Trends in Fetal Growth Between 2000 to 2014 in Singleton Live Births from Israel

Gestational Diabetes Mellitus, Obstetric Data, and Simple Congenital Ptosis

PURPOSE

This retrospective cohort study aimed to identify obstetric risk factors for simple congenital ptosis and propose an underlying pathophysiological mechanism.

METHODS

Newborns diagnosed with simple congenital ptosis (n = 51) were compared with existing population data in terms of obstetric parameters.

RESULTS

Positive associations were found between simple congenital ptosis and gestational diabetes mellitus (11.8% vs. 5%, p = 0.026), preterm delivery (15.7% vs. 0.05%, p < 0.001), and lower birth weight (2,998 ± 506 vs. 3,255 ± 484, p < 0.001).

CONCLUSIONS

This study pioneers an association between simple congenital ptosis and gestational diabetes mellitus, potentially linked to insulin-like growth factor 1 levels. We advocate for early ophthalmology checkups for specific newborn subsets.

Obstetrical Outcome following Diagnosis of Gestational Diabetes in the Third Trimester (>29 Weeks) versus Second Trimester (24-28 Weeks): A Retrospective Comparative Study

OBJECTIVE

This study aimed to compare obstetrical outcomes between women diagnosed with gestational diabetes mellitus (GDM) in the third trimester after testing negative for GDM in two-step screening in the second trimester and women diagnosed in the second trimester.

STUDY DESIGN

This retrospective study compared obstetrical outcomes between 375 women diagnosed with GDM in the second trimester and 125 diagnosed in the third trimester.

RESULTS

Among women diagnosed with GDM in the third versus second trimester, the incidences were higher of morbid obesity (body mass index ≥35 kg/m2), macrosomia, and cesarean section (CS) due to suspected macrosomia: 23.2 versus 9.8%, p < 0.001; 44.0 versus 10.1%, p < 0.001; and 24.8 versus 6.3%, p < 0.001, respectively. For those diagnosed in the third versus second trimester, the incidences were lower of hypertensive disorders of pregnancy and intrauterine growth restriction, and a lower proportion of women needed pharmacological therapy for glucose control: 2.4 versus 9.0%, p = 0.016; 0.8 versus 8.2%, p < 0.001; and 12.0 versus 29.7%, p < 0.001, respectively. Multivariate analysis supported a correlation between third-trimester-diagnosed GDM and macrosomia, and between second-trimester-diagnosed GDM and hypertensive disorders of pregnancy.

CONCLUSION

Among women diagnosed with GDM in the third compared with the second trimester, the incidence of morbid obesity was higher; accordingly, the risks were higher for large for gestational age infants and delivery by CS, and lower for hypertensive disorders. Guidelines regarding repeat oral glucose tolerance testing in the third trimester should be considered following prospective studies.

KEY POINTS

· Third-trimester GDM was 29.9% among women with normal second-trimester screening.. · Morbid obesity and macrosomia were more frequent in third- versus second-trimester GDM.. · Incidence of preeclampsia was lower in third- versus second-trimester-diagnosed GDM..

Birthweights at term have increased globally: insights from a systematic review of 183 million births

OBJECTIVE

This study aimed to assess global trends in mean birthweights at term, as reported in peer-reviewed literature.

DATA SOURCES

We electronically searched PubMed, Embase, and Web of Science up to September 2023, using combinations of the search terms: "birth weight"; "birth-weight"; "birthweight"; "trend". There were no restrictions based on language or geographic area.

STUDY ELIGIBILITY CRITERIA

We included all ecological and observational studies reporting mean birthweight at term as a continuous numerical variable over time.

METHODS

We assessed the quality of included studies using the Dufault and Klar checklist modified by Betran et al. Univariate and multivariate linear models were used to examine the effects of time (years) and geographical origins. Subgroup analyses focused on national data sources and on data collected from 1950 onward.

