Maternal physical activity mode and fetal heart outcome

Background

Maternal leisure-time physical activity (LTPA) improves cardiac autonomic function in the fetus. The specific physical activity attributes (e.g., mode) that produce this benefit are not well understood.

Aim

To determine if more time spent performing non-continuous LTPA during pregnancy is significantly associated with lower fetal heart rate (HR) and increased heart rate variability (HRV).

Study design

This paper presents a retrospective analysis of previously reported data. Fetal magnetocardiograms (MCG) were recorded from 40 pregnant women at 36-wk gestational age.

Outcome measures

Metrics of fetal HR and HRV, self-reported min of continuous and non-continuous LTPA performed during the 3-months preceding the 36-wk assessment point and covariates (maternal weight change pre to 36-wk, age, and resting HR and fetal activity state during MCG recordings.

Results

Positive correlations were significant (p < 0.05) between min of continuous LTPA, the time domain metrics that describe fetal overall HRV, short-term HRV and a frequency domain metric that reflects vagal activity. Time spent in non-continuous LTPA was positively correlated (p < 0.05) with two HRV metrics that reflect fetal overall HRV. In the multiple regression analyses, minutes of non-continuous LTPA remained associated with fetal vagal activity (p < 0.05) and the relationships between minutes of non-continuous LTPA and fetal overall HRV (p < 0.005) persisted.

Conclusion

These data suggest non-continuous physical activity provides unique benefits to the fetal autonomic nervous system that may give the fetus an adaptive advantage. Further studies are needed to understand the physiological mechanisms and long-term health effects of physical activity (both non-continuous and continuous) performed during pregnancy to both women and their offspring.     

Aerobic exercise during pregnancy influences fetal cardiac autonomic control of heart rate and heart rate variability

Background

Previous studies using ultrasound technology showed that fetal heart rate (HR) may be responsive to maternal aerobic exercise. Although it is recognized that cardiac autonomic control may be influenced by the intrauterine environment, little is known about how maternal exercise affects fetal heart development.

Aims

This study tested the hypothesis that regular maternal exercise throughout gestation influences fetal cardiac autonomic control of HR and heart rate variability (HRV) when compared to fetuses of non-exercising women.

Study design

Magnetocardiograms (MCGs) were recorded using a dedicated fetal biomagnetometer at 28, 32 and 36 weeks gestational age (GA) from 26 regularly exercising (> 30 min of aerobic exercise, 3× per week) and 35 healthy, non-exercising pregnant women. Fetal MCG was isolated and normal R-peaks were marked to derive fetal HR and HRV in the time and frequency domains. We applied a mixed-effects model to investigate the effects of exercise, GA and fetal activity state.

Results

At 36 weeks GA, during the active fetal state, fetal HR was significantly lower in the exercise group (p = < 0.0006). Post-hoc comparisons showed significantly increased HRV in the exercise group during the active fetal state at 36 weeks GA for both time and frequency domain measures.

Conclusion

These results indicate that regular maternal exercise throughout gestation results in significantly lower fetal HR and increased HRV.     

Leptin,fetal growth and insulin resistance in non-diabetic pregnancies

Background

Interrogation of the association between leptin, insulin resistance and fetal growth may provide a biological link for the fetal programming of later metabolic health.

Aims

Our aim was to clarify the relationship between maternal and fetal leptin, insulin resistance and fetal growth.

Study design

Maternal leptin, glucose and insulin were measured in early pregnancy and at 28 weeks and the HOMA index calculated. At 34 weeks, ultrasound scan assessed fetal weight and adiposity (abdominal wall width). At delivery birthweight was recorded and cord blood analyzed for fetal c-peptide and leptin. Analysis was performed using a multivariate linear regression model.

Subjects

574 non-diabetic pregnant women.

Outcome measures

Fetal growth and maternal and fetal insulin resistance.

Results

On multivariate analysis a relationship was identified between maternal and fetal leptin concentrations at each time point and maternal body mass index. Maternal leptin was related to insulin resistance in early pregnancy (β = 0.15, p = 0.02) and at 28 week gestation (β = 0.27, p < 0.001). Fetal insulin resistance correlated with maternal leptin in early pregnancy (β = 0.17, p = 0.004); at 28 weeks (β = 0.12, p = 0.05), and with leptin in cord blood (r = 0.28, p < 0.001).Fetal weight at 34 weeks was related to maternal leptin in early pregnancy (β = 0.16, p = 0.02). Both maternal and fetal leptin correlated with infant size at birth (β = 0.12, p = 0.07 in early pregnancy, β = 0.21, p = 0.004 in cord blood), independent of all other outcome measures.

