Periodontitis and preterm low birth weight

During the past decade an issue of influence of periodontitis on developing of systemic social diseases with polyfactorial etiology (atherosclerosis, myocardial infarction and stroke, diabetes, lung diseases) was taken up. Several researches have also proved that periodontitis could be an independent risk factor for preterm low birth weight (PLBW). The nature of this connection is not clear yet. The aim of this article is to show the current evidence from experimental studies in animals and human case-control studies on the relationship between these pathologies. Potential etiopathogenic mechanisms for periodontitis and preterm low-birth weight mothers have also been demonstrated. It's possible that treatment of periodontitis may reduce the risk of preterm birth.     

Lifetime and during pregnancy experience of violence and the risk of low birth weight and preterm birth

In order to assess the relationship between lifetime and during pregnancy experience of violence and low birth weight (LBW) and preterm birth outcomes, we designed a prospective cohort study in which the birth outcomes of women who experienced violence before their pregnancy or who experienced violence during pregnancy were compared to women who reported no lifetime experience of violence. We found that the risk of having a low birth weight or preterm baby was higher for women who did not experience violence. The proportion of women who had LBW babies was 7.1% for women who experienced violence during pregnancy, 7.8% for women who experienced violence before the current pregnancy, and 9.1% for nonexposed women. The proportion of preterm births was 3.5% for women exposed to violence during pregnancy, 8.5% for women exposed before the current pregnancy, and 9.7% for nonexposed women. However, married women who experienced violence had a higher proportion of LBW and preterm infants compared to the reference group of nonvictims of violence. Overall, women who experienced violence during pregnancy and before their current pregnancy did not have a greater proportion of LBW babies or preterm births. The findings suggest that married women in certain populations may experience more frequent or more severe experience of violence than unmarried women.     

Growth of low birth weight preterm children

Very low birth weight premature (VLBWPT) infants demonstrate growth patterns in the early years of life which differ from those of term and large low birth weight preterm (LBWPT) peers. Optimal post natal growth of VLBWPT children is associated with more positive later health and neurodevelopmental outcomes. The neonatologist engaged in the follow of care of VLBWPT infants after discharge from the Neonatal Intensive Care Unit should monitor over time the velocity of weight, length, head circumference and weight/length ratio utilizing appropriate growth references. VLBW children who demonstrate atypically low weight gain in the early years of life have a higher probability of less than optimal cognitive development over time, while those with excessive weight gain have a greater likelihood of later childhood and adult obesity, cardiovascular disease, and diabetes. Nutritional planning should provide adequate calories for gradual normalization in all growth variables, while attempting to avoid atypically low or excessive weight gain. This nutritional planning should take into account the child's genetic growth potential, small for gestational age (SGA) or at gestational age (AGA), and clinical issues such as the presence of diseases like gastroesophageal (GE) reflux or chronic lung disease. Whatever nutritional approach is used, the neonatologist in follow up should track weight, length, head circumference, and weight/length ratio and adjust the nutrition plan and caloric intake to assure gradual return to normal in all growth variables while avoiding excessive weight gain.     

Breastfeeding the low birth weight preterm infant

The recent increase in the use of human milk in feeding low birth weight (LBW) preterm infants has stimulated new research questions in infant nutrition, especially in regards to the nutritional adequacy and nutrient composition of milk from mothers of mature and preterm infants. The current state of knowledge on the effect of feeding human milk with or without nutritional supplements on growth of the low birth weight infant is summarized. Recommendations and guidelines for feeding human milk and/or supplementing human milk in LBW infants are discussed and appropriate handling of human milk and feeding schedules are outlined.     

Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight

Objective

To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).

Methods

The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients’ records.

Results

The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P = 0.004; LBW: 7.6% versus 5.8%, P = 0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1–1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03–1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.

Conclusion

Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.     

