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Bailey BA, Azar M, Nadolski K, Dodge P. Fetal Growth Following Electronic Cigarette Use in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1179. [PMID: 39338062 PMCID: PMC11431261 DOI: 10.3390/ijerph21091179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/30/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024]
Abstract
Electronic cigarette (e-cig) use in pregnancy is common, but potential effects on fetal development are largely unknown. This study's goal was to examine the association between e-cig exposure and fetal growth. Data were extracted from medical charts in this single-site retrospective study. The sample, excluding those with known tobacco, alcohol, illicit drug, opioid, and benzodiazepine use, contained women who used e-cigs throughout pregnancy and non-e-cig user controls. Fetal size measurements from second- and third-trimester ultrasounds and at birth were expressed as percentiles for gestational age. Following adjustment for confounding factors, in the second trimester, only femur length was significant, with an adjusted deficit of 11.5 percentile points for e-cig exposure compared to controls. By the third trimester, the femur length difference was 28.5 points, with the fetal weight difference also significant (17.2 points). At birth, all three size parameter differences between groups were significant. Significant size deficits were predicted by prenatal e-cig exposure, becoming larger and impacting more parameters with increasing gestation. While additional studies are warranted to confirm and expand upon these findings, this study adds to emerging data pointing to specific harms following e-cig exposure in pregnancy and suggests that e-cigs may not be a "safer" alternative to combustible cigarette smoking in pregnancy.
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Affiliation(s)
- Beth A. Bailey
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48859, USA
| | - Michelle Azar
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mount Pleasant, MI 48859, USA
| | - Katherine Nadolski
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Phoebe Dodge
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
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Chen Q, He Z, Wang Y, Yang X, Liu N, Zhang S, Ma L, Shi X, Jia X, Yang Y, Sun Y, He Y. Effect of Maternal Pre-Pregnancy Body Mass Index on Longitudinal Fetal Growth and Mediating Role of Maternal Fasting Plasma Glucose: A Retrospective Cohort Study. Diabetes Metab Syndr Obes 2024; 17:1911-1921. [PMID: 38711675 PMCID: PMC11073526 DOI: 10.2147/dmso.s449706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
Purpose To assess the impact of maternal pre-pregnancy body mass index (BMI) on longitudinal fetal growth, and the potential mediation effect of the maternal fasting plasma glucose in first trimester. Methods In this retrospective cohort study, we collected pre-pregnancy BMI data and ultrasound measurements during pregnancy of 3879 singleton pregnant women who underwent antenatal examinations and delivered at Peking Union Medical College Hospital. Generalized estimation equations, linear regression, and logistic regression were used to examine the association between pre-pregnancy BMI with fetal growth and adverse neonatal outcomes. Mediation analyses were also used to examine the mediating role of maternal fasting plasma glucose (FPG) in first trimester. Results A per 1 Kg/m² increase in pre-pregnancy BMI was associated with increase fetal body length Z-score (β 0.010, 95% CI 0.001, 0.019) and fetal body weight (β 0.017, 95% CI 0.008, 0.027). In mid pregnancy, pre-pregnancy BMI also correlated with an increase Z-score of fetal abdominal circumference, femur length (FL). Pre-pregnancy BMI was associated with an increased risk of large for gestational age and macrosomia. Mediation analysis indicated that the associations between pre-pregnancy BMI and fetal weight in mid and late pregnancy, and at birth were partially mediated by maternal FPG in first trimester (mediation proportion: 5.0%, 8.3%, 1.6%, respectively). Conclusion Maternal pre-pregnancy BMI was associated with the longitudinal fetal growth, and the association was partly driven by maternal FPG in first trimester. The study emphasized the importance of identifying and managing mothers with higher pre-pregnancy BMI to prevent fetal overgrowth.
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Affiliation(s)
- Qinzheng Chen
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhen He
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yaxin Wang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Xuanjin Yang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Nana Liu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Suhan Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Liangkun Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yin Sun
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences (CAMS) and PUMC, Beijing, People’s Republic of China
| | - Yuan He
- National Human Genetic Resources Center, National Research Institute for Family Planning, Beijing, People’s Republic of China
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Ovadia YS, Dror I, Liberty G, Gavra-Shlissel H, Anteby EY, Fox S, Berkowitz B, Zohav E. Amniotic fluid rubidium concentration association with newborn birthweight: a maternal-neonatal pilot study. Am J Obstet Gynecol MFM 2023; 5:101149. [PMID: 37660761 DOI: 10.1016/j.ajogmf.2023.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Although most biological systems, including human tissues, contain rubidium, its biogeochemical functions and possible role in neonatal birthweight are largely unknown. An animal study indicated a correlation between rubidium deficiency in the maternal diet and lower newborn birthweight. OBJECTIVE This pilot study measured rubidium concentrations in amniotic fluid during the second trimester of (low-risk) pregnancy and investigated potential correlations between rubidium levels and third-trimester newborn birthweight-small for gestational age, appropriate for gestational age, and large for gestational age-and between preterm birth and term birth in uncomplicated pregnancies. STUDY DESIGN This prospective, single-center study investigated a possible relationship between rubidium concentration in second-trimester amniotic fluid and third-trimester birthweight percentile. Amniotic fluid (at a median gestational age of 19 weeks) was sampled to determine rubidium concentration. Maternal and newborn characteristics were obtained from participant and delivery records. RESULTS After screening 173 pregnant women, 99 amniotic fluid samples were evaluated. Midpregnancy median rubidium concentrations were significantly lower among newborns that were classified as small for gestational age than among newborns that were classified as appropriate for gestational age (106 vs 136 μg/L; P<.01). Based on a logistic regression random forest model, amniotic fluid rubidium was identified as a significant contributing factor to appropriate-for-gestational-age birthweight with 54% of the total contribution. CONCLUSION Amniotic fluid rubidium concentration seems to be a strong predictor of appropriate-for-gestational-age birthweight and a potential marker for newborn birthweight classifications. In particular, low rubidium concentrations in amniotic fluid during midpregnancy are linked to third-trimester lower birthweight percentile. These findings could potentially serve as a valuable tool for early identification of pregnancy outcomes. Further investigation is necessary to fully explore the effect of rubidium on fetal development.
