The effect of umbilical venous constriction on placental development, cord length and perinatal outcome

BACKGROUND: Umbilical vein constriction at the fetal abdominal inlet is a common finding after week 13, when the period of umbilical herniation is brought to an end. AIMS: To test the hypothesis that a constricting umbilical ring within physiological ranges affects fetal hemodynamics by either pooling blood in the placenta or restricting nutrient transfer to the fetus and thus shift the birthweight/placental weight (BW/PW) ratio. A constriction could also cause pressure changes and elongation of the cord and possibly be a disadvantage during labour. STUDY DESIGN: Cross-sectional. SUBJECTS: 359 Low-risk singleton pregnancies at 13-40 weeks of gestation. OUTCOME MEASURES: Standard deviation score (z-score) and regression analysis were used to determine the effect of umbilical vein constriction (expressed by increased blood velocity) on birthweight/placental weight ratio (BW/PW), cord length, Apgar score and emergency delivery due to fetal distress. RESULTS: Umbilical venous constriction had a mild but significant effect on BW/PW in male (p=0.018) but not in female fetuses. Increased constriction was also associated with increased length of the cord but only in female fetuses (p=0.019). Cord length was positively related to birthweight and placental weight, but an increased length of the cord was also associated with decreasing BW/PW ratio for the male fetuses only (p=0.044). Increasing degree of venous constriction was associated with Apgar score < or =7 at 1 (p=0.009) but not at 5 min after birth and was not associated with emergency delivery. CONCLUSION: Physiological umbilical venous constriction exerts a mild but significant gender-specific hemodynamic impact on intrauterine development.     

Congenital malaria in neonates: two case reports and review of the literature

Congenital malaria is uncommon in nonendemic countries. We describe two cases involving neonates hospitalized with fever, anaemia and thrombocytopaenia. Thick and thin blood smears were positive for Plasmodium vivax (P. vivax) and P. ovale, respectively. These two cases were discussed regarding the literature and potential implications of HIV coinfection in the mother. CONCLUSION: Consistent data in the literature suggest that peripheral blood films should be performed in HIV-positive women who travelled to an endemic area or with a history of malaria prior to gestation. With today's travelling patterns, congenital malaria should be considered as an important differential diagnosis of neonatal sepsis.     

1996至2010年北京市活产新生儿出生体重变化趋势及其影响因素

目的 描述1996至2010年北京市新生儿出生体重变化趋势,并分析其影响因素。方法 采用病例回顾分析方法,选取北京妇产医院和北京市海淀区妇幼保健院1996、1997、1998、1999、2000、2005、2010出生的活产新生儿63 661例,描述1996至2010年低出生体重发生率变化趋势。以2010年北京妇产医院出生的活产新生儿11 006例为研究对象分析出生体重的影响因素。结果 1996至2010年,北京市新生儿出生体重变化趋势表现为2000年以前快速递增,2000年以后缓慢递减,2010年新生儿出生体重均值为3 331 g,高于2005年全国九城市儿童体格发育调查城市出生体重水平。多元回归分析显示,新生儿出生体重与产妇年龄、文化程度、孕前BMI、孕期增重、胎数、孕次、产次、早产、羊水量、新生儿性别、妊娠糖尿病和妊娠高血压均有相关性。结论 北京市新生儿出生体重变化趋势表现为2000年前快速递增,2000年后缓慢递减。应加强孕前保持正常BMI范围、控制孕期增重、避免早产、预防妊娠糖尿病和妊娠高血压的科普宣传教育。     

The relationships between maternal HbA1, maternal size and fetoplacental size in indian pregnancies

A study of pregnant Punjabi, Indian women was carried out to establish whether or not there was a relationship between maternal HbA₁ at term and birth weight of the baby.Measurements were made on the mother, placenta and baby. The regression of birth weight on placenta weight gave a correlation (r = 0.7, P < 0.01, n = 59). No correlation was found between HbA₁, and birth weight, birth weight corrected for placenta weight, or placenta weight. However, there was a weak but significant correlation between HbA₁, and an adjusted placenta weight, expressed as a ratio Bwt′/Plwt′, (r = 0.27, P < 0.05, n = 56).     

