks' gestation and the control group included patients presented with spontaneous preterm delivery at 28-34 weeks' gestation. Both groups were subdivided according to gestational age - early (28-31 weeks' gestation) versus late (32-34 weeks' gestation). Adverse neonatal outcome included neonatal death, intraventricular haemorrhage grade 3/4, respiratory distress syndrome, periventricular leucomalacia and neonatal sepsis. The study and control groups included 94 and 86 women, respectively. The study group had a lower incidence of adverse neonatal outcome at the earlier weeks (28-31), compared with the control group at the same gestational age. In contrast, at 32-34 weeks' gestation no difference in the risk for adverse neonatal outcome was noticed. Additionally, within the study group, chorioamnionitis rate was significantly higher among those who delivered at 32-34 weeks' gestation (p < 0.01). No advantage for conservative management of PPROM was demonstrated beyond 31 weeks' gestation. Moreover, conservative management of PPROM at 32-34 weeks' gestation may expose both mother and neonate to infectious morbidity.

  5. Variation in term birthweight across European countries affects the prevalence of small for gestational age among very preterm infants

    DEFF Research Database (Denmark)

    Zeitlin, Jennifer; Bonamy, Anna-Karin Edstedt; Piedvache, Aurelie

    2017-01-01

    's approach and Hadlock's foetal growth model, using national data on birthweights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011...

  6. Individual exposures to drinking water trihalomethanes, low birth weight and small for gestational age risk: a prospective Kaunas cohort study

    Science.gov (United States)

    2011-01-01

    Background Evidence for an association between exposure during pregnancy to trihalomethanes (THMs) in drinking water and impaired fetal growth is still inconsistent and inconclusive, in particular, for various exposure routes. We examined the relationship of individual exposures to THMs in drinking water on low birth weight (LBW), small for gestational age (SGA), and birth weight (BW) in singleton births. Methods We conducted a cohort study of 4,161 pregnant women in Kaunas (Lithuania), using individual information on drinking water, ingestion, showering and bathing, and uptake factors of THMs in blood, to estimate an internal dose of THM. We used regression analysis to evaluate the relationship between internal THM dose and birth outcomes, adjusting for family status, education, smoking, alcohol consumption, body mass index, blood pressure, ethnic group, previous preterm, infant gender, and birth year. Results The estimated internal dose of THMs ranged from 0.0025 to 2.40 mg/d. We found dose-response relationships for the entire pregnancy and trimester-specific THM and chloroform internal dose and risk for LBW and a reduction in BW. The adjusted odds ratio for third tertile vs. first tertile chloroform internal dose of entire pregnancy was 2.17, 95% CI 1.19-3.98 for LBW; the OR per every 0.1 μg/d increase in chloroform internal dose was 1.10, 95% CI 1.01-1.19. Chloroform internal dose was associated with a slightly increased risk of SGA (OR 1.19, 95% CI 0.87-1.63 and OR 1.22, 95% CI 0.89-1.68, respectively, for second and third tertile of third trimester); the risk increased by 4% per every 0.1 μg/d increase in chloroform internal dose (OR 1.04, 95% CI 1.00-1.09). Conclusions THM internal dose in pregnancy varies substantially across individuals, and depends on both water THM levels and water use habits. Increased internal dose may affect fetal growth. PMID:21501533

  7. Early postnatal alteration of body composition in preterm and small-for-gestational-age infants: implications of catch-up fat.

    Science.gov (United States)

    Okada, Tomoo; Takahashi, Shigeru; Nagano, Nobuhiko; Yoshikawa, Kayo; Usukura, Yukihiro; Hosono, Shigeharu

    2015-01-01

    The concept of the developmental origins of health and disease is based on studies by Barker et al. They proposed a hypothesis that undernutrition in utero permanently changes the body's structure, function, and metabolism in ways that lead to atherosclerosis and insulin resistance in later life. In addition, profound effects on the extent of body fatness and insulin sensitivity are demonstrated, if there is a "mismatch" between prenatal and postnatal environments. In previous studies, undernutrition in utero has been evaluated simply by birth weight itself or birth weight for gestational age, and the degree of mismatch has been estimated by postnatal rapid weight gain. Recently, we investigated subcutaneous fat accumulation in small-for-gestational-age infants and found that a rapid catch-up in skinfold thickness developed prior to the body weight catch-up. Furthermore, insulin-like growth factor-I and lipoprotein lipase mass concentrations also demonstrate rapid increase during the neonatal period with fat accumulation. Investigating the precise mechanisms of developmental origins of health and disease including mediating metabolic and hormonal factors may provide a new approach to prevent atherosclerosis and insulin resistance. Better management of undernutrition during gestation and neonatal growth during the early postnatal period is an important theme for future health.

  8. Association of Helicobacter pylori infection with serum vitamin B12 level in women of gestational age in Khorram Abad

    Directory of Open Access Journals (Sweden)

    fatemeh Yari

    2006-02-01

    Findings: There was no significant difference between mean age of HP positive and HP negative participants. 76 out of 110 (72.2% samples were HP positive. The rate of HP seropositivity was significantly higher in patients with serum vitamin B12 level less than 12 pg/ml. who had lower and moderate vitamin B12 levels (145-180 pg/ml, that is 94% vs 64.5%, P<0.013. Conclusion: High HP seropositivity rate among patients with low-normal less serum vitamin B12 levels than normal indicates that there may be an association between HP infection and serum vitamin B12 levels.

  9. Associations between high birth weight, being large for gestational age, and high blood pressure among adolescents: a cross-sectional study.

    Science.gov (United States)

    Kuciene, Renata; Dulskiene, Virginija; Medzioniene, Jurate

    2018-02-01

    Low birth weight and being small for gestational age are associated with increased risk of cardiometabolic diseases. However, the results from the studies examining the associations between high birth weight (HBW), being large for gestational age (LGA), and high blood pressure (HBP) are inconsistent. The aim of this study was to evaluate the associations between HBW and being LGA alone and in combinations with body mass index (BMI) categories in adolescence and HBP among Lithuanian adolescents aged 12-15 years. The participants with HBP (≥90th percentile) were screened on two separate occasions. Data on the BMI, birth weight (BW), gestational age, and BP were analyzed in 4598 adolescents. Adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models. The overall prevalence of HBW (>4000 g), being LGA, adolescent overweight/obesity, and HBP were 13.9, 10.4, 14.5, and 25.6%, respectively. After adjustment for age, sex, and BMI, significant positive associations were found between HBW and being LGA and HBP (HBW: aOR 1.34; 95% CI, 1.11-1.63; LGA: aOR 1.44; 95% CI, 1.16-1.79). After adjustment for age and sex and compared to BW 2500-4000 g and being AGA (appropriate for gestational age) with normal weight in adolescence, the combinations that included both risk factors-HBW with overweight/obesity and being LGA with overweight/obesity-showed higher aORs (aOR 4.36; 95% CI, 3.04-6.26; and aOR 5.03; 95% CI, 3.33-7.60, respectively) than those with either of these risk factors alone did. HBW and being LGA were positively associated with HBP in Lithuanian adolescents aged 12-15 years. The highest odds of having HBP were observed for subjects with both risk factors-neonatal HBW or being LGA and overweight/obesity in adolescence.

  10. Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants.

    Science.gov (United States)

    Wadhawan, R; Oh, W; Perritt, R; Laptook, A R; Poole, K; Wright, L L; Fanaroff, A A; Duara, S; Stoll, B J; Goldberg, R

    2007-06-01

    To examine the association between weight loss during the first 10 days of life and the incidence of death or bronchopulmonary dysplasia (BPD) in small for gestational age (SGA) and appropriate for gestational age (AGA) extremely low-birth-weight infants. This is a retrospective analysis of a cohort of ELBW (birth weight BPD, within each birth weight/gestation category (SGA or AGA). BPD and death were also analyzed separately in relation to EPWL. Logistic regression analysis was done to evaluate the risk of death or BPD in SGA and AGA groups, controlling for maternal and neonatal demographic and clinical factors found to be significant by univariate analysis. SGA ELBW infants had a lower prevalence of EPWL as compared with AGA ELBW infants (81.2 vs 93.7%, respectively, PBPD rate was lower in the group of infants with EPWL compared with infants without EPWL (53.4 vs 74.3%, respectively, PBPD (47.2 vs 64%, PBPD (OR 0.47, 95% CI: 0.37-0.60). In SGA infants, on univariate analysis, a similar association between EPWL and outcomes was seen as shown in AGA infants: death or BPD (55.9 vs 75.2%, PBPD rate (48.3 vs 62.1%, P=0.002) and rate death (19 vs 40.8%, PBPD (OR 0.60, 95% CI: 0.41-0.89) among SGA infants. SGA infants experienced less EPWL when compared with their AGA counterparts. EPWL was associated with a lower risk of death or BPD in both ELBW AGA and SGA infants. These data suggest that clinicians who consider the association between EPWL and risk of death or BPD should do so independent of gestation/birth weight status.

  11. The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register-based cohort study in Aberdeen, Scotland.

    Science.gov (United States)

    Woolner, A; Bhattacharya, S; Bhattacharya, Soh

    2014-02-01

    To determine whether termination of pregnancy (TOP), including the method used or gestational age at termination, affects future obstetric and perinatal outcomes. Register-based cohort. Aberdeen Maternity Hospital, Scotland, UK. From the Aberdeen Maternity and Neonatal Databank (AMND) we identified 3186 women who had terminated their first pregnancy and then had a second pregnancy of beyond 24 weeks of gestation between 1986 and 2010. We identified 42,446 women who had their first delivery in the same time period, for comparison. Univariate and multivariate logistic regression was used to compare outcomes between groups. Complete case analysis with adjustment of confounding factors was carried out, and adjusted odds ratios (aORs) with 99% confidence intervals are presented. The primary outcome was spontaneous preterm delivery (SPTD). No statistically significant association was found between TOP in the first pregnancy and SPTD in the next pregnancy (aOR 1.05; 99% CI 0.83-1.32). Neither medical (aOR 1.03; 99% CI 0.72-1.46) nor surgical (aOR 1.06; 99% CI 0.78-1.44) termination appeared to affect the risk of spontaneous preterm delivery in the subsequent pregnancy. Late termination (≥13 weeks of gestation) did not appear to increase the risk of spontaneous preterm delivery compared with early termination (obstetric and perinatal outcomes following TOP remains conflicting. This study suggests that TOP is not associated with an increased risk of spontaneous preterm delivery. Neither the method nor the gestational age of TOP has any effect on this lack of association. © 2013 Royal College of Obstetricians and Gynaecologists.

  12. Patient-provider communication about gestational weight gain among nulliparous women: a qualitative study of the views of obstetricians and first-time pregnant women.

    Science.gov (United States)

    Duthie, Elizabeth A; Drew, Elaine M; Flynn, Kathryn E

    2013-12-11

    In 2009 the Institute of Medicine updated its guidelines for weight gain during pregnancy, in part because women of childbearing age now weigh more pre-pregnancy and tend to gain more weight during pregnancy than women did when the previous set of guidelines were released in 1990. Women who begin pregnancy overweight or obese and women who gain weight outside IOM recommendations are at risk for poor maternal and fetal health outcomes. With these concerns in mind, we examined what obstetricians communicate about gestational weight gain to their pregnant patients and how nulliparous patients perceive weight-related counseling from their obstetricians. We conducted one-on-one, semi-structured interviews with 19 nulliparous women and 7 obstetricians recruited from a single clinic at a large academic medical center in the United States. Interviews were transcribed verbatim and analyzed inductively using thematic analysis. We identified 4 major themes: 1) Discussions about the amount and pace of gestational weight gain: obstetricians reported variation in the frequency and timing of weight-related discussions with patients while most patients said that weight was not emphasized by their obstetricians; 2) The content of communication about nutrition and physical activity: obstetricians said they discuss nutrition and activity with all patients while most patients reported that their obstetrician either discussed these topics in general terms or not at all; 3) Communication about postpartum weight loss: obstetricians said that they do not typically address postpartum weight loss with patients during prenatal visits while patients had concerns about postpartum weight; and 4) Patient feelings about obstetrician advice: most patients said that their obstetrician does not tend to offer "unsolicited advice", instead offering information in response to patient questions or concerns. Women were divided about whether they desired more advice from their obstetrician on weight gain

  13. Metabolomics of prematurity: analysis of patterns of amino acids, enzymes, and endocrine markers by categories of gestational age.

