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Objectives: The size, shape, and contractility of the heart's atrial chambers have not been evaluated in fetuses with growth restriction (FGR) or who are small-for-gestational-age (SGA) as defined by the Delphi consensus protocol. This study aimed to examine the atrial chambers using speckle tracking analysis to identify any changes that may be specific for either growth disturbance., Methods: Sixty-three fetuses were evaluated with an estimated fetal weight <10th percentile who were classified as FGR or SGA based on the Delphi consensus protocol. The atrial cardiac cycle was defined as end-diastole, end-systole, and end-diastole, equivalent to ventricular end-systole, end-diastole, and end-systole. The atrial size, shape, and contractility were computed from 24 transverse segments and one length measurement identified from speckle tracking analysis of the endocardium at end-diastole and end-systole. The z-score for each atrial measurement was computed using the mean and standard deviation equations from a control group of 200 fetuses. The z-score values were compared between the control and FGR/SGA fetuses as well as between FGR and SGA fetuses using the Kruskal-Wallis test. A P-value of <.05 was considered significant., Results: Of the 63 fetuses with an estimated fetal weight (EFW) <10th percentile, 60% (38/63) were classified as FGR and 40% (25/63) as SGA. The following abnormal atrial measurements were unique to FGR fetuses: decreased end-diastolic left atrial (LA) area, decreased LA base and mid-chamber end-diastolic width, decreased LA base sphericity index, decreased right atrial (RA) mid-chamber sphericity index, decreased LA ejection volume, and decreased LA emptying volume. The following were unique to the SGA fetuses: Increased RA mid-chamber length, decreased LA fractional area change, decreased RA reservoir strain, decreased RA basal-apical length fractional shortening, and decreased LA base width transverse fractional shortening. The significant difference was an increased LA mid-chamber length in the SGA fetuses., Conclusions: Fetuses with an EFW <10th percentile who are classified as either SGA or FGR demonstrate unique abnormalities of atrial size, shape, and contractility, thus allowing the examiner to differentiate between FGR and SGA fetuses., (© 2025 American Institute of Ultrasound in Medicine.)

Objective: To evaluate the impact of twin dating by ultrasound-measured crown-rump length (CRL) of the larger (CRL-L), smaller (CRL-S) or mean twin measurement (CRL-M) on the rates of preterm birth (PTB) and detection of small for gestational age (SGA) births., Design: A retrospective cohort study., Setting: A tertiary fetal medicine centre (London, UK)., Population or Sample: All twin pregnancies between 1998 and 2023 who underwent first trimester CRL ultrasound assessment and fetal growth assessment., Methods: Data collection included CRL measurement, estimated fetal weight (EFW), pregnancy outcome and birthweight (BW) for each twin. Pregnancies were retrospectively re-dated by CRL-S, CRL-L and CRL-M., Main Outcome Measures: SGA < 10th centile and extreme PTB rates (< 28 weeks)., Results: In the 1129 twin pregnancies, median CRL-S was 61 mm (interquartile range [IQR]: 56.0-66.0) and CRL-L was 63 mm (IQR: 58.4-68.9) with a mean discordance of 4.0%. Prenatal SGA diagnosis occurred in 19.8% and 23.1% of smaller twins when dated by CRL-S and CRL-L, respectively. When pregnancies were dated by CRL-M versus CRL-S or CRL-L, there was no difference in prenatal SGA diagnosis (p = 0.275 and p = 0.419); SGA at birth (p = 0.132 and p = 0.325); or extreme PTB (p = > 0.999 and p = 0.765 respectively)., Conclusions: Dating by the smaller, larger or mean twin CRL does not significantly alter rates of extreme preterm birth, SGA detection or SGA birth. Dating by the mean twin CRL reduces stigmatisation of the smaller twin and retains the utility of accurate gestational age assessment without impacting clinical outcomes., (© 2025 John Wiley & Sons Ltd.)

Objective: The objective of this study was to conduct a longitudinal assessment of inter-twin growth and Doppler discordance, to identify possible distinct patterns, and to investigate the predictive value of longitudinal discordance patterns for adverse perinatal outcomes in twin pregnancies., Methods: This retrospective cohort study included twin pregnancies followed and delivered at a tertiary University Hospital in London (UK), between 2010 and 2023. We included pregnancies with at least three ultrasound assessments after 18 weeks and delivery after 34 weeks' gestation. Monoamniotic twin pregnancies, pregnancies with twin-to-twin transfusion syndrome, genetic or structural abnormalities, or incomplete data were excluded. Data on chorionicity, biometry, Doppler indices, maternal characteristics, and obstetric as well as neonatal outcomes were extracted from electronic records. Doppler assessment included velocimetry of the umbilical artery, middle cerebral artery and cerebroplacental ratio. Inter-twin growth discordance was calculated for each scan. The primary outcome was a composite of perinatal mortality and neonatal morbidity. Statistical analysis involved multilevel mixed-effects regression models and unsupervised machine learning algorithms, specifically k-means clustering, to identify distinct patterns of inter-twin discordance and their predictive value. Predictive models were compared using the area under the receiver operating characteristics curve, calibration intercept, and slope, validated with repeated cross-validation. Analyses were performed using R, with significance set at p<0.05., Results: Data from a total of 823 twin pregnancies (647 dichorionic, 176 monochorionic) were analyzed. Five distinct patterns of inter-twin growth discordance-low-stable (n=204, 24.8%), mild-decreasing (n=171, 20.8%), low-increasing (n=173, 21.0%), mild-increasing (n=189, 23.0%), and high-stable (n=86, 10.4%)-were derived using an unsupervised learning algorithm that clustered twin pairs based on the progression and patterns of discordance over gestation. In the high-stable cluster, the rates of perinatal morbidity (46.5%, 40/86) and mortality (9.3%, 8/86) were significantly higher, compared to the low-stable (reference) cluster (p<0.001). High-stable growth pattern was also associated with a significantly higher risk of composite adverse perinatal outcomes (Odds ratio 70.19, 95% confidence interval 24.18-299.03, p<0.001; adjusted Odds ratio 76.44, 95% confidence interval 25.39-333.02, p<0.001). The model integrating discordance pattern with CPR discordance at the last ultrasound before delivery demonstrated superior predictive accuracy, evidenced by the highest area under the receiver operating characteristics curve of 0.802 (95% confidence interval 0.712 - 0.892 0.046, p<0.001), compared to only discordance patterns (area under the receiver operating characteristics curve 0.785, 95% confidence interval 0.697 -0.873), intertwin weight discordance at the last ultrasound prior to delivery (area under the receiver operating characteristics curve 0.677, 95% confidence interval 0.545 - 0.809), combination of single measurements of estimated fetal weight and CPR discordance at the last ultrasound prior to delivery (area under the receiver operating characteristics curve 0.702, 95% confidence interval 0.586 -0.818) and single measurement of CPR discordance only at the last ultrasound (area under the receiver operating characteristics curve 0.633, 95% confidence interval 0.515 - 0.751)., Conclusion: We identified five distinct trajectories of inter-twin fetal growth discordance using an unsupervised machine learning algorithm. Consistent high discordance is associated with increased rates of adverse perinatal outcomes, with a dose-response relationship. Additionally, a predictive model integrating discordance trajectory and CPR discordance at the last visit demonstrated superior predictive accuracy for the prediction of composite adverse perinatal outcomes, compared to either of these measurements alone or a single value of estimated fetal weight discordance at the last ultrasound prior to delivery., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Maternal stress is a potential factor affecting fetal growth, but it is unknown whether it directly affects fetal growth restriction. This study aims to investigate the association between pre-pregnancy maternal stress with small for gestational age (SGA)., Methods: This study used a population-based retrospective cohort analysis to examine the association between pre-pregnancy maternal stress and SGA in offspring. Data were extracted from the National Preconception Health Care Project (NPHCP), conducted between 2010 and 2012, which encompassed preconception health-related information from 572,989 individuals across various regions in China. Logistic regression models were used to assess the associations between pre-pregnancy maternal stress variables and the risk of SGA. In addition, Synthetic Minority Over-sampling Technique (SMOTE) and Propensity Scores (PS) methods were used to enhance the model's ability to the associations between pre-pregnancy maternal stress and SGA., Results: Pre-pregnancy maternal stress was significantly associated with an increased the risk of SGA in offspring (OR 1.35, 95% CI 1.20 to 1.51, P < 0.001). Stress related to life and economic factors notably increased the risk of SGA across different socio-economic conditions, whereas stress related to friends did not show a statistically significant association (P > 0.05). Specially, individuals with lower socio-economic status that characterized by below high school education levels (OR = 1.45, 95% CI: 1.23 to 1.70), farmer occupation (OR = 1.33, 95% CI: 1.15 to 1.55, P = 0.002), rural residence (OR = 1.38, 95% CI: 1.22 to 1.56, P < 0.001), and younger age (under 35 years: OR = 1.35, 95% CI: 1.20 to 1.52, P < 0.001) were more susceptible to pre-pregnancy maternal stress, increasing