Maternal low birth weight and gestational hyperglycemia

We aimed to investigate whether birth weight could predict the subsequent risk of gestational diabetes and impaired glucose tolerance. Consecutive women with a singleton pregnancy and gestational diabetes (n = 50) ,impaired glucose tolerance (n = 50) and normoglycemia (n = 200) were included in the study. Birth data were collected from original hospital records of the women. Women with gestational hyperglycemia were significantly older and heavier than those with normoglycemia. Maternal birth weights significantly declined for each class of glucose tolerance (3389 ± 644; 3184 ± 583 and 3077 ± 661 ,respectively for women with normoglycemia ,impaired glucose tolerance and gestational diabetes). After adjustment for age ,gestational age and weight gain ,maternal diabetes ,and pre-pregnancy body mass index ,maternal birth weight was negatively related to impaired glucose tolerance (OR 0.88 ,95% CI 0.81-0.97) and to gestational diabetes (OR 0.82 ,95% CI 0.74-0.91) in a multiple logistic regression model. These findings suggest that women with low birth weight constitute a group at increased risk for both gestational impaired glucose tolerance and diabetes.     

Birth weight for gestational age centiles for Italian neonates.

OBJECTIVE: To provide centiles for birth weight (BW) according to gestational age (GA) and sex for infants born in Italy. METHODS: We used records of the whole neonatal population of Tuscany, a region in Italy, from July 1991 to June 2002 as resulting from the database of the cystic fibrosis neonatal screening program (n=290129). We excluded as unlikely for GA those BW that were more than two interquartile ranges above the 75th centile or below the 25th centile for each GA and gender group. RESULTS: We present the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles of BW for GA from the 24th to 43rd week of gestation for male and female Italian neonates, as both tables and smoothed curves. CONCLUSIONS: The large size of the examined population allows us to provide up-to-date, reliable BW for GA centiles for Italian newborns, especially for lower GAs.     

Fetal programming for adult disease: where next?

The Barker hypothesis of fetal programming for adult cardiovascular and metabolic diseases has attracted much interest over the past few years. In this review, we summarize the main studies in this field, give a brief outline of some of the laboratory models used to investigate this hypothesis and discuss potential mechanisms underlying these clinical observations that are amenable to future research.     

Use of antihistamine drugs in early pregnancy and delivery outcome

Objective: To study the impact of antihistamine use in early pregnancy on delivery outcome. Methods: Using prospectively collected information on drug use in early pregnancy, delivery outcome was studied among 17 266 women with 17 776 deliveries and 18 197 infants. The analysis was performed according to the main reason for antihistamine use: nausea and vomiting in pregnancy and allergy. Results: In the nausea and vomiting in pregnancy group, we found a significant increase in twin births and a significant reduction in preterm births, low birth weight and being small-for-gestational age among singletons. The perinatal death rate was reduced and the rate of congenital malformations was normal. A reduction was seen in the occurrence of congenital cardiovascular defects after the use of antihistamines. The odds ratio for specified cardiac defects, with the exception of ventricular and atrium septal defects, after the use of antihistamines for nausea and vomiting in pregnancy (0.54) was significantly lower than that for non-cardiovascular congenital malformations (0.95). No statistically significant effects on delivery outcome were seen after the use of antihistamine drugs for allergy. However, there was a non-significant tendency for a reduced risk for cardiovascular defects (odds ratio 0.71). Conclusions: The beneficial effects on delivery outcome observed are most probably related to the underlying nausea and vomiting in pregnancy. There is no clear teratogenic effect of the antihistamines studied.     

Leukemoid reaction and chronic lung disease in infants with very low birth weight

Objectives: To analyze the relationship between the leukemoid reaction and chronic lung disease in very-low-birth-weight (VLBW) infants. Methods: Neonates born weighing less than 1500 g without evidence of congenital anomalies and admitted to our hospital from October 1985 to December 1999 comprised our study. Leukemoid reaction was defined as a peripheral white blood cell (WBC) count of ≥ 50 × 10³/μl. The infants who demonstrated a leukemoid reaction formed the study group, while the remainder formed the control group. The relationship between neonatal variables and WBC counts was studied. Results: Fourteen of the 486 infants demonstrated WBC counts of ≥ 50 × 10³/μl, with an incidence of 2.9%. Univariate analysis demonstrated a significant association between a leukemoid reaction and chronic lung disease following intrauterine infection. Conclusion: A leukemoid reaction was observed in 2.9% of VLBW infants in our neonatal intensive care unit. A significant association was demonstrated between the leukemoid reaction and chronic lung disease following intrauterine infection.     

