Early-Onset Thrombocytopenia in Small-For-Gestational-Age Neonates: A Retrospective Cohort Study.

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S F Fustolo-Gunnink

Full Text Available Thrombocytopenia is a common finding in small for gestational age (SGA neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to identify risk factors for thrombocytopenia. We performed a retrospective cohort study of all consecutive SGA neonates admitted to our ward and a control group of appropriate for gestational age (AGA neonates matched for gestational age at birth. Main outcome measures were incidence and severity of thrombocytopenia, hematological and clinical risk factors for thrombocytopenia, and bleeding. A total of 330 SGA and 330 AGA neonates were included, with a mean gestational age at birth of 32.9 ± 4 weeks. Thrombocytopenia (<150x109/L was found in 53% (176/329 of SGA neonates and 20% (66/330 of AGA neonates (relative risk (RR 2.7, 95% confidence interval (CI [2.1, 3.4]. Severe thrombocytopenia (21-50x109/L occurred in 25 neonates (8% in the SGA and 2 neonates (1% in the AGA group (RR 12.5, 95% CI [3.0, 52.5]. Platelet counts <20x109/L were not recorded. Within the SGA group, lower gestational age at birth (p = <0.01 and erythroblastosis (p<0.01 were independently associated with a decrease in platelet count. Platelet count was positively correlated with birth weight centiles. In conclusion, early-onset thrombocytopenia is present in over 50% of SGA neonates and occurs 2.7 times as often as in AGA neonates. Thrombocytopenia is seldom severe and is independently associated with lower gestational age at birth and erythroblastosis.

Small-for-gestational age and preterm birth across generations: a population-based study of Illinois births.

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Castrillio, Stephanie M; Rankin, Kristin M; David, Richard J; Collins, James W

2014-12-01

Small for gestational age (weight for gestational age mothers (1956-1976) with appended US census income information. Former SGA White mothers (N = 8,993) had a twofold greater infant SGA frequency than former non-SGA White mothers (N = 101,312); 14.4 versus 6.9 %, RR = 2.1 (2.0-2.2). Former SGA African American (N = 4,861) mothers had a SGA birth frequency of 25.7 % compared to 16.1 % for former non-SGA mothers (N = 28,090); RR = 1.5 (1.5-1.6). The adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, cigarette smoking, and hypertension) RR (95 % CI) of infant SGA for former SGA (compared to non-SGA) White and African-American mothers equaled 2.0 (1.9-2.1 and 1.5 (1.5-1.6), respectively. The adjusted RR (95 % CI) of infant preterm birth for former preterm (compared to term) White and African-American mothers were 1.1 (1.0-1.2). The findings were minimally changed among mothers with a lifelong residence in impoverished or affluent neighborhoods. In both races, approximately 8 % of SGA births were attributable to maternal SGA. There is a transgenerational association of SGA but not preterm birth among non-Hispanic Whites and African-Americans. In both races, a similar proportion of SGA births are attributable to maternal SGA.

Maternal homocysteine and small-for-gestational-age offspring: systematic review and meta-analysis

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Hogeveen, M.; Blom, H.J.; den Heijer, M.

2012-01-01

Background: Growth retardation in utero leading to small-for-gestational- age (SGA) newborns is associated with increased neonatal morbidity and mortality and with lifelong consequences such as poor cognitive function and cardiovascular diseases. Maternal total homocysteine (tHcy) concentrations

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

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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

Homocysteine in small-for-gestational age and appropriate-for-gestational age preterm neonates from mothers receiving folic acid supplementation.

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Gomes, Thushari S; Lindner, Ulrike; Tennekoon, Kamani H; Karandagoda, Wimal; Gortner, Ludwig; Obeid, Rima

2010-08-01

Prematurity and small-for-gestational age (SGA) neonates are at risk for postnatal complications. Concentrations of total homocysteine (tHcy) might be related to neonatal outcome. We hypothesized that concentrations of tHcy are not related to growth restriction in neonates from mothers receiving 5 mg/day folic acid. We studied a total of 133 preterm neonates from normotensive mothers; SGA (n=96) and appropriate-for-gestational age (AGA, n=37). Concentrations of tHcy, folate and vitamin B12 were measured in venous umbilical cord plasma. AGA preterm neonates had higher mean birth weight (BW) compared to SGA preterms (2472 g vs. 2007 g; pgestational age (GA) (35.1 vs. 35.7 weeks; p=0.059). Concentrations of tHcy (4.86 vs. 4.95 micromol/L), folate (63.3 vs. 55.7 nmol/L), and vitamin B12 (409 vs. 394 pmol/L) were not significantly different between the groups. GA was a strong positive predictor, BW was a significant negative predictor of cord plasma folate. Vitamin B12 concentration was a significant negative predictor of cord tHcy. Concentrations of tHcy did not differ between SGA and AGA preterm neonates born to mothers supplemented with folic acid. This finding argues against a causal role for folate deficiency or increased tHcy in growth restriction.

Early-Onset Thrombocytopenia in Small-For-Gestational-Age Neonates: A Retrospective Cohort Study

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Fustolo-Gunnink, S. F.; Vlug, R. D.; Smits-Wintjens, V. E. H. J.; Heckman, E. J.; te Pas, A. B.; Fijnvandraat, K.; Lopriore, E.

2016-01-01

Thrombocytopenia is a common finding in small for gestational age (SGA) neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to

Breast milk fat content of mothers to small-for-gestational-age infants.

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Domany, K Armoni; Mandel, D; Kedem, M Hausman; Lubetzky, R

2015-06-01

Little is known about the composition of human milk (HM) expressed by mothers of asymmetrically growth-restricted infants. To test the null hypothesis that lactating mothers of small-for-gestational-age (SGA) infants produce milk with fat content similar to that of lactating mothers of infants whose growth is appropriate for gestational age (AGA). Fifty-six lactating mothers of newborns (26 SGA and 30 AGA) were recruited within the first 3 days of delivery. Creamatocrit (CMT) levels in HM were measured at 72 h, 7 days and 14 days postdelivery in capillary tubes after centrifugation at 9000 r.p.m. for 5 min. The groups did not differ in terms of maternal age, body mass index, gestational age (GA), pregnancy weight gain and parity. They differed significantly in terms of infant's birth weight by design. The mean CMT levels at the three time points were similar for the two groups. This remained true when timing of the sample (colostrum, transitional, mature milk) was introduced as a confounder in the analysis of variance (general linear model). Fat content of HM is not affected by fetal growth status. We suggest that mothers of SGA infants may be reassured that their milk contains adequate amount of fat that is appropriate for the growth of their infants.

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.

Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987-2003

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Mortensen, Laust H; Lauridsen, Jørgen T; Diderichsen, Finn

2010-01-01

In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs).......In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs)....

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

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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...... birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age......  CHERG birth cohorts from 14 population based sites in low and middle income countries. Main outcome measures In low and middle income countries in the year 2012, the number and proportion of infants born small for gestational age; number and proportion of neonatal deaths attributable to small...

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......-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 ....0002), primiparity (p = 0.0003), and hypertension (p = 0.015). Serum YKL-40 increased from 12 to 20 weeks and decreased from 20-25 and 25-32 weeks of gestation. No association was found between preeclampsia and serum YKL-40. Small-for-gestational-age at birth was significantly associated with a 5.4% increase...

Early biometric lag in the prediction of small for gestational age neonates and preeclampsia.

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Schwartz, Nadav; Pessel, Cara; Coletta, Jaclyn; Krieger, Abba M; Timor-Tritsch, Ilan E

2011-01-01

An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P biometric lag variables and the development of preeclampsia. Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes.

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

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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

Comparison of serum 25-hydroxy vitamin D levels between mothers with small for gestational age and appropriate for gestational age newborns in Kerman.

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Mirzaei, Fatemeh; Amiri Moghadam, Tayebeh; Arasteh, Peyman

2015-04-01

Vitamin D deficiency during pregnancy is associated with some adverse pregnancy outcomes but its relationship with fetal growth is unknown. We compared the 25-hydroxy vitamin D levels between mothers and their small for gestational age (SGA) newborns with mothers and their appropriate for gestational age (AGA) newborns. The study population included pregnant women that referred to Afzalipour Hospital in Kerman from 2012 to 2013. The case and control group consisted of 40 pregnant mothers with SGA and AGA newborns, respectively. The maternal and infants 25-hydroxy vitamin D levels were measured in the two groups. 25-hydroxy vitamin D deficiency (mothers and infants in both the SGA group and the AGA group was significant. Our study reveals a high prevalence of vitamin D deficiency in women with SGA infants in comparison to women with AGA children. In addition, maternal vitamin D deficiency is associated with its deficiency in newborns.

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

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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.

Combined Influence of Gestational Weight Gain and Estimated Fetal Weight on Risk Assessment for Small- or Large-for-Gestational-Age Birth Weight: A Prospective Cohort Study.

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

2018-04-01

To evaluate the frequency with which gestational weight gain and estimated fetal weight do not track across gestation and to assess the risk of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight as a function of tracking. This study included a pregnancy cohort (2009-2013) of 2438 women from 4 racial/ethnic groups in the United States. We calculated race- and trimester-specific gestational weight gain and estimated fetal weight z scores. The prevalence of how often gestational weight gain and estimated fetal weight did not or did directly track was examined by grouping z scores into measure-specific categories (1 SD) and then examining 2-measure combinations. Trimester-specific relative risks for SGA and LGA births were estimated with a gestational weight gain and estimated fetal weight z score interaction. We estimated coefficients for selected gestational weight gain and estimated fetal weight values (-1 SD, 0 SD, and +1 SD) compared with the referent of 0 SD for both measures. Small and large for gestational age were calculated as birth weight below the 10th and at or above the 90th percentiles, respectively. Gestational weight gain and estimated fetal weight were within 1 SD 55.5%, 51.5%, and 48.2% of the time in the first, second, and third trimesters, respectively. There was no significant interaction between gestational weight gain and estimated fetal weight on the risk of SGA in the first and second trimesters (interaction term P = .48; P = .79). In the third trimester, there was a significant interaction (P = .002), resulting in a 71% (95% confidence interval, 1.45-2.02) increased risk of SGA when estimated fetal weight was low and gestational weight gain was high. These relationships were similar for the risk of LGA. Deviations in either measure, even in the presence of average gestational weight gain or estimated fetal weight, still suggest an increased risk of SGA and LGA. © 2017 by the American Institute of

Cognitive ability in adolescents born small for gestational age

DEFF Research Database (Denmark)

Jensen, Rikke Beck; Juul, Anders; Larsen, Torben

2015-01-01

cognitive ability in late adolescence. Full-scale IQ was positively related to head circumference (HC) in adolescence (B: 1.30, 95% CI: 0.32-2.28, p=0.01). HC at birth and three months was positively associated with full-scale IQ. Catch-up growth in the group of SGA children was associated......BACKGROUND: Small size at birth may be associated with impaired cognitive ability later in life. The aim of this study was to examine the effect of being born small for gestational age (SGA), with or without intrauterine growth restriction (IUGR) on cognitive ability in late adolescence. STUDY...... with a significantly increased height, larger HC, increased levels of insulin-like growth factor-I (IGF-I) and increased full-scale IQ compared to those born SGA without catch-up growth. CONCLUSION: SGA and IUGR may not be harmful for adult cognitive ability, at least not in individuals born at near-term. However...

Application of First Trimester Screening in the Prognostication of Small for Gestational Age

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Reza Saeidi

2018-05-01

Full Text Available Background: Fetal growth restriction is defined as the failure of the fetus to achieve its full growth potential. The present study aimed to investigate the application of first trimester screening in the prediction of small for gestational age (SGA.Methods: This cohort study was conducted on the consecutive and unselected women with singleton pregnancies undergoing routine first-trimester examinations in a health center affiliated to Neyshabur University of Medical Sciences in Razavi Khorasan Iran during February 2014-March 2016. Subjects received a first-trimester visit by a physician, which included the entry of basic maternal characteristics, medical history, measurement of maternal weight and height, ultrasound examination for fetal anatomy, and measurement of crown-rump length to assess gestational age.Results: SGA was significantly correlated with maternal age, parity, and body mass index. Furthermore, a significant association was observed between SGA and smoking habits in the mothers.Conclusion: According to the results, first trimester screening was a useful method for the prediction of SGA.

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

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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.

Postnatal Growth Disadvantage of the Small for Gestational Age Preterm Twins

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Iris Morag

2018-04-01

Full Text Available In this study, we examined early growth characteristics among small-for-gestational-age (SGA preterm twins compared to their appropriate-for-gestational-age (AGA counterparts. A retrospective study evaluated all consecutive twins born between 2008 and 2015 at a tertiary referral center whose gestational age ranged from 30.0 to 34.86 weeks. Included were twins in which one twin was AGA and the other SGA at birth. Changes of ≥2, 1–1.99, and 0–0.99 in z-score between births and 36 weeks post menstrual age (PMA were respectively defined as severe, moderate, and mild postnatal growth failure (PNGF in weight or head circumference (HC. Early neonatal morbidities were documented. Multiple logistic regression analysis was applied to determine conditions associated with PNGF and its severity. Out of 666 sets of twins, 83 met the inclusion criteria. Weight PNGF was similar and mild among the SGA and the AGA groups (0.9 ± 0.46 vs. 0.96 ± 0.44 z-score, respectively, p = 0.24. At 36 weeks PMA, a significantly larger proportion of SGAs were below −2 z-scores in weight (84.3% compared to birth (31.3% or to the AGAs (8.4%. In both groups, weight PNGF correlated with the time needed to regain birth weight. HC PNGF was mild among both groups, yet significantly more prominent among the AGAs (0.39 ± 0.72 z-score vs. SGAs (0.75 ± 0.65 z-score, p = 0.001. We suggest that among preterm SGA infants, the absolute z-score should be used to assess the severity of weight PNGF. Individual nutritional strategies to decrease time to regain birth weight may mitigate severe malnutrition among SGAs.

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

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

2012-09-01

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

Smoking overrules many other risk factors for small for gestational age birth in less educated mothers

NARCIS (Netherlands)

van den Berg, Gerrit; van Eijsden, Manon; Galindo-Garre, Francisca; Vrijkotte, Tanja G. M.; Gemke, Reinoud J. B. J.

2013-01-01

Although there is convincing evidence for the association between small for gestational age (SGA) and socioeconomic status (SES), it is not known to what extent explanatory factors contribute to this association. To examine to what extent risk factors could explain educational inequalities in SGA.

The effects of maternal depression and use of antidepressants during pregnancy on risk of a child small for gestational age

DEFF Research Database (Denmark)

Jensen, Hans Mørch; Grøn, Randi; Lidegaard, Ojvind

2013-01-01

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.......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....

Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers.

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Lesley M E McCowan

Full Text Available Most small for gestational age pregnancies are unrecognised before birth, resulting in substantial avoidable perinatal mortality and morbidity. Our objective was to develop multivariable prediction models for small for gestational age combining clinical risk factors and biomarkers at 15±1 weeks' with ultrasound parameters at 20±1 weeks' gestation.Data from 5606 participants in the Screening for Pregnancy Endpoints (SCOPE cohort study were divided into Training (n = 3735 and Validation datasets (n = 1871. The primary outcomes were All-SGA (small for gestational age with birthweight <10th customised centile, Normotensive-SGA (small for gestational age with a normotensive mother and Hypertensive-SGA (small for gestational age with an hypertensive mother. The comparison group comprised women without the respective small for gestational age phenotype. Multivariable analysis was performed using stepwise logistic regression beginning with clinical variables, and subsequent additions of biomarker and then ultrasound (biometry and Doppler variables. Model performance was assessed in Training and Validation datasets by calculating area under the curve.633 (11.2% infants were All-SGA, 465(8.2% Normotensive-SGA and 168 (3% Hypertensive-SGA. Area under the curve (95% Confidence Intervals for All-SGA using 15±1 weeks' clinical variables, 15±1 weeks' clinical+ biomarker variables and clinical + biomarkers + biometry /Doppler at 20±1 weeks' were: 0.63 (0.59-0.67, 0.64 (0.60-0.68 and 0.69 (0.66-0.73 respectively in the Validation dataset; Normotensive-SGA results were similar: 0.61 (0.57-0.66, 0.61 (0.56-0.66 and 0.68 (0.64-0.73 with small increases in performance in the Training datasets. Area under the curve (95% Confidence Intervals for Hypertensive-SGA were: 0.76 (0.70-0.82, 0.80 (0.75-0.86 and 0.84 (0.78-0.89 with minimal change in the Training datasets.Models for prediction of small for gestational age, which combine biomarkers, clinical and

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

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

2016-01-01

Objectives 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. Methods 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. Results 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. Conclusions 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. PMID:27501456

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

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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.

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

million low-birthweight babies, 59% were term-SGA and 41% were preterm-SGA. Two-thirds of small-for-gestational-age infants were born in Asia (17·4 million in south Asia). Preterm-SGA babies totalled 2·8 million births in low-income and middle-income countries. Most small-for-gestational-age infants were......BACKGROUND: National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low...... birthweight (age was defined as lower than the 10th centile for fetal growth from the 1991 US national reference population. Data from 22 birth cohort studies (14 low-income and middle-income countries) and from...

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.

[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.

Social class, ethnicity and other risk factors for small for gestational age and preterm delivery in the Netherlands

NARCIS (Netherlands)

Verkerk, P.H.; Zaadstra, B.M.; Reerink, J.D.; Herngreen, W.P.; Verloove-Vanhorick, S.P.

1994-01-01

Social class and ethnicity are important risk factors for small-for-gestational-age and preterm delivery in many countries. This study was performed to assess whether this is also the case in the Netherlands, a country with a high level of social security, relatively small income differences and

Long-Term Survival of Individuals Born Small and Large for Gestational Age.

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E Christina M Wennerström

Full Text Available Little is known on long-term survival and causes of death among individuals born small or large for gestational age. This study investigates birth weight in relation to survival and causes of death over time.A national cohort of 1.7 million live-born singletons in Denmark was followed during 1979-2011, using the Danish Civil Registration System, the Medical Birth Registry and the Cause of Death Registry. Cox proportional hazards were estimated for the impact of small (SGA and large (LGA gestation weight and mortality overall, by age group and birth cohort.Compared to normal weight children, SGA children were associated with increased risk of dying over time. Though most of the deaths occurred during the first year of life, the cumulative mortality risk was increased until 30 years of age. The hazard ratios [HR] for dying among SGA children ages <2 years were: 3.47 (95% CI, 3.30-3.64 and 1.06 (95% CI, 0.60-1.87 in 30 years and older. HR for dying among SGA adults (20-29 years were: 1.20 (95% CI, 0.99-1.46 in years 1979-1982 and 1.61 (95% CI, 1.04-2.51 in years 1989-1994. The SGA born had increased risk of dying from infection, heart disease, respiratory disease, digestive disease, congenital malformation, perinatal conditions, and accidents, suicide, and homicide. Individuals born LGA were associated with decreased mortality risk, but with increased risk of dying from malignant neoplasm.Survival has improved independently of birth weight the past 30 years. However, children born SGA remain at significantly increased risk of dying up till they turn 30 years of age. Individuals born LGA have lower mortality risk but only in the first two years of life.

Methylphenidate and the Response to Growth Hormone Treatment in Short Children Born Small for Gestational Age

NARCIS (Netherlands)

J.S. Renes (Judith); M.A.J. de Ridder (Maria); P.E. Breukhoven (Petra); A.J. Lem (Annemieke); A.C.S. Hokken-Koelega (Anita)

2012-01-01

textabstractBackground: Growth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with

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

OBJECTIVE: To examine the ability of predicting fetuses being small-for-gestational-age (SGA) at delivery with the maternal serum markers pregnancy-associated plasma protein A (PAPP-A), beta-human chorionic gonadotrophin (beta-hCG) and A disintegrin and metalloprotease 12 (ADAM12) in first...... trimester. METHODS: In all,36 cases being SGA (birth weight gestational age...

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.

Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age: A longitudinal study

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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.

Small-for-gestational age prevalence risk factors in central Appalachian states with mountain-top mining.

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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

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 1...

Endocrine and metabolic diurnal rhythms in young adult men born small vs appropriate for gestational age

DEFF Research Database (Denmark)

Brøns, Charlotte; Saltbæk, Pernille N; Friedrichsen, Martin

2016-01-01

OBJECTIVE: Sleep disturbances and alterations of diurnal endocrine rhythms are associated with increased risk of type 2 diabetes (T2D). We previously showed that young men born small for gestational age (SGA) and with increased risk of T2D have elevated fat and decreased glucose oxidation rates d...

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.

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

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Rosanna M. Giaffredo Angrisani

2013-12-01

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

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

International Nuclear Information System (INIS)

Hotoura, Efthalia; Giapros, Vasilios; Drougia, Aikaterini; Argyropoulou, Maria; Papadopoulou, Frederica; Nikolopoulos, Panayiotis; Andronikou, Styliani

2005-01-01

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.)

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...

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.

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.

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

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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

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

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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.

Risk of hearing loss in small for gestational age neonates

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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

Risk of hearing loss in small for gestational age neonates

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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

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...

Estimating Gestational Age From Ultrasound Fetal Biometrics.

Science.gov (United States)

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

2017-08-01

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

Newborns of mothers with intellectual disability have a higher risk of perinatal death and being small for gestational age.

Science.gov (United States)

Höglund, Berit; Lindgren, Peter; Larsson, Margareta

2012-12-01

To study mode of birth, perinatal health and death in children born to mothers with intellectual disability (ID) in Sweden. Population-based register study. National registers; the National Patient Register linked to the Medical Birth Register. Children of first-time mothers with ID (n = 326; classified in the International Classification of Diseases 8-10) were identified and compared with 340 624 children of first-time mothers without ID or any other psychiatric diagnosis between 1999 and 2007. Population-based data were extracted from the National Patient Register and the Medical Birth Register. Mode of birth, preterm birth, small for gestational age, Apgar score, stillbirth and perinatal death. Children born to mothers with ID were more often stillborn (1.2 vs. 0.3%) or died perinatally (1.8 vs. 0.4%) than children born to mothers without ID. They had a higher proportion of cesarean section birth (24.5 vs. 17.7%) and preterm birth (12.2 vs. 6.1%), were small for gestational age (8.4 vs. 3.1%) and had lower Apgar scores (mothers without ID. Logistic regression adjusted for maternal characteristics confirmed an increased risk of small for gestational age (odds ratio 2.25), stillbirth (odds ratio 4.53) and perinatal death (odds ratio 4.25) in children born to mothers with ID. Unborn and newborn children of mothers with ID should be considered a risk group, and their mothers may need better individual-based care and support. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Fetal eyeball volume: relationship to gestational age and biparietal diameter.

Science.gov (United States)

Odeh, Marwan; Feldman, Yulia; Degani, Shimon; Grinin, Vitali; Ophir, Ella; Bornstein, Jacob

2009-08-01

To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation. The volume of the fetal eyeball was measured with three-dimensional ultrasound between 14 and 40 weeks of gestation using the VOCAL software.Only singleton pregnancies without fetal growth restriction, diabetes mellitus, hypertension or major fetal malformation were included. Over all, 203 women were studied. In 125 both eyeballs were measured while in 78 only one eyeball was measured. The volume of the eyeball correlated strongly with gestational age (right: R = 0.946, P eyeball volume and the BPD were: square of right eyeball = -0.180 + 0.187 BPD, square of left eyeball = -0.182 + 0.187 BPD. The volume of the eyeball has strong positive correlations with gestational age and BPD. Our data may be helpful in fetuses suspected of having eye anomalies.

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

Smoking ban and small-for-gestational age births in Ireland.

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Zubair Kabir

Full Text Available 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 <5(th percentile and very SGA (vSGA - BW<3(rd 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 comprehensive

Ghrelin and obestatin plasma levels and ghrelin/obestatin prepropeptide gene polymorphisms in small for gestational age infants.

