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Guellec I, Simon L, Vayssiere C, Senat MV, Ego A, Zeitlin J, Subtil D, Verspyck E, Lapillonne A, Roze JC, Claris O, Picaud JC, Monier I, Geraldine G. Growth charts for use at birth and in the neonatal period: Recommendations of the French Neonatal Society. J Pediatr Gastroenterol Nutr 2024; 79:352-361. [PMID: 38808729 DOI: 10.1002/jpn3.12238] [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: 09/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). OBJECTIVES (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. METHODS Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. RESULTS Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. CONCLUSION The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.
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Affiliation(s)
- Isabelle Guellec
- Neonatal Intensive Care Unit, Nice University Hospital, Nice, France
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Laure Simon
- Neonatal Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Marie-Victoire Senat
- Obstetrics Department, Kremlin Bicêtre University Hospital, AP-HP, Paris, France
| | - Anne Ego
- Public Health Department, Univ. Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP Institute of Engineering Univ. Grenoble Alpes, TIMC-IMAG, Grenoble, France
| | - Jennifer Zeitlin
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Damien Subtil
- Obstetrics Department, Lille University Hospital, Lille, France
| | - Eric Verspyck
- Obstetrics Department, Rouen University Hospital, Rouen, France
| | - Alexandre Lapillonne
- Neonatal Intensive Care Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | | | - Olivier Claris
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Lyon Civil Hospices University Hospital, Lyon, France
| | - Isabelle Monier
- Université Paris Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France
| | - Gascoin Geraldine
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
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Chou FS, Yeh HW, Clark RH. A comparative study of postnatal anthropometric growth in very preterm infants and intrauterine growth. Nat Commun 2023; 14:5626. [PMID: 37726287 PMCID: PMC10509139 DOI: 10.1038/s41467-023-41069-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
Most growth references for very preterm infants were developed using measurements taken at birth, and were thought to represent intrauterine growth. However, it remains unclear whether the goal of approximating an intrauterine growth rate as stated by the American Academy of Pediatrics is attainable by very preterm infants. Using real-world measurement data from very preterm infants born between 2010 through 2020, we develop models to characterize the patterns of postnatal growth, and compare them to intrauterine growth. By assessing the weight growth rate, we show three phases of postnatal growth not evident in intrauterine growth. Furthermore, postnatal length and head circumference growth exhibit a slow rate after birth, followed by an acceleration. Collectively, postnatal and intrauterine growth are distinctly different. Although postnatal growth models do not represent optimal growth of very preterm infants, they can serve as a practical tool for clinical assessment of growth and for nutrition research.
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Affiliation(s)
- Fu-Sheng Chou
- Department of Neonatology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
- Clinician Investigator Program, Southern California Permanente Medical Group, Pasadena, CA, USA.
| | - Hung-Wen Yeh
- Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Reese H Clark
- Center for Research, Education, Quality and Safety, Pediatrix® Medical Group, Sunrise, FL, USA
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Raja EA, Bhattacharya S, Maheshwari A, McLernon DJ. A comparison of perinatal outcomes following fresh blastocyst or cleavage stage embryo transfer in singletons and twins and between singleton siblings. Hum Reprod Open 2023; 2023:hoad003. [PMID: 36909797 PMCID: PMC9995092 DOI: 10.1093/hropen/hoad003] [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: 07/14/2022] [Revised: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
STUDY QUESTION Are perinatal outcomes following fresh blastocyst versus fresh cleavage stage embryo transfer (ET) different in singletons, twins, and between singleton siblings? SUMMARY ANSWER Singleton babies conceived following fresh blastocyst, versus cleavage stage, ET are less likely to be small for gestational age (SGA) or to have a congenital anomaly (a result confirmed by comparing singleton siblings), while singletons born following fresh blastocyst ET were at a higher risk of being large for gestational age (LGA) than their sibling born following fresh cleavage stage ET. WHAT IS KNOWN ALREADY Blastocyst stage transfer is now the preferred strategy in most IVF units. Previous studies have suggested that babies conceived through blastocyst transfer are at increased risk of preterm birth and LGA. STUDY DESIGN SIZE DURATION A national population-based retrospective cohort study was performed using linked Human Fertilisation and Embryology Authority (HFEA) data on 130 516 IVF and ICSI livebirths occurring from 103 062 women between 2000 and 2017. PARTICIPANTS/MATERIALS SETTING METHODS We included women who had at least one singleton livebirth resulting from IVF/ICSI fresh embryo treatment, using their own eggs and partner's sperm. A linked HFEA dataset was analysed using a multilevel framework, which accommodated repeated IVF cycles resulting in livebirths in the same woman. A population-averaged robust Poisson model was used for binary outcomes and a multinomial logistic regression model was used for categorical outcomes. Unadjusted and adjusted risk ratios (aRRs) (95% CI) were calculated. MAIN RESULTS AND THE ROLE OF CHANCE There were 130 516 livebirths in 103 062 women, including 86 630 singletons, 43 886 twin births, and 5384 pairs of singleton siblings. In comparison with fresh cleavage stage ET, fresh blastocyst stage transfer in singletons was associated with a lower risk of low birthweight (aRR = 0.92; 95% CI 0.86, 0.99), lower risk of being SGA (0.83; 0.78, 0.89), and lower risk of congenital anomaly (0.79; 0.71, 0.89). This analysis did not show an increase in risk associated with preterm birth (1.00; 0.94, 1.06), high birthweight (0.99; 0.93, 1.06), LGA (0.99; 0.93, 1.05), and the chance of healthy singleton baby (1.00; 1.00, 1.02). Twins resulting from fresh blastocyst stage ET were at slightly higher risk of preterm birth (1.05; 1.02, 1.10) compared with twins conceived following fresh cleavage stage ET. There was insufficient evidence for an association with the other perinatal outcomes. Singleton siblings born following fresh blastocyst stage ET were at a higher risk of being LGA (1.57; 1.01, 2.46) and at lower risk of having a congenital anomaly (0.52; 0.28, 0.97) compared to their singleton siblings born following cleavage stage ET. There was some evidence of excess risk of preterm birth (1.42; 0.97, 2.23) associated with blastocyst stage transfer. However, we could not confirm an association between blastocyst stage ET and low birthweight (1.35; 0.81, 2.27), high birthweight (1.19; 0.80, 1.77), and the chance of being a healthy baby (0.97; 0.86, 1.09). LIMITATIONS REASONS FOR CAUTION This was an observational study where we were unable to adjust for some key confounders, such as maternal smoking status and BMI, which may change from one pregnancy to another and are not recorded in the HFEA dataset. WIDER IMPLICATIONS OF THE FINDINGS In the largest study of its kind, our analysis of singleton siblings, corrected for unmeasured, non-time varying maternal factors, confirms the previously reported association between blastocyst transfer and LGA babies, and shows a reduced risk of congenital anomaly following blastocyst transfer. Our sibling analysis did not confirm a decreased risk of low birthweight following blastocyst transfer. Overall, absolute risks are low and there is insufficient evidence to challenge the practice of extended culture of embryos. STUDY FUNDING/COMPETING INTERESTS This project is financed by an NHS Grampian Endowment Research Grant, project number 17/052. One of the authors, S.B., was the Editor in Chief of HROpen until 31 December 2022 and would have been in that role when the paper was first submitted. As an invited speaker, S.B. has received travel expenses, accommodation and honoraria from Merck, Organon, and Ferring. A.M. has received travel expenses, accommodation, and honoraria from Merck Serono, Cook Medical, Pharmasure, Gedeon Richter, and Ferring. D.J.M. is currently a HROpen Associate Editor. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Edwin-Amalraj Raja
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, UK
| | | | | | - David J McLernon
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, UK
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Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study. PLoS One 2022; 17:e0271952. [PMID: 35976808 PMCID: PMC9385000 DOI: 10.1371/journal.pone.0271952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.
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Raja EA, Bhattacharya S, Maheshwari A, McLernon DJ. Comparison of perinatal outcomes after frozen or fresh embryo transfer: separate analyses of singleton, twin, and sibling live births from a linked national in vitro fertilization registry. Fertil Steril 2022; 118:323-334. [PMID: 35717287 DOI: 10.1016/j.fertnstert.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether perinatal outcomes following frozen vs. fresh embryo transfer (ET) differ within singletons, within sets of twins, and between siblings. DESIGN Population-based retrospective cohort study. SETTING Academic Medical School PATIENT(S): 200,075 live births in 151,561 women who underwent in vitro fertilization with frozen or fresh ET between 1992 and 2017. MAIN OUTCOME MEASURE(S) Gestational age at birth, birthweight, congenital anomaly, and healthy baby (≥37 weeks of gestation, birthweight 2,500-4,000 g, no congenital malformations). RESULT(S) There were 200,075 live births in 151,561 women including 132,679 singletons, 33,698 sets of twins, and 5,723 pairs of singleton siblings. In singletons, frozen ET was associated with a lower risk of very preterm birth (adjusted relative risk [aRR], 0.83; 95% confidence interval [CI], 0.73, 0.94), preterm birth (aRR, 0.93; 95% CI, 0.88, 0.97), low birthweight (<2,500 g) (aRR, 0.72; 95% CI, 0.68, 0.77), small for gestational age (aRR, 0.66; 95% CI, 0.62, 0.70) and congenital anomaly (aRR, 0.85; 95% CI, 0.78, 0.94), but higher risk of high birthweight (>4,000 g) (aRR, 1.64; 95% CI, 1.58, 1.72) and large for gestational age (aRR, 1.62; 95% CI, 1.55, 1.70) in comparison with fresh ET. In twins, frozen ET was associated with lower risk of very preterm birth (aRR, 0.84; 95% CI, 0.73, 0.97), and low birthweight (aRR, 0.72; 95% CI, 0.68, 0.77), but with a higher chance of a healthy baby (aRR, 1.11; 95% CI, 1.06, 1.16) compared to fresh ET. Singletons conceived following frozen ET had a lower risk of low birthweight (aRR, 0.56; 95% CI, 0.44, 0.74) and being small for gestational age (aRR, 0.54; 95% CI, 0.42, 0.68) than a singleton sibling born after a fresh ET. Frozen ET also was associated with higher risk of high birthweight (aRR, 1.85; 95% CI, 1.54, 2.24) and being large for gestational age (aRR, 1.81; 95% CI, 1.50, 2.20), and also were less likely to be preterm (aRR, 0.81; 95% CI, 0.67, 0.99). CONCLUSION(S) Our key finding is that singletons born following a frozen ET are less likely to be small for gestational age than a singleton sibling born following fresh ET but are more likely to be large for gestational age.
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Affiliation(s)
- Edwin-Amalraj Raja
- Institute of Applied Health Sciences, Polwarth Building, University of Aberdeen, Aberdeen, United Kingdom.
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Aberdeen, United Kingdom
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Shakya A, Bhatta NK, Singh RR, Yadav SP, Thakur J. Gestational age specific anthropometric postnatal percentile charts for neonates born at tertiary hospital in Eastern Nepal. BMC Pediatr 2022; 22:94. [PMID: 35168593 PMCID: PMC8845386 DOI: 10.1186/s12887-022-03157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Birth weight, Head circumference (HC), and Length are important clinical indicators for evaluation of prenatal growth and identification of neonates requiring detail assessment and monitoring. Gestational age-specific percentile charts are essential tool for both obstetricians and pediatricians in their day to day practice. This study aimed to develop gestational age specific percentile chart of Birth weight, Length and HC for neonates. METHODS In this Cross sectional observational study, HC, Birth weight and Length of live singleton neonates from 28 to 42 weeks of gestation fulfilling the inclusion criteria were measured over a period of one year. Mean, standard deviation, and percentiles values for different gestational age were calculated. Graphs were constructed using two way graph and Lowess smoothening method. RESULTS Of total 2662 neonates, male: female ratio was 1.3:1 with maximum neonates in 40 weeks of gestation. The mean Birth weight, HC and Length was 2852.02 gm, 33.6 and 48.42 cm respectively. Overall males have more mean weight than females by 46.35gms. However, mean HC of male and female were similar 33.6 and 33.61 cm respectively and on average males were 0.27 cm longer compared to female. The mean Birth weight, HC and Length at 40 weeks was 3123.43gm (± 427.82), 34.249 cm (± 0.87) and 49.61 cm(± 1.85) respectively. The 10th, 50th and 90th percentile at 40 weeks for Birth weight being 2550gm, 3100gm and 3750gm respectively. The gestational age specific percentile chart and growth curve are appropriately placed in the manuscript. CONCLUSIONS The percentile charts in this study may be used as reference for local population and similar data from various parts of the nation can provide a national reference curve for healthy neonates.
