Symphysis-fundus height and weight gain pattern in Japanese women with twin pregnancies

OBJECTIVE: To determine the normogram for symphysis-fundus height and weight gain pattern in Japanese women with twin pregnancies and to examine whether fundus height and weight gain pattern are altered in women who give birth to twin infants complicated by fetal growth restriction (FGR). STUDY DESIGN: A retrospective review of the medical records of 186 twin gestations that had been followed at our institution together with 229 singleton pregnancies as a control. We examined maternal symphysis-fundus height, body weight gain and increase in body mass index (BMI) according to gestational age and compared them between women with and without FGR. RESULTS: As compared to women with singleton pregnancies, those with twins exhibited larger fundus height, larger weight gain and larger increase in BMI, all of which were observed from as early as 16-18 weeks of gestation until delivery. Mothers of twins with at least one FGR infant showed smaller fundus height, smaller weight gain and smaller increase in BMI as compared to those without. CONCLUSION: We constructed the normogram for symphysis-fundus height and weight gain pattern in Japanese twin gestations and determined the characteristic change in these parameters in FGR in women with twins. These results may be of use in identifying mothers of twins with FGR.     

Factors associated with low birth weight of infants delivered at term

The singleton births in the 1958 British Perinatal Mortality Survey (Butler and Bonhan, 1963; Butler and Alberman, 1969) were used to study the aetiology of low birth weight of infants delivered at term. After exclusion of macerated stillbirths and infants with lethal congenital defects, 468 infants of 259 days or more gestation and a birth weight which was less than 2500 g were identified. The mothers and their pregnancies were compared with those of the population of 16 994 singleton births. Delivery at term of a low birth weight infant was significantly associated with maternal prepregnant weight, maternal height, maternal smoking, primiparity, maternal employment, low social class, a previous infant of low birth weight, threatened abortion and severe toxaemia. No significant associations were found with illegitimacy, area of residence, previous spontaneous abortion, essential hypertension, mild toxaemia, chronic or acute infections or other conditions. There were significant negative associations with a history of previous large infants and with maternal blood group AB.     

Symphysis-fundus height and pregnancy characteristics in ultrasound-dated pregnancies.

OBJECTIVE: To investigate the relation between maternal and pregnancy characteristics and symphysis-fundus height values at term in an obstetric population dated by sonography. METHODS: Three hundred twenty-five women were recruited from the antenatal clinics of the Queen's Medical Centre, Nottingham, United Kingdom for measurement of fundal height and for ultrasound scans. Symphysis-fundus height measurements were analyzed by multivariate regression analysis in relation to gestational age, maternal height and weight, ethnic group, and smoking. RESULTS: Gestational age and maternal characteristics explained nearly half of the variability in symphysis-fundus height. Gestational age was the most important determinant, followed by maternal weight, parity, and sex of the infant. The other variables were not significantly correlated. CONCLUSION: Maternal characteristics had statistically significant effects on the expected symphysis-fundus height, which suggests that individually adjusted fundal height charts may improve the precision of clinical screening for fetal growth restriction.     

Macrosomic births in the united states: determinants,outcomes, and proposed grades of risk

OBJECTIVE: We describe maternal risk factors for macrosomia and assess birth weight categories to determine predictive thresholds of adverse outcomes. STUDY DESIGN: We analyzed linked live birth and infant death cohort files from 1995 to 1997 for the United States with the use of selected term (37-44 weeks of gestation) single live births to mothers who were US residents. We compared macrosomic infants (4000-4499 g, 4500-4999 g, and >5000 g infants) with a normosomic control group of infants who weighed 3000 to 3999 g. RESULTS: Maternal risk factors for macrosomia included nonsmoking, advanced age, married, diabetes mellitus, hypertension, and previous macrosomic infant or pregnancy loss. The risks of labor complications, birth injuries, and newborn morbidity rose with each gradation of macrosomic birth weight. Infant mortality rates increased significantly among infants weighing >5000 g. CONCLUSION: Although a definition of macrosomia as >4000 g (grade 1) may be useful for the identification of increased risks of labor and newborn complications, >4500 g (grade 2) may be more predictive of neonatal morbidity, and >5000 g (grade 3) may be a better indicator of infant mortality risk.     