Science.gov (United States)

Zhang, Shulian; Zhai, Guanpeng; Zhang, Jinping; Zhou, Jianguo; Chen, Chao

2014-12-01

To investigate plasma ghrelin and obestatin levels, and ghrelin/obestatin prepropeptide gene polymorphisms, in sequentially enrolled small for gestational age (SGA) infants. Neonates were sequentially enrolled into this study and were then subdivided into different groups, according to different study aims and availability of study materials. Consequently, plasma ghrelin and obestatin levels were measured in term SGA, term appropriate for gestational age (AGA), term large for gestational age (LGA), preterm SGA and preterm AGA neonates. Levels of both peptides were also measured in AGA infants of different gestational ages, and in term AGA neonates at different days following birth. Three ghrelin/obestatin prepropeptide gene single nucleotide polymorphisms (SNPs), Arg51Gln, Leu72Met, and Gln90Leu, were measured in neonates. The study involved a total cohort of 581 neonates. Out of 150 neonates (30 term AGA, 30 term SGA, 30 term LGA, 30 preterm AGA, and 30 preterm SGA), plasma obestatin levels were significantly higher in term SGA versus term LGA neonates (0.21 ± 0.02 ng/ml versus 0.17 ± 0.01 ng/ml, respectively). Out of a wider cohort, there were no significant differences in genotypes and allele frequencies of Arg51Gln, Leu72Met, and Gln90Leu SNPs between term SGA and AGA neonates, or between preterm SGA and AGA neonates. Ghrelin/obestatin prepropeptide polymorphisms were not found to be associated with SGA status in neonates; however, ghrelin and obestatin levels may be involved in growth and development. Further studies are required to understand the relationship between ghrelin, obestatin and prenatal development. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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

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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

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

Science.gov (United States)

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

2018-02-01

Small for gestational age is usually defined as an infant with a birthweight restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth. Improved identification, accompanied by surveillance and timely delivery, is associated with reduction in small-for-gestational-age stillbirths. Internationally and regionally, detection of small for gestational age and management of fetal growth problems vary considerably. The aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines; and identify future research priorities in this field. A search of MEDLINE, Google, and the International Guideline Library identified 6 national guidelines on management of pregnancies complicated by fetal growth restriction/small for gestational age published from 2010 onwards. There is general consensus between guidelines (at least 4 of 6 guidelines in agreement) in early pregnancy risk selection, and use of low-dose aspirin for women with major risk factors for placental insufficiency. All highlight the importance of smoking cessation to prevent small for gestational age. While there is consensus in recommending fundal height measurement in the third trimester, 3 specify the use of a customized growth chart, while 2 recommend McDonald rule. Routine third-trimester scanning is not recommended for small-for-gestational-age screening, while women with major risk factors should have serial scanning in the third trimester. Umbilical artery Doppler studies in suspected small-for-gestational-age

Comparison of bone age in small-for-gestationalage children vs appropriate-for-getational-age children

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Lionardus Edward

2010-04-01

Full Text Available BackgroundAbout 10-15% small-for-gestational-age children are in higher risk for having linear growth retardation due to growth hormone-insulin like growth factor 1 axis defect (GH-IGF 1 which causes bone age delay.ObjectivesTo compare bone age in 24-36 month old children born small-for-gestational-age (SGA to that in children born appropriate-for-gestational-age (AGA.MethodsA cross-sectional study was conducted in Hasan Sadikin General Hospital, Bandung, from January to April 2009.Subjects consisted of50 healthy children of 24-36 months old (25 children born at term, SGA, 25 children born at term, AGA. We compared the appropriateness and delay of bone age between the two groups. ResultsMean bone age in the SGA group was 20.8 (SD 7.7 months, and in the AGA group was 25.7 (SD 7.1 months (P=0.022. Mean bone age deficit was -10.5 (6.5 months in the SGA group and -5.5 (SD 5.7 months in the AGA group (P=0.009. The prevalence ratio was 1.77 (95% CI: 1.19–2.62. Bone age delay was found to be higher in children born SGA than that in children of the other group (23 vs 13. On the contrary, appropriate bone age was found more in children born AGA (12 vs 2 (P=0.002.Conclusion Bone age delay in 24-36 months old children born small-for-gestational-age was found to be higher than in those born appropriate-for-gestational-age.

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

DEFF Research Database (Denmark)

Tinggaard, Jeanette; Jensen, Rikke Beck; 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...... in SGA girls is prudent. Altogether, the findings are reassuring. However, long-term effects of GH treatment on adult reproductive function remain unknown.CLINICAL TRIAL REGISTRATION NUMBER: EudraCT 2005-001507-19....

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

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Morgan Angharad R

2010-08-01

Full Text Available Abstract 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.

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

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

Science.gov (United States)

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

2018-01-01

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

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

Science.gov (United States)

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

2018-01-31

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

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.

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.

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

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Henrica M A de Bie

Full Text Available 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.

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.

Intelligence and psychosocial functioning during long-term growth hormone therapy in children born small for gestational age [IF: 5.9

NARCIS (Netherlands)

van Pareren, Y.K.; Duivenvoorden, H.; Slijper, F.S.M.; Koot, H.M.; Hokken-Koelega, A.C.S.

2004-01-01

Short stature is not the only problem faced by small for gestational age (SGA) children. Being born SGA has also been associated with lowered intelligence, poor academic performance, low social competence, and behavioral problems. Although GH treatment in short children born SGA can result in a

Predictors of Size for Gestational Age in St. Louis City and County

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Pamela K. Xaverius

2014-01-01

Full Text Available Objective. To identify social, behavioral, and physiological risk factors associated with small for gestational age (SGA by gestational age category in St. Louis City and County. Methods. A retrospective cohort study was conducted using birth certificate and fetal death records from 2000 to 2009 (n = 142,017. Adjusted associations of risk factors with SGA were explored using bivariate logistic regression. Four separate multivariable logistic regression analyses, stratified by gestational age, were conducted to estimate adjusted odds ratios. Results. Preeclampsia and inadequate weight gain contributed significantly to increased odds for SGA across all gestational age categories. The point estimates ranged from a 3.41 increased odds among women with preeclampsia and 1.76 for women with inadequate weight gain at 24–28 weeks’ gestational age to 2.19 and 2.11 for full-term infants, respectively. Among full-term infants, smoking (aOR = 2.08, chronic hypertension (aOR = 1.46, and inadequate prenatal care (aOR = 1.25 had the next most robust and significant impact on SGA. Conclusion. Preeclampsia and inadequate weight gain are significant risk factors for SGA, regardless of gestational age. Education on the importance of nutrition and adequate weight gain during pregnancy is vital. In this community, disparities in SGA and smoking rates are important considerations for interventions designed to improve birth outcomes.

For Debate: Growth Hormone Treatment of Infants Born Small for Gestational Age should be Started at or before the First Year of Age.

Science.gov (United States)

Laron, Zvi; Laron-Kenet, Tamar; Klinger, Gil

2016-12-01

Children born small for gestational age without early catch-up of somatic growth and head circumference subsequently remain short and suffer from various degrees of neurocognitive and psychological impairment. Based upon the role of growth hormone (GH) and insulin-like growth factor-I on early brain growth and maturation, we propose that GH treatment of these infants be instituted prior to their 2nd birthday. Copyright© of YS Medical Media ltd.

First trimester serum PAPP-A levels and the prediction of small-for-gestational age infants

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Nilgün Güdücü

2012-06-01

Full Text Available Objectives: The aim of this study was to detect thepredictive value of PAPP-A in small-for-gestational age(SGA infants.Materials and methods: We retrospectively searchedthe patient charts of our hospital for first trimester Downsyndrome screening test results. PAPP-A levels less than5th percentile were considered as predictive of SGA infants.Results: Low PAPP-A levels were associated with SGAinfants, sensitivity was 3,5%, specificity 90%, positivepredictive value 1,6% and negative predictive value 95%.Conclusions: The low positive predictive value of PAPPAprevents it from being used as a screening test for thedetection of SGA infants. J Clin Exp Invest 2012; 3(2:185-188

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.

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...... short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature. METHODS: We conducted an individual participant data meta-analysis with the use of data sets from 12...... population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each...

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

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...... with lower term birthweights (39.9%) - Portugal, Italy and France - and higher term birthweights, namely Denmark, the Netherlands, Sweden (28.9%; p third...

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.

Gene expression of placental hormones regulating energy balance in small for gestational age neonates.

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Struwe, Ellen; Berzl, Gabriele M; Schild, Ralf L; Dötsch, Jörg

2009-01-01

Fetal growth restriction is associated with an increased risk for metabolic and cardiovascular disease in later life. To further elucidate mechanisms that might be involved in the process of prenatal programming, we measured the adipokines leptin, resistin, and adiponectin and the GH-releasing hormone ghrelin in the placenta of small for gestational age (SGA) neonates. The control group included 24 placentas of appropriate for gestational age (AGA) newborns, in the study group were 16 placentas of SGA neonates. Gene expression of leptin, resistin, adiponectin, and ghrelin was examined. For hormones showing alterations in gene regulation placental protein expression was measured by Western blot. Placental mRNA expression of leptin was significantly increased in SGA placentas (p=0.0035, related to beta-actin). Protein concentration was increased, as well. There were no differences in placental resistin, adiponectin, or ghrelin gene expressions between SGA neonates and controls. Leptin was the only hormone to demonstrate a significant inverse correlation with birth weight (r=-0.44, p=0.01). Adiponectin correlated significantly with leptin (r=0.53, p=0.0023) and ghrelin (r=0.50, p=0.0045). Placental leptin gene expression and protein concentration showed the expected increase in the SGA group. Leptin was inversely correlated with birth weight. Positive correlation of adiponectin with leptin and ghrelin expression suggests an interaction between these hormones in the placenta. However, the unchanged expression of resistin, adiponectin, and ghrelin in SGA placentas and the absence of correlation with birth weight cast doubt whether these hormones produced in the placenta play a key role in fetal programming.

Enamel defect of deciduous teeth in small gestational age children

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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

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

Insulin resistance in young adults born small for gestational age (SGA).

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Putzker, Stephanie; Bechtold-Dalla Pozza, Susanne; Kugler, Karl; Schwarz, Hans P; Bonfig, Walter

2014-03-01

This work aimed to assess glucose metabolism and insulin sensitivity in young adults born small for gestational age (SGA) as well as to measure the body composition and adipocytokines of these subjects. A total of 108 out of 342 SGA-born participants were invited for reexamination from the former Bavarian Longitudinal Study (BLS), in which 7505 risk-newborns of the years 1985 to 1986 were prospectively followed. Of these, 76 (34 female/42 male) participants at the age of 19.7±0.5 years were enrolled. Clinical examination and oral glucose tolerance testing (oGTT) was performed with assessment of insulin resistance indices, HbA1c, body mass index (BMI), adipocytokines, and body composition by bioimpedance analysis (BIA). A total of 25 out of 76 (32.9%) patients had abnormal fasting and/or glucose-stimulated insulin levels. Glucose values measured during oGTT showed no abnormalities, except one participant who had impaired glucose tolerance. Homeostasis model assessment insulin resistance index (HOMA-IR) was 1.92±4.2, and insulin sensitivity index by Matsuda (ISI(Matsuda)) showed mean values of 7.85±4.49. HOMA-IR>2.5 was found in 8 patients (10.5%), and 20 patients (26.3%) had an ISI(Matsuda)range for both genders and correlated significantly with BMI (r=0.465, p0.001), but not with adiponectin. Insulin resistance correlated with change in weight-for-height Z-score during the first 3 months of age, indicating that weight gain during that early phase might be a risk factor for the development of insulin resistance in children born SGA. A high percentage of insulin-resistant subjects were reconfirmed in a large German cohort of young adults born SGA. Therefore, regular screening for disturbances in glucose metabolism is recommended in these subjects.

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

Analysis of amino acids and acyl carnitine profiles in low birth weight, preterm, and small for gestational age neonates.

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Liu, Qian; Wu, Jing; Shen, Wen; Wei, Ran; Jiang, Jianhui; Liang, Jinqun; Chen, Min; Zhong, Mei; Yin, Aihua

2017-11-01

To analyze the amino acids (AA) and acyl carnitine (AC) profiles in dry blood spot (DBS) specimens of low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA), and to compare the concentration difference of AA and AC with those without above. This is a retrospectively study. Eight thousand nine hundred and seventy-nine uncomplicated pregnant newborns were enrolled into the study. DBS were collected on the third day of life, and concentrations of 11 types of AA, free carnitine and 30 types of AC were detected by using high-performance liquid chromatography tandem mass spectrometry (HPLC-MS). Shapiro-Wilk test and Kruskal-Wallis rank test were applied in statistical analysis. Concentrations of most AA and AC in infants born in SGA were significantly higher than those in non-SGA group, while lower in LBW and PTB groups than those in non-LBW and non-PTB groups (p < 0.05). The difference of concentration of AA and AC in the subgroups suggested there may be a dysutilization of AA and AC in SGA, but an inborn insufficient of AA and AC in LBW and PTB neonates.

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.

The Effects of Antenatal Corticosteroids on Short- and Long-Term Outcomes in Small-for-Gestational-Age Infants

Science.gov (United States)

Ishikawa, Hiroshi; Miyazaki, Ken; Ikeda, Tomoaki; Murabayashi, Nao; Hayashi, Kazutoshi; Kai, Akihiko; Ishikawa, Kaoru; Miyamoto, Yoshihiro; Nishimura, Kunihiro; Kono, Yumi; Kusuda, Satoshi; Fujimura, Masanori

2015-01-01

Aim: To evaluate the effect of antenatal corticosteroids (ANS) on short- and long-term outcomes in small-for-gestational age (SGA) infants. Methods: A retrospective database analysis was performed. A total of 1,931 single infants (birth weight <1,500 g) born at a gestational age between 22 weeks and 33 weeks 6 days who were determined to be SGA registered in the Neonatal Research Network Database in Japan between 2003 and 2007 were evaluated for short-term outcome and long-term outcome. Results: ANS was administered to a total of 719 infants (37%) in the short-term outcome evaluation group and 344 infants (36%) in the long-term outcome evaluation group. There were no significant differences between the ANS group and the no-ANS group for primary short-term outcome (adjusted odds ratio (OR) 0.73; 95% confidence interval (CI) 0.45-1.20; P-value 0.22) or primary long-term outcome (adjusted OR 0.69; 95% CI 0.40-1.17; P-value 0.17). Conclusions: Our results show that ANS does not affect short- or long-term outcome in SGA infants when the birth weight is less than 1500 g. This study strongly suggests that administration of ANS resulted in few benefits for preterm FGR fetuses. PMID:25897289

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.

Management of small-for-gestational-age twins with absent/reversed end diastolic flow in the umbilical artery: outcome of a policy of daily biophysical profile (BPP).

Science.gov (United States)

Kennelly, Máiréad M; Sturgiss, Stephen N

2007-01-01

To evaluate a strategy of daily biophysical profile (BPP) for pregnancies with small-for-gestational-age twins and with absent or reversed end diastolic flow (AREDF) in the umbilical artery of one twin and to assess the latency interval between detection and delivery in monochorionic (MC) and dichorionic (DC) twin pregnancy. A search of the Fetal Medicine Database was carried out between 2000 and 2005 at a single tertiary centre to identify all cases with AREDF in the umbilical artery with one small-for-gestational-age twin. Active monitoring with daily BPP was undertaken, once the estimated fetal weights (EFW) was >or= 500 g and at a gestational age of >or= 24 weeks in both twins. Delivery was timed on the basis of an abnormal BPP, two equivocal BPP within 12 h or gestational age of >or= 32(+0) weeks. Twenty-two MC and 17 DC twin pregnancies were identified. There were no fetal losses in the viable actively monitored MC (19) and DC (13) twins. There was a longer latency interval in the MC group at 21.7 days versus 14.4 days in the DC group (p = 0.13). Delivery was indicated for an abnormal BPP (57.8% MC vs 30.8% DC). A strategy of daily BPP can be used to monitor preterm twin fetuses with AREDF, prolonging pregnancy with an acceptable perinatal outcome. Copyright 2007 John Wiley & Sons, Ltd.

Nitrosatable Drug Exposure during Pregnancy and Preterm and Small-for-Gestational-Age Births.

Science.gov (United States)

Vuong, Ann M; Shinde, Mayura U; Brender, Jean D; Shipp, Eva M; Huber, John C; Zheng, Qi; McDonald, Thomas J; Sharkey, Joseph R; Hoyt, Adrienne T; Werler, Martha M; Kelley, Katherine E; Langlois, Peter H; Canfield, Mark A

2015-01-01

Nitrosatable drugs react with nitrite in the stomach to form N-nitroso compounds, observed in animal models to result in adverse pregnancy outcomes, such as birth defects and reduced fetal weight. Previous studies examining prenatal exposure to medications classified as nitrosatable have reported an increased risk of preterm births (PTBs) and small-for-gestational-age (SGA) infants. Using data from mothers (controls) of babies without major birth defects from the National Birth Defects Prevention Study, prenatal nitrosatable drug usage by trimester and month of gestation was examined in relation to PTBs and SGA infants. Positive associations were observed with nitrosatable drug use and PTBs, with the strongest relationship with second trimester exposure (adjusted hazard ratio [aHR] 1.37, [95% confidence interval (CI) 1.10, 1.70]). Of the nitrosatable functional groups, secondary amines were the most notable, with a higher association among women with second (aHR 1.37, [95% CI 1.05, 1.79]) and third (aHR 1.34, [95% CI 1.02, 1.76]) trimester exposure compared with women with no prenatal nitrosatable drug use. Among SGA infants, a borderline association was noted with amide exposure during the third trimester (adjusted odds ratio 1.43 [95% confidence interval [CI] 1.00, 2.05]). Prenatal exposure to nitrosatable drugs during the second and third trimester of pregnancy, particularly secondary amines, might increase the risk of PTBs. However, prenatal exposure to nitrosatable drugs was not associated with SGA infants, with the exception of amide drugs. © 2014 John Wiley & Sons Ltd.

Determination of gestational age by ultrasound.

Science.gov (United States)

Butt, Kimberly; Lim, Ken

2014-02-01

To assist clinicians in assigning gestational age based on ultrasound biometry. To determine whether ultrasound dating provides more accurate gestational age assessment than menstrual dating with or without the use of ultrasound. To provide maternity health care providers and researchers with evidence-based guidelines for the assignment of gestational age. To determine which ultrasound biometric parameters are superior when gestational age is uncertain. To determine whether ultrasound gestational age assessment is cost effective. Published literature was retrieved through searches of PubMed or MEDLINE and The Cochrane Library in 2013 using appropriate controlled vocabulary and key words (gestational age, ultrasound biometry, ultrasound dating). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to July 31, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Accurate assignment of gestational age may reduce post-dates labour induction and may improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. More accurate dating allows for optimal performance of prenatal screening tests for aneuploidy. A national algorithm for the assignment of gestational age may reduce practice variations across Canada for clinicians and researchers. Potential harms include the possible reassignment of dates when significant fetal pathology

Comparison of secondhand smoke exposure measures during pregnancy in the development of a clinical prediction model for small-for-gestational-age among non-smoking Chinese pregnant women.

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Xie, Chuanbo; Wen, Xiaozhong; Niu, Zhongzheng; Ding, Peng; Liu, Tao; He, Yanhui; Lin, Jianmiao; Yuan, Shixin; Guo, Xiaoling; Jia, Deqin; Chen, Weiqing

2015-10-01

To compare predictive values of small-for-gestational-age (SGA) by different measures for secondhand smoke (SHS) exposure during pregnancy and to develop and validate a prediction model for SGA using SHS exposure along with sociodemographic and pregnancy factors. We compared the predictability of different measures of SHS exposure during pregnancy for SGA among 545 Chinese pregnant women, and then used the optimal SHS measure along with other clinically available factors to develop and validate a prediction model for SGA. We fit logistic regression models to predict SGA by single measures of SHS exposure (self-report, serum cotinine and CYP2A6*4) and different combinations (self-report+cotinine, cotinine+CYP2A6*4, self-report+CYP2A6*4 and self-report+cotinine+CYP2A6*4). We found that self-reported SHS exposure alone predicted SGA (area under the receiver operating characteristic curve or area under the receiver operating curve (AUROC), 0.578) better than the other two single measures (cotinine, 0.547; CYP2A6*4, 0.529) or as accurately as combined SHS measures (0.545-0.584). The final prediction model that contained self-reported SHS exposure, prepregnancy body mass index, gestational weight gain velocity during the second and third trimesters, gestational diabetes, gestational hypertension and the third-trimester biparietal diameter Z-score could predict SGA fairly accurately (AUROC, 0.698). Self-reported SHS exposure at peribirth performs better in predicting SGA than a single measure of serum cotinine at the same time, although repeated biochemical cotinine assessments throughout pregnancy may be optimal. Our simple prediction model is fairly accurate and can be potentially used in routine prenatal care. 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.

Large for Gestational Age (LGA)

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... mother Other risk factors for having large-for-gestational-age newborns include Maternal obesity Having had previous LGA babies Genetic abnormalities or syndromes (for example, Beckwith-Wiedemann syndrome or Sotos syndrome) Excessive weight gain during pregnancy (the fetus gets more calories as ...

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

DEFF Research Database (Denmark)

Mortensen, Laust Hvas

2013-01-01

had the highest risk. Maternal education was inversely associated with the risk of small for gestational age in cohort analyses, attenuated between mothers who were siblings, and not present between children who were siblings. For example, the hazard ratio of preterm birth of women with a college....../university degree when compared to women with only mandatory education was 0.64 (95% confidence interval: 0.60-0.67) in the cohort analysis, 0.90 (0.78-1.04) between mothers who were siblings, and 1.01 (0.82-1.24) between children who were siblings. The corresponding hazard ratios of small for gestational age were...... 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...

Cognitive ability in adolescents born small for gestational age: Associations with fetal growth velocity, head circumference and postnatal growth.

Science.gov (United States)

Jensen, Rikke Beck; Juul, Anders; Larsen, Torben; Mortensen, Erik Lykke; Greisen, Gorm

2015-12-01

Small size at birth may be associated with impaired cognitive ability later in life. The aim of this study was to examine the effect of being born small for gestational age (SGA), with or without intrauterine growth restriction (IUGR) on cognitive ability in late adolescence. A follow-up study of a former cohort included 123 participants (52 males); 47 born SGA and 76 born appropriate for gestational age (AGA). Fetal growth velocity (FGV) was determined by serial ultrasound measurements during the third trimester. A control group matched for age and birthplace was included. The original Wechsler Adult Intelligence Scale (WAIS) was administered, and verbal, performance and full-scale Intelligence Quotient (IQ) scores were calculated. There was no difference in IQ between adolescents born SGA and AGA. FGV or IUGR during the third trimester did not influence cognitive ability in late adolescence. Full-scale IQ was positively related to head circumference (HC) in adolescence (B: 1.30, 95% CI: 0.32-2.28, p=0.01). HC at birth and three months was positively associated with full-scale IQ. Catch-up growth in the group of SGA children was associated with a significantly increased height, larger HC, increased levels of insulin-like growth factor-I (IGF-I) and increased full-scale IQ compared to those born SGA without catch-up growth. SGA and IUGR may not be harmful for adult cognitive ability, at least not in individuals born at near-term. However, known risk factors of impaired fetal growth may explain the link between early growth and cognitive ability in adulthood. Copyright © 2015. Published by Elsevier Ireland Ltd.

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 deficit and degree of body disproportion (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.

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...

Neurodevelopmental outcomes of near-term small-for-gestational-age infants with and without signs of placental underperfusion.

Science.gov (United States)

Parra-Saavedra, Miguel; Crovetto, Francesca; Triunfo, Stefania; Savchev, Stefan; Peguero, Anna; Nadal, Alfons; Parra, Guido; Gratacos, Eduard; Figueras, Francesc

2014-04-01

To evaluate 2-year neurodevelopmental outcomes of near-term, small-for-gestational-age (SGA) newborns segregated by presence or absence of histopathology reflecting placental underperfusion (PUP). A cohort of consecutive near-term (≥ 34.0 weeks) SGA newborns with normal prenatal umbilical artery Doppler studies was selected. All placentas were inspected for evidence of underperfusion and classified in accordance with established histologic criteria. Neurodevelopmental outcomes at 24 months (age-corrected) were then evaluated, applying the Bayley Scale for Infant and Toddler Development, Third Edition (Bayley-III) to assess cognitive, language, and motor competencies. The impact of PUP on each domain was measured via analysis of covariance, logistic and ordinal regression, with adjustment for smoking, socioeconomic status, gestational age at birth, gender, and breastfeeding. A total of 83 near-term SGA deliveries were studied, 46 (55.4%) of which showed signs of PUP. At 2 years, adjusted neurodevelopmental outcomes were significantly poorer in births involving PUP (relative to SGA infants without PUP) for all three domains of the Bayley scale: cognitive (105.5 vs 96.3, adjusted-p = 0.03), language (98.6 vs 87.8, adjusted-p<0.001), and motor (102.7 vs 94.5, adjusted-p = 0.007). Similarly, the adjusted likelihood of abnormal cognitive, language, and motor competencies in instances of underperfusion was 9.3-, 17.5-, and 1.44-fold higher, respectively, differing significantly for the former two domains. In a substantial fraction of near-term SGA babies without Doppler evidence of placental insufficiency, histologic changes compatible with PUP are still identifiable. These infants are at greater risk of abnormal neurodevelopmental outcomes at 2 years. Copyright © 2014 Elsevier Ltd. All rights reserved.

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.

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

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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.

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

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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

Efficacy of pharmacologic closure of patent ductus arteriosus in small-for-gestational-age extremely preterm infants.

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Boghossian, Nansi S; Do, Barbara T; Bell, Edward F; Dagle, John M; Brumbaugh, Jane E; Stoll, Barbara J; Vohr, Betty R; Das, Abhik; Shankaran, Seetha; Sanchez, Pablo J; Wyckoff, Myra H; Bethany Ball, M

2017-10-01

Optimal management of the patent ductus arteriosus (PDA) in preterm infants remains controversial. Therefore, studies identifying infants who are most likely to benefit from PDA treatment are needed. We sought to examine if significant intrauterine growth restriction, defined by birth weight z-score, reduces the efficacy of PDA closure with indomethacin or ibuprofen and thereby increases the need for surgical closure of PDA after pharmacologic treatment. We studied infants 23-28weeks' gestation born 2006-2013 at NICHD Neonatal Research Network centers. We examined the responses to PDA treatment with indomethacin and/or ibuprofen and whether the PDA was subsequently closed surgically. Logistic regression generated adjusted odds ratios (ORs) for the associations between the z-score groups (-0.5) and PDA surgery following pharmacologic treatment. 5606 infants were diagnosed with PDA; 3587 (64.0%) received indomethacin or ibuprofen or both, and 909 (25.3%) underwent PDA surgery. Mothers of infants with PDA non-closure were less likely to have hypertension (19% vs. 28%). Infants with non-closure were more likely to be female (53% vs. 49%), have lower gestational age and birth weight and to develop sepsis (42% vs. 31%). Compared to infants with z-score>-0.5, PDA surgery was increased among infants with z-score -2 to -0.5 (OR=1.23; 95% CI 1.02-1.47) but not among infants with z-score<-2. Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Mothers with alcoholic liver disease and the risk for preterm and small-for-gestational-age birth.

