Meconium-stained amniotic fluid – risk factors and immediate perinatal outcomes among SGA infants

Objective: To detect factors that are associated with meconium-stained amniotic fluid (MSAF) among deliveries of small for gestational age (SGA) neonates and to identify perinatal outcomes of deliveries of SGA infants complicated with MSAF.

Methods: A population-based study comparing deliveries of SGA neonates with and without MSAF was conducted. Deliveries occurred during the years 1988–2007 at the Soroka University Medical Center. Risk factors for MSAF among SGA infants were evaluated. Incidence of adverse pregnancy outcomes were compared between deliveries of SGA neonates with and without MSAF.

Results: During the study period 9583 deliveries were of SGA neonates. Of these, 16.6% (n?=?1597) were complicated with MSAF. Among SGA neonates, older maternal age, multiparty, lack of prenatal care and weight were significantly associated with MSAF. Having delivered an SGA infant with MSAF was associated with decreased rates of induction of labor and increased rates of labor dystocia, delivery by cesarean section and fetal distress. Using multivariable regression models, having delivered an SGA infant with MSAF was independently associated with fetal distress.

Conclusion: Among SGA neonates, deliveries complicated with MSAF are associated with additional adverse pregnancy outcomes.     

Perinatal outcome of pregnancies complicated with extreme birth weights at term

Objective: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA,??95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA).

Methods: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders.

Results: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n?=?207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5–6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0–2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9–17.0, and aOR 1.7, 95%CI 1.2–2.6, respectively).

Conclusions: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality.     

Does being born small-for-gestational-age affect cerebellar size in neonates?

Objective: To investigate how cerebellar vermis height (CVH) and transverse cerebellar diameter (TCD) measurements are affected in SGA neonates.

Methods: A total of 176 [88 SGA and 88 appropriate for gestational age (AGA)] neonates between 26 and 42 weeks of gestation were included. Midsagittal plane through the anterior fontanel and coronal plane through the left mastoid fontanel were used to measure CVH and TCD, respectively. CVH and TCD values were considered normal when they were ≥?10th percentile, according to nomograms of AGA neonates.

Results: Thirty-six asymmetric SGA neonates, 52 symmetric SGA neonates and their 88 gestational age-matched AGA controls were studied. The percentages of neonates with normal CVH and TCD in the symmetric SGA sub-group were significantly lower than those in the AGA and asymmetric SGA sub-groups. The percentages with normal CVH and TCD in the asymmetric SGA sub-group were also found to be low when compared with the AGA sub-group.

Conclusion: Growth and development of cerebellum may be less spared in SGA neonates. Further studies with larger series are needed in order to evaluate how being born SGA (symmetric and asymmetric) affects cerebellar size and also to see how these findings influence the neurocognitive outcomes of these infants at long-term follow-up.     

Adverse perinatal outcome and maternal risk factors in population versus customized defined SGA babies

Objective.?The purpose of this study was to compare population and customized-based birth weight centiles in their association with perinatal outcome and maternal risk factors, in nulliparous Caucasian women in a socio-economic disadvantaged region.

Methods.?We analyzed perinatal outcomes in births of 302 Caucasian women of which 155 were small for gestational age (SGA) and 147 were appropriate for gestational age (AGA). Out of the overall study group, two cohort studies were designed. One was classified by population centiles as either SGA (n= 133) or AGA (n?= 169) and the other was classified by customized centiles as either SGA (n?= 131) or AGA (n?= 172). Maternal risk factors and operative delivery rates for fetal distress, Apgar scores, need for resuscitation and neonatal nursery care given, were determined for both customized and population-based SGA babies.

Results.?The customized SGA only group showed more mental health problems and special nursery in comparison with the AGA group. The population SGA only group had more smoking and mental health problems than the AGA group, but no differences on neonatal outcome measures.

Conclusion.?Use of customized centiles does identify an additional group neonates with a significantly higher need for special nursery admission in a homogeneous ethnic Caucasian group.     

Pregnancy outcome and placental pathology in small for gestational age neonates in relation to the severity of their growth restriction

Purpose: To investigate neonatal outcome and placental pathology in pregnancies complicated with small for gestational age neonates (SGA), in relation to the severity of growth restriction.