Second trimester amniotic fluid transferrin and uric acid predict infant birth outcomes

OBJECTIVE: To establish whether second trimester amniotic fluid protein and/or uric acid concentrations were associated with and predictive of infant birth weight and/or gestational age. METHODS: Second trimester amniotic fluid samples (n = 230) in mothers undergoing age-related amniocentesis for genetic testing were collected and quantified using capillary zone electrophoresis (CZE) for albumin, IgG, transferrin and uric acid. Maternal characteristics (prepregnancy weight and height, parity, ethnicity, smoking status) and infant birth weight, gestational age and gender were obtained from questionnaires and maternal obstetrical chart review. RESULTS: Preterm infants had higher concentrations of second trimester amniotic fluid transferrin than term infants (P = 0.0215). Transferrin was negatively associated with length of gestation, whereas uric acid was positively associated with the gestational age in spontaneous vaginal delivery (SVD) infants. Uric acid was also a significant predictor of the infant birth weight in grams. CONCLUSION: Second trimester amniotic fluid transferrin and uric acid concentrations are related to subsequent birth outcomes and might emerge as biomarkers of early fetal development. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Subsequent pregnancy following labor of a very-low-birth-weight infant

During a period of 5 years (1978-1982), 55 mothers with an average age of 27.5 +/- 5.4 years, delivered 59 infants, weighing less than 1500 g. These infants had a mean birth weight of 1160.5 +/- 263 g and a mean gestational age of 28.7 +/- 2.25 weeks (range 25-32 weeks). Subsequently 47 (79.6%) survived and 12 (20.4%) died. There was a statistical difference of both mean gestational age and of mean gestational weight between survivors or infants with neonatal death. Twenty two of 29 mothers who subsequently became pregnant, gave birth to liveborn infants, who subsequently survived (four pregnancies terminated in induced abortion). Mean gestational age was 37 +/- 3 weeks (range 32-41 weeks) (P less than 0.001) and a mean birth weight was 2753.2 +/- 570 g (range 1620-3600 g) (P less than 0.001. All the 22 infants subsequently born weighed more than 1501 g, 7 (31.8%) infants weighed 1501-2500 g and 15 (68.2%) more than 2500 g. Similar data were obtained from a control group of 615 mothers (chosen at random) who delivered a normal infant at term, 202 subsequently became pregnant and 176 gave birth to a normal infant at term. Mean gestational age was 39.54 +/- 1.24 weeks (P less than 0.001) and mean birth weight was 3299.3 +/- 412 g (P less than 0.001). (In the control group 10 pregnancies terminated in induced abortions). The above data could be used in advising for future pregnancy outcome in regard to women with premature births.     

Does Maternal Age Predict Multiple Birth,Preterm Delivery or Low Birth Weight in Successful In Vitro Fertilization Pregnancies?

Objective: to describe the influence of maternal age on births associated with in vitro fertilization (IVF), including lower birth weights, delivery prior to 37 weeks gestational age, and multiple birth.Methods: data on IVF pregnancies from 1994 to 1997 was reviewed. This data included infant birth weight, gestational age, occurrence of multiple births, and maternal age.The age of mothers was categorized as less than 30 years, 30 to 34 years, and 35 years or greater.Results: maternal age information was available for 76 percent of the clients. Four hundred and forty-six births were reviewed, of which 306 (49.8%) infants were multiples, 236 (38.4%) infants were less than 2,500 g and 329 (53.8%) were less than 37 weeks gestation. In successful IVF pregnancies, mothers age 35 and over, compared to those under age 30, were slightly less likely to have a multiple birth (26.1 % versus 37.3%, p<0.08 ), less likely to deliver a low birth weight infant (LBW, <2,500 g) (32.4% versus 48.3%, p<0.005), and less likely to deliver at less than 37 weeks (49.6% versus 57.1%, p<0.005). Among singleton deliveries, advanced maternal age was not associated with higher rates of LBW (9.6% versus 13.5%, p = 0.54) or preterm delivery (21.3% versus 13.5%, p = 0.24).Conclusions: these findings indicate that IVF can be performed in older women without concern that infant morbidity is greater than among younger IVF clients.     

