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Onuoha C, Schulte CCM, Thaweethai T, Hsu S, Pant D, James KE, Sen S, Kaimal A, Powe CE. The simultaneous occurrence of gestational diabetes and hypertensive disorders of pregnancy affects fetal growth and neonatal morbidity. Am J Obstet Gynecol 2024:S0002-9378(24)00438-1. [PMID: 38492713 DOI: 10.1016/j.ajog.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/04/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Gestational diabetes is associated with increased risk of hypertensive disorders of pregnancy, but there are limited data on fetal growth and neonatal outcomes when both conditions are present. OBJECTIVE We evaluated the risk of abnormal fetal growth and neonatal morbidity in pregnancies with co-occurrence of gestational diabetes and hypertensive disorders of pregnancy. STUDY DESIGN In a retrospective study of 47,093 singleton pregnancies, we compared the incidence of appropriate for gestational age birthweight in pregnancies affected by gestational diabetes alone, hypertensive disorders of pregnancy alone, or both gestational diabetes and hypertensive disorders of pregnancy with that in pregnancies affected by neither disorder using generalized estimating equations (covariates: maternal age, nulliparity, body mass index, insurance type, race, marital status, and prenatal care site). Secondary outcomes were large for gestational age birthweight, small for gestational age birthweight, and a neonatal morbidity composite outcome (stillbirth, hypoglycemia, hyperbilirubinemia, respiratory distress, encephalopathy, preterm delivery, neonatal death, and neonatal intensive care unit admission). RESULTS The median (interquartile range) birthweight percentile in pregnancies with both gestational diabetes and hypertensive disorders of pregnancy (50 [24.0-78.0]; N=179) was similar to that of unaffected pregnancies (50 [27.0-73.0]; N=35,833). However, the absolute rate of appropriate for gestational age birthweight was lower for gestational diabetes/hypertensive disorders of pregnancy co-occurrence (78.2% vs 84.9% for unaffected pregnancies). Adjusted analyses showed decreased odds of appropriate for gestational age birthweight in pregnancies with both gestational diabetes and hypertensive disorders of pregnancy compared with unaffected pregnancies (adjusted odds ratio, 0.72 [95% confidence interval, 0.52-1.00]; P=.049), and in pregnancies complicated by gestational diabetes alone (adjusted odds ratio, 0.78 [0.68-0.89]; P<.001) or hypertensive disorders of pregnancy alone (adjusted odds ratio, 0.73 [0.66-0.81]; P<.001). The absolute risk of large for gestational age birthweight was greater in pregnancies with both gestational diabetes and hypertensive disorders of pregnancy (14.5%) than in unaffected pregnancies (8.2%), without apparent difference in the risk of small for gestational age birthweight (7.3% vs 6.9%). However, in adjusted models comparing pregnancies with gestational diabetes/hypertensive disorders of pregnancy co-occurrence with unaffected pregnancies, neither an association with large for gestational age birthweight (adjusted odds ratio, 1.33 [0.88-2.00]; P=.171) nor small for gestational age birthweight (adjusted odds ratio, 1.32 [0.80-2.19]; P=.293) reached statistical significance. Gestational diabetes/hypertensive disorders of pregnancy co-occurrence carried an increased risk of neonatal morbidity that was greater than that observed with either condition alone (gestational diabetes/hypertensive disorders of pregnancy: adjusted odds ratio, 3.13 [2.35-4.17]; P<.001; gestational diabetes alone: adjusted odds ratio, 2.01 [1.78-2.27]; P<.001; hypertensive disorders of pregnancy alone: adjusted odds ratio, 1.38 [1.26-1.50]; P<.001). CONCLUSION Although pregnancies with both gestational diabetes and hypertensive disorders of pregnancy have a similar median birthweight percentile to those affected by neither condition, pregnancies concurrently affected by both conditions have a higher risk of abnormal fetal growth and neonatal morbidity.
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Affiliation(s)
- Chioma Onuoha
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Tanayott Thaweethai
- Biostatistics Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Sarah Hsu
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA
| | - Deepti Pant
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Kaitlyn E James
- Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sarbattama Sen
- Harvard Medical School, Boston, MA; Department of Pediatrics, Brigham and Women's Hospital, Boston, MA
| | - Anjali Kaimal
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Camille E Powe
- Harvard Medical School, Boston, MA; Broad Institute, Cambridge, MA; Diabetes Unit, Endocrinology Division, Massachusetts General Hospital, Boston, MA.
