Endocrine Pancreatic Function in Fetuses of Gestational Diabetic and Nondiabetic Mothers

C-peptide, insulin, and glucagon levels were measured in the cord blood of 112 nondiabetics controls and 63 diabetic mothers. The cord blood levels of insulin and C-peptide were significantly higher in the diabetic compared to the control group. In the control group, C-peptide levels were positively correlated with fetal birthweight. In the diabetic group, there was a positive correlation between birth-weight and both C-peptide and insulin levels. Neonates were stratified into six categories of birthweight centiles. In the diabetic group, the insulin level was significantly higher than in the control group at all categories of birthweight centiles. Also, the C-peptide level was higher in the diabetic than in the control group, except at the >25 and ≥10 categories of birthweight centile. Glucagon levels were significantly higher among controls, at all categories of birthweight centiles, except in fetuses below the 10th centile of birth weight. The insulin/C-peptide ratio, a ratio that reflects hepatic insulin metabolism, was higher in the control than in the diabetic group. The results of the present study suggest that, even in the absence of macrosomia, fetuses of diabetic mothers are exposed to variable degrees of metabolic stress/adaptation, i.e., hyperinsulinaemia, increased hepatic insulin uptake, and a decrease in glucagon secretion. The long-term consequences of these changes may turn out to be more significant than its possible short-term effects on fetal growth and weight at birth.     

Customised birthweight centiles are useful for identifying small-for-gestational-age babies in women with type 2 diabetes

Background: Customised birthweight centiles identify small-for-gestational-age (SGA) babies at increased risk of morbidity more accurately than population centiles, but they have not been validated in obese populations.
Aims: To compare the rates of SGA by population and customised birthweight centiles in babies of women with type 2 diabetes and examine perinatal outcomes in customised SGA infants.
Methods: Data were from a previous retrospective cohort study detailing pregnancy outcomes in 212 women with type 2 diabetes. Customised and population birthweight centiles were calculated; pregnancy details and neonatal outcomes were compared between groups that delivered infants who were SGA (birthweight < 10th customised centile) and appropriate weight for gestational age (AGA) (birthweight 10–90th customised centile).
Results: Fifteen (7%) babies were SGA by population centiles and 32 (15%) by customised centiles. Two babies of Indian women were reclassified from SGA to AGA by customised centiles. Nineteen babies were reclassified from AGA to SGA by customised centiles; of these, 15 (79%) were born to Polynesian women, five (26%) were born less than 32 weeks and two (11%) were stillborn. Customised SGA infants, compared with AGA infants, were more likely to be born preterm (19 (59%) vs 20 (16%), P  < 0.001) and more likely to be stillborn (4 (13%) vs 0 P  = 0.001). After excluding still births, admission to the neonatal unit was also more common (19 of 28 (68%) vs 43 of 127 (34%), P  < 0.001).
Conclusions: In our population more babies were classified as SGA by customised compared with population centiles. These customised SGA babies have high rates of morbidity.     

Antenatal biochemical screening to predict low birthweight infants

Summary. Urine and plasma oestriol, plasma progesterone, human placental lactogen, α-glycoprotein and serum cystyl aminopeptidase were measured at intervals during 608 pregnancies. The predictive accuracy of low values for identification of pregnancies with low birthweight outcomes was assessed for each test at various gestations. Data were analysed to obtain 10th–90th centile values for each test from 28 weeks to delivery.
Groups with values under different centile levels were compared: those under the lower centiles had higher proportions but smaller absolute numbers of low birthweight infants than those under higher centiles. No test was superior to the others at all centiles and gestations. Biochemical screening of pregnant populations to identify high-risk groups for intensive fetal monitoring has limited potential. If screening is used, the definition of high-risk groups is best achieved by practical rather than statistical criteria. If monitoring facilities are available and well accepted by patients then higher centile'cut-offs'to define fetal risk may be used than when they are not. Combining any pair of tests with values below the 10th centile did not reduce false positive and negative predictions any more than could be achieved by movement of centiles up or down for a single test.     

