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Díaz M, Casano P, Quesada T, López-Bermejo A, de Zegher F, Villarroya F, Ibáñez L. Circulating exosomes decrease in size and increase in number between birth and age 7: relations to fetal growth and liver fat. Front Endocrinol (Lausanne) 2023; 14:1257768. [PMID: 38027180 PMCID: PMC10653443 DOI: 10.3389/fendo.2023.1257768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Exosomes play a key role in cell-to-cell communication by transferring their cargo to target tissues. Little is known on the course of exosome size and number in infants and children. Methods Longitudinally, we assessed the size and number of circulating exosomes at birth and at ages 2 and 7 yr in 75 infants/children born appropriate-for-gestational-age (AGA; n=40) or small-for-gestational-age (SGA; n=35 with spontaneous catch-up), and related those results to concomitantly assessed measures of endocrine-metabolic health (HOMA-IR; IGF-1), body composition (by DXA at ages 0 and 2) and abdominal fat partitioning (subcutaneous, visceral and hepatic fat by MRI at age 7). Results Circulating exosomes of AGAs decreased in size (on average by 4.2%) and increased in number (on average by 77%) between birth and age 7. Circulating exosomes of SGAs (as compared to those of AGAs) had a larger size at birth [146.8 vs 137.8 nm, respectively; p=0.02], and were in lower number at ages 2 [4.3x1011 vs 5.6x1011 particles/mL, respectively; p=0.01] and 7 [6.3x1011 vs 6.8x1011 particles/mL, respectively; p=0.006]. Longitudinal changes were thus more pronounced in SGAs for exosome size, and in AGAs for exosome number. At age 7, exosome size associated (P<0.0001) to liver fat in the whole study population. Conclusion Early-life changes in circulating exosomes include a minor decrease in size and a major increase in number, and these changes may be influenced by fetal growth. Exosome size may become one of the first circulating markers of liver fat in childhood.
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Affiliation(s)
- Marta Díaz
- Endocrinology Department, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Casano
- Endocrinology Department, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tania Quesada
- Department of Biomedicine, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Network Biomedical Research Center of Physiopathology of Obesity and Nutrition (CIBEROBN), Health Institute Carlos III, Madrid, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Institute for Biomedical Research (IDIBGI), Faculty of Medicine, University of Girona and Dr. Josep Trueta Hospital, Girona, Spain
| | - Francis de Zegher
- Leuven Research & Development, University of Leuven, Leuven, Belgium
| | - Francesc Villarroya
- Network Biomedical Research Center of Physiopathology of Obesity and Nutrition (CIBEROBN), Health Institute Carlos III, Madrid, Spain
- Biochemistry and Molecular Biomedicine Department, Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues, Spain
| | - Lourdes Ibáñez
- Endocrinology Department, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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Martini S, Lenzi J, Paoletti V, Maffei M, Toni F, Fetta A, Aceti A, Cordelli DM, Zuccarini M, Guarini A, Sansavini A, Corvaglia L. Neurodevelopmental Correlates of Brain Magnetic Resonance Imaging Abnormalities in Extremely Low-birth-weight Infants. J Pediatr 2023; 262:113646. [PMID: 37516269 DOI: 10.1016/j.jpeds.2023.113646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/19/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To evaluate the relationship between impaired brain growth and structural brain abnormalities at term-equivalent age (TEA) and neurodevelopment in extremely low-birth-weight (ELBW) infants over the first 2 years. METHODS ELBW infants born from 2009 through 2018 and undergoing brain magnetic resonance imaging (MRI) at TEA were enrolled in this retrospective cohort study. MRI scans were reviewed using a validated quali-quantitative score, including several white and gray matter items. Neurodevelopment was assessed at 6, 12, 18, and 24 months using the Griffiths scales. The independent associations between MRI subscores and the trajectories of general and specific neurodevelopmental functions were analyzed by generalized estimating equations. RESULTS One hundred-nine ELBW infants were included. White matter volume reduction and delayed myelination were associated with worse general development (b = -2.33, P = .040; b = -6.88, P = .049 respectively), social skills (b = -3.13, P = .019; b = -4.79, P = .049), and eye-hand coordination (b = -3.48, P = .009; b = -7.21, P = .045). Cystic white matter lesions were associated with poorer motor outcomes (b = -4.99, P = .027), while white matter signal abnormalities and corpus callosum thinning were associated with worse nonverbal cognitive performances (b = -6.42, P = .010; b = -6.72, P = .021, respectively). Deep gray matter volume reduction correlated with worse developmental trajectories. CONCLUSIONS Distinctive MRI abnormalities correlate with specific later developmental skills. This finding may suggest that TEA brain MRI may assist with neurodevelopmental prediction, counseling of families, and development of targeted supportive interventions to improve neurodevelopment in ELBW neonates.
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Affiliation(s)
- Silvia Martini
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Monica Maffei
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
| | - Anna Fetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy.
| | - Arianna Aceti
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Bologna, Italy
| | - Mariagrazia Zuccarini
- Department of Education Studies "Giovanni Maria Bertin", University of Bologna, Bologna, Italy
| | - Annalisa Guarini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Zhao L, Li T, Wang H, Fan YM, Xiao Y, Wang X, Wang S, Sun P, Wang P, Jiangcuo Z, Tong L, Wang L, Peng W. Association of co-exposure to metal(loid)s during pregnancy with birth outcomes in the Tibetan plateau. CHEMOSPHERE 2023; 342:140144. [PMID: 37704082 DOI: 10.1016/j.chemosphere.2023.140144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023]
Abstract
Maternal metal (loid)s exposure has been related to birth outcomes but the results are still inconclusive. Most previous studies have discussed the single metal (loid)s, neglecting the scene of co-exposure. We examined the associations of both single metal (loid)s and metal mixtures with birth outcomes in a birth cohort from the Tibetan Plateau, including body weight, body length, head circumference, small for gestational age (SGA), and Ponderal index (PI). In our analysis of 1069 women, we measured 29 metal (loid)s in urine samples in the third trimester. The associations of single metal (loid)s with categorical or continuous birth outcomes were evaluated using a generalized linear mixed-effects model or linear mixed-effects model, respectively. The least absolute shrinkage and selection operator, Bayesian kernel machine, and Quantile g-computation regression were used to explore the joint association. We also evaluated the interactive effects of ethnicity and altitude on the effect of metal (loid)s on birth outcomes. Copper (Cu) concentration in maternal urine was positively associated with SGA, birth weight, birth length, and head circumference in the single pollutant models. For instance, Cu was associated with an increased risk of SGA [OR (95% CI) = 1.56 (1.23, 1.97); P < 0.001]. We didn't find significant joint association of metal mixtures with birth outcomes except a positive association between the mixture of Cu, Magnesium (Mg), and Iron (Fe) with the risk of SGA when the exposure level was above its 80th percentile, and Cu dominated the adverse association in a non-linear manner. Living altitude modified the associations of Cu with SGA and the positive association was only found in participants living at high altitude. In conclusion, maternal urinary metal (loid)s, especially Cu, was the dominant harmful metal (loid)s when associated with SGA on the Tibetan Plateau.
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Affiliation(s)
- Lei Zhao
- Department of Public Health, Nutrition and Health Promotion Center, Medical College, Qinghai University, Xining, China
| | - Tiemei Li
- Department of Public Health, Nutrition and Health Promotion Center, Medical College, Qinghai University, Xining, China
| | - Haijing Wang
- Department of Public Health, Nutrition and Health Promotion Center, Medical College, Qinghai University, Xining, China
| | - Yue-Mei Fan
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yuancan Xiao
- Qinghai Provincial Key Laboratory of Tibetan Medicine Pharmacology and Safety Evaluation, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, China
| | - Xuejun Wang
- Department of Anesthesiology, Qinghai Red Cross Hospital, Xining, China
| | - Shulin Wang
- Department of Public Health, Nutrition and Health Promotion Center, Medical College, Qinghai University, Xining, China
| | - Pin Sun
- Department of Occupational Health and Toxicology, School of Public Health, Fudan University, Shanghai, China
| | - Pinhua Wang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Xining, China
| | | | - Li Tong
- Department of Traditional Chinese Medicine, Medical College of Qinghai University, Xining, China; Qinghai Provincial Key Laboratory of Traditional Chinese Medicine Research for Glucolipid Metabolic Diseases, Medical College, Qinghai University, Qinghai, China
| | - Liehong Wang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Xining, China.
| | - Wen Peng
- Department of Public Health, Nutrition and Health Promotion Center, Medical College, Qinghai University, Xining, China; Qinghai Provincial Key Laboratory of Traditional Chinese Medicine Research for Glucolipid Metabolic Diseases, Medical College, Qinghai University, Qinghai, China.
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Correani A, Lanciotti L, Giorgetti C, Palazzi ML, Monachesi C, Antognoli L, Burattini I, Cogo P, Carnielli V. Reduced pulmonary oxygen diffusion at 36 weeks of postmenstrual age in small-for-gestational-age preterm infants of less than 32 weeks without bronchopulmonary dysplasia. Pediatr Pulmonol 2023; 58:3054-3062. [PMID: 37594147 DOI: 10.1002/ppul.26620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/07/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Small-for-gestational-age (SGA) preterm infants are at increased risk of developing bronchopulmonary dysplasia (BPD). There is limited information on pulmonary oxygen diffusion of SGA preterm infants, particularly in those without BPD. OBJECTIVE To compare the pulmonary oxygen diffusion of SGA to that of appropriate-for-gestational-age (AGA) preterm infants without BPD. STUDY DESIGN Preterm infants with a gestational age (GA) between 24.0 and 31.6 weeks were studied. The oxygen saturation (SpO2 ), fraction to inspired oxygen (FiO2 ), and the SpO2 to FiO2 ratio (SFR) were compared between SGA and AGA infants. The association between SGA and SFR at 36 weeks was assessed using a multiple regression analysis. In the subgroup without BPD, SGA were match-paired for GA and gender with AGA infants. RESULTS We analyzed 1189 infants surviving at 36 weeks: 194 (16%) were SGA and 995 (84%) AGA. The incidence of BPD was significantly higher in SGA than AGA infants (32% vs. 13%; p = .000). Out of the 995 infants without BPD, 132 (13%) were SGA and 863 (87%) AGA. SGA was negatively associated with the SFR value at 36 weeks, independently from BPD. SGA infants without BPD had significantly higher (better) SFR at birth, but lower (worse) SpO2 and SFR and from 33 to 36 weeks than their matched AGA counterpart. At 36 weeks, median SpO2 and SFR values were 97.7 versus 98.4 (p = .006) and 465 versus 468 (p = .010) in match-paired SGA and AGA, respectively. CONCLUSION Among preterm infants of less than 32 weeks and without BPD, SGA infants had a reduced pulmonary oxygen diffusion at 36 weeks in comparison with AGA infants.
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Affiliation(s)
- Alessio Correani
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Lucia Lanciotti
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Giorgetti
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Maria Laura Palazzi
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Chiara Monachesi
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Luca Antognoli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Ilaria Burattini
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
| | - Paola Cogo
- Department of Medicine, University Hospital S Maria della Misericordia, University of Udine, Udine, Italy
| | - Virgilio Carnielli
- Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
- Division of Neonatology, Mother and Child Department, G. Salesi Children Hospital, Azienda Ospedaliero Universitaria delle, Ancona, Marche, Italy
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Halevy J, Peretz R, Ziv-Baran T, Katorza E. Fetal brain volumes and neurodevelopmental outcome of intrauterine growth restricted fetuses. Eur J Radiol 2023; 168:111143. [PMID: 37832199 DOI: 10.1016/j.ejrad.2023.111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE This study aims to investigate the correlation of MRI measured fetal brain volumetrics with long-term neurodevelopmental outcome, among intrauterine growth restricted (IUGR) and apparently healthy fetuses. STUDY DESIGN A historical cohort study at a single tertiary referral medical center during 6 years period, of fetuses diagnosed with IUGR due to placental insufficiency, and apparently healthy fetuses, who had fetal brain MRI scan. The volumes of the supratentorial brain region, both hemispheres and the cerebellum were measured by 3D MRI semi-automated volume measurements. The cerebellar to supratentorial ratio (CER/ST) was calculated. Volumes were plotted on normal growth curves. 17 IUGR fetuses, and 53 apparently healthy fetuses adhered to participate in the VABS-II questionnaire, evaluating neurodevelopmental outcome. RESULTS 70 patients (mean age at conducting VABS-II questionnaire 4.4 ± 2.1 years, 38 males) were evaluated. Among fetuses born in a gestational age of 36 weeks or later, IUGR fetuses demonstrated a significantly larger number of abnormal results in the VABS-II communication domain (p =.049). No significant differences were found in other domains or in overall neurodevelopmental outcome. The CER/ST ratio correlated with the overall neurodevelopmental outcome of the total study population (r = 0.40, p <.001), and of the IUGR group separately (ρ = 0.58, p =.02). CONCLUSION CER/ST ratio measured using fetal brain MRI was found to be correlated with long term neurodevelopmental outcome. This result may aid in clinical interpretation of biometric data obtained by fetal brain MRI, linking it with long term neurodevelopmental outcome.