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M N N, J K, S R S, Raavi V. Methylation Status of IGF-Axis Genes in the Placenta of South Indian Neonates with Appropriate and Small for Gestational Age. Fetal Pediatr Pathol 2024; 43:5-20. [PMID: 37975569 DOI: 10.1080/15513815.2023.2280660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Altered methylation patterns of insulin-like growth factor (IGF)-axis genes in small for gestational age (SGA) have been reported in different populations. In the present study, we analyzed the methylation status of IGF-axis genes in the placenta of appropriate for gestational age (AGA) and SGA neonates of South Indian women. METHODS Placental samples were collected from AGA (n = 40) and SAG (n = 40) neonates. The methylation of IGF-axis genes promoter was analyzed using MS-PCR. RESULTS IGF2, H19, IGF1, and IGFR1 genes promoter methylation was 2.5, 1.5, 5, and 7.5% lower in SGA compared to AGA, respectively. Co-methylation of IGF-axis genes promoter was 40% and 20% in AGA and SGA, respectively. IGF-axis gene promoter methylation significantly (p < 0.05) influenced the levels of IGFBP3 protein, birth weight, mitotic index, gestational weeks, and IGFR1 and IGFR2 gene expression. CONCLUSION IGF-axis genes methylation was lower in SGA than in AGA, and the methylation significantly influenced the IGF-axis components.
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Affiliation(s)
- Nithya M N
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Krishnappa J
- Department of Paediatrics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Sheela S R
- Department of Obstetrics and Gynaecology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
| | - Venkateswarlu Raavi
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research (Deemed to be University), Kolar, Karnataka, India
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Dominguez-Menendez G, Poggi H, Ochoa-Molina F, D'Apremont I, Moore R, Allende F, Solari S, Martinez-Aguayo A. Extremely and very preterm children who were born appropriate for gestational age show no differences in cortisol concentrations or diurnal rhythms compared to full-term children. J Pediatr Endocrinol Metab 2023; 36:1018-1027. [PMID: 37795843 DOI: 10.1515/jpem-2023-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES The objective of this study was to compare the diurnal variations in cortisol and cortisone concentrations in serum and saliva among extremely preterm (EPT), very preterm (VPT), and full-term (FT) children, all born appropriate for gestational age (AGA). METHODS EPT, VPT, and FT children, all born AGA, were recruited from two healthcare centers. Cortisol and cortisone concentrations in serum and saliva were measured by liquid chromatography-mass spectrometry (LC‒MS). Statistical analysis was performed using nonparametric tests. RESULTS A total of 101 children (5.0-8.9 years old) were included in this study: EPT=18, VPT=43 and FT=40. All groups had similar distributions in terms of age, birth weight standard deviation score (SDS) and BMI (SDS), showing no differences in serum ACTH, cortisol, or cortisone levels. Additionally, salivary cortisol and cortisone concentrations decreased significantly throughout the day (p-values<0.0001). Salivary cortisol concentrations were below the limit of detection (0.55 nmol/L) before dinner and before bedtime in approximately one-third and two-thirds of all children, respectively. Salivary cortisone was detectable in all but one sample. CONCLUSIONS The diurnal cortisol rhythm was preserved in all preterm children, regardless of their gestational age, and no differences in cortisol concentrations among the groups were found. This may have significant implications for the clinical management and follow-up of preterm individuals.
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Affiliation(s)
- Gonzalo Dominguez-Menendez
- Endocrinology Division, Department of Paediatric, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Helena Poggi
- Endocrinology Units, Paediatrics Division, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fernanda Ochoa-Molina
- Endocrinology Units, Paediatrics Division, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ivonne D'Apremont
- Endocrinology Units, Paediatrics Division, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rosario Moore
- Endocrinology Units, Paediatrics Division, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fidel Allende
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Catolica de Chile, Macul, Chile
| | - Sandra Solari
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Catolica de Chile, Macul, Chile
| | - Alejandro Martinez-Aguayo
- Endocrinology Units, Paediatrics Division, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Lan Y, Pan S, Chen B, Zhou F, Yang F, Chao S, Hua Y, Liu H. The relationship between gut microbiota, short-chain fatty acids, and glucolipid metabolism in pregnant women with large for gestational age infants. J Appl Microbiol 2023; 134:lxad240. [PMID: 37883533 DOI: 10.1093/jambio/lxad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/02/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
AIM To elucidate the association between gut microbiota, short-chain fatty acids (SCFAs), and glucolipid metabolism in women with large for gestational age (LGA) infants. METHODS AND RESULTS A single-center, observational prospective cohort study was performed at a tertiary hospital in Wenzhou, China. Normal pregnant women were divided into LGA group and appropriate for gestational age (AGA) group according to the neonatal birth weight. Fecal samples were collected from each subject before delivery for the analysis of gut microbiota composition (GMC) and SCFAs. Blood samples were obtained at 24-28 weeks of gestation age to measure fasting blood glucose and fasting insulin levels, as well as just before delivery to assess serum triglycerides, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein. The GMC exhibited differences at various taxonomic levels. Within the Firmicutes phylum, genus Lactobacillus, genus Clostridium, species Lactobacillus agil, and species Lactobacillus salivarius were enriched in the LGA group. Microbispora at genus level, Microbispora rosea at species level belonging to the Actinobacteria phylum, Neisseriales at order level, Bartonellaceae at family level, Paracoccus aminovorans, and Methylobacterium at genus level from the Proteobacteria phylum were more abundant in the LGA group. In contrast, within the Bacteroidetes phylum, Prevotella at genus level and Parabacteroides distasonis at species level were enriched in the AGA group. Although there were few differences observed in SCFA levels and most glucolipid metabolism indicators between the two groups, the serum HDL level was significantly lower in the LGA group compared to the AGA group. No significant relevance among GMC, SCFAs, and glucolipid metabolism indicators was found in the LGA group or in the AGA group. CONCLUSIONS Multiple different taxa, especially phylum Firmicutes, genus Prevotella, and genus Clostridium, might play an important role in excessive fetal growth, and LGA might be associated with the lower serum HDL level.