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Affiliation(s)
- Anjum Shakya
- Department of Pediatrics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nisha Keshary Bhatta
- Department of Pediatrics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan, Nepal
| | - Rupa Rajbhandari Singh
- Department of Pediatrics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan, Nepal
| | - Shankar Prasad Yadav
- Department of Pediatrics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal. .,Department of Pediatrics and Adolescent Medicine, BPKIHS, Dharan, Nepal.
| | - Jitendra Thakur
- Department of Pediatrics, B.P.Koirala Institute of Health Sciences, Dharan, Nepal
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Wu Q, Zhang HY, Zhang L, Xu YQ, Sun J, Gao NN, Qiao XY, Li Y. A New Birthweight Reference by Gestational Age: A Population Study Based on the Generalized Additive Model for Location, Scale, and Shape Method. Front Pediatr 2022; 10:810203. [PMID: 35386253 PMCID: PMC8978627 DOI: 10.3389/fped.2022.810203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND It is important to choose a suitable birthweight reference to assess newborns, especially those that are small for gestational age (SGA). Currently, there is no regional standard reference for the north of China or for Shandong province. METHODS A total of 130,911 data records of singleton, live neonates born at 24-42 weeks of gestation were collected from 2016 to 2018 in Shandong province. A new birthweight-for-gestational age percentile reference was constructed based on the Generalized Additive Model for Location, Scale and Shape (GAMLSS) package in R version 3.5. The established gestational age weight curve was compared separately with the Fenton curve, INTERGROWTH-21st curve, and the Chinese Neonatal Network Standard curve of 2015. RESULTS We established the reference values of birthweight by gestational age at the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles. Newborns had much heavier birthweights than those in the INTERGROWTH-21st and Fenton curves at most gestational ages. Although the newborns' birthweight references were closer to the Chinese Neonatal Network Standard except a few for gestational age, this study and INTERGROWTH-21st had similar birthweight curve shapes. CONCLUSIONS There are obvious differences among the criteria for newborn birthweights. Therefore, it is more accurate to assess newborns using the local birthweight reference.
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Affiliation(s)
- Qiong Wu
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Hui-Yun Zhang
- Department of Pediatrics, Shandong Maternal and Child Health Hospital, Jinan, China
| | - Li Zhang
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Yue-Qin Xu
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Jin Sun
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Nan-Nan Gao
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Xiu-Yun Qiao
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
| | - Yan Li
- Department of Pediatrics, Child Health Care Center, The First Affiliated Hospital of Shandong, First Medical University, Jinan, China
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Duke RP, Bai S, Bornhorst JA, ElHassan NO, Kaiser JR. Different glucose analyzers report different glucose concentration values in term newborns. Front Pediatr 2022; 10:933508. [PMID: 36210937 PMCID: PMC9532546 DOI: 10.3389/fped.2022.933508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The American Academy of Pediatrics and Pediatric Endocrine Society neonatal hypoglycemia guidelines based their glucose concentration treatment thresholds on studies that predominantly used Beckman and Yellow Springs Glucose Oxidase Analyzers. Currently, a majority (76%) of U.S. hospital laboratories utilizing glucose oxidase methodology use Vitros® Glucose Analyzers. However, a bias of ~+5% between glucose concentrations from Beckman vs. Vitros Glucose Analyzers has been reported; this could have a clinically significant effect when using published guideline treatment thresholds. METHODS To determine if there is similar instrument bias between Beckman and Vitros Analyzers in reported glucose concentrations from term newborns, we compared plasma glucose concentrations measured within the first 3 h after birth by Beckman vs. Vitros Analyzers in a total of 1,987 newborns (Beckman n = 904, Vitros n = 1,083). Data were fit using nonlinear cubic spline models between collection time and glucose concentration. RESULTS The non-linear patterns of initial glucose concentrations (during the first 3 h after birth) as measured by Beckman and Vitros Analyzers paralleled each other with no overlap of the fit spline curve 95% confidence intervals, with an approximate +5 mg/dL constant bias. Additionally, in method comparison studies performed in the Chemistry Laboratory on adult samples, there was a +4.2-7.4 mg/dL measured glucose bias for the Beckman vs. Vitros Analyzer. CONCLUSION Glucose concentrations from term, appropriate size for gestational age newborns were about 5 mg/dL higher when measured by Beckman vs. Vitros Analyzers. Perhaps, concentrations of 45 mg/dL reported from Beckman Analyzers may be equivalent to 40 mg/dL from Vitros Analyzers. When managing neonatal hypoglycemia, it is important to know which analyzer was used and whether adjusting for potential instrument bias is necessary when following published guidelines.
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Affiliation(s)
- Rina P Duke
- Department of Pediatrics (Neonatology), Lehigh Valley Reilly Children's Hospital, Allentown, PA, United States
| | - Shasha Bai
- Pediatrics Biostatistics Core, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Joshua A Bornhorst
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Nahed O ElHassan
- Department of Pediatrics (Neonatal-Perinatal Medicine), University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jeffrey R Kaiser
- Departments of Pediatrics (Neonatal-Perinatal Medicine) and Obstetrics and Gynecology, Penn State Children's Hospital, Hershey, PA, United States
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Prakash A, Venkatesh S, Sadagopan S, Palanisamy S. Regional Gestational Age and Gender-Specific Birth Weight Reference Charts and its Comparison with Existing National and International Standards: A Cross-Sectional Study. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1740464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Growth potential is influenced by race, ethnicity, and environmental factors and assessment of growth using standardized charts is important for quality improvement initiatives in health care delivery and public health interventions of any nation.
Objective This article aims to develop regional gestational age and gender-specific reference for birth weight and to compare it with published literature.
Methodology This study was conducted in a teaching hospital in Puducherry, India and included 2,507 singleton babies. Babies with major congenital anomalies, maternal chronic illness, and nonavailability of first trimester dating scan were excluded. Detailed anthropometric measurement was done for these babies by single investigator as per established norms, their gestation- and sex-specific mean weight and weight percentiles were calculated and compared with existing data.
Results Both 10th and 90th percentiles were lower across all gestational ages compared with existing international standards. The proportion of late preterm and term small for gestational age (SGA) babies was 23% using Fenton-2013 reference chart, 14% using Intergrowth-21 chart, and 10% using the current study data (p < 0.0001). The proportion of large for gestational age (LGA) babies was 8.5%, using study data. Mean birth weight of male and female term babies born to primiparae were significantly higher compared with multiparae (p = 0.03 and 0.02, respectively).
Conclusion Indian babies may be overdiagnosed as SGA or underdiagnosed as LGA based on existing western standards in which our patient population is underrepresented. There is a need for gestational age-, gender-, and parity-specific regional growth charts for better characterization of anthropometric measures of Indian babies.
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Affiliation(s)
- Ajay Prakash
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
| | - Soma Venkatesh
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
| | - Srinivasan Sadagopan
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
| | - Soundararajan Palanisamy
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India
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Fetal Sex Does Not Impact Placental Blood Flow or Placental Amino Acid Transfer in Late Gestation Pregnant Sheep With or Without Placental Insufficiency. Reprod Sci 2021; 29:1776-1789. [PMID: 34611848 DOI: 10.1007/s43032-021-00750-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Pregnant sheep have been used to model complications of human pregnancies including placental insufficiency and intrauterine growth restriction. Some of the hallmarks of placental insufficiency are slower uterine and umbilical blood flow rates, impaired placental transport of oxygen and amino acids, and lower fetal arterial concentrations of anabolic growth factors. An impact of fetal sex on these outcomes has not been identified in either human or sheep pregnancies. This is likely because most studies measuring these outcomes have used small numbers of subjects or animals. We undertook a secondary analysis of previously published data generated by our laboratory in late-gestation (gestational age of 133 ± 0 days gestational age) control sheep (n = 29 male fetuses; n = 26 female fetuses; n = 3 sex not recorded) and sheep exposed to elevated ambient temperatures to cause experimental placental insufficiency (n = 23 male fetuses; n = 17 female fetuses; n = 1 sex not recorded). The primary goal was to determine how fetal sex modifies the effect of the experimental insult on outcomes related to placental blood flow, amino acid and oxygen transport, and fetal hormones. Of the 112 outcomes measured, we only found an interaction between fetal sex and experimental insult for the uterine uptake rates of isoleucine, phenylalanine, and arginine. Additionally, most outcomes measured did not show a difference based on fetal sex when adjusting for the impact of placental insufficiency. Exceptions included fetal norepinephrine and cortisol concentrations, which were higher in female compared to male fetuses. For the parameters measured in the current analysis, the impact of fetal sex was not widespread.
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11
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Howard DM, Pain O, Arathimos R, Barbu MC, Amador C, Walker RM, Jermy B, Adams MJ, Deary IJ, Porteous D, Campbell A, Sullivan PF, Evans KL, Arseneault L, Wray NR, Meaney M, McIntosh AM, Lewis CM. Methylome-wide association study of early life stressors and adult mental health. Hum Mol Genet 2021; 31:651-664. [PMID: 34523677 PMCID: PMC8863421 DOI: 10.1093/hmg/ddab274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022] Open
Abstract
The environment and events that we are exposed to in utero, during birth and in early childhood influence our future physical and mental health. The underlying mechanisms that lead to these outcomes are unclear, but long-term changes in epigenetic marks, such as DNA methylation, could act as a mediating factor or biomarker. DNA methylation data were assayed at 713 522 CpG sites from 9537 participants of the Generation Scotland: Scottish Family Health Study, a family-based cohort with extensive genetic, medical, family history and lifestyle information. Methylome-wide association studies of eight early life environment phenotypes and two adult mental health phenotypes (major depressive disorder and brief resilience scale) were conducted using DNA methylation data collected from adult whole blood samples. Two genes involved with different developmental pathways (PRICKLE2, Prickle Planar Cell Polarity Protein 2 and ABI1, Abl-Interactor-1) were annotated to CpG sites associated with preterm birth (P < 1.27 × 10−9). A further two genes important to the development of sensory pathways (SOBP, Sine Oculis Binding Protein Homolog and RPGRIP1, Retinitis Pigmentosa GTPase Regulator Interacting Protein) were annotated to sites associated with low birth weight (P < 4.35 × 10−8). The examination of methylation profile scores and genes and gene-sets annotated from associated CpGs sites found no evidence of overlap between the early life environment and mental health conditions. Birth date was associated with a significant difference in estimated lymphocyte and neutrophil counts. Previous studies have shown that early life environments influence the risk of developing mental health disorders later in life; however, this study found no evidence that this is mediated by stable changes to the methylome detectable in peripheral blood.
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Affiliation(s)
- David M Howard
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Oliver Pain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ryan Arathimos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Miruna C Barbu
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Carmen Amador
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Rosie M Walker
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.,Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh, UK
| | - Bradley Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - David Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.,Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Genetics, University of North Carolina, Chapel Hill, NC, USA.,Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Kathryn L Evans
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Louise Arseneault
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Naomi R Wray
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Meaney
- Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada.,Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Montréal, QC, Canada.,Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK.,Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
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12
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Alterman N, Johnson S, Carson C, Petrou S, Rivero-Arias O, Kurinczuk JJ, Macfarlane A, Boyle E, Quigley MA. Gestational age at birth and child special educational needs: a UK representative birth cohort study. Arch Dis Child 2021; 106:842-848. [PMID: 33483377 PMCID: PMC7613205 DOI: 10.1136/archdischild-2020-320213] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/09/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age. METHODS The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000-2002. Information about the child's birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders. RESULTS The sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37-38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons. CONCLUSION Children born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.