RESULTS

Among 6447 reviewed articles, 29 met our criteria, reporting mean birthweight data from over 183 million infants worldwide. Most studies were hospital-based (48.3%), 44.8% used national data, and a minority used municipality, community, or regional data (6.9%). Geographically, North America (31.0%) had the highest representation, followed by Asia and Europe (27.6% each), and South America and Oceania (6.9% each). Our univariate linear regression model (Model 1) revealed a significant increase in mean birthweight at term over time (4.74 g/y; 95% confidence interval, 3.95-5.53; P<.001). Model 2, incorporating continental dummy variables into the first model, confirmed this trend (3.85 g/y; 95% confidence interval, 2.96-4.74; P<.001). Model 3, focusing on available national data, did not find a significant relationship. Model 4 narrowed its focus on records from 1950 onward, reporting a robust annual increase of 7.26 g/y (95% confidence interval, 6.19-8.33; P<.001). Model 5, adjusting for the number of participants included in each study, reported a conclusive mean term birthweight increase of 1.46 g/y (95% confidence interval, 0.74-2.18; P<.001).

CONCLUSION

This systematic review of 29 studies shows an increase in term birthweights over time, particularly when considering data since 1950. Limitations include study quality variations, data source diversity, and data sparsity, underscoring the need for future research to use precise gestational age distinctions and predetermined time frames to gain a deeper understanding of this trend and its implications for maternal and child health.

Family Income and Low Birth Weight in Term Infants: a Nationwide Study in Israel

OBJECTIVES

To explore the influence of income on Low Birth Weight (LBW), taking into account other socio-economic measurements.

METHODS

This retrospective cohort study is based on the Israel National Insurance Institute (NII) database. The study population included 58,454 women who gave birth between 2008 and 2013 to 85,605 infants. Only singleton births at term (gestational age in weeks = 37 and later) were included. Logistic regression models with a Generalized Estimating Equation approach were used in order to assess the independent effect of income and Socio-Economic Regional Index (SERI), maternal age, family status, population group and occupational status on LBW. In addition, sibling analysis was conducted to assess the influence of a change in income on birth weight (BW) among 21,998 women.

RESULTS

Lower income was associated with higher odds of LBW (odds ratio (OR) = 1.266; 95% CI:1.115-1.437. Immigrants from Ethiopia, Bedouins from the Negev, the youngest, the oldest, and single mothers had higher odds for LBW newborns. Compared to women whose income quartile had not changed between the most recent and the first births, for women who experienced a deterioration of three and two quartiles in family income, significantly lower birth weight was observed at the time point with lower income: 103 g (p = .049) and 71 g (p = .008), respectively. Improvement in income revealed an almost linear increase in birth weight.

CONCLUSIONS FOR PRACTICE

In an effort to prevent LBW associated mortality and diseases, interventions should be focused first of all on women from population groups who are disadvantaged.

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

OBJECTIVE

We aimed to assess whether maternal first-trimester low body mass index (BMI) has a protective effect against macrosomia.

METHODS

This was a cross-sectional study from January 1, 2011, to June 30, 2021, and 84,900 participants were included. The predictive performance of maternal first-trimester and parental pre-pregnancy BMI for macrosomia was assessed using the area under the receiver-operating characteristics curve (AUC). Multivariate logistic regression analyses were performed to evaluate the independent effect of maternal first-trimester low BMI on macrosomia. Interactions were investigated to evaluate the potential variation of the effect of first-trimester low BMI across different groups. Furthermore, interactions were also examined across groups determined by multiple factors jointly: a) gestational diabetes mellitus (GDM)/GDM history status, parity, and maternal age; and b) GDM/GDM history status, fetal sex, and season of delivery.