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Affiliation(s)
- Yaniv S Ovadia
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel (Drs Ovadia, Gavra-Shlissel, and Prof. Anteby); Department of Earth and Planetary Sciences, Weizmann Institute of Science, Rehovot, Israel (Drs Ovadia, Dror, and Prof. Berkowitz)
| | - Ishai Dror
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Rehovot, Israel (Drs Ovadia, Dror, and Prof. Berkowitz).
| | - Gad Liberty
- Obstetrics and Gynecology Ultrasound Unit, Barzilai University Medical Center, Ashkelon, Israel (Drs Liberty and Zohav); Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Dr Liberty, Prof. Anteby and Dr Zohav)
| | - Hadar Gavra-Shlissel
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel (Drs Ovadia, Gavra-Shlissel, and Prof. Anteby)
| | - Eyal Y Anteby
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Ashkelon, Israel (Drs Ovadia, Gavra-Shlissel, and Prof. Anteby); Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel (Dr Fox)
| | - Stephen Fox
- Department of Chemical Research Support, Weizmann Institute of Science, Rehovot, Israel (Dr Fox)
| | - Brian Berkowitz
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, Rehovot, Israel (Drs Ovadia, Dror, and Prof. Berkowitz)
| | - Efraim Zohav
- Obstetrics and Gynecology Ultrasound Unit, Barzilai University Medical Center, Ashkelon, Israel (Drs Liberty and Zohav); Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Dr Liberty, Prof. Anteby and Dr Zohav)
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Malm E, Vilhelmsson A, Högfeldt H, Deshayes I, Källén K, Hansson SR, Lindh CH, Rylander L. Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Early Pregnancy and Small for Gestational Age in Southern Sweden. TOXICS 2023; 11:750. [PMID: 37755760 PMCID: PMC10534445 DOI: 10.3390/toxics11090750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
Small for gestational age (SGA) is considered an adverse birth outcome. Per- and polyfluoralkyl substances (PFAS) have become increasingly investigated as contributing environmental factors, thus far with inconclusive results. The current study aimed to investigate the hypothesized association between increased maternal PFAS levels in early pregnancy and an increased risk for SGA birth. This population-based study used data from a sample of children born in Scania, Southern Sweden, between 1995 and 2009. Two groups were compared: cases born with SGA (n = 298) and non-SGA controls (n = 580). The cases consisted of two subgroups: one included women whose children's growth in late pregnancy was in the lowest quartile, and another included women from the remaining growth quartiles. Corresponding maternal serum samples were collected from a biobank and analyzed for concentrations of four types of PFAS: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonic acid (PFOS) using liquid chromatography-tandem mass spectrometry (LC/MS/MS). The results were combined with information from birth registers and analyzed using Mann-Whitney U-tests and logistic regression-unadjusted as well as adjusted for potential confounders. In conclusion, elevated maternal concentrations of PFAS were not associated with an increased risk of SGA birth. However, significant ORs were observed in a subgroup analysis restricted to women of Nordic origin (unadjusted OR 3.2 and adjusted OR 2.4) for PFHxS.
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Affiliation(s)
- Ellen Malm
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
| | - Andreas Vilhelmsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
| | - Hannah Högfeldt
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
| | - Isabelle Deshayes
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
| | - Karin Källén
- Tornblad Institute, Lund University, Biskopsgatan 7, 223 62 Lund, Sweden;
| | - Stefan R. Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden;
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, MV (Building 402a), 223 81 Lund, Sweden; (A.V.); (H.H.); (I.D.); (C.H.L.); (L.R.)
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Malm G, Lindh CH, Hansson SR, Källén K, Malm J, Rylander L. Maternal serum vitamin D level in early pregnancy and risk for preeclampsia: A case-control study in Southern Sweden. PLoS One 2023; 18:e0281234. [PMID: 36749741 PMCID: PMC9904465 DOI: 10.1371/journal.pone.0281234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Preeclampsia is considered a major cause of maternal and fetal morbidity and mortality. The aim of the present case-control study in Sweden was to assess the hypothesized association between low serum vitamin D concentrations in early pregnancy and the risk of developing preeclampsia since vitamin D may play a role in early placental development. METHODS The study included 296 women diagnosed with preeclampsia (cases) and 580 healthy pregnant women (controls). Serum samples were obtained from a biobank of samples collected in early pregnancy including almost all pregnancies in Southern Sweden. Concentrations of 25-hydroxyvitamin D3 (vitamin D) were analyzed using liquid chromatography-tandem-mass-spectrometry (LC/MS/MS). The cases were divided into two categories: i) infants were born before gestational week 34 (early onset) and/or born small-for-gestational age (SGA)(n = 51), ii) and others defined as late onset (n = 245). Vitamin D concentrations were analyzed both as a continuous and a categorized variable. RESULTS When all preeclampsia cases were included in the analyses no consistent patterns were observed. However, the median serum concentrations of vitamin D were significantly lower among the cases who were early onset and/or were born SGA (median 39.2 nmol/L, range 1.2-93.6) as compared to the controls (49.0 nmol/L, 0.1-219; p = 0.01). In addition, high concentrations were statistically significantly associated with a decreased risk of preeclampsia (>66.9 vs ≤30.1 nmol/L; crude OR 0.39, 95% CI 0.16-0.96). When potential confounders were included in the models the associations were even more pronounced. CONCLUSIONS Our results support the hypothesis that vitamin D deficiency is a risk factor for preeclampsia, but only in preeclampsia cases who were early-onset and/or were born SGA. Preeclampsia is not a homogenous condition and more studies are needed before vitamin D supplementation during pregnancy can be recommended.
