Macrosomia and large for gestational age in Asia: One size does not fit all

Development and evaluation of machine learning models for predicting large-for-gestational-age newborns in women exposed to radiation prior to pregnancy

INTRODUCTION

The correlation between radiation exposure before pregnancy and abnormal birth weight has been previously proven. However, for large-for-gestational-age (LGA) babies in women exposed to radiation before becoming pregnant, there is no prediction model yet.

MATERIAL AND METHODS

The data were collected from the National Free Preconception Health Examination Project in China. A sum of 455 neonates (42 SGA births and 423 non-LGA births) were included. A training set (n = 319) and a test set (n = 136) were created from the dataset at random. To develop prediction models for LGA neonates, conventional logistic regression (LR) method and six machine learning methods were used in this study. Recursive feature elimination approach was performed by choosing 10 features which made a big contribution to the prediction models. And the Shapley Additive Explanation model was applied to interpret the most important characteristics that affected forecast outputs.

RESULTS

The random forest (RF) model had the highest average area under the receiver-operating-characteristic curve (AUC) for predicting LGA in the test set (0.843, 95% confidence interval [CI]: 0.714-0.974). Except for the logistic regression model (AUC: 0.603, 95%CI: 0.440-0.767), other models' AUCs displayed well. Thereinto, the RF algorithm's final prediction model using 10 characteristics achieved an average AUC of 0.821 (95% CI: 0.693-0.949).

CONCLUSION

The prediction model based on machine learning might be a promising tool for the prenatal prediction of LGA births in women with radiation exposure before pregnancy.

BMI modifies the effect of pregnancy complications on risk of small- or large-for-gestational-age newborns

BACKGROUND

Maternal physical condition (reflected by maternal body mass index (BMI) at delivery) and pregnancy complications influence neonatal health outcomes. High BMI during pregnancy increases various health problems' risks, but studies about the synthesized effect of these factors on fetal growth, are scarce.

METHODS

The retrospective cohort study was conducted in Zhejiang Province, China from 1 January 2019 to 31 December 2021. The associations between complications and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) were measured by the Fine-Gray model and subgroup analysis. Effect modification and interaction analyses were conducted to explore BMI's modification effect and complications' interaction.

RESULTS

Several complications increased the risk for SGA and LGA, some significance varied in different subgroups. There was a positive effect modification of gestational diabetes mellitus (GDM) across BMI strata on LGA (relative excess risk due to interaction (RERI) [95% CI] = 0.57 [0.09,1.04]). Several pairwise complications' interactions were synergistic (e.g., pregestational diabetes and intraamniotic infection for SGA (ratio of ORs [95% CI] = 8.50 [1.74,41.37]), pregestational diabetes and assisted reproductive technology (ART) for LGA (ratio of ORs [95% CI] = 2.71 [1.11,6.62])), one was antagonistic (placental problems and ART for LGA (ratio of ORs [95% CI] = 0.58 [0.35,0.96])).

CONCLUSIONS

High-BMI positively modified the risk of GDM on LGA. Many interactions existed when two specific pregnancy complications occurred simultaneously.

IMPACT

This is the largest retrospective study covering more than 10 pregnancy complications to date in this aspect. High-BMI (BMI > 28 kg/m2) positively modifies the risk of GDM on LGA. Many pregnancy complications influence the risk of SGA and LGA, with several interactions that may create a "syndrome" effect. Pregnant women with different BMIs should consider the additional risks caused by pregnancy complications for their heterogeneous effects on abnormal fetal growth. Measures should be taken to prevent the occurrence of other exposure factors in the "syndrome". This study may aid in developing a new strategy for improving neonatal outcomes.

Large for Gestational Age and Adverse Outcomes: Stratified By Diabetes Status

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..

Association between being large for gestational age and cardiovascular metabolic health in children conceived from assisted reproductive technology: a prospective cohort study

BACKGROUND

To the best of our knowledge, no study has investigated the potential joint effect of large for gestational age (LGA) and assisted reproductive technology (ART) on the long-term health of children.

METHODS

This was a prospective cohort study that recruited children whose parents had received ART treatment in the Center for Reproductive Medicine, Shandong Provincial Hospital, affiliated to Shandong University, between January 2006 and December 2017. Linear mixed model was used to compare the main outcomes. The mediation model was used to evaluate the intermediary effect of body mass index (BMI).