RESULTS

The proportion of macrosomia was 6.14% (5,215 of 84,900). Maternal first-trimester BMI showed the best discrimination of macrosomia (all Delong tests: P < 0.001). The protective effect of maternal first-trimester low BMI against macrosomia remained significant after adjusting for all confounders of this study [adjusted odds ratios (aOR) = 0.37, 95% CI: 0.32-0.43]. Maternal first-trimester low BMI was inversely associated with macrosomia, irrespective of parity, fetal sex, season of delivery, maternal age, and GDM/GDM history status. The protective effect was most pronounced among pregnant women without GDM/GDM history aged 25 to 29 years old, irrespective of parity (multipara: aOR = 0.32, 95% CI: 0.22-0.47; nullipara: aOR = 0.32, 95% CI: 0.24-0.43). In multipara with GDM/GDM history, the protective effect of low BMI was only observed in the 30- to 34-year-old group (aOR = 0.12, 95% CI: 0.02-0.86). For pregnant women without GDM/GDM history, the protective effect of maternal first-trimester low BMI against macrosomia was the weakest in infants born in winter, irrespective of fetal sex (female: aOR = 0.45, 95% CI: 0.29-0.69; male: aOR = 0.39, 95% CI: 0.28-0.55).

CONCLUSION

Maternal first-trimester low BMI was inversely associated with macrosomia, and the protective effect was most pronounced among 25- to 29-year-old pregnant women without GDM/GDM history and was only found among 30- to 34-year-old multipara with GDM/GDM history. The protective effect of maternal first-trimester low BMI against macrosomia was the weakest in winter among mothers without GDM/GDM history.

Maternal iodine deficiency: a newborns' overweight risk factor? A prospective study

OBJECTIVES

Childhood obesity and iodine deficiency are global public health concerns. Whether maternal iodine status mediates overweight in infancy has yet to be explored. We aimed to assess the relationship between maternal iodine status and infant birth weight, including small and large for gestational age (SGA and LGA, respectively).

METHODS

A prospective study was carried out among 134 mother-infant pairs from Israel. Maternal iodine intake and status were estimated via questionnaire and serum thyroglobulin (Tg), respectively. Estimated iodine intake below the Recommended Daily Allowance for iodine sufficiency in pregnancy (220 μg/d) considered Inadequate. Maternal and neonatal thyroid function and anthropometric measurements, as well as maternal thyroid antibodies were also tested.

RESULTS

After screening, 118 participants met the inclusion criteria (distributed trimesters I, II and III: n = 3, n = 21, and n = 94, respectively). There was a negative association of iodine intake with Tg values among the study population. Maternal median Tg value was higher than the sufficiency cutoff (16.5 vs 13 µg/L), indicating insufficient iodine status. No SGA cases were found. Inadequate iodine intake was associated with maternal isolated hypothyroxinemia (OR = 3.4; 95% CI 1.2, 9.9) and higher birthweight (including macrosomia and LGA) rates. A suggestive association of elevated Tg with a greater risk of LGA was observed. Offsprings' birth weight percentiles were associated with Tg values in pregnant women with suggestive sufficient iodine status (n = 62, R² = 0.11, p < 0.05).

CONCLUSIONS

Iodine status during pregnancy can be associated with newborn anthropometric index. Maternal inadequate iodine intake may alter fetal growth and might increase the risk of LGA among newborns. These initial findings support the need to further study the impact of iodine deficiency on newborns overweight in Israel and elsewhere.

Low and High Ambient Temperatures during Pregnancy and Birth Weight among 624,940 Singleton Term Births in Israel (2010-2014): An Investigation of Potential Windows of Susceptibility

BACKGROUND

Exposure to heat during pregnancy has been associated with reduced fetal growth. Less is known about associations with cold and the potential for critical time windows of exposure.

OBJECTIVES

We aimed to evaluate, in a national retrospective cohort, critical windows of susceptibility during pregnancy to extreme temperatures (low and high) and fetal growth, among 624,940 singleton term births in Israel during the period 2010-2014.