Term birthweight centiles for babies from New Zealand's main ethnic groups

BACKGROUND: There are significant differences in mean birthweights between New Zealand's main ethnic groups. Birthweight centiles developed predominantly from babies of European ethnicity may therefore not be appropriate to classify babies from other ethnic groups. AIMS: To develop ethnic specific birthweight centiles for New Zealand babies delivered at term (>37 weeks). METHODS: Births from the National Women's Hospital database from 1993 to 2000 who also had scan data at <24 weeks comprised the study population (n = 10 292). Multiple pregnancies, fetal abnormalities, stillbirths and preterm births were excluded. For six ethnic groupings, born at gestational weeks from 38 to 41, sex specific centiles were generated and smoothed. RESULTS: Birthweight centiles were constructed from 5203 European, 801 Maori, 825 Samoan, 577 Tongan, 1058 Chinese, 433 Indian and 1395 other ethnic group births. Mean birthweights by ethnic group were: European 3521 g, Maori 3467 g, Samoan 3691 g, Tongan 3791 g, Chinese 3418 g, Indian 3192 g and other 3466 g. Tongan and Samoan babies were significantly heavier and Indian babies were significantly lighter than babies from all other ethnic groups (P < 0.001 for all comparisons). Overall Maori babies were approximately 50 g lighter than European babies but this difference was not statistically significant (P = 0.08), whereas Chinese babies were significantly lighter with a mean birthweight 100 g less than European (P < 0.001). CONCLUSIONS: These ethnic specific centile charts are likely to identify term babies with inappropriate growth better than population centiles generated predominantly from one ethnic group.     

Prediction of size of infants at birth by measurement of symphysis fundus height

Symphysis fundus heights (SF) were measured approximately 15 times during pregnancy in a consecutive series of 2941 women with regular menstrual cycles and known last menstrual period. A reference SF chart from 17 to 40 weeks of pregnancy was derived from measurements in 1350 of these women who were healthy, and heights and pre-pregnancy weights within the 10th and 90th centiles and were delivered vaginally of healthy infants with a birthweight/length ratio within +/- 2 SD. The reference chart was used to predict fetal growth deviations in the unselected series of pregnancies. The effectiveness of SF measures to detect fetuses with an infant birthweight/length ratio below -2 SD or a birthweight below the 10th centile was low; the sensitivity was only 16.7 and 26.6% and the predictive value of positive screening result was 1.8 and 18.0%, respectively. Corresponding values for fetuses with an infant birthweight/length ratio above + 2 SD or a birthweight above the 90th centile were 31.8 and 37.5% and 3.3 and 24.5%, respectively. Symphysis fundus (SF) measurement has thus been found to be of limited value as a screening method to detect abnormal size at birth.     

Prediction of size of infants at birth by measurement of symphysis fundus height

Summary. Symphysis fundus heights (SF) were measured approximately 15 times during pregnancy in a consecutive series of 2941 women with regular menstrual cycles and known last menstrual period. A reference SF chart from 17 to 40 weeks of pregnancy was derived from measurements in 1350 of these women who were healthy, and heights and pre-pregnancy weights within the 10th and 90th centiles and were delivered vaginally of healthy infants with a birthweight/length ratio within ±2SD. The reference chart was used to predict fetal growth deviations in the unselected series of pregnancies. The effectiveness of SF measures to detect fetuses with an infant birthweight/length ratio below −2SD or a birthweight below the 10th centile was low; the sensitivity was only 16·7 and 26·6% and the predictive value of positive screening result was 1·8 and 18·0%, respectively. Corresponding values for fetuses with an infant birthweight/length ratio above +2 SD or a birthweight above the 90th centile were 31·8 and 37·5% and 3·3 and 24·5%, respectively. Symphysis fundus (SF) measurement has thus been found to be of limited value as a screening method to detect abnormal size at birth.     

Antenatal biochemical screening to predict low birthweight infants

Urine and plasma oestriol, plasma progesterone, human placental lactogen, beta 1-glycoprotein and serum cystyl aminopeptidase were measured at intervals during 608 pregnancies. The predictive accuracy of low values for identification of pregnancies with low birthweight outcomes was assessed for each test at various gestations. Data were analysed to obtain 10th-90th centile values for each test from 28 weeks to delivery. Groups with values under different centile levels were compared: those under the lower centiles had higher proportions but smaller absolute numbers of low birthweight infants than those under higher centiles. No test was superior to the others at all centiles and gestations. Biochemical screening of pregnant populations to identify high-risk groups for intensive fetal monitoring has limited potential. If screening is used, the definition of high-risk groups is best achieved by practical rather than statistical criteria. If monitoring facilities are available and well accepted by patients then higher centile 'cut-offs' to define fetal risk may be used than when they are not. Combining any pair of tests with values below the 10th centile did not reduce false positive and negative predictions any more than could be achieved by movement of centiles up or down for a single test.     

