The impact of maternal smoking on fetal and infant growth

Fetal Growth Following Electronic Cigarette Use in Pregnancy

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.

Consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas

Chewing tobacco may play a contributing role in complications during pregnancy as it contains various kinds of toxic metals such as lead (Pb), cadmium (Cd), cobalt (Co), manganese (Mn), chromium (Cr), and can cause alteration in serum metal concentration. Hence, the present study aimed to explore the effects of chewing tobacco consumption on serum metal contents in pregnant women. A total number of 200 chewing tobacco consumer pregnant women and 200 age-matched non-consumer pregnant women were selected for the study from the outpatient department of gynaecology at Rural Health Centre Tandojam, Pakistan. After obtaining the sociodemographic characteristics of all participants, 10 ml of venous blood was also drawn for serum metal analysis by atomic absorption spectroscopy. Different chewing tobacco samples consumed by consumer pregnant women were collected from local shops of Tandojam, Pakistan. Drinking water samples from the residential areas of consumer and non-consumer pregnant women were prepared and analysed for the same metal contents. In present study, serum Pb, Cd, K and Co were found significantly increased in CPW as compared to NCPW. Serum Pb was found significantly increased in gutkha consumers in comparison to mainpuri consumers. Serum Pb, Cd, and Co were present with significantly increased concentration in serum of CPW who were taking canal and well water for drinking purpose when compared with NCPW. Significant negative strong correlation of serum Pb with K and Cr of drinking water and Na of chewing tobacco samples were observed. Strong positive correlation of serum Cd and Cr with Co of drinking water had been observed. Whereas, serum maternal Co was strongly negatively correlated with Mn of chewing tobacco samples, and serum Cu of CPW had a strong positive correlation with K and Cr of drinking water and Na of chewing tobacco samples. In conclusion, consumption of chewing tobacco alters the serum metal contents in pregnant women at Tandojam and adjoining areas, Pakistan.

Multimodal machine learning for modeling infant head circumference, mothers' milk composition, and their shared environment

Links between human milk (HM) and infant development are poorly understood and often focus on individual HM components. Here we apply multi-modal predictive machine learning to study HM and head circumference (a proxy for brain development) among 1022 mother-infant dyads of the CHILD Cohort. We integrated HM data (19 oligosaccharides, 28 fatty acids, 3 hormones, 28 chemokines) with maternal and infant demographic, health, dietary and home environment data. Head circumference was significantly predictable at 3 and 12 months. Two of the most associated features were HM n3-polyunsaturated fatty acid C22:6n3 (docosahexaenoic acid, DHA; p = 9.6e-05) and maternal intake of fish (p = 4.1e-03), a key dietary source of DHA with established relationships to brain function. Thus, using a systems biology approach, we identified meaningful relationships between HM and brain development, which validates our statistical approach, gives credence to the novel associations we observed, and sets the foundation for further research with additional cohorts and HM analytes.

Maternal excess adiposity and serum 25-hydroxyvitamin D < 50 nmol/L are associated with elevated whole body fat mass in healthy breastfed neonates

BACKGROUND

Vitamin D status of pregnant women is associated with body composition of the offspring. The objective of this study was to assess whether the association between maternal vitamin D status and neonatal adiposity is modified by maternal adiposity preconception.

METHODS

Healthy mothers and their term appropriate weight for gestational age (AGA) infants (n = 142; 59% male, Greater Montreal, March 2016-2019) were studied at birth and 1 month postpartum (2-6 weeks). Newborn (24-36 h) serum was collected to measure total 25-hydroxyvitamin D [25(OH)D] (immunoassay); maternal pre-pregnancy BMI was obtained from the medical record. Anthropometry, body composition (dual-energy X-ray absorptiometry) and serum 25(OH)D were measured at 2-6 weeks postpartum in mothers and infants. Mothers were grouped into 4 categories based on their vitamin D status (sufficient 25(OH)D ≥ 50 nmol/L vs. at risk of being insufficient < 50 nmol/L) and pre-pregnancy BMI (< 25 vs. ≥25 kg/m2): insufficient-recommended weight (I-RW, n = 24); insufficient-overweight/obese (I-OW/O, n = 21); sufficient-recommended weight (S-RW, n = 69); and sufficient-overweight/obese (S-OW/O, n = 28). Partial correlation and linear fixed effects model were used while adjusting for covariates.

RESULTS

At birth, infant serum 25(OH)D mean concentrations were below 50 nmol/L, the cut-point for sufficiency, for both maternal pre-pregnancy BMI categories; 47.8 [95%CI: 43.8, 51.9] nmol/L if BMI < 25 kg/m2 and 38.1 [95%CI: 33.5, 42.7] nmol/L if BMI ≥25 kg/m2. Infant serum 25(OH)D concentrations at birth (r = 0.77; P < 0.0001) and 1 month (r = 0.59, P < 0.0001) were positively correlated with maternal postpartum serum 25(OH)D concentrations. Maternal serum 25(OH)D concentration was weakly correlated with maternal percent whole body fat mass (r = - 0.26, P = 0.002). Infants of mothers in I-OW/O had higher fat mass versus those of mothers in S-OW/O (914.0 [95%CI: 766.4, 1061.6] vs. 780.7 [95%CI: 659.3, 902.0] g; effect size [Hedges' g: 0.42]; P = 0.04 adjusting for covariates) with magnitude of difference of 220.4 g or ~ 28% difference.

CONCLUSIONS

Maternal and neonatal vitamin D status are positively correlated. In this study, maternal adiposity and serum 25(OH)D < 50 nmol/L are dual exposures for neonatal adiposity. These findings reinforce the importance of vitamin D supplementation early in infancy irrespective of vitamin D stores acquired in utero and maternal weight status.

Serological screening for hepatitis C during pregnancy: Seroprevalence and maternal and neonatal outcomes in 45,000 pregnant women

OBJECTIVES

The study evaluates the trend over time and the results of serological screening for hepatitis C infection in pregnancy and obstetric and neonatal outcomes.