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Affiliation(s)
- Gunilla Malm
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,* E-mail:
| | - Christian H. Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karin Källén
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden,Tornblad Institute, Lund University, Lund, Sweden
| | - Johan Malm
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lars Rylander
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Inequalities in Birth Weight in Relation to Maternal Factors: A Population-Based Study of 3,813,757 Live Births. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031384. [PMID: 35162402 PMCID: PMC8835086 DOI: 10.3390/ijerph19031384] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 02/06/2023]
Abstract
Background: Despite numerous studies of women having children later in life, evidence of the relationship between maternal factors and newborn outcomes in Central and Eastern European countries is limited. This study aimed to examine the association between maternal age, biological determinants, including parity and sex of the newborn, demographic and social background, and birth weight in 3.8 million singleton live births in Poland. Methods: The effect of maternal age on birth weight (in grams and Z-scores) adjusted for confounders was assessed using Generalized Linear Models. Results: The mean (±SD) birth weights of neonates born to primiparous women and multiparous women were 3356.3 ± 524.9 g and 3422.7 ± 538.6 g, respectively, which corresponded to a Z-score of −0.07 ± 0.96 and 0.14 ± 1.00, respectively (p ≤ 0.001). After controlling for biological, demographic, and social factors, a significant decrease in birth weight was found for primiparous women of the age group ≥30 years and multiparous women aged ≥35 years compared to the age group of 25–29 years. The lowest neonatal birth weight was observed in the case of women aged ≥45 years. Confounders did not affect birth weight Z-scores among primiparous women, whereas among multiparous women, together with educational factors, they reversed Z-scores from positive to negative values. The lower birth weight of neonates was overall associated with lower maternal education. Conclusions: Regardless of parity, advanced maternal age is strongly associated with a decreased neonatal birth weight, implying complications in early pregnancy and the antenatal period as well as obstetric complications. Counseling to support women’s family planning decisions and improving women’s education during their reproductive age may help to alleviate unfavorable newborn outcomes.
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Kishan A, Moodithaya SS, Shetty PK, U. SB. Evaluation of role of maternal antenatal cardiac autonomic and biochemical stress markers in prediction of psychological stress levels during postpartum period. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kjölhede K, Berntorp K, Kristensen K, Katsarou A, Shaat N, Wiberg N, Knop FK, Kristensen L, Dotevall A, Elfvin A, Sandgren U, Sengpiel V, Englund-Ögge L. Glycemic, maternal and neonatal outcomes in women with type 1 diabetes using continuous glucose monitoring during pregnancy - Pump vs multiple daily injections, a secondary analysis of an observational cohort study. Acta Obstet Gynecol Scand 2021; 100:927-933. [PMID: 33176006 DOI: 10.1111/aogs.14039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Continuous glucose monitoring (CGM) provides detailed information about glucose level fluctuations over time. The method is increasingly being used in pregnant women with type 1 diabetes. However, only one previous study compared CGM results related to pregnancy outcomes in women using insulin pumps with those administering multiple daily injections (MDI). We performed a secondary analysis of CGM metrics from an observational cohort of pregnant women with type 1 diabetes and compared insulin pump and MDI therapies in relation to maternal and neonatal outcomes. MATERIAL AND METHODS The study included 185 pregnant Swedish women with type 1 diabetes undergoing CGM throughout pregnancy. Women were divided according to insulin administration mode, ie MDI (n = 131) or pump (n = 54). A total of 91 women used real-time CGM and 94 women used intermittently viewed CGM. Maternal demographics and maternal and neonatal outcome data were collected from medical records. CGM data were analyzed according to predefined glycemic indices: mean glucose; standard deviation; percentage of time within, below and above glucose target range; mean amplitude of glycemic excursion; high and low glucose indices; and coefficient variation in percent. Associations between insulin administration mode and CGM data, on the one hand, and maternal and neonatal outcomes, on the other, were analyzed with analysis of covariance and logistic regression, respectively, adjusted for confounders. RESULTS There were no differences in maternal characteristics or glycemic indices between the MDI and pump groups, except for a longer duration of type 1 diabetes and higher frequencies of microangiopathy and real-time CGM among pump users. Despite improvement with each trimester, glucose levels remained suboptimal throughout pregnancy in both groups. There were no differences between the MDI and pump groups concerning the respective associations with any of the outcomes. The frequency of large for gestational age was high in both groups (MDI 49% vs pump 63%) and did not differ significantly. CONCLUSIONS Pregnant women with type 1 diabetes did not differ in glycemic control or pregnancy outcome, related to MDI or pump administration of insulin. Glycemic control remained suboptimal throughout pregnancy, regardless of insulin administration mode.
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Affiliation(s)
- Karin Kjölhede
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.,The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nana Wiberg
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Ystad Hospital, Ystad, Sweden
| | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lars Kristensen
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika Dotevall
- Department of Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ulrika Sandgren
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Linda Englund-Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Kristensen K, Ögge LE, Sengpiel V, Kjölhede K, Dotevall A, Elfvin A, Knop FK, Wiberg N, Katsarou A, Shaat N, Kristensen L, Berntorp K. Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies. Diabetologia 2019; 62:1143-1153. [PMID: 30904938 PMCID: PMC6560021 DOI: 10.1007/s00125-019-4850-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 02/25/2019] [Indexed: 01/12/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes. METHODS This was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5-7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders. RESULTS The number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target. CONCLUSIONS/INTERPRETATION Higher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-to-day glucose control was not optimal and the incidence of LGA remained high.
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Affiliation(s)
- Karl Kristensen
- Department of Clinical Sciences Lund, Lund University, Sölvegatan 19, 221 84, Lund, Sweden.