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Affiliation(s)
- Yehui Lan
- Department of Obstetrics and Gynecology and General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Shuangjia Pan
- Department of Obstetrics and Gynecology and General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Baoyi Chen
- Department of Obstetrics and Gynecology and General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Feifei Zhou
- Department of Obstetrics and Gynecology, The Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou 325027, China
| | - Fan Yang
- Key Laboratory of Cell Engineering in Guizhou Province, Affiliated Hospital of Zunyi Medical University, Zunyi 563000,China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai 200240, China
- Research Center for Lin He Academician New Medicine, Institutes for Shanghai Pudong Decoding Life, Shanghai 2000240, China
| | - Shan Chao
- Research Center for Lin He Academician New Medicine, Institutes for Shanghai Pudong Decoding Life, Shanghai 2000240, China
| | - Ying Hua
- Department of Obstetrics and Gynecology and General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Haibin Liu
- Department of Obstetrics and Gynecology and General Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
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Calek E, Binder J, Palmrich P, Eibensteiner F, Thajer A, Kainz T, Harreiter K, Berger A, Binder C. Effects of Intrauterine Growth Restriction (IUGR) on Growth and Body Composition Compared to Constitutionally Small Infants. Nutrients 2023; 15:4158. [PMID: 37836441 PMCID: PMC10574227 DOI: 10.3390/nu15194158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Intrauterine growth restriction (IUGR) is associated with multiple morbidities including growth restriction and impaired neurodevelopment. Small for gestational age (SGA) is defined as a birth weight <10th percentile, regardless of the etiology. The term is commonly used as a proxy for IUGR, but it may represent a healthy constitutionally small infant. Differentiating between IUGR and constitutionally small infants is essential for the nutritional management. (2) Infants born at <37 weeks of gestation between 2017 and 2022, who underwent body composition measurement (FFM: fat-free mass; FM: fat mass) at term-equivalent age, were included in this study. Infants with IUGR and constitutionally small infants (SGA) were compared to infants appropriate for gestational age (AGA). (3) A total of 300 infants (AGA: n = 249; IUGR: n = 40; SGA: n = 11) were analyzed. FFM (p < 0.001) and weight growth velocity (p = 0.022) were significantly lower in IUGR compared to AGA infants, but equal in SGA and AGA infants. FM was not significantly different between all groups. (4) The FFM Z-score was significantly lower in IUGR compared to AGA infants (p = 0.017). Being born constitutionally small compared to AGA had no impact on growth and body composition. These data showed that early aggressive nutritional management is essential in IUGR infants to avoid impaired growth and loss of FFM.
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Affiliation(s)
- Elisabeth Calek
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Julia Binder
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Pilar Palmrich
- Department of Obstetrics and Gynecology, Medical University of Vienna, 1090 Vienna, Austria; (J.B.); (P.P.)
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Alexandra Thajer
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Theresa Kainz
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Karin Harreiter
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria; (E.C.); (A.T.); (T.K.); (K.H.); (A.B.)
