Biochemical EFA status of mothers and their neonates after normal pregnancy

The essential fatty acid (EFA) status of neonates was compared with that of their mothers by determining the fatty acid compositions of phospholipids (PL), isolated from umbilical arterial and venous tissue, blood cells (BC) and plasma, from maternal venous plasma and BC, and from non-infarcted placental tissue. The PL of umbilical arterial tissue (efferent fetal vessels) contained fewer fatty acids of the (n-6) family and more of the (n-9) family than umbilical venous tissue (afferent fetal vessel). The relative amounts of (n-6) and (n-3) fatty acids were less in arterial than in venous plasma. Mead acid, 20:3(n-9), the presence of which indicates a poor EFA status, was 5 times higher in the efferent than in afferent cord vessels. In neonatal plasma and BC it was twice as high as compared with maternal levels. In general, the fatty acid composition of the placenta PL showed a comparable pattern as neonatal venous plasma PL. These findings demonstrate that the biochemical EFA status of neonates after a normal pregnancy is not optimal. The significant correlations between neonatal and maternal EFAs indicate that the neonatal EFA status depends on the EFA content of the maternal diet.     

Cerebral palsy and multiple births.

AIM: To compare the birthweight specific prevalence of cerebral palsy in singleton and multiple births. METHODS: Registered births of babies with cerebral palsy born to mothers resident in the counties of Merseyside and Cheshire during the period 1982 to 1989 were ascertained. RESULTS: The crude prevalence of cerebral palsy was 2.3 per 1000 infant survivors in singletons, 12.6 in twins, and 44.8 in triplets. The prevalence of cerebral palsy rose with decreasing birthweight. The birthweight specific prevalence among those of low birthweight < 2500 g was not significantly different in singleton than in multiple births. Among infants weighing > or = 2500 g, there was a significantly higher risk in multiple than in singleton births. The higher crude cerebral palsy prevalence in multiple births is partly due to the lower birthweight distribution and partly due to the higher risk among normal birthweight infants. CONCLUSIONS: Multiple birth babies are at increased risk of cerebral palsy. There is also an increased risk of cerebral palsy within a twin pregnancy if the co-twin has died in utero.     

Cord blood fatty acid composition in infants and in their mothers during the third trimester

Since essential fatty acids are required for normal brain development, we studied plasma lipids and EFA levels in 16 postpartum mothers (28 to 44 weeks) and in the umbilical vein and artery of 32 newborn infants. Groups of eight 24 to 33-, 34 to 37-, 38 to 42-, and 43 to 44-week-old infants were studied. Plasma fatty acid composition was studied in PL, CE, TG, and FFA by thin-layer and gas-liquid chromatography. Increased values for PL, CE, and TG (P less than 0.001) were noted in maternal plasma compared to cord plasma; linoleic acid was lower (P less than 0.001) in cord plasma PL, CE, and FA. EFA derivatives dihomo-gamma-linolenic, arachidonic, and docosahexaenoic acids were higher in cord plasma (P less than 0.001). Total polyenoic EFA increased with advanced gestation, and at term, was close to maternal levels. delta-5,8,11-eicosatrienoic acid (elevated in EFA deficiency) was elevated in cord plasma as compared with maternal values (P less than 0.001); other criteria of EFA deficiency were absent. These data indicate that fetal EFAs are elongated and desaturated during the third trimester. These higher polyenoic acids may incorporate into lipids in the developing CNS. The lower linoleic acid levels in the fetus may be important to the transplacental transport of EFA.     

母婴因素对脐血CD34+造血干/祖细胞的影响

目的 比较不同母婴因素与脐血有核细胞总数及CD34⁺造血干/祖细胞数量的关系,为脐血库合理选择脐血提供参考。方法 前瞻性收集130例2019年6月至2020年1月期间于大连市妇女儿童医疗中心分娩的新生儿脐血标本,男女比例为1：1。收集围生期相关信息：孕母年龄及血型,有/无妊娠糖尿病、妊娠高血压,妊娠方式、分娩方式、单胎/双胎,新生儿体重、性别、生后Apgar评分,以及胎盘、羊水、脐带情况。结果 根据孕母血型、妊娠糖尿病、妊娠高血压、妊娠方式、分娩方式、单胎/双胎,新生儿性别、生后Apgar评分,胎盘形态、羊水胎粪污染、脐带绕颈等情况进行分组,组间比较脐血有核细胞总数及CD34⁺细胞计数差异均无统计学意义（P > 0.05）。孕母年龄、新生儿体重与脐血有核细胞总数无相关性（P > 0.05）,新生儿体重与CD34⁺细胞计数无相关性（P > 0.05）,孕母年龄与CD34⁺细胞计数呈正相关（P < 0.05）。结论 脐血中CD34⁺细胞数量随孕母年龄增大而增多,故脐血库在筛选脐血时,同等条件下可以选择年龄偏大的孕妇。     