Conclusion

Our findings have confirmed that in a non-diabetic cohort there is a link between maternal and fetal leptin and insulin resistance. We also established a link between maternal leptin in early pregnancy and both fetal and neonatal size. These results add to the growing body of evidence suggesting a role for leptin in the fetal programming of childhood obesity and metabolic dysfunction.     

Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain

Purpose

Maternal nutritional status is one of the most important factors of fetal growth and development. Consequently, the currently increasing prevalence of underweight women worldwide has come in the focus of interest of perinatal medicine. The aim of the study was to assess the effect of low pre-pregnancy body mass index (BMI) on fetal growth.

Materials and methods

Data on 4678 pregnant women and their neonates were retrospectively analyzed. Pre-pregnancy BMI of study women was categorized according to the WHO standards. Fetal growth was assessed by birth weight and birth length, birth weight for gestational age, and ponderal index.

Results

Study group included 351 (7.6%) women with pregestational BMI < 18.5 kg/m², while all women with pregestational BMI 18.5–25 kg/m² (n = 3688; 78.8%) served as a control group. The mean birth weight and birth length of neonates born to underweight mothers were by 167 g and 0.8 cm lower in comparison with the neonates born to mothers of normal nutritional status, respectively (P < 0.001 both). The prevalence of small for gestational age (SGA) births was twofold that found in the control group of mothers of normal nutritional status (9.7% vs. 4.9%; P < 0.001). The inappropriately low gestational weight gain additionally increased the rate of SGA infants in the group of mothers with low pre-pregnancy BMI (21.4% vs. 10.4%; P = 0.02). Pre-pregnancy BMI category did not influence neonatal growth symmetry.

Conclusion

Low maternal pregestational BMI is associated with fetal growth assessment. Improvement of the maternal nutritional status before pregnancy can increase the likelihood of perinatal outcome.     

Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction

Background

Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown.

Aims

This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction.

Study design and participants

Mothers of infants aged 12 months old (N = 111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device.

Results

Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction.

Conclusions

Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.     

Infant developmental outcomes following prenatal exposure to antidepressants,and maternal depressed mood and positive affect

Background

Prenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical.

Aims

To examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10 months of age.

Study design

Prospective study of mothers and their 10-month-old infants.

Subjects

We examined 31 mother–child pairs exposed prenatally to SRIs and 52 mother–child pairs who were nonexposed.

Outcome measure

The Bayley Scales of Infant Development (third edition) scores.

Results

Infants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P = 0.03), social–emotional (P = 0.04) and adaptive behavior (P = 0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P > 0.05). Increased levels of maternal positive affect at 10 months predicted increased social–emotional scores (P = 0.03).

Conclusions

Infants prenatally exposed to SRIs score significantly lower on the gross motor, social–emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.     

Prenatal depression restricts fetal growth

Objective

To identify whether prenatal depression is a risk factor for fetal growth restriction.

Methods

Midgestation (18-20 weeks GA) estimated fetal weight and urine cortisol and birthweight and gestational age at birth data were collected on a sample of 40 depressed and 40 non-depressed women. Estimated fetal weight and birthweight data were then used to compute fetal growth rates.

Results

Depressed women had a 13% greater incidence of premature delivery (Odds ratio (OR) = 2.61) and 15% greater incidence of low birthweight (OR = 4.75) than non-depressed women. Depressed women also had elevated prenatal cortisol levels (p = .006) and fetuses who were smaller (p = .001) and who showed slower fetal growth rates (p = .011) and lower birthweights (p = .008). Mediation analyses further revealed that prenatal maternal cortisol levels were a potential mediator for the relationship between maternal symptoms of depression and both gestational age at birth and the rate of fetal growth. After controlling for maternal demographic variables, prenatal maternal cortisol levels were associated with 30% of the variance in gestational age at birth and 14% of the variance in the rate of fetal growth.