Maternal Weight Gain, Smoking and Other Factors in Pregnancy as Predictors of Infant Birth-weight in Sydney Women

Summary: Two hundred and four (204) women attending a Sydney maternity hospital and their babies were followed throughout pregnancy in a study, which aimed: 1) to describe the distribution of maternal weight gain in present day Australian women and 2) to determine the effect of weight gain and other factors on birth-weight.
Maternal weights and skinfold thicknesses were measured serially to give an indication of weight gain. Mean weight gain from conception to term was 14.2kg and mean birth-weight was 3,442g.
Maternal predictors of birth-weight such as maternal weight gain, parity, age, education, height, public or private booking status, smoking, prepregnancy weight, and sex of the infant and gestational age were explored using simple and multiple regression analysis. Weight gain was predictive of birth-weight, each kg increase in total weight gain resulting in about a 30g increase in birthweight. Other strong predictors were gestational age, maternal smoking, sex of the infant and maternal parity. Maternal height was less strongly predictive and age and prepregnant weight were not predictive.
Smoking mothers had infants who were 268g lighter than those of nonsmoking mothers. However, smokers were also younger, shorter, had less education and were more likely to book as public patients than nonsmokers. After adjusting for all other predictors, the birth-weight of infants whose mothers smoked, was still 224g less than that for nonsmoking mothers.     

Maternal perceived quality of life following childbirth

OBJECTIVE: To examine preterm, near-term, and term mothers' self-reported quality of life in the early postpartum period. DESIGN: Prospective, longitudinal repeated measures design. SETTING: Four medical centers in the Midwest. PATIENTS/PARTICIPANTS: A convenience sample of 184 mothers of either a preterm, near-term, or term infant. MAIN OUTCOME MEASURE: Maternal Postpartum Quality of Life tool. RESULTS: Mothers of preterm infants scored significantly lower on the subscale psychological/baby of the Maternal Postpartum Quality of Life tool compared to mothers of near-term and term infants. CONCLUSIONS: Infant gestational age at birth has relevance for maternal quality of life during the postpartum period. Health care professionals need to be cognizant relative to infant gestational age and individualize nursing care.     

Premature delivery and subsequent reproduction

To examine the relationship between premature delivery and subsequent reproductive behavior, we attempted to trace 100 mothers four years after the birth of a surviving preterm or term infant. Seventy mothers were successfully traced. Maternal age, ethnicity, gravidity, parity, religion, and socioeconomic status, and the sex, birthweight, gestational age, mode of delivery, and hospital days of the index infant were jointly related to three outcome measures: occurrence of subsequent pregnancy, and, among those who again became pregnant, pregnancy interval and number of subsequent children. Among women who had one or more subsequent births during the follow-up period, those whose index infants were of lower gestational age had fewer subsequent births (r = 0.602, df = 32, p less than 0.011). No other variables, including cesarean birth, were significantly related to later reproductive behavior. These findings indicate that the birth of a premature infant may have a significant effect of decreasing or delaying subsequent reproduction. Through confirmatory studies are needed, awareness of this relationship may help obstetric perinatologists and neonatologists sensitively discuss plans for contraception and further childbearing with women who have experienced the stress of the birth of a premature infant.     