Maternal smoking and fetal growth of full term infants

Results of investigation into the effects of maternal smoking and other selected independent variables on fetal growth indicated that smoking by gravida was assoicated with reductions in birth weights and crown-heel lengths, but not with ponderal indices of newborn infants. Mothers of single infants were interviewed following delivery and before discharge about the amount of smoking during pregnancy. Infants were weighed and measured at birth, and step-wise multiple regression analyses were used to interpret the data for 4 groups of infants: males born to primiparas, males born to multiparas, females born to primiparas, and females born to multiparas. Results indicate that maternal smoking during pregnancy was associated with reductions in birth weights and crown-heel lengths, but not in ponderal indices of these groups of full-term infants. The effects of smoking on fetal growth did not appear to be related to poor maternal nutrition, and mean weight gains during the last 2 trimesters of pregnancy were not significantly different in smoking and nonsmoking mothers. Conflicting opinions exist concerning whether the reduction in crown-heel lengths are transitory or not; thus further study is recommended.     

Normal and abnormal growth of multiples

Growth curves of twins and triplets do not support a growth restriction patterns seen in singletons. At the same time that individual members of a twin or a triplet set may be smaller than singletons of the same gestational age, only a minority are indeed SGA by singleton standards. When comparing the entire ‘fetal mass’ of a multiple pregnancy to that of singletons, multiple gestations are in fact growth promoted, and their individual smaller size are better described asgrowth adaptation . Data from large twin and triplet series suggest that significant birth weight discordance result from the inability of the uterine milieu to equally nurture twins. In order to promote maturity – gestational age – mild compensation in the form of size discordance begins after mid-gestation. When the uterine environment competently nurtures multiples, total birth weight increases and discordance decreases. Failed adaptation, however, may result in significant growth discordance and restriction.     

Food and drug reactions,wheezing, and eczema in preterm infants.

Allergic reactions were investigated in 777 preterm infants who were randomly assigned to early diet and followed up to 18 months post term. Wheezing or asthma was common (incidence 23%); it was associated with neonatal ventilation, maternal smoking, and a family history of atopy and was unexpectedly reduced in babies born by caesarean section. Even in non-ventilated infants, the incidence of subsequent wheezing was 18%, rising to an estimated 44% (using logistic regression) when the foregoing risk factors (excluding ventilation) were present. Eczema occurred in 151 infants (19%) and was strongly associated with multiple pregnancy (30% incidence in twins or triplets). Reactions to cows'' milk (incidence: 4.4% from detailed history; 0.8% confirmed by challenge), other foods (10%), and drugs (5%) were within the range reported in full term infants. Milk and food reactions were associated with multiple pregnancy (19%) and a family history of atopy. Reactions to drugs were least likely to occur in infants who had been ventilated and were on multiple medications in the neonatal period, suggesting that drug tolerance may have developed. We speculate that preterm infants may be a high risk group for asthma and eczema, which could imply an association between atopy and prematurity.     

Preterm twin and triplet pregnancies are at increased risk for the development of cystic periventricular leukomalacia

BackgroundAn increased risk of cerebral palsy in multiples has been reported.AimsTo determine the risk for the development of periventricular leukomalacia (PVL) of twin and triplet pregnancy.Study designRetrospective single-centre study at a tertiary care university hospital.SubjectsInfants ≤35 weeks gestational age born between 1988 and 2008.Outcome measuresRisk of twin and triplet compared to singleton pregnancy regarding development of PVL in one offspring.ResultsOf 6195 infants 117 singletons and 39 multiples were diagnosed as having cystic PVL. Perinatal data did not differ as did not ultrasonographic findings and neurologic outcome. The relative risk (RR) of a twin pregnancy resulting in at least one infant with PVL when born prior to 36 weeks was 2.181 (CI 95% 1.474–3.228, p < .0001), and 6.793 (CI 95% 2.470–13.108, p < .0001) of a triplet pregnancy. In-vitro fertilisation was present in 3% of affected twins compared to 100% in triplets (p < .001).ConclusionWe found an increased risk for PVL in preterm twin and triplet pregnancies.     