Conclusion

Prenatal depression was associated with adverse perinatal outcomes, including premature delivery and slower fetal growth rates. Prenatal maternal cortisol levels appear to play a role in mediating these outcomes.     

Mode of delivery may influence neonatal responsiveness to maternal separation

Introduction

Maternal–infant separation (MIS) is a highly stressful situation for the neonate.

Materials and methods

A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal–infant separation situation was videotaped to observe the reactions of the newborns within the first 12–48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, “motherese” speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured.

Results

Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8 ± 8.6 s) to calm down than those born by C-section (0.9 ± 1.4 s) (p = 0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r = 0.41; p = 0.02).

Conclusion

Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother–infant attachment during the first days of life.     

Is maternal obesity associated with sustained inflammation in extremely low gestational age newborns?

Background

The offspring of obese women are at increased risk for systemic inflammation. Blood concentrations of inflammatory proteins in preterm newborns of obese women have not been reported.

Aim

To compare blood concentrations in the highest quartile for gestational age of inflammatory proteins and day of blood specimen collection on two days at least one week apart of newborns of overweight (i.e., BMI 25–29) and obese women (i.e., BMI ≥ 30) with newborns of women with lower BMIs. Because deliveries for spontaneous indications are more likely than those for other indications to be associated with inflammation, we evaluated spontaneous indication deliveries separately from maternal or fetal indications.

Study design

Prospective cohort study.

Subjects and outcome measures

We measured from 939 children born before the 28th week of gestation 25 inflammation-related proteins in blood obtained on postnatal day 1 (range 1–3), day 7 (range 5–8) and day 14 (range 12–15).

Results

Among infants delivered for spontaneous indications, maternal BMI was not related to elevated concentrations of any protein. Among infants delivered for maternal (i.e., preeclampsia) or fetal indications, those whose mother was overweight or obese were more likely than others to have elevated concentrations of inflammation proteins.

Conclusions

Maternal pre-pregnancy overweight and obesity appear to contribute to a pro-inflammatory state in very preterm newborns delivered for maternal or fetal indications. Our failure to see a similar pattern among newborns delivered for spontaneous indications, which often have inflammatory characteristics, might reflect competing risks.     

Fetal response to abbreviated relaxation techniques. A randomized controlled study

Background

Stress during pregnancy can have adverse effects on the course of pregnancy and on fetal development. There are few studies investigating the outcome of stress reduction interventions on maternal well-being and obstetric outcome.

Aims

This study aims (1) to obtain fetal behavioral states (quiet/active sleep, quiet/active wakefulness), (2) to investigate the effects of maternal relaxation on fetal behavior as well as on uterine activity, and (3) to investigate maternal physiological and endocrine parameters as potential underlying mechanisms for maternal-fetal relaxation-transferral.

Study design

The behavior of 33 fetuses was analyzed during laboratory relaxation/quiet rest (control group, CG) and controlled for baseline fetal behavior. Potential associations between relaxation/quiet rest and fetal behavior (fetal heart rate (FHR), FHR variation, FHR acceleration, and body movements) and uterine activity were studied, using a computerized cardiotocogram (CTG) system. Maternal heart rate, blood pressure, cortisol, and norepinephrine were measured.

Results

Intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in fetal behavior. The intervention groups had higher long-term variation during and after relaxation compared to the CG (p = .039). CG fetuses had more FHR acceleration, especially during and after quiet rest (p = .027). Women in the PMR group had significantly more uterine activity than women in the GI group (p = .011) and than CG women. Maternal heart rate, blood pressure, and stress hormones were not associated with fetal behavior.

Conclusions

This study indicates that the fetus might participate in maternal relaxation and suggests that GI is superior to PMR. This could especially be true for women who tend to direct their attention to body sensations such as abdominal activity.     

Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.     

Early communication in preterm infants following intervention in the NICU

Background

Despite ongoing improvements in clinical care, preterm infants experience a variety of stressors in the first weeks of life, including necessary medical procedures, which may affect development. Some stress-reduction programmes based in the Neonatal Intensive Care Unit (NICU) have reported a positive impact on development. In particular, trials of the Mother–Infant Transaction Program (MITP) have shown positive short and longer term effects, and are based on training parents to recognise and minimise stress responses in preterm infants.

