Gestational weight gain adequacy among twin pregnancies in France

The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population‐based JUmeaux MODe d''Accouchement (JUMODA) cohort study (2014–2015). Following the IOM approach, we selected a ‘standard’ population of term pregnancies with ‘optimal’ birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index [BMI]: 16.8–24.5 kg [also utilized for underweight BMI]; overweight: 14.1–22.7 kg; obese: 11.4–19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA‐derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13–21 kg; normal weight: 13–20 kg; overweight: 11–19 kg; obese: 7–16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA‐derived classification is more appropriate for French twin gestations.     

No significant difference in birth weight for offspring of birth weight discordant monozygotic female twins

Birth weights of offspring of 105 female, monozygotic twin pairs discordant in birth weight were studied. No significant differences were found when offspring of the larger twin were compared with offspring of the smaller twin. The results do not support the hypothesis that in utero effects on females associated with low birth weight will influence their subsequent chance of having low birth weight offspring.     

Specific role of maternal weight change in the first trimester of pregnancy on birth size

The specific role of weight change in the first weeks of gestation in fetal growth has not been fully explored in humans. Our aims were to investigate: (1) the specific association between weight change in the first trimester of pregnancy (WCT1) and size at birth in term pregnancies; and (2) the role of placental weight in this relationship. From 2002 women included in the French EDEN study, 1744 mother–child pairs reached term, had pre‐pregnancy weight available and at least five measures of weight in pregnancy. We extrapolated women's weight at each week of gestation with a three‐degree polynomial model and estimated weight change during each trimester of gestation. We used a multivariate linear model to investigate the associations between WCT1 and birth size after taking into account potential confounders (age, parity, BMI, tobacco use, educational level, length of gestation, newborn gender, weight change after the first trimester and centre of study). Then, we performed path analysis to investigate whether the relation between WCT1 and birth size could be mediated by placental weight. After taking into account weight gain in later gestation, WCT1 was positively associated with birthweight. Results of path analysis showed that there was no direct association between WCT1 and birth size, but that this association was mediated by placental weight. Weight change during the first weeks of pregnancy may impact on fetal growth independently of weight change later in pregnancy through its effects on placental growth and function.     

High birth weight, asthma and atopy at the age of 16 yr

The association between high birth weight and asthma has been suggested. The Northern Finland Birth Cohort 1986, a longitudinal cohort originally including 9479 participants, has been followed up since birth until the age of 16 yr. Using the data of this study, we analyzed the association of high birth weight with asthma and atopic sensitization at the age of 16 yr. The analysis included the 5995 subjects with complete skin prick test data and the 5500 subjects with data on doctor-diagnosed asthma (written questionnaire) at the age of 16 yr. Atopy was defined as at least one positive skin prick test reaction, which definition was also used to separate atopic and non-atopic asthma. There was a significant association between high birth weight (>4510 g) and asthma among the atopic subjects (OR 2.40, 95% CI 1.33–4.32). When looking at atopy, the highest risk was observed among the subjects with highest birth weight category (>4510 g) (OR 1.44, 95% CI 1.05–1.97) and the adjacent (4200–4500 g) birth weight category (OR 1.24, 95% CI 1.01–1.53), when compared with the reference category (2500–3340 g). Our results support the notion that high birth weight is associated with an increased risk of asthma and suggest that the association is mostly explained by an increased risk of atopy. The biological mechanisms behind the associations are unknown, but they could be related to obesity.     

出生体质量与儿童代谢综合征的相关性

代谢综合征(metabolic syndrome,MetS)是中心性肥胖、糖耐量异常、高血压、高三酰甘油血症和低高密度脂蛋白胆固醇血症等代谢紊乱症候群。研究显示,出生体质量异常新生儿在成年期发生代谢性疾病的概率大于出生体质量正常者。出生体质量异常可能会导致儿童及成年期一系列代谢性改变,但目前对于巨大儿及低出生体质量儿发展为儿童代谢综合征的机制还处于探索阶段。与此同时,很多实验研究各自采用不同的儿童代谢综合征的定义,因而难以对这些实验结论做出直接横向比较。文章将分别阐述出生体质量异常与儿童代谢综合征各组分相关性研究进展。     

A multicenter study of diet quality on birth weight and gestational age in infants of HIV‐infected women

