Early postnatal growth in preterm infants and cord blood leptin.

Although circulating leptin and insulin concentration is linked to intrauterine growth, fetal development and birth weight in full-term infants, there has been no enquiry into the influence of cord blood insulin and leptin for catch-up growth in preterm infants. The study evaluated the association of cord blood leptin with growth and weight gain of 96 premature babies during 6 months (corrected age). The temporal changes of anthropometric indexes over this period were calculated by repeated random regression (PROC MIXED) using SAS. Cord blood leptin was negatively associated with the rate of change in BMI (p=0.01) and length (p<0.001), from birth until 64 postnatal weeks. Insulin was positively associated with the change rate in BMI (p=0.03); however, this disappeared when adjusted for birth weight. For the first time, the association between lower leptin levels with greater catch up growth is shown for both BMI and length among preterm children. In conclusion, leptin levels at birth, but not insulin levels, predict growth rates.     

Relationship of maternal amino acids and proteins to fetal growth and mental development.

The relationship of maternal amino acids, proteins, and certain other factors to fetal development (weight and cranial volume at birth and mental and motor scores at 8 months of age) was investigated in 129 gravidas. Maternal prepregnancy weight was significantly related to birth weight and cranial volume in the newborn. Among amino acids, glycine, lysine, and total amino acids were positively correlated with birth weight, whereas valine and threonine showed a negative correlation. Cranial volume at birth was significantly related to the level of glycine and alpha1 globulin. Other protein and amino acids which contributed to cranial volume included threonine, histidine, glutamic acid, and beta globulin, negatively correlated, whereas glutamine was positively correlated. Alpha1 globulin (negatively) and glycine (positively) made significant contributions to motor development. For mental development, alpha 1 globulin and histidine showed a negative correlation, whereas isoleucine was positively correlated. Findings indicated that the concentrations of certain maternal amino acids and proteins in the third trimester of pregnancy correlated significantly with fetal growth and development. This study suggests: (1) specific proteins or amino acids may be responsible for different developmental measures; (2) injudicious dietary restrictions in pregnancy should be avoided; (3) the determination of alpha1 globulin and a few amino acids such as glycine, lysine, and histidine in late pregancy may be used as predictors of fetal growth and development.     

小于胎龄儿脑发育的随访观察

目的　探讨小于胎龄儿 (SGA)出生时脑发育受影响的程度和出生后脑发育的情况 ,为有脑发育异常的 SGA进行早期干预提供依据。　方法　运用颅脑超声对 SGA的小脑进行冠状位和矢状位小脑面积、周长、纵横径及大脑半球宽度的测量 ,并与适于胎龄儿 (AGA)进行比较分析。　结果　婴儿出生时小脑面积、周长、横径及纵径与其胎龄和出生体重存在较好的相关关系 ,尤以小脑面积和周长与其胎龄和出生体重相关较好 ;大脑半球宽度也与婴儿出生体重存在较好的相关关系。出生时 SGA的脑发育落后于 AGA,出生后 SGA的脑生长速度与 AGA相似 ,但随访至 12个月时 SGA脑发育仍落后于 AGA ,SGA其他脑的异常发生率也较 AGA高。　结论　 SGA不仅在宫内脑的发育受到影响 ,而且可影响到生后脑和神经系统发育 ,故应加强围产期保健 ,制订早期干预计划 ,做好优生工作。     

Intrauterine growth and spastic cerebral palsy. I. Association with birth weight for gestational age

Birth weight, gestational age at delivery, and other factors were collected for 171 white children with spastic cerebral palsy. Their birth weights were compared with the birth weight distribution expected for a population of the same race, gestation, sex, maternal height, and parity, born in the same geographic area, and during the same time period. Birth weights of children with spastic cerebral palsy tended to be significantly lower than the median birth weight of their comparison population. Analysis stratified by gestation at delivery suggested that if the reduced birth weight were causally associated with the spastic cerebral palsy, 22% of cases were attributable to being below the 10th percentile of the comparison population birth weight distribution. The risk of spastic cerebral palsy associated with poor intrauterine growth was dependent on gestation at delivery; poorly grown infants delivered between 34 and 37 weeks' gestation were at highest risk. Some probable pathways by which growth retardation could result in brain damage (intrapartum hypoxia, hypoglycemia, and hypothermia) were investigated. Only intrapartum hypoxia may have played a causal role but probably accounted for less than 2% of all cases. These data suggest that spastic cerebral palsy is associated with poor intrauterine growth in infants of more than 33 weeks' gestation, but no important causal mechanism has yet been identified.     