STUDY DESIGN

It is a retrospective observational study of all pregnant women delivered in maternity units in Trento province, North East Italy, between 2009-2018. Serological screening data for hepatitis C virus were collected through the birth attendance certificate that is the mandatory tool in Italy for the birth report and the monitoring of the pregnancy, childbirth and health of the newborn. We also used the informations collected in the Hospital information system in order to get, for confirmed positive cases, the data of the entire serological profile. On this basis, we calculated the coverage of serological screening, the seroprevalence of the infection and the obstetric and neonatal outcomes.

RESULTS

A total of 45,493 pregnant women were analysed, 75.5% Italians and 24.5% foreigners. The mean coverage for serological HCV screening in pregnancy was 99.4%. 177 women tested positive for HCV antibodies (107 Italian and 70 foreign women). Mean overall seroprevalence in pregnant women was 3.9‰ (95% CI: 3.8-4.0); amongst Italians it was 3.2‰ (95% CI: 3.0-3.4) and amongst foreigners it was 6.1‰ (95% CI: 5.9-6.2). The highest seroprevalence was recorded in mothers coming from Asian countries. HCV positive mothers present an excess risk for intrahepatic cholestasis and gestational diabetes compared to HCV negative mothers. The neonatal outcomes considered bring to light a statistically significant increase in preterm births, low birth weight, elective Caesarean births, hospitalisation at birth and bottle- or mixed-feeding vs breast-only feeding. There are differences in obstetric and neonatal outcomes in relation to the HCV positive subgroup of the mother defined in particular by exposure to smoke and/or opioids.

CONCLUSIONS

The availability and integration of current information sources allows you to verify compliance with national recommendations on the serological screening of hepatitis C virus infection, to determine infection seroprevalence, the characteristics of the cases and the obstetric and neonatal outcomes. Only part of the maternal and neonatal outcomes studied can be attributed to the presence of HCV.

The relationship between gestational active and passive smoking and early postpartum complications

Objective: The studies especially on the postpartum effects of passive exposure to cigarette smoke are limited, although there are studies investigating early and late postpartum effects of active smoking during pregnancy. This study aimed to investigate the relationship between gestational active and passive smoking and early postpartum complications.Methods: This study was conducted with 217 women in the early postpartum period (first 7 days after birth) in a research hospital, gynecology and obstetrics clinic. Data were collected using the questionnaire form prepared in accordance with the literature by the face-to-face interview method. They were evaluated in the SPSS 23.0 program, and descriptive statistics, logistic regression analysis in multivariate analyses and multiple linear regression analysis were in the analysis of data.Results: In the study, it was found that active smoking was associated with cardiac anomalies (OR = 0.18, 95% = CI 0.03-0.91; p = .039), developmental retardation (OR = 0.11, 95% CI = 0.02-0.56; p = .008), respiratory distress (OR = 0.12, 95% CI = 0.02-0.58; p = .008), low birth weight (OR = 0.22, 95% CI = 0.08-0.57; p = .003) and premature labor (OR = 0.30, 95% CI = 0.16-0.59; p = .000) while passive smoking was associated with premature labor (OR = 0.47, 95% CI = 0.25-0.89; p = .021). It was determined that passive smoking was associated with gestational hypertension (OR 0.30, 95% CI = 0.09-0.85; p = .025). Nevertheless, it was found that active smoking negatively affected the infant's birth weight (p = .000), length (p = .040), head circumference (p = .000) and breastfeeding (p = .005).Conclusion: Gestational active and passive smoking has significant negative effects on maternal and infant health in the early postpartum period.

The 'Dangerous Cocktail': an epidemiological survey on the attitude of a population of pregnant women towards some pregnancy risk factors

Many investigations have shown the important role played by risk factors such as tobacco and alcohol and infectious agents (especially Rubella) in the development of congenital anomalies (CAs). Through the administration of a questionnaire, we evaluated the attitude of a population of pregnant women towards some risk factors in pregnancy (smoking and alcohol habit and risk of contracting one of TORCH agents). 14% of the women continued to smoke despite pregnancy; the majority of these were 34-35 years old, divorced, workers and with a high educational level. The 4.3% who identified as moderate drinkers; were mainly younger and married. Concerning the TORCH agents, it a high percentage were negative to the Rubella antibodies (62.8%). In order to improve the awareness of pregnant women on these risk factors, health education campaigns represent a public health cornerstone. Impact statementWhat is already known on this subject? Several investigations have shown an association between congenital anomalies (CAs) and various exogenous factors such as air pollutants, pesticides, metals, radiations and others present in the environmental matrices. Moreover, an important role is played by some risk factors linked to the lifestyles (i.e. tobacco and alcohol).What do the results of this study add? Our study shows that the awareness of the women about the importance of these risk factors is still rather poor, especially concerning the avoidable risks associated with smoke and alcohol and the preventable risk associated with rubella infection.What are the implications of these findings for clinical practice and/or further research? Our results highlight the importance of continuous health education both about the risk to smoke and drink during pregnancy and about the risk not to have had contract the rubella infection before the pregnancy. Particularly, about the latter issue, it appears necessary to increase the pre-conceptional diagnosis and, eventually, to vaccinate the women resulted negative in order to eliminate congenital rubella.

Postnatal growth in children born small for gestational age with and without smoking mother

BACKGROUND

Maternal smoking impairs fetal growth; however, if postnatal growth differs between children born small for gestational age (SGA) with smoking and non-smoking mother is unknown.

METHODS

Cohort-study of term born children born appropriate for gestational age with non-smoking mother (AGA-NS, n = 30,561), SGA (birthweight <10^th percentile) with smoking mother (SGA-S, n = 171) or SGA with non-smoking mother (SGA-NS, n = 1761). Means of height and weight measurements, collected at birth, 1.5, 3, 4, and 5 years, were compared using a generalized linear mixed effect model. Relative risks of short stature (<10^th percentile) were expressed as adjusted risk ratios (aRR).