We determined factors associated with diet quality and assessed the relationship between diet quality, birth weight, and gestational age in a prospective national multicenter cohort study. We evaluated diet quality with the Healthy Eating Index (HEI, scale 0–100) in the third trimester of pregnancy with three 24‐hr multiple‐pass dietary recalls in 266 HIV+ women enrolled in the Pediatric HIV/AIDS Cohort Study. Covariates included demographics, food security, pre‐pregnancy body mass index, HIV disease severity, substance use, and antiretroviral exposures. A two‐stage multivariate process using classification and regression trees (CART) followed by multiple regression described HEI tendencies, controlled possible confounding effects, and examined the association of HEI with birth weight and gestational age. To assess the stability of the CART solution, both the HEI 2005 and 2010 were evaluated. The mean HEI scores were 56.1 and 47.5 for the 2005 and 2010 HEI, respectively. The first‐stage CART analysis examined the relationship between HEI and covariates. Non‐US born versus US‐born mothers had higher HEI scores (15‐point difference, R² = 0.28). There was a secondary partition due to alcohol/cigarette/illicit drug usage (3.5‐point difference, R² = 0.03) among US‐born women. For the second‐stage CART adjusted multiple regression, birth weight z‐score was positively related to HEI 2005 and 2010 (partial r's > 0.13, P's ≤ 0.0398), but not gestational age (r = 0.00). We conclude that diet quality among HIV+ women is associated with higher birth weight. Despite the influence of a large cultural effect and poor prenatal behaviors, interventions to improve diet in HIV+ women may help to increase birth weight.     

Trends in human birth weight across two successive generations

Objective  To determine the correlation between parental and offspring birthweight (BW) in India. Methods  The study involved two birth cohorts of successive generations. The parental cohort comprised of 472 fathers and 422 mothers from an earlier study. Details of their anthropometry at birth and in adulthood were available. 1525 children born to them comprised the offspring cohort. BW was obtained from hospital records for the offspring cohort. Odds ratios and regression coefficients were calculated to estimate the risks of a low birth weight (LBW) parent producing a LBW baby and quantitate the effects after adjusting for confounders. Results  A LBW mother had a 2.8 times risk (95%CI 1.2–6.4) of delivering a LBW baby (p=0.02) and a LBW father was twice as likely to produce a LBW baby (OR 2.2; 95%Cl 1.0–4.8; p=0.05). Every 100g increase in maternal BW was associated with an increase in offspring BW of 14g; the equivalent figure for paternal BW was 18.1g (p<0.001 for both). Between the generations, the incidence of LBW decreased from 19.7% to 17.2% (p=0.1). Mean BW increased in males (2846 g vs 2861 g; p=0.59) but not in females (2790 g vs 2743 g; p=0.08). Conclusion  Both maternal and paternal BW are strong determinants of offspring BW. The effect of mothers’ BW on offspring BW is weaker than that seen in developed nations. Stronger intrauterine constraint exhibited by Indian women secondary to a higher prevalence of growth restriction in utero may be responsible. Paternal effects may be governed by paternal genes inherited by the offspring.     

出生体重与5至8岁儿童超重和肥胖关联的队列研究

目的以回顾性队列研究探讨出生体重与5~8岁儿童超重和肥胖的关系。方法利用上海市闵行区所辖的13家社区卫生服务中心3~12岁儿童的体格检查数据库,截取5~8岁儿童的身高和体重数据进行分析。体检时行问卷调查生育史、出生体重、妊娠情况和出生后喂养史。按照出生体重分为:2 500 g(低出生体重儿)、~3 000 g、~3 500 g、~4 000 g和≥4 000 g组(巨大儿)。采用多元logistics分析评估出生体重与5~8岁儿童超重和肥胖的关系,并调整相关因素的影响。结果 99 897名5~8岁儿童进入分析,超重发生率为10.1%,肥胖发生率为5.0%。11.4%的儿童为低出生体重,7.3%为巨大儿;出生体重2 500 g、~3 000 g、~3 500 g、~3 500 g、~4 000 g和≥4 000 g组超重检出率分别为8.4%、7.6%、9.2%、11.5%和14.5%;肥胖检出率分别为4.7%、3.9%、4.4%、5.9%和7.9%。2简单相关分析发现,~3 500 g、~4 000 g和≥4 000 g组出生体重与儿童体重呈正相关(P0.000 1),在调整了性别、年龄、身高、分娩史、孕周、喂养史和身高后,仍具有显著相关性。3与出生体重~3 500 g组相比,~4 000 g组超重和肥胖的发生率增加31%和43%,~4 500 g组超重和肥胖的发生率增加76%和103%;~3 000 g组发生超重和肥胖的风险最低(RR=0.80,95%CI:0.73~0.88,P0.000 1;RR=0.87,95%CI:0.77~0.98,P0.000 1),调整了年龄、性别、孕周和产式等因素后,仍具有相关性;5、6、7和8岁儿童~4 000 g和≥4 000 g组发生超重和肥胖的风险相近;2 500 g组肥胖的风险RR为1.07(95%CI:0.79~1.43),P=0.27。结论出生体重对5~8岁儿童超重和肥胖的影响呈非线性关系。出生体重3 500 g儿童5~8岁超重和肥胖的风险显著增高。     

Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post‐partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post‐partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio‐economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed‐effects models. The average cumulative weight loss at 6 months post‐partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post‐partum. After adjustment, the data indicated that for every 1‐point increase in breastfeeding score, the estimated average post‐partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post‐partum weight loss at all stages of the study during the 24‐month follow‐up.     

Intestinal microbiota in allergic and nonallergic 1‐year‐old very low birth weight infants after neonatal glutamine supplementation

Aim: Previously, glutamine‐enriched enteral nutrition in very low birth weight infants (VLBW) decreased the incidence of atopic dermatitis at age 1 year. The aim of this study was to determine whether this effect is related to changes in intestinal bacterial species that are associated with allergy, such as bifidobacteria, clostridium histolyticum, clostridium lituseburense (Chis/lit group) and Escherichia coli at age 1 year. Methods: Eighty‐nine infants were eligible for this follow‐up study, conducted at a Tertiary care hospital. Bifidobacteria, Chis/lit group and E. coli were measured by fluorescent in situ hybridization in faecal samples collected at age 1 year. Information on allergic and infectious diseases was previously determined by questionnaire. Results: Seventy‐two of 89 (81%) infants were participated. Prevalence of all studied species was not different between glutamine‐supplemented and control groups. Allergic infants were less frequently colonized with bifidobacteria than nonallergic infants (p = 0.04). Between neonatal period and 1 year, prevalence of bifidobacteria was increased (p < 0.001), of Chis/lit group was unchanged (p = 0.84), and of E. coli was decreased (p < 0.001). Conclusion: The beneficial effect of glutamine‐enriched enteral nutrition on the incidence of atopic dermatitis in the first year of life in VLBW infants is not related to changes in bifidobacteria, Chis/lit group or E. coli. Allergic VLBW infants are less frequently colonized with bifidobacteria compared to nonallergic VLBW infants.     

Prenatal maternal depression is associated with low birth weight through shorter gestational age in term infants in Korea

Background

Maternal prenatal depression is associated with lower offspring birth weight, yet the impact of gestational age on this association remains inadequately understood.

Aims

We aimed to investigate the effect of prenatal depression on low birth weight, gestational age, and weight for gestational age at term.

Study design

Prospective cohort study.

Subject

Data were collected from 691 women in their third trimester of pregnancy who went on to give birth to a singleton at term without perinatal complications. One hundred and fifty-two women had a Center for Epidemiologic Studies Depression Scale-10 score ≥ 10 and were classed as prenatally depressed.

Outcome measures

Low birth weight (< 2500 g), gestational age at birth, and birth weight percentile for gestational age.

Results

Offspring of prenatally depressed women were more likely to be low birth weight (Odds ratio [OR] 2.94, 95% confidence interval [CI] 1.14–7.58) than offspring of prenatally non-depressed women, but the association was attenuated (OR 1.66, 95% CI 0.55–5.02) when adjusted for gestational age. Offspring of prenatally depressed women had lower gestational age in weeks (OR for one week increase in gestational age: 0.66, 95% CI 0.47–0.93) than offspring of prenatally non-depressed women. There was no association between prenatal depression and birth weight percentile for gestational age.

Conclusions

Prenatal depression was not associated with low birth weight at term, but was associated with gestational age, suggesting that association between maternal depression and birth weight may be a reflection of the impact of depression on offspring gestational age.     

Epidemiological co-relates of low birth weight in rural TamilNadu

A total of 328 consecutive births born between July and September 1990 were analysed. The rate of LBW was 24.6%. The mean birth weight was 2.72 kg (± 0.44 kg). Association between LBW and parity, mother’s age, mother’s height, gestational weight, risk status at pregnancy and antenatal care was observed. These results indicate that there is a need to strengthen maternal services to address the problem of LBW in India.     

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超低出生体重儿(extremely low birth weight infant,ELBWI)是指出生体重低于1000g的新生儿,大多为胎龄小于32周的极早产儿[1]。伴随围生期医学和新生儿医学的不断发展,ELBWI出生率不断上升,可能存活者的体重和孕周不断降低。     

Predictors of post‐partum weight retention in a prospective longitudinal study

Post‐partum weight retention (WR) occurs in 60–80% of women with some retaining ≥10 kg with contributing factors reported as pre‐pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12‐month post‐partum follow‐up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre‐pregnancy weight was self‐reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post‐partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre‐pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1–8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre‐pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of ‘any’ breastfeeding contributed to post‐partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.     