their risk of SGA., Conclusions: Pre-pregnancy maternal stress was positively associated with an increased risk of SGA in offspring. Individuals with lower socio-economic status were more likely to experience pre-pregnancy maternal stress related to life and economic factors, which in turn contributed to a higher risk of SGA., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethics approval from the Institutional Review Board of the Chinese Association of Maternal and Child Health Studies (IRB201001), and all participants provided written informed consent upon enrollment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Identifying fetal growth restriction and distinguishing it from a constitutionally small fetus can be challenging. The umbilical vein blood flow is a surrogate parameter of the amount of oxygen and nutrients delivered to the fetus, providing valuable insights about the function of the placenta. Nevertheless, currently, this parameter is not used in the diagnosis and management of fetal growth restriction., Objectives: To evaluate the umbilical vein blood flow and fetal growth velocity in small for gestational age fetuses and in fetal growth restriction, and to evaluate their capacity to predict adverse perinatal outcome and iatrogenic preterm birth. Secondly, to assess the correlation between umbilical vein blood flow and fetal growth velocity., Study Design: This was a prospective multicentric observational cohort study of women with a diagnosis of small for gestational age or fetal growth restriction in which fetal biometry and Doppler assessment, including umbilical vein blood flow measurement, were performed. The fetal growth velocity was derived from the difference between the estimated fetal weight calculated in two consecutive sonographic evaluations. The pregnancies were followed until delivery. Between-group differences were evaluated, and Pearson or Spearman correlation coefficients were reported to assess the relationship between variables of interest. Optimal cut-offs on the resulting receiver operating characteristic curve were determined and used to predict the outcomes of interest. Simple and multiple logistic regression models were estimated using umbilical vein blood flow and fetal growth velocity to predict adverse perinatal outcomes and iatrogenic preterm birth., Results: The study population included 64 small for gestational age and 58 growth restricted fetuses. When compared to reference ranges, small for gestational age fetuses had significantly lower fetal growth velocity and umbilical vein blood flow (p<0.001). When compared to small for gestational age, fetuses with growth restriction had lower umbilical vein blood flow (p<0.001), umbilical vein blood flow corrected for estimated fetal weight and abdominal circumference (p<0.01 and p<0.001), and fetal growth velocity (p<0.001). Fetal growth velocity was positively correlated with umbilical vein blood flow (r=0.46, p<0.001). The multivariable logistic regression analyses showed that, after adjusting for diagnosis of fetal growth restriction, umbilical vein blood flow ≤0.65 MoM (adjusted odds ratio [aOR] 3.5; 95%CI 1.0-11.8) and fetal growth velocity ≤0.63 MoM (aOR 3.0, 95%CI 1.2-7.9) were associated with adverse perinatal outcome. Furthermore, when accounting for fetal growth restriction diagnosis, umbilical vein blood flow ≤0.60 MoM (aOR 5.2, 95%CI 1.7-15.9), and fetal growth velocity ≤0.63 MoM (aOR 3.6, 95%CI 1.1-12.6) were significant predictors of iatrogenic preterm birth., Conclusions: Umbilical vein blood flow could play a role to identify fetuses with fetal growth restriction and to predict fetal growth at the subsequent biometric evaluation. We found a significant correlation between umbilical vein blood flow and fetal growth. Umbilical vein blood flow and fetal growth velocity are independent predictors of iatrogenic preterm birth and adverse perinatal outcome in a population of small fetuses, regardless of the Delphi consensus criteria. These results support future study on the predictive value of this parameter in fetuses with a suspected fetal growth restriction., (Copyright © 2025. Published by Elsevier Inc.)

Background: Optimal management of fetuses diagnosed as small for gestational age based on an estimated fetal weight of <10th percentile represents a major clinical problem. The standard approach is to increase fetal surveillance with serial biometry and antepartum testing to assess fetal well-being and timing of delivery. Observational studies have indicated that maternal rest in the left lateral position improves maternal cardiac output and uterine blood flow. However, maternal bed rest has not been recommended based on the results of a randomized clinical trial that showed that maternal rest does not improve fetal growth in small-for-gestational-age fetuses. This study was conducted to revisit this question., Objective: This study aimed to determine whether maternal bed rest was associated with an increase in the fetal biometric parameters that reflect growth after the diagnosis of a small-for-gestational-age fetus., Study Design: A retrospective study was conducted on fetuses who were diagnosed as small for gestational age because of an estimated fetal weight of <10th percentile for gestational age. The mothers were asked to rest in the left lateral recumbent position. Fetal biometry was performed 2 weeks after the diagnosis. All fetuses before entry into the study had a previous ultrasound that demonstrated an estimated fetal weight of >10th percentile. To assess the response to bed rest, the change in fetal biometric parameters (estimated fetal weight, head circumference, abdominal circumference, and femur length) after the recommendation of bed rest was computed for 2 periods: (1) before the diagnosis of a weight of <10th percentile vs at the time of diagnosis of a weight of <10th percentile and (2) at the time of diagnosis of a weight of <10th percentile vs 2 weeks after maternal bed rest. For repeated measures, proportions were compared using the McNemar test, and percentile values were compared using the Bonferroni Multiple Comparison Test. A P value of <.05 was considered significant. To describe changes in the estimated fetal weight without bed rest, 2 control groups in which the mothers were not placed on bed rest after the diagnosis of a small-for-gestational-age fetus were included., Results: A total of 265 fetuses were observed before and after maternal bed rest. The following were observed in this study: (1) after 2 weeks of maternal rest, 199 of 265 fetuses (75%) had a fetal weight of >10th percentile; (2) the median fetal weight percentile increased from 6.8 (interquartile range, 4.4-8.4) to 18.0 (interquartile range, 9.5-29.5) after 2 weeks of bed rest; (3) similar trends were noted for the head circumference, abdominal circumference, and femur length. In the groups of patients who were not asked to be on bed rest, a reassignment to a weight of >10th percentile at a follow-up examination only occurred in 7 of 37 patients (19%) in the Texas-Michigan group and 13 of 111 patients (12%) in the Colorado group compared with the bed rest group (199/265 [75%]) (P<.001)., Conclusion: Patients who were prescribed 2 weeks of bed rest after the diagnosis of a fetal weight of <10th percentile had an increase in weight of >10th percentile in 199 of 265 fetuses (75%). This increase in fetal weight was significantly higher than that in the 2 control groups in which bed rest was not prescribed. This observation suggests that bed rest improves fetal growth in a subset of patients., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to investigate changes in the blood metabolic profiles of newborns with varying intrauterine growth conditions. Specifically, we analyzed the levels of amino acids, carnitine, and succinylacetone among full-term newborns, including small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). We aim to identify differential metabolites and metabolic pathways that may offer insights into clinical interventions., Methods: A total of 5106 full-term newborns were included in the study. Blood samples were obtained from all newborns between 3 and 5 days after birth and analyzed using tandem mass spectrometry to detect blood metabolites. Subsequently, we screened for different metabolites and metabolic pathways among the groups using the MetaboAnalystR package (Version 1.0.1) in R software (R-3.6.0)., Results: The levels of blood amino acids and carnitine metabolism differed significantly among newborns with varying intrauterine growth conditions. Full-term SGA newborns exhibited a decrease in multiple amino acids and an increase in multiple carnitines, while full-term LGA newborns showed an increase in multiple amino acids and acylcarnitines., Conclusion: Continuous monitoring of the short-term and long-term growth and metabolic status of full-term SGA and LGA newborns is warranted with individualized dietary and nutritional adjustments to promote healthy growth in a timely manner. The findings of this research contribute to the broader understanding of SGA/LGA and shall inform future research on metabolomics, interventions, and long-term outcomes., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2024 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Introduction: The placenta supports the metabolic and respiratory requirements of the fetus. Placental disorders, caused by various pathophysiological mechanisms, may result in adverse pregnancy and neonatal outcomes. Knowledge gaps remain in the understanding, reporting and interpretation of placental pathology relating to clinical conditions. This project aimed to collaboratively identify the most important unanswered research questions related to placental pathology., Methods: An international Priority Setting Partnership (PSP) was conducted, involving (perinatal) pathologists, obstetricians, paediatrician-neonatologists, midwives, and scientists with expertise in placental pathology. In the first survey, participants identified their three most important unanswered research questions. Afterwards literature was reviewed for evidence on the proposed questions. In a second survey, participants ranked the most important questions from an initial long-list. The top-ranked questions were then discussed and finalized in a 1-h online consensus workshop., Results: Ninety participants completed the first survey. The majority of stakeholders were perinatal pathologists (n = 39 (43.3 %) and most were based in Europe (n = 43 (47.8 %). 