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Hunt KJ, Wen CC, Neelon B, Wilson DA, Mateus J, Pearce J, Chundru K, Simpson S, Korte JE, Florez H, Malek AM. Increasing Prevalence of Diagnosed Gestational Diabetes in South Carolina: 2015-2021. J Womens Health (Larchmt) 2024. [PMID: 39229709 DOI: 10.1089/jwh.2023.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Objective: To examine trends with a focus on racial and ethnic disparities in reported gestational diabetes mellitus (GDM) and related outcomes (macrosomia, large for gestational age infants) before and during the COVID-19 pandemic in South Carolina (SC). Methods: A retrospective cohort study of pregnancies resulting in livebirths from 2015 through 2021 was conducted in SC. Statewide maternal hospital and emergency department discharge codes were linked to birth certificate data. GDM was defined by ICD-9-CM (i.e., 648.01-648.02, 648.81-648.82) or ICD-10-CM codes (i.e., O24.4, O24.1, O24.9), or indication of GDM on the birth certificate without evidence of diabetes outside pregnancy (ICD-9-CM: 250.xx; ICD-10-CM: E10, E11, O24.0, O24.1, O24.3). Results: Our study included 194,777 non-Hispanic White (White), 108,165 non-Hispanic Black (Black), 25,556 Hispanic, and 16,344 other race-ethnic group pregnancies. The relative risk for GDM associated with a 1-year increase was 1.01 (95% confidence interval [CI]: 1.01-1.02) before the pandemic and 1.12 (1.09-1.14) during the pandemic. While there were race-ethnic differences in the prevalence of GDM, increasing trends were similar across all race-ethnic groups before and during the pandemic. From quarter 1, 2020, to quarter 4, 2021, the prevalence of reported GDM increased from 8.92% to 10.85% in White, from 8.04% to 9.78% in Black, from 11.2% to 13.65% in Hispanic, and from 13.3% to 16.16% in other race-ethnic women. Conclusion: An increasing prevalence of diagnosed GDM was reported during the COVID-19 pandemic. Future studies are needed to understand the mechanisms underlying increasing trends, to develop interventions, and to determine whether the increasing trend continues in subsequent years.
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Affiliation(s)
- Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Dulaney A Wilson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julio Mateus
- Maternal-Fetal Medicine Division, Department of Obstetrics & Gynecology, Atrium Health, Charlotte, North Carolina, USA
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kalyan Chundru
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah Simpson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hermes Florez
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Kauffman E. Cesarean reduction efforts undercut by not attempting vaginal birth. Birth 2024; 51:471-474. [PMID: 38766955 DOI: 10.1111/birt.12826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
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Lerner Y, Peled T, Priner Adler S, Rotem R, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Induction of labor in term pregnancies with isolated polyhydramnios: Is it beneficial or harmful? Int J Gynaecol Obstet 2024; 166:1203-1211. [PMID: 38581215 DOI: 10.1002/ijgo.15527] [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: 11/28/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To compare rates of adverse pregnancy outcomes in term pregnancies complicated by polyhydramnios between women who had induction of labor (IOB) versus women who had expectant management. METHODS This multicenter retrospective study included term pregnancies complicated by isolated polyhydramnios. Patients who underwent IOB were compared with those who had expectant management. The primary outcome was defined as a composite adverse maternal outcome, and secondary outcomes were various maternal and neonatal adverse outcomes. Univariate analyses were followed by multivariate logistic regression. RESULTS A total of 865 pregnancies with term isolated polyhydramnios were included: 169 patients underwent IOB (19.5%), while 696 had expectant management and developed spontaneous onset of labor (80.5%). Women who underwent IOB had significantly higher rates of composite adverse maternal outcome (23.1% vs 9.8%, P < 0.01), prolonged hospital stay, perineal tear grade 3/4, intrapartum cesarean, postpartum hemorrhage, blood products transfusion, and neonatal asphyxia compared with expectant management. While the perinatal fetal death rate was similar between the groups (0.6% vs 0.6%, P = 0.98), the timing of the loss was different. Four women in the expectant management group had a stillbirth, while in the induction group one case of intrapartum fetal death occurred due to uterine rupture. Multivariate analyses revealed that IOB was associated with a higher rate of composite adverse maternal outcome (adjusted odds ratio, 2.22 [95% CI, 1.28-3.83]; P < 0.01). CONCLUSION IOB in women with term isolated polyhydramnios is associated with higher rates of adverse maternal outcomes in comparison to expectant management. Further research is needed to determine the optimal approach for the management of isolated polyhydramnios at term.
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Affiliation(s)
- Yael Lerner
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Tzuria Peled
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Shira Priner Adler
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Holopainen LS, Tähtinen HH, Gissler M, Korhonen PE, Ekblad MO. Interaction of maternal smoking and gestational diabetes mellitus on newborn head circumference and birthweight. Acta Obstet Gynecol Scand 2024; 103:1859-1867. [PMID: 39004941 PMCID: PMC11324935 DOI: 10.1111/aogs.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Maternal smoking during pregnancy and gestational diabetes mellitus (GDM) have opposite effects on fetal growth during pregnancy. The aim of the study was to evaluate the interaction of smoking during pregnancy and gestational diabetes mellitus on head circumference and birthweight of newborns. MATERIAL AND METHODS The study included all primiparous women with singleton pregnancies (n = 290 602) without previously diagnosed diabetes or hypertension in Finland between 2006 and 2018. The information on gestational diabetes mellitus, newborn birthweight and head circumference, and maternal smoking and backgrounds was derived from the Finnish Medical Birth Register. Linear regression models were used in the analyses. RESULTS In total 8.0% of parturients quit smoking during the first trimester and 9.9% continued smoking thereafter. The prevalence of GDM was 8.9% (n = 25 948). Newborns of women who continued smoking had a smaller head circumference (b = -0.24, SE = 0.01, p < 0.0001) and birthweight (b = -0.28, SE = 0.01, p < 0.0001) compared to newborns of women who did not smoke. Head circumference and birthweight were greater in newborns of women with GDM (b = 0.09, SE = 0.01, p < 0.0001 and b = 0.16, SE = 0.01, p < 0.0001, respectively) compared to newborns of women without GDM. In the interaction analyses, head circumference (b = -0.13, SE = 0.01, p < 0.0001) was smaller and birthweight (b = -0.13, SE = 0.02, p < 0.0001) was lower in newborns of women with GDM who continued smoking compared to newborns of women without GDM who did not smoke. CONCLUSIONS Although smoking and GDM have opposite effects on fetal growth, the negative effects of exposure to smoking are also seen in newborns of women with GDM. Compared to smoking after the first trimester of pregnancy, cessation of smoking during the first trimester was associated with greater head circumference and birthweight in newborns.
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Affiliation(s)
- Lotta S Holopainen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Hanna H Tähtinen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
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Zeevi G, Regev N, Key-Segal C, Romano A, Houri O, Bercovich O, Hadar E, Berezowsky A. To know or not to know: Effect of third-trimester sonographic fetal weight estimation on outcomes of large-for-gestational age neonates. Int J Gynaecol Obstet 2024; 166:1108-1113. [PMID: 38532548 DOI: 10.1002/ijgo.15495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The aim of the present study was to evaluate the impact of late third-trimester sonographic estimation of large for gestational age fetuses on pregnancy management and selected fetal and maternal adverse outcomes. METHODS A retrospective cohort study was conducted in a tertiary, university-affiliated medical center between 2015 and 2019. All singleton large-for-gestational-age neonates born during this period were included. The cohort was divided into two groups: neonates for whom fetal weight was estimated on late third trimester (<14 days before delivery) sonography and neonates with no recent fetal weight estimation. The groups were compared for pregnancy management strategies, rates of labor induction, cesarean deliveries, and maternal and neonatal outcomes. RESULTS A total of 1712 neonates were included in the study, among whom 791 (46.2%) had a late third-trimester fetal weight estimation (study group) and 921 (53.8%) did not (control group). Compared to the control group, the study group was characterized by higher rates of maternal primiparity (24.20% vs 19.20%, P = 0.013), higher maternal body mass index (26.0 ± 6.2 kg/m2 vs 24.7 ± 4.5 kg/m2, P = 0.002), more inductions of labor (29.84% vs 16.40%, P < 0.001) and cesarean deliveries (31.0% vs 19.97%, P < 0.001). There were no clinical differences in neonatal birth weight (4041 ± 256 g vs 3984 264 g, P < 0.001) and no significant differences between other neonatal outcomes, as rates of admission to the neonatal intensive care unit, jaundice, hypoglycemia, and shoulder dystocia. CONCLUSION Late third-trimester sonographic fetal weight estimation is associated with a higher rate of labor induction and planned and intrapartum cesarean deliveries. In this retrospective cohort study, those interventions did not lead to reduction in maternal or neonatal adverse outcomes.
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Affiliation(s)
- Gil Zeevi
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Noam Regev
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Chen Key-Segal
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Asaf Romano
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Ohad Houri
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Or Bercovich
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Eran Hadar
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Alexandra Berezowsky
- Faculty of Medical Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, University of Toronto and St. Michael's Hospital, Toronto, Canada
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Gleason JL, Reddy UM, Chen Z, Grobman WA, Wapner RJ, Steller JG, Simhan H, Scifres CM, Blue N, Parry S, Grantz KL. Comparing population-based fetal growth standards in a US cohort. Am J Obstet Gynecol 2024; 231:338.e1-338.e18. [PMID: 38151220 PMCID: PMC11196385 DOI: 10.1016/j.ajog.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND No fetal growth standard is currently endorsed for universal use in the United States. Newer standards improve upon the methodologic limitations of older studies; however, before adopting into practice, it is important to know how recent standards perform at identifying fetal undergrowth or overgrowth and at predicting subsequent neonatal morbidity or mortality in US populations. OBJECTIVE To compare classification of estimated fetal weight that is <5th or 10th percentile or >90th percentile by 6 population-based fetal growth standards and the ability of these standards to predict a composite of neonatal morbidity and mortality. STUDY DESIGN We used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be cohort, which recruited nulliparous women in the first trimester at 8 US clinical centers (2010-2014). Estimated fetal weight was obtained from ultrasounds at 16 to 21 and 22 to 29 weeks of gestation (N=9534 women). We calculated rates of fetal growth restriction (estimated fetal weight <5th and 10th percentiles; fetal growth restriction<5 and fetal growth restriction<10) and estimated fetal weight >90th percentile (estimated fetal weight>90) from 3 large prospective fetal growth cohorts with similar rigorous methodologies: INTERGROWTH-21, World Health Organization-sex-specific and combined, Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific and unified, and the historic Hadlock reference. To determine whether differential classification of fetal growth restriction or estimated fetal weight >90 among standards was clinically meaningful, we then compared area under the curve and sensitivity of each standard to predict small for gestational age or large for gestational age at birth, composite perinatal morbidity and mortality alone, and small for gestational age or large for gestational age with composite perinatal morbidity and mortality. RESULTS The standards classified different proportions of fetal growth restriction and estimated fetal weight>90 for ultrasounds at 16 to 21 (visit 2) and 22 to 29 (visit 3) weeks of gestation. At visit 2, the Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific, World Health Organization sex-specific and World Health Organization-combined identified similar rates of fetal growth restriction<10 (8.4%-8.5%) with the other 2 having lower rates, whereas Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific identified the highest rate of fetal growth restriction<5 (5.0%) compared with the other references. At visit 3, World Health Organization sex-specific classified 9.2% of fetuses as fetal growth restriction<10, whereas the other 5 classified a lower proportion as follows: World Health Organization-combined (8.4%), Eunice Kennedy Shriver National Institute of Child Health and Human Development race-ethnic-specific (7.7%), INTERGROWTH (6.2%), Hadlock (6.1%), and Eunice Kennedy Shriver National Institute of Child Health and Human Development unified (5.1%). INTERGROWTH classified the highest (21.3%) as estimated fetal weight>90 whereas Hadlock classified the lowest (8.3%). When predicting composite perinatal morbidity and mortality in the setting of early-onset fetal growth restriction, World Health Organization had the highest area under the curve of 0.53 (95% confidence interval, 0.51-0.53) for fetal growth restriction<10 at 22 to 29 weeks of gestation, but the areas under the curve were similar among standards (0.52). Sensitivity was generally low across standards (22.7%-29.1%). When predicting small for gestational age birthweight with composite neonatal morbidity or mortality, for fetal growth restriction<10 at 22 to 29 weeks of gestation, World Health Organization sex-specific had the highest area under the curve (0.64; 95% confidence interval, 0.60-0.67) and INTERGROWTH had the lowest (area under the curve=0.58; 95% confidence interval 0.55-0.62), though all standards had low sensitivity (7.0%-9.6%). CONCLUSION Despite classifying different proportions of fetuses as fetal growth restriction or estimated fetal weight>90, all standards performed similarly in predicting perinatal morbidity and mortality. Classification of different percentages of fetuses as fetal growth restriction or estimated fetal weight>90 among references may have clinical implications in the management of pregnancies, such as increased antenatal monitoring for fetal growth restriction or cesarean delivery for suspected large for gestational age. Our findings highlight the importance of knowing how standards perform in local populations, but more research is needed to determine if any standard performs better at identifying the risk of morbidity or mortality.