    Science.gov (United States)

    Wilson, Kumanan; Hawken, Steven; Ducharme, Robin; Potter, Beth K; Little, Julian; Thébaud, Bernard; Chakraborty, Pranesh

    2014-02-01

    Prematurity may influence the levels of amino acids, enzymes, and endocrine markers obtained through newborn screening. Identifying which analytes are the most affected by degree of prematurity could provide insight into how prematurity impacts metabolism. Analytes from blood spots assayed by Newborn Screening Ontario between March 2006 and April 2009 were used in this analysis. We examined the associations between the degree of prematurity and the levels of amino acids, enzymes, and endocrine markers in all newborns with and without adjustment for birth weight, feeding status, sample timing, transfusion, and sex. Our analysis included the following cohorts: 373,819 children born at term (>36 wk gestation), 26,483 near-term children (33-36 wk gestation), 4,354 very premature children (28-32 wk gestation), and 1,146 extremely premature children (prematurity, the levels of three amino acids (arginine, leucine, and valine) were at least 50% different between the cohorts of extremely premature and term children. The levels of 17-hydroxyprogesterone increased with increasing prematurity, while thyrotropin-stimulating hormone values consistently decreased with increasing prematurity. None of the three enzyme markers we examined showed a trend in levels across categories of prematurity. This study demonstrates that children at different stages of prematurity are metabolically distinct. Future research should focus on the mechanism by which specific analytes are influenced by prematurity.

  14. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.

    Science.gov (United States)

    Romero, Roberto; Conde-Agudelo, Agustin; Da Fonseca, Eduardo; O'Brien, John M; Cetingoz, Elcin; Creasy, George W; Hassan, Sonia S; Nicolaides, Kypros H

    2018-02-01

    The efficacy of vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix has been questioned after publication of the OPPTIMUM study. To determine whether vaginal progesterone prevents preterm birth and improves perinatal outcomes in asymptomatic women with a singleton gestation and a midtrimester sonographic short cervix. We searched MEDLINE, EMBASE, LILACS, and CINAHL (from their inception to September 2017); Cochrane databases; bibliographies; and conference proceedings for randomized controlled trials comparing vaginal progesterone vs placebo/no treatment in women with a singleton gestation and a midtrimester sonographic cervical length ≤25 mm. This was a systematic review and meta-analysis of individual patient data. The primary outcome was preterm birth preterm birth preterm birth preterm birth preterm birth and improves perinatal outcomes in singleton gestations with a midtrimester sonographic short cervix, without any demonstrable deleterious effects on childhood neurodevelopment. Published by Elsevier Inc.

  15. An investigative study into psychological and fertility sequelae of gestational trophoblastic disease: the impact on patients' perceived fertility, anxiety and depression.

    Directory of Open Access Journals (Sweden)

    Valentina E Di Mattei

    Full Text Available Gestational Trophoblastic Disease (GTD comprises a group of disorders that derive from the placenta. Even if full recovery is generally expected, women diagnosed with GTD have to confront: the loss of a pregnancy, a potentially life-threatening diagnosis and delays in future pregnancies. The aim of the study is to evaluate the psychological impact of GTD, focusing on perceived fertility, depression and anxiety.37 patients treated for GTD at San Raffaele Hospital, Milan, took part in the study. The STAI-Y (State-Trait Anxiety Inventory, the BDI-SF (Beck Depression Scale-Short Form and the FPI (Fertility Problem Inventory were used. Patients were grouped on the basis of presence of children (with or without, age (< or ≥35 and type of diagnosis (Hydatidiform Mole, HM, or Gestational Trophoblastic Neoplasia, GTN. Differences in the values between variables were assessed by a t-type test statistic. Three-way ANOVAs were also carried out considering the same block factors.The study highlights that women suffering from GTN had higher depression scores compared to women suffering from HM. A significant correlation was found between anxiety (state and trait and depression. Younger women presented higher Global Stress scores on the FPI, especially tied to Need for Parenthood and Relationship Concern subscales. Need for Parenthood mean scores significantly varied between women with and without children too.We can conclude that fertility perception seems to be negatively affected by GTD diagnosis, particularly in younger women and in those without children. Patients should be followed by a multidisciplinary team so as to be supported in the disease's psychological aspects too.

  16. Maternal Obesity, Overweight and Gestational Diabetes Affect the Offspring Neurodevelopment at 6 and 18 Months of Age--A Follow Up from the PREOBE Cohort.

    Directory of Open Access Journals (Sweden)

    Francisco J Torres-Espinola

    Full Text Available Brain development in fetal life and early infancy is critical to determine lifelong performance in various neuropsychological domains. Metabolic pathologies such as overweight, obesity, and gestational diabetes in pregnant women are prevalent and increasing risk factors that may adversely affect long-term brain development in their offspring.The objective of this research was to investigate the influence of maternal metabolic pathologies on the neurodevelopment of the offspring at 6 and 18 months of life.This was a prospective case-control study of 331 mother- and child pairs from Granada, Spain. The mothers were included during pregnancy into four groups according to their pre-gestational body mass index and their gestational diabetes status; overweight (n:56, obese (n:64, gestational diabetic (n:79, and healthy normal weight controls (n:132. At 6 months and 18 months we assessed the children with the Bayley III scales of neurodevelopment.At 6 months (n=215, we found significant group differences in cognition composite language, and expressive language. Post hoc test revealed unexpectedly higher scores in the obese group compared to the normal weight group and a similar trend in overweight and diabetic group. The effects on language remained significant after adjusting for confounders with an adjusted odds ratio for a value above median in composite language score of 3.3 (95% CI: 1.1, 10.0; p=0.035 for children of obese mothers. At 18 month (n=197, the offspring born to obese mothers had lost five points in language composite scores and the previous differences in language and cognition was replaced by a suggestive trend of lower gross motor scores in the overweight, obese, and diabetic groups.Infants of obese mothers had a temporary accelerated development of cognition and language, followed by a rapid deceleration until 18 months of age, particularly of language scores. This novel observation prompts further confirmative studies to explore

  17. Gestational diabetes

    African Journals Online (AJOL)

    ::wercome the pregnancy-related decline in insulin sensitivity. Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance presenting during pregnancy; it is usual for GDM to abate after delivery.7 A number of diagnostic criteria have been used to define GDM since its recognrtion by Bennewitz and its fuller ...

  18. Circulating galanin levels are increased in patients with gestational diabetes mellitus.

    Science.gov (United States)

    Fang, Penghua; Bo, Ping; Shi, Mingyi; Yu, Mei; Zhang, Zhenwen

    2013-06-01

    Galanin is a 29/30-amino acid peptide that stimulates food intake and regulates energy metabolism. A significantly higher level of plasma galanin was found in diabetes in non-pregnant women, but there are no data regarding galanin levels in diabetes in pregnant women. In this study we compared plasma galanin concentrations in pregnant women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT). The study registered twenty pregnant women with GDM and twenty pregnant women with NGT. Fasting venous blood samples were collected from all cases. Galanin was analyzed by an enzyme-linked immunosorbent assay. A statistically significant higher level of galanin was found in pregnant women with GDM compared with NGT (Prelated to the changes of blood glucose in GDM. The higher level of galanin observed in GDM may represent a physiological adaptation to the rise of glucose associated with GDM. Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  19. Comparative evaluation of short-term biomarker response to treatment for growth hormone deficiency in Chinese children with growth hormone deficiency born small for or appropriate for gestational age: a randomized phase IV open-label study.

    Science.gov (United States)

    Lu, Wenli; Shen, Shuixian; Luo, Xiaoping; Gong, Chunxiu; Gu, Xuefan; Li, Yun; Du, Minlian; Jin, Runming; Zhou, Queena; Wang, Wei

    2013-04-01

    To compare the response between Chinese children with growth hormone deficiency (GHD) born either small for gestational age (SGA) or appropriate for gestational age (AGA) after 4 weeks of recombinant human growth hormone (r-hGH) therapy. This was a phase IV, open-label, multicenter, interventional study (NCT01187550). Prepubertal children with GHD received open-label treatment with daily r-hGH (0.033 mg/kg) for 4 weeks. Serum levels of insulin-like growth factor I (IGF-I) and insulin-like growth factor-binding protein 3 (IGFBP3), and metabolic markers (including fasting glucose, insulin, total cholesterol, and homeostasis model assessment of insulin resistance) were assessed at baseline and after 4 weeks of treatment, and were analyzed according to patient subgroup (SGA or AGA). A total of 205 children with GHD (mean age 10.4 years; 175 AGA, 30 SGA) were included in the analysis. Mean baseline serum IGF-I and IGFBP3 standard deviation scores (SDS) across the whole patient population were lower than the population norms (mean values: -2.1 SDS for IGF-I and -1.2 SDS for IGFBP3), with no significant differences between the two patient subgroups. After 4 weeks, IGF-I and IGFBP3 levels increased by 1.0 SDS (p < 0.001) and 0.34 SDS (p < 0.001), respectively, but no significant differences were found between the two patient subgroups for growth-related or metabolic markers. For children with GHD born SGA, IGF-I and IGFBP3 are short-term biomarkers of responsiveness to treatment with growth hormone, as for children with GHD born AGA.

  20. Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature

    Science.gov (United States)

    Murphy, Mary M; Stettler, Nicolas; Smith, Kimberly M; Reiss, Richard

    2014-01-01

    Maternal nutrition is recognized as one of the determinants of fetal growth. Consumption of fruits and vegetables is promoted as part of a healthful diet; however, intakes are typically lower than recommended levels. The purpose of this study was to systematically review results from studies examining the relationship between maternal consumption of fruits and vegetables during pregnancy with infant birth weight or risk for delivering a small for gestational age baby. A comprehensive search of PubMed and EMBASE was conducted and abstracts were screened using predefined criteria. Eleven relevant studies were identified and systematically reviewed, including six prospective cohort studies, three retrospective cohort studies, and two case–control studies. Seven studies were conducted in cohorts from highly developed countries. One prospective study from a highly developed area reported increased risk for small for gestational age birth by women with low vegetable intakes (odds ratio 3.1; 95% confidence interval 1.4–6.9; P=0.01); another large prospective study reported a 10.4 g increase in birth weight per quintile increase in fruit intake (95% confidence interval 6.9–3.9; Pfruits and vegetables (combined) or fruits, vegetables, and juice (combined), respectively. One retrospective study reported an association between low fruit intake and birth weight. In less developed countries, increased vegetable or fruit intake was associated with increased birth weight in two prospective studies. Overall, limited inconclusive evidence of a protective effect of increased consumption of vegetables and risk for small for gestational age birth, and increased consumption of fruits and vegetables and increased birth weight among women from highly developed countries was identified. Among women in less developed countries, limited inconclusive evidence suggests that increased consumption of vegetables or fruits may be associated with higher infant birth weight. The available

  1. Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant: a cohort study in a low-risk population.

