Birthweight and mortality in adulthood: a systematic review and meta-analysis

Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System

OBJECTIVE

This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions.

METHODS

Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors.

RESULTS

The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth.

DISCUSSION

Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.

Maternal Age at Menarche Gene Polymorphisms Are Associated with Offspring Birth Weight

In this study, the association between maternal age at menarche (AAM)-related polymorphisms and offspring birth weight (BW) was studied. The work was performed on a sample of 716 pregnant women and their newborns. All pregnant women underwent genotyping of 50 SNPs of AAM candidate genes. Regression methods (linear and Model-Based Multifactor Dimensionality Reduction (MB-MDR)) with permutation procedures (the indicator pperm was calculated) were used to identify the correlation between SNPs and newborn weight (transformed BW values were analyzed) and in silico bioinformatic examination was applied to assess the intended functionality of BW-associated loci. Four AAM-related genetic variants were BW-associated including genes such as POMC (rs7589318) (βadditive = 0.202/pperm = 0.015), KDM3B (rs757647) (βrecessive = 0.323/pperm = 0.005), INHBA (rs1079866) (βadditive = 0.110/pperm = 0.014) and NKX2-1 (rs999460) (βrecessive = -0.176/pperm = 0.015). Ten BW-significant models of interSNPs interactions (pperm ≤ 0.001) were identified for 20 polymorphisms. SNPs rs7538038 KISS1, rs713586 RBJ, rs12324955 FTO and rs713586 RBJ-rs12324955 FTO two-locus interaction were included in the largest number of BW-associated models (30% models each). BW-associated AAM-linked 22 SNPs and 350 proxy loci were functionally related to 49 genes relevant to pathways such as the hormone biosynthesis/process and female/male gonad development. In conclusion, maternal AMM-related genes polymorphism is associated with the offspring BW.

Blood pressure and cardiovascular risk in relation to birth weight and urinary sodium: an individual-participant meta-analysis of European family-based population studies

BACKGROUND

Although the relation of salt intake with blood pressure (BP) is linear, it is U-shaped for mortality and cardiovascular disease (CVD). This individual-participant meta-analysis explored whether the relation of hypertension, death or CVD with 24-h urinary sodium excretion (UVNA) or sodium-to-potassium (UNAK) ratio was modified by birth weight.

METHODS

Families were randomly enrolled in the Flemish Study on Genes, Environment and Health Outcomes (1985-2004) and the European Project on Genes in Hypertension (1999-2001). Categories of birth weight, UVNA and UNAK (≤2500, >2500-4000, >4000 g; <2.3, 2.3-4.6 and >4.6 g; and <1, 1-2, >2, respectively) were coded using deviation-from-mean coding and analyzed by Kaplan-Meier survival functions and linear and Cox regression.

RESULTS

The study population was subdivided into the Outcome ( n  = 1945), Hypertension ( n  = 1460) and Blood Pressure cohorts ( n  = 1039) to analyze the incidence of mortality and cardiovascular endpoints, hypertension and BP changes as function of UVNA changes. The prevalence of low/medium/high birth weight in the Outcome cohort was 5.8/84.5/9.7%. Over 16.7 years (median), rates were 4.9, 8 and 27.1% for mortality, CVD and hypertension, respectively, but were not associated with birth weight. Multivariable-adjusted hazard ratios were not significant for any endpoint in any of the birth weight, UVNA and UNAK strata. Adult body weight tracked with birth weight ( P  < 0.0001). The partial r in the low-birth-weight group associating changes from baseline to follow-up in UVNA and SBP was 0.68 ( P  = 0.023) but not significant in other birth weight groups.

CONCLUSION

This study did not substantiate its prior hypothesis but showed tracking of adult with birth weight and suggest that low birth weight increases salt sensitivity.

Low birthweight is associated with epigenetic age acceleration in the first 3 years of life

Background and objectives

The Developmental Origins of Health and Disease hypothesis posits that early life adversity is associated with poor adult health outcomes. Epidemiological evidence has supported this framework by linking low birthweight with adult health and mortality, but the mechanisms remain unclear. Accelerated epigenetic aging may be a pathway to connect early life experiences with adult health outcomes, based on associations of accelerated epigenetic aging with increased morbidity and mortality.

Methodology

Sixty-seven mother-infant dyads were recruited in the eastern Democratic Republic of Congo. Birthweight data were collected at birth, and blood samples were collected at birth and follow-up visits up to age 3. DNA methylation data were generated with the Illumina MethylationEPIC array and used to estimate epigenetic age. A multilevel model was used to test for associations between birthweight and epigenetic age acceleration.

Results

Chronological age was highly correlated with epigenetic age from birth to age 3 (r = 0.95, p < 2.2 × 10-16). Variation in epigenetic age acceleration increased over time. Birthweight, dichotomized around 2500 g, predicted epigenetic age acceleration over the first 3 years of life (b = -0.39, p = 0.005).

Conclusions and implications

Our longitudinal analysis provides the first evidence for accelerated epigenetic aging that emerges between birth and age 3 and associates with low birthweight. These results suggest that early life experiences, such as low birthweight, may shape the trajectory of epigenetic aging in early childhood. Furthermore, accelerated epigenetic aging may be a pathway that links low birthweight and poor adult health outcomes.

Intergenerational transmission of birth weight: a systematic review and meta-analysis

The objectives of this study were (1) to systematically review the literature on the association between birth weight in children born in the first and second generation and (2) to quantify this association by performing a meta-analysis. A systematic review was carried out in six databases (PubMed, Science Direct, Web of Science, Embase, Scopus, CINAHL and LILACS), in January 2021, for studies that recorded the birth weight of parents and children. A meta-analysis using random effects to obtain a pooled effect of the difference in birth weight and the association of low birth weight (LBW) between generations was performed. Furthermore, univariable meta-regression was conducted to assess heterogeneity. Egger's tests were used to possible publication biases. Of the 9878 identified studies, seventy were read in full and twenty were included in the meta-analysis (ten prospective cohorts and ten retrospective cohorts), fourteen studies for difference in means and eleven studies for the association of LBW between generations (twenty-three estimates). Across all studies, there was no statistically significant mean difference (MD) birth weight between first and second generation (MD 19·26, 95 % CI 28·85, 67·36; P = 0·43). Overall, children of LBW parents were 69 % more likely to have LBW (pooled effect size 1·69, 95 % CI (1·46, 1·95); I2:85·8 %). No source of heterogeneity was identified among the studies and no publication bias. The average birth weight of parents does not influence the average birth weight of children; however, the proportion of LBW among the parents seems to affect the offspring's birth weight.

Childhood socioeconomic position and cardiometabolic risk in young adulthood- the impact of mental health

BACKGROUND

Low socioeconomic position in childhood is associated with greater cardiometabolic disease risk later in life. The aim of the current study is to examine the mediating impact of mental health on the association between childhood socioeconomic position and cardiometabolic disease risk in young adulthood.

METHODS

We used a combination of national registers, longitudinal questionnaire-data and clinical measurements from a sub-sample (N = 259) of a Danish youth cohort. Childhood socioeconomic position was indicated by the educational level of the mother and the father at age 14. Mental health was measured by four different symptom scales at four age-points (age 15, 18, 21 and 28), and combined into one global score. Cardiometabolic disease risk was measured by nine biomarkers at age 28-30 and combined into one global score by sample-specific z-scores. We conducted analyses within the causal inference framework and evaluated the associations using nested counterfactuals.

RESULTS

We found an inverse association between childhood socioeconomic position and cardiometabolic disease risk in young adulthood. The proportion of the association which was mediated by mental health was 10 (95% CI: -4; 24) % and 12 (95% CI: -4; 28) % using educational level of the mother and the father as indicator, respectively.

CONCLUSIONS

Accumulated poorer mental health in childhood, youth and early adulthood partially explained the association between low childhood socioeconomic position and increased cardiometabolic disease risk in young adulthood. The results of the causal inference analyses rely on the underlying assumptions and correct depiction of the DAG. Since these are not all testable, we cannot exclude violations that potentially could bias the estimates. If the findings can be replicated, this would support a causal relationship and direct potentials for intervention. However, the findings point to a potential for intervention in young age in order to impede the translation of childhood social stratification into later cardiometabolic disease risk disparities.

A modular systematic review of antenatal interventions targeting modifiable environmental exposures in improving low birth weight

BACKGROUND

Low birth weight (LBW) increases the risk of short- and long-term morbidity and mortality from early life to adulthood. Despite research effort to improve birth outcomes the progress has been slow.

OBJECTIVE

This systematic search and review of English language scientific literature on clinical trials aimed to compare the efficacy antenatal interventions to reduce environmental exposures including a reduction of toxins exposure, and improving sanitation, hygiene, and health-seeking behaviors, which target pregnant women to improve birth outcomes.

METHODS

We performed eight systematic searches in MEDLINE (OvidSP), Embase (OvidSP), Cochrane Database of Systematic Reviews (Wiley Cochrane Library), Cochrane Central Register of Controlled Trials (Wiley Cochrane Library), CINAHL Complete (EbscoHOST) between 17 March 2020 and 26 May 2020.

RESULTS

Four documents identified describe interventions to reduce indoor air pollution: two randomised controlled trials (RCTs), one systematic review and meta-analysis (SRMA) on preventative antihelminth treatment and one RCT on antenatal counselling against unnecessary caesarean section. Based on the published literature, interventions to reduce indoor air pollution (LBW: RR: 0.90 [0.56, 1.44], PTB: OR: 2.37 [1.11, 5.07]) or preventative antihelminth treatment (LBW: RR: 1.00 [0.79, 1.27], PTB: RR: 0.88 [0.43, 1.78]) are not likely to reduce the risk of LBW or Preterm birth (PTB). Data is insufficient on antenatal counselling against caesarian-sections. For other interventions, there is lack of published research data from RCTs.

CONCLUSIONS

We conclude that there is a paucity of evidence from RCT on interventions that modify environmental risk factors during pregnancy to potentially improve birth outcomes. Magic bullets approach might not work and that it would be important to study the effect of the broader interventions, particularly in LMIC settings. Global interdisciplinary action to reduce harmful environmental exposures, is likely to help to reach global targets for LBW reduction and sustainably improve long-term population health.