270 questions were submitted; after review, these were subdivided into 32 overarching questions. The second ranking survey was completed by 53 participants. Twenty-five participants attended the online workshop, which reached consensus on the top 10. The questions focus, among others, on causes, recurrence risk, consistency of reporting, diagnosing tools and potential use of artificial intelligence., Discussion: Following this international PSP, the top 10 prioritized research questions on placental pathology have been identified. This will inform the research agenda for funders and policy-makers, and is intended to improve care for patients suffering from placental insufficiency., Competing Interests: Declaration of competing interest The authors report no potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aimed to investigate the association between maternal factors and first-trimester biophysical and biochemical markers with small for gestational age (SGA) neonates in twin pregnancies (TwPs)., Methods: Single-center retrospective cohort study of TwPs followed from January 2010 to December 2022 at a tertiary perinatal center, Portugal. Maternal and pregnancy characteristics, mean arterial pressure, pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-HCG), and uterine artery pulsatility index (UtA-PI) were analyzed. Univariable, multivariable logistic regression (LR) and receiver-operating characteristic curve analyses were performed. The main outcome measures considered were: SGA < 3rd, < 5th and < 10th percentile, the composite outcome of SGA combined with preterm birth (PTB) (< 32, < 34, and < 36 weeks)., Results: 572 TwPs were included, 450 (78.7%) DC and 122 (21.3%) MC. TwPs affected with SGA < 3rd, < 5th or < 10th percentiles were 120/572 (20.9%), 157/572 (27.4%) and 190/572 (33.2%), respectively. SGA < 3rd percentile was associated with a higher rate of PTB, 59.0% of cases < 32 weeks, OR 6.4 (95% CI: 3.2-12.7, p < 0.001). Shorter maternal height, UtA-PI ≥ 95th percentile, and low PAPP-A were identified as significant independent risk factors associated with SGA and SGA combined with PTB. The best LR model was obtained for the composite outcome SGA < 3rd percentile and PTB < 32 weeks, with an AUC of 0.834, a sensitivity rate of 77%, and a false positive rate of 17%., Conclusion: The majority of pregnancies at risk for SGA combined with prematurity can be detected in the first trimester. However, larger datasets are necessary to develop robust predictive models., Competing Interests: Declarations. Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Ethical approval: The present study was sought and granted approval by the Local Ethical Committees of Nova Medical School-Universidade Nova de Lisboa (No. 81/2020/CEFCM) and CHULC (reference number 950/2020). Both retrospective analyses before 2020 and prospective inclusions after 2020 were approved by the ethical committees, according to institutional policies and national laws. Consent to participate and for publication: Verbal informed consent was obtained from all subjects for participation and publication of data collection and obstetric outcomes in this cohort. Written consent was not sought for the present study before 2020 due to its retrospective nature and anonymous data collection. After 2020, written consent was obtained from all subjects for participation and publication. Declaration of generative AI and AI-assisted technologies in the writing process: During the preparation of this work, the authors used ChatGTP 3.5 only to improve language and readability. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the publication’s content., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: An increasing number of childbearing-aged women have undergone bariatric surgery (BS). Although pregnancy outcomes generally improve after BS, concern remains over the impact of rapid weight loss and the catabolic state that occurs soon after BS. At least a 12-month surgery-to-conception time (SCT) is recommended, though the reasoning behind this has been questioned. This retrospective study was conducted to compare post-BS pregnancies with SCTs of less (Group 1) or more (Group 2) than 12 months., Methods: The Hospital Register and Finnish Medical Birth Register were queried for data on BS and subsequent pregnancies. The characteristics of women at surgery and maternal and newborn outcomes in post-BS pregnancies were collected., Results: Between 2010 and 2022, 113 women gave birth after BS. This included 17 and 96 patients in Groups 1 and 2. The mean SCTs were 8.0 ± 2.7 and 39.0 ± 24.3 months (p < 0.001), respectively. At BS, the characteristics of age (p = 0.316), weight (p = 0.718), body mass index (BMI) (p = 0.114) and surgical technique used (p = 0.648) were similar. During pregnancy, the mean age of Group 1 women was significantly lower (p = 0.005). With no difference in weight (p = 0.961) or BMI (p = 0.567), the incidence of gestational diabetes mellitus (GDM, p = 0.039) was higher in Group 2. The mean gestational age at delivery (p = 0.206) and incidence rates of preterm (p = 0.645), post-term (p = 1.00) and caesarean deliveries (p = 1.00) in the groups were similar. A significantly higher incidence of delivery induction (p < 0.001 was detected in Group 2. The mean newborn weight in Group 1 was lower (p = 0.038), but the mean birth weight standard deviation (p = 0.883) and incidences of low birth weight (< 2500 g, p = 0.345) and small-for-gestational-age newborns (p = 0.469) were similar. The 1- (p = 0.191) and 5-min (p = 0.174) Apgar points in the groups were similar, and no associations between pregnancy outcomes and surgery technique were detected., Conclusions: The outcome in pregnancies with an SCT 12 months, postponing pregnancy may not always improve pregnancy outcomes. Therefore, all risks should be weighed when counselling women regarding the optimal time of pregnancy after BS., Competing Interests: Declarations. Ethical approval: Ethics approval was not needed for this retrospective study. According to Finnish legislation, informed consent from patients is not required for this type of retrospective study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Melamine, its analogues, and aromatic amines (AAs) were commonly detected in a previous study of pregnant women in the Environmental influences on Child Health Outcomes (ECHO) Cohort. While these chemicals have identified toxicities, little is known about their influences on fetal development. We measured these chemicals in gestational urine samples in 3 ECHO cohort sites to assess associations with birth outcomes (n = 1,231). We estimated beta coefficients and 95% confidence intervals (CIs) using adjusted linear mixed models with continuous dilution-standardized concentrations (log 2 transformed and scaled by interquartile range, IQR) or binary indicators for detection. As secondary analyses, we repeated analyses using categorical outcomes. Forty-one of 45 analytes were detected in at least one sample, with > 95 % detection of melamine, cyanuric acid, ammelide, and aniline. Higher melamine concentration was associated with longer gestational age (β^ per IQR increase of log 2 -transformed: 0.082 [95 % CI: -0.012, 0.177]; 2nd vs 1st tertile: 0.173 [-0.048, 0.394]; 3rd vs 1st tertile: 0.186 [-0.035, 0.407]). Similarly in secondary analyses using categorical outcomes, an IQR increase in log 2 (melamine) was associated with 1.22 [0.99, 1.50] higher odds of post-term (>40 & ≤42 weeks) as compared to full-term (≥38 & ≤40 weeks). Several AAs were associated with birthweight and gestational length, with the direction of associations varying by AA. Some stronger associations were observed in females. Our findings suggest melamine and its analogs and AAs may influence gestational length and birthweight., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: There is still uncertainty regarding the association between maternal serum levels of retinol-binding protein 4 (RBP4) and pregnancy outcomes. This study aimed to determine the association between RBP4 levels and incidence of small/large for gestational age (SGA/LGA) infants among the Chinese population., Methods: This was a retrospective study of 11,854 pregnant women who delivered at Changzhou Maternal and Child Health Care Hospital between 2016 and 2017 and whose serum RBP4 levels were measured at the time of admission. The incidence of SGA/LGA deliveries was retrieved from the medical records of the participants., Results: Maternal RBP4 levels in the second, third and fourth quartiles (28.8-34.0, 34.1-40.0, and >40.0 mg/L, respectively) were associated with lower birthweights relative to those in the first quartile (<28.8 mg/L), with estimated average decreases of 51.30 g (95% CI: -70.51, -32.10), 86.86 g (95% CI: -106.50, -67.22) and 124.08 g (95% CI: -144.51, -103.64), respectively (P for trend <0.01). Pregnant women in the fourth quartile for RBP4 levels had a greater SGA risk (OR: 2.14, 95% CI: 1.72, 2.65) and lower LGA risk (OR: 0.53, 95% CI: 0.45, 0.63) than those in the first quartile after controlling for demographic variables, gestational age, pregnancy complications and other laboratory results. The sensitivity analysis indicated the consistency of these findings., Conclusion: High RBP4 levels in late pregnancy are associated with an increased SGA risk and decreased LGA risk, indicating that serum RBP4 levels at the time of admission for delivery could be a promising predictor of SGA/LGA delivery.