    Science.gov (United States)

    Simic, Marija; Wikström, Anna-Karin; Stephansson, Olof

    2017-10-01

    Our objective was to examine the association between fetal growth in early pregnancy and risk of severe large-for-gestational-age (LGA) and macrosomia at birth in a low-risk population. Cohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm-Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m 2 ). When adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second-trimester scan (adjusted odds ratio 1.80; 95% CI 1.23-2.64 and adjusted odds ratio 2.15; 95% CI 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second-trimester ultrasound was at least 7 days. In a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. The association of bone turnover markers with pro- and anti-inflammatory adipokines in patients with gestational diabetes

    Directory of Open Access Journals (Sweden)

    Beata Telejko

    2015-05-01

    Full Text Available Objective. The aim of the study was to assess differences in circulating osteocalcin (OC and osteoprotegerin (OPG, as well as in their expression in subcutaneous adipose tissue (SAT, visceral adipose tissue (VAT and placental tissue obtained from patients with gestational diabetes mellitus (GDM and normal glucose tolerance (NGT. Materials and method. Serum levels of OC, OPG and soluble nuclear factor-kB ligand (sRANKL were measured in 49 women with GDM and 30 subjects with NGT between weeks 24–32 of gestation, and three months after childbirth. OC and OPG mRNA expression was measured in 23 patients with GDM and 23 women with NGT at term, using quantitative real-time RT-PCR. Results. The patients with GDM had decreased OC mRNA expression in SAT (p=0.015, lower adiponectin mRNA expression in VAT (p=0.039, and a lower circulating adiponectin level (p=0.04. Multiple regression analysis revealed that serum adiponectin was significantly associated with OC mRNA expression in SAT (b=0.49, p=0.03. Three months postpartum, the OPG/sRANKL ratio was markedly higher in the subjects with prior GDM (p=0.03 and correlated positively with HbA1c (R=0.33; p=0.04, fasting insulin (R=0.35; p=0.03 and HOMA-IR (R=0.34; p=0.04. Conclusions. In the patients with GDM decreased OC mRNA expression in SAT might be associated with a reduced stimulatory effect on adiponectin expression in adipose tissue. On the other hand, higher OPG/sRANKL ratio suggests a better protection against bone loss in the subjects with prior GDM.

  3. A hyperoxic lung injury model in premature rabbits: the influence of different gestational ages and oxygen concentrations.

    Directory of Open Access Journals (Sweden)

    Roberta Munhoz Manzano

    Full Text Available BACKGROUND: Many animal models have been developed to study bronchopulmonary dysplasia (BPD. The preterm rabbit is a low-cost, easy-to-handle model, but it has a high mortality rate in response to the high oxygen concentrations used to induce lung injury. The aim of this study was to compare the mortality rates of two models of hyperoxia-induced lung injury in preterm rabbits. METHODS: Pregnant New Zealand white rabbits were subjected to caesarean section on gestational day 28 or 29 (full term  = 31 days. The premature rabbits in the 28-day gestation group were exposed to room air or FiO₂ ≥95%, and the rabbits in the 29-day gestation group were exposed to room air or FiO₂  = 80% for 11 days. The mean linear intercept (Lm, internal surface area (ISA, number of alveoli, septal thickness and proportion of elastic and collagen fibers were quantified. RESULTS: The survival rates in the 29-day groups were improved compared with the 28-day groups. Hyperoxia impaired the normal development of the lung, as demonstrated by an increase in the Lm, the septal thickness and the proportion of elastic fibers. Hyperoxia also decreased the ISA, the number of alveoli and the proportion of collagen fibers in the 28-day oxygen-exposed group compared with the control 28-day group. A reduced number of alveoli was found in the 29-day oxygen exposed animals compared with the control 29-day group. CONCLUSIONS: The 29-day preterm rabbits had a reduced mortality rate compared with the 28-day preterm rabbits and maintained a reduction in the alveoli number, which is comparable to BPD in humans.

  4. Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Murphy MM

    2014-10-01

    Full Text Available Mary M Murphy,1 Nicolas Stettler,1,2 Kimberly M Smith,1 Richard Reiss3 1Exponent, Inc., Center for Chemical Regulation and Food Safety, Washington, DC, USA; 2The Lewin Group, Falls Church, VA, USA; 3Exponent, Inc., Center for Chemical Regulation and Food Safety, Alexandria, VA, USA Abstract: Maternal nutrition is recognized as one of the determinants of fetal growth. Consumption of fruits and vegetables is promoted as part of a healthful diet; however, intakes are typically lower than recommended levels. The purpose of this study was to systematically review results from studies examining the relationship between maternal consumption of fruits and vegetables during pregnancy with infant birth weight or risk for delivering a small for gestational age baby. A comprehensive search of PubMed and EMBASE was conducted and abstracts were screened using predefined criteria. Eleven relevant studies were identified and systematically reviewed, including six prospective cohort studies, three retrospective cohort studies, and two case–control studies. Seven studies were conducted in cohorts from highly developed countries. One prospective study from a highly developed area reported increased risk for small for gestational age birth by women with low vegetable intakes (odds ratio 3.1; 95% confidence interval 1.4–6.9; P=0.01; another large prospective study reported a 10.4 g increase in birth weight per quintile increase in fruit intake (95% confidence interval 6.9–3.9; P<0.0001 and increases of 8.4 or 7.7 g per quintile intake of fruits and vegetables (combined or fruits, vegetables, and juice (combined, respectively. One retrospective study reported an association between low fruit intake and birth weight. In less developed countries, increased vegetable or fruit intake was associated with increased birth weight in two prospective studies. Overall, limited inconclusive evidence of a protective effect of increased consumption of vegetables and risk for

  5. Maternal Continuing Folic Acid Supplementation after the First Trimester of Pregnancy Increased the Risk of Large-for-Gestational-Age Birth: A Population-Based Birth Cohort Study.

    Science.gov (United States)

    Wang, Sufang; Ge, Xing; Zhu, Beibei; Xuan, Yujie; Huang, Kun; Rutayisire, Erigene; Mao, Leijing; Huang, Sanhuan; Yan, Shuangqin; Tao, Fangbiao

    2016-08-15

    Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma'anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma'anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn's gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these findings, additional

  6. Prophylactic Methylxanthines for Preventing Extubation Failure in the Preterm Neonates with the Gestational Age of ≤30 Weeks: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    M Shivakumar

    2017-09-01

    Full Text Available Background: Preterm neonates are at a high risk of respiratory depression at birth. Incidence of respiratory distress is reported in 60-80% of the neonates born with the gestational age of less than 28 weeks and 15-30% of the neonates with the gestational age of less than 32-34 weeks. The present study aimed to compare the incidence and risk of failed extubation in using caffeine and aminophylline in the preterm neonates with the gestational age of ≤30 weeks in the periextubation period.Methods: This single-centered, parallel, open-label, randomized controlled trial was conducted in a tertiary care referral hospital in India during June 2014-2016. Neonates with the gestational age of ≤30 weeks who were intubated for a minimum of 24 hours were enrolled in the study. Neonates with major anomalies, heart disease, and sepsis were excluded from the study. After the random allocation of the infants to treatment with the standard dose of caffeine citrate and aminophylline methylxanthine, intubation continued for seven consecutive days with or without non-invasive ventilatory support. As the primary objective, the incidence and risk of failed extubation were assessed. Secondary objective of the research was to compare the relative incidence of acute adverse effects, persistent apnea, and the associated morbidities.Results: Neonates treated by caffeine were at a higher risk of extubation failure (1.09 times adjusted with birth weight (31.5% versus 21.4%; RR=1.09; 95% CI: 0.81-1.46; P=0.55, which was not statistically significant. In addition, risk of apnea within seven days and after seven days of methylxanthine therapy was 1.57 (95% CI: 0.95-2.61 and 1.10 (95% CI: 0.95-2.61 times higher in the neonates with caffeine treatment. Also, rate of tachycardia was high in the neonates treated by aminophylline, which was statistically significant (RR=0.27; 95% CI: 0.13-0.56; P

  7. Growth and development are similar in VLBW children born appropriate and small for gestational age: an interim report on 97 preschool children.

    Science.gov (United States)

    Ranke, Michael B; Vollmer, Brigitte; Traunecker, Richard; Wollmann, Hartmut A; Goelz, Rangmar R; Seibold-Weiger, Karin; Speer, Christian P; Krägeloh-Mann, Ingeborg

    2007-09-01

    To investigate growth and development in a cohort of children born with very low birth weight (VLBW) treated at a single tertiary neonatal unit. We studied 97 children born between January 1995 and July 1997 with BW development were collected. Small for gestational age (SGA) was defined as weight and/or length at birth <10th percentile; shortness at follow-up was defined as height <10th percentile. Comparison was made between the appropriate for gestational age (AGA) (n = 46) and SGA (n = 51) groups. At follow-up, 23 AGA and 35 SGA children were short, had a smaller head circumference (-1.9 vs -0.8 SDS), were lighter at birth (BW -1.3 vs -0.7 SDS), and had a higher rate of broncho-pulmonary dysplasia (BPD) (28 vs 12); no differences in neonatal characteristics or neurological status were evident. A higher frequency of motor delay occurred in the 'short' group. Short children also had a smaller head circumference (HC) (-1.6 vs -0.7). Short SGA children had a higher frequency of BPD, smaller HC (-2.1 vs -1.0), and a slightly higher proportion of suspicious neurological findings, motor delay, and speech and language delay (n.s.). Preterm VLBW infants, whether AGA or SGA at birth, face the risk of being short at preschool age. Height outcome is probably influenced by postnatal factors. Our data also suggest that short stature is associated with developmental difficulties in this population.

  8. Closure versus non-closure of the visceral peritoneum (VP) in patients with gestational hypertension--an observational analysis.

    Science.gov (United States)

    Malvasi, Antonio; Tinelli, Andrea; Hudelist, Gernot; Vergara, Daniele; Martignago, Roberta; Tinelli, Raffaele

    2009-01-01

    Caesarean section (CS) is one of the most frequently performed surgical procedures worldwide. Surgical variants include closure and non-closure of the peritoneum: in case of non-suturing the visceral peritoneum (VP), abnormal fluid collections such as blood clots may lead to formation of a hematoperitoneum. In this retrospective, observational study we reviewed 1848 patients with gestational hypertension (GH) undergoing repeat and primary CS performed by non-closure of the visceral peritoneum (VP). Six of these patients had major early post-CS complications: 5 patients experienced hypovolaemic shock that required urgent operative intervention. Four patients underwent repeat laparotomy and one patient was treated by laparoscopy. As an early major post-CS complication, hematoperitoneum occurs in cases with poor haemostasis and/or with haemodynamic disorders such as GH. A decrease in blood pressure (BP) during CS caused by spinal/epidural anaesthesia and the following BP increase in GH patients may favour bleeding complications. Closure of the VP may facilitate early detection of a subperitoneal hematoma. In contrast, hematoperitoneum may develop in cases of non-closure of the VP followed by hypovolemic shock. Early and aggressive intervention results in excellent prognosis of this complication.

  9. Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control.