Benefits and harms associated with an increase in gestational diabetes diagnosis in Queensland, Australia: a retrospective cohort comparison of diagnosis rates, outcomes, interventions and medication use for two periods, 2011-2013 and 2016-2018, using a large perinatal database

OBJECTIVES

To assess benefits and harms arising from increasing gestational diabetes (GDM) diagnosis, including for women with normal-sized babies.

DESIGN, SETTING AND PARTICIPANTS

Diagnosis rates, outcomes, interventions and medication use are compared in a retrospective cohort study of 229 757 women birthing in public hospitals of the Australian State of Queensland during two periods, 2011-2013 and 2016-2018, using data from the Queensland Perinatal Data Collection.

OUTCOME MEASURES

Comparisons include hypertensive disorders, caesarean section, shoulder dystocia and associated harm, induction of labour (IOL), planned birth (PB), early planned birth <39 weeks (EPB), spontaneous labour onset with vaginal birth (SLVB) and medication use.

RESULTS

GDM diagnosis increased from 7.8% to 14.3%. There was no improvement in shoulder dystocia associated injuries, hypertensive disorders or caesarean sections. There was an increase in IOL (21.8%-30.0%; p<0.001), PB (36.3% to 46.0%; p<0.001) and EPB (13.5%-20.6%; p<0.001), and a decrease in SLVB (56.0%-47.3%; p<0.001). Women with GDM experienced an increase in IOL (40.9%-49.8%; p<0.001), PB (62.9% to 71.8%; p<0.001) and EPB (35.3%-45.7%; p<0.001), and a decrease in SLVB (30.01%-23.6%; p<0.001), with similar changes for mothers with normal-sized babies. Of women prescribed insulin in 2016-2018, 60.4% experienced IOL, 88.5% PB, 76.4% EPB and 8.0% SLVB. Medication use increased from 41.2% to 49.4% in women with GDM, from 3.2% to 7.1% in the antenatal population overall, from 3.3% to 7.5% in women with normal-sized babies and from 2.21% to 4.38% with babies less than the 10th percentile.

CONCLUSION

Outcomes were not apparently improved with increased GDM diagnosis. The merits of increased IOL or decreased SLVB depend on the views of individual women, but categorising more pregnancies as abnormal, and exposing more babies to the potential effects of early birth, medication effects and growth limitation may be harmful.

Myocardial function including estimates of myocardial work in young adults born very preterm or with extremely low birthweight - a cohort study

BACKGROUND

Preterm birth and low birthweight have been associated with increased risk of heart failure and cardiovascular disease in young adulthood. However, results from clinical studies of myocardial function are not consistent. Echocardiographic strain analyses allow detection of early stages of cardiac dysfunction, and non-invasive estimates of myocardial work can provide additional information on cardiac function. We aimed to evaluate left ventricular (LV) myocardial function including measures of myocardial work in young adults born very preterm (gestational age < 29 weeks) or with extremely low birthweight (< 1000 g) (PB/ELBW), compared with term-born age- and sex matched controls.

METHODS

63 PB/ELBW and 64 controls born in Norway in the periods 1982-1985, 1991-1992, and 1999-2000 were examined with echocardiography. LV ejection fraction (EF) and LV global longitudinal strain (GLS) were measured. Myocardial work was estimated from LV pressure-strain loops after determination of GLS and construction of a LV pressure curve. Diastolic function was evaluated by determination of the presence or absence of elevated LV filling pressure, including measures of left atrial longitudinal strain.

RESULTS

The PB/ELBW with mean birthweight 945 (standard deviation (SD) 217) grams, mean gestational age 27 (SD 2) weeks, and mean age 27 (SD 6) years had LV systolic function mainly within normal range. Only 6% had EF < 50% or impaired GLS >-16%, but 22% had borderline impaired GLS between - 16% and - 18%. Mean GLS in PB/ELBW (-19.4% (95% confidence interval (CI) -20.0, -18.9)) was impaired compared to controls (-20.6% (95% CI -21.1, -20.1)), p = 0.003. Lower birthweight was associated to more impaired GLS (Pearson correlation coefficient - 0.2). Means of EF, measures of diastolic function including left atrial reservoir strain, global constructive and wasted work, global work index and global work efficiency was similar in PB/ELBW and controls.

CONCLUSION

The young adults born very preterm or with extremely low birthweight had impaired LV-GLS compared to controls, although systolic function mainly within normal range. Lower birthweight was associated with more impaired LV-GLS. These findings could indicate an elevated lifetime risk of developing heart failure in preterm born individuals. Measures of diastolic function and myocardial work were similar compared to controls.

Prenatal Exposure to Ambient Particle Radioactivity and Fetal Growth in Eastern Massachusetts

Background

The radioactive component of particulate matter (PM), particle radioactivity (PR), can continue to emit radiation after inhalation. While PR has been associated with other adverse pregnancy outcomes, no studies have examined the association with fetal growth.

Methods

Our retrospective cohort included singleton pregnancies that underwent obstetric ultrasounds at an academic medical center in Massachusetts from 2011 through 2016. PR was represented by particle gross β-activity estimated from an ensemble model and was assigned based on residential zip-code. We considered the cumulative (conception until date of fetal growth measurement) and first 16 weeks of gestation PR exposure windows. Standardized z-scores were constructed for biparietal diameter (BPD), head circumference, femur length (FL), abdominal circumference (AC), and birth weight. We used linear mixed regression models adjusted for PM ≤2.5 μm exposure, maternal sociodemographic factors, meteorological variables, and long-term trends.

Results

Among 9,404 pregnancies, an interquartile range increase in cumulative PR exposure was associated with reduced BPD (-0.06 [95% CI: -0.12, -0.01] z-score) and FL (-0.06 [95% CI: -0.12, -0.01] z-score) in scans conducted before 24 weeks' gestation, with increased AC (0.05 [95% CI: 0.01, 0.09]) in scans conducted on or after 24 weeks' gestation, and with lower birth weight (-0.05 [95% CI: -0.11, -0.001] z-score). The first 16 weeks of gestation was not a critical exposure window.

Conclusions

Prenatal PR was associated with fetal growth, with associations generally negative before 24 weeks' gestation and positive later in pregnancy. Our findings bring awareness to a novel environmental exposure.

Association of Isolated Hypothyroxinemia and Subclinical Hypothyroidism With Birthweight: A Cohort Study in Japan

Context

Isolated hypothyroxinemia (low maternal free thyroxine [FT4] in the absence of thyroid-stimulating hormone [TSH] elevation) and subclinical hypothyroidism (high TSH in the absence of FT4 elevation) during early pregnancy are common. However, there are limited data regarding pregnancy outcomes, particularly their association with birthweight.

Objective

We assessed the association between isolated hypothyroxinemia and subclinical hypothyroidism during the first trimester and birthweight.

Methods

Analyses were conducted using a database of pregnant women (n = 1105; median age, 35 years) who delivered at the National Center for Child Health and Development, a tertiary hospital in Tokyo. The primary outcomes included the rates of small for gestational age (SGA), large for gestational age (LGA), and low birth weight.

Results

Of the 1105 pregnant women, 981 were classified into the euthyroidism group, 25 into the isolated hypothyroxinemia group, and 26 into the subclinical hypothyroidism group during the first trimester. The prevalence of SGA was significantly higher in isolated hypothyroxinemia and subclinical hypothyroidism groups than the euthyroidism group (28.0% and 19.2%, respectively, vs 5.7%; P < .01). The odds ratio with 95% CI for SGA was 12.51 (4.41-35.53) for isolated hypothyroxinemia and 4.44 (1.57-12.56) for subclinical hypothyroidism in a multivariable adjustment model. Isolated hypothyroxinemia and subclinical hypothyroidism were not significantly associated with LGA and low birth weight.

Conclusion

Pregnant women with isolated hypothyroxinemia and subclinical hypothyroidism in the first trimester have an increased likelihood of SGA. Screening and careful perinatal checkups for isolated hypothyroxinemia and subclinical hypothyroidism may help identify pregnant women at high risk for SGA.

Effect of covering perinatal health-care costs on neonatal outcomes in Switzerland: a quasi-experimental population-based study

BACKGROUND

Low birthweight and preterm birth are associated with an increased risk of neonatal death and chronic conditions across the life course. Reducing these adverse birth outcomes is a global public health priority and requires strategies to improve health care during pregnancy. We aimed to assess the effect of a Swiss health policy expansion fully covering illness-related costs during pregnancy on health outcomes in newborn babies.

METHODS

We implemented a quasi-experimental difference in regression discontinuity design to assess the effect of expansion of Swiss health insurance (on March 1, 2014), to fully cover health-care costs during pregnancy and 8 weeks postpartum, on neonatal outcomes. Before this reform, only costs specific to the standard monitoring of a normal pregnancy were covered. Babies born before March 1, 2014, and their mothers were assigned to the unexposed group, and babies born on or after March 1, 2014, and their mothers were assigned to the exposed group. We included nearly all children born 2011-19 in Switzerland within a period of 9 months around the date March 1, 2014, and control years 2012, 2016, and 2018. Outcomes were birthweight, low birthweight, very low birthweight, gestational age, preterm or extremely preterm birth, and neonatal death. We estimated the intention-to-treat effect of the policy using parametric regression models.

FINDINGS

61 910 children were born 9 months before and 63 991 were born 9 months after March 1, 2014. 382 861 children were born in the same time period around the three control dates. In the period before policy implementation, mean birthweight was 3289 g, gestational age was 275 days, and 6·5% of children had low birthweight, 1·0% very low birthweight, 7·1% were preterm, 0·4% were extremely preterm, and 0·3% died within the first 28 days of life. After initiation of the policy (vs before) mean birthweight increased by 23 g (95% CI 5 to 40) and the predicted proportion of low birthweight births decreased by 0·81% (0·14 to 1·48) and of very low birthweight births decreased by 0·41% (0·17 to 0·65). The effect on very low birthweight was not robust in sensitivity analyses. The policy had a negligible effect on gestational age (mean difference 1 day, 95% CI 0 to 1) and no clear effects on the other examined outcomes. The change in predicted proportion for preterm births was -0·39% (95% CI -1·2 to 0·38), for extremely preterm births was -0·09% (-0·27 to 0·08), and for neonatal death was -0·07% (-0·2 to 0·07).