RESULTS

4138 (29.5%) children born LGA and 9910 (70.5%) children born appropriate for gestational age (AGA) were included in the present study. The offspring ranged from 0.4 to 9.9 years. LGAs conceived through ART were shown to have higher BMI, blood pressure, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance values, even after controlling for all covariates. The odds of overweight and insulin resistance are also higher in LGA subjects. After adjusting for all covariates, LGAs conceived through ART had BMI and BMI z-scores that were 0.48 kg/m2 and 0.34 units greater than those of AGAs, respectively. The effect of LGA on BMI was identified as early as infancy and remained consistently significant throughout pre-puberty.

CONCLUSIONS

Compared to AGA, LGA children conceived from ART were associated with increased cardiovascular-metabolic events, which appeared as early as infancy and with no recovery by pre-puberty.

Fetal overgrowth and weight trajectories during infancy and adiposity in early childhood

BACKGROUND

Large-for-gestational age (LGA), a marker of fetal overgrowth, has been linked to obesity in adulthood. Little is known about how infancy growth trajectories affect adiposity in early childhood in LGA.

METHODS

In the Shanghai Birth Cohort, we followed up 259 LGA (birth weight >90th percentile) and 1673 appropriate-for-gestational age (AGA, 10th-90th percentiles) children on body composition (by InBody 770) at age 4 years. Adiposity outcomes include body fat mass (BFM), percent body fat (PBF), body mass index (BMI), overweight/obesity, and high adiposity (PBF >85th percentile).

RESULTS

Three weight growth trajectories (low, mid, and high) during infancy (0-2 years) were identified in AGA and LGA subjects separately. BFM, PBF and BMI were progressively higher from low- to mid-to high-growth trajectories in both AGA and LGA children. Compared to the mid-growth trajectory, the high-growth trajectory was associated with greater increases in BFM and the odds of overweight/obesity or high adiposity in LGA than in AGA children (tests for interactions, all P < 0.05).

CONCLUSIONS

Weight trajectories during infancy affect adiposity in early childhood regardless of LGA or not. The study is the first to demonstrate that high-growth weight trajectory during infancy has a greater impact on adiposity in early childhood in LGA than in AGA subjects.

IMPACT

Large-for-gestational age (LGA), a marker of fetal overgrowth, has been linked to obesity in adulthood, but little is known about how weight trajectories during infancy affect adiposity during early childhood in LGA subjects. The study is the first to demonstrate a greater impact of high-growth weight trajectory during infancy (0-2 years) on adiposity in early childhood (at age 4 years) in subjects with fetal overgrowth (LGA) than in those with normal birth size (appropriate-for-gestational age). Weight trajectory monitoring may be a valuable tool in identifying high-risk LGA children for close follow-ups and interventions to decrease the risk of obesity.

Improved estimation of the relationship between fetal growth and late stillbirth in the United States, 2014-15

In the United States the rate of stillbirth after 28 weeks' gestation (late stillbirth) is 2.7/1000 births. Fetuses that are small for gestational age (SGA) or large for gestational age (LGA) are at increased risk of stillbirth. SGA and LGA are often categorized as growth or birthweight ≤ 10th and ≥ 90th centile, respectively; however, these cut-offs are arbitrary. We sought to characterize the relationship between birthweight and stillbirth risk in greater detail. Data on singleton births between 28- and 44-weeks' gestation from 2014 to 2015 were extracted from the US Centers for Disease Control and Prevention live birth and fetal death files. Growth was assessed using customized birthweight centiles (Gestation Related Optimal Weight; GROW). The analyses included logistic regression using SGA/LGA categories and a generalized additive model (GAM) using birthweight centile as a continuous exposure. Although the SGA and LGA categories identified infants at risk of stillbirth, categorical models provided poor fits to the data within the high-risk bins, and in particular markedly underestimated the risk for the extreme centiles. For example, for fetuses in the lowest GROW centile, the observed rate was 39.8/1000 births compared with a predicted rate of 11.7/1000 from the category-based analysis. In contrast, the model-predicted risk from the GAM tracked closely with the observed risk, with the GAM providing an accurate characterization of stillbirth risk across the entire birthweight continuum. This study provides stillbirth risk estimates for each GROW centile, which clinicians can use in conjunction with other clinical details to guide obstetric management.