    Science.gov (United States)

    Boamah, Ellen A; Asante, Kp; Ae-Ngibise, Ka; Kinney, Patrick L; Jack, Darby W; Manu, Grace; Azindow, Irene T; Owusu-Agyei, Seth; Wylie, Blair J

    2014-12-18

    Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves). The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program. Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed. Publication of trial results is anticipated in late 2016. Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual

  10. Fetal Doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term.

    Science.gov (United States)

    Jo, Ji Hye; Choi, Yong Hee; Wie, Jeong Ha; Ko, Hyun Sun; Park, In Yang; Shin, Jong Chul

    2018-03-01

    To evaluate the significance of fetal Doppler parameters in predicting adverse neonatal outcomes and the risk of cesarean delivery due to non-reassuring fetal status, in severe small for gestational age (SGA) fetuses of late preterm and term gestation. Fetal brain and umbilical artery (UmA) Doppler parameters of cerebroplacental ratio (CPR) and UmA pulsatility index (PI) were evaluated in a cohort of 184 SGA fetuses between 34 and 41 weeks gestational age, who were less than the 5th percentile. The risks of neonatal morbidities and cesarean delivery due to non-reassuring fetal status were analyzed. Univariate analysis revealed that abnormal CPR was significantly associated with cesarean delivery due to non-reassuring fetal status ( P =0.018), but not with neonatal morbidities. However, abnormal CPR did not increase the risk of cesarean delivery due to non-reassuring fetal status in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA was associated with low Apgar score at 1 minute ( P =0.048), mechanical ventilation ( P =0.013) and cesarean delivery due to non-reassuring fetal status ( P cesarean delivery for non-reassuring fetal status (adjusted odds ratio, 7.0; 95% confidence interval, 1.2-41.3; P =0.033), but did not increase risk of low Apgar score or mechanical ventilation in multivariate logistic regression analysis. Abnormal CPR with abnormal PI of UmA increases the risk of cesarean delivery for non-reassuring fetal status, in severe SGA fetuses of late preterm and term. Monitoring of CPR and PI of UmA can help guide management including maternal hospitalization and fetal monitoring.

  11. Perinatal Outcome in Assisted Reproductive Pregnancies: Comparative Analysis of Reduced versus Unreduced Gestation

    Directory of Open Access Journals (Sweden)

    Shilpa Bhandari

    2016-01-01

    Full Text Available Objectives. This study aims to evaluate perinatal outcomes such as gestational age at delivery and live birth rate in singleton and twin gestation with or without fetal reduction. Method. A retrospective analysis was done on patients which were divided into reduced and unreduced groups on the basis of order of reduction of one or more fetuses between 6 and 13 weeks of gestation. Patients records were studied to note gestational age at delivery/abortion, birth weight, and neonatal outcome. Result. The cohort included a total of 292 patients: 102 singletons and 190 twins. 52 pregnancies were reduced in singleton cohort and 68 were reduced in twin cohort. No statistical difference was observed in live birth rate, gestational age at delivery, and birth weight and significant higher incidence of IUGR was observed in reduced and unreduced twin gestation. In singleton pregnancies however preterm delivery rate increased with fetal reduction. Conclusion. Although reduction does not reduce the live birth rate, it does reduce gestation age of delivery and birth weight of newborn. This effect is more apparent when multiple gestation is reduced to singleton.

  12. Transplacental Distribution of Lidocaine and Its Metabolite in Peridural Anesthesia Administered to Patients With Gestational Diabetes Mellitus

    Science.gov (United States)

    Duarte, Luciana de Barros; Cavalli, Ricardo de Carvalho; Carvalho, Daniela Miarelli; Filgueira, Gabriela Campos de Oliveira; Marques, Maria Paula; Lanchote, Vera Lucia; Duarte, Geraldo

    2015-01-01

    Background: Neonatal effects of drugs administered to mothers before delivery depend on the quantity that crosses the placental barrier, which is determined by the pharmacokinetics of the drug in the mother, fetus, and placenta. Diabetes mellitus can alter the kinetic disposition and the metabolism of drugs. This study investigated the placental transfer of lidocaine and its metabolite monoethylglycinexylidide (MEGX) in pregnant women with gestational diabetes mellitus (GDM) submitted to peridural anesthesia. Patients and Methods: A total of 10 normal pregnant women (group 1) and 6 pregnant women with GDM (group 2) were studied, all at term. The patients received 200 mg 2% lidocaine hydrochloride by the peridural locoregional route. Maternal blood samples were collected at the time of delivery and, after placental expulsion, blood samples were collected from the intervillous space, umbilical artery, and vein for determination of lidocaine and MEGX concentrations and analysis of the placental transfer of the drug. Results: The following respective lidocaine ratios between the maternal and the fetal compartments were obtained for groups 1 and 2: umbilical vein/maternal peripheral blood, 0.60 and 0.46; intervillous space/maternal blood, 1.01 and 0.88; umbilical artery/umbilical vein, 0.77 and 0.91; and umbilical vein/intervillous space, 0.53 and 0.51. The following MEGX ratios for groups 1 and 2 were, respectively, fetal/maternal, 0.43 and 0.97; intervillous space/maternal blood, 0.64 and 0.90; umbilical artery/umbilical vein, 1.09 and 0.99; and umbilical vein/intervillous space, 0.55 and 0.78. Conclusion: Gestational diabetes mellitus did not affect the transplacental transfer of lidocaine but interfered with the transfer of MEGX, acting as a mechanism facilitating the transport of the metabolite. PMID:25563756

  13. Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth.

    Science.gov (United States)

    Stawerska, Renata; Szałapska, Małgorzata; Hilczer, Maciej; Lewiński, Andrzej

    2016-08-01

    In children born small for gestational age (SGA) with catch-up growth, a higher risk of insulin resistance (IR) and cardiovascular diseases is noted. Ghrelin stimulates a growth hormone (GH) secretion and regulates lipid and carbohydrate metabolism. We assessed gherlin's influence on achieving normal height and the occurrence of metabolic complications in SGA children. Ghrelin, insulin-like growth factor type I (IGF-I), leptin, adiponectin, resistin, glucose, insulin and lipid concentrations were analysed in 134 prepubertal children in four groups: normal-height SGA, short SGA, normal-height born appropriate for gestational age (AGA) and short AGA. Ghrelin and IGF-I concentrations were significantly higher while adiponectin - lower in normal-height SGA comparing to others. The increased production of ghrelin and IGF-I seems to be an adaptive mechanism to achieve normal growth in SGA children. The significance of high ghrelin and low adiponectin concentrations, observed in normal-height prepubertal SGA children, requires elucidation, with reference to the development of metabolic complications.

  14. A randomised controlled trial evaluating IGF1 titration in contrast to current GH dosing strategies in children born small for gestational age

    DEFF Research Database (Denmark)

    Jensen, Rikke Beck; Thankamony, Ajay; O'Connell, Susan M

    2014-01-01

    BACKGROUND: 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. METHODS: 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. RESULTS: 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...

  15. Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: A longitudinal study

    Directory of Open Access Journals (Sweden)

    Kajantie Eero

    2010-12-01

    Full Text Available Abstract Background It remains unclear whether it is more detrimental to be born too early or too small in relation to symptoms of attention deficit/hyperactivity disorder (ADHD. Thus, we tested whether preterm birth and small body size at birth adjusted for gestational age are independently associated with symptoms of ADHD in children. Methods A longitudinal regional birth cohort study comprising 1535 live-born infants between 03/15/1985 and 03/14/1986 admitted to the neonatal wards and 658 randomly recruited non-admitted infants, in Finland. The present study sample comprised 828 children followed up to 56 months. The association between birth status and parent-rated ADHD symptoms of the child was analysed with multiple linear and logistic regression analyses. Results Neither prematurity (birth Conclusions Intrauterine growth restriction, reflected in SGA status and lower birth weight, rather than prematurity or lower gestational age per se, may increase risk for symptoms of ADHD in young children.

  16. Body composition and circulating high-molecular-weight adiponectin and IGF-I in infants born small for gestational age: breast- versus formula-feeding.

    Science.gov (United States)

    de Zegher, Francis; Sebastiani, Giorgia; Diaz, Marta; Sánchez-Infantes, David; Lopez-Bermejo, Abel; Ibáñez, Lourdes

    2012-08-01

    Prenatal growth restraint, if followed by postnatal overweight, confers risk for adult disease including diabetes. The mechanisms whereby neonatal nutrition may modulate such risk are poorly understood. We studied the effects of nutrition (breast-feeding [BRF] vs. formula-feeding [FOF]) on weight partitioning and endocrine state (as judged by high-molecular-weight [HMW] adiponectin and IGF-I) of infants born small for gestational age (SGA). Body composition (by absorptiometry), HMW adiponectin, and IGF-I were assessed at birth and 4 months in BRF infants born appropriate for gestational age (AGA; n = 72) and SGA infants receiving BRF (n = 46) or FOF (n = 56), the latter being randomized to receive a standard (FOF1) or protein-rich formula (FOF2). Compared with AGA-BRF infants, the catchup growth of SGA infants was confined to lean mass, independently of nutrition. Compared with AGA-BRF infants, SGA-BRF infants had normal HMW adiponectin and IGF-I levels at 4 months, whereas SGA-FOF infants had elevated levels of HMW adiponectin (particularly SGA-FOF1) and IGF-I (particularly SGA-FOF2). In conclusion, neonatal nutrition seems to influence endocrinology more readily than body composition of SGA infants. Follow-up will disclose whether the endocrine abnormalities in SGA-FOF infants can serve as early markers of an unfavorable metabolic course and whether they may contribute to design early interventions that prevent subsequent disease, including diabetes.

  17. Maternal Plane of Nutrition during Late Gestation and Weaning Age Alter Angus × Simmental Offspring Longissimus Muscle Transcriptome and Intramuscular Fat.

    Science.gov (United States)

    Moisá, Sonia J; Shike, Daniel W; Shoup, Lindsay; Rodriguez-Zas, Sandra L; Loor, Juan J

    2015-01-01

    In model organisms both the nutrition of the mother and the young offspring could induce long-lasting transcriptional changes in tissues. In livestock, such changes could have important roles in determining nutrient use and meat quality. The main objective was to evaluate if plane of maternal nutrition during late-gestation and weaning age alter the offspring's Longissimus muscle (LM) transcriptome, animal performance, and metabolic hormones. Whole-transcriptome microarray analysis was performed on LM samples of early (EW) and normal weaned (NW) Angus × Simmental calves born to grazing cows receiving no supplement [low plane of nutrition (LPN)] or 2.3 kg high-grain mix/day [medium plane of nutrition (MPN)] during the last 105 days of gestation. Biopsies of LM were harvested at 78 (EW), 187 (NW) and 354 (before slaughter) days of age. Despite greater feed intake in MPN offspring, blood insulin was greater in LPN offspring. Carcass intramuscular fat content was greater in EW offspring. Bioinformatics analysis of the transcriptome highlighted a modest overall response to maternal plane of nutrition, resulting in only 35 differentially expressed genes (DEG). However, weaning age and a high-grain diet (EW) strongly impacted the transcriptome (DEG = 167), especially causing a lipogenic program activation. In addition, between 78 and 187 days of age, EW steers had an activation of the innate immune system due presumably to macrophage infiltration of intramuscular fat. Between 187 and 354 days of age (the "finishing" phase), NW steers had an activation of the lipogenic transcriptome machinery, while EW steers had a clear inhibition through the epigenetic control of histone acetylases. Results underscored the need to conduct further studies to understand better the functional outcome of transcriptome changes induced in the offspring by pre- and post-natal nutrition. Additional knowledge on molecular and functional outcomes would help produce more efficient beef cattle.

  18. Maternal Plane of Nutrition during Late Gestation and Weaning Age Alter Angus × Simmental Offspring Longissimus Muscle Transcriptome and Intramuscular Fat.