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Affiliation(s)
- Neora Alterman
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Elaine Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Bartho LA, O'Callaghan JL, Fisher JJ, Cuffe JSM, Kaitu'u-Lino TJ, Hannan NJ, Clifton VL, Perkins AV. Analysis of mitochondrial regulatory transcripts in publicly available datasets with validation in placentae from pre-term, post-term and fetal growth restriction pregnancies. Placenta 2021; 112:162-171. [PMID: 34364121 DOI: 10.1016/j.placenta.2021.07.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The human placenta has a defined lifespan and placental aging is a key feature as pregnancy progresses. Placental aging and mitochondrial dysfunction are known to play a key role in pregnancy pathophysiology. Premature aging of the placenta has also been linked with placental dysfunction resulting in poor fetal development and premature birth. METHODS The expression of key mitochondrial-related genes were analysed in a series of publicly available databases then expression changes were validated in placental samples collected from term, pre-term, post-term pregnancies and pregnancies complicated by fetal growth restriction (FGR). Gene and protein expression levels of MFN1, MFN2, TFAM, TOMM20, OPA3 and SIRT4 were measured in placental tissues via qPCR and western blotting. RESULTS Initial analysis found that key mitochondrial transcripts related to biogenesis, bioenergetics and mitophagy clustered by pregnancy trimester. A refined list of 13 mitochondrial-related genes were investigated in additional external datasets of pregnancy complications. In the new cohort, protein expression of MFN1 was decreased in FGR and MFN2 is decreased in post-term placenta. Analysis of placental tissues revealed that TOMM20 gene and protein expression was altered in FGR and post-term placenta. DISCUSSION MFN1 and MFN2 play a major role in mitochondrial dynamics, and alterations in these markers have been highlighted in early unexplained miscarriage. TOMM20 is an importer protein that plays a major role in mitophagy and changes have also been identified in age-related diseases. Significant changes in MFN1, MFN2 and TOMM20 indicate that mitochondrial regulators play a critical role in placental aging and placental pathophysiology.
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Affiliation(s)
- Lucy A Bartho
- School of Pharmacy and Medical Science, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Jessica L O'Callaghan
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - Joshua J Fisher
- Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - James S M Cuffe
- School of Biomedical Sciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Tu'uhevaha J Kaitu'u-Lino
- Translational Obstetrics Group, Dept of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Natalie J Hannan
- Translational Obstetrics Group, Dept of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Vicki L Clifton
- Pregnancy and Development Group, Mater Research, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - Anthony V Perkins
- School of Pharmacy and Medical Science, Griffith University, Gold Coast Campus, Southport, Queensland, Australia.
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15
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Castillo CM, Horne G, Fitzgerald CT, Johnstone ED, Brison DR, Roberts SA. The impact of IVF on birthweight from 1991 to 2015: a cross-sectional study. Hum Reprod 2020; 34:920-931. [PMID: 30868153 DOI: 10.1093/humrep/dez025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/14/2018] [Accepted: 02/14/2019] [Indexed: 12/15/2022] Open
Abstract
STUDY QUESTION Has birthweight (BW) changed over time among IVF-conceived singletons? SUMMARY ANSWER Singleton BW has increased markedly over the past 25 years. WHAT IS KNOWN ALREADY IVF conceived singletons have had a higher incidence of low BW compared to spontaneously conceived singletons, and this has raised concerns over long-term increased risks of cardio-metabolic disease. However, few causal links between IVF procedures and BW have been robustly established, and few studies have examined whether BW has changed over time as IVF techniques have developed. STUDY DESIGN, SIZE, DURATION A total of 2780 live born singletons conceived via IVF or ICSI treated in the reproductive medicine department of a single publicly funded tertiary care centre between 1991 and 2015 were included in this retrospective study. The primary outcome measure was singleton BW adjusted for gestational age, maternal parity and child gender. Multivariable linear regression models were used to estimate the associations between patient prognostic factors and IVF treatment procedures with adjusted BW. PARTICIPANTS/MATERIALS, SETTING, METHODS All singletons conceived at the centre following IVF/ICSI using the mother's own oocytes, and non-donated fresh or frozen/thawed embryos with complete electronic data records, were investigated. Available electronic records were retrieved from the Human Fertilization and Embryology Authority for dataset collation. Multiple linear regression analysis was used to evaluate associations between IVF treatment parameters and BW, after adjusting for the year of treatment and patient characteristics and pregnancy factors. MAIN RESULTS AND THE ROLE OF CHANCE In the primary multivariable model, singleton BW increased by 7.4 g per year (95% CI: 3.2-11.6 g, P = 0.001), an increase of close to 180 g throughout the 25-year period after accounting for gestational age, maternal parity, child gender, IVF treatment parameters, patient prognostic characteristics and pregnancy factors. Fresh and frozen embryo transfer-conceived singletons showed a similar increase in BW. Frozen/thawed embryo transfer conceived singletons were on average 53 g heavier than their fresh embryo conceived counterparts (95% CI: 3.7-103.3 g, P = 0.035). LIMITATIONS, REASONS FOR CAUTION The independent variables included in the study were limited to those that have been consistently recorded and stored electronically over the past two decades. WIDER IMPLICATIONS OF THE FINDINGS There has been a progressive BW increase in IVF singletons over time in one large centre with consistent treatment eligibility criteria. Such a change is not seen in the general population of live born singletons in the UK or other developed countries, and seems to be specific to this IVF population. This may be a reflection of changes in practice such as undisturbed extended embryo culture to the blastocyst stage, optimized commercial culture media composition, single embryo transfer and ICSI. Moreover, singletons conceived from frozen/thawed embryos had higher birth weights when compared to their fresh embryo transfer counterparts. The causal pathway is unknown; however, it could be due to the impact on embryos of the freeze/thaw process, self-selection of embryos from couples who produce a surplus of embryos, and/or embryo replacement into a more receptive maternal environment. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the EU FP7 project grant, EpiHealthNet (FP7-PEOPLE-2012-ITN-317146). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Catherine M Castillo
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK.,Maternal & Fetal Health Research Centre, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK
| | - Gregory Horne
- Department of Reproductive Medicine, Old St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK
| | - Cheryl T Fitzgerald
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK.,Department of Reproductive Medicine, Old St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK
| | - Edward D Johnstone
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK.,Maternal & Fetal Health Research Centre, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK
| | - Daniel R Brison
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK.,Maternal & Fetal Health Research Centre, St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK.,Department of Reproductive Medicine, Old St. Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Oxford Rd., Manchester, UK
| | - Stephen A Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Rd., Manchester, UK
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Hardelid P, Verfuerden M, McMenamin J, Smyth RL, Gilbert R. The contribution of child, family and health service factors to respiratory syncytial virus (RSV) hospital admissions in the first 3 years of life: birth cohort study in Scotland, 2009 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 30621817 PMCID: PMC6325667 DOI: 10.2807/1560-7917.es.2019.24.1.1800046] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Several vaccines for respiratory syncytial virus (RSV) are under development. Designing an effective vaccination programme for RSV requires information about the relative contribution of risk factors for severe RSV symptoms. Aim To inform preventive strategies in Europe by quantifying the contribution of key child, family and health service risk factors to the burden of RSV hospital admissions in young children. Methods We constructed a birth cohort study of all singleton children born in Scotland between October 2009 and September 2012 using linkage between birth registration, maternity, vaccination and hospital admission records, with follow-up until the age of 3 years. RSV-confirmed hospital admissions were defined using linkage to national laboratory surveillance data. We estimated hospital admission rates per 1,000 child years and length of stay according to each risk factor. Cox proportional hazard regression models were used to estimate adjusted hazard ratios. Results There were 5,185 RSV admissions among the 169,726 children in the cohort: 48.6% of admissions occurred before the age of 6 months, and 29.6% after the age of 1 year. Children born prematurely, small for gestational age, between July and December, with chronic conditions, older siblings, mothers < 30 years old or delayed infant vaccination had a significantly increased risk of admission. Minimising the risk posed by older siblings could reduce RSV admissions by up to 34%. Conclusion Future RSV vaccination programmes must protect children throughout early childhood. Vaccination and/or interventions to reduce transmission by older siblings could substantially reduce RSV hospital admissions.
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Affiliation(s)
- Pia Hardelid
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | - Rosalind L Smyth
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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17
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A new customised placental weight standard redefines the relationship between maternal obesity and extremes of placental size and is more closely associated with pregnancy complications than an existing population standard. J Dev Orig Health Dis 2019; 11:350-359. [PMID: 31587680 DOI: 10.1017/s2040174419000576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Placental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37-43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%-129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.
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18
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Mackin ST, Nelson SM, Wild SH, Colhoun HM, Wood R, Lindsay RS. Factors associated with stillbirth in women with diabetes. Diabetologia 2019; 62:1938-1947. [PMID: 31353418 PMCID: PMC6731193 DOI: 10.1007/s00125-019-4943-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/20/2019] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS Stillbirth risk is increased in pregnancy complicated by diabetes. Fear of stillbirth has major influence on obstetric management, particularly timing of delivery. We analysed population-level data from Scotland to describe timing of stillbirths in women with diabetes and associated risk factors. METHODS A retrospective cohort of singleton deliveries to mothers with type 1 (n = 3778) and type 2 diabetes (n = 1614) from 1 April 1998 to 30 June 2016 was analysed using linked routine care datasets. Maternal and fetal characteristics, HbA1c data and delivery timing were compared between stillborn and liveborn groups. RESULTS Stillbirth rates were 16.1 (95% CI 12.4, 20.8) and 22.9 (95% CI 16.4, 31.8) per 1000 births in women with type 1 (n = 61) and type 2 diabetes (n = 37), respectively. In women with type 1 diabetes, higher HbA1c before pregnancy (OR 1.03 [95% CI 1.01, 1.04]; p = 0.0003) and in later pregnancy (OR 1.06 [95% CI 1.04, 1.08]; p < 0.0001) were associated with stillbirth, while in women with type 2 diabetes, higher maternal BMI (OR 1.07 [95% CI 1.01, 1.14]; p = 0.02) and pre-pregnancy HbA1c (OR 1.02 [95% CI 1.00, 1.04]; p = 0.016) were associated with stillbirth. Risk was highest in infants with birthweights <10th centile (sixfold higher born to women with type 1 diabetes [n = 5 stillbirths, 67 livebirths]; threefold higher for women with type 2 diabetes [n = 4 stillbirths, 78 livebirths]) compared with those in the 10th-90th centile (n = 20 stillbirths, 1685 livebirths). Risk was twofold higher in infants with birthweights >95th centile born to women with type 2 diabetes (n = 15 stillbirths, 402 livebirths). A high proportion of stillborn infants were male among mothers with type 2 diabetes (81.1% vs 50.5% livebirths, p = 0.0002). A third of stillbirths occurred at term, with highest rates in the 38th week (7.0 [95% CI 3.7, 12.9] per 1000 ongoing pregnancies) among mothers with type 1 diabetes and in the 39th week (9.3 [95% CI 2.4, 29.2]) for type 2 diabetes. CONCLUSIONS/INTERPRETATION Maternal blood glucose levels and BMI are important modifiable risk factors for stillbirth in diabetes. Babies at extremes of weight centiles are at most risk. Many stillbirths occur at term and could potentially be prevented by change in routine care and delivery policies.