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Stokkeland, Knut; Ebrahim, Fereshte; Hultcrantz, Rolf; Ekbom, Anders; Stephansson, Olof

2013-01-01

To study pregnancy outcome in women with alcoholic liver disease (ALD). Using the Swedish nation-wide Patient and Medical Birth Registers, we investigated risk of adverse pregnancy outcome in 720 women diagnosed with ALD before and 1720 diagnosed after birth and compared them with 24 460 population-based control births. Women with ALD diagnosed before or after birth were generally of higher age and body mass index, more likely to smoke cigarettes during pregnancy and to have a low socio-economic status compared with controls. Women diagnosed with ALD before birth had an increased risk of moderately and very preterm birth, adjusted odd ratio (OR) = 1.53 (95% confidence interval (CI): 1.37-1.72 and 1.15-2.06 95%), respectively. Infants of mothers with ALD before birth were more often small-for-gestational age, adjusted OR = 1.22 (95% CI: 1.05-1.43), and were at increased risk for low Apgar scores (<7) at 5 min, adjusted OR = 1.49 (95% CI: 1.15-1.92) compared with controls. Similar associations with slightly lower-risk estimates were found among women diagnosed with ALD after birth. ALD is associated with adverse-birth outcomes, highlighting the importance of screening women for alcohol dependence in antenatal care.

Small for gestational age birth outcomes in pregnant women with perinatally acquired HIV.

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Jao, Jennifer; Sigel, Keith M; Chen, Katherine T; Rodriguez-Caprio, Gabriela; Posada, Roberto; Shust, Gail; Wisnivesky, Juan; Abrams, Elaine J; Sperling, Rhoda S

2012-04-24

To compare small for gestational age (SGA) birth weight in children born to women with perinatally acquired HIV (PAH) vs. those with behaviorally acquired HIV (BAH). Retrospective cohort study of HIV-infected pregnant women who received care and delivered a live born at a single hospital in New York City from January 2004 to April 2011. We collected data via chart review on demographics, behavioral risk factors, HIV clinical markers, antiretroviral therapy (ART), mode of HIV acquisition, and pregnancy outcomes on study participants. We compared rates of these exposures among participants by method of HIV acquisition. Generalized Estimating Equation was applied to evaluate the effect of HIV acquisition type on SGA birth weight, adjusting for potential confounders. Of 87 live births evaluated, 17 were born to 14 women with PAH. Overall, 20 (23%) were SGA. Eight of these SGA neonates were born preterm. Live births to women with PAH were more likely to be born SGA in our unadjusted analysis [odds ratio (OR) = 4.13, 95% confidence interval (CI) = 1.38-12.41). After adjusting for mother's age, substance use during pregnancy, nadir CD4 cell count during pregnancy, viral suppression at delivery, and second-line ART use during pregnancy, this relationship persisted with an adjusted OR of 5.7 (95% CI = 1.03-31.61). In comparison to infants born to women with BAH, infants born to women with PAH were at high risk for compromised intrauterine growth. Future studies are warranted to determine possible causal mechanisms.

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

Investigation on the ability of first trimester glycodelin and angiopoietin-2 to predict small-for-gestational age pregnancies at delivery

DEFF Research Database (Denmark)

Hansen, Young Bae; Myrhøj, Vibeke; Jørgensen, Finn Stener

2016-01-01

BACKGROUND: The aim was to investigate whether first trimester glycodelin and angiopoietin-2 can predict small-for-gestational age (SGA) at delivery, individually or in combination. METHODS: In this case-control study we measured glycodelin and angiopoietin-2 on serum from 170 singleton pregnant...... women delivering SGA neonates and 985 singleton pregnant women delivering normal-weighted neonates. All values were converted to multiples of the medians (MoM). RESULTS: Pregnant women delivering SGA neonates had lower first trimester glycodelin and angiopoietin-2 MoM values [median (interquartile range...

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

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

2014-09-01

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

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

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

2007-09-01

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

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

Polychlorinated biphenyls in adipose tissue, liver, and brain from nine stillborns of varying gestational ages

NARCIS (Netherlands)

Huisman, M; Muskiet, FAJ; Van Der Paauw, CG; Essed, CE; Boersma, ER

We analyzed polychlorinated biphenyls (PCBs) in s.c. adipose tissue, liver, and brain of nine fetuses who died in utero. Their median (range) gestational ages and birth weights were 34 (17-40) wk and 2050 (162-3225) g. Three fetuses were small for gestational age. The levels of PCB congener nos.

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

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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

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.

Overnight Levels of Luteinizing Hormone, Follicle-Stimulating Hormone and Growth Hormone before and during Gonadotropin-Releasing Hormone Analogue Treatment in Short Boys Born Small for Gestational Age

NARCIS (Netherlands)

van der Kaay, Danielle C. M.; de Jong, Frank H.; Rose, Susan R.; Odink, Roelof J. H.; Bakker-van Waarde, Willie M.; Sulkers, Eric J.; Hokken-Koelega, Anita C. S.

2009-01-01

Aims: To evaluate if 3 months of gonadotropin-releasing hormone analogue (GnRHa) treatment results in sufficient suppression of pubertal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) profile patterns in short pubertal small for gestational age (SGA) boys. To compare growth hormone

CALCIUM, CREATININE AND URINARY PHOSPHATE/CREATININE RATIO CONCENTRATIONS IN NEONATES OF VARIOUS GESTATIONAL AGES

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O. I. Fomina

2014-01-01

Full Text Available Objective: specify peculiarities of calcium and phosphates excretion in neonates of various gestational ages and types of feeding in neonatal period. Patients and methods. Calcium-creatinine (Ca/Cr and phosphate-creatinine (P/Cr ratio concentrations were determined in 96 healthy neonates of 38-40 weeks of gestational age and 146 premature infants of 28-37 weeks of gestational age of various types of feeding. Results. The Ca/Cr ratio concentration in healthy term infants in the early neonatal period amounted to 0.9-2.2 (median – 1.8, the P/Cr ratio concentration – 0.8-2.1 (median – 1.6. The Ca/Cr ratio concentration in premature infants (28-37 weeks of gestational age amounted to 0.9-2.4 (median – 1.9, which is comparable to this parameter’s value in term infants. The P/Cr ratio concentration amounted to 0.7-3.1 (median – 2.4, which exceeds this parameter’s value in term infants. The lesser the gestational age and birth weight, the higher the Ca/Cr and P/Cr ratio concentrations. The authors revealed hypercalciuria and hyperphosphaturia in premature infants with a very low body weight fed with specialized formulas. Conclusions. Use of specialized formulas in small premature infants (gestational age < 33 weeks with VLBW results in excessive calcium and phosphates excretion. It is reasonable to monitor their concentrations using a non-invasive and informative method of determining Ca/Cr and P/Cr ratios. Feeding of premature infants with BW > 1,500 g with breast milk only (in case of the mother’s adequate lactation allows avoiding hypercalciuria and hyperphosphaturia and preventing risk of a renal pathology. 

The gestational age pattern of human mortality

DEFF Research Database (Denmark)

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

-infant lifetable by gestational age spanning week 23 until week 100 after the last menstrual period of the mother. This joint lifetable shows a remarkable regularity in the gestational age profile of fetal- and infant mortality: Mortality rates are declining over the whole observed age range with the exception......In order to check hypotheses about the cause for "ontogenescense" -- the phenomenon of a declining force of mortality prior to maturity -- I analyse data on human mortality by gestational age. Based on extensive microdata on births, fetal- and infant deaths in the US 2009 I calculate a joint fetal...... 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...

Neurological follow-up of small-for-gestational age newborn infants: a study of risk factors related to prognosis at one year of age

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José Luiz D. Gherpelli

1993-03-01

Full Text Available To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p=0.000l and developmental (p=0.001 abnormalities at 1 year. None of the other risk factors were statistically related to neurological prognosis at 1 year.

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

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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

Pregnancy-Associated Plasma Protein A Levels in Late First Trimester Pregnancies with Small-for-Gestational Age Neonates: A Prospective Case-Control Study.

Science.gov (United States)

Agarwal, Rachna; Kumari, Radhika; Mehndiratta, Mohit; Radhakrishnan, Gita; Faridi, M M A; Chandra, Nilesh

2017-08-01

We aimed to investigate the association of pregnancy associated plasma protein A (PAPP-A) levels in late first trimester with small for gestational age (SGA) neonates and adverse pregnancy outcomes in a low-income setting. The inclusion criteria were late first trimester (11-13 + 6 weeks) women with singleton and non-anomalous pregnancy. Enrolled participants were sampled for PAPP-A and prospectively followed up for delivery outcome and antenatal complications. A multiple of median (MoM) was calculated and statistically compared between groups. Out of total 284 subjects, 14.54% delivered SGA babies and formed cases (Group A), 66.5% delivered appropriate for gestational age (AGA) neonates with uneventful antenatal period (controls, Group B), and 19.3% were AGA group with adverse pregnancy complications (Group C). The late first trimester median PAPP-A MoM was significantly lower (0.61) in Group A compared to Group B (1.47). Using receiver operating characteristic (ROC) curve for PAPP-A MoM, optimal cutoff value was found at 0.45 MoM, with positive predictive value of 56.2%, specificity of 92.6% and sensitivity of 45%. The median interquartile range (IQR) of PAPP-A MoM value in Group C in comparison with Group B was significantly lower except for abruption. At PAPP-A MoM cutoff value <1, <0.8, <0.6 and <0.4, the odds ratio for adverse pregnancy outcome was 8.30, 7.29, 10.97 and 10.60, respectively, indicating an inverse relationship. With 0.45 MoM cutoff of PAPP-A, the detection rate, specificity and positive predictive value for SGA were 45, 92.6 and 56.2%, respectively. As PAPP-A MoM values decreased, the odds ratio of having adverse pregnancy outcomes increased.

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.)

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.

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

Science.gov (United States)

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

2013-03-01

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

Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women.

Science.gov (United States)

Love, Catherine; David, Richard J; Rankin, Kristin M; Collins, James W

2010-07-15

White women experience their lowest rate of low birth weight (LBW) in their late 20s; the nadir LBW for African-American women is under 20 years with rates rising monotonically thereafter, hypothesized as due to "weathering" or deteriorating health with cumulative disadvantage. Current residential environment affects birth outcomes for all women, but little is known about the impact of early life environment. The authors linked neighborhood income to a transgenerational birth file containing infant and maternal birth data, allowing assessment of economic effects over a woman's life course. African-American women who were born in poorer neighborhoods and were still poor as mothers showed significant weathering with regard to LBW and small for gestational age (SGA) but not preterm birth (PTB). However, African-American women in upper-income areas at both time points had a steady fall in LBW and SGA rate with age, similar to the pattern seen in white women. No group of white women, even those always living in poorer neighborhoods, exhibited weathering with regard to LBW, SGA, or PTB. In contrast, the degree of weathering among African-American women is related to duration of exposure to low-income areas and disappears for those with a life residence in non-poor neighborhoods.

Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.

Directory of Open Access Journals (Sweden)

Ingrid J M Snijdewind

Full Text Available The benefits of combination anti-retroviral therapy (cART in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT] currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands.We included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight <10th percentile for gestational age, low birth weight and preterm delivery.A total of 1392 children born to 1022 mothers were included. Of these, 331 (23.8% children were SGA. Women starting cART before conception had an increased risk of having a SGA infant compared to women starting cART after conception (OR 1.35, 95% CI 1.03-1.77, p = 0.03. The risk for SGA was highest in women who started a protease inhibitor-(PI based regimen prior to pregnancy, compared with women who initiated PI-based cART during pregnancy. While the association of preterm delivery and preconception cART was significant in univariate analysis, on multivariate analysis only a non-significant trend was observed (OR 1.39, 95% CI 0.94-1.92, p = 0.06 in women who had started cART before compared to after conception. In multivariate analysis, the risk of low birth weight (OR 1.34, 95% CI 0.94-1.92, p = 0.11 was not significantly increased in women who had started cART prior to conception compared to after conception.In our cohort of pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in

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

Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age.

Science.gov (United States)

Snijdewind, Ingrid J M; Smit, Colette; Godfried, Mieke H; Bakker, Rachel; Nellen, Jeannine F J B; Jaddoe, Vincent W V; van Leeuwen, Elisabeth; Reiss, Peter; Steegers, Eric A P; van der Ende, Marchina E

2018-01-01

The benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands. We included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in the risk of PTD associated with preconception use of cART compared to its use after conception. More studies are needed with regard to the mechanisms taking place in the placenta during fetal growth in pregnant HIV-positive women using cART. It will only be with this knowledge that we can begin to understand the potential impact of HIV and cART on the fetus, in order to be able to determine the optimal individualised drug regimen for HIV-infected women of childbearing age.

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.

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

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.

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 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 (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.

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...

Blood pressure and heart rate during stress in children born small for gestational age.

Science.gov (United States)

Pirojsakul, Kwanchai; Thanapinyo, Apinya; Nuntnarumit, Pracha

2017-06-01

Increased sympathetic nervous system activity has been proposed as a potential mechanism for the blood pressure (BP) elevation seen in individuals born small for gestational age (SGA). This study was carried out to detect the changes in BP and heart rate (HR) in children born SGA during exposure to stress and to assess for changes in urinary catecholamine excretion. Nineteen children aged 6-14 years born SGA and 17 age- and gender-matched healthy controls were included in the study. The stress test included a mathematical test and venipuncture. BP and HR were monitored during the test. Spot urine samples were collected at baseline and after the stress test to determine dopamine, epinephrine and norepinephrine levels. At baseline, there was no difference in BP and HR between the SGA and control groups, but mean urinary norepinephrine levels were slightly higher in the SGA group (55.7 ± 16.1 vs. 43.4 ± 3.8 mcg/gCr; P = 0.10). Compared to the control group, mean maximal HR increase was higher in the SGA group (31.3 ± 3.1 vs. 19.2 ± 3.8%; P = 0.008), and mean duration of maximal HR to baseline HR was longer (186 ± 23 vs. 97 ± 13 s, respectively; P = 0.003). There was a significant negative correlation between birth weight and maximal HR increase (r = -0.497, P = 0.003). Children born SGA showed significantly greater increases in HR and significantly longer periods of tachycardia during exposure to stress than did healthy controls. The rise in HR was inversely correlated with birth weight. These findings suggest that children born SGA have a greater increase in sympathetic response when exposed to stress than do healthy individuals.

Performance of third-trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies.

Science.gov (United States)

Souka, A P; Papastefanou, I; Pilalis, A; Michalitsi, V; Kassanos, D

2012-05-01

To assess the performance of third-trimester fetal biometry and fetal Doppler studies for the prediction of small-for-gestational-age (SGA) neonates, and to explore contingency strategies using a first-trimester prediction model based on maternal and fetal parameters and third-trimester ultrasound. This was an observational cross-sectional study of uncomplicated singleton pregnancies. Risk assessment for chromosomal abnormality was carried out in 4702 pregnancies using a combination of ultrasound markers (fetal nuchal translucency thickness (NT) and nasal bone assessment) and biochemistry (free beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A)) at 11 to 13 + 6 weeks. Maternal demographic characteristics and method of conception were recorded. Third-trimester (30-34 weeks) fetal biometry (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL)) and umbilical artery (UA) and middle cerebral artery Doppler studies were performed routinely in a subgroup (n = 2310). Reference ranges for birth weight were constructed using the cohort of 4702 women, and neonates were classified as small (SGA, ≤ 5th centile) or appropriate (AGA) for gestational age. First-trimester, third-trimester and integrated first- and third-trimester prediction models for SGA were constructed using regression analysis and three different contingency strategies of rescanning in the third trimester were investigated. According to the areas under the receiver-operating characteristics curves (AUCs), AC (AUC = 0.85) and ultrasound-estimated fetal weight (EFW, AUC = 0.87) were equally good predictors of SGA. The model was marginally improved by the addition of UA Doppler, smoking status and first-trimester indices (free β-hCG and PAPP-A multiples of the median) (combined model, AUC = 0.88), but the difference was not statistically significant. A contingency strategy of rescanning 50% of the population in the

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.

Comparison of the fatty acid composition of transitional and mature milk of mothers who delivered healthy full-term babies, preterm babies and full-term small for gestational age infants.

Science.gov (United States)

Bobiński, R; Mikulska, M; Mojska, H; Simon, M

2013-09-01

The fatty acid (FA) composition of breast milk throughout the period of lactation is fairly well understood. What is not known, however, is the FA composition of breast milk at the interface of physiology and pathology of pregnancy. We therefore decided to analyse and compare the differences in the FA composition of transitional and mature milk of mothers who delivered small for gestational age (SGA) neonates born at term; infants delivered at 35-37 weeks of gestation, that is 'late preterm'; and that of mothers who gave birth to appropriate for gestational age neonates (AGA). The FAs were analysed by HPLC equipped with MS detector. We found differences in the percentage share of the studied FA pool regarding levels of capric, lauric and gadoleic acids. Comparing transitional and mature milk, the greatest diversity was seen in the group of mothers of AGA neonates and the least was noted in the group of mothers of SGA neonates. Both 'late prematurity' and reduced neonatal weight of children born at term affect the FA composition of breast milk. Even a small degree of fetal malformation alters the composition of breast milk, which is probably related to the child's needs and condition.

Early growth patterns are associated with intelligence quotient scores in children born small-for-gestational age.

Science.gov (United States)

Varella, Marcia H; Moss, William J

2015-08-01

To assess whether patterns of growth trajectory during infancy are associated with intelligence quotient (IQ) scores at 4 years of age in children born small-for-gestational age (SGA). Children in the Collaborative Perinatal Project born SGA were eligible for analysis. The primary outcome was the Stanford-Binet IQ score at 4 years of age. Growth patterns were defined based on changes in weight-for-age z-scores from birth to 4 months and 4 to 12 months of age and consisted of steady, early catch-up, late catch-up, constant catch-up, early catch-down, late catch-down, constant catch-down, early catch-up & late catch-down, and early catch-down & late catch-up. Multivariate linear regression was used to assess associations between patterns of growth and IQ. We evaluated patterns of growth and IQ in 5640 children. Compared with children with steady growth, IQ scores were 2.9 [standard deviation (SD)=0.54], 1.5 (SD=0.63), and 2.2 (SD=0.9) higher in children with early catch-up, early catch-up and later catch-down, and constant catch-up growth patterns, respectively, and 4.4 (SD=1.4) and 3.9 (SD=1.5) lower in children with early catch-down & late catch-up, and early catch-down growth patterns, respectively. Patterns in weight gain before 4 months of age were associated with differences in IQ scores at 4 years of age, with children with early catch-up having slightly higher IQ scores than children with steady growth and children with early catch-down having slightly lower IQ scores. These findings have implications for early infant nutrition in children born SGA. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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.

Recent Declines in Induction of Labor by Gestational Age

Science.gov (United States)

... for singleton births per 100 singleton births. Gestational age categories : Early preterm: Births prior to 34 completed weeks of ... delivery is managed for multiple gestation pregnancies. The primary measure used to determine gestational age is the interval between the first day of ...

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.

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

Science.gov (United States)

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

2016-07-01

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

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.

Placental Growth Factor (PlGF in Women with Suspected Pre-Eclampsia Prior to 35 Weeks' Gestation: A Budget Impact Analysis.

Directory of Open Access Journals (Sweden)

Suzy Duckworth

Full Text Available To model the resource implications of placental growth factor (PlGF testing in women with suspected pre-eclampsia prior to 35 weeks' gestation as part of a management algorithm, compared with current practice.Data on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks' gestation, enrolled in a prospective observational cohort study evaluating PlGF measurement within antenatal assessment units within two UK consultant-led maternity units was extracted by case note review. A decision analytic model was developed using these data to establish the budget impact of managing women with suspected pre-eclampsia for two weeks from the date of PlGF testing, using a clinical management algorithm and reference cost tariffs. The main outcome measures of resource use (numbers of outpatient appointments, ultrasound investigations and hospital admissions were correlated to final diagnosis and used to calculate comparative management regimes.The mean cost saving associated with the PlGF test (in the PlGF plus management arm was £35,087 (95% CI -£33,181 to -£36,992 per 1,000 women. This equated to a saving of £582 (95% CI -552 to -£613 per woman tested. In 94% of iterations, PlGF testing was associated with cost saving compared to current practice.This analysis suggests PlGF used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks' gestation could provide cost savings by reducing unnecessary resource use. Introduction of PlGF testing could be used to direct appropriate resource allocation and overall would be cost saving.

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.

Gestational Weight Gain-for-Gestational Age Z-Score Charts Applied across U.S. Populations.

Science.gov (United States)

Leonard, Stephanie A; Hutcheon, Jennifer A; Bodnar, Lisa M; Petito, Lucia C; Abrams, Barbara

2018-03-01

Gestational weight gain may be a modifiable contributor to infant health outcomes, but the effect of gestational duration on gestational weight gain has limited the identification of optimal weight gain ranges. Recently developed z-score and percentile charts can be used to classify gestational weight gain independent of gestational duration. However, racial/ethnic variation in gestational weight gain and the possibility that optimal weight gain differs among racial/ethnic groups could affect generalizability of the z-score charts. The objectives of this study were (1) to apply the weight gain z-score charts in two different U.S. populations as an assessment of generalisability and (2) to determine whether race/ethnicity modifies the weight gain range associated with minimal risk of preterm birth. The study sample included over 4 million live, singleton births in California (2007-2012) and Pennsylvania (2003-2013). We implemented a noninferiority margin approach in stratified subgroups to determine weight gain ranges for which the adjusted predicted marginal risk of preterm birth (gestation gain between California and Pennsylvania births, and among several racial/ethnic groups in California. The optimal ranges decreased as severity of prepregnancy obesity increased in all groups. The findings support the use of weight gain z-score charts for studying gestational age-dependent outcomes in diverse U.S. populations and do not support weight gain recommendations tailored to race/ethnicity. © 2017 John Wiley & Sons Ltd.

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

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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

Objectives To assess the value of single and serial fetal biometry for the prediction of small- (SGA) and large-for-gestational-age (LGA) neonates delivered preterm or at term. Methods A cohort study of 3,971 women with singleton pregnancies was conducted from the first trimester until delivery with 3,440 pregnancies (17,334 scans) meeting the following inclusion criteria: 1) delivery of a live neonate after 33 gestational weeks and 2) two or more ultrasound examinations with fetal biometry parameters obtained at ≤36 weeks. Primary outcomes were SGA (95th centile) at birth based on INTERGROWTH-21st gender-specific standards. Fetus-specific estimated fetal weight (EFW) trajectories were calculated by linear mixed-effects models using data up to a fixed gestational age (GA) cutoff (28, 32, or 36 weeks) for fetuses having two or more measurements before the GA cutoff and not already delivered. A screen test positive for single biometry was based on Z-scores of EFW at the last scan before each GA cut-off so that the false positive rate (FPR) was 10%. Similarly, a screen test positive for the longitudinal analysis was based on the projected (extrapolated) EFW at 40 weeks from all available measurements before each cutoff for each fetus. Results Fetal abdominal and head circumference measurements, as well as birth weights in the Detroit population, matched well to the INTERGROWTH-21st standards, yet this was not the case for biparietal diameter (BPD) and femur length (FL) (up to 9% and 10% discrepancy for mean and confidence intervals, respectively), mainly due to differences in the measurement technique. Single biometry based on EFW at the last scan at ≤32 weeks (GA IQR: 27.4–30.9 weeks) had a sensitivity of 50% and 53% (FPR = 10%) to detect preterm and term SGA and LGA neonates, respectively (AUC of 82% both). For the detection of LGA using data up to 32- and 36-week cutoffs, single biometry analysis had higher sensitivity than longitudinal analysis (52% vs 46

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.

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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.

Alterações morfológicas placentárias de recém-nascidos pequenos para a idade gestacional Changes in placental morphology of small for gestational age newborns

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Lúcio H. Oliveira

2002-09-01

Full Text Available Objetivo: verificar a morfologia placentária de recém-nascidos a termo pequenos para a idade gestacional, tendo como hipótese a existência mais freqüente de alterações placentárias em recém-nascidos pequenos para a idade gestacional do que em adequados para a idade gestacional. Métodos: realizou-se estudo transversal, na maternidade Terezinha de Jesus, em Juiz de Fora, MG, no período compreendido entre fevereiro e novembro de 1996, no qual foram coletados dados referentes a cinqüenta recém-nascidos a termo, estimados como pequenos para a idade gestacional. Como grupo controle, foram incluídos recém-nascidos a termo, estimados como adequados para a idade gestacional, randomizados na proporção de um controle para cada caso. Dos 100 recém-nascidos participantes do estudo, foram obtidas as placentas, cordão umbilical e membranas, que foram examinados no Laboratório de Histologia e Embriologia do Departamento de Morfologia da UFJF e no Departamento de Anatomia Patológica e Medicina Legal da UFMG. As mães foram entrevistadas, e os recém-nascidos avaliados quanto à idade gestacional, peso, comprimento e perímetro cefálico. Resultados: as placentas dos recém-nascidos pequenos para a idade gestacional apresentaram maior incidência de corioamnionite, infarto placentário, deposição perivilosa extensa de fibrina e vilosite crônica em focos múltiplos de localização parabasal, além de mostrarem menor peso e menores diâmetros em relação às placentas do grupo de recém-nascidos adequados para a idade gestacional (p Objective: to verify changes in placental morphology of small for gestational age newborns, considering that the occurrence of placental alterations is more frequent in small for gestational age (SGA infants than in appropriate for gestational age (AGA infants. Methods: fifty SGA newborns were included in a cross-sectional study, which involved gross anatomy and light microscopy of placenta, membranes and

Short Adolescents Born Small for Gestational Age : Gonadal and thyroid function, bone mineral density, quality of life and adult height: The effects of growth hormone and additional postponement of puberty

NARCIS (Netherlands)

A.J. Lem (Annemieke)

2012-01-01

textabstractFrom 1991, our research group and others have been investigating children with short stature who were born small for gestational age (SGA), both before and during treatment with biosynthetic growth hormone (GH). In 2005, GH treatment was licensed for short SGA children in the

[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].

