Is there a correlation between birth weights and first-trimester crown-rump length growth velocity?

Objective: To test the hypothesis that small- or large-for-gestational-age (SGA or LGA) newborns have anomalous crown-rump length (CRL) growth rates in the first trimester. Methods: Prospective observational study. Women in the first trimester presenting to the Early Pregnancy Unit, between November 2006 and December 2010, underwent transvaginal scan. Women with viable singleton pregnancies in the first trimester who had at least two CRL measurements > 5 mm, recorded at least 2 weeks apart, and also had birth weight data available were included in the final analysis. Birth weight percentiles were calculated and adjusted for gestational age and gender. SGA was equivalent to < 10th centile and LGA was equivalent to > 90th centile. Correlation analysis was performed between birthweight percentiles and first-trimester CRL growth-rate coefficients. In addition, we estimated early fetal growth rates (EFGR) by calculating the Δ CRL/Δ time (mm/day) to see if these differed according to the birth-weight percentiles. Results: A total of 107 women had complete data. The mean maternal characteristics were age 27.5 ± 6 years, weight 87 ± 29 kg and height 163 ± 8 cm. The mean birth weight and gestational age at delivery were 3405 g (SD = 597) and 269 days (SD = 13), respectively. The proportions of SGA and LGA were 7.5% and 18.7%, respectively. There were no significant correlations between birth-weight percentiles and any of the CRL growth rates. There were also no significant differences in the mean CRL velocities when comparing the SGA and LGA newborns birth weights. EFGR for SGA and LGA newborns were 1.34 mm/day (SD = 0.17) and 1.32 mm/day (SD = 0.24), respectively (p > 0.05). Conclusions: Newborns who are found to be SGA or LGA at delivery do not appear to have anomalous CRL growth patterns in the first trimester. The EFGR also did not correlate with birth-weight percentiles.     

The relationship between serum visfatin,adiponectin, and insulin sensitivity markers in neonates after birth

Aim.?The aim of this study was to assess the adiponectin and visfatin concentrations in small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) newborns and their mothers. Sixty parturients giving birth to 20 term AGA singleton infants, 20 term singleton SGA infants, and 20 term singleton LGA infants were included into the study.

Results.?Mean visfatin levels were found significantly higher in the SGA (p?<?0.001) and LGA (p?<?0.001) groups, and adiponectin levels were found significantly lower in the SGA group (p?<?0.001) when compared with the AGA group. The SGA and LGA groups had higher insulin concentrations and HOMA-IR in comparison with the AGA group. The visfatin, glucose levels, and HOMA-IR (p?<?0.001, p?<?0.001, and p: 0.002, respectively) were higher in the LGA group than SGA group.

Conclusion.?We found significantly higher insulin and visfatin levels in LGA neonates and lower adiponectin levels in SGA neonates. We concluded that the relationship between adiponectin and visfatin and insulin sensitivity (metabolic disturbances) is very complex with little evidence of correlation in SGA and LGA neonates.     

The association between birth weight at term and long-term endocrine morbidity of the offspring*

Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity.

Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders.

Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n?=?11,062), 91% were AGA (n?=?214,249), and 4.3% were LGA neonates (n?=?10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR?=?1.4; 95%CI?=?1.1–1.8; p?=?.015 and aOR?=?1.4; 95%CI?=?1.1–1.8; p?=?.005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR?=?1.7; 95%CI?=?1.2–2.5; p?=?.001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR?=?3.2; 95%CI?=?1.8–5.8; p?=?.001).

Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.     

Clinical significance of low result of 1-h 50-g glucose-challenge test in pregnant women

Objective: The objective of this study is to examine the effect of low-glucose value on the 1-h 50-g glucose challenge test (GCT) on neonatal body weight in low-risk Asian singleton pregnant women.

Method: We retrospectively analyzed women who delivered a singleton neonate at term at a tertiary center and underwent GCT at 24–28 weeks of gestation between June 2001 and June 2015. The low GCT group was defined as <75?mg/dL and 75–139?mg/dL were control. We compared these two groups of maternal characteristics, small for gestational age neonate (SGA), large for gestational age neonate (LGA), low-birth weight, and macrosomia. The χ² test, Fisher’s exact test, and Student’s t test were used.

