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Osteen SJ, Yang Z, McKinzie AH, Teal E, Tepper RS, Rhoads E, Quinney SK, Haneline LS, Haas DM. Long-term childhood outcomes for babies born at term who were exposed to antenatal corticosteroids. Am J Obstet Gynecol 2023; 228:80.e1-80.e6. [PMID: 35872037 PMCID: PMC9790027 DOI: 10.1016/j.ajog.2022.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/21/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Antenatal corticosteroids improve neonatal outcomes when administered to infants who are at risk of preterm delivery. Many women who receive antenatal corticosteroids for threatened preterm labor proceed to deliver at term. Thus, long-term outcomes should be evaluated for term-born infants who were exposed to antenatal corticosteroids in utero. OBJECTIVE This study aimed to compare long-term outcomes between term-born children aged ≥5 years who were born to women who received antenatal corticosteroids for threatened preterm labor and children whose mothers were also evaluated for threatened preterm labor but did not receive antenatal corticosteroids. STUDY DESIGN We performed a retrospective cohort study of children born at ≥37 weeks' gestation, aged ≥5 years, and born to mothers diagnosed with threatened preterm labor during pregnancy. The primary exposure of interest was receiving antenatal corticosteroids. Among the collected childhood medical conditions, the primary outcome of interest was a diagnosis of asthma. RESULTS Of the 3556 term-born children aged ≥5 years, 629 (17.6%) were exposed to antenatal corticosteroids (all betamethasone), and 2927 (82.3%) were controls whose mothers were evaluated for threatened preterm birth but did not get antenatal corticosteroid injections. Women receiving antenatal corticosteroids had higher rates of maternal comorbidities (diabetes mellitus, hypertension; P≤.01). Antenatal corticosteroid-exposed children had no difference in diagnosis of asthma (12.6% vs 11.6%), attention deficit disorder, or developmental delay (P=.47, .54, and .10, respectively). Controlling for maternal and neonatal characteristics, asthma was not different between those exposed to antenatal corticosteroids and controls (odds ratio, 1.05; 95% confidence interval, 0.79-1.39). The odds of the child's weight percentile being <10% were increased for antenatal corticosteroid-exposed children born at term (odds ratio, 2.00; 95% confidence interval, 1.22-3.25). CONCLUSION Children born at term who were exposed to antenatal corticosteroids may have increased odds of being in a lower growth percentile than those not exposed. However, rates of diagnoses such as asthma, developmental delay, and attention deficit disorders were not different.
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Affiliation(s)
- Samantha J Osteen
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Ziyi Yang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Alexandra H McKinzie
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | | | - Robert S Tepper
- Division of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN
| | - Eli Rhoads
- Division of Pediatric Pulmonology, Indiana University School of Medicine, Indianapolis, IN
| | - Sara K Quinney
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Laura S Haneline
- Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.
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Bruno AM, Blue NR, Allshouse AA, Haas DM, Shanks AL, Grobman WA, Simhan H, Reddy UM, Silver RM, Metz TD. Marijuana use, fetal growth, and uterine artery Dopplers. J Matern Fetal Neonatal Med 2022; 35:7717-7724. [PMID: 34470115 PMCID: PMC9080638 DOI: 10.1080/14767058.2021.1960973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/07/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Marijuana (MJ) use is associated with adverse effects on fetal growth. We aimed to investigate the timing of suboptimal fetal growth onset in MJ-exposed pregnancies. In addition, we aimed to explore the relationship between MJ-exposure and both abnormal uterine artery (UtA) Doppler parameters and small for gestational age (SGA). STUDY DESIGN This was a secondary analysis of a prospective multicenter cohort that enrolled nulliparous individuals delivering non-anomalous fetuses beyond 20 weeks' gestation. Marijuana exposure was ascertained by self-report or clinical urine toxicology testing. Ultrasound estimated fetal weights (EFWs) were assessed in participants at both 16w0d-21w6d and 22w0d-29w6d. EFWs and birth weight (BW) were converted to weight percentiles (wPCT). EFW and BW wPCTs were calculated using population-based standards. Additionally, a customized standard designed to be applicable to both EFWs and BWs within the same model was also used to allow for EFW to BW percentile trajectories. The primary outcome, longitudinal wPCT, was compared between individuals with and without MJ use in a linear mixed-effects regression model adjusting for tobacco. For modeling, wPCT was smoothed across gestational age; MJ was estimated as an intercept and linear difference in the slope of gestational age. UtA Doppler notching, resistance index (RI), and pulsatility index (PI) at 16w0d-21w6d were compared using t-test and χ2. SGA at delivery was also compared. RESULTS Nine thousand one hundred and sixty-three individuals met inclusion criteria; 136 (1.5%) used MJ during pregnancy. Individuals who used MJ were more likely to be younger, identify as non-Hispanic Black, and have had less education. Fetuses exposed to MJ had lower wPCT beginning at 28 weeks using population-based and customized standards, when compared to those without exposure. UtA notching, PI, and RI were similar between groups. SGA was more frequent in neonates exposed to MJ using both population-based (22 vs. 9%, p<.001) and customized (25 vs. 14%, p<.001) curves. CONCLUSIONS MJ-exposed fetuses were estimated to be smaller than unexposed fetuses starting at 28 weeks' gestation across both growth standards without a difference in UtA Doppler parameters.