    Directory of Open Access Journals (Sweden)

    Sonia J Moisá

    Full Text Available In model organisms both the nutrition of the mother and the young offspring could induce long-lasting transcriptional changes in tissues. In livestock, such changes could have important roles in determining nutrient use and meat quality. The main objective was to evaluate if plane of maternal nutrition during late-gestation and weaning age alter the offspring's Longissimus muscle (LM transcriptome, animal performance, and metabolic hormones. Whole-transcriptome microarray analysis was performed on LM samples of early (EW and normal weaned (NW Angus × Simmental calves born to grazing cows receiving no supplement [low plane of nutrition (LPN] or 2.3 kg high-grain mix/day [medium plane of nutrition (MPN] during the last 105 days of gestation. Biopsies of LM were harvested at 78 (EW, 187 (NW and 354 (before slaughter days of age. Despite greater feed intake in MPN offspring, blood insulin was greater in LPN offspring. Carcass intramuscular fat content was greater in EW offspring. Bioinformatics analysis of the transcriptome highlighted a modest overall response to maternal plane of nutrition, resulting in only 35 differentially expressed genes (DEG. However, weaning age and a high-grain diet (EW strongly impacted the transcriptome (DEG = 167, especially causing a lipogenic program activation. In addition, between 78 and 187 days of age, EW steers had an activation of the innate immune system due presumably to macrophage infiltration of intramuscular fat. Between 187 and 354 days of age (the "finishing" phase, NW steers had an activation of the lipogenic transcriptome machinery, while EW steers had a clear inhibition through the epigenetic control of histone acetylases. Results underscored the need to conduct further studies to understand better the functional outcome of transcriptome changes induced in the offspring by pre- and post-natal nutrition. Additional knowledge on molecular and functional outcomes would help produce more efficient beef

  19. Complementary feeding at 4 versus 6 months of age for preterm infants born at less than 34 weeks of gestation: a randomised, open-label, multicentre trial.

    Science.gov (United States)

    Gupta, Shuchita; Agarwal, Ramesh; Aggarwal, Kailash Chandra; Chellani, Harish; Duggal, Anil; Arya, Sugandha; Bhatia, Sunita; Sankar, Mari Jeeva; Sreenivas, Vishnubhatla; Jain, Vandana; Gupta, Arun Kumar; Deorari, Ashok K; Paul, Vinod K

    2017-05-01

    Evidence on the optimal time to initiation of complementary feeding in preterm infants is scarce. We examined the effect of initiation of complementary feeding at 4 months versus 6 months of corrected age on weight for age at 12 months corrected age in preterm infants less than 34 weeks of gestation. In this open-label, randomised trial, we enrolled infants born at less than 34 weeks of gestation with no major malformation from three public health facilities in India. Eligible infants were tracked from birth and randomly assigned (1:1) at 4 months corrected age to receive complementary feeding at 4 months corrected age (4 month group), or continuation of milk feeding and initiation of complementary feeding at 6 months corrected age (6 month group), using computer generated randomisation schedule of variable block size, stratified by gestation (30 weeks or less, and 31-33 weeks). Iron supplementation was provided as standard. Participants and the implementation team could not be masked to group assignment, but outcome assessors were masked. Primary outcome was weight for age Z-score at 12 months corrected age (WAZ 12 ) based on WHO Multicentre Growth Reference Study growth standards. Analyses were by intention to treat. The trial is registered with Clinical Trials Registry of India, number CTRI/2012/11/003149. Between March 20, 2013, and April 24, 2015, 403 infants were randomly assigned: 206 to receive complementary feeding from 4 months and 197 to receive complementary feeding from 6 months. 22 infants in the 4 month group (four deaths, two withdrawals, 16 lost to follow-up) and eight infants in the 6 month group (two deaths, six lost to follow-up) were excluded from analysis of primary outcome. There was no difference in WAZ 12 between two groups: -1·6 (SD 1·2) in the 4 month group versus -1·6 (SD 1·3) in the 6 month group (mean difference 0·005, 95% CI -0·24 to 0·25; p=0·965). There were more hospital admissions in the 4 month group compared with the 6

  20. Body mass index values for newborns according to gestational age Valores de Índice de Masa Corporal en recién nacidos de acuerdo con la edad gestacional

    OpenAIRE

    R. S. Brock; M. C. Falcão; C. Leone

    2008-01-01

    Objective: The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve. Methods: Retrospective study including 2,406 appropriate for gestational...

  1. Increase of long-term 'diabesity' risk, hyperphagia, and altered hypothalamic neuropeptide expression in neonatally overnourished 'small-for-gestational-age' (SGA rats.

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    Karen Schellong

    Full Text Available BACKGROUND: Epidemiological data have shown long-term health adversity in low birth weight subjects, especially concerning the metabolic syndrome and 'diabesity' risk. Alterations in adult food intake have been suggested to be causally involved. Responsible mechanisms remain unclear. METHODS AND FINDINGS: By rearing in normal (NL vs. small litters (SL, small-for-gestational-age (SGA rats were neonatally exposed to either normal (SGA-in-NL or over-feeding (SGA-in-SL, and followed up into late adult age as compared to normally reared appropriate-for-gestational-age control rats (AGA-in-NL. SGA-in-SL rats displayed rapid neonatal weight gain within one week after birth, while SGA-in-NL growth caught up only at juvenile age (day 60, as compared to AGA-in-NL controls. In adulthood, an increase in lipids, leptin, insulin, insulin/glucose-ratio (all p<0.05, and hyperphagia under normal chow as well as high-energy/high-fat diet, modelling modern 'westernized' lifestyle, were observed only in SGA-in-SL as compared to both SGA-in-NL and AGA-in-NL rats (p<0.05. Lasercapture microdissection (LMD-based neuropeptide expression analyses in single neuron pools of the arcuate hypothalamic nucleus (ARC revealed a significant shift towards down-regulation of the anorexigenic melanocortinergic system (proopiomelanocortin, Pomc in SGA-in-SL rats (p<0.05. Neuropeptide expression within the orexigenic system (neuropeptide Y (Npy, agouti-related-peptide (Agrp and galanin (Gal was not significantly altered. In essence, the 'orexigenic index', proposed here as a neuroendocrine 'net-indicator', was increased in SGA-in-SL regarding Npy/Pomc expression (p<0.01, correlated to food intake (p<0.05. CONCLUSION: Adult SGA rats developed increased 'diabesity' risk only if exposed to neonatal overfeeding. Hypothalamic malprogramming towards decreased anorexigenic activity was involved into the pathophysiology of this neonatally acquired adverse phenotype. Neonatal overfeeding

  2. Gestational Diabetes Mellitus and Associated Risk Factors in Patients Attending Diabetic Association Medical College Hospital in Faridpur

    Directory of Open Access Journals (Sweden)

    Poly Begum

    2017-09-01

    Full Text Available Background: The prevalence of gestational diabetes mellitus (GDM is increasing all over the world and varies widely depending on the region of the country, dietary habits and socio-economic status. The prevalence of GDM with its associated risk factors has important health complications for both mother and child. Objectives: The aim of this study was to evaluate the prevalence of GDM and risk factors associated with it in women attending Diabetic Association Medical College Hospital in Faridpur for ante-natal care. Materials and Methods: In this cross-sectional study, screening for GDM was performed in 303 pregnant women. Women who consented to participate underwent a standardized 2-hour 75 gm oral glucose tolerance test (OGTT. A proforma containing general information on demographic characteristics, socio-economic status, education level, parity, family history of diabetes and past history of GDM etc. was filled in. American Diabetes Association (ADA criteria for 75 gm 2-hour OGTT was used for diagnosing GDM. Results: A total of 303 women participated in the study and GDM was diagnosed in 22 (7.3% women. A single abnormal value was observed in additional 33 (10.89% women. On bivariate analysis risk factors found to be significantly associated with GDM were age, household income, parity, educational level, socio-economic status, hypertension, BMI, weight gain, acanthosis nigricans, family history of diabetes and past history of GDM; but on multivariate analysis only upper middle class and presence of acanthosis nigricans were found to be significantly associated with GDM. Conclusion: This study demonstrates a high prevalence of GDM in Bangladesh. These estimates for GDM may help for new suggestions to prevent and manage gestational diabetes.

  3. First trimester maternal serum PAPP-A, beta-hCG and ADAM12 in prediction of small-for-gestational-age fetuses

    DEFF Research Database (Denmark)

    Pihl, Kasper; Larsen, Torben; Krebs, Lone

    2008-01-01

    trimester. METHODS: In all,36 cases being SGA (birth weight controls being non-SGA were matched on ethnicity (only Caucasians), smoking status (only nonsmokers), body mass index (BMI), age and parity. Stored blood samples from PAPP-A and beta-hCG testing obtained at gestational age......-hCG (0.74 vs 1.04, p = 0.007) and ADAM12 (0.74 vs 0.97, p = 0.004) were significantly reduced in cases compared to controls. The combination of PAPP-A MoM and beta-hCG MoM yielded a detection rate (DR) for SGA of 26% for a 5% false-positive rate (FPR). Addition of ADAM12 only improved (28% DR for a 5...

  4. Effect of parental obesity and gestational diabetes on child neuropsychological and behavioral development at 4 years of age: the Rhea mother-child cohort, Crete, Greece.

    Science.gov (United States)

    Daraki, Vasiliki; Roumeliotaki, Theano; Koutra, Katerina; Georgiou, Vaggelis; Kampouri, Mariza; Kyriklaki, Andriani; Vafeiadi, Marina; Papavasiliou, Stathis; Kogevinas, Manolis; Chatzi, Leda

    2017-06-01

    Studies have suggested an association between maternal obesity pre-pregnancy and gestational diabetes (GDM) with impaired offspring neurodevelopment, but it is not clear if these associations are explained by shared familiar characteristics. We aimed to assess the associations of maternal and paternal obesity, maternal glucose intolerance in early pregnancy and GDM, with offspring neurodevelopment at 4 years of age. We included 772 mother-child pairs from the "Rhea" Mother-Child cohort in Crete, Greece. Data on maternal/paternal body mass index (BMI) and maternal fasting serum samples for glucose and insulin measurements were collected at 12 weeks of gestation. GDM screening was performed at 24-28 weeks. Neurodevelopment at 4 years was assessed using the McCarthy Scales of Children's Abilities. Behavioral difficulties were assessed by Strengths and Difficulties Questionnaire and Attention Deficit Hyperactivity Disorder Test. Multivariate linear regression analyses showed that maternal obesity was associated with a significant score reduction in general cognitive ability (β-coeff -4.03, 95% CI: -7.08, -0.97), perceptual performance (β-coeff -4.60, 95% CI: -7.74, -1.47), quantitative ability (β-coeff -4.43, 95% CI: -7.68, -1.18), and executive functions (β-coeff -4.92, 95% CI: -8.06, -1.78) at 4 years of age, after adjustment for several confounders and paternal BMI. Maternal obesity was also associated with increased behavioral difficulties (β-coeff 1.22, 95% CI: 0.09, 2.34) and ADHD symptoms (β-coeff 4.28, 95% CI: 1.20, 7.36) at preschool age. Paternal obesity maternal glucose intolerance in early pregnancy and GDM was not associated with child neurodevelopment. These findings suggest that maternal obesity may impair optimal child neurodevelopment at preschool age independently of family shared characteristics.

  5. Age Estimation for Dental Patients Using Orthopantomographs

    Science.gov (United States)

    Karaarslan, Bekir; Karaarslan, Emine Sirin; Ozsevik, Abdul Semih; Ertas, Ertan

    2010-01-01

    Objectives: The aim of this study was to conduct age estimates for dental patients using orthopantomographs (OPGs). The OPGs were selected by an independent author with respect to criteria and evaluated by two independent dentists. The results were compared to chronologic ages. The reliability of the estimates, concurrently made by the two independent dentists using OPGs, was also evaluated. Methods: In this retrospective study, the OPGs of 238 Turkish individuals of known chronological age, ranging from 1 to 60 years, were measured. Patients were then classified. Radiographs were evaluated by two independent dentists and age estimation was achieved according to the decades. Results: The truest age estimates made by the dentists were in the 1–10 years age range (89.6%), the most inaccurate age estimates were in the 41–50 years age range (41.7%). Results indicate that the accuracy of age estimation diminishes with age. Conclusions: Despite the variations related to the practitioners, in this study, there were no significant differences in age estimations between the two participant practitioners. Age estimation through evaluating OPGs was the most accurate in the first decade and the least in fourth decade. It can be concluded that OPGs are not adequate for accurate age estimation. PMID:20922158

  6. Low-dose aspirin reduces uteroplacental vascular impedance in early and mid gestation in IVF and ICSI patients: a randomized, placebo-controlled double-blind study.

