1
|
Wang J, Li J, Yang Z, Duan Y, Li F, Zhou P, Lai J. Trajectory of gestational weight gain is related to birthweight: The TAWS cohort study in China. MATERNAL & CHILD NUTRITION 2024; 20:e13578. [PMID: 38576191 PMCID: PMC11168369 DOI: 10.1111/mcn.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 04/06/2024]
Abstract
Few studies have reported the timing and amount of gestational weight gain (GWG) to prevent large-for-gestational-age (LGA) or small-for-gestational-age (SGA). This study aimed to evaluate the association of GWG velocity in each trimester with LGA or SGA based on data from the Taicang and Wuqiang cohort study (TAWS, n = 2008). We used a linear mixed model to evaluate the association of trimester-specific GWG velocity with birthweight categories and stratified by prepregnancy body mass index category and parity. For normal-weight pregnant women, mothers with LGA births had higher GWG velocities than mothers with appropriate-for-gestational-age (AGA) births in the first trimester (0.108 vs. 0.031 kg/week, p < 0.01), second trimester (0.755 vs. 0.631 kg/week, p < 0.01) and third trimester (0.664 vs. 0.594 kg/week, p < 0.01); in contrast, mothers with SGA births had lower GWG velocities than mothers with AGA births in the second trimester (0.528 vs. 0.631 kg/week, p < 0.01) and third trimester (0.541 vs. 0.594 kg/week, p < 0.01). For normal-weight pregnant women with AGA births, multiparous women had lower GWG velocities than primiparous women in the second (0.602 vs. 0.643 kg/week, p < 0.01) and third trimesters (0.553 vs. 0.606 kg/week, p < 0.01). Therefore, for normal-weight women, LGA prevention would begin in early pregnancy and continue until delivery and the second and third trimesters may be critical periods for preventing SGA; in addition, among normal-weight pregnant women with AGA births, multiparous women tend to have lower weight gain velocities than primiparous women.
Collapse
Affiliation(s)
- Jie Wang
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Jun Li
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Zhenyu Yang
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Yifan Duan
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| | - Fang Li
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Pinjiao Zhou
- Taicang Service Center for Mother and Child Health and Family Planning, TaicangSuzhouChina
| | - Jianqiang Lai
- National Institute for Nutrition and HealthChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Human Milk ScienceChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Trace Element NutritionNational Health Commission of ChinaBeijingChina
| |
Collapse
|
2
|
Chen Y, Zhang H, Jiang Y, Ning W, Huang L, Wang Y, Chu X. Perinatal factors and early neonatal outcomes of abnormal birthweight infants in Hangzhou, China, 2015-2021: a retrospective cohort study. BMJ Paediatr Open 2024; 8:e002347. [PMID: 38769046 PMCID: PMC11110602 DOI: 10.1136/bmjpo-2023-002347] [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: 10/20/2023] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND This study aimed to investigate the perinatal factors and early neonatal outcomes of abnormal birth weight (ABW) in Hangzhou, China from 2015 to 2021. METHODS A retrospective cohort study was designed to analyse the data of 76 847 newborns, in which the case groups included 3042 cases of low birth weight (LBW) and 2941 cases of fetal macrosomia (MAC), and 70 864 cases of normal weight were as the reference group. RESULTS The incidence of LBW and MAC was 3.96% and 3.83% in Hangzhou, China from 2015 to 2021. Prematurity (<37 weeks), multiple births, hospitalisation >7 days, fetal anomalies, caesarean section, pregnancy complications, maternal coinfection with pathogens and summer births would be correlated with the incidence of LBW (ORs=43.50, 7.60, 2.09, 1.89, 1.57, 1.28, 1.19 and 1.18, all p<0.05). Factors such as post-term pregnancy (>41 weeks), scarred uterus, anterior vaginal incision and gravidity ≥2 were correlated with decreased incidence of LBW, with ORs of 0.05, 0.54, 0.65 and 0.80. Moreover, caesarean delivery, post-term pregnancy (> 41 weeks), parity ≥1, lateral vaginal incision, gravidity ≥2, hospitalisation >7 days, winter births and pregnancy complications also have association with the incidence of MAC (ORs=3.92, 2.73, 2.19, 1.87, 1.22, 1.20, 1.17 and 1.13, all p<0.05) while prematurity (<37 weeks), scarred uterus and anterior vaginal incision have close association with decreased incidence of MAC, with ORs of 0.07, 0.21 and 0.74 (all p<0.05). CONCLUSION There was a trend of yearly increase in ABW in Hangzhou, China from 2015 to 2021. Several neonatal and maternal-related variables such as caesarean section, pregnancy complications and hospitalisation >7 days are associated with the odds of LBW and MAC, however, factors such as pregnancy with scarred uterus relate to the decrease of ABW. Close monitoring and intervention during pregnancy are essential to reduce the occurrence of ABW.