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Affiliation(s)
- Sharon T Mackin
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | | | - Sarah H Wild
- Usher Institute of Population Health Science and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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Fitzpatrick KE, Kurinczuk JJ, Bhattacharya S, Quigley MA. Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLoS Med 2019; 16:e1002913. [PMID: 31550245 PMCID: PMC6759152 DOI: 10.1371/journal.pmed.1002913] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Policy consensus in high-income countries supports offering pregnant women with previous cesarean section a choice between planning an elective repeat cesarean section (ERCS) or attempting a vaginal birth, known as a planned vaginal birth after previous cesarean (VBAC), provided they do not have contraindications to planned VBAC. However, robust comprehensive information on the associated outcomes to counsel eligible women about this choice is lacking. This study investigated the short-term maternal and perinatal outcomes associated with planned mode of delivery after previous cesarean section among women delivering a term singleton and considered eligible to have a planned VBAC. METHODS AND FINDINGS A population-based cohort of 74,043 term singleton births in Scotland between 2002 and 2015 to women with one or more previous cesarean sections was conducted using linked Scottish national datasets. Logistic or modified Poisson regression, as appropriate, was used to estimate the effect of planned mode of delivery on maternal and perinatal outcomes adjusted for sociodemographic, maternal medical, and obstetric-related characteristics. A total of 45,579 women gave birth by ERCS, and 28,464 had a planned VBAC, 28.4% of whom went on to have an in-labor nonelective repeat cesarean section. Compared to women delivering by ERCS, those who had a planned VBAC were significantly more likely to have uterine rupture (0.24%, n = 69 versus 0.04%, n = 17, adjusted odds ratio [aOR] 7.3, 95% confidence interval [CI] 3.9-13.9, p < 0.001), a blood transfusion (1.14%, n = 324 versus 0.50%, n = 226, aOR 2.3, 95% CI 1.9-2.8, p < 0.001), puerperal sepsis (0.27%, n = 76 versus 0.17%, n = 78, aOR 1.8, 95% CI 1.3-2.7, p = 0.002), and surgical injury (0.17% versus 0.09%, n = 40, aOR 3.0, 95% CI 1.8-4.8, p < 0.001) and experience adverse perinatal outcomes including perinatal death, admission to a neonatal unit, resuscitation requiring drugs and/or intubation, and an Apgar score < 7 at 5 minutes (7.99%, n = 2,049 versus 6.37%, n = 2,570, aOR 1.6, 95% CI 1.5-1.7, p < 0.001). However, women who had a planned VBAC were more likely than those delivering by ERCS to breastfeed at birth or hospital discharge (63.6%, n = 14,906 versus 54.5%, n = 21,403, adjusted risk ratio [aRR] 1.2, 95% CI 1.1-1.2, p < 0.001) and were more likely to breastfeed at 6-8 weeks postpartum (43.6%, n = 10,496 versus 34.5%, n = 13,556, aRR 1.2, 95% CI 1.2-1.3, p < 0.001). The effect of planned mode of delivery on the mother's risk of having a postnatal stay greater than 5 days, an overnight readmission to hospital within 42 days of birth, and other puerperal infection varied according to whether she had any prior vaginal deliveries and, in the case of length of postnatal stay, also varied according to the number of prior cesarean sections. The study is mainly limited by the potential for residual confounding and misclassification bias. CONCLUSIONS Among women considered eligible to have a planned VBAC, planned VBAC compared to ERCS is associated with an increased risk of the mother having serious birth-related maternal and perinatal complications. Conversely, planned VBAC is associated with an increased likelihood of breastfeeding, whereas the effect on other maternal outcomes differs according to whether a woman has any prior vaginal deliveries and the number of prior cesarean sections she has had. However, the absolute risk of adverse outcomes is small for either delivery approach. This information can be used to counsel and manage the increasing number of women with previous cesarean section, but more research is needed on longer-term outcomes.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sohinee Bhattacharya
- The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Lun MX, Gui C, Zhang L, Shang N, Xiao YW, Lv LJ, Huang HL. Application of the LMS method of constructing fetal reference charts: comparison with the original method. J Matern Fetal Neonatal Med 2019; 34:395-402. [PMID: 31039657 DOI: 10.1080/14767058.2019.1608942] [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: 10/26/2022]
Abstract
Objectives: In view of the concern expressed about the current references, new references for fetal biparietal diameter and head circumference should be constructed for contemporary local populations.Methods: We conducted a retrospective cross-sectional study in two hospitals in Guangdong, Southern China. Fetal biparietal diameter and head circumference percentiles regression were fitted using Cole's LMS method. The BPD and HC data were then transformed into Z-scores that were calculated using two series of reference equations obtained from two methods: Cole's LMS method and the original "mean and SD method." Each Z-score distribution was presented as the mean and standard deviation. Finally, the sensitivity and specificity of each reference for identifying fetuses <2.5th or >97.5th percentile (based on the observed distribution of Z-scores) were calculated. The misclassified number and Youden's index were listed.Results: A total of 17,974 biparietal diameter and 18,269 head circumference measurements were chosen to establish a reference chart. The LMS method could fit the local population better than the "mean and SD method" as it had a lower number of misclassified fetuses and a higher Youden's index.Conclusion: The Cole's LMS method was able to construct a satisfied reference range of fetal head sizes in Southern China.
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Affiliation(s)
- Miao-Xu Lun
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Cheng Gui
- Department of The Medical Record, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Liang Zhang
- Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Ning Shang
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Yi-Wei Xiao
- Department of Ultrasound, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Li-Juan Lv
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, PR China
| | - Han-Lin Huang
- Guangdong Women and Children Hospital, Guangzhou, PR China
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Hardelid P, Verfuerden M, McMenamin J, Smyth RL, Gilbert R. The contribution of child, family and health service factors to respiratory syncytial virus (RSV) hospital admissions in the first 3 years of life: birth cohort study in Scotland, 2009 to 2015. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2019. [PMID: 30621817 DOI: 10.2807/1560‐7917.es.2019.24.1.1800046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IntroductionSeveral vaccines for respiratory syncytial virus (RSV) are under development. Designing an effective vaccination programme for RSV requires information about the relative contribution of risk factors for severe RSV symptoms.AimTo inform preventive strategies in Europe by quantifying the contribution of key child, family and health service risk factors to the burden of RSV hospital admissions in young children.MethodsWe constructed a birth cohort study of all singleton children born in Scotland between October 2009 and September 2012 using linkage between birth registration, maternity, vaccination and hospital admission records, with follow-up until the age of 3 years. RSV-confirmed hospital admissions were defined using linkage to national laboratory surveillance data. We estimated hospital admission rates per 1,000 child years and length of stay according to each risk factor. Cox proportional hazard regression models were used to estimate adjusted hazard ratios.ResultsThere were 5,185 RSV admissions among the 169,726 children in the cohort: 48.6% of admissions occurred before the age of 6 months, and 29.6% after the age of 1 year. Children born prematurely, small for gestational age, between July and December, with chronic conditions, older siblings, mothers < 30 years old or delayed infant vaccination had a significantly increased risk of admission. Minimising the risk posed by older siblings could reduce RSV admissions by up to 34%.ConclusionFuture RSV vaccination programmes must protect children throughout early childhood. Vaccination and/or interventions to reduce transmission by older siblings could substantially reduce RSV hospital admissions.
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Affiliation(s)
- Pia Hardelid
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | - Rosalind L Smyth
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Yao F, Miao H, Li B, Wu Y, Zhao Q. New birthweight percentiles by sex and gestational age in Southern China and its comparison with the INTERGROWTH-21st Standard. Sci Rep 2018; 8:7567. [PMID: 29765081 PMCID: PMC5954150 DOI: 10.1038/s41598-018-25744-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/23/2018] [Indexed: 11/09/2022] Open
Abstract
We first showed the sex- and gestational age (week)-specific birthweight distributions from primiparous and multiparous mothers. Birthweight percentiles were created by using the Lambda Mu Sigma (LMS) method. We established the birthweight percentiles in Southern China and provide clinicians and researchers with up-to-date population norms of birthweight percentiles. Then we use the data from Birth Certificate System between Jan 1st, 2017 and Oct 31st, 2017, which included 1,245,364 live births to calculate SGA and LGA ratio by these three birthweight references- the new INTERGROWTH-21st standard, China’s 2015 research standard and our birthweight percentiles. The overall prevalence of SGA estimated by our standards, the China’s 2015 research standards and INTERGROWTH-21st standards, were 10.21%, 12.93% and 7.98%, respectively, whereas the overall prevalence of LGA was 9.88%, 4.48% and 8.37%, respectively.
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Affiliation(s)
- Fei Yao
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, Guangdong, China
| | - Huazhang Miao
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, Guangdong, China
| | - Bing Li
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, Guangdong, China
| | - Yuntao Wu
- Department of Healthcare, Guangdong Women and Children Hospital, No. 521 Xingnan Road, Guangzhou, 511442, Guangdong, China
| | - Qingguo Zhao
- Epidemiological Research Office of Key Laboratory of Male Reproduction and Genetics (National Health and Family Planning Commission), Family Planning Research Institute of Guangdong Province, No. 17 Meidong Road, Guangzhou, 510600, Guangdong, China.
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Mackin ST, Nelson SM, Kerssens JJ, Wood R, Wild S, Colhoun HM, Leese GP, Philip S, Lindsay RS. Diabetes and pregnancy: national trends over a 15 year period. Diabetologia 2018; 61:1081-1088. [PMID: 29322220 PMCID: PMC6448996 DOI: 10.1007/s00125-017-4529-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/13/2017] [Indexed: 10/31/2022]
Abstract
AIMS/HYPOTHESIS We aimed to examine time trends in national perinatal outcomes in pregnancies complicated by pre-existing type 1 or type 2 diabetes. METHODS We analysed episode-level data on all obstetric inpatient delivery events (live or stillbirth) between 1 April 1998 and 31 March 2013 (n = 813,921) using the Scottish Morbidity Record (SMR02). Pregnancies to mothers with type 1 (n = 3229) and type 2 (n = 1452) diabetes were identified from the national diabetes database (Scottish Care Information-Diabetes), and perinatal outcomes were compared among women with type 1 diabetes, type 2 diabetes and those without diabetes. RESULTS The number of pregnancies complicated by diabetes increased significantly, by 44% in type 1 diabetes and 90% in type 2 diabetes, across the 15 years examined, to rates of 1 in 210 and 1 in 504 deliveries, respectively. Compared with women without diabetes, delivery occurred 2.6 weeks earlier (type 1 diabetes 36.7 ± 2.3 weeks) and 2 weeks earlier (type 2 diabetes 37.3 ± 2.4 weeks), respectively, showing significant reductions for both type 1 (from 36.7 weeks to 36.4 weeks, p = 0.03) and type 2 (from 38.0 weeks to 37.2 weeks, p < 0.001) diabetes across the time period. The proportions of preterm delivery were markedly increased in women with diabetes (35.3% type 1 diabetes, 21.8% type 2 diabetes, 6.1% without diabetes; p < 0.0001), and these proportions increased with time for both groups (p < 0.005). Proportions of elective Caesarean sections (29.4% type 1 diabetes, 30.5% type 2 diabetes, 9.6% without diabetes) and emergency Caesarean sections (38.3% type 1 diabetes, 29.1% type 2 diabetes, 14.6% without diabetes) were greatly increased in women with diabetes and increased over time except for stable rates of emergency Caesarean section in type 1 diabetes. Gestational age-, sex- and parity-adjusted z score for birthweight (1.33 ± 1.34; p < 0.001) were higher in type 1 diabetes and increased over time from 1.22 to 1.47 (p < 0.001). Birthweight was also increased in type 2 diabetes (0.94 ± 1.34; p < 0.001) but did not alter with time. There were 65 perinatal deaths in offspring of mothers with type 1 diabetes and 39 to mothers with type 2 diabetes, representing perinatal mortality rates of 20.1 (95% CI 14.7, 24.3) and 26.9 (16.7, 32.9) per 1000 births, respectively, and rates 3.1 and 4.2 times, respectively, those observed in the non-diabetic population (p < 0.001). Stillbirth rates in type 1 and type 2 diabetes were 4.0-fold and 5.1-fold that in the non-diabetic population (p < 0.001). Perinatal mortality and stillbirth rates showed no significant fall over time despite small falls in the rates for the non-diabetic population. CONCLUSIONS/INTERPRETATION Women with diabetes are receiving increased intervention in pregnancy (earlier delivery, increased Caesarean section rates), but despite this, higher birthweights are being recorded. Improvements in rates of stillbirth seen in the general population are not being reflected in changes in stillbirth or perinatal mortality in our population with diabetes.
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Affiliation(s)
- Sharon T Mackin
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | | | | | | | | | - Helen M Colhoun
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graham P Leese
- Department of Diabetes, Ninewells Hospital and Medical School, Dundee, UK
| | - Sam Philip
- Department of Diabetes, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
- Glasgow Royal Infirmary, Glasgow, UK.