Psychosocial predictors of low birthweight: a prospective study.

OBJECTIVE: To examine the role of psychosocial risk factors for low birthweight. DESIGN: A prospective study. SETTING: Obstetric outpatient clinics of the University Hospital Vrije Universiteit, Amsterdam. PARTICIPANTS: Three hundred and ninety-six nulliparous women. METHODS: Questionnaires on background variables, daily stressors, psychological and mental wellbeing, social support and work factors were completed by the women in the first, second and third trimester of pregnancy. Low birthweight for gestational age was defined at different cut off points: 1. < or = 10th customised birthweight centile (n = 69); 2. < or = 5th customised birthweight centile (n = 54); 3. < 3rd customised birthweight centile (n = 35); and 4. < or = the 10th Dutch birthweight centile (n = 40). Multivariate logistic regression was applied and the results were expressed in odds ratios and their 95% confidence intervals. RESULTS: When the cut off level was defined < or = 5th and < 3rd customised centile, the number of daily stressors in the first trimester was a statistically significant risk factor (OR 1.04, 95% CI 1.01-1.07 and OR 1.04, 95% CI 1.01-1.08). No significant psychosocial risk factors could be identified when low birthweight for gestational age was defined < or = the 10th customised birthweight centile. When low birthweight for gestational age was defined < or = the 10th Dutch birthweight centile, number of hours housekeeping per week in the first trimester (OR 1.59, 95% CI 1.03-2.46), low subjective severity rating of daily stressors in the first trimester (OR 0.41, 95% CI 0.17-0.97) and depressive mood in the first trimester (OR 1.12, 95% CI 1.01-1.24) were statistically significant psychosocial risk factors after controlling for maternal weight and height, number of cigarettes smoked per day and educational level. CONCLUSIONS: In the first trimester of pregnancy maternal psychosocial factors are associated with an increased risk of low birthweight. The specific psychosocial risk factors found were different when the definition of low birthweight was changed. Therefore, in this field of research, we suggest use of the most valid outcome measure for low birthweight, being the customised birthweight centiles.     

Chronic villitis of unknown aetiology and intrauterine growth-retarded infants of normal and low ponderal index

Placentae from 211 term pregnancies were studied. The placentae were divided into three groups: group I, 57 placentae from neonates with birthweight over the 25th centile of the normal birthweight curve; group II, 49 placentae from neonates whose birthweight fell between the 10th and 25th centiles of this curve, and group III, 105 placentae from neonates whose birthweights were below the 10th centile of the curve. Each of the studied groups were divided into two subgroups, one comprising those infants with a normal Ponderal Index (PI) and the other comprising those with a low PI. A higher incidence of chronic villitis and of inflamed villi was observed as the average birthweight decreased in cases with normal PI as well as in cases with low PI, the highest incidence being found in placentae from infants with harmonic intrauterine growth retardation (normal PI). The same was observed with respect to the presence of maternal vascular lesions in all groups studied. It is suggested that an infant's birthweight and crown-heel length may be affected as a consequence of the extension and severity of the placental lesions and the timing of their appearance in gestation.     

Birthweights in sickle cell trait pregnancies

Objectives  Available evidence on the effect of sickle cell trait (SCT) on birthweight is conflicting, not gestational age specific, and does not account for maternal and infant factors. The objectives of this study are to determine the contemporary mean birthweight, mean customised birthweight centile, and to analyse the risk of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) babies in SCT pregnancies.
Design  Large retrospective cohort study.
Setting  London hospital.
Population  Singleton pregnancies between 24 and 42 completed weeks delivered between 2000 and 2005 in parturient with body mass index between 18.0 and 35.0 kg/m².
Methods  All qualifying pregnancies were identified on Terra Nova Healthware. Birthweight centiles of these cases were computed with Gardosi customised bulk centile calculator using collected data on maternal height, weight, ethnicity and parity, and the infant's gender, gestational age and birthweight. Birthweight and birthweight centiles of SCT and pregnancies with no haemoglobinopathy (control) were compared. Statistical analysis was performed using Stata version 9.2.
Main outcome measures  Birthweight and birthweight centiles.
Results  Five hundred and five SCT and 16 320 controls were analysed. The mean birthweight of SCT pregnancies was 3223 g, 57 g lower than controls ( P = 0.024). However, its mean birthweight centile was 49.0% similar to that of controls' 47.5% ( P = 0.320). There is an apparent risk of LGA babies in SCT pregnancies, but logistic regression analysis suggests that the odds are related to being an older non-white parturient and a male infant rather than SCT status.
Conclusions  SCT is not a risk factor for SGA or LGA infants.     