    Science.gov (United States)

    Haapsamo, M; Martikainen, H; Räsänen, J

    2008-10-01

    To determine whether low-dose aspirin improves uteroplacental hemodynamics in unselected in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) subjects when medication is started concomitantly with controlled ovarian hyperstimulation. Thirty-seven pregnant women who had undergone IVF/ICSI and had been randomized to receive 100 mg aspirin (n = 17) or placebo (n = 20) daily, started concomitantly with controlled ovarian hyperstimulation, were included in this study. Doppler ultrasound examination was performed at 6, 10, 13 and 18 weeks' gestation. Uterine artery (UtA) pulsatility index (PI) was calculated and bilateral UtA notching was noted. Subplacental arcuate artery PI was obtained at 6 and 10 weeks' gestation. Umbilical artery (UA) PI and mean velocity were calculated at 10, 13 and 18 weeks' gestation. In the aspirin group there was one early pregnancy miscarriage, and one patient discontinued the study medication owing to early pregnancy bleeding. A total of 15 women in the aspirin group and 20 women in the placebo group underwent the complete ultrasound protocol. At 6 weeks' gestation, arcuate artery PI and at 18 weeks' gestation, UtA PI were lower (P UtA notching tended to be more common in the placebo group (40%) than in the aspirin group (13%) (P = 0.06). UA PI and mean velocity did not differ significantly between the groups. Low-dose aspirin reduces uteroplacental vascular impedance in early and mid pregnancy in unselected IVF/ICSI subjects when medication is started concomitantly with controlled ovarian hyperstimulation.

  7. Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study.

    Science.gov (United States)

    Regev, Rivka H; Arnon, Shmuel; Litmanovitz, Ita; Bauer-Rusek, Sofia; Boyko, Valentina; Lerner-Geva, Liat; Reichman, Brian

    2015-04-01

    Pregnancy-induced hypertension (PIH) has been associated with a decreased risk of infant mortality in small for gestational age (SGA) preterm infants. To evaluate the influence of PIH on mortality and major neonatal morbidities in singleton preterm SGA infants, in the presence and absence of acute pregnancy complications. Population-based observational study of singleton SGA infants, born at 24 to 32 weeks gestation in the period 1995-2010 (n = 2139). Multivariable logistic regression analyses were used to assess the independent effect of PIH on mortality and neonatal morbidities. Acute pregnancy complications comprised premature labor, premature rupture of membranes >6 h, antepartum hemorrhage and clinical chorioamnionitis. In the absence of pregnancy complications, the odds ratio (95% confidence interval) for mortality (0.77; 0.50-1.16), survival without severe neurological morbidity (1.14; 0.79-1.65) and survival without bronchopulmonary dysplasia (BPD) (0.85; 0.59-1.21) were similar in the PIH versus no-PIH groups. In the presence of pregnancy complications, mortality (0.76; 0.40-1.44), survival without severe neurological morbidity (1.16; 0.64-2.12) and survival without BPD (1.04; 0.58-1.86) were also similar in the PIH versus no-PIH groups. PIH was not associated with improved outcome in preterm SGA infants, both in the presence and absence of acute pregnancy complications.

  8. The influence of INS VNTR class III allele on auxological parameters, glucose, insulin, lipids, and adipocytokines secretion in prepubertal children born small for gestational age.

    Science.gov (United States)

    Stawerska, Renata; Szałapska, Małgorzata; Borowiec, Maciej; Antosik, Karolina; Młynarski, Wojciech; Lewiński, Andrzej

    2016-01-01

    The insulin gene variable number of tandem repeats (INS VNTR) class III allele has been implicated in lower birth weight, obesity, and insulin resistance. We assessed its influence on birth weight in the Polish population and on the current body mass and metabolic profile in prepubertal children born small for gestational age (SGA). DNA for genotyping of INS VNTR was available for 123 subjects born SGA and 132 born appropriate for gestational age (AGA). We identified two alleles: class I and class III. Next, in 112 prepubertal (aged: 6.8 ± 1.38 years) SGA children, the auxological measurements, fasting serum C-peptide, triglycerides, cholesterol, ghrelin, leptin, adiponectin, resistin, cortisol, and insulin-like growth factor type I (IGF-I) concentrations, as well as glucose and insulin during oral glucose tolerance test (OGTT), were assessed and insulin resistance indices were calculated. The results were analysed depending on INS VNTR variants. The occurrence of individual INS VNTR variants were similar in the SGA and AGA groups. In prepubertal SGA children, we did not observe any statistical differences as regards birth weight, body mass, lipids, or adipocytokine concentrations among I/I, I/III, and III/III class groups. The concentration of insulin in 120' of OGTT was significantly higher in class III homozygous than in class I homozygous individuals. Variant INS VNTR class III was shown not to be associated in any essential way with birth weight in the Polish population. Among prepubertal SGA children, the presence of INS VNTR class III is related to higher insulin secretion during OGTT. (Endokrynol Pol 2016; 67 (6): 585-591).

  9. VEGF 936C>T is predictive of threshold retinopathy of prematurity in Japanese infants with a 30-week gestational age or less

    Directory of Open Access Journals (Sweden)

    Mariko Yagi

    2011-03-01

    Full Text Available Mariko Yagi1, Motohiro Yamamori4, Ichiro Morioka2, Naoki Yokoyama2, Shigeru Honda3, Akira Negi3, Tsutomu Nakamura1, Noboru Okamura4, Katsuhiko Okumura1, Toshiyuki Sakaeda5, Masafumi Matsuo21Department of Clinical Evaluation of Pharmacotherapy, 2Department of Pediatrics, 3Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan; 4Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Mukogawa Women's University, Nishinomiya, Japan; 5Center for Integrative Education of Pharmacy Frontier, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, JapanAbstract: Vascular endothelial growth factor (VEGF contributes to the development of retinopathy of prematurity (ROP. We investigated the association of ROP with VEGF genetic polymorphisms and its clinical parameters in Japanese people. Sixty-seven infants with a gestational age of 30 weeks or less were enrolled and classified into the threshold ROP group (infants with Stage 3 ROP in zone I or II, five continuous or eight total clock hours of the retina and the presence of plus disease, n = 30 and the nonthreshold ROP group (n = 37. The VEGF genotypes of −1498T>C, −1154G>A, −634C>G, −7C>T, 936C>T, and 1612G>A were determined. VEGF 936C>T polymorphism and 11 clinical parameters were significantly different between the two ROP groups by univariate analysis. A logistic regression analysis with adjustments for gestational age and birth weight showed that the heterozygous or homozygous carrier state of the T alleles of VEGF 936C>T polymorphism (odds ratio 5.12; 95% confidence interval: 1.25–20.92; P = 0.023 and duration of oxygen administration (odds ratio 1.05; 95% confidence interval: 1.00–1.10; P = 0.042 were independent risk factors of threshold ROP. VEGF 936C>T polymorphism may predict threshold ROP in Japanese infants with a gestational age of 30 weeks or less.Keywords: retinopathy of prematurity, vascular

  10. Increment of absolute neutrophil count in the third trimester and increased risk of small-for-gestational-age birth: Hirakata Risk Associated with Pregnancy Assessment Research (HIRAPAR).

    Science.gov (United States)

    Harita, Nobuko; Kariya, Masatoshi; Hayashi, Tomoshige; Sato, Kyoko Kogawa; Nakamura, Kimihiko; Endo, Ginji; Narimoto, Katsuhiko

    2012-09-01

    Small-for-gestational-age (SGA) infants, who have growth restriction, have higher perinatal morbidity and mortality. Excessive inflammatory reaction such as neutrophil activation has been observed in pregnant women whose offspring had restricted fetal growth, but the association between white blood cell (WBC) counts and SGA birth has not yet been assessed. We therefore examined the association of WBC count and its change with the risk of SGA birth. We enrolled 2356 pregnant women who had full-term singleton delivery at a private maternity hospital in Hirakata, Japan. SGA was defined as under the 10th percentile of birthweight for gestational age, baby sex, and mother's parity according to the Japanese neonatal anthropometric charts renewed in 2010. Blood samples were measured in the first and third trimesters. We performed multiple logistic regression analysis to assess associations between total and differential WBC counts and SGA birth. Women with SGA birth tended to have higher total WBC count in the third trimester compared with women who did not have SGA birth. This tendency was not observed for total WBC count in the first trimester. After adjustment for age, height, body mass index at entry, smoking habit, weekly gestational weight gain, and pregnancy-induced hypertension, higher total WBC count in the third trimester was associated with an increased risk of SGA birth. Total WBC count in the first trimester did not show any significant association with SGA birth. The ratio of total WBC count in the third trimester to that in the first trimester was associated with SGA birth; the odds ratio for 1 unit increase was 3.02 (95% CI: 1.54-5.92). Regarding differential WBC counts in the third trimester, neutrophil count but not lymphocyte count was associated positively with SGA birth. Higher total WBC and absolute neutrophil counts in the third trimester were associated with SGA birth. In addition, greater ratio of increase in total WBC counts during pregnancy

  11. Analysis of epigenetic changes in survivors of preterm birth reveals the effect of gestational age and evidence for a long term legacy

    Science.gov (United States)

    2013-01-01

    Background Preterm birth confers a high risk of adverse long term health outcomes for survivors, yet the underlying molecular mechanisms are unclear. We hypothesized that effects of preterm birth can be mediated through measurable epigenomic changes throughout development. We therefore used a longitudinal birth cohort to measure the epigenetic mark of DNA methylation at birth and 18 years comparing survivors of extremely preterm birth with infants born at term. Methods Using 12 extreme preterm birth cases and 12 matched, term controls, we extracted DNA from archived neonatal blood spots and blood collected in a similar way at 18 years of age. DNA methylation was measured at 347,789 autosomal locations throughout the genome using Infinium HM450 arrays. Representative methylation differences were confirmed by Sequenom MassArray EpiTYPER. Results At birth we found 1,555 sites with significant differences in methylation between term and preterm babies. At 18 years of age, these differences had largely resolved, suggesting that DNA methylation differences at birth are mainly driven by factors relating to gestational age, such as cell composition and/or maturity. Using matched longitudinal samples, we found evidence for an epigenetic legacy associated with preterm birth, identifying persistent methylation differences at ten genomic loci. Longitudinal comparisons of DNA methylation at birth and 18 years uncovered a significant overlap between sites that were differentially-methylated at birth and those that changed with age. However, we note that overlapping sites may either differ in the same (300/1,555) or opposite (431/1,555) direction during gestation and aging respectively. Conclusions We present evidence for widespread methylation differences between extreme preterm and term infants at birth that are largely resolved by 18 years of age. These results are consistent with methylation changes associated with blood cell development, cellular composition, immune

  12. 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

    Science.gov (United States)

    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...