INTERPRETATION

Free access to prenatal care in Switzerland reduced the risk of some adverse health outcomes in newborn babies. Expanding health-care coverage is a relevant health system intervention to reduce the risk of adverse health outcomes in the newborn baby and, potentially, across the life course.

FUNDING

Swiss National Science Foundation.

Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association

BACKGROUND

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Determinants of birthweight in rural Sri Lanka; a cohort study

BACKGROUND

Identifying determinants of birthweight among disadvantaged communities is critical to further reducing the inequitable burden of perinatal health issues in low-and-middle income settings. Therefore, we adopted a bio-psycho-social approach to identify the determinants of birthweight in a mother-infant cohort from a rural setting in Sri Lanka, a lower-middle-income country.

METHODS

All third-trimester pregnant women with a singleton pregnancy registered for the national antenatal care programme at Ipalogama health division in 2017 were invited for a prospective cohort study. Data was collected using a self-completed questionnaire and data extraction from health records. The mother-infant cohort was followed up until one month after delivery. A principal component analysis was performed using economic, social, and psychological variables, and two composite variables were achieved. Care from husband and household members, perceived wellbeing, frequency of abuse, and affect during the third trimester strongly loaded to the variable 'psychosocial wellbeing'. Monthly income, husband's education level, and use of biomass fuel strongly loaded to the variable 'socioeconomic status'. Hierarchical logistic regression was used to predict factors associated with birthweight. Maternal age, parity, baby's sex, and gestational period at pregnancy registration were entered at the first step. BMI, psychosocial wellbeing, socioeconomic status, hypertensive disorders, and gestational/chronic diabetes were entered at step two. Preterm birth was entered at step three.

RESULTS

532 women were recruited, and 495 were retained at the postpartum follow-up. 421 (74.8%) had reported being abused at least once during the preceding month. Birthweight was approximately normally distributed (mean 2912 g, SD 456.6 g). Low birthweight was present in 72 (14.6%, 95% CI 11.7,17.9), and 46 (9.3%, 95% CI 7.0,12.1) had birthweights > 3500 g. The regression model explained 13.2% of the variance in birthweight. Preterm birth, maternal BMI, and mid-pregnancy psychosocial wellbeing could explain 6.9%(p < 0.001), 3.9(p < 0.001), and 1.2%(p = 0.02) of unique variance, respectively.

CONCLUSIONS

In a setting where a large proportion of pregnant women suffer 'abuse' in their homes, psychosocial wellbeing during pregnancy was an important determinant of birthweight of babies. Expanding routine maternal care services, especially at the primary care level, to cater to the psychosocial issues of pregnant women would help reduce inequities in perinatal health.

Prenatal exposure to heavy metal mixtures and anthropometric birth outcomes: a cross-sectional study

BACKGROUND

Numerous studies have suggested significant associations between prenatal exposure to heavy metals and newborn anthropometric measures. However, little is known about the effect of various heavy metal mixtures at relatively low concentrations. Hence, this study aimed to investigate associations between prenatal exposures to a wide range of individual heavy metals and heavy metal mixtures with anthropometric measures of newborns.

METHODS

We recruited 975 mother-term infant pairs from two major hospitals in Israel. Associations between eight heavy metals (arsenic, cadmium, chromium, mercury, nickel, lead, selenium, and thallium) detected in maternal urine samples on the day of delivery with weight, length, and head circumference at birth were estimated using linear and Bayesian kernel machine regression (BKMR) models.

RESULTS

Most heavy metals examined in our study were observed in lower concentrations than in other studies, except for selenium. In the linear as well as the BKMR models, birth weight and length were negatively associated with levels of chromium. Birth weight was found to be negatively associated with thallium and positively associated with nickel.

CONCLUSION

By using a large sample size and advanced statistical models, we could examine the association between prenatal exposure to metals in relatively low concentrations and anthropometric measures of newborns. Chromium was suggested to be the most influential metal in the mixture, and its associations with birth weight and length were found negative. Head circumference was neither associated with any of the metals, yet the levels of metals detected in our sample were relatively low. The suggested associations should be further investigated and could shed light on complex biochemical processes involved in intrauterine fetal development.

A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms

Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

Partnership, living arrangements, and low birth weight: evidence from a population-based study on Spanish mothers

BACKGROUND

Birth weight is considered a crucial indicator of individual and population health, as it determines a newborn's growth and development. An extensive body of research has explored various determinants of perinatal health, including the impact of living arrangements. This population-based study analyzes the relationship between mothers' partnership status and household structure and children's low birth weights. It addresses two basic research objectives: on one hand, how living/not living in a couple affects birth weight; on the other, how partnership status impact on birthweight when mothers live in extended households with other non-nuclear members.

METHODS

A novel database provided by the Spanish Office for National Statistics (INE), which links the 2011 census with births registered from 2011 to 2015 (sample size 22,433) is used. Llogistic regression models are estimated tto obtain adjusted odds ratios (OR) for the relative effects of living arrangements and other covariates such as characteristics of births and mothers' socioeconomic profiles, on birth weight.

RESULTS

Differences in low-birth-weight rates may be attributed to the dissimilar socio-demographic characteristics of the groups of mothers in the different coresidential situations. Although our models revealed that the impact of the covariates on birth weight was similar to that shown by previous studies, this was not the case for the effect of the main explanatory variable. Contrary to expectations, the presence/absence of a male partner in nuclear or in extended households does not reveal significant protection against low birth weight. Children born in households in which the male partner was absent were not more likely to have a low birth weight. On the other hand, analyzing the possible protective effect of extended households, we did not detect significant differences in the likelihood of low birth weight between single mothers without and with non-nuclear coresidents in their households.

CONCLUSIONS

Our analysis provides novel evidence regarding the effect of partnership status and household type on perinatal health in Spain. First, contrary to what has been observed in previous studies in Spain and elsewhere, our study shows that living without a partner has no effect on low birth weight. Second, we reveal that households including non-nuclear coresidents are associated with low birth weight suggesting that even in a basically familist societal context such as the Spanish one, the extended family does not fully protect against poor perinatal outcomes.

Definition of low birth weight in domestic mammals: a scoping review

In people and animals, low birth weight (LBW) is recognized as highly predictive of health trajectory from the neonatal period to elderly ages. Regarding the neonatal period, although LBW is recognized as a major risk factor for neonatal mortality, there does not appear to be a clear definition of 'when a birth weight should be considered low' in all species. The aim of this work was to use the scientific literature available to map the various thresholds proposed to define LBW in domestic mammals. Using a standardized methodology, a scoping review was conducted through a literature search in three different bibliographic databases. After a two-step screening of 1729 abstracts and full-text publications by two independent reviewers, eleven studies met the inclusion criteria. Selected publications represented six mammalian species (rat, mouse, dog, pig, cow, and rabbit). Birth weight thresholds were identified through six different methods. In addition to the scarcity of scientific literature about the definition of LBW, this scoping review revealed the lack of standardization for the description, evaluation or the pertinence these definitions. Because the health consequences of LBW could be preventable, providing early identification of at-risk neonates, a consensus for the standardized definition of LBW is required.

Glucose-lowering drugs with cardiovascular benefits as modifiers of critical elements of the human life history

The life history theory assumes that all organisms are under selective pressure to harvest external resources and allocate them to maximise fitness: only organisms making the best use of energy obtain the greatest fitness benefits. The trade-off of energy spans four functions: maintenance, growth, reproduction, and defence against pathogens. The innovative antihyperglycaemic agents glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors decrease bodyweight and have the potential to counter low-grade inflammation. These key activities could rewire two components of the life history theory operative in adulthood-ie, maintenance and defence. In this Personal View, we postulate that the benefits of these medications on the cardiovascular system, beyond their glucose-lowering effects, could be mediated by the reduction of the maintenance cost driven by obesity and efforts spent on blunting low-grade inflammation.

Life Span, Cause of Death and Neoplasia in B6C3F1 Mice Exposed In Utero to Low- and Medium-Dose-Rate Gamma Rays

Previously, we reported that while low-dose-rate (LDR) gamma-ray exposure to 20 mGy/day for the entire gestation period (gestation days 0-18) did not result in any significant effect in B6C3F1 pups up to 10 weeks of age when compared to the non-irradiated controls, exposure to medium-dose-rates (MDR, 200 and 400 mGy/day) resulted in growth retardation and gonadal hypoplasia, in addition to delayed ossification (only at 400 mGy/day). In the present work, we investigated the late effects of continuous in utero exposure to gamma rays at LDRs (0.05, 1.0 and 20 mGy/day) and at an MDR of 400 mGy/day, on life span, causes of death, neoplastic and non-neoplastic disease incidences in B6C3F1 mice. Reproductive parameters such as litter size and weaning rates was not significantly different among the LDR groups, but was significantly decreased in the MDR group, when compared to the non-irradiated controls. Mean life spans were not significantly different among the LDR exposed groups compared to the non-irradiated controls, whereas the life spans of those exposed to the MDR were significantly shorter than the non-irradiated controls. There was no significant difference in tumor spectra between the non-irradiated and LDR nor MDR irradiated groups. In mice exposed to MDR in utero, the over-all incidence rates shifted with increased incidences in the number of neoplasms of liver (both sexes) and endocrine (adrenals, pituitary and ovaries in females) origin with corresponding decreases in the incidence of malignant lymphomas (both sexes) and lung neoplasms (males). Multiple primary neoplasms were significantly increased only in females exposed to MDR. Results show that B6C3F1 mice exposed to gamma-rays in utero at LDRs of 0.05, 1 and 20 mGy/day for the entire gestation period (18 days) does not significantly alter lifespan, cause of death, neoplasm incidence rates and tumor spectra.