Fetal erythroblasts in maternal blood in relation to gestational age

Objective:?To determine the distribution of fetal erythroblasts in the maternal circulation at different gestations. Materials and methods:?Maternal blood was obtained from 152 normal singleton pregnancies at 11–40 weeks of gestation. Fetal erythroblasts were isolated using triple density gradient separation and anti-CD71 magnetic cell sorting techniques. The enriched erythroblasts were stained with Kleihauer–Giemsa and with fluorescent antibodies for the zeta (ζ), epsilon (?) and gamma (γ) globin chains. The percentage of fetal cells positive for each stain was calculated. Fluorescence in situ hybridization for X and Y chromosomes was also performed. Comparison was made in the proportion of positive fetal erythroblasts among the different gestational ages. Results:?The proportion of erythroblasts stained positive with γ-globin chain and Kleihauer–Giemsa decreased withgestation from a median of 2% at 11 weeks to 0.5% at 40 weeks. Similarly, there was a decrease in the percentage of Y-signal-positive cells from 1% at 11 weeks to 0.3% at 40 weeks. The proportion of enriched fetal erythroblasts stained positive with ζ- and ?-globin chains decreased exponentially from respective medians of 0.6% and 1.5% at 11 weeks to zero after 19 weeks and 24 weeks. Conclusion:?In normal singleton pregnancy the percentage of fetal erythroblasts enriched from maternal blood decreases withgestation.     

Synchronized ventilation of very-low-birth-weight infants; report of 6 years' experience

Objectives: To evaluate the effects of long-term patient triggered ventilation (PTV) using assist/control or synchronized intermittent mandatory ventilation (SIMV) in very-low-birth-weight infants with respiratory distress.

Methods: Ninety-seven very-low-birth-weight infants who had undergone synchronized ventilation for respiratory distress or insufficiency were assessed from January 1995 to December 2000. Death, oxygen support, pneumothorax development while ventilated, intracranial hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, retinopathy of prematurity and duration of ventilation were noted as the mean outcome measures.

Results: The mean birth weight was 1139?±?268?g (range 450–1500?g) and the mean gestational age was 29.0?±?2.8 weeks (range 23–36 weeks). Eighty-four per cent of 97 infants survived. Antenatal steroids were administered to only 20% of mothers. Surfactant was administered to all of the 67% of infants with respiratory distress syndrome. The mean duration of ventilator support was 4.7?±?7.3 days (1–43 days) for survivors and 8.9?±?11 days (1–45 days) for infants who died. No respiratory paralysis was necessary in any case during ventilation and pneumothorax was diagnosed in only eight infants. Severe intracranial hemorrhage (grade ??III) and periventricular leukomalacia developed in 15% and 12% of infants, respectively. Necrotizing enterocolitis (Bell's classification stage ??2) and retinopathy of prematurity were noted in two infants. Four infants had evidence of chronic lung disease. The rate of survival without major morbidity was 83.5%.

Conclusion: Patient-triggered ventilation, initially PTV with Asist/Control and subsequently with SIMV in very-low-birth-weight infants with respiratory distress is feasible, but optimization of trigger and ventilator performance with respect to respiratory diagnosis is essential.     

Influence of gestational age and fetal heart rate on the fetal mechanical PR interval

Objective: The fetal mechanical PR interval obtained via pulsed Doppler has previously been demonstrated to correlate with electrocardiographic PR interval measured in the neonate. We sought to further analyze the influence of fetal heart rate and gestational age upon the fetal mechanical PR interval.

Methods: We searched our database for mechanical PR intervals, which were obtained during fetal echocardiography performed in our antenatal diagnostic unit. We included fetuses with a normal cardiac structural survey. The mechanical PR interval is measured from the A wave of the mitral valve to the beginning of ventricular systole corresponding to the opening of the aortic valve. Linear regression curves were generated to examine the correlation of mechanical PR interval with gestational age and fetal heart rate. Analysis of variance was used to compare the mean variation across three gestational age groups: 17–21.9 weeks (n?=?24), 22–25.9 weeks (n?=?52) and 26–38 weeks (n?=?20).