One Size Does Not Fit All: Differences in Newborn Weight Among Mothers of Philippine and Other East Asian Origin

ObjectiveTo determine the likelihood that infants born to Filipina, other East Asian, and Canadian-born women may be misclassified as small for gestational age when using conventional Canadian birth weight curves rather than those specific to their world region.MethodsWe conducted a population-based study of 548 418 singleton live births in Ontario between 2002 and 2007. Smoothed birth weight percentile curves were generated for males and females born to women from Canada, the Philippines, and the rest of East Asia/Pacific. We determined the likelihood of misclassifying an infant as small for gestational age (SGA < 10th percentile weight) or large for gestational age (LGA ≥ 90th percentile weight) on a Canadian-born birth weight curve vs. a curve specific to the other two world regions.ResultsFor gestation-specific 10th and 50th percentiles, term infants born to women from the Philippines often had significantly lower birth weights than infants of Canadian-born mothers. Controlling for maternal age and parity, approximately 88 per 1000 male newborns (95% CI 82 to 95) and 72 per 1000 female newborns (95% CI 54 to 60) of mothers from the Philippines were at risk of being misclassified as SGA. LGA would be missed in approximately 54 per 1000 male newborns (95% CI 49 to 59) and 49 per 1000 female newborns (95% CI 44 to 54) of Filipina mothers. Misclassification of both SGA and LGA was more pronounced among infants of Filipina mothers than of mothers from other East Asian origin.ConclusionsInfants of mothers born in the Philippines weigh significantly less than those of Canadian-born women or mothers emigrating from other East Asian countries. Those who use birth weight curves should consider these differences.     

Maternal characteristics and lifestyle factors and the risk of delivering high birth weight infants

OBJECTIVE: To identify factors associated with an increased risk of giving birth to infants weighing more than 4000 g and to study whether changes in these factors over time can explain the increasing proportion of high birth weight infants over the last decade. METHODS: Our analyses included 24,093 pregnancies of nondiabetic women with information on potential risk factors for high birth weight: maternal prepregnancy weight, height, age, parity, smoking habits, alcohol and caffeine intake, marital status, educational level, gestational age, and infant gender. Information was obtained from questionnaires completed during pregnancy and birth registration forms at the Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark, from 1990 to 1999. RESULTS: We found a statistically significantly increased risk of giving birth to infants weighing more than 4000 g for women with high prepregnancy weight and height, parity greater than 2, gestational age greater than 42 weeks, and male infant gender and for nonsmokers. Women with a low caffeine intake or 10 or more years of education were also at statistically significantly higher risk. The variation found in birth weight over the past 10-year period was explained by changes in maternal prepregnancy weight, height, smoking habits, educational level, and caffeine intake over the same period. CONCLUSION: Risk factors associated with a higher proportion of high birth weight infants may be clinically significant and have an impact on public health. High birth weight increases the risk of adverse outcomes of delivery as well as the risk of childhood morbidity.     

Mother's birth weight as a predictor of macrosomia

The relationship between a mother's own birth weight and the risk of delivering a large for gestational age infant was studied in 1335 women. Compared to women who weighed 8 pounds or more at birth, women who weighed 6 to 7.9 pounds were only 50% as likely (p = 0.007) and women who weighed 4 to 5.9 pounds were only 15% as likely (p = 0.002) to give birth to a large for gestational age infant. When this relationship was adjusted for nine other factors known to influence birth weight, including maternal weight and weight gain during pregnancy, maternal birth weight was second only to weight gain during pregnancy in predicting the birth of large for gestational age infants. Maternal birth weight was also accurate in the prediction of macrosomia (birth weight greater than 4000 gm). Because of its ability to predict the delivery of a large infant, maternal birth weight should become part of the routine obstetric history.     

Determinants of birth size in Northeast Spain

Abstract

Objective: To update knowledge on determinants of newborn body size in Northeast of Spain considering gestational, parental and socio-cultural variables.

Methods: Cross-sectional assessment of 1442 infants from Aragón (Spain), born at term between March 2009 and March 2010. Obstetric, neonatal, socio-demographic and parental anthropometry data were collected during the first infant scheduled health examination. Hierarchical linear regression models were used to explore associations between newborn anthropometry and included variables.