Methods: The medical records and placental histology reports of all neonates with a birth-weight (BW) ≤10th percentile, born between 24–42 weeks, during 2010–2015, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions. Results were compared between neonates with BW <5th percentile (severe SGA group), neonates with BW between 5th–10th percentile (mild SGA group) and a control group of appropriate for gestational age (AGA) neonates. Composite neonatal outcome was defined as one or more of early complications.

Results: Overall, 753 neonates were included, 238 in the severe SGA group, 266 in the mild SGA group, and 249 in the control group. The severe SGA group had higher rates of composite adverse neonatal outcome as compared with the mild SGA and control groups (37.2 versus 17.6%, versus 24.5%, respectively, p?p?Conclusions: Worse neonatal outcome and more placental MVM and FVM lesions correlate with the severity of neonatal growth restriction in a “dose-dependent” manner.     

The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity*

Introduction: An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies.

Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analysis was limited to births between 34 and 42?weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGA_pop) and another using obese pregnancies (SGA_cust). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation?>6?h.

Results: Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGA_pop, and 1.21 [0.54, 2.74] for SGA_cust-pop. The risks for the following neonatal complications were slightly higher for SGA_cust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGA_pop.

Conclusions: Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.     

Does small for gestational age worsen outcomes in gestational diabetics?*

Objective: Our goal was to determine whether pregnancy outcomes are worse in gestational diabetics with small for gestational age (SGA) than those without.

Methods: This was a retrospective cohort study of 114 199 pregnancies with gestational diabetes mellitus (GDM) in California, 6446 of which were complicated by SGA. SGA was defined as birth weight Results: In the term 37?+?0 to 41?+?6 week GDM cohort the risk of RDS increased from 0.4% to 1.3%, the risk of neonatal demise from 0.02% to 0.09%, the risk of IUFD from 0.1% to 0.4%, the risk of hypoglycemia from 0.4% to 1.0% and the risk of jaundice from 18.0% to 23.3% (p?Conclusions: The presence of SGA in a patient with gestational diabetes is associated with significantly increased risks of adverse outcomes compared to gestational diabetics without SGA including increased risks of RDS, neonatal demise, IUFD, hypoglycemia and jaundice.     

Composite neonatal and maternal morbidities with small- versus appropriate- for gestational age among uncomplicated obese women undergoing repeat cesarean delivery*

Purpose: Our goal was to compare composite neonatal and maternal morbidities (composite neonatal morbidity (CNM), composite maternal morbidity (CMM)) among deliveries with small for age (SGA) versus appropriate for gestational age (AGA; birthweight 10–89%) among obese versus non-obese women undergoing repeat cesarean delivery (CD).

Study design: This is a secondary analysis of a prospective observational study. Women who had elective CD ≥37 weeks were studied. We excluded multiple gestations, fetal anomalies,?>?1 prior CD, and medical diseases. Patients were divided into BMI ≥30 versus <30?kg/m². CNM included respiratory distress syndrome, necrotizing enterocolitis, severe intraventricular hemorrhage, seizure, or death; CMM included transfusion, hysterectomy, operative injury, coagulopathy, thromboembolism, pulmonary edema, or death. Multivariate logistic regression was used to control for confounding factors.

Results: Of 7561 women, we included 65% were obese and 35% were not. SGA rates differed significantly: 8 versus 12% (p?Conclusions: SGA occurred in 8% of low-risk obese women with prior CD. CNM of SGA babies in obese versus non-obese women were similar. Paradoxically, CMM was lower in obese cases, possibly reflecting the caution that obese patients receive preoperatively. Our findings may assist in counseling patients and designing trials.     