The objective of this study is to evaluate whether early hypoglycemia is an independent risk factor for 2-year cognitive (COG) impairment in small for gestational age (SGA) preterm infants with gestational age (GA) < 32 weeks. We retrospectively reviewed data of 1364 preterm infants with a GA 24 +0/7 -31 +6/7  weeks. Infants were classified based on blood glucose concentrations within the first 6 h of life (HOL) as < or ≥ 40 mg/dL (Glyc < 40 [Birth-6HOL] and Glyc ≥ 40 [Birth-6HOL] , respectively) and subsequently by birth weight z-score as SGA or appropriate for gestational age (AGA). Propensity score matching analyses were conducted for each comparison. Multiple logistic regression was used to evaluate the association of Glyc < 40 [Birth-6HOL] with 2-year COG impairment, defined as a Bayley-III score < 85, in SGA infants. Out of the 747 preterm infants who met the inclusion criteria, 173 (23.2%) were classified as Glyc < 40 [Birth-6HOL] , and 574 (76.8%) as Glyc ≥ 40 [Birth-6HOL] . The proportion of SGA infants was significantly higher in Glyc < 40 [Birth-6HOL] than in Glyc ≥ 40 [Birth-6HOL] (25.4 vs 18.3%, p = 0.039). The incidence of 2-year COG impairment was significantly higher in SGA infants compared to matched AGA counterparts both in Glyc < 40 [Birth-6HOL] (+ 20%, p = 0.040) and Glyc ≥ 40 [Birth-6HOL] (+ 17%, p = 0.029). Neither in the entire cohort nor in the SGA infants, Glyc < 40 [Birth-6HOL] was significantly associated with 2-year COG impairment (aOR: 1.077, p = 0.768; 0.993, p = 0.935; respectively) after the adjustment for GA, sex, Apgar score at 5 min < 7, SGA status, complications of prematurity, duration of mechanical ventilator support > 7 days, cumulative energy intakes from birth to 36 weeks, and maternal university level., Conclusion:  Among SGA preterm infants with GA between 24 +0/7 and 31 +6/7  weeks/days, hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment., What Is Known: • Hypoglycemia is associated with poor neurodevelopmental outcomes in preterm infants. • Small for gestational age (SGA) preterm infants are more prone to cognitive (COG) impairment compared to AGA counterparts., What Is New: • In a large cohort of preterm infants < 32 weeks, the incidence of hypoglycemia within the first 6 hours of life (HOL) was higher in SGA compared to AGA. • Hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment in SGA preterm infants., Competing Interests: Declarations. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Adverse birth outcomes (preterm birth, low birth weight, small for gestational age, and stillbirth) seem to persist in infants born to people with HIV, even in the context of maternal antiretroviral therapy. However, findings have been disparate, inconclusive, and difficult to compare directly across settings, partly owing to variable outcome definitions. We aimed to collate, compare, and map existing adverse birth outcome definitions to inform a harmonized approach to universally measure these outcomes in studies including pregnant people with HIV., Methods: We conducted a scoping review of studies that reported adverse birth outcomes associated with maternal HIV and antiretroviral use in pregnancy, specifically those that included definitions of 'preterm birth', 'low birth weight', 'small for gestational age', and 'stillbirth'. Five databases were searched from 01 January 2011 to 15 August 2022. Title, abstract and full-text screening was conducted independently in duplicate. A comparative quantitative analysis was conducted to compare study characteristics by period of study (< 2013; 2013-2015; > 2016) and country income group. A qualitative content analysis was conducted to compare and map deviations from the WHO definitions as a reference., Results: Of the 294 articles that included at least one adverse birth outcome, 214 (73%) studies started before 2013, 268 (91%) were published as primary research articles, and 137 (47%) were conducted in Eastern and Southern Africa. Among the 283 studies included in the country income group analysis, 178 (63%) were conducted in low- and middle-income countries. Studies reporting low birth weight, preterm birth, small for gestational age and stillbirth deviated from the WHO definitions in n = 11/169 (7%), n = 93/246 (39%), n = 40/112 (36%) and n = 85/108 (79%) instances, respectively. The variations included the use of different thresholds and the addition of new terminology., Conclusion: The current WHO definitions are valuable tools for population-level monitoring; however, through consensus, these definitions need to be optimized for research data collection, analysis, and presentation. In conjunction with good reporting, variation in adverse birth outcome definitions can be decreased to facilitate comparability of studies as well as pooling of data for enhanced evidence synthesis., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from the Human Research Ethics Committee of Stellenbosch University (S22/07/138). This study did not involve participants. Consent for publication: Not applicable. Competing interests: The authors have no competing interests to declare., (© 2024. The Author(s).)

Background: Numerous agents in the workplace are suspected of impairing fetal growth. To date, no epidemiological studies have specifically described the occupational exposome during pregnancy., Objective: The objectives were to determine maternal occupational exposome profiles and study their associations with intrauterine growth characteristics measured by small for gestational age (SGA), birthweight (BW), and head circumference (HC)., Methods: We used data from the French national ELFE cohort. Occupational exposures to 47 agents (chemical, physical, biological, biomechanical, organizational and psychosocial), were identified using job exposure matrices. Mothers were classified as occupationally not exposed, uncertainly exposed, or exposed depending on their probability of exposure. Outcomes of interest were BW, SGA and HC. Maternal profiles of the occupational exposome were determined using hierarchical clustering of principal components. Associations between profiles and intrauterine growth outcomes were studied using linear or logistic regression models adjusted for potential confounders. Analyses were carried out depending on whether mothers stopped working during pregnancy., Results: The 12,851 included women were exposed to a median of 6 factors. Four occupational exposome profiles were identified, characterized by "low exposure, stress at work"; "strenuous, high organization, low decision"; "postural constraints, psychosocial factors", "postural and strength constraints, chemical and biological factors". In multivariate analyses, and among women who stopped working during the third trimester of pregnancy, analyses found associations between the profile "postural constraints, psychosocial factor" and SGA, and HC. None of the other exposure profiles were statistically significantly associated with foetal growth outcomes., Conclusion: The results show that the specific profile "postural constraints, psychosocial factors" may increase the risk of foetal growth retardation. Although these results need to be replicated, this study provides a first better understanding of the exposome of pregnant women at the workplace which may help to better adapt prevention strategies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Previous studies have reported that ambient air pollutants such as PM2.5 can increase the risk of adverse birth outcomes. The objective of this study was to ascertain whether air purifier usage during pregnancy is associated with a lower risk of adverse birth outcomes in a large Japanese birth cohort., Methods: We conducted a prospective cohort analysis using data from the Japan Environment and Children's Study. Use of air purifiers during pregnancy was assessed using a self-administered questionnaire. Primary outcomes were the prevalence of preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW). Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: The prevalence of outcomes was 4.5% for PTB, 7.4% for SGA, and 8.1% for LBW. The crude model analysis revealed that PTB, SGA, and LBW showed lower ORs in the group that used an air purifier, although the association disappeared in the adjusted model except for SGA (OR: 0.94; 95% CI: 0.89, 1.00, p = 0.048) and LBW (OR: 0.93; 95% CI: 0.88, 0.98, p = 0.003). Subgroup analysis stratified by infant sex revealed that the lower OR for LBW was observed only in male infants., Conclusions: Our results suggest that avoiding maternal air pollution exposure during pregnancy may be useful in preventing adverse birth outcomes. These findings provide evidence supporting the development of protective measures against air pollutants in the gestational period by relevant health agencies., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures involving human subjects in the JECS protocol were reviewed and approved by the Japanese Ministry of the Environment’s Institutional Review Board on Epidemiological Studies (100910001) and the ethics committees of all participating institutions. All participants in this study gave their informed consent. This specific research was further approved by the Institutional Review Board of the University of Toyama (R2023221). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Context: Long-term data regarding health-related quality of life (HRQoL) and problem behavior in adults born small for gestational age (SGA) who were treated with GH during childhood are lacking., Objective: To investigate longitudinal changes in HRQoL and problem behavior in adults born SGA during 12 years after cessation of childhood GH treatment (SGA-GH) and compare these with 3 control groups at age around 30 years., Participants: One hundred seventy-six SGA-GH adults and 3 untreated age-matched control groups: 50 born SGA with short stature (SGA-S), 77 born SGA with spontaneous catch-up growth to normal height (SGA-CU), and 99 born appropriate-for-gestational-age with normal height (AGA)., Main Outcome Measures: HRQoL and problem behavior were assessed using the TNO-AZL Adults Quality of Life questionnaire and Adolescent Behavior Check List at 6 months and 2, 5, and 12 years after GH cessation. Data at 12 years after GH cessation were compared with 3 control groups., Results: During 12 years after GH cessation, HRQoL remained similar on 9 subscales in SGA-GH adults but decreased on 3 subscales (gross motor functioning, pain, sleep). Externalizing problem behavior decreased significantly, and internalizing problem behavior tended to decrease. SGA-GH and SGA-S adults had similar HRQoL and problem behavior. SGA-GH adults had, compared to AGA adults, similar HRQoL on 7 subscales, lower HRQoL on 5 subscales, and more internalizing and externalizing problem behavior. All SGA adults had lower HRQoL and more internalizing problem behavior than AGA adults. Adult height associated negatively with externalizing problem behavior, but the influence was small., Conclusion: During 12 years after GH cessation, HRQoL remained mostly similar and problem behavior decreased in SGA-GH adults. SGA-GH and SGA-S adults had similar HRQoL and problem behavior. All SGA adults had lower HRQoL and more internalizing problem behavior than AGA adults., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background: Globally, small for gestational age (SGA) is increasingly prevalent, paralleling the common high-risk pregnancies with inappropriate gestational weight gain (GWG). However, whether maternal GWG was associated with their SGA offspring's long-term development remained unresolved., Objective: To examine the associations of maternal GWG with the long-term physical and neurological development of SGA children based on a real-world cohort in our hospital., Study Design: This retrospective cohort was conducted at our hospital between July 1, 2020, and December 2022. At baseline, we included 319 children diagnosed as SGA and followed up with these children for 12 to 48 months (median: 29 months). The primary outcomes were children's physical and neurological development at follow-ups which were grouped into those with inadequate, adequate, or excessive maternal GWG. We standardized the weight, height (length), body mass index, and ASQ-3 / ASQ:SE domain scores of children with different ages and genders into Z-scores to increase comparability. The adjusted odds ratio (OR) and its 95 % confidence interval (CI) controlling for covariates were calculated using the Hosmer-Lemeshow test model to assess the risk of impaired neurodevelopment., Results: Firstly, the birth weight and birth length of newborns in the inadequate GWG group were both smaller than those in the adequate GWG group and excessive GWG group. The proportions of severe SGA, neonatal respiratory distress syndrome, and bronchopulmonary dysplasia were higher in the inadequate GWG group compared to the adequate GWG group. Secondly, follow-up observations found that inadequate GWG group had significantly lower weight Z scores(0.12 vs 0.34), height Z scores(-0.11 vs 0.32)and high emaciation incidence (14.3 % vs. 5.0 %) compared to the adequate GWG group. Thirdly, in the follow-up of the neurodevelopment, children in the adequate GWG group had statistically higher Z scores in the gross motor, fine motor, problem-solving and personal-social domains compared to those in the inadequate GWG group and had statistically higher Z scores in the gross motor domain compared to those in the excessive GWG group; children in the excessive GWG group had statistically higher Z scores in the fine motor and personal-social domains compared to those in the inadequate GWG group. Inadequate GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.79, 95 % CI 1.15-2.77), fine motor (OR 1.6, 95 % CI 1.06-2.78), problem-solving (OR 2.08, 95 % CI 1.16-3.56), personal-social (OR 1.51, 95 % CI 1.05-2.18), and social-emotional (ASQ:SE) (OR 1.84, 95 % CI 1.05-3.22) domains than adequate GWG group. Meanwhile, excessive GWG group was significantly correlated with a higher risk of delayed development in gross motor (OR 1.6, 95 % CI 1.02-2.48) domain than adequate GWG group., Conclusion: Inappropriate maternal GWG (inadequate or excessive) may affect the long-term physical and neurological development of SGA infants. Pregnant women, especially those with intrauterine growth restriction, need to maintain reasonable GWG and receive close monitoring and timely interventions to improve SGA children' long-term outcomes., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background : Small vulnerable newborns (SVNs), including those born preterm, small for gestational age, or with low birth weight, are at higher risk of neonatal mortality and long-term health complications. Early exposure to maternal vaginal microbiota and breastfeeding plays a critical role in the development of the neonatal microbiota and immune system, especially in low-resource settings like Burkina Faso, where neonatal mortality rates remain high. Objectives : The DenBalo study aims to investigate the role of maternal and neonatal factors, such as vaginal and gut microbiota, immune development, and early nutrition, in shaping health outcomes in SVNs and healthy infants. Methods : This prospective cohort observational study will recruit 141 mother-infant pairs (70 SVNs and 71 healthy controls) from four health centers in Bobo-Dioulasso, Burkina Faso. The mother-infant pairs will be followed for six months with anthropometric measurements and biospecimen collections, including blood, breast milk, saliva, stool, vaginal swabs, and placental biopsies. Multi-omics approaches, encompassing metagenomics, metabolomics, proteomics, and immune profiling, will be used to assess vaginal and gut microbiota composition and functionality, immune cell maturation, and cytokine levels at critical developmental stages. Conclusions : This study will generate comprehensive data on how microbiota, metabolomic, and proteomic profiles, along with immune system development, differ between SVNs and healthy infants. These findings will guide targeted interventions to improve neonatal health outcomes and reduce mortality, particularly in vulnerable populations.

The combination of hypertension with systemic inflammation during pregnancy is a hallmark of preeclampsia, but both processes also convey dynamic information about its antecedents and correlates (e.g., fetal growth restriction) and potentially related offspring sequelae. Causal inferences are further complicated by the increasingly frequent overlap of preeclampsia, fetal growth restriction, and multiple indicators of acute and chronic inflammation, with decreased gestational length and its correlates (e.g., social vulnerability). This complexity prompted our group to summarize information from mechanistic studies, integrated with key clinical evidence, to discuss the possibility that sustained or intermittent systemic inflammation-related phenomena offer hints about viable therapeutic targets, not only for the prevention of preeclampsia, but also the neurobehavioral and other developmental deficits that appear to be overrepresented in surviving offspring. Importantly, we feel that carefully designed hypothesis-driven observational studies are necessary if we are to translate the mechanistic evidence into child health benefits, namely because multiple pregnancy disorders might contribute to heightened risks of neuroinflammation, arrested brain development, or dysconnectivity in survivors who exhibit developmental problems later in life.