Neonatal Birthweight Spectrum: Maternal Risk Factors and Pregnancy Outcomes in Saudi Arabia

Background and Objectives: Low-birth-weight (LBW) neonates are at increased risk of morbidity and mortality which are inversely proportional to birth weight, while macrosomic babies are at risk of birth injuries and other related complications. Many maternal risk factors were associated with the extremes of birthweight. The objectives of this study are to investigate maternal risk factors for low and high birthweight and to report on the neonatal complications associated with abnormal birth weights. Materials and Methods: We conducted a retrospective analysis of medical records of deliveries ≥ 23 weeks. We classified the included participants according to birth weight into normal birth weight (NBW), LBW, very LBW (VLBW), and macrosomia. The following maternal risk factors were included, mother's age, parity, maternal body mass index (BMI), maternal diabetes, and hypertension. The neonatal outcomes were APGAR scores < 7, admission to neonatal intensive care unit (NICU), respiratory distress (RD), and hyperbilirubinemia. Data were analyzed using SAS Studio, multivariable logistic regression analyses were used to investigate the independent effect of maternal risk factors on birthweight categories and results were reported as an adjusted odds ratio (aOR) and 95% Confidence Interval (CI). Results: A total of 1855 were included in the study. There were 1638 neonates (88.3%) with NBW, 153 (8.2%) with LBW, 27 (1.5%) with VLBW, and 37 (2.0%) with macrosomia. LBW was associated with maternal hypertension (aOR = 3.5, 95% CI = 1.62-7.63), while increasing gestational age was less likely associated with LBW (aOR = 0.51, 95% CI = 0.46-0.57). Macrosomia was associated with maternal diabetes (aOR = 3.75, 95% CI = 1.67-8.41), in addition to maternal obesity (aOR = 3.18, 95% CI = 1.24-8.14). The odds of VLBW were reduced significantly with increasing gestational age (aOR = 0.41, 95% CI = 0.32-0.53). In total, 81.5% of VLBW neonates were admitted to the NICU, compared to 47.7% of LBW and 21.6% of those with macrosomia. RD was diagnosed in 59.3% of VLBW neonates, in 23% of LBW, in 2.7% of macrosomic and in 3% of normal-weight neonates. Hyperbilirubinemia was reported in 37.04%, 34.21%, 22.26%, and 18.92% of VLBW, LBW, NBW, and macrosomic newborns, respectively. Conclusions: Most neonates in this study had normal birthweights. Maternal hypertension and lower gestational age were associated with increased risk of LBW. Additionally, maternal obesity and diabetes increased the risk of macrosomia. Neonatal complications were predominantly concentrated in the LBW and VLBW, with a rising gradient as birthweight decreased. The main complications included respiratory distress and NICU admissions.

Maternal age-specific risks for adverse birth weights according to gestational weight gain: a prospective cohort in Chinese women older than 30

BACKGROUND

It is unclear whether the effects of abnormal gestational weight gain (GWG) on birth outcomes are differently in women with different maternal ages. This study aimed to investigate maternal age-specific association between GWG and adverse birth weights in Chinese women older than 30.

METHODS

19,854 mother-child dyads were selected from a prospective cohort study in Southwest China between 2019 and 2022. Logistic regression model was used to assess the association between GWG, which defined by the 2009 Institute of Medicine guidelines, and adverse birth weights including large- and small-for-gestational-age (LGA and SGA), stratified by maternal age (31-34 years and ≥ 35 years).

RESULTS

In both maternal age groups, excessive and insufficient GWG were associated with increased odds of LGA and SGA, respectively. After women were categorized by pre-pregnancy body mass index, the associations remained significant in women aged 31-34 years, whereas for women aged ≥ 35 years, the association between excessive GWG and the risk of LGA was only significant in normal weight and overweight/obese women, and the significant effect of insufficient GWG on the risk of SGA was only observed in underweight and overweight/obese women. Moreover, among overweight/obese women, the magnitude of the association between insufficient GWG and the risk of SGA was greater in those aged ≥ 35 years (31-34 years: OR 2.08, 95% CI 1.19-3.55; ≥35 years: OR 2.65, 95% CI 1.47-4.74), while the impact of excessive GWG on the risk of LGA was more pronounced in those aged 31-34 years (31-34 years: OR 2.18, 95% CI 1.68-2.88; ≥35 years: OR 1.71, 95% CI 1.30-2.25).

CONCLUSIONS

The stronger associations between abnormal GWG and adverse birth weights were mainly observed in women aged 31-34 years, and more attention should be paid to this age group.