Relationship between customised birthweight centiles and neonatal anthropometric features of growth restriction

Objective To determine the relationship between customised birthweight centiles (adjusted for maternal and fetal physiological variables) and neonatal anthropometric features of intrauterine growth restriction (IUGR).
Design Observational study.
Population Two-hundred and seventy women with low risk pregnancies participating in a cohort study of serial ultrasound biometry.
Methods Customised birthweight centiles were calculated following adjustment for maternal weight, height and ethnic origin, gestational age at delivery, birth order, and sex of the infant. Three separate neonatal anthropometric measures were used to define IUGR: subscapular or triceps skinfold thickness  <10th  centile; ponderal index  <25th  centile; and mid-arm circumference to occipito-frontal circumference ratio (MAC/OFC) <−1 standard deviation (SD). Relationship of the centiles to these outcomes was evaluated using likelihood ratios (LR) and kappa statistic. These approaches allowed us to examine the strength of the association: an LR of 5–10 would be expected to generate moderate changes in the pre-test probability of IUGR, whereas a kappa value of 0.2–0.4 would reflect fair agreement between customised birthweight centiles and neonatal anthropometric measures.
Results Customised birthweight centile of 10 or less had the following LR values for the various anthropometric criteria for IUGR: 5.1 (95% CI 3–8.5) for low skinfold thickness; 4.3 (95% CI 2.5–7.1) for low ponderal index; and 3.9 (95% CI 2–6.6) for low MAC/OFC ratio. The kappa values were: 0.4 (95% CI 0.26–0.51) for low skinfold thickness; 0.33 (95% CI 0.21–0.46) for low ponderal index; and 0.13 (95% CI 0–0.26) for low MAC/OFC ratio.
Conclusion In a low risk population, customised birthweight centiles can only be moderately useful in the identification of neonates with low skinfold thickness and low ponderal index.     

Intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in the prediction of small-for-dates babies in a high-risk obstetric population.

Summary. . The value of fetal biparietal diameter and abdominal area, total intrauterine, intra-amniotic and placental volume measurements for predicting small-for-dates babies in a high-risk obstetric population was investigated in 130 women. A parallel planimetric area method was used to measure volume. The commonest risk factors were suspected intrauterine growth-retardation, hypertensive complications and previous poor obstetric history. The prevalence of birthweight at and below the 10th or 3rd centiles was 30 and 16% respectively. Fetal abdominal area and total intrauterine volume measurements had the highest and comparable sensitivity, specificity and positive predictive value in the detection of infants with birthweights of 10th and 3rd centiles. While these measurements are of use in consolidating the clinical diagnosis of small-for-dates fetuses (growth retardation), high false positive rates (10% and 16–17% for birthweights 10th centile, and 3rd centile respectively) make further discriminatory tests necessary for part of the population.     

Is obstetric and neonatal outcome worse in fetuses who fail to reach their own growth potential?

OBJECTIVES: To determine the perinatal outcome of fetuses who had birthweights less than that expected from early third trimester ultrasound scanning. DESIGN: Retrospective estimation of centile fetal weight at early third trimester ultrasound scanning compared with actual centile birthweight corrected for gestational age, parity and sex. SETTING: Teaching Hospital Obstetric Unit, London. SUBJECTS: 197 unselected women with singleton cephalic pregnancies who were delivered at term in our unit between October 1989 and May 1990. MAIN OUTCOME MEASURES: CTG abnormality, need for fetal blood sampling in labour, meconium-staining of the amniotic fluid, mode of delivery, Apgar scores at 1 and 5 min, need for transfer of baby to neonatal unit, and need for neonatal intubation of the neonate at delivery. RESULTS: An actual birthweight greater than 5% less than the birthweight estimated from ultrasound scanning identified 44 babies (22%) with an increased risk of CTG abnormalities (chi 2 = 8.38, P less than 0.0025; Odds ratio (OR) = 2.54; 95% CI 1.36 to 4.78) and need for operative delivery (chi 2 = 5.81, P less than 0.0125; OR = 1.94; 95% CI 1.15 to 3.27), when compared with the remainder of the sample. Overall 14 (32%) of this group had birthweights above the 50th centile. A group of 44 babies selected as being the smallest for gestational age, without reference to growth pattern, had a similar excess morbidity. (All this group had birthweights below the 39th centile). CONCLUSIONS: This study supports the hypothesis that in-utero fetal growth pattern is as important for perinatal outcome as being small for gestational age per se.     

Intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in the prediction of small-for-dates babies in a high-risk obstetric population

The value of fetal biparietal diameter and abdominal area, total intrauterine, intra-amniotic and placental volume measurements for predicting small-for-dates babies in a high-risk obstetric population was investigated in 130 women. A parallel planimetric area method was used to measure volume. The commonest risk factors were suspected intrauterine growth-retardation, hypertensive complications and previous poor obstetric history. The prevalence of birthweight at and below the 10th or 3rd centiles was 30 and 16% respectively. Fetal abdominal area and total intrauterine volume measurements had the highest and comparable sensitivity, specificity and positive predictive value in the detection of infants with birthweights of less than or equal to 10th and less than or equal to 3rd centiles. While these measurements are of use in consolidating the clinical diagnosis of small-for-dates fetuses (growth retardation), high false positive rates (10% and 16-17% for birthweights less than or equal to 10th centile, and less than or equal to 3rd centile respectively) make further discriminatory tests necessary for part of the population.     

Efficacy of intrauterine volume, fetal abdominal area and biparietal diameter measurements with ultrasound in screening for small-for-dates babies

Summary. The efficacy of total intrauterine, intra-amniotic and placental volume measurements with ultrasound in screening for low birthweight (10th and 3rd centile) was compared prospectively with fetal biparietal diameter and abdominal area measurements at 32 and 36 weeks gestation in an unselected population of 362 women. In all of them the gestation was dated by ultrasound in the first half of pregnancy. Reference values were from a separate normal population studied previously. Total intrauterine volume showed the highest sensitivity in predicting babies weighing 10th centile (58% at 32 weeks and 62% at 36 weeks) and those weighing 3rd centile (78% at 32 weeks and 83% at 36 weeks). A higher number of false-positive tests resulted in a lower predictive value of a positive test (mean 34% for babies weighing 10th centile) than that found for abdominal area (mean 54%). Abdominal measurements selected a smaller'at risk'group. Biparietal diameter, intra-amniotic and placental volume measurements had inferior predictive capability than total intrauterine volume and abdominal area. For screening purposes abdominal area measurements are presently more suitable than intrauterine volume. The higher sensitivity of intrauterine volume, particularly in early third trimester, is an advantage that requires further investigation with reference to intrauterine growth retardation.     

Association between first trimester maternal serum pregnancy associated plasma protein-A and adverse pregnancy outcome

AIMS: To investigate whether low pregnancy associated plasma protein-A (PAPP-A) levels in the first trimester of pregnancy are associated with subsequent intrauterine fetal growth restriction, stillbirth and preterm delivery. METHODS: A retrospective review of pregnancy outcomes was undertaken in women who had PAPP-A carried out in the first trimester of pregnancy at the time of nuchal translucency scan. Pregnancy outcomes were assessed by the review of medical records, and postal questionnaires. Delivery details were collected, including livebirth, neonatal birthweight and gestational age at delivery. The chi2 test was used to investigate the association between low first trimester serum PAPP-A levels and adverse fetal outcomes. Unpaired t-test was used for continuous variables. Sensitivities and specificities were then calculated. RESULTS: A total of 894 women who had blood collected for PAPP-A were identified, and data was obtained for 827 deliveries. Each had a normal karyotype. There were six intrauterine deaths, 13 babies with birthweights below the 3rd centile, 55 babies weighing below the 10th centile, and 96 women who delivered prematurely. Four of six intrauterine deaths had low PAPP-A levels (<0.5 multiples of the median), with a relative risk of 13.75. Low PAPP-A levels were associated with fetal weight below the 10th centile (P = 0.01) but not the 3rd centile. There was no statistically significant association between low maternal serum PAPP-A levels and preterm delivery. CONCLUSION: At 11-13 weeks' gestation, low maternal serum PAPP-A levels are associated with fetal death in utero and birthweight below the 10th centile. First trimester PAPP-A may be a useful tool for identifying pregnancies at risk of adverse fetal outcomes.     

