Maternal hemoglobin concentration and its association with birth weight in newborns of mothers with preeclampsia

Abstract

Objective.?Maternal hemoglobin concentration is inversely related to newborn size presumably through plasma volume constriction. We sought to determine whether birth weight would show an inverse relationship to hemoglobin concentration in a group of infants whose mothers had preeclampsia, where plasma volume constriction is common.

Methods.?Electronic and paper chart review identified 142 nulliparous women with preeclampsia (excluding hemolysis, elevated liver enzymes, low platelets syndrome). Birth weight percentile was determined based on cross-sectional hybrid growth curves. Maximal third trimester maternal hemoglobin concentrations were obtained and standardised to z-scores based on gestational age matched normative data. Birth weight percentile was examined as a function of hemoglobin z-score using appropriate statistics.

Results.?Average gestational age at delivery was 35.9?±?1.9 weeks. Mean birth weight percentile for infants of preeclamptic mothers was 34?±?32. Mean hemoglobin z-score for mothers with preeclampsia was 0.3?±?1.5, significantly higher than a control population (p?=?0.04). Maternal hemoglobin z-score was inversely associated with birth weight percentile (r?=??0.18, p?=?0.03).

Conclusion.?Maternal hemoglobin concentrations are significantly elevated prior to delivery in women with preeclampsia. There is a statistically significant inverse correlation of maternal hemoglobin concentration to birth weight percentile.     

Obstetric difficulties in developing countries motivate preference for birth size

The aim of this study was to assess the influence of labor difficulties on mothers preference for birth size. A total of 502 pregnant Ghanaian women were interviewed to ascertain what size of infant they wished to deliver. Information on reasons, measures taken to achieve preferred birth size and birth weight of infants delivered by them was obtained. Results showed that even though mothers had particular preferences for birth size, actual birth weight of infants delivered did not tally with mothers’ preference. More women with previous childbirth experience wanted small infants than those who had no experience. Overall 41 % of the mothers preferred small or medium size infants for easy labor. Large infants on delivery were preferred by 11% of the mothers because they claimed large infants are tough. Approximately 48% of mothers had no particular preference for birth size. It seemed mothers wanting small infants had previous labor problems due to large birth size. A substantial number (40%) of the mothers did not take measures to achieve the preferred birth size. About 4% reported to have reduced their dietary intake to less than the non-pregnancy intake to deliver small infants. About 7% of the women who preferred large infants at birth claimed they ate more food to achieve their aim. Mothers who had mechanical difficulties during labor delivered infants of significantly higher birth weight than those who delivered normally without extra assistance (p < 0.002). Women who experienced a difficult childbirth, believed that high infant birth weight can pose labor problems.     

Early,rapidly progressive enteral nutrition promotes growth of very low birth weight (VLBW) infants

Aim: This study describes the effects of a quality improvement program to promote improved postnatal nutrition on the growth of very low birth weight (VLBW) infants.

Methods: Daily data regarding nutrition and growth were collected from the medical record of VLBW infants born during 1995–2010. The infants were grouped by year of birth in order to compare infants from before, during and after the policy change. Evaluation of growth included age in days at a return to birth weight and the proportion of infants with weight below the 10th percentile at discharge.

Results: The caloric and protein intake improved significantly. The age at a return to birth weight fell (p?p?p?Conclusion: Increasing awareness led to increase in caloric and protein intake in VLBW infants. Aggressive EF was associated with more rapid weight gain. However, the provision of protein and calories during the first 2 weeks of life still falls short of the latest European Society of Pediatric Gastroenterology, Hepatology and Nutrition recommendations.     

Divergence of estimated fetal weight and birth weight in singleton fetuses

Objective: To evaluate differences in distribution of estimated fetal weight (EFW) and birth weight (BW) of ongoing fetuses and neonates of the same gestational age.

Methods: Reference curves for EFW (Hadlock BPD-HC-AC-FL formula, N?=?1191) and BW (N?=?1036) in singleton pregnancies from 24⁺⁰ to 40⁺⁶ gestational weeks were calculated. Multiple pregnancies, fetuses with major or multiple abnormalities or syndromes and iatrogenic preterm deliveries due to preeclampsia or abnormal fetal Doppler were excluded. The standardized residuals for EFW and BW were calculated and compared.

Results: EFW and BW can be accurately described by quadratic equations (R²?=?0.944 and 0.807, respectively). The distribution of standardized residuals for BW using the EFW formula was negative from 28⁺⁰ to 35⁺⁶ weeks. The 50th and 5th centiles of BW were lower than those of EFW throughout prematurity, and they converged at approximately 38 gestational weeks. The 5th centile for BW was 30% lower than the 5th centile for EFW at 27 weeks, 27.5% lower at 30 weeks and 19.4% at 34 weeks.