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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.

Different Risk Factors for Very Low Birth Weight, Term-Small-for-Gestational-Age, or Preterm Birth in Japan

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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.

Smoking overrules many other risk factors for small for gestational age birth in less educated mothers.

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van den Berg, Gerrit; van Eijsden, Manon; Galindo-Garre, Francisca; Vrijkotte, Tanja G M; Gemke, Reinoud J B J

2013-07-01

Although there is convincing evidence for the association between small for gestational age (SGA) and socioeconomic status (SES), it is not known to what extent explanatory factors contribute to this association. To examine to what extent risk factors could explain educational inequalities in SGA. In this study fully completed data were available for 3793 pregnant women of Dutch origin from a population-based cohort (ABCD study). Path-analysis was conducted to examine the role of explanatory factors in the relation of maternal education to SGA. Low-educated pregnant women had a higher risk of SGA offspring compared to the high-educated women (OR 1.98, 95% CI 1.35-2.89). In path-analysis, maternal cigarette smoking and maternal height explained this association. Maternal age, hypertension, chronic disease, late entry into antenatal care, neighborhood income, underweight, environmental cigarette smoking, drug abuse, alcohol use, caffeine intake, fish intake, folic acid intake, anxiety, and depressive symptoms did not play a role in the association between maternal education and SGA birth. Among a large array of potential factors, the elevated risk of SGA birth among low-educated women appeared largely attributable to maternal smoking and to a lesser extent to maternal height. To reduce educational inequalities more effort is required to include low-educated women especially in prenatal intervention programs such as smoking cessation programs instead of effort into reducing other SGA-risk factors, though these factors might still be relevant at the individual level. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mental Health in Low-to-Moderate Risk Preterm, Low Birth Weight, and Small for Gestational Age Children at 4 to 5 Years: The Role of Early Maternal Parenting

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Westrupp, Elizabeth M.; Mensah, Fiona K.; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M.

2012-01-01

Objectives: The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal…

Velocimetria Doppler no período neonatal em recém-nascidos a termo pequenos para idade gestacional Neonatal Doppler velocimetry in full term small-for-gestational age newborns

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Iracema Augusta Carvalho Cortez Muniz

2003-09-01

Full Text Available Este estudo teve como objetivo avaliar o fluxo sanguíneo cerebral em recém-nascidos a termo pequenos para idade gestacional, utilizando ultra-sonografia Doppler craniana ao nascimento. O estudo foi desenvolvido no CAISM/UNICAMP (Centro de Saúde Terciário para Mulheres. Foram selecionados sessenta recém-nascidos e divididos em 2 grupos: 36 adequados para idade gestacional (AIG e 24 pequenos para idade gestacional (PIG. Foi realizada a avaliação de ultra-sonografia Doppler craniana nos grupos, entre 24-48 horas após o nascimento. A velocidade de fluxo sanguíneo cerebral foi menor no grupo PIG na artéria cerebral anterior (ACA. As medidas Doppler foram estatisticamente diferentes entre os grupos apenas para valores relacionados à velocidade de fluxo de pico sistólico (VFPS e velocidade de fluxo médio (VFM na ACA. Não houve diferenças significantes para nenhum dos parâmetros avaliados de velocidade de fluxo na artéria cerebral média (ACM. Concluiu-se que recém-nascidos PIG apresentaram VFPS e VFM significativamente menores apenas na ACA. A adequação peso/idade gestacional, presença de policitemia neonatal e valores de pressão arterial média estiveram estatisticamente associados a VFM na ACA. A presença de sofrimento fetal, valores de pressão arterial média e hábito de fumar durante a gestação estiveram estatisticamente associados a VFM na ACM.This study aimed to evaluate the cerebral blood flow of full term small-for-gestational age newborns, using cranial ultrasound Doppler at birth. This study was performed at CAISM/UNICAMP (Tertiary Health Center for Women. Sixty term newborns were selected and divided in two groups: appropriate-for-gestational age (AGA (36 neonates and small-for-gestational age (SGA (24 neonates. Cranial ultrasound Doppler evaluation was performed on both groups, between 24 and 48 hours after birth. Cerebral blood flow velocity (CBFV was lower in the small-for-gestational age group, in the anterior

Brown adipose tissue in young adults who were born preterm or small for gestational age.

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Kistner, Anna; Rydén, Henric; Anderstam, Björn; Hellström, Ann; Skorpil, Mikael

2018-06-27

Brown adipose tissue (BAT) is present and functions to dissipate energy as heat in young adults and can be assessed using magnetic resonance imaging (MRI) to estimate the voxel fat fraction, i.e. proton density fat fraction (PDFF). It is hypothesized that subjects born preterm or small for gestational age (SGA) may exhibit disrupted BAT formation coupled to metabolic factors. Our purpose was to assess the presence of BAT in young adults born extremely preterm or SGA in comparison with controls. We studied 30 healthy subjects (median age, 21 years): 10 born extremely preterm, 10 full term but SGA and 10 full term with a normal birth weight (controls). We utilized an MRI technique combining multiple scans to enable smaller echo spacing and an advanced fat-water separation method applying graph cuts to estimate B0 inhomogeneity. We measured supraclavicular/cervical PDFF, R2*, fat volume, insulin-like growth factor 1, glucagon, thyroid stimulating hormone and the BAT-associated hormones fibroblast growth factor 21 and irisin. The groups did not significantly differ in supraclavicular/cervical PDFF, R2*, fat volume or hormone levels. The mean supraclavicular/cervical PDFF was equivalent between the groups (range 75-77%). Young adults born extremely preterm or SGA show BAT development similar to those born full term at a normal birth weight. Thus, the increased risk of cardiovascular and metabolic disorders in these groups is not due to the absence of BAT, although our results do not exclude possible BAT involvement in this scenario. Larger studies are needed to understand these relationships.

[Detection of small for gestational age fetuses during third trimester ultrasound. A monocentric observational study].

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Peyronnet, V; Kayem, G; Mandelbrot, L; Sibiude, J

2016-09-01

Fetus small for gestational age (SGA) screening rate is evaluated around 21,7 % in France. Recommendations were developed to improve the efficiency of ultrasound conducted in the third trimester (T3), because neonatal consequences can be significant. This study aims to evaluate screening of SGA during T3 ultrasound and to describe causes for failure and differences with the recommendations of CNGOF. All children born between 2011 and 2012 with a birth weight below the 3rd percentile were included in this observational, retrospective, monocentric study. We noted that the diagnosis of SGA was placed on file. Then, as recommended by the CNGOF, we calculated estimated fetal weight (EFW) with Hadlock 3 and Hadlock 4, and the corresponding percentiles, using the biometrics from the ultrasound report. We thus could evaluate a new screening rate with SGA fetus identified through this technique. A total of 142 patients were included. By calculating correctly all EFW and checking abdominal circumference percentiles, the screening rate of SGA fetuses with T3 ultrasound increased from 40 % to 50 % and the overall screening rate (clinical and ultrasound) from 54 % to 66 %. By following the recommendations we found a real improvement in fetal SGA screening rates to T3 ultrasound with a potential benefit for their care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

Science.gov (United States)

2013-01-01

Background Short and long birth intervals have previously been linked to adverse neonatal outcomes. However, much of the existing literature uses cross-sectional studies, from which deriving causal inference is complex. We examine the association between short/long birth intervals and adverse neonatal outcomes by calculating and meta-analyzing associations using original data from cohort studies conducted in low-and middle-income countries (LMIC). Methods We identified five cohort studies. Adjusted odds ratios (aOR) were calculated for each study, with birth interval as the exposure and small-for-gestational-age (SGA) and/or preterm birth, and neonatal and infant mortality as outcomes. The associations were controlled for potential confounders and meta-analyzed. Results Birth interval of shorter than 18 months had statistically significant increased odds of SGA (pooled aOR: 1.51, 95% CI: 1.31-1.75), preterm (pooled aOR: 1.58, 95% CI: 1.19-2.10) and infant mortality (pooled aOR: 1.83, 95% CI: 1.19-2.81) after controlling for potential confounding factors (reference 36-gestational-age, and preterm-SGA. Birth interval over 60 months had increased risk of SGA (pooled aOR: 1.22, 95% CI: 1.07-1.39) and term-SGA (pooled aOR: 1.14, 95% CI: 1.03-1.27), but was not associated with other outcomes. Conclusions Birth intervals shorter than 18 months are significantly associated with SGA, preterm birth and death in the first year of life. Lack of access to family planning interventions thus contributes to the burden of adverse birth outcomes and infant mortality in LMICs. Programs and policies must assess ways to provide equitable access to reproductive health interventions to mothers before or soon after delivering a child, but also address underlying socioeconomic factors that may modify and worsen the effect of short intervals. PMID:24564484

Low birth weight, small for gestational age and preterm births before and after the economic collapse in Iceland: a population based cohort study.

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Eiríksdóttir, Védís Helga; Ásgeirsdóttir, Tinna Laufey; Bjarnadóttir, Ragnheiður Ingibjörg; Kaestner, Robert; Cnattingius, Sven; Valdimarsdóttir, Unnur Anna

2013-01-01

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. The study population constituted all Icelandic women giving birth to live-born singletons from January 1(st) 2006 to December 31(st) 2009. LBW infants were defined as those weighing birth, PB infants as those born before 37 weeks of gestation and SGA as those with a birth weight for gestational age more than 2 standard deviations (SD's) below the mean according to the Swedish fetal growth curve. We used logistic regression analysis to estimate odds ratios [OR] and corresponding 95 percent confidence intervals [95% CI] of adverse birth outcomes by exposure to calendar time of the economic collapse, i.e. after October 6(th) 2008. Compared to the preceding period, we observed an increased adjusted odds in LBW-deliveries following the collapse (aOR = 1.24, 95% CI [1.02, 1.52]), particularly among infants born to mothers younger than 25 years (aOR = 1.85, 95% CI [1.25, 2.72]) and not working mothers (aOR = 1.61, 95% CI [1.10, 2.35]). Similarly, we found a tendency towards higher incidence of SGA-births (aOR = 1.14, 95% CI [0.86, 1.51]) particularly among children born to mothers younger than 25 years (aOR = 1.87, 95% CI [1.09, 3.23]) and not working mothers (aOR = 1.86, 95% CI [1.09, 3.17]). No change in risk of PB was observed. The increase of LBW was most distinct 6-9 months after the collapse. The results suggest an increase in risk of LBW shortly after the collapse of the Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation.

Low birth weight, small for gestational age and preterm births before and after the economic collapse in Iceland: a population based cohort study.

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Védís Helga Eiríksdóttir

Full Text Available 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.The study population constituted all Icelandic women giving birth to live-born singletons from January 1(st 2006 to December 31(st 2009. LBW infants were defined as those weighing <2500 grams at birth, PB infants as those born before 37 weeks of gestation and SGA as those with a birth weight for gestational age more than 2 standard deviations (SD's below the mean according to the Swedish fetal growth curve. We used logistic regression analysis to estimate odds ratios [OR] and corresponding 95 percent confidence intervals [95% CI] of adverse birth outcomes by exposure to calendar time of the economic collapse, i.e. after October 6(th 2008.Compared to the preceding period, we observed an increased adjusted odds in LBW-deliveries following the collapse (aOR = 1.24, 95% CI [1.02, 1.52], particularly among infants born to mothers younger than 25 years (aOR = 1.85, 95% CI [1.25, 2.72] and not working mothers (aOR = 1.61, 95% CI [1.10, 2.35]. Similarly, we found a tendency towards higher incidence of SGA-births (aOR = 1.14, 95% CI [0.86, 1.51] particularly among children born to mothers younger than 25 years (aOR = 1.87, 95% CI [1.09, 3.23] and not working mothers (aOR = 1.86, 95% CI [1.09, 3.17]. No change in risk of PB was observed. The increase of LBW was most distinct 6-9 months after the collapse.The results suggest an increase in risk of LBW shortly after the collapse of the Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation.

Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study.

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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.

The role of the follow-up chest radiograph in suspected non-accidental injury

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Anilkumar, Adikesavalu; Fender, Laura J; Broderick, Nigel J; Somers, John M; Halliday, Katharine E [Nottingham University Hospital NHS Trust, Department of Radiology, Queen' s Medical Centre, Nottingham (United Kingdom)

2006-03-15

Rib fractures in children under the age of 2 years have a strong correlation with non-accidental injury (NAI). Follow-up radiographs can improve detection. To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. The study included all children less than 2 years of age who were investigated for suspected NAI in our institution between January 1998 and October 2003. Prior to January 2000, only selected patients were asked to attend for a follow-up chest radiograph. From January 2000 onwards all children were asked to reattend. Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children. (orig.)

The role of the follow-up chest radiograph in suspected non-accidental injury

International Nuclear Information System (INIS)

Anilkumar, Adikesavalu; Fender, Laura J.; Broderick, Nigel J.; Somers, John M.; Halliday, Katharine E.

2006-01-01

Rib fractures in children under the age of 2 years have a strong correlation with non-accidental injury (NAI). Follow-up radiographs can improve detection. To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. The study included all children less than 2 years of age who were investigated for suspected NAI in our institution between January 1998 and October 2003. Prior to January 2000, only selected patients were asked to attend for a follow-up chest radiograph. From January 2000 onwards all children were asked to reattend. Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children. (orig.)

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

[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.

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

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

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

Science.gov (United States)

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

2017-08-01

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 LGA and childhood asthma is unclear. Importantly, recent studies have suggested that the association between overweight and asthma may be related to non-allergic pathways. If this also applies to the association between LGA and asthma, the association between being born LGA and asthma may be different for atopic and non-atopic children. We investigated the association of being LGA with the prevalence of asthma at age 8 in atopic and non-atopic children and the role of overweight in this association. Complete data on asthma, anthropometry and atopy at age of 8 years, and potential confounders were available for 1608 participants of the PIAMA birth cohort. Odds ratios for the association between LGA and asthma in atopic and non-atopic children were estimated by logistic regression analysis adjusting for potential confounders. Overweight was assessed as a potential modifier of the association between LGA and asthma. Being born LGA was not significantly associated with asthma at age of 8 in atopic and non-atopic children. However, overweight at age of 8 years modified the association between asthma at age of 8 and LGA. In non-atopic children, children who were born LGA and were overweight at age of 8 years had a significantly increased odds of asthma compared to non-LGA, non-overweight children (adj OR 7.04; 95% CI 2.2-24). We observed that non-atopic children born LGA, who were overweight by 8 years have an increased risk of asthma. If confirmed, these findings suggest that non-atopic children born LGA may be identified early in life as a high-risk group for asthma. © 2017 John Wiley & Sons Ltd.

GESTATIONAL AGE AT BIRTH AND RISK OF TESTICULAR CANCER

Science.gov (United States)

Crump, Casey; Sundquist, Kristina; Winkleby, Marilyn A.; Sieh, Weiva; Sundquist, Jan

2011-01-01

Most testicular germ cell tumors originate from carcinoma in situ cells in fetal life, possibly related to sex hormone imbalances in early pregnancy. Previous studies of association between gestational age at birth and testicular cancer have yielded discrepant results and have not examined extreme preterm birth. Our objective was to determine whether low gestational age at birth is independently associated with testicular cancer in later life. We conducted a national cohort study of 354,860 men born in Sweden in 1973–1979, including 19,214 born preterm (gestational age testicular cancer incidence through 2008. A total of 767 testicular cancers (296 seminomas and 471 nonseminomatous germ cell tumors) were identified in 11.2 million person-years of follow-up. Extreme preterm birth was associated with an increased risk of testicular cancer (hazard ratio 3.95; 95% CI, 1.67–9.34) after adjusting for other perinatal factors, family history of testicular cancer, and cryptorchidism. Only five cases (three seminomas and two nonseminomas) occurred among men born extremely preterm, limiting the precision of risk estimates. No association was found between later preterm birth, post-term birth, or low or high fetal growth and testicular cancer. These findings suggest that extreme but not later preterm birth may be independently associated with testicular cancer in later life. They are based on a small number of cases and will need confirmation in other large cohorts. Elucidation of the key prenatal etiologic factors may potentially lead to preventive interventions in early life. PMID:22314417

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

Science.gov (United States)

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

2014-01-01

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

Ultrasound Measurements of Thyroid Gland Volume at 36 Weeks' Corrected Gestational Age in Extremely Preterm Infants Born before 28 Weeks' Gestation.

Science.gov (United States)

Ng, Sze May; Turner, Mark A; Avula, Shivaram

2018-01-01

Thyroid ultrasound is a non-invasive imaging tool and provides good evaluation of thyroid anatomy, location, vascularisation, and echogenicity. The aim of this study was to assess thyroid function and thyroid volume in extremely preterm infants born before 28 weeks' gestation evaluated at 36 weeks' corrected gestational age (CGA) compared to term infants' normative data in the literature. In this largest prospective UK study of extremely premature infants born at less than 28 weeks' gestation, thyroid volume measurement was assessed at 36 weeks' CGA. Fifty-five extremely preterm infants (28 males) who were born before 28 weeks' gestation were recruited to the study. All infants had ultrasound assessment of the thyroid gland at 36 weeks' CGA. We also prospectively measured thyroid stimulating hormone (TSH) and free thyroxine (FT 4 ) in all infants at the time of recruitment (within 5 days of birth), at days 14, 21, and 28, and at 36 weeks' CGA. The mean thyroid volume was measured at 0.57 mL (SD ±0.18). There was no association between mean thyroid volume and thyroid function (TSH or FT 4 ). No associations were found between mean thyroid volume and gestation or birth weight in these infants. Our findings provide a reference range with a mean thyroid volume of 0.57 mL (SD ±0.18) in this extremely preterm age group if less than 28 weeks' gestation. Thyroid volume at birth can vary from country to country due to variations in iodine intake as well as gestational age.

Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort.

Directory of Open Access Journals (Sweden)

Lesley M E McCowan

Full Text Available Small for gestational age (SGA infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants.5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15 ± 1 weeks' gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20 ± 1 weeks'. The cohort was divided into training (n = 3735 and validation datasets (n = 1871. All-SGA (birthweight 12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥ 80. Recreational walking ≥ 4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10(th centile and increasing uterine artery Doppler resistance at 20 ± 1 weeks' were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively.Predictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.

Periconceptional multivitamin use and risk of preterm or small-for-gestational-age births in the Danish National Birth Cohort.

Science.gov (United States)

Catov, Janet M; Bodnar, Lisa M; Olsen, Jorn; Olsen, Sjurdur; Nohr, Ellen A

2011-09-01

The intake of periconceptional multivitamins may decrease the risk of preterm births (PTBs) or small-for-gestational-age (SGA) births. We related the timing and frequency of periconceptional multivitamin use to SGA births and PTBs and its clinical presentations (ie, preterm labor, premature rupture of membranes, and medical induction). Women in the Danish National Birth Cohort (n = 35,897) reported the number of weeks of multivitamin use during a 12-wk periconceptional period. Cox regression was used to estimate the relation between any multivitamin use and PTBs (2 SDs below the mean on the basis of fetal growth curves). The timing (preconception and postconception) and frequency of use were also analyzed. Regular users (4-6 wk) and partial users (1-3 wk) in each period were compared with nonusers. The association between periconceptional multivitamin use and PTBs varied according to prepregnancy overweight status (P-interaction = 0.07). Regular preconception and postconception multivitamin use in women with a prepregnancy BMI (in kg/m(2)) PTBs in nonoverweight women.

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.

Long-term effects of growth hormone (GH) treatment on body composition and bone mineral density in short children born small-for-gestational-age : six-year follow-up of a randomized controlled GH trial

NARCIS (Netherlands)

Willemsen, Ruben H.; Arends, Nicolette J. T.; Waarde, Willie M. Bakker-van; Jansen, Maarten; van Mil, Edgar G. A. H.; Mulder, Jaap; Odink, Roelof J.; Reeser, Maarten; Rongen-Westerlaken, Ciska; Stokvis-Brantsma, Wilhelmina H.; Waelkens, Johan J. J.; Hokken-Koelega, Anita C. S.

2007-01-01

Context Alterations in the GH-IGF-I axis in short small-for-gestational-age (SGA) children might be associated with abnormalities in bone mineral density (BMD) and body composition. In addition, birth weight has been inversely associated with diabetes and cardiovascular disease in adult life. Data

The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

Science.gov (United States)

2013-01-01

Background Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Methods Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Results Nulliparous, age mothers, suggesting that reproductive health interventions need to address the entirety of a woman’s reproductive period. Funding Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group. PMID:24564800

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...... into account the impact of potential confounding from the above mentioned factors.   Results: We found 209 singleton pregnancies of which 59% (95% CI: 52%-65%) terminated with a LGA baby. HbA1c, BMI, and weight gain were all associated with increasing risk of delivering a LGA baby. Analyses stratified...

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.

Glycemic Status During Pregnancy in Gestational Diabetic & Non-Gestational Diabetic Women & its Effect on Maternal & Fetal Outcome

Directory of Open Access Journals (Sweden)

A P Sawant

2012-01-01

Full Text Available Aims & Objectives: 1.To study the time course of plasma glucose, in gestational diabetic and normal pregnant women. 2.To compare maternal outcome and fetal outcome in gestational diabetic and normal pregnant women. Materials and Methods: Five hundred pregnant individuals visiting the Antenatal Clinic of Rural Medical College, Loni in either half of the gestation were screened and gestational diabetes mellitus was diagnosed according to the WHO criteria. Results: The scope of diabetes and pregnancy encompasses not only diabetics marching through pregnancy but also, any form of abnormal glucose tolerance developing during gestation, termed as gestational diabetes, abnormal glucose tolerance of any etiology recognized or unrecognized starting before pregnancy or revealed during pregnancy, is associated with a high risk of a poor maternal and fetal outcomes. In our study we found a significantly higher incidence of caesarean section in-patients with GDM when compared with the normal group (67% versus 25%, P <0.001. In GDM cases, we observed fetal macrosomia, high birth weight etc. Naturally these are the factors, which add to the pre-existing unfavourable maternal factors affecting the process of labour adversely. We observed a significant difference in the incidence of preterm labour in between the GDM and non-GDM groups (22% Vs 13%, p<0.05. These individuals underwent a process of preterm labour at a gestational age of 32+3 weeks. Hyperglycemia and polyhydramnios are held responsible for preterm labour. The incidence rate of PIH was more in subjects with GDM as compared to the other group. However this difference failed to prove statistically significant at 5% level of significance. Though we did not get a significant difference in occurrence of PIH in between the GDM and non-GDM groups, we do agree with the comment that hyperglycemia earlier in the pregnancy is associated with greater incidence of PIH as three of the four cases who were diagnosed

Risk for late-onset blood-culture proven sepsis in very-low-birth weight infants born small for gestational age: a large multicenter study from the German Neonatal Network.

Science.gov (United States)

Tröger, Birte; Göpel, Wolfgang; Faust, Kirstin; Müller, Thilo; Jorch, Gerhard; Felderhoff-Müser, Ursula; Gortner, Ludwig; Heitmann, Friedhelm; Hoehn, Thomas; Kribs, Angela; Laux, Reinhard; Roll, Claudia; Emeis, Michael; Mögel, Michael; Siegel, Jens; Vochem, Matthias; von der Wense, Axel; Wieg, Christian; Herting, Egbert; Härtel, Christoph

2014-03-01

It was the aim of this study to assess whether very-low-birth-weight (VLBW) infants born small for gestational age (SGA; birth weight less than 10th percentile) are at increased risk for late-onset sepsis. This was a prospective, multicenter study of the German Neonatal Network including VLBW infants from 23 to risk with coagulase-negative staphylococci in our SGA cohort. In a multivariate logistic regression analysis, higher gestational age [per week; odds ratio (OR): 0.75, 95% confidence interval (CI): 0.72-0.78, PGerman descendance (OR: 0.76, 95% CI: 0.63-0.91, P = 0.003) and prophylaxis with glycopeptide antibiotics (OR: 0.64, 95% CI: 0.47-0.87, P = 0.005) were shown to be protective against late-onset sepsis. In contrast, longer duration of parenteral nutrition (per day; OR: 1.016, 95% CI: 1.011-1.021, P risk factors (OR: 1.31, 95% CI: 1.02-1.68, P= 0.03). SGA contributes to the risk of late-onset sepsis in VLBW infants. Future studies are needed to investigate the underlying pathophysiology to guide individualized preventive measures in this vulnerable subgroup.