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Affiliation(s)
- Jessica L Gleason
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - William A Grobman
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Jon G Steller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of California, Irvine, Irvine, CA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Christina M Scifres
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Nathan Blue
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
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Chiossi G, Cuoghi Costantini R, Menichini D, Tramontano AL, Diamanti M, Facchinetti F, D'Amico R. Do maternal BMI and gestational weight gain equally affect the risk of infant hypoxic and traumatic events? PLoS One 2024; 19:e0308441. [PMID: 39106291 DOI: 10.1371/journal.pone.0308441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/23/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Small (SGA) and large (LGA) for gestational age infants have higher risks of infant morbidity when compared to those who are appropriate for gestational age (AGA). Increasing pre-pregnancy maternal BMI and gestational weight gain (GWG) are associated with higher risks of LGA and lower risks of SGA infants; however, their direct effects on infant morbidity are unknown. Therefore, we intended to 1) assess how maternal pre-pregnancy BMI, GWG, and birthweight (categorized as SGA, AGA or LGA) affect infant morbidity and 2) estimate at entry of care the risk of infant morbidity according to pre-pregnancy BMI and possible GWG. METHODS we used Consortium on Safe Labor data, a retrospective observational cohort study collecting pregnancy and birth data from 2002 to 2008 in 12 US centers. The association between maternal BMI, GWG and infant morbidity was estimated in singleton gestations delivering ≥ 37 weeks using binomial logistic regression. Hypoxic composite neonatal morbidity was defined as any the following: stillbirth, neonatal death, resuscitation at birth, NICU admission, intracranial hemorrhage, PVH grade III and IV, neonatal seizures, NEC, meconium aspiration, CPAP or mechanical ventilation, RDS, and sepsis. Traumatic composite neonatal morbidity included shoulder dystocia or birth injuries. RESULTS In this study of 110,594 mother-infant dyads, a total of 8,369 (7.6%) infants experienced hypoxic, while 2,134 (1.9%) developed traumatic morbidity. The risk of hypoxic morbidity among SGA, AGA and LGA infants increased when mothers were overweight (aOR 1.26 [95%CI 1.18-1.34]) or obese (class 1: aOR 1.3 [1.2-1.4]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2]) as opposed to normal weight, and when GWG exceeded (aOR 1.08 [1.02-1.014]) rather than remained within recommendations. The risk of traumatic morbidity increased with maternal obesity (class 1: aOR 1.3 [1.1-1.5]), whilst it dropped with GWG below recommendations (aOR 0.7 [0.6-0.8]). The risk of hypoxic events estimated at entry of care increased with maternal overweight (aOR 1.27 [1.19-1.35]) or obesity (class 1: aOR 1.4 [1.2-1.5]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2.1]), and with possible GWG above (aOR 1.09 [1.03-1.015]) recommendations. The risk of traumatic morbidity increased with overweight (aOR 1.1 [1-1.3]) or obesity (class 1: aOR 1.4 [1.2-1.6]; class 2: aOR 1.3 [1-1.6]), with possible GWG above (aOR 1.2 [1-1.3]), as opposed to below recommendations (aOR 0.7 [0.6-0.8]). CONCLUSIONS While maternal pre-pregnancy BMI and GWG equally affected traumatic morbidity, the former had a greater impact on hypoxic complications. Therefore, weight control prior to pregnancy is at least as effective as avoiding excessive gestational weight gain to prevent neonatal morbidity.
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Affiliation(s)
- Giuseppe Chiossi
- Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Cuoghi Costantini
- Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Menichini
- Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Luna Tramontano
- Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Marialaura Diamanti
- Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy
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Schuyler AQ, Koch FR, Goodier CG. Understanding Obstetrical Surgical Planning for the Pediatrician. Neoreviews 2024; 25:e497-e505. [PMID: 39085174 DOI: 10.1542/neo.25-8-e497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
Cesarean deliveries are common in the United States, occurring in approximately one-third of deliveries in 2021. Given this high rate of cesarean deliveries, it is important for all clinicians caring for the pregnant person-infant dyad to be educated about cesarean deliveries. In this review, we describe the indications for cesarean delivery, the evidence-based practices of preoperative planning to ensure safe deliveries, and the clinical decision-making behind various cesarean incisions. In addition, we discuss the most common complications of cesarean deliveries for the pregnant person-infant dyad.
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Affiliation(s)
- Amelia Q Schuyler
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL
| | | | - Christopher G Goodier
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
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Bommarito PA, Stevens DR, Welch BM, Meeker JD, Cantonwine DE, McElrath TF, Ferguson KK. Prenatal exposure to environmental phenols and fetal growth across pregnancy in the LIFECODES fetal growth study. ENVIRONMENT INTERNATIONAL 2024; 190:108866. [PMID: 38968832 PMCID: PMC11349462 DOI: 10.1016/j.envint.2024.108866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/31/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION Environmental phenols are endocrine disrupting chemicals hypothesized to affect early life development. Previous research examining the effects of phenols on fetal growth has focused primarily on associations with measures of size at delivery. Few have included ultrasound measures to examine growth across pregnancy. OBJECTIVE Investigate associations between prenatal exposure to phenols and ultrasound and delivery measures of fetal growth. METHODS Using the LIFECODES Fetal Growth Study (n = 900), a case-cohort including 248 small-for-gestational-age, 240 large-for-gestational age, and 412 appropriate-for-gestational-age births, we estimated prenatal exposure to 12 phenols using three urine samples collected during pregnancy (median 10, 24, and 35 weeks gestation). We abstracted ultrasound and delivery measures of fetal growth from medical records. We estimated associations between pregnancy-average phenol biomarker concentrations and repeated ultrasound measures of fetal growth using linear mixed effects models and associations with birthweight using linear regression models. We also used logistic regression models to estimate associations with having a small- or large-for-gestational birth. RESULTS We observed positive associations between 2,4-dichlorophenol, benzophenone-3, and triclosan (TCS) and multiple ultrasound measures of fetal growth. For example, TCS was associated with a 0.09 (95 % CI: 0.01, 0.18) higher estimated fetal weight z-score longitudinally across pregnancy. This effect size corresponds to a 21 g increase in estimated fetal weight at 30 weeks gestation. Associations with delivery measures of growth were attenuated, but TCS remained positively associated with birthweight z-scores (mean difference: 0.13, 95 % CI: 0.02, 0.25). Conversely, methylparaben was associated with higher odds of a small-for-gestational age birth (odds ratio: 1.45, 95 % CI: 1.06, 1.98). DISCUSSION We observed associations between some biomarkers of phenol exposure and ultrasound measures of fetal growth, though associations at the time of delivery were attenuated. These findings are consistent with hypotheses that phenols have the potential to affect growth during the prenatal period.
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Affiliation(s)
- Paige A Bommarito
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Danielle R Stevens
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Barrett M Welch
- School of Public Health, University of Nevada, Reno, NV, USA
| | - John D Meeker
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - David E Cantonwine
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly K Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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10
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Baek MJ, Na ED, Lee H, Park SH, Kim S, Kim T, Jung SH, Jang JH. Neonatal head circumference to maternal mid-transverse pelvic distance ratio as a key anatomical predictor for dystocia: Retrospective case-control study. J Obstet Gynaecol Res 2024; 50:1383-1391. [PMID: 38777330 DOI: 10.1111/jog.15974] [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: 02/25/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to examine maternal and neonatal factors in cesarean deliveries due to dystocia, including cephalopelvic disproportion, latent-phase prolongation, and fetal malposition or malpresentation. Additionally, we sought to compare the differences between the dystocia subgroups. METHOD AND MATERIALS This retrospective case-control study included women who delivered between January 2010 and June 2021 after 37 weeks of pregnancy and underwent abdominal-pelvic CT scans within 5 years before and after delivery. Neonatal factors were extracted from medical charts immediately after delivery. RESULTS Among the 292 women studied, those with cesarean deliveries for dystocia were older (mean ± SD, 34.2 ± 4.27 vs. 32.2 ± 3.8, p-value = 0.002), had higher pre-pregnancy BMI (22.7 ± 3.67 vs. 21.4 ± 3.48, p-value = 0.012) and term-BMI (27.4 ± 3.72 vs. 25.9 ± 3.66, p-value = 0.010), shorter interspinous distance (ISD, the distance between ischial spine) (10.8 ± 0.76 vs. 11.2 ± 0.85 cm, p-value = 0.003), and longer head circumference (HC) (35 ± 1.47 vs. 34.4 ± 1.36 cm, p-value = 0.003) compared to those who had vaginal deliveries. Univariate logistic regression for dystocia revealed associations between HC/maternal height and HC/ISD ratios (OR, 2.02 [95% confidence interval, CI, 1.4 ~ 2.92], 12.13 [3.2 ~ 46.04], respectively). Multivariate logistic analysis indicated that maternal age, ISD, and HC were significant factors for dystocia (OR, 1.11 [95% CI, 1.01 ~ 1.21], 0.49 [0.26 ~ 0.91], 1.53 [1.07 ~ 2.19], respectively). The subgroup with latent-phase prolongation exhibited the lowest birthweight/term-BMI ratio (124 ± 18.8 vs. 113 ± 10.3 vs. 134 ± 19.1, p-value = 0.013). CONCLUSION The HC/ISD ratio emerged as a crucial predictor of dystocia, suggesting that reducing term-BMI could potentially mitigate latent-phase prolongation. Further research assessing the maternal mid-pelvis during pregnancy and labor is warranted, along with efforts to reduce BMI during pregnancy.
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Affiliation(s)
- Min Jung Baek
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hanna Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - So Hyeon Park
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seoyeon Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Taeho Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Hee Jung
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Ji Hyon Jang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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11
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Luo Y, Qin Y, Kong L, Long J, Lukacs-Kornek V, Li J, Wei H, Qin J. Clinical and pathological characteristics of gestational diabetes mellitus with different insulin resistance. J Diabetes Complications 2024; 38:108796. [PMID: 38991491 DOI: 10.1016/j.jdiacomp.2024.108796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/09/2024] [Accepted: 06/09/2024] [Indexed: 07/13/2024]
Abstract
AIMS To elucidate the clinical and pathological characteristics of gestational diabetes mellitus (GDM) with high and low insulin resistance. METHODS In total, 1393 GDM and 1001 non-GDM singleton deliveries were included in this study. Insulin resistance subtypes were classified according to the HOMA2-IR value. Clinical data were analyzed using SPSS 26.0. Placenta samples were collected for pathological analysis. RESULTS Maternal age and fasting glucose were identified as independent risk factors for GDM with high insulin resistance (p < 0.01), while fasting glucose was the sole risk factor for GDM with low insulin resistance (p < 0.001). Fetal distress was associated with both of GDM subtypes (both p < 0.01), while anemia, fetal growth restriction, large for gestational age and intrahepatic cholestasis in pregnancy were related to specific GDM insulin resistance subtype. In addition, GDM with high insulin resistance showed an increase of syncytial knots with down-regulation of PI3K/AKT signaling, while GDM with low insulin resistance showed normal syncytial knot counts and up-regulation of PI3K/AKT signaling. CONCLUSIONS Our findings provide novel perspectives to the clinical and pathological comprehensions of GDM with high and low insulin resistance, which might facilitate the mechanism study of GDM and its precision pregnancy management.
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Affiliation(s)
- Yidan Luo
- Ruikang Clinical Medical College, Guangxi University of Chinese Medicine, Nanning, PR China(2); Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2)
| | - Yuqin Qin
- Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2)
| | - Lin Kong
- Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2)
| | - Junqing Long
- Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2)
| | - Veronika Lukacs-Kornek
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Jian Li
- Institute of Molecular Medicine and Experimental Immunology, University Clinic of Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hongwei Wei
- Ruikang Clinical Medical College, Guangxi University of Chinese Medicine, Nanning, PR China(2); Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2); Birth Defects Prevention and Control Institute, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China.
| | - Jie Qin
- Department of Obstetrics, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China(2); Birth Defects Prevention and Control Institute, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, PR China; Guangxi Key Laboratory of Birth Defects and Stem Cell Biobank, Nanning, PR China.
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12
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Simpson B, Barker K, Parnell L, Waring GJ. Bigger babies: what happens in real practice in a non-academic UK center? Detection accuracy and outcomes with induction. Minerva Obstet Gynecol 2024; 76:305-311. [PMID: 36943256 DOI: 10.23736/s2724-606x.22.05167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is emerging evidence of improved outcomes with induction of labour for pregnancies in which the baby is thought to be large. This trial identifies scan accuracy and the effect of intervention for pregnancies complicated by suspected large for gestational age (LGA) on customized chart outside an academic center. METHODS This is a retrospective cohort study of 3 groups of induced pregnancies; women with a suspected LGA fetus, women with diabetes (DM) and a control group (C) of women that underwent induction of labour on or after 280 days gestation. Data collection and analysis were prespecified. Scan accuracy and outcomes between the cohorts were compared. RESULTS Over 1 year there were 845 cases: LGA (128), DM (116) and control cases (601). Mean birthweights differed significantly. PPV of EFW for birthweight >90th centile on GROW chart, WHO chart, and >4 kg was 0.35-0.40. Projected birthweight of >4 kg significantly better predicted itself (AUROC 0.70, 0.74 and 0.80). Mean scan error was -5.2% and +15.6% for DM and LGA. Shoulder dystocia and neonatal morbidity were not increased in LGA despite the significant increase in AVD 28/128, 21.9% vs. 99/601, 16.5%, aOR 2.20 (1.07-4.5). SVD was significantly less likely LGA vs. C at 69/128, 53.9% vs. 413/601, 68.7% aOR 0.38 (95% CI: 0.21-0.70). CONCLUSIONS Third trimester EFW for bigger babies was poorly predictive of macrosomia. Fetal outcomes were good but women selected and induced as LGA had higher rates of hemorrhage and intervention.