Risk of preterm delivery in relation to maternal low birth weight

OBJECTIVE: We examined the relationship between maternal low birth weight and preterm delivery risk. METHODS: Information concerning maternal birth weight was collected during in-person interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Preterm delivery cases were studied in aggregate, in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34-36 weeks], and early preterm delivery [gestational age at delivery<34 weeks]). RESULTS: After adjusting for confounders, women weighing<2,500 g at birth had a 1.54-fold increased risk of preterm delivery versus women weighing=2,500 g (95% CI 0.97-2.44). Maternal low birth weight was associated with a 2-fold increased risk of spontaneous preterm delivery (95% CI 1.03-3.89), but weakly associated with preterm premature rupture of membranes (OR=1.44; 95% CI 0.67-3.09) and medically induced preterm delivery (OR=1.10; 95% CI 0.43-2.82). Maternal low birth weight was more strongly associated with early preterm delivery (OR=1.94) than with moderate preterm delivery (OR=1.46). Women weighing<2,500 g at birth and who became obese (pre-pregnancy body mass index, =30 kg/m2) before pregnancy had a 3.65-fold increased risk of preterm delivery (95% CI 1.33-10.02) versus women weighing=2,500 g at birth and who were not obese prior to pregnancy (<30 kg/m2). CONCLUSIONS: Results confirm earlier findings linking maternal low birth weight with future risk of preterm delivery.     

Association between maternal periodontal disease and preterm delivery and low birth weight

ObjectiveIt has been suggested that periodontal disease is an important risk factor for preterm low birth weight (PLBW). The purpose of this study was to determine the association of maternal periodontitis with low birth weight (LBW) and preterm birth (PB).Materials and MethodsPregnant women (n = 211) aged 22–40 years were enrolled while receiving prenatal care. Dental plaque, probing depth, bleeding on probing, and clinical attachment level were used as criteria to classify three groups: a healthy group (HG; n = 82), a gingivitis group (GG; n = 67), and a periodontitis group (PG; n = 62). At delivery, birth weight was recorded.ResultsMean infant weight at delivery was 3084.9 g. The total incidence of preterm birth and LBW infants was 10.4% and 8.1%, respectively. The incidence of LBW infants was 4.2% for term and 40.9% for preterm gestations. Maternal height was not correlated with infant birth weight (p = 0.245). Significant differences in mean infant birth weight were observed among the HG, GG, and PG groups (p = 0.030). No significant relationship was found between periodontal disease and PB, but the association between periodontal disease and LBW was significant.ConclusionAfter appropriately controlling for confounding variables, our results do not support the hypothesis of an association that was observed in previous studies of maternal periodontal disease and infant PB, but the association between periodontal disease and LBW is significant.     

High gestational weight gain and the risk of preterm birth and low birth weight: a systematic review and meta-analysis

ObjectiveMany women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births.Data SourcesWe searched Medline and Embase and reference lists.Study SelectionTwo assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams).Data extraction and synthesisThirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90).ConclusionAlthough women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.     

两种辅助通气方式早期应用于早产极低出生体重儿的临床效果比较

目的 比较鼻塞持续气道正压通气(nasal continuous positive airway pressure,nCPAP)与气管插管接呼吸机通气在早产极低出生体重儿生后早期应用的临床效果. 方法 选择生后60 min内出现呼吸窘迫症状的早产极低出生体重儿共123例纳入本前瞻性随机对照研究,nCPAP组63例,气管插管接呼吸机通气组(对照组)60例.采用卡方检验和t检验比较2组患儿支气管肺发育不良发生率、病死率、用氧、辅助通气使用和临床并发症情况. 结果 nCPAP组与对照组比较,支气管肺发育不良发生率[4.8％(3/63)与3.3％(2/60)]和病死率[7.9％(5/63)与6.6％(4/60)]差异均无统计学意义(x2 =0.16和0.07,P＞0.05).nCPAP组肺表面活性物质使用率(27.0％,17/63)低于对照组(83.3％,50/60),差异有统计学意义(x2=39.34,OR=0.3,90％ CI:0.2～0.6,P＜0.05).生后28 d时,nCPAP组辅助通气的比例(17.5％,11/63)低于对照组(25.0％,15/60)(OR=0.7,90％ CI:0.4～1.4);至纠正胎龄36周时,nCPAP组辅助通气比例(6.3％,4/63)仍低于对照组(8.3％,5/60)(OR=0.8,90％ CI:0.2～2.4),但差异均无统计学意义(x2分别为1.05和0.01,P均＞0.05).nCPAP组气漏发生率(11.1％,7/63)低于对照组(33.3％,20/60),差异有统计学意义(x2=8.86,OR=0.3,90％ CI:0.2～0.7,P＜0.05). 结论 与气管插管接呼吸机通气相比,在早产极低出生体重儿中早期使用nCPAP,不能降低病死率或支气管肺发育不良发生率,但可缩短辅助机械通气时间,降低气漏和使用肺表面活性物质的比例.     

Twin birth weight discordance and risk of preterm birth

OBJECTIVES: Our purpose was to determine whether birth weight discordance is a risk factor for preterm birth of twins, and to further characterize the relationships involved.Study Design: Maternally linked 1978-1990 Missouri birth certificates were used to analyze gestations resulting in live twins. We used contingency tables and multiple logistic regression. RESULTS: The degree of discordance correlated strongly with risk for live preterm birth but only for discordances >30% and preterm birth at <32 weeks' gestation. Among 9479 pregnancies with discordance <30%, 9.5% ended in birth at <32 weeks' gestation, versus 13.7% of 326 with discordance of 30% to 40% (P =.03) and versus 34.1% of 126 with discordance > or =40% (P <. 001). There were 42 preterm twin births at <32 weeks' gestation with discordances > or =40%. Of these, 51% were attributable to fetal growth restriction and 16% to large size for gestational age in one infant; in 72% the smaller twin was the second born, and in 86% the twins were like sex. The relative association between > or =40% discordance and preterm birth at <32 weeks' gestation was strengthened (final odds ratio, 9.54; P <.0001) in a multivariate model containing other risk factors for delivery at <32 weeks' gestation: black race, either twin small for gestational age, unmarried, teenage mother, number of male fetuses, like fetal sex, education <12 years, nulliparity, and cigarette smoking. CONCLUSIONS: Twin birth weight discordance has now clearly been demonstrated to be a risk factor for preterm birth. The effect was found particularly with discordances > or =40% before 32 weeks' gestation. Discordance was usually attributable to fetal growth restriction, most often in the second-born twin.     

极低出生体重早产儿动脉导管未闭的治疗

目的探讨极低出生体重早产儿有临床表现的动脉导管未闭的治疗方法方法 本研究为前瞻性队列研究.2008年1月1日至2010年12月31日间出生体重＜1500 g的确诊有临床表现的动脉导管未闭早产儿78例,其中42例采用口服吲哚美辛治疗者作为治疗组,36例未治疗者为对照组.观察吲哚美辛的疗效、副作用以及对早产儿的近远期预后.结果治疗组及对照组在性别比例、胎龄、动脉导管直径、合并心力衰竭、败血症、新生儿呼吸窘迫综合征、脑室内出血的差异均无统计学意义(P均＞0.05).治疗组治疗后动脉导管关闭33例,关闭率为78.6%,高于对照组,自发关闭9例,关闭率25.0%,差异有统计学意义(χ2=22.39,P=0.000).治疗组治疗前后的血肌酐、血小板差异无统计学意义(P均＞0.05).治疗组较对照组有较少的脑室内出血发生比例(z=1.167,P=0.030)、较短的总用氧时间[分别为(8.0±5.5) d和(13.3±9.3) d,t=2.225,P=0.032]及住院时间[(39.0±7.7) d和(43.6±10.6) d,t=2.229,P=0.029],且支气管肺发育不良、坏死性小肠结肠炎的发生情况组间差异无统计学意义(P均＞0.05).治疗组中有5例药物治疗失败后使用胸腔镜钳闭动脉导管,术后3例发生肺部感染,1例出现胸腔积液,无死亡及气胸发生.结论极低出生体重早产儿有临床表现的动脉导管未闭应积极干预,口服吲哚美辛可有效关闭动脉导管,胸腔镜钳闭动脉导管可作为药物治疗失败后的一种选择.