Aims

To evaluate the impact on early developmental milestones of an enhanced MITP (PremieStart) delivered over an extended period in the NICU.

Study design

This was a parallel 2-group randomised controlled trial involving 109 women with 123 infants born at < 30 weeks gestation assessed initially at term-equivalent age and then at 6 months' corrected-age.

Results

Intervention mothers were more sensitive in providing infant care, stressed their infants less, showed greater awareness of, and responded more appropriately to, negative infant cues (p < 0.05 in each case). Intervention infants displayed significantly lower stress when being bathed by mothers at term-equivalent age (p < 0.05). At 6 months corrected-age, intervention infants showed higher mean scores on the Communication and Symbolic Behavior Scales Developmental Profile Infant–Toddler Checklist. The strongest effects appeared in Symbolic behaviour (p = 0.05) and this was reflected in the Total score (p < 0.05).

Conclusions

As significant cognitive and language deficits are reported in longitudinal studies of preterm children, an intervention that improves early infant communication abilities is promising, especially since previous research suggests that the strongest benefits may emerge at later ages.     

Maternal vitamin B-12 and folate status during pregnancy and excessive infant crying

Background

The etiology of excessive infant crying is largely unknown. We hypothesize that excessive infant crying may have an early nutritional origin during fetal development.

Aims

This study is the first to explore whether (1) maternal vitamin B-12 and folate status during pregnancy are associated with excessive infant crying, and (2) whether and how maternal psychological well-being during pregnancy affects these associations.

Study design

Women were approached around the 12th pregnancy week to complete a questionnaire (n = 8266) and to donate a blood sample (n = 4389); vitamin B-12 and folate concentrations were determined in serum. Infant crying behavior was measured through a postpartum questionnaire (± 3 months; n = 5218).

Subjects

Pregnant women living in Amsterdam and their newborn child.

Outcome measures

Excessive infant crying, defined as crying ≥ 3 h/day on average in the past week.

Results

Multiple logistic regression analysis was performed for 2921 (vitamin B-12) and 2622 (folate) women.Vitamin B-12 concentration (categorized into quintiles) was associated with excessive infant crying after adjustment for maternal age, parity, ethnicity, education, maternal smoking and psychological problems (OR[95%CI]: Q1 = 3.31[1.48-7.41]; Q2 = 2.50[1.08-5.77]; Q3 = 2.59[1.12-6.00]; Q4 = 2.77[1.20-6.40]; Q5 = reference). Stratified analysis suggested a stronger association among women with high levels of psychological problems during pregnancy. Folate concentration was not associated with excessive infant crying.

Conclusions

First evidence is provided for an early nutritional origin in excessive infant crying. A low maternal vitamin B-12 status during pregnancy could, in theory, affect infant crying behavior through two potential mechanisms: the methionine-homocysteine metabolism and/or the maturation of the sleep-wake rhythm.     

Changes in spectral power of fetal heart rate variability in small-for-gestational-age fetuses are associated with fetal sex

Background

Little is known about the influences of fetal weight and sex on spectral analysis of fetal heart rate (FHR) variability.

Aim

The study aims to assess whether there are differences in spectral power of FHR variability according to fetal weight and sex during labor.

Study design

Case–control study. A total of 414 singleton term deliveries without fetal acidemia were divided into small-for-gestational-age (SGA) (n = 29) and non-SGA (n = 385) groups. Analyses were performed separately according to fetal sex.

Subjects

FHR recordings obtained with cardiotocography during the last 2 h of labor preceding delivery.

Outcome measures

Our outcome measures include spectral power of FHR variability.

Results

For the male group, SGA fetuses had significantly lower values for low, movement, high, and total frequencies of spectral power compared with non-SGA fetuses (all P < 0.005). Normalized low frequency (LFn) was significantly higher, and normalized high frequency (HFn) was significantly lower in SGA fetuses compared with non-SGA fetuses (all P < 0.005). In contrast, for the female group, there were no significant differences in any of the indices of spectral power between the SGA and non-SGA fetuses. In addition, SGA males had significantly higher LFn spectral power and lower HFn spectral power compared to SGA females (P = 0.016, and 0.041, respectively).

Conclusions

SGA males have decreased spectral power of FHR variability compared with non-SGA males during labor. However, there are no differences between SGA and non-SGA female fetuses. It is important in the clinical setting to take fetal weight and sex into account during FHR monitoring using spectral analysis.     