Customized birthweight centiles predict SGA pregnancies with perinatal morbidity

OBJECTIVES: To determine the following: (1) the proportion of babies reclassified as small or appropriately grown using customized and population centiles; and (2) the relative risks of perinatal morbidity, including abnormal umbilical Doppler studies, in babies classified as small for gestational age (SGA) and appropriate for gestational age (non-SGA) using the two centile calculations. DESIGN: Cohort study in SGA and general hospital populations. SETTING: National Women's Hospital, Auckland, NZ. POPULATION: A cohort of SGA pregnancies (n= 374) and a general obstetric population (n= 12,879). METHODS: Pregnancy outcomes were compared between 'non-SGA both' (> or =10th% by population and customized centiles) and those who were 'SGA both' (<10th% by population and customized centiles), 'SGA customized only' (SGA by customized but non-SGA by population centiles) and 'SGA population only' (SGA by population but non-SGA by customized centiles). MAIN OUTCOME MEASURES: Maternal and newborn morbidity and perinatal death. RESULTS: In the SGA cohort 271 (72%) babies were 'SGA both', 27 (7%) were 'SGA customized only', 32 (9%) were 'population SGA only' and 44 (12%) were 'non-SGA both'. In the general obstetric population 863 (6.7%) babies were 'SGA both', 445 (3.5%) were 'customized SGA only', 285 (2.2%) were 'population SGA only' and 11,286 (88%) were 'non-SGA both'. Perinatal death and newborn morbidity including nursery admission and long hospital stay were increased and comparable between 'SGA both' and 'customized SGA only' in both study populations. Newborn morbidity was low and comparable between 'population SGA only' and 'non-SGA both'. No perinatal deaths occurred in 'population SGA only' babies. Abnormal Doppler studies were more common in 'SGA both' or 'customized SGA only' but not in 'population SGA only' groups compared with 'non-SGA both'. CONCLUSIONS: Customized birthweight centiles identified small babies at risk of morbidity and mortality. Use of customized centiles is likely to detect more babies at risk of perinatal morbidity and mortality than would be detected by population centiles.     

Use of insulin glargine during pregnancy: a case-control pilot study

OBJECTIVE: To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN: A matched case-control study. SETTING: Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE: Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS: Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES: Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS: There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS: The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.     

Application of a customised birthweight standard in the assessment of perinatal outcome in a high risk population

Objective Physiological as well as pathological variables influence birthweight. The aim of the present study was to examine perinatal outcome in relation to birthweight centiles applying a customised birthweight standard.
Methods Two hundred and seventeen babies from high risk pregnancies were evaluated and classified as small or not small for gestational age according to two standards: 1. conventional Dutch birthweight centiles and 2. customised centiles which adjust individually for physiological variables like maternal booking weight, height and ethnic origin.
Results Customisation of the weight standards resulted in identification of an additional group of infants who were small for gestational age, but not by the Dutch standards. These babies were associated with significantly more adverse perinatal events than those who were not small for gestational age as defined by a customised standard.
Conclusions Adjustment of birthweight centiles for physiological variables significantly improves the identification of infants who have failed to reach the expected birthweight and who are at increased risk for adverse perinatal events.     

Pregnancy outcome in women presenting with pre-eclampsia at less than 25 weeks gestation

OBJECTIVE: We aimed to (i) assess maternal and perinatal outcomes in pre-eclampsia at < 25(0) weeks; and (ii) determine if any antenatal factors were associated with adverse maternal and perinatal outcomes. DESIGN: A retrospective study. SETTING: Tertiary referral hospital, Auckland, New Zealand. METHODS: Data were extracted from the clinical record and hospital database. The study population involved women admitted with pre-eclampsia at < 25(0) weeks, with a live singleton pregnancy, from 1997 to 2004 and managed expectantly. OUTCOME MEASURES: Maternal morbidity, perinatal death, neurodevelopmental outcome at 18 months, small for gestational age assessed by population and customised birthweight centiles. RESULTS: Gestation at admission was the only antenatal variable associated with adverse perinatal outcome. Of 14 women admitted < 23 weeks, no babies survived, but eight (62%) babies of women admitted in the 24th week (24(0)-24(6)) survived. Neurodevelopmental outcome was assessed in eight of nine survivors; two (25%) had moderate and two (25%) had minor disability. All babies in this cohort had birthweights < 5th customised centile. Only one baby (10%) weighing < 500 g survived. CONCLUSION: Maternal morbidity was high in this expectantly managed cohort. As no babies survived when pre-eclampsia occurred before 23 weeks, induction of labour should be considered. In the 24th week two-thirds of babies survived and 25% had moderate handicap. This information may help clinicians and women in the future to make informed choices about management.