The Association of Self-Reported Birthweight with Lung Function and Respiratory Diseases: Results from a Multi-Centre, Multi-Case Control Study in Italy

Early life conditions are associated with lung function and the development of respiratory and non-respiratory illnesses. The relationship with birthweight (BW), however, is conflicting. We examined associations of self-reported BW with lung function and the development of respiratory and also non-respiratory diseases within the GEIRD (Gene-Environment Interaction in Respiratory Diseases) project, an Italian multi-centre, multi-case control study involving cases of COPD, asthma, allergic rhinitis and controls. Multinomial logistic regression was performed with case/control status as response variable; BW as main determinant; and adjusting for sex, age and smoking status. Of the 2287 participants reporting BW, 6.4% (n = 147) had low BW (<2500 g), and this proportion was greater in women than men (7.8% vs. 5.1%; p = 0.006). Both men and women with low BW were shorter than those with normal BW (mean ± SD: 160.2 ± 5.5 vs. 162.6 ± 6.5 cm in women, p = 0.009; 172.4 ± 6.1 vs. 174.8 ± 7.2 cm in men, p < 0.001). Although FEV1 and FVC were reduced in individuals with low BW, this was explained by associations with sex and height. In multivariable analysis, BW was not associated with respiratory diseases in adulthood. However, those with low BW had a higher risk of self-reported hospitalisation for lung disease before the age of two (10.3% vs. 4.1%; p < 0.001), severe respiratory infection before the age of five (16.9% vs. 8.8%; p = 0.001) and hypertension in adulthood (29.9% vs. 23.7%; p = 0.001); however, they had a lower risk of arrhythmia (2.7% vs. 5.8%; p = 0.027).

Double jeopardy-pregnancy and birth during a catastrophic bushfire event followed by a pandemic lockdown, a natural experiment

BACKGROUND

From November 2019 to January 2020, eastern Australia experienced the worst bushfires in recorded history. Two months later, Sydney and surrounds were placed into lockdown for six weeks due to the COVID-19 pandemic, followed by ongoing restrictions. Many pregnant women at this time were exposed to both the bushfires and COVID-19 restrictions.

OBJECTIVE

To assess the impact of exposure to bushfires and pandemic restrictions on perinatal outcomes.

METHODS

The study included 60 054 pregnant women who gave birth between November 2017 and December 2020 in South Sydney. Exposure cohorts were based on conception and birthing dates: 1) bushfire late pregnancy, born before lockdown; 2) bushfires in early-mid pregnancy, born during lockdown or soon after; 3) conceived during bushfires, lockdown in second trimester; 4) conceived after bushfires, pregnancy during restrictions. Exposure cohorts were compared with pregnancies in the matching periods in the two years prior. Associations between exposure cohorts and gestational diabetes, preeclampsia, hypertension, stillbirth, mode of birth, birthweight, preterm birth and small for gestational age were assessed using generalised estimating equations, adjusting for covariates.

RESULTS

A decrease in low birth weight was observed for cohort 1 (aOR 0.81, 95%CI 0.69, 0.95). Conversely, cohort 2 showed an increase in low birth weight, and increases in prelabour rupture of membranes, and caesarean sections (aOR 1.18, 95%CI 1.03, 1.37; aOR 1.21, 95%CI 1.07, 1.37; aOR 1.10 (1.02, 1.18) respectively). Cohort 3 showed an increase in unplanned caesarean sections and high birth weight babies (aOR 1.15, 95%CI 1.04, 1.27 and aOR 1.16, 95%CI 1.02, 1.31 respectively), and a decrease in gestational diabetes mellitus was observed for both cohorts 3 and 4.

CONCLUSION

Pregnancies exposed to both severe climate events and pandemic disruptions appear to have increased risk of adverse perinatal outcomes beyond only experiencing one event, but further research is needed.

Maternal diet quality moderates associations between parabens and birth outcomes

BACKGROUND/OBJECTIVE

Maternal paraben exposure and diet quality are both independently associated with birth outcomes, but whether these interact is unknown. We assessed sex-specific associations of parabens with birth outcomes and differences by maternal diet quality.

METHODS

Illinois pregnant women (n = 458) provided five first-morning urines collected at 8-40 weeks gestation, which we pooled for quantification of ethylparaben, methylparaben, and propylparaben concentrations. We collected/measured gestational age at delivery, birth weight, body length, and head circumference within 24 h of birth, and calculated sex-specific birth weight-for-gestational-age z-scores and weight/length ratio. Women completed three-month food frequency questionnaires in early and mid-to-late pregnancy, which we used to calculate the Alternative Healthy Eating Index (AHEI)-2010. Linear regression models evaluated sex-specific associations of parabens with birth outcomes, and differences in associations by average pregnancy AHEI-2010.

RESULTS

In this predominately non-Hispanic white, college-educated sample, maternal urinary paraben concentrations were only modestly inversely associated with head circumference and gestational length. However, methylparaben and propylparaben were inversely associated with birth weight, birth weight z-scores, body length, and weight/length ratio in female, but not male newborns. For example, each 2-fold increase in methylparaben concentrations was associated with -46.61 g (95% CI: -74.70, -18.51) lower birth weight, -0.09 (95% CI: -0.15, -0.03) lower birth weight z-scores, -0.21 cm (95% CI: -0.34, -0.07) shorter body length, and -0.64 g/cm (95% CI: -1.10, -0.19) smaller weight/length ratio in females. These inverse associations were more prominent in females of mothers with poorer diets (AHEI-2010 < median), but attenuated in those with healthier diets (AHEI-2010 ≥ median). In newborn males of mothers with healthier diets, moderate inverse associations emerged for propylparaben with gestational length and head circumference.

CONCLUSIONS

Maternal diet may moderate associations of parabens with birth size in a sex-specific manner. Additional studies may consider understanding the inflammatory and metabolic mechanisms underlying these findings.

Birth weight and long-term risk of mortality among US men and women: Results from three prospective cohort studies

Background

Weight at birth has been associated with the development of various adult diseases, but its association with mortality remains unclear.

Methods

We included 22,389 men from the Health Professionals Follow-up Study (1994-2018) and 162,231 women from the Nurses' Health Study (1992-2018) and the Nurses' Health Study II (1991-2019). The hazard ratios (HRs) of mortality according to birth weight were estimated by Cox proportional hazards regression models with adjustment for potential confounders.

Findings

Compared to women reporting a birth weight of 3.16-3.82 kg, the pooled HRs for all-cause mortality were 1.13 (95% CI, 1.08 to 1.17), 0.99 (95% CI, 0.96 to 1.02), 1.04 (95% CI, 1.00 to 1.08), and 1.03 (95% CI, 0.96 to 1.10), respectively, for women with a birth weight of <2.5, 2.5-3.15, 3.83-4.5, and >4.5 kg. In cause-specific mortality analyses, women reporting birth weight >4.5 kg had a higher risk of cancer mortality (HR=1.15, 95% CI: 1.00 to 1.31), whereas women with a birth weight <2.5 kg had an elevated risk of mortality from cardiovascular diseases (HR=1.15; 95% CI, 1.05 to 1.25) and respiratory diseases (HR=1.35; 95% CI, 1.18 to 1.54). Birth weight was unrelated to all-cause mortality among men, but cause-specific mortality analyses showed an inverse association with cardiovascular disease mortality and a positive association with cancer mortality (p for linear trend = 0.012 and 0.0039, respectively).

Interpretation

low birth weight was associated with a greater risk of cardiovascular and respiratory disease mortality among women, while large birth weight was associated with a greater cancer mortality risk in both men and women.

Funding

The National Institutes of Health grants U01-HL145386, U01-CA176726, R01-HL034594, R01-HL088521, UM-CA186107, P01-CA87969, R01-CA49449, R01-CA67262, U01-HL145386, U01-CA167552, R01-HL35464, and R24-ES028521-01 support this study.

Birth Weight and Body Composition as Determined by Isotopic Dilution with Deuterium Oxide in 6- to 8-Year-Old South African Children

Low and high birth weight (BW) are associated with obesity later in life; however, this association has not been extensively studied in African countries. This study determines the association between BW and body composition derived from deuterium oxide (D2O) dilution in 6- to 8-year-old South African children (n = 91; 40 boys, 51 girls). BW was recorded retrospectively from the children’s Road-to-Health cards. Weight and height were measured using standard procedures, and D2O dilution was used to determine total body water and, subsequently, to determine body fat. Fatness was classified using the McCarthy centiles, set at 2nd, 85th, and 95th (underfat, overfat and obese). BW correlated with body composition measures, such as body weight (r = 0.23, p = 0.03), height (r = 0.33, p < 0.001), and fat free mass (FFM; r = 0.27, p = 0.01). When multiple regression analysis was employed, BW significantly and positively associated with FFM (β = 0.24, p = 0.013; 95% CI: 0.032; 0.441) and fat mass (β = 0.21, p = 0.02, 95%CI: 0.001; 0.412) in girls and boys combined. A total of 13% of the children had a low BW, with 21% being overweight and 17% obese. More girls than boys were overweight and obese. Intervention strategies that promote healthy uterine growth for optimal BW are needed in order to curb the global obesity pandemic.

Association between indoor residual spraying and pregnancy outcomes: a quasi-experimental study from Uganda

BACKGROUND

Malaria is a risk factor for adverse pregnancy outcomes. Indoor residual spraying with insecticide (IRS) reduces malaria infections, yet the effects of IRS on pregnancy outcomes are not well established. We evaluated the impact of a large-scale IRS campaign on pregnancy outcomes in Eastern Uganda.

METHODS

Birth records (n = 59 992) were obtained from routine surveillance data at 25 health facilities from five districts that were part of the IRS campaign and six neighbouring control districts ∼27 months before and ∼24 months after the start of the campaign (January 2013-May 2017). Campaign effects on low birthweight (LBW) and stillbirth incidence were estimated using the matrix completion method (MC-NNM), a machine-learning approach to estimating potential outcomes, and compared with the difference-in-differences (DiD) estimator. Subgroup analyses were conducted by HIV and gravidity.