Maternal sounds elicit lower heart rate in preterm newborns in the first month of life

Background

The preferential response to mother's voice in the fetus and term newborn is well documented. However, the response of preterm neonates is not well understood and more difficult to interpret due to the intensive clinical care and range of medical complications.

Aim

This study examined the physiological response to maternal sounds and its sustainability in the first month of life in infants born very pretermaturely.

Methods

Heart rate changes were monitored in 20 hospitalized preterm infants born between 25 and 32 weeks of gestation during 30-minute exposure vs. non-exposure periods of recorded maternal sounds played inside the incubator. A total of 13,680 min of HR data was sampled throughout the first month of life during gavage feeds with and without exposure to maternal sounds.

Results

During exposure periods, infants had significantly lower heart rate compared to matched periods of care without exposure on the same day (p < .0001). This effect was observed in all infants, across the first month of life, irrespective of day of life, gestational age at birth, birth weight, age at testing, Apgar score, caffeine therapy, and requirement for respiratory support. No adverse effects were observed.

Conclusion

Preterm newborns responded to maternal sounds with decreased heart rate throughout the first month of life. It is possible that maternal sounds improve autonomic stability and provide a more relaxing environment for this population of newborns. Further studies are needed to determine the therapeutic implications of maternal sound exposure for optimizing care practices and developmental outcomes.     

Small for gestational age babies are not related to changes in markers of adipose tissue dysfunction during reproductive age

Background

Small for gestational age (SGA) birth has been associated with adipocyte dysfunction during later phases of life. Because SGA women are at a higher risk of developing polycystic ovary syndrome (PCOS), adipocyte dysfunction detected in patients with PCOS may be associated with SGA birth.

Aims

To determine whether SGA birth is related to altered serum markers of adipose tissue dysfunction during the third decade of life in Brazilian women. A secondary objective was to relate the presence of PCOS with serum markers of adipose tissue dysfunction.

Study design

Prospective cohort observational study.

Subjects

A total of 384 women born at 37 to 42 weeks of gestation from June 1, 1978 to May 31, 1979 in Ribeirão Preto, State of São Paulo, Brazil. After exclusion, 165 women participated in the study. Of these women, 43 were in the SGA group and 122 were in the adequate for gestational age group based on birth weight determined from cohort files.

Outcome measures

Body mass index (BMI), arterial systolic and diastolic pressures, abdominal circumference and serum concentrations of total testosterone, fasting glucose and insulin, lipid profile, adiponectin, leptin and necrosis factor alpha tumor (TNFα).

Results

BMI was an independent predictor of lower adiponectin (adjusted coefficient = − 0.02, p = 0.01) and higher leptin (adjusted coefficient = 0.06, p = 0.01) concentrations. The serum insulin concentration was associated with higher leptin (adjusted coefficient = 0.03, p = 0.02) and TNF-α (adjusted coefficient = 0.01, p = 0.03) concentrations. Having PCOS or being born SGA did not predict any markers of adipocyte dysfunction.     

Accumulation of subcutaneous fat,but not visceral fat,is a predictor of adiponectin levels in preterm infants at term-equivalent age

Background

Preterm infants have altered fat tissue development, including a higher percentage of fat mass and increased volume of visceral fat. They also have altered adiponectin levels, including a lower ratio of high-molecular-weight adiponectin (HMW-Ad) to total adiponectin (T-Ad) at term-equivalent age, compared with term infants.

Aims

The objective of this study was to investigate the association between adiponectin levels and fat tissue accumulation or distribution in preterm infants at term-equivalent age.

Study design

Cross-sectional clinical study.

Subjects

Study subjects were 53 preterm infants born at ≤ 34 weeks gestation with a mean birth weight of 1592 g.

Outcome measures

Serum levels of T-Ad and HMW-Ad were measured and a computed tomography (CT) scan was performed at the level of the umbilicus at term-equivalent age to analyze how fat tissue accumulation or distribution was correlated with adiponectin levels.