METHODS

Temperature exposures were estimated using a spatially refined gridded climate data set with a 1-h and 1-km2 resolution. Percentiles of temperature were categorized by climatic zone for the entire pregnancy and by trimesters and weeks. Generalized additive models with the distributed lag nonlinear model framework were used to estimate unadjusted and adjusted associations between percentiles and categories of temperature and fetal growth markers: term [births after 36 weeks of gestational age (GA)] mean birth weight and term low birth weight (tLBW, term infants with birth weight below 2,500g).

RESULTS

After adjustment, extreme temperatures (percentiles) during the entire pregnancy were associated with a lower mean birth weight {≤10th vs. 41st-50th percentile: -56g [95% confidence interval (CI): -63g, -50g)]; >90th vs. 41st-50th percentile: -65g; 95% CI: -72g, -58g}. Similar inverse U-shaped patterns were observed for all trimesters, with stronger associations for heat than for cold and for exposures during the third trimester. For heat, results suggest critical windows between 3-9 and 19-34 GA-weeks, with the strongest association estimated at 3 GA-weeks (temperature >90th vs. 41st-50th percentiles: -3.8g; 95% CI: -7.1g, -0.4g). For cold, there was a consistent trend of null associations early in pregnancy and stronger inverse associations over time, with the strongest association at 36 GA-week (≤10th vs. 41st-50th percentiles: -2.9g; 95% CI: -6.5g, 0.7g). For tLBW, U-shape patterns were estimated for the entire pregnancy and third trimester exposures, as well as nonsignificant associations with heat for 29-36 GA-weeks. Generally, the patterns of associations with temperatures during the entire pregnancy were consistent when stratified by urbanicity and geocoding hierarchy, when estimated for daily minimum and maximum temperatures, when exposures were classified based on temperature distributions in 49 natural regions, and when estimated for all live births.

DISCUSSION

Findings from our study of term live births in Israel (2010-2014) suggest that exposure to extreme temperatures, especially heat, during specific time windows may result in reduced fetal growth. https://doi.org/10.1289/EHP8117.

Large-for-gestational-age or macrosomia as a classifier for risk of adverse perinatal outcome: a retrospective cross-sectional study

OBJECTIVE

Small for gestational age (SGA) fetuses and neonates are of great interest, while those who are too big are much less studied. The aim was to analyze the classifiers described by ACOG "Fetal macrosomia" practice bulletin as predictors of adverse perinatal outcomes for overgrown fetuses and their mothers.

MATERIALS

From a database of 53,586 singleton term births, appropriate-for-gestational-age (AGA), large for gestational age (LGA), and macrosomic deliveries were selected. AGA served as a control. The crude and adjusted odds ratios (aORs) were calculated for large-for-gestational-age >90th centile, and macrosomia >4000 g, >4250 g, and >4500 g. Patients with and without diabetes were analyzed separately.

RESULTS

Macrosomia >4000 g performed poorer than other classifiers. LGA performed comparably to other definitions of macrosomia. Diabetes carries a severe risk of complications for overgrown neonates, but those non-diabetic also have increased risk.

CONCLUSIONS

Definition of macrosomia as weight >4000 g should be reconsidered. LGA >90th centile should be used as a definition of fetal overgrowth along with other definitions of macrosomia.

Mean birth weight among term newborns: direction, magnitude and associated factors

A trend towards increasing birth weight has been shown, but factors that explain these trends have not been elucidated. The objectives of this study were to evaluate changes in mean birth weight of term newborns and to identify factors associated with them. All cohorts are population-based studies in which random samples of births (Ribeirão Preto, São Paulo State in 1978/1979, 1994 and 2010; Pelotas, Rio Grande do Sul State in 1982, 1993 and 2004; and São Luís, Maranhão State in 1997/1998 and 2010, Brazil). A total of 32,147 full-term, singleton live births were included. Mean birth weight reduced in the first study period (-89.1g in Ribeirão Preto from 1978/1979 to 1994, and -27.7g in Pelotas from 1982 to 1993) and increased +30.2g in Ribeirão Preto from 1994 to 2010 and +24.7g in São Luís from 1997 to 2010. In the first period, in Ribeirão Preto, mean birth weight reduction was steeper among mothers with high school education and among those born 39-41 weeks. In the second period, the increase in mean birth weight was steeper among mothers with low schooling in Ribeirão Preto and São Luís, females and those born 37-38 weeks in Ribeirão Preto and cesarean section in São Luís. Birth weight decreased in the first study period then increased thereafter. The variables that seem to have been able to explain these changes varied over time.