RESULTS

At birth, children born SGA-S were shorter than SGA-NS, but they did not differ in weight. At 1.5 years, SGA-S had reached the same height as SGA-NS. At 5 years, SGA-S were 1.1 cm taller and 1.2 kg heavier than SGA-NS. Compared with AGA-NS, SGA-S did not have increased risk of short stature at 1.5 or 5 years, while SGA-NS had increased risk of short stature at both ages; aRRs 3.0 (95% CI 2.6;3.4) and 2.3 (95% CI 2.0;2.7), respectively.

CONCLUSIONS

Children born SGA-S have a more rapid catch-up growth than SGA-NS. This may have consequences for metabolic and cardiovascular health in children with smoking mothers.

The importance of anthropological methods in the diagnosis of rare diseases

Most of inborn errors of metabolism (IEMs) and rare endocrine-metabolic diseases (REMD) are rare diseases. According to the European Commission on Public Health, a rare disease is defined, based on its prevalence, as one affecting one in 2000 people. Many IEMs affect body stature, cause craniofacial abnormalities, and disturb the developmental process. Therefore, body proportion, dysmorphic characteristics, and morphological parameters must be assessed and closely monitored. This can be achieved only with the help of an anthropologist who has adequate tools. This is why the role of an anthropologist in collaboration with the physician in the diagnostic process is not to be underestimated. Clinical anthropologists contribute to assessing physical development and improve our understanding of the natural history of rare metabolic diseases. This paper presents anthropometric techniques and methods, such as analysis of demographic data, anthropometric parameters at birth, percentile charts, growth patterns, bioimpedance, somatometric profiles, craniofacial profiles, body proportion indices, and mathematical models of growth curves used in certain rare diseases. Contemporary anthropological methods play an important role in the diagnostic process of rare genetic diseases.

Aetiology of Legg-Calvé-Perthes disease: A systematic review

BACKGROUND

Legg-Calvé-Perthes disease (LCPD) is a clinical condition affecting the femoral head of children during their growth. Its prevalence is set to be between 0.4/100000 to 29.0/100000 children less than 15 years of age with a peak of incidence in children aged from 4 years to 8 years. LCPD aetiology has been widely studied, but it is still poorly understood.

AIM

To analyse the available literature to document the up-to-date evidence on LCPD aetiology.

METHODS

A systematic review of the literature was performed regarding LCPD aetiology, using the following inclusion criteria: studies of any level of evidence, reporting clinical or preclinical results and dealing with the aetiology or pathogenesis of LCPD. Two reviewers searched the PubMed and Science Direct databases from their date of inception to the 20th of May 2018 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. To achieve the maximum sensitivity of the search strategy, we combined the terms: ‘‘Perthes disease OR LCPD OR children avascular femoral head necrosis” with “pathology OR aetiology OR biomechanics OR genetics” as either key words or MeSH terms.

RESULTS

We include 64 articles in this review. The available evidence on LCPD aetiology is still debated. Several hypotheses have been researched, but none of them was found decisive. While emerging evidence showed the role of environmental risk factors and evidence from twin studies did not support a major role for genetic factors, a congenital or acquired predisposition cannot be excluded in disease pathogenesis. One of the most supported theories involved mechanical induced ischemia that evolved into avascular necrosis of the femoral head in sensible patients.

CONCLUSION

The literature available on the aetiology of LCPD presents major limitations in terms of great heterogeneity and a lack of high-profile studies. Although a lot of studies focused on the genetic, biomechanical and radiological background of the disease, there is a lack of consensus on one or multiple major actors of the etiopathogenesis. More studies are needed to understand the complex and multifactorial genesis of the avascular necrosis characterizing the disease.

Effects of national smoke-free legislation on the rates of preterm births and low birthweights in Taiwan

This study evaluated the effects of partial and complete island-wide smoking bans on perinatal outcomes in Taiwan. Trends were determined in the yearly prevalence rates for preterm births and low birth weight (LBW) for a 1978 to 1997 pre-ban period, a 1998 to 2008 Phase 1 partial ban period, and a 2009 to 2016 Phase 2 complete ban period. Poisson regression with a yearly time-series model was employed to determine alterations in trends in prevalence rates for preterm births and LBW. Compared with pre-ban period, the rate ratio (RR) for Phase 1 preterm births was 0.969 (95% confidence interval [CI] = 0.968-0.971) and Phase 2 0.995 (95% CI = 0.992-0.998). The Phase 1 RR LBW fell 0.4% (95% CI = 0.2%-0.5%), but Phase 2 RR rose 1.7% (95% CI = 1.4%-2.1%). Data indicated that the risk of preterm births and LBW in Taiwan was reduced significantly after implementation of the smoking ban. These findings are in agreement with growing evidence suggesting that smoke-free legislation exerted a beneficial health effect on pregnant women and their newborn infants.

Maternal and infant factors had a significant impact on birthweight and longitudinal growth in a South African birth cohort

Aim

This birth cohort study investigated longitudinal infant growth and associated factors in a multiethnic population living in a low‐resource district surrounding the town of Paarl in South Africa.

Methods

Between March 2012 and October 2014, all mothers attending their second trimester antenatal visit at Paarl Hospital were approached for enrolment. Mother–infant pairs were followed from birth until 12 months of age. Comprehensive socio‐demographic, nutritional and psychosocial data were collected at birth, two, six and 12 months. Infant anthropometry was analysed as z‐scores for weight and height. Linear regression was used to investigate predictors of birthweight, and linear mixed‐effects models were used to investigate predictors of infant growth.

Results

Longitudinal anthropometric data from 792 infants were included: 53% were Black African, 47% were mixed race, and 15% were born preterm. Stunting occurred in 13% of infants at 12 months. Maternal height, antenatal alcohol and tobacco use, ethnicity and socioeconomic status were significant predictors of birthweight. In the adjusted mixed‐effects model, birthweight was a significant predictor of growth during the first year of life.

Conclusion

Birthweight was an important predictor of growth trajectory during infancy. Birthweight and growth were influenced by several important modifiable factors.

