Placental ratio and anemia in third-trimester pregnancy

OBJECTIVE: To perform a prospective, observational study in a tertiary center to determine whether anemia (hemoglobin level < 10 g/dL) developing in the third trimester was associated with an increased placental weight/birth weight ratio (placental ratio) and whether the placental ratio correlated with the hemoglobin level at different periods and with other factors, such as gestational age and parity. STUDY DESIGN: A total of 476 nonanemic women with low-risk singleton pregnancies were recruited at their 28-30-week antenatal visit over a three-month period. Excluded from the final analysis were 20 women who delivered elsewhere and 19 found to be carriers of thalassemia traits due to their low mean cell volume. All women received standard obstetric care, and ferrous sulphate was prescribed for those who developed anemia. RESULTS: Anemia developed in 45 (10.3%) of the remaining 437 women. This group had significantly decreased red cell indices, gestational age (38.3 +/- 2.0 vs. 39.2 +/- 1.3 weeks, P = .004) and birth weight (3,082 +/- 416 vs. 3,220 +/- 411 g, P = .035) but no difference in placental weight (609 +/- 102 vs. 594 +/- 108 g), so the placental ratio was increased as compared with that in the control group (0.196 +/- 0.026 vs. 0.185 +/- 0.026, P = .002). Multiple regression analysis confirmed that the placental ratio correlated only with the last hemoglobin level (P = .041). CONCLUSION: Our results indicate that placental size increased relative to infant size in pregnancies complicated by anemia, but whether this phenomenon reflected actual placental hypertrophy or failure of fetal growth to keep up with placental growth remains to be determined.     

Placental maternal vascular malperfusion and adverse pregnancy outcomes in gestational diabetes mellitus

IntroductionMaternal vascular malperfusion (MVM) lesions represent hypoxic-ischemic damage to the placenta, and they are associated with adverse pregnancy outcomes. Women with gestational diabetes (GDM) are at increased risk for pregnancy complications, so we set out to characterize the prevalence and clinical correlates of MVM lesions in this cohort.MethodsThis was a retrospective cohort study of 1187/1374 (86.4%) women with GDM delivered between 2009 and 2012 who had placental pathology available. Placental lesions of all types were tabulated and grouped into constructs of related entities. MVM lesions specifically included villous infarcts, decidual vasculopathy, increased syncytial knots, perivillous fibrin, and fibrin deposition. We compared maternal characteristics between women with and without MVM lesions, and we also assessed the impact of these lesions on birth weight, preterm birth, and pre-eclampsia using multivariable logistic regression analysis.ResultsMVM lesions were the most common placental lesion type in women with GDM (n = 362, 30.5%). Excess gestational weight gain was independently associated with MVM lesions (aOR 1.42, 95% CI 1.06–1.91, p = 0.02) after adjusting for maternal characteristics. MVM lesions were associated with lower birth weight (−90.3 g, 95% CI -148.0 to −32.7, p = 0.002), as well as a 2-fold increased risk for delivery of a small for gestational age infant (10.8 vs 5.9%, p = 0.01) in overweight and obese women. MVM lesions were also associated with increased risk for preterm birth <34 weeks (adjusted OR 2.36, 95% CI 1.31–4.23, p = 0.004) and hypertensive disorders of pregnancy (HDP; adjusted OR 1.58, 95% CI 1.13–2.22, p = 0.02).DiscussionPlacental maternal vascular malperfusion lesions may be one pathway linking excess gestational weight gain to adverse pregnancy outcomes in women with GDM, and future studies are needed to identify metabolic factors that may explain this association.     

Placental concentrations of bisphenol A and birth weight from births in the Southeastern U.S.

IntroductionBisphenol A (BPA) is a weakly estrogenic compound that has been detected in a wide variety of food products and biological matrices (saliva, blood, urine, etc). Despite the potential risk of human exposure to BPA, little information exists concerning maternal and fetal exposure to BPA during pregnancy. The aim of this study is to evaluate the correlation between placental BPA concentration, infant birth weight and calculated birth weight centile, and several other maternal and infant parameters.MethodsPlacental sample were collected from 200 subjects. BPA levels were measured by isotope dilution GC–MS. Additional maternal and infant data were gathered from medical charts and were potential correlates with placental BPA levels.ResultsPlacental BPA concentrations ranged from 4.4 ng/g to 273.9 ng/g in oven-dried tissue (average 103.4 ± 61.8 ng/g). There was a significant negative correlation between calculated birth weight centile and levels of placental BPA (p < 0.05). Low birth weight and small for gestational age infants also had significantly greater placental BPA concentrations as compared to normal weight infants and average/large for gestational age infants. Infants born to African American mothers also had greater placental BPA concentrations as compared to infants born to Hispanic mothers.DiscussionPlacental BPA concentrations are correlated with the growth potential of the fetus and may play a role in reduced fetal growth.     

Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries

Our objective was to evaluate the utility of gray-scale placental ultrasound for the detection of pathological lesions in the placentas of preterm pregnancies with abnormal fetoplacental blood flow (defined by absent or reversed end-diastolic flow velocities [ARED] in the umbilical arteries) before 32 weeks of gestation. Sixty consecutive structurally and chromosomally normal singleton pregnancies were evaluated. Pre-defined criteria were used to describe placental appearances using gray-scale real-time ultrasound. Proximal uterine artery Doppler waveforms were recorded using pulsed and color Doppler ultrasound. Each patient had a thrombophilia profile. Following delivery, a single perinatal pathologist reviewed each placenta at a gross and microscopic level blinded to the placental ultrasound findings. Placental shape or texture was abnormal on gray-scale ultrasound in 43/59 (73%) and echogenic cystic lesions (ECL) were found in 16 (27%). Uterine artery Doppler was abnormal in 47/60 (78%) cases. Thirty-eight pregnancies were subsequently delivered by planned Caesarean section in the fetal and/or maternal interest (birthweights 540-2300 g, mean gestational age 30.6 weeks) and 21 pregnancies resulted in the vaginal delivery of a stillborn fetus where fetal weight and/or gestational age did not justify Caesarean section (birthweights 85-600 g, mean gestational age 24.9 weeks). ECL had a low positive predictive value for both villous infarcts (63%) and for focal/massive perivillous fibrin deposition (40%). Nevertheless, the combination of abnormal uterine artery Doppler and abnormal gray-scale findings (abnormal placental morphology or ECL) was strongly predictive of stillbirth (17/21; sensitivity 81%, PPV 52%, p = 0.006 Fisher's exact test). Pregnancies with ARED in the umbilical arteries have a high perinatal mortality associated with pathology of the placental villi. Ultrasound examination of the placenta and its maternal blood supply may contribute to the perinatal management of these pregnancies.     

The association of birthweight with maternal and cord serum and amniotic fluid growth hormone and insulin levels, and with neonatal and maternal factors in pregnant women who delivered at term

AIM: To investigate the influence of maternal and cord serum and amniotic fluid growth hormone (GH) and insulin and other neonatal and maternal factors on birthweight. METHODS: A total of 160 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 50), large for gestational age (LGA) (n = 50) or average for gestational age (AGA) (n = 60). GH and insulin levels were measured in maternal and cord serum and amniotic fluid at birth. RESULTS: GH levels in maternal and cord serum and amniotic fluid showed no differences among the three weight groups (P > 0.05). The cord insulin level was significantly lower in SGA (P < 0.01). The insulin level in venous cord blood correlated with birth and placental weights and neonatal height, whereas maternal serum and amniotic fluid insulin levels, and maternal and cord serum and amniotic fluid GH levels did not show any correlation with birthweight. The cord GH level at birth was correlated with GH levels after 4 postnatal weeks in the SGA group (P < 0.01). In addition, birthweight showed a correlation with prepartum maternal weight, maternal weight gain, maternal height, neonatal length and placental weight in all three weight groups. CONCLUSIONS: Cord GH, maternal serum and amniotic fluid GH and insulin levels did not correlate with birthweight in all three weight groups. The lack of correlation for GH levels in maternal and cord serum and amniotic fluid suggests that these compartments may be non-communicating separate units.     