Results: There were 313 low GCT groups and 4611 control. The low GCT group were younger, had lower prepregnancy body weight, higher stature, and lower prepregnancy body mass index (BMI). After adjusting these variables, the low GCT group had a lower rate of LGA and a higher rate of SGA. Neonatal body weight is more influenced by maternal physique than by low GCT result (standardized coefficient (β); GCT 0.071, height 0.188, prepregnancy BMI 0.143).

Conclusions: Neonatal body weight was only slightly influenced by low GCT result, but markedly influenced by maternal physique, such as height and prepregnancy BMI.     

First-trimester crown-rump length as a predictor of fetal LGA and SGA at term

Objective.?To determine whether first-trimester crown-rump length (CRL) is associated with birthweight extremes at term.

Methods.?Included in this study were all term, small for gestational age (SGA), and large for gestational age (LGA) neonates with no other obstetric complications and no abnormal outcomes of pregnancy. CRL at 12.0 to 12.6 weeks of estimated gestational age obtained during nuchal translucency screening was selected as an estimate of early fetal growth. Mean first-trimester CRL of the LGA noenates at term was compared via student’s t-test with mean first-trimester CRL of SGA neonates at term.

Results.?In all, 121 neonates were included in the study. Mean first-trimester CRL of the 63 LGA-term neonates was 62.7?±?6.0 mm (95% confidence interval, ±1.49 mm; range, 61.21–64.19), while that of the 58 SGA-term neonates was smaller at 58.8?±?6.9 mm (95% confidence interval, ±1.79 mm; range, 57.01–60.59 mm). This 3.9 mm difference between the means was statistically significant (P?=?0.01).

Conclusion.?We found that birthweights of LGA and SGA neonates at term were associated with their first-trimester CRL measurements, thus, indicating that fetal growth patterns apparent early in pregnancy continue through term.     

Update on the birth weight standard and its diagnostic value in small for gestational age (SGA) infants in China

Objectives: To identify the difference between the current newborn birth weight standard and the previous standard in China, and to evaluate the diagnostic value of newborn birth weight in small for gestational age (SGA) infants.

Methods: A retrospective analysis was conducted of 112?441 delivery cases in 2011, from 39 hospitals at different levels in 14 provinces and autonomous regions. Cases with incomplete data, gestational age?<24 weeks, or severe fetal malformations or fetal death were excluded. Data were recorded and entered on hard paper copies and into an online database. SPSS 18.0 and SAS 9.2 statistical software were used for data analysis.

Results: This study included 109?004 valid cases with an average birth weight of 3226.02?±?525.82?g. Birth weight changed significantly from 1988 for all gestational ages. In preterm infants with gestational age?<37 weeks, birth weight for each gestational week was lower than that in the birth weight standard from 15 cities in China in 1988 (p?+6 weeks showed significantly higher average birth weights compared with the previous birth weight standards (p?Conclusions: The current birth weight standard used in Chinese medical institutions was enacted in 1988. This is not suitable for today’s socioeconomic and clinical requirements, and needs to be updated. Diagnosis of preterm infants with SGA based upon the updated demographic birth weight standard manifested higher accuracy and avoided unnecessary medical interventions. However, the updated demographic birth weight standards were no better diagnostically than the previous standard for full-term infants. Customized birth weight standards from larger sample sizes and multi-center studies will be necessary to determine the appropriate birth weight standards in developing countries.     

The effect of intrauterine growth on leukocyte telomere length at birth

Abstract

Objective: Telomeres are specialized nucleoprotein structures located at the ends of chromosomes, which play a crucial role in genomic stability. Telomere shortening has been proposed as a biomarker for the onset of age-related diseases. This study aimed to determine whether restricted or increased intrauterine growth affects leukocyte telomere length (LTL) at birth.

Materials and methods: One hundred sixty-five (n?=?165) full-term neonates participated in the study. Fetuses were classified as intrauterine growth restriction (IUGR, n?=?21), large-for-gestational-age (LGA, n?=?15), or appropriate-for-gestational-age (AGA, n?=?129), based on customized birth-weight standards. Mixed arteriovenous cord blood samples were collected for isolation of leukocyte DNA. The LTL was measured using multiplex monochrome quantitative real-time PCR and telomeric restriction fragments through Southern blot analysis (terminal restriction fragment [TRF]).