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Pan T, Huang Y, Cheng Q, Chen L, Hu Y, Dai Y, Liu X, Jiang Z, Zhong Y, Zhang Z, Chen Q, Zhang Q, Zhang X. A retrospective study on the physical growth of twins in the first year after birth. Front Nutr 2023; 10:1168849. [PMID: 37810921 PMCID: PMC10557485 DOI: 10.3389/fnut.2023.1168849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives This study analyzed the physical growth of small for gestational age (SGA) and appropriate for gestational age (AGA) twins up to one year after birth. Methods Weight, length, and head circumference data of 0-1 year-old twins were collected from the Child Health Care System from 2010 to 2019. Physical data were presented as Z-scores. Five parameters - growth level of weight, body length, head circumference, growth velocity, and body proportion (weight for length) were compared in twins. Results A total of 3,909 cases were collected (22.61% SGA, 77.39% AGA). 1. In both groups, WAZ (Weight for age z-score), HCZ (Head circumference for age z-score), and LAZ (Length for age z-score) increased more rapidly in the first 6 months. By one year of age, WAZ, HCZ, and LAZ had reached the normal range, but none had reached the average level of normal singleton children. 2. The mean values of WAZ, HCZ, and LAZ in the AGA group were between -1 and 0, and between -2 and - 1 in the SGA group, in the first year after birth. The SGA group lagged significantly behind the AGA group. The LAZ score of SGA and AGA was lower than the WAZ and HCZ scores. 3. The proportion of preterm AGA was the largest in twins, and the growth rate of preterm AGA was the fastest. Preterm twins had greater growth potential than term twins. However, the growth level of preterm SGA was always low. 4. The WFLZ (Weight for length z-score) in each group was approximately close to 0. The WFLZ of SGA was smaller than that of AGA twins at most time points. After 4 months of age, the WFLZ of twins had a downward trend. The WFLZ of preterm SGA approached -1 at approximately 1 year old. Conclusion The physical growth of SGA and AGA in twins in the first year can reach the normal range but cannot reach the average level of normal singleton children. More attention should be paid to SGA in twins, especially preterm SGA. We should give proper nutritional guidance after 4 months of age to ensure the appropriate body proportion (weight for length) of SGA in twins. Clinical trial registration www.chictr.org.cn, CTR2000034761.
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Affiliation(s)
- Ting Pan
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yanru Huang
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Child Health Care, Luzhou People’s Hospital, Luzhou, Sichuan, China
| | - Qian Cheng
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Li Chen
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Hu
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Dai
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Liu
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyang Jiang
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanfeng Zhong
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhanzhan Zhang
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Chen
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Zhang
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Zhang
- Department of Child Health Care, Chongqing Growth, Development and Mental Health Center for Children and Adolescents, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Health and Nutrition, Children’s Hospital of Chongqing Medical University, Chongqing, China
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Taine M, Forhan A, Morgan AS, Bernard JY, Peyre H, Dufourg MN, Martin LM, Charles MA, Botton J, Heude B. Early postnatal growth and subsequent neurodevelopment in children delivered at term: The ELFE cohort study. Paediatr Perinat Epidemiol 2021; 35:748-757. [PMID: 34255382 DOI: 10.1111/ppe.12798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the limited evidence, accelerated early postnatal growth (EPG) is commonly believed to benefit neurodevelopment for term-born infants, especially those small for gestational age. OBJECTIVES To investigate the existence of critical time windows in the association of EPG with neurodevelopment, considering birth size groups. STUDY DESIGN In the French ELFE birth cohort, 12,854 term-born neonates were classified as small, appropriate or large for gestational age (SGA, AGA, LGA, respectively). Parents reported their child's development by using the Child Development Inventory (CDI-score) at age 12 months and the MacArthur-Bates Development Inventory (MAB-score; 100 score units) assessing language ability at age 24 months. Predictions of individual weight, body mass index (BMI), length, and head circumference (HC) from birth to age 24 months were obtained from repeated measurements fitted with the Jenss-Bayley mixed-effects model. For each infant, conditional gains (CG) in these growth parameters were generated at four-time points (3, 6, 12 and 24 months) representing specific variations in growth parameters during 0-3, 3-6, 6-12, 12-24 months, independent of previous measures. Using multivariable linear regression models, we provided the estimate differences of the neurodevelopmental scores according to variation of each growth parameter CG, by birth size group. RESULTS For SGA infants, the MAB-score differed by 5.8 (95% confidence interval [CI] -0.2, 11.8), 6.7 (95% CI -0.1, 13.3), and 9.7 (95% CI 1.9, 17.5) score units when CG in BMI, weight, and HC at 3 months varied from -2 to 1 standard deviation, respectively. For all infants, MAB-score was linearly and positively associated with length conditional gains at 12 months, with stronger magnitude for SGA infants. Results for the CDI-score were overall consistent with those for MAB-score. CONCLUSIONS For term-born SGA infants, moderate catch-up in HC, BMI and weight within the first 3 months of life may benefit later neurodevelopment, which could guide clinicians to monitor EPG.