Introduction: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) results from parental incompatibility in human platelet antigens (HPA) and subsequent maternal sensitization. The HPA-1a epitope is also expressed on placental tissue. Chronic placental inflammation and lower birth weight is observed more often in HPA-1a alloimmunized pregnancies, suggesting a placental component in the pathophysiology of FNAIT. Today, prediction of FNAIT severity is limited. The aim of the study was to investigate whether dysregulated maternal angiogenic proteins are associated with neonatal outcome in HPA-1a alloimmunized pregnancies., Material and Methods: Eighty-seven HPA-1a negative pregnant women were identified from a large prospective screening study in Poland (PREVFNAIT) including 43 HPA-1a immunized and 44 non-immunized controls. Placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) were measured in maternal plasma from 2nd and 3rd trimester by enzyme-linked immunosorbent assay and levels/ratios were compared between study groups, using uni- and multivariable analyses. Main outcome measures were either classic FNAIT-related (severe thrombocytopenia, petechia, intracranial hemorrhage), placenta-related (small for gestational age) or a composite variable combining them all., Results: There were no significant differences in plasma concentrations of sFlt-1, PlGF, sEng nor sFlt-1/PlGF ratio when comparing immunized and non-immunized pregnancies. Among HPA-1a alloimmunized pregnancies, increasing levels of the sFlt-1 protein in 3rd trimester were significantly associated with lower neonatal platelet count (multivariable linear regression, p = 0.024). Increased sFlt-1 and sFlt-1/PlGF ratio in 3rd trimester were significantly associated with higher odds of a composite adverse neonatal outcome in alloimmunized pregnancies (multivariable logistic regression, p = 0.029 and p = 0.019, respectively)., Conclusion: An anti-angiogenic profile in HPA-1a alloimmunized mothers is associated with a composite adverse neonatal outcome. This suggests that sFlt-1 and the sFlt-1/PlGF ratio may assist in predelivery risk stratification and clinical management decisions for FNAIT., Competing Interests: Declaration of competing interest AH is one of the founders and owners of Prophylix Pharma AS, which has been developing a prophylaxis for the prevention of FNAIT. All rights of the company were sold to RallyBio in 2019. ACT has in some previous research studies been provided with in-kind reagents from Roche Diagnostics (Rotkreuz, Switzerland) for sFlt-1 and PlGF biomarker analysis. HT received consulting fees as a research consultant and as member of steering committee for Janssen Research & Development, LLC, Spring House, PA, USA and previous payment from Prophylix AS related to patent on a monoclonal anti-HPA-1a antibody. HT is local study site principal investigator in an ongoing multicenter natural history study on FNAIT sponsored by Rallybio. The other authors report no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Hypertensive disorders of pregnancy occur in 5-10 % of pregnancies and are associated with an increased risk of adverse perinatal outcomes., Objectives: This review investigates the association between first trimester blood pressure (BP), mid-pregnancy BP drop, and BP-trajectories during pregnancy and adverse perinatal outcomes, exploring the fit of prediction and prevention., Search Strategy: Observational studies published before September 2023, reporting on desired determinants of BP and outcomes (preeclampsia (PE), severe hypertension, small for gestational age (SGA), fetal growth restriction (FGR)) were identified in MEDLINE, Embase and Cochrane., Data Collection and Analysis: Data were collected in Excel. Results were analysed per BP-determinant. Meta analysis was performed for first trimester BP., Main Results: Ten studies met selection criteria. A great variety of cut-off values were used for BP categorization. Pooled analysis of 6 studies showed that women with borderline or hypertensive first trimester BP had a higher risk of PE compared to normotensive BP, OR 3.23 (95 % CI 1.99-5.26) and 7.86 (95 % CI 1.28-48.31), respectively. Additionally, first trimester hypertension correlated with a higher risk of SGA neonate (pooled OR of 1.87 (95 % CI 1.17-2.99)) compared to normotension or borderline hypertension. Throughout pregnancy, prehypertension, hypertension, elevated and high stable trajectories increased PE risk. High-stable trajectory increased SGA neonate risk., Conclusions: The findings suggest that women with borderline and hypertensive BP in the first trimester are at increased risk for PE and SGA. However, standardization of cut-off values and BP measurement is necessary to estimate outcome risks more accurately., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to compare the neuropsychological function in early adolescence between children born small for gestational age (SGA) or large for gestational age (LGA) and those born appropriate for gestational age (AGA)., Methods: This retrospective cohort study utilized data from the Adolescent Brain Cognitive Development study in 2016-18. Children born of singleton pregnancy with complete information of birth weight and delivery week were enrolled. Their neuropsychological functioning were assessed by the brain structural magnetic resonance imaging (MRI), combined with cognitive and behavioral measurements. Linear mixed-effects models and subgroup analyses were performed., Results: Among 5,922 children aged 9-11, children born SGA and LGA demonstrated similar cognitive and behavioral performances as children born AGA (P > 0.05). In the MRI measurement, brain area and volume were lower among SGA children compared to AGA children (t=-5.626, Cohen's d = 0.448, P < 0.001; t=-6.071, Cohen's d = 0.427, P < 0.001); brain area and volume were higher among LGA children compared to AGA children (t = 8.562, Cohen's d = 0.470, P < 0.001; t = 8.562, Cohen's d = 0.470, P < 0.001). Cortical thickness was of no statistical difference (P > 0.05). These associations were confirmed by sensitivity analyses and propensity score matching., Conclusion: Children born of SGA and LGA status were associated with altered brain area and volume structure in early adolescence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aims/hypothesis: Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes because of suboptimal glucose management and glucose control and excessive weight gain. Metformin can offset these factors but is associated with small for gestational age (SGA) infants. We sought to identify risk factors for SGA infants, including the effect of metformin exposure on SGA status., Methods: In this prespecified secondary analysis of the EMERGE trial, which evaluated the effectiveness of metformin vs placebo in treating GDM and found reduced gestational weight gain and longer time to insulin initiation with metformin use, we included women with a live-born infant and known infant birthweight and gestational age at delivery. We compared the numbers of SGA infants in both groups and explored baseline predictive factors to help identify those at highest risk of delivering an SGA infant., Results: Baseline maternal characteristics were similar between SGA and non-SGA pregnancies. On multivariable-adjusted regression, no baseline maternal variables were associated with SGA status. Mothers of SGA infants were more likely to develop pre-eclampsia or gestational hypertension (18.2% vs 2.0%, p=0.001; 22.7% vs 5.4%, p=0.005, respectively); after multivariable adjustment, pre-eclampsia was positively associated with SGA status). Among SGA pregnancies, important perinatal outcomes including preterm birth, Caesarean delivery and neonatal care unit admission did not differ between the metformin and placebo groups (20.0% vs 14.3%, p=1.00; 50.0% vs 28.6%, p=0.25; 13.3% vs 42.9%, p=0.27, respectively)., Conclusions/interpretation: Pre-eclampsia was strongly associated with SGA infants. Metformin-exposed SGA infants did not display a more severe SGA phenotype than infants treated with placebo., Trial Registration: Clinical Trials.gov NCT02980276; EudraCT number: 2016-001644-19., Competing Interests: Data availability: Data are not available as ongoing and long-term follow-up is underway. Funding: Open Access funding provided by the IReL Consortium. The trial was funded by the Health Research Board of Ireland (HRB), coordinated by the HRB-Clinical Research Facility Galway. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Authors’ relationships and activities: The authors received non-financial support from Merck Healthcare KGaA and Ascensia, which contributed metformin and matched placebo and blood glucose monitoring strips, respectively. Contribution statement: FD, AE, AS, DD and MOD devised the concept for this trial and FD, AE, CN, AS, DD, PO’S and MO’D wrote the protocol. AA-I and PG performed the statistical analysis. All authors drafted and revised the manuscript and approved the final version to be published. FD and CN are accountable for the integrity of the work as a whole., (© 2024. The Author(s).)