Gestational Age at First Antenatal Care Visit in Malawi.

Science.gov (United States)

Mkandawire, Paul

2015-11-01

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

[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.

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

DEFF Research Database (Denmark)

Lykke, Jacob Alexander; Langhoff-Roos, Jens; Lockwood, Charles J

2010-01-01

cardiovascular and non-cardiovascular causes following preterm delivery, small-for-gestational-age offspring and hypertensive disorders of pregnancy. We found that preterm delivery and small-for-gestational-age were both associated with subsequent death of mothers from cardiovascular and non...... cardiovascular and non-cardiovascular causes, while hypertensive disorders of pregnancy are markers of early death of mothers from cardiovascular causes....

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. [

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.

The Estimation of Gestational Age at Birth in Database Studies.

Science.gov (United States)

Eberg, Maria; Platt, Robert W; Filion, Kristian B

2017-11-01

Studies on the safety of prenatal medication use require valid estimation of the pregnancy duration. However, gestational age is often incompletely recorded in administrative and clinical databases. Our objective was to compare different approaches to estimating the pregnancy duration. Using data from the Clinical Practice Research Datalink and Hospital Episode Statistics, we examined the following four approaches to estimating missing gestational age: (1) generalized estimating equations for longitudinal data; (2) multiple imputation; (3) estimation based on fetal birth weight and sex; and (4) conventional approaches that assigned a fixed value (39 weeks for all or 39 weeks for full term and 35 weeks for preterm). The gestational age recorded in Hospital Episode Statistics was considered the gold standard. We conducted a simulation study comparing the described approaches in terms of estimated bias and mean square error. A total of 25,929 infants from 22,774 mothers were included in our "gold standard" cohort. The smallest average absolute bias was observed for the generalized estimating equation that included birth weight, while the largest absolute bias occurred when assigning 39-week gestation to all those with missing values. The smallest mean square errors were detected with generalized estimating equations while multiple imputation had the highest mean square errors. The use of generalized estimating equations resulted in the most accurate estimation of missing gestational age when birth weight information was available. In the absence of birth weight, assignment of fixed gestational age based on term/preterm status may be the optimal approach.

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.

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

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Ozdemir Ozdemir

2015-06-01

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

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

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

2014-03-01

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

Methylphenidate and the response to growth hormone treatment in short children born small for gestational age.

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Renes, Judith S; de Ridder, Maria A J; Breukhoven, Petra E; Lem, Annemieke J; Hokken-Koelega, Anita C S

2012-01-01

Growth hormone (GH) treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA). Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD). Treatment of ADHD with methylphenidate (MP) has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory. To explore the effects of MP treatment on growth in GH-treated short SGA children Anthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr), 39 of whom were also treated with MP (SGA-GH/MP). The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis. The SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (± 0.1 SD) lower in the SGA-GH/MP group (P = 0.17). Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (-1.9 SDS and -1.9 SDS respectively, P = 0.46). Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups. MP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected.

Methylphenidate and the response to growth hormone treatment in short children born small for gestational age.

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Judith S Renes

Full Text Available BACKGROUND: Growth hormone (GH treatment has become a frequently applied growth promoting therapy in short children born small for gestational age (SGA. Children born SGA have a higher risk of developing attention deficit hyperactivity disorder (ADHD. Treatment of ADHD with methylphenidate (MP has greatly increased in recent years, therefore more children are being treated with GH and MP simultaneously. Some studies have found an association between MP treatment and growth deceleration, but data are contradictory. OBJECTIVE: To explore the effects of MP treatment on growth in GH-treated short SGA children METHODS: Anthropometric measurements were performed in 78 GH-treated short SGA children (mean age 10.6 yr, 39 of whom were also treated with MP (SGA-GH/MP. The SGA-GH/MP group was compared to 39 SGA-GH treated subjects. They were matched for sex, age and height at start of GH, height SDS at start of MP treatment and target height SDS. Serum insulin-like growth factor-I (IGF-I and IGF binding protein-3 (IGFBP-3 levels were yearly determined. Growth, serum IGF-I and IGFBP-3 levels during the first three years of treatment were analyzed using repeated measures regression analysis. RESULTS: The SGA-GH/MP group had a lower height gain during the first 3 years than the SGA-GH subjects, only significant between 6 and 12 months of MP treatment. After 3 years of MP treatment, the height gain was 0.2 SDS (± 0.1 SD lower in the SGA-GH/MP group (P = 0.17. Adult height was not significantly different between the SGA-GH/MP and SGA-GH group (-1.9 SDS and -1.9 SDS respectively, P = 0.46. Moreover, during the first 3 years of MP treatment IGF-I and IGFBP-3 measurements were similar in both groups. CONCLUSION: MP has some negative effect on growth during the first years in short SGA children treated with GH, but adult height is not affected.

RELATION OF FETAL BLOOD-GASES AND DATA FROM COMPUTER-ASSISTED ANALYSIS OF FETAL HEART-RATE PATTERNS IN SMALL FOR GESTATION FETUSES

NARCIS (Netherlands)

RIBBERT, LSM; SNIJDERS, RJM; NICOLAIDES, KH; VISSER, GHA

Fetal heart rate (FHR) monitoring and computer-assisted analysis were performed immediately before cordocentesis in 25 severely small-for-gestational age fetuses. There were significant associations between FHR variation and both umbilical vein blood Po2 (r = 0.66) and pH (r = 0.69). However, the

Customized versus Population Fetal Growth Norms and Adverse Outcomes Associated with Small for Gestational Age Infants in a High-Risk Cohort.

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Moussa, Hind N; Wu, Zhao Helen; Han, Yimei; Pacheco, Luis D; Blackwell, Sean C; Sibai, Baha M; Saade, George; Costantine, Maged M

2015-06-01

To compare population versus customized fetal growth norms in identifying neonates at risk for adverse perinatal and neonatal outcomes (AOs) associated with small for gestational age (SGA) in high-risk women. Secondary analysis to a multicenter treatment trial of pregnant women at high risk for preeclampsia using low-dose aspirin versus placebo. The associations between SGA by population (SGApop) and customized (SGAcust) norms and AOs were evaluated. A total of 2,289 mother/infant pairs were included in the analysis. The rates of SGA in the aspirin and placebo groups were similar by the customized (22.8% vs 23.9%; p = 0.55) or population (8.7% vs 7.5%; p = 0.54) norms; however, they were lower using population norms compared with customized norms (p growth was associated with higher SGA rates and better identification of SGA neonates at risk for AOs. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Science.gov (United States)

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

2010-07-01

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

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

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

Assessing the Risk of Having Small for Gestational Age Newborns Among Lebanese Underweight and Normal Pre-pregnancy Weight Women.

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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.

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.

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

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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.

New Option in the Lives Saved Tool (LiST) Allows for the Conversion of Prevalence of Small-for-Gestational-Age and Preterm Births to Prevalence of Low Birth Weight.

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Kozuki, Naoko; Katz, Joanne; Clermont, Adrienne; Walker, Neff

2017-11-01

Background: The Lives Saved Tool (LiST) is a software model that estimates the health impact of scaling up interventions on maternal and child health. One of the outputs of the model is an estimation of births by fetal size [appropriate-for-gestational-age (AGA) or small-for-gestational-age (SGA)] and by length of gestation (term or preterm), both of which influence birth weight. LiST uses prevalence estimates of births in these categories rather than of birth weight categories, because the causes and health consequences differ between SGA and preterm birth. The World Health Assembly nutrition plan, however, has set the prevalence of low birth weight (LBW) as a key indicator, with a specific goal of a 30% reduction in LBW prevalence by 2025. Objective: The objective of the study is to develop an algorithm that will allow LiST users to estimate changes in prevalence of LBW on the basis of changes in coverage of interventions and the resulting impact on prevalence estimates of SGA and preterm births. Methods: The study used 13 prospective cohort data sets from low- and middle-income countries (LMICs; 4 from sub-Saharan Africa, 5 from Asia, and 4 from Latin America), with reliable measures of gestational age and birth weight. By calculating the proportion of LBW births among SGA and preterm births in each data set and meta-analyzing those estimates, we calculated region-specific pooled rates of LBW among SGA and preterm births. Results: In Africa, 0.4% of term-AGA, 36.7% of term-SGA, 49.3% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. In Asia, 1.0% of term-SGA, 47.0% of term-SGA, 36.7% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. In Latin America, 0.4% of term-AGA, 34.4% of term-SGA, 32.3% of preterm-AGA, and 100.0% of preterm-SGA births were LBW. Conclusions: The simple conversion factor proposed here allows for the estimation of LBW within LiST for most LMICs. This will allow LiST users to approximate the impact of their health programs on

Neonatal outcomes according to different therapies for gestational diabetes mellitus,

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Amanda L. da Silva

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

Mental health in low-to-moderate risk preterm, low birth weight, and small for gestational age children at 4 to 5 years: the role of early maternal parenting.

Science.gov (United States)

Westrupp, Elizabeth M; Mensah, Fiona K; Giallo, Rebecca; Cooklin, Amanda; Nicholson, Jan M

2012-03-01

The majority of children born preterm, with low birth weight, or small for gestational age are born with low-to-moderate risk (LTM), yet most research focuses on the high-risk group. Little is known about whether children with LTM perinatal risk are at greater risk for mental health problems, or what the role of early maternal parenting is in determining these outcomes. Longitudinal data were from a large nationally representative Australian cohort of 5,000 children, aged 0 to 1, 2 to 3, and 4 to 5 years of age. Participants were 354 children with LTM perinatal risk born at 33 to 36 weeks, with birth weight 1,501 to 2,499 grams, or born between the first and 10th percentiles for gestational age; and 2,461 children in the normal birth weight, term comparison group. Child mental health was measured by mother-report on the Strengths and Difficulties Questionnaire (SDQ). Parenting irritability, warmth, self-efficacy, maternal separation anxiety, and overprotective parenting were measured when children were 0 to 1 and 2 to 3 years of age. Parents in the LTM perinatal risk group were more likely to experience parenting difficulties on one of eight parenting measures (irritable parenting at age 0-1 year) when adjusting for socio-demographic differences (odds ratio = 1.43; 95% confidence interval = 1.05, 1.95, p parenting, pathway to psychological risk in children born with LTM perinatal risk. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Pregnancy-specific stress, preterm birth, and gestational age among high-risk young women.

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Cole-Lewis, Heather J; Kershaw, Trace S; Earnshaw, Valerie A; Yonkers, Kimberly Ann; Lin, Haiqun; Ickovics, Jeannette R

2014-09-01

There is evidence that pregnancy-specific stress is associated with preterm birth. The purpose of this study is to examine the association between change in pregnancy-specific stress over the course of pregnancy and birth outcomes (i.e., preterm birth and gestational age) in an understudied but vulnerable group using a theoretically derived model. Multivariate linear and logistic regression techniques were used to examine the association between pregnancy-specific stress (measured in second and third trimester) and length of gestation (i.e., preterm birth and gestational age) among a sample of 920 Black and/or Latina adolescent and young women. Second trimester pregnancy-specific stress was not associated with preterm birth or gestational age. Third trimester pregnancy-specific stress was associated with preterm birth but not with gestational age. Change in pregnancy-specific stress between second and third trimester was significantly associated with increased likelihood of preterm delivery and shortened gestational age, even after controlling for important biological, behavioral, psychological, interpersonal, and sociocultural risk factors. Findings emphasize the importance of measuring pregnancy-specific stress across pregnancy, as the longitudinal change from second to third trimester was significantly associated with length of gestation measured both as a dichotomous variable (preterm birth) and a continuous variable (gestational age). Furthermore, this is the first study to observe the association of pregnancy-specific stress with length of gestation in this understudied population-unique in age, race, and ethnicity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Influence of maternal age, gestational age and fetal gender on expression of immune mediators in amniotic fluid

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Weissenbacher Tobias

2012-07-01

Full Text Available Abstract Background Variations in cytokine and immune mediator expression patterns in amniotic fluid due to gestational age, maternal age and fetal gender were investigated. Findings Amniotic fluid samples were obtained from 192 women, 82 with a mid-trimester amniocentesis (median gestational age 17 weeks and 110 with a caesarean section not in labor (median gestational age 39 weeks. Amniotic fluid was screened by commercial ELISAs for the TH1/TH2/TH17 cytokines and immune mediators IL-1 beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF alpha, GRO-alpha, MIP1alpha, MIP1beta, Histone, and IP10. Analysis was by Bonferroni correction for multiple comparisons. None of the 15 examined cytokines revealed any differences in expression patterns regarding fetal gender. Significant differences were found in IL-4, IL-10, IL-12, TNF- alpha, GRO-alpha and MIP1-beta with respect to gestational age and in GRO-alpha regarding maternal age. Conclusion Cytokines utilized as biomarkers in the diagnosis of intrauterine infections are not influenced in their expression pattern by fetal gender but may vary with respect to maternal age and gestational age.

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...

Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction.

LENUS (Irish Health Repository)

Levine, Terri A

2017-06-21

To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes.

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

[Growth patterns of appropriate for gestational age infants of gestational diabetic mothers during the first year].

Science.gov (United States)

Zhao, Y L; Ma, R M; Zhang, Y; Mo, Y X; Chen, Z; Sun, Y H; Ding, Z B

2016-08-02

To explore the growth pattern of appropriate for gestational age (AGA) infants of mother with gestational diabetes mellitus (GDM). The objects of this study were offspring of women who delivered in our hospital from January to December 2011. The GDM group included 70 AGA infants (36 male cases and 34 female cases) of mother with GDM. The control group included 154 AGA infants (66 male cases and 88 female cases) of women with normal glucose tolerance. The data of demographic characteristics of mothers of two groups were collected. Body weight and length of infants in two groups were measured at 3, 6 and 12 months age respectively. Body mass index (BMI), weight and height gain during infancy (0-3 months, 3-6 months and 6-12 months) of infants in two groups were also calculated. Body weight, length and BMI of male AGA infants in GDM group were less than that of control group at 3 months and 6 months age, but more than that of control group at 12 months age, however, there were no significant differences between two group(P>0.05). The weight and height gain during infancy (0-3 months, 3-6 months) of male AGA infants in GDM group were lower than that of control group, but the difference was statistically significant only at 3-6 months[(1.1±0.4) vs (1.4±0.4) kg, P=0.040; (4.9±2.3) vs (6.3±1.2) cm, P=0.026]. The weight and height gain during infancy (6-12 months) of male AGA infants of gestational diabetic mothers were higher than that of control group, but the difference was not statistically significant[(2.1±0.5) vs (1.8±0.5) kg, P=0.361; (8.4±1.3) vs (7.8±1.4) cm, P=0.464]. Male infants of gestational diabetic mothers grew slowly during their infancy of 0-6 months, and then their growth became increasingly fast, which suggested that the influence of intrauterine hyperglycemia environment of GDM mothers on fetal growth might continue after birth.

Periconceptional multivitamin use and risk of preterm or small-for-gestational-age births in the Danish National Birth Cohort1234

Science.gov (United States)

Bodnar, Lisa M; Olsen, Jorn; Olsen, Sjurdur; Nohr, Ellen A

2011-01-01

Background: The intake of periconceptional multivitamins may decrease the risk of preterm births (PTBs) or small-for-gestational-age (SGA) births. Objective: We related the timing and frequency of periconceptional multivitamin use to SGA births and PTBs and its clinical presentations (ie, preterm labor, premature rupture of membranes, and medical induction). Design: Women in the Danish National Birth Cohort (n = 35,897) reported the number of weeks of multivitamin use during a 12-wk periconceptional period. Cox regression was used to estimate the relation between any multivitamin use and PTBs (2 SDs below the mean on the basis of fetal growth curves). The timing (preconception and postconception) and frequency of use were also analyzed. Regular users (4–6 wk) and partial users (1–3 wk) in each period were compared with nonusers. Results: The association between periconceptional multivitamin use and PTBs varied according to prepregnancy overweight status (P-interaction = 0.07). Regular preconception and postconception multivitamin use in women with a prepregnancy BMI (in kg/m2) PTBs in nonoverweight women. PMID:21795441

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).

Neonatal outcomes according to different therapies for gestational diabetes mellitus.

Science.gov (United States)

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

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

Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec.

Science.gov (United States)

Auger, Nathalie; Park, Alison L; Zoungrana, Hamado; McHugh, Nancy Gros-Louis; Luo, Zhong-Cheng

2013-04-02

Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age- and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.

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)

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)

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

Science.gov (United States)

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

2011-01-01

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

Prenatal exposure to endocrine disrupting chemicals and risk of being born small for gestational age: Pooled analysis of seven European birth cohorts.

Science.gov (United States)

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

2018-06-01

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). We used PCB 153, p,p'-DDE, HCB, PFOS and PFOA measured in maternal, cord blood or breast milk samples of 5446 mother-child pairs (subset of 693 for the perfluorinated compounds) from seven European birth cohorts (1997-2012). SGA infants were those with birth weight below the 10th percentile for the norms defined by gestational age, country and infant's sex. We modelled the association between measured or estimated cord serum EDC concentrations and SGA using multiple logistic regression analyses. We explored effect modification by child's sex and maternal smoking during pregnancy. Among the 5446 newborns, 570 (10.5%) were SGA. An interquartile range (IQR) increase in PCB 153 was associated with a modestly increased risk of SGA (odds ratio (OR) of 1.05 [95% CI: 1.04-1.07]) that was stronger in girls (OR of 1.09 [95% CI: 1.04-1.14]) than in boys (OR of 1.03 [95% CI: 1.03-1.04]) (p-interaction = 0.025). For HCB, we found a modestly increased odds of SGA in girls (OR of 1.04 [95% CI: 1.01-1.07] per IQR increase), and an inverse association in boys (OR of 0.90 [95% CI: 0.85-0.95]) (p-interaction = 0.0003). Assessment of the HCB-sex-smoking interaction suggested that the increased odds of SGA associated with HCB exposure was only in girls of smoking mothers (OR of 1.18 [95% CI: 1.11-1.25]) (p-interaction = 0.055). Higher concentrations of PFOA were associated with greater risk of SGA (OR of 1.64 [95% CI: 0.97-2.76]). Elevated PFOS levels were associated with increased odds of SGA in newborns of mothers who smoked during pregnancy (OR of 1.63 [95% CI: 1.02-2.59]), while an inverse association was found in those of non-smoking mothers (OR of 0.66 [95% CI: 0.61-0.72]) (p-interaction = 0.0004). No significant associations were

Histopathological and immunohistochemical analysis of small intestinal biopsies in adults suspected of celiac disease

International Nuclear Information System (INIS)

Iftikhar, R.; Jamal, S.; Zafar, A.; Saadia, A.

2016-01-01

Objective: To analyse histomorphological and immunohistochemical analysis of small intestinal biopsies in adults suspected of celiac disease. Study Design: Descriptive study. Place and Duration of Study: Department of Histopathology, Army Medical College, Rawalpindi, from November 2014 to December 2015. Methodology: Fifty cases of small intestinal mucosal biopsies (duodenal and jejunal) were analysed in adult patients aged above 14 years suspected of celiac disease. Their histomorphological data was recorded using Modified Marsh Criteria. Type of intraepithelial lymphocytes was assessed using immunohistochemistry. Intraepithelial lymphocytes were counted both by H and E stain and immunostain CD3 and CD20. Results: Thirty-four percent patients were aged between 21 - 30 years and 22% patients aged between 41 - 50 years. There were 84% (n=42) males. Thirteen (26%) cases showed focal villous atrophy, 32 (64%) cases showed partial villous atrophy and 5 (10%) cases showed complete villous atrophy. Anti-tissue transglutaminase antibody was positive in 21 (42%) cases. CD3 immunomarker was positive for intraepithelial lymphocytes in all 50 cases while CD20 immunomarker showed focal positivity in areas with lymphoid follicle formation. The count of intraepithelial lymphocytes was found to be almost equal (with a difference of 3 - 4 lymphocytes) on both H and E stain and immunostain CD3 and CD20. Conclusion: Males aged 21 - 30 years were the most commonly affected group. The most frequent change in histology was partial villous atrophy along with lymphocytic enteritis. All the intraepithelial lymphocytes were present in crescendo-pattern of distribution. (author)

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

DEFF Research Database (Denmark)

Lykke, Jacob Alexander; Langhoff-Roos, Jens; Lockwood, Charles J

2010-01-01

The combined effects of preterm delivery, small-for-gestational-age offspring, hypertensive disorders of pregnancy, placental abruption and stillbirth on early maternal death from cardiovascular causes have not previously been described in a large cohort. We investigated the effects of pregnancy...... cardiovascular and non-cardiovascular causes following preterm delivery, small-for-gestational-age offspring and hypertensive disorders of pregnancy. We found that preterm delivery and small-for-gestational-age were both associated with subsequent death of mothers from cardiovascular and non......-cardiovascular causes. Severe pre-eclampsia was associated with death from cardiovascular causes only. There was a less than additive effect on cardiovascular mortality hazard ratios with increasing number of pregnancy complications: preterm delivery 1.90 [95% confidence intervals 1.49, 2.43]; preterm delivery...

Preconception use of cART by HIV-positive pregnant women increases the risk of infants being born small for gestational age

Science.gov (United States)

Smit, Colette; Godfried, Mieke H.; Bakker, Rachel; Nellen, Jeannine F. J. B.; Jaddoe, Vincent W. V.; van Leeuwen, Elisabeth; Reiss, Peter; Steegers, Eric A. P.; van der Ende, Marchina E.

2018-01-01

Background The benefits of combination anti-retroviral therapy (cART) in HIV-positive pregnant women (improved maternal health and prevention of mother to child transmission [pMTCT]) currently outweigh the adverse effects due to cART. As the variety of cART increases, however, the question arises as to which type of cART is safest for pregnant women and women of childbearing age. We studied the effect of timing and exposure to different classes of cART on adverse birth outcomes in a large HIV cohort in the Netherlands. Materials and methods We included singleton HEU infants registered in the ATHENA cohort from 1997 to 2015. Multivariate logistic regression analysis for single and multiple pregnancies was used to evaluate predictors of small for gestational age (SGA, birth weight Women starting cART before conception had an increased risk of having a SGA infant compared to women starting cART after conception (OR 1.35, 95% CI 1.03−1.77, p = 0.03). The risk for SGA was highest in women who started a protease inhibitor-(PI) based regimen prior to pregnancy, compared with women who initiated PI-based cART during pregnancy. While the association of preterm delivery and preconception cART was significant in univariate analysis, on multivariate analysis only a non-significant trend was observed (OR 1.39, 95% CI 0.94−1.92, p = 0.06) in women who had started cART before compared to after conception. In multivariate analysis, the risk of low birth weight (OR 1.34, 95% CI 0.94−1.92, p = 0.11) was not significantly increased in women who had started cART prior to conception compared to after conception. Conclusion In our cohort of pregnant HIV-positive women, the use of cART prior to conception, most notably a PI-based regimen, was associated with intrauterine growth restriction resulting in SGA. Data showed a non-significant trend in the risk of PTD associated with preconception use of cART compared to its use after conception. More studies are needed with regard to the

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...... interviews of the mother during pregnancy and post partum. Adjusted odds ratios (OR) with 95% confidence intervals (in brackets) are presented. Infantile colic was defined as crying for more than three hours per day and for more than three days per week (modified Wessel’s criteria). Results A total of 4...... with GA gestational weeks 32-40. Finally, after adjusting for GA...

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

Science.gov (United States)

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

2015-10-01

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

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.

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 exam...

Comparison between transcerebellar diameter with biparietal diameter of ultrasound for gestational age measurement in third trimester of pregnancy

International Nuclear Information System (INIS)

Naseem, F.; Fatima, N.; Yasmeen, S.; Saleem, S.

2013-01-01

To determine the frequency of correct assessment by transcerebeller diameter (TCD) versus biparietal diameter (BPD) for gestational age measurement at 36 weeks of pregnancy using first day of last menstrual period (LMP) for actual period of gestation. Study Design: Quasi experimental. Place and Duration of Study: Department of Obstetrics and Gynaecology, Bahawal Victoria Hospital, Bahawalpur from May to November 2010. Methodology: This study was performed on 228 patients at 36 weeks of pregnancy fulfilling the inclusion criteria. Ultrasound measurements of TCD and BPD was made and compared with LMP. Collected data was analyzed by SPSS version 10. Proportoin of correct diagnosis by each measurement was determined and compared using chi-square test with significance at p < 0.05. Results: Out of 228 patients, TCD was found to give correct assessment in 209 patients (91.7%; p = 0.001) corresponding to the gestational age by LMP i.e 36 weeks. BPD was found to give correct assessment corresponding to the gestational age by LMP in 176 patients (77.2%). Conclusion: Although both BPD and TCD are accurate biometric parameters at 36 weeks of gestation, transcerebellar diameter is more reliable method of gestational age determination in third trimester of pregnancy than biparietal diameter. TCD can be used as a tool to assist in the assessment of gestational age in third trimester. (author)

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.

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

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

DEFF Research Database (Denmark)

Wu, Chunsen; Sun, Yuelian; Nohr, Ellen Aagaard

2015-01-01

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......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...

Intelligence and psychosocial functioning during long-term growth hormone therapy in children born small for gestational age.