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Landau-Crangle E, Rochow N, Fenton TR, Liu K, Ali A, So HY, Fusch G, Marrin ML, Fusch C. Individualized Postnatal Growth Trajectories for Preterm Infants. JPEN J Parenter Enteral Nutr 2018; 42:1084-1092. [PMID: 29419902 DOI: 10.1002/jpen.1138] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/27/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Growth of preterm infants is monitored using fetal charts despite individual trajectories being downshifted postnatally by adaptational processes. The study aims to compare different approaches to create individualized postnatal trajectories. METHODS Three approaches to achieve growth similar to healthy term infants at 42+0/7 weeks postmenstrual age (PMA) on World Health Organization growth standards (WHOGS) (target weight) were tested by comparing trajectories obtained by: 1) following birth percentiles (Birth-Weight-Percentile Approach); 2) following percentiles achieved at day of life 21 (Postnatal-Percentile Approach); 3) using day-specific fetal median growth velocities starting at day of life 21 (Fetal-Median-Growth Approach [FMGA]). The primary outcome was delta weight (ΔW), defined as difference between target weight (WHOGS) at 42+0/7 weeks and weight predicted by trajectories. The secondary outcome was ΔW vs %fat mass in a cohort of 20 disease-free surviving very low-birth-weight infants. RESULTS Birth-Weight-Percentile and Postnatal-Percentile Approach showed high ΔW; FMGA alone reduced ΔW. Introducing a factor to FMGA to reflect the transition to extrauterine conditions (Growth-Velocity Approach [GVA]) minimized ΔW. GVA merged with target and best normalized for body composition related to ΔW. CONCLUSIONS GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.
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Affiliation(s)
| | - Niels Rochow
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tanis R Fenton
- Alberta Children's Hospital Research Institute, Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kai Liu
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Anaam Ali
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Hon Yiu So
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Michael L Marrin
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Christoph Fusch
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Germany
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Adams J, van der Waal Z, Rushton S, Rankin J. Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods. BMJ Open 2018; 8:e017697. [PMID: 29391362 PMCID: PMC5829653 DOI: 10.1136/bmjopen-2017-017697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To determine whether introduction or withdrawal of a maternal financial incentive was associated with changes in timing of first attendance for antenatal care ('booking'), or incidence of small for gestational age. DESIGN A natural experimental evaluation using interrupted time series analysis. SETTING A hospital-based maternity unit in the north of England. PARTICIPANTS 34 589 women (and their live-born babies) who delivered at the study hospital and completed the 25th week of pregnancy in the 75 months before (January 2003 to March 2009), 21 months during (April 2009 to December 2010) and 36 months after (January 2011 to December 2013) the incentive was available. INTERVENTION The Health in Pregnancy Grant was a financial incentive of £190 ($235; €211) payable to pregnant women in the UK from the 25th week of pregnancy, contingent on them receiving routine antenatal care. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mean gestational age at booking. Secondary outcomes were proportion of women booking by 10, 18 and 25 weeks' gestation; and proportion of babies that were small for gestational age. RESULTS By 21 months after introduction of the grant (ie, immediately prior to withdrawal), compared with what was predicted given prior trends, there was an reduction in mean gestational age at booking of 4.8 days (95% CI 2.3 to 8.2). The comparable figure for 24 months after withdrawal was an increase of 14.0 days (95% CI 2.8 to 16.8). No changes in incidence of small for gestational age babies were seen. CONCLUSIONS The introduction of a universal financial incentive for timely attendance at antenatal care was associated with a reduction in mean gestational age at first attendance, but not the proportion of babies that were small for gestational age. Future research should explore the effects of incentives offered at different times in pregnancy and of differing values; and how stakeholders view such incentives.
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Affiliation(s)
- Jean Adams
- MRC Epidemiology Unit, Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | | | - Steven Rushton
- School of Biology, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Kaiser JR, Bai S, Rozance PJ. Newborn Plasma Glucose Concentration Nadirs by Gestational-Age Group. Neonatology 2018; 113:353-359. [PMID: 29510404 DOI: 10.1159/000487222] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The glucose concentrations and times to nadir for newborns of all gestational ages when intrapartum glucose-containing solutions are not routinely provided are unknown. OBJECTIVE To characterize and compare patterns of initial glucose concentration nadirs by gestational-age groups. METHODS A cross-sectional cohort study of 1,366 newborns born in 1998 at the University of Arkansas for Medical Sciences, appropriate for gestational age, nonasphyxiated, nonpolycythemic, and not infants of diabetic mothers, were included. Initial plasma glucose concentrations, before intravenous fluids or feedings, were plotted against time after birth for 4 gestational-age groups (full term [FT], ≥37-42 weeks; late preterm [LPT], ≥34 and < 37 weeks; preterm [PT], ≥28 and < 34 weeks; and extremely low gestational age newborns [ELGAN], 23 and < 28 weeks of gestation). RESULTS ELGAN had the earliest nadir at 61 ± 4 min, followed by PT newborns (71 ± 2 min), and then LPT and FT newborns at 92-93 min. The time to nadir for ELGAN and PT newborns was significantly earlier than for FT newborns. Glucose nadir concentrations for ELGAN, PT, and LPT newborns were significantly lower than for FT newborns. LPT newborns' pattern of glucose paralleled those of FT newborns, with values approximately 5-6 mg/dL lower during the first 3 h. CONCLUSION Plasma glucose nadirs occurred at different times among gestational-age groups during the early postnatal period as follows: ELGAN < PT < LPT ≈ FT. In order to potentially prevent low glucose concentrations at the time of the nadir, exogenous glucose should be provided to all newborns as soon as possible after birth.
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Affiliation(s)
- Jeffrey R Kaiser
- Departments of Pediatrics (Neonatal-Perinatal Medicine) and Obstetrics and Gynecology, Penn State Health Children's Hospital, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Shasha Bai
- Biostatistics, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Paul J Rozance
- Department of Pediatrics, Colorado School of Medicine, Aurora, Colorado, USA
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Abduljalil K, Johnson TN, Rostami-Hodjegan A. Fetal Physiologically-Based Pharmacokinetic Models: Systems Information on Fetal Biometry and Gross Composition. Clin Pharmacokinet 2017; 57:1149-1171. [DOI: 10.1007/s40262-017-0618-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Smith RB, Fecht D, Gulliver J, Beevers SD, Dajnak D, Blangiardo M, Ghosh RE, Hansell AL, Kelly FJ, Anderson HR, Toledano MB. Impact of London's road traffic air and noise pollution on birth weight: retrospective population based cohort study. BMJ 2017; 359:j5299. [PMID: 29208602 PMCID: PMC5712860 DOI: 10.1136/bmj.j5299] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To investigate the relation between exposure to both air and noise pollution from road traffic and birth weight outcomes.Design Retrospective population based cohort study.Setting Greater London and surrounding counties up to the M25 motorway (2317 km2), UK, from 2006 to 2010.Participants 540 365 singleton term live births.Main outcome measures Term low birth weight (LBW), small for gestational age (SGA) at term, and term birth weight.Results Average air pollutant exposures across pregnancy were 41 μg/m3 nitrogen dioxide (NO2), 73 μg/m3 nitrogen oxides (NOx), 14 μg/m3 particulate matter with aerodynamic diameter <2.5 μm (PM2.5), 23 μg/m3 particulate matter with aerodynamic diameter <10 μm (PM10), and 32 μg/m3 ozone (O3). Average daytime (LAeq,16hr) and night-time (Lnight) road traffic A-weighted noise levels were 58 dB and 53 dB respectively. Interquartile range increases in NO2, NOx, PM2.5, PM10, and source specific PM2.5 from traffic exhaust (PM2.5 traffic exhaust) and traffic non-exhaust (brake or tyre wear and resuspension) (PM2.5 traffic non-exhaust) were associated with 2% to 6% increased odds of term LBW, and 1% to 3% increased odds of term SGA. Air pollutant associations were robust to adjustment for road traffic noise. Trends of decreasing birth weight across increasing road traffic noise categories were observed, but were strongly attenuated when adjusted for primary traffic related air pollutants. Only PM2.5 traffic exhaust and PM2.5 were consistently associated with increased risk of term LBW after adjustment for each of the other air pollutants. It was estimated that 3% of term LBW cases in London are directly attributable to residential exposure to PM2.5>13.8 μg/m3during pregnancy.Conclusions The findings suggest that air pollution from road traffic in London is adversely affecting fetal growth. The results suggest little evidence for an independent exposure-response effect of traffic related noise on birth weight outcomes.
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Affiliation(s)
- Rachel B Smith
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
- NIHR HPRU in Health Impact of Environmental Hazards, King's College London, London, UK
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Sean D Beevers
- MRC-PHE Centre for Environment and Health, Environmental Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - David Dajnak
- MRC-PHE Centre for Environment and Health, Environmental Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Marta Blangiardo
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
| | - Rebecca E Ghosh
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Anna L Hansell
- NIHR HPRU in Health Impact of Environmental Hazards, King's College London, London, UK
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Frank J Kelly
- NIHR HPRU in Health Impact of Environmental Hazards, King's College London, London, UK
- MRC-PHE Centre for Environment and Health, Environmental Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - H Ross Anderson
- MRC-PHE Centre for Environment and Health, Environmental Research Group, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mireille B Toledano
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK
- NIHR HPRU in Health Impact of Environmental Hazards, King's College London, London, UK
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Socioeconomic disadvantage, fetal environment and child development: linked Scottish administrative records based study. Int J Equity Health 2017; 16:203. [PMID: 29166913 PMCID: PMC5700527 DOI: 10.1186/s12939-017-0698-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/08/2017] [Indexed: 12/27/2022] Open
Abstract
Background Cognitive development in childhood is negatively affected by socioeconomic disadvantage. This study examined whether differences in fetal environment might mediate the association between family socioeconomic position and child development. Methods Data were linked from the Scottish Longitudinal Study, maternity inpatient records and the Child Health Surveillance Programme – Pre School for 32,238 children. The outcome variables were based on health visitor assessment of gross motor, hearing and language, vision and fine motor, and social development. Socioeconomic position was measured using parental social class and highest qualification attained. Random-effects logistic regression models were estimated to account for multiple reviews and familial clustering. Mediation analysis was conducted using the Karlson-Holm-Breen method. Results Hearing and language, vision and fine motor, and social development were associated with lower parental social class and lower parental educational qualifications after adjustment for fetal environment. Fetal environment partially mediated the estimated effect of having parents without educational qualifications for hearing and language (β = 0·15; 95% confidence interval (CI) = 0·07, 0·23), vision and fine motor (β = 0·19; CI = 0·10, 0·28) and social development (β = 0·14; CI = 0·03 to 0·25). Conclusions Socioeconomic position predicted hearing and language, vision and fine motor, and social development but not gross motor development. For children of parents without educational qualifications, fetal environment appears to contribute to a part of the socioeconomic gradient in child development abnormalities but post-natal environment appears to still explain the majority of the gradient and for other children most of it. Electronic supplementary material The online version of this article (10.1186/s12939-017-0698-4) contains supplementary material, which is available to authorized users.
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Leyland AH, Ouédraogo S, Nam J, Bond L, Briggs AH, Gray R, Wood R, Dundas R. Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background
Pregnancy and the period around birth are critical for the development and improvement of population health as well as the health of mothers and babies, with outcomes such as birthweight influencing adult health.
Objectives
We evaluated the clinical effectiveness and cost-effectiveness of the Health in Pregnancy (HiP) grants in Scotland, looking for differential outcomes when the scheme was in place, as well as before its implementation and after its withdrawal.
Design
The HiP grants were evaluated as a natural experiment using interrupted time series analysis. We had comparison groups of women who delivered before the grants were introduced and after the grants were withdrawn.
Setting
Scotland, UK.
Participants
A total of 525,400 singleton births delivered between 24 and 44 weeks in hospitals across Scotland between 1 January 2004 and 31 December 2014.
Intervention
The HiP grant was a universal, unconditional cash transfer of £190 for women in Great Britain and Northern Ireland reaching 25 weeks of pregnancy if they had sought health advice from a doctor or midwife. The grant was introduced for women with a due date on or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on or after 1 January 2011. The programme was paid for by Her Majesty’s Treasury.