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Affiliation(s)
- Ann M. Bruno
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Nathan R. Blue
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Amanda A. Allshouse
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
| | - David M. Haas
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - Anthony L. Shanks
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN, USA
| | - William A. Grobman
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL, USA
| | - Hyagriv Simhan
- Department of Obstetrics & Gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Uma M. Reddy
- Department of Obstetrics & Gynecology, Yale University, New Haven, CT, USA
| | - Robert M. Silver
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
| | - Torri D. Metz
- Department of Obstetrics & Gynecology, University of Utah Health, Salt Lake City, UT, USA
- Department of Obstetrics & Gynecology, Intermountain Healthcare, Murray, UT, USA
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Bruckner M, Khan Z, Binder C, Morris N, Windisch B, Holasek S, Urlesberger B. Extremely Preterm Infants Have a Higher Fat Mass Percentage in Comparison to Very Preterm Infants at Term-Equivalent Age. Front Pediatr 2020; 8:61. [PMID: 32219084 PMCID: PMC7078645 DOI: 10.3389/fped.2020.00061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Early nutritional support of preterm infants is important because it influences long-term health and development. Body composition has an influence on cardiovascular disease, metabolic syndrome, and neurocognitive outcome in the long term. Objective: To assess body composition in preterm infants <32 weeks of gestation at term-equivalent age and to analyze the influence of an optimized nutritional approach. Methods: This is a prespecified secondary outcome analysis of a prospective observational study comparing the body composition in regard to gestational age. The preterm infants were classified according to gestational age as extremely preterm infants (<28 weeks gestation at birth) and very preterm infants (≥28 weeks gestation at birth) and according to weight percentile as appropriate for gestational age and small for gestational age. Body composition was determined by air displacement plethysmography using the PEA POD. The preterm infants obtained nutrition according to the ESPGHAN 2010 Guidelines. Results: Seventy-four preterm infants were analyzed. The mean (SD) gestational age was 28.7 (2.4) weeks, and birth weight was 1,162 (372) g. Fat mass percentage was significantly higher in extremely preterm infants in comparison to very preterm infants [17.0, 95% confidence interval (CI) 15.9-18.1 vs. 15.5, 95% CI 14.7-16.2]. There was no significant difference of fat mass percentage according to weight percentiles. Conclusions: Extremely preterm infants had a significantly higher fat mass percentage compared to very preterm infants at term-equivalent age. There was no significant difference of fat mass percentage according to weight percentiles.
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Affiliation(s)
- Marlies Bruckner
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Zahra Khan
- Department of Food Science and Human Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Christoph Binder
- Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicholas Morris
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernadette Windisch
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Holasek
- Division of Immunology and Pathophysiology, Otto Loewi Research Centre, Medical University Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Puccio G, Giuffré M, Piccione M, Piro E, Malerba V, Corsello G. Intrauterine growth pattern and birthweight discordance in twin pregnancies: a retrospective study. Ital J Pediatr 2014; 40:43. [PMID: 24887062 PMCID: PMC4018970 DOI: 10.1186/1824-7288-40-43] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Twins, compared to singletons, have an increased risk of perinatal mortality and morbidity, due mainly to a higher prevalence of preterm birth and low birthweight. Intrauterine growth restriction (IUGR) is also common and can affect one or both fetuses. In some cases, however, one twin is much smaller than the other (growth discordance). Usually, high birthweight discordance is associated with increased perinatal morbidity. The aim of this study is to describe the epidemiological features of a population of twins at birth, with particular reference to the interpretation and clinical effects of birthweight discordance. METHODS We evaluated retrospectively the clinical features of 70 infants born from twin pregnancies and assessed birthweight discordance in 31 pregnancies where both twins were followed at our institution. Discordance was treated both as a continuous and a categorical variable, using a cutoff of 18%. Possible relationships between birthweight discordance and other variables, such as maternal age, gestational age, birthweight percentile, number of SGA newborns in the pair, Hematocrit (Ht) discordance and neonatal anemia, prevalence of malformations, neonatal morbidity and death, were analyzed. RESULTS In our cohort birthweight percentile decreased slightly with increasing gestational age. Birthweight discordance, on the contrary, increased slightly with the increase of gestational age.A high discordance is associated to the presence of one SGA twin, with the other AGA or LGA. In our population, all 6 pregnancies in which discordance exceeded 18% belonged to this category (one SGA twin).Ht discordance at birth is associated to the presence of neonatal anemia in a twin, but it is not significantly related to weight discordance.Finally, in our case history, weight discordance is not associated in any way with the prevalence of malformations, morbidity and mortality. CONCLUSIONS Birthweight discordance is an important indicator of complications that act asymmetrically on the two fetuses, affecting intrauterine growth in one of them, and usually determining the birth of a SGA infant.Our case history shows a significant statistical association between pair discordance and IUGR in one of the twins, but we could not demonstrate any relationship between discordance and the prevalence of malformations, morbidity and mortality.
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Affiliation(s)
- Giuseppe Puccio
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
| | - Mario Giuffré
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
| | - Maria Piccione
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
| | - Ettore Piro
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
| | - Valentina Malerba
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
| | - Giovanni Corsello
- Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Università degli Studi di Palermo, Palermo, Italy
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