Maternal Weight Gain During Pregnancy and Child Weight at Age 3 Years

Objectives To determine the importance of pregnancy weight gain as a predictor of overweight (Body Mass Index [BMI] >85th percentile) in offspring at age 3 years and if its influence varies by maternal BMI. Methods Chi-square and logistic regression analyses were conducted on a sample of 208 mother-child pairs from an earlier observational cohort study on postpartum weight retention. Results In the final reduced regression model, maternal early pregnancy BMI was positively and significantly associated with overweight in offspring, as were birth weight above the sample median of 3,600 g and maternal smoking during pregnancy (P ≤ 0.01). In addition, a significant interaction was found between maternal BMI and gestational weight gain (P = 0.03). The risk of offspring overweight that is associated with 5 excess pounds of net pregnancy weight gain increases with maternal BMI. Conclusions Excess pregnancy weight gain is associated with increased risk of child overweight at age 3 years and its impact is greater among high and obese BMI women than it is in normal BMI women. Reducing maternal BMI in the preconception period in overweight women and preventing excessive weight gain in pregnancy for all women appear to be appropriate strategies to address the childhood obesity epidemic.     

Body Composition and “Catch-Up” Fat Growth in Healthy Small for Gestational Age Preterm Infants and Neurodevelopmental Outcomes

To examine the growth and body composition of small for gestational age (SGA) and appropriate for gestational age (AGA) very low birth weight infants (VLBW) and their outpatient neurodevelopmental outcomes. From 2006–2012, VLBW infants (n = 57 of 92) admitted to the Neonatal Intensive Care Unit (NICU) had serial air displacement plethysmography (ADP) scans and were followed as outpatients. Serial developmental testing (CAT/CLAMS, Peabody Gross Motor Scales) and anthropometrics were obtained from n = 37 infants (29 AGA and 8 SGA) and analyzed via repeated measures analyses of variances. The percentage of body fat, percentage of lean mass, and weight gain were statistically significant between SGA and AGA groups at the first ADP assessment. There was no difference between the two groups in outpatient neurodevelopmental testing. Weight gain as “catch-up” body fat accrual occurs by 67 weeks of PMA. This catch-up growth is associated with normal SGA preterm neurodevelopment as compared to AGA preterm infants.     

The safety of quinolones—A meta-analysis of pregnancy outcomes

Objective

We conducted a meta-analysis of all published data in order to evaluate the risk for birth defects, stillbirths, preterm births and low birth weight following exposure to quinolones in the first trimester of pregnancy.

Study design

Medline, Embase, Scopus, Biological Abstracts and Proquest Thesis Dissertation databases were searched. Other papers and abstracts were located from the retrieved articles’ references, meeting booklets, internet web sites and books on teratology.

Results

Five studies met the inclusion criteria. The summary odds ratio for all the included studies was 1.05 (95% CI 0.90–1.22) for major malformations, 2.6 (95% CI 0.36–18.67) for stillbirths, 1.15 (95% CI 0.69–1.91) for preterm births and 0.73 (95% CI 0.30–1.79) for low birth weight. In an additional analysis including only fluoroquinolones (nalidixic acid was removed), the summary odds ratio for major malformations remained non-significant (1.11, 95% CI 0.57–2.15).

Conclusions

The use of quinolones during the first trimester of pregnancy does not appear to represent an increased risk for major malformations recognized after birth, stillbirths, preterm births or low birth weight.     

Discovering a new part of the phenotypic spectrum of Coffin-Siris syndrome in a fetal cohort

PurposeGenome-wide sequencing is increasingly being performed during pregnancy to identify the genetic cause of congenital anomalies. The interpretation of prenatally identified variants can be challenging and is hampered by our often limited knowledge of prenatal phenotypes. To better delineate the prenatal phenotype of Coffin-Siris syndrome (CSS), we collected clinical data from patients with a prenatal phenotype and a pathogenic variant in one of the CSS-associated genes.MethodsClinical data was collected through an extensive web-based survey.ResultsWe included 44 patients with a variant in a CSS-associated gene and a prenatal phenotype; 9 of these patients have been reported before. Prenatal anomalies that were frequently observed in our cohort include hydrocephalus, agenesis of the corpus callosum, hypoplastic left heart syndrome, persistent left vena cava, diaphragmatic hernia, renal agenesis, and intrauterine growth restriction. Anal anomalies were frequently identified after birth in patients with ARID1A variants (6/14, 43%). Interestingly, pathogenic ARID1A variants were much more frequently identified in the current prenatal cohort (16/44, 36%) than in postnatal CSS cohorts (5%-9%).ConclusionOur data shed new light on the prenatal phenotype of patients with pathogenic variants in CSS genes.     