Effect of marital distance on birth weight and length of offspring

Marital distance (MD), the geographical distance between birthplaces of spouses, is considered an agent favouring occurrence of heterosis and can be used as a measure of its level. Heterosis itself is a phenomenon of hybrid vigour and seems to be an important factor regulating human growth and development. The main aim of the study is to examine potential effects of MD on birth weight and length of offspring, controlling for socioeconomic status (SES), mother’s age and birth order. Birth weight (2562 boys and 2572 girls) and length (2526 boys, 2542 girls) of children born in Ostrowiec Swietokrzyski (Poland) in 1980, 1983, 1985 and 1988 were recorded during cross-sectional surveys carried out between 1994-1999. Data regarding the socio-demographic variables of families were provided by the parents. Analysis of covariance showed that MD significantly affected both birth weight and length, allowing for sex, birth order, mother’s age and SES of family. For both sexes, a greater marital distance was associated with a higher birth weight and a longer birth length. Our results support the hypothesis that a greater geographical distance between the birth places of parents may contribute to the heterosis effects in offspring. Better birth outcomes may be one of the manifestations of these effects.

Acoustic absorbance measurements in neonates exposed to smoking during pregnancy

OBJECTIVE

To analyze acoustic absorbance using wideband tympanometry in neonates exposed to passive smoking during pregnancy.

METHOD

A study comprising 54 neonates in the control group (CG - unexposed) and 19 in the study group (SG - exposed) was carried out. Subjects were submitted to the wideband tympanometry test and subsequent analysis of absorbance of 17 frequencies.

RESULT

Low frequencies had a lower level of absorbance compared to high frequencies for both ambient and peak pressures, with no difference between the groups.

CONCLUSION

No effect of passive smoking on acoustic absorbance measurements in neonates was observed.

A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

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.

Smoking in pregnancy: a cross-sectional study in China

BACKGROUND

Findings on smoking among pregnant women were mostly from high income countries and were rarely from China. This study aimed to estimate the prevalence of smoking and its influencing factors among pregnant women living in China.

METHODS

A cross-sectional analysis was conducted in this study. Data from pregnant women were collected in this study from June to August 2015 from 5 provinces of mainland China. A total of 2345 pregnant women were included in this study, the mean age of the participants was 28.12 years (SD 4.13).

RESULTS

About 82.9% of smoking women quit smoking after they were pregnant. The prevalence of smoking among pregnant women was 3.8%. Among the participants, 40.0, 30.7, 1.8, 29.9, 0.8, 31.4, 31.2, and 26.7% had husbands, fathers-in-law, mothers-in-law, fathers, mothers, colleagues, friends, and relatives, respectively, who were smokers. Compared with pregnant women of basic education level (junior middle school or below), those of the higher education level (undergraduate or above) were at higher risk of smoking (OR, 5.17; 95% CI, 2.00-13.39). Compared with pregnant women from rural areas, urban pregnant women were less likely to be current smokers (OR, 0.55; 95% CI, 0.32-0.94). Compared with pregnant women whose mothers-in-law did not smoke, those whose mothers-in-law smoked were at higher risk of smoking (OR, 4.67; 95% CI, 1.87-11.70). However, compared with pregnant women whose husband did not smoke, those whose husband smoked were not significantly at higher risk of smoking (OR, 1.12; 95% CI, 0.73-1.73).

CONCLUSIONS

Most of smoking women quit smoking after they became pregnant. Tailored intervention programs to reduce smoking in pregnant women should focus on those with higher education level, from rural areas, and pregnant women whose mothers-in-law smoke.

Maternal smoking and newborn sex, birth weight and breastfeeding: a population-based study

OBJECTIVE

Today, it is acknowledged that smoking during pregnancy and/or the postnatal period has significant risks for a foetus and newborn child. This research examines the relationship between smoking only postnatally, both during pregnancy and postnatally, and the newborn sex, birth weight and breastfeeding.

METHODS

Total 664 women of randomly selected five primary healthcare centres between the dates 20 February 2010 and 20 July 2010 were included in the research. Statistical analyses were performed with SPSS for Windows 19.0 (Statistical Package for Social Sciences software package). Data were described as mean, standard deviation, percentages and Chi-square tests and backward stepwise logistic regression were analysed.

RESULTS

It was found that the percentage of smoking women with daughters is 2.5 times higher than women with sons. Women who smoke are 3.9 times more likely to start feeding their baby with supplementary infant foods at 4 months or earlier than those who do not smoke. Finally, the risk of a birth weight under 2500 g is 3.8 times higher for maternal smokers.

CONCLUSIONS

This study suggests that women who expect a girl smoke more heavily than those who expect a boy. The birth weight of maternal smokers' newborns is lower. Those women who smoke while breastfeeding start feeding their babies with supplementary infant foods at an earlier age.

Parental smoking during pregnancy shortens offspring's legs

One of the most severe detrimental environmental factors acting during pregnancy is foetal smoke exposure. The aim of this study was to assess the effect of maternal, paternal and parental smoking during pregnancy on relative leg length in 7- to 10-year-old children. The research conducted in the years 2001-2002 included 978 term-born children, 348 boys and 630 girls, at the age of 7-10 years. Information concerning the birth weight of a child was obtained from the health records of the women. Information about the mother's and the father's smoking habits during pregnancy and about the mothers' education level was obtained from a questionnaire. The influence of parental smoking on relative leg length, controlled for age, sex, birth weight and the mother's education, as a proxy measure of socioeconomic status, and controlled for an interaction between sex and birth weight, was assessed by an analysis of covariance, where relative leg length was the dependent variable, smoking and sex were the independent variables, and birth weight as well as the mother's education were the covariates. Three separate analyses were run for the three models of smoking habits during pregnancy: the mother's smoking, the father's smoking and both parents' smoking. Only both parents' smoking showed a significant effect on relative leg length of offspring. It is probable that foetal hypoxia caused by carbon monoxide contained in smoke decelerated the growth of the long bones of foetuses.