Study of Association of Fetal Cerebroplacental Ratio with Adverse Perinatal Outcome in Uncomplicated Term AGA Pregnancies

BackgroundThe cerebroplacental ratio (CPR) is emerging as a predictor for adverse perinatal outcome in term pregnancies. Earlier, it has shown a role in small for gestational age (SGA) pregnancies, but a proportion of appropriate for gestational age foetuses (AGA) despite of good size have impaired growth velocity and are thereby at risk of adverse outcome. CPR has implication for assessment of well being of SGA and AGA foetuses close to term.ObjectiveTo investigate the association between foetal CPR and adverse perinatal outcome in uncomplicated term AGA pregnancies.MethodsThis was a prospective observational study done in Department of Obstetric and Gynaecology, King George Medical University, Lucknow, over a period of one year. Women > 37 week singleton pregnancy with no known risk factor who had Doppler USG done within a week of delivery were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. These patients were followed up till delivery to look for various perinatal outcomes. Results Out of 127 low-risk AGA pregnancies who went for USG colour Doppler scan, 117 patients who met our inclusion criteria were analysed; out of 117 patients 23(i.e. 19.65 %) were having CPR < 1 and 94 patients (i.e. 80.34%) were having CPR>1. Among 23 patients with CPR < 1, 22 (91.30%) had adverse outcome as compared to only 20.21% patients with CPR > 1, and this is found to be statistically significant (p < 0.001).ConclusionOur study found CPR measure to be a very promising tool for optimising the identification of at risk foetus in low-risk AGA pregnancies.     

Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity

Objective The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality.Methods The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications.Results The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; CI 12.6–33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48–11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81–4.07), chronic hypertension (OR 2.45; 95% CI 1.02–5.9), congenital malformations (OR 1.93; 95% CI 1.14–3.24) and SGA (OR 1.47; 95% CI 1.07–2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% CI 47.27–825.27), GDM Class B–R (OR 21.22; 95% CI 2.34–192.25), GDM class A (OR 4.64; 95% CI 2.62–8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35–25.42), hydramnios (OR 1.95; 95% CI 1.3–2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12–3.02) and malpresentation (OR 1.56; 95% CI 1.32–1.84).Conclusion The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.     

Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks’ gestation are associated with adverse perinatal outcomes

Objective: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone.

Methods: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD).

Results: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p?p?p?p?p?p?p?=?0.015), and IUFD (1.5% versus 0.3%, p?Conclusions: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates.     

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.     

Ultrasound estimation of fetal weight in small for gestational age pregnancies

Objective.?Approximately half of small for gestational age (SGA) cases are due to maternal or fetal pathology, and may result in significant neonatal morbidity and mortality. The estimated fetal weight (EFW) measurement is the cornerstone of ultrasonographic findings when diagnosing and managing SGA pregnancies. Our objective was to determine the ultrasound accuracy of EFW in SGA pregnancies.

Methods.?A retrospective chart review was performed of all pregnancies complicated by SGA from a single institution (Stanford University) over a 2-year-period (2004–2006). SGA was defined as EFW?≤?10%. 98 neonates whose last ultrasound for EFW occurred within 7 days of delivery were included in the study. The absolute differences between the EFW and birthweight (BW) were analyzed, and the absolute percent errors were calculated as (EFW???BW)/BW?× 100. The mean absolute differences and mean absolute percent errors were analyzed across all gestational ages (GA) and EFWs using one-way analysis of variance.

Results.?The mean absolute percent error for the entire cohort was 8.7% (±6.3%). There was no statistically significant difference in the mean absolute percent error across all GAs (<32 weeks, 32–36 weeks, >36 weeks), and EFWs (<1500?g, 1500–2000?g, >2000?g).

Conclusion.?Ultrasound measurement of EFW in SGA pregnancies is consistent across all GAs and EFW measurements.     

Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants

Objective: To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia.

Method: Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis.

Results: Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR]?=?1.61), gestational age (OR?=?0.68), gestational diabetes (OR?=?0.22), macrosomia (OR?=?4.87), small for gestational age neonate [SGA] (OR?=?6.83) and admission cervical dilation (OR?=?0.79). For intrapartum factors, only cesarean section (OR?=?1.57) and last cervical dilation (OR?=?0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR?=?4.18), gentamycin/clindamycin in labor (OR?=?5.35), gestational age (OR?=?0.59) and macrosomia (OR?=?5.62).

Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions.

Conclusion: Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.     

Brain growth in preterm infants is affected by the degree of growth restriction at birth

Abstract

Objective: Documentation of examination of brain structural development by magnetic resonance imaging (MRI) beyond the neonatal period is scarce for both preterm and small for gestational age (SGA) infants.

Aim: To investigate structural brain development during infancy in preterm children born SGA by MRI.