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Affiliation(s)
- Ben Simpson
- Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK -
| | - Katie Barker
- Department of Obstetrics and Gynecology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Laura Parnell
- Department of Maternal-Fetal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth J Waring
- Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Department of Maternal-Fetal Medicine, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Avagliano L, Castiglioni S, Lettieri A, Parodi C, Di Fede E, Taci E, Grazioli P, Colombo EA, Gervasini C, Massa V. Intrauterine growth in chromatinopathies: A long road for better understanding and for improving clinical management. Birth Defects Res 2024; 116:e2383. [PMID: 38984779 DOI: 10.1002/bdr2.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Chromatinopathies are a heterogeneous group of genetic disorders caused by pathogenic variants in genes coding for chromatin state balance proteins. Remarkably, many of these syndromes present unbalanced postnatal growth, both under- and over-, although little has been described in the literature. Fetal growth measurements are common practice in pregnancy management and values within normal ranges indicate proper intrauterine growth progression; on the contrary, abnormalities in intrauterine fetal growth open the discussion of possible pathogenesis affecting growth even in the postnatal period. METHODS Among the numerous chromatinopathies, we have selected six of the most documented in the literature offering evidence about two fetal overgrowth (Sotos and Weaver syndrome) and four fetal undergrowth syndromes (Bohring Opitz, Cornelia de Lange, Floating-Harbor, and Meier Gorlin syndrome), describing their molecular characteristics, maternal biochemical results and early pregnancy findings, prenatal ultrasound findings, and postnatal characteristics. RESULTS/CONCLUSION To date, the scarce data in the literature on prenatal findings are few and inconclusive, even though these parameters may contribute to a more rapid and accurate diagnosis, calling for a better and more detailed description of pregnancy findings.
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Affiliation(s)
| | - Silvia Castiglioni
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Antonella Lettieri
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Chiara Parodi
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Elisabetta Di Fede
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milan, Italy
| | - Esi Taci
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milan, Italy
| | - Paolo Grazioli
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Elisa Adele Colombo
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Cristina Gervasini
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milan, Italy
| | - Valentina Massa
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Università Degli Studi di Milano, Milan, Italy
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14
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Kukkonen A, Hantunen S, Voutilainen A, Ruusunen A, Backman K, Kirjavainen PV, Ylilauri M, Voutilainen R, Pasanen M, Keski-Nisula L. Maternal caffeine intake during pregnancy and the risk of delivering a small for gestational age baby: Kuopio Birth Cohort. Arch Gynecol Obstet 2024; 310:359-368. [PMID: 38767721 PMCID: PMC11169027 DOI: 10.1007/s00404-024-07538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE High caffeine intake during pregnancy is associated with restricted fetal growth. We aimed to evaluate the association between maternal caffeine intake during early and late pregnancy and the risk of delivering a small for gestational age (SGA) baby. METHODS Kuopio Birth Cohort (KuBiCo) is a prospective cohort study including women whose pregnancies and deliveries were treated at the prenatal clinics in outpatient healthcare centers and in Kuopio University Hospital, Finland. Maternal diet and caffeine intake during the first (n = 2007) and third (n = 4362) trimester of pregnancy were assessed using a 160-item food frequency questionnaire (2013-2022). SGA was defined as birth weight corrected for gestational age below - 2 standard deviations from the mean, according to the sex-specific Finnish fetal growth curves. RESULTS Altogether in 32 and 38% (1st and 3rd trimester) of all women and in 44 and 52% of coffee drinkers, caffeine intake exceeded the recommendation for caffeine intake ( ≤ 200 mg/day) during pregnancy. The women with moderate (51-200 mg/day) (aOR 1.87; 95% CI: 1.16-3.02) and high (> 200 mg/day) (aOR 1.51; 95% CI: 1.08-2.10) caffeine intake during the first trimester were in the highest risk of having an SGA newborn. Caffeine intake in the third trimester of pregnancy was not associated with SGA. CONCLUSIONS Moderate and high caffeine intake during early pregnancy is associated with SGA. As the results suggest that even moderate caffeine intake during the first trimester may increase the risk of SGA, the intake within recommendation limits does not necessarily appear to be safe for pregnant women and their newborns.
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Affiliation(s)
- Anni Kukkonen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Australia
| | - Katri Backman
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Maija Ylilauri
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Raimo Voutilainen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Pasanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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15
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Bommarito PA, Stevens DR, Welch BM, Ospina M, Calafat AM, Meeker JD, Cantonwine DE, McElrath TF, Ferguson KK. Organophosphate Ester Flame Retardants and Plasticizers in Relation to Fetal Growth in the LIFECODES Fetal Growth Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:77001. [PMID: 38968089 PMCID: PMC11225970 DOI: 10.1289/ehp14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/07/2024] [Accepted: 06/13/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Organophosphate esters (OPEs), used ubiquitously as flame retardants and plasticizers in consumer products, are suspected of having developmental toxicity. OBJECTIVES Our study aimed to estimate associations between prenatal exposure to OPEs and fetal growth, including both ultrasound (head circumference, abdominal circumference, femur length, and estimated fetal weight) and delivery [birth weight z-score, small-for-gestational age (SGA), and large-for-gestational age (LGA)] measures of growth. METHODS In the LIFECODES Fetal Growth Study (2008-2018), an enriched case-cohort of 900 babies born at the small and large ends of the growth spectrum, we quantified OPE biomarkers in three urine samples per pregnant participant and abstracted ultrasound and delivery measures of fetal growth from medical records. We estimated associations between pregnancy-averaged log-transformed OPE biomarkers and repeated ultrasound measures of fetal growth using linear mixed-effects models, and delivery measures of fetal growth using linear (birth weight) and logistic (SGA and LGA) regression models. RESULTS Most OPE biomarkers were positively associated with at least one ultrasound measure of fetal growth, but associations with delivery measures were largely null. For example, an interquartile range (IQR; 1.31 ng / mL ) increase in bis(2-chloroethyl) phosphate concentration was associated with larger z-scores in head circumference [mean difference (difference): 0.09; 95% confidence interval (CI): 0.01, 0.17], abdominal circumference (difference: 0.10; 95% CI: 0.02, 0.18), femur length (difference: 0.11; 95% CI: 0.03, 0.19), and estimated fetal weight (difference: 0.13; 95% CI: 0.04, 0.22) but not birth weight (difference: 0.04; 95% CI: - 0.08 , 0.17). At delivery, an IQR (1.00 ng / mL ) increase in diphenyl phosphate (DPHP) concentration was associated with an SGA birth (odds ratio: 1.46; 95% CI: 1.10, 1.94). CONCLUSIONS In a large prospective cohort, gestational OPE exposures were associated with larger fetal size during pregnancy, but associations at delivery were null. DPHP concentrations were associated with heightened risk of an SGA birth. These findings suggest that OPE exposure may affect fetal development. https://doi.org/10.1289/EHP14647.
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Affiliation(s)
- Paige A. Bommarito
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Danielle R. Stevens
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Barrett M. Welch
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - David E. Cantonwine
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas F. McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly K. Ferguson
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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16
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Sousa KS, Leite HV, Corrêa MD, Sousa MS, Queiroz ALR. Prevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo48. [PMID: 38994466 PMCID: PMC11239214 DOI: 10.61622/rbgo/2024rbgo48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/07/2024] [Indexed: 07/13/2024] Open
Abstract
Objective Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams. Methods This is an observational study, case-control type, carried out by searching for data in hospital's own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis. Results From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common. Conclusion Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.
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Affiliation(s)
- Kellen Silva Sousa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Henrique Vitor Leite
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Mário Dias Corrêa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Matheus Silva Sousa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Anna Luíza Rocha Queiroz
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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17
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Singh S, Bortoletto P, Wylie BJ, Melnick AP, Prabhu M. The impact of reference growth standards on small- and large-for-gestational age outcomes among pregnancies conceived by fresh and frozen embryo transfers. F S Rep 2024; 5:164-169. [PMID: 38983739 PMCID: PMC11228793 DOI: 10.1016/j.xfre.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 07/11/2024] Open
Abstract
Objective To describe differences in the frequency of small-for-gestational age (SGA) and large-for-gestational age (LGA) driven by different birth weight curves in assisted reproductive technology (ART)-conceived pregnancies. Design Retrospective cohort study. Setting Single academic medical center. Patients Singleton live births between the gestational ages of 36 weeks and 0 days and 42 weeks and 6 days from fresh or frozen embryo transfer (ET). Interventions None. Main Outcome Measures SGA (<10th percentile) and LGA (>90th percentile) classified by Fenton, INTERGROWTH-21, World Health Organization, Duryea, and Oken curves. Results The median birth weight and gestational age at birth among fresh ET pregnancies were 3,289g (interquartile range [IQR], 2,977-3,600g) and 39.4 (IQR, 38.6-40.3) weeks, respectively, and those among frozen ET pregnancies were 3,399g (IQR, 3,065-3,685g) and 39.4 (IQR, 38.7-40.1) weeks, respectively. The frequencies of SGA neonates using each birth weight standard ranged from 5.8% to 13.4% for fresh ET and from 3.5% to 8.7% for frozen ET. Those of LGA neonates ranged from 5.3% to 14.3% for fresh ET and from 6.6% to 21.2% for frozen ET. Conclusion The frequency of SGA and LGA neonates among ART-conceived gestations is partially driven by the birth weight standard. Selecting an appropriate standard that best reflects the patient population is critical to quantifying the risk of ART-conceived pregnancies.
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Affiliation(s)
- Sunidhi Singh
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
- Boston IVF, Waltham, Massachusetts
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Alexis P Melnick
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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18
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Badr DA, Carlin A, Boulvain M, Kadji C, Cannie MM, Jani JC, Gucciardo L. A simulation study to assess the potential benefits of MRI-based fetal weight estimation as a second-line test for suspected macrosomia. Eur J Obstet Gynecol Reprod Biol 2024; 297:126-131. [PMID: 38615575 DOI: 10.1016/j.ejogrb.2024.04.009] [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: 01/07/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To simulate the outcomes of Boulvain's trial by using magnetic resonance imaging (MRI) for estimated fetal weight (EFW) as a second-line confirmatory imaging. STUDY DESIGN Data derived from the Boulvain's trial and the study PREMACRO (PREdict MACROsomia) were used to simulate a 1000-patient trial. Boulvain's trial compared induction of labor (IOL) to expectant management in suspected macrosomia, whereas PREMACRO study compared the performance of ultrasound-EFW (US-EFW) and MRI-EFW in the prediction of birthweight. The primary outcome was the incidence of significant shoulder dystocia (SD). Cesarean delivery (CD), hyperbilirubinemia (HB), and IOL at < 39 weeks of gestation (WG) were selected as secondary outcomes. A subgroup analysis of the Boulvain's trial was performed to estimate the incidence of the primary and secondary outcomes in the true positive and false positive groups for the two study arms. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for the prediction of macrosomia by MRI-EFW at 36 WG were calculated, and a decision tree was constructed for each outcome. RESULTS The PPV of US-EFW for the prediction of macrosomia in the PREMACRO trial was 56.3 %. MRI-EFW was superior to US-EFW as a predictive tool resulting in lower rates of induction for false-positive cases. Repeating Boulvain's trial using MRI-EFW as a second-line test would result in similar rates of SD (relative risk [RR]:0.36), CD (RR:0.84), and neonatal HB (RR:2.6), as in the original trial. Increasing the sensitivity and specificity of MRI-EFW resulted in a similar relative risk for SD as in Boulvain's trial, but with reduced rates of IOL < 39 WG, and improved the RR of CD in favor of IOL. We found an inverse relationship between IOL rate and incidence of SD for both US-EFW and MRI-EFW, although overall rates of IOL, CD, and neonatal HB would be lower with MRI-derived estimates of fetal weight. CONCLUSION The superior accuracy of MRI-EFW over US-EFW for the diagnosis of macrosomia could result in lower rates of IOL without compromising the relative advantages of the intervention but fails to demonstrate a significant benefit to justify a replication of the original trial using MRI-EFW as a second-line test.
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Affiliation(s)
- Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Boulvain
- Department of Obstetrics and Gynecology, UZ Brussels, Vrije Universiteit Brussel, Brussels Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Leonardo Gucciardo
- Department of Obstetrics and Gynecology, UZ Brussels, Vrije Universiteit Brussel, Brussels Belgium
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19
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Nazeer SA, Chen HY, Cornthwaite JA, Chauhan SP, Sibai B, Wagner S, Bartal MF. Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status. Am J Perinatol 2024. [PMID: 38688321 DOI: 10.1055/a-2316-9007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To examine the association of adverse outcomes among parturients with large for gestational age (LGA; birth weight ≥ 90th) newborns, stratified by diabetes status. Additionally, we described the temporal trends of adverse outcomes among LGA neonates. STUDY DESIGN This retrospective cohort study used the U.S. Vital Statistics dataset between 2014 and 2020. The inclusion criteria were singleton, nonanomalous LGA live births who labored and delivered at 24 to 41 weeks with known diabetes status. The coprimary outcomes were composite neonatal adverse outcomes of the following: Apgar score < 5 at 5 minutes, assisted ventilation > 6 hours, seizure, or neonatal or infant mortality, and maternal adverse outcomes of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). Average annual percent change (AAPC) was calculated to assess changes in rates of LGA and morbidity over time. RESULTS Of 27 million births in 7 years, 1,843,467 (6.8%) met the inclusion criteria. While 1,656,888 (89.9%) did not have diabetes, 186,579 (10.1%) were with diabetes. Composite neonatal adverse outcomes (aRR = 1.48, 95% CI = 1.43, 1.52) and composite maternal adverse outcomes (aRR = 1.37, 95% CI = 1.36, 1.38) were significantly higher among individuals with diabetes, compared with those without diabetes. From 2014 to 2020, the LGA rate was stable among people without diabetes. However, there was a downward trend of LGA in people with diabetes (AAPC = - 2.4, 95% CI = - 3.5, -1.4). CONCLUSION In pregnancies with LGA newborns, composite neonatal and maternal morbidities were higher in those with diabetes, compared with those without diabetes. KEY POINTS · Large for gestational age stratified by diabetes status.. · Composite neonatal and maternal adverse outcomes are worse among individuals with diabetes as compared to those without.. · During 2014 to 2020, the trend of LGA in individuals without diabetes increased..