Science.gov (United States)

van Pareren, Yvonne K; Duivenvoorden, Hugo J; Slijper, Froukje S M; Koot, Hans M; Hokken-Koelega, Anita C S

2004-11-01

Short stature is not the only problem faced by small for gestational age (SGA) children. Being born SGA has also been associated with lowered intelligence, poor academic performance, low social competence, and behavioral problems. Although GH treatment in short children born SGA can result in a normalization of height during childhood, the effect of GH treatment on intelligence and psychosocial functioning remains to be investigated. We show the longitudinal results of a randomized, double-blind, GH-dose response study initiated in 1991 to follow growth, intelligence quotient (IQ), and psychosocial functioning in SGA children during long-term GH treatment. Patients were assigned to one of two treatment groups (1 or 2 mg GH/m(2) body surface.d, or approximately 0.035 or 0.07 mg/kg.d). Intelligence and psychosocial functioning were evaluated at start of GH treatment (n = 74), after 2 yr of GH treatment (n = 76), and in 2001 (n = 53). IQ was assessed by a short-form Wechsler Intelligence Scale for Children-Revised or Wechsler Adult Intelligence Scale (Block-design and Vocabulary subtests). Behavioral problems were measured by the Achenbach Child Behavior Checklist or Young Adult Behavior Checklist, and self-perception was measured by the Harter Self-Perception Profile. Mean (sem) birth length sd score was -3.6 (0.2), mean age and height at start was 7.4 (0.2) yr and -3.0 (0.1) sd score, respectively, mean duration of GH treatment was 8.0 (0.2) yr, and mean age in 2001 was 16.5 (0.3) yr. After 2 yr of GH treatment, 96% of both GH groups showed a height gain sd score of 1 sd from the start of treatment or more, resulting in a normal height (i.e. height >/= -2.0 sd for age and sex) in 70% of the children. In 2001, 48 (91%) of the 53 children participating in this study had reached a normal height. Block-design s-score and the estimated total IQ significantly increased (P growth in adolescents born SGA, IQ, behavior, and self-perception showed a significant improvement

Gene expression in placentas from nondiabetic women giving birth to large for gestational age infants

NARCIS (Netherlands)

Ahlsson, F.; Åkerud, H.; Schijven, D.; Olivier, J.; Sundstrom-Poromaa, I.

2015-01-01

Gestational diabetes, obesity, and excessive weight gain are known independent risk factors for the birth of a large for gestational age (LGA) infant. However, only 1 of the 10 infants born LGA is born by mothers with diabetes or obesity. Thus, the aim of the present study was to compare placental

Association of maternal risk factors with large for gestational age fetuses in Indian population

OpenAIRE

Shamim Khandaker; Shabana Munshi

2015-01-01

Objective: To estimate the risk of delivering large-for gestational age (LGA) fetuses associated with maternal obesity, excessive maternal weight gain, and gestational diabetes mellitus (GDM)- in Indian mothers. Design: Retrospective study. Settings: Fernandez Hospital Private Limited, Hyderabad, Andhra Pradesh, India; a tertiary perinatal centre. Populations: Pregnant singleton mothers with correct pregnancy dating. Methods: Estimated fetal weight (EFW) is determined using ultrasound variabl...

Neonatal BCG has no effect on allergic sensitization and suspected food allergy until 13 months.

Science.gov (United States)

Thøstesen, Lisbeth Marianne; Kjaer, Henrik Fomsgaard; Pihl, Gitte Thybo; Nissen, Thomas Nørrelykke; Birk, Nina Marie; Kjaergaard, Jesper; Jensen, Aksel Karl Georg; Aaby, Peter; Olesen, Annette Wind; Stensballe, Lone Graff; Jeppesen, Dorthe Lisbeth; Benn, Christine Stabell; Kofoed, Poul-Erik

2017-09-01

Vaccination with Bacillus Calmette-Guérin (BCG) is used in many countries as protection against tuberculosis. Studies have suggested that BCG may also have non-specific effects, reducing non-tuberculosis mortality, morbidity, and atopic manifestations. In this study, we evaluated the effect of neonatal BCG vaccination on allergic sensitization and suspected food allergy at 13 months of age. The Danish Calmette Study was conducted from 2012 to 2015 at three Danish hospitals. Within 7 days of birth, the 4262 newborns of 4184 included mothers were randomized 1:1 to BCG or to a no-intervention control group. Exclusion criteria were gestational age food allergy, resulting in a risk ratio comparing BCG-vaccinated children with control children of 0.91 (95% CI 0.71-1.16). Among 1370 blood samples, sensitization (Phadiatop Infant >0.35 kUA/L) was found in 55 of 743 (7.4%) children in the BCG group and 50 of 627 (8.0%) of the control group (risk ratio 0.94 [0.65-1.36]). In this randomized clinical trial, neonatal BCG had no significant effect on suspected food allergy or on sensitization at 13 months of age. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

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

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

2007-04-01

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

Income-related and educational inequality in small-for-gestational age and preterm birth in Denmark and Finland 1987-2003.

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Mortensen, Laust H; Lauridsen, Jørgen T; Diderichsen, Finn; Kaplan, George A; Gissler, Mika; Andersen, Anne-Marie N

2010-02-01

In this paper, we examine income- and education-related inequality in small-for-gestational age (SGA) and preterm birth in Denmark and Finland from 1987 to 2003 using concentration indexes (CIXs). From the national medical birth registries we gathered information on all births from 1987 to 2003. Information on highest completed maternal education and household income in the year preceding birth of the offspring was obtained for 1,012,400 births in Denmark and 499,390 in Finland. We then calculated CIXs for income- and education-related inequality in SGA and preterm birth. The mean household income-related inequality in SGA was -0.04 (95% confidence interval: -0.05, -0.04) in Denmark and -0.03 (-0.04, -0.02) in Finland. The maternal education-related inequality in SGA was -0.08 (-0.10, -0.06) in Denmark and -0.07 (-0.08, -0.06) in Finland. The income-related inequality in preterm birth was -0.03 (-0.03, -0.02) in Denmark and -0.03 (-0.04, -0.02) in Finland. The education-related inequality in preterm birth was -0.05 (-0.07, -0.04) in Denmark and -0.04 (-0.05, -0.03) in Finland. In Denmark, the income-related and education-related inequity in SGA increased over time. In Finland, the income-related inequality in SGA birth increased slightly, while education-related inequalities remained stable. Inequalities in preterm birth decreased over time in both countries. Denmark and Finland are examples of nations with free prenatal care and publicly financed obstetric care of high quality. During the period of study there were macroeconomic shocks affecting both countries. However, only small income- and education-related inequalities in SGA and preterm births during the period were observed.

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

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

2017-11-13

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

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

Science.gov (United States)

... delivered by cesarean per 100 multiple births. Gestational age categories Early preterm : Births prior to 34 completed weeks of ... delivery among multiple births compared with singletons. The primary measure used to determine gestational age is the interval between the first day of ...

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.

Fetal cardiac function in late-onset intrauterine growth restriction vs small-for-gestational age, as defined by estimated fetal weight, cerebroplacental ratio and uterine artery Doppler.

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Pérez-Cruz, M; Cruz-Lemini, M; Fernández, M T; Parra, J A; Bartrons, J; Gómez-Roig, M D; Crispi, F; Gratacós, E

2015-10-01

Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and mean uterine artery (UtA) pulsatility index (PI) can predict a subgroup of fetuses with poor perinatal outcome; however, the association of these criteria with fetal cardiac structure and function is unknown. Our aim was to determine the presence and severity of signs indicating cardiac dysfunction in small fetuses, classified as intrauterine growth-restricted (IUGR) or small-for-gestational age (SGA), according to EFW, CPR and UtA-PI. A cohort of 209 late-onset small fetuses that were delivered > 34 weeks of gestation was divided in two categories: SGA (n = 59) if EFW was between the 3(rd) and 9(th) centiles with normal CPR and UtA-PI; and IUGR (n = 150) if EFW was  95(th) centile. The small population was compared with 150 appropriately grown fetuses (controls). Fetal cardiac morphometry and function were assessed by echocardiography using two-dimensional M-mode, conventional and tissue Doppler. Compared with controls, both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index ± SD: controls, 1.8 ± 0.3; SGA, 1.5 ± 0.2; and IUGR, 1.6 ± 0.3; P < 0.01) and showed signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (mean ± SD: controls, 8.2 ± 1.1; SGA, 7.4 ± 1.2; and IUGR, 6.9 ± 1.1; P < 0.001) and increased left myocardial performance index (mean ± SD: controls, 0.45 ± 0.14; SGA, 0.51 ± 0.08; and IUGR, 0.57 ± 0.1; P < 0.001). Despite a perinatal outcome comparable to that of normal fetuses, the population of so-defined SGA fetuses showed signs of prenatal cardiac dysfunction. This supports the concept that at least a proportion of them are not 'constitutionally small' and that further research is needed. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

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

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

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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.

Smoking in preeclamptic women is associated with higher birthweight for gestational age and lower soluble fms-like tyrosine kinase-1 levels: a nested case control study

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Kahn Susan R

2011-11-01

Full Text Available Abstract Background Smoking paradoxically increases the risk of small-for-gestational-age (SGA birth but protects against preeclampsia. Some studies have reported a "U-shaped" distribution of fetal growth in preeclamptic pregnancies, but reasons for this are unknown. We investigated whether cigarette smoking interacts with preeclampsia to affect fetal growth, and compared levels of soluble fms-like tyrosine kinase-1 (sFlt-1, a circulating anti-angiogenic protein, in preeclamptic smokers and non-smokers. Methods From a multicenter cohort of 5337 pregnant women, we prospectively identified 113 women who developed preeclampsia (cases and 443 controls. Smoking exposure was assessed by self-report and maternal hair nicotine levels. Fetal growth was assessed as z-score of birthweight for gestational age (BWGA. sFlt-1 was measured in plasma samples collected at the 24-26-week visit. Results In linear regression, smoking and preeclampsia were each associated with lower BWGA z-scores (β = -0.29; p = 0.008, and β = -0.67; p Conclusions Maternal smoking seems to protect against preeclampsia-associated fetal growth restriction and may account, at least partly, for the U-shaped pattern of fetal growth described in preeclamptic pregnancies. Smoking may exert this effect by reducing levels of the anti-angiogenic protein sFlt-1.

Foetal radiography for suspected skeletal dysplasia: technique, normal appearances, diagnostic approach

Energy Technology Data Exchange (ETDEWEB)

Calder, Alistair D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Radiology Department, London (United Kingdom); Offiah, Amaka C. [Sheffield Children' s NHS Foundation Trust, Academic Unit of Child Health, Sheffield (United Kingdom)

2015-04-01

Despite advances in antenatal imaging and genetic techniques, post-delivery post-mortem foetal radiography remains the key investigation in accurate diagnosis of skeletal dysplasia manifesting in the foetus. Foetal radiography is best performed using pathology-specimen radiography equipment and is often carried out in the pathology department without involvement of the radiology unit. However, paediatric radiologists may be asked to interpret post-mortem foetal radiographs when an abnormality is suspected. Many foetal radiographs are carried out before 20 weeks' gestation, and the interpreting radiologist needs to be familiar with the range of normal post-mortem foetal appearances at different gestational ages, as well as the appearances of some of the more commonly presenting skeletal dysplasias, and will benefit from a systematic approach when assessing more challenging cases. In this pictorial essay, we illustrate various normal post-mortem foetal radiographic appearances, give examples of commonly occurring skeletal dysplasias, and describe an approach to establishing more difficult diagnoses. (orig.)

Foetal radiography for suspected skeletal dysplasia: technique, normal appearances, diagnostic approach

International Nuclear Information System (INIS)

Calder, Alistair D.; Offiah, Amaka C.

2015-01-01

Despite advances in antenatal imaging and genetic techniques, post-delivery post-mortem foetal radiography remains the key investigation in accurate diagnosis of skeletal dysplasia manifesting in the foetus. Foetal radiography is best performed using pathology-specimen radiography equipment and is often carried out in the pathology department without involvement of the radiology unit. However, paediatric radiologists may be asked to interpret post-mortem foetal radiographs when an abnormality is suspected. Many foetal radiographs are carried out before 20 weeks' gestation, and the interpreting radiologist needs to be familiar with the range of normal post-mortem foetal appearances at different gestational ages, as well as the appearances of some of the more commonly presenting skeletal dysplasias, and will benefit from a systematic approach when assessing more challenging cases. In this pictorial essay, we illustrate various normal post-mortem foetal radiographic appearances, give examples of commonly occurring skeletal dysplasias, and describe an approach to establishing more difficult diagnoses. (orig.)

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

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

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

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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.

Intimate Partner Violence, Small for Gestational Age Birth and Cigarette Smoking in the Pregnancy Risk Assessment Monitoring System.

Science.gov (United States)

Alhusen, Jeanne L; Geller, Ruth; Jellig, Jerry; Budhathoki, Chakra; Decker, Michele

2018-04-01

Exposure to intimate partner violence (IPV) in the perinatal period is associated with obstetric complications, poor maternal mental health, neonatal complications, and increased risk of infant mortality and morbidity. Less is known about how IPV may influence small for gestational age (SGA) birth. Data were obtained for 231,081 United States mothers who delivered neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2-9 months after delivery. Weighted descriptive statistics and multivariate logistic regression models were used. IPV in the year before or during pregnancy was related to SGA bivariately (odds ratio 1.39, 95% confidence interval [CI] 1.28, 1.51), and after adjustment for demographic and obstetric factors, this association attenuated after further adjustment for perinatal smoking patterns, (adjusted odds ratio [aOR] 1.06, 95% CI 0.97, 1.15). Compared with nonabused women, women experiencing perinatal IPV were more than twice as likely to smoke before pregnancy (aOR 2.34, 95% CI 2.19, 2.49), and nearly 1.5 times as likely to report sustained smoking into the last 3 months of pregnancy (aOR 1.45, 95% CI 1.32, 1.59). In turn, among prepregnancy smokers, sustained smoking was associated with delivery of a SGA neonate (aOR 1.87, 95% CI 1.72, 2.03), fully attenuating the association of perinatal IPV with SGA. Women who experienced perinatal IPV were significantly more likely to smoke prepregnancy and sustain smoking into the last 3 months of pregnancy. Through behavioral and physiological pathways, smoking cessation may be uniquely challenging for women experiencing IPV, yet critical to address clinically to mitigate risk for SGA.

Customized versus population-based growth curves: prediction of low body fat percent at term corrected gestational age following preterm birth.

Science.gov (United States)

Law, Tameeka L; Katikaneni, Lakshmi D; Taylor, Sarah N; Korte, Jeffrey E; Ebeling, Myla D; Wagner, Carol L; Newman, Roger B

2012-07-01

Compare customized versus population-based growth curves for identification of small-for-gestational-age (SGA) and body fat percent (BF%) among preterm infants. Prospective cohort study of 204 preterm infants classified as SGA or appropriate-for-gestational-age (AGA) by population-based and customized growth curves. BF% was determined by air-displacement plethysmography. Differences between groups were compared using bivariable and multivariable linear and logistic regression analyses. Customized curves reclassified 30% of the preterm infants as SGA. SGA infants identified by customized method only had significantly lower BF% (13.8 ± 6.0) than the AGA (16.2 ± 6.3, p = 0.02) infants and similar to the SGA infants classified by both methods (14.6 ± 6.7, p = 0.51). Customized growth curves were a significant predictor of BF% (p = 0.02), whereas population-based growth curves were not a significant independent predictor of BF% (p = 0.50) at term corrected gestational age. Customized growth potential improves the differentiation of SGA infants and low BF% compared with a standard population-based growth curve among a cohort of preterm infants.

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

DEFF Research Database (Denmark)

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

2006-01-01

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...... 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...

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...

Second- to third-trimester longitudinal growth assessment for prediction of small-for-gestational age and late fetal growth restriction.

Science.gov (United States)

Caradeux, J; Eixarch, E; Mazarico, E; Basuki, T R; Gratacós, E; Figueras, F

2018-02-01

Detection of fetal growth restriction (FGR) remains poor and most screening strategies rely on cross-sectional evaluation of fetal size during the third trimester. A longitudinal and individualized approach has been proposed as an alternative method of evaluation. The aim of this study was to compare second- to third-trimester longitudinal growth assessment to cross-sectional evaluation in the third trimester for the prediction of small-for-gestational age (SGA) and late FGR in low-risk singleton pregnancy. This was a prospective cohort study of 2696 unselected consecutive low-risk singleton pregnancies scanned at 21 ± 2 and 32 ± 2 weeks. For cross-sectional growth assessment, abdominal circumference (AC) measurements were transformed to z-values according the 21st-INTERGROWTH standards. Longitudinal growth assessment was performed by calculating the AC z-velocity and the second- to third-trimester AC conditional growth centile. Longitudinal assessment was compared with cross-sectional assessment at 32 weeks. Association of cross-sectional and longitudinal evaluations with SGA and late FGR was assessed by logistic regression analysis. Predictive performance was determined by receiver-operating characteristics curve analysis. In total, 210 (7.8%) newborns were classified as SGA and 103 (3.8%) as late FGR. Neither longitudinal measurement improved the association with SGA or late FGR provided by cross-sectional evaluation of AC z-score at 32 weeks. Areas under the curves of AC z-velocity and conditional AC growth were significantly smaller than those of cross-sectional AC z-scores (P third trimester has a low predictive capacity for SGA and late FGR in low-risk singleton pregnancy compared with cross-sectional growth evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Neu-Laxova syndrome in an appropriate for gestational age newborn

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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.

Comparison of methods for identifying small-for-gestational-age infants at risk of perinatal mortality among obese mothers: a hospital-based cohort study.

Science.gov (United States)

Hinkle, S N; Sjaarda, L A; Albert, P S; Mendola, P; Grantz, K L

2016-11-01

To assess differences in small-for-gestational age (SGA) classifications for the detection of neonates with increased perinatal mortality risk among obese women and subsequently assess the association between prepregnancy body mass index (BMI) status and SGA. Hospital-based cohort. Twelve US clinical centres (2002-08). A total of 114 626 singleton, nonanomalous pregnancies. Data were collected using electronic medical record abstraction. Relative risks (RR) with 95% CI were estimated. SGA trends (birthweight < 10th centile) classified using population-based (SGA POP ), intrauterine (SGA IU ) and customised (SGA CUST ) references were assessed. The SGA-associated perinatal mortality risk was estimated among obese women. Using the SGA method most associated with perinatal mortality, the association between prepregnancy BMI and SGA was estimated. The overall perinatal mortality prevalence was 0.55% and this increased significantly with increasing BMI (P < 0.01). Among obese women, SGA IU detected the highest proportion of perinatal mortality cases (2.49%). Perinatal mortality was 5.32 times (95% CI 3.72-7.60) more likely among SGA IU neonates than non-SGA IU neonates. This is in comparison with the 3.71-fold (2.49-5.53) and 4.81-fold (3.41-6.80) increased risk observed when SGA POP and SGA CUST were used, respectively. Compared with women of normal weight, overweight women (RR = 0.82, 95% CI 0.78-0.86) and obese women (RR = 0.80; 95% CI 0.75-0.83) had a lower risk for delivering an SGA IU neonate. Among obese women, the intrauterine reference best identified neonates at risk of perinatal mortality. Based on SGA IU , SGA is less common among obese women but these SGA babies are at a high risk of death and remain an important group for surveillance. SGA is less common among obese women but these SGA babies are at a high risk of death. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

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

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

2011-01-01

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

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

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

1997-01-01

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

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

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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

Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

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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.

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

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

2016-11-01

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

Gestational Weight Gain and Pregnancy Outcomes in 481 Obese Glucose-Tolerant Women

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Jensen, Dorte Møller; Ovesen, Per; Beck-Nielsen, Henning

2005-01-01

OBJECTIVE: To investigate the effect of gestational weight gain in obese glucose-tolerant women. RESEARCH DESIGN AND METHODS: We performed a historical cohort study of 481 women with prepregnancy BMI > or = 30 kg/m2 and a normal 2-h 75-g oral glucose tolerance test (OGTT) during the third trimester......-weight women (3,478 g). In multivariate analyses, increasing weight gain was associated with significantly higher rates of hypertension (OR 4.8 [95% CI for group 4 vs. group 1: 1.7-13.1]), cesarean section (3.5 [1.6-7.8]), induction of labor (3.7 [1.7-8.0]), and large-for-gestational-age infants (4.7 [2.......0-11.0]). There was no difference in rates of small-for-gestational-age infants. Significant predictors for birth weight (determined by multiple linear regression) were gestational weight gain, 2-h OGTT result, pre-gestational BMI, maternal age, gestational age, and smoking. CONCLUSIONS: Increasing weight gain in obese women...

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

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Adeyekun, A A; Orji, M O

2014-04-01

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

Gestational age and adolescent mental health: evidence from Hong Kong's 'Children of 1997' birth cohort.

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Wang, Hui; Leung, Gabriel M; Lam, H S; Schooling, C Mary

2015-09-01

Preterm, and more recently early term, birth has been identified as a risk factor for poor health. Whether the sequelae of late preterm or early term birth extends to poor mental health and well-being in adolescence is unclear and has not been systematically assessed. Linear regression was used to assess the adjusted associations of gestational age (very/moderate preterm (self-reported self-esteem at ∼11 years (n=6935), parent-reported Rutter score assessing the common emotional and behavioural problems at ∼7 years (n=6292) and ∼11 years (n=5596) and self-reported depressive symptoms at ∼13 years (n=5795) in a population-representative Hong Kong Chinese birth cohort 'Children of 1997' where gestational age has little social patterning. Very/moderate preterm birth was associated with higher Rutter subscore for hyperactivity (ß coefficients 0.5, 95% CI 0.01 to 1.00) at ∼7 years but not at ∼11 years, adjusted for sex, age, socio-economic position, parents' age at birth, birth order and secondhand smoke exposure. Similarly adjusted, late preterm, early term, late term and post-term birth were not associated with self-esteem or depressive symptoms. In a population-representative birth cohort from a non-Western-developed setting, gestational age had few associations with mental health and well-being in adolescence, whereas very preterm birth was specifically associated with hyperactivity in childhood. Inconsistencies with studies from Western settings suggest setting specific unmeasured confounding may underlie any observed associations. 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.

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

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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.

The joint influence of marital status, interpregnancy interval, and neighborhood on small for gestational age birth: a retrospective cohort study

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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.

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

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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...

The Implications of Diagnosis of Small for Gestational Age Fetuses Using European and South Asian Growth Charts: An Outcome-Based Comparative Study

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Gianpaolo Maso

2014-01-01

Full Text Available The antenatal condition of small for gestational age (SGA is significantly associated with perinatal morbidity and mortality and it is known that there are significant differences in birth weight and fetal size among different populations. The aim of our study was to assess the impact on outcomes of the diagnosis of SGA according to Bangladeshi and European antenatal growth charts in Sri Lankan population. The estimated fetal weight before delivery was retrospectively reviewed according to Bangladeshi and European growth references. Three groups were identified: Group 1-SGA according to Bangladeshi growth chart; Group 2-SGA according to European growth chart but not having SGA according to Bangladeshi growth chart; Group 3-No SGA according to both charts. There was a difference in prevalence of SGA between Bangladeshi and European growth charts: 12.7% and 51.7%, respectively. There were statistically significant higher rates in emergency cesarean section, fetal distress in labour, and intrauterine death (P<0.001 in Group 1 compared with Group, 2 and 3. No differences of outcomes occurred between Groups 2 and 3. Our study demonstrated that only cases diagnosed as SGA according to population-based growth charts are at risk of adverse outcome. The use of inappropriate prenatal growth charts might lead to misdiagnosis and potential unnecessary interventions.

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

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

2009-01-01

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

Refractive status at birth: its relation to newborn physical parameters at birth and gestational age.

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Raji Mathew Varghese

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

A longitudinal analysis of regional brain volumes in macaques exposed to X-irradiation in early gestation.

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Kristina Aldridge

Full Text Available Early gestation represents a period of vulnerability to environmental insult that has been associated with adult psychiatric disease. However, little is known about how prenatal perturbation translates into adult brain dysfunction. Here, we use a longitudinal study design to examine the effects of disruption of early gestational neurogenesis on brain volume in the non-human primate.Five Rhesus macaques were exposed to x-irradiation in early gestation (E30-E41, and four control monkeys were sham-irradiated at comparable ages. Whole brain magnetic resonance imaging was performed at 6 months, 12 months, and 3 and 5 years of age. Volumes of whole cerebrum, cortical gray matter, caudate, putamen, and thalamus were estimated using semi-automated segmentation methods and high dimensional brain mapping. Volume reductions spanning all ages were observed in irradiated monkeys in the putamen (15-24%, p = 0.01 and in cortical gray matter (6-15%, p = 0.01. Upon covarying for whole cerebral volume, group differences were reduced to trend levels (putamen: p = 0.07; cortical gray matter: p = 0.08. No group-by-age effects were significant.Due to the small number of observations, the conclusions drawn from this study must be viewed as tentative. Early gestational irradiation may result in non-uniform reduction of gray matter, mainly affecting the putamen and cerebral cortex. This may be relevant to understanding how early prenatal environmental insult could lead to brain morphological differences in neurodevelopmental diseases.

The Independent Importance of Pre-pregnancy Weight and Gestational Weight Gain for the Prevention of Large-for Gestational Age Brazilian Newborns.