Results: Birth weight was significantly higher in males than in females (130.7?g), when mother did not smoke during pregnancy (126.3?g), in immigrant mothers (113.1?g) and when parity increased (67.1?g per additional birth). Body weight at birth was 16.9?g higher per kg of maternal weight gain during pregnancy, 5.4?g higher per kg of maternal pre-pregnancy weight and 5.1?g higher per cm of maternal height. Birth length was also significantly higher in males than in females (0.87?cm), when mother did not smoke (0.48?cm), in immigrant mothers (0.64?cm), and it was positively associated with parity, maternal anthropometry and paternal height. Newborn anthropometry was not associated with maternal age, educational level or living location.

Conclusions: Independently of gestational age and newborn sex, the main predictors of birth weight and length were maternal pre-pregnancy anthropometry and weight gain during gestation, to smoke during pregnancy, parity and maternal origin. Our results identify potential modifiable factors influencing newborn body size.     

East German percentile values for newborn infants--1985 relation of age, parity, body weight and height of the mother and the birth weight of newborn infants

Based on an analysis of very comprehensive data material multidimensional investigations on connections between age, parity, weight and height of mothers and birth weight of infants have been made. Maternal height as well as maternal weight have a considerable influence on birth weight of infants. At the same maternal height infant birth weight will rise in connection with the rise of maternal weight. Maternal age, parity and weight are correlated variables. The older a woman, the higher on average is not only her parity but at the same her weight, too. The rise of maternal weight per year in the statistic mean amounts to 401 g. Moreover, at the same age like primiparae second and subsequent parae are of higher weights so that partly maternal weight contains indirectly not only maternal age but also maternal parity. The following range of the influencing factors maternal height, weight, parity and age on birth weight can be given: 1. Height and weight as relatively equivalent factors, 2. parity and 3. age.     

Nursery survival for infants of birth weight 500-1500 grams during 1982-1995.

OBJECTIVE: To evaluate nursery survival of very low birth weight infants (VLBW) over time, born in the same large inner-city hospital with a predominantly Hispanic population. METHODS: All liveborn VLBW infants weighing 500-1500 g at birth were included in four time periods of 2 years' duration during 1982 to 1995. Demographics were collected for the obstetric population. Clinical data were collected including maternal and infant perinatal factors. All infants were assigned a cause of death and infants dying with lethal anomalies were then excluded from further evaluations. RESULTS: Overall survival improved progressively (p = 0.0001) with dramatic improvement in survival of infants 500-750 g birth weight (BW) in period 4 (1994-1995). The number of lethal anomalies did not increase but accounted for a larger portion of deaths in period 4. Decreases in other causes of death over time reflected changes in perinatal care. Although the mothers were high-risk, none of the maternal factors evaluated showed any consistent effect on infant survival. Improved labor and delivery care was associated with improvement in Apgar scores, a decrease in intracranial hemorrhage/intraventricular hemorrhage as a cause of death and an improvement in survival between the first two periods. In spite of the increase in Cesarean sections for infants of 500-750 g BW and their improved survival in period 4, no clear advantage for Cesarean section could be demonstrated. The marked improvement seen in period 4 was associated with three changes in care: increased use of maternal steroids, administration of surfactant, and the use of newer ventilatory methods including high-frequency oscillatory ventilation. Although female gender has been reported to confer a protective influence for survival, this was not found in the final period. Black mothers comprised only about 2.5% of the total obstetric population but delivered approximately 10% of the VLBW infants. Despite the increased incidence of small for gestational age (SGA) among black infants, there were no differences in survival between blacks and Hispanics. Mean birth weight and gestational age in both survivors and nonsurvivors decreased significantly over the four time periods. In period 4, 50% survival occurred at a birth weight of 600-700 g and a gestational age of 23 weeks. CONCLUSION: Nursery survival improved throughout the period of the study from 1982 to 1995 but especially during period 4 (1994-1995). Improved survival was associated with changes in both maternal and infant care. In infants of BW 500-750 g, gestational age rather than birth weight was more closely associated with survival.     

Expansion of intravascular volume and fetal outcome in patients with chronic hypertension and pregnancy.