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Affiliation(s)
- Sarah A Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Joycelyn Ashby Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Department of Obstetrics and Gynecology, Delaware Center of Maternal-Fetal Medicine, Newark, Delaware
| | - Baha Sibai
- Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Stephen Wagner
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michal F Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Yang X, Wang G, Liu N, Wang Y, Zhang S, Lin H, Zhu C, Liu L, Sun Y, Ma L. Mediating effect of gestational weight gain on the preventive effect of exercise during pregnancy on macrosomia: a randomized clinical trial. BMC Pregnancy Childbirth 2024; 24:384. [PMID: 38778289 PMCID: PMC11112785 DOI: 10.1186/s12884-024-06527-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE We sought to investigate the impact of individualized exercise guidance during pregnancy on the incidence of macrosomia and the mediating effect of gestational weight gain (GWG). DESIGN A prospective randomized clinical trial. SETTING A Hospital in Xingtai District, Hebei Province. POPULATION Older than 20 years of age, mid-pregnancy, and singleton pregnant women without contraindications to exercise during pregnancy. METHODS A randomized clinical trial was conducted from December 2021 to September 2022 to compare the effects of standard prenatal care with individualized exercise guidance on the incidence of macrosomia. MAIN OUTCOME MEASURE Incidence of macrosomia. RESULTS In all, 312 singleton women were randomized into an intervention group (N = 162) or a control group (N = 150). Participants who received individualized exercise guidance had a significantly lower incidence of macrosomia (3.73% vs. 13.61%, P = 0.002) and infants large for gestational age (9.94% vs. 19.73%, P = 0.015). However, no differences were observed in the rate of preterm birth (1.86% vs. 3.40%, P = 0.397) or the average gestational age at birth (39.14 ± 1.51 vs. 38.69 ± 1.85, P = 0.258). Mediation analysis revealed that GWG mediated the effect of exercise on reducing the incidence of macrosomia. CONCLUSION Individualized exercise guidance may be a preventive tool for macrosomia, and GWG mediates the effect of exercise on reducing the incidence of macrosomia. However, evidence does not show that exercise increases the rate of preterm birth or affects the average gestational age at birth. TRIAL REGISTRATION The trial is registered at www.clinicaltrails.gov [registration number: NCT05760768; registration date: 08/03/2023 (retrospectively registered)].
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Affiliation(s)
- Xuanjin Yang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China
| | - Guifang Wang
- Xingtai Xindu District Central Hospital, Hebei Xingtai, 054000, China
| | - Nana Liu
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China
| | - Yaxin Wang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China
| | - Suhan Zhang
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China
| | - Hang Lin
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China
| | - Can Zhu
- Chinese Academy of Medical Sciences & Peking Union Medical College Nursing College, Beijing, 100144, China
| | - Li Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College Nursing College, Beijing, 100144, China
| | - Yin Sun
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China.
| | - Liangkun Ma
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng, Beijing, 100370, China.
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21
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Ewington LJ, Hugh O, Butler E, Quenby S, Gardosi J. Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study. Am J Obstet Gynecol 2024:S0002-9378(24)00578-7. [PMID: 38723984 DOI: 10.1016/j.ajog.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Pregnancies with large-for-gestational-age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options, including expectant management, induction of labor, and cesarean delivery. For women to make an informed decision about birth, antenatal detection of large for gestational age is essential. OBJECTIVE To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth. STUDY DESIGN In this retrospective cohort study, we analyzed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound-estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication and a subgroup where the reason for the scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW percentile for estimated fetal weight as well as neonatal weight. In addition, we tested the performance of an uncustomized standard, with Hadlock fetal weight >90th percentile and neonatal weight >4 kg. We calculated diagnostic characteristics for the whole population and groups with different maternal body mass indexes. RESULTS The study cohort consisted of 26,527 pregnancies, which, on average, had a scan at 36+4 weeks gestation and delivered 20 days later at a median of 39+3 weeks (interquartile range 15). In total, 2241 (8.4%) of neonates were large for gestational age by customized percentiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th percentile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with a sensitivity of 77.1% and false positive rate of 36.0%. When comparing subgroups from low (<18.5 kg/m2) to high body mass index (>30 kg/m2), sensitivity increased from 55.6% to 67.8%, false positive rate from 5.2% to 11.5%, and positive predictive value from 32.1% to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4 kg), and of these, 1058 (40.9%) were large for gestational age (>90th percentile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized than uncustomized standards for low body mass index (<18.5; diagnostic odds ratio, 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ratio, 16.2 vs 8.8). CONCLUSION Late third-trimester ultrasound estimation of fetal weight for any indication has a good ability to identify and predict large for gestational age at birth and improves with the use of a customized standard. The detection rate is better when an ultrasound is performed for a suspected large fetus but at the risk of a higher false positive diagnosis. Our results provide information for women and clinicians to aid antenatal decision-making about the birth of a fetus suspected of being large for gestational age.
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Affiliation(s)
- Lauren J Ewington
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom
| | - Oliver Hugh
- Perinatal Institute, Birmingham, United Kingdom
| | | | - Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom; University Hospitals Coventry and Warwickshire, United Kingdom
| | - Jason Gardosi
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom; Perinatal Institute, Birmingham, United Kingdom.
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22
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Sgayer I, Nskovica K, Murkhovskyi I, Shqara RA, Bilyk A, Lowenstein L, Wolf MF. The Impact on Birth Outcomes of Sonographic Fetal Weight Estimation in Neonatal Macrosomia. Am J Perinatol 2024. [PMID: 38698595 DOI: 10.1055/s-0044-1786743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Our objective was to examine the association between sonographic estimated fetal weight (EFW) and obstetrical and neonatal outcomes in women with neonatal macrosomia. STUDY DESIGN This study, conducted at a tertiary university-affiliated hospital from 2017 to 2021, compared obstetrical and neonatal outcomes between two groups of women who delivered macrosomic newborns (actual birthweight ≥ 4,000 g): (1) those with EFW ≥ 3,800 g (suspected impending macrosomia) and (2) those with EFW < 3,800 g (unsuspected impending macrosomia). RESULTS During the study period, 854 women with neonatal macrosomia attempted vaginal delivery. Only 9.2% had a sonographic EFW ≥ 4,000 g. Among women with EFW ≥ 3,800 g (n = 317) compared with EFW < 3,800 g (n = 537), the cesarean delivery (CD) rate was higher (17.0 vs. 10.5%, p = 0.004) and the operative delivery rate was lower (3.2 vs. 0.6%, p = 0.015). Among primiparous women, the CD rate was higher among those with EFW ≥ 3,800 versus <3,800 g (37.3 vs. 23.2%, p = 0.033). EFW ≥3,800 g was associated with CD, regardless of predelivery body mass index, parity, diabetes mellitus, maximal fetal weight at previous deliveries, actual birthweight, and labor induction (p = 0.014). EFW ≥ 3,800 g and diabetes mellitus were independent predictors of CD. Among women with EFW ≥3,800 g and diabetes mellitus, the risk of CD was double that of those without diabetes and with EFW ≥ 3,800 g (31.4% vs. 15.2%, p = 0.02), although their actual birthweights were similar. Obstetrical and neonatal outcomes were similar between those with sonographic EFW ≥ 3,800 and < 3,800 g. CONCLUSION Larger EFW increased CD risk among pregnancies with actual neonatal macrosomia. Antenatally suspected macrosomia might alter labor management due to concerns for potential complications, especially when associated with primiparity, diabetes mellitus, or maternal obesity. The increase in the CD rate did not show an association with improved maternal and neonatal outcomes. KEY POINTS · Antenatally suspected macrosomia might alter labor management due to concerns about complications.. · Larger EFW increased cesarean delivery risk among pregnancies with actual neonatal macrosomia.. · The increase in the cesarean delivery rate was not associated with improved outcomes..
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Karina Nskovica
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Iuliia Murkhovskyi
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Artyom Bilyk
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Collins-Smith A, Prasannan L, Shan W, Dori E, Katzow M, Blitz MJ. Effect of Lockdown Period of COVID-19 Pandemic on Maternal Weight Gain, Gestational Diabetes, and Newborn Birth Weight. Am J Perinatol 2024; 41:e584-e593. [PMID: 35973792 PMCID: PMC10243366 DOI: 10.1055/a-1925-1347] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to determine whether the lockdown period of the initial novel coronavirus disease 2019 (COVID-19) surge in New York affected gestational weight gain (GWG), newborn birth weight (BW), and the frequency of gestational diabetes mellitus (GDM). Maternal and newborn outcomes during the first wave of the pandemic were compared with those during the same timeframe in the previous 2 years. STUDY DESIGN Retrospective cross-sectional study of all live singleton term deliveries from April 1 to July 31 between 2018 and 2020 at seven hospitals within a large academic health system in New York. Patients were excluded for missing data on: BW, GWG, prepregnancy body mass index, and gestational age at delivery. We compared GWG, GDM, and BW during the pandemic period (April-July 2020) with the same months in 2018 and 2019 (prepandemic) to account for seasonality. Linear regression was used to model the continuous outcomes of GWG and BW. Logistic regression was used to model the binary outcome of GDM. RESULTS A total of 20,548 patients were included in the study: 6,672 delivered during the pandemic period and 13,876 delivered during the prepandemic period. On regression analysis, after adjustment for study epoch and patient characteristics, the pandemic period was associated with lower GWG (β = -0.46, 95% confidence interval [CI]: -0.87 to -0.05), more GDM (adjusted odds ratio [aOR] = 1.24, 95% CI: 1.10-1.39), and no change in newborn BW (β = 0.03, 95% CI: -11.7 to 11.8) compared with the referent period. The largest increases in GDM between the two study epochs were noted in patients who identified as Hispanic (8.6 vs. 6.0%; p < 0.005) and multiracial/other (11.8 vs. 7.0%; p < 0.001). CONCLUSION The lockdown period of the pandemic was associated with a decrease in GWG and increase in GDM. Not all groups were affected equally. Hispanic and multiracial patients experienced a larger percentage change in GDM compared with non-Hispanic white patients. KEY POINTS · The COVID-19 lockdown was associated with decreased GWG and increased GDM.. · No change in newborn BW was seen during the lockdown.. · Overall, the lockdown did not have a large clinical effect on these pregnancy outcomes..
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Affiliation(s)
- Ana Collins-Smith
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Lakha Prasannan
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Weiwei Shan
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Ezra Dori
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Michelle Katzow
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Research, Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Matthew J. Blitz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Research, Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
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24
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McKee KS, Tang X, Tung I, Wu G, Alshawabkeh AN, Arizaga JA, Bastain TM, Brennan PA, Breton CV, Camargo CA, Cioffi CC, Cordero JF, Dabelea D, Deutsch AR, Duarte CS, Dunlop AL, Elliott AJ, Ferrara A, Karagas MR, Lester B, McEvoy CT, Meeker J, Neiderhiser JM, Herbstman J, Trasande L, O’Connor TG, Hipwell AE, Comstock SS. Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program. Am J Perinatol 2024; 41:e1404-e1420. [PMID: 36781160 PMCID: PMC11195909 DOI: 10.1055/a-2033-5610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. STUDY DESIGN Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. RESULTS Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life. CONCLUSION In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic. KEY POINTS · COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..