RESULTS

MC-NNM estimates indicated that the campaign was associated with a 33% reduction in LBW incidence: incidence rate ratio (IRR) = 0.67 [95% confidence interval (CI): 0.49-0.93)]. DiD estimates were similar to MC-NNM [IRR = 0.69 (0.47-1.01)], despite a parallel trends violation during the pre-IRS period. The campaign was not associated with substantial reductions in stillbirth incidence [IRRMC-NNM = 0.94 (0.50-1.77)]. HIV status modified the effects of the IRS campaign on LBW [βIRSxHIV = 0.42 (0.05-0.78)], whereby HIV-negative women appeared to benefit from the campaign [IRR = 0.70 (0.61-0.81)], but not HIV-positive women [IRR = 1.12 (0.59-2.12)].

CONCLUSIONS

Our results support the effectiveness of the campaign in Eastern Uganda based on its benefit to LBW prevention, though HIV-positive women may require additional interventions. The IRS campaign was not associated with a substantively lower stillbirth incidence, warranting further research.

Determining Gentrification's Relationship to Birth Outcomes in Metropolitan California

There is inconsistent evidence as to whether gentrification, the increase of affluent residents into low-income neighborhoods, is detrimental to health. To date, there is no systematic evidence on how gentrification may matter for a range of birth outcomes across cities with varying characteristics. We utilize California's Birth Cohort File (2009-2012), Decennial Census data, and the American Community Survey (2008-2012) to investigate the relationship of gentrification to: preterm birth, low birthweight, and small-for-gestational-age across California. We find that socioeconomic gentrification is uniformly associated with better birth outcomes. Notably, however, we find that only places specifically experiencing increases in non-White gentrification had this positive impact. These associations vary somewhat by maternal characteristics and by type of gentrification measure utilized; discrepancies between alternative measurement strategies are explored. This study provides evidence that socioeconomic gentrification is positively related to birth outcomes and the race-ethnic character of gentrification matters, emphasizing the continued need to examine how gentrification may impact a range of health and social outcomes.

In-utero personal exposure to PM2.5 impacted by indoor and outdoor sources and birthweight in the MADRES cohort

BACKGROUND

In-utero exposure to outdoor particulate matter with aerodynamic diameter less than 2.5 μm (PM_2.5) is linked with low birthweight. However, previous results are mixed, likely due to measurement error introduced by estimating personal exposure from ambient data. This study investigated the effect of total personal PM_2.5 exposure on birthweight and whether it differed when it was more heavily impacted by sources of indoor vs outdoor origin in the MADRES cohort study.

METHODS

Personal PM_2.5 exposure was measured in 205 pregnant women in the 3rd trimester using 48 h integrated, filter-based sampling. Linear regression was used to test the association between personal PM_2.5 exposure and birthweight, adjusting for key covariates. Interactions of PM_2.5 with variables representing indoor sources of PM_2.5, home ventilation, or time spent indoors tested whether the effect of total PM_2.5 on birthweight varied when it was more impacted by sources of indoor vs outdoor origin.

RESULTS

In a sample of largely Hispanic (81%) pregnant women, total personal PM_2.5 was not significantly associated with birthweight (β = 38.6 per 1SD increase in PM_2.5; 95% CI:-21.1, 98.2). This association however, differed by home type (single family home: 156.9 (26.9, 287.0), 2-4 attached units:-16.6 (-111.9, 78.7), 5+ units:-62.6 (-184.9, 59.6), missing: 145.4 (-4.1, 294.9), interaction p = 0.028) and by household air conditioner use (none of the time: -27.6 (-101.5, 46.3) vs. some of the time: 139.9 (42.9, 237.0), interaction p = 0.008) Additionally, the effect of personal PM_2.5 on birthweight varied by time spent indoors (none or little of the time: - 45.1 (-208.3, 118.1) vs. most or all of the time: 57.1 (-7.3, 121.6), interaction p = 0.255).

CONCLUSIONS

While no significant association between total personal PM_2.5 exposure and birthweight was found, there was evidence that multi-unit housing (vs. single-family homes), candle and/or incense smoke, and greater outdoor source contributions to personal PM_2.5 were more strongly associated with lower birthweight.

Prevalence, Risk Factors, and Short-Term Outcomes of Full-Term Low Birth Weight Infants Born at a Tertiary Academic Center: A Prospective Case-Control Study

OBJECTIVE

Low birth weight (LBW) infants (<2,500 g) continued to be a global health problem because of the associated short- and long-term adverse outcomes. The study aimed to determine the prevalence, risk factors, and short-term outcomes of term LBW infants STUDY DESIGN:  A prospective and case-control study. All infants born consecutively from September 1, 2018 to August 31, 2019 were included. Cases, term LBW infants, were 1:1 matched to controls, appropriate for gestational age (AGA) term infants. Major congenital or chromosomal anomalies and multiple pregnancies were excluded.

RESULTS

The prevalence of term LBW in the studied period was 4.8%. Mothers of term LBW infants had significantly lower body mass index (p = 0.05), gained less weight (p = 0.01), had a history of previous LBW (p = 0.01), and lower monthly income (p = 0.04) compared with mothers of term AGA infants even after adjustment for confounders. A nonsignificant higher number of term LBW infants needed NICU admission, while their need for phototherapy was deemed significant.

CONCLUSION

We identified nutritional and socioeconomic maternal factors that are significantly associated with LBW infants and should be targeted during antenatal visits to improve neonatal outcomes.

KEY POINTS

· LBW infants (<2,500 g) are at risk of short- and long-term morbidities.. · Poor maternal nutritional and socioeconomic factors increase the risk of LBW infant.. · Targeting identified risk factors of LBW infant antenatally improve neonatal outcomes.

Piperaquine-Induced QTc Prolongation Decreases With Repeated Monthly Dihydroartemisinin-Piperaquine Dosing in Pregnant Ugandan Women

BACKGROUND

Intermittent preventive treatment with monthly dihydroartemisinin-piperaquine (DHA-PQ) is highly effective at preventing both malaria during pregnancy and placental malaria. Piperaquine prolongs the corrected QT interval (QTc), and it is possible that repeated monthly dosing could lead to progressive QTc prolongation. Intensive characterization of the relationship between piperaquine concentration and QTc interval throughout pregnancy can inform effective, safe prevention guidelines.

METHODS

Data were collected from a randomized controlled trial, where pregnant Ugandan women received malaria chemoprevention with monthly DHA-PQ (120/960 mg DHA/PQ; n = 373) or sulfadoxine-pyrimethamine (SP; 1500/75 mg; n = 375) during the second and third trimesters of pregnancy. Monthly trough piperaquine samples were collected throughout pregnancy, and pre- and postdose electrocardiograms were recorded at 20, 28, and 36 weeks' gestation in each woman. The pharmacokinetics-QTc relationship for piperaquine and QTc for SP were assessed using nonlinear mixed-effects modeling.

RESULTS

A positive linear relationship between piperaquine concentration and Fridericia corrected QTc interval was identified. This relationship progressively decreased from a 4.42 to 3.28 to 2.13 millisecond increase per 100 ng/mL increase in piperaquine concentration at 20, 28, and 36 weeks' gestation, respectively. Furthermore, 61% (n = 183) of women had a smaller change in QTc at week 36 than week 20. Nine women given DHA-PQ had grade 3-4 cardiac adverse events. SP was not associated with any change in QTc.

CONCLUSIONS

Repeated DHA-PQ dosing did not result in increased risk of QTc prolongation and the postdose QTc intervals progressively decreased. Monthly dosing of DHA-PQ in pregnant women carries minimal risk of QTc prolongation.

CLINICAL TRIALS REGISTRATION

NCT02793622.

Prenatal adherence to the Mediterranean diet decreases the risk of having a small-for-gestational-age baby, ECLIPSES study

There is little evidence regarding the role that consuming a Mediterranean diet (MedDiet) during pregnancy plays in foetal growth. We therefore examined the relationship between maternal MedDiet adherence during pregnancy and anthropometric measures and small-for-gestational-age (SGA) at birth in a Spanish population on the north-eastern Mediterranean coast of Spain. Prospective analysis involved 614 mother–newborn pairs from the ECLIPSES study. Diet during pregnancy was assessed using a validated food frequency questionnaire, and a relative MedDiet score (rMedDiet) was calculated. Neonatal information, including weight, length, head circumference and SGA (< 10th percentile) at birth, was recorded. Multivariable logistic regression analyses were performed. The mean rMedDiet score was 9.8 (SD 2.1), ranging from 5 to 16 points. In the sample, 45% of the women had low (≤ 9 points), 32% had medium (10–11 points), and 22% had high (≥ 12 points) adherence to the rMedDiet. There was no association between rMedDiet and birth weight, length, head circumference or anthropometric indices (weight/length ratio and ponderal index). Pregnant women with a high rMedDiet score had a lower risk of delivering a SGA baby for weight (high vs low, OR = 0.36; 95% CI 0.16–0.79) and head circumference (high vs low, OR = 0.39; 95% CI 0.18–0.86), and a nonsignificant decrease in risk of SGA for length (high vs low, OR = 0.57; 95% CI 0.28–1.17). In conclusion, closer adherence to the MedDiet during pregnancy may have beneficial effects on foetal growth.

Associations between seasonal ambient air pollution and adverse perinatal outcomes: a retrospective cohort study in Wenzhou, China

Prenatal exposure to ambient air pollution has been associated with adverse perinatal outcomes in previous studies. However, few studies have examined the interaction between air pollution and the season of conception on term low birth weight (TLBW) or macrosomia. Birth registry data of singleton live births in Wenzhou, China, between January 2015 and December 2016 were accessed from the Wenzhou Maternal and Child Health Information Management platform, and data on the ambient air pollutants in Wenzhou were obtained from the Chinese Air Quality Online Monitoring and Analysis Platform. Single-/two-pollutant binary logistic regression models were used to assess the associations between ambient air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, and O₃) and TLBW/macrosomia, further exploring whether the season of conception interacts with air pollution to impact birth weight. Finally, 213,959 term newborns were selected, including 2452 (1.1%) infants with TLBW and 13,173 (6.1%) infants with macrosomia. In the single-/two-pollutant models, we observed an increased risk of TLBW associated with maternal exposure to PM_2.5, PM₁₀, SO₂, and NO₂ during the entire pregnancy, especially in the 2nd trimester. Maternal exposure to O₃ during the 1st trimester was associated with increased macrosomia risk, and O₃ exposure during the 3rd trimester was associated with increased TLBW risk. Pregnant women who conceive in the warm season may experience a more adverse ambient air environment that is related to the risks of TLBW. These findings add to the evidence suggesting that air pollution and the season of conception may have synergistic effects on adverse perinatal outcomes, especially TLBW. Further prospective cohort studies are needed to validate our results.