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden.
| | - Linda E Ögge
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Kjölhede
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Dotevall
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Östra/Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Elfvin
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Filip K Knop
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nana Wiberg
- Department of Clinical Sciences Lund, Lund University, Sölvegatan 19, 221 84, Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Anastasia Katsarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Lars Kristensen
- The Parker Institute, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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10
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Jalali LM, Koski KG. Amniotic fluid minerals, trace elements, and prenatal supplement use in humans emerge as determinants of fetal growth. J Trace Elem Med Biol 2018; 50:139-145. [PMID: 30262271 DOI: 10.1016/j.jtemb.2018.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/04/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023]
Abstract
Amniotic fluid (AF), which is swallowed by the developing fetus, contains minerals and trace elements, but their association with fetal growth has not been explored. Our objectives were to assess (1) whether concentrations of AF minerals and trace elements were associated with changes in 5 fetal ultrasound measurements (estimated weight, bi-parietal diameter, head circumference, abdominal circumference, femur length) between 16-20 and 32-36 wks gestation and (2) whether a prenatal supplement was associated with concentrations of AF minerals and trace elements or the 5 fetal ultrasound measurements. We measured, using inductively coupled plasma-mass spectrometry (ICP-MS), 15 minerals and trace elements (aluminum, arsenic, calcium, chromium, copper, iron, lead, magnesium, nickel, potassium, rubidium, selenium, silver strontium, zinc) in amniotic fluid collected from 176 pregnant women undergoing age-related amniocentesis for genetic testing (15.7 ± 1.1 wks). AF mineral concentrations, prenatal supplement use, and determinants of ultrasound measurements during early and late pregnancy were used in models to assess their impact on change in fetal ultrasound measurements. Positive associations were identified for change in bi-parietal diameter with AF calcium, for change in head circumference with AF copper and nickel, and for change in femur length with AF selenium. Arsenic was negatively associated with estimated fetal weight, and this relationship was modified by prenatal supplement use. Additionally, AF chromium concentrations were lower in women taking prenatal supplements. In conclusion, AF minerals were associated with fetal ultrasound indices, supporting a biological role for calcium, copper, nickel and selenium in promoting in-utero fetal growth. Evidence of a mineral-vitamin interaction between arsenic and folic acid in prenatal supplements and mineral-mineral interaction between iron and chromium would suggest that attention be paid to mineral and trace element formulation of prenatal supplements.
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Affiliation(s)
- Lauren M Jalali
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
| | - Kristine G Koski
- School of Human Nutrition, Macdonald Stewart Building, McGill University, 21111 Lakeshore Road, Ste-Anne de Bellevue, QC, H9X 3V9, Canada.
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11
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Ladfors L, Shaat N, Wiberg N, Katasarou A, Berntorp K, Kristensen K. Fetal overgrowth in women with type 1 and type 2 diabetes mellitus. PLoS One 2017; 12:e0187917. [PMID: 29121112 PMCID: PMC5679529 DOI: 10.1371/journal.pone.0187917] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Despite improved glycemic control, the rate of large-for-gestational-age (LGA) infants remains high in pregnancies complicated by diabetes mellitus type 1 (T1DM) and type 2 (T2DM). Poor glycemic control, obesity, and excessive gestational weight gain are the main risk factors. The aim of this study was to determine the relative contribution of these risk factors for LGA in women with T1DM and T2DM, after controlling for important confounders such as age, smoking, and parity. METHODS In this retrospective chart review study, we analyzed the medical files of pregnant women with T1DM and T2DM who attended the antenatal care program at Skåne University Hospital during the years 2006 to 2016. HbA1c was used as a measure of glycemic control. Maternal weight in early pregnancy and at term was registered. LGA was defined as birth weight > 2 standard deviations of the mean. Univariable and multivariable logistic regression analysis was used to calculate odds ratios (OR's) and 95% confidence intervals (CIs) for LGA. RESULTS Over the 11-year period, we identified 308 singleton pregnancies in 221 women with T1DM and in 87 women with T2DM. The rate of LGA was 50% in women with T1DM and 23% in women with T2DM. The multivariable regression model identified gestational weight gain and second-trimester HbA1c as risk factors for LGA in T1DM pregnancies (OR = 1.107, 95% CI: 1.044-1.17, and OR = 1.047, 95% CI: 1.015-1.080, respectively) and gestational weight gain as a risk factor in T2DM pregnancies (OR = 1.175, 95% CI: 1.048-1.318), independent of body mass index. CONCLUSIONS Gestational weight gain was associated with LGA in women with T1DM and T2DM, independent of maternal body mass index. The findings suggest that monitoring and regulation of gestational weight gain is important in the clinical care of these women, to minimize the risk of fetal overgrowth.
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Affiliation(s)
- Linnea Ladfors
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Nael Shaat
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nana Wiberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anastasia Katasarou
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Kerstin Berntorp
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Karl Kristensen
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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12
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Gómez Roig MD, Mazarico E, Ferrero S, Montejo R, Ibáñez L, Grima F, Vela A. Differences in dietary and lifestyle habits between pregnant women with small fetuses and appropriate-for-gestational-age fetuses. J Obstet Gynaecol Res 2017; 43:1145-1151. [PMID: 28503776 DOI: 10.1111/jog.13330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/30/2017] [Accepted: 02/12/2017] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to determine differences in lifestyle and dietary habits between pregnant women with small for gestational age (SGA) fetuses and those appropriate for gestational age (AGA). METHODS This cross-sectional, prospective study was conducted over 14 months and included 46 mothers with SGA and 81 with AGA fetuses. Fetal growth was assessed by a routine third trimester scan. Participants completed questionnaires regarding dietary habits, lifestyle behavior and sociodemographic characteristics during the third trimester. RESULTS Mothers maintaining a Mediterranean-type diet and lifestyle were more likely to have an AGA fetus (P < 0.05). The same number of women in both groups ate a vegetarian diet. Women in the SGA group had a lower intake of certain micronutrients: carotene, folic acid, iron, potassium and magnesium (P < 0.05). Women in the AGA group ate more vegetables, especially green beans, carrots, lettuce and oranges (P < 0.05). Bread, pasta, cakes and jam were also more frequently consumed by the AGA group (P < 0.05). Mothers in the SGA group drank more cola (P < 0.05), while mothers in the AGA group drank more diet cola and wine (P < 0.05). Women in the SGA group smoked more cigarettes per day (P < 0.05). CONCLUSIONS Mothers of SGA fetuses had a different nutritional intake and cigarette smoking habits compared with mothers of AGA fetuses. No other differentiating lifestyle habits were observed between the groups. Thus, intrauterine growth conditions might be improved by the endorsement of certain dietary habits during pregnancy.