Maternal characteristics and lifestyle factors and the risk of delivering high birth weight infants

OBJECTIVE: To identify factors associated with an increased risk of giving birth to infants weighing more than 4000 g and to study whether changes in these factors over time can explain the increasing proportion of high birth weight infants over the last decade. METHODS: Our analyses included 24,093 pregnancies of nondiabetic women with information on potential risk factors for high birth weight: maternal prepregnancy weight, height, age, parity, smoking habits, alcohol and caffeine intake, marital status, educational level, gestational age, and infant gender. Information was obtained from questionnaires completed during pregnancy and birth registration forms at the Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark, from 1990 to 1999. RESULTS: We found a statistically significantly increased risk of giving birth to infants weighing more than 4000 g for women with high prepregnancy weight and height, parity greater than 2, gestational age greater than 42 weeks, and male infant gender and for nonsmokers. Women with a low caffeine intake or 10 or more years of education were also at statistically significantly higher risk. The variation found in birth weight over the past 10-year period was explained by changes in maternal prepregnancy weight, height, smoking habits, educational level, and caffeine intake over the same period. CONCLUSION: Risk factors associated with a higher proportion of high birth weight infants may be clinically significant and have an impact on public health. High birth weight increases the risk of adverse outcomes of delivery as well as the risk of childhood morbidity.     

Implications of a high placental ratio in pregnancies with appropriate-for-gestational age neonates

OBJECTIVE: To determine the relationship between the placental weight to birth weight ratio (placental ratio) with maternal pre-pregnancy weight, gestational weight gain, and neonatal outcome in non-diabetic pregnancies resulting in appropriate-for-gestational age (AGA) infants. METHODS: A retrospective study was performed on 593 patients with singleton pregnancies, normal results in the 75-gram oral glucose tolerance test and who delivered AGA newborns within a 1-year period. The patients were categorized into high placental ratio (> mean +1 SD based on previous data, n = 113 or 19.1%) and normal ratio groups for the comparison of maternal and neonatal anthropometric parameters. RESULTS: The high placental ratio group had a higher pre-pregnancy weight, body mass index, placental weight, and incidence of low Apgar score, but decreased absolute and percentage gestational weight gain, gestational age, and birth weight. After controlling for pre-pregnancy weight and gestational age, only the correlation between placental weight and percent weight gain remained significant. CONCLUSION: Our finding suggests that a high placental ratio can identify AGA newborns who are disproportionately small relative to maternal size, and may reflect some form of fetal growth impairment.     

The relationship of maternal erythrocyte oxygen transport parameters to intrauterine growth retardation

The relation of fetal growth and maternal oxygen transport as assessed by red blood cell 2,3-diphosphoglycerate, hemoglobin oxygen affinity, hemoglobin, pH, and PCO2 was evaluated in 21 pregnant women. The study was performed in the third trimester and each subject evaluated had sonographic evidence of fetal growth retardation without other obvious abnormalities. Decreased maternal 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity were related linearly to the birth weight normalized for the expected sea level values of gestational age expressed as a birth weight (gestational age-normalized) Z score. The correlation coefficients and p values were r = 0.71, p less than 0.001 and r = 0.67, p less than 0.001, respectively. The ponderal index-normalized Z score correlated with the 2,3-diphosphoglycerate/hemoglobin molar ratio (r = 0.46, p less than 0.04), but the relation was not as strong as the birth weight-normalized Z score. The crown-heel length/head circumference ratio did not correlate with the 2,3-diphosphoglycerate/hemoglobin molar ratio (r = 0.29, NS). The birth weight (gestational age)-normalized Z score did not correlate with hemoglobin, PCO2, or pH. In the regulation of hemoglobin oxygen affinity, calculations indicated that the 2,3-diphosphoglycerate/hemoglobin molar ratio played a highly significant role (p less than 0.001), pH was minimally significant (p less than 0.025), but PCO2 had little or no significant effects in this study. It appears that fetal growth is related to the maternal red blood cell oxygen transport parameters 2,3-diphosphoglycerate/hemoglobin molar ratio and hemoglobin oxygen affinity. Moreover, the 2,3-diphosphoglycerate/hemoglobin molar ratio is the principal regulator of hemoglobin oxygen affinity.     

Distribution and potential significance of intravillous and intrafibrinous particulate microcalcification

Radiologic studies indicate that placental calcifications seen at 28–32 weeks' gestation are associated with adverse fetal outcome. One type of placental calcification is typically located at the basement membrane of chorionic villi. It has a fine particulate appearance and can only be seen microscopically. We have designated these calcifications as Intravillous and Intrafibrinous Particulate MicroCalcification (IPMC). In this study we examined the distribution and potential significance of IPMC. Placentas from 14 groups of fetal and maternal outcomes are examined histologically for IPMC. These groups were preterm birth, post term birth, intrauterine fetal demise, fetuses with non-reassuring heart rates, intrauterine growth restriction, fetal anomalies, mothers with gestational hypertension, gestational diabetes, placental abruption, pre-eclampsia and placentas of normal spontaneous vaginal births and placentas with chorioamnionitis, chronic villitis and infarcts. We observed fine dust-like particulates deposited in continuous and discrete patches. The particulates were predominantly located in the basement membranes of fibrotic chorionic villi and in perivillous fibrin. Compared to placentas without adverse outcomes, a higher incidence of IPMC was seen in intrauterine fetal demise cases and in cases with infarcts which suggests that hypoxia played a role in the etiology of IPMC.     