Study protocol for a randomized trial on timely delivery versus expectant management in late preterm small for gestational age pregnancies with an abnormal umbilicocerebral ratio (UCR): the DRIGITAT study

BACKGROUND

The clinical inability to correctly identify late fetal growth restriction (FGR) within a group of fetuses who are identified as small for gestational age (SGA) is an everyday problem for all obstetrician-gynecologists. This leads to substantial overtreatment of healthy small fetuses but also inadequate detection of the growth-restricted fetuses that may benefit from timely delivery. Redistribution of the fetal circulation, signaled by an abnormal ratio of the Doppler velocity flow profiles of the umbilical artery and the middle cerebral artery, more specifically an increased umbilicocerebral ratio (UCR) (or its inverse: a decreased cerebroplacental ratio (CPR)), is an adaptation to chronic hypoxemia and nutritional scarcity with long-term consequences in survivors. The relevance of an abnormal UCR has been signaled extensively, and there is a general consensus that it is a signal of FGR, independent of size, with a strong association with poor outcomes. Yet, in the current literature, no comparisons of a monitoring-delivery strategy based on unfavorable UCR have been published. The objective of the Doppler Ratio In fetal Growth restriction Intervention Trial At (near) Term (DRIGITAT) is to evaluate if the timing of the delivery based on an abnormal UCR in late preterm fetuses identified as SGA improves neurodevelopmental outcomes at 2 years of age.

METHODS

The DRIGITAT study is a national multicenter cohort study of women with singleton pregnancies between 32 and 37 weeks of gestation identified as SGA, with a nested randomized controlled trial (RCT) in case of an abnormal UCR (> 0.8). Recruiting centers are in The Netherlands. In the nested RCT, women are randomized to either immediate induction of labor or expectant management from 34 weeks in case of severely abnormal size (EFW or FAC < p3) and from 36 weeks in case of mildly abnormal size (EFW or FAC p3-p10). The primary outcome measure is the 7-point average difference in the composite cognitive score (CCS) and composite motor score (CMS) on the Bayley-3 at 2 years. Secondary outcome measures include a composite outcome of neonatal morbidity, perinatal mortality, mode of delivery, maternal quality of life, costs, and predictive value of serum biomarkers. Analyses will be by intention to treat. The required sample size is determined for the nested RCT as 185 patients.

DISCUSSION

This study will provide insight into the diagnostic efficacy of UCR measurement in the evaluation of SGA fetuses in order to differentiate the healthy SGA fetus from the growth-restricted fetus and to determine if a fetus with abnormal UCR benefits from early delivery.

TRIAL REGISTRATION

Healthcare Evaluation Netherlands NTR6663 . Registered on 14 August 2017.

Risk factors in adolescence as predictors of trajectories of somatic symptoms over 27 years

BACKGROUND

Somatic symptoms among adolescents are common, yet little is known about long-term trajectories of somatic symptoms and the factors in adolescence that shape them. We examined individual, family and school-based factors at age 16 as predictors of trajectories of somatic symptoms over 27 years.

METHODS

Participants from the Northern Swedish Cohort (n = 1001) responded to questions about individual factors (e.g. health behaviours), family factors (e.g. contact with parents, social and material adversity) and school satisfaction at age 16; as well as 10 somatic symptoms at ages 16, 18, 21, 30 and 43. Teacher assessments at age 16 included overall ability at school and peer relations. Age 16 predictors of somatic symptom trajectory group membership were analysed using multinomial logistic regression.

RESULTS

Poor contact with mother and poor school satisfaction were significant predictors of adverse symptom trajectories among both men and women. Low birth weight and low parental academic involvement were contributing factors for women, while smoking and social adversity were more relevant factors for men.

CONCLUSIONS

Our findings emphasize the importance of a holistic approach that considers the unique contributions of individual, family and school-based factors in the development of trajectories of somatic symptoms from adolescence to middle age.

Mother-level random effect in the association between PM2.5 and fetal growth: A population-based pregnancy cohort

BACKGROUND

A growing body of literature reports associations between exposure to particulate matter with diameter ≤2.5 μm (PM_2.5) during pregnancy and birth outcomes. However, findings are inconsistent across studies.

OBJECTIVES

To assess the association between PM_2.5 and birth outcomes of fetal growth in a cohort with high prevalence of siblings by multilevel models accounting for geographical- and mother-level correlations.

METHODS

In Israel, we used Maccabi Healthcare Services data to establish a population-based cohort of 381,265 singleton births reaching 24-42 weeks' gestation and birth weight of 500-5000 g (2004-2015). Daily PM_2.5 predictions from a satellite-based spatiotemporal model were linked to the date of birth and maternal residence. We generated mean PM_2.5 values for the entire pregnancy and for exposure periods during pregnancy. Associations between exposure and birth outcomes were modeled by using multilevel logistic regression with random effects for maternal locality of residence, administrative census area (ACA) and mother.

RESULTS

In fully adjusted models with a mother-level random intercept only, a 10-μg/m³ increase in PM_2.5 over the entire pregnancy was positively associated with term low birth weight (TLBW) (Odds ratio, OR = 1.25, 95% confidence interval, CI: 1.09,1.43) and small for gestational age (SGA) (OR = 1.15, 95% CI: 1.06,1.26). Locality- and ACA-level effects accounted for <0.4% of the variance while mother-level effects explained ∼50% of the variability. Associations varied by exposure period, infants' sex, birth order, and maternal pre-pregnancy BMI.

CONCLUSIONS

Consideration of mother-level variability in a region with high fertility rates provides new insights on the strength of associations between PM_2.5 and birth outcomes.

Unintended consequences of welfare reform: Evidence from birthweight of Aboriginal children in Australia

In 2007, Australia introduced its most radical welfare reform in recent history, targeting Aboriginal communities with the aim of protecting children from harm. The 'income management' policy forced Aboriginal welfare recipients to spend at least half of their government transfers on essentials (e.g. food, housing), and less on non-essentials (e.g. alcohol, tobacco). By exploiting its staggered rollout, we estimate the impact of in utero exposure to the policy rollout on birthweight. We find that exposure to the income management policy reduced average birthweight robustly by 85 g and increased the risk of low birth weight by 3 percentage points. This finding is not explained by behavioral change (fertility, maternal risk behavior, access to care), or survival probabilities of at-risk fetuses. More likely, a lack of policy implementation planning and infrastructure led to acute income insecurity and stress during the rollout period, exacerbating the existing health inequalities it sought to address.

Household income, fetal size and birth weight: an analysis of eight populations

BACKGROUND

The age at onset of the association between poverty and poor health is not understood. Our hypothesis was that individuals from highest household income (HI), compared to those with lowest HI, will have increased fetal size in the second and third trimester and birth.

METHODS

Second and third trimester fetal ultrasound measurements and birth measurements were obtained from eight cohorts. Results were analysed in cross-sectional two-stage individual patient data (IPD) analyses and also a longitudinal one-stage IPD analysis.

RESULTS

The eight cohorts included 21 714 individuals. In the two-stage (cross-sectional) IPD analysis, individuals from the highest HI category compared with those from the lowest HI category had larger head size at birth (mean difference 0.22 z score (0.07, 0.36)), in the third trimester (0.25 (0.16, 0.33)) and second trimester (0.11 (0.02, 0.19)). Weight was higher at birth in the highest HI category. In the one-stage (longitudinal) IPD analysis which included data from six cohorts (n=11 062), head size was larger (mean difference 0.13 (0.03, 0.23)) for individuals in the highest HI compared with lowest category, and this difference became greater between the second trimester and birth. Similarly, in the one-stage IPD, weight was heavier in second highest HI category compared with the lowest (mean difference 0.10 (0 .00, 0.20)) and the difference widened as pregnancy progressed. Length was not linked to HI category in the longitudinal model.

CONCLUSIONS

The association between HI, an index of poverty, and fetal size is already present in the second trimester.

Using Mendelian Randomisation to Prioritise Candidate Maternal Metabolic Traits Influencing Offspring Birthweight

Marked physiological changes in pregnancy are essential to support foetal growth; however, evidence on the role of specific maternal metabolic traits from human studies is limited. We integrated Mendelian randomisation (MR) and metabolomics data to probe the effect of 46 maternal metabolic traits on offspring birthweight (N = 210,267). We implemented univariable two-sample MR (UVMR) to identify candidate metabolic traits affecting offspring birthweight. We then applied two-sample multivariable MR (MVMR) to jointly estimate the potential direct causal effect for each candidate maternal metabolic trait. In the main analyses, UVMR indicated that higher maternal glucose was related to higher offspring birthweight (0.328 SD difference in mean birthweight per 1 SD difference in glucose (95% CI: 0.104, 0.414)), as were maternal glutamine (0.089 (95% CI: 0.033, 0.144)) and alanine (0.137 (95% CI: 0.036, 0.239)). In additional analyses, UVMR estimates were broadly consistent when selecting instruments from an independent data source, albeit imprecise for glutamine and alanine, and were attenuated for alanine when using other UVMR methods. MVMR results supported independent effects of these metabolites, with effect estimates consistent with those seen with the UVMR results. Among the remaining 43 metabolic traits, UVMR estimates indicated a null effect for most lipid-related traits and a high degree of uncertainty for other amino acids and ketone bodies. Our findings suggest that maternal gestational glucose and glutamine are causally related to offspring birthweight.

Associations of Fetal and Infant Growth Patterns With Early Markers of Arterial Health in School-Aged Children

IMPORTANCE

Fetal life and infancy might be critical periods for predisposing individuals to develop cardiovascular disease in adulthood.

OBJECTIVE

To examine the associations of fetal and infant weight growth patterns with early markers of arterial health.

DESIGN, SETTING, AND PARTICIPANTS

This population-based prospective cohort study was conducted from early fetal life onward among 4484 offspring of women in Rotterdam, the Netherlands, delivering between April 1, 2002, and January 31, 2006. Statistical analysis was performed between January 1 and August 31, 2021.