Methods: A total of 205 preterm infants, 139 appropriate for gestational age (AGA) and 66 SGA, of which 33 had birth weight (BW)?<?3rd percentile and 33 had BW 3rd–10th percentile, were examined prospectively by brain MRI at the corrected age of 5 months. The total volume of the brain, ventricles and cerebellum, the area of vermis and corpus callosum, and the height of the pituitary, mesencephalon and pons were estimated on MRI.

Results: Brain volume was smaller in the SGA?<?3rd percentile infants, independent of other perinatal factors. Chronic lung disease was an independent predictor of low brain volume. Pituitary height was greater in SGA?<?3rd percentile than in AGA infants. The corpus callosum area was less in SGA?<?3rd percentile than in SGA of 3rd–10th percentile infants.

Conclusions: Preterm infants born SGA with BW?<?3rd percentile had differences in brain structural measurements at the corrected age of 5 months, compared with preterm AGA infants, which could have implications for their neurocognitive development.     

Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes?

Objective: To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).

Study design: A cohort of patients with twin pregnancies and GDM were identified from one maternal–fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded. First, outcomes were compared between patients with GDMA1 and GDMA2 (gestational age at delivery, birthweight, small for gestational age (SGA, birthweight <10th percentile), preeclampsia, and cesarean delivery). Then, finger stick glucose logs were reviewed and correlated with the risk of SGA and preeclampsia. Abnormal finger stick values were defined as: fasting ≥90?mg/dL, 1-h postprandial ≥140?mg/dL, 2-h postprandial ≥120?mg/dL.

Results: Sixty-six patients with twin pregnancies and GDM were identified (incidence 9.1%). Comparing the 43 patients with GDMA1 to the 23 patients with GDMA2, outcomes were similar, aside from patients with GDMA1 having lower birthweight of the smaller twin (2184?±?519?g versus 2438?±?428?g, p?=?0.040). The risk of preeclampsia was not associated with glycemic control. Patients with SGA had lower mean fasting values (83.3?±?5.5 versus 87.2?±?7.7?mg/dL, p?=?0.033), and a lower percentage of abnormal fasting values (24.0% versus 36.9%, p?=?0.040), abnormal post-breakfast values (9.9% versus 27.1%, p?=?0.003), and total abnormal values (20.1% versus 27.7%, p?=?0.055).

Conclusion: In twin pregnancies with GDM, improved glycemic control is not associated with improved outcomes, and is associated with a higher risk of SGA. Prospective trials in twin pregnancies should be performed to establish goals for glycemic control in twin pregnancies.     

Maternal and neonatal circulating visfatin concentrations in patients with pre-eclampsia and a small-for-gestational age neonate

Objective.?Maternal circulating visfatin concentrations are higher in patients with a small-for-gestational-age (SGA) neonate than in those who delivered an appropriate-for-gestational age (AGA) neonate or in those with pre-eclampsia. It has been proposed that enhanced transfer of visfatin from the foetal to maternal circulation may account for the high concentrations of maternal visfatin observed in patients with an SGA neonate. The aims of this study were: (1) to determine whether cord blood visfatin concentrations differ between normal neonates, SGA neonates and newborns of pre-eclamptic mothers; and (2) to assess the relationship between maternal and foetal circulating visfatin concentrations in patients with an SGA neonate and those with pre-eclampsia.

Study design.?This cross-sectional study included 88 pregnant women and their neonates, as well as 22 preterm neonates in the following groups: (1) 44 normal pregnant women at term and their AGA neonates; (2) 22 normotensive pregnant women and their SGA neonates; (3) 22 women with pre-eclampsia and their neonates; and (4) 22 preterm neonates delivered following spontaneous preterm labour without funisitis or histologic chorioamnionitis, matched for gestational age with infants of pre-eclamptic mothers. Maternal plasma and cord blood visfatin concentrations were determined by ELISA. Non-parametric statistics were used for analyses.

Results.?(1) The median visfatin concentration was lower in umbilical cord blood than in maternal circulation, in normal pregnancy, SGA and pre-eclampsia groups (p?<?0.001 for all comparisons); (2) the median cord blood visfatin concentrations did not differ significantly between term AGA or SGA neonates, infants of mothers with pre-eclampsia and their gestational-age-matched preterm AGA neonates; (3) maternal and cord blood visfatin concentrations correlated only in the normal term group (r?=?0.48, p?=?0.04).