Main outcome measures
Our primary outcome measure was birthweight. Secondary outcome measures included maternal behaviour, measures of size, measures of stage and birth outcomes.
Data sources
The data came from the Scottish maternity and neonatal database held by the Information and Services Division at the NHS National Services Scotland.
Results
There was no statistically significant effect on birthweight, with births during the intervention period being, on average, 2.3 g [95% confidence interval (CI) –1.9 to 6.6 g] lighter than would have been expected had the pre-intervention trend continued. Mean gestational age at booking (i.e. the first antenatal appointment with a health-care professional) decreased by 0.35 weeks (95% CI 0.29 to 0.41 weeks) and the odds of booking before 25 weeks increased by 10% [odds ratio (OR) 1.10, 95% CI 1.02 to 1.18] during the intervention but decreased again post intervention (OR 0.91, 95% CI 0.83 to 1.00). The odds of neonatal death increased by 84% (OR 1.84, 95% CI 1.22 to 2.78) and the odds of having an emergency caesarean section increased by 7% (OR 1.07, 95% CI 1.03 to 1.10) during the intervention period.
Conclusions
The decrease in the odds of booking before 25 weeks following withdrawal of the intervention makes it likely that the HiP grants influenced maternal health-care-seeking behaviour. It is unclear why neonatal mortality and emergency caesarean section rates increased, but plausible explanations include the effects of the swine flu outbreak in 2009 and the global financial crisis. The study is limited by its non-randomised design. Future research could assess an eligibility threshold for payment earlier than the 25th week of pregnancy.
Funding
The National Institute for Health Research Public Health Research programme. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
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Affiliation(s)
- Alastair H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Samiratou Ouédraogo
- University of Montréal Hospital Research Centre, University of Montréal, Montréal, QC, Canada
| | | | - Lyndal Bond
- College of Health and Biomedicine, Victoria Hospital, Melbourne, VIC, Australia
| | | | - Ron Gray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rachael Wood
- Information Service Division, NHS National Services Scotland, Edinburgh, UK
| | - Ruth Dundas
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Denison FC, MacGregor H, Stirrat LI, Stevenson K, Norman JE, Reynolds RM. Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective case-note analysis. BMJ Open 2017; 7:e015218. [PMID: 28637644 PMCID: PMC5730005 DOI: 10.1136/bmjopen-2016-015218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine whether attendance at a specialised multidisciplinary antenatal clinic for women with class III obesity (BMI >40 kg/m2) is associated with improved clinical outcomes compared with standard antenatal care. DESIGN Retrospective cohort study using routinely collected data from electronic patient record. SETTING Community and hospital based antenatal care. PARTICIPANTS Women with a singleton pregnancy with class III obesity booked for antenatal care and delivered in one of two hospitals in NHS Lothian, Scotland, UK between 2008 and 2014. Maternal and offspring outcomes were compared in women who attended a specialised obesity clinic (n=511) compared with standard antenatal care (n=502). MAIN OUTCOME MEASURES Included stillbirth, low birth weight, gestational diabetes, induction of labour and caesarean section. RESULTS Compared with standard care, women receiving specialist care were less likely to have a stillbirth (OR 0.12, 95% CI 0.06 to 0.97) and a low birthweight baby (OR 0.57, 95% CI 0.33 to 0.99) and more likely to be screened for (100% vs 73.6%; p<0.001) and diagnosed with (26.0% vs 12.5%; p<0.001) gestational diabetes, to require induction of labour (38.4% vs 29.9%; p=0.009), an elective (20.3% vs 17.7%; p<0.001) and emergency (23.9% vs 20.3%; p<0.001) caesarean section and attend antenatal triage one or more times during pregnancy (77.7% vs 53.1%; p<0.001). Women attending the specialist clinic had a higher BMI (44.5 kg/m2 (4.3) vs 43.2 kg/m2 (3.1); p<0.001) and were more likely to be nulliparous (46.0% vs 24.9%; p<0.001). There were no other differences in maternal demographic or maternal and offspring outcomes between groups. CONCLUSIONS Attendance at a specialised antenatal clinic for obesity is associated with reduced rates of stillbirth and low birth weight and improved detection of gestational diabetes. The improvement in clinical outcomes is associated with an increase in healthcare attendance to obstetric triage and clinical interventions including induction of labour and caesarean section.
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Affiliation(s)
- Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Heather MacGregor
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Laura I Stirrat
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Kerrie Stevenson
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- British Heart Foundation Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK
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Wallace JM, Bhattacharya S, Horgan GW. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. PLoS One 2017. [PMID: 28628636 PMCID: PMC5476268 DOI: 10.1371/journal.pone.0179589] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance. METHODS Direction, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression. RESULTS More women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk. CONCLUSION Half the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.
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Affiliation(s)
- Jacqueline M. Wallace
- Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- * E-mail:
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Graham W. Horgan
- Biomathematics & Statistics Scotland, Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Lee JY, Ahn S, Lee JR, Jee BC, Kim CH, Seo S, Suh CS, Kim SH. Reference Values for the Revised Anti-Müllerian Hormone Generation II Assay: Infertile Population-based Study. J Korean Med Sci 2017; 32:825-829. [PMID: 28378557 PMCID: PMC5383616 DOI: 10.3346/jkms.2017.32.5.825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
Anti-Müllerian hormone (AMH) is now accepted as an important clinical marker of ovarian reserve and is increasingly measured as an initial evaluation at infertility clinics. The aim of this study was to establish reference values for the revised second generation (Gen II) assay using population-based data. In this population-based cohort study, AMH data from unselected infertile women aged 25-45 years from June 2013 to June 2014 (n = 15,801) were collected. The AMH values were measured using the revised Gen II assay. We established and validated 5 AMH-age regression models. Based on the optimal AMH-age model, reference values and centile charts were obtained. The quadratic model (log AMH = 0.410 × age -0.008 × age² -3.791) was the most appropriate for describing the age-dependent decrease in AMH measured using the revised Gen II assay. This is the largest population-based study to establish age-specific reference values of AMH using the revised Gen II assay. These reference values may provide more specific information regarding the ovarian reserve estimation of infertile women.
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Affiliation(s)
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | - Soyeon Seo
- Samkwang Medical Laboratories, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Elia EG, Robb AO, Hemming K, Price MJ, Riley RD, French-Constant A, Denison FC, Kilby MD, Morris RK, Stock SJ. Is the first urinary albumin/creatinine ratio (ACR) in women with suspected preeclampsia a prognostic factor for maternal and neonatal adverse outcome? A retrospective cohort study. Acta Obstet Gynecol Scand 2017; 96:580-588. [PMID: 28247485 PMCID: PMC5413808 DOI: 10.1111/aogs.13123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/08/2017] [Indexed: 12/23/2022]
Abstract
Introduction The aim of this study was to determine the prognostic value of the first urinary albumin/creatinine ratio (ACR) for adverse maternal and neonatal outcomes and how it relates to other prognostic factors. Material and methods We performed a retrospective cohort study from December 2009 to February 2012 with analysis of demographic, clinical and biochemical data from two obstetric day assessment units in hospitals in Southeast Scotland. We included 717 pregnant women, with singleton pregnancies after 20 weeks’ gestation, referred for evaluation of suspected preeclampsia and having their first ACR performed. The ability of ACR to predict future outcomes was assessed in both univariable and multivariable logistic regression models. The latter assessed its prognostic value independent of (adjusting for) existing prognostic factors. Primary outcome measures were maternal and neonatal composite adverse outcomes, and a secondary outcome was gestation at delivery. Results In all, 204 women (28.5%) experienced a composite adverse maternal outcome and 146 women (20.4%) experienced a composite adverse neonatal outcome. Multivariate analysis of log‐transformed ACR demonstrated that a 1‐unit increase in log ACR is associated with an increased odds of adverse maternal [odds ratio 1.60, 95% confidence interval (CI) 1.45–1.80] and adverse neonatal (odds ratio 1.15, 95% CI 1.02–1.29) composite outcomes, and with reduced gestational age at delivery (coefficient: −0.46, 95% CI −0.54 to −0.38). Conclusions ACR is an independent prognostic factor for maternal and neonatal adverse outcomes in suspected preeclampsia. ACR may be useful to inform risk predictions within a prognostic model.
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Affiliation(s)
- Eleni G Elia
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Amy O Robb
- The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karla Hemming
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Malcolm J Price
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Richard D Riley
- Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Anna French-Constant
- The Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Fiona C Denison
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK
| | - Mark D Kilby
- Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel K Morris
- Birmingham Centre for Women's & Newborn's Health, Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sarah J Stock
- Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh Queen's Medical Research Institute, Edinburgh, UK.,School of Women's and Infant's Health, University of Western Australia, The University of Western Australia at King Edward Memorial Hospital, Crawley, WA, Australia
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Gestational age and chronic 'body-mind' health problems in childhood: dose-response association and risk factors. Eur Child Adolesc Psychiatry 2017; 26:57-65. [PMID: 27246900 DOI: 10.1007/s00787-016-0872-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Understanding the developmental course of all health issues associated with preterm birth is important from an individual, clinical and public health point-of-view. Both the number of preterm births and proportion of survivors have increased steadily in recent years. The UK Millennium Cohort Study (n = 18,818) was used to examine the association of gestational age with maternal ratings of general health and behavior problems at ages 5 and 11 years using binary and multinomial logistic regression analyses. The association between mothers' ratings of general health and behavior problems was relatively weak at each time point. Children rated as being in poor general health remained constant over time (4.0 % at age 5, 3.8 % at age 11), but children rated as having behavioral problems increased by almost 100 % (5.6 % at 5; 10.5 % at 11). A gradient of increasing risk with decreasing gestational age was observed for a composite health measure (general health problems and/or behavior problems) at age 5, amplified at age 11 and was strongest for those with chronic problems (poor health at both age 5 and age 11). This association was found to be compounded by child sex, maternal characteristics at birth (education, employment, marital status) and duration of breast feeding. Integrated support to at-risk families initiated during, or soon after pregnancy, may prevent chronic problems and might potentially reduce long term health costs for both the individual and health services.
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Fitzpatrick A, Carter J, Quigley MA. Association of Gestational Age With Verbal Ability and Spatial Working Memory at Age 11. Pediatrics 2016; 138:peds.2016-0578. [PMID: 27940669 DOI: 10.1542/peds.2016-0578] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although children born very preterm (gestation <32 weeks) have an increased risk of cognitive impairment compared with full-term children (39-41 weeks), the risk for children born moderately (32-33 weeks) to late preterm (34-36 weeks) and early term (37-38 weeks) is unclear. This study describes the relationship between gestational age and cognitive outcomes at 11 years and the trajectory of deficits in verbal ability from age 3 to 11 years. METHODS Cognitive ability was assessed by using the Spatial Working Memory test from the Cambridge Neuropsychological Test Automated Working Battery (n = 11 395) and British Ability Scale Verbal Similarities test (n = 11 889) in the UK Millennium Cohort Study. Each gestational group was compared with the full-term group by using differences in z scores and odds ratios for delay (scoring ≥1 SD below the mean). RESULTS Very and moderately preterm children demonstrated significantly lower working memory scores compared with full-term children (adjusted difference -0.2 to -0.6) and were more likely to be delayed. There was no significant relationship between late-preterm or early-term birth and working memory (adjusted differences < -0.1), or between gestational age and verbal ability at 11 years. There appears to be a general attenuation in odds ratios as the child ages. CONCLUSIONS Very preterm children exhibited working memory deficits at 11 years. However, the absence of delayed verbal skills at 11 years despite earlier delays could indicate "catch-up" effects.