Conclusions: Preterm infants have lower BW distribution compared to the expected EFW of ongoing pregnancies of the same gestational age, supporting the concept of hidden intrauterine morbidity for a proportion of these infants.     

The lowest surviving birth weight infant delivered from a systemic lupus erythematosus mother with antiphospholipid syndrome

We report the intact surviving case of a newborn with a birth weight of 412?g delivered from an active systemic lupus erythematosus (SLE) mother with antiphospholipid syndrome. A review of the literature revealed that our infant is the lowest surviving birth weight in newborns from SLE mothers to date.     

Fetal congenital heart disease and intrauterine growth restriction: a retrospective cohort study

Objective: Fetal congenital heart disease may lead to abnormal fetal growth. Our objective was to estimate the association between fetal congenital heart disease (CHD) and intrauterine growth restriction (IUGR) in an effort to better inform clinical management of continuing pregnancies complicated by fetal congenital heart disease. Methods: In a retrospective cohort study, outcome data was collected from singleton pregnancies undergoing routine anatomic survey at a tertiary medical center between 1990 and 2008. Dedicated research nurses collected information on delivery outcomes in an on-going manner. Subjects with a prenatal diagnosis of fetal CHD were compared to those without CHD. Stratified analyses for isolated fetal CHD and major CHD were performed. The primary outcome was IUGR less than 10th percentile by the Alexander growth standard. Logistic regression was used to adjust for confounding variables and refine the estimates of risk. Results: Among 67,823 patients, there were 193 cases of fetal CHD (0.3%) and 5,669 cases of IUGR (8.4%). Prenatal diagnosis of CHD was associated with an increased risk of IUGR (23.8% vs. 8.5%, adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.4–4.6), and the risk was greatest in fetuses with major CHD (16.5% vs. 8.5%, aOR 2.1, 95% CI 1.3–3.2). Isolated CHD was also associated with an increased risk of IUGR (17.8% vs. 8.5%, aOR 2.2, 95% CI 1.4–3.7). Conclusion: Patients with a prenatal diagnosis of fetal CHD have a three-fold increase in risk of developing IUGR; patients with isolated fetal CHD are twice as likely to develop IUGR. Based on our findings, serial growth assessment may be a reasonable option for patients with fetal CHD diagnosed at routine anatomic survey.     

Racial discrimination and the black-white gap in adverse birth outcomes: a review

Introduction: The purpose of this integrative review was to evaluate what is known about the relationship between racial discrimination and adverse birth outcomes. Methods: A search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO was conducted. The keywords used were: preterm birth, premature birth, preterm delivery, preterm labor, low birth weight, very low birth weight, racism, racial discrimination, and prejudice. Ten research studies were reviewed. All of the studies included African American women in their samples, were conducted in the United States, and were written in English. We did not limit the year of publication for the studies. Data were extracted based on the birth outcomes of preterm birth, low birth weight, or very low birth weight. Results: A consistent positive relationship existed between perceptions of racial discrimination and preterm birth, low birth weight, and very low birth weight. No relationship was found between racial discrimination and gestational age at birth. Discussion: Future research should explore the effects of racial discrimination as a chronic stressor contributing to the persistent gap in birth outcomes between racial groups.     

The investigation of missing paternal information in birth certificates and low birth weight

Objective.?To determine if missing paternal information in birth certificates is associated with an increased risk of low birth weight (LBW).

Methods.?This was a retrospective single cohort analysis including all live births at our institution between April 1999 and May 2002. We created two study groups, one with father's information complete (FIC) and one with father's information missing (FIM). We utilised a three-tier approach (univariate analysis, multivariate analysis and propensity matching) to determine if FIM was related to LBW.

Results.?Univariate analysis showed a significant difference in LBW rates between the FIM and FIC groups (14.6 vs. 9.1%, p < 0.001). However, this difference was not observed in the multivariate (odds ratio = 1, p = 0.858, ns) or propensity matching analysis (13.9 vs. 13.8%, p = 0.954, ns).

Conclusion.?After controlling for LBW risk factors, FIM was not an independent predictor of LBW.     

Exposure to life-threatening stressful situations and the risk of preterm birth and low birth weight

Objective

To evaluate the association between exposure to life-threatening rocket attacks and the risks of preterm birth (PTB) and low birth weight (LBW).

Methods

The present retrospective cohort study compared the outcomes of 1851 births by women exposed to rocket attacks and 2979 births by unexposed women. The timing, frequency, and intensity of exposure were calculated for each trimester and for the entire pregnancy period. Demographic and medical data were abstracted from the patients’ records.