孕母患自身免疫性甲状腺疾病对新生儿出生体重及甲状腺功能的影响

目的　探讨孕母患自身免疫性甲状腺疾病对新生儿出生体重及甲状腺功能的影响。方法　通过浙江省新生儿疾病筛查网络系统 ,自 1999年 8月至 2 0 0 2年 6月对 12 2例母亲患有自身免疫性甲状腺疾病的新生儿出生体重、甲状腺功能进行追踪观察。结果　 (1)格雷夫斯病母亲的新生儿出生体重为 (32 2 4 4± 330 2 )g ,明显低于健康母亲及慢性淋巴细胞性甲状腺炎母亲的新生儿 ;(2 ) 12 2例新生儿中 ,甲状腺功能正常 97例 ,暂时性促甲状腺激素 (TSH)升高 2 1例 ,先天性甲状腺功能减低症 3例 ,甲状腺功能亢进症 1例 ,与同期健康母亲的新生儿相比有显著差异 (P <0 0 1) ,且 4例甲状腺功能异常的新生儿 ,其母亲妊娠期甲状腺功能均不正常。结论　孕母患自身免疫性甲状腺炎 ,尤为妊娠期甲状腺功能不正常对新生儿出生体重及甲状腺功能影响较大 ,加强对患自身免疫性甲状腺疾病的母亲及其孩子的管理十分重要。     

The effect of genetic and seasonal factors on birth weight

Obesity is a heterogeneous group of disorders that have in common disturbances of energy balance and an increase of fat cells. Genetic and development factors, however, have an important role in making obese or not obese people. Recently there has been a surge of interest on the possible relationship of obesity with birth weight and with season of birth.We have studied the effect of season of conception and ACP1 phenotype (an enzyme associated with obesity disorders) on birth weight in a sample of 809 newborn infants from the Caucasian population of Central Italy.Birth weight of newborn conceived in the period January-April is higher compared to that of subjects conceived in the subsequent period of year. The effects of season of conception on birth weight is enhanced in newborns carrying the heterozygous ACP1BA phenotype. BA infants are also more represented among those conceived in the first months of the year.The observations suggest that environmental and genetic factors favouring reproduction in the early months of the year also favour the birth of well nourished offspring. These infants could have an increased susceptibility to over-weight during adult life in Western populations.     

中国不同出生胎龄新生儿体重身长比、体质指数和重量指数的参照标准及生长曲线

目的:制定中国出生胎龄24~42周新生儿体重身长比、体质指数和重量指数的参照标准及生长曲线,为新生儿出生时身体比例及营养状况评价提供参考依据。方法:横断面研究,于2015年6月至2018年11月在北京、哈尔滨、西安、上海、南京、武汉、广州、福州、昆明等13个城市调查出生胎龄24~42周单胎活产新生儿24375名,排除了影响参照标准建立的母亲和新生儿因素。采用基于位置、尺度、形状的广义可加模型构建出生胎龄24~42周男、女新生儿体重身长比、体质指数和重量指数的百分位数(P 3、P 10、P 25、P 50、P 75、P 90、P 97)参照值及生长曲线。将研制的参照标准与我国1988年数值、INTERGROWTH项目及美国相关参照值进行比较。结果:24375名新生儿中早产儿12264名(男7042名、女5222名),足月儿12111名(男6155名、女5956名)。研制出出生胎龄24~42周男、女新生儿体重身长比、体质指数和重量指数百分位数生长参照值及生长曲线。男新生儿体重身长比在不同出生胎龄P 10、P 50、P 90上比女新生儿高0~0.2 kg/m,男新生儿体质指数在不同出生胎龄P 10、P 50、P 90上比女新生儿高0.1~0.3 kg/m²。体重身长比和体质指数曲线在高百分位数上、重量指数曲线在高、低百分位数上与我国1988年数值均有较大差异,如体重身长比、体质指数、重量指数与我国1988年数值在P 90上的差值范围分别为-1.09~0.40 kg/m、-1.19~0.92 kg/m²、-0.64~0.81 kg/m³。体重身长比曲线与INTERGROWTH项目参照值有较好的一致性,在P 50上的差值范围-0.17~0.20 kg/m,出生胎龄≤32周时在P 90上低0.02~0.40 kg/m、在P 10上高0.13~0.41 kg/m。体质指数曲线与美国参照值差异较为明显,在P 50上的差值范围-0.47~0.17 kg/m²,出生胎龄≥37周时在P 90上低0.53~1.10 kg/m²但≤28周时高0.17~0.45 kg/m²。结论:建立中国出生胎龄24~42周新生儿不同性别的体重身长比、体质指数和重量指数的标准化参照值,可供临床及相关科研工作参照使用。     