Children conceived by in vitro fertilisation after fresh embryo transfer

AIMS—To compare the outcome in in vitro fertilisation (IVF) children (after fresh embryo transfer) from multiple and singleton births with one another, and with normally conceived control children.METHODS—A cohort of 278 children (150 singletons, 100 twins, 24 triplets and four quadruplets), conceived by IVF after three fresh embryos had been transferred, born between October 1984 and December 1991, and 278 normally conceived control children (all singletons), were followed up for four years after birth. They were assessed for neonatal conditions, minor congenital anomalies, major congenital malformations, cerebral palsy and other disabilities. Control children, all born at term, were matched for age, sex and social class.RESULTS—The ratio of male:female births was 1.03. Forty six per cent of IVF children were from multiple births; 34.9% were from preterm deliveries; and 43.2% weighed less than 2500 g at birth. The IVF singletons were on average born one week earlier than the controls, weighed 400 g less, and had a threefold greater chance of being born by caesarean section. The higher percentage of preterm deliveries was largely due to multiple births and they contributed to neonatal conditions in 45.0% of all IVF children. The types of congenital abnormalities varied: 3.6% of IVF children and 2.5% of controls had minor congenital anomalies, and 2.5% of IVF children and none of the controls had major congenital malformations. The numbers of each specific type of congenital abnormality were small and were not significantly related to multiple births. IVF children (2.1%) and 0.4% of the controls had mild/moderate disabilities. They were all from multiple births, including two children with cerebral palsy who were triplets.CONCLUSIONS—The outcome of IVF treatment leading to multiple births is less satisfactory than that in singletons because of neonatal conditions associated with preterm delivery and disabilities in later childhood. A reduction of multiple pregnancies by limiting the transfer of embryos to two instead of three remains a high priority.     

Serum leptin levels in twins and singleton newborns

BACKGROUND AND OBJECTIVE: Leptin is produced by the human placenta besides adipose tissue and is suggested to be related to fetal growth. In order to find out whether multiple pregnancy is a factor affecting serum leptin levels, we compared neonatal serum leptin concentrations of twins and singleton newborns who were all appropriate for gestational age (AGA). INFANTS AND METHODS: Thirty newborns were studied. Group 1 consisted of 15 infants from twin pregnancies and group 2 (control group) consisted of 15 infants from singleton pregnancies. Serum samples were taken at 24 hours following delivery and leptin concentrations were measured. RESULTS: There were no significant differences in birth weight, gestational age and male/female ratio between infants of twin and single gestations. However, serum leptin concentrations of twins (mean +/- SEM: 1.13 +/- 0.35 ng/ml) were significantly lower than of the singleton infants (4.27 +/- 0.63 ng/ml) (p < 0.001). CONCLUSION: Twin pregnancy might be a factor affecting serum leptin concentrations in newborn infants.     

THE FOETAL DEVELOPMENT OF SERUM LEVELS OF IgG AND IgM

The serum concentrations of the immunoglobulins G and M were studied in non-viable foetuses with gestational ages of 13–26 weeks, and also in premature, mature and postmature infants. Among the prematurely born infants there was an overrepresentation of infants with very low gestational ages. The serum IgG concentrations in the mothers at the time of abortion or delivery were also studied. In full-term infants there was a systematic difference between simultaneously taken capillary and umbilical cord samples, with higher serum concentrations of IgG in the former. For this reason umbilical cord sera were used throughout in this study. The maternal serum concentration of IgG was found to be of some importance for the foetal IgG level. The foetal: maternal IgG ratio increased, as also did the foetal IgG concentration, exponentially during pregnancy, with the exception of its last weeks when the development took place relatively more slowly. IgM in serum was observed (>1 mg/100 ml) in two foetuses with gestational ages as short as 14 and 16 weeks. From the 24th week of pregnancy onwards, IgM was found in the serum in practically all cases. From about the 29th-30th week of pregnancy, no significant increase in the serum IgM with increasing gestational age was observed in the infants studied.     