Pathologic features of placentas from singleton pregnancies obtained by in vitro fertilization and embryo transfer

Fifty placentas were collected at term from singleton pregnancies resulting from in vitro fertilization (IVF) and intrauterine embryo transfer. Their pathologic features were compared with those of a control group composed of 50 placentas obtained from spontaneous singleton pregnancies. The mean maternal age, mean gestational age, mean fetal weight, sex ratio, and rate of pregnancy complications did not differ. There was also no significant difference between the groups in the mean placental weight and in the incidence of placental pathologic lesions, including extended infarcts, massive perivillous fibrin depositions, chorioangiomas, and placental inflammatory lesions. The incidence of abnormal placental shapes was significantly (P less than .05) greater in the IVF group (22%) compared with the control group (6%). A significant (P less than .025) difference was observed between the groups in the distribution of umbilical cord insertions. The mean distance between the cord insertion and the closest placental margin was significantly (P less than .005) shorter in the group conceived by IVF (3.23 +/- 1.91 cm) than in the control group (4.54 +/- 2.42 cm). A relationship between these placental morphologic features and the superficial implantation and/or inadequate orientation of the blastocyst after IVF and intrauterine embryo transfer is proposed.     

妊娠期高浓度血红蛋白对妊娠结局的影响

妊娠期母体血液系统发生一系列生理变化以适应胎儿生长发育,血液总容量增加并有一定程度的血液稀释。如果妊娠期血液不能有效稀释,血红蛋白浓度过高,会引起血液黏度增加,全身血液循环不能适应子宫-胎盘血流的需要。其结果可能导致子宫-胎盘血流量减少、减慢,而引起子宫胎盘缺血缺氧、血管痉挛、血压升高等,而发生妊娠期高血压疾病、小于胎龄儿、早产、低出生体质量、妊娠期糖尿病、死产等。综述妊娠期高浓度血红蛋白对不良妊娠结局的影响, 以引起对妊娠期高浓度血红蛋白的重视。     

Maternal hemoglobin F levels may have an adverse effect on neonatal birth weight in pregnancies with sickle cell disease

A total of 26 patients with sickle cell disease were followed up through 32 pregnancies. There was no correlation between days in hospital or number of painful crises and either birth weight or birth weight percentile. The number of dense irreversibly sickled and least deformable cells was negatively correlated with birth weight percentile (r = -0.63, p less than 0.01). Patients' initial hemoglobin levels were positively correlated with birth weight percentile (r = 0.52, p less than 0.004). Hemoglobin F, on the other hand, was significantly inversely correlated with birth weight percentile. Nine pregnancies with small-for-gestational-age infants had an average hemoglobin level of 9.1% +/- 4.5%. In contrast, patients who were delivered of appropriate-for-gestational-age infants (23 pregnancies) had an average hemoglobin F level of 3.6% +/- 2.9% (p less than 0.01). We conclude that total hemoglobin levels and dense cells are correlated with birth weight percentile; moreover, the higher the maternal hemoglobin F levels the higher the risk of small-for-gestational-age infants. We speculate that although high hemoglobin levels may be beneficial to the fetus, high maternal hemoglobin F levels could increase the desaturation of non-F cells and induce placental obstruction.     

The "pregnancy zone" protein and fetal welfare

The frequency of women with demonstrable "pregnancy zone" protein (assumed to be a steroid-induced alpha-2-globulin) at term of pregnancy was determined in order to investigate whether lack of this protein in maternal serum was in any way related to maternal age, parity, abortion history, or some factors reflecting fetal maturity (birth weight, placental weight, and gestational age). 311 (88.9%) out of 350 pregnant women demonstrated "pregnancy zone" protein in their sera. Birth weight was significantly lower (p less than .05) among infants of women lacking this protein. No apparent correlation was found between lack of "pregnancy zone" protein in maternal serum and maternal age, parity, previous abortion, placental age, or gestational age. The results indicated that lack of or low levels of this protein in the maternal circulation at term is a phenomenon compatible with normal pregnancy, although some slight effect on fetal development cannot be excluded.     