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Affiliation(s)
- Jorden Halevy
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Israel.
| | - Reut Peretz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel; Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel
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Cortez Ferreira M, Mafra J, Dias A, Santos Silva I, Taborda A. Impact of early-onset fetal growth restriction on the neurodevelopmental outcome of very preterm infants at 24 months: a retrospective cohort study. BMC Pediatr 2023; 23:533. [PMID: 37884935 PMCID: PMC10601105 DOI: 10.1186/s12887-023-04361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The association between fetal growth restriction (FGR) and childhood neurodevelopmental delay is unclear and the evidence available to the present date shows conflicting results. Our aim was to analyse the impact of early-onset FGR on the neurodevelopmental outcome at 24 months of corrected age in very preterm infants. METHODS Retrospective cohort study of very preterm infants (≤ 32 weeks' gestation) admitted to a neonatal intensive care unit between 1 January 2013-31 December 2019. The control group comprised appropriate for gestational age (AGA) newborns. Griffiths III Mental Development Scale was performed at 24 months of corrected age. RESULTS 132 infants were included: 44 FGR and 88 AGA. Mean Global Development Quotient (GDQ) was lower for FGR infants (p = 0.004) even after adjusting for maternal and perinatal factors (βadjusted -16.703; p = 0.009). The average scores for the neurodevelopmental domains were highest for personal-social-emotional skills (107.02 ± 16.34), followed by eye/hand coordination (105.61 ± 14.20) and foundation of learning skills (102.23 ± 13.74) and were lowest for gross motor (97.90 ± 11.88) and language/communication skills (96.39 ± 18.88). FGR had a significant negative impact on all domains except for gross motor skills. After adjustment, FGR continued to have a significant adverse impact on language/communication (βadjusted -21.924; p = 0.013), eye/hand coordination (βadjusted -15.446; p = 0.015) and foundation of learning skills (βadjusted -15.211; p = 0.013). CONCLUSIONS In very preterm infants, FGR was associated with a significantly increased risk of poor neurodevelopmental outcome at 24 months of corrected age compared to age-matched AGA infants.
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Affiliation(s)
- Mariana Cortez Ferreira
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Joana Mafra
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Dias
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Santos Silva
- Obstetrics Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Neonatology Department, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Della Gatta AN, Aceti A, Spinedi SF, Martini S, Corvaglia L, Sansavini A, Zuccarini M, Lenzi J, Seidenari A, Dionisi C, Pilu G, Simonazzi G. Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow. Eur J Pediatr 2023; 182:4467-4476. [PMID: 37490110 PMCID: PMC10587239 DOI: 10.1007/s00431-023-05104-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20-24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20-24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0-2 years. A regression analysis was performed to identify early predictors of preterm infants' neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain. Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors. What is Known: • Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes. • Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation). What is New: • The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment. • Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.
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Affiliation(s)
- Anna Nunzia Della Gatta
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Arianna Aceti
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy.
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy.
| | - Sofia Fiore Spinedi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Silvia Martini
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | | | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Seidenari
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Camilla Dionisi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Gianluigi Pilu
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
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Calek E, Binder J, Palmrich P, Eibensteiner F, Thajer A, Kainz T, Harreiter K, Berger A, Binder C. Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants. Nutrients 2023; 15:4158. [PMID: 37836441 PMCID: PMC10574227 DOI: 10.3390/nu15194158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Intrauterine growth restriction (IUGR) is associated with multiple morbidities including growth restriction and impaired neurodevelopment. Small for gestational age (SGA) is defined as a birth weight <10th percentile, regardless of the etiology. The term is commonly used as a proxy for IUGR, but it may represent a healthy constitutionally small infant. Differentiating between IUGR and constitutionally small infants is essential for the nutritional management. (2) Infants born at <37 weeks of gestation between 2017 and 2022, who underwent body composition measurement (FFM: fat-free mass; FM: fat mass) at term-equivalent age, were included in this study. Infants with IUGR and constitutionally small infants (SGA) were compared to infants appropriate for gestational age (AGA). (3) A total of 300 infants (AGA: n = 249; IUGR: n = 40; SGA: n = 11) were analyzed. FFM (p < 0.001) and weight growth velocity (p = 0.022) were significantly lower in IUGR compared to AGA infants, but equal in SGA and AGA infants. FM was not significantly different between all groups. (4) The FFM Z-score was significantly lower in IUGR compared to AGA infants (p = 0.017). Being born constitutionally small compared to AGA had no impact on growth and body composition. These data showed that early aggressive nutritional management is essential in IUGR infants to avoid impaired growth and loss of FFM.
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Affiliation(s)
- Elisabeth Calek
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Julia Binder
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Pilar Palmrich
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Alexandra Thajer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Theresa Kainz
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Karin Harreiter
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
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Sayres L, Flockton AR, Ji S, Rey Diaz C, Gumina DL, Su EJ. Angiogenic Function of Human Placental Endothelial Cells in Severe Fetal Growth Restriction Is Not Rescued by Individual Extracellular Matrix Proteins. Cells 2023; 12:2339. [PMID: 37830553 PMCID: PMC10572031 DOI: 10.3390/cells12192339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Severe fetal growth restriction (FGR) is characterized by increased placental vascular resistance resulting from aberrant angiogenesis. Interactions between endothelial cells (ECs) and the extracellular matrix (ECM) are critical to the complex process of angiogenesis. We have previously found that placental stromal abnormalities contribute to impaired angiogenesis in severe FGR. The objective of this research is to better characterize the effect of individual ECM proteins on placental angiogenic properties in the setting of severe FGR. ECs were isolated from human placentae, either control or affected by severe FGR, and subjected to a series of experiments to interrogate the role of ECM proteins on adhesion, proliferation, migration, and apoptosis. We found impaired proliferation and migration of growth-restricted ECs. Although individual substrates did not substantially impact migratory capacity, collagens I, III, and IV partially mitigated proliferative defects seen in FGR ECs. Differences in adhesion and apoptosis between control and FGR ECs were not evident. Our findings demonstrate that placental angiogenic defects that characterize severe FGR cannot be explained by a singular ECM protein, but rather, the placental stroma as a whole. Further investigation of the effects of stromal composition, architecture, stiffness, growth factor sequestration, and capacity for remodeling is essential to better understand the role of ECM in impaired angiogenesis in severe FGR.
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Affiliation(s)
- Lauren Sayres
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Amanda R. Flockton
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Shuhan Ji
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Carla Rey Diaz
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Diane L. Gumina
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
| | - Emily J. Su
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, CO 80045, USA
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Wang KW, Ling ZJ, Yuan Z, Zhang J, Yi SJ, Xiong YW, Chang W, Lin ZJ, Zhu HL, Yang L, Wang H. The Long-Term Effect of Maternal Iron Levels in the Second Trimester on Mild Thinness among Preschoolers: The Modifying Effect of Small for Gestational Age. Nutrients 2023; 15:3939. [PMID: 37764723 PMCID: PMC10535896 DOI: 10.3390/nu15183939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
The supplementation of multiple micronutrients throughout pregnancy can reduce the risk of adverse birth outcomes and various diseases in children. However, the long-term effect of maternal multiple micronutrient levels in the second trimester on the overall development of preschoolers remains unknown. Therefore, 1017 singleton mother-infant pairs and 6-year-old preschoolers were recruited based on the China-Wuxi Birth Cohort Study. Meanwhile, information on the demographic characteristics of pregnant women and preschoolers, maternal copper, calcium, iron, magnesium, and zinc levels in whole blood during the second trimester, and neonatal outcomes, were collected. We aimed to investigate the long-term impact of maternal copper, calcium, iron, magnesium, and zinc levels in the second trimester on mild thinness among 6-year-old preschoolers, and the modifying effect of small for gestational age (SGA), within the Chinese population. Multiple logistic regression models revealed that high-level maternal iron in the second trimester reduced the risk of mild thinness [adjusted OR: 0.46 (95% CI: 0.26, 0.80)] among 6-year-old preschoolers. However, no significant association was found for the remaining four maternal essential metal elements. Additionally, the restricted cubic spline function showed that the risk of mild thinness decreased when maternal iron concentration exceeded 7.47 mmol/L in whole blood during the second trimester. Furthermore, subgroup analysis indicated that the long-term protective effect of high-level maternal iron on mild thinness was only observed in SGA infants. Summarily, high-level maternal iron in the second trimester distinctly lowers the risk of mild thinness among 6-year-old preschoolers, especially in preschoolers with birth outcomes of SGA. Our findings offer evidence for the implementation of iron supplementation in the second trimester as a preventive measure against mild thinness in children.
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Affiliation(s)
- Kai-Wen Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zheng-Jia Ling
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Zhi Yuan
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Jin Zhang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Song-Jia Yi
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Yong-Wei Xiong
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Wei Chang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Zhi-Jing Lin
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Hua-Long Zhu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
| | - Lan Yang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Medical Genetics and Prenatal Diagnosis, Wuxi Maternity and Child Health Care Hospital, Wuxi 214002, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China
- Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei 230032, China
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Lee B, Janzen C, Aliabadi AR, Lei MYY, Wu H, Liu D, Vangala SS, Devaskar SU, Sung K. Early pregnancy imaging predicts ischemic placental disease. Placenta 2023; 140:90-99. [PMID: 37549442 PMCID: PMC11090111 DOI: 10.1016/j.placenta.2023.07.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION To characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups. METHODS In a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery. RESULTS In early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA. DISCUSSION MRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.
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Affiliation(s)
- Brian Lee
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Carla Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Arya R Aliabadi
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Margarida Y Y Lei
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Holden Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Dapeng Liu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
| | - Sitaram S Vangala
- Department of Medicine Statistical Core, David Geffen School of Medicine, University of California, 1100 Glendon Ave Suite 1820, Los Angeles, CA, 90095, USA.
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Kyunghyun Sung
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 Medical Plaza, B119, Los Angeles, CA 90095, USA.
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Gaur P, Darwin KC, Kohn JR, Uribe KA, Shippey E, Eke AC. The relationship between COVID-19 vaccination status in pregnancy and birthweight. Am J Obstet Gynecol MFM 2023; 5:101057. [PMID: 37330010 PMCID: PMC10268810 DOI: 10.1016/j.ajogmf.2023.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Despite findings that maternal COVID-19 infection in pregnancy is associated with low birthweight (weight of ≤2500 g), previous studies demonstrate no difference in low birthweight risk between COVID-19 vaccinated and unvaccinated pregnant persons. Few studies, however, have examined the association between unvaccinated, incomplete vaccination, and complete vaccination on low birthweight, and they have been limited by small sample sizes and lack of adjustment for covariates. OBJECTIVE We sought to address key limitations of prior work and evaluate this association between unvaccinated, incomplete, and complete COVID-19 vaccination status in pregnancy and low birthweight. We predicted a protective association of vaccination on low birthweight that varies by number of doses received. STUDY DESIGN We performed a population-based retrospective study using the Vizient clinical database, which included data from 192 hospitals in the United States. Our sample included pregnant persons who delivered between January 2021 and April 2022 at hospitals that reported maternal vaccination data and birthweight at delivery. Pregnant persons were categorized into 3 groups as follows: unvaccinated; incompletely vaccinated (1 dose of Pfizer or Moderna); or completely vaccinated (1 dose of Johnson & Johnson or ≥2 doses of Moderna or Pfizer). Demographics and outcomes were analyzed using standard statistical tests. We performed multivariable logistic regression to account for potential confounders between vaccination status and low birthweight in the original cohort. Propensity score matching was used to reduce bias related to the likelihood of vaccination, and the multivariable logistic regression model was then applied to the propensity score-matched cohort. Stratification analysis was performed for gestational age and race and ethnicity. RESULTS Of the 377,995 participants, 31,155 (8.2%) had low birthweight, and these participants were more likely to be unvaccinated than those without low birthweight (98.8% vs 98.5%, P<.001). Incompletely vaccinated pregnant persons were 13% less likely to have low birthweight neonates compared to unvaccinated persons (odds ratio, 0.87; 95% confidence interval, 0.73-1.04), and completely vaccinated persons were 21% less likely to have low birthweight neonates (odds ratio, 0.79; 95% confidence interval, 0.79-0.89). After controlling for maternal age, race or ethnicity, hypertension, pregestational diabetes, lupus, tobacco use, multifetal gestation, obesity, use of assisted reproductive technology, and maternal or neonatal COVID-19 infections in the original cohort, these associations remained significant for only complete vaccination (adjusted odds ratio, 0.80; 95% confidence interval, 0.70-0.91) and not incomplete vaccination (adjusted odds ratio, 0.87; 95% confidence interval, 0.71-1.04). In the propensity score-matched cohort, pregnant persons who were completely vaccinated against COVID-19 were 22% less likely to have low birthweight neonates compared to unvaccinated and incompletely vaccinated individuals (adjusted odds ratio, 0.78; 95% confidence interval, 0.76-0.79). CONCLUSION Pregnant persons who were completely vaccinated against COVID-19 were less likely to have low birthweight neonates compared to unvaccinated and incompletely vaccinated individuals. This novel association was observed among a large population after adjusting for confounders of low birthweight and factors influencing the likelihood of receiving the COVID-19 vaccine.