Analysis of birth weight and gestational age in Taiwan.

Appropriate interpretation of monitored fetal growth throughout pregnancy in individual patients and populations is dependent upon the availability of adequate standards. Previously published standards either were based on small samples, data decades old or were characteristic of foreign subpopulations. We have reviewed the data on a series of 46,575 singleton live births at Chang Gung Memorial Hospital from 1979 to 1989. The ratio of males to females was 1.08. The fetal growth pattern in the third trimester of pregnancy approximates a sigmoid curve. Fetal growth was most rapid from the 32nd to the 37th week of gestation with an average increase of 240 g per week. The birth weight declined beyond 42 weeks' gestation. There were significantly greater weight gains amongst male fetuses as compared to female fetuses from the 34th to the 42nd week of gestation. The mean birth weight recorded at 40 weeks' gestation in male and female newborns was 3,381 g and 3,262 g, respectively. Comparing the birth weight of term pregnancies using our data, with those of a previous, two-decade old report (1945-1967) by Chen, we found that birth weight were slightly higher in this study. The derived fetal growth curves are useful for clinical, public health, and investigational purposes.     

Relationship of insulin-like growth factor-I and insulin-like growth factor binding proteins in umbilical cord plasma to preeclampsia and infant birth weight.

OBJECTIVE: To determine whether preeclampsia influences insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-1 (IGFBP-1), and insulin-like growth factor binding protein-3 (IGFBP-3), independent of its effect on birth weight. METHODS: Cord blood was collected in 12,804 consecutive deliveries. We identified 258 preeclamptic pregnancies that were subclassified as mild or severe and early or late. For comparison, 609 control pregnancies were selected. Fetal growth was expressed as the ratio between observed and expected birth weight, with adjustment for gestational age at birth. IGF-I, IGFBP-1, and IGFBP-3 were measured in umbilical plasma. The contribution of preeclampsia and birth weight to each measured factor was assessed by multiple linear regression analyses. RESULTS: Between mild preeclampsia and controls, there were no differences in IGF-I, IGFBP-1, and IGFBP-3. In severe and early onset preeclampsia, umbilical cord plasma IGF-I was approximately 50% lower, and IGFBP-1 was more than twice as high as in controls (both P <.01). At each birth weight level, IGF-I was lower and IGFBP-1 was higher in severe or early preeclampsia than among controls of similar weight. Birth weight and preeclampsia were, independent of each other, associated with IGF-I, whereas birth weight, but not preeclampsia, was associated with IGFBP-1, after adjustment for gestational age. CONCLUSION: Fetal growth restriction caused by severe or early preeclampsia is associated with lower umbilical levels of IGF-I than low birth weight caused by other conditions. Preeclampsia may contribute to the observed IGF-I reduction, either as part of the underlying causes of preeclampsia, or as a consequence of the disease.     

Maternal anthropometrics are associated with fetal size in different periods of pregnancy and at birth. The Generation R Study

Objective  We aimed to examine the associations of maternal anthropometrics with fetal weight measured in different periods of pregnancy and with birth outcomes.
Design  Population-based birth cohort study.
Setting  Data of pregnant women and their children in Rotterdam, the Netherlands.
Population  In 8541 mothers, height, prepregnancy body mass index (BMI) and gestational weight gain were available.
Methods  Fetal growth was measured by ultrasound in mid- and late pregnancy. Regression analyses were used to assess the impact of maternal anthropometrics on fetal weight and birth outcomes.
Main outcome measures  Fetal weight and birth outcomes: weight (grams) and the risks of small (<5th percentile) and large (>95th percentile) size for gestational age at birth.
Results  Maternal BMI in pregnancy was positively associated with estimated fetal weight during pregnancy. The effect estimates increased with advancing gestational age. All maternal anthropometrics were positively associated with fetal size ( P -values for trend <0.01). Mothers with both their prepregnancy BMI and gestational weight gain quartile in the lowest and highest quartiles showed the highest risks of having a small and large size for gestational age child at birth, respectively. The effect of prepregnancy BMI was strongly modified by gestational weight gain.
Conclusions  Fetal growth is positively affected by maternal BMI during pregnancy. Maternal height, prepregnancy BMI and gestational weight gain are all associated with increased risks of small and large size for gestational age at birth in the offspring, with an increased effect when combined.     