The relationship between food insecurity and obesity in rural childbearing women.

CONTEXT: While food insecurity and obesity have been shown to be positively associated in women, little is known about the direction of the causal relationship between these 2 constructs. PURPOSE: To clarify the direction of the causal relationship between food insecurity and obesity. METHODS: Chi-square and logistic regression analysis of data from a cohort of 622 healthy childbearing women living in a 10-county rural area of upstate New York and followed from early pregnancy until 2 years postpartum. FINDINGS: Obesity in early pregnancy was associated with increased risk of food insecurity at 2 years postpartum. Initial food insecurity was not associated with increased risk of obesity at 2 years postpartum. Women who were both obese and food insecure in early pregnancy were at greatest risk of major weight gain over the pregnancy and postpartum period. CONCLUSIONS: Obesity appears to lead to food insecurity rather than the converse. Obesity combined with food insecurity present the greatest risk for major weight gain in this sample of childbearing women.     

Effect of human milk fortifiers on bacterial growth in human milk.

BACKGROUND: As a component in human milk fortifiers (HMF), iron may equilibrate with human milk for as long as 24 hours, bind important bacteriostatic proteins, and potentially affect the host defense properties of human milk. OBJECTIVE: We compared bacterial growth in human milk prepared with each of two HMF differing in their content of iron. STUDY DESIGN: Samples of human milk obtained from mothers of premature infants were divided and mixed with one of two HMF and maintained at refrigerator temperature. Refrigerated milk samples were removed at 0, 24, and 72 hours for determination of total bacterial colony counts (TBCC). RESULTS: TBCC did not differ between groups but declined from 0 to 72 hours, p<0.001. CONCLUSION: These data suggest that differences in iron content, or other nutrients in HMF, do not affect bacterial growth in human milk. Storage of fortified human milk at refrigerator temperature for 72 hours results in decreased bacterial growth.As a component in human milk fortifiers (HMF), iron may equilibrate with human milk for as long as 24 hours, bind important bacteriostatic proteins, and potentially affect the host defense properties of human milk.We compared bacterial growth in human milk prepared with each of two HMF differing in their content of iron.Samples of human milk obtained from mothers of premature infants were divided and mixed with one of two HMF and maintained at refrigerator temperature. Refrigerated milk samples were removed at 0, 24, and 72 hours for determination of total bacterial colony counts (TBCC).     

Prenatal Care and Prematurity: Is There an Association in Uncomplicated Pregnancies?

ABSTRACT: A retrospective investigation examined patterns of use of prenatal care and pregnancy outcomes (low birthweight and preterm births) in 6176 pregnancies without antepartum medical complications. Prenatal care use patterns differed significantly by mother's age, marital status, race, education, method of payment, and gravidity. By controlling for these differences through a logistic regression procedure, results showed that prenatal care was associated with significant reductions in the number of infants who were delivered preterm or had low birthweight. Fewer very low-birthweight (<1500 g) infants were among the preterm infants delivered to mothers with prenatal care compared with women who received no prenatal care. These data suggest that significant improvements in pregnancy outcomes are seen among women who use prenatal care, and these benefits occur in the absence of antepartum complications.     

Evaluation of the six-minute walk in multiple sclerosis subjects and healthy controls

OBJECTIVE: To assess the characteristics of the 6-min walk (6MW) in multiple sclerosis (MS) subjects of varied disability, and controls. To assess the correlation of 6MW to subjective measures of fatigue, health status and ambulation using the modified fatigue impact scale (MFIS), short form-36 Health Questionnaire physical component score and MS walking scale (MSWS). METHODS: Forty MS expanded disability status scale [(EDSS) 0-6.5] and 20 control subjects were recruited from a MS outpatient clinic. Subjects completed survey material and three 6MWs with 1-h interval rest in a single study visit. RESULTS: There was no practice effect or fatigability with repeat 6MW tests with a one-h rest period between test sessions. The 6MW had excellent intra-[intraclass correlation coefficient (ICC) = 0.95] and inter-rater (ICC = 0.91) reliability. MS subjects demonstrated reduced 6MW distance and speed compared with controls (P < 0.0001). Within the MS population 6MW distance was significantly reduced with increasing disability (P = 0.05). Compared with the EDSS, the 6MW had a stronger correlation to subjective measures of ambulation and physical fatigue: MSWS (r = -0.81 versus 0.69) and MFISphy (0.66 versus 0.63). CONCLUSIONS: The 6MW is a feasible, reproducible, and reliable measure in MS. MS subjects demonstrate motor fatigue in both 6MW distance and speed compared with controls. In MS subjects there is an inverse relationship between motor fatigue and disability. 6MW has a strong correlation to subjective measures of ambulation and physical fatigue.