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Affiliation(s)
- Maria Dolores Gómez Roig
- BCNatal - Barcelona Center of Maternal Fetal Medicine and Neonatology, Hospital Sant Joan de Déu and Hospital Clínic, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.,Maternal and Child Health and Development Network II (SAMID II), Madrid, Spain
| | - Edurne Mazarico
- BCNatal - Barcelona Center of Maternal Fetal Medicine and Neonatology, Hospital Sant Joan de Déu and Hospital Clínic, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.,Maternal and Child Health and Development Network II (SAMID II), Madrid, Spain
| | - Silvia Ferrero
- BCNatal - Barcelona Center of Maternal Fetal Medicine and Neonatology, Hospital Sant Joan de Déu and Hospital Clínic, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.,Maternal and Child Health and Development Network II (SAMID II), Madrid, Spain
| | - Rocío Montejo
- Department of Obstetrics and Gynecology, Fuenlabrada University Hospital, Madrid, Spain
| | - Lourdes Ibáñez
- Endocrinology Unit, Sant Joan de Déu University Hospital, University of Barcelona & CIBERDEM, ISCIII, Madrid, Spain
| | - Francisco Grima
- Health Sciences Department, Navarra University, Navarra, Spain
| | - Antonio Vela
- BCNatal - Barcelona Center of Maternal Fetal Medicine and Neonatology, Hospital Sant Joan de Déu and Hospital Clínic, Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.,Maternal and Child Health and Development Network II (SAMID II), Madrid, Spain
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13
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DeVore GR. Computing the Z Score and Centiles for Cross-sectional Analysis: A Practical Approach. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:459-473. [PMID: 28093799 DOI: 10.7863/ultra.16.03025] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
Although Z scores have been reported in the literature, one of the problems for the nonstatistician is understanding the systematic approach used to compute the predicted mean and standard deviation, components of the Z score equation, which may vary as the independent variable changes over time (eg, gestational age). This review focuses on a step-by-step analysis using linear, quadratic, and fractional polynomials to compute the mean and standard deviation as a function of a continuous independent variable. Once the mean and standard deviation are computed, the Z score and centile can be derived and Z score calculators created that enable investigators to implement the results in the laboratory and/or clinical setting.
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Affiliation(s)
- Greggory R DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Fetal Diagnostic Centers, Pasadena, Tarzana, and Lancaster, California, USA
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14
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Abraham M, Alramadhan S, Iniguez C, Duijts L, Jaddoe VWV, Den Dekker HT, Crozier S, Godfrey KM, Hindmarsh P, Vik T, Jacobsen GW, Hanke W, Sobala W, Devereux G, Turner S. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS One 2017; 12:e0170946. [PMID: 28231292 PMCID: PMC5322900 DOI: 10.1371/journal.pone.0170946] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/12/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis. METHODS Studies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements. RESULTS There were 284 abstracts identified, 16 papers were included in the review and the meta-analysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18 SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked. CONCLUSIONS Maternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy.
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Affiliation(s)
- Miriam Abraham
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Carmen Iniguez
- FISABIO – Universitat Jaume I – Universitat de València Epidemiology and Environmental Health Joint Research Unit and Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Valencia, Spain
| | - Liesbeth Duijts
- The Generation R Study, Department of Paediatrics, Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vincent W. V. Jaddoe
- The Generation R Study, Department of Paediatrics, Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Herman T. Den Dekker
- The Generation R Study, Department of Paediatrics, Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Torstein Vik
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir W. Jacobsen
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Wojciech Sobala
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Graham Devereux
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, United Kingdom
- * E-mail:
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15
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De Genna NM, Goldschmidt L, Day NL, Cornelius MD. Maternal trajectories of cigarette use as a function of maternal age and race. Addict Behav 2017; 65:33-39. [PMID: 27716477 DOI: 10.1016/j.addbeh.2016.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/19/2016] [Accepted: 09/28/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patterns of smoking vary as a function of age and race. The goals of this study were to identify trajectories of maternal cigarette use over a 17-year span, and to determine if maternal age at first birth and race were associated with smoking trajectories. METHODS Pregnant women (N=690) were recruited at an urban prenatal clinic. The women (13-42years old; 62% African-American, 38% White) were interviewed about cigarette use during pregnancy and 6, 10, 14, and 16years postpartum. Growth mixture modeling (GMM) was used to identify trajectories. Regressions were used to determine if maternal age at first birth and race predicted trajectory class membership. RESULTS A GMM of maternal cigarette use delineated 5 groups: none/unlikely to use (33%), decreasing likelihood of use (6%), late desistance (5%), increasing likelihood of use (17%), and chronic use (39%). Women who became mothers at a younger age were more likely to be classified as late desisters or increasingly likely to smoke. White mothers were more likely to be chronic smokers. Different smoking trajectories and predictors of trajectories were identified for the African-American and White mothers. Covariates including prenatal substance use, hostility, education, and economic hardship also differentiated smoking trajectories. CONCLUSIONS Both prevention and treatment of smoking should be targeted to specific groups by age of first pregnancy and race. Pregnant smokers should be provided with more information and resources to help them avoid cigarettes during pregnancy and maintain abstinence after pregnancy.