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Affiliation(s)
- Priyanka Gaur
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Drs Gaur and Uribe).
| | - Kristin C Darwin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Drs Darwin, Kohn, and Eke)
| | - Jaden R Kohn
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Drs Darwin, Kohn, and Eke)
| | - Katelyn A Uribe
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Drs Gaur and Uribe)
| | | | - Ahizechukwu C Eke
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD (Drs Darwin, Kohn, and Eke); Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD (Dr Eke)
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Sériès T, Guillot M, Angoa G, Pronovost E, Ndiaye ABKT, Mohamed I, Simonyan D, Lavoie PM, Synnes A, Marc I. Does Growth Velocity Affect Associations between Birth Weight and Neurodevelopment for Infants Born Very Preterm? J Pediatr 2023; 260:113531. [PMID: 37268036 DOI: 10.1016/j.jpeds.2023.113531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To determine how neonatal growth velocity affects the association between birth weight and neurodevelopmental outcomes in infants born preterm. STUDY DESIGN This study is a secondary analysis of the Maternal Omega-3 Supplementation to Reduce Bronchopulmonary Dysplasia in Very Preterm Infants (MOBYDIck) randomized multicenter trial conducted in breastfed infants born at <29 weeks of gestation, whose mothers were supplemented with docosahexaenoic acid or placebo during the neonatal period. Neurodevelopmental outcomes were assessed at 18-22 months of corrected age using the Bayley-III cognitive and language composite scores. The role of neonatal growth velocity was assessed with causal mediation and linear regression models. Subgroup analyses were stratified by birth weight z-score categories (<25th, ≥25th-≤75th, and >75th percentiles). RESULTS Neurodevelopmental outcomes were available for 379 children (mean gestational age, 26.7 ± 1.5 weeks). Growth velocity partially mediated the relationships between birth weight and cognitive (β = -1.1; 95% CI, -2.2 to -0.02; P = .05) and language scores (β = -2.1; 95% CI, -3.3 to -0.8; P = .002). An increase by 1 g/kg/day in growth velocity was associated with an increase by 1.1 point in the cognitive score (95% CI, -0.03 to 2.1; P = .06) and 1.9 point in the language score (95% CI, 0.7 to 3.1; P = .001), after adjustment for birth weight z-score. For children with birth weight <25th percentile, a 1 g/kg/day increase in growth velocity was associated with an increase by 3.3 points in the cognitive score (95% CI, 0.5 to 6.0; P = .02) and 4.1 points in the language score (95% CI, 1.3 to 7.0; P = .004). CONCLUSIONS Postnatal growth velocity mediated the relationship between birth weight and neurodevelopmental performance, with larger effects for children with lower birth weight. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02371460.
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Affiliation(s)
- Thibaut Sériès
- School of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Mireille Guillot
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Georgina Angoa
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Etienne Pronovost
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | | | - Ibrahim Mohamed
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Canada
| | - David Simonyan
- Clinical and Evaluative Research platform, Centre de recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada
| | - Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Anne Synnes
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Isabelle Marc
- Department of Pediatrics, Faculty of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Canada.
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Chen WY, Sun SF. Clinical efficacy of low-dose aspirin combined with calcium in preventing preeclampsia: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34620. [PMID: 37653760 PMCID: PMC10470755 DOI: 10.1097/md.0000000000034620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to evaluate the clinical effectiveness of low-dose aspirin combined with calcium supplements for the prevention of preeclampsia. METHODS China National Knowledge Infrastructure, VIP, Wanfang, PubMed, EMBASE, and Cochrane Library databases were searched from inception until December 2022. Randomized controlled trials investigating the preventive use of aspirin in combination with calcium supplementation for preeclampsia in high-risk pregnant women were included. The quality of the literature was evaluated, and a meta-analysis was conducted using RevMan 5.3 software to analyze the clinical efficacy of low-dose aspirin combined with calcium supplementation in preventing preeclampsia. RESULTS Seven randomized controlled trials were included in this meta-analysis, and compared with the control group, the experimental group had lower incidence rates of preeclampsia with gestational hypertension (odds ratios [OR]: 0.17, 95% confidence interval [CI]: 0.11-0.28), preeclampsia (OR: 0.20, 95% CI: 0.10-0.37), gestational hypertension (OR: 0.15, 95% CI: 0.07-0.31), preterm birth (OR: 0.26, 95% CI: 0.16-0.44), postpartum hemorrhage (OR: 0.15, 95% CI: 0.08-0.27), and fetal growth restriction (OR: 0.16, 95% CI: 0.08-0.33). CONCLUSION Compared with aspirin alone, low-dose aspirin combined with calcium supplementation was more effective in preventing preeclampsia, reduced the risk of preterm birth and postpartum hemorrhage, and promoted fetal growth. This intervention has clinical value and should be considered for high-risk pregnant women.
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Affiliation(s)
- Wen-Yue Chen
- Department of Obstetrical, Hangzhou Fuyang District First People’s Hospital, Hangzhou, Zhejiang, China
| | - Su-Fang Sun
- Department of Obstetrical, Hangzhou Fuyang District First People’s Hospital, Hangzhou, Zhejiang, China
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Eves R, Wolke D, Spiegler J, Lemola S. Association of Birth Weight Centiles and Gestational Age With Cognitive Performance at Age 5 Years. JAMA Netw Open 2023; 6:e2331815. [PMID: 37651137 PMCID: PMC10472194 DOI: 10.1001/jamanetworkopen.2023.31815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
Importance Birth weight percentiles (BWPs) are often dichotomized at the 10th percentile and show statistically significant association with later cognitive performance, for both preterm and term-born children. However, research testing nonlinear associations between BWPs and cognitive performance is scarce. Objective To investigate culturally invariant, nonlinear associations of BWPs and gestational age with later cognitive performance. Design, Setting, and Participants In this cohort study, participants with valid neonatal and cognitive data were combined from 4 observational cohorts, including the Millennium Cohort Study, the National Longitudinal Survey of Youth 1979 Child and Young Adult cohort, Growing Up in Ireland, and the Longitudinal Study of Australian Children, with children born between 2000 and 2002, 1980 and 2010, 2007 and 2008, and 2003 and 2004, respectively. Neonatal data were parent reported before age 1 year. At approximately 5 years of age, multiple cognitive tests were performed. Follow-up at 5 years of age was the predominant focus. Data were analyzed July 17, 2023. Exposure The parent-reported neonatal data were used to calculate BWPs according to the Fenton growth chart. Main Outcome and Measure Scores for IQ were created from multiple measures of cognition, which were z standardized separately within each cohort. Results Of 30 643 participants (50.8% male), 7.5% were born preterm (before 37 weeks gestation) and 92.5% were term born (between 37 and 42 weeks gestation). In the pooled data using multivariate adaptive regression splines, IQ linearly increased by 4.2 points as BWPs increased from the first to the 69th percentile before completely plateauing. For gestational age, IQ linearly increased by 1.3 points per week up until 32 weeks, with the association reducing to 0.3 points per week after 32 weeks. The association of BWP with IQ was not moderated by gestational age. For term-born infants, the estimated IQ score was only clinically meaningfully lower than average when birth weight was below the third percentile. Consistent results were found when instead using multivariable regression where gestational age and BWPs were categorized into groups. Conclusions and Relevance In this cohort study, lower BWPs and gestational age were independently associated with lower IQ. For term-born infants, a cutoff of the third percentile would be more appropriate than the traditionally used 10th percentile when the aim is estimating meaningful cognitive differences.
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Affiliation(s)
- Robert Eves
- Fakultät für Psychologie und Sportwissenschaft, Universität Bielefeld, Bielefeld, Germany
- Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Warwick, England, United Kingdom
| | - Dieter Wolke
- Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Warwick, England, United Kingdom
| | - Juliane Spiegler
- Kinderklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Sakari Lemola
- Fakultät für Psychologie und Sportwissenschaft, Universität Bielefeld, Bielefeld, Germany
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Molad M, Gover A, Marai Z, Lavie-Nevo K, Kessel I, Shemer-Meiri L, Soloveichik M. Neurodevelopmental Outcome of Very Low Birth Weight Infants in the Northern District of Israel: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1320. [PMID: 37628319 PMCID: PMC10453082 DOI: 10.3390/children10081320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Currently, no local database in Israel collects neurodevelopmental outcomes of very low birth weight (VLBW) preterm infants. We investigated neurodevelopmental outcomes in one district of the largest healthcare organization in Israel. METHODS A cross-sectional study including all VLBW (<1500 g) preterm infants born between 1 January 2006 and 31 December 2016 who were followed in any of seven child development centers in Israel's Northern District. Data were retrospectively collected from the computerized medical record database. RESULTS Out of 436 participants, 55.1% had normal developmental outcomes. A total of 8.9% had cerebral palsy (CP), 12.2% had a global developmental delay (GDD), and 33.4% had a language delay. Out of the extremely preterm infants (n = 109), 20.2% had CP, 22.0% had GDD, and 44.9% had language delay. We found a statistically significant higher rate of abnormal neurodevelopment outcomes in non-Jews compared to Jews (57% vs. 37.8%, respectively, p < 0.0001). CONCLUSIONS We found a relatively high overall rate of CP in our local population and a significant difference in neurodevelopmental outcomes between Jews and non-Jews. This study emphasizes the need for an expanded and detailed national database collecting post-discharge outcomes, as well as an assessment of national healthcare resource allocation and inequalities in preterm infants' post-discharge care.
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Affiliation(s)
- Michal Molad
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Ayala Gover
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa 31048, Israel
| | - Zaki Marai
- Pediatrics Department, Carmel Medical Center, Haifa, 3436212, Israel;
| | - Karen Lavie-Nevo
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Irina Kessel
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
| | - Lilach Shemer-Meiri
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
- Pediatrics Department, Carmel Medical Center, Haifa, 3436212, Israel;
| | - Marina Soloveichik
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3436212, Israel; (M.M.); (K.L.-N.); (I.K.); (M.S.)
- Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa 3525433, Israel;
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Bomback M, Everett S, Lyford A, Sahni R, Kim F, Baptiste C, Motelow JE, Tolia V, Clark R, Hays T. The Contribution of Commonly Diagnosed Genetic Disorders to Small for Gestational Age Birth and Subsequent Morbidity and Mortality in Preterm Infants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.14.23292682. [PMID: 37503041 PMCID: PMC10371189 DOI: 10.1101/2023.07.14.23292682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective Preterm infants born small, vs. appropriate for gestational age (SGA, AGA) are at greater risk for morbidity and mortality. The contribution of genetic disorders to preterm SGA birth, morbidity, and mortality is unknown. We sought to determine the association between genetic disorders and preterm SGA birth, and the association between genetic disorders and morbidity or mortality within preterm SGA infants. We hypothesized that genetic disorders were significantly associated with both. Study Design This was a retrospective multicenter cohort study of 409 339 infants, born 23-33 weeks' gestation between 2000 and 2020. The odds of preterm SGA (vs AGA) birth, and the odds of severe morbidity or mortality within SGA preterm infants were determined for infants with genetic disorders, after adjusting for known risk factors. Results Genetic disorders were present in 3.0 and 1.3% of SGA and AGA preterm infants respectively; genetic disorders conferred an aOR (95% CI) of 2.06 (1.92, 2.21) of SGA birth. Genetic disorders were present in 4.3 of preterm SGA infants with morbidity or mortality and 2.1% of preterm SGA infants that did not experience morbidity or mortality. Genetic disorders conferred an aOR (95% CI) of 2.12 (2.66, 3.08) of morbidity or mortality. Conclusions Genetic disorders are strongly associated with preterm SGA birth, morbidity, and mortality. Clinicians should consider genetic testing of preterm SGA infants, particularly in the setting of other comorbidities or anomalies. Prospective, genomic research is needed to clarify the contribution of genetic disorders to disease in this population.
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Lin CY, Chang HY, Chang JH, Hsu CH, Jim WT, Peng CC, Chen CH. The impact of small-for-gestational-age Status on the outcomes in very-Low-birth-weight (VLBW) premature infants: a prospective cohort study in Taiwan. Front Pediatr 2023; 11:1209765. [PMID: 37520047 PMCID: PMC10376714 DOI: 10.3389/fped.2023.1209765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Background The impact of small-for-gestational-age (SGA) on very-low-birth-weight (VLBW) premature infants remains inconclusive. This study aimed to assess the effects of being born SGA status on the short-term and long-term outcomes in VLBW preterm infants. Methods We conducted a population-based, prospective cohort study on VLBW preterm infants born in Taiwan between 2012 and 2017. Sociodemographic, neonatal, growth and neurological data at 2 years of corrected age were collected. A total of 4243 VLBW infants born at 24 through 32 completed weeks' gestation participated in this study, of whom 1,005 had SGA status defined as a birth weight <10th percentile of gestation, and 3,238 did not (the non-SGA group).We compared the risks of short-term outcomes (neonatal mortality and morbidities), long-term outcomes (growth status, including weight, height, and head circumference <10th percentile, and neurodevelopmental impairments at 2 years of age). Subgroup analysis was performed by stratification of gestation age (GA): GA 24-26, 27-29 and 30-32 weeks. Results In the analysis of short-term outcomes, the SGA group had an increased risk of neonatal mortality [adjusted odds ratio (OR) = 2.66, 2.99, and 2.19, respectively] in all GA subgroups in comparison with the non-SGA group (p < 0.05). The SGA group had a significantly increased risk of bronchopulmonary dysplasia in GA 27-29 and 30-32 weeks (adjusted OR = 2.11 and 1.86, respectively). We also found that there was an increased risk of severe retinopathy of prematurity in GA 24-26 and 27-29 weeks in the SGA group compared with the non-SGA group (adjusted OR = 1.68 and 1.59, respectively).In the analysis of long-term outcomes, the SGA group had a significantly increased risk of NDI throughout all GA subgroups (adjusted = 1.94, 1.33, and 1.35, respectively) in comparison with the non-SGA group. The SGA groups also had an increased risk of growth status <10th percentile at 2 years of age (p < 0.05). Conclusions SGA VLBW premature infants had higher risks of neonatal death, growth status <10th percentile, and NDI at 2 years of corrected age compared with the non- SGA premature infants. Prenatal surveillance, postnatal attention, and long- term follow-up are warranted to improve the outcomes of VLBW SGA premature infants.