Maternal serum ferritin as a clinical tool at 34–36 weeks’ gestation for distinguishing subgroups of fetal growth restriction

Objective: To compare maternal ferritin levels across pregnancies with fetal growth restriction including SGA and IUGR compared to appropriate for gestational age (AGA). Methods: Three groups were enrolled: AGA, SGA (birth weight below 10th percentile for gestational age with no placental insufficiency findings), and IUGR (birth weight below 5th percentile for gestational age accompanied by abnormal umbilical artery Doppler waveforms and/or oligohydramnios). Maternal serum ferritin samples were obtained at gestational weeks 34 through 36, and delivery occurred at or beyond 36 weeks. Results: A total of 126 pregnancies with AGA (36%), SGA (40%), and IUGR (24%) were enrolled. The mean maternal serum ferritin level was higher in the IUGR group than in the AGA group (59?μg/l versus 32.5?μg/l, p?Conclusion: Maternal serum ferritin levels differ in pregnancies with IUGR. The role of maternal serum ferritin measurements as a clinical tool for distinguishing different forms of fetal growth restriction warrants further investigation.     

Early neonatal hypoglycemia: incidence of and risk factors. A cohort study using universal point of care screening

Objective: The objective of this study is to determine the true incidence of early neonatal hypoglycemia and to confirm potential risk factors.

Study design: The study was conducted at tertiary Medical Center in Israel, between June and September 2014. First blood glucose concentrations of all infants admitted to the nursery were measured using a “point of care” analyzer (Accu-Chek). We recorded risk factors for hypoglycemia such as birth weight, gestational age, maternal diabetes and demographics and analyzed their association with two hypoglycemia cutoffs: 40 and 47?mg/dl.

Results: Of 4000 newborns admitted during that period, 3595 were analyzed after excluding 405 who had missing data. Glucose level was obtained at a mean age of 74?±?30?min. One hundred and twenty-four newborns (3.4%) had blood glucose levels below 40?mg/dl and 435 (12.1%) below 47?mg/dl. Univariate analyses revealed that gestational age, maternal diabetes, low birth weight (<2500?g), and twin delivery were associated with early neonatal hypoglycemia. Other risk factors (e.g. large or small for gestational age, birth weight >3800?g) were not. In multivariate analysis, gestational age remained the strongest association, while maternal diabetes and low birth weight became non-significant.

Conclusions: We showed a high occurrence of early hypoglycemia in normal newborns using universal screening. The strongest risk factor was early gestational age. Surprisingly, incidence of early hypoglycemia in the presence of other classical risk factors was like that of the general population.     

Maternal age and incidence of low birth weight at term: a population study

A total of 184,567 singleton live births with gestational ages of 40 weeks were examined from the 1980-1984 Illinois birth certificate data to determine the independent effect of maternal age on the incidence of low birth weight at term. The incidence is highest in mothers less than 17 years of age (3.2%) and gradually declines with advancing maternal age to reach 1.3% in women aged 25 to 34 years. It increases to 1.7% for those greater than 35 years of age. To separate out the independent effect of maternal age on the incidence of low birth weight infants at term, the presence of other maternal factors, such as race, education, parity, marital status, and prenatal care, were adjusted by use of a series of multiple logistic regression analyses. All of these analyses consistently demonstrated that the adjusted risk for low birth weight at term is the lowest in teenagers and increases with advancing maternal age. These results indicate that the high incidence of this factor in young mothers apparently reflects their poor sociodemographic and prenatal care status. Advancing maternal age is associated with a decreased potential for fetal growth, possibly reflecting biologic aging of maternal tissues and systems or the cumulative effects of disease.     

Hemoglobin, altitude and birth weight: does maternal anemia during pregnancy influence fetal growth?