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Affiliation(s)
- Marion Taine
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France.,Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Anne Forhan
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France
| | - Andrei S Morgan
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Paris, France.,Elizabeth Garrett Anderson Institute for Womens' Health, UCL, London, UK.,Embrace Yorkshire and Humber Infant and Children's Transport Service, Barnsley, UK
| | - Jonathan Y Bernard
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Hugo Peyre
- Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France.,Laboratoire de Sciences Cognitives et Psycholinguistique (ENS, EHESS, CNRS), Ecole Normale Supérieure, PSL Research University, Paris, France.,Sorbonne Paris Cité, INSERM UMRS 1141, Paris Diderot University, Paris, France
| | | | - Laetitia Marchand Martin
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Paris, France
| | - Marie-Aline Charles
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France.,Unité mixte Inserm-Ined-EFS ELFE, Ined, Paris, France
| | - Jérémie Botton
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Barbara Heude
- Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France
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Ortiz JU, Graupner O, Karge A, Flechsenhar S, Haller B, Ostermayer E, Abel K, Kuschel B, Lobmaier SM. Does gestational age at term play a role in the association between cerebroplacental ratio and operative delivery for intrapartum fetal compromise? Acta Obstet Gynecol Scand 2021; 100:1910-1916. [PMID: 34212368 DOI: 10.1111/aogs.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/27/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To assess the impact of gestational age at term on the association between cerebroplacental ratio (CPR) and operative delivery for intrapartum fetal compromise (IFC) and prognostic performance of CPR to predict operative delivery for IFC. MATERIAL AND METHODS This was a retrospective cohort study including 2052 singleton pregnancies delivered between 37+0 and 41+6 weeks of gestation in a single tertiary referral center over an 8-year period. CPR was measured within 1 week of delivery. IFC was defined as the presence of persistent pathological cardiotocography pattern or the combination of pathological cardiotocography pattern and fetal scalp pH < 7.20. Operative delivery included instrumental vaginal delivery and cesarean section. Pregnancies were grouped according to birthweight (small for gestational age [SGA, birthweight <10th centile] and appropriate for gestational age [AGA, birthweight 10th-90th centile]) and gestational age by week at delivery. Rates of operative delivery were compared between the subgroups. Prognostic value of CPR was assessed using receiver operating characteristic curve. RESULTS Of the study cohort, 308 (15%) had a CPR <10th centile, 374 (18%) operative delivery for IFC, and 298 (15%) were SGA at birth. Overall, the rates of operative delivery for IFC were higher in the low CPR group both in SGA (35% vs. 22%; p = 0.023) and in AGA (23% vs. 16%; p = 0.007). According to gestational age by week at delivery, fetuses with low CPR showed higher rates of operative delivery for IFC with advancing gestational age, mainly in pregnancies delivered at 40 weeks (54% vs. 23%; p = 0.004) and at 41 weeks (60% vs. 19%; p = 0.010) for SGA and at 41 weeks (39% vs. 20%; p = 0.001) for AGA. The predictive value of CPR remained stable throughout term and was poor both in SGA and in AGA. CONCLUSIONS Both SGA and AGA fetuses with low CPR showed higher rates of operative delivery for IFC at term with advancing gestational age. Prognostic value of CPR throughout term was poor.
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Affiliation(s)
- Javier U Ortiz
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oliver Graupner
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anne Karge
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sarah Flechsenhar
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institut for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eva Ostermayer
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kathrin Abel
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bettina Kuschel
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Silvia M Lobmaier
- Division of Obstetrics and Perinatal Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Chaudhary N, Yadav SN, Kalra SK, Pathak S, Gupta BK, Shrestha S, Patel M, Satia I, Sadhra S, Bolton CE, Kurmi OP. Prognostic factors associated with small for gestational age babies in a tertiary care hospital of Western Nepal: A cross-sectional study. Health Sci Rep 2021; 4:e250. [PMID: 33614985 PMCID: PMC7883381 DOI: 10.1002/hsr2.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Small for gestational age (SGA) is common among newborns in low-income countries like Nepal and has higher immediate mortality and morbidities. OBJECTIVES To study the prevalence and prognostic factors of SGA babies in Western Nepal. METHODS A cross-sectional study (November 2016-October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio-demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. RESULTS Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female-SGA was greater in comparison to male-SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. CONCLUSIONS SGA is common in Western Nepal and associated with several modifiable prognostic factors.
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Affiliation(s)
- Nagendra Chaudhary
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Shree Narayan Yadav
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Suresh Kumar Kalra
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Santosh Pathak
- Department of PediatricsChitwan Medical CollegeBharatpurNepal
| | - Binod Kumar Gupta
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Sandeep Shrestha
- Department of PediatricsUniversal College of Medical SciencesBhairahawaNepal
| | - Matthew Patel
- The Royal College of Surgeons in IrelandDublinIreland
| | - Imran Satia
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Steven Sadhra
- Institute of Clinical SciencesCollege of Medical and Dental Sciences, University of BirminghamBirminghamUK
| | - Charlotte Emma Bolton
- NIHR Nottingham Biomedical Research CentreSchool of Medicine, University of NottinghamNottinghamUK
| | - Om Prakash Kurmi
- Division of Respirology, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Faculty of Health and Life SciencesUniversity of CoventryCoventryUK
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Kajdy A, Modzelewski J, Herman K, Muzyka-Placzynska K, Rabijewski M. Growth charts and prediction of abnormal growth - what is known, what is not known and what is misunderstood. Ginekol Pol 2019; 90:717-21. [PMID: 31909466 DOI: 10.5603/GP.2019.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/23/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Assessment of fetal growth has an important effect on perinatal morbidity and mortality. To understand what tool to choose best for a given population a basic knowledge of how growth charts are developed and used has to be acquired. For this reason, this literature review was performed. MATERIAL AND METHODS An extensive literature review aimed at identifying articles related to the development of growth assessment in both spectrums of abnormal fetal growth - large and small. The analyzed articles were chosen and presented to show both the historical aspects of growth assessment, current trends and future considerations. RESULTS Identification of both large and small fetuses and neonates is equally crucial. Definitions and methodology vary worldwide and there is an ongoing discussion on the best tool to choose for a given population. An important part of the debate is how to differentiate between the physiologically small fetus and the truly growth restricted fetus who is at risk of perinatal complication. Similarly, the diagnosis of a large fetus is important in prevention of perinatal complications and surgical deliveries. Many clinical settings still lack growth standards. CONCLUSIONS Birthweight for gestational age charts are biased for weight in preterm birth. Prediction and management of outcome cannot be based solely on fetal size. Small is not the only problem, we have to think large as well. A common misunderstanding in clinical practice is not using uniform charts in defining growth.