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Affiliation(s)
- Kimberly S. McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Xiaodan Tang
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Irene Tung
- Department of Psychology, California State University Dominguez Hills, Carson, California
| | - Guojing Wu
- Department of Epidemology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, Massachusetts
| | - Jessica A. Arizaga
- Department of Psychiatry and Behavioral Sciences, University of California-San Francisco, San Francisco, California
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Jose F. Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, Athens, Georgia
| | - Dana Dabelea
- Department of Epidemiology, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Arielle R. Deutsch
- Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota
| | | | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Department of Pediatrics, Avera Research Institute, University of South Dakota School of Medicine, Sioux Falls, South Dakota
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire
| | - Barry Lester
- Center for the Study of Children at Risk, Brown University, Providence, Rhode Island
| | - Cindy T. McEvoy
- Department of Pediatrics, MCR Oregon Health and Science University, Portland, Oregon
| | - John Meeker
- University of Michigan, Environmental Health Sciences, Global Public Health, Ann Arbor, Michigan
| | - Jenae M. Neiderhiser
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Julie Herbstman
- Columbia Mailman School of Public Health, Environmental Health Sciences, New York, New York
| | - Leonardo Trasande
- Department of Pediatrics, New York University, New York
- Department of Environmental Medicine, and Population Health, New York University Grossman School of Medicine and New York University School of Global Public Health, New York University, New York
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan
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Santos EAM, Zaccara TA, Paganoti CF, Peres SV, Francisco RPV, Costa RA. Association between extrapolated time in range and large for gestational age infants in pregnant women with type 1 diabetes. J Diabetes Complications 2024; 38:108724. [PMID: 38615422 DOI: 10.1016/j.jdiacomp.2024.108724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/01/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024]
Abstract
AIMS To evaluate the association between extrapolated time in range (eTIR), measured by self-monitoring of blood glucose (SMBG), and large-for-gestational-age (LGA) infants in pregnancies with type 1 diabetes (T1D). METHODS Retrospective cohort analysis including singleton pregnancies with T1D who started antenatal care before 20 gestational weeks and delivered live newborns at a Brazilian hospital between 2010 and 2019, with LGA fetuses as the main outcome. Glycemic records acquired using SMBG were categorized as eTIR, extrapolated time below range (eTBR), and extrapolated time above range (eTAR). Women were divided into two groups (LGA and adequate for gestational age [AGA]) and compared regarding clinical characteristics, obstetric outcomes, and frequencies of eTIR, eTBR, and eTAR. Logistic regression analysis verified the independent predictive variables for LGA infants. RESULTS Data from 125 pregnancies were analyzed. For the first, second and third trimesters, each 1 % increase in eTIR was associated with a decreased risk of LGA by 2.9 % (OR: 0.971; 95%CI: 0.945-0.998), 2.5 % (OR: 0.975; 95%CI: 0.951-0.999) and 2.3 % (OR: 0.977; 95%CI: 0.955-0.998) and each 1 % increase in eTAR was associated with an increased risk of LGA by 2.7 % (OR: 1.027; 95%CI: 1.005-1.050), 3.9 % (OR: 1.039; 95%CI: 1.014-1.063) and 4.6 % (OR: 1.046; 95%CI: 1.018-1.075), respectively. CONCLUSION The concept of TIR can be extrapolated to patients undergoing SMBG to assess the risk of LGA infants in pregnant women with T1D.
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Affiliation(s)
- Enio A M Santos
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia da Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tatiana A Zaccara
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cristiane F Paganoti
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Stela V Peres
- Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rossana P V Francisco
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia da Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rafaela A Costa
- Disciplina de Obstetricia, Departamento de Obstetricia e Ginecologia da Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Divisao de Clinica Obstetrica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Bitar G, Cornthwaite JA, Sadek S, Ghorayeb T, Daye N, Nazeer S, Ghafir D, Cornthwaite J, Chauhan SP, Sibai BM, Fishel Bartal M. Continuous Glucose Monitoring and Time in Range: Association with Adverse Outcomes among People with Type 2 or Gestational Diabetes Mellitus. Am J Perinatol 2024; 41:e1370-e1377. [PMID: 36858069 DOI: 10.1055/s-0043-1764208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) has become available for women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) during pregnancy. The recommended time in range (TIR, blood glucose 70-140 mg/dL) and its correlation with adverse pregnancy outcomes in this group is unknown. Our aim was to compare maternal and neonatal outcomes in pregnant people with T2DM or GDM with average CGM TIR values >70 versus ≤70%. STUDY DESIGN We conducted a retrospective cohort study of all individuals using CGM during pregnancy from January 2017 to June 2022. Individuals with type 1 diabetes mellitus, or those missing CGM or delivery data were excluded. Primary composite neonatal outcome included any of the following: large for gestational age, NICU admission, need for intravenous glucose, respiratory support, or neonatal death. Secondary outcomes included other maternal and neonatal outcomes. Regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS During the study period, 141 individuals with diabetes utilized CGM during pregnancy, with 65 (46%) meeting inclusion criteria. Of the study population, 28 (43%) had TIR ≤70% and 37 (57%) had TIR > 70%. Compared with those with TIR > 70%, the primary composite outcome occurred more frequently in neonates of individuals TIR ≤70% (71.4 vs. 37.8%, aOR: 4.8, 95% CI: 1.6, 15.7). Furthermore, individuals with TIR ≤70% were more likely to have hypertensive disorders (42.9 vs. 16.2%, OR: 3.9, 95% CI: 1.3, 13.0), preterm delivery (54 vs. 27%, OR: 3.1, 95% CI: 1.1, 9.1): , and cesarean delivery (96.4 vs. 51.4%, OR: 4.6, 95% CI: 2.2, 15.1) compared with those with TIR >70%. CONCLUSION Among people with T2DM or GDM who utilized CGM during pregnancy, 4 out 10 individuals had TIR ≤70% and, compared with those with TIR > 70%, they had a higher likelihood of adverse neonatal and maternal outcomes. KEY POINTS · Time in range can be utilized as a metric for pregnant patients using continuous glucose monitor.. · Time in range >70% is achievable by 6 out of 10 patients.. · Time in range below goal is associated with adverse neonatal and maternal outcomes..
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Affiliation(s)
- Ghamar Bitar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Joycelyn A Cornthwaite
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sandra Sadek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Tala Ghorayeb
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nahla Daye
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sarah Nazeer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Danna Ghafir
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John Cornthwaite
- Department of Earth, Environmental and Planetary Science, Rice University, Houston, Texas
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mooberry M, Voss N, Wendt L, Kenne KA, Jackson JB, Rysavy MB. Predictors of Postpartum Hemorrhage and Associated Outcomes at a Midwest Academic Medical Center. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:358-366. [PMID: 39035139 PMCID: PMC11257117 DOI: 10.1089/whr.2023.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 07/23/2024]
Abstract
Background Postpartum hemorrhage (PPH) remains a significant cause of maternal morbidity and mortality around the world, with rates increasing in the United States. The objective of this study was to determine predictors of, and outcomes associated with, PPH at a Midwest academic health center. Methods Demographic and clinical data were obtained from the electronic medical record on all consecutive delivering patients between May 1, 2020, and April 30, 2021. Associations between PPH and perinatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons. Results Of the 2497 delivering patients during the study period, 437 (18%) experienced PPH. Chronic hypertension, gestational hypertension, and preeclampsia with and without severe features were all associated with increased odds of PPH (odds rations [ORs], respectively, 1.61 (95% CI:1.13-2.24, p = 0.006), 1.62 (95% CI 1.18-2.21, p = 0.003), 1.81 (95% CI 1.14-2.80, p ≤ 0.001), and 1.92 (95% CI 1.29-2.82, p = 0.009). There were also increased odds of PPH with type I diabetes: 2.83 (95% CI 1.45-5.30, p = 0.001), type II diabetes: 2.14 (95% CI 1.15-3.82, p = 0.012), twin delivery: 3.20 (95% CI 2.11-4.81, p ≤ 0.001), cesarean delivery: 5.66 (95% CI 4.53-7.09, p ≤ 0.001), and assisted vaginal delivery: 3.12 (95% CI1.95-4.88, p ≤ 0.001). Infants of mothers with PPH had high odds of NICU admission (CI = 1.34-2.07, p < 0.001) and hypoxic ischemic encephalopathy (CI = 1.64-7.14, p < 0.001). Conclusion Our findings confirm previous literature that preexisting and pregnancy-related hypertension, diabetes mellitus, multiple gestation, cesarean delivery, and assisted vaginal delivery are important predictors of PPH. In addition, we found that neonates of mothers with PPH had more adverse outcomes. These results may help to inform clinical care as rates of PPH continue to rise in the United States.
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Affiliation(s)
- Megan Mooberry
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Natalie Voss
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Kimberly A. Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | | | - Mary B. Rysavy
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Han W, Wang J, Yan X, Liu C, Huang J, Zhang L, Zhang Y, Zhao Y, Hou Y, Zheng W, Li G. Butyrate and iso-butyrate: a new perspective on nutrition prevention of gestational diabetes mellitus. Nutr Diabetes 2024; 14:24. [PMID: 38658555 PMCID: PMC11043397 DOI: 10.1038/s41387-024-00276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Dietary imbalance, such as a lower proportion of complex carbohydrates and a higher protein diet, may contribute to gestational diabetes mellitus (GDM) risks through their metabolisms. However, there is a lack of knowledge regarding the association between butyrate, iso-butyrate, and GDM, which are metabolisms of the two primary nutrients above. This study aimed to clarify the association of butyrate and iso-butyrate with GDM. METHODS A nested case-control study was conducted based on the Beijing Birth Cohort Study (BBCS) from 2017 to 2018. Totally, 99 singleton women were involved (GDM: n = 49, control: n = 50). All participants provided blood samples twice (in their first and second trimesters). Gas chromatography-mass spectrometry (GC-MS) was used for butyrate and iso-butyrate detection. Unconditional logistic regression and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. RESULTS The results showed that butyrate in the first trimester was negatively correlated with GDM (odds ratio (OR): 0.00, 95% confidential interval (CI): 0.00-0.21, P = 0.008), and iso-butyrate in the second trimester was positively related to GDM (OR: 627.68, 95% CI: 40.51-9724.56, P < 0.001). The ratio (butyrate/iso-butyrate) was negatively associated with GDM, both in the first trimester (OR: 0.00, 95%CI: 0.00-0.05, P < 0.001) and in the second trimester (OR: 0.52, 95% CI: 0.34-0.80, P = 0.003). The area under the curve (AUC) using the ratio in the first trimester combined with clinical risk factors achieved 0.89 (95% CI: 0.83-0.95). Iso-butyrate in the second trimester combined with clinical risk factors achieved an AUC of 0.97 (95% CI: 0.92-1.00). CONCLUSIONS High iso-butyrate and low butyrate levels may be associated with an increased risk of GDM. As they are produced through dietary nutrient formation by gut microbiota, further studies on the association of dietary intake and butyrate or iso-butyrate concentration in plasma may help find a novel approach to nutritional intervention for GDM.
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Affiliation(s)
- Weiling Han
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jia Wang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xin Yan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Cheng Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Junhua Huang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Lirui Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yujie Zhang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
- Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yiqing Zhao
- Hyproca Nutrition Co., Ltd, Changsha, Hunan, China
| | - Yanmei Hou
- Hyproca Nutrition Co., Ltd, Changsha, Hunan, China
| | - Wei Zheng
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, China.
| | - Guanghui Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, China.
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Yuan X, Ma Y, Wang J, Zhao Y, Zheng W, Yang R, Zhang L, Yan X, Li G. The influence of maternal prepregnancy weight and gestational weight gain on the umbilical cord blood metabolome: a case-control study. BMC Pregnancy Childbirth 2024; 24:297. [PMID: 38649888 PMCID: PMC11034091 DOI: 10.1186/s12884-024-06507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Maternal overweight/obesity and excessive gestational weight gain (GWG) are frequently reported to be risk factors for obesity and other metabolic disorders in offspring. Cord blood metabolites provide information on fetal nutritional and metabolic health and could provide an early window of detection of potential health issues among newborns. The aim of the study was to explore the impact of maternal prepregnancy overweight/obesity and excessive GWG on cord blood metabolic profiles. METHODS A case control study including 33 pairs of mothers with prepregnancy overweight/obesity and their neonates, 30 pairs of mothers with excessive GWG and their neonates, and 32 control mother-neonate pairs. Untargeted metabolomic profiling of umbilical cord blood samples were performed using UHPLC‒MS/MS. RESULTS Forty-six metabolites exhibited a significant increase and 60 metabolites exhibited a significant reduction in umbilical cord blood from overweight and obese mothers compared with mothers with normal body weight. Steroid hormone biosynthesis and neuroactive ligand‒receptor interactions were the two top-ranking pathways enriched with these metabolites (P = 0.01 and 0.03, respectively). Compared with mothers with normal GWG, in mothers with excessive GWG, the levels of 63 metabolites were increased and those of 46 metabolites were decreased in umbilical cord blood. Biosynthesis of unsaturated fatty acids was the most altered pathway enriched with these metabolites (P < 0.01). CONCLUSIONS Prepregnancy overweight and obesity affected the fetal steroid hormone biosynthesis pathway, while excessive GWG affected fetal fatty acid metabolism. This emphasizes the importance of preconception weight loss and maintaining an appropriate GWG, which are beneficial for the long-term metabolic health of offspring.
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Affiliation(s)
- Xianxian Yuan
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Yuru Ma
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Jia Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, 130041, Jilin, China
| | - Yan Zhao
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Wei Zheng
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Ruihua Yang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Lirui Zhang
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Xin Yan
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
| | - Guanghui Li
- Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
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Grantz KL, Lee W, Chen Z, Hinkle S, Mack L, Cortes MS, Goncalves LF, Espinoza J, Gore-Langton RE, Sherman S, He D, Zhang C, Grewal J. The NICHD Fetal 3D Study: A Pregnancy Cohort Study of Fetal Body Composition and Volumes. Am J Epidemiol 2024; 193:580-595. [PMID: 37946325 DOI: 10.1093/aje/kwad210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
There's a paucity of robust normal fractional limb and organ volume standards from a large and diverse ethnic population. The Fetal 3D Study was designed to develop research and clinical applications for fetal soft tissue and organ volume assessment. The NICHD Fetal Growth Studies (2009-2013) collected 2D and 3D fetal volumes. In the Fetal 3D Study (2015-2019), sonographers performed longitudinal 2D and 3D measurements for specific fetal anatomical structures in research ultrasounds of singletons and dichorionic twins. The primary aim was to establish standards for fetal body composition and organ volumes, overall and by maternal race/ethnicity, and determine whether these standards vary for twins versus singletons. We describe the study design, methods, and details about reviewer training. Basic characteristics of this cohort, with their corresponding distributions of fetal 3D measurements by anatomical structure, are summarized. This investigation is responsive to critical data gaps in understanding serial changes in fetal subcutaneous fat, lean body mass, and organ volume in association with pregnancy complications. In the future, this cohort can answer critical questions regarding the potential influence of maternal characteristics, lifestyle factors, nutrition, and biomarker and chemical data on longitudinal measures of fetal subcutaneous fat, lean body mass, and organ volumes.