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Affiliation(s)
- Alyssa Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jennifer Carter
- Clinical Trial Service Unit and Epidemiological Studies Unit, and
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Differences in uterine artery blood flow and fetal growth between the early and late onset of pregnancy-induced hypertension. J Med Ultrason (2001) 2016; 43:509-17. [DOI: 10.1007/s10396-016-0729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Dilli D, Ozkan E, Ozkan MB, Aydin B, Özyazici A, Fettah N, Zenciroğlu A, Okumuş N. Umbilical cord asymmetric dimethylarginine levels and ultrasound assessment of carotid arteries in neonates born small for gestational age. J Matern Fetal Neonatal Med 2016; 30:492-496. [PMID: 27072784 DOI: 10.1080/14767058.2016.1176136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND To examine asymmetric dimethylarginine (ADMA) level as an endothelial function parameter in addition to ultrasonographic evaluation of carotid arteries in babies born small for gestational age (SGA). METHODS Twenty-six neonates born SGA and 34 appropriate for gestational age (AGA) controls were included in the study. The serum levels of ADMA were measured. Intima-media thickness (cIMT) and resistive index (cRI) of the both carotid arteries were determined by ultrasonography. RESULTS The mean ADMA level was higher in SGA neonates compared to AGAs (16 267.7 ± 6050 versus 12 810.2 ± 3302 ng/L; p = 0.01). The mean cIMT (0.34 ± 0.02 versus 0.31 ± 0.03 mm; p = 0.001) and cRI (0.66 ± 0.07 versus 0.61 ± 0.04, p = 0.003) were also higher in SGAs. Serum ADMA levels were positively correlated to the mean cIMT (r = 0.41, p = 0.001). Although there was a weak correlation between cIMT and mean cRI (r = 0.26, p = 0.04), no correlation was found between ADMA and mean cRI (r = 0.17, p = 0.18). CONCLUSIONS Neonates born SGA have elevated cord blood ADMA level in addition to thicker IMT and higher RI of carotid arteries at birth. ADMA was correlated to cIMT, suggesting that higher ADMA levels might influence vascular health in later life in these neonates.
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Affiliation(s)
- Dilek Dilli
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Elif Ozkan
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Mehmet Burak Ozkan
- b Department of Radiology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
| | - Banu Aydin
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Ahmet Özyazici
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Nurdan Fettah
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Ayşegül Zenciroğlu
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
| | - Nurullah Okumuş
- a Department of Neonatology , Dr Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey and
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Wallace JM, Bhattacharya S, Campbell DM, Horgan GW. Inter-Pregnancy Weight Change and the Risk of Recurrent Pregnancy Complications. PLoS One 2016; 11:e0154812. [PMID: 27145132 PMCID: PMC4856284 DOI: 10.1371/journal.pone.0154812] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
Women with specific adverse pregnancy outcomes in their first pregnancy may be receptive to inter-pregnancy weight management guidance aimed at preventing these complications reoccurring in subsequent pregnancies. Thus the association between inter-pregnancy weight change and the risk of recurrent pregnancy complications at the second pregnancy was investigated in a retrospective cohort study of 24,520 women with their first-ever and second consecutive deliveries in Aberdeen using logistic regression. Compared with women who were weight stable, weight loss (>2BMI units) between pregnancies was associated with an increased risk of recurrent small for gestational age (SGA) birth and elective Cesarean-section, and was protective against recurrent pre-eclampsia, placental oversize and large for gestational age (LGA) birth. Conversely weight gain (>2BMI units) between pregnancies increased the risk of recurrent gestational hypertension, placental oversize and LGA birth and was protective against recurrent low placental weight and SGA birth. The relationships between weight gain, and placental and birth weight extremes were evident only in women with a healthy weight at first pregnancy (BMI<25units), while that between weight gain and the increased risk of recurrent gestational hypertension was largely independent of first pregnancy BMI. No relationship was detected between inter-pregnancy weight change and the risk of recurrent spontaneous preterm delivery, labour induction, instrumental delivery, emergency Cesarean-section or postpartum hemorrhage. Therefor inter-pregnancy weight change impacts the risk of recurrent hypertensive disorders, SGA and LGA birth and women with a prior history of these specific conditions may benefit from targeted nutritional advice to either lose or gain weight after their first pregnancy.
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Affiliation(s)
- Jacqueline M. Wallace
- Lifelong Health Division, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- * E-mail:
| | - Sohinee Bhattacharya
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Doris M. Campbell
- Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom
| | - Graham W. Horgan
- Biomathematics & Statistics Scotland, Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Cronin FM, Segurado R, McAuliffe FM, Kelleher CC, Tremblay RE. Gestational Age at Birth and 'Body-Mind' Health at 5 Years of Age: A Population Based Cohort Study. PLoS One 2016; 11:e0151222. [PMID: 26975048 PMCID: PMC4790848 DOI: 10.1371/journal.pone.0151222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/23/2016] [Indexed: 11/18/2022] Open
Abstract
Numerous studies have identified the effects of prematurity on the neonate’s physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000–2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children’s general health and severity of behavior problems. The association between parent’s general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32–36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%–6.2%), compared to 1% (0.2–2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.
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Affiliation(s)
- Frances M. Cronin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Ricardo Segurado
- UCD CSTAR, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M. McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Cecily C. Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Richard E. Tremblay
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Departments of Pediatrics and Psychology, University of Montreal, Montreal, Canada
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Giuliani F, Cheikh Ismail L, Bertino E, Bhutta ZA, Ohuma EO, Rovelli I, Conde-Agudelo A, Villar J, Kennedy SH. Monitoring postnatal growth of preterm infants: present and future. Am J Clin Nutr 2016; 103:635S-47S. [PMID: 26791186 PMCID: PMC6443302 DOI: 10.3945/ajcn.114.106310] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants. OBJECTIVE We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality. DESIGN A systematic review of observational longitudinal studies, having as their primary objective the creation of postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included studies were computed. RESULTS Sixty-one studies met the inclusion criteria. Twenty-seven (44.3%) of the 61 studies scored ≥50%, of which 10 scored >60% and only 1 scored >66%. The median (range, IQR) quality score for the 61 included studies was 47% (26-75%, 34-56%). The scores for the domains study design, statistical methods, and reporting methods were 44% (19-67%, 33-52%), 25% (0-88%, 13-38%), and 33% (0-100%, 0-33%), respectively. The most common shortcomings were observed in items related to anthropometric measures (the main variable of interest), gestational age estimation, follow-up duration, reporting of postnatal care and morbidities, assessment of outliers, covariates, and chart presentation. CONCLUSIONS The overall methodologic quality of existing longitudinal studies was fair to low. To overcome these problems, the Preterm Postnatal Follow-up Study, 1 of the 3 main components of The International Fetal and Newborn Growth Consortium for the 21st Century Project, was designed to construct preterm postnatal growth standards from a prospective cohort of "healthy" pregnancies and preterm newborns without evidence of fetal growth restriction.
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Affiliation(s)
- Francesca Giuliani
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Leila Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Enrico Bertino
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology, and Centre for Statistics in Medicine, University of Oxford Botnar Research Centre, Oxford, United Kingdom
| | - Ilaria Rovelli
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; National Institutes of Health/Department of Health and Human Services, Detroit, MI
| | - José Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom;
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Gibson KS, Waters TP, Gunzler DD, Catalano PM. A retrospective cohort study of factors relating to the longitudinal change in birth weight. BMC Pregnancy Childbirth 2015; 15:344. [PMID: 26693917 PMCID: PMC4687143 DOI: 10.1186/s12884-015-0777-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/04/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Recent reports have shown a decrease in birth weight, a change from prior steady increases. Therefore we sought to describe the demographic and anthropometric changes in singleton term fetal growth. METHODS This was a retrospective cohort analysis of term singleton deliveries (37-42 weeks) from January 1, 1995 to January 1, 2010 at a single tertiary obstetric unit. We included all 43,217 neonates from term, singleton, non-anomalous pregnancies. Data were grouped into five 3-year intervals. Mean and median birth weight (BW), birth length (BL), and Ponderal Index (PI) were estimated by year, race and gestational age. Our primary outcome was change in BW over time. The secondary outcomes were changes in BL and PI over time. RESULTS Mean and median BW decreased by 72 and 70 g respectively (p < 0.0001) over the 15 year period while BL also significantly decreased by 1.0 cm (P < 0.001). This contributed to an increase in the neonatal PI by 0.11 kg/m(3) (P < 0.001). Mean gestational age at delivery decreased while maternal BMI at delivery, hypertension, diabetes, and African American race increased. Adjusting for gestational age, race, infant sex, maternal BMI, smoking, diabetes, hypertension, and parity, year of birth contributed 0.1 % to the variance (-1.7 g/year; 26 g) of BW, 1.8% (-0.06 cm/year; 0.9 cm) of BL, and 0.7% (+0.008 kg/m(3)/year; 0.12 kg/m(3)) of PI. These findings were independent of the proportional change in race or gestational age. CONCLUSIONS We observed a crude decrease in mean BW of 72 g and BL of 1 cm over 15 years. Furthermore, once controlling for gestational age, race, infant sex, maternal BMI, smoking, diabetes, hypertension, and parity, we identified that increasing year of birth was associated with a decrease in BW of 1.7 g/year. The significant increase in PI, despite the decrease in BW emphasizes the limitation of using birth weight alone to define changes in fetal growth.
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Affiliation(s)
- Kelly S Gibson
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
| | - Thaddeus P Waters
- Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL, 60153, USA.
| | - Douglas D Gunzler
- Center for Health Care Research & Policy, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
| | - Patrick M Catalano
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA.
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Forbes S, Barr SM, Reynolds RM, Semple S, Gray C, Andrew R, Denison FC, Walker BR, Norman JE. Convergence in insulin resistance between very severely obese and lean women at the end of pregnancy. Diabetologia 2015; 58:2615-26. [PMID: 26248646 PMCID: PMC4589551 DOI: 10.1007/s00125-015-3708-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
AIMS Disrupted intermediary metabolism may contribute to the adverse pregnancy outcomes in women with very severe obesity. Our aim was to study metabolism in such pregnancies. METHODS We recruited a longitudinal cohort of very severely obese (n = 190) and lean (n = 118) glucose-tolerant women for anthropometric and metabolic measurements at early, mid and late gestation and postpartum. In case-control studies of very severely obese and lean women we measured glucose and glycerol turnover during low- and high-dose hyperinsulinaemic-euglycaemic clamps (HEC) at early and late pregnancy and in non-pregnant women (each n = 6-9) and body fat distribution by MRI in late pregnancy (n = 10/group). RESULTS Although greater glucose, insulin, NEFA and insulin resistance (HOMA-IR), and greater weight and % fat mass (FM) was observed in very severely obese vs lean participants, the degree of worsening was attenuated in the very severely obese individuals with advancing gestation, with no difference in triacylglycerol (TG) concentrations between very severely obese and lean women at term. Enhanced glycerol production was observed in early pregnancy only in very severely obese individuals, with similar intrahepatic FM in very severely obese vs lean women by late gestation. Offspring from obese mothers were heavier (p = 0.04). CONCLUSIONS/INTERPRETATION Pregnancies complicated by obesity demonstrate attenuation in weight gain and insulin resistance compared with pregnancies in lean women. Increased glycerol production is confined to obese women in early pregnancy and obese and lean individuals have similar intrahepatic FM by term. When targeting maternal metabolism to treat adverse pregnancy outcomes, therapeutic intervention may be most effective applied early in pregnancy.