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Mastroeni, Marco F; Czarnobay, Sandra A; Kroll, Caroline; Figueirêdo, Katherinne B W; Mastroeni, Silmara S B S; Silva, Jean C; Khan, Mohammad K A; Loehr, Sarah; Veugelers, Paul J

2017-04-01

Objectives To study the independent effect of pre-pregnancy weight, gestational weight gain (GWG), and other important risk factors on newborn birth weight. Methods Baseline data of 435 adult women and their singletons born between January and February 2012 at a public hospital in Brazil were used. Logistic regression was applied to determine the independent importance of pre-pregnancy weight and GWG for large for gestational age (LGA) newborns. Results Among all mothers, 37.9 % were overweight and obese before pregnancy and 45.3 % experienced excessive GWG. Among the newborns, 24.4 % were classified as LGA. Univariate analysis showed an association of family income, GWG, pre-pregnancy BMI and excessive GWG with LGA newborns. Smoking before and during pregnancy was associated with a decreased likelihood of giving birth to an LGA newborn compared to mothers who did not smoke. After adjustment for confounding variables, age at birth of first child, GWG, HbA1c and pre-pregnancy weight-GWG were significant and independent determinants of giving birth to an LGA newborn. Mothers with pre-pregnancy overweight and excessive GWG were more likely to deliver an LGA newborn (OR 2.54, P weight and experienced adequate GWG. Conclusions for Practice Age at first birth of child, GWG, HbA1c and pre-pregnancy overweight combined with excessive GWG are independent determinants of LGA newborns. The results of this study suggest that both primary prevention of overweight in women of childbearing age and management of GWG may be important strategies to reduce the number of LGA newborns and, consequently, the long-term public health burden of obesity.

Postural control of small for gestational age infants born at term Controle postural de lactentes nascidos a termo pequenos para a idade gestacional

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D Campos

2007-02-01

Full Text Available OBJECTIVE: This study compared the postural control of small (SGA and appropriate (AGA for gestational age infants born at term, at the ages of 3, 6, 9 and 12 months. METHOD: This was a cohort study of infants born at term, with birth weight less than the 10th percentile for the SGA group and between the 10th and 90th percentiles for the AGA group. Infants with genetic syndromes, malformations, congenital infections and internment in neonatal intensive care unit were excluded. The evaluation instrument was the Alberta Infant Motor Scale. RESULTS: Comparison of the SGA and AGA groups did not show any significant differences (p>0.05 at the assessment times. However, the postural control of the SGA group was influenced by the gestational age (r=-0.83; p= 0.006 and 5th minute Apgar (r= 0.79; p= 0.01 in the 3rd month, and by maternal occupation (r= 0.67; p= 0.01 in the 6th month. CONCLUSION: It was concluded that the postural control was similar in the groups. However, the postural control of the SGA group was influenced by biological and environmental factors.OBJETIVO: Este estudo teve por objetivo comparar o controle postural de lactentes nascidos a termo, pequenos (PIG e adequados para a idade gestacional (AIG nos 3º, 6º, 9º e 12º meses. MÉTODO: Estudo longitudinal de lactentes nascidos a termo, com peso de nascimento menor que o percentil 10 para o grupo PIG e entre o percentil 10 e 90 para o grupo AIG. Síndromes genéticas, más-formações, infecções congênitas e internados em unidade de terapia intensiva neonatal foram excluídos. O instrumento de avaliação foi Alberta Infant Motor Scale. RESULTADOS: A comparação do grupo PIG e AIG não mostrou diferença significativa (p> 0,05 nos meses avaliados. Entretanto, o controle postural do grupo PIG foi influenciado pela idade gestacional (r= -0,83/p= 0,006 e Apgar de 5' (r= 0,79/p= 0,01 no 3º mês; e pela ocupação materna (r= 0,67/p= 0,01 no 6º mês. CONCLUSÃO: Concluiu-se que o

End-of-life decisions for extremely low-gestational-age infants: why simple rules for complicated decisions should be avoided.

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Dupont-Thibodeau, Amélie; Barrington, Keith J; Farlow, Barbara; Janvier, Annie

2014-02-01

Interventions for extremely preterm infants bring up many ethical questions. Guidelines for intervention in the "periviable" period generally divide infants using predefined categories, such as "futile," "beneficial," and "gray zone" based on completed 7-day periods of gestation; however, such definitions often differ among countries. The ethical justification for using gestational age as the determination of the category boundaries is rarely discussed. Rational criteria used to make decisions regarding life-sustaining interventions must incorporate other important prognostic information. Precise guidelines based on imprecise data are not rational. Gestational age-based guidelines include an implicit judgment of what is deemed to be an unacceptably poor chance of "intact" survival but fail to explore the determination of acceptability. Furthermore, unclear definitions of severe disability, the difficulty, or impossibility, of accurately predicting outcome in the prenatal or immediate postnatal period make such simplistic formulae inappropriate. Similarly, if guidelines for intervention for the newborn are based on the "qualitative futility" of survival, it should be explicitly stated and justified according to established ethical guidelines. They should discuss whether newborn infants are morally different to older individuals or explain why thresholds recommended for intervention are different to recommendations for those in older persons. The aim should be to establish individualized goals of care with families while recognizing uncertainty, rather than acting on labels derived from gestational age categories alone. Copyright © 2014 Elsevier Inc. All rights reserved.

Gestational diabetes mellitus screening and outcomes.

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Aktün, Hale Lebriz; Uyan, Derya; Yorgunlar, Betül; Acet, Mustafa

2015-01-01

To verify the usefulness of the World Health Organization criteria for the diagnosis of gestational diabetes mellitus in pregnant women and its effectiveness in the prevention of maternal and neonatal adverse results in women younger than 35 years without apparent risk factors for gestational diabetes mellitus. This is a retrospective study based on population involving 1360 pregnant women who delivered and who were followed-up in a university hospital in Istanbul. All women underwent the 75-g oral glucose tolerance test screening, usually in between the 24(th)-28(th) weeks of pregnancy. In all cases, the identification of gestational diabetes mellitus was determined in accordance with the World Health Organization criteria. Approximately 28% of the pregnant women aged younger than 35 years with no risk factors for gestational diabetes mellitus were diagnosed with the oral glucose tolerance test in this study. In the gestational diabetes mellitus group, the primary cesarean section rate was importantly higher than that in the non-gestational diabetes mellitus group. Preterm delivery was also associated with gestational diabetes mellitus. The diagnosis of gestational diabetes mellitus was strongly associated with admittance to the neonatal intensive care unit. Neonatal respiratory problems didn't showed any significant deviation between the groups. There was a moderate association between gestational diabetes mellitus and metabolic complications. Pregnant women with no obvious risk factors were diagnosed with gestational diabetes mellitus using the World Health Organization criteria. The treatment of these women potentially reduced their risk of adverse maternal and neonatal hyperglycemia-related events, such as cesarean section, polyhydramnios, preterm delivery, admission to neonatal intensive care unit, large for gestational age, and higher neonatal weight.

Ethnicity and first birth: age, smoking, delivery, gestation, weight and feeding: Scottish Health and Ethnicity Linkage Study.

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Bansal, Narinder; Chalmers, James W T; Fischbacher, Colin M; Steiner, Markus F C; Bhopal, Raj S

2014-12-01

We linked census and health service data sets to address the shortage of information comparing maternal characteristics and pregnancy outcomes by ethnic group in Scotland. Retrospective cohort study linking the 2001 National Census for Scotland and hospital obstetric data (2001-08), comparing maternal age, smoking status, gestational age, caesarean section rates, birthweight, preterm birth and breastfeeding rates by ethnic group. In all, 144 344 women were identified as having had a first birth between 1 May 2001 and 30 April 2008. White Scottish mothers were younger [mean age 27.3 years; 95% confidence interval (CI): 27.3, 27.4] than other white groups and most non-white groups. They had the highest smoking rates (25.8%; CI: 25.5, 26.0) and the lowest rates of breastfeeding at 6-8 weeks (23.4%; CI: 23.1, 23.6), with most of the other groups being around 40%. Women from non-white minority ethnic groups in Scotland tended to have babies of lower birthweight (e.g. Pakistani mean birthweight-3105 g, white Scottish-3356 g), even after adjustment for gestational age, maternal age, education, smoking and housing tenure. This effect was more noticeable for women born in the UK. White English, Irish and other white babies tended to have higher birthweights. There was little variation between groups in caesarean section rates. Pregnant women from ethnic minority populations in Scotland have more favourable health behaviour than the white Scottish, although the non-white groups tend to have lower birthweight. Further exploration of the reasons for these differences has potential to benefit women from the majority population. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries: Individual Participant Data Meta-Analysis and Population Attributable Fraction.

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Kozuki, Naoko; Katz, Joanne; Lee, Anne C C; Vogel, Joshua P; Silveira, Mariangela F; Sania, Ayesha; Stevens, Gretchen A; Cousens, Simon; Caulfield, Laura E; Christian, Parul; Huybregts, Lieven; Roberfroid, Dominique; Schmiegelow, Christentze; Adair, Linda S; Barros, Fernando C; Cowan, Melanie; Fawzi, Wafaie; Kolsteren, Patrick; Merialdi, Mario; Mongkolchati, Aroonsri; Saville, Naomi; Victora, Cesar G; Bhutta, Zulfiqar A; Blencowe, Hannah; Ezzati, Majid; Lawn, Joy E; Black, Robert E

2015-11-01

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. The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature. We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed. All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated

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

Science.gov (United States)

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

2018-04-01

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

Non-Meckel Small Intestine Diverticulitis

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Shamim Ejaz

2017-08-01

Full Text Available Non-Meckel small intestine diverticulitis can have many manifestations and its management is not well-defined. We report 4 unselect cases of small intestine diverticulitis; all patients were seen by the same physician at the Emergency Center at The University of Texas MD Anderson Cancer Center between 1999 and 2014. The median age at diagnosis of these patients was 82 years (range, 76–87 years. All 4 patients presented with acute onset of abdominal pain, and computed tomography scans showed characteristics of small intestine diverticulitis unrelated to cancer. Most of the diverticula were found in the region of the duodenum and jejuno-ileal segments of the small intestine. The patients, even those with peripancreatic inflammation and localized perforation, were treated conservatively. Non-Meckel diverticulitis can be overlooked in the initial diagnosis because of the location of the diverticulosis, the age of the patient, and the rarity of the disease. Because patients with non-Meckel small intestine diverticulitis can present with acute abdominal pain, non-Meckel small intestine diverticulitis should be considered in the differential diagnosis of patients with acute abdominal pain, and computed tomography scans can help identify the condition. Because of the rarity of non-Meckel small intestine diverticulitis, few studies have been published, and the data are inconclusive about how best to approach these patients. Our experience with these 4 elderly patients indicates that non-Meckel small intestine diverticulitis can be treated conservatively, which avoids the potential morbidity and mortality of a surgical approach.

Quality of CT pulmonary angiography for suspected pulmonary embolus in pregnancy

International Nuclear Information System (INIS)

U-King-Im, Jean Marie; Freeman, Susan J.; Boylan, Teresa; Cheow, Heok K.

2008-01-01

The main objective of this study was to assess the quality of CT pulmonary angiography (CTPA) for suspected pulmonary embolus (PE) in the pregnant population. We retrospectively identified 40 consecutive pregnant patients who underwent CTPA from January 2005 to December 2006. Forty consecutive age-matched non-pregnant women were used as a control group. Studies were subjectively graded according to overall image quality by two readers in consensus, in randomised and blinded manner. Moreover, contrast enhancement of pulmonary arteries was subjectively and objectively evaluated. The proportion of sub-optimal studies was more than three times higher in the pregnant group (27.5%, n = 11) compared with the non-pregnant group (7.5%, n = 3; p = 0.015). Mean contrast enhancement was consistently higher in the non-pregnant group compared with pregnant group, both subjectively and objectively. The percentage of inadequately opacified vascular segments was more than two times higher in the pregnant group (28.7%, n = 264) than in the non-pregnant group (13.3%, n 122; p = 0.0001). The incidence of sub-optimal CTPA studies is higher in pregnancy when compared with an age-matched non-pregnant control group. In addition to radiation issues, this should also be considered when implementing diagnostic strategies for suspected PE in pregnancy. (orig.)

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...

F-18 fluorodeoxyglucose positron emission tomography in the mediastinal nodal staging of non-small cell lung carcinoma

International Nuclear Information System (INIS)

Berlangieri, S.U.; Scott, A.M.; Knight, S.; Fitt, G.J.; Hess, E.M.; Pathmaraj, K.; Hennessy, O.F.; Tochon-Danguy, H.J.; Chan, J.G.; Egan, G.F.; Sinclair, R.A.; Clarke, C.P.; McKay, W.J.; St Vincents Hospital, Fitzroy, VIC

1998-01-01

Full text: Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG), as a metabolic tumour marker, has been proposed for staging of oncological disease. To determine its role in the mediastinal staging of lung cancer, a prospective comparison of FDG PET with surgery was performed in patients with suspected non-small cell lung carcinoma. The analysis group consists of 70 patients, 49 men and 21 women, mean age 64 yrs (range 41-83 yrs). The PET study was acquired on a Siemens 951/31R scanner over 3 bed positions, 45 minutes following 400MBq FDG. The emission scan was attenuation corrected using measured transmission data. The FDG PET were interpreted by a nuclear physician blinded to the clinical data and the results of the patients' CT scan. On PET, nodes were graded qualitatively on a 5 point scale with scores 4 or greater, positive for tumour involvement. Surgical specimens were obtained in all patients by thoracotomy or mediastinoscopy. The PET metabolic studies and pathology were mapped according to the American Thoracic Society nodal classification resulting in a total of 277 nodal stations evaluated. The PET studies analysed N2 or N3 tumour involvement by nodal station in comparison to histology of pathological specimens or direct visual assessment of the nodal stations at surgery. All patients had proven non-small cell lung carcinoma, except two, in whom, a tissue confirmation of the suspected diagnosis was not attained. PET excluded tumour in 237 of 246 nodal stations (specificity 96%). PET correctly identified 23 of 31 nodal stations with disease (sensitivity 74%). PET correctly staged 260 of 277 nodal stations (accuracy 94%) for disease. FDG PET is an accurate non-invasive functional imaging modality for the mediastinal staging of non-small cell lung cancer and has an important clinical role in the preoperative staging of lung cancer patients

[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.

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......% 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...... LGA as a late phenomenon in pregnancy. Knowing the result from the late scanning, the result from the early scanning contributed almost no further information about whether the infant would be LGA at birth. Basic epidemiological characteristics of other comparable investigations on high...

RESEARCHES REGARDING THE MAIN REPRODUCTION INDICATORS DETERMINATED IN SOWS, STAND GESTATION PEN TIPE

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RAMONA UNTARU

2007-05-01

Full Text Available Current researches were carried out with the goal to quantisize the lost from the weaning to early gestation at the sows housed in open pen gestation. In this trail we tested two pen types, different not only by size, but also by feeders’ emplacement. The main reproduction indicators that we calculated until the 28 gestation day were the proportion of sows in heat after weaning, the weaning to estrus interval and the gestation rates. The weaning to estrus interval was about 4 to 7 days, most sows were in heat in the day 5 and 6 days after weaning. The percent of heat detection after weaning was 71.42% for the small pens and 70.71% for the big pens (differences statistically non significant, chi test value was 0.983. The gestation rate at 28 days after insemination was 91.62% for the small pens and 94.72% for the large pens (chi test value 0,959, statistically non significant differences. The overpopulation for heat induction and after that chipping animals together in those pens, show that the lost are up to 40.47%, between weaning – day 28 of gestation.

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

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

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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.

Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer.

LENUS (Irish Health Repository)

Harewood, Gavin C

2010-03-01

Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.

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

Science.gov (United States)

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

2017-09-01

Inadequate or excessive total gestational weight gain is associated with increased risks of small- and large-for-gestational-age births, respectively, but evidence is sparse regarding overall and trimester-specific patterns of gestational weight gain in relation to these risks. Characterizing the interrelationship between patterns of gestational weight gain across trimesters can reveal whether the trajectory of gestational weight gain in the first trimester sets the path for gestational weight gain in subsequent trimesters, thereby serving as an early marker for at-risk pregnancies. We sought to describe overall trajectories of gestational weight gain across gestation and assess the risk of adverse birthweight outcomes associated with the overall trajectory and whether the timing of gestational weight gain (first vs second/third trimester) is differentially associated with adverse outcomes. We conducted a secondary analysis of a prospective cohort of 2802 singleton pregnancies from 12 US prenatal centers (2009 through 2013). Small and large for gestational age were calculated using sex-specific birthweight references gain and separate first- and second-/third-trimester trajectories to assess tracking. Robust Poisson regression was used to estimate the relative risk of small- and large-for-gestational-age outcomes by the probability of trajectory membership. We tested whether relationships were modified by prepregnancy body mass index. There were 2779 women with a mean of 15 (SD 5) weights measured across gestation. Four distinct gestational weight gain trajectories were identified based on the lowest Bayesian information criterion value, classifying 10.0%, 41.8%, 39.2%, and 9.0% of the population from lowest to highest weight gain trajectories, with an inflection at 14 weeks. The average rate in each trajectory group from lowest to highest for 0-gaining trajectory resembled the Institute of Medicine recommendations and was designated as the reference with the other

Small head size after atomic irradiation

International Nuclear Information System (INIS)

Miller, R.W.; Mulvihill, J.J.

1975-01-01

A study of children exposed to nuclear explosions in Hiroshima and Nagasaki showed small head size and mental retardation when exposure occurred less than 18 weeks of gestational age. Increased frequency of small head size occurred when maternal exposure was 10 to 19 rad. Tables and graphs are presented to show relationships between dose, gestational age, and frequency of small head size

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

Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

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Francisco Flávio Costa Filho

2015-11-01

Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

Value of MDCT and Clinical and Laboratory Data for Predicting the Need for Surgical Intervention in Suspected Small-Bowel Obstruction.

Science.gov (United States)

Scrima, Andrew; Lubner, Meghan G; King, Scott; Pankratz, Joshua; Kennedy, Gregory; Pickhardt, Perry J

2017-04-01

The purpose of this article is to assess the value of a large panel of clinical and MDCT variables in patients with suspected small-bowel obstruction (SBO) for predicting urgent surgical intervention (data were abstracted from electronic medical record review. Univariate and multivariate analyses were performed. Among all 179 patients with suspected SBO, 56 (31.3%) underwent surgical intervention within 72 hours, 10 (5.6%) had ischemia at surgery, and nine (5.0%) required small-bowel resection. On univariate analysis, multiple CT findings were highly significant (p < 0.01) for predicting the main surgical outcomes, including degree of obstruction, 5-point radiology likelihood scores, and the presence of a transition point, closed loop, and mesenteric congestion. None of the objective clinical or laboratory variables (including serum lactate level) reached this level of significance. At multivariate analysis, forward stepwise logistic regression with 0.05 significance level cutoff included both degree of obstruction (p < 0.001) and closed loop (p < 0.01), with the presence of a transition point showing a trend toward significance (p = 0.081). A number of findings at abdominal MDCT are associated with the need for surgery and other important surgical outcomes in patients with suspected SBO. Overall radiologist impression of need for surgical intervention was a better predictor than any clinical or laboratory parameter.

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

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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.

Effects of advancing gestation and non-Caucasian race on ductus arteriosus gene expression

Science.gov (United States)

Waleh, Nahid; Barrette, Anne Marie; Dagle, John M.; Momany, Allison; Jin, Chengshi; Hills, Nancy K.; Shelton, Elaine L.; Reese, Jeff; Clyman, Ronald I.

2015-01-01

Objective To identify genes affected by advancing gestation and racial/ethnic origin in human ductus arteriosus (DA). Study design We collected three sets of DA tissue (n=93, n=89, n=91; total = 273 fetuses) from second trimester pregnancies. We examined four genes, with DNA polymorphisms that distribute along racial lines, to identify "Caucasian" and "Non-Caucasian" DA. We used RT-PCR to measure RNA expression of 48 candidate genes involved in functional closure of the DA, and used multivariable regression analyses to examine the relationships between advancing gestation, "Non-Caucasian" race, and gene expression. Results Mature gestation and Non-Caucasian race are significant predictors for identifying infants who will close their patent DA when treated with indomethacin. Advancing gestation consistently altered gene expression in pathways involved with oxygen-induced constriction (e.g., calcium-channels, potassium-channels, and endothelin signaling), contractile protein maturation, tissue remodeling, and prostaglandin and nitric oxide signaling in all three tissue sets. None of the pathways involved with oxygen-induced constriction appeared to be altered in "Non-Caucasian" DA. Two genes, SLCO2A1 and NOS3, (involved with prostaglandin reuptake/metabolism and nitric oxide production, respectively) were consistently decreased in "Non-Caucasian" DA. Conclusions Prostaglandins and nitric oxide are the most important vasodilators opposing DA closure. Indomethacin inhibits prostaglandin production, but not nitric oxide production. Because decreased SLCO2A1 and NOS3 expression can lead to increased prostaglandin and decreased nitric oxide concentrations, we speculate that prostaglandin-mediated vasodilation may play a more dominant role in maintaining the "Non-Caucasian" PDA, making it more likely to close when inhibited by indomethacin. PMID:26265282

Effects of Gestational Age and Birth Weight on Brain Volumes in Healthy 9 Year-Old Children

NARCIS (Netherlands)

van Soelen, I.L.C.; Brouwer, R.M.; Peper, J.S.; van Beijsterveldt, C.E.M.; van Leeuwen, M.; de Vries, L.S.; Kahn, R.S.; Hulshoff Pol, H.E.; Boomsma, D.I.

2010-01-01

Objective: To assess the effects of gestational age and birth weight on brain volumes in a population-based sample of normal developing children at the age of 9 years. Study design: A total of 192 children from twin births were included in the analyses. Data on gestational age and birth weight were

Double-read of skeletal surveys in suspected non-accidental trauma: what we learned

Energy Technology Data Exchange (ETDEWEB)

Karmazyn, Boaz; Wanner, Matthew R.; Marine, Megan B. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indianapolis, IN (United States); Miller, Elise M.; Jennings, S.G. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Lay, Sara E. [Indiana University School of Medicine, Methodist Hospital, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Massey, James M. [The Children' s Hospital at TriStar Centennial, Department of Imaging, Nashville, TN (United States); Ouyang, Fangqian [Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN (United States); Hibbard, Roberta A. [Indiana University School of Medicine, Department of Pediatrics, Section of Child Protection Programs, Riley Hospital for Children, Indianapolis, IN (United States)

2017-05-15

Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown. To determine the advantage of double-read versus single-read of radiographic skeletal surveys for suspected non-accidental trauma. The study was performed in two phases. In the first phase (April 2013 to September 2013), double-read was performed for all skeletal surveys obtained during weekday working hours. Because we had no new double-read findings in studies initially read as negative, we conducted a second phase (January 2014 to March 2014). In the second phase we limited double-reads to skeletal surveys found positive on the first read. At the end of this period, we retrospectively performed double-read for all initially negative skeletal surveys. We excluded follow-up skeletal surveys. The difference in discrepancy (new fracture or false diagnosis of a fracture) ratio between negative and positive skeletal surveys was evaluated using the Fisher exact test, and change in discrepancy ratio between the first and second study phases was evaluated using the stratified Cochran-Mantel-Haenszel test. Overall in the two phases, 178 skeletal surveys were performed in 178 children (67 girls) with mean age of 9 months (range 3 days to 3.7 years). Double-read found 16 discrepancies in 8/178 (4.5%) skeletal surveys. Seven of these studies showed additional fractures (n=15). In one study, an initial read of a skull fracture was read as a variant on the second read. There was a significant (P=0.01) difference between rate of disagreement in negative skeletal surveys (1/104, 1.0%) and positive skeletal surveys (7/74, 9.5%). No significant change in disagreement rate was demonstrated between the two phases of the study (P=0.59). Double-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found

Double-read of skeletal surveys in suspected non-accidental trauma: what we learned

International Nuclear Information System (INIS)

Karmazyn, Boaz; Wanner, Matthew R.; Marine, Megan B.; Miller, Elise M.; Jennings, S.G.; Lay, Sara E.; Massey, James M.; Ouyang, Fangqian; Hibbard, Roberta A.

2017-01-01

Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown. To determine the advantage of double-read versus single-read of radiographic skeletal surveys for suspected non-accidental trauma. The study was performed in two phases. In the first phase (April 2013 to September 2013), double-read was performed for all skeletal surveys obtained during weekday working hours. Because we had no new double-read findings in studies initially read as negative, we conducted a second phase (January 2014 to March 2014). In the second phase we limited double-reads to skeletal surveys found positive on the first read. At the end of this period, we retrospectively performed double-read for all initially negative skeletal surveys. We excluded follow-up skeletal surveys. The difference in discrepancy (new fracture or false diagnosis of a fracture) ratio between negative and positive skeletal surveys was evaluated using the Fisher exact test, and change in discrepancy ratio between the first and second study phases was evaluated using the stratified Cochran-Mantel-Haenszel test. Overall in the two phases, 178 skeletal surveys were performed in 178 children (67 girls) with mean age of 9 months (range 3 days to 3.7 years). Double-read found 16 discrepancies in 8/178 (4.5%) skeletal surveys. Seven of these studies showed additional fractures (n=15). In one study, an initial read of a skull fracture was read as a variant on the second read. There was a significant (P=0.01) difference between rate of disagreement in negative skeletal surveys (1/104, 1.0%) and positive skeletal surveys (7/74, 9.5%). No significant change in disagreement rate was demonstrated between the two phases of the study (P=0.59). Double-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found

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

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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...