Effects of prepregnancy dietary patterns on infant birth weight: a prospective cohort study

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.

Association of Triglyceride-Glucose Index with Risk of Large for Gestational Age: A Prospective Cohort Study

Background

To evaluate the association of the baseline triglyceride-glucose (TyG) index in the first trimester of pregnancy with the risk of large for gestational age (LGA) in Southeast Chinese pregnant women.

Methods

A prospective birth cohort study recruiting 12,108 pregnant women at their first prenatal visit before 13 gestation weeks was conducted in 2019-2022. Baseline characteristics were collected from medical records or using questionnaires and blood samples were collected in the first trimester. The TyG index was obtained through the formula: ln[triglyceride (mg/dl)×fasting plasma glucose (mg/dl)/2]. The binary logistic regression model was performed to calculate the odds ratio (OR) and 95% confidence intervals (CI) to reveal the relationship between TyG index and LGA. Receiver-operating characteristic curve analysis was conducted to evaluate the ability of the TyG index to predict the risks of LGA.

Results

The overall incidence of LGA in the current study was 11.4% and the incidence of LGA increased with the baseline TyG index increasing. The risk of LGA was 2.05 (1.64, 2.57) for per unit increase in baseline TyG index. The increasing trend was found across the TyG index quartiles and the highest TyG quartiles raised the risk of LGA to 1.86 (95% CI: 1.51, 2.27) compared to the bottom TyG quartiles after full adjustment. The risk of LGA remained positive after stratification analysis. The AUC was 0.584 (95% CI: 0.569~0.600) in the entire subject, and the threshold was 8.34, with a sensitivity of 0.74 and specificity of 0.38.

Conclusion

The findings suggested that a higher TyG index in the first trimester was independently associated with higher risk of LGA and high TyG index in the first trimester may play as a early predictor for LGA.

Analysis of the Incidence of Macrosomia in Japan by Parental Nationalities at 5-year Intervals From 1995 to 2020

OBJECTIVES

We investigated trends in the incidence rate of macrosomia and its association with parental nationalities using Vital Statistics data in Japan.

METHODS

We used singleton birth data every 5 years from 1995 to 2020. The incidence rate of macrosomia was calculated according to specific attributes (maternal age, infant's sex, parental nationalities, parity, and household occupation) over time (years). In addition, a log-binomial model was used to investigate the relationship between the incidence of macrosomia and the attributes. This study compared Korea, China, the Philippines, Brazil, and other countries with Japan in terms of parental nationalities. "Other countries" indicates countries except for Japan, Korea, China, the Philippines, and Brazil.

RESULTS

The study included 6 180 787 births. The rate of macrosomia in Japan decreased from 1.43% in 1995 to 0.88% in 2020, and the decrease was observed across all parental nationalities. The rates for Japanese parents were the lowest values among parental nationalities during the timespan investigated. Multivariate regression analysis showed that mothers from Korea, China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.91, 2.82, 1.59, 1.74, and 1.64, respectively). Furthermore, fathers from China, the Philippines, Brazil, and other countries had a significantly higher risk of macrosomia than those from Japan (risk ratio, 1.66, 1.38, 1.88, and 3.02, respectively).

CONCLUSIONS

The rate of macrosomia decreased from 1995 to 2020 in Japan for parents of all nationalities, and the risk of macrosomia incidence was associated with parental nationality.

The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting

Introduction

Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births.

Methods

This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs).

Results

The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors.

Discussion

The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.

Association between excessive fetal growth and maternal cancer in Shanghai, China: a large, population-based cohort study

The prevalence of high birth weight or large for gestational age (LGA) infants is increasing, with increasing evidence of pregnancy-related factors that may have long-term impacts on the health of the mother and baby. We aimed to determine the association between excessive fetal growth, specifically LGA and macrosomia, and subsequent maternal cancer by performing a prospective population-based cohort study. The data set was based on the Shanghai Birth Registry and Shanghai Cancer Registry, with medical records from the Shanghai Health Information Network as a supplement. Macrosomia and LGA prevalence was higher in women who developed cancer than in women who did not. Having an LGA child in the first delivery was associated with a subsequently increased risk of maternal cancer (hazard ratio [HR] = 1.08, 95% confidence interval [CI] 1.04-1.11). Additionally, in the last and heaviest deliveries, there were similar associations between LGA births and maternal cancer rates (HR = 1.08, 95% CI 1.04-1.12; HR = 1.08, 95% CI 1.05-1.12, respectively). Furthermore, a substantially increased trend in the risk of maternal cancer was associated with birth weights exceeding 2500 g. Our study supports the association between LGA births and increased risks of maternal cancer, but this risk requires further investigation.