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Abstract
Birthweight is often used as a proxy for fetal weight. Problems with this practice have recently been brought to light. We explore whether data available at birth can be used to predict estimated fetal weight using linear and quantile regression, random forests, Bayesian additive regression trees, and generalized boosted models. We train and validate each approach using 18,517 pregnancies (31,948 ultrasound visits) from the Magee-Womens Obstetric Maternal and Infant data and 240 pregnancies in a separate dataset of high-risk pregnancies. We also quantify the relation between smoking and small-for-gestational-age birth, defined as a birthweight in the lower 10th percentile of a population birthweight standard and estimated and predicted fetal weight standard. Using mean squared error and median absolute deviation criteria, quantile regression performed best among the regression-based approaches, but generalized boosted models performed best overall. Using the birthweight standard, smoking during pregnancy increased the risk of small-for-gestational-age 3.84-fold (95% CI: 2.70, 5.47). This ratio dropped to 1.65 (95% CI: 1.50, 1.81) when using the correct fetal weight standard, which was no different from the machine learning-based predicted standards, but higher than the regression-based predicted standards. Machine learning algorithms show promise in recovering missing fetal weight information. See video abstract at, http://links.lww.com/EDE/B314.
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Affiliation(s)
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University
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Ferrazzi E, Stampalija T, Monasta L, Di Martino D, Vonck S, Gyselaers W. Maternal hemodynamics: a method to classify hypertensive disorders of pregnancy. Am J Obstet Gynecol 2018; 218:124.e1-124.e11. [PMID: 29102503 DOI: 10.1016/j.ajog.2017.10.226] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The classification of hypertensive disorders of pregnancy is based on the time at the onset of hypertension, proteinuria, and other associated complications. Maternal hemodynamic interrogation in hypertensive disorders of pregnancy considers not only the peripheral blood pressure but also the entire cardiovascular system, and it might help to classify the different clinical phenotypes of this syndrome. OBJECTIVE This study aimed to examine cardiovascular parameters in a cohort of patients affected by hypertensive disorders of pregnancy according to the clinical phenotypes that prioritize fetoplacental characteristics and not the time at onset of hypertensive disorders of pregnancy. STUDY DESIGN At the fetal-maternal medicine unit of Ziekenhuis Oost-Limburg (Genk, Belgium), maternal cardiovascular parameters were obtained through impedance cardiography using a noninvasive continuous cardiac output monitor with the patients placed in a standing position. The patients were classified as pregnant women with hypertensive disorders of pregnancy who delivered appropriate- and small-for-gestational-age fetuses. Normotensive pregnant women with an appropriate-for-gestational-age fetus at delivery were enrolled as the control group. The possible impact of obesity (body mass index ≥30 kg/m2) on maternal hemodynamics was reassessed in the same groups. RESULTS Maternal age, parity, body mass index, and blood pressure were not significantly different between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and hypertensive disorders of pregnancy/small-for-gestational-age groups. The mean uterine artery pulsatility index was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group. The cardiac output and cardiac index were significantly lower in the hypertensive disorders of pregnancy/small-for-gestational-age group (cardiac output 6.5 L/min, cardiac index 3.6) than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group (cardiac output 7.6 L/min, cardiac index 3.9) but not between the hypertensive disorders of pregnancy/appropriate-for-gestational-age and control groups (cardiac output 7.6 L/min, cardiac index 4.0). Total vascular resistance was significantly higher in the hypertensive disorders of pregnancy/small-for-gestational-age group than in the hypertensive disorders of pregnancy/appropriate-for-gestational-age group and the control group. All women with hypertensive disorders of pregnancy showed signs of central arterial dysfunction. The cardiovascular parameters were not influenced by gestational age at the onset of hypertensive disorders of pregnancy, and no difference was observed between the women with appropriate-for-gestational-age fetuses affected by preeclampsia or by gestational hypertension with appropriate-for-gestational-age fetuses. Women in the obese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and obese/hypertensive disorders of pregnancy/small-for-gestational-age groups showed a significant increase in cardiac output, as well as significant changes in other parameters, compared with the nonobese/hypertensive disorders of pregnancy/appropriate-for-gestational-age and nonobese/hypertensive disorders of pregnancy/small-for-gestational-age groups. CONCLUSION Significantly low cardiac output and high total vascular resistance characterized the women with hypertensive disorders of pregnancy associated with small for gestational age due to placental insufficiency, independent of the gestational age at the onset of hypertension. The cardiovascular parameters were not significantly different in the women with appropriate-for-gestational-age or small-for-gestational-age fetuses affected by preeclampsia or gestational hypertension. These findings support the view that maternal hemodynamics may be a candidate diagnostic tool to identify hypertensive disorders in pregnancies associated with small-for-gestational-age fetuses. This additional tool matches other reported evidence provided by uterine Doppler velocimetry, low vascular growth factors in the first trimester, and placental pathology. Obesity is associated with a significantly higher cardiac output and outweighs other determinants of hemodynamics in pregnancy; therefore, in future studies on hypertensive disorders, obesity should be studied as an additional disease and not simply as a demographic characteristic.