Results: Despite differences among groups in birth weight, length and head circumference, LTL did not differ among AGA (6.78?±?0.58), IUGR (10.54?±?1.80), and LGA (11.95?±?2.42) neonates (p?=?.098). Cord blood IGF-1 and IGFBP-3 concentrations were higher in the LGA group. LTL positively correlated with birth length (r?=?0.176, p?=?.032).

Conclusions: Intrauterine growth does not seem to affect LTL at birth. Further studies, comprising a larger sample size of IUGR, LGA, and AGA neonates, are required to determine whether growth at birth influences LTL.     

Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants

Objective.?To determine body iron stores at birth in term small-for-gestational age (SGA) infants as compared to appropriate-for-gestational age (AGA) infants.

Methods.?In this prospective study, mother–infant pairs with gestation of?≥37 weeks and birth weight of at least 1.5?kg were enrolled. Asymmetric SGA infants were taken as cases and term AGA infants as controls. Maternal, cord blood, and infant blood samples at 4 weeks were obtained for measurement of various iron indices – cord serum ferritin, serum ferritin at 4 weeks, and correlation among maternal and neonatal iron indices – Hb, serum iron, ferritin, and total iron binding capacity (TIBC).

Results.?There were 50 SGA and 50 AGA mother–infant pairs. Cord serum ferritin levels were low in SGA group as compared to AGA [median (IQR): 68 (30,136) vs. 141 (63,259), p?=?0.007]. The proportion of infants with ‘low’ cord ferritin (<40?μg/l) were more in SGA [p?=?0.05]. There was no correlation among various maternal and neonatal cord iron parameters. The serum ferritin levels at 4 weeks were similar in both the groups (p?=?0.16).

Conclusions.?Term SGA infants have lesser total iron stores as compared to AGA infants at birth. Future studies can be designed to look at long-term neurodevelopmental outcome of the SGA babies with low as well as normal ferritin and also the role of early iron supplementation in term SGA neonates.     

Added value of cerebro-placental ratio and uterine artery Doppler at routine third trimester screening as a predictor of SGA and FGR in non-selected pregnancies

Objectives: The objective of this study is to determine the added value of cerebroplacental ratio (CPR) and uterine Doppler velocimetry at third trimester scan in an unselected obstetric population to predict smallness and growth restriction.

Methods: We constructed a prospective cohort study of women with singleton pregnancies attended for routine third trimester screening (32⁺⁰–34⁺⁶ weeks). Fetal biometry and fetal–maternal Doppler ultrasound examinations were performed by certified sonographers. The CPR was calculated as a ratio of the middle cerebral artery to the umbilical artery pulsatility indices. Both attending professionals and patients were blinded to the results, except in cases of estimated fetal weight Results: A total of 1030 pregnancies were included. The mean gestational age at scan was 33 weeks (SD 0.6). The addition of CPR and uterine Doppler to maternal characteristics plus EFW improved the explained uncertainty of the predicting models for SGA (15 versus 10%, p?p?=?.03). However, the addition of CPR and uterine Doppler to maternal characteristics plus EFW only marginally improved the detection rates for SGA (38 versus 34% for a 10% of false positives) and did not change the predictive performance for FGR.

Conclusions: The added value of CPR and uterine Doppler at 33 weeks of gestation for detecting defective growth is poor.     

First trimester 3D volumetry. Association of the gestational volumes with the birth weight

Objective.?To evaluate the three dimensional ultrasound (3D) in the volume assessment of the gestational contents during the 1st trimester of pregnancy. Our aim was to correlate the embryo, gestational sac, and placenta volume with the birth weight. To monitor the increase of these volumes according to the gestational age.

Method.?Prospective study of 199 singleton low risk pregnant women undergoing the 1st trimester ultrasound for fetal anomalies. In these women, gestational volumetry was performed and it was compared with the crown-rump length (CRL). Regression models were computed in order to analyze the dependence of birth weight with the volumes.