Determinants of Weight Gain during the First Two Years of Life--The GECKO Drenthe Birth Cohort

Objectives

To explain weight gain patterns in the first two years of life, we compared the predictive values of potential risk factors individually and within four different domains: prenatal, nutrition, lifestyle and socioeconomic factors.

Methods

In a Dutch population-based birth cohort, length and weight were measured in 2475 infants at 1, 6, 12 and 24 months. Factors that might influence weight gain (e.g. birth weight, parental BMI, breastfeeding, hours of sleep and maternal education) were retrieved from health care files and parental questionnaires. Factors were compared with linear regression to best explain differences in weight gain, defined as changes in Z-score of weight-for-age and weight-for-length over 1–6, 6–12 and 12–24 months. In a two-step approach, factors were first studied individually for their association with growth velocity, followed by a comparison of the explained variance of the four domains.

Results

Birth weight and type of feeding were most importantly related to weight gain in the first six months. Breastfeeding versus formula feeding showed distinct growth patterns in the first six months, but not thereafter. From six months onwards, the ability to explain differences in weight gain decreased substantially (from R²_total = 38.7% to R²_total<7%).

Conclusion

Birth weight and breast feeding were most important to explain early weight gain, especially in the first six months of life. After the first six months of life other yet undetermined factors start to play a role.

Tobacco use and environmental smoke exposure among Taiwanese pregnant smokers and recent quitters: risk perception, attitude, and avoidance behavior

In this study, we conducted an empirical survey of the avoidance behaviors and risk perceptions of active and passive smoking pregnant smokers and recent quitters. We employed an online questionnaire survey by recruiting 166 voluntary participants from an online parenting community in Taiwan. The results of the empirical survey revealed that three-fourths of smokers quit smoking during pregnancy and one-fourth continued smoking. All pregnant women who continued smoking had partners or lived with relatives who smoked. Current smokers and quitters differed significantly in their risk perceptions and attitudes toward smoking during pregnancy. Most pregnant smokers and quitters adopted passive smoking avoidance behaviors at home and in public. Nevertheless, one-fifth of pregnant women chose not to avoid passive smoking. We concluded that most women stop smoking during pregnancy; however, most women continue to be exposed to passive-smoking environments. Perceived fetal health risks and attitudes toward smoking during pregnancy are critical predictors of the anti-smoking behaviors of pregnant women.

Smoking ban and small-for-gestational age births in Ireland

Background

Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births.

Methods and Findings

We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5^th percentile) and very SGA (vSGA - BW<3^rd percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ∼2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(−5.3%; 95% CI −5.43% to −5.17%, p<0.0001) and (−0.45%; 95% CI: −0.7% to −0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, −0.6% (p<0.0001) and −0.02% (p<0.0001), respectively.

Conclusions

A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful comprehensive smoke-free legislation in a vulnerable population group as pregnant women.

Effects of tobacco smoking in pregnancy on offspring intelligence at the age of 5

The aim of the study was to examine the effects of tobacco smoking in pregnancy on children's IQ at the age of 5. A prospective follow-up study was conducted on 1,782 women, and their offspring were sampled from the Danish National Birth Cohort. At 5 years of age, the children were tested with the Wechsler Preschool and Primary Scale of Intelligence-Revised. Parental education, maternal IQ, maternal alcohol consumption in pregnancy, the sex and age of the child, and tester were considered core confounders, but the full model also controlled for prenatal paternal smoking, maternal age and Bodymass Mass Index, parity, family/home environment, postnatal parental smoking, breast feeding, the child's health status, and indicators for hearing and vision impairments. Unadjusted analyses showed a statistically significant decrement of 4 points on full-scale IQ (FSIQ) associated with smoking 10+ cigarettes per day compared to nonsmoking. After adjustment for potential confounders, no significant effects of prenatal exposure to tobacco smoking were found. Considering the indisputable teratogenic effects of tobacco smoking, these findings should be interpreted with caution. Still, the results may indicate that previous studies that failed to control for important confounders, particularly maternal intelligence, may be subject to substantial residual confounding.

Maternal active smoking and newborn body composition

OBJECTIVE

Maternal smoking during pregnancy is associated with a reduction in birth size but very few studies have collated changes in neonatal anthropometry. Our aims were both to assess body composition differences by anthropometry between new-borns from smoking mothers and those from non-smoking mothers, and to show whether these differences affect proportional body mass distribution.

METHODS

Caucasian mothers and their full term singleton new-borns (N=1216) were selected during 2009. A structured questionnaire was completed regarding obstetric and demographic data, as well as tobacco consumption. Women were categorized, according to their smoking habits, into a non-smoking group (never smoked or stopped smoking prior to pregnancy) and a smoking group (smoked throughout pregnancy).

RESULTS

22.1% of mothers smoked during pregnancy (median: 6 cigarettes/day, range: l-40). Smoking mothers were significantly younger than non-smoking mothers but there were no differences regarding other aspects which could affect infant weight. Infants from non-smoking mothers were heavier, longer, and body circumferences were all larger than those from smoking mothers (p<0.001), but the Ponderal Index showed no statistical differences. Skinfold thicknesses were significantly lower in new-borns from smoking mothers but these differences were less evident than those from body size. Subcutaneous fat distribution did not show statistical differences between the two groups. After gestational age, to smoke during gestation is the second main determinant of birth weight.

CONCLUSIONS

Smoking during pregnancy involves a generalized reduction of most axiological parameters as a result of proportionate fetal growth impairment. In those infants born from mothers who smoked during gestation, neonatal lean body mass appears to be more affected than body fat, and distribution of subcutaneous fat is not different.

Maternal smoking during pregnancy: impact on otoacoustic emissions in neonates

OBJECTIVES

To determine the effect of maternal smoking during pregnancy on transient evoked otoacoustic emissions levels in neonates.