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Affiliation(s)
- Natacha Marie De Genna
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Lidush Goldschmidt
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Nancy L Day
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - Marie D Cornelius
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
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16
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Zahran M, Tohma YA, Erkaya S, Evliyaoğlu Ö, Çolak E, Çoşkun B. Analysis of the effectiveness of ultrasound and clinical examination methods in fetal weight estimation for term pregnancies. Turk J Obstet Gynecol 2015; 12:220-225. [PMID: 28913073 PMCID: PMC5588475 DOI: 10.4274/tjod.28044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/26/2015] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the accuracy of clinical and ultrasonographic (USG) estimation of fetal weight in non-complicated, term pregnancies. Materials and Methods: Two hundred term pregnant women were included in the study. We used three formulae for the estimation of fetal weight at term; the Hadlock formula for the USG method, and two different formulas for clinical methods, maternal symphysis-fundal height and abdominal circumference at the level of umbilicus. Accuracy was determined by mean percentage error, mean absolute percentage error and proportion of estimates within 10% of actual birth weight (birth weight ±10%). Patients were divided into two groups according to actual birth weight, the normal birth weight group (2500-3999 g) and high birth weight group (≥4000 g). Results: All three methods statistically overestimated birth weight for the high and normal birth weight groups (p<0.001, p=1.000, p=0.233) (p=0.037, p<0.001, and p<0.001). For both groups, the mean absolute percentage errors of USG were smaller than for the other two clinical methods and the number of estimates were within 10% of actual birth weight for USG was greater than for the clinical methods; the differences were statistically significant (p<0.001). No statistically significant difference of accuracy was observed for all three methods for the high birth weight group (p=0.365, p=0.768, and p=0.540). However, USG systematically underestimated birth weight in this group. Conclusion: For estimation of fetal birth weight in term pregnancies, ultrasonography is better than clinical methods. In the suspicion of macrosomia, it must be remembered that no method is better than any other. In addition, if ultrasonography is used, careful management is recommended because ultrasonography overestimates in this group.
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Affiliation(s)
- Mehmet Zahran
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Yusuf Aytaç Tohma
- Başkent University Faculty of Medicine, Department of Obstetrics and Gynecology, Konya, Turkey
| | - Salim Erkaya
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Özlem Evliyaoğlu
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Eser Çolak
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Bora Çoşkun
- Etlik Zübeyde Hanım Womens's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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17
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Berntorp K, Anderberg E, Claesson R, Ignell C, Källén K. The relative importance of maternal body mass index and glucose levels for prediction of large-for-gestational-age births. BMC Pregnancy Childbirth 2015; 15:280. [PMID: 26514116 PMCID: PMC4627395 DOI: 10.1186/s12884-015-0722-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/21/2015] [Indexed: 01/06/2023] Open
Abstract
Background The risk of gestational diabetes mellitus (GDM) increases substantially with increasing maternal body mass index (BMI). The aim of the present study was to evaluate the relative importance of maternal BMI and glucose levels in prediction of large-for-gestational-age (LGA) births. Method This observational cohort study was based on women giving birth in southern Sweden during the years 2003–2005. Information on 10 974 pregnancies was retrieved from a population-based perinatal register. A 75-g oral glucose tolerance test (OGTT) was performed in the 28 week of pregnancy for determination of the 2-h plasma glucose concentration. BMI was obtained during the first trimester. The dataset was divided into a development set and a validation set. Using the development set, multiple logistic regression analysis was used to identify maternal characteristics associated with LGA. The prediction of LGA was assessed by receiver-operating characteristic (ROC) curves, with LGA defined as birth weight > +2 standard deviations of the mean. Results In the final multivariable model including BMI, 2-h glucose level and maternal demographics, the factor most strongly associated with LGA was BMI (odds ratio 1.1, 95 % confidence interval [CI] 1.08–1.30). Based on the total dataset, the area under the ROC curve (AUC) of 2-h glucose level to predict LGA was 0.54 (95 % CI 0.48–0.60), indicating poor performance. Using the validation database, the AUC for the final multiple model was 0.69 (95 % CI 0.66–0.72), which was identical to the AUC retrieved from a model not including 2-h glucose (0.69, 95 % CI 0.66–0.72), and larger than from a model including 2-h glucose but not BMI (0.63, 95 % CI 0.60–0.67). Conclusions Both the 2-h glucose level of the OGTT and maternal BMI had a significant effect on the risk of LGA births, but the relative contribution was higher for BMI. The findings highlight the importance of concentrating on healthy body weight in pregnant women and closer monitoring of weight during pregnancy as a strategy for reducing the risk of excessive fetal growth.
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Affiliation(s)
- Kerstin Berntorp
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - Eva Anderberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rickard Claesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. .,Department of Obstetrics and Gynecology, Office for Healthcare "Kryh", Ystad, SE-27182, Sweden.
| | - Claes Ignell
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Obstetrics and Gynecology, Office for Healthcare "Sund", Helsingborg, Sweden
| | - Karin Källén
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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18
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Sonographic fetal weight estimation in normal and overweight/obese healthy term pregnant women by gestation-adjusted projection (GAP) method. Arch Gynecol Obstet 2015; 293:775-81. [PMID: 26482584 DOI: 10.1007/s00404-015-3910-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this study is to assess the ultrasound accuracy in fetal weight estimation related to the time distance between the actual weight recorded at delivery and the period of sonography among normal and overweight/obese pregnant women within 3 weeks prior birth at term. METHODS Four-hundred and ninety patients with healthy pregnancy were studied in a cohort study. The absolute percent error in estimation was achieved by gestation-adjusted projection method from Hadlock model for weight calculation as measure of accuracy. The mean percentage error variation over the weeks was correlated to maternal body mass index (BMI, Kg/m(2)) at ultrasound. The relationship between BMI and ultrasound performance was assessed by linear regression. RESULTS The overall proportion of supposed sonographic estimated fetal weight at birth within ±10 % of the birth weight significantly declines over the weeks (P = .016). The trend toward a progressive deterioration in ultrasound accuracy is not statistically significant for normal weight women (P = .272) but it is for over-weight/obese (P = .044). On univariate analysis, the absolute percent error and absolute error are positively related to BMI. CONCLUSIONS Accuracy is related to the week at ultrasound scan with a gradual deterioration over the time and it worsens with increasing distance in days between the date of ultrasounds and delivery. The deterioration is greater for BMI ≥ 25.