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Affiliation(s)
- Chia-Ying Lin
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chia-Huei Chen
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Christians JK, Ahmadzadeh-Seddeighi S, Bilal A, Bogdanovic A, Ho R, Leung EV, MacGregor MA, Nadasdy NM, Principe GM. Sex differences in the effects of prematurity and/or low birthweight on neurodevelopmental outcomes: systematic review and meta-analyses. Biol Sex Differ 2023; 14:47. [PMID: 37434174 DOI: 10.1186/s13293-023-00532-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Premature birth and/or low birthweight have long-lasting effects on cognition. The purpose of the present systematic review is to examine whether the effects of prematurity and/or low birth weight on neurodevelopmental outcomes differ between males and females. METHODS Web of Science, Scopus, and Ovid MEDLINE were searched for studies of humans born premature and/or of low birthweight, where neurodevelopmental phenotypes were measured at 1 year of age or older. Studies must have reported outcomes in such a way that it was possible to assess whether effects were greater in one sex than the other. Risk of bias was assessed using both the Newcastle-Ottawa scale and the National Institutes of Health Quality assessment tool for observational cohort and cross-sectional studies. RESULTS Seventy-five studies were included for descriptive synthesis, although only 24 presented data in a way that could be extracted for meta-analyses. Meta-analyses found that severe and moderate prematurity/low birthweight impaired cognitive function, and severe prematurity/low birthweight also increased internalizing problem scores. Moderate, but not severe, prematurity/low birthweight significantly increased externalizing problem scores. In no case did effects of prematurity/low birthweight differ between males and females. Heterogeneity among studies was generally high and significant, although age at assessment was not a significant moderator of effect. Descriptive synthesis did not identify an obvious excess or deficiency of male-biased or female-biased effects for any trait category. Individual study quality was generally good, and we found no evidence of publication bias. CONCLUSIONS We found no evidence that the sexes differ in their susceptibility to the effects of severe or moderate prematurity/low birthweight on cognitive function, internalizing traits or externalizing traits. Result heterogeneity tended to be high, but this reflects that one sex is not consistently more affected than the other. Frequently stated generalizations that one sex is more susceptible to prenatal adversity should be re-evaluated.
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Affiliation(s)
- Julian K Christians
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Centre for Cell Biology, Development and Disease, Simon Fraser University, Burnaby, BC, Canada.
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | | | - Alishba Bilal
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Anastasia Bogdanovic
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Rebecca Ho
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Estee V Leung
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Megan A MacGregor
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Nolan M Nadasdy
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
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Argaw A, Toe LC, Hanley-Cook G, Dailey-Chwalibóg T, de Kok B, Ouédraogo L, Compaoré A, Ouédraogo M, Sawadogo A, Ganaba R, Vanslambrouck K, Kolsteren P, Lachat C, Huybregts L. Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition: A sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso. PLoS Med 2023; 20:e1004242. [PMID: 37486952 PMCID: PMC10406330 DOI: 10.1371/journal.pmed.1004242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/07/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Micronutrient-fortified balanced energy-protein (BEP) supplements are promising interventions to prevent intrauterine growth retardation in low- and middle-income countries. On the other hand, one concern with blanket prenatal supplementation programs using energy-dense supplements is that they could lead to more maternal and/or infant overweight. However, evidence is lacking on the potential effect of BEP on maternal and offspring body composition. This study evaluates the effects of micronutrient-fortified BEP supplementation during pregnancy on body composition of mothers and their newborns in rural Burkina Faso. METHODS AND FINDINGS The MISAME-III study is an open label individually randomized controlled trial where pregnant women (n = 1,897) of gestational age <21 weeks received either a combination of micronutrient-fortified BEP and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control). The prenatal phase of the MISAME-III study was conducted between the first enrollment in October 2019 and the last delivery in August 2021. In a sub-study nested under the MISAME-III trial, we evaluated anthropometry and body composition in newborns who were born starting from 17 November 2020 (n: control = 368 and intervention = 352) and their mothers (n: control = 185 and intervention = 186). Primary study outcomes were newborn and maternal fat-free mass (FFMI) and fat-mass (FMI) indices. We used the deuterium dilution method to determine FFMI and FMI and %FFM and %FM of total body weight within 1 month postpartum. Our main analysis followed a modified intention-to-treat approach by analyzing all subjects with body composition data available. Univariable and multivariable linear regression models were fitted to compare the intervention and control arms, with adjusted models included baseline maternal age, height, arm fat index, hemoglobin concentration and primiparity, household size, wealth and food security indices, and newborn age (days). At study enrollment, the mean ± SD maternal age was 24.8 ± 6.13 years and body mass index (BMI) was 22.1 ± 3.02 kg/m2 with 7.05% of the mothers were underweight and 11.5% were overweight. Prenatal micronutrient-fortified BEP supplementation resulted in a significantly higher FFMI in mothers (MD (mean difference): 0.45; 95% CI (confidence interval): 0.05, 0.84; P = 0.026) and newborns (MD: 0.28; 95% CI: 0.06, 0.50; P = 0.012), whereas no statistically significant effects were found on FMI. The effect of micronutrient-fortified BEP on maternal FFMI was greater among mothers from food secure households and among those with a better nutritional status (BMI ≥21.0 kg/m2 or mid-upper arm circumference (MUAC) ≥23 cm). Key limitations of the study are the relatively high degree of missing data (approximately 18%), the lack of baseline maternal body composition values, and the lack of follow-up body composition measurements to evaluate any long-term effects. CONCLUSIONS Micronutrient-fortified BEP supplementation during pregnancy can increase maternal and newborn FFMI, without significant effects on FMI. TRIAL REGISTRATION ClinicalTrials.gov with identifier NCT03533712.
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Affiliation(s)
- Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia Celine Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | | | | | | | | | - Katrien Vanslambrouck
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
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Pan D, Lin M, Mu C, Yu C, Ye B, Liang J, Sheng Y, Huang D, Liu S, Zeng X, Jennifer Tan HJ, Chongsuvivatwong V, Qiu X. Maternal exposure to neonicotinoid insecticides and fetal growth restriction: A nested case-control study in the guangxi Zhuang birth cohort. CHEMOSPHERE 2023:139217. [PMID: 37336441 DOI: 10.1016/j.chemosphere.2023.139217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Fetal growth restriction (FGR) is a major determinant of perinatal morbidity and mortality, with adverse long-term neurocognitive effects in childhood and adulthood. Prenatal exposure to environmental pollutants has been reported to be associated with FGR. Neonicotinoids (NEOs) are extensively used insecticides worldwide and are suggested to have embryonic and developmental neurotoxicity. However, the effects of NEOs exposure on FGR is unknown. OBJECTIVES We aimed to quantify the single and combined associations of maternal exposure to NEOs and FGR. METHODS We conducted a nested case-control study based on the Guangxi Zhuang Birth Cohort, China. A total of 387 with FGR cases and 1096 without- FGR controls were included between 2015 and 2018. Ten NEOs were measured by UPLC-MS from the maternal blood samples were pre-collected in the first trimester. After adjusting for potential confounders, multivariable logistic regressions, weighted quantile sum regression and quantile g-computation were performed for individual and NEOs mixtures. RESULTS In the individual exposure models, each 1-standard deviation increment of the natural-log in dinotefuran and acetamiprid concentrations were significantly associated with odds ratios of 1.93 (95% CI: 1.69, 2.20) and 1.31 (95% CI: 1.07, 1.59) higher odds of FGR, respectively. However, the FGR risk was negatively associated with thiacloprid, sulfoxaflor, and nitenpyram (OR = 0.23, 95%CI: 0.15, 0.34; OR = 0.48, 95%CI: 0.41, 0.56; OR = 0.86, 95%CI: 0.80, 0.93; respectively). Similar findings were found in the combined exposure analysis. Dinotefuran was the most strongly attributable to increase FGR, while sulfoxaflor and thiacloprid contributed the highest negative weighted on FGR. Furthermore, each quintile increase in all ten NEOs exposures was associated with FGR (OR = 0.21, 95% CI: 0.08, 0.54). CONCLUSION Our findings suggest that maternal single and combined exposures to NEOs were associated with varying FGR risks. They contribute to the mounting evidence on serum NEOs exposure impact on FGR. However, a replication of these associations in other populations is warranted.
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Affiliation(s)
- Dongxiang Pan
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Mengrui Lin
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Changhui Mu
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chuanxiang Yu
- Wuxi Center for Disease Control and Prevention, Jiangsu, China
| | - Bowen Ye
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jun Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Yonghong Sheng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Dongping Huang
- Department of Sanitary Chemistry, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Shun Liu
- Department of Child and Adolescent Health & Maternal and Child Health, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Xiaoyun Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Hui Juan Jennifer Tan
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Virasakdi Chongsuvivatwong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand.
| | - Xiaoqiang Qiu
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Chandran S, Jaya-Bodestyne SL, Rajadurai VS, Saffari SE, Chua MC, Yap F. Watchful waiting versus pharmacological management of small-for-gestational-age infants with hyperinsulinemic hypoglycemia. Front Endocrinol (Lausanne) 2023; 14:1163591. [PMID: 37435482 PMCID: PMC10332304 DOI: 10.3389/fendo.2023.1163591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Given that reports on severe diazoxide (DZX) toxicity are increasing, we aimed to understand if the short-term clinical outcomes of small-for-gestational-age (SGA) infants with hyperinsulinemic hypoglycemia (HH) managed primarily by supportive care, termed watchful waiting (WW), are different from those treated with DZX. Method A real-life observational cohort study was conducted from 1 September 2014 to 30 September 2020. The WW or DZX management decision was based on clinical and biochemical criteria. We compared central line duration (CLD), postnatal length of stay (LOS), and total intervention days (TIDs) among SGA-HH infants treated with DZX versus those on a WW approach. Fasting studies determined the resolution of HH. Result Among 71,836 live births, 11,493 were SGA, and 51 SGA infants had HH. There were 26 and 25 SGA-HH infants in the DZX and WW groups, respectively. Clinical and biochemical parameters were similar between groups. The median day of DZX initiation was day 10 of life (range 4-32), at a median dose of 4 mg/kg/day (range 3-10). All infants underwent fasting studies. Median CLD [DZX, 15 days (6-27) vs. WW, 14 days (5-31), P = 0.582] and postnatal LOS [DZX, 23 days (11-49) vs. WW, 22 days (8-61), P = 0.915] were comparable. Median TID was >3-fold longer in the DZX than the WW group [62.5 days (9-198) vs. 16 days (6-27), P < 0.001]. Conclusion CLD and LOS are comparable between WW and DZX groups. Since fasting studies determine the resolution of HH, physicians should be aware that clinical intervention of DZX-treated SGA-HH patients extends beyond the initial LOS.
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Affiliation(s)
- Suresh Chandran
- Department of Neonatology, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
- Pediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Pediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Pediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Victor Samuel Rajadurai
- Department of Neonatology, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
- Pediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Pediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Pediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Center for Quantitative Medicine, Office of Clinical Science, Duke-NUS Medical School, Singapore, Singapore
| | - Mei Chien Chua
- Department of Neonatology, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
- Pediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Pediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Pediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Fabian Yap
- Pediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Pediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- Pediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore, Singapore
- Department of Pediatric Endocrinology, Kandang Kerbau (KK) Women’s and Children’s Hospital, Singapore, Singapore
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Li X, Jing MA, Cheng Y, Feng L, Wang S, Dong G. The relationship between extreme ambient temperature and small for gestational age: A cohort study of 1,436,480 singleton term births in China. ENVIRONMENTAL RESEARCH 2023:116412. [PMID: 37315757 DOI: 10.1016/j.envres.2023.116412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 06/16/2023]
Abstract
Studies have shown that exposure to extreme ambient temperature can contribute to adverse pregnancy outcomes, however, results across studies have been inconsistent. We aimed to evaluate the relationships between trimester-specific extreme temperature exposures and fetal growth restriction indicated by small for gestational age (SGA) in term pregnancies, and to assess whether and to what extent this relationship varies between different geographic regions. We linked 1,436,480 singleton term newborns (2014-2016) in Hubei Province, China, with a sub-district-level temperature exposures estimated by a generalized additive spatio-temporal model. Mixed-effects logistic regression models were employed to estimate the effects of extreme cold (temperature ≤5th percentile) and heat exposures (temperature >95th percentile) on term SGA in three different geographic regions, while adjusting for the effects of maternal age, infant sex, the frequency of health checks, parity, educational level, season of birth, area-level income, and PM2.5 exposure. We also stratified our analyses by infant sex, maternal age, urban‒rural type, income categories and PM2.5 exposure for robustness analyses. We found that both cold (OR:1.32, 95% CI: 1.25-1.39) and heat (OR:1.17, 95% CI: 1.13-1.22) exposures during the third trimester significantly increased the risk of SGA in the East region. Only extreme heat exposure (OR:1.29, 95% CI: 1.21-1.37) during the third trimester was significantly related to SGA in the Middle region. Our findings suggest that extreme ambient temperature exposure during pregnancy can lead to fetal growth restriction. Governments and public health institutions should pay more attention to environmental stresses during gestation, especially in the late stage of the pregnancy.
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Affiliation(s)
- Xiang Li
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China.
| | - M A Jing
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China.
| | - Yang Cheng
- Beijing Key Laboratory for Remote Sensing of Environment and Digital Cities, Faculty of Geographical Science, Beijing Normal University, 19 Xinjiekouwai Street, Beijing. 100875, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Road, Wuhan, 430030, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Road, Wuhan, 430030, China
| | - Guanpeng Dong
- Key Research Institute of Yellow River Civilization and Sustainable Development, Henan University, 85, Minglun Street, Kaifeng, 475001, China; Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions, Henan University, 85, Minglun Street, Kaifeng, 475001, China.