Collapse
Affiliation(s)
- Yiming Chen
- Department of Prenatal diagnosis and screening center, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
- The Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huimin Zhang
- The Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yan Jiang
- Department of Obstetrics, The First People's Hospital of Linping District, Hangzhou, Zhejiang, China
| | - Wenwen Ning
- The Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Clinical Laboratory, Hangzhou Geriatric Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Lingling Huang
- Department of Laboratory, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yanan Wang
- Department of Laboratory, Maternal and Child Health Hospital of Linping District, Hangzhou, Zhejiang, China
| | - Xuelian Chu
- Department of Laboratory, Maternal and Child Health Hospital of Linping District, Hangzhou, Zhejiang, China
| |
Collapse
|
3
|
Habek D, Mikuš M, Cerovac A. The proposal of the novel fetal shoulder dystocia graduation: a clinical-based opinion. J Perinat Med 2023; 51:1129-1131. [PMID: 37329307 DOI: 10.1515/jpm-2022-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Shoulder dystocia is a peracute mechanical dystocia and a prepartum, usually unpredictable, life-threatening entity with significant forensic implications due to significantly poor perinatal outcome, especially permanent disability or perinatal death. CONTENT To better objectify the graduation and to include other important clinical parameters, we believe it is appropriate to present a proposal for a complete perinatal weighted graduation of shoulder dystocia, based on several years of numerous other and our own clinical and forensic studies and thematic biobibliography. Obstetric maneuvers, neonatal outcome, and maternal outcome are three components, which are evaluated according to the severity of 0-4 proposed components. Thus, the gradation is ultimately in four degrees according to the total score: I. degreee, score 0-3: slightly shoulder dystocia with simple obstetric interventions, but without birth injuries; II. degree, score 4-7: mild shoulder dystocia resolved by external, secondary interventions and minor injuries; III. degree, score 8-10: severe shoulder dystocia with severe peripartum injuries; IV. degree, score 11-12: extremely difficult, severe shoulder dystocia with ultima ratio interventions applied and resulting extremely severe injuries with chronic disability, including perinatal death. SUMMARY As a clinically evaluated graduation, it certainly has an applicable long-term anamnestic and prognostic component for subsequent pregnancies and access to subsequent births, as it includes all relevant components of clinical forensic objectification.