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19
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O'Connor C, Doolan A, O'Higgins A, Segurado R, Sheridan-Pereira M, Fitzpatrick C, Turner MJ, Stuart B, Kennelly MM. Maternal body composition in the first trimester as a predictor of neonatal body composition after birth. Obes Res Clin Pract 2015; 9:405-7. [PMID: 26021443 DOI: 10.1016/j.orcp.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Clare O'Connor
- Ultrasound and Fetal Medicine Centre, Coombe Women and Infants University Hospital, Dublin, Ireland; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
| | - Anne Doolan
- TCD Department of Paediatrics, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Amy O'Higgins
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | | | | | - Chris Fitzpatrick
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Bernard Stuart
- Ultrasound and Fetal Medicine Centre, Coombe Women and Infants University Hospital, Dublin, Ireland; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Máireád M Kennelly
- Ultrasound and Fetal Medicine Centre, Coombe Women and Infants University Hospital, Dublin, Ireland; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
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20
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Feldkamp ML, Srisukhumbowornchai S, Romitti PA, Olney RS, Richardson SD, Botto LD. Self-reported maternal cigarette smoke exposure during the periconceptional period and the risk for omphalocoele. Paediatr Perinat Epidemiol 2014; 28:67-73. [PMID: 24313669 PMCID: PMC4427045 DOI: 10.1111/ppe.12093] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We investigated whether maternal exposure to cigarette smoke was associated with omphalocoele and whether periconceptional folic acid modified the association. METHODS : We analysed data from the National Birth Defects Prevention Study on omphalocoele case (n = 301) and control (n = 8135) mothers for infants born from 1997 through 2007. Mothers who reported active smoking or exposure to second-hand smoke during the periconceptional period (1 month before conception to 3 months after) were considered exposed. Those who reported use of folic acid supplements during the same period were considered supplement users. Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression adjusted for alcohol use, preconception body mass index, and race/ethnicity. RESULTS One hundred fifteen (38.2%) case and 2592 (31.9%) control mothers reported exposure to cigarette smoke during the periconceptional period. Adjusted odds ratios [95% confidence intervals] were 1.19 [0.94, 1.53] for any smoke exposure, 0.87 [0.54, 1.40] for active smoking, 1.38 [1.00, 1.90] for second-hand smoke exposure, and 1.16 [0.80, 1.67] for both exposures combined. No dose-response relationship was observed. Folic acid-containing supplements did not reduce the risk for omphalocoele among women with active or second-hand smoke exposure. CONCLUSIONS Self-reported active maternal smoking, with or without exposure to second-hand smoke, during the periconceptional period was not associated with omphalocoele. In contrast, there was a possible association with periconceptional exposure to second-hand smoke.
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Affiliation(s)
| | | | | | - Richard S. Olney
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA
| | | | - Lorenzo D. Botto
- Department of Pediatrics, University of Utah, Salt Lake City, UT
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Eriksson JG, Kajantie E, Lampl M, Osmond C, Barker DJP. Small head circumference at birth and early age at adiposity rebound. Acta Physiol (Oxf) 2014; 210:154-60. [PMID: 23796386 DOI: 10.1111/apha.12142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/09/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
Abstract
AIMS The adiposity rebound is the age in childhood when body mass index is at a minimum before increasing again. The age at rebound is highly variable. An early age is associated with increased obesity in later childhood and adult life. We have reported that an early rebound is predicted by low weight gain between birth and 1 year of age and resulting low body mass index at 1 year. Here, we examine whether age at adiposity rebound is determined by influences during infancy or is a consequence of foetal growth. Our hypothesis was that measurements of body size at birth are related to age at adiposity rebound. METHODS Longitudinal study of 2877 children born in Helsinki, Finland, during 1934-1944. RESULTS Early age at adiposity rebound was associated with small head circumference and biparietal diameter at birth, but not with other measurements of body size at birth. The mean age at adiposity rebound rose from 5.8 years in babies with a head circumference of ≤33 cm to 6.2 in babies with a head circumference of >36 cm (P for trend = 0.007). The association between thinness in infancy and early rebound became apparent at 6 months of age. It was not associated with adverse living conditions. In a simultaneous regression, small head circumference at birth, high mother's body mass index and tall maternal stature each had statistically significant trends with early adiposity rebound (P = 0.002, <0.001, 0.004). CONCLUSION We hypothesize that the small head size at birth that preceded an early adiposity rebound was the result of inability to sustain a rapid intra-uterine growth trajectory initiated in association with large maternal body size. This was followed by catch-up growth in infancy, and we hypothesize that this depleted the infant's fat stores.