New-onset hypertension in late pregnancy and fetal growth: different associations between singletons and twins.

OBJECTIVE: To compare the effects of new-onset hypertension (NOH) in late pregnancy on fetal growth in singletons and twins. METHODS: A retrospective cohort study was conducted to evaluate the effect of NOH on fetal growth in 17, 720, 900 singletons and 463, 104 twins born in the United States between 1995 and 2000. RESULTS: NOH was associated with lower mean birth weight in both preterm and term singletons. Increased risk of low birth weight and decreased risk of high birth weight was associated with NOH in preterm and term singletons. NOH was associated with increased risk for small-for-gestational-age (SGA) births and decreased risk for large-for-gestational-age (LGA) births in preterm singletons, whereas it was associated with increased risk of both SGA and LGA births in term singletons. NOH was associated with higher mean birth weight in early preterm twins, and lower mean birth weight in term twins. Decreased risk for low birth weight was found in the NOH group among early preterm twins, and increased risk for low birth weight in term twins. NOH was associated with increased risk of SGA births and decreased risk for large-for-gestational-age (LGA) births in early preterm twins, while increased risk of SGA births in term twins. CONCLUSION: NOH is associated with slower fetal growth in singletons delivered at different gestational ages, but the effect varies in twins depending on gestational age at delivery with faster growth in early preterm twins.     

Evaluation of symphysis-fundus measurements and weighing during pregnancy.

To evaluate the value of using symphysis-fundus (SF) distance and maternal weight gain measurements in predicting an infant's birth weight, these measurements were analysed in 831 single-birth deliveries at Aker University Hospital during a period of 3 months. Of the 96 babies with a birth weight below the 10th percentile for gestational age, 39 (41%) could be detected by a series of SF-measurements. For every third correctly identified SGA (small for gestational age) baby, there were 7 false positive predictions. Only 13 (14%) of the mothers who gave birth to SGA babies demonstrated a weight gain at each medical check-up during pregnancy, whereas 197 (30%) of the women giving birth to normal-weight babies showed a weight gain each time (p = 0.02). However, for maternal weight gain, both predictive value (14%) and specificity (29%) were low. Hence, these two screening methods for the detection of SGA babies remain imprecise in practice. Test procedures should be improved, and factors influencing fetal growth should be emphasized to detect fetuses at risk.     

Prediction of extrauterine growth retardation (EUGR) in VVLBW infants.

BACKGROUND: Long-term growth failure in very very low birth weight (VVLBW) infants is a common complication of extreme prematurity. Critical illnesses create challenges to adequate nutriture. PURPOSE: To identify predictors of extrauterine growth retardation (EUGR) in VVLBW infants and to evaluate their nutritional intake and subsequent growth. STUDY DESIGN: A 4-year retrospective chart review of 221 infants 相似文献   

Growth failure in the preterm infant: can we catch up?

