Does Sonographic Determination of Placental Location Predict Fetal Birth Weight in Diamniotic‐Dichorionic Twins?

OBJECTIVE: The purpose of this study was to determine the association between placental location in diamniotic-dichorionic twins as determined at the time of anatomic survey and birth weight. METHODS: We retrospectively identified all diamniotic-dichorionic twins in our Maternal-Fetal Medicine sonography database between 2000 and 2005 who had an anatomic survey, went on to be delivered at our hospital, and had records available for review (n = 304). Placental location for each twin was determined at the time of anatomic survey and grouped into both anterior or both posterior versus separate anterior and posterior. Maternal and fetal characteristics were collected from chart review. Placental pathologic findings were available for 249 (83%) patients. Outcomes analyzed were percent discordance, small size for gestational age of twin A or B, and difference in birth weight as a continuous variable. Multivariable logistic regression using stepwise backward elimination was used to adjust for potential confounders. RESULTS: There was no difference in discordance of 20% or greater or incidence of small size for gestational age when both placentas were both anterior and both posterior compared with separate anterior and posterior: adjusted odds ratio (AdjOR), 1.38 (95% confidence interval [CI], 0.64-2.95); and AdjOR, 1.29 (95% CI, 0.57-2.89). The actual birth weight difference (A - B) was not affected by placental location (P = .36). Opposite sex fetuses and nulliparity were significantly associated with birth weight discordance: AdjOR, 2.68 (95% CI, 1.39-5.17); and AdjOR, 0.34 (95% CI, 0.28-0.94). CONCLUSIONS: We did not find a correlation between birth weight and placental location in our cohort analysis. The presence of sex-discordant twins was associated with birth weight discordance of 20% or greater, whereas nulliparity was protective.     

Helping Individuals Achieve a Healthy Weight Gain During Pregnancy: A Multipronged Approach

Approximately half of pregnant individuals in the United States exceed recommendations for gestational weight gain (GWG). Excessive GWG is associated with negative outcomes for maternal and infant health. In this article, we provide guidance to nurses who counsel patients about GWG. Because of negative bias toward persons with obesity, nurses need to understand their own attitudes toward obesity to provide supportive GWG counseling. The use of words such as weight is preferred to obese, and recommended GWG goals should be consistent with established guidelines. The setting of specific, measurable, attainable, realistic, and trackable behavioral goals can help translate a goal for GWG into practical actions in daily living. Mobile phone apps, if carefully chosen, may help individuals learn about and track GWG.     

Improved Ultrasonographic Estimation of Birth Weight in Macrosomic Fetuses by Application of a Correction Factor to the Gestation‐Adjusted Projection Method

Objective. The purpose of this study was to improve estimated birth weight (EBW) determination in macrosomic fetuses (estimated fetal weight ≥4000 g) by application of a correction factor to the gestation‐adjusted projection (GAP) method. Methods. A review was performed of 411 singleton pregnancies delivered at term. On the basis of ultrasonographic examinations previously performed between 34.0 and 36.9 weeks' gestation, an EBW was calculated for each patient by the GAP method (EBW_GAP). Using linear regression, a correction factor was developed that minimized the systematic error in the EBW_GAP. The model was then tested retrospectively on a second group of 317 patients. Results. The GAP method systematically overestimated weights of the heavier fetuses in our population. The model we derived showed improved accuracy compared with the GAP method. When applied to a second group of 317 patients, our correction to the GAP method improved specificity for macrosomia from 94.7% to 98.6% (P = .003). Stated differently, the false‐positive rate was reduced from 5.3% to 1.4%. The difference in sensitivity for macrosomia was not significant: 41.2% and 35.3% (P = .68). Conclusions. Application of our model to our study population reduced the number of false‐positive results for fetal macrosomia.     

Weight Status of Persons with Intellectual Disabilities

Background The aim was to study the weight and weight status of the study group in 2002 and 2007, and to study the differences in weight and weight status between 2002 and 2007 and the risk groups for (becoming) overweight/obese. Materials and Methods The Body Mass Index (BMI) of 336 clients of a Dutch service provider for persons with intellectual disabilities was calculated in 2002 and 2007. Results The mean increase in BMI between 2002 and 2007 was 0.8 (2.2 kg). In 2002, 36% of the study group was overweight/obese; this was higher in 2007: 45%. The expected relationship between increase in BMI and the change in living circumstances could not be confirmed. Conclusions Further research into health‐control programmes, weight status, food‐intake and physical exercise is recommended.