Results: Mechanical PR intervals were measured in 96 fetuses with normal fetal echocardiography. The mechanical PR interval was 123.9?±?10.3?ms (mean?±?SD), with a range of 90–150?ms. Linear regression curves correlating mechanical PR interval with fetal heart rate and gestational age demonstrated a flat slope with R²?=?0.016, p?=?0.22 and R²?=?0.0004, p?=?0.85, respectively. The mechanical PR interval measured over the three gestational ages was as follows (mean?±?SD): 122.3?±?10.5?ms for 17–21.9 weeks; 125.0?±?9.6?ms for 22–25.9 weeks; and 123.1?±?11.9?ms for 26–38 weeks. Analysis of variance revealed no difference among the mechanical PR interval means measured over the three gestational age groups (p?=?0.53).

Conclusions: Fetal mechanical PR interval ranges from 90 to 150?ms in fetuses with sonographically normal fetal cardiac structure and rate. The mechanical PR interval appears to be independent of gestational age and fetal heart rate.     

Risk factors for intrapair birth weight discordance in twins

Objectives: To determine the risk factors for birth weight discordance in twins. Methods: We used the United States (1995-97) Matched Multiple Birth File (n = 294 568) to assess the association between birth weight discordance and maternal sociodemographic, pregnancy and infant characteristics. Results: Eighty-four per cent of the twins were 0-19% discordant, 11.1% were 20-29% discordant, 3.4% were 30-39% discordant, and 1.8% were ≥ 40% discordant. The risk factors for birth weight discordance for same-sex twins were eclampsia (odds ratio (OR) 1.39, 95% confidence interval (CI) 1.20, 1.61), pre-eclampsia (OR 1.31, 95% CI 1.24, 1.38), pre-existing hypertension (OR 1.32, 95% CI 1.12, 1.56), diabetes (OR 1.13, 95% CI 1.04, 1.24) and certain congenital anomalies. For opposite-sex twins, the risk factors for birth weight discordance were pre-eclampsia (OR 1.17, 95% CI 1.09, 1.27), pre-existing hypertension (OR 1.59, 95% CI 1.32, 1.91), and certain congenital anomalies. Also, smoking and increased maternal age were associated with birth weight discordance in both same-sex and opposite-sex twins. Conclusions: Maternal hypertensive disorders, smoking and delayed childbearing were associated with intrapair birth weight discordance. The mechanisms of these associations deserve further investigation.     

Birth weight, gestational age and medications during pregnancy

Objective: To determine the effect of medication on birth weight and gestational age in 29 004 healthy newborn infants born to mothers with or without treatment of drugs. Method: Birth weight and gestational age were evaluated in healthy control newborn infants in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities (1980–1991) using multiple regression analysis. Results: Of 114 drugs used in more than 100 pregnant women, 19 had a positive or negative impact. Conclusions: Further studies should be carried out to identify the possible mechanisms of medication and/or the maternal disorder for which this medication was given.     

Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index

Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM’s recommended GWG, overweight (OR 1.99; 95%CI 1.17–3.37) or obese (OR 2.64; 95% CI 1.59–4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09–3.92), as was parity (OR 1.49; 95% CI 1.22–1.82). Smoking (OR 0.53; 95%CI 0.35–0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60–4.95) or obese (OR 6.71; 95% CI 4.83–9.31). Conclusion: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman’s chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.     

Birth weight and gestational age of newborns from Wielkopolski and Lubuski regions

OBJECTIVES: The correlation between the gestational age and the birth body weight are among others the basis of the estimation of newborn's maturity. Because of the acceleration of development and the decrease in the gestational age and birth body weight regarded as a limitation to newborn's survivalship there is a necessity of bringing up to date the existing reference systems. DESIGN: The main goal of this work is to modernize the reference system of birth body weight in relation to gestational age. MATERIALS AND METHODS: The data of the birth body weight of 48,443 (25,225 boys and 23,218 girls) newborn, singleton children with a gestational age of 24-43 weeks were examined. Data was collected in 2001 and 2002 in Wielkopolski and Lubuski region. Values of the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile were calculated. The analysis was carried out separately for both sexes. Additionally, because of lack of dimorphic differences until the 33rd week of gestation, percentile values were calculated for both sexes together in the partition of 24 to 33 weeks of gestation. CONCLUSIONS: In comparison to previous reference systems, the obtained results showed a tendency for the birth body weight to increase.     