EXPOSURES

Estimated fetal weight was measured in the second and third trimester. Data on weight and gestational age at birth were collected from midwives. Infant weight was measured at 6, 12, and 24 months.

MAIN OUTCOMES AND MEASURES

The common carotid intima-media thickness (cIMT) and carotid distensibility were measured as early markers of arterial health.

RESULTS

Follow-up measurements were available for 4484 children (2260 girls [50.4%]; median age, 9.7 years [95% range, 9.3-10.5 years]; and 2578 [57.5%] of Dutch ethnicity). Gestational age at birth was not associated with markers of arterial health. A 500-g-higher birth weight was associated with increased cIMT (standard deviation score [SDS], 0.08 mm [95% CI, 0.05-0.10 mm]) and a lower carotid distensibility (SDS, -0.05 × 10-3 kPa-1; [95% CI, -0.08 to -0.03 × 10-3 kPa-1]). Compared with children with a birth weight of 2500 to 4500 g, those weighing more than 4500 g had the lowest carotid distensibility (difference in SDS, -0.22 × 10-3 kPa-1 [95% CI, -0.42 to -0.02 × 10-3 kPa-1]). Conditional regression analyses showed that higher third-trimester fetal weight and birth weight were associated with increased cIMT (difference in SDS: third-trimester fetal weight, 0.08 mm [95% CI, 0.04-0.12 mm]; birth weight, 0.05 mm [95% CI, 0.01-0.09 mm]) and that higher weight at 6, 12, and 24 months was associated with increased cIMT (difference in SDS: 6 months, 0.05 mm [95% CI, 0.01-0.10 mm]; 12 months, 0.06 mm [95% CI, 0.02-0.10 mm]; and 24 months, 0.07 mm [95% CI, 0.03-0.11 mm]) and lower carotid distensibility (difference in SDS: 6 months, -0.04 × 10-3 kPa-1 [95% CI, -0.09 to -0.001 × 10-3 kPa-1]; 12 months, -0.05 × 10-3 kPa-1 [95% CI, -0.09 to -0.01 × 10-3 kPa-1]; and 24 months, -0.10 × 10-3 kPa-1 [95% CI, -0.15 to -0.06 × 10-3 kPa-1]). Compared with children with normal fetal and infant growth, children with normal fetal growth that was followed by accelerated infant growth had the highest cIMT (SDS, 0.19 mm [95% CI, 0.07-0.31 mm]) and lowest carotid distensibility (SDS, -0.16 × 10-3 kPa-1 [95% CI, -0.28 to -0.03 × 10-3 kPa-1]). The observed associations were largely explained by childhood body mass index.

CONCLUSIONS AND RELEVANCE

In this cohort study of 4484 children aged approximately 10 years, higher fetal and infant weight growth patterns were associated with early markers of impaired arterial health. Childhood body mass index seemed to be involved in the underlying pathways of the observed associations.

Risk factors associated with low birth weight

OBJECTIVES

Low birth weight (LBW) is one of the major factors affecting child morbidity and mortality worldwide. Every day, approximately 800 women die from causes related to pregnancy and childbirth worldwide. Maternal ill health increases the risk of LBW. This study seeks to investigate determinants and incidence of LBW.

METHODS

This study was conducted based on the medical records of mothers and their 1,946 infants born in 2016-2019 at the Department of Gynaecology and Obstetrics of Louis Pasteur University Hospital in Košice. Data on mothers and newborn infants were obtained from the Reports on mothers at childbirth. The inclusion criteria were singleton births and birth weight > 500 g. The exclusion criteria were twins or multiple births, congenital anomalies and stillbirths, birth weight ≥ 4,000 g or ≤ 500 g, and Roma ethnicity. Roma children are more likely to be born prematurely, with low birth weight. Roma mothers have different lifestyle. Univariate analysis was employed to evaluate the association between the independent variables and LBW. Variables that were found to be statistically significant were then further analysed using multivariable logistic analysis for each dependent variable. The implementation of the research was approved by the Ethics Committee.

RESULTS

Of 1,946 newborns, 271 (13.90%) have low birth weight. The mean of birth weight at delivery was 3,068.62 (SD 671.16) grams. Factors that were associated with LBW were primary maternal education (OR = 2.98, 95% CI: 1.08-8.21, p = 0.034), marital status single (OR = 2.88, 95% CI: 1.68-4.94, p < 0.001), number of prenatal care visits less than 8 (OR = 1.62, 95% CI: 1.01-2.61, p = 0.047), and preterm birth (OR = 74.94, 95% CI: 45.44-123.61, p < 0.001).

CONCLUSION

The reducing of LBW requires strategies to improve maternal lifestyle, maternal care before, during and after birth and to strengthen social support.

Social Isolation Stress Modulates Pregnancy Outcomes and the Inflammatory Profile of Rat Uterus

Prenatal stressors have been linked to adverse pregnancy outcomes; including preterm birth (PTB). Recent work demonstrates that social isolation in mothers represents a silent stressor contributing to PTB risk. Here; we investigate the association of inflammatory and stress markers with PTB risk in Long–Evans rats exposed to social isolation stress (SIS) during preconception and pregnancy across four generations (F0-F3). Gestational length; blood glucose; corticosterone levels; and maternal and offspring weights were assessed in two SIS paradigms: transgenerational (TG) and multigenerational (MG) exposure. Maternal uterine tissues were collected 21 days after the dams gave birth. Exposure to SIS reduced pregnancy lengths in the parental generation and neonatal birth weights in the F1 and F2 generations. Interleukin (IL)-1β (Il1b) mRNA levels increased in F0 animals but decreased in the offspring of both stress lineages. Protein levels of IL-1β decreased in the TG lineage. Corticotrophin-releasing hormone receptor 1 (Crhr1) expression decreased in SIS-exposed F0 animals and increased in the TG-F2 and MG-F1 offspring. Expression of enzyme 11-β hydroxysteroid dehydrogenase-2 (11bHSD2) was enhanced in F1 animals. These findings suggest SIS has adverse consequences on the F0 mothers; but their F1–F3 progeny may adapt to this chronic stress; thus supporting the fetal programming hypothesis.

Trends in Mortality of Low Birth Weight Infants - China, 2004-2019

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?

Low birth weight (LBW) significantly affects the health of children during the perinatal period, neonatal period, and infancy, and is an important risk factor for neonatal death.

WHAT IS ADDED BY THIS REPORT?

The mortality rate of low birth weight infants(LBWI) decreased from 2004 to 2019 in China, while the proportion of overall infant deaths due to LBW increased.

WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICES?

A key way to reduce child mortality and improve children's health is to reduce the occurrence of LBW and associated mortality.

Joint associations among prenatal metal mixtures and nutritional factors on birth weight z-score: Evidence from an urban U.S. population

The benefits of nutritional factors on birth outcomes have been recognized, however, limited studies have examined the role of nutritional factors in mitigating the detrimental effects of metals exposure during gestation. We used data collected from 526 mother-infant dyads enrolled in the Programming of Intergenerational Stress Mechanisms longitudinal pregnancy cohort to examine the joint effects of prenatal exposure to metals and maternal nutrition on birth weight for gestational age (BWGA) z-scores. We measured concentrations of twelve metals and trace elements in urine samples collected during pregnancy. Maternal nutritional intake was measured using the Block98 Food Frequency Questionnaire and converted into energy-adjusted consumption of individual nutrients. Using multivariable linear regression and Bayesian Kernel Machine Regression, we found that three metals [cobalt (Co), nickel (Ni), and lead (Pb)] and five metals [barium (Ba), caesium (Cs), copper (Cu), Ni, and zinc (Zn)] were associated with BWGA z-score in male and female infants, respectively. When examining the sex-specific interactions between these metals and nutrient groups [macro nutrients, minerals, A vitamins, B vitamins, anti-oxidant, methyl-donor nutrients, and inflammatory (pro- and anti-)] using a Cross-validated Kernel Ensemble model, we identified significant interactions between the macro nutrients and Co (p = 0.05), minerals and Pb (p = 0.04), and A vitamins and Ni (p = 0.001) in males. No significant interactions were found in females. Furthermore, three minerals (phosphorus, iron, potassium) and vitamin A were found to be more crucial than other nutrients in modifying the association between each respective metal and BWGA z-score in males. A better understanding of the sex-specific interactions between nutrients and metals on birth weight can guide pregnant women to protect their neonates from the adverse health impacts of metal exposures by optimizing nutrient intakes accordingly.

Placental multi-omics integration identifies candidate functional genes for birthweight

Abnormal birthweight is associated with increased risk for cardiometabolic diseases in later life. Although the placenta is critical to fetal development and later life health, it has not been integrated into largescale functional genomics initiatives, and mechanisms of birthweight-associated variants identified by genome wide association studies (GWAS) are unclear. The goal of this study is to provide functional mechanistic insight into the causal pathway from a genetic variant to birthweight by integrating placental methylation and gene expression with established GWAS loci for birthweight. We identify placental DNA methylation and gene expression targets for several birthweight GWAS loci. The target genes are broadly enriched in cardiometabolic, immune response, and hormonal pathways. We find that methylation causally influences WNT3A, CTDNEP1, and RANBP2 expression in placenta. Multi-trait colocalization identifies PLEKHA1, FES, CTDNEP1, and PRMT7 as likely functional effector genes. These findings reveal candidate functional pathways that underpin the genetic regulation of birthweight via placental epigenetic and transcriptomic mechanisms. Clinical trial registration; ClinicalTrials.gov, NCT00912132.

Effect of Nutrition Interventions Before and/or During Early Pregnancy on Low Birth Weight in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

This review aimed at synthesizing evidence on the effectiveness of nutritional interventions that were carried out before and/or during early pregnancy versus the control groups on reducing the risk of low weight at birth in sub-Saharan Africa.