Conclusion.?Circulating visfatin concentrations are lower in the foetal than in the maternal circulation and did not significantly differ between the study groups. Thus, it is unlikely that the foetal circulation is the source of the high maternal visfatin concentrations reported in patients with an SGA neonate.     

Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management

111 pregnancies complicated with premature rupture of the membranes (PROM) at a gestational age between 20 and 34 weeks, were observed prospectively with expectant management. Median duration of the latency period was 7 (0–109) days. The duration of the latency period was inversely related to the gestational age at PROM. Intra-uterine death ensued in 9.9% of the pregnancies. Clinical chorioamnionitis ensued in 12.6% of the pregnancies. Eight (7.6%) neonates developed sepsis. None of the babies died as a consequence of sepsis alone. Of the 43 (41.0%) neonates who developed idiopathic respiratory distress syndrome (IRDS), 8 (7.6%) babies died. The perinatal mortality rate was 18.6%. The study seems to justify the expectant management of PROM pregnancies of less than 34 weeks of gestation.     

Umbilical cord asymmetric dimethylarginine levels and ultrasound assessment of carotid arteries in neonates born small for gestational age

Background: To examine asymmetric dimethylarginine (ADMA) level as an endothelial function parameter in addition to ultrasonographic evaluation of carotid arteries in babies born small for gestational age (SGA).

Methods: Twenty-six neonates born SGA and 34 appropriate for gestational age (AGA) controls were included in the study. The serum levels of ADMA were measured. Intima-media thickness (cIMT) and resistive index (cRI) of the both carotid arteries were determined by ultrasonography.

Results: The mean ADMA level was higher in SGA neonates compared to AGAs (16 267.7?±?6050 versus 12 810.2?±?3302?ng/L; p?=?0.01). The mean cIMT (0.34?±?0.02 versus 0.31?±?0.03?mm; p?=?0.001) and cRI (0.66?±?0.07 versus 0.61?±?0.04, p?=?0.003) were also higher in SGAs. Serum ADMA levels were positively correlated to the mean cIMT (r?=?0.41, p?=?0.001). Although there was a weak correlation between cIMT and mean cRI (r?=?0.26, p?=?0.04), no correlation was found between ADMA and mean cRI (r?=?0.17, p?=?0.18).

Conclusions: Neonates born SGA have elevated cord blood ADMA level in addition to thicker IMT and higher RI of carotid arteries at birth. ADMA was correlated to cIMT, suggesting that higher ADMA levels might influence vascular health in later life in these neonates.     

Induction of labor for term small-for-gestational-age fetuses: what are the consequences?

Objective

To evaluate whether early term labor induction for suspected intrauterine growth restriction (weeks 37–39) improves neonatal outcome for small-for-gestational-age (SGA) neonates.

Study design

Delivery room data for 2004–2008 from a single tertiary medical center were linked to neonatal discharge data from the same institution. Data were limited to all singleton, liveborn SGA neonates born at 37–42 weeks of gestation and their mothers. Births with known congenital anomalies were excluded. Women undergoing induction of labor for suspected growth restriction between 37 and 39 weeks’ gestation (early induction SGA) were compared with women who gave birth to term SGA neonates without early induction. SGA (<10th percentile for gestational age and gender) was used as a surrogate for intrauterine growth restriction. Associations between early term labor induction and neonatal morbidities were estimated using logistic regression.

Results

A total of 2378 SGA neonates meeting study criteria were identified. Of these, 445 underwent early term induction and 1933 were in the non-early induction SGA group. Intrauterine demise among term (37–42 weeks) SGAs occurred in one case at 37 weeks. Early term induction for SGA was associated with an increased risk of cesarean delivery. Several neonatal complications, including hyperbilirubinemia, hypoglycemia and respiratory complications were more prevalent in the early induction SGA group. The increased odds for neonatal complications persisted after controlling for possible confounders.

Conclusions

Early term induction for SGA fetuses results in an increased risk of cesarean deliveries as well as neonatal metabolic and respiratory complications, with no apparent neonatal benefit.