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Affiliation(s)
- Shareen Forbes
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Sarah M Barr
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Scott Semple
- Clinical Research Imaging Centre, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Ruth Andrew
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Fiona C Denison
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Brian R Walker
- Endocrinology Unit, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Jane E Norman
- Tommy's Centre for Fetal and Maternal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
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Chiswick C, Reynolds RM, Denison F, Drake AJ, Forbes S, Newby DE, Walker BR, Quenby S, Wray S, Weeks A, Lashen H, Rodriguez A, Murray G, Whyte S, Norman JE. Effect of metformin on maternal and fetal outcomes in obese pregnant women (EMPOWaR): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2015; 3:778-86. [PMID: 26165398 PMCID: PMC4673088 DOI: 10.1016/s2213-8587(15)00219-3] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Maternal obesity is associated with increased birthweight, and obesity and premature mortality in adult offspring. The mechanism by which maternal obesity leads to these outcomes is not well understood, but maternal hyperglycaemia and insulin resistance are both implicated. We aimed to establish whether the insulin sensitising drug metformin improves maternal and fetal outcomes in obese pregnant women without diabetes. METHODS We did this randomised, double-blind, placebo-controlled trial in antenatal clinics at 15 National Health Service hospitals in the UK. Pregnant women (aged ≥16 years) between 12 and 16 weeks' gestation who had a BMI of 30 kg/m(2) or more and normal glucose tolerance were randomly assigned (1:1), via a web-based computer-generated block randomisation procedure (block size of two to four), to receive oral metformin 500 mg (increasing to a maximum of 2500 mg) or matched placebo daily from between 12 and 16 weeks' gestation until delivery of the baby. Randomisation was stratified by study site and BMI band (30-39 vs ≥40 kg/m(2)). Participants, caregivers, and study personnel were masked to treatment assignment. The primary outcome was Z score corresponding to the gestational age, parity, and sex-standardised birthweight percentile of liveborn babies delivered at 24 weeks or more of gestation. We did analysis by modified intention to treat. This trial is registered, ISRCTN number 51279843. FINDINGS Between Feb 3, 2011, and Jan 16, 2014, inclusive, we randomly assigned 449 women to either placebo (n=223) or metformin (n=226), of whom 434 (97%) were included in the final modified intention-to-treat analysis. Mean birthweight at delivery was 3463 g (SD 660) in the placebo group and 3462 g (548) in the metformin group. The estimated effect size of metformin on the primary outcome was non-significant (adjusted mean difference -0·029, 95% CI -0·217 to 0·158; p=0·7597). The difference in the number of women reporting the combined adverse outcome of miscarriage, termination of pregnancy, stillbirth, or neonatal death in the metformin group (n=7) versus the placebo group (n=2) was not significant (odds ratio 3·60, 95% CI 0·74-17·50; p=0·11). INTERPRETATION Metformin has no significant effect on birthweight percentile in obese pregnant women. Further follow-up of babies born to mothers in the EMPOWaR study will identify longer-term outcomes of metformin in this population; in the meantime, metformin should not be used to improve pregnancy outcomes in obese women without diabetes. FUNDING The Efficacy and Mechanism Evaluation (EME) Programme, a Medical Research Council and National Institute for Health Research partnership.
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Affiliation(s)
- Carolyn Chiswick
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - Rebecca M Reynolds
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
| | - Fiona Denison
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - Amanda J Drake
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
| | - Shareen Forbes
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
| | - David E Newby
- Chancellor's Building, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
| | - Siobhan Quenby
- Division of Reproductive Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Susan Wray
- Faculty of Health and Life Sciences, First Floor, Liverpool Women's Hospital, Liverpool, UK
| | - Andrew Weeks
- Faculty of Health and Life Sciences, First Floor, Liverpool Women's Hospital, Liverpool, UK
| | - Hany Lashen
- Academic Unit of Reproductive and Developmental Medicine, The Jessop Wing, Sheffield, UK
| | | | - Gordon Murray
- Centre for Population Health Sciences, Teviot Place, Edinburgh, UK
| | - Sonia Whyte
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK
| | - Jane E Norman
- Tommy's Centre for Maternal and Fetal Health, Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, UK.
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Macnaught G, Gray C, Walker J, Simpson M, Norman J, Semple S, Denison F. (1)H MRS: a potential biomarker of in utero placental function. NMR IN BIOMEDICINE 2015; 28:1275-1282. [PMID: 26313636 DOI: 10.1002/nbm.3370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The placenta is a temporary organ that is essential for a healthy pregnancy. It performs several important functions, including the transport of nutrients, the removal of waste products and the metabolism of certain substances. Placental disorders have been found to account for over 50% of stillbirths. Despite this, there are currently no methods available to directly and non-invasively assess placental function in utero. The primary aim of this pilot study was to investigate the use of (1)H MRS for this purpose. (1)H MRS offers the possibility to detect several placental metabolites, including choline, lipids and the amino acids glutamine and glutamate (Glx), which are vital to fetal development and placental function. Here, in utero placental spectra were acquired from nine small for gestational age (SGA) pregnancies, a cohort who are at increased risk of perinatal morbidity and mortality, and from nine healthy gestation-matched pregnancies. All subjects were between 26 and 39 weeks of gestation. Placenta Glx, choline and lipids at 1.3 and 0.9 ppm were quantified as amplitude ratios to that of intrinsic H2O. Wilcoxon signed rank tests indicated a significant difference in Glx/H2O (p = 0.024) between the two groups, but not in choline/H2O (p = 0.722) or in either lipid/H2O ratio (1.3 ppm, p = 0.813; 0.9 ppm, p = 0.058). This study has demonstrated that (1)H MRS has potential for the detection of placental metabolites in utero. This warrants further investigation as a tool for the monitoring of placental function.
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Affiliation(s)
- Gillian Macnaught
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Calum Gray
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
| | - Jane Walker
- Simpson Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
| | - Mary Simpson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Jane Norman
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fiona Denison
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Kiseli M, Gürsoy AY, Akincioglu E, Çağlar GS, Çandar T, Demirtaş S. The association between ischemia modified albumin and placental histopathology in uncomplicated term deliveries. Placenta 2015; 36:1056-8. [PMID: 26190038 DOI: 10.1016/j.placenta.2015.07.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/05/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
Ischemia modified albumin (IMA) is a marker of ischemia elevated in different clinical conditions and its use for hypoxia in perinatology is of current interest. We aimed to investigate the association between maternal and cord blood IMA levels and placental histopathological findings in uncomplicated term deliveries. In this study, placental histopathological evaluation in uncomplicated deliveries that ended with healthy newborns revealed 80.6% vasculopathy. The results support the hypothesis that hypoxia exceeding the placental reserve ends with fetal compromise. Moreover, the presence of maternal vasculopathy in placenta is not correlated with maternal and fetal IMA levels.
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Affiliation(s)
- Mine Kiseli
- Ufuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey.
| | - Aslı Yarci Gürsoy
- Ufuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey
| | - Egemen Akincioglu
- Ufuk University Faculty of Medicine, Department of Pathology, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey
| | - Gamze Sinem Çağlar
- Ufuk University Faculty of Medicine, Department of Obstetrics and Gynecology, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey
| | - Tuba Çandar
- Ufuk University Faculty of Medicine, Department of Biochemistry, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey
| | - Selda Demirtaş
- Ufuk University Faculty of Medicine, Department of Biochemistry, Mevlana Bulvari, No:86 Balgat, Ankara, Turkey
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Brewster AJ, Hardock V, Bhattacharya S. Exploring the relationship between maternal body mass index and offspring birth weight: Analysis of routinely collected data from 1967 to 2010 in Aberdeen, Scotland. J OBSTET GYNAECOL 2015; 35:810-6. [PMID: 26076310 DOI: 10.3109/01443615.2015.1017557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A retrospective cohort study was undertaken to assess the relationship between maternal body mass index (BMI) and neonatal birth weight. Data were extracted from Aberdeen Maternity and Neonatal Databank on all deliveries (n = 94049) occurring between 1967 and 2010. Compared with mothers whose weight was in the normal range, the adjusted odds of delivering a high-birth-weight infant were 0.63 (95% confidence interval: 0.59, 0.67), 1.44 (1.39, 1.50); 1.83 (1.72, 1.95); 2.22 (2.04, 2.43) in underweight, overweight, obese and morbidly obese mothers, respectively. Similarly, the adjusted odds of delivering a low-birth-weight baby decreased with increasing maternal BMI from 1.38 (1.23, 1.55) in underweight women to 0.80 (0.72, 0.89) in overweight women; 0.78 (0.67, 0.93) in obese and 0.56 (0.44, 0.71) in morbidly obese mothers. These relationships were only evident after adjustment for gestational age, presumably because higher maternal BMI is also, in some cases, associated with pre-term deliveries.
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Affiliation(s)
- A J Brewster
- a Department of Obstetric Epidemiology , University of Aberdeen , Aberdeen , UK
| | - V Hardock
- a Department of Obstetric Epidemiology , University of Aberdeen , Aberdeen , UK
| | - S Bhattacharya
- a Department of Obstetric Epidemiology , University of Aberdeen , Aberdeen , UK
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Tennant PWG, Bilous RW, Prathapan S, Bell R. Risk and recurrence of serious adverse outcomes in the first and second pregnancies of women with preexisting diabetes. Diabetes Care 2015; 38:610-9. [PMID: 25573880 DOI: 10.2337/dc14-1888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Women with preexisting (type 1 or type 2) diabetes experience an increased risk of serious adverse pregnancy outcomes. It is not known, however, how these risks change between the first and second pregnancy and whether there is an increased risk of recurrence. This study describes the absolute risks and recurrence of serious adverse pregnancy outcomes in 220 women with preexisting diabetes. RESEARCH DESIGN AND METHODS A total of 440 pregnancies occurring in 220 women with preexisting diabetes who delivered successive singleton pregnancies in the North of England during 1996-2008 were identified from the Northern Diabetes in Pregnancy Survey (NorDIP). Predictors of serious adverse outcome were estimated by competing-risks regression. RESULTS Sixty-seven first pregnancies (30.5%) ended in serious adverse outcome, including 14 (6.4%) with congenital anomalies and 53 (24.1%) additional fetal or infant deaths. Thirty-seven second pregnancies (16.8%) ended in serious adverse outcome--half the rate among first pregnancies (P = 0.0004)--including 21 (9.5%) with congenital anomalies and 16 (7.3%) additional fetal or infant deaths. Serious adverse outcomes in the second pregnancy occurred twice as frequently in women who experienced a previous adverse outcome than in those who did not (26.9% vs. 12.4%, P = 0.004), but previous adverse outcome was not associated with preparation for the following pregnancy. CONCLUSIONS Serious adverse outcomes are less common in the second pregnancies of women with preexisting diabetes, although the risk is comparable in those whose first pregnancy ends in adverse outcome. Reducing the risk of recurrence may require more support in the immediate period after an adverse pregnancy outcome.
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Affiliation(s)
- Peter W G Tennant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, U.K.
| | - Rudy W Bilous
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, U.K. James Cook University Hospital, South Tees National Health Service Trust, Middlesbrough, U.K
| | - Shamini Prathapan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, U.K
| | - Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, U.K. Regional Maternity Survey Office, Public Health England, Newcastle upon Tyne, U.K
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Size at birth by gestational age and hospital mortality in very preterm infants: results of the area-based ACTION project. Early Hum Dev 2015; 91:77-85. [PMID: 25555236 DOI: 10.1016/j.earlhumdev.2014.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Size at birth is an important predictor of neonatal outcomes, but there are inconsistencies on the definitions and optimal cut-offs. AIMS The aim of this study is to compute birth size percentiles for Italian very preterm singleton infants and assess relationship with hospital mortality. STUDY DESIGN Prospective area-based cohort study. SUBJECTS All singleton Italian infants with gestational age 22-31 weeks admitted to neonatal care in 6 Italian regions (Friuli Venezia-Giulia, Lombardia, Marche, Tuscany, Lazio and Calabria) (n. 1605). OUTCOME MEASURE Hospital mortality. METHODS Anthropometric reference charts were derived, separately for males and females, using the lambda (λ) mu (μ) and sigma (σ) method (LMS). Logistic regression analysis was used to estimate mortality rates by gestational age and birth weight centile class, adjusting for sex, congenital anomalies and region. RESULTS At any gestational age, mortality decreased as birth weight centile increased, with lowest values observed between the 50th and the 89th centiles interval. Using the 75th-89th centile class as reference, adjusted mortality odds ratios were 7.94 (95% CI 4.18-15.08) below 10th centile; 3.04 (95% CI 1.63-5.65) between the 10th and 24th; 1.96 (95% CI 1.07-3.62) between the 25th and the 49th; 1.25 (95% CI 0.68-2.30) between the 50(h) and the 74th; and 2.07 (95% CI 1.01-4.25) at the 90th and above. CONCLUSIONS Compared to the reference, we found significantly increasing adjusted risk of death up to the 49th centile, challenging the usual 10th centile criterion as risk indicator. Continuous measures such as the birthweight z-score may be more appropriate to explore the relationship between growth retardation and adverse perinatal outcomes.
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Mitsui T, Masuyama H, Eto E, Nobumoto E, Hayata K, Hiramatsu Y. Different Fetal and Neonatal Growth between Early- and Late-Onset Preeclampsia. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojog.2015.59074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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