Postnatal growth failure is extremely common in the very low birth weight and extremely low birth weight infant. Recent data from the National Institute of Child and Human Development (NICHD) Neonatal Research Network indicates that 16% of extremely low birth weight infants are small for gestational age at birth, but by 36 weeks corrected age, 89% have growth failure. Follow-up at 18 to 22 months corrected age shows that 40% still have weights, lengths, and head circumferences less than the 10th percentile. Growth failure is associated with an increased risk of poor neurodevelopmental outcome. Inadequate postnatal nutrition is an important factor contributing to growth failure, as most extremely low birth weight infants experience major protein and energy deficits during the neonatal intensive care unit hospitalization, in spite of the fact that nutrition sufficient to support intrauterine growth rates can generally be provided safely. Aggressive nutritional support--parenteral and enteral--is well tolerated in the extremely low birth weight infant and is effective in improving growth. Continued provision of appropriate nutrition (premature formula or fortified human milk) is important throughout the neonatal intensive care unit stay. After discharge, nutrient-enriched postdischarge formula should be continued for approximately 9 months post-term. Exclusively breast-fed infants require additional supplementation/fortification postdischarge as well. Additional trials are needed to address a number of important questions concerning the role of nutrition and growth on ultimate development.     

Weight percentile at birth. II. Prediction by endocrinological and sonographic measurements

In a prospective study of 847 singleton pregnancies, the importance of various endocrine methods (serum estriol, HPL, SP1, beta-HCG, estradiol-17 beta, urinary estrogen excretion) and of two sonographic measurements (biparietal and thoracic diameter) for the diagnosis of growth retardation in the third trimester was studied. HPL and estriol determinations were best suited for the diagnosis of growth retardation. The thoracic diameter correlated most closely with the birthweight of the newborns. Sensitivity in relationship to growth retardation was between 17 and 35% for the HPL and estriol determinations as well as for both sonographic methods. Specificity was around 90% for these methods. The validity for all methods improved as the time of birth approached. Through the simultaneous measurement of one of the hormones and the thoracic diameter, an antepartal diagnosis of up to 50% of the hypo- and hypertrophic growth disorders was achieved. In the first two years of life a relationship between development and the HPL and estriol concentrations could be observed which was independent of the weight percentile at birth.     

Matrilineal transmission of birth weight in the rhesus monkey (Macaca mulatta) across several generations.

OBJECTIVE: To investigate how secular trends in maternal weight characteristics, in response to living in a permissive laboratory environment, influence intergenerational trends in birth weight in the rhesus monkey (Macaca mulatta) and to assess the role of female offspring in perpetuating these matrilineal traits. METHODS: A multigenerational data set was used to evaluate the relationship between familial and contemporaneous pregnancy factors and infant birth weight across several generations. These records provided 25 years of information on the maternal and paternal ancestries and reproductive histories, gestation lengths, and birth weights for 1321 infants. RESULTS: Pregnancy weight gain, gestation length, and maternal familial factors were the most important predictors of infant birth weight, followed by infant sex, paternity, and maternal pregravid weight (P<.001 for each variable). Furthermore, the trend in fetal growth across generations followed a matrilineal pattern of transmission that was much more pronounced for female than male offspring (P<.001). Although secular increases in maternal pregravid weight and pregnancy weight gain were detected, the upward shift in female birth weight was not explained solely by these changes in maternal weight parameters. CONCLUSION: With the delivery of ample nutrition and health care in a laboratory setting, there was a dramatic increase in the birth weight of daughters within certain matrilines, providing evidence that an intrauterine mechanism transmitted through female progeny can regulate fetal development. Further, the upward trend in female birth weight had a beneficial influence on the reproductive performance of female descendants in those lineages.     

Birth weight in twins: an analysis of discordancy and growth retardation

Sonographic estimation of fetal weight offers the potential of antenatal diagnosis of discordancy and growth retardation in twins. Although standards for intertwin birth weight percent differences in infants over 2500 g are available, similar norms are not available at lower weights. Intertwin birth weight percent differences in live-born twins above 500 g in 500-g increments were analyzed. Intertwin birth weight differences, expressed as a percentage of the weight of the larger twin, were relatively uniform across a wide range of birth weights. Differences above 15% were increasingly more likely to be associated with growth retardation in one of the infants.     