METHODS

This was a cross-sectional study investigating neonates in the maternity ward of a university hospital in the city of São Paulo, Brazil. A total of 418 term neonates without prenatal or perinatal complications were evaluated. The neonates were divided into two groups: a study group, which comprised 98 neonates born to mothers who had smoked during pregnancy; and a control group, which comprised 320 neonates born to mothers who had not. In order to compare the two ears and the two groups in terms of the mean overall response and the mean transient evoked otoacoustic emissions in response to acoustic stimuli delivered at different frequencies, we used analysis of variance with repeated measures.

RESULTS

The mean overall response and the mean frequency-specific response levels were lower in the neonates in the study group (p<0.001). The mean difference between the groups was 2.47 dB sound pressure level (95% confidence interval: 1.47-3.48).

CONCLUSIONS

Maternal smoking during pregnancy had a negative effect on cochlear function, as determined by otoacoustic emissions testing. Therefore, pregnant women should be warned of this additional hazard of smoking. It is important that smoking control be viewed as a public health priority and that strategies for treating tobacco dependence be devised.

Effects of secondhand smoke exposure on the health and development of african american premature infants

Objective. To explore the effects of secondhand smoke exposure on growth, health-related illness, and child development in rural African American premature infants through 24 months corrected age. Method. 171 premature infants (72 boys, 99 girls) of African American mothers with a mean birthweight of 1114 grams. Mothers reported on household smoking and infant health at 2, 6, 12, 18, and 24 months corrected age. Infant growth was measured at 6, 12, 18, and 24 months, and developmental assessments were conducted at 12 and 24 months. Results. Thirty percent of infants were exposed to secondhand smoke within their first 2 years of life. Secondhand smoke exposure was associated with poorer growth of head circumference and the development of otitis media at 2 months corrected age. Height, weight, wheezing, and child development were not related to secondhand smoke exposure. Conclusion. Exposure to secondhand smoke may negatively impact health of rural African American premature infants. Interventions targeted at reducing exposure could potentially improve infant outcomes.

Determinants of infant growth in four age windows: a twin study

OBJECTIVE

To identify determinants of growth during infancy.

STUDY DESIGN

The sample included 424 twin pairs from the East Flanders Prospective Twin Survey. Multilevel regression analysis was performed and intrapair growth correlations were calculated. The main outcome measure was growth, measured in g/kg/d (0-1 month) or in change in weight z-score (0-6, 6-12 and 12-24 months).

RESULTS

Growth during infancy was associated with birth weight and gestational age. One z-score increase in birth weight resulted in -1.77 g/kg/d less growth from 0-1 month (P < .0001). The effect size decreased with age until -0.02 (P = .70) z-scores less growth from 12 to 24 months. Corresponding numbers for one z-score increase in gestational age decreased from 0.78 (P = .001) to 0.06 (P = .40). From 12 to 24 months, paternal height had a significant positive effect. The difference in growth similarity within the twin pair between monozygotic and dizygotic twins increased from non-significant from 0 to 1 month (P = .49) to a monozygotic:dizygotic ratio approximating 2:1 from 12 to 24 months (P = .002).

CONCLUSION

From 0 to 1 month, environmental factors are most important for growth, whereas genetic factors become more important over time. This is a first step in identifying age windows for future counseling and interventions on the effects of accelerated growth.

Mother's anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20-22 weeks of gestation

To examine effects of mother's anxiety and depression and associated risk factors during early pregnancy on fetal growth and activity. Repeated measures of mother's anxiety (State-Anxiety Inventory (STAI-S)) and depression (Edinburgh Postnatal Depression Scale (EPDS)) and related socio demographics and substance consumption were obtained at the 1st and 2nd pregnancy trimesters, and fetus' (N = 147) biometric data and behavior was recorded during ultrasound examination at 20-22 weeks of gestation. Higher anxiety symptoms were associated to both lower fetal growth and higher fetal activity. While lower education, primiparity, adolescent motherhood, and tobacco consumption predicted lower fetal growth, coffee intake predicted lower fetal activity. Vulnerability of fetal development to mother's psychological symptoms as well as to other sociodemographic and substance consumption risk factors during early and mid pregnancy is suggested.

Denial of smoking-related risk among pregnant smokers

OBJECTIVE

To examine pregnant women's denial of risk, tobacco dependence and their partner's smoking status on smoking behavior during pregnancy.

DESIGN

Cross-sectional design with convenience sampling.

SETTING

Data collection was carried out in hospitals and antenatal clinics in Budapest and 12 other Hungarian cities.

POPULATION OR SAMPLE

A total of 406 adult pregnant women (mean age: 28.2 years; SD = 5.6) with a mean gestational age of 23.3 weeks ranging from 4 to 40 (SD = 8.9).

METHODS

Pregnant women were enrolled in the study by midwives and home-care attendants.

MAIN OUTCOME MEASURES

Smoking status was assessed by self-report questions. Further measures included the Fagerstrom Test of Nicotine Dependence to assess nicotine dependence, and the Wisconsin Inventory of Smoking Dependence Motives to assess the motivational background of smoking. Risk perception was assessed by Haslam and Draper's (2000) 12-item risk perception questionnaire.

RESULTS

Prevalence of occasional and daily smokers was 21.7 and 29.3%, respectively. Some 59.7% of the pregnant women have a partner who smokes. Daily smokers had a higher level of risk denial than occasional or non-smokers (Welch F = 91.607; p < 0.001). Current smokers also had a higher denial than temporary quitters (t = -3.153; p = 0.003). Denial of risk correlated significantly with nicotine dependence (r = 0.30) and the main motivational factors (r = 0.34-0.48). A multinomial logistic regression model of denial of risk concurrently predicted women's smoking status (p = 0.001), even when controlling for age, education, partner's smoking status and parity.

CONCLUSIONS

A higher level of risk denial seems to be one of the major determinants of women's smoking status during pregnancy.

Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban

OBJECTIVE

It is well-established that maternal smoking has adverse birth outcomes (low birthweight, LBW, and preterm births). The comprehensive Irish workplace smoking ban was successfully introduced in March 2004. We examined LBW and preterm birth rates 1 year before and after the workplace smoking ban in Dublin.