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Abstract
OBJECTIVE The aim of this study was to evaluate the performance of New Ballard Score (NBS) in small-for-gestational age (SGA) neonates. METHODOLOGY Neonates born at 35-40 weeks of gestation were included if accurate obstetric gestation estimate was available and birth weight was <10th percentile for gestation. Gestation-matched appropriate-for-gestational-age neonates were enrolled as controls. Gestation derived from NBS was compared with gestation calculated from last menstrual period. RESULTS Gestational age estimated by NBS was significantly higher in SGA neonates (mean difference: 0.7 weeks). Neuromuscular component score was similar but physical component score was significantly higher in SGA neonates. Reanalysis after reducing score of 4 to 3 of SGA babies for skin and plantar crease physical parameters showed overestimation of gestational age decreased to 0.4 weeks. CONCLUSIONS The physical parameters of NBS overestimate gestation in SGA neonates. Changing scores of skin and plantar creases in SGA neonates better estimates gestation age.
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Affiliation(s)
- Ravish Singhal
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
| | - Deepak Chawla
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
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Bocca-Tjeertes IFA, Kerstjens JM, Reijneveld SA, Veldman K, Bos AF, de Winter AF. Growth patterns of large for gestational age children up to age 4 years. Pediatrics 2014; 133:e643-9. [PMID: 24567020 DOI: 10.1542/peds.2013-0985] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine how growth of large for gestational age (LGA) preterm (PT) children was affected by their PT birth and their LGA status. METHODS This is a community-based cohort study of 1302 PT and 489 full-term (FT) children, born 2002 and 2003. RESULTS We found that growth in height, weight, and head circumference of LGA PT children was well balanced during infancy and that only weight gain accelerated during subsequent years. This led to high BMIs comparable to those of LGA FT children. Being born both LGA and PT resulted in a median growth at the age of 4 years that was 0.1 SD lower for weight (P = .44), 0.1 SD lower for height (P = .48), and 0.5 SD lower for head circumference compared with LGA FT counterparts (P = .016), whereas BMI at age 4 years was equal. Compared with appropriate for gestational age (AGA) PT children, these measures for LGA PT children were 0.9 SD, 0.6 SD, and 0.4 SD (all P < .001) higher, respectively. That led to the BMI of LGA PT children at age 4 years being significantly higher (0.9 points, i.e., 0.7 SD) than that of AGA PT and also higher (0.6 points, i.e., 0.4 SD) than that of AGA FT children. CONCLUSIONS The growth patterns of LGA PT-born children are distinctly different from other PT or FT children. In particular, we found substantially greater weight gains and relatively higher BMIs among them, which added to their already increased metabolic risks based on their gestational age.
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Abstract
OBJECTIVE To determine how symmetric (proportionate; SGR) and asymmetric (disproportionate; AGR) growth restriction influence growth and development in preterms from birth to 4 years. METHODS This community-based cohort study of 810 children comprised 86 SGR, 61 AGR, and 663 non-growth restricted (NGR) preterms, born in 2002 and 2003. Symmetrical growth restriction was defined as a birth weight below the 16th percentile (-1 SD) compared with full-terms and a head circumference (HC) z score not exceeding the infant's birth weight z score by >1 SD. Asymmetric growth restriction was defined as a HC z score exceeding that for by >1 SD as a proxy of brain sparing. Developmental delay was assessed by the Ages and Stages Questionnaire at 4 years. RESULTS Longitudinal gains in weight and height were similar for SGR and AGR children and less compared with NGR children. At age 4, z scores for weight were -1.1 for SGR and -0.7 for AGR children vs -0.3 for NGR children. z scores for height were -0.8 and -0.5 vs. -0.2. HC gain were 2 cm more in SGR, but at 1 year, they were -0.2 vs. 0.2 (AGR) and 0.1 (NGR). Developmental delay increased with odds ratios of 2.5 (95% confidence interval 1.1-6.0) for SGR and 2.1 (95% confidence interval 0.7-5.9) for AGR. CONCLUSIONS Weight and height gains were similar for AGR and SGR children but poorer compared with NGR children. SGR children caught up on HC. Developmental delay was more likely in growth-restricted preterms independent of HC at birth.