Perinatal outcomes in inflammatory bowel disease

Objective: To determine whether inflammatory bowel disease (IBD) is associated with increased risk for adverse perinatal outcome.

Methods: A case–control study of 116 singleton pregnancies with IBD compared to 56?398 singleton controls delivered between 1986 and 2001.

Results: Patients with IBD were slightly older (32.8 vs. 30.6 years, p <?0.001), more likely to be Caucasian or Asian than Black or Latino (92% vs. 57%, p <?0.001) and have private health insurance (33% vs. 3%, p <?0.001). IBD was associated with an increased risk for labor induction (32% vs. 24%, p?=?0.002), chorioamnionitis (7% vs. 3%, p?=?0.04) and Cesarean section (32% vs. 22%, p?=?0.007), but there were no differences in neonatal outcomes. Subgroup analysis demonstrated an increased risk for low birth weight (LBW) in the ulcerative colitis group vs. the Crohn's disease group (19% vs. 0%, p?=?0.002). Patients with prior surgery for IBD had a lower incidence of LBW (0% vs. 12%, p?=?0.03). Flares during pregnancy were associated with an increased risk for preterm delivery (27% vs. 8%, p?=?0.02) and LBW (32% vs. 3%, p?=?0.003).

Conclusion: IBD was an independent risk factor for Cesarean section but there was no increase in adverse perinatal outcome. Crohn's disease, prior IBD surgery and quiescent disease were associated with a lower risk for LBW.     

Birth weight for gestational age of Mexican American infants born in the United States.

OBJECTIVE: To develop a reference for birth weight for gestational age to identify Mexican American infants born in the United States who are small or large for gestational age. METHODS: Reference percentiles were developed for Mexican American and non-Hispanic white births, using national vital statistics from 1992-1994 for Mexican Americans (n = 1,197,916) and 1994 for non-Hispanic whites (n = 2,238,457). Birth weights and gestation from the last menstrual period were taken from birth certificates. Smoothed curves were fit, using unweighted fourth-degree polynomial equations, for the tenth, 50th, and 90th percentiles by gender and parity. RESULTS: Mexican American infants were heavier than non-Hispanic white infants between 30 and 37 weeks' gestation for all parities and both genders. However, at term there was consistent crossover. Non-Hispanic white infants were heavier at or after 37 through 42 weeks' gestation, whereas the growth of Mexican American infants appeared to slow. Beginning at 37 weeks, the differences in weights of infants of primiparas increased to more than 100 g by 40 weeks; the differences were only slightly less for infants of multiparas. CONCLUSION: Given differences in distribution of birth weights for gestational age between Mexican Americans and non-Hispanic whites, the ability to recognize fetal growth restriction (FGR) or excessive growth is questionable. These data provide a reference for Mexican Americans for clinical use and for future studies in identifying infants at risk for FGR or overgrowth.     

A planned randomized clinical trial of treatment for mild gestational diabetes mellitus

Objective: A planned study is described which will determine whether a benefit exists for the treatment of mild carbohydrate intolerance during pregnancy. Methods: A randomized clinical trial of women with mild gestational diabetes will compare perinatal outcomes in those receiving diet therapy and insulin as required versus those randomized to no specific treatment. Results: The primary outcome of this study will be a composite of neonatal morbidity in the treatment and control groups. Conclusions: A randomized treatment trial of mild gestational diabetes mellitus will clarify whether identification and treatment of mild gestational diabetes mellitus reduces perinatal morbidity. This information will aid in selecting appropriate thresholds for the treatment of gestational diabetes mellitus.     

Birth weight by gestational age in twin pregnancies: analysis of 661 pairs.