Association of large for gestational age with cardiovascular metabolic risks: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to clarify the relationships among large for gestational age (LGA) and cardiometabolic risk factors.

METHODS

PubMed, Web of Science, and the Cochrane Library databases were searched to identify studies on LGA and outcomes of interest, including BMI, blood pressure, glucose metabolism, and lipid profiles. Data were independently extracted by two reviewers. A meta-analysis was performed using a random-effects model. The Newcastle-Ottawa Scale and funnel graph were used to assess the quality and publication bias, respectively.

RESULTS

Overall, 42 studies involving 841,325 individuals were included. Compared with individuals born appropriate for gestational age, individuals born LGA had higher odds of overweight and obesity (odds ratios [OR] = 1.44, 95% CI: 1.31-1.59), type 1 diabetes (OR = 1.28, 95% CI: 1.15-1.43), hypertension (OR = 1.23, 95% CI: 1.01-1.51), and metabolic syndrome (OR = 1.43, 95%; CI: 1.05-1.96). No significant difference was found in hypertriglyceridemia and hypercholesterolemia. Stratified analyses showed that, compared with individuals born appropriate for gestational age, individuals born LGA had higher odds for overweight and obesity from toddler age to puberty age (toddler age: OR = 2.12, 95% CI: 1.22-3.70; preschool: OR = 1.81, 95% CI: 1.55-2.12; school age: OR = 1.53, 95% CI: 1.09-2.14; puberty: OR = 1.40, 95% CI: 1.11-1.77).

CONCLUSIONS

LGA is associated with increased odds of obesity and metabolic syndrome later in life. Future studies should focus on elucidating the potential mechanisms and identifying risk factors.

Secular Trends of Birth Weight in Twins and Singletons in South Korea from 2000 to 2020

Whether the decline of birth weight (BW) reported in developed countries in the early 2000s is ongoing remains unknown. Furthermore, despite recent sharp increases in twin births, comparing secular trends of BW between singletons and twins is difficult, as studies have rarely examined secular trends of BW in twins and singletons simultaneously. Therefore, this study aimed to investigate the most recent 20-year trends (2000-2020) of BW in twins and singletons in South Korea. Annual natality files from 2000 to 2020 obtained from the Korean Statistical Information Service were analyzed. A yearly decrease of BW was 3 g among singletons and 5 to 6 g in twins from 2000 to 2020, indicating a widening gap of BW between twins and singletons with increasing years. Gestational age (GA) also decreased in twins and singletons with yearly decreases of 0.28 days in singletons and 0.41 days in twins. Whereas BW decreased in term (GA ≥ 37 weeks), and very preterm groups (28 weeks ≤ GA < 32 weeks) from 2000 to 2020 in twins and singletons, it increased in moderate to late preterm (32 weeks ≤ GA < 37 weeks) groups, indicating a non-linear relationship between BW and GA. The prevalence of macrosomia (BW > 4000 g) in singletons decreased from 2000 to 2020, whereas low birth weight (LBW; BW < 2500 g) increased in twins and singletons. LBW is associated with adverse health outcomes. Effective public health strategies aiming at reduction in the incidence of LBW in the population should be developed.

Burden and Trend of Macrosomia and Large-for-Gestational-Age Neonates Attributable to High Pre-Pregnancy Body Mass Index in China, 2013-2017: A Population-Based Retrospective Cohort Study

Background: The world is transitioning to an obese future, but few studies have measured the burden of increased maternal body mass index (BMI) on pathological fetal overgrowth, especially the trends in this burden and its heterogeneity in populations with different characteristics. Methods: A population-based retrospective cohort study was conducted with 7,998,620 Chinese females who had participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2017. The proportions of macrosomic and LGA neonates attributable to high BMI (population attributable fraction, PAF) and annual percent change of yearly PAFs were estimated. Results: We found that the burden of macrosomic and LGA (large-for-gestational-age) neonates attributable to high pre-pregnancy BMI increased among Chinese females with planned pregnancies during 2013-2017. The PAF of macrosomia attributable to high BMI increased from 3.16% (95% confidence interval: 2.97-3.35%) to 7.11% (6.79-7.42%) by 23.60% (16.76-30.85%) annually, and the PAF of LGA increased from 2.35% (2.21-2.48%) to 5.00% (4.79-5.21%) by 21.98% (16.14-28.11%) annually. Our study identified that participants with disadvantaged socioeconomic status (including those without higher education, living in provinces with GDP per capita < 40,000 CNY, tier IV, and tier V cities) and residing in northern and southwestern China were at high risk of a rapidly expanding burden. Conclusions: Government authorities should control pre-pregnancy BMI through nationwide intervention programs and direct more resources to focus on the unfair burden on females with disadvantaged socioeconomic status.