Effect of birth weight, maternal education and prenatal smoking on offspring intelligence at school age

To examine the combined effect of birth weight, mothers’ education and prenatal smoking on psychometrically measured intelligence at school age 1,822 children born in 1992-1999 and attending the first six grades from 45 schools representing all of the fifteen Estonian counties with information on birth weight, gestational age and mother's age, marital status, education, parity and smoking in pregnancy, and intelligence tests were studied. The scores of Raven's Standard Progressive Matrices were related to the birth weight: in the normal range of birth weight (≥ 2500 g) every 500 g increase in birth weight was accompanied by around 0.7-point increase in IQ scores. A strong association between birth weight and IQ remained even if gestational age and mother's age, marital status, education, place of residence, parity and smoking during pregnancy have been taken into account. Maternal prenatal smoking was accompanied by a 3.3-point deficit in children's intellectual abilities. Marriage and mother's education had an independent positive correlation with offspring intelligence. We concluded that the statistical effect of birth weight, maternal education and smoking in pregnancy on offspring's IQ scores was remarkable and remained even if other factors have been taken into account.     

Estimating the relative contributions of maternal genetic, paternal genetic and intrauterine factors to offspring birth weight and head circumference

Background

Genetic factors and the prenatal environment contribute to birth weight. However, very few types of study design can disentangle their relative contribution.

Aims

To examine maternal genetic and intrauterine contributions to offspring birth weight and head circumference. To compare the contribution of maternal and paternal genetic effects.

Study design

Mothers and fathers were either genetically related or unrelated to their offspring who had been conceived by in vitro fertilization.

Subjects

423 singleton full term offspring, of whom 262 were conceived via homologous IVF (both parents related), 66 via sperm donation (mother only related) and 95 via egg donation (father only related).

Measures

Maternal weight at antenatal booking, current weight and maternal height. Paternal current weight and height were all predictors. Infant birth weight and head circumference were outcomes.

Results

Genetic relatedness was the main contributing factor between measures of parental weight and offspring birth weight as correlations were only significant when the parent was related to the child. However, there was a contribution of the intrauterine environment to the association between maternal height and both infant birth weight and infant head circumference as these were significant even when mothers were unrelated to their child.

Conclusions

Both maternal and paternal genes made contributions to infant birth weight. Maternal height appeared to index a contribution of the intrauterine environment to infant growth and gestational age. Results suggested a possible biological interaction between the intrauterine environment and maternal inherited characteristics which suppresses the influence of paternal genes.     

Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population-based prospective study

All pregnant women in Uppsala county in 1987 were questioned on three different occasions about smoking habits, socio-demographic factors and obstetric history. After delivery, information was collected regarding their children. Twenty percent of the mothers continued to smoke during pregnancy, while 8% stopped smoking. The mean birth weight of infants of smokers was 3378 g and of non-smokers 3589 g. The difference was significant ( p < 0.001) and persisted after statistical adjustment for maternal age, parity and educational level. Perinatal morbidity (admission to the Department of Neonatology) was higher in thc smoking group (11.4% versus 8.8%, p < 0.05). The proportion of infants with a birth weight less than 2500 g and that of small-for-gestational-age infants were 60% and 100% greater, respectively, in the smoking group. The mean birth weight and perinatal morbidity rate in infants of mothers who stopped smoking were almost identical to those in infants of non-smokers. Cessation of smoking improves foetal growth and perinatal health.     

Relationship of insulin-like growth factor-I, insulin-like growth factor binding protein-3, insulin, growth hormone in cord blood and maternal factors with birth height and birthweight