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Mazzone E, Kadji C, Cannie MM, Badr DA, Jani JC. Prediction of large-for-gestational age at 36 weeks' gestation: two-dimensional ultrasound vs three-dimensional ultrasound vs magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:489-496. [PMID: 37725758 DOI: 10.1002/uog.27485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare the performance of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) at 36 weeks' gestation in predicting the delivery of a large-for-gestational-age (LGA) neonate, defined as birth weight ≥ 95th percentile, in patients at high and low risk for macrosomia. METHODS This was a secondary analysis of a prospective observational study conducted between January 2017 and February 2019. Women with a singleton pregnancy at 36 weeks' gestation underwent 2D-US, 3D-US and MRI within 15 min for estimation of fetal weight. Weight estimations and birth weight were plotted on a growth curve to obtain percentiles for comparison. Participants were considered high risk if they had at least one of the following risk factors: diabetes mellitus, estimated fetal weight ≥ 90th percentile at the routine third-trimester ultrasound examination, obesity (prepregnancy body mass index ≥ 30 kg/m2) or excessive weight gain during pregnancy. The outcome was the diagnostic performance of each modality in the prediction of birth weight ≥ 95th percentile, expressed as the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values. RESULTS A total of 965 women were included, of whom 533 (55.23%) were high risk and 432 (44.77%) were low risk. In the low-risk group, the AUCs for birth weight ≥ 95th percentile were 0.982 for MRI, 0.964 for 2D-US and 0.962 for 3D-US; pairwise comparisons were non-significant. In the high-risk group, the AUCs were 0.959 for MRI, 0.909 for 2D-US and 0.894 for 3D-US. A statistically significant difference was noted between MRI and both 2D-US (P = 0.002) and 3D-US (P = 0.002), but not between 2D-US and 3D-US (P = 0.503). In the high-risk group, MRI had the highest sensitivity (65.79%) compared with 2D-US (36.84%, P = 0.002) and 3D-US (21.05%, P < 0.001), whereas 3D-US had the highest specificity (98.99%) compared with 2D-US (96.77%, P = 0.005) and MRI (96.97%, P = 0.004). CONCLUSIONS At 36 weeks' gestation, MRI has better performance compared with 2D-US and 3D-US in predicting birth weight ≥ 95th percentile in patients at high risk for macrosomia, whereas the performance of 2D-US and 3D-US is comparable. For low-risk patients, the three modalities perform similarly. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Mazzone
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - C Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Ikenoue S, Akiba Y, Ishii R, Otani T, Kasuga Y, Tanaka M. Association of maternal obesity with growth of fetal fractional limb volume. Early Hum Dev 2024; 191:105990. [PMID: 38518425 DOI: 10.1016/j.earlhumdev.2024.105990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Maternal obesity influences birth weight and newborn adiposity. Fetal fractional limb volume has recently been introduced as a useful parameter for the proxy of fetal adiposity. However, the association between maternal adiposity and the growth of fetal fractional limb volume has not been examined. AIMS To investigate the association of maternal pre-pregnancy BMI with the growth of fetal fractional limb volume. STUDY DESIGN Prospective cohort study. SUBJECTS Women with singleton uncomplicated pregnancies enrolled between July 2017 and June 2020. OUTCOME MEASURES Fetal fractional limb volume was assessed between 20 and 40 weeks' gestation, measured as cylindrical limb volume based on 50 % of the total diaphysis length. The measured fractional limb volume at each gestational week were converted to z-scores based on a previous report. The association between pre-pregnancy BMI and fetal fractional limb volume was examined. Maternal age, parity, gestational weight gain and fetal sex were considered as potential confounding variables. RESULTS Ultrasound scans of 455 fractional arm volume and thigh volume were obtained. Fractional limb volume increased linearly until the second trimester of gestation, then increased exponentially in the third trimester. Maternal pre-pregnancy BMI was significantly correlated with z-scores of fractional arm volume and thigh volume across gestation. The post-hoc analysis showed the association between pre-pregnancy BMI and fractional arm volume was significant especially between 34 and 40 weeks. CONCLUSIONS Maternal obesity influences the growth pattern of fetal fractional limb volume. Fractional arm volume may potentially provide a useful surrogate marker of fetal nutritional status in late gestation.
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Affiliation(s)
- Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan; Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan.
| | - Yohei Akiba
- Department of Obstetrics and Gynecology, Saitama Municipal Hospital, Saitama, Japan
| | - Ryota Ishii
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Japan
| | - Toshimitsu Otani
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Marra MC, Mappa I, Pietrolucci ME, Lu JLA, D' Antonio F, Rizzo G. Fetal brain development in pregnancies complicated by gestational diabetes mellitus. J Perinat Med 2024; 52:310-316. [PMID: 38231478 DOI: 10.1515/jpm-2023-0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) carries an increased risk of neurocognitive impairment in offsprings. However, the contribution of maternal hyperglycemia in affecting fetal brain development is not fully elucidated yet. The aim of this study was to evaluate fetal brain and sulci development in pregnancies complicated by GDM. METHODS Prospective observational study including 100 singleton pregnancies complicated by GDM and 100 matched controls. All fetuses underwent neurosonography at 29-34 weeks of gestation, including the assessment of the length of the corpus callosum (CC), cerebellar vermis (CV), Sylvian (SF), parieto-occipital (POF) and calcarine fissures (CF). Sub-group analysis according to the specific treatment regimen adopted (n 67 diet vs. 33 insulin therapy) was also performed. RESULTS Fetuses from mothers with GDM under insulin therapy had a smaller CC (35.54 mm) compared to both controls (40 mm; p<0.001) and women with GDM under diet (39.26 mm; p=0.022) while there was no difference in the HC between the groups. Likewise, when corrected for HC, CV depth was smaller in fetuses with GDM both under insulin therapy (7.03 mm) and diet (7.05 mm,) compared to controls (7.36 mm; p=0.013). Finally, when assessing the sulci development of the brain SF (p≤0.0001), POF (p≤0.0001) and CF (p≤0.0001) were significantly smaller in fetuses with maternal GDM. Post-hoc analysis showed that fetuses of GDM mothers requiring insulin therapy had significantly lower values of SF (p=0.032), POF (p=0.016) and CF (p=0.001). CONCLUSIONS Pregnancies complicated by GDM showed a peculiar pattern of fetal brain growth and cortical development and these changes, which are more evident in those requiring insulin supplementation.
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Affiliation(s)
- Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Pittyanont S, Suriya N, Sirilert S, Tongsong T. Comparisons of the Rates of Large-for-Gestational-Age Newborns between Women with Diet-Controlled Gestational Diabetes Mellitus and Those with Non-Gestational Diabetes Mellitus. Clin Pract 2024; 14:536-545. [PMID: 38666799 PMCID: PMC11048916 DOI: 10.3390/clinpract14020041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/24/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Objectives: The primary objective is to compare the rate of large-for-gestational-age (LGA) between women with diet-controlled gestational diabetes mellitus (GDM) and those with non-GDM, and to assess whether or not diet-controlled GDM is an independent factor of LGA fetuses. The secondary objectives are to compare the rates of other common adverse pregnancy outcomes, such as preeclampsia, cesarean section rate, preterm birth, and low Apgar score, between pregnancies with diet-controlled GDM and non-GDM pregnancies. (2) Methods: A retrospective cohort study was conducted on singleton pregnancies, diagnosed with GDM and non-GDM between 24 and 28 weeks of gestation, based on a two-step screening test. The prospective database of the obstetric department was accessed to retrieve the records meeting the inclusion criteria, and full medical records were comprehensively reviewed. The patients were categorized into two groups, GDM (study group) and non-GDM (control group). The main outcome was the rate of LGA newborns, and the secondary outcomes included pregnancy-induced hypertension, preterm birth, cesarean rate, low Apgar scores, etc. (3) Results: Of 1364 recruited women, 1342 met the inclusion criteria, including 1177 cases in the non-GDM group and 165 (12.3%) in the GDM group. Maternal age and pre-pregnancy BMI were significantly higher in the GDM group. The rates of LGA newborns, PIH, and cesarean section were significantly higher in the GDM group (15.1% vs. 7.1%, p-value < 0.001; 7.8% vs. 2.6%, p-value = 0.004; and 54.5% vs. 41.5%, p-value = 0.002; respectively). On logistic regression analysis, GDM was not significantly associated with LGA (odds ratio 1.64, 95% CI: 0.97-2.77), while BMI and gender were still significantly associated with LGA. Likewise, GDM was not significantly associated with the rate of PIH (odds ratio: 1.7, 95% CI: 0.825-3.504), while BMI and maternal age were significantly associated with PIH, after controlling confounding factors. (4) Conclusions: The rates of LGA newborns, PIH, and cesarean section are significantly higher in women with diet-controlled GDM than those with non-GDM. Nevertheless, the rates of LGA newborns and PIH are not directly caused by GDM but mainly caused high pre-pregnancy BMI and advanced maternal age, which are more commonly encountered among women with GDM.
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Affiliation(s)
- Sirida Pittyanont
- Department of Obstetrics and Gynecology, Prapokklao Hospital, Chanthaburi 22000, Thailand; (S.P.); (N.S.)
| | - Narongwat Suriya
- Department of Obstetrics and Gynecology, Prapokklao Hospital, Chanthaburi 22000, Thailand; (S.P.); (N.S.)
| | - Sirinart Sirilert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Kawakita T, Sridhar S, Mokhtari N, Landy HJ. The Rate of Intrapartum Cesarean Delivery Based on Estimated Fetal Weight in Comparison to Previous Child's Birth Weight. Am J Perinatol 2024; 41:276-281. [PMID: 34666384 DOI: 10.1055/a-1673-5455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the study is to examine whether an estimated fetal weight of the current pregnancy greater than previous birth weight is associated with increased odds of intrapartum cesarean delivery. STUDY DESIGN We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at a single labor and delivery unit. We only analyzed the second pregnancy in the dataset. We excluded women who had preterm birth in the second pregnancy. Women were categorized according to the difference between estimated fetal weight and previous birth weight-estimated fetal weight close to previous birth weight within 500 g (similar weight group); estimated fetal weight significantly (more than 500 g) greater than previous birth weight (larger weight group); and estimated fetal weight significantly (more than 500 g) lower than previous birth weight (smaller weight group). The primary outcome was intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratios (aORs) with 95% confidence interval (95% confidence interval [CI]) after adjusting for predefined covariates. RESULTS Of 1,887 women, there were 1,415 (75%) in the similar weight group, 384 (20%) in the greater weight group, and 88 (5%) in the smaller weight group. Individuals in the larger weight group compared with those in the similar weight group had higher odds of undergoing intrapartum cesarean delivery (11.2 vs. 4.5%; aOR 2.91; 95% CI 1.91-4.45). The odds of intrapartum cesarean delivery in the smaller weight group compared with those in the similar weight group were not increased (3.4 vs. 4.5%; crude OR 0.75; 95%CI 0.23-2.42). CONCLUSION The difference between current estimated fetal weight and previous birth weight plays an important role in assessing the risk of intrapartum cesarean delivery. KEY POINTS · Estimated fetal weight compared with previous birth weight is an important factor.. · Cesarean delivery is infrequent if estimated fetal weight is similar to previous birth weight.. · Larger estimated fetal weight greater than the previous birth weight is associated with cesarean delivery..
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Affiliation(s)
- Tetsuya Kawakita
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Shobha Sridhar
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Neggin Mokhtari
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Helain J Landy
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, MedStar Georgetown University Hospital, Washington, DC
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Sörsjö Stevenazzi A, Pihl S, Blomberg M, Axelsson D. The association between maternal vitamin D deficiency and postpartum hemorrhage and uterine atony. Acta Obstet Gynecol Scand 2024; 103:286-293. [PMID: 37960966 PMCID: PMC10823403 DOI: 10.1111/aogs.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown. MATERIAL AND METHODS This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders. RESULTS Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage. CONCLUSIONS In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.
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Affiliation(s)
| | - Sofia Pihl
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Daniel Axelsson
- Department of Obstetrics and GynecologyRyhov County HospitalJönköpingSweden
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
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Carvalho M, Barreto MI, Cabral J, Balacó I, Alves C. Neonatal upper limb fractures - a narrative overview of the literature. BMC Pediatr 2024; 24:59. [PMID: 38243191 PMCID: PMC10797735 DOI: 10.1186/s12887-024-04538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024] Open
Abstract
The aim of this paper is to review the topic of neonatal fractures of the upper limb, describing the different types of fractures focusing on the etiology, epidemiology, risk factors, clinical approach, diagnosis, treatment and prognosis of these injuries. We included all types of research studies, both experimental and observational, published in English, French, Portuguese and Spanish. The information was obtained using the keywords neonatal upper limb fracture, clavicle fracture or humerus fracture from the following resources: MEDLINE database, Embase® database and LILACS database. Other resources such as hand searches of the references of retrieved literature and authoritative texts, personal and hospital libraries searching for texts on upper limb neonatal fractures, discussions with experts in the field of upper limb neonatal fractures and personal experience, were also considered for the completion of the article.Neonatal fractures of the upper limb are consensually considered to have a good prognosis and no long-term sequelae. Conservative treatment is the option in the vast majority of the fractures and is associated with excellent results, with good healing, full range of motion, adequate remodeling without obvious deformity, neurologic impairment or functional implications.