Maternal smoking during pregnancy and behavioural characteristics in 2 - 4-month-old infants

The study aimed to assess potential relationship between maternal smoking during pregnancy and behavioural characteristics in 2 - 4-month-old infants. It covered period from 1999 to 2000 and comprised 250 randomly selected, apparently healthy singleton born infants from community setting (129 boys, 121 girls). The mothers were asked to complete the questionnaires addressing infant, maternal, demographic major characteristics with particular emphasis on maternal smoking during pregnancy. To objectively assess behavioural peculiarities of the infants, the mothers were requested to complete the Early Infancy Temperament Questionnaire. Of 250 mothers, 64. women (25.6 %) smoked during pregnancy. The infants of smoking mothers were more often born low birth weight and were also lighter at study; more frequently they were born at earlier gestational age, had lower Apgar score at 5 th minute, were less frequently breast fed at birth and at the time of study. Mothers who smoked during pregnancy were younger, had lower educational level, and less frequently were married. The infants born to smoking mothers had more frequent fussy periods occurring at about the same time of the day, protesting behaviour at face washing and washing in bath, indifferent attitude to the mother when held by new person, extreme reactions (either indifference or much feeling) during diapering and bowel movement, less attention to the parents during parent-infant play activity, and more sensitivity to the wet diaper. They were also characterised by more intensive reactions (displayed more amount of energy regardless of positive or negative behaviour) compared with the babies from the non-smoking group. This association remained after adjustment has been made for major potential confounders, and had a significant "dose-response" effect. Maternal smoking during pregnancy may serve as a risk factor for infant's behavioural deviations.     

初产足月儿与经产足月儿宫内生长水平差异的研究

目的 制定不同胎龄初产足月儿与经产足月儿宫内生长百分位曲线,研究分娩产次对宫内生长潜力的影响。方法 采用整群取样法于2013年4月至2015年9月对深圳市两家医院出生的胎龄37~41周单胎足月儿进行体格生长现场测量。曲线拟合应用Lambda-Mu-Sigma（LMS）法。结果 获得了14 529例胎龄37~41周初产、经产足月儿各胎龄出生体重、身长、头围、胸围、顶臀长均值,并制定了其10th、25th、50th、75th、90th百分位曲线。经产足月儿上述5项指标的百分位曲线的形态和增长趋势与初产足月儿一致,但37~41周各胎龄经产足月儿上述5项指标的均值及百分位曲线值均高于初产足月儿。除胎龄41周组初产与经产组顶臀长比较差异无统计学意义外,其余各胎龄组5项指标均值比较差异均有统计学意义（P < 0.05）。结论 胎龄37~41周经产足月儿各胎龄体重、身长、头围、胸围、顶臀长5项指标宫内生长水平均高于初产足月儿,提示分娩产次是宫内生长潜力重要的影响因素。     

Risk factors for preterm and small-for-gestational-age babies: a cohort from the Pacific Islands Families Study

AIM: To explore risk factors that are associated with preterm birth and full-term small-for-gestational-age (SGA) birth for a Pacific population. METHODS: Data were gathered from the Pacific Islands Families Study. Mothers of a cohort of 1398 Pacific infants born in South Auckland, New Zealand during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned regarding maternal health, antenatal care and life-style behaviours. Data regarding birth outcomes were obtained from hospital records. Analyses focused on 1324 biological mothers who gave birth to a singleton and had valid data for birth outcomes. RESULTS: Of 1324 singleton infants, the mean birthweight was 3.60 kg with standard deviation of 0.60 kg. Fifty-two (3.9%) had birthweight less than 2500 g. Ninety-four (7.1%) were born at less than 37 weeks of gestation. Most socio-demographic factors were not associated with poor birth outcomes. Primiparous birth, less frequent attendance of antenatal care and mother's history of high blood pressure were associated with preterm birth and SGA. Smoking during pregnancy increased the odds of having an SGA but not preterm birth. On the other hand, unplanned/unsure pregnancy and prior early pregnancy loss were associated with preterm birth but not SGA. CONCLUSION: Corroborating research conducted with other populations, most of the internationally and nationally recognised risk factors for preterm birth and SGA are also important for Pacific people. Smoking seems to explain more poor birth outcomes in Pacific Islands than in the New Zealand population as a whole.     