The mortality of twin infants is four to five times higher than that of singletons, and one-half to two-thirds of all twins weigh < 2,500 g at birth. The appropriate interpretation of fetal growth throughout pregnancy is dependent upon the availability of adequate standards. We reviewed 661 pairs of live twin infants born at Chang Gung Memorial Hospital from 1979 to 1990. The frequency of twin births was 1.17% (1:86), and the ratio of males to females was 1.03. The frequency of preterm births (< 37 weeks) was 36.9%, the frequency of low birth weight (< 2,500 g) was 47.9% and very low birth weight (< 1,500 g) was 6.7%. A fetus grows most rapidly from the 32nd to the 35th week of gestation (200 g per week). The growth was 145 g per week from the 28th to the 32nd week and from the 35th to the 38th week of gestation. After the 38th week, the mean birth weight increased by only 35 g per week. Compared with a singleton birth, the mean birth weight of twins was about 100 g lighter during the 28th to the 32nd week, then the difference increased gradually to about 500 g at term.     

Meconium mineral content in small for gestational age neonates

The mineral concentration of meconia of small for gestational age (SGA) newborns were compared with those of appropriate for gestational age (AGA) newborns of similar gestational ages (GA) to determine whether differences may provide clues of possible nutritional deficits of SGA infants, given that levels of meconium minerals could indicate the use of minerals by the fetus and the sufficiency of the maternal supply of minerals. Twenty-one SGA and 24 AGA newborns were included. Eleven SGA and 15 AGA were < or = 35 weeks GA. Ten SGA and nine AGA infants were > or = 36 weeks GA. All meconia from each neonate was processed and assayed for iron, zinc, copper, manganese, calcium, magnesium, and phosphorus. In the < or = 35-week subgroups, the SGA infants had lower meconium iron and manganese concentrations than that of the AGA. Among > or = 36-week newborns, SGA infants had a higher birthweight-adjusted copper concentration than AGA infants, but no differences were observed for the remaining elements. Lower iron and manganese meconium in < or = 35-week SGA infants may reflect either a greater use or a decreased maternal supply. The higher birthweight-adjusted meconium copper in the > or = 36-week SGA infants may be due to a comparatively reduced fetal use or increased maternal supply. These data may assist in clarifying potential mechanisms affecting intrauterine growth and/or potential nutrient deficits in the neonatal period.     

Pregnancy-induced hypertension and infant mortality: Roles of birthweight centiles and gestational age

OBJECTIVE: To assess the effect of pregnancy-induced hypertension (PIH) on infant mortality in different birthweight centiles (small for gestational age [SGA], appropriate for gestational age [AGA], and large for gestational age [LGA]) and gestational ages (early preterm, late preterm, and full term). DESIGN: Retrospective cohort study. SETTING: Linked birth and infant death data set of USA between 1995 and 2000. POPULATION: A total of 17 464 560 eligible liveborn singleton births delivered after 20th gestational week. METHODS: Multivariate logistic regression models were applied to evaluate the association between PIH and infant mortality, with adjustment of potential confounders stratified by birthweight centiles and gestational age. MAIN OUTCOME MEASURE: Infant death (0-364 days) and its three components: early neonatal death (0-6 days), late neonatal death (7-27 days), and postneonatal death (28-364 days). RESULTS: PIH was associated with decreased risks of infant mortality, early neonatal mortality, and late neonatal mortality in both preterm and term SGA births, and PIH was associated with lower postneonatal mortality in preterm SGA births. PIH was associated with decreased risks of infant mortality, early neonatal mortality, late neonatal mortality and postneonatal mortality in preterm AGA births. Decreased risk of infant mortality and early neonatal mortality was associated with PIH in early preterm LGA births. CONCLUSIONS: The association between PIH and infant mortality varies depending on different birthweight centiles, gestational age, and age at death. PIH is associated with a decreased risk of infant mortality in SGA births, preterm AGA births, and early preterm LGA births.     

Risk factors associated with severely small for gestational age neonates

Risk factors were studied in 118 severely small for gestational age (SGA) infants. The control infants were matched for gestational age and mode of delivery. A low maternal prepregnancy weight and a maternal history of a previous SGA infant were the most important prepregnancy risk factors, whereas poor weight gain during pregnancy, toxemia, and smoking were the most important pregnancy-related risk factors associated with severely SGA infants. The two groups were similar for primiparity, previous abortions, and placental abnormalities in mothers and for parental ages and heights. Thirty percent of SGA infants were diagnosed antenatally. Most of the risk factors cannot be avoided, but the effects of these risk factors on the fetus and neonate can be minimized by careful screening and observation of mothers with these risk factors.