亲代出生体重对子代出生体重的影响

目的探讨亲代出生体重对子代出生体重的影响及母亲宫内发育不良的经历是否会影响子代宫内发育状况，为研究环境和遗传因素对出生体重的影响提供线索。 方法首都儿科研究所采用回顾性队列研究，于1995~2001年以1948~1954年北京协和医院出生的“宫内发育与成人疾病”队列人群为基础，利用研究对象的出生记录和回顾性问卷调查资料，分析出生体重在亲代与子代之间的关联。 结果在控制了母亲的产次、生育年龄以及配偶的身高体重等影响因素后，母亲的出生体重与其子代出生体重之间存在显著的正相关关系(r=0.38,P<0.001)，而父亲与子代之间在出生指标尚未表现出相关性；母亲为低出生体重(出生体重<2500g)，其子代中低出生体重发生的危险是对照组(亲代出生体重≥3500g)的3倍多。 结论母亲与子代在出生体重上存在明显正相关，母亲低出生体重可能会增加子代发生低出生体重的危险。     

The risks of spontaneous preterm delivery and perinatal mortality in relation to size at birth according to fetal versus neonatal growth standards

OBJECTIVE: The aim of this study was to test the null hypothesis that size at birth relative to fetal or neonatal growth standards is not a significant variable related to the risk of spontaneous preterm delivery. STUDY DESIGN: This was a hospital-based cohort study of consecutive births at a tertiary care perinatal center from January 1, 1985, to December 31, 1996. A total of 37,377 pregnancies met the following inclusion criteria: (1) singleton gestation, (2) 25 to 40 weeks' gestation, and (3) no anomalies. Neonates were divided into 5 birth weight categories according to either fetal (uncorrected for sex) or neonatal (corrected for sex) growth standards, as follows: (1) intrauterine growth restriction, birth weight <3rd percentile; (2) borderline intrauterine growth restriction, birth weight > or = 3rd percentile and <10th percentile; (3) appropriate for gestational age, birth weight from 10th percentile through 90th percentile; (4) borderline large for gestational age, birth weight >90th percentile but < or = 97th percentile, and (5) large for gestational age, birth weight >97th percentile. Logistic regression analysis was used to estimate the independent effect of birth weight category on the risk of preterm delivery after spontaneous onset of labor, with the appropriate-for-gestational-age group serving as a reference. RESULTS: When fetal growth standards were applied, there was a significant increase in the risk of spontaneous preterm delivery when birth weight was outside the appropriate-for-gestational-age range (odds ratios of 2.5, 1.4, 1.2, and 1.9 for intrauterine growth restriction, borderline intrauterine growth restriction, borderline large-for-gestational age, and large-for-gestational-age groups, respectively). In contrast, when neonatal growth standards were applied, the risks of spontaneous preterm delivery in intrauterine growth restriction, borderline intrauterine growth restriction, and large-for-gestational-age groups were significantly lower (odds ratios of 0.5, 0.7, and 0.7 for intrauterine growth restriction, borderline intrauterine growth restriction, and large-for-gestational-age groups, respectively) because of an underestimation in the number of fetuses with abnormal size at birth delivered prematurely. With both fetal and neonatal growth standards there was a 5-to 6-fold greater risk of perinatal death for both preterm and term fetuses with intrauterine growth restriction. CONCLUSION: Fetal growth standards are more appropriate in predicting the impact of birth weight category on the risk of spontaneous preterm delivery than are neonatal growth standards. When fetal standards are applied, the risks of preterm birth in both extreme abnormal birth weight categories (intrauterine growth restriction and large for gestational age) are 2- to 3-fold greater than the risk among appropriate-for-gestational-age infants.     

ANTI-HYPERTENSIVE DRUGS IN PREGNANCY AND FETAL GROWTH: EVIDENCE FOR “PHARMACOLOGICAL PROGRAMMING” IN THE FIRST TRIMESTER?