Delayed neurological adaptation in infants delivered by elective cesarean section and the relation to catecholamine levels

We have studied the effect of mode of delivery and catecholamine (CA) surge at birth on neurobehaviour 1, 2 and 5 days after birth. Fifteen full-term infants were delivered by elective cesarean section (CS) and 15 full-term control infants were born vaginally. Infants born after elective CS were less excitable and had significantly reduced number of optimal responses during the first 2 days after delivery, compared to the controls. On the 5th day no significant neurological differences were found between the groups. Adrenaline and noradrenaline (NA) in umbilical arterial plasma were analysed in all infants. The mean values of NA were lower in the CS infants as compared to the vaginally delivered infants. Statistically significant correlations were found between low CA levels and poor muscle tone and/or lower grade of excitability in the CS infants. These results suggest that the high CA surge at birth might be of importance for the neurological adaptation after birth.     

Maternal nutritional status, diabetes and risk of macrosomia among Native Canadian women

Multivariate methods were used to identify risk factors for macrosomia (birth weight >4000 g) among 741 singleton births to Native Canadian women from Sioux Lookout Zone, Ontario, Canada, in 1990–1993. The average birth weight was 3691±577 g, and 29.2% of infants weighed more than 4000 g at birth. Macrosomic infants were born at later gestational ages and were more likely to be male. Women delivering macrosomic infants were taller, entered pregnancy with higher body mass indexes (BMI) and gained more weight during pregnancy, but were less likely to smoke cigarettes. They were more likely to have previously delivered a macrosomic infant and to have had gestational diabetes mellitus (GDM). Risk of macrosomia was associated with maternal glycemic status; women with pre-existing diabetes were at greatest risk, followed by those with GDM A₂ (fasting glucose ≥6 mmol/l). Women with GDM A₁ (fasting glucose <6 mmol/l) were not at increased risk for delivering a macrosomic infant, but glucose-tolerant women with high glucose concentrations 1 h after the 50 g challenge were at somewhat increased risk. Maternal glycemic status and maternal nutritional status before and during pregnancy are important determinants of macrosomia in this native population.     

Physical and mental development of Turkish twins

BACKGROUND: Multiple gestations are known to bring some risks in the prenatal and natal period, but whether it is a risk for development in childhood is a matter of debate. The aim of the present study was to evaluate physical and mental development of Turkish twins and then to assess whether being a twin poses risks for their development. METHODS: Fifty-two twin pairs (104 children) aged between 1 and 5 years were enrolled in the study. The control group consisted of 91 singletons, who were matched according to age, sex, gestational week and maternal educational level. The Denver Developmental Screening Test (DDST) was administered to assess cognitive development. Student t-test and chi2 test were used to compare the two groups. RESULTS: The mean age of the mothers of twins did not differ from that of singleton mothers (P > 0.05). Twins were more frequently born in cases of assisted fertilization and were more often born via cesarean section. The birthweights of twins were lower and they were more frequently hospitalized after birth. The breast feeding period was shorter in twins and they had more chronic diseases than singletons (P < 0.05). Mothers of twins needed more help while caring for their infants. Physical development of twins and singletons did not differ statistically (P > 0.05). Twins had more suspect and delayed results in the DDST, especially in the language section of the test. CONCLUSION: Physical and mental development of twins does not differ significantly from singletons except that twins might have a tendency towards slow language acquisition.     