Prenatal magnetic resonance imaging: brain normal linear biometric values below 24 gestational weeks

International Nuclear Information System (INIS)

Parazzini, C.; Righini, A.; Triulzi, F.; Rustico, M.; Consonni, D.

2008-01-01

Prenatal magnetic resonance (MR) imaging is currently used to measure quantitative data concerning brain structural development. At present, morphometric MR imaging studies have been focused mostly on the third trimester of gestational age. However, in many countries, because of legal restriction on abortion timing, the majority of MR imaging fetal examination has to be carried out during the last part of the second trimester of pregnancy (i.e., before the 24th week of gestation). Accurate and reliable normative data of the brain between 20 and 24 weeks of gestation is not available. This report provides easy and practical parametric support to assess those normative data. From a database of 1,200 fetal MR imaging studies, we retrospectively selected 84 studies of the brain of fetuses aged 20-24 weeks of gestation that resulted normal on clinical and radiological follow-up. Fetuses with proved or suspected infections, twin pregnancy, and fetuses of mothers affected by pathology that might have influenced fetal growth were excluded. Linear biometrical measurements of the main cerebral structures were obtained by three experienced pediatric neuroradiologists. A substantial interobserver agreement for each measurements was reached, and normative data with median, maximum, and minimum value were obtained for brain structures. The knowledge of a range of normality and interindividual variability of linear biometrical values for the developing brain between 20th and 24th weeks of gestation may be valuable in assessing normal brain development in clinical settings. (orig.)

Prenatal magnetic resonance imaging: brain normal linear biometric values below 24 gestational weeks

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Parazzini, C.; Righini, A.; Triulzi, F. [Children' s Hospital ' ' V. Buzzi' ' , Department of Radiology and Neuroradiology, Milan (Italy); Rustico, M. [Children' s Hospital ' ' V. Buzzi' ' , Department of Obstetrics and Gynecology, Milan (Italy); Consonni, D. [Fondazione IRCCS Ospedale Maggiore Policlinico, Unit of Epidemiology, Milan (Italy)

2008-10-15

Prenatal magnetic resonance (MR) imaging is currently used to measure quantitative data concerning brain structural development. At present, morphometric MR imaging studies have been focused mostly on the third trimester of gestational age. However, in many countries, because of legal restriction on abortion timing, the majority of MR imaging fetal examination has to be carried out during the last part of the second trimester of pregnancy (i.e., before the 24th week of gestation). Accurate and reliable normative data of the brain between 20 and 24 weeks of gestation is not available. This report provides easy and practical parametric support to assess those normative data. From a database of 1,200 fetal MR imaging studies, we retrospectively selected 84 studies of the brain of fetuses aged 20-24 weeks of gestation that resulted normal on clinical and radiological follow-up. Fetuses with proved or suspected infections, twin pregnancy, and fetuses of mothers affected by pathology that might have influenced fetal growth were excluded. Linear biometrical measurements of the main cerebral structures were obtained by three experienced pediatric neuroradiologists. A substantial interobserver agreement for each measurements was reached, and normative data with median, maximum, and minimum value were obtained for brain structures. The knowledge of a range of normality and interindividual variability of linear biometrical values for the developing brain between 20th and 24th weeks of gestation may be valuable in assessing normal brain development in clinical settings. (orig.)

High resolution post-mortem MRI of non-fixed in situ foetal brain in the second trimester of gestation. Normal foetal brain development

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Scola, Elisa; Palumbo, Giovanni; Avignone, Sabrina; Cinnante, Claudia Maria [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Conte, Giorgio [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Universita degli Studi di Milano, Postgraduation School in Radiodiagnostics, Milan (Italy); Boito, Simona; Persico, Nicola [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Department of Obstetrics and Gynaecology ' L. Mangiagalli' , Milan (Italy); Rizzuti, Tommaso [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Pathology Unit, Milan (Italy); Triulzi, Fabio [Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan (Italy); Universita degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan (Italy)

2018-01-15

To describe normal foetal brain development with high resolution post-mortem MRI (PMMRI) of non-fixed foetal brains. We retrospectively collected PMMRIs of foetuses without intracranial abnormalities and chromosomal aberrations studied after a termination of pregnancy due to extracranial abnormalities or after a spontaneous intrauterine death. PMMRIs were performed on a 3-T scanner without any fixation and without removing the brain from the skull. All PMMRIs were evaluated in consensus by two neuroradiologists. Our analysis included ten PMMRIs (median gestational age (GA): 21 weeks; range: 17-28 weeks). At 19 and 20 weeks of GA, the corticospinal tracts are recognisable in the medulla oblongata, becoming less visible from 21 weeks. Prior to 20 weeks the posterior limb of the internal capsule (PLIC) is more hypointense than surrounding deep grey nuclei; starting from 21 weeks the PLIC becomes isointense, and is hyperintense at 28 weeks. From 19-22 weeks, the cerebral hemispheres show transient layers: marginal zone, cortical plate, subplate, and intermediate, subventricular and germinal zones. PMMRI of non-fixed in situ foetal brains preserves the natural tissue contrast and skull integrity. We assessed foetal brain development in a small cohort of foetuses, focusing on 19-22 weeks of gestation. (orig.)

High resolution post-mortem MRI of non-fixed in situ foetal brain in the second trimester of gestation. Normal foetal brain development

International Nuclear Information System (INIS)

Scola, Elisa; Palumbo, Giovanni; Avignone, Sabrina; Cinnante, Claudia Maria; Conte, Giorgio; Boito, Simona; Persico, Nicola; Rizzuti, Tommaso; Triulzi, Fabio

2018-01-01

To describe normal foetal brain development with high resolution post-mortem MRI (PMMRI) of non-fixed foetal brains. We retrospectively collected PMMRIs of foetuses without intracranial abnormalities and chromosomal aberrations studied after a termination of pregnancy due to extracranial abnormalities or after a spontaneous intrauterine death. PMMRIs were performed on a 3-T scanner without any fixation and without removing the brain from the skull. All PMMRIs were evaluated in consensus by two neuroradiologists. Our analysis included ten PMMRIs (median gestational age (GA): 21 weeks; range: 17-28 weeks). At 19 and 20 weeks of GA, the corticospinal tracts are recognisable in the medulla oblongata, becoming less visible from 21 weeks. Prior to 20 weeks the posterior limb of the internal capsule (PLIC) is more hypointense than surrounding deep grey nuclei; starting from 21 weeks the PLIC becomes isointense, and is hyperintense at 28 weeks. From 19-22 weeks, the cerebral hemispheres show transient layers: marginal zone, cortical plate, subplate, and intermediate, subventricular and germinal zones. PMMRI of non-fixed in situ foetal brains preserves the natural tissue contrast and skull integrity. We assessed foetal brain development in a small cohort of foetuses, focusing on 19-22 weeks of gestation. (orig.)

Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight.

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Doriane Madeleneau

Full Text Available Therapeutic strategies for patent ductus arteriosus (PDA in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA newborns.This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea: 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes.The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003.There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.

Coronary vascular age: An alternate means for predicting stress-induced myocardial ischemia in patients with suspected coronary artery disease.

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Nappi, Carmela; Gaudieri, Valeria; Acampa, Wanda; Arumugam, Parthiban; Assante, Roberta; Zampella, Emilia; Mannarino, Teresa; Mainolfi, Ciro Gabriele; Imbriaco, Massimo; Petretta, Mario; Cuocolo, Alberto

2018-01-22

Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year's scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD). A total of 717 subjects referred to CAC scoring and 82 Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied. CAC score was measured according to the Agatston method and coronary vascular age by equating estimated CAD risk for chronological age and CAC using the formula 39.1 + 7.25 × ln(CAC + 1). Stress-induced ischemia was present in 105 (15%) patients. Mean chronological age, CAC score, and coronary vascular age were higher (all P age was added to clinical variables. Including vascular age in the model, the global Chi square further increased from 68.77 to 106.38 (P age to clinical data, continuous net reclassification improvement (cNRI) was 0.57, while adding vascular age to clinical data and chronological age cNRI was 0.62. At decision curve analysis, the model including vascular age was associated with the highest net benefit compared to the model including only clinical data, to the model including chronological age and clinical data, and to a strategy considering that all patients had ischemia. The model including vascular age also showed the largest reduction in false-positive rate without missing any ischemic patients. In subjects with suspected CAD, coronary vascular age is strongly associated with stress-induced ischemia. The communication of a given vascular age would have a superior emotive impact improving observance of therapies and healthier lifestyles.

Pregnancy outcome following gestational exposure to azithromycin

Directory of Open Access Journals (Sweden)

Woodland C Cindy

2006-05-01

Full Text Available Abstract Background Azithromycin is an azalide antibiotic with an extensive range of indications and has become a common treatment option due to its convenient dosing regimen and therapeutic advantages. Human studies addressing gestational use of azithromycin have primarily focused on antibiotic efficacy rather than fetal safety. Our primary objective was to evaluate the possibility of teratogenic risk following gestational exposure to azithromycin. Methods There were 3 groups of pregnant women enrolled in our study: 1 women who took azithromycin. 2 women exposed to non-teratogenic antibiotics for similar indications, and 3 women exposed to non-teratogenic agents. They were matched for gestational age at time of call, maternal age, cigarette and alcohol consumption. Rates of major malformations and other endpoints of interest were compared among the three groups. Results Pregnancy outcome of 123 women in each group was ascertained. There were no statistically significant differences among the three groups in the rates of major malformations; 3.4% (exposed versus 2.3% (disease matched and 3.4% (non teratogen or any other endpoints that were examined. In the azithromycin group, 88 (71.6% women took the drug during the first trimester Conclusion Results suggest that gestational exposure to azithromycin is not associated with an increase in the rate of major malformations above the baseline of 1–3%. Our data adds to previous research showing that macrolide antibiotics, as a group, are generally safe in pregnancy and provides an evidence-based option for health professionals caring for populations with chlamydia.

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

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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.

Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis

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Leeuwenburgh, Marjolein M.N., E-mail: m.m.leeuwenburgh@amc.uva.nl [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands); Wiarda, Bart M. [Department of Radiology, Alkmaar Medical Center, Alkmaar (Netherlands); Jensch, Sebastiaan [Department of Radiology, Sint Lucas Andreas Hospital, Amsterdam (Netherlands); Wouter van Es, H. [Department of Radiology, Sint Antonius Hospital, Nieuwegein (Netherlands); Stockmann, Hein B.A.C. [Department of Surgery, Kennemer Gasthuis, Haarlem (Netherlands); Gratama, Jan Willem C. [Department of Radiology, Gelre Hospitals, Apeldoorn (Netherlands); Cobben, Lodewijk P.J. [Department of Radiology, Haaglanden Medical Center, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam (Netherlands); Boermeester, Marja A. [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands)

2014-01-15

Objective: To compare accuracy and interobserver agreement between radiologists with limited experience in the evaluation of abdominal MRI (non-experts), and radiologists with longer MR reading experience (experts), in reading MRI in patients with suspected appendicitis. Methods: MR imaging was performed in 223 adult patients with suspected appendicitis and read independently by two members of a team of eight MR-inexperienced radiologists, who were trained with 100 MR examinations previous to this study (non-expert reading). Expert reading was performed by two radiologists with a larger abdominal MR experience (>500 examinations) in consensus. A final diagnosis was assigned after three months based on all available information, except MRI findings. We estimated MRI sensitivity and specificity for appendicitis and for all urgent diagnoses separately. Interobserver agreement was evaluated using kappa statistics. Results: Urgent diagnoses were assigned to 147 of 223 patients; 117 had appendicitis. Sensitivity for appendicitis was 0.89 by MR-non-expert radiologists and 0.97 in MR-expert reading (p = 0.01). Specificity was 0.83 for MR-non-experts versus 0.93 for MR-expert reading (p = 0.002). MR-experts and MR-non-experts agreed on appendicitis in 89% of cases (kappa 0.78). Accuracy in detecting urgent diagnoses was significantly lower in MR-non-experts compared to MR-expert reading: sensitivity 0.84 versus 0.95 (p < 0.001) and specificity 0.71 versus 0.82 (p = 0.03), respectively. Agreement on urgent diagnoses was 83% (kappa 0.63). Conclusion: MR-non-experts have sufficient sensitivity in reading MRI in patients with suspected appendicitis, with good agreement with MR-expert reading, but accuracy of MR-expert reading was higher.

Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis

International Nuclear Information System (INIS)

Leeuwenburgh, Marjolein M.N.; Wiarda, Bart M.; Jensch, Sebastiaan; Wouter van Es, H.; Stockmann, Hein B.A.C.; Gratama, Jan Willem C.; Cobben, Lodewijk P.J.; Bossuyt, Patrick M.M.; Boermeester, Marja A.; Stoker, Jaap

2014-01-01

Objective: To compare accuracy and interobserver agreement between radiologists with limited experience in the evaluation of abdominal MRI (non-experts), and radiologists with longer MR reading experience (experts), in reading MRI in patients with suspected appendicitis. Methods: MR imaging was performed in 223 adult patients with suspected appendicitis and read independently by two members of a team of eight MR-inexperienced radiologists, who were trained with 100 MR examinations previous to this study (non-expert reading). Expert reading was performed by two radiologists with a larger abdominal MR experience (>500 examinations) in consensus. A final diagnosis was assigned after three months based on all available information, except MRI findings. We estimated MRI sensitivity and specificity for appendicitis and for all urgent diagnoses separately. Interobserver agreement was evaluated using kappa statistics. Results: Urgent diagnoses were assigned to 147 of 223 patients; 117 had appendicitis. Sensitivity for appendicitis was 0.89 by MR-non-expert radiologists and 0.97 in MR-expert reading (p = 0.01). Specificity was 0.83 for MR-non-experts versus 0.93 for MR-expert reading (p = 0.002). MR-experts and MR-non-experts agreed on appendicitis in 89% of cases (kappa 0.78). Accuracy in detecting urgent diagnoses was significantly lower in MR-non-experts compared to MR-expert reading: sensitivity 0.84 versus 0.95 (p < 0.001) and specificity 0.71 versus 0.82 (p = 0.03), respectively. Agreement on urgent diagnoses was 83% (kappa 0.63). Conclusion: MR-non-experts have sufficient sensitivity in reading MRI in patients with suspected appendicitis, with good agreement with MR-expert reading, but accuracy of MR-expert reading was higher

Small for Gestational Age (SGA)

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... area – the recommendation is not in the bathroom. Purchase a bottle containing the fewest tests; date the ... their specialty, but may have little or no experience with the specific and interrelated problems seen in ...

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

Science.gov (United States)

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

2011-09-01

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

Small-bowel capsule endoscopy in patients with suspected Crohn's disease-diagnostic value and complications.

Science.gov (United States)

Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

2010-01-01

The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

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

Baseline HbA1c to Identify High-Risk Gestational Diabetes: Utility in Early vs Standard Gestational Diabetes.

Science.gov (United States)

Sweeting, Arianne N; Ross, Glynis P; Hyett, Jon; Molyneaux, Lynda; Tan, Kris; Constantino, Maria; Harding, Anna Jane; Wong, Jencia

2017-01-01

The increasing prevalence of gestational diabetes mellitus (GDM) necessitates risk stratification directing limited antenatal resources to those at greatest risk. Recent evidence demonstrates that an early pregnancy glycated hemoglobin (HbA1c ≥5.9% (41 mmol/mol) predicts adverse pregnancy outcomes. To determine the optimal HbA1c threshold for adverse pregnancy outcomes in GDM in a treated multiethnic cohort and whether this differs in women diagnosed HbA1c (single-laboratory) measurement at the time of GDM diagnosis. Maternal clinical and pregnancy outcome data were collected prospectively. The association between baseline HbA1c and adverse pregnancy outcomes in early vs standard GDM. HbA1c was measured at a median of 17.6 ± 3.3 weeks' gestation in early GDM (n = 844) and 29.4 ± 2.6 weeks' gestation in standard GDM (n = 2254). In standard GDM, HbA1c >5.9% (41 mmol/mol) was associated with the greatest risk of large-for-gestational-age (odds ratio [95% confidence interval] = 2.7 [1.5-4.9]), macrosomia (3.5 [1.4-8.6]), cesarean section (3.6 [2.1-6.2]), and hypertensive disorders (2.6 [1.1-5.8]). In early GDM, similar HbA1c associations were seen; however, lower HbA1c correlated with the greatest risk of small-for-gestational-age (P trend = 0.004) and prevalence of neonatal hypoglycemia. Baseline HbA1c >5.9% (41 mmol/mol) identifies an increased risk of large-for-gestational-age, macrosomia, cesarean section, and hypertensive disorders in standard GDM. Although similar associations are seen in early GDM, higher HbA1c levels do not adequately capture risk-limiting utility as a triage tool in this cohort. Copyright © 2017 by the Endocrine Society

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

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

1976-01-01

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

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

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

2018-03-31

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

Gestational Trophoblastic Disease -Choriocarcinoma

International Nuclear Information System (INIS)

Bozik, M.

2011-01-01

Gestational trophoblastic tumors are a group of a diseases from the benign hydatidiform mole, through the invasive mole to the highly malignant form of a choriocarcinoma. Choriocarcinoma is a rare tumor and it is the most malignant and aggressive neoplasm of all the gestational trophoblastic diseases. It grows rapidly and metastasizes to the lung, liver, and, less frequently, to the brain. The author presents the case of a 26-year-old woman who is indicated to the CT examination for suspected brain tumor based on the previous examinations. The patient was diagnosed with metastatic choriocarcinoma to the brain, kidney and adrenal gland on the basis of an anamnesis by her husband, a high value of beta-hCG and a gynecological examination. (author)

Maternal pre-pregnancy body mass index, gestational weight gain influence birth weight.

Science.gov (United States)

Zhao, R; Xu, L; Wu, M L; Huang, S H; Cao, X J

2018-02-01

Evidence suggests that pre-pregnancy body mass index and gestational weight gain have impact on pregnancy and birth weight, yet whether maternal gestational weight gain has a differential effect on the rates of adverse birth weight among women with different pre-pregnancy body mass index categories are unknown. We selected 1617 children matched with their mothers as study subjects. The subjects were divided into three categories: weight gain below the American Institute of Medicine guidelines, weight gain within the American Institute of Medicine guidelines and weight gain above the American Institute of Medicine guidelines. The prevalence of pre-pregnancy underweight and overweight/obese women was 16.3% and 12.3%. And nearly 15.2% of the women had gestational weight gain below American Institute of Medicine guideline, 52.1% of the women had gestational weight gain above American Institute of Medicine guideline. Maternal overweight and obese was associated with increased risk for macrosomia and large-for-gestational age. Women had gestational weight gain below American Institute of Medicine guideline were more likely to have low birth weight and small-for-gestational age than women who had gestational weight gain within American Institute of Medicine guideline. Furthermore, the risks for macrosomia and large-for-gestational age were increased in women with above American Institute of Medicine guideline. And for women with a normal weight before pregnancy, gestational weight gain above the American Institute of Medicine guidelines were associated with higher rates of macrosomia and large-for-gestational age, compared with the women of similar pre-pregnancy weight category but with gestational weight gain within the American Institute of Medicine guidelines. Women with abnormal pre-pregnancy body mass index and gestational weight gain are at risk for adverse birth weight outcomes. Moreover, gestational weight gain has a differential effect on the rates of adverse

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

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Sakari Lemola

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

Maternal dietary glycaemic load during pregnancy and gestational weight gain, birth weight and postpartum weight retention: a study within the Danish National Birth Cohort

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Knudsen, Vibeke Kildegaard; Heitmann, Berit L.; Halldorsson, Thorhallur I.

2013-01-01

-for-gestational age (LGA) or small-for-gestational age and postpartum weight retention (PPWR). Data were derived from the Danish National Birth Cohort (1996–2002), including data on gestational and lifestyle factors in pregnancy and 18 months postpartum. Dietary data were collected using a validated FFQ. Information...

Resuscitation of neonates at 23 weeks' gestational age: a cost-effectiveness analysis.

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Partridge, J Colin; Robertson, Kathryn R; Rogers, Elizabeth E; Landman, Geri Ottaviano; Allen, Allison J; Caughey, Aaron B

2015-01-01

Resuscitation of infants at 23 weeks' gestation remains controversial; clinical practices vary. We sought to investigate the cost effectiveness of resuscitation of infants born 23 0/7-23 6/7 weeks' gestation. Decision-analytic modeling comparing universal and selective resuscitation to non-resuscitation for 5176 live births at 23 weeks in a theoretic U.S. cohort. Estimates of death (77%) and disability (64-86%) were taken from the literature. Maternal and combined maternal-neonatal utilities were applied to discounted life expectancy to generate QALYs. Incremental cost-effectiveness ratios were calculated, discounting costs and QALYs. Main outcomes included number of survivors, their outcome status and incremental cost-effectiveness ratios for the three strategies. A cost-effectiveness threshold of $100 000/QALY was utilized. Universal resuscitation would save 1059 infants: 138 severely disabled, 413 moderately impaired and 508 without significant sequelae. Selective resuscitation would save 717 infants: 93 severely disabled, 279 moderately impaired and 343 without significant sequelae. For mothers, non-resuscitation is less expensive ($19.9 million) and more effective (127 844 mQALYs) than universal resuscitation ($1.2 billion; 126 574 mQALYs) or selective resuscitation ($845 million; 125 966 mQALYs). For neonates, both universal and selective resuscitation were cost-effective, resulting in 22 256 and 15 134 nQALYS, respectively, versus 247 nQALYs for non-resuscitation. In sensitivity analyses, universal resuscitation was cost-effective from a maternal perspective only at utilities for neonatal death permissive response to parental requests for aggressive intervention at 23 weeks' gestation.

Risk factors for gestational diabetes mellitus in Sudanese pregnant ...

African Journals Online (AJOL)

McRoy

Key words: Diabetes mellitus, gestation, risk factors, Sudan. INTRODUCTION. Gestational diabetes mellitus (GDM) is a universal risk factor for maternal and neonatal morbidity and mortality.[1] Low gestational age, neonatal macrosomia, hypoglycemia, respiratory distress syndrome are frequent complications of GDM and ...

The incidence of meconium-stained amniotic fluid from 1980 through 1986, by year and gestational age.

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Dysart, M; Graves, B W; Sharp, E S; Cotsonis, G

1991-09-01

The annual incidence of meconium-stained amniotic fluid was analyzed for changes in a total obstetric sample of 45,115 singleton, vertex, liveborn infants over a 7-year study period. The incidence of meconium-stained amniotic fluid for the total obstetric population was calculated for each year of the study period. The sample was then stratified by estimated gestational age, and the incidence of meconium-stained amniotic fluid was calculated for each gestational age group. The incidence of meconium-stained amniotic fluid increased 40.9% over the study period, from 18.8% in 1980 to 26.5% in 1986 (P less than .001). This increase was found to be in a consistent linear trend (P less than .05). The incidence of meconium-stained amniotic fluid was also found to increase significantly in a linear trend as gestational age of the fetus increased. These findings lend support to both the maturational theory and the stress theory of meconium passage in utero.

Individual exposures to drinking water trihalomethanes, low birth weight and small for gestational age risk: a prospective Kaunas cohort study

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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

Growth hormone therapy for children born small for gestational age: height gain is less dose dependent over the long term than over the short term.

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de Zegher, Francis; Hokken-Koelega, Anita

2005-04-01

Approximately 3% of children are born small for gestational age (SGA), and approximately 10% of SGA children maintain a small body size throughout childhood and often into adult life. Among short SGA children, growth hormone (GH) therapy increases short-term growth in a dose-dependent manner; experience with long-term therapy is limited. To delineate the dose dependency of long-term height gain among short SGA children receiving GH therapy. We performed an epianalysis of the first adult height data for SGA children (n = 28) enrolled in 3 randomized trials comparing the growth-promoting efficacy of 2 continuous GH regimens (33 or 67 microg/kg per day for approximately 10 years, starting at approximately 5 years of age); in addition, we performed a meta-analysis of the adult height results published previously and those presented here. Epianalysis outcomes (n = 28) suggested that adult height increased more with a higher-dose regimen than with a lower-dose regimen. In the meta-analysis (n = 82), the higher-dose regimen was found to elicit a long-term height gain superior to that achieved with the lower-dose regimen by a mean of 0.4 SD (approximately 1 inch). Children who were shorter at the start of therapy experienced more long-term height gain. These findings confirm GH therapy as an effective and safe approach to reduce the adult height deficit that short SGA children otherwise face. In addition, the first meta-analysis indicated that height gain is less dose dependent over the long term than over the short term, at least within the dose range explored to date. For SGA children whose stature is not extremely short, current data support the use of a GH dose of approximately 33 microg/kg per day from start to adult height, particularly if treatment starts at a young age; shorter children (for example, height below -3 SD) might benefit from an approach in which short-term catch-up growth is achieved with a higher dose (> or =50 microg/kg per day) and long-term growth

Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

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Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

2010-01-01

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy. PMID:20811612

Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

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Pedro Figueiredo

2010-01-01

Full Text Available Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD. Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%. The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

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Jørgensen, Rasmus Wejnold; Dippmann, Christian; Dahl, L

2016-01-01

BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option...... associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg's lateral center-edge angle (CE-angle) together with Leqeusne's acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis...... for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment...