Gestational weight gain and newborn anthropometric outcomes in rural Bangladesh

Low gestational weight gain (GWG) is a known predictor of fetal growth restriction in higher income countries, but there is little information on this association in lower income countries. Our objective is to describe the association between GWG and birth outcomes among pregnant women in rural Bangladesh. Pregnant women were identified in a community‐based programme and enrolled into the study at an average of 13 weeks' gestation (n = 4,011). Maternal weight and height were measured at enrolment, maternal weight was measured at 36 weeks' gestation, and newborns were measured after birth. Rate of GWG (g/weeks) was calculated, and women were categorized as having adequate or inadequate GWG (Institute of Medicine recommendations). Newborn anthropometric outcomes included weight‐for‐age z score (WAZ), length‐for‐age z score (LAZ), head‐circumference‐for‐age z score (HCZ), body mass index (BMI)‐for‐age z score (BMIZ), low birthweight (LBW < 2,500 g), WAZ < ?2, LAZ < ?2, HCZ < ?2, BMIZ < ?2, and small for gestational age (SGA: <10th percentile). Multivariate models were adjusted for confounders. Only 26% of the 2,562 women in these analyses had adequate GWG. Compared with newborns of women with inadequate GWG, infants of women with adequate GWG had a lower risk of adverse anthropometric outcomes (relative risk [95% confidence interval]: LBW = 0.68 [0.59, 0.80], LAZ < ?2 = 0.64 [0.51, 0.80], HCZ < ?2 = 0.75 [0.60, 0.93], BMIZ < ?2 = 0.70 [0.59, 0.83], and SGA = 0.80 [0.73, 0.86]), but there was no significant difference in mean (SE) duration of gestation, 39.7 (0.08) versus 39.7 (0.05) weeks. In this population, GWG rate is a strong predictor of newborn anthropometric outcomes, but not duration of gestation.     

Associations between prepregnancy body mass index,gestational weight gain and weight catch-up in small-for-gestational-age children

Inadequate gestational weight gain (GWG) was related with a higher incidence of small-for-gestational-age (SGA) births than appropriate GWG; however, the long-term association of maternal GWG with weight catch-up growth in SGA children remains unknown. The objective of this study is to evaluate the associations between prepregnancy body mass index (pBMI), GWG and weight catch-up patterns in SGA children. Data were from the Collaborative Perinatal Project, an American multicentre prospective cohort study. A total of 56,990 gravidas were recruited at the first prenatal visit, and children were followed up until school age. Maternal pBMI, GWG and physical growth of the offspring at birth, 4 months, 1 year, 4 years and 7 years old were recorded. The latent class analysis was employed to form weight catch-up growth patterns (appropriate, excessive, slow, regression and no catch-up patterns) in SGA children. SGA children who developed the ‘appropriate catch-up growth’ pattern and whose mothers had appropriate pBMI and GWG were chosen as the reference. Associations between GWG for different pBMI and weight catch-up patterns were analysed by multivariate logistic regression models. A total of 1619 infants (9.45%) were born term SGA. After adjusting for relevant confounders, compared with SGA children whose mothers had appropriate pBMI and GWG, SGA children with maternal prepregnancy underweight (for inadequate GWG, GWG below recommendations, adjusted OR: 2.88, 95% CI: 1.13–7.31; for appropriate/excessive GWG, adjusted OR: 3.07, 95% CI: 1.74–5.42) or with prepregnancy normal weight but inadequate GWG (adjusted OR: 2.14, 95% CI: 1.36–3.38) were at a higher risk of having the ‘no catch-up growth’ pattern. We suggest that SGA children with maternal prepregnancy underweight or inadequate GWG tend to have a poor weight catch-up growth at least until school age.     

Risk factors for small for gestational age

BACKGROUND: The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. METHODS: The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. RESULTS: Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P 12 kg. CONCLUSION: The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.     

Screening for fetal growth restriction and placental insufficiency

Fetal growth restriction (FGR) continues to be a leading cause of preventable stillbirth and poor neurodevelopmental outcomes in offspring, and furthermore is strongly associated with the obstetrical complications of iatrogenic preterm birth and pre-eclampsia. The terms small for gestational age (SGA) and FGR have, for too long, been considered equivalent and therefore used interchangeably. However, the delivery of improved clinical outcomes requires that clinicians effectively distinguish fetuses that are pathologically growth-restricted from those that are constitutively small. A greater understanding of the multifactorial pathogenesis of both early- and late-onset FGR, especially the role of underlying placental pathologies, may offer insight into targeted treatment strategies that preserve placental function. The new maternal blood biomarker placenta growth factor offers much potential in this context. This review highlights new approaches to effective screening for FGR based on a comprehensive review of: etiology, diagnosis, antenatal surveillance and management. Recent advances in novel imaging methods provide the basis for stepwise multi-parametric testing that may deliver cost-effective screening within existing antenatal care systems.     

Maternal and paternal height and BMI and patterns of fetal growth: The Pune Maternal Nutrition Study

We examined the differential associations of each parent's height and BMI with fetal growth, and examined the pattern of the associations through gestation. Data are from 557 term pregnancies in the Pune Maternal Nutrition Study. Size and conditional growth outcomes from 17 to 29 weeks to birth were derived from ultrasound and birth measures of head circumference, abdominal circumference, femur length and placental volume (at 17 weeks only). Parental height was positively associated with fetal head circumference and femur length. The associations with paternal height were detectible earlier in gestation (17-29 weeks) compared to the associations with maternal height. Fetuses of mothers with a higher BMI had a smaller mean head circumference at 17 weeks, but caught up to have larger head circumference at birth. Maternal but not paternal BMI, and paternal but not maternal height, were positively associated with placental volume. The opposing associations of placenta and fetal head growth with maternal BMI at 17 weeks could indicate prioritisation of early placental development, possibly as a strategy to facilitate growth in late gestation. This study has highlighted how the pattern of parental-fetal associations varies over gestation. Further follow-up will determine whether and how these variations in fetal/placental development relate to health in later life.     

Ghrelin levels from fetal life through early adulthood: relationship with endocrine and metabolic and anthropometric measures

OBJECTIVE: To establish mean plasma ghrelin levels during fetal life and childhood.Study design Cord blood was obtained at birth from premature (n=29) and full-term newborns (n=124). Fasting blood samples were taken from 224 normal subjects divided according to Tanner stage and sex. Ponderal index or body mass index was determined. Ghrelin; insulin-like growth factor (IGF)-I; IGF-II; IGF binding proteins 1, 2, and 3; insulin; glucose; and leptin levels were measured. RESULTS: Ghrelin levels did not differ between preterm and full-term newborns. Ghrelin increased significantly after birth, peaking during the first 2 years of life, then decreasing until the end of puberty. Ghrelin levels correlated negatively with anthropometric variables in full-term newborns and postnatally, but not in preterm newborns. A positive correlation between ghrelin and IGF binding protein 1 was found. CONCLUSIONS: Ghrelin changes significantly throughout development, correlating with anthropometric and metabolic parameters during extrauterine life. The highest levels of ghrelin are found during early postnatal life, when growth hormone begins to exert its effects on growth and important changes in food intake occur, suggesting that this hormone may participate in these processes.     

Prevalence and temporal trends in prepregnancy nutritional status and gestational weight gain of adult women followed in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018

Prepregnancy body mass index (BMI) and gestational weight gain (GWG) are the most investigated indicators of maternal nutritional status, which is a modifiable factor that plays a vital role in maternal and infant health. This study describes prepregnancy BMI and GWG of 840,243 women with 2,087,765 weight observations in the Brazilian Food and Nutrition Surveillance System from 2008 to 2018. Prepregnancy BMI was classified according to the World Health Organization cut-offs. Total GWG was calculated from weight measurements taken after 36 weeks of pregnancy and classified according to the Institute of Medicine guidelines. Temporal trends in prepregnancy BMI status were examined, and maps were used to evaluate changes in excessive GWG in each Brazilian federation unit. On overall, prepregnancy overweight and obesity increased from 22.6% to 28.8% and from 9.8% to 19.8%, respectively, between 2008 and 2018. The prevalence of excessive GWG rose from 34.2% to 38.7% during the same period and in 11 of the 27 Brazilian federation units between 2008 and 2016. Women with underweight showed the highest values for mean total GWG for all the compared years (overall variation from 12.3 to 13.1 kg), followed by those with normal weight (11.9 to 12.5 kg), overweight (10.1 to 10.9 kg) and obesity (from 8.2 to 8.9 kg). Within each BMI group, values remained fairly stable throughout the studied period for first- and second-trimester GWG and total GWG. These results help to fill a significant gap in understanding the distribution of prepregnancy BMI and GWG in Brazilian women.     

Catch-up growth of supine length/height of very low birth weight, small for gestational age preterm infants to adulthood

OBJECTIVE: To analyze linear growth of very low birth weight (VLBW), small for gestational age (SGA; < 10th percentile) preterm infants from birth as to catch-up or no catch-up growth. STUDY DESIGN: VLBW SGA preterm infants (n = 46) with primarily symmetric intrauterine growth restriction from the Bonn Longitudinal Study were compared with 62 appropriate for gestational age (AGA) VLBW preterm and 73 term infants and with their parents. RESULTS: Forty-six percent of VLBW SGA (21 of 46) had complete height catch-up by adult age, and most became taller than target height (TH) (15 of 21; 71%). The others did not catch up; most of them remained shorter than TH (18 of 25; 72%) after initial catch-up followed by catch-down growth. Mean adult height z-score was lower than that for birth length. Mean body mass index was similar in the catch-up and no catch-up groups (21.8 and 21.3, respectively) and lower than in the controls (23.2). Approximately 1/2 of the head circumference (HC) catch-up children achieved height catch-up as well. CONCLUSIONS: Height catch-up extended beyond age 6 years, independent of HC growth. We could not predict height catch-down or successful catch-up.     

Parental race, birth weight, gestational age, and fetal growth among twin infants in the United States

BACKGROUND: No previous study has examined the association between paternal race and birth weight among twins. AIMS: To examine the association of parents' race and birth weight among twins. STUDY DESIGN: Population-based retrospective cohort study to examine the association between parents' race and birth weight, and its two components, gestation duration and fetal growth among four group of infants: both parents blacks (FB-MB), father white and mother black (FW-MB), father black and mother white (FB-MW), and both parents whites (FW-MW), with "risk-free" analysis to control confounding factors. SUBJECTS: Twin births (304,466 twins) registered in the United States in 1995-1997. OUTCOME MEASURES: The means of birth weight, gestational age, and birth-weight-for-gestational age z score, and rates of very low birth weight (VLBW, <1500 g), very preterm birth (VPTB, <32 weeks of gestation), and fetal growth restriction (FGR, <10th percentile of z score). RESULTS: Means of birth weight, gestational age, and z score were 2234.0, 2301.9, 2361.1, and 2433.8, and 35.02, 35.24, 35.65, and 35.78, and -0.136, -0.070, -0.039, and 0.063, respectively, and the rates of VLBW, VPTB, and FGR were 14.5, 12.3, 10.5, and 8.1, and 16.0, 13.0, 11.6, and 9.2, and 12.6, 11.1, 10.8, and 8.7, respectively, in the FB-MB, FW-MB, FB-MW, and FW-MW groups. Excluding subjects with various risk factors by risk-free analysis did not change the results. CONCLUSIONS: Both parents' races are important determinants of birth weight, gestational age, and fetal growth among twin pregnancies, with higher effect on gestational age and greater maternal influence than paternal influence.     

Paediatric consequences of fetal growth restriction

The evidence for outcome following fetal growth restriction (FGR) has previously been inferred from studies, based on babies who were born small for gestational age (SGA). Great care is required when evaluating studies in this area due to a number of potential confounders. It does appear, however, that FGR is associated with an increased risk of poor neurological outcome. This includes an increased risk of cerebral palsy in babies greater than 32 weeks' gestation. Below 32 weeks, the effects of prematurity appear to negate the effects of FGR. FGR is also associated with cognitive deficit and behaviour problems. Babies with poor prenatal head growth appear to have a worse cognitive outcome. However, the role of 'fetal brain sparing' remains unclear, as impaired cognitive outcome is still evident in babies with appropriate head growth. Recent studies, which have identified FGR more accurately using fetal growth standards, have found an increased incidence of major intracranial injury and other adverse neonatal outcomes, which had previously been thought to occur less frequently in FGR babies. FGR is also associated with poor postnatal growth. The majority of children with FGR demonstrate catch-up growth in the first 2 years of life. Children who fail to demonstrate catch-up growth have a high risk of long-term growth problems. There is evidence of impaired growth hormone activity in some children with FGR who have persistent poor growth in the postnatal period.     

Longitudinal follow-up of growth in children born small for gestational age

Postnatal growth was followed in a population-based group of 123 small-for-gestational-age (SGA, birth weight < -2 SD) children (66 boys and 57 girls) to four years of age in order to determine the incidence and time of catch-up growth. Gestational age was determined by ultrasound in gestational weeks 16–17 in all pregnancies, thus eliminating the problem of distinguishing between SGA and preterm infants. Infants with well-defined causes for slow growth rate, i.e. those infants with chromosomal disorders, severe malformations, intrauterine viral infections or cerebral palsy, were excluded. The boys showed an extremely fast weight catch-up, 85% of them reaching weights greater than -2 SD at the age of three months and remaining above this level to the end of the study period. Such a fast catch-up growth was observed in only two-thirds of the girls, but at four years of age 85?4 of the girls were also above -2SD. Length catch-up was more gradual than weight catch-up. Of the boys, 54% had lengths below -2 SD at birth, 26% at 1 year of age, 22% at 2 years of age, 17% at 2.5 years of age and 11% (n= 8) at 4 years of age. Corresponding figures for girls were: 69% at birth, 28%) at 1 year, 15% at 2 years, 12% at 2.5 years and 5%) (n = 3) at 4 years. At 4 years of age, only six boys and three girls remained below -2 SD for both weight and height. We conclude that in Sweden the prognosis for catch-up growth for an SGA child, when children with well-defined causes of growth disturbances are excluded, is very good and it is extremely rare for the child still to have a height below -2 SD by the age of 4 years.     

Natural growth in children born small for gestational age with and without catch-up growth

This first report from a population-based postnatal growth study of 3650 healthy Swedish subjects born at full term provides new reference values for height and weight and shows that over the last 20 years there has been a small secular trend in height (0.2–0.4 SDS over the whole age range) in Sweden in both boys and girls. Within this cohort, 111 (3.1%) were of low birth weight (below –2 SDS) and 141 (3.5%) were of low birth length (below –2 SDS); 54 (1.5%) were both light and short at birth. Of the children born small for gestational age, 87% showed full catch-up growth within 2 years of life. They attained puberty at a normal or early age and reached a mean final height of –0.7 SDS. The remaining subgroup of 13% born small for gestational age remained below –2 SDS throughout childhood and reached puberty somewhat early. Their mean final height was –1.7 SDS. The current data set is too small to identify possible background factors, but it is being expanded with this objective in mind.     

Maternal cardiovascular disease risk in relation to the number of offspring born small for gestational age: national, multi-generational study of 2.7 million births

Aim: To investigate the risk of small for gestational age (SGA) births in relation to maternal history of cardiovascular disease (CVD) across two generations and additionally to analyse maternal CVD risk based on number of SGA offspring.
Methods: We used register data from 1.4 million women and 2.7 million offspring. The outcome measures were risk of being SGA in relation to maternal total CVD (n = 10 436) across two generations, as well as risk of CVD in mothers in relation to the number of their SGA offspring, stratified by educational level.
Results: Compared to no family history of CVD (reference) the hazard ratio (HR) for being SGA in female offspring was 1.11 (95% confidence interval (CI) 1.09–1.13) for a positive maternal history of CVD. The highest risk was shown in daughters when both the mother and the grandmother had a history of CVD (HR 1.32, 95% CI 1.24–1.39). There was a stepwise increased risk of CVD events in mothers in relation to the number of their SGA offspring (HR 1.41–1.86) when 'no SGA offspring' was used as reference. The risk of CVD in relation to SGA status was increased in the least educated group (HR 2.7–5.0) compared to the group with the highest level of education with no SGA offspring.
Conclusion: The risk of SGA offspring and the risk of maternal CVD are mutually interdependent and both conditions increased in women with a low level of education.     

218例无追赶生长的小于胎龄儿儿童期糖代谢分析

目的 探索无追赶生长的小于胎龄儿在儿童期的胰岛素敏感性.方法 收集2008年8月至2016年8月于北京大学第三医院儿科门诊就诊的身材矮小患儿439例,分为小于胎龄儿组(small for gestational age,SGA)218例和特发性矮小组(idiopathic short stature,ISS)221例.比较两组之间的空腹胰岛素、空腹血糖、空腹血糖与胰岛素比值、胰岛β细胞功能(HOMA%)和胰岛素抵抗指数(HOMA-IR)特点.结果 两组患儿均根据青春期分期及性别分组,SGA组与ISS组,青春期前男性患儿的空腹血糖分别为(4.7±0.6)mmol/L和(4.8±0.6)mmol/L,P=0.678,空腹胰岛素(5.1±4.0)mU/L和(4.3±4.7)mU/L,P=0.345,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期前女性患儿的空腹血糖分别为(4.5±0.5)mmol/L和(4.6±0.5)mmol/L,P=0.828,空腹胰岛素分别为(4.7±3.5)mU/L和(4.5±3.3)mU/L,P=0.603,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期男性患儿的空腹血糖分别为(5.0±0.8)mmol/L和(4.9±0.5)mmol/L,P=0.176,空腹胰岛素分别为(5.9±4.3)mU/L和(6.0±4.5)mU/L,P=0.958,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义;青春期女性患儿的空腹血糖分别为(4.9±0.6)mmol/L和(4.8±0.4)mmol/L,P=0.141,空腹胰岛素分别为(7.5±6.4)mU/L和(7.4±8.6)mU/L,P=0.448,血糖胰岛素比值、HOMA%及HOMA-IR的差异均无统计学意义.