Binge alcohol drinking before pregnancy is closely associated with the development of macrosomia: Korean pregnancy registry cohort

Background

Alcohol drinking during pregnancy has been well-known to cause the detrimental effects on fetal development; however, the adverse effects of pre-pregnancy drinking are largely unknown. We investigate whether alcohol drinking status before pregnancy is associated with the risk for macrosomia, an offspring’s adverse outcome, in a Korean pregnancy registry cohort (n = 4,542) enrolled between 2013 and 2017.

Methods

Binge drinking was defined as consuming ≥5 drinks on one occasion and ≥2 times a week, and a total 2,886 pregnant, included in the final statistical analysis, were divided into 3 groups: never, non-binge, and binge drinking.

Results

The prevalence of macrosomia was higher in binge drinking before pregnancy than those with never or non-binge drinking (7.5% vs. 3.2% or 2.9%, p = 0.002). Multivariable logistic regression analysis demonstrated an independent association between macrosomia and prepregnancy binge drinking after adjusting for other confounders (adjusted odds ratio = 2.29; 95% CI, 1.08–4.86; p = 0.031). The model added binge drinking before pregnancy led to improvement of 10.6% (95% CI, 2.03–19.07; p = 0.0006) in discrimination from traditional risk prediction models.

Conclusion

Together, binge drinking before pregnancy might be an independent risk factor for developing macrosomia. Intensified intervention for drinking alcohol in women who are planning a pregnancy is important and may help prevent macrosomia.

Association between gestational abnormal glucose tolerance and maternal-fetal outcomes

AIM

To investigate the relationship between abnormal glucose tolerance during pregnancy and maternal-fetal outcomes, after categorizing women into groups with different levels of gestational abnormal glucose tolerance.

METHODS

A total of 1858 pregnant women who received two-step screening for gestational diabetes mellitus (GDM) at Fooyin University Hospital were categorized into four groups, according to their glucose abnormalities, and their maternal-fetal outcomes were investigated from October 2015 to June 2020.

RESULTS

Among the groups having different levels of abnormal glucose tolerance, there were significant differences and trends in mother's age, currently married status, and prepregnancy overweight or obesity, incidences of cesarean section, preterm, and gestational hypertension or preeclampsia; and with respect to neonatal incidence of large for gestational age (LGA), average weight, and average height (p < 0.05). After adjusting for potential factors, there were higher incidences of cesarean section (AOR = 1.71; 95% confidence interval [CI]: 1.12-2.61), preterm (AOR = 2.20; 95% CI: 1.23-3.91), neonatal LGA (AOR = 4.94; 95% CI: 2.87-8.51), and neonatal intensive care unit (NICU) admission (AOR = 2.66; 95% CI: 1.14-6.24) in the GDM group, relative to the control group. Furthermore, the women in the oral glucose tolerance test (OGTT)-1 group had a higher incidence of neonatal LGA when compared with the women in the normal group (AOR = 2.31; 95% CI: 1.02-5.33).

CONCLUSIONS

We found higher incidences of cesarean section, preterm, and neonatal LGA and NICU admission in the GDM women, and a higher incidence of neonatal LGA in the OGTT-1 group, relative to control group.