Incidence of surrogacy in the USA and Israel and implications on women's health: a quantitative comparison

PURPOSE

Gestational surrogacy (GS) has been researched in multiple qualitative studies. In contrast, quantitative aspects of the practice are conspicuously understudied. The present article assesses and compares the incidence of GS in the USA and Israel, two industrialized countries that have maintained active commercial surrogacy practice, for over two decades.

METHOD

The article is a secondary analysis of GS figures published by the Israeli Parliament's Centre for Research and Information (2018) and by the USA's Centers for Disease Control (2016) and related professional publications. Each dataset is analyzed in reference to the respective country, so as to devise local incidence scores that are then juxtaposed in inter-country comparison.

RESULTS

The incidence of GS rises steeply in both countries. Though US surrogates are contracted by local and international, heterosexual and gay, and partnered and single intended parents, the relative incidence of GS is lower in the USA than in Israel, where only local heterosexual couples could contract a gestational surrogate. An exceptionally high rate of multiple births was observed in both settings, suggesting some overlooking of professional recommendations for elective single-embryo transfer.

CONCLUSION

GS incidence appears to resemble the ratio between the countries' respective fertility rates. The paper underscores two main risks facing gestational surrogates: the risk of not conceiving and not being paid and the risk of carrying a multiple pregnancy, which is extremely prevalent in GS pregnancies, and sustaining the short- and long-term health complications that are more prevalent in such pregnancies.

Mean and variance of greenness and pregnancy outcomes in Tel Aviv during 2000–14: longitudinal and cross-sectional approaches

Background

Natural environments may have beneficial impacts on pregnancy outcomes. However, longitudinal evidence is limited and the associations with variance in surrounding greenness is unknown. Our objective was to evaluate these associations among 73 221 live births in Tel Aviv, Israel.

Methods

Longitudinal exposure to mean of greenness during pregnancy and trimesters were calculated using satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) Normalised Difference Vegetation Index (NDVI) data. In addition, exposure to mean and variation of NDVI from high-resolution satellite and percentage of tree cover [Vegetation Continuous Fields (VCF)] at 300-m buffer were evaluated in a cross-sectional approach. Generalized linear models were used to estimate the crude and adjusted associations. We explore the possible mediating role of ambient exposures and distance to ‘outdoor gyms’ located in parks.

Results

Crude beneficial associations between exposure to higher mean NDVI during pregnancy and pregnancy outcomes were observed [for birthweight, 3rd/1st tertile exposure increased the mean by 25.5 g, 95% confidence intervals (CIs): 15.4, 35.5] and decreased the odds of low birthweight, small for gestational age, preterm deliveries (PTD) and very PTD. Adjustment for individual and neighbourhood-level markers of socio-economic status (SES) attenuated all the associations. Strongest associations were observed during the first and second trimesters. Cross-sectional associations for mean greenness were similar with narrower CIs, and associations with NDVI were stronger than with tree cover and stronger for mean compared with variance of greenness. Associations were consistent for term births, different buffer sizes and for further adjustment to maternal education. Stronger associations were observed for lowest SES. Distance to ‘outdoor gyms’ and variance of greenness had the largest estimates of mediation.

Conclusion

This study adds to the limited information on when exposure to greenness is most beneficial, on the association with variance of greenness and the possible pathways. These observations require confirmation in other populations.