  13. Literature-Informed Analysis of a Genome-Wide Association Study of Gestational Age in Norwegian Women and Children Suggests Involvement of Inflammatory Pathways

    Science.gov (United States)

    Bacelis, Jonas; Juodakis, Julius; Sengpiel, Verena; Zhang, Ge; Myhre, Ronny; Muglia, Louis J.; Nilsson, Staffan; Jacobsson, Bo

    2016-01-01

    Background Five-to-eighteen percent of pregnancies worldwide end in preterm birth, which is the major cause of neonatal death and morbidity. Approximately 30% of the variation in gestational age at birth can be attributed to genetic factors. Genome-wide association studies (GWAS) have not shown robust evidence of association with genomic loci yet. Methods We separately investigated 1921 Norwegian mothers and 1199 children from pregnancies with spontaneous onset of delivery. Individuals were further divided based on the onset of delivery: initiated by labor or prelabor rupture of membranes. Genetic association with ultrasound-dated gestational age was evaluated using three genetic models and adaptive permutations. The top-ranked loci were tested for enrichment in 12 candidate gene-sets generated by text-mining PubMed abstracts containing pregnancy-related keywords. Results The six GWAS did not reveal significant associations, with the most extreme empirical p = 5.1 × 10−7. The top loci from maternal GWAS with deliveries initiated by labor showed significant enrichment in 10 PubMed gene-sets, e.g., p = 0.001 and 0.005 for keywords "uterus" and "preterm" respectively. Enrichment signals were mainly caused by infection/inflammation-related genes TLR4, NFKB1, ABCA1, MMP9. Literature-informed analysis of top loci revealed further immunity genes: IL1A, IL1B, CAMP, TREM1, TFRC, NFKBIA, MEFV, IRF8, WNT5A. Conclusion Our analyses support the role of inflammatory pathways in determining pregnancy duration and provide a list of 32 candidate genes for a follow-up work. We observed that the top regions from GWAS in mothers with labor-initiated deliveries significantly more often overlap with pregnancy-related genes than would be expected by chance, suggesting that increased sample size would benefit similar studies. PMID:27490719

  14. Impact of Periconceptional Folic Acid Supplementation on Low Birth Weight and Small-for-Gestational-Age Infants in China: A Large Prospective Cohort Study.

    Science.gov (United States)

    Li, Nan; Li, Zhiwen; Ye, Rongwei; Liu, Jianmeng; Ren, Aiguo

    2017-08-01

    To explore the effects of maternal folic acid supplementation alone during pregnancy on the incidence of low birth weight (LBW) and small-for-gestational-age (SGA) infant status. Data were derived from a large population-based cohort study performed in China to evaluate the prevention of neural tube defects with folic acid supplementation. The sample comprised 200 589 singleton live births registered in 2 southern Chinese provinces by mothers for whom detailed information on folic acid use was available. Gestational age was calculated from the first day of the last menstrual period. LBW was defined as a birth weight birth weight was below the 10th percentile as defined by a national survey performed in 1998. Logistic regression was used to estimate the effects of folic acid after adjusting for the principal potential confounders. The overall incidence of LBW and SGA status was 2.18% and 5.82%, respectively. The incidence of LBW and SGA status was 2.09% and 5.73% in women who took folic acid, and 2.27% and 5.90% in those who did not. The adjusted risk ratios associated with folic acid use were 0.85 (95% CI: 0.80-0.90) for LBW and 0.93 (95% CI: 0.89-0.96) for SGA status. Folic acid use during pregnancy appeared to be particularly important to prevent LBW and SGA status. A maternal daily intake of 400 µg folic acid alone significantly reduced the risks of infant LBW and SGA status. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A Program Aimed at Reducing Anxiety in Pregnant Women Diagnosed With a Small-for-Gestational-Age Fetus: Evaluative Findings From a Spanish Study.

    Science.gov (United States)

    Arranz Betegón, Ángela; García, Marta; Parés, Sandra; Montenegro, Gala; Feixas, Georgina; Padilla, Nelly; Camacho, Alba; Goberna, Josefina; Botet, Francesc; Gratacós, Eduard

    The objective of this study was to evaluate the effect of anxiety-reducing techniques including music therapy, sophrology, and creative visualization in pregnant women with a fetus diagnosed as small for gestational age and improved fetal and neonatal weight. This was a quasi-experimental study with a nonrandomized clinical trial design. We compared 2 groups of pregnant women with a fetus diagnosed as small for gestational age with no abnormalities on Doppler studies. The control group (n = 93) received standard care, and the intervention group (n = 65), in addition to standard care, underwent a program of 6 sessions led by a midwife or nurse who taught anxiety-reduction techniques. The State-Trait Anxiety Inventory (STAI) including trait and state subscales were completed by both groups at the start of the study, and only the STAI-State subscale was completed again at the end of the study. Comparisons between the 2 groups regarding fetal weight and centile and maternal STAI scores were performed using the t test and the χ test. There were no significant differences in the STAI-Trait scores between the 2 groups. There were statistically significant differences in the intervention group's STAI-State score percentiles between the start and the end of the study, being lower at the end of the study (P < .001). There were significant differences between the 2 groups in fetal weight trajectory on the basis of fetal weight: the intervention group had a larger weight gain (P < .005). The program designed to reduce anxiety in pregnant women was effective at reducing anxiety in the women in the intervention group, leading to a favorable fetal weight trajectory in this group.

  16. Folate treatment partially reverses gestational low-protein diet-induced glucose intolerance and the magnitude of reversal is age and sex dependent.

    Science.gov (United States)

    Blesson, Chellakkan S; Schutt, Amy; Mathew, Pretty R; Tanchico, Daren; Balakrishnan, Meena; Yallampalli, Uma; Yallampalli, Chandra

    2017-11-13

    Gestational low-protein (LP) programming causes glucose intolerance (GI) and insulin resistance (IR) in adult offspring. Folate supplementation has been shown to rescue the offspring from various programming effects. The aim of this study was to investigate whether folate supplementation during pregnancy reverses LP-induced GI and IR. Pregnant rats were fed control (20% protein), isocaloric low-protein (LP, 6%) or LP with 5 mg/kg folate (LPF) diets from gestational day 4 to delivery. The control diet was given during lactation and to pups after weaning. Glucose tolerance test was done at 1, 2, and 3 mo of age followed by euglycemic-hyperinsulinemic clamp at 4 mo. Rats were sacrificed at 4 mo and their gonadal, renal, inguinal, brown fat, and pancreas were weighed and expressed relative to their body weight. LP- and LPF-fed dams showed similar weight loss during late pregnancy after decreased feed intake. Both LP and LPF pups were smaller at birth but their weights caught up like that of controls by 3 mo. In males, folate supplementation reduced LP-induced GI at 2 mo (glucose area under the curve [AUC]: 1940 mmol/L × 180 min in LP, 1629 mmol/L × 180 min in LPF, and 1653 mmol/L × 180 min in controls; P reverses LP-induced GI and the magnitude of reversal is age and sex dependent. Furthermore, folate treatment does not reverse IR in either sex but makes it worse in males at 4 mo. The present study demonstrated that folate treatment is not sufficient to rescue the LP programming effects. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. The role of serum and urinary urea in the evaluation of enteral protein intake in adequate and small-for-gestational-age very low birth weight infants

    Directory of Open Access Journals (Sweden)

    Silvana Darcie

    Full Text Available CONTEXT AND OBJECTIVE: Very low birth weight (VLBW infants have special nutritional needs. There is a current tendency to individualize their protein needs. The objective of this study was to determine the suitability of serum and urinary urea as indicators for protein intake in adequate-for-gestational-age (AGA and small-for-gestational-age (SGA VLBW infants. DESIGN AND SETTING: Prospective study in the nursery attached to the Maternity Ward of the "Prof. Pedro de Alcântara" Children's Institute, Hospital das Clínicas, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, Brazil. METHODS: Seventy-two VLBW infants (mean protein intake = 3.7 mg/kg/day were enrolled in a prospective cohort study in two groups: AGA (n = 34 and SGA (n = 38. Blood samples, six-hour urine (6hUr collections and urine sample tests (STUr were obtained for urea and creatinine assays at three and five weeks of life. Statistical analysis: Student's t test, Pearson correlation and linear regression (p < 0.05. RESULTS: There were no differences between groups for serum urea, 6hUr and STUr, or between two assessments within each group. Serum urea correlated with 6hUr in both AGA and SGA, and to STUr in SGA; 6hUr correlated with STUr in both AGA and SGA. There was no correlation between protein intake and serum or urine urea. CONCLUSIONS: Serum and urinary urea did not reflect protein intake when mean intakes of 3.7 g/kg/day were used. Sample tests of urinary urea can be as reliable as urea from urine collected over longer periods.

  18. The prevalence and risk factors of preterm small-for-gestational-age infants: a population-based retrospective cohort study in rural Chinese population.

    Science.gov (United States)

    Chen, Shi; Zhu, Rong; Zhu, Huijuan; Yang, Hongbo; Gong, Fengying; Wang, Linjie; Jiang, Yu; Lian, Bill Q; Yan, Chengsheng; Li, Jianqiang; Wang, Qing; Zhang, Shi-Kun; Pan, Hui

    2017-07-20

    Preterm birth and small for gestational age (SGA) are strong indicators of neonatal adverse outcomes. With the growing importance of preterm SGA infants, we aim to evaluate the prevalence and risk factors for preterm SGA in China. We analyzed the data of parents and infants from a population-based cohort research of the free National Pre-pregnancy Checkups Project (NPCP) in rural China. Only singleton live births that occurred between 24 weeks +0 days and 36 weeks +6 days of pregnancy were included in this study. SGA was defined as birth weight less than the 10th percentile of the reference birth-weight-for-gestational-age population. A multiple logistic regression model was built using the statistically significant variables from the 371 variables in the questionnaire. A total of 11,474 singleton, preterm, live-birth infants were included. Of the total infants, 317 (2.77%) were preterm SGA infants. A higher risk of preterm SGA infants was observed among mothers who were on oral contraceptives (OR: 8.162, 95% CI: 1.622-41.072), mothers who had syphilis (OR: 12.800, 95% CI: 1.250-131.041), and mothers with a high eosinophil percentage (OR: 13.292, 95% CI: 1.282-135.796). Maternal intake of folic acid at least 3 months before pregnancy (OR: 0.284, 95% CI:0.124-0.654) and paternal intake of egg and meat (OR: 0.097,95% CI:0.030-0.315) were protective factors. Compared with North China, the incidence of preterm SGA infants was higher in South China. Preterm SGA infants were associated with both maternal and paternal factors.

  19. The role of umbilical cord thickness and HbA1c levels for the prediction of fetal macrosomia in patients with gestational diabetes mellitus.

    Science.gov (United States)

    Binbir, Birol; Yeniel, A Ozgur; Ergenoglu, A Mete; Kazandi, Mert; Akercan, Fuat; Sagol, Sermet

    2012-03-01

    The aim of this study was to investigate the effects of HbA1c levels and umbilical cord thickness upon birth weight, particularly in pregestational and gestational diabetic patients. Pregnant women were included in the study and were divided into two groups. The first group consisted of patients who were diagnosed with pregestational or gestational diabetes mellitus. The control group consisted of pregnant women who were not diagnosed with pregestational or gestational diabetes mellitus. Ultrasound examination was performed twice. Examinations were performed at 27-28 weeks and 36-37 weeks of gestation, respectively. During ultrasound examinations, fetal anthropometric parameters, biparietal diameter, abdominal circumference, femur length and estimated fetal weight (which was calculated automatically according to Hadlock's formula) were measured. Additionally, the sonographic cross-sectional areas of the umbilical cord, the umbilical arteries and the umbilical vein were measured in a free loop of the umbilical cord, using the software of the ultrasound machine. The cross-sectional area of Wharton's jelly was computed by subtracting the cross-sectional area of the vessels from that of the umbilical cord. HbA1c levels were measured for diabetic patients. At 27-28 gestational weeks, umbilical cord area and Wharton's jelly values were found to be statistically different in macrosomic fetuses compared with non-macrosomic fetuses for both groups (for cord area, P = 0.012; for Wharton's jelly, P = 0.001). Additionally, umbilical cord diameter vein and artery values were not statistically different between the two groups when macrosomic fetuses were compared with non-macrosomic fetuses. At 36-37 gestational weeks, when the relationship between umbilical cord components and birth weight was examined, there was a statistically significant difference when comparing macrosomic fetuses with non-macrosomic fetuses. There was a statistically significant correlation between

  20. Motor trajectories from 4 to 18 months corrected age in infants born at less than 30 weeks of gestation.

    Science.gov (United States)

    Pin, Tamis W; Eldridge, Bev; Galea, Mary P

    2010-09-01

    Preterm infants are recognised as developing at a significantly slower rate than their full-term peers and with different movement quality. This study aimed to describe the longitudinal gross motor trajectories of these infants in the first 18 months of (corrected) age and investigate factors associated with gross motor development. A longitudinal study was conducted with convenience samples of 58 preterm infants born Alberta Infant Motor Scale (AIMS). Forty-six preterm and 48 control infants completed all four assessments. The preterm group scored significantly lower on various sub-scores at all age levels. Almost half of the preterm infants demonstrated less progression in the sit sub-scale from 4 to 8 months (corrected) age, possibly due to an imbalance between flexor and extensor strength in the trunk. At 12 and 18 months of (corrected) age, lack of rotation and fluency in their movements were evident in some preterm infants. Presence of intra-ventricular haemorrhage and chronic lung disease were associated with poor motor performance at 4 months and use of postnatal steroids was associated with poor motor performance at 4, 8 and 18 months of corrected age. The imbalance between flexor and extensor muscle strength in preterm infants had a stronger impact on motor development than usually expected. The AIMS appears to be a sensitive assessment tool to demonstrate the unique movement characteristics in this preterm cohort. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  1. Catch-Up Growth and Neurobehavioral Development among Full-Term, Small-for-Gestational-Age Children: A Nationwide Japanese Population-Based Study.