Results

The rates of PTB and LBW were higher among exposed than unexposed women (PTB: 9.1% versus 6.8%, P = 0.004; LBW: 7.6% versus 5.8%, P = 0.02). The rate of infants who were small for gestational age did not differ between the groups. After controlling for potential confounders, the risks for PTB and LBW remained significantly higher in the exposed group (PTB: adjusted odds ratio 1.3 [95% confidence interval, 1.1–1.7]; LBW: adjusted odds ratio 1.3 [95% confidence interval, 1.03–1.7]). There was no linear association between the intensity of exposure and the risk of PTB or LBW.

Conclusion

Maternal exposure to intermittent but repeated life-threatening rocket attacks for a prolonged period might be associated with increased risks of PTB and LBW.     

Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study

Objective: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH).

Methods: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion.

Results: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p?>?0.05). There was no increased risk of SGA (unadjusted OR?=?1.28, 95% confidence interval [CI] 0.9–1.83; adjusted OR?=?1.35, 95% CI 0.91–2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p?>?0.05). Also, we did not find a significant risk of IUGR (OR?=?0.66; 95% CI 0.34–1.28; adjusted OR?=?0.843; 95% CI 0.42–1.70).

Conclusions: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.     

Management of vaginal birth after cesarean

OBJECTIVE: To raise the success rate of vaginal birth after cesarean (VBAC) without increasing maternal or perinatal morbidity and mortality rates. METHODS: Of 468 women with a prior scar, 365 gave valid informed consent for our management of VBAC at Akashi Municipal Hospital during 1986-1999. Trials of labor (TOL) were attempted in 322 cases principally by waiting for spontaneous labor onset and teaching the patients a breathing method to avoid straining until expulsion by vacuum extraction become possible, controlling the intrauterine pressure. Our selection criteria for TOL changed during the trial; from 1991-1999 patients with a prior scar extending into fundus were excluded. RESULTS: Of the 322 TOL, 88.2% were successful, and VBAC was successful in 77.8% (284 of the 365 patients). Uterine rupture was observed in 2 cases (0.62%). Fetal death occurred in 1 case. Three women gave birth to neonates with a 1-minute Apgar score < or = 6. CONCLUSION: The rate of VBAC was 77.8% in all women with a prior scar. During our management of VBAC, maternal or perinatal morbidity and mortality rates did not increase significantly.     

亲代出生体重对子代出生体重的影响

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

Mother's birth weight as a predictor of macrosomia

The relationship between a mother's own birth weight and the risk of delivering a large for gestational age infant was studied in 1335 women. Compared to women who weighed 8 pounds or more at birth, women who weighed 6 to 7.9 pounds were only 50% as likely (p = 0.007) and women who weighed 4 to 5.9 pounds were only 15% as likely (p = 0.002) to give birth to a large for gestational age infant. When this relationship was adjusted for nine other factors known to influence birth weight, including maternal weight and weight gain during pregnancy, maternal birth weight was second only to weight gain during pregnancy in predicting the birth of large for gestational age infants. Maternal birth weight was also accurate in the prediction of macrosomia (birth weight greater than 4000 gm). Because of its ability to predict the delivery of a large infant, maternal birth weight should become part of the routine obstetric history.     

阴道分泌物胎儿纤维连接蛋白与宫颈长度联合预测早产的多中心前瞻性研究

目的 探讨阴道分泌物胎儿纤维连接蛋白(fFN)与宫颈长度测量联合应用在早产预测中的价值.方法 选择2006年12月至2007年12月在北京大学第一医院等四家医院就诊的孕22～35周,有不规律宫缩,或有早产高危因素的511例孕妇为研究对象,检测其宫颈阴道分泌物中fFN,同时B超测量宫颈长度,比较其临产的时间及孕周情况.结果 fFN阳性对7 d内分娩预测的敏感度为77.4%,特异度69.4%,阴性预测值97.9%,对34周内分娩预测的敏感度、特异度和阴性预测值分别为70.5%,70.0%,96.2%.宫颈缩短(≤3 cm)者7 d内分娩的敏感度、特异度、阴性预测值分别为54.8%、66.3%、95.8%;对34周内分娩预测的敏感度、特异度和阴性预测值分别为59.1%、67.2%、和94.6%,二者联合7 d内分娩预测敏感度、特异度、阳性预测值和阴性预测值分别为51.6%、87.1%和96.5%;预测34周内分娩的敏感度45.5%,特异度87.6%,阴性预测值94.5%.结论 阴道分泌物fFN比宫颈长度对预测7 d及34周内分娩有较高的阴性预测值及特异度,与超声宫颈长度测量联合应用可进一步提高其阳性预测值和特异度,提高对早产的预测.     