Results.?The embryo volume reveals the strongest association with the birth weight at delivery (β?=?0.24), followed by the CRL (β?=?0.20) and the gestational sac volume (β?=?0.20). The placenta volume appears the weakest association with fetal weight at delivery (β?=?0.16). All volumes increased significantly from 11⁺⁰–11⁺⁶ to 13⁺⁰–13⁺⁶ weeks of gestation (p?<?0.001). Ten cubic millimeter increase in embryo volume corresponds to a mean birth weight increase of 75?g, while 1?mm increase in the CRL corresponds to a birth weight increase of 113?g.

Conclusion.?Our results provide evidence that the embryo volume during the first trimester of pregnancy correlates better with birth weight than the CRL. This might assist in the identification of the high risk pregnancies caring macrosomic and low birth weight fetuses.     

The association between glucose challenge test level and fetal nutritional status

Abstract

Objective: To examine the relationship between maternal glucose challenge test (GCT) levels and fetal nutritional status index (FNSI: a ratio of child’s birth weight (kg) over squared maternal height (m²).

Methods: A total of 2193 women from the Beichen district, Tianjin, China, who had 50?g GCT at gestational age 24–28 weeks, gave a full-term singleton birth between June 2011 and October 2012, and with both maternal height and birth weight measures are included in this report.

Results: Approximately 28.0% of women had a GCT?≥?7.8?mmol/L. The newborns of mothers with a GCT?≥?7.8?mmol/L had significantly higher level of FNSI ([kg/m²], boys: 1.336 versus 1.296, p?<?0.001; girls: 1.312 versus 1.268, p?<?0.0001). Logistic regression results, after adjustment for maternal age, residence, education, nationality, history of disease and reproduction, insurance and gestational age, indicated that every unit increase in FNSI was associated with approximately threefold higher odds (OR [95% CI]: 3.6 [1.5, 8.9]) of being in GCT?≥?7.8?mmol/L for women giving birth as boys and fivefold higher odds (5.9 [2.5, 14.1]) for giving birth as girls.

Conclusions: Women with a GCT?≥?7.8?mmol/L have babies with a higher FNSI, suggesting that these infants may be overnourished before birth and may increase cardiovascular risk in their future.     

Maternal Visceral Adipose Tissue and Risk of Having a Small or Large for Gestational Age Infant

ObjectiveTo determine whether first-trimester visceral adipose tissue (VAT) depth is associated with small-for-gestational-age (SGA; <10^th percentile) or large-for-gestational-age (LGA; >90^th percentile) birthweight, including when taking into consideration ethnicity-specific birthweight curves.MethodsWe conducted a prospective cohort study involving 452 women with a singleton livebirth. Maternal VAT depth was measured by ultrasound at 11 to 14 weeks gestation. Newborn weight was plotted on population-based and ethnicity-specific birthweight percentile curves. Modelling was performed using linear and logistic regression, adjusting for parity, smoking status, and weight gain.ResultsMean maternal age was 32.9 ± 4.7 years, and mean VAT depth was 4.1 ± 1.7 cm. Using a population-based curve, each 1-cm increase in VAT depth was associated with a 1.5 (95% CI 0.03–3.0) higher birthweight percentile. Taking into account ethnicity-specific curves, a 1-cm higher VAT depth was associated with a 1.7 (95% CI 0.02–3.3) greater birthweight percentile. Using a population-based curve, comparing VAT depth Q4 with VAT depth Q1–3, the adjusted odds ratio (aOR) for LGA was 1.9 (95% CI 0.8–4.1); with ethnicity-specific curves, the aOR for LGA was 1.5 (95% CI 0.7–3.2). The aOR for SGA was 0.8 (95% CI 0.4 to 1.7) comparing Q1 with Q2–4 VAT depth.ConclusionHigher first-trimester maternal VAT depth was associated with a somewhat greater newborn weight percentile, which varies by which birthweight curve is used. There were marginally higher odds of giving birth to an LGA infant for women in highest quartile for VAT depth, with no evident association with SGA.     

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.     

Maternal cytokines and disease severity influence pregnancy outcomes in women with rheumatoid arthritis

Objectives: To assess the influence of maternal cytokine levels, disease activity and severity on preterm delivery, small for gestational age (SGA) and cesarean delivery in pregnant women with rheumatoid arthritis (RA).