Abstract：

Objective To investigate the treatment of symptomatic patent ductus arteriosus (PDA) in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants (birth weight＜1500 g) were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin (0.2 mg/kg, every 12 hrs for three times) were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for ductus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups (P>0.05, respectively). The ductus arteriosus closed in 33 patients of treatment group (78.6%) and in nine patients of control group (25.0%)(χ2=22.39,P=0.000). There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group(P>0.05). Compared with control group, the treatment group had lower incidence of intraventricular hemorrhage (z=1.167, P=0.030), shorter duration of oxygen therapy [(8.0±5.5) d vs (13.3±9.3) d, t=2.225, P=0.032] and shorter hospital stay [(39.0±7.7) d vs (43.6±10.6) d, t=2.229, P=0.029]; while the incidence of bronchopulmonary dysplasia and necrotizing enterocolitis were similar (P>0.05). The five cases of PDA who received video-assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant death associated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight preterm infants should be treated actively. Oral indomethacin was an effective and safe method to cure the PDA in these infants. Surgical ligation under video-assisted thoracoscopic surgery after failure of indomethacin treatment might be a good option.     

Maternal hematological status and risk of low birth weight and preterm delivery in Nepal

BACKGROUND: Our aim was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant Nepali women. METHODS: In a case-control study, 1400 pregnant women attending Patan Hospital, Kathmandu, Nepal for antenatal care and delivery in the period 1994 to 1996 were included. Women with twin pregnancies (n=15) and those delivering infants with congenital malformations (n=13) were excluded from the study. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight, gestation at delivery, Apgar score, mode of delivery, and perinatal death. Linear and logistic regression models were used to analyze data. RESULTS: Severe anemia (hematocrit < or =24%) was associated with a significantly increased risk of low birth weight (<2500 g) and preterm delivery (<37 weeks gestation). High hematocrit values (> or =40%) did not increase the risk of low birth weight or preterm delivery. The risk of low Apgar score or operative deliveries was significantly increased in women with severe anemia in the first trimester. Teenagers, women with short height or low body mass index, and those belonging to the ethnic group Brahmins, had significantly higher risks of delivering low birth weight infants. CONCLUSIONS: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improvements in the nutritional status of young Nepali women could contribute to improved health among their infants.     

Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns.

OBJECTIVE: To examine the relationship between first-trimester hemoglobin (Hb) concentration and risk of low birth weight (LBW), preterm birth and small for gestational age (SGA). METHODS: Data were obtained from a population-based prenatal care program in China. A total of 88,149 women who delivered during 1995-2000 and had their Hb measured in the first trimester were selected as study subjects. RESULTS: The prevalence of anemia (Hb<110 g/L) was 22.1% in the first trimester. The risk of LBW, preterm birth and SGA was increased steadily with the decrease of first-trimester Hb concentration. After controlling for confounding factors, women with Hb 80-99 g/L had significantly higher risk for LBW (OR=1.44, 95% CI 1.17-1.78), preterm birth (OR=1.34, 95% CI 1.16-1.55) and SGA (OR=1.13, 95% CI 0.98-1.31) than women with Hb 100-119 g/L. No elevated risk was noted for women with Hb> or =120 g/L. CONCLUSION: Low first-trimester Hb concentration increases the risk of LBW, preterm birth and SGA.