Intellectual psycho-educational and functional status of low birth weight survivors beyond 5 years of age

To determine the intellectual, psycho-educational and functional status of low birth weight (LBW) survivors (birth weight ≤2000 gms) beyond 5 years of age and to compare their status with normal birth weight counterparts. This was cross-sectional study. On hospital based cohort on longitudinal follow-up at the High Risk and Well Baby Clinics of a teaching hospital. The demographic data of these children was recorded. A detailed physical examination was performed. The tests of cognition included the Stanford Binet and the Raven’s Progressive Matrices. Academic achievement was evaluated by the Wide range achievement test-Revised (WRAT-R). Assessment of visuo motor integration was done by the Bender Gestalt Test. The proportion of children having soft neurological signs was determined. Vineland Social Maturity Scale was performed on all children. Fifty-nine LBW children and fifty-seven matched control children participated in the study. 27 of LBW children were examined at a mean age of 7.0 ±1.1 years (group I) and 32 were examined at a mean age of 10.6 ±1.2 years (group II). The LBW children as a group performed in the normal range on the tests of cognition and academic achievement, but were significantly disadvantaged (p < 0.005) as compared to controls. A higher percentage of LBW children had low scores on the Bender Gestalt. Test as compared to controls but the difference was not significant. A significantly higher proportion of LBW children of both the groups showed the presence of soft neurological signs as compared to controls. The social quotient as assessed by the vineland Social Maturity Scale was significantly lower in the LBW children as compared to controls. Thus, though the LBW children were performing in the normal range on various measures, comparison with the control group showed that they were clearly disadvantaged on nearly every measure tested, emphasizing the need for early detection and referral for special education.     

Predictor of low birth weight babies by anthropometry

OBJECTIVE: The present study was undertaken to find out the best simple anthropometric parameter for identifying low birth weight (LBW) babies. STUDY DESIGN: Hospital-based cross-sectional study. PARTICIPANTS: Newborn babies born in KHS hospital, Sevagram. RESULTS: In the present study, out of 868 newborn babies studied, 52.2% were male. Total 12.6% of them were birth weight < 2000 g and 44.6% were birth weight < 2500 g. Birth weight was significantly correlated (p < 0.001) with thigh circumference (TC), mid-arm circumference (MAC), calf circumference (CFC) and head circumference (HC). All anthropometric indicators had a statistically significant sensitivity, specificity and predictive value (p < 0.001) for identifying < or =2500 g birth weight babies. Receiver operating curve (ROC) analysis was done to identify the optimal cut-off points of these anthropometric measures separately for LBW babies and <2000 g birth weight babies. CONCLUSION: HC and TC appears to be better indicators for picking up LBW babies and MAC and CFC appears to be better in picking up very LBW babies.     

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND: Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported. AIMS: To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition. METHODS: A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted. RESULTS: Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks. CONCLUSIONS: These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.     

Associations between maternal scaffolding and executive functioning in 3 and 4 year olds born very low birth weight and normal birth weight

Background

Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers.

Aims

The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW.

Subjects

A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study.

Outcome measures

VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence — Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions.

Study design

Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender.

Results

Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon.

Conclusion

Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.     

Early working memory and maternal communication in toddlers born very low birth weight

Aim: Early working memory is emerging as an important indicator of developmental outcome predicting later cognitive, behavioural and academic competencies. The current study compared early working memory in a sample of toddlers (18–22 months) born very low birth weight (VLBW; n = 40) and full term (n = 51) and the relationship between early working memory , mental developmental index (MDI) , and maternal communication in both samples.
Methods: Early working memory, measured by object permanence; Bayley mental developmental index ; and maternal communication, coded during mother-toddler play interaction, were examined in 39 toddlers born VLBW and 41 toddlers born full term.
Results: Toddlers born VLBW were found to be 6.4 times less likely to demonstrate attainment of object permanence than were toddlers born full term, adjusting for age at testing. MDI and maternal communication were found to be positively associated with attainment of object permanence in the VLBW group only.
Conclusion: The difference found in the early working memory performance of toddlers born VLBW , compared with those born full term , emphasizes the importance of assessing early working memory in at-risk populations, while the maternal communication finding highlights potential targets of intervention for improving working memory in toddlers born VLBW.