Long-Term Health Associated with Small and Large for Gestational Age Births among Young Thai Adults

We examined the long-term health outcomes associated with being born small for gestational age (SGA) or large for gestational age (LGA). A total of 632 young adults aged ≈20.6 years were recruited from a longitudinal study (Chiang Mai, Thailand) in 2010: 473 born appropriate for gestational age (AGA), 142 SGA, and 17 LGA. The clinical assessments included anthropometry, blood pressure (BP), lipid profile, and an oral glucose tolerance test (OGTT). Young adults born SGA were 1.8 and 3.2 cm shorter than AGA (p = 0.0006) and LGA (p = 0.019) participants, respectively. The incidence of short stature was 8% among SGA compared with 3% in AGA and no cases among LGA participants, with the adjusted relative risk (aRR) of short stature among SGA 2.70 times higher than that of AGA counterparts (p = 0.013). SGA participants also had a 2 h glucose 7% higher than that of the AGA group (105 vs. 99 mg/dL; p = 0.006). Young adults born LGA had a BMI greater by 2.42 kg/m² (p = 0.025) and 2.11 kg/m² (p = 0.040) than those of SGA and AGA, respectively. Thus, the rate of overweight/obesity was 35% in the LGA group compared with 14.2% and 16.6% of SGA and AGA groups, respectively, with corresponding aRR of overweight/obesity of 2.95 (p = 0.011) and 2.50 (p = 0.017), respectively. LGA participants had markedly higher rates of BP abnormalities (prehypertension and/or hypertension) with an aRR of systolic BP abnormalities of 2.30 (p = 0.023) and 2.79 (p = 0.003) compared with SGA and AGA groups, respectively. Thai young adults born SGA had an increased risk of short stature and displayed some impairment in glucose metabolism. In contrast, those born LGA were at an increased risk of overweight/obesity and elevated blood pressure. The long-term follow-up of this cohort is important to ascertain whether these early abnormalities accentuate over time, leading to overt cardiometabolic conditions.

Is HbA1c in the first trimester associated with adverse outcomes among pregnant Asian Indian women without gestational diabetes?

AIMS

The aim of this study is to determine the association of elevated HbA1c in the first trimester (HbA1c-FT) with adverse events among pregnant Asian Indian women without gestational diabetes (GDM).

METHODS

This retrospective cohort study included 1618 pregnant women who delivered at a single urban tertiary care center and had HbA1c-FT estimation between January 2011 and September 2017. Those with GDM according to a 75-g OGTT after 24 gestational weeks were excluded. Multivariable logistic regression models assessed the association between elevated HbA1c-FT and adverse events.

RESULTS

At a cutoff of ≥37 mmol/mol (5.5%), HbA1c-FT was associated with preterm birth at <37 gestational weeks (adjusted odds ratio (OR) 2.10, 95% CI 1.11-3.98). There was a continuum of risk for primary caesarean delivery with higher HbA1c-FT levels (adjusted OR per 5-mmol/mol (0.5%) increase in HbA1c-FT for primary caesarean delivery: 1.27, 95% CI 1.06-1.52). In the crude analysis, gestational hypertension was associated with HbA1c-FT, but not after adjustment for confounding factors. HbA1c-FT was not associated with other adverse events (macrosomia, large for gestational age babies, or other neonatal complications).

CONCLUSIONS

Even without GDM, the results suggest an association of HbA1c-FT with preterm birth and primary caesarian delivery among Asian Indian women.

The Influence of Maternal Vitamin E Concentrations in Different Trimesters on Gestational Diabetes and Large-for-Gestational-Age: A Retrospective Study in China

Vitamin E can protect pregnant women from oxidative stress and further affect pregnancy outcomes. This study aimed to investigate maternal vitamin E concentration in each trimester and its associations with gestational diabetes (GDM) and large-for-gestational-age (LGA). The data were derived from Peking University Retrospective Birth Cohort in Tongzhou, collected from 2015 to 2018 (n = 19,647). Maternal serum vitamin E were measured from blood samples collected in each trimester. Logistic regressions were performed to analyze the association between maternal vitamin E levels and outcomes. The median levels of maternal vitamin E increased from the first (10.00 mg/L) to the third (16.00 mg/L) trimester. Among mothers who had inadequate vitamin E levels, most of them had excessive amounts. Excessive vitamin E level in the second trimester was a risk factor for GDM (aOR = 1.640, 95% CI: 1.316-2.044) and LGA (aOR = 1.334, 95% CI: 1.022-1.742). Maternal vitamin E concentrations in the first and second trimesters were positively associated with GDM (first: aOR = 1.056, 95% CI: 1.038-1.073; second: aOR = 1.062, 95% CI: 1.043-1.082) and LGA (first: aOR = 1.030, 95% CI: 1.009-1.051; second: aOR = 1.040, 95% CI: 1.017-1.064). Avoiding an excess of vitamin E during pregnancy might be an effective measure to reduce GDM and LGA. Studies to explore the potential mechanisms are warranted.