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Affiliation(s)
- Marcos Carvalho
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal.
| | - Maria Inês Barreto
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - João Cabral
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - Inês Balacó
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
| | - Cristina Alves
- Department of Pediatric Orthopaedics, Pediatric Hospital of Coimbra - Centro Hospitalar e Universitário de Coimbra (CHUC), EPE; Av Afonso Romão, 3000-602, Coimbra, Portugal
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Bramsved R, Bygdell M, Martikainen J, Mårild S, Lindh I, Rosengren A, Ohlsson C, Kindblom JM. Birth Weight, Childhood and Young Adult Overweight, and the Risk of Coronary Heart Disease in Men. Arterioscler Thromb Vasc Biol 2024; 44:314-321. [PMID: 37970719 PMCID: PMC10749680 DOI: 10.1161/atvbaha.123.320095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Low birth weight is a known risk factor for adult coronary heart disease (CHD), but the additional effect of weight development during childhood and early adult life has not been studied. METHODS We included 35 659 men born 1945 to 1961 from the population-based BMI Epidemiology Study Gothenburg, with data available on birthweight, BMI in childhood (8 years), and BMI in young adulthood (20 years). Information on CHD diagnoses was retrieved from national registers. We used Cox proportional hazards regression to estimate hazard ratios and 95% CIs for the risk of early and late CHD (before and after 58.4 years of age, respectively). RESULTS During follow-up, a total of 3380 cases of CHD (fatal and nonfatal) were registered. Birth weight was inversely associated with the risk of both early (hazard ratio, 0.88 per SD increase [95% CI, 0.84-0.92]) and late (hazard ratio, 0.94 per SD increase [95% CI, 0.90-0.98]) CHD, independently of BMI at 8 years and BMI change during puberty. In a model including birth weight (below or above the median) together with overweight at 8 and 20 years, only birth weight and young adult overweight, but not overweight in childhood, were significantly associated with the risk of CHD. A birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (hazard ratio, 2.29 [95% CI, 1.86-2.81]), compared with the reference (birth weight above the median and normal weight at 20 years of age). This excess risk was even more pronounced for a birthweight below 2.5 kg. CONCLUSIONS We demonstrate that low birth weight and young adult overweight are important developmental markers of risk for adult CHD. These findings motivate a life course perspective for prevention and risk assessment of adult CHD.
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Affiliation(s)
- Rebecka Bramsved
- Department of Pediatrics, Institute of Clinical Sciences (R.B., S.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Maria Bygdell
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jari Martikainen
- Bioinformatics and Data Centre (J.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Staffan Mårild
- Department of Pediatrics, Institute of Clinical Sciences (R.B., S.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences (I.L.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at Gothenburg University, Sweden (A.R.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (C.O., J.M.K.)
| | - Jenny M. Kindblom
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (C.O., J.M.K.)
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Chen A, Acharya G, Hu M, Gao X, Cheng G, Jiang L, Ni Q. Association of maternal SARS-CoV-2 infection at the time of admission for delivery with labor process and outcomes of vaginal birth: A cohort study. Acta Obstet Gynecol Scand 2024; 103:103-110. [PMID: 37926941 PMCID: PMC10755127 DOI: 10.1111/aogs.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION This study aimed to investigate the impact of maternal SARS-CoV-2 infection at the time of admission for delivery on labor process and outcomes of vaginal birth. MATERIAL AND METHODS A cohort study was carried out at the Obstetrics Department of Anhui Provincial Hospital, China, where universal reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 infection was introduced for all women admitted for labor and delivery from December 1-31, 2022. Women were divided into positive and negative groups based on the test result. All women having a singleton vaginal birth were included in final analysis. The effect of SARS-CoV-2 positivity on labor process and outcomes of vaginal birth was estimated by regression analyses. RESULTS Among a total of 360 women included, 87 had a positive SARS-CoV-2 test and 273 a negative test. Women in the positive group had an increased likelihood of having longer labor (median 9.3 vs 8.3 hours; sB [log-transformed] 0.19; 95% confidence interval [CI] 0.09-0.28), episiotomy (39.1% vs 23.8%; adjusted odds ratio [aOR] 2.31; 95% CI 1.27-4.21), grade III meconium-stained amniotic fluid (19.5% vs 7.0%; aOR 2.52; 95% CI 1.15-5.54) and postpartum hospital stay exceeding 37 hours (58.6% vs 46.5%; aOR 1.71; 95% CI 1.00-2.91). They had reduced rates exclusive breastfeeding (26.7% vs 39%; aOR 0.21; 95% CI 0.09-0.46) as well as mixed feeding (46.5% vs 52.2%; aOR 0.28; 95% CI 0.13-0.60) at 1 week postpartum. No significant differences were observed in other aspects of labor process and birth outcomes, including the uptake of labor analgesia, postpartum hemorrhage (>500 mL) or neonatal outcomes. CONCLUSIONS A positive maternal SARS-CoV-2 test in labor among women having vaginal birth was associated with a slightly longer duration of labor, increased likelihood of episiotomy, increased incidence of grade III meconium-stained amniotic fluid, a longer postpartum hospital stay and a lower rate of breastfeeding 1 week postpartum. However, it did not have an adverse impact on other birth outcomes.
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Affiliation(s)
- An Chen
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Ganesh Acharya
- Division of Obstetrics & Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska InstitutetStockholmSweden
- Department of Clinical MedicineUiT The Arctic University of TromsøTromsøNorway
| | - Min Hu
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of University of Science and Technology of China (USTC)HefeiChina
| | - Xin Gao
- Medical Teaching and Research SectionAnhui Open UniversityHefeiChina
| | - Guizhi Cheng
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of University of Science and Technology of China (USTC)HefeiChina
| | - Lai Jiang
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of University of Science and Technology of China (USTC)HefeiChina
| | - Qianqian Ni
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of University of Science and Technology of China (USTC)HefeiChina
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Naskovica K, Amdur Zilberfarb I, Lowenstein L, Frank Wolf M. Relations between maternal height, shoe size, and the success of vaginal delivery in birth weight over 4000 g. Taiwan J Obstet Gynecol 2024; 63:64-67. [PMID: 38216271 DOI: 10.1016/j.tjog.2023.09.021] [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] [Accepted: 09/18/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Macrosomia is associated with increased risk of fetal and maternal complications such as trauma during birth, cesarean delivery, postpartum hemorrhage, and shoulder dystocia. Sonographic estimation of fetal weight is imprecise particularly in excessively large fetuses, prompting the need for additional measures to assess the feasibility of vaginal delivery of a macrosomic newborn and thus improve prenatal consultation. MATERIALS AND METHODS This retrospective case-control study included women who delivered a singleton macrosomic newborn (birth weight>4,000 g), either vaginally (N = 762) or by urgent cesarean delivery during labor (N = 109). Using multivariable analysis, we examined correlations of maternal height≥170 cm and shoe size≥40 with successful vaginal delivery. RESULTS Women who delivered vaginally had lower mean intrapartum BMI (p < 0.001) and lower rate of gestational diabetes (p = 0.003). Women with a shoe size≥40 were 2.2 times more likely to give birth vaginally. Cesarean section rate was 5.9 % among women with height≥170 cm and shoe size≥40; and 16.5 % among women with height<170 cm and shoe size<40. Multivariable analysis, adjusted for gestational diabetes, parity, and BMI, revealed that shoe size≥40 and maternal height≥170 cm correlated with success in vaginal delivery, OR = 3.1 (95%CI 1.3-7.3, p = 0.009). CONCLUSION Shoe size and maternal height may help predict success of vaginal birth of the macrosomic newborns.
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Affiliation(s)
- Karina Naskovica
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Inna Amdur Zilberfarb
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics & Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Badr DA, Cannie MM, Kadji C, Kang X, Carlin A, Jani JC. Performance of fetal ultrasound and magnetic resonance imaging in predicting birthweight according to the test-to-delivery interval: A cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 292:138-146. [PMID: 38006818 DOI: 10.1016/j.ejogrb.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE To assess the influence of the test-to-delivery interval (TDI) on the performance of ultrasound (US) and magnetic resonance imaging (MRI) for predicting birthweight (BW). STUDY DESIGN This is a secondary analysis of a prospective, single center, blinded cohort study that compared MRI and US for the prediction of BW ≥ 95th percentile in singleton pregnancies. Patients that were included in the initial study underwent US and MRI for estimation of fetal weight between 36 + 0/7 and 36 + 6/7 weeks of gestation (WG). The primary outcome of the current study was to report the changes of US and MRI sensitivity and specificity in the prediction of BW > 95th percentile, BW > 90th percentile, BW < 10th percentile, and BW < 5th percentile, according to the TDI. The secondary outcome was to represent the performance of both tools in the prediction of BW > 90th percentile when TDI is<2 weeks, between 2 and 4 weeks, and>4 weeks. Receiver operating characteristic (ROC) curves were constructed accordingly. RESULTS 2378 patients were eligible for final analysis. For the prediction of BW > 95th or 90th percentile, the sensitivity of MRI remains high until 2 weeks, and it decreases slowly between 2 and 4 weeks, in contrast to the sensitivity of US which decreases rapidly 2 weeks after examination (p < 0.001). For the prediction of BW < 10th or 5th percentile, the sensitivity of both tools decreases in parallel between 1 and 2 weeks. The specificities of both tools remain high from examination till delivery. These findings are reproducible with the use of the antenatal customized and the postnatal national growth charts. CONCLUSION The performance of MRI in the prediction of BW, especially in large-for-gestational age, is maximal when delivery occurs within two weeks of the examination, decreasing slightly thereafter, in contrast with the performance of US which decreases drastically over time.
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Affiliation(s)
- Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xin Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
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Li S, Tan H, Fu H, Du J, Liu P, Qin Y. Maternal and neonatal complications after IVF/ICSI-fresh embryo transfer in low-prognosis women under the POSEIDON criteria: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:855. [PMID: 38087253 PMCID: PMC10714626 DOI: 10.1186/s12884-023-06176-2] [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: 02/15/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Several studies on pregnancy complications of poor ovarian response (POR) patients did not draw a consistent conclusion. The POSEIDON criteria introduces the concept of "low prognosis" and divides POR patients into four groups based on age, AFC and AMH for individualized management. We analyzed low-prognosis population and patients with regular ovarian response, compared maternal and neonatal complications and discussed the relevant risk factors. METHODS A retrospective cohort study was conducted of females who achieved a singleton clinical pregnancy after IVF / ICSI-fresh embryo transfer in a single center from January 2014 to March 2019. Participants with low prognosis, as defined by the POSEIDON criteria, were enrolled in the study groups. The controls were defined as AFC ≥ five and number of retrieved oocytes > nine. Maternal and neonatal complications were compared among those groups. RESULTS There were 2554 cycles in POSEIDON group 1, 971 in POSEIDON group 2, 141 in POSEIDON group 3, 142 in POSEIDON group 4, and 3820 in Control. Univariate analysis roughly showed that Groups 2 and 4 had an increased tendency of pregnancy complications. Multi-variable generalized estimating equations (GEE) analysis showed that the risks of GDM, total pregnancy loss, and first-trimester pregnancy loss in Groups 2 and 4 were significantly higher than in Control. The risk of hypertensive disorders of pregnancy (HDP) in Groups 2 and 3 increased, and Group 4 had an increased tendency without statistical significance. After classification by age, GEE analysis showed no significant difference in risks of all complications among groups ≥ 35 years. In patients < 35 years, the risk of HDP in POSEIDON group 3 was significantly higher than in controls (< 35 years), and there was no significant increase in the risk of other complications. CONCLUSION Compared to patients with regular ovarian response, low-prognosis population have increased tendency of maternal and neonatal complications. In low-prognosis patients, advanced age (≥ 35 years) might be the predominant risk factor for pregnancy complications. In those < 35 years, poor ovarian reserve could contribute to HDP.
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Affiliation(s)
- Shiguang Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
- Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Huifang Tan
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Huimin Fu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Juan Du
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China
| | - Peihao Liu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
| | - Yingying Qin
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.
- Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
- Shandong Technology Innovation Center for Reproductive Health, Jinan, 250012, Shandong, China.
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, 250012, Shandong, China.
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Lipsky L, Cummings J, Siega-Riz AM, Nansel T. Relationships of pregnancy and postpartum diet quality with offspring birth weight and weight status through 12 months. Obesity (Silver Spring) 2023; 31:3008-3015. [PMID: 37731285 PMCID: PMC10872787 DOI: 10.1002/oby.23891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE This study examined relationships of maternal pregnancy and postpartum diet quality with infant birth size and weight status indicators through 12 months and tested whether breastfeeding duration modifies these associations. METHODS In the Pregnancy Eating Attributes Study (PEAS), dietary intake was assessed six times in 458 mothers who were followed from early pregnancy through 12 months postpartum (2014-2018). Logistic and linear mixed models estimated relationships of pregnancy and postpartum diet quality (Healthy Eating Index [HEI]) with offspring who were large-for-gestational-age (LGA) at birth, as well as BMI z score (BMIz) and weight-for-length z score (WFLz) at birth, 6 weeks, 6 months, and 12 months. RESULTS Pregnancy HEI was inversely related to LGA (odds ratio [OR] = 0.95, 95% CI: 0.92 to 0.98); HEI was also inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.002) and BMIz (β = -0.009, 95% CI: -0.02 to -0.0009) from birth through 12 months. Postpartum HEI was inversely related to WFLz (β = -0.01, 95% CI: -0.02 to -0.0009) and BMIz (β = -0.008, 95% CI: -0.02 to 0.0007) in infants who were breastfed for at least 6 months, but not in those who were breastfed for a shorter duration. CONCLUSIONS Maternal diet quality during pregnancy (and during postpartum in mothers who breastfed for a longer duration) was inversely related to LGA and weight status indicators from birth through 12 months. Increasing maternal diet quality may have use for promoting healthy infant weight development.