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Yang L, Feng L, Huang L, Li X, Qiu W, Yang K, Qiu J, Li H. Maternal Factors for Intrauterine Growth Retardation: Systematic Review and Meta-Analysis of Observational Studies. Reprod Sci 2023; 30:1737-1745. [PMID: 36662420 DOI: 10.1007/s43032-021-00756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/25/2021] [Indexed: 01/21/2023]
Abstract
Intrauterine growth retardation (IUGR) is a major complication of pregnancy and is the second leading cause of perinatal morbidity and mortality. The etiology of IUGR is multifactorial and the maternal factors are easily identifiable and modifiable. The present study aimed to perform a meta-analysis to identify the association between various maternal factors and IUGR. Eight electronic databases (PubMed, Cochrane, Embase, CIHNAL Plus, CNKI, VIP database, CBM, and WanFang database) were searched from their inception until July 2020. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. The Newcastle-Ottawa Quality Assessment Form and the Joanna Briggs Institute critical appraisal tool were used to evaluate the quality of included studies. The outcomes of study were calculated by OR with 95%CI. The study protocol was registered with PROSPERO (No. CRD42020210615). A total of 15 studies were included, with a sample size range from 152 to 9372. The quality of included studies ranged from moderate to high. The pooled results identified seven factors: smoking (OR = 1.62, 95%CI 1.38-1.90), primiparity (OR = 1.64, 95%CI 1.20-2.24), and prepregnancy.BMI < 18.5 (OR = 1.98, 95%CI 1.29-3.03), anemia (OR = 2.01, 95%CI 1.44-2.82), hypoproteinemia (OR = 2.91, 95%CI 1.94-4.36), pregnancy-induced hypertension (OR = 3.45, 95%CI 1.80-6.58), and maternal gestational weight gain (OR = 2.51, 95%CI 1.88-3.35). The present study identified several maternal factors for IUGR: smoking, primiparity, prepregnancy BMI < 18.5, poor gestational weight gain, PIH, anemia, and hypoproteinemia. The result could serve to generate risk factors prediction models, improve the management and education for child-bearing or early pregnant women.
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Affiliation(s)
- Liu Yang
- School of Nursing, Lanzhou University, Lanzhou, 730011, Gansu, China
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China
| | - Lufang Feng
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, Gansu, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Lijuan Huang
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Xuejiao Li
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China
| | - Wenwen Qiu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China.
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, Gansu, China.
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, Gansu, China.
| | - Jie Qiu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China.
| | - Haihong Li
- School of Nursing, Lanzhou University, Lanzhou, 730011, Gansu, China.
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, 730050, Gansu, China.
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Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. Small vulnerable newborns-big potential for impact. Lancet 2023; 401:1692-1706. [PMID: 37167991 DOI: 10.1016/s0140-6736(23)00354-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/13/2023]
Abstract
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
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Affiliation(s)
- Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | - Rajiv Bahl
- Indian Council for Medical Research, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nita Dalmiya
- United Nations Children's Fund, New York, NY, USA
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy Shiffman
- Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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76
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Musco H, Beecher K, Chand KK, Colditz PB, Wixey JA. Blood Biomarkers in the Fetally Growth Restricted and Small for Gestational Age Neonate: Associations with Brain Injury. Dev Neurosci 2023; 46:84-97. [PMID: 37231871 DOI: 10.1159/000530492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
Fetal growth restriction (FGR) and small for gestational age (SGA) infants have increased risk of mortality and morbidity. Although both FGR and SGA infants have low birthweights for gestational age, a diagnosis of FGR also requires assessments of umbilical artery Doppler, physiological determinants, neonatal features of malnutrition, and in utero growth retardation. Both FGR and SGA are associated with adverse neurodevelopmental outcomes ranging from learning and behavioral difficulties to cerebral palsy. Up to 50% of FGR, newborns are not diagnosed until around the time of birth, yet this diagnosis lacks further indication of the risk of brain injury or adverse neurodevelopmental outcomes. Blood biomarkers may be a promising tool. Defining blood biomarkers indicating an infant's risk of brain injury would provide the opportunity for early detection and therefore earlier support. The aim of this review was to summarize the current literature to assist in guiding the future direction for the early detection of adverse brain outcomes in FGR and SGA neonates. The studies investigated potential diagnostic blood biomarkers from cord and neonatal blood or serum from FGR and SGA human neonates. Results were often conflicting with heterogeneity common in the biomarkers examined, timepoints, gestational age, and definitions of FGR and SGA used. Due to these variations, it was difficult to draw strong conclusions from the results. The search for blood biomarkers of brain injury in FGR and SGA neonates should continue as early detection and intervention is critical to improve outcomes for these neonates.
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Affiliation(s)
- Hannah Musco
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Kate Beecher
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Kirat K Chand
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Paul B Colditz
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Julie A Wixey
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Suárez-Idueta L, Yargawa J, Blencowe H, Bradley E, Okwaraji YB, Pingray V, Gibbons L, Gordon A, Warrilow K, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Mardones F, Caulier-Cisterna R, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Gissler M, Heidarzadeh M, Moradi-Lakeh M, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, Broeders L, van Dijk AE, Huicho L, Quezada-Pinedo HG, Cajachagua-Torres KN, Alyafei F, AlQubaisi M, Cho GJ, Kim HY, Razaz N, Söderling J, Smith LK, Kurinczuk J, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Ohuma EO, Lawn JE. Vulnerable newborn types: Analysis of population-based registries for 165 million births in 23 countries, 2000-2021. BJOG 2023. [PMID: 37156241 DOI: 10.1111/1471-0528.17505] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/04/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. DESIGN Population-based, multi-country analysis. SETTING National data systems in 23 middle- and high-income countries. POPULATION Liveborn infants. METHODS Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types. MAIN OUTCOME MEASURES Prevalence of six newborn types. RESULTS We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. CONCLUSIONS The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries.
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Affiliation(s)
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Pingray
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Gibbons
- Department of Mother & Child Health, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kara Warrilow
- Centre for Research Excellence in Stillbirth, MRI-UQ, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Enny S Paixao
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ila Rocha Falcão
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Petr Velebil
- Department of Obstetrics and Gynaecology, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jitka Jírová
- Department of Data Analysis, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | | | | | - Luule Sakkeus
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Lili Abuladze
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Maziar Moradi-Lakeh
- Department of Community Medicine, Preventive Medicine and Public Health Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Khalid A Yunis
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayah Al Bizri
- Department of Paediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Shamala D Karalasingam
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
| | - Ravichandran Jeganathan
- Department of Obstetrics & Gynaecology, Hospital Sultanah Aminah, Ministry of Health, Johor Bahru, Malaysia
| | - Arturo Barranco
- Directorate of Health Information, Ministry of Health, Mexico City, Mexico
| | | | | | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hugo Guillermo Quezada-Pinedo
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kim Nail Cajachagua-Torres
- The Generation R Study Group, Department of Paediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Geum Joon Cho
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynaecology, Korea University College of Medicine, Seoul, South Korea
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lucy K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jennifer Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Estelle Lowry
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Neil Rowland
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kirsten Monteath
- Department of Maternity and Sexual Health Team, Public Health Scotland, Edinburgh, UK
| | - Isabel Pereyra
- Catholic University of the Maule, Región del Maule, Chile
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Gabriella Pravia
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Damhuis SE, Kamphof HD, Ravelli ACJ, Gordijn SJ, Ganzevoort WJ. Perinatal mortality rate and adverse perinatal outcomes presumably attributable to placental dysfunction in (near) term gestation: A nationwide 5-year cohort study. PLoS One 2023; 18:e0285096. [PMID: 37141189 PMCID: PMC10159202 DOI: 10.1371/journal.pone.0285096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Placental dysfunction can lead to perinatal hypoxic events including stillbirth. Unless there is overt severe fetal growth restriction, placental dysfunction is frequently not identified in (near) term pregnancy, particularly because fetal size is not necessarily small. This study aimed to evaluate, among (near) term births, the burden of hypoxia-related adverse perinatal outcomes reflected in an association with birth weight centiles as a proxy for placental function. MATERIAL AND METHOD A nationwide 5-year cohort of the Dutch national birth registry (PeriNed) including 684,938 singleton pregnancies between 36+0 and 41+6 weeks of gestation. Diabetes, congenital anomalies, chromosomal abnormalities and non-cephalic presentations at delivery were excluded. The main outcome was antenatal mortality rate according to birthweight centiles and gestational age. Secondary outcomes included perinatal hypoxia-related outcomes, including perinatal death and neonatal morbidity, analyzed according to birthweight centiles. RESULTS Between 2015 and 2019, 1,074 perinatal deaths (0.16%) occurred in the study population (n = 684,938), of which 727 (0.10%) antenatally. Of all antenatal- and perinatal deaths, 29.4% and 27.9% occurred in birthweights below the 10th centile. The incidence of perinatal hypoxia-related outcomes was highest in fetuses with lowest birthweight centiles (18.0%), falling gradually up to the 50th and 90th centile where the lowest rates of hypoxia-related outcomes (5.4%) were observed. CONCLUSION Perinatal hypoxia-related events have the highest incidence in the lowest birthweight centiles but are identifiable throughout the entire spectrum. In fact, the majority of the adverse outcome burden in absolute numbers occurs in the group with a birthweight above the 10th centile. We hypothesize that in most cases these events are attributable to reduced placental function. Additional diagnostic modalities that indicate placental dysfunction at (near) term gestation throughout all birth weight centiles are eagerly wanted.
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Affiliation(s)
- Stefanie Elisabeth Damhuis
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Hester Dorien Kamphof
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anita C. J. Ravelli
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sanne Jehanne Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wessel J. Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Wang Z, Zhang Y, Shang X, Miao R, Yin M, Yang H, Yu Y, Wei D. The likelihood of a healthy live birth after frozen embryo transfer with endometrium prepared by natural ovulation regimen vs programmed regimen: a propensity-score matching study. AJOG GLOBAL REPORTS 2023; 3:100210. [PMID: 37275439 PMCID: PMC10236214 DOI: 10.1016/j.xagr.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND The number of frozen embryo transfer cycles is increasing, but the optimal method of endometrial preparation for frozen embryo transfer remains controversial. Few studies have investigated the healthy live birth outcome after the natural ovulation regimen vs the programmed regimen. OBJECTIVE This study aimed to explore whether the likelihood of a healthy live birth after frozen embryo transfer differs between the natural ovulation regimen and the programmed regimen. STUDY DESIGN We conducted a retrospective cohort study including 7824 ovulatory women who underwent the first frozen embryo transfer cycle of single-blastocyst transfer with endometrial preparation by natural ovulation regimen vs programmed regimen, between June 2017 and June 2021. Propensity score matching was used to control for confounding variables in a 1:1 ratio. The primary outcome was healthy live birth, defined as birth of a live, singleton infant born at term, with an appropriate birthweight for gestational age. RESULTS The natural ovulation regimen resulted in a higher probability of achieving healthy live birth compared with the programmed regimen (35.8% vs 30.6%; P<.0001). In addition, a higher rate of singleton live birth was observed after the natural ovulation regimen relative to the programmed regimen (49.6% vs 45.7%; P=.003). Women with the natural ovulation regimen were also less likely to experience clinical pregnancy loss (16.0% vs 19.7%; P=.005) and hypertensive disorders of pregnancy (3.9% vs 6.0%; P=.004) compared with women with the programmed regimen. Singletons born after the programmed regimen had greater mean birthweight (3441.50±539.97 vs 3394.96±503.87; P=.020) and higher risk of being large for gestational age (23.3% vs 18.7%; P=.003) than those conceived after the natural ovulation regimen. CONCLUSION The natural ovulation regimen may be superior to the programmed regimen with regard to higher likelihood of healthy live birth and lower risk of pregnancy loss and maternal hypertensive disorders of pregnancy.
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Affiliation(s)
- Ze Wang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
| | - Yingxin Zhang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China (Dr Zhang)
| | - Xue Shang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
| | - Ruolan Miao
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
| | - Mengfei Yin
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
| | - Huiming Yang
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
| | - Yunhai Yu
- Department of Obstetrics and Gynecology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (Dr Yu)
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, China (Dr Wang, Ms Shang, Dr Miao, Dr Yin, Dr Yang, and Dr Wei)
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80
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Okido MM, Cavalli RDC, Cardoso VC, Marcolin AC. Prediction of Perinatal and Neurodevelopmental Outcomes in Newborns with a Birth Weight below the 3rd Percentile: Performance of Two International Curves - Prospective Cohort from a Brazilian City. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:225-234. [PMID: 37339641 PMCID: PMC10281769 DOI: 10.1055/s-0043-1770131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVES To evaluate the performance of Intergrowth-21 st (INT) and Fetal Medicine Foundation (FMF) curves in predicting perinatal and neurodevelopmental outcomes in newborns weighing below the 3rd percentile. METHODS Pregnant women with a single fetus aged less than 20 weeks from a general population in non-hospital health units were included. Their children were evaluated at birth and in the second or third years of life. Newborns (NB) had their weight percentiles calculated for both curves. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and area under the ROC curve (ROC-AUC) for perinatal outcomes and neurodevelopmental delay were calculated using birth weight < 3rd percentile as the cutoff. RESULTS A total of 967 children were evaluated. Gestational age at birth was 39.3 (±3.6) weeks and birth weight was 3,215.0 (±588.0) g. INT and FMF classified 19 (2.4%) and 49 (5.7%) newborns below the 3rd percentile, respectively. The prevalence of preterm birth, tracheal intubation >24 hours in the first three months of life, 5th minute Apgar <7, admission to a neonatal care unit (NICU admission), cesarean section rate, and the neurodevelopmental delay was 9.3%, 3.3%, 1.3%, 5.9%, 38.9%, and 7.3% respectively. In general, the 3rd percentile of both curves showed low sensitivity and PPV and high specificity and NPV. The 3rd percentile of FMF showed superior sensitivity for preterm birth, NICU admission, and cesarean section rate. INT was more specific for all outcomes and presented a higher PPV for the neurodevelopmental delay. However, except for a slight difference in the prediction of preterm birth in favor of INT, the ROC curves showed no differences in the prediction of perinatal and neurodevelopmental outcomes. CONCLUSION Birth weight below the 3rd percentile according to INT or FMF alone was insufficient for a good diagnostic performance of perinatal and neurodevelopmental outcomes. The analyzes performed could not show that one curve is better than the other in our population. INT may have an advantage in resource contingency scenarios as it discriminates fewer NB below the 3rd percentile without increasing adverse outcomes.