Results

T-Ad (r = 0.315, p = 0.022) and HMW-Ad levels (r = 0.338, p = 0.013) were positively associated with subcutaneous fat area evaluated by performing CT scan at term-equivalent age, but were not associated with visceral fat area in simple regression analyses. In addition, T-Ad (β = 0.487, p = 0.003) and HMW-Ad levels (β = 0.602, p < 0.001) were positively associated with subcutaneous fat tissue area, but they were not associated with visceral fat area also in multiple regression analyses.

Conclusion

Subcutaneous fat accumulation contributes to increased levels of T-Ad and HMW-Ad, while visceral fat accumulation does not influence adiponectin levels in preterm infants at term-equivalent age.     

Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: Different phenotypes of dysregulation?

Background

Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design.

Aim

To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age.

Study design

A prospective study from birth to 8.5 years of age.

Subjects

1120 infants born at risk.

Measures

RP were assessed at 5 months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56 months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5 years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD).

Results

23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (β = − .17; 95% CI (− .21; − .10)), behaviour problems (β = − .10; 95% CI (− .15; − .03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders.

Conclusions

Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.     

Hyperglycemia and lower diet quality in pregnant overweight women and increased infant size at birth and at 13 months of age — STEPS study

Aims

To study whether maternal overweight and/or hyperglycemia combined with life-style factors in healthy women predisposes to adverse pregnancy or infant health outcomes, such as differences in growth.

Methods

At 26–28 weeks of gestation 82 overweight pregnant women (prepregnancy BMI ≥ 25 kg/m²) and 67 normal weight pregnant women (prepregnancy BMI < 25 kg/m²) participating to STEPS study attended 2-hour oral glucose tolerance test (OGTT) with measurement of plasma glucose and insulin and calculation of HOMA, QUICKI and Matsuda ISI indices. Birth weights and lengths were obtained from hospital records and weights and heights at 13 months from study visits. Maternal physical activity and diet quality were studied with questionnaires.

Results

Glucose concentrations were higher in overweight non-diabetic women (0 h = 4.9, 1 h = 7.7, 2 h = 6.2 mmol/l, n = 80) than normal weight women (0 h = 4.5, 1 h = 6.8, 2 h = 5.6 mmol/l, all P < 0.05, n = 66) as were insulin concentrations at baseline (12.3 vs. 9.0 mU/l, P < 0.05), but not later (1 h = 88.1 vs. 72.8 mU/l; 2 h = 63.5 vs. 55.5 mU/l, both P > 0.05). Insulin resistance was higher and sensitivity lower (P < 0.05 for all) in overweight than in normal weight women. The offspring of overweight mothers were 273 g heavier at birth and 700 g heavier at 13 months of age than the offspring of normal weight women (P < 0.001). Normal weight women had preferable diet quality (P = 0.023). No differences were seen in self-reported physical activity between overweight and normal weight women.

Conclusions

Maternal prepregnancy overweight increases risk of hyperglycemia in late-pregnancy and increased infant size at birth and 13 months possibly predisposing the infant to health risks later in life.     

Pre-eclampsia—An additional risk factor for cognitive impairment at school age after intrauterine growth restriction and very preterm birth

Objective

To explore the possible influence of pre-eclampsia on cognitive outcome in children born very preterm after intrauterine growth restriction (IUGR) and abnormal umbilical artery blood flow.

Methods

Cognitive function was evaluated at 5–8 years of age with Wechsler scales in 34 children born before 30 gestational weeks after IUGR (PT-IUGR) (11 children were exposed to maternal pre-eclampsia, 23 non-exposed) and in 34 children with no maternal pre-eclampsia and birth weight appropriate-for-gestational age (PT-AGA) matched for gestational age at birth, gender and age at examination.

Results

The subjects in the PT-IUGR group exposed to maternal pre-eclampsia had lower mean verbal IQ (VIQ) (mean ± SD 74 ± 16) and lower full scale IQ (FSIQ) (70 ± 19) in comparison with both the non-exposed PT-IUGR (VIQ 89 ± 15; p = 0.013; FSIQ 83 ± 14, p = 0.029), and, the PT-AGA group (VIQ 96 ± 15, p < 0.001; FSIQ 90 ± 14, p = 0.001). The differences remained significant after adjustment for known confounders. VIQ and FSIQ did not differ between the non-exposed IUGR and PT-AGA children.

Conclusion

Fetal exposure to maternal pre-eclampsia seems to have an additional negative impact to that of IUGR on cognitive function in children born very preterm.