    Science.gov (United States)

    Takeuchi, Akihito; Yorifuji, Takashi; Nakamura, Kazue; Tamai, Kei; Mori, Shigehiro; Nakamura, Makoto; Kageyama, Misao; Kubo, Toshihide; Ogino, Tatsuya; Kobayashi, Katsuhiro; Doi, Hiroyuki

    2018-01-01

    To examine the relationship between catch-up growth of full-term, small for gestational age (SGA) children and their neurobehavioral development. Data were obtained from a population-based nationwide Japanese longitudinal survey that started in 2001. Study participants were full-term children with information on height at 2 years of age (n = 32 533). Catch-up growth for SGA infants was defined as achieving a height at 2 years of age of more than -2.0 standard deviations for chronological age. Logistic regression analyses were used to estimate ORs and 95% CIs for the associations of SGA and catch-up growth status with neurobehavioral development at 2.5 and 8 years of age, adjusting for potential infant- and parent-related confounding factors. Fifteen percent of term SGA infants failed to catch up in height. At 2.5 years of age, SGA children without catch-up growth were more likely to be unable to climb stairs (OR, 10.42; 95% CI, 5.55-19.56) and unable to compose a 2-word sentence (OR, 3.58; 95% CI, 1.81-7.08) compared with children with normal growth at birth. Furthermore, SGA children without catch-up growth were at increased risk for aggressive behaviors (OR, 3.85; 95% CI, 1.19-12.47) at 8 years of age. Continuous follow-up for full-term SGA infants with failure of catch-up growth or poor postnatal growth may be beneficial for early detection and intervention for behavioral problems. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Serum adiponectin levels, insulin resistance, and lipid profile in children born small for gestational age are affected by the severity of growth retardation at birth.

    Science.gov (United States)

    Evagelidou, Eleni N; Giapros, Vasileios I; Challa, Anna S; Kiortsis, Dimitrios N; Tsatsoulis, Agathocles A; Andronikou, Styliani K

    2007-02-01

    Insulin resistance has been linked to intrauterine growth retardation (IUGR); adiponectin is a protein with insulin-sensitizing properties. This study was designed to test whether being born small for gestational age (SGA) has an effect on blood levels of adiponectin and leptin, insulin resistance parameters, and lipid profile in pre-puberty, taking into consideration the severity of IUGR. Serum levels of adiponectin, leptin, total cholesterol (t-CHOL), high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, triglycerides, apolipoproteins A-1 (Apo A-1), Apo B and Apo E, lipoprotein(a) (Lp(a)), fasting glucose, and insulin (Ins), the homeostasis model assessment insulin resistance index (HOMA-IR) and anthropometric indices were evaluated in 70 children aged 6-8 years, born appropriate for gestational age (AGA; n = 35) and SGA (n = 35), matched for age, gender, height, and BMI. SGA children were divided into two subgroups according to the severity of IUGR: SGA<3rd percentile (n = 20), and SGA 3rd-10th percentile (n = 15). They were also subdivided in two subgroups, those with (n = 25) and those without (n = 10) catch-up growth, considering their actual height corrected for mid-parental height. SGA children had higher Ins and HOMA-IR than AGA children (Ins, 42 +/- 23 vs 32 +/- 11 pmol/l; HOMA-IR, 1.30 +/- 0.8 vs 0.92 +/- 0.3; P<0.05). No significant difference in serum leptin was found between the SGA and the AGA groups but adiponectin showed a trend to be higher in SGA children (13.6 +/- 5.7 vs 10.8 +/- 5.9 microg/ml respectively). SGA children without catch-up growth had higher adiponectin (15.6 +/- 8.5 microg/ml, P<0.05) than AGA children. Among the SGA children, the subgroup <3rd percentile had higher Lp(a) than the subgroup 3rd-10th percentile (P<0.05). An independent positive correlation between adiponectin and Lp(a) was observed in SGA children (R = 0.59, P<0.01). SGA children, although more insulin resistant, had similar or

  3. Kiss1 and Kiss1r mRNA expression in the rat placenta: changes with gestational age and regulation by glucocorticoids.

    Science.gov (United States)

    Mark, P J; Jones, M L; Lewis, J L; Waddell, B J; Smith, J T

    2013-08-01

    Kisspeptin, the neuropeptide product of the KISS1 gene, is synthesized by neurons within the hypothalamus and is critical for fertility. Human placenta also expresses KISS1 and kisspeptin receptor (KISS1R) mRNA within the trophoblast compartment, where it is thought to act as a physiological invasion inhibitor. We determined the expression of Kiss1 mRNA in rat placenta and examined the effect of gestational age and feto-placental growth restriction, achieved through excess maternal glucocorticoid exposure. Dexamethasone induced fetal growth restriction at both day 16 and day 22 of gestation, but placental growth restriction only at day 22. Real-time quantitative RT-PCR revealed an increase in Kiss1 and Kiss1r mRNA from day 16-22 in the labyrinth and junctional zones of the rat placenta. Immunolocalization confirmed kisspeptin expression in the placenta and was prominent in trophoblast tissue. Dexamethasone exposure elevated the expression of Kiss1 mRNA in the labyrinth and junctional zones of day 16 placentas. In contrast, Kiss1 mRNA in the labyrinth zone was reduced following dexamethasone-treatment at day 22. Kiss1r expression was increased in both placental zones at day 16 and 22 in response to dexamethasone-treatment. We confirm the presence of Kiss1 and Kiss1r mRNA in the rat placenta with expression increasing over the final third of pregnancy, suggestive of a role in restricting placental growth. Furthermore, the effects of dexamethasone on placental Kiss1/Kiss1r suggest glucocorticoid-induced placental growth retardation could be mediated, in part, via early stimulation of Kiss1 and the subsequent inhibition of trophoblast proliferation and invasion. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Mechanisms affecting neuroendocrine and epigenetic regulation of body weight and onset of puberty: potential implications in the child born small for gestational age (SGA).

    Science.gov (United States)

    Roth, Christian L; Sathyanarayana, Sheela

    2012-06-01

    Signaling peptides produced in peripheral tissues such as gut, adipose tissue, and pancreas communicate with brain centers, such as hypothalamus and hindbrain to manage energy homeostasis. These regulatory mechanisms of energy intake and storage have evolved during long periods of hunger in the evolution of man to protect the species from extinction. It is now clear that these circuitries are influenced by prenatal and postnatal environmental factors including endocrine disruptive chemicals. Hypothalamic appetite regulatory systems develop and mature in utero and early infancy, and involve signaling pathways that are important also for the regulation of puberty onset. Recent studies in humans and animals have shown that metabolic pathways involved in regulation of growth, body weight gain and sexual maturation are largely affected by epigenetic programming that can impact both current and future generations. In particular, intrauterine and early infantile developmental phases of high plasticity are susceptible to factors that affect metabolic programming that therefore, affect metabolic function throughout life. In children born small for gestational age, poor nutritional conditions during gestation can modify metabolic systems to adapt to expectations of chronic undernutrition. These children are potentially poorly equipped to cope with energy-dense diets and are possibly programmed to store as much energy as possible, leading to later obesity, metabolic syndrome, disturbed regulation of normal puberty and early onset of cardiovascular disease. Most cases of disturbed energy balance are likely a result of a combination of genetics, epigenetics and environment. This review will discuss potential mechanisms linking intrauterine growth retardation with changes in growth, energy homeostasis and sexual maturation.

  5. Clinical and sonographic risk factors and complications of shoulder dystocia - a case-control study with parity and gestational age matched controls.

    Science.gov (United States)

    Parantainen, Jukka; Palomäki, Outi; Talola, Nina; Uotila, Jukka

    2014-06-01

    To examine the clinical risk factors and complications of shoulder dystocia today and to evaluate ultrasound methods predicting it. Retrospective, matched case-control study at a University Hospital with 5000 annual deliveries. The study population consisted of 152 deliveries complicated by shoulder dystocia over a period of 8.5 years (January 2004-June 2012) and 152 controls matched for gestational age and parity. The data was collected from the medical records of mothers and children and analyzed by conditional logistic regression. Incidences and odds ratios were calculated for risk factors and complications. Antenatal ultrasound data was analyzed when available by conditional logistic regression to test for significant differences between study groups. Birthweight (OR 12.1 for ≥4000 g; 95% CI 4.18-35.0) and vacuum extraction (OR 3.98; 95% CI 1.25-12.7) remained the most significant clinical risk factors. Only a trend of an association of pregestational or gestational diabetes was noticed (OR 1.87; 95% CI 0.997-3.495, probability of type II error 51%). Of the complications of shoulder dystocia the incidence of brachial plexus palsies was high (40%). Antenatal ultrasound method based on the difference between abdominal and biparietal diameters had a significant difference between cases and controls. The impact of diabetes as a risk factor has diminished, which may reflect improved screening and treatment. Antenatal ultrasound methods are showing some promise, but the predictive value of ultrasound alone is probably low. Copyright © 2014. Published by Elsevier Ireland Ltd.

  6. A follow-up of a randomised study of metformin and insulin in gestational diabetes mellitus: growth and development of the children at the age of 18 months.

    Science.gov (United States)

    Ijäs, H; Vääräsmäki, M; Saarela, T; Keravuo, R; Raudaskoski, T

    2015-06-01

    To compare the growth and development of children born to mothers with gestational diabetes mellitus (GDM) requiring pharmacological treatment, and randomised to treatment with metformin or insulin. Follow-up of a randomised controlled trial (RCT) comparing metformin and insulin treatment of GDM. Data were gathered during routine visits to child welfare clinics at the ages of 6, 12, and 18 months, including weight and height measurements, and assessment of motor, social, and linguistic development. The children of mothers with GDM randomised to metformin (n = 47) or insulin (n = 50) treatment during pregnancy. Data were collected from the structured questionnaire filled in at the child welfare clinics. The growth and development of the children until the age of 18 months. Children exposed to metformin were significantly heavier (10.47 versus 9.85 kg, 95% CI 0.04-1.20) at the age of 12 months and taller and heavier (83.9 vs 82.2 cm, 95% CI 0.23-3.03, 12.05 vs 11.32 kg, 95% CI 0.04-1.43) at the age of 18 months. The mean ponderal index (PI) did not differ significantly. The motor, social, or linguistic development evaluated at the age of 18 months did not differ between the groups. Children prenatally exposed to metformin were heavier at the 12 months measurements and taller and heavier at the 18 months measurements than those exposed to insulin, but their body composition defined by PI did not