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Affiliation(s)
- Marcos Masaru Okido
- Department of Obstetrics and Gynecology, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Viviane Cunha Cardoso
- Department of Puericulture and Pediatrics, University of São Paulo, Ribeirão Preto, Brazil
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81
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Mozas-Moreno J, Sánchez-Fernández M, González-Mesa E, Olmedo-Requena R, Amezcua-Prieto C, Jiménez-Moleón JJ. Perinatal and Maternal Outcomes According to the Accurate Term Antepartum Ultrasound Estimation of Extreme Fetal Weights. J Clin Med 2023; 12:jcm12082995. [PMID: 37109331 PMCID: PMC10146552 DOI: 10.3390/jcm12082995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: The accuracy of ultrasound estimation of fetal weight (EFW) at term may be useful in addressing obstetric complications since birth weight (BW) is a parameter that represents an important prognostic factor for perinatal and maternal morbidity. (2) Methods: In a retrospective cohort study of 2156 women with a singleton pregnancy, it is verified whether or not perinatal and maternal morbidity differs between extreme BWs estimated at term by ultrasound within the seven days prior to birth with Accurate EFW (difference < 10% between EFW and BW) and those with Non-Accurate EFW (difference ≥ 10% between EFW and BW). (3) Results: Significantly worse perinatal outcomes (according to different variables such as higher rate of arterial pH at birth < 7.20, higher rate of 1-min Apgar < 7, higher rate of 5-min Apgar < 7, higher grade of neonatal resuscitation and need for admission to the neonatal care unit) were found for extreme BW estimated by antepartum ultrasounds with Non-Accurate EFW compared with those with Accurate EFW. This was the case when extreme BWs were compared according to percentile distribution by sex and gestational age following the national reference growth charts (small for gestational age and large for gestational age), and when they were compared according to weight range (low birth weight and high birth weight). (4) Conclusions: Clinicians should make a greater effort when performing EFW by ultrasound at term in cases of suspected extreme fetal weights, and need to take an increasingly prudent approach to its management.
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Affiliation(s)
- Juan Mozas-Moreno
- Department of Obstetrics and Gynecology, University of Granada, 18016 Granada, Spain
- Obstetrics and Gynecology Service, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
| | | | - Ernesto González-Mesa
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Plataforma BIONAND), Research Group in Maternal-Fetal Medicine, Epigenetics, Women's Diseases and Reproductive Health, 29071 Málaga, Spain
- Obstetrics and Gynecology Service, Regional University Hospital of Malaga, 29011 Malaga, Spain
- Department of Surgical Specialties, Biochemistry and Immunology, University of Malaga, 29071 Malaga, Spain
| | - Rocío Olmedo-Requena
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Carmen Amezcua-Prieto
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - José J Jiménez-Moleón
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain
- Biohealth Research Institute (Instituto de Investigación Biosanitaria Ibs.GRANADA), 18014 Granada, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, 18016 Granada, Spain
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82
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Zhang X, Zhang F, Gao Y, Zhong Y, Zhang Y, Zhao G, Zhu S, Zhang X, Li T, Chen B, Han A, Wei J, Zhu W, Li D. Synergic effects of PM 1 and thermal inversion on the incidence of small for gestational age infants: a weekly-based assessment. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023:10.1038/s41370-023-00542-0. [PMID: 37019981 DOI: 10.1038/s41370-023-00542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The synergic effects of thermal inversion (TI) and particulate matter with an aerodynamic diameter ≤1 μm (PM1) exposure and incidence of small for gestational age (SGA) was not clear. OBJECTIVE We aimed to explore the independent effects of prenatal TI and PM1 exposure on incidence of SGA and their potential interactive effects. METHODS A total of 27,990 pregnant women who delivered in Wuhan Children's Hospital from 2017 to 2020 were included. The daily mean concentration of PM1 was obtained from ChinaHighAirPollutants (CHAP) and matched with the residential address of each woman. Data on TI was derived from National Aeronautics and Space Administration (NASA). The independent effects of PM1 and TI exposures on SGA in each gestational week were estimated by the distributed lag model (DLM) nested in Cox regression model, and the potential interactive effects of PM1 and TI on SGA were investigated by adapting the relative excess risk due to interaction (RERI) index. RESULTS Per 10 μg/m3 increase in PM1 was associated with an increase in the risk of SGA at 1-3 and 17-23 gestational weeks, with the strongest effect at the first gestational week (HR = 1.043, 95%CI: 1.008, 1.078). Significant links between one day increase of TI and SGA were found at the 1-4 and 13-23 gestational weeks and the largest effects were observed at the 17th gestational week (HR = 1.018, 95%CI: 1.009, 1.027). Synergistic effects of PM1 and TI on SGA were detected in the 20th gestational week, with RERI of 0.208 (95%CI: 0.033,0.383). IMPACT STATEMENT Both prebirth PM1 and TI exposure were significantly associated with SGA. Simultaneous exposure to PM1 and TI might have synergistic effect on SGA. The second trimester seems to be a sensitive window of environmental and air pollution exposure.
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Affiliation(s)
- Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Yan Gao
- Department of Neonatology, Lianyungang Maternal and Child Health Hospital, Lianyungang, 222006, China
| | - Yuanyuan Zhong
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Tianzhou Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Bingbing Chen
- Department of Global Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Aojing Han
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, 20740, USA.
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Dejia Li
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
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83
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Noda M, Yoshida S, Kawakami C, Takeuchi M, Kawakami K, Ito S. Association between combined spinal-epidural analgesia and neurodevelopment at 3 years old: The Japan Environment and Children's Study. J Obstet Gynaecol Res 2023. [PMID: 37005004 DOI: 10.1111/jog.15642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
AIM To investigate the association between maternal combined spinal-epidural analgesia during vaginal delivery and neurodevelopment in 3-year-old children. METHODS Using data from the Japan Environment and Children's Study, a birth cohort study on pregnant women and their offspring, we described the background, perinatal outcomes, and neurodevelopmental outcomes of participants with a singleton pregnancy who received combined spinal-epidural analgesia during vaginal delivery and those who did not. The association between maternal combined spinal-epidural analgesia and abnormalities in five domains of the Ages and Stages Questionnaire, Third Edition, was analyzed using univariable and multivariable logistic regression analyses. Crude and adjusted odds ratios with 95% confidence intervals (95% CI) were calculated. RESULTS Among 59 379 participants, 82 (0.1%) children (exposed group) were born to mothers who received combined spinal-epidural analgesia during vaginal delivery. In the exposed versus control groups, 1.2% versus 3.7% had communication abnormalities (adjusted odds ratio [95% CI]: 0.30 [0.04-2.19]), 6.1% versus 4.1% exhibited gross-motor abnormalities (1.36 [95% CI: 0.55-3.36]), 10.9% vs. 7.1% had fine-motor abnormalities (1.46 [95% CI: 0.72-2.96]), 6.1% vs. 6.9% showed difficulties with problem-solving (0.81 [95% CI: 0.33-2.01]), and 2.4% vs. 3.0% had personal-social problems (0.70 [95% CI: 0.17-2.85]). CONCLUSIONS Exposure to combined spinal-epidural analgesia during vaginal delivery was not associated with the risk of neurodevelopmental abnormalities; however, the sample size of our study might not be appropriate for the study design.
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Affiliation(s)
- Masahiro Noda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chihiro Kawakami
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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84
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Cruz-Rodríguez J, Díaz-López A, Canals-Sans J, Arija V. Maternal Vitamin B12 Status during Pregnancy and Early Infant Neurodevelopment: The ECLIPSES Study. Nutrients 2023; 15:nu15061529. [PMID: 36986259 PMCID: PMC10051123 DOI: 10.3390/nu15061529] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
In this prospective cohort study of 434 mother-infant pairs from the ECLIPSES study, we examine the association between maternal vitamin B12 status at the beginning and end of pregnancy and the neurodevelopmental outcomes of infants 40 days after birth in a pregnant population from a Mediterranean region of northern Spain. Maternal vitamin B12 concentrations were determined in the first and third trimesters, and sociodemographic, nutritional, and psychological data were collected. At 40 days postpartum, the Bayley Scales of Infant Development-III (BSID-III, cognitive, language, and motor skills) were administered to the infants and several obstetrical data were recorded. In the multivariable models, medium maternal first-trimester vitamin B12 levels (312 to 408 pg/mL, tertile 2) were associated with better neonatal performance in the motor, gross motor, language, and cognitive skills with respect to tertile 1 (<312 pg/mL). The probability of obtaining a neonatal motor, gross motor, and receptive language score >75th percentile was significantly higher also in the tertile 2 group. In summary, good maternal vitamin B12 status in the early stage of pregnancy appears to be associated with better infant motor, language, and cognitive performance at 40 days postpartum.
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Affiliation(s)
- Josué Cruz-Rodríguez
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili (URV), 43201 Tarragona, Spain
| | - Andrés Díaz-López
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili (URV), 43201 Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
| | - Josefa Canals-Sans
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili (URV), 43201 Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Centre de Recerca en Avaluació i Mesura de la Conducta (CRAMC), Department of Psychology, Universitat Rovira i Virgili, 43007 Tarragona, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili (URV), 43201 Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), 43005 Tarragona, Spain
- Institut d'Investigació en Atenció Primària IDIAP Jordi Gol, Institut Català de la Salut (ICS), 08007 Barcelona, Spain
- Collaborative Research Group on Lifestyles, Nutrition and Smoking (CENIT), IDIAP Jordi Gol, 43202 Reus, Spain
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85
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Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review. BJOG 2023; 130:336-347. [PMID: 36424902 PMCID: PMC10107208 DOI: 10.1111/1471-0528.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. OBJECTIVES Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. SEARCH STRATEGY Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists. SELECTION CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low. CONCLUSIONS Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
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Affiliation(s)
- Orla A Houlihan
- School of Public Health, University College Cork, Cork, Ireland
| | - Daire Buckley
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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86
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Bora S. Beyond Survival: Challenges and Opportunities to Improve Neurodevelopmental Outcomes of Preterm Birth in Low- and Middle-Income Countries. Clin Perinatol 2023; 50:215-223. [PMID: 36868706 DOI: 10.1016/j.clp.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Low- and middle-income countries account for the greatest burden of preterm birth globally; however, there is limited understanding of neurodevelopmental outcomes of survivors within these resource-constrained settings. To accelerate progress, current priorities are to generate more high-quality data; engage with diverse local stakeholders including families of infants born preterm to identify neurodevelopmental outcomes meaningful to them within their contexts; and develop sustainable, scalable, high-quality models of neonatal follow-up, codesigned with local stakeholders, addressing the unique needs of low- and middle-income countries. Advocacy is critical to recognize optimal neurodevelopment as an "outcome of priority" along with the reduction in mortality.
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Affiliation(s)
- Samudragupta Bora
- University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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87
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Magán-Maganto M, Canal-Bedia R, Bejarano-Martín Á, Martín-Cilleros MV, Hernández-Fabián A, Calvarro-Castañeda AL, Roeyers H, Jenaro-Río C, Posada de la Paz M. Predictors of autism spectrum disorder diagnosis in a spanish sample of preterm children with very low birthweight: A cross-sectional study. Health Sci Rep 2023; 6:e1143. [PMID: 36875930 PMCID: PMC9981873 DOI: 10.1002/hsr2.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/29/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Aims Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a higher likelihood of being diagnosed in preterm populations. Likewise, low birthweight has also been connected with an increased likelihood of ASD. The objectives were to study the frequency and define the relationship between ASD, gestational age, birthweight, and growth percentiles for preterm children. Methods A sample of preterm children with very low birthweight was selected from the Spanish population at 7-10 years old. Families were contacted from the hospital, and they were offered an appointment to conduct a neuropsychological assessment. The children who showed signs of ASD were referred to the diagnostic unit for differential diagnosis. Results A total of 57 children completed full assessments, with 4 confirmed ASD diagnoses. The estimated prevalence was 7.02%. There were statistically significant weak correlations between ASD and gestational age (τb = -0.23), and birthweight (τb = -0.25), suggesting there is a higher likelihood of developing ASD for those born smaller or earlier in their gestation. Conclusion These results could improve ASD detection and outcomes for this vulnerable population while also supporting and enhancing previous findings.