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Abdel Hakeem AHA, Saed SZ, El Rehany MA, Yassin EE. Serum level of ghrelin in umbilical cord in small and appropriate for gestational age newborn infants and its relationship to anthropometric measures. J Clin Neonatol 2013; 1:135-8. [PMID: 24027709 PMCID: PMC3762029 DOI: 10.4103/2249-4847.101694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare the cord blood ghrelin level in (SGA) infants with the level in appropriate for gestational age (AGA) infants, and determine its relationship to anthropometric measurements at delivery. MATERIALS AND METHODS Fifty newborn infants (30 SGA newborns and 20 AGA infants) were included in the study and were subjected to complete clinical examinations, anthropometric measurement, and ghrelin assays. RESULTS The cord blood ghrelin level in SGA infants was significantly higher than that in AGA infants. Cord ghrelin level correlated negatively with gestational age, weight, length, and body mass index in SGA group. CONCLUSION Cord ghrelin concentration increased in SGA infants due to state of prolonged undernutrition the source of ghrelin unknown may be from the mother placenta or fetal tissues.
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Mussap M, Antonucci R, Noto A, Fanos V. The role of metabolomics in neonatal and pediatric laboratory medicine. Clin Chim Acta 2013; 426:127-38. [PMID: 24035970 DOI: 10.1016/j.cca.2013.08.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/22/2022]
Abstract
Metabolomics consists of the quantitative analysis of a large number of low molecular mass metabolites involving substrates or products in metabolic pathways existing in all living systems. The analysis of the metabolic profile detectable in a human biological fluid allows to instantly identify changes in the composition of endogenous and exogenous metabolites caused by the interaction between specific physiopathological states, gene expression, and environment. In pediatrics and neonatology, metabolomics offers new encouraging perspectives for the improvement of critically ill patient outcome, for the early recognition of metabolic profiles associated with the development of diseases in the adult life, and for delivery of individualized medicine. In this view, nutrimetabolomics, based on the recognition of specific cluster of metabolites associated with nutrition and pharmacometabolomics, based on the capacity to personalize drug therapy by analyzing metabolic modifications due to therapeutic treatment may open new frontiers in the prevention and in the treatment of pediatric and neonatal diseases. This review summarizes the most relevant results published in the literature on the application of metabolomics in pediatric and neonatal clinical settings. However, there is the urgent need to standardize physiological and preanalytical variables, analytical methods, data processing, and result presentation, before establishing the definitive clinical value of results.
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Affiliation(s)
- Michele Mussap
- Laboratory Medicine Service, IRCCS AOU San Martino-IST, University-Hospital, National Institute for Cancer Research, Genova, Italy
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Lee SM, Namgung R, Park MS, Eun HS, Kim NH, Park KI, Lee C. Parenteral nutrition associated cholestasis is earlier, more prolonged and severe in small for gestational age compared with appropriate for gestational age very low birth weight infants. Yonsei Med J 2013; 54:839-44. [PMID: 23709416 PMCID: PMC3663238 DOI: 10.3349/ymj.2013.54.4.839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that parenteral nutrition associated cholestasis (PNAC) would be more severe in small for gestational age (SGA) compared with appropriate for gestational age (AGA) very low birth weight (VLBW) infants. MATERIALS AND METHODS Sixty-one VLBW infants were diagnosed as PNAC with exposure to parenteral nutrition with elevation of direct bilirubin≥2 mg/dL for ≥14 days. Twenty-one SGA infants and 40 AGA infants matched for gestation were compared. RESULTS Compared with AGA infants, PNAC in SGA infants was diagnosed earlier (25±7 days vs. 35±14 days, p=0.002) and persisted longer (62±36 days vs. 46±27 days, p=0.048). Severe PNAC, defined as persistent elevation of direct bilirubin≥4 mg/dL for more than 1 month with elevation of liver enzymes, was more frequent in SGA than in AGA infants (61% vs. 35%, p=0.018). The serum total bilirubin and direct bilirubin levels during the 13 weeks of life were significantly different in SGA compared with AGA infants. SGA infants had more frequent (76% vs. 50%, p=0.046), and persistent elevation of alanine aminotransferase. CONCLUSION The clinical course of PNAC is more persistent and severe in SGA infants. Careful monitoring and treatment are required for SGA infants.
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Affiliation(s)
- Soon Min Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hyo Kim
- Department of Pediatrics, Sung-Ae General Hospital, Seoul, Korea
| | - Kook In Park
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Lee
- Division of Neonatology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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