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Affiliation(s)
- Leah Lipsky
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda MD
| | - Jenna Cummings
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda MD
- Current: Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Anna Maria Siega-Riz
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC; current: Departments of Nutrition and Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
| | - Tonja Nansel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda MD
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Oliveira D, de Oliveira JM, Martins MDR, Barroso MR, Castro R, Cordeiro L, Pereira F. Maternal Profiles and Pregnancy Outcomes: A Descriptive Cross-Sectional Study from Angola. Matern Child Health J 2023; 27:2091-2098. [PMID: 37815656 DOI: 10.1007/s10995-023-03782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. METHODS We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. RESULTS Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). CONCLUSIONS There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango.
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Affiliation(s)
- Dinamene Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal.
| | | | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Rosalina Barroso
- Unidade de Cuidados Intensivos Neonatais, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Rita Castro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
| | - Lemuel Cordeiro
- Gabinete de Ensino, Pesquisa e Pós-graduação, Clínica Girassol, Luanda, Angola
| | - Filomena Pereira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical-Universidade Nova de Lisboa, Lisboa, Portugal
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Zhang Y, Zhao Y, Duan Y, Liu C, Yang Z, Duan J, Cui Z. Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study. J Matern Fetal Neonatal Med 2023; 36:2273216. [PMID: 37904502 DOI: 10.1080/14767058.2023.2273216] [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: 06/12/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns. OBJECTIVES This study aimed to explore the effects between prepregnancy dietary patterns on birth weight. METHODS This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother-Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI). RESULTS Four dietary patterns were identified based on 15 food groups. These patterns were named as "cereals-vegetables-fruits," "vegetables-poultry-aquatic products," "milk-meat-eggs," and "nuts-aquatic products-snacks." After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the "cereals-vegetables-fruits" pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the "nuts-aquatic products-snacks" pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, "cereals-vegetables-fruits" pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480). CONCLUSIONS An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy.
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Affiliation(s)
- Yiman Zhang
- School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Yongli Zhao
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Yifan Duan
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changqing Liu
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Zhenyu Yang
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Jingtao Duan
- Department of Epidemiology, Wuqiang Center for Disease Control and Prevention, Hengshui, China
| | - Ze Cui
- Institute for Nutrition and Food Safety, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
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Yalcin SS, Savcı RG, Yalcin S, Eryurt MA. Accuracy of Syrain Refugee Mothers' Perceptions of Newborn's Birth Size: Insights from a National Survey in Turkey. J Immigr Minor Health 2023; 25:1363-1373. [PMID: 37402934 DOI: 10.1007/s10903-023-01519-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
This study aims to assess the accuracy of maternally perceived birth size and its associated factors among the Syrian refugees in Turkey, using the data from 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (TDHS-SM-18). The study includes information on the last-born child, singleton pregnancies, births in healthcare facilities, children under 5 living with their mothers, with recorded birth weight (n = 969). The study categorizes the mother's perception of size into three groups : compatible, overestimated, and underestimated. Various factors, including sociodemographic characteristics, financial aspects, maternal characteristics, and child characteristics, are considered as explanatory variables. The analysis employs a complex sample multiple logistic regression model. The findings reveal that the majority of mothers accurately perceive the birth size, but 17.1% of them do not. Maternal factors such as region of residence, literacy, occupation, age at birth, and child factors such as birth order, birth interval, gender, and birth weight are identified as associated factors with maternal misperception. This study provides valuable insights into the accuracy of maternally perceived birth size and sheds light on the factors influencing this perception among Syrian refugee mothers in Turkey.
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Affiliation(s)
- Siddika Songül Yalcin
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Refia Gözdenur Savcı
- Departmant of Social Pediatrics, Institute of Child Health, Hacettepe University, Ankara, Turkey
| | - Suzan Yalcin
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey
| | - Mehmet Ali Eryurt
- Institute of Population Studies, Hacettepe University, Ankara, Turkey
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Suárez-Idueta L, Ohuma EO, Chang CJ, Hazel EA, Yargawa J, Okwaraji YB, Bradley E, Gordon A, Sexton J, Lawford HLS, Paixao ES, Falcão IR, Lisonkova S, Wen Q, Velebil P, Jírová J, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Yunis KA, Al Bizri A, Alvarez SL, Broeders L, van Dijk AE, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Lowry E, Rowland N, Wood R, Monteath K, Pereyra I, Pravia G, Lawn JE, Blencowe H. Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020. BJOG 2023. [PMID: 38012114 DOI: 10.1111/1471-0528.17706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020. DESIGN Population-based, multi-country study. SETTING National healthcare systems. POPULATION Liveborn infants. METHODS We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population. MAIN OUTCOME MEASURES Prevalence and neonatal mortality risks. RESULTS Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life. CONCLUSIONS In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.
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Affiliation(s)
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Chia-Jung Chang
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth A Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Jessica Sexton
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Harriet L S Lawford
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Enny S Paixao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ila R Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz Bahia, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Petr Velebil
- Department of Obstetrics and Gynaecology, Institute for the Care of Mother and Child, Prague, Czech Republic
| | - Jitka Jírová
- Department of Data Analysis, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Erzsebet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Luule Sakkeus
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Lili Abuladze
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Khalid A Yunis
- The National Collaborative Perinatal Neonatal Network (NCPNN) Coordinating Center at the Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayah Al Bizri
- The National Collaborative Perinatal Neonatal Network (NCPNN) Coordinating Center at the Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lucy K Smith
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ruth J Matthews
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Estelle Lowry
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Neil Rowland
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Rachael Wood
- Usher Institute, Edinburgh, UK
- Pregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK
| | - Kirsten Monteath
- Pregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK
| | - Isabel Pereyra
- Faculty of Health Sciences, Catholic University of Maule, Curicó, Chile
| | - Gabriella Pravia
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Belfort GP, Farias DR, Padilha PDC, da Silva LBG, dos Santos K, dos Santos MS, Zajdenverg L, Keating E, Saunders C. Influence of the DASH Diet on Gestational Weight Gain and Perinatal Outcomes in Women with Pre-Existing Diabetes Mellitus: A Randomized, Single-Blind, Controlled Clinical Trial. Life (Basel) 2023; 13:2191. [PMID: 38004331 PMCID: PMC10671988 DOI: 10.3390/life13112191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.
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Affiliation(s)
- Gabriella P. Belfort
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Dayana R. Farias
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Patricia de C. Padilha
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Letícia B. G. da Silva
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
| | - Karina dos Santos
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- School of Nutrition, Federal University of the State of Rio de Janeiro, Pasteur Ave, 296, Urca, Rio de Janeiro 22290-240, RJ, Brazil
| | - Mayara S. dos Santos
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Lenita Zajdenverg
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
| | - Elisa Keating
- Unit of Biochemistry, Department of Biomedicine, Faculty of Medicine, University of Porto, Prof. Hernâni Monteiro Ave, 4200-319 Porto, Portugal
| | - Claudia Saunders
- Postgraduate Program in Nutrition, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Carlos Chagas Filho Ave, 373, University City, Rio de Janeiro 21941-590, RJ, Brazil; (D.R.F.); (C.S.)
- Maternity School of the Federal University of Rio de Janeiro, Laranjeiras Street, 180, Rio de Janeiro 22240-003, RJ, Brazil; (M.S.d.S.); (L.Z.)
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Quezada-Robles A, Quispe-Sarmiento F, Bendezu-Quispe G, Vargas-Fernández R. Fetal Macrosomia and Postpartum Hemorrhage in Latin American and Caribbean Region: Systematic Review and Meta-analysis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e706-e723. [PMID: 38029773 PMCID: PMC10686756 DOI: 10.1055/s-0043-1772597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/22/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To determine the association between fetal macrosomia (FM) and postpartum hemorrhage (PPH) in Latin American and Caribbean (LAC) women. DATA SOURCES Studies evaluating the association between FM and PPH (≥ 500 ml) and severe PPH (≥ 1,000 ml) until November 4, 2021, indexed in CINHAL, Scopus, Embase, Cochrane Library, MEDLINE, LILACS, and SciELO. SELECTION OF STUDIES Inclusion criteria were cohort and case-control studies that provided the number of PPH and FM cases. Exclusion criteria were studies lacking information about the number of cases, with a population of women who were not from LAC; published in a language other than English, Spanish, or Portuguese, and with a different design. DATA COLLECTION Data extraction was performed independently by two authors, and discrepancies were resolved with a third author. Data regarding FM and PPH cases were retrieved. DATA SYNTHESIS Of the 1,044 articles evaluated, 5 studies were included, from 6 different countries: Argentina and Uruguay (multi-country), West Indies, Antigua and Barbuda, French Guyana, and Suriname. The pooled odds ratio (OR) for FM and PPH in the meta-analysis (five studies) was 2.10 (95% confidence interval [CI]: 1.79-2.47; I2: 0%), with estimates within this 95% CI in the sensitivity analysis. The combined OR for severe PPH (3 studies) was 1.61 (95% CI: 0.40-6.48; I2: 91.89%), showing high heterogeneity. CONCLUSION There was a positive association between FM and PPH in the LAC, increasing the risk of the presence of this event 2-fold. The high heterogeneity of the studies that measured severe PPH does not allow drawing conclusions about the estimates obtained.
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Badr DA, Cannie MM, Kadji C, Kang X, Carlin A, Jani JC. The impact of different growth charts on birthweight prediction: obstetrical ultrasound vs magnetic resonance imaging. Am J Obstet Gynecol MFM 2023; 5:101123. [PMID: 37574047 DOI: 10.1016/j.ajogmf.2023.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The estimation of fetal weight by fetal magnetic resonance imaging is a simple and rapid method with a high sensitivity in predicting birthweight in comparison with ultrasound. Several national and international growth charts are currently in use, but there is substantial heterogeneity among these charts due to variations in the selected populations from which they were derived, in methodologies, and in statistical analysis of data. OBJECTIVE This study aimed to compare the performance of magnetic resonance imaging and ultrasound for the prediction of birthweight using 3 commonly used fetal growth charts: the INTERGROWTH-21st Project, World Health Organization, and Fetal Medicine Foundation charts. STUDY DESIGN Data derived from a prospective, single-center, blinded cohort study that compared the performance of magnetic resonance imaging and ultrasound between 36+0/7 and 36+6/7 weeks of gestation for the prediction of birthweight ≥95th percentile were reanalyzed. Estimated fetal weight was categorized as above or below the 5th, 10th, 90th, and 95th percentile according to the 3 growth charts. Birthweight was similarly categorized according to the birthweight standards of each chart. The performances of ultrasound and magnetic resonance imaging for the prediction of birthweight <5th, <10th, >90th, and >95th percentile using the different growth charts were compared. Data were analyzed with R software, version 4.1.2. The comparison of sensitivity and specificity was done using McNemar and exact binomial tests. P values <.05 were considered statistically significant. RESULTS A total of 2378 women were eligible for final analysis. Ultrasound and magnetic resonance imaging were performed at a median gestational age of 36+3/7 weeks, delivery occurred at a median gestational age of 39+3/7 weeks, and median birthweight was 3380 g. The incidences of birthweight <5th and <10th percentiles were highest with the Fetal Medicine Foundation chart and lowest with the INTERGROWTH-21st chart, whereas the incidences of birthweight >90th and >95th percentiles were lowest with the Fetal Medicine Foundation chart and highest with the INTERGROWTH-21st chart. The sensitivity of magnetic resonance imaging with an estimated fetal weight >95th percentile in the prediction of birthweight >95th percentile was significantly higher than that of ultrasound across the 3 growth charts; however, its specificity was slightly lower than that of ultrasound. In contrast, the sensitivity of magnetic resonance imaging with an estimated fetal weight <10th percentile for predicting birthweight <10th percentile was significantly lower than that of ultrasound in the INTERGROWTH-21st and Fetal Medicine Foundation charts, whereas the specificity and positive predictive value of magnetic resonance imaging were significantly higher than those of ultrasound for all 3 charts. Findings for the prediction of birthweight >90th percentile were close to those of birthweight >95th percentile, and findings for the prediction of birthweight <5th percentile were close to those of birthweight <10th percentile. CONCLUSION The sensitivity of magnetic resonance imaging is superior to that of ultrasound for the prediction of large for gestational age fetuses and inferior to that of ultrasound for the prediction of small for gestational age fetuses across the 3 different growth charts. The reverse is true for the specificity of magnetic resonance imaging in comparison with that of ultrasound.
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Affiliation(s)
- Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Badr, Kadji, Kang, Carlin, and Jani)
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Dr Cannie); Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (Dr Cannie)
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Badr, Kadji, Kang, Carlin, and Jani)
| | - Xin Kang
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Badr, Kadji, Kang, Carlin, and Jani)
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Badr, Kadji, Kang, Carlin, and Jani)
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Badr, Kadji, Kang, Carlin, and Jani).
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