Measurements of blood volume were carried out between 24 and 40 weeks of gestation in 20 multiparous patients with chronic hypertension and pregnancy. Hypertensive patients had both reduced blood volume and infants of smaller weight (p less than 0.01) than nonhypertensive control subjects. There was a significant difference (p less than 0.01) in the degree of blood volume expansion in hypertensive mothers who were delivered of infants who were adequate for gestational age (AGA), term, or premature, compared to those who were delivered of infants who were small for gestational age (SGA) or stillborn. Classification of chronic hypertension during pregnancy according to the American Committee on Maternal Welfare classification or according to severity of the hypertension was of no value in identifying the mothers at risk of delivering intrauterine growth-retarded infants. However, failure in achieving a blood volume expansion of at least 60 c.c. per kilogram clearly identified those pregnancies leading to growth retardation and fetal death. The decrease or lack of intravascular volume expansion was reflected in the presence of creatinine clearance values at nonpregnant levels in the mothers who were delivered of SGA infants and in a significant reduction below the nonpregnant levels in those who were delivered of stillborn infants. These data suggest that measurement of blood volume and endogenous creatinine clearance in patients with chronic hypertension and pregnancy is a useful parameter in the identification of those patients who will have a poor fetal outcome.     

Birth weight curves tailored to maternal world region

BackgroundNewborns of certain immigrant mothers are smaller at birth than those of domestically born mothers. Contemporary, population-derived percentile curves for these newborns are lacking, as are estimates of their risk of being misclassified as too small or too large using conventional rather than tailored birth weight curves.MethodsWe completed a population-based study of 766 688 singleton live births in Ontario from 2002 to 2007. Smoothed birth weight percentile curves were generated for males and females, categorized by maternal world region of birth: Canada (63.5%), Europe/Western nations (7.6%), Africa/Caribbean (4.9%), Middle East/North Africa (3.4%), Latin America (3.4%), East Asia/Pacific (8.1%), and South Asia (9.2%). We determined the likelihood of misclassifying an infant as small for gestational age (≤ 10th percentile for weight) or as large for gestational age (≥ 90th percentile for weight) on a Canadian-born maternal curve versus one specific to maternal world region of origin.ResultsSignificantly lower birth weights were seen at gestationspecific 10th, 50th, and 90th percentiles among term infants born to mothers from each world region, with the exception of Europe/Western nations, compared with those for infants of Canadian-born mothers. For example, for South Asian babies born at 40 weeks’ gestation, the absolute difference at the 10th percentile was 198 g (95% CI 183 to 212) for males and 170 g (95% CI 161 to 179) for females. Controlling for maternal age and parity, South Asian males had an odds ratio of 2.60 (95% CI 2.53 to 2.68) of being misclassified as small for gestational age, equivalent to approximately 116 in 1000 newborns; for South Asian females the OR was 2.41 (95% CI 2.34 to 2.48), equivalent to approximately 106 per 1000 newborns. Large for gestational age would be missed in approximately 61 per 1000 male and 57 per 1000 female South Asian newborns if conventional rather than ethnicity-specific birth weight curves were used.ConclusionsBirth weight curves need to be modified for newborns of immigrant mothers originating from non-European/Western nations.     

The incidence, sociobiological factors and obstetric complications associated with large infants at Ilorin, Nigeria

The study examined the incidence, sociobiological factors and obstetric complications related to the deliveries of 351 large infants, weighing 4000 g and above, and compared them to the findings among controls, comprising of 6563 full-size term infants; all deliveries took place at the University of Ilorin Teaching Hospital, June-December, 1983. Large infants constituted 4.7% of singleton deliveries and the male/female ratio among large infants was significantly higher than among controls. Significant associations were found in the occurrence of large infants with increasing age, parity and weight, but not with height. Large infants occurred more frequently among the high social class women who could pay for health services. Rate of cesarean section and postpartum hemorrhage increased four-fold with deliveries of large infants. Shoulder dystocia complicated six deliveries resulting in four stillbirths and two cases of Erb's palsy. It is advocated that prenatal screening for gestational diabetes be performed on mothers with advanced maternal age, high parity, overweight and particularly of high social class.