METHODS

We have searched on MEDLINE, SCOPUS, CINAHL, HINARI, and Cochrane Library of systematic review databases for published articles in English language from 2010 to 2021 years. For unpublished studies, we searched on Google scholar. Randomized controlled trial studies of nutritional interventions carried out before/or during early pregnancy in sub-Saharan Africa to improve low birth weight were considered. The data were extracted and pooled using the Joanna Briggs Institute software. The effect size was calculated using fixed-effect models. Mantel-Haenszel method was used to calculate the relative risk with their respective 95% CI. Heterogeneity was assessed using the standard chi-square and I ² tests.

RESULTS

Seven studies were included in the review with a total of 5934 participants. Three types of nutritional interventions were identified: iron supplementations, lipid-based supplementations, and nutritional education and counseling. We have identified only one intervention started during preconception. The meta-analysis showed that none of the identified nutrition interventions had a statistically significant effect on low birth weight.

CONCLUSIONS

Based on the review evidence, nutritional interventions before and/or during early pregnancy in sub-Saharan Africa had no significant effect on low birth weight. However, since our evidence was derived from a small number of trials and participants, a large-scale randomized controlled trials review might be required to elucidate the finding.

Immigrant ancestry and birthweight across two generations born in Sweden: an intergenerational cohort study

INTRODUCTION

Differences in birthweight are often seen between migrants and natives. However, whether migrant-native birthweight inequalities widen, narrow or remain persistent across generations when comparing the descendants of immigrants and natives remains understudied. We examined inequalities in birthweight of mothers (G2) and daughters (G3) of foreign-born grandmothers (G1) compared with those of Swedish-born grandmothers.

METHODS

We used population registers with multigenerational linkages to identify 314 415 daughters born in Sweden during the period 1989-2012 (G3), linked to 246 642 mothers (G2) born in Sweden during 1973-1996, and to their grandmothers (G1) who were Swedish or foreign-born. We classified migrants into non-western, Eastern European, the rest of Nordic and Western. We used multivariable methods to examine mean birthweight and low birthweight (<2500 g; LBW).

RESULTS

Birthweight between individuals with Swedish background (G1) and non-western groups increased from -80 g to -147 g between G2 (mothers) and G3 (daughters), respectively. Furthermore, the odds of LBW increased among the G3 non-western immigrants compared with those with Swedish grandmothers (OR: 1.38, 95% CI 1.12 to 1.69). Birthweight increased in both descendants of Swedes and non-western immigrants, but less so in the latter (83 g vs 16 g).

CONCLUSION

We observed an increase in birthweight inequalities across generations between descendants of non-western immigrants and descendants of Swedes. This finding is puzzling considering Sweden has been lauded for its humanitarian approach to migration, for being one of the most egalitarian countries in the world and providing universal access to healthcare and education.

Foeto-maternal complications associated with low birth weight: A prospective multicenter study in northern Ghana

Objective

The study evaluated the socio-demographic characteristics, obstetric variables and foeto-maternal complications associated with low birth weight (LBW) in order to provide better treatment and management options.

Methods

The prospective study conducted from February, 2019 to June, 2020 recruited 312 primigravid pregnant women who reported for antenatal care in three tertiary referral hospitals in northern Ghana. Their socio-demographic, obstetric and adverse foeto-maternal outcome information were obtained with a well-structured questionnaire according to the World Health Organisation (WHO) guidelines. Participants’ blood samples were collected for haematological tests. Odds ratio [OR, 95% confidence interval (CI)] for the association between socio-demographic, obstetric characteristics, foeto-maternal complications and haematological tests in relation to LBW were assessed using logistic regression model.

Results

This study reported a LBW prevalence of 13.5%. Increasing maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 1st visit, before and after delivery significantly increased the odds of LBW. Preterm delivery (PTD<37 weeks) (COR = 9.92, 95% CI (4.87–2020), p<0.001), preeclampsia (PE) (COR = 5.94, 95% CI (2.96–11.94), p<0.001), blood transfusion (COR = 14.11, 95% CI (2.50–79.65), p = 0.003), caesarian delivery (COR = 3.86, 95% CI (1.96–7.58), p<0.001) and male sex neonates (COR = 2.25, 95%CI (1.14–4.47), P = 0.020) presented with increased odds of LBW. Increasing gestational age at delivery presented with 28% reduced odds of LBW (COR = 0.72, 95% CI (1.12–4.40), P = 0.023). Upon controlling for potential confounders in multivariate logistic regression, only gestational age at delivery (AOR = 0.67, 95% CI (0.47–0.96), P = 0.030) remained significantly associated with reduced odds of LBW.

Conclusion

This study found that high blood pressure at 1st visit, before and after delivery results in increased chances of delivering a baby with LBW. Furthermore, PTD<37 weeks, having PE in current pregnancy, and male sex potentiate the risk of LBW. On the other hand, increasing gestational age reduces the risk of LBW. Thus, we recommend that midwives should intensify education to pregnant women on the benefits of regular ANC visits to aid in the early detection of adverse foeto-maternal complications. We also recommend proper clinical management of pregnancies associated with an elevated blood pressure at registration. Also, maternal intrapartum blood pressure measurement could be used to predict LBW in low resourced settings.

Clinical phenotypes for risk stratification in small-for-gestational-age fetuses

OBJECTIVE

To evaluate whether clinical phenotypes of small-for-gestational-age (SGA) fetuses can be identified and used for adverse perinatal outcome risk stratification to facilitate clinical decision-making.

METHODS

This was a multicenter observational cohort study conducted in two tertiary care university hospitals. SGA fetuses were classified according to maternal, fetal and placental conditions using a two-step cluster algorithm, in which fetuses with more than one condition were assigned to the cluster associated with the highest mortality risk. Delivery and perinatal outcomes were compared using chi-square test among SGA clusters, and the associations between outcomes and each cluster were evaluated by calculating odds ratios (OR), adjusted for gestational age.

RESULTS

The study included 17 631 consecutive singleton pregnancies, of which 1274 (7.2%) were defined as SGA at birth according to INTERGROWTH-21^st standards. Nine SGA clinical phenotypes were identified using a predefined conceptual framework. All delivery and perinatal outcomes analyzed were significantly different among the nine phenotypes. The whole SGA cohort had a three-times higher risk of perinatal mortality compared with non-SGA fetuses (1.4% vs 0.4%; P < 0.001). SGA clinical phenotypes exhibited three patterns of perinatal mortality risk: the highest risk was associated with congenital anomaly (8.3%; OR, 17.17 (95% CI, 2.17-136.12)) and second- or third-trimester hemorrhage (8.3%; OR, 9.94 (95% CI, 1.23-80.02)) clusters; medium risk was associated with gestational diabetes (3.8%; OR, 9.59 (95% CI, 1.27-72.57)), preterm birth (3.2%; OR, 4.65 (95% CI, 0.62-35.01)) and intrauterine growth restriction (3.1%; OR, 5.93 (95% CI, 3.21-10.95)) clusters; and the lowest risk was associated with the remaining clusters. Perinatal mortality rate did not differ between SGA fetuses without other clinical conditions (54.1% of SGA fetuses) and appropriate-for-gestational-age fetuses (0.1% vs 0.4%; OR, 0.41 (95% CI, 0.06-2.94); P = 0.27). SGA combined with other obstetric pathologies increased significantly the risk of perinatal mortality, as demonstrated by the increased odds of perinatal death in SGA cases with gestational diabetes compared to non-SGA cases with the same condition (OR, 24.40 (95% CI, 1.31-453.91)).

CONCLUSIONS

We identified nine SGA clinical phenotypes associated with different patterns of risk for adverse perinatal outcome. Our findings suggest that considering clinical characteristics in addition to ultrasound findings could improve risk stratification and decision-making for management of SGA fetuses. Future clinical trials investigating management of fetuses with SGA should take into account clinical information in addition to Doppler parameters and estimated fetal weight. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Low birth weight infant among teenage pregnancy in Terengganu, Malaysia: A cross-sectional study

INTRODUCTION

The purpose of this research is to determine the factors associated with low-birth-weight (LBW) infants in teenage pregnancy.

METHODS

A cross-sectional study was conducted in Terengganu, Malaysia, from January 1, 2020, to May 31, 2020. Records of teenage pregnancies in 2018 were retrieved from the Maternal Health Record Book and Pregnant Woman and Postnatal Book Registry. Simple logistic and multiple logistic regression analysis was used to analyse the factors associated with LBW infants in teenage pregnancy.

RESULTS

All 357 cases that fulfilled the study criteria were included. LBW infants were the most common perinatal outcome among teenage pregnancies (19.3%), followed by preterm birth (9.0 %), and both low Apgar score and stillbirth (1.4% each). Factors associated with low-birth-weight infants in teenage pregnancy in Terengganu were a teenage husband (AOR 2.0; 95% CI: 1.01, 3.96; p=0.047) and a mother with a low level of education (AOR 3.07; 95% CI: 1.20, 7.85; p=0.019).

CONCLUSION

Teenage husband and low level of maternal education are significant factors that need to be addressed to improve teenage pregnancy outcomes. Interventions to improve these factors should continue to be encouraged.

Association of In Utero Exposures With Risk of Early Natural Menopause

Suboptimal pregnancy conditions may affect ovarian development in the fetus and be associated with early natural menopause (ENM) for offspring. A total of 106,633 premenopausal participants in Nurses' Health Study II who provided data on their own prenatal characteristics, including diethylstilbestrol (DES) exposure, maternal cigarette smoking exposure, multiplicity, prematurity, and birth weight, were followed from 1989 to 2017. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of in utero exposures with ENM. During 1.6 million person-years of follow-up, 2,579 participants experienced ENM. In multivariable models, women with prenatal DES exposure had higher risk of ENM compared with those without it (HR = 1.33, 95% CI: 1.06, 1.67). Increased risk of ENM was observed for those with low (<5.5 pounds (<2.5 kg)) versus normal (7.0-8.4 pounds (3.2-3.8 kg)) birth weight (HR = 1.21, 95% CI: 1.01, 1.45). Decreasing risk was observed per 1-pound (0.45-kg) increase in birth weight (HR = 0.93, 95% CI: 0.90, 0.97). Prenatal smoking exposure, being part of a multiple birth, and prematurity were not associated with ENM. In this large cohort study, lower birth weight and prenatal DES exposure were associated with higher risk of ENM. Our results support a need for future research to examine in utero exposures that may affect offspring reproductive health.