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Affiliation(s)
- J. G. Eriksson
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
- Department of General Practice and Primary Health Care; University of Helsinki; Helsinki Finland
- Vasa Central Hospital; Vasa Finland
- Folkhälsan Research Centre; Helsingfors Universitet; Helsinki Finland
- Unit of General Practice; Helsinki University Central Hospital; Helsinki Finland
| | - E. Kajantie
- Department of Chronic Disease Prevention; National Institute for Health and Welfare; Helsinki Finland
- Hospital for Children and Adolescents; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
| | - M. Lampl
- Center for the Study of Human Health; Emory University; Atlanta GA USA
| | - C. Osmond
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton General Hospital; Southampton UK
| | - D. J. P. Barker
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton General Hospital; Southampton UK
- Chair of Fetal Programming; King Saud University; Riyadh Saudi Arabia
- Oregon Health and Science University; Heart Research Center; Portland OR USA
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Deeluea J, Sirichotiyakul S, Weerakiet S, Arora R, Patumanond J. Fundal height growth curve for underweight and overweight and obese pregnant women in Thai population. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:657692. [PMID: 24455289 PMCID: PMC3880769 DOI: 10.1155/2013/657692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
Objectives. To develop fundal height growth curves for underweight and overweight and obese pregnant women based on gestational age from last menstrual period and/or ultrasound. Methods. A retrospective study was conducted at four hospitals in the northern part of Thailand between January 2009 and March 2011. Fundal height, gestational age, height, and prepregnancy weight were extracted from antenatal care and delivery records. Fundal height growth curves were presented as smoothed function of the 10th, 50th, and 90th percentiles between 20 and 40 weeks of gestation, derived from multilevel models. Results. Fundal height growth curve of the underweight was derived from 1,486 measurements (208 women) and the overweight and obese curve was derived from 1,281 measurements (169 women). The 50th percentile line of the underweight was 0.1-0.4 cm below the normal weight at weeks 23-31 and 0.5-0.8 cm at weeks 32-40. The overweight and obese line was 0.1-0.4 cm above the normal weight at weeks 22-29 and 0.6-0.8 cm at weeks 30-40. Conclusions. Fundal height growth curves of the underweight and overweight and obese pregnant women were different from the normal weight. In monitoring or screening for abnormal intrauterine growth in these women, fundal height growth curves specifically developed for such women should be applied.
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Affiliation(s)
- Jirawan Deeluea
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sawaek Weerakiet
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Rajin Arora
- Department of Obstetrics and Gynecology, Lampang Regional Hospital, Lampang 52000, Thailand
| | - Jayanton Patumanond
- Clinical Epidemiology Unit & Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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O’Connor C, Stuart B, Fitzpatrick C, Turner MJ, Kennelly MM. A review of contemporary modalities for identifying abnormal fetal growth. J OBSTET GYNAECOL 2013; 33:239-45. [DOI: 10.3109/01443615.2012.753423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lindell G, Maršál K, Källén K. Predicting risk for large-for-gestational age neonates at term: a population-based Bayesian theorem study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:398-405. [PMID: 23505150 DOI: 10.1002/uog.11218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the prediction of large-for-gestational age (LGA) term neonates using the routine third-trimester ultrasound examination and to investigate whether the prediction could be further improved by adding information on maternal characteristics. METHODS Information on 56,792 singleton term pregnancies with a routine ultrasound examination at 32-34 weeks' gestation was retrieved from a population-based perinatal register. Estimated fetal weights (FW) were expressed as gestational age-specific standard deviation scores (Z-scores). The prediction of LGA was assessed by receiver-operating characteristics (ROC) curves, with LGA defined as birth weight Z-score > + 2. The data set with complete clinical information (n = 48,809) was divided into a development and a validation set. Using the development set, multiple logistic regression analysis was performed to identify maternal characteristics associated with LGA. The odds ratios obtained were converted into likelihood ratios. These were then applied to the validation set and the probability for LGA for each infant was estimated using the Bayesian theorem. RESULTS The FW Z-score showed a high predictive ability for LGA (area under the ROC curve (AUC) 0.89 (95% CI, 0.89-0.90)). Prediction was further improved by using the model that included both FW Z-scores and maternal variables (AUC 0.91 (95% CI, 0.90-0.92)) (P for difference < 10(-6) ). The corresponding AUC for a model including maternal characteristics only was 0.74 (95% CI, 0.73-0.76). CONCLUSIONS Routine third-trimester ultrasound FW estimation is effective in the prediction of LGA neonates at term. The prediction of LGA might be further improved by using a model including maternal characteristics.
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Affiliation(s)
- G Lindell
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund, Sweden.
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Tanvig M, Wehberg S, Vinter CA, Joergensen JS, Ovesen PG, Beck-Nielsen H, Jensen DM, Christesen HT. Pregestational body mass index is related to neonatal abdominal circumference at birth--a Danish population-based study. BJOG 2012; 120:320-30. [PMID: 23146023 DOI: 10.1111/1471-0528.12062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the impact of maternal pregestational body mass index (BMI) and smoking on neonatal abdominal circumference (AC) and weight at birth. To define reference curves for birth AC and weight in offspring of healthy, nonsmoking, normal weight women. DESIGN Population-based study. SETTING Data from the Danish Medical Birth Registry. POPULATION All live singletons without congenital malformations in Denmark 2004-10. METHODS Data on 366,886 singletons at 35(+0) to 41(+6) weeks(+days) of gestation were extracted and analysed using multivariate linear regressions. MAIN OUTCOME MEASURES Birth AC and weight in relation to pregestational maternal BMI, maternal smoking and medical conditions (any). RESULTS Birth AC and weight increased with increasing pregestational BMI, and decreased with smoking (P < 0.0001). Reference curves were created for offspring of healthy, nonsmoking mothers with normal pregestational BMI. Mean AC ranged from 30.1 cm and 30.2 cm at 35 weeks of gestation to 33.9 cm and 34.1 cm at 41 weeks of gestation, for girls and boys, respectively. Mean birthweight ranged from 2581 and 2666 g at 35 weeks to 3705 and 3852 g at 41 weeks of gestation for girls and boys, respectively. Pregestational BMI correlated more to the Z score of birthweight than to the Z score of AC (P < 0.0001). CONCLUSION Birth AC and weight are affected by maternal smoking status and pregestational BMI. Pregestational BMI correlated more to birthweight than to AC. Using data from healthy, nonsmoking mothers with normal pregestational BMI we have provided new reference curves for birth AC and birthweight.
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Affiliation(s)
- M Tanvig
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
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