Methods: A prospective study in 47 pregnant women with RA and 22 healthy pregnant controls. The main outcome measures were birth weight in relation to maternal serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and RA activity and severity at three different time points: preconception and during the first and third trimesters.

Results: During the third trimester, IL-10 was detectable in 23.4% of patients with RA, IL-6 in 76.6%. Mean birth weight born to mothers with RA was higher when IL-10 level was high compared with low (p?=?0.001), and lower when IL-6 was high compared with low (p?=?0.035). Also increase in disease activity score-28 (in 60.1%, p?=?0.001), Health Assessment Questionnaire–Disability Index (in 87.5%, p?=?0.013), and pain score (56.9?±?11.4, p?=?0.003) associated with increased risk of SGA. High patient’s global scale was associated with unfavorable pregnancy outcome (preterm, SGA, and cesarean).

Conclusion: High maternal IL-10 levels are associated with higher birth weight and high IL-6 levels are associated with lower birth weight (SGA). Among women with RA, disease activity and severity are predictive of unfavorable pregnancy outcomes suggesting that better disease management early in the pregnancy could improve pregnancy outcomes.     

Customized weight curves for Spanish fetuses and newborns

Abstract

Objectives: To construct a model of customized birthweight curves for use in a Spanish population.

Materials and methods: Data of 20 331 newborns were used to construct a customized birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27?507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models.

Results: The resulting formula for the calculation of optimal neonatal weight was:

Optimum weight (g)?=?3289.681?+?135.413*GA40–14.063*GA40²–0.838*GA40^3?+?113.889 (if multiparous)?+?165.560 (if origin?=?Asia)?+?161.550 (South America)?+?67.927 (rest of Europe)?+109.265 (North Africa)?+?9.392*Maternal-Height?+?4.856*Maternal-Weight–0.098*Maternal-Weight^2?+?0.001*Maternal-Weight^3?+?67.188*Sex?+?GA40*(6.890*Sex?+?9.032 (If multiparous)?+0.006*Maternal-Height^3?+?0.260*Maternal-Weight)?+?GA40² (?0.378*Maternal-Height – 0.008*Maternal-Height²)?+?GA40³ (?0.032*Maternal-Height).

Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was “good” (κ?=?0.717 and κ?=?0.736; p?<?0.001).

Conclusions: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.     

Dose–response association between maternal body mass index and small for gestational age: a meta-analysis

Objective: This study was performed to determine the dose–response relationships between maternal anthropometric variables and risk of small for gestational age (SGA).

Methods: Linear and nonlinear dose–response meta-analyses were performed to summarize the adjusted relative risks of SGA. Ten databases, including PubMed (MEDLINE), were searched. Study quality was assessed using the Newcastle–Ottawa scale.

Results: A total of 323 243 subjects were extracted from high-quality studies to evaluate maternal body mass index (BMI) (n?=?9). The generalizability of the findings regarding height and weight (n?=?3 and 2, respectively) was limited. The non-linear model (p for non-linearity 2). The slope of the dose–response curve between maternal BMI and SGA (i.e. the amount of reduction in SGA risk) decreased gradually.

Conclusions: SGA risk may be reduced by increasing BMI of normal (i.e. 18.5?kg/m^2?≤ BMI?2) and overweight women (i.e. 25?kg/m^2?≤?BMI?2), but the most marked reduction is achieved by increasing BMI of underweight women (i.e. BMI?2).     

Maternal obesity is not associated with increased crown-rump length in first-trimester ultrasounds of singleton gestations

Objective: To evaluate whether or not obesity affects fetal growth in the first trimester of pregnancy.

Study design: A retrospective cohort study of obese versus non-obese women in our ultrasound database was performed to compare crown-rump length (CRL), a surrogate of fetal growth, at the first-trimester genetic screening.

Results: A total of 50 obese and 50 non-obese women were included. CRL for both groups was performed at an average of 12wk5d?±?3 d. A linear regression analysis demonstrated that there was no difference between the cohorts in respect to CRL in the first trimester (p?=?.482). However, the estimated fetal weight at second-trimester anatomy ultrasound and the neonatal birth weight were increased in obese women (p?Conclusion: Maternal obesity does not significantly alter the fetal CRL. However, maternal obesity appears to be associated with increased fetal growth as early as the second trimester.     