BACKGROUND: To determine whether the following factors are related to birthweight or birth height, we measured insulin-like growth factor (IGF)-I, insulin-like growth factor binding protein (IGFBP)-3, insulin and growth hormone (GH) levels in cord blood and also observed the relationship between birthweight, birth height and maternal factors. METHODS: One hundred and ninety-four cord bloods were collected, 106 from males and 88 from females. Three newborns were small for gestational age (SGA), 168 were appropriate (AGA) and 23 were large (LGA); 21 newborns were preterm and 172 were term. RESULTS: Levels of IGF-I and IGFBP-3, measured by enzyme-linked immunosorbent assay, were significantly lower in preterm babies (35.3 +/- 15.1 and 1025.6 +/- 562.8 ng/mL, respectively) than in term babies (61.6 +/- 39.5 and 1252.6 +/- 403.2 ng/mL, respectively; P < 0.01), but neither insulin nor GH levels, measured by radioimmunoassay, showed any significant difference between the two groups (P > 0.05). Among term babies, IGF-I and IGFBP-3 levels were significantly higher in the LGA group (96.1 +/- 34.1 and 1544.7 +/- 418.1 ng/mL, respectively) than in the AGA group (56.4 +/- 37.6 and 1212.8 +/- 383.4 ng/mL, respectively; P < 0.01). Levels of IGF-I and IGFBP-3 showed significant correlation with birthweight and length, respectively (P < 0.01), although GH and insulin levels did not (P > 0.05). There was a significant correlation between IGF-I and IGFBP-3 levels (P < 0.01, r = 0.64), but IGF-I and IGFBP-3 levels showed no relationship with GH or insulin levels. Birthweight correlated significantly with prepartum maternal weight, maternal weight gain and maternal height (P < 0.05), but birth length correlated significantly only with maternal height (P < 0.05). CONCLUSIONS: Our results suggest that fetal growth depends on fetal levels of IGF-I and IGFBP-3 and maternal factors, not on insulin or GH. Levels of IGF-I and IGFBP-3 may not be regulated by insulin alone, but by the complex interactions between several factors, such as insulin, GH and maternal factors.     

母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

背景：高尿酸血症（HUA）患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。 目的：探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。 设计：回顾性巢式病例对照研究。 方法：以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平（μmol·L-1）分为低浓度（<360）、中浓度（~420）和高浓度（>420）,采用线性回归和Logistic 回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。 主要结局指标：孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。 结果：共纳入孕母2 397例（新生儿2 581例）,HUA组216例（9.0%）,非HUA组2 181例。HUA组孕母所生新生儿出生体重低于非HUA组（2 925 g vs 3 260 g,P<0.001）,差异均有统计学意义;而早产（18.5% vs 8.9%）、低出生体重（23.1% vs 7.1%）、小于胎龄儿（29.2% vs 10.6%）和转儿科比例（19.9% vs 11.1%）均高于非HUA组,差异均有统计学意义（P<0.001）。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g（95%CI：-106.5~-1.6,P=0.043）,发生早产的风险增加74%（OR=1.74,95%CI：1.08~2.8,P=0.023）,发生小于胎龄儿的风险增加85%（OR=1.85,95%CI：1.26~2.73,P=0.002）。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关（r=0.613,P=0.000）。两组早产儿合并症差异无统计学意义。 结论：母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。     

The effect of maternal and infant factors on cord blood yield

Umbilical cord blood (CB) can be used as an alternative hematopoietic stem cell source for transplantation in hematological malignancy and blood disorders. The success of transplantation is highly related to the levels of total nucleated cell and CD34⁺ cell counts. The evaluation of optimal conditions can decrease the rate of graft rejection due to low cell count and increases the quality of CB units (CBUs) in the blood bank and the success rate of engraftment. To this end, we review the maternal and infant parameters affecting the quality and quantity of CBUs.     

母血及脐血IGF-1、C肽和IGFBP-1质量浓度与新生儿出生体重的关系

目的探讨母体和脐血血清胰岛素样生长因子-1(IGF-1)、C肽(CP)及胰岛素样生长因子结合蛋白-1(IGFBP-1)质量浓度对新生儿出生体重的影响.方法选择12例大于胎龄儿(LGA)、15例适于胎龄儿(AGA)和20例小于胎龄儿(SGA),分为3组,分别抽取脐血和其母外周静脉血,分离血清.采用ELISA法测定IGF-1、CP和IGFBP-1.结果 (1)LGA组脐血IGF-1、CP、IGFBP-1质量浓度(ng·mL-1)分别为59.76±14.50,1.36±0.58,53.78±19.67;AGA组为33.65±12.74,0.90±0.45,104.79±27.60;SGA组为17.05±8.10,0.52±0.22,169.21±55.30;3组间差异有显著性意义(P<0.01).(2)LGA组新生儿母亲血清IGF-1、CP、IGFBP-1质量浓度(ng·mL-1)分别为267.15±99.43,2.84±0.93,158.50±51.25;AGA组母亲分别为237.34±105.56,2.71±0.72,170.78±63.69;SGA组分别为229.53±94.17,2.59±0.83,188.90±74.04;3组间比较差异均无显著性.但同组患儿母血IGF-1、CP及IGFBP-1均显著高于脐血水平(除SGA组母血与脐血IGFBP-1差异无显著性外).(3)新生儿出生体重与脐血IGF-1、CP呈正相关(r分别为0.814、0.654,P<0.01);与IGFBP-1呈负相关(r=-0.759,P<0.01);而与母血IGF-1、CP及IGFBP-1无明显相关性.结论脐血IGF-1、CP及IGFBP-1与胎儿生长关系密切.营养物质-胰岛素-胰岛素样生长因子轴是调节胎儿宫内生长发育的重要因素.     