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Affiliation(s)
- María Magán-Maganto
- University Institute of Community Integration (INICO), Centro de Atención Integral al Autismo (INFOAUTISMO), Faculty of Education Universidad de Salamanca Salamanca Spain
| | - Ricardo Canal-Bedia
- University Institute of Community Integration (INICO), Centro de Atención Integral al Autismo (INFOAUTISMO), Faculty of Education Universidad de Salamanca Salamanca Spain
| | - Álvaro Bejarano-Martín
- University Institute of Community Integration (INICO), Centro de Atención Integral al Autismo (INFOAUTISMO), Faculty of Education Universidad de Salamanca Salamanca Spain
| | - Maria Victoria Martín-Cilleros
- University Institute of Community Integration (INICO), Centro de Atención Integral al Autismo (INFOAUTISMO), Faculty of Education Universidad de Salamanca Salamanca Spain
| | | | - Andrea Luz Calvarro-Castañeda
- University Institute of Community Integration (INICO), Centro de Atención Integral al Autismo (INFOAUTISMO), Faculty of Education Universidad de Salamanca Salamanca Spain
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Research in Developmental Disorders Lab (RIDDL) Ghent University Ghent Belgium
| | - Cristina Jenaro-Río
- University Institute of Community Integration (INICO), Faculty of Psychology Universidad de Salamanca Salamanca Spain
| | - Manuel Posada de la Paz
- Rare Diseases Institute of Rare Diseases Research & Institute of Health Carlos III Madrid Spain
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88
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Chen X, Chen S, Zhu Z, Luo J, Wang H, Wulayin M, Huang C, Zhao W, Wang Q. Identifying the critical windows and joint effects of temperature and PM 2.5 exposure on small for gestational age. ENVIRONMENT INTERNATIONAL 2023; 173:107832. [PMID: 36822007 DOI: 10.1016/j.envint.2023.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
The potential critical windows for extreme ambient temperature, air pollution exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint effects on SGA. In a national multi-center prospective cohort, we included 179,761 pairs of mother-infant from 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM2.5 concentration were matched to the maternal residential address to estimate personal exposure. Extreme temperature exposures were categorized by a series of percentile in each meteorological and geographic division for the entire pregnancy, each trimester and gestational week (GA-week). Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used to estimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme temperature and PM2.5 exposures with SGA. Combined effects were evaluated with the relative excess risk due to interaction (RERI) and proportion attributable to interaction (AP). We observed that by referring to temperature at the 41st - 50th percentile, heat (>90th percentile) exposure during 13th - 29th GA-weeks was associated with SGA; odds ratio (OR) and 95 % confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations were observed during the 1st - 8th GA-weeks. PM2.5 exposure during the 2nd - 5th and 19th - 27th GA-weeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95 %CI: 1.0001, 1.0034, for a 10 μg/m3 increase). No interactive effects between ambient temperature and PM2.5 on SGA were observed. Our findings suggest the weekly susceptibility windows for heat and PM2.5 exposure were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.
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Affiliation(s)
- Xin Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Sidi Chen
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenghong Zhu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiajun Luo
- Institute for Population and Precision Health, the University of Chicago, Chicago, USA
| | - Huailin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.
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89
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Rodrígez JMR, Toda LI, López ID, Muñoz JB, Fresno LS, Hernández EF, de Arriba Muñoz A. Adult height and health-related quality of life in patients born small for gestational age treated with recombinant growth hormone. Sci Rep 2023; 13:3135. [PMID: 36823445 PMCID: PMC9950462 DOI: 10.1038/s41598-023-30281-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Health related quality of life (HRQoL) is a relevant result when assessing the course of different pathologies and the efficacy of their treatments. HRQoL has been studied previously on adults born small for gestational age (SGA), both in the general population and in patients who had received recombinant human growth hormone (rhGH) treatment, with disparate results. Our study included 50 adults who had received rhGH treatment for the SGA indication in 4 Spanish hospitals. Data have been gathered retrospectively from their clinical records, current weight and height were measured, and patients have been asked to fill out SF-36 and QoLAGHDA quality of life forms, and the Graffar test to evaluate their socio-economical status. Patient's adult height was - 1.2 ± 0.9 SD, lower than their target height of 1 ± 0.8 SD, but gaining 1.7 ± 1 SD from the beginning of the treatment. SF-36 test results showed lower scoring on Mental Health domains than on those related to Physical Health. No correlation was found between HRQoL results and final height, rhGH treatment duration or puberty. Correlation was indeed found between QoLAGHDA and several domains of SF-36, but QoLAGHDA detected fewer patients with low HRQoL than SF-36. Thus, it is concluded that SGA patient's follow-up should include a HRQoL, neuro-cognitive and psychiatric assessment in their transition to adult age. Adult SGA patients without catch up growth have impaired HRQoL, especially in mental health domains.
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Affiliation(s)
| | | | - Ignacio Díez López
- Pediatric Endocrinology Unit, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - Jordi Bosch Muñoz
- Pediatric Endocrinology Unit, Arnau de Vilanova Hospital, Lleida, Spain
| | | | | | - Antonio de Arriba Muñoz
- Pediatric Endocrinology Unit, Miguel Servet Hospital, Av Isabel La Católica 1-3, 50009, Zaragoza, Spain.
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90
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Tzafrir T, Wainstock T, Sheiner E, Miodownik S, Pariente G. Fetal Growth Restriction and Long-Term Cardiovascular Morbidity of Offspring in Dichorionic-Diamniotic Twin Pregnancies. J Clin Med 2023; 12:jcm12041628. [PMID: 36836163 PMCID: PMC9964996 DOI: 10.3390/jcm12041628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Objective: We opted to investigate whether fetal growth restriction (FGR) in dichorionic-diamniotic twins is a risk factor for long-term cardiovascular morbidity in offspring. Study design: A population-based retrospective cohort study, comparing long-term cardiovascular morbidity among FGR and non-FGR twins, born between the years 1991 and 2021 in a tertiary medical center. Study groups were followed until 18 years of age (6570 days) for cardiovascular-related morbidity. A Kaplan-Meier survival curve compared the cumulative cardiovascular morbidity. A Cox proportional hazard model assisted with adjusting for confounders. Results: In this study, 4222 dichorionic-diamniotic twins were included; 116 were complicated with FGR and demonstrated a significantly higher rate of long-term cardiovascular morbidity (4.4% vs. 1.3%, OR = 3.4, 95% CI 1.35-8.78, p = 0.006). The cumulative incidence of long-term cardiovascular morbidity was significantly higher among FGR twins (Kaplan-Meier Log rank test p = 0.007). A Cox proportional-hazard model found an independent association between FGR and long-term cardiovascular morbidity, when adjusted for both birth order and gender (adjusted HR 3.3, 95% CI 1.31-8.19, p = 0.011). Conclusions: FGR in dichorionic-diamniotic twins is independently associated with an increased risk for long-term cardiovascular morbidity in offspring. Therefore, increased surveillance may be beneficial.
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Affiliation(s)
- Tuval Tzafrir
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
- Correspondence: ; Tel.: +972-508668466
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Shayna Miodownik
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8410101, Israel
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91
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Lovato I, Simonelli A, Visentin S, Priante E, Baraldi E, Sacchi C. Prenatal environment and developmental trajectories: the intrauterine growth restriction. Minerva Pediatr (Torino) 2023; 75:62-74. [PMID: 35708036 DOI: 10.23736/s2724-5276.22.06949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prenatal environment is of fundamental importance for the fetus, as the fetus is particularly susceptible to environmental influences while in utero, and several prenatal adversities may constitute a risk factor for fetal growth and child development. Intrauterine growth restriction (IUGR) refers to a pregnancy complication involving the inadequate growth of the fetus in utero, with potential programming consequences on the children's brain-behavior development. In this narrative review we will discuss the most recent literature about IUGR children, including their development and their relationship with the prenatal and postnatal environment. In particular, as an attempt to an adaptive response to intrauterine changes, the brain development of IUGR fetuses follows abnormal developmental pathways, which likely has cascade effects on the future neurodevelopmental outcomes of the children. Cognitive and motor functions are in fact impaired, as well as IUGR children present, across studies, poor socio-emotional abilities and a greater risk for internalizing and externalizing behavior problems. The current work also highlights how the postnatal environment, and in particular parental care, has an important role in IUGR development, acting as a protective factor, or otherwise increasing their constitutional vulnerabilities. Overall, this narrative review has important implications for clinical practice, suggesting the need for long-term follow-up care with IUGR children and strategies supporting parent-child interactions as well.
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Affiliation(s)
- Irene Lovato
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy
| | - Silvia Visentin
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Elena Priante
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Eugenio Baraldi
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Chiara Sacchi
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy -
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92
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Undetected Fetal Growth Restriction During the Coronavirus Disease 2019 (COVID-19) Pandemic. Obstet Gynecol 2023; 141:414-417. [PMID: 36649315 DOI: 10.1097/aog.0000000000005052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/27/2022] [Indexed: 01/18/2023]
Abstract
This was a retrospective cohort study of patients who delivered singleton, small-for-gestational-age (SGA) neonates between April and June 2019, before the coronavirus disease 2019 (COVID-19) pandemic (pre-COVID-19), and between April and July 2020, during the pandemic (COVID-19 epoch). The primary outcome was the rate of undetected antenatal fetal growth restriction (FGR) in the two periods. A total of 268 patients met inclusion criteria. Patients who delivered small-for-gestational-age neonates during the COVID-19 epoch were significantly more likely to have undetected FGR compared with those who delivered pre-COVID-19 (70.1% vs 58.1%, P =.04). Patients who delivered SGA neonates during the COVID-19 epoch had more telehealth visits but fewer in-person prenatal visits, recorded fundal height measurements, and growth ultrasonograms. As telemedicine continues to be incorporated into prenatal care, these data may lend further support toward self-assessment of fundal height or routine third-trimester growth ultrasonograms to identify fetal growth abnormalities.
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93
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Radaelli G, Leal-Conceição E, Kalil Neto F, Taurisano MRG, Majolo F, Bruzzo FTK, Booij L, Nunes ML. Motor and cognitive outcomes of neonates with low birth weight in Brazil: a systematic review and meta-analysis. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:186-200. [PMID: 36863403 PMCID: PMC10033196 DOI: 10.1055/s-0042-1758866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Data on the outcomes of preterm newborns in South American countries are scarce. Given the great effect of low birth weight (LBW) and/or prematurity on children's neurodevelopment, it is extremely necessary to conduct studies on these phenomena in greater depth in more heterogeneous populations such as those ones from countries with limited resources. METHODS We conducted a comprehensive literature search on databases including PubMed, the Cochrane Library, and Web of Science for articles published in Portuguese and English up to March 2021 involving children born and evaluated in Brazil. The analysis of the risk of bias was adapted from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to evaluate the methodology of the included studies. RESULTS From the eligible trials, 25 articles were selected for qualitative synthesis, and 5 of those, for quantitative synthesis (meta-analysis). The meta-analyses showed that children born with LBW presented lower scores on motor development when compared with controls (standardized mean difference: -1.15; 95% confidence interval [95%CI]: -1.56--0.73]; I2: 80%) and also scored lower in terms of cognitive development (standardized mean difference: -0.71; 95% CI: -0.99--0.44; I2: 67%). CONCLUSION The results of the present study reinforce that impaired motor and cognitive functions can be a significant long-term outcome of LBW. The lower the gestational age at delivery, the higher the risk of impairment in those domains. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database under number CRD42019112403.
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Affiliation(s)
- Graciane Radaelli
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Eduardo Leal-Conceição
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Felipe Kalil Neto
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Melissa Rogick Guzzi Taurisano
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Fernanda Majolo
- Universidade do Vale do Taquari, Programa de Pós-Graduação em Biotecnologia, Lajeado RS, Brazil
| | - Fernanda Thays Konat Bruzzo
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Linda Booij
- Concordia University, Faculty of Arts and Science, Department of Psychology, Montreal QC, Canada
| | - Magda Lahorgue Nunes
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina e InsCer, Disciplina de Neurologia, Porto Alegre RS, Brazil
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94
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Wan L, He X, He M, Yu Y, Jiang W, Liang C, Luo K, Gong X, Yang Y, Dong Q, Chen P. Docosahexaenoic acid improves cognition and hippocampal pyroptosis in rats with intrauterine growth restriction. Heliyon 2023; 9:e12920. [PMID: 36747549 PMCID: PMC9898307 DOI: 10.1016/j.heliyon.2023.e12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background and Objective Intrauterine growth restriction (IUGR) is defined as the failure of a fetus to reach its genetic growth potential in utero resulted by maternal, placental, fetal, and genetic factors. Previous studies have reported that IUGR is associated with a high incidence of neurological damage, although the precise causes of such damage remain unclear. We aimed to investigate whether cognitive impairment in rats with IUGR is related to pyroptosis of hippocampal neurons and determine the effect of early intervention with docosahexaenoic acid (DHA). Methods Learning and memory function was assessed using the Morris water maze test. The morphological structure and ultrastructure of the hippocampus was examined via hematoxylin and eosin staining and electron microscopy respectively. The pyroptosis of hippocampal neuron was detected by gasdermin-D (GSDMD) immunofluorescence staining, mRNA and protein expression of nuclear localization leucine-rich-repeat protein 1 (NLRP1), caspase-1, GSDMD, and quantification of inflammatory cytokines interleukin (IL)-1β and IL-18 in the hippocampus. Results IUGR rats exhibited decreased learning and memory function, morphological structure and ultrastructural changes in hippocampus compared to controls. IUGR rats also exhibited increased hippocampal quantification of GSDMD immunofluorescence staining, increased mRNA and protein expression of NLRP1, caspase-1, and GSDMD, and increased quantification of IL-1β and IL-18 in the hippocampus. Intervention with DHA attenuated these effects. Conclusion Cognitive impairment in rats with IUGR may be related to pyroptosis of hippocampal neurons. Early intervention with DHA may attenuate cognitive impairment and reduce hippocampal pyroptosis in rats with IUGR.
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Affiliation(s)
- Lijia Wan
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Department of Child Healthcare, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan 410011, PR China
| | - Xiaori He
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Mingfeng He
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Yuanqiang Yu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Weiming Jiang
- Children's Institute of Three Gorges University, Yichang Central People's Hospital, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang 443003, PR China
| | - Can Liang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Kaiju Luo
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Xiaoyun Gong
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Yonghui Yang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Qingyi Dong
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China
| | - Pingyang Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China,Laboratory of Neonatal Disease, Institute of Pediatrics, Central South University, Changsha, Hunan 410011, PR China,Corresponding author. NO.139, Renmin Middle Road, furong District, Changsha, Hunan 410011, PR China.