Maternal characteristics and birth outcomes of pregnant women who had offspring with congenital ear abnormalities – a population-based case–control study

Objective.?To describe the maternal characteristics and birth outcomes of newborn infants affected with isolated ear congenital abnormalities (IECA), mainly isolated anotia/microtia and unclassified multiple congenital abnormalities (CAs) including anotia/microtia (UMAM).

Method.?Cases with IECA and UMAM were compared with their matched controls and all controls without any defect and malformed controls affected with other defects in the population-based large dataset of the Hungarian Case–Control Surveillance of Congenital Abnormalities.

Results.?The mothers of 354 cases with IECA did not show significant difference in age, but their mean birth order was higher while their socio-economic status based on the maternal employment status was lower compared to the figures of their matched controls. There was a male excess among cases with microtia and mainly with UMAM. The evaluation of birth outcomes of newborns affected with IECA indicated intrauterine fetal growth retardation.

Conclusions.?Newborn infants with isolated microtia had intrauterine growth retardation and the association of this developmental defect localized for a small region of head with the general fetal development raises interesting theoretical question.     

Effects of smoking and preeclampsia on birth weight for gestational age

Objective: A counterintuitive interaction between smoking during pregnancy and preeclampsia on birth weight for gestational age (BWGA) outcomes was recently reported. In this report, we examine the relationship between these factors in a well-documented study population with exposure data on trimester of maternal smoking.

Methods: Preeclamptic (n?=?238), gestational hypertensive (n?=?219), and normotensive women (n?=?342) were selected from live-births to nulliparous Iowa women. Disease status was verified by medical chart review, and smoking exposure was assessed by self-report. Fetal growth was assessed as z-score of BWGA. Multiple linear regression was used to test for the association of maternal smoking and preeclampsia with BWGA z-score.

Results: There was no interaction between smoking with preeclampsia or gestational hypertension on fetal growth. BWGA z-scores were significantly lower among women with preeclampsia and those who smoked any time during pregnancy (β?=??0.33, p?=?<0.0001 and β?=??0.25, p?=?0.05) compared to normotensive and non-smoking women, respectively. Infants of women with gestational hypertension were comparable in size to infants born to normotensive women.

Conclusions: Women who developed preeclampsia and those who smoked during pregnancy delivered infants that were significantly smaller than infants of women who did not develop preeclampsia and non-smoking women, respectively.     

Determinants of place of birth decisions in uncomplicated childbirth in Bangladesh: An empirical study

Objective

to test the predictive value of women's self-identified criteria in place of birth decisions in the event of uncomplicated childbirth in a setting where facility based skilled birth attendants are available.

Design

a retrospective, cross-sectional study was conducted in two phases. The first phase used data from in-depth interviews. The second phase used data from semi-structured questionnaires.

Setting

the service area of Matlab, Bangladesh.

Participants

women 18–49 years who had an uncomplicated pregnancy and delivery resulting in a live birth.

Findings

a women's intention about where to deliver during pregnancy, her perception of labour progress, the availability of transportation at the time of labour, and the close proximity of a dai to the household were independent predictors of facility-based SBA use. Marital age was also significant predictor of use.

Key conclusions

the availability of delivery services does not guarantee use and instead specific considerations and conditions during pregnancy and in and around the time of birth influence the preventive health seeking behaviour of women during childbirth. Our findings have implications for birth preparedness and complication readiness initiatives that aim to strengthen timely use of SBAs for all births. Demand side strategies to reduce barriers to health seeking, as part of an overall health system strengthening approach, are needed to meet the Millennium Development 5 goal.     

A hospital-based birth weight analysis using computerized perinatal data base for a Chinese population

Objectives.?We aimed to construct birth weight-for-gestational age nomograms based on a computerized perinatal data base in a hospital-based Chinese population.

Methods.?Retrospectively collected 28,052 singleton deliveries at Women and Children's Medical Center, Guangzhou, China. Standard curves of birth weight from 27 to 43 week's gestation were computed. The nomograms included the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles and standard deviations.

Results.?79.9% pregnant women delivered between 38, 39, and 40 gestational week, and the mean birth weights are 3160, 3282, and 3388?g, respectively. Preterm birth is 5.7%. In general, male birth weights are greater than females at each gestational week. The hospital-based Chinese population birth weight is lower than that of North American and Scandinavian population.

Conclusions.?A different standard birth weight is needed for different population. A hospital-based birth weight curve by gestational week is established, which can be a useful tool to estimate intrauterine fetal growth to define SGA or LGA fetuses.