Collapse
Affiliation(s)
- Dubravko Habek
- Department of Obstetrics and Gynecology, Clinical Hospital Merkur, Zagreb, Croatia
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
- Collegium of the Surgical Sciences, Croatian Academy of Medical Sciences, Zagreb, Croatia
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Anis Cerovac
- Department of Gynaecology and Obstetrics, General Hospital Tešanj, Tešanj, Bosnia and Herzegovina
| |
Collapse
|
4
|
Habek D, Prka M, Luetić AT, Marton I, Medić F, Miletić AI. Obstetrics injuries during shoulder dystocia in a tertiary perinatal center. Eur J Obstet Gynecol Reprod Biol 2022; 278:33-37. [PMID: 36113284 DOI: 10.1016/j.ejogrb.2022.09.009] [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: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study will present our results in management of fetal shoulder dystocia with special consideration of maternal and neonatal outcome. STUDY DESIGN A retrospective study was performed at a university tertiary perinatal center. The study included data of singleton vaginal term deliveries in the period of 15 years (2006-2020). Analized informations include: obstetrics maternal and neonatal data and outcomes. RESULTS This period included 45,687 deliveries with diagnosed shoulder dystocia in 254 (0.7 %) cases in vaginal deliveries. Most of the deliveries were spontaneous births 69.7 %, induced deliveries 30.3 %, 47.2 % primiparas and preexisting or gestational diabetes in 21.7 %. The delivery was managed by vacuum extraction in 13.8 %, mediolateral episiotomy in 48.0 % of births, most of the shoulder dystocia were unilateral anterior, while only two cases were diagnosed as more difficult bilateral and 5 cases were recurrent. 87.4 % cases were resolved by McRobert's maneuver, 7.8 % by Barnum's 3.9 % by Wood's maneuver and one case was managed by Menticoglou and by Bourgoise-Siegemundin maneuver. 4.3 % injuries were classified as OASIS of III/IV degree, early postpartum hemorrhage due in 1.6 %. 54.3 % of newborns were male sex, 61.0 % of newborns had birth weight of above 4000 g (mean 4071 g). Maximal Apgar scores were atributed to 92.5 % in first and to 97.2 % in fifth minute, one case that requaired resuscitation. Clavicle fracture was found in 9.5 %, humerus fracture in 0.4 %, transient form of Duchenne Erb obstetrics brachial palsy was diagnosed in only in 7.5 % newborns, while we have not found any case of permanent brachial palsy. CONCLUSIONS Our results confirmed that strategy of prompt identification of shoulder dystocia accompanied by cessation of axial fetal head traction decrease the risk of brachial plexus strain, injury or tear, while performance of exact obstetrical maneuvers resulted in decanceration of fetal shoulders without permanent obstetrics brachial palsy or cerebral morbidity. We think that our good results corelate with our opinion that the performance of external obstetrical manoeuvres should be done without one minute postpone since efforts should be put in sooner shoulder liberation decreasing the time of fetal hypoxia.
Collapse
Affiliation(s)
- Dubravko Habek
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia.
| | - Matija Prka
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Ana Tikvica Luetić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Ingrid Marton
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Filip Medić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| | - Antonio Ivan Miletić
- University Department of Gynecology and Obstetrics, Clinical Hospital "Sveti Duh" Zagreb, School of Medicine, Catholic University of Croatia Zagreb, Croatia
| |
Collapse
|
5
|
Habek D. Intrapartal fetal decapitation after shoulder dystocia - a forensically acceptable or unacceptable complication? J Perinat Med 2022; 50:503-504. [PMID: 34904426 DOI: 10.1515/jpm-2021-0638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Dubravko Habek
- University Department of Obstetrics and Gynecology Clinical Hospital "Sveti Duh", School of Medicine Zagreb, Catholic University of Croatia, Croatian Academy of Medical Sciences, Sveti Duh 64, 10000 Zagreb, Croatia
| |
Collapse
|
6
|
Kekki M, Tihtonen K, Salonen A, Koukkula T, Gissler M, Laivuori H, Huttunen TT. Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland. Int J Gynaecol Obstet 2021; 159:195-203. [PMID: 34927725 PMCID: PMC9545198 DOI: 10.1002/ijgo.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022]
Abstract
Objective To examine severe birth‐related injuries in neonates among mothers with different types of diabetes. Methods Retrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35+0 weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes. Results There were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non‐diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum‐assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies. Conclusion Neonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non‐diabetic women is generally low.
Collapse
Affiliation(s)
- Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere, Finland
| | - Anne Salonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Department of Pediatric and Adolescent Surgery, Tampere University Hospital, Tampere, Finland
| | - Topias Koukkula
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Mika Gissler
- Information Services Department, THL, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institute and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Hannele Laivuori
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Tampere University, Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere, Finland.,Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tuomas T Huttunen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| |
Collapse
|