新生儿脐血pH和BE影响因素的研究

目的通过大样本收集新生儿脐血血气,研究脐血血气统计学参考值范围与不同影响因素的相关关系。方法选择2012年5～11月广东省妇幼保健院和新会妇幼保健院产科出生的新生儿进行前瞻性研究,选取其中1rainApgar评分〉7分者的脐血血气结果进行统计分析,了解正常新生儿脐血血气的统计学参考值范围;重点分析影响新生儿脐血pH和BE的因素。结果2000例新生儿中,1min Apgar评分≤7分11例,〉7分1989例,低Apgar评分组pH〈7．2的比例为45．5％,正常Apgar评分组pH〈7．2的比例为3．5％,差异有统计学意义（P〈0．001）;1800例足月单胎、体重适于或大于胎龄新生儿中,1794例1min Apgar评分〉7分者脐血pH和BE的统计学参考值范围分别是7．34±0．14（X±1．96S）和-3．53±6．57（X±1．96s）。单因素分析显示,宫内窘迫组、妊娠期并发症组pH值均低于对照组,剖宫产组pH和BE值均高于阴道分娩组,脐带绕颈组pH值降低,双胎组BE值高于单胎组;羊水性状对pH、BE值均无影响。多因素分析显示,宫内窘迫、分娩方式均对脐血血气有影响。结论足月单胎、体重适于或大于胎龄新生儿中,1min Apgar评分〉7分者脐血pH值和BE值的统计学参考值范围分别是7．34±0．14和-3．53±6．57;Apgar评分与脐血血气分析具有一致性,但单独使用Apgar评分诊断早产儿窒息可能会增加窒息的误诊率;宫内窘迫可能会增加新生儿酸中毒的发生率,不同分娩方式对脐血血气pH、BE值均有影响。     

Temperament at 9 months of very preterm infants born at less than 29 weeks' gestation: the Epipage study

The objective was to determine whether the temperament of very preterm singleton infants born before 29 weeks' gestation differs from their full-term counterparts at 9 months and to examine the influence of neurological sequelae on temperament in very preterm infants. The parents of very preterm infants from nine French regions and a group of full-term infants were sent the Infant Characteristics Questionnaire when the infants were 9 months old. The analysis included 266 singleton very preterm infants from the same regions born before 29 weeks' gestation and 546 full-term singleton infants. There were no significant differences for the Difficult, Unadaptable, and Unpredictable scales between very premature and term infants. Very preterm infants had a slightly higher Dull scale score than term infants. After taking into account mother's age, duration of hospitalization, and cerebral lesions found on neonatal ultrasound scans, this difference was no longer significant. Among very premature infants, those with cerebral lesions as diagnosed by neonatal ultrasound scan were rated higher on the Dull and Unadaptable scales. Delays in development at 9 months were also related to higher Dull and Unpredictable scales. These data suggest that prematurity does not affect temperament ratings at 9 months as assessed by the mother. However, very preterm infants with neurological insults, documented by the neonatal cerebral ultrasound or by a delay in development, are rated higher by their mothers on the Dull, Unadaptable, and Unpredictable scales.     

晚期早产儿健康状况及其影响因素探讨

目的 研究北京市海淀区妇幼保健院1年内,晚期早产儿的出生率、病死率、各系统并发症及早产相关因素等,为进一步建立系统、有效的临床防治方案提供依据.方法 前瞻性统计2007年1月1日至12月31日,北京市海淀区妇幼保健院出生的全部新生儿.胎龄35-37周的晚期早产儿为观察组,生后24 h内检查血、尿、便常规、血气分析、血电解质、监测微最血糖、胸片、头颅B超及心脏彩超;随机选每月1日出生的足月新生儿为对照组,详细记录两组并发症.并对观察组母亲年龄、孕期感染、妊高征、糖尿病、贫血、胎膜早破、羊水异常、脐带异常、胎盘异常、双胎进行分析比较.结果 晚期早产儿333例,出生率为2.71%(333/12 286);并发症以高胆红素血症发生率最高(33.6%),其次为呼吸系统疾病发生率(16.8%)、低血糖(9.0%)、颅内出血(8.1%)、贫血或红细胞增多症(5.7%)、消化系统疾病(5.4%),较足月儿组明显增高(P<0.05);妊高征、贫血、胎膜早破、双胎妊娠是导致晚期早产儿早产的主要高危因素;其病死率为1.20%(4/333),明显高于足月新生儿的0.08%,差异有统计学意义(P<0.05);晚期早产儿住院时间(5.1 d±3.90 d)明显高于足月新生儿(3.2 d±1.61 d)(P<0.05).结论 北京市海淀区妇幼保健院晚期早产儿的出生率为2.71%;其并发症发生率、病死率高于足月新生儿,住院时间也较足月新生儿长;高胆红素血症为最常见并发症;妊高征、贫血、胎膜早破、双胎妊娠是导致晚期早产儿的主要早产因素.儿科医生应重视晚期早产儿,常规收人新生儿科观察治疗.