系统性红斑狼疮产妇孕期体重增长对新生儿出生体重影响的巢式病例对照研究

目的 考察系统性红斑狼疮(SLE)产妇孕期体重增长(GWG)对新生儿出生体重的影响。方法 以上海交通大学医学院附属仁济医院(我院)产科分娩的SLE产妇及其新生儿为研究对象。采集产妇一般情况(年龄、身高、孕前体重、教育程度、GWG、既往疾病史、分娩孕周)、第一次产检指标(收缩压、舒张压、胆固醇、甘油三酯、空腹血糖)、新生儿性别、Apgar评分及出生体重。根据年龄和教育程度1:3匹配健康产妇及其新生儿作为对照。产妇GWG与新生儿出生体重关系采用一般线性回归分析。结果 共纳入SLE产妇45例和健康产妇135例。所有产妇平均年龄(29.0±3.0)岁,新生儿平均出生体重(3 198.8±501.8)g。SLE组GWG显著低于对照组,(12.4±5.5)kg vs (15.0±5.1)kg, P=0.004,GWG 低于适宜体重增长的比例显著高于对照组(37.8% vs 16.3%, P<0.01)。将所有产妇按GWG进行四分位分组,结果显示随着GWG增长,新生儿出生体重明显增加。与GWG处于最低四分位的SLE产妇相比,处于最高四分位的产妇的新生儿出生体重多(246.4±234.1)g,差异无统计学意义。结论 SLE产妇GWG明显低于正常产妇,随着GWG的增加,新生儿出生体重有增加趋势。     

人脐血及脐带间充质干细胞的分离培养及表面标记分析

目的探讨从人脐带血及脐带分离和培养间充质干细胞(MSCs)的方法,并分析MSCs的表面标记。方法人脐带血按常规方法制备单个核细胞,利用MSCs贴壁生长的特性,经培养、换液、传代纯化MSCs;分离脐带华尔通胶(Wharton’s jelly),采用组织块贴壁法获得脐带MSCs并传代。将传代的MSCs冻存,1个月后再复苏,观察复苏后MSCs的生长情况。利用FACScan流式细胞仪检测脐带血及脐带细胞表面抗原。结果经过传代后,贴壁细胞形态趋于同一。人脐血及脐带MSCs体外生长形态相似,类似成纤维细胞,可以稳定增殖和传代。经冷冻保存,复苏后仍能较好生长。人脐血及脐带来源的MSCs表面标记CD29、CD44、CD59高表达,而表面标记CD14、CD33、CD34和CD45低表达。结论人脐带血及脐带均可分离出MSCs,在体外能扩增纯化及冻存复苏,为组织工程提供丰富的细胞来源。     

Specific role of maternal weight change in the first trimester of pregnancy on birth size

The specific role of weight change in the first weeks of gestation in fetal growth has not been fully explored in humans. Our aims were to investigate: (1) the specific association between weight change in the first trimester of pregnancy (WCT1) and size at birth in term pregnancies; and (2) the role of placental weight in this relationship. From 2002 women included in the French EDEN study, 1744 mother–child pairs reached term, had pre‐pregnancy weight available and at least five measures of weight in pregnancy. We extrapolated women's weight at each week of gestation with a three‐degree polynomial model and estimated weight change during each trimester of gestation. We used a multivariate linear model to investigate the associations between WCT1 and birth size after taking into account potential confounders (age, parity, BMI, tobacco use, educational level, length of gestation, newborn gender, weight change after the first trimester and centre of study). Then, we performed path analysis to investigate whether the relation between WCT1 and birth size could be mediated by placental weight. After taking into account weight gain in later gestation, WCT1 was positively associated with birthweight. Results of path analysis showed that there was no direct association between WCT1 and birth size, but that this association was mediated by placental weight. Weight change during the first weeks of pregnancy may impact on fetal growth independently of weight change later in pregnancy through its effects on placental growth and function.