Objectives: To determine the timing and exact nature of the effect of the drug atenolol upon fetal growth. Also to discover if the reduction in fetal growth is due to superimposed pre-eclampsia or any other confounding variable. Design: A retrospective cohort study of prospectively collected data in a hypertensive pregnancy database. Setting: Two district general hospitals in the midlands of England. Both hospitals have specialised medical antenatal clinics for pregnant women with chronic hypertension. Participants: 491 pregnancies in 380 women with essential or secondary hypertension. Outcome measures: The outcome measures used were the infant birth weight, birth weight standardized for gestational age, and the ponderal index at birth, a surrogate measure for in utero growth restriction. Results: The babies of women taking atenolol at conception or during the first trimester had significantly lower birth weights (by 139–512 g, p<0.01) than women on calcium channel blockers or no medication. Likewise the ponderal index was also significantly reduced, p<0.01. In addition most of these babies were small for gestational age (SGA) with 70% on or below the 10th centile and 40% below the third centile. No such independent association was seen with anti-hypertensives taken in the second trimester. Conclusions: Atenolol taken at the time of conception and/or during the first trimester of pregnancy was associated with low birth weight. This finding was independent of the development of superimposed pre-eclampsia. Other anti-hypertensives were not found to be associated with low birth weight. Use of atenolol in the second trimester of pregnancy did not produce the same effect and was not materially different in its effects from the other anti-hypertensive drugs. In the second trimester, the development of superimposed pre-eclampsia is the over-riding effect in the reduction of infant birth weight. Atenolol used in the first trimester could be pharmacologically programming these infants to restricted growth patterns.     

Intrauterine development and MNSs blood groups in repeated spontaneous abortion.

OBJECTIVES: To determine whether the maternal MNSs genotype has an effect on the birth weight and gestation duration of the live offspring of women with repeated primary spontaneous abortion (RSA). METHODS: The study sample consisted of 239 healthy white women who had been delivered of a live infant, and 137 women with a history of primary RSA-54 of whom had recently been delivered of a live infant and 83 who had had a spontaneous abortion. Maternal MNSs phenotypes were determined by standard serological methods, and the results were analyzed for relationships between these phenotypes and the mothers' reproductive status and the infants' birth weight and gestational age. Analysis of variance, the chi(2)-test of independence, and the Mantel-Haenszel test for linear association were performed for data analysis. RESULTS: Infants born to mothers with the Ss genotype showed significantly lower birth weight and gestational duration compared with the infants of mothers with other genotypes. Additionally, the MNSs haplotype was found to be associated with birth weight. CONCLUSIONS: Previous studies have shown that the MNSs system influences the gestational age of aborted fetuses in cases of RSA. The present study supports the hypothesis that this genetic factor influences intrauterine growth and development in women experiencing RSA.     

Influence of Maternal Weight,Smoking, and Socioeconomic Status on Infant Triceps Skinfold Thickness and Growth During the First Year

ABSTRACT: The effect of pregravid weight-for-height status, pregnancy weight gain, demographic factors, and smoking on several infant growth parameters from birth to eleven months of age was investigated in 120 mother/infant pairs. Pregravid weight-for-height status and total weight gain during pregnancy were positively related to infant birth weight but were not predictive of triceps skinfold measurements or changes in weight/length ratios from one to eleven months of age measured at bimonthly intervals. Although maternal smoking habits were related to lower infant birthweight, they did account for some increase in triceps measurements and changes in weight/length ratios at nine to eleven months of age. In light of the fact that maternal factors were not highly predictive of infant growth, except at birth, other factors in the early infant environment may play a more significant role in determining infant growth patterns.     

First trimester prediction of growth discordance in twin gestations

OBJECTIVE: The purpose of this study was to determine whether first trimester ultrasound scanning can identify twin gestations that are at risk for subsequent growth discordance. STUDY DESIGN: Ultrasound examinations of dichorionic twin pregnancies between 11 and 14 weeks of gestation were evaluated for growth discordance with crown-rump length. Pregnancies that were complicated by fetal death or anomalies were excluded from the analysis. Birth weight discordance was defined as >or=20% difference in birth weight, relative to the larger twin. Fisher's exact, Mann Whitney U, and Spearman rho tests were used for statistical analysis. RESULTS: Of 130 twin pregnancies, 16 pregnancies (12.3%) had discordant birth weight. Crown-rump length disparity was correlated positively with birth weight discordance (r=0.31; P<.001). Of pregnancies with a discrepancy of 3 days discrepancy (P=.004), which resulted in a likelihood ratio of 5.9 for having discordant birth weight. CONCLUSION: Twins who are ultimately discordant at birth may exhibit differences in growth as early as 11 to 14 weeks of gestation.