DESIGN

A cross-sectional observational study analysing routinely collected data using the Euroking K2 maternity system.

SETTING

Coombe University Maternal Hospital.

POPULATION

Only singleton live births were included for analyses (7593 and 7648, in 2003 and 2005, respectively).

METHODS

Detailed gestational and clinical characteristics were collected and analysed using multivariable logistic regression analyses and subgroup analyses.

MAIN OUTCOME MEASURES

Maternal smoking rates, mean birthweights, and adjusted odds ratios (ORs) of LBW and preterm births in 2005 versus 2003.

RESULTS

There was a 25% decreased risk of preterm births (OR, 0.75; 95% CI, 0.59-0.96), a 43% increased risk of LBW (OR, 1.43; 95% CI, 1.10-1.85), and a 12% fall in maternal smoking rates (from 23.4 to 20.6%) in 2005 relative to 2003. Such patterns were significantly maintained when specific subgroups were also analysed. Mean birthweights decreased in 2005, but were not significant (P=0.99). There was a marginal increase in smoking cessation before pregnancy in 2005 (P=0.047).

CONCLUSIONS

Significant declines in preterm births and in maternal smoking rates after the smoking ban are welcome signs. However, the increased LBW birth risks might reflect a secular trend, as observed in many industrialised nations, and merits further investigations.

Impaired postnatal growth of infants prenatally exposed to cigarette smoking

Most of the previous studies have shown a significant inverse relationship between smoking during pregnancy and weight, height and head circumference of infants at birth, but there is limited literature that assesses the head circumference measures of infants of smoker mothers in postnatal follow-up. The aim of this study was to assess the effects of maternal smoking and passive smoking during pregnancy on postnatal anthropometric measures of infants. Infants were divided into 3 groups: infants of smokers (n = 48), passive smokers (n = 57) and nonsmokers (n = 54), and were evaluated for their weight, height and head circumference at birth, 3 months and 6 months of age. Infants of smokers showed significant weight and head circumference deficits at birth compared to nonsmokers' infants (p < 0.05 and p < 0.001, respectively). At 6 months of age, infants of smokers continued to show significant deficits in all 3 measures compared to nonsmokers' infants (p < 0.001 for each), and infants of passive smokers showed only marginal decreases. Moreover, the weight and height growth velocities of the smokers' infants remained deficient, whereas their growth velocity of the head circumferences increased from birth up to 6 months and reached the growth velocity of the nonsmokers' infants. Infants of passive smokers showed a complete catch-up growth at 6 months. This study indicates that smoking during pregnancy results in serious deficits in infants' growth even after birth. Therefore, it is essential to inform smoker women before pregnancy the possible growth retardation of infants.

Maternal smoking, biofuel smoke exposure and child height-for-age in seven developing countries

BACKGROUND

Children are at high risk of exposure to environmental tobacco smoke and biofuel smoke at home in developing countries. This study examines whether exposure to cigarette and biofuel smoke is associated with height-for-age of children (0-59 months) in seven developing countries.

METHODS

The data are from Demographic and Health Surveys conducted in Cambodia, Dominican Republic, Haiti, Jordan, Moldova, Namibia and Nepal between 2005 and 2007. The respondents were women (15-49 years) and their children in seven countries (n = 28 439), and men (15-59 years) from four countries. The outcome is a physical measurement of child height-for-age in standard deviation units.

RESULTS

Multilevel regression analysis showed that the country of residence modified the association between maternal smoking and child height-for-age. Exposure to maternal smoking was associated negatively with child height-for-age in Cambodia, Namibia and Nepal, whereas it was not in other countries. Multilevel regression analysis revealed that biofuel smoke exposure was associated with a decrease in child height-for-age [b = -0.13, 95% confidence interval (CI) = -0.19 to -0.07, P < 0.001]. No interaction was found between country of residence and biofuel smoke exposure. Multinomial logistic regression results showed that biofuel smoke exposure was associated with both stunting [odds ratio (OR) = 1.25, 95% CI = 1.08-1.44, P = 0.002) and severe stunting (OR = 1.27, 95% CI = 1.02-1.59, P = 0.04), after controlling for covariates.

CONCLUSION

The findings suggest that exposure to maternal smoking and biofuel smoke may contribute to growth deficiencies in young children. Programmes are needed to ensure smoke-free home environments for children.

Effects of maternal cigarette smoking on placental volume and vascularization measured by 3-dimensional power Doppler ultrasonography at 11+0 to 13+6 weeks of gestation

OBJECTIVE

We sought to establish the effect of maternal smoking on placental volume and vascularization in early gestation.

STUDY DESIGN

Three-dimensional power Doppler ultrasonography of the placenta was performed at 11+0 to 13+6 weeks in 80 pregnancies categorized according to cigarette consumption: group A never smoked, B smoking < 10 cigarettes/day, C smoking 10-20 cigarettes/day, and D smoking > 20 cigarettes/day. Using a standardized setting, placental volume and vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated.

RESULTS

No differences were found in placental volume among groups. In groups C and D lower values were found for VI (group C: t = 4.52, P = .0002; group D: t = 3.72, P = .0014), FI (group C: t = 5.06, P = .0001; group D: t = 4.59, P = .0002), and VFI (group C: t = 3.49, P = .0024; group D: t = 2.88, P = .0095). Placental vascular indices were significantly related to birthweight (VI r = 0.563, FI r = 0.580, VFI r = 0.601; P < .001).

CONCLUSION

Maternal smoking is associated with altered 3-dimensional placental Doppler indices and these changes are related to birth weight.

Maternal smoking cessation in early pregnancy and offspring weight status at four years of age. A prospective birth cohort study

BACKGROUND

Maternal smoking during pregnancy is associated with fetal growth restriction, but also with increased risk for overweight in childhood. If the mother stops smoking in early pregnancy fetal growth is not restricted, but whether the risk for later overweight persists is unclear.

