Choosing the Best Newborn Anthropometric Measure Associated With the Risks and Outcomes of Intrauterine Growth Restriction

Choosing placental hypoxic-ischemic measures that have clinical implications in child development and diseases

PURPOSE

Placental hypoxic-ischemic pathology is one of the common causes for adverse outcomes. But there is no commonly accepted evaluation system on specific morphological and histopathological measures of the placenta.

OBJECTIVE

This study aims to systematically select several core placental hypoxic-ischemic measures that have a high prognostic relevance to child health.

METHODS

We used data from the Collaborative Perinatal Project, a multicenter prospective cohort study that recruited over 55,000 pregnant women and followed their offspring to 7 years old. Women who had information on placental pathology and child outcomes were included. 57 placental measures considered to be relevant to hypoxia-ischemia were selected. Apgar score, intelligence quotient, preeclampsia, birth weight and subclinical neurology injuries were chosen as outcomes. The least absolute shrinkage and selection operator (LASSO) procedure as well as training and testing methods were used to select a more efficient and simpler placental hypoxic-ischemic measures that may have clinical implications.

RESULTS

Of the 57 measures, 7 were selected as candidates by LASSO. Based on the training and testing methods, we retained placental measures with a higher odds ratio of child morbidity. We further narrowed down to four measures that had the highest prognostic relevance. They were: short cord length (ΣOR = 8.51), calcification of cut surface (ΣOR = 8.31), opaque membranes (ΣOR = 5.26), Hofbauer cells in terminal villi (ΣOR = 4.69).

CONCLUSIONS

Our four-measure system is relatively simple and closely related to the child health. It may be used as a novel placental hypoxic-ischemic evaluation criterion, and function as the first line tool for future research.

Effects of maternal smoking on body size and proportions at birth: a register-based cohort study of 1.4 million births

OBJECTIVES

The aim of our work was to analyse the effect of maternal smoking on body size and body proportions of newborns when the mother had smoked only during the first trimester, in comparison with continued smoking after the first trimester. Furthermore, we have evaluated how growth restriction associated with maternal smoking contributes to changes in body proportions.

DESIGN

Register-based cohort study SETTING: Maternal Exposure (MATEX) cohort identified from the Finnish Medical Birth Register.

PARTICIPANTS

Singleton births without congenital anomalies and missing data (1.38 million) from 1 January 1991 to 31 December 2016.

METHODS

Logistic regression was used to quantify the effect of maternal smoking, stratified by the maternal smoking status.

OUTCOME MEASURES

Body proportions indicated by low brain-to-body ratio (defined as <10th percentile); high ponderal index and high head-to-length ratio (defined as >90th percentile); small body size for gestational age at birth (defined as weight, length or head circumference <10th percentile) and preterm birth (<37 weeks) and low birth weight (2500 g).

RESULTS

Continued smoking after the first trimester was associated with high ponderal index (OR 1.26, 95% CI 1.23 to 1.28), low brain-to-body ratio (1.11, 1.07-1.15) and high head-to-length ratio (1.22, 1.19-1.26), corresponding with absolute risks of 22%, 10% and 19%, respectively). The effects were slightly lower when smoking had been quit during the first trimester. Similar effects were seen for the body size variables and low birth weight. Preterm birth was not associated with smoking only during first trimester.

CONCLUSIONS

Maternal smoking, independent of smoking duration during pregnancy, was associated with abnormal body proportions resulting from larger reduction of length and head circumference in comparison to weight. The effects of having quit smoking during the first trimester and having continued smoking after the first trimester were similar, suggesting the importance of early pregnancy as a sensitive exposure window.

Chest circumference in full-term newborns: how can it be predicted?

Background

Although over the years a number of studies have used chest circumference (CC) as a sensitive tool to identify the health status of infants, a particularly important aspect for this population is the lack of data on normal values and prediction equations. In order to facilitate and validate the interpretation of CC data in newborn (NB), the aim was to study the relation between CC and other anthropometric variables and develop a predictive equation for CC in a population of full-term newborns.

Methods

Cross-sectional study, carried out with full-term infants. The anthropometric (CC, head circumference - HC, length, age and weight) and hemodynamic variables were evaluated during the first 24 h of life. Bivariate analysis was performed between CC and HC, weight, length and type of delivery, followed by multiple linear regression analysis, including variables that were significant in the bivariate analysis. For data analysis, we used the SPSS program, considering p < 0.05 and 95% CI.

Results

The birth weight of the 120 NB varied between 2580 and 4225 g (mean 3360 g) and the gestational age between 37 and 42 weeks (mean 39 weeks). Approximately 61% of the sample were delivered vaginally and 67 (56%) were boys. The variables that remained statistically associated with CC after multivariate analysis were weight (β 0.003, CI: 0.002: 0.003, p = 0.001) and HC (β 0.287, CI: 0.156: 0.417, p = 0.001). For the linear regression model, the predictive equation of CC was 14.87+ (0.003 x weight) + (0.287 x HC), with a prediction of 76%.

Conclusion

The results show a positive correlation between CC and weight, length and HC, and based on the linear regression model, the predictive equation for CC is based only on weight and HC.