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95
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Weider S, Lærum AMW, Evensen KAI, Reitan SK, Lydersen S, Brubakk AM, Skranes J, Indredavik MS. Neurocognitive function and associations with mental health in adults born preterm with very low birthweight or small for gestational age at term. Front Psychol 2023; 13:1078232. [PMID: 36743594 PMCID: PMC9890170 DOI: 10.3389/fpsyg.2022.1078232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives To assess neurocognitive function in adults born with low birthweight compared with controls and to explore associations between neurocognitive function and psychopathology in these groups. Methods In this prospective cohort study, one group born preterm with very low birthweight (VLBW: birthweight <1,500 g, n = 53), one group born small for gestational age at term (SGA: birthweight <10th percentile, n = 63) and one term-born control group (birthweight ≥10th percentile, n = 81) were assessed with neurocognitive tests, diagnostic interviews, and self-report questionnaires at 26 years of age. Results The VLBW group scored significantly below the control group on several neurocognitive measures, including IQ measures, psychomotor speed, verbal fluency, aspects of visual learning and memory, attention, social cognition, working memory and fine motor speed. The SGA group consistently scored at an intermediate level between the VLBW and the control group and had significantly lower scores than controls on Performance IQ and psychomotor speed, including switching. In the VLBW group, associations were found between lower spatial working memory and the presence of anxiety disorders, internalizing and attention problems, and autistic traits. Furthermore, lower Full scale IQ was associated with attention problems when adjusting for sex and parental socioeconomic status. Conclusion Adults born preterm with VLBW or born term SGA displayed neurocognitive difficulties. Spatial working memory was associated with difficulties with attention, anxiety, and social function of VLBW adults. The finding and its clinical applicability should be further explored.
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Affiliation(s)
- Siri Weider
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway,*Correspondence: Siri Weider, ✉
| | - Astrid M. W. Lærum
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kari Anne I. Evensen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Children’s Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway,Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Psychiatry, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ann Mari Brubakk
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Skranes
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Pediatrics, Sørlandet Hospital, Arendal, Norway
| | - Marit S. Indredavik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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96
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Husby A, Wohlfahrt J, Melbye M. Gestational age at birth and cognitive outcomes in adolescence: population based full sibling cohort study. BMJ 2023; 380:e072779. [PMID: 36653028 PMCID: PMC9846680 DOI: 10.1136/bmj-2022-072779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the association between gestational age at birth and cognitive outcomes in adolescence. DESIGN Nationwide population based full sibling cohort study. SETTING Denmark. PARTICIPANTS 1.2 million children born between 1 January 1986 and 31 December 2003, of whom 792 724 had one or more full siblings born in the same period. MAIN OUTCOME MEASURES Scores in written language (Danish) and mathematics examinations as graded by masked assessors at the end of compulsory schooling (ninth grade, ages 15-16 years), in addition to intelligence test score at military conscription (predominantly at age 18 years) for a nested sub-cohort of male adolescents. School grades were standardised as z scores according to year of examination, and intelligence test scores were standardised as z scores according to year of birth. RESULTS Among 792 724 full siblings in the cohort, 44 322 (5.6%) were born before 37+0 weeks of gestation. After adjusting for multiple confounders (sex, birth weight, malformations, parental age at birth, parental educational level, and number of older siblings) and shared family factors between siblings, only children born at <34 gestational weeks showed reduced mean grades in written language (z score difference -0.10 (95% confidence interval -0.20 to -0.01) for ≤27 gestational weeks) and mathematics (-0.05 (-0.08 to -0.01) for 32-33 gestational weeks, -0.13 (-0.17 to -0.09) for 28-31 gestational weeks, and -0.23 (-0.32 to -0.15) for ≤27 gestational weeks), compared with children born at 40 gestational weeks. In a nested sub-cohort of full brothers with intelligence test scores, those born at 32-33, 28-31, and ≤27 gestational weeks showed a reduction in IQ points of 2.4 (95% confidence interval 1.1 to 3.6), 3.8 (2.3 to 5.3), and 4.2 (0.8 to 7.5), respectively, whereas children born at 34-39 gestational weeks showed a reduction in intelligence of <1 IQ point, compared with children born at 40 gestational weeks. CONCLUSIONS Cognitive outcomes in adolescence did not differ between those born at 34-39 gestational weeks and those born at 40 gestational weeks, whereas those with a gestational age of <34 weeks showed substantial deficits in multiple cognitive domains.
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Affiliation(s)
- Anders Husby
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Mads Melbye
- Center for Fertility and Health, Norwegian Institute of Public Health, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Norwegian University for Science and Technology, Norway
- Department of Genetics, Stanford University School of Medicine, CA, USA
- Danish Cancer Society Research Center, Copenhagen, Denmark
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97
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Hokken-Koelega ACS, van der Steen M, Boguszewski MCS, Cianfarani S, Dahlgren J, Horikawa R, Mericq V, Rapaport R, Alherbish A, Braslavsky D, Charmandari E, Chernausek SD, Cutfield WS, Dauber A, Deeb A, Goedegebuure WJ, Hofman PL, Isganatis E, Jorge AA, Kanaka-Gantenbein C, Kashimada K, Khadilkar V, Luo XP, Mathai S, Nakano Y, Yau M. International Consensus Guideline on Small for Gestational Age (SGA): Etiology and Management from Infancy to Early Adulthood. Endocr Rev 2023; 44:539-565. [PMID: 36635911 PMCID: PMC10166266 DOI: 10.1210/endrev/bnad002] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/31/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
This International Consensus Guideline was developed by experts in the field of SGA of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Besides, it presents long-term consequences of SGA birth and new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, and the metabolic and cardiovascular health of young adults born SGA after cessation of childhood-GH-treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardio-metabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at age of 3-4 years, should be referred for diagnostic work-up. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033-0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3-4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.
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Affiliation(s)
- Anita C S Hokken-Koelega
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manouk van der Steen
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stefano Cianfarani
- Department of Systems Medicine, University of Rome 'Tor Vergata', Children's Hospital, Rome, Italy.,Diabetology and Growth Disorders Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, the Sahlgrenska Academy, the University of Gothenburg and Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Veronica Mericq
- Institute of Maternal and Child Research, faculty of Medicine, University of Chile
| | - Robert Rapaport
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | | | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas "Dr. Cesar Bergadá" (CEDIE), División de Endocrinología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece.,Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| | - Steven D Chernausek
- Department of Pediatrics, Section of Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Andrew Dauber
- Division of Endocrinology, Children's National Hospital, Washington, DC 20012, USA
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City and College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Wesley J Goedegebuure
- Department of Pediatrics, subdivision of Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Alexander A Jorge
- Unidade de Endocrinologia Genética (LIM25) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Xiao-Ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sarah Mathai
- Department of Pediatrics, Christian Medical College, Vellore, India
| | - Yuya Nakano
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Mabel Yau
- Icahn School of Medicine, Division of Pediatric Endocrinology, Mount Sinai Kravis Children's Hospital, New York, NY, USA
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98
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Joint Effects of Prenatal Folic Acid Supplement with Prenatal Multivitamin and Iron Supplement on Obesity in Preschoolers Born SGA: Sex Specific Difference. Nutrients 2023; 15:nu15020380. [PMID: 36678251 PMCID: PMC9863758 DOI: 10.3390/nu15020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Prenatal maternal nutrient supplementation has been reported to be associated with offspring obesity, but the reports are inconsistent and have mainly ignored the differences between the total children population and children born small for gestational age (SGA). This study aimed to examine the joint effects of folic acid, iron, and multivitamin supplementation during pregnancy on the risk of obesity in preschoolers born SGA. A total of 8918 children aged 3-6.5 years born SGA were recruited from Longhua District in Shenzhen of China in 2021. Their mothers completed a structured questionnaire about the child's and parents' socio-demographic characteristics, maternal prepregnant obesity, and mothers' prenatal supplementation of folic acid, iron, and multivitamin. In addition, the children's current weight and height were measured by trained nurses. Logistic regression models were used to analyze the associations between prenatal supplementations and the current presence of childhood obesity. After controlling for potential confounders, the results of the logistic regression analysis showed that prenatal supplement of folic acid (OR = 0.72, 95% CI = 0.55~0.93) was associated with a lower likelihood of being an obese preschooler born SGA. In contrast, the ingestion of multivitamin or iron supplements during pregnancy did not seem to be related to the likelihood of childhood obesity in preschoolers born SGA. Moreover, cross-over analysis of prenatal folic acid and multivitamin obtained significant negative associations of prenatal folic acid supplement only (OR = 0.73, 95% CI = 0.55~0.97) and combination supplement of folic acid and multivitamin (OR = 0.67, 95% CI = 0.50~0.90) with obesity of preschoolers born SGA; while the cross-over analysis of prenatal folic acid and iron observed significant negative associations between obesity of preschoolers born SGA and a combination supplement of folic acid and iron (OR = 0.70, 95% CI = 0.52~0.96). Furthermore, the aforementioned significant associations were only found in girls and not in boys when the analyses were stratified by sex. Our findings suggest that the prenatal folic acid supplementation may decrease the risk of obesity in preschool girls born SGA, and that this effect may be modified by prenatal multivitamin or iron supplementation.
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99
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Zhang F, Zhang X, Zhong Y, Zhu S, Zhao G, Zhang X, Li T, Zhang Y, Zhu W. Joint Exposure to Ambient Air Pollutants Might Elevate the Risk of Small for Gestational Age (SGA) Infants in Wuhan: Evidence From a Cross-Sectional Study. Int J Public Health 2023; 67:1605391. [PMID: 36686387 PMCID: PMC9849243 DOI: 10.3389/ijph.2022.1605391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: To investigate the effect of exposure to multiple ambient air pollutants during pregnancy on the risk of children being born small for gestational age (SGA). Methods: An Air Pollution Score (APS) was constructed to assess the effects of being exposed to six air pollutants simultaneously, PM2.5, PM10, SO2, NO2, CO, and O3 (referred to as joint exposure). A logistic regression model was applied to estimate the associations of APS and SGA. Results: The adjusted odds ratios (ORs) of SGA per 10 ug/m3 increased in APS during the first and second trimesters and the entire pregnancy were 1.003 [95% confidence intervals (CIs): 1.000, 1.007], 1.018 (1.012, 1.025), and 1.020 (1.009, 1.031), respectively. The ORs of SGA for each 10 μg/m3 elevated in APS during the whole pregnancy were 1.025 (1.005, 1.046) for mothers aged over 35 years old vs. 1.018 (1.005, 1.031) for mothers aged under 35 years old. Women who were pregnant for the first time were more vulnerable to joint ambient air pollution. Conclusion: In summary, the results of the present study suggested that joint exposure to ambient air pollutants was associated with the increment in the risks of SGA.
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Affiliation(s)
- Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Yuanyuan Zhong
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Tianzhou Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Yan Zhang, ; Wei Zhu,
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Yan Zhang, ; Wei Zhu,
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100
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Cumberland A, Hale N, Azhan A, Gilchrist CP, Chincarini G, Tolcos M. Excitatory and inhibitory neuron imbalance in the intrauterine growth restricted fetal guinea pig brain: Relevance to the developmental origins of schizophrenia and autism. Dev Neurobiol 2023; 83:40-53. [PMID: 36373424 PMCID: PMC10953391 DOI: 10.1002/dneu.22907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/15/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Neurodevelopmental disorders such as schizophrenia and autism are thought to involve an imbalance of excitatory and inhibitory signaling in the brain. Intrauterine growth restriction (IUGR) is a risk factor for these disorders, with IUGR onset occurring during critical periods of neurodevelopment. The aim of this study was to determine the impact of IUGR on excitatory and inhibitory neurons of the fetal neocortex and hippocampus. Fetal brains (n = 2) were first collected from an unoperated pregnant guinea pig at mid-gestation (32 days of gestation [dg]; term ∼67 dg) to visualize excitatory (Ctip2) and inhibitory (calretinin [CR] and somatostatin [SST]) neurons via immunohistochemistry. Chronic placental insufficiency (CPI) was then induced via radial artery ablation at 30 dg in another cohort of pregnant guinea pigs (n = 8) to generate IUGR fetuses (52 dg; n = 8); control fetuses (52 dg; n = 7) were from sham surgeries with no radial artery ablation. At 32 dg, Ctip2- and CR-immunoreactive (IR) cells had populated the cerebral cortex, whereas SST-IR cells had not, suggesting these neurons were yet to complete migration. At 52 dg, in IUGR versus control fetuses, there was a reduction in SST-IR cell density in the cerebral cortex (p = .0175) and hilus of the dentate gyrus (p = .0035) but not the striatum (p > .05). There was no difference between groups in the density of Ctip2-IR (cortex) or CR-IR (cortex, hippocampus) neurons (p > 0.05). Thus, we propose that an imbalance in inhibitory (SST-IR) and excitatory (Ctip2-IR) neurons in the IUGR fetal guinea pig brain could lead to excitatory/inhibitory dysfunction commonly seen in neurodevelopmental disorders such as autism and schizophrenia.
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Affiliation(s)
- Angela Cumberland
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Nadia Hale
- The Ritchie Centre, Hudson Institute of Medical ResearchMonash UniversityMelbourneVictoriaAustralia
| | - Aminath Azhan
- The Ritchie Centre, Hudson Institute of Medical ResearchMonash UniversityMelbourneVictoriaAustralia
| | - Courtney P. Gilchrist
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
- Victorian Infant Brain StudiesMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Ginevra Chincarini
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
| | - Mary Tolcos
- School of Health and Biomedical SciencesRMIT UniversityBundooraVictoriaAustralia
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