A propensity-matched study of the association between pre-pregnancy maternal underweight and perinatal outcomes of singletons conceived through assisted reproductive technology

Research questionIs pre-pregnancy maternal underweight associated with perinatal outcomes of singletons who were conceived through assisted reproductive technology (ART)?DesignA 10-year (2006–2015) Chinese sample of 6538 women and their singleton infants who were conceived through ART was used to examine the association between pre-pregnancy maternal underweight and perinatal outcomes. Propensity scores for underweight were calculated for each participant using multivariable logistic regression, which was used to match 740 (91.36% of 810) underweight women with 740 normal weight women; the effects of underweight on birth weight and gestational age were then assessed by generalized estimating equation model.ResultsAfter propensity score matching, the birth weight was lower (difference –136.83 g, 95% CI –184.11 to –89.55 g) in the underweight group than in the normal weight group. The risks of low birth weight (LBW) and small for gestational age (SGA) were increased in the underweight group compared with those in the normal weight group (LBW: RR 1.64, 95% CI 1.01 to 2.67; SGA: RR 1.46, 95% CI 1.06 to 2.02). The risks of fetal macrosomia and being large for gestational age (LGA) were decreased in the underweight group compared with those in the normal weight group (macrosomia: RR 0.39, 95% CI 0.26 to 0.61; LGA: RR 0.36, 95% CI 0.24 to 0.53). The associations between underweight, gestational age and preterm birth were not statistically significant.ConclusionsAmong women undergoing ART, pre-pregnancy maternal underweight was associated with lower birth weight, increased LBW and SGA risks, and decreased fetal macrosomia and LGA risks in singleton infants.     

Villitis of unknown etiology – prevalence and clinical associations

Objectives: We aimed to determine the association of villitis of unknown etiology (VUE) in complicated and uncomplicated pregnancies.

Methods: Placentas from term pregnancies (≥37 weeks) were sent to histopathology evaluation. Maternal and labor characteristics and pathological reports were compared between placentas with VUE (VUE group) and without VUE (controls). Immunohistochemical studies were performed to identify T-cells infiltration in foci of VUE. Placentas were analyzed for concomitant lesions consistent with maternal malperfusion, fetal vascular supply and inflammatory lesions. Small for gestational age (SGA) was defined as birth weight below the 10th %.

Results: A total of 1203 placentas were obtained, in which VUE was diagnosed in 5% (n?=?60). Compared to controls ((n?=?1143), the VUE group was characterized by lower birth weights, p?<?0.001, higher rate of SGA, p?=?0.009 and lower placental weight, p?<?0.001. By logistic regression analysis, after controlling for gestational age, nulliparity, pregnancy complications, obesity, smoking and SGA, only SGA was found to be independently associated with VUE, aOR: 2.3, 95% CI: 1.2–4.4, p?=?0.012. Additionally, VUA and maternal malperfusion lesions were found to be independent risk factors for the development SGA.

Conclusions: VUE is associated with lower birth weights, SGA and lower placental weight. Both VUE and maternal malperfusion lesions are risk factors for the development of SGA.     

Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants?

Objective: Examine the association between placental inflammation and neonatal infections, and 25OH vitamin D (25OH D) levels at birth among very low birth weight infants (VLBWI).

Study design: Serum 25OH D levels were measured in 89 VLBWI (≤1250?g) and 47 mothers on day one, and in 78 infants on day 21. Placentas were examined for maternal and fetal inflammation. Infants were divided into deficient (≤10?ng/ml) and adequate (>10?ng/ml) groups based on 25OH D levels on day 1.

Results: Mean?±?SD maternal levels of 25OH D (21?±?9?ng/ml) correlated with infants’ levels (15?±?8?ng/ml), (p?p?=?.011). Infants’ 25OH D levels rose significantly by day 21 (p?p?>?.05). Logistic regression analyses revealed no association between deficient 25OH D levels and the odds of maternal or fetal inflammation or other infections. Levels of 25OH D did not correlate with severity of placental inflammation.

Conclusions: Deficient levels of 25OH D at birth are not associated with the occurrence of placental inflammation or neonatal infections among VLBWI.