AIM

To study if four year old children of mothers who stopped smoking in early pregnancy have higher mean body mass index (BMI) and/or increased odds of being overweight compared with children of non-smokers.

STUDY DESIGN

Prospective population based study on Norwegian mothers and children.

SUBJECTS

Among 711 children available for analysis, 540 were children of never smoking mothers, 114 of mothers who stopped smoking in early pregnancy, and 57 of mothers who continued to smoke throughout pregnancy.

OUTCOME MEASURES

BMI and overweight defined by international criteria at age four.

RESULTS

Compared with children of never smoking mothers, children of smoking mothers had higher mean BMI (mean difference: 0.47; 95% CI: 0.10, 0.84 kg/m(2)), whereas mean BMI was not higher among children of mothers who stopped smoking (mean difference: 0.02; 95% CI: -0.24, 0.28 kg/m(2). Similarly, children of smoking mothers had increased odds for overweight (adjusted OR: 2.83; 95% CI: 1.13, 7.10), whereas children of mothers who stopped smoking did not have increased odds (adjusted OR: 1.29; 95% CI: 0.62, 2.68) compared with children of never smoking mothers.

CONCLUSIONS

In this study, the association between smoking exposure and childhood overweight did not persist in children of mothers who stopped smoking early in pregnancy.

Exposure to cigarette smoke in utero: comparison of reports from mother and daughter

BACKGROUND

Smoking during pregnancy has been associated with asthma, obesity, and decreased cognitive functioning in the offspring. To study the role of in utero smoking exposure in offsprings' adult health outcomes, it may be necessary to rely upon reports by the offspring themselves.

METHODS

We studied 34,949 mother-daughter pairs participating in the Nurses' Health Study II for whom data on the daughter's early passive cigarette smoke exposure had been obtained from both mother and daughter. We calculated sensitivity and specificity of daughter's early exposure to smoke (using mother's report as the gold standard), as well as kappa statistics. Mother and daughter reports were also analyzed as risk factors for asthma and birthweight to demonstrate face validity.

RESULTS

Sensitivity of daughters' reported prenatal exposure ranged from 74% to 85%, while specificity was between 90% and 95% (kappa = 0.72-0.81). Daughter's reported childhood exposure as a proxy for mother's report of smoking during pregnancy had a sensitivity of 89% and specificity of 88%. Results were similar for daughter's report of father's smoking during her childhood. Maternal smoking during pregnancy is consistently associated with reductions in offspring birthweight, and with asthma risk in offspring. The daughter's risk of being very low (<1500 g) or low birthweight (<2500 g) or of having asthma were similar when exposure was defined according to mother's report, daughter's report of fetal smoke exposure, and daughter's report of mother's smoking during childhood.

CONCLUSIONS

Daughter's report of mother's smoking prenatally and in childhood are good proxy measures for mother's own report of smoking during pregnancy.

Maternal smoking during pregnancy, other prenatal and perinatal factors, and the risk of Legg-Calvé-Perthes disease

OBJECTIVE

The causes of Legg-Calvé-Perthes disease are largely unknown, but this pediatric disease seems to result from interruption of the blood supply to the proximal femur and is considered a vascular disease. Because maternal smoking during pregnancy influences fetal development and is associated with cardiovascular diseases in offspring, we hypothesized that this exposure is a risk for Legg-Calvé-Perthes disease and also investigated other markers of impaired fetal development and early-life exposures.

MATERIALS AND METHODS

The Swedish Inpatient Register identified 852 individuals with a diagnosis of Legg-Calvé-Perthes disease from 1983 to 2005, individually matched by year of birth, age, sex, and region of residence with 4432 randomly selected control subjects. Linkage with the Swedish Medical Birth Register provided information on prenatal factors, including maternal smoking. Conditional logistic regression examined associations of maternal smoking during pregnancy and the other measures with the risk of Legg-Calvé-Perthes disease in offspring, adjusted for socioeconomic index and other potential confounding factors.

RESULTS

Maternal smoking during pregnancy was associated with an increased Legg-Calvé-Perthes disease risk, and heavy smoking was associated with a risk increase of almost 100%. Very low birth weight and cesarean section were independently associated with approximately 240% and 36% increases in the risk of Legg-Calvé-Perthes disease, respectively.

CONCLUSION

Maternal smoking during pregnancy and other factors indicated by impaired fetal development may be associated with an increased risk of Legg-Calvé-Perthes disease.

First-trimester maternal placental protein 13 levels in pregnancies resulting in adverse outcomes

BACKGROUND

In a previous study, reduced levels of maternal serum placental protein 13 (PP13) in the first trimester have been correlated with adverse pregnancy outcomes. The objective of this study was to compare first-trimester PP13 levels in control pregnancies with pregnancies resulting in one or more of the following adverse outcomes: intrauterine growth restriction (IUGR), small and very small (3rd, 5th, 10th centile) for gestational age (SGA), low (<1.5 and < 2.5 kg) birth weight (LBW), macrosomia (the > 90th centile), large birth weight (>4.5 kg), preterm (35-36 weeks) and very early (<34 weeks) delivery (PTD), and intrauterine fetal demise (IUFD).

METHODS

Maternal serum samples from 1940, 11 to 14 weeks singleton pregnancies, were assayed for PP13 and the concentrations were corrected for gestational age, maternal weight, smoking status, and ethnic origin. A comparison of the levels of PP13 in 364 controls and 1576 adverse outcome categories was made. PP13 levels were expressed in terms of both concentration and multiple of medians (MoMs).

RESULTS

Comparison of PP13 MoMs from SGA, PTD, and low birth weight samples with control pregnancy samples showed no statistically significant difference. In macrosomic pregnancies (>90th centile), levels of PP13 were significantly higher than controls (p = 0.0263) although the number of cases in this study was small.

CONCLUSION

Decreased levels of PP13 were not significantly correlated with the studied adverse pregnancy outcomes of IUGR, PTD low birth weight, and IUFD. Further studies are required to evaluate if measurement of PP13 has any value in the early assessment of pregnancies.