OBJECTIVE: To investigate the relationship between maternal hemoglobin concentration, altitude and birth weight. STUDY DESIGN: Birth weights in 235 term pregnancies were investigated for their dependence on maternal hemoglobin concentration after other maternal and pregnancy-specific influences on fetal weight were taken into account. The additional predictive value of hemoglobin concentration on birth weight was assessed using multiple regression. Using published data, the relationship of hemoglobin concentration to altitude was determined, as was the effect of increasing altitude on birth weight. The quantitative effect of hemoglobin concentration on birth weight was correlated with the effect of altitude on hemoglobin concentration to assess whether this could account for the known decrease in birth weight with increasing altitude. RESULTS: Birth weights ranged from 2,220 to 4,850 g (mean, 3,505+/-443), and hemoglobin concentrations ranged from 9.3 to 13.5 g/dL (mean, 11.6+/-0.8). Apart from other known predictive variables, the variation in maternal hemoglobin concentrations at constant altitude independently explained 2.6% of the variance in birth weight (r=-.18, P=.003). Term birth weight was reduced by 89 g for each 1.0 g/dL increase in hemoglobin concentration (P<.01). For every 1,000-m increase in altitude, hemoglobin concentration increased by 1.52 g/dL and birth weight decreased by 117 g. CONCLUSION: Birth weight correlates negatively with maternal hemoglobin concentration. This is consistent with the well-known effect of high-altitude exposure during pregnancy, which increases both hematocrit and blood viscosity and lowers birth weight. The quantitative effect on birth weight of increasing maternal hemoglobin concentration at constant altitude is within 13% of the change in birth weight that can be attributed to the change in hemoglobin concentration associated with increases in altitude.     

妊娠期高浓度血红蛋白对妊娠结局的影响

妊娠期母体血液系统发生一系列生理变化以适应胎儿生长发育,血液总容量增加并有一定程度的血液稀释。如果妊娠期血液不能有效稀释,血红蛋白浓度过高,会引起血液黏度增加,全身血液循环不能适应子宫-胎盘血流的需要。其结果可能导致子宫-胎盘血流量减少、减慢,而引起子宫胎盘缺血缺氧、血管痉挛、血压升高等,而发生妊娠期高血压疾病、小于胎龄儿、早产、低出生体质量、妊娠期糖尿病、死产等。综述妊娠期高浓度血红蛋白对不良妊娠结局的影响,以引起对妊娠期高浓度血红蛋白的重视。     

Perinatal morbidity and placental size in gestational impaired glucose tolerance.

OBJECTIVE: The clinical significance of large placentas in diabetic pregnancies is not known. A retrospective study was performed to determine whether a disproportionately large placenta, as represented by a high ratio of placental weight to birth weight (placental ratio), in pregnancies complicated by the World Health Organization category of impaired glucose tolerance (IGT), was associated with perinatal morbidity. METHODS: We categorized 1472 consecutive singleton pregnancies with gestational IGT as having a high placental ratio (> 0.2095 or mean plus one standard deviation of the value established for appropriate-for-gestational age infants from nondiabetic pregnancies in a previous study) or a normal ratio. Maternal characteristics and glycemic parameters, infant birth weight and neonatal complications, and placental weight were compared between these two groups. RESULTS: A high placental ratio was found in 400 (27.2%) pregnancies. This group had similar maternal anthropometric and glycemic parameters, except for a slightly higher prepregnancy body mass index and fasting glucose level in the oral glucose tolerance test. The high placental ratio was from increased placental weight rather than the decreased birth weight. The neonates had increased incidence of low 1-minute Apgar score, treatment for neonatal jaundice and infection, and respiratory complications. After adjusting for the effects of preterm birth and vaginal delivery, a high ratio was still associated with low Apgar score, respiratory complications, and treatment for infection. CONCLUSIONS: The placental ratio in pregnancies complicated by IGT was unrelated to maternal characteristics or glycemic status, but a high ratio was associated with increased perinatal morbidity.     

Review: Is rapid fat accumulation in early life associated with adverse later health outcomes?

This review discusses ways in which the maternal environment and placental function affect the birth weight and adult health outcomes of offspring. These maternal and placental factors have varying and sometimes opposing effects on birth weight, resulting in infants that are born small for gestational age (SGA), large for gestational age (LGA) or preterm. However, all these alterations in weight have similar effects on adult health, increasing the risk of obesity and its associated cardiovascular and metabolic disorders. While birth weight has been used as a marker for risk of adverse adult health, we propose that a common feature of all these scenarios – early accumulation of excess body fat – may be a better marker than birth weight alone. Furthermore, altered neonatal fat accumulation may be more closely related to the mechanism by which maternal environment and placental adaptation mediate effects on adult health. We suggest that more research should be focussed on early fat accretion, factors that promote fat accretion and if it can be avoided, and whether it would be beneficial to try to reduce fat accumulation in early life.