Purpose: The study aimed to evaluate the factors influencing recombinant human growth hormone (rhGH) treatment in Chinese children with short stature born small for gestational age (SGA)., Methods: A single-centre, real-world retrospective study was conducted in short stature children born SGA in China. Outcomes were observed at 6, 12, 18, 24, 30, and 36 months. Outcome measures included height standard deviation score (HTSDS), height, growth velocity (GV), and change of HTSDS (ΔHTSDS). The study used the generalized estimating equation (GEE) to identify potential influencing factors, such as rhGH treatment duration, age at rhGH initiation, sex, 11p15 hypomethylation, GH secretion, and birth weight. A subgroup analysis was conducted to investigate the impact of 11p15 hypomethylation related to SGA or impaired GH secretion., Results: Of all 101 SGA patients included in the screening, 41 were eligible for inclusion in the study. The mean age at rhGH initiation was 5.6 ± 2.4 years. The results of the GEE analysis showed a significant association between time after rhGH initiation and HTSDS, height, GV, and ΔHTSDS. GV increased after treatment, with the highest increase observed in the first six months. Additionally, the study found negative correlations between 11p15 hypomethylation and GV, as well as between birth weight and both GV and ΔHTSDS. The study found a positive correlation between impairment in GH secretion and both GV and ΔHTSDS. No statistically significant difference was observed in the comparison of GV or ΔHTSDS between the initiation age of GH treatment and 11p15 hypomethylation. After 24 and 30 months of rhGH treatment, patients with impaired GH secretion had significantly higher ΔHTSDS scores., Conclusions: In short stature Chinese children born SGA, those without SGA-related 11p15 hypomethylation or with impaired GH secretion showed better response to rhGH treatment. These findings highlight the importance of pre-treatment evaluation, including genetic and endocrine assessments., Competing Interests: Compliance with ethical standards Conflict of interest The authors declare no competing interests. Ethical approval This study involved human participants. It was approved by the Ethic Committees of the Children’s Hospital of Fudan University ([2015]-124). Consent to participate Written informed consent was not obtained from each patient or their family guardian because this study was a single-centre, retrospective, real-world study. Consent to publish The manuscript contains no individual person’s data., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To investigate the association between infant mortality and birth weight using estimated fetal weight (EFW) versus birth-weight charts, by gestational age (GA)., Methods: This nationwide population-based study used data from the Finnish Medical Birth Register from 2006 to 2016 on non-malformed singleton live births at 24-41 +6 weeks of gestation (N = 563 630). The outcome was death in the first year of life. Mortality risks by birth-weight z score, defined as a continuous variable using Maršál's EFW and Sankilampi's birth-weight charts, were assessed using generalized additive models by GA (24-27 +6 , 28-31 +6 , 32-36 +6 , 37-38 +6 , 39-41 +6  weeks). We calculated z score thresholds associated with a two- and three-fold increased risk of infant death compared with newborns with a birth weight between 0 and 0.675 standard deviations., Results: The z score thresholds (with corresponding centiles in parentheses) associated with a two-fold increase in infant mortality were: -3.43 (<0.1) at 24-27 +6 weeks, -3.46 (<0.1) at 28-31 +6 weeks, -1.29 (9.9) at 32-36 +6 weeks, -1.18 (11.9) at 37-38 +6 weeks, and - 1.34 (9.0) at 39-41 +6 weeks according to the EFW chart. These values were - 2.43 (0.8), -2.62 (0.4), -1.34 (9.0), -1.37 (8.5), and - 1.43 (7.6) according to the birth-weight chart., Conclusion: The association between birth weight and infant mortality varies by GA whichever chart is used, suggesting that different thresholds for the screening of growth anomalies could be used across GA to identify high-risk newborns., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Preterm small for gestational age (SGA) children are at increased risk for low bone mineral content later in life; however, data on SGA children born at term are scarce. We included 44 SGA and 57 adequate for gestational age (AGA) children aged 6 to 11 years to compare bone mineral density (BMD) and bone mineral content (BMC) and to identify which anthropometric and biochemical values influence bone mineralization in these children. Fat mass, appendicular skeletal muscle mass index (ASMMI), BMC, and BMD were significantly lower in SGA children than in AGA ( P ≤ .005). Appendicular muscle mass index correlated with BMC (TBLH,FN,L1-L4) and BMD (TBLH,FN,L1-L4) in both groups (r 2 = 0.7, P < .05). In multivariate analysis, ASMMI was strongly associated with BMC and BMD in both groups. There were no differences in clinical biomarkers, calcium intake, and physical activity between the groups. Achieving adequate muscle mass contributes to adequate bone mineralization and a lower risk for low BMC and BMD in SGA children., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical Standards DisclosureThis study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Bioethics Committee of the Nutrition School (Universidad Autónoma de Querétaro). Written informed consent was obtained from all subjects and their parents.

Objective: With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity., Methods: A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes., Results: The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18-1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16-1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09-1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69-0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31-0.93, among mild cases only). A dose-response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11-1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31-3.19, for severe cases)., Conclusions: Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose-response manner and when diagnosed during the second trimester., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Maternal sleep disturbance is a risk factor for adverse outcomes like preterm birth. However, the association of maternal sleep quality and duration with the risk of the infant being small for gestational age (SGA) remains inconclusive, and the specific critical window of vulnerability has yet to be clearly identified. Therefore, this study aims to investigate the effect of maternal sleep quality and duration on the risk of having an SGA infant and to identify the critical window for this association., Methods: One thousand six hundred and seventy-seven participants from the Shenzhen Birth Cohort Study were included. Maternal sleep duration and quality during pregnancy were assessed using the Pittsburgh Sleep Quality Index (PSQI) in early (<19 weeks), mid- (24-28 weeks), and late (32-38 weeks) pregnancy. Multivariate logistic regression analyses were used to examine the association of an SGA infant with sleep duration and quality, along with their specific effects across the different pregnancy stages., Results: The pregnant women with short sleep duration (≤7 h/day) in the early stage of pregnancy appeared to have a higher risk of having an SGA infant (aOR = 1.93, 95% CI = 1.32~2.79). Additionally, poor sleep quality combined with short sleep duration was associated with an even higher risk of having an SGA infant (aOR = 2.08, 95% CI = 1.32~3.23). However, this association was observed only during early pregnancy., Conclusions: The women with short sleep duration were associated with SGA risk, and the early stage of pregnancy might be a particularly sensitive period for this relationship. Addressing maternal sleep problems during pregnancy as part of antenatal care is crucial for reducing the likelihood of having an SGA infant and improving the overall birth outcomes.

The short-term respiratory consequences of small for gestational (SGA) are only partially known. Our aim was to compare the early respiratory features between SGA and appropriate for gestational age (AGA) in very preterm infants. We conducted a secondary analysis of the French prospective EPIPAGE-2 cohort. Eligible children were those born alive before 32 weeks' gestation. The exposed group consisted of children with SGA. The unexposed group consisted of AGA children. SGA and AGA children were randomly matched in a ratio of 1:1 on the same gestational age and sex. Primary outcomes were age at final extubation and age at weaning from any respiratory support. Among 3.964 very preterm from the EPIPAGE2 cohort, 1123 SGA and 1123 AGA very preterm children were included in the study. The median gestational age was 30.0 weeks (interquartile range 28.0-31.0) in both groups. The median birthweight was 1440 g (1138-1680) in the AGA group and 1000 g (780-1184) in the SGA group. Invasive mechanical ventilation was less common in the SGA than in the AGA group: 68.6% (770/1123) versus 72.0% (808/1062), odds ratio 0.85 (95% CI [0.72-1.00]). In cases of mechanical ventilation, median age at final extubation was 4 days (1-23) and 2 days (1-9) in the SGA and AGA groups. Median postmenstrual age at weaning from any respiratory support was 33.4 weeks (31.7-35.9) in the SGA group and 32.4 weeks (31.4-34.3) in the AGA group., Conclusion: SGA is associated with delayed extubation and respiratory support weaning., What Is Known: • Small for gestational age concerns more than 30% of very preterm children. • The condition is strongly associated with increased neonatal mortality and morbidity, including bronchopulmonary dysplasia., What Is New: • Small for gestational age is associated with delayed extubation and respiratory support weaning in very preterm children. • Shortening invasive mechanical ventilation as much as possible is a crucial issue in this population to try to reduce the risk of bronchopulmonary dysplasia., Competing Interests: Declarations. Ethics approval: Recruitment and data collection at birth occurred only after families had received information and gave their consent to participate. French law and regulations have been followed. The EPIPAGE-2 cohort was approved by the national data protection authority (CNIL no. 911009) and by the appropriate ethics committees. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The study aims to explore the associations of maternal serum iodine concentrations (SIC) with thyroid function, obstetric, and birth outcomes. This was a prospective study embedded in the Huizhou Mother-Infant Cohort. Singleton mothers aged 18-45 years were enrolled at their first antenatal visits. Maternal SIC and thyroid markers were tested by inductively coupled plasma mass spectrometry and electronic chemiluminescent assay, respectively. Obstetric and birth outcomes were retrieved from the Hospital Information System. Two nested 1:1 age and body mass index-matched case-control studies were embedded in the cohort including 224 pairs of mothers with gestational diabetes mellitus (GDM) and 302 paired of newborns with small for gestational age (SGA) and their respective healthy controls. Multivariable linear and conditional logistic regression models were applied to explore the relationship of maternal SIC with obstetric complications and birth outcomes. A total of 1558 mothers were included for analysis. Receiver operating characteristic curve (ROC) analysis showed that maternal SIC in the 1st trimester (T1) had well diagnostic ability for clinical and subclinical hyperthyroidism, clinical hypothyroidism, and hypothyroxinemia with the areas under the curve of 0.907, 0.734, 0.867, and 0.927, respectively (all p < 0.05). Mothers in the highest quartile of SIC at T1 had an increased risk of SGA (OR = 2.043, 95% CI: 1.198-3.483, p = 0.009) but not for GDM risk. Maternal SIC were significantly and inversely associated with gestational weight gain (GWG), birth weight, and Ponderal index (all p < 0.05). SIC at T1 had well diagnostic values for thyroid dysfunction. High gestational SIC during early pregnancy were associated with lowered GWG, birth size, and increased risk of SGA. Study registration no: NCT03922087 at Clinicaltrial.gov.com., Competing Interests: Declarations. Ethical Approval: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by The Ethics Committees of Huizhou First Mother and Child Health Care Hospital (protocol code: 2018002 and date of approval: 9 March 2018). Consent to Participate: Informed consent has been obtained from all women at enrolment in the Huizhou Birth Cohort. Conflict of Interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To develop machine learning prediction models for small for gestational age with baseline characteristics and biochemical tests of various pregnancy stages individually and collectively and compare predictive performance., Study Design: This retrospective study included singleton pregnancies with infants born between May 2018 and March 2023. Small for gestational age was defined as a birth weight below the 10th percentile according to the Intergrowth-21st fetal growth standards. The pregnancy data were categorized into four datasets at different gestational time points (14 and 28 weeks and admission). The LightGBM framework was utilized to assess the variable importance by employing a five-fold cross-validation. RandomizedSearchCV and sequential feature selection were applied to estimate the optimal number of features. Seven machine learning algorithms were used to develop prediction models, with an 8:2 ratio for training and testing. The model performance was evaluated using receiver operating characteristic curve analysis and sensitivity at a false positive rate of 10 %., Results: We included data of 4,394 women with singleton pregnancies, including 148 (3.4%) small for gestational age infants. Women delivering small for gestational age infants exhibited significantly shorter stature and lower fundal height and abdominal circumference at admission. Maternal height, age, and pre-pregnancy weight consistently ranked among the top 20 features in prediction models with any dataset. The models incorporated variables of admission stage have strong predictive performance with the area under the curves exceeding 0.8. The prediction model developed with variables of admission stage yielded the best performance, achieving an area under the curve of 0.85 and a sensitivity of 73% at the false positive rate of 10%., Conclusions: By machine learning, various pregnancy stages' prediction models for small for gestational age showed good predictive performance, and the predictive value of variables at each pregnancy stage was fully explored. The prediction model with the best performance was established with variables of admission stage and emphasized the significance of prenatal physical examinations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: We evaluated the impact of absent end-diastolic flow in the umbilical artery (UA-AEDF) in severe small for gestational age (SGA) cases., Methods: This retrospective cohort study focused on fetuses with severe SGA (defined as birth weight ≤2.5 SD). Clinical measurements and neonatal outcomes were compared between the UA-AEDF and non-UA-AEDF groups., Results: Fifty-four patients were categorized into UA-AEDF (15 patients) and non-UA-AEDF (39 patients) groups. Regarding neonatal short-term prognosis, the UA-AEDF group showed higher rates of respiratory distress syndrome (RDS), late circulatory dysfunction, late metabolic acidosis, and retinopathy of prematurity (ROP) requiring laser treatment than the non-UA-AEDF group. However, within 32 weeks of gestation, the complication rates between the two groups were not significantly different. In the 32 weeks before delivery, the overall developmental quotient (DQ) scores of children in the UA-AEDF group were lower than those in the non-UAAEDF group. Specifically, within the UA-AEDF group, the mean DQ scores at 1.5 years of corrected age was significantly lower prior to 32 weeks of gestation than in the other groups., Discussion: This study demonstrated that UA-AEDF in severely SGA infants before 32 weeks of gestation may be associated with poor long-term prognosis, comparable to preterm infants. Conversely, in non-UA-AEDF cases, the frequency of poor long-term prognosis, involving DQ, remained consistent before and after 32 weeks of gestation. This study highlights the potential significance of UA-AEDF in predicting neurodevelopmental outcomes in severe SGA infants; thus, incorporating UA Doppler findings into clinical protocols for severe SGA cases is helpful., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Human papillomaviruses are common in the urogenital tract amongst women of childbearing age. A few studies indicate a possible association between human papillomavirus infections in pregnancy and adverse pregnancy outcomes whilst other studies find no such association. We aimed to investigate the association between human papillomavirus infections during pregnancy and adverse pregnancy outcomes linked to placental dysfunction, including hypertensive disorders of pregnancy, gestational diabetes mellitus and newborns small for gestational age., Materials and Methods: Pregnant women from the general population in Norway and Sweden were enrolled at the time of routine mid-gestational ultrasound examination. Urine samples collected at mid-gestation in 950 and at delivery in 753 participants, were analyzed for 28 human papillomavirus genotypes, including 12 high-risk genotypes. Participants completed electronic questionnaires at enrollment and medical records were reviewed for background characteristics and for the following adverse pregnancy outcomes: hypertensive disorders of pregnancy including gestational hypertension, preeclampsia, superimposed preeclampsia, eclampsia and Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome, gestational diabetes mellitus, and newborns small for gestational age. Associations between adverse pregnancy outcomes and (a) any human papillomavirus, high-risk human papillomavirus and human papillomavirus genotype 16 infection at mid-gestation, (b) multiple genotype infections at mid-gestation, and (c) persisting infections during pregnancy were assessed with univariable and multivariable logistic regression models. Missing covariates were imputed using multiple imputation., Results: At mid-gestation, 40% (377/950) of women were positive for any of the 28 genotypes, 24% (231/950) for high-risk genotypes and human papillomavirus 16 was found in 6% (59/950) of the women. Hypertensive disorders of pregnancy was observed in 9% (83/950), gestational diabetes mellitus in 4% (40/950) and newborns small for gestational age in 7% (67/950). Human papillomavirus infection with any genotype, high-risk or human papillomavirus genotype 16 at mid-gestation was not associated with adverse pregnancy outcomes. No associations were found for multiple genotype infections at mid-gestation or persisting infections., Conclusion: In a general population of pregnant women, we found no evidence of human papillomavirus infections during pregnancy being associated with hypertensive disorders of pregnancy, gestational diabetes mellitus, or newborns small for gestational age., Trial Registration: Trial registration The study is registered at ClincialTrials.gov; NCT02449850 on May 19th, 2015., Competing Interests: Declarations Ethical approval Statement and consent to participate The PreventADALL study with the current sub-study was approved by the Regional Ethical Committee for Medical and Health Research in South-Eastern Norway (REC 2014/518 and REC 2017/1053) and in Sweden (2014/2242-31/4). All women included in the current study signed an informed consent form, with the opportunity to withdraw from the study at any time and without the need to disclose reason for withdrawal. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Post-term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High-income countries have responded to this risk by widely adopting labour induction protocols in late-term, but many low- and middle-income countries have not. However, understanding underlying mechanisms linking post-term births to adverse newborn and infant outcomes remains limited., Objective: To investigate the (a) prevalence of post-term, (b) the risk factors associated with post-term (c) the association between post-term births and the risk of small-for-gestational-age (SGA) neonates and of infant mortality in middle-income settings., Methods: We used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post-term birth and SGA and infant mortality., Results: We analysed 21,335,033 live births in Brazil (2011-2018), 23,416,126 in Mexico (2008-2019), and 966,102 in Palestinian refugees (2010-2020) (N = 45,717,261). Post-term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post-term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post-term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post-term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates., Conclusions: These findings emphasise the critical significance of implementing induction strategies to prevent post-term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH-21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post-term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention., (© 2024 John Wiley & Sons Ltd.)

Background/Objectives : Systematic quality review of ultrasound exams is recommended to ensure accurate diagnosis. Our primary objectives were to develop a quantitative method for quality review of estimated fetal weight (EFW) and to assess the accuracy of EFW for an entire practice and for individual personnel. A secondary objective was to evaluate the accuracy of fetal sex determination. Methods: This is a retrospective cohort study. Eligible ultrasound exams included singleton pregnancies with live birth and known birth weight (BW). A published method was used to predict BW from EFW for exams with ultrasound-to-delivery intervals of up to 12 weeks. Mean error and median absolute error (AE) were compared between different personnel. Image audits were performed for exams with AE > 30% and exams with reported fetal sex different than newborn sex. Results: We analyzed 1938 exams from 890 patients. In the last exam before birth, the median AE was 5.9%, and the predicted BW was within ±20% of the actual BW in 97.2% of patients. AE was >30% in 28 exams (1.4%); image audit found correct caliper placement in all 28. Only two patients (0.2%) had AE > 30% on the last exam before birth. One sonographer systematically over-measured head and abdominal circumferences, leading to EFWs that were overestimated. Reported fetal sex differed from newborn sex in seven exams (0.4%) and five patients (0.6%). Images in four of these patients were annotated with the correct fetal sex, but a clerical error was made in the report. In one patient, an unclear image was labeled "probably female", but the newborn was male. Conclusions: The accuracy of EFW in this practice was similar to literature reports. The quantitative analysis identified a sonographer with outlier measurements. Time-consuming image audits could be focused on a small number of exams with large errors. We suggest some enhancements to ultrasound reporting software that may help to reduce clerical errors. We provide tools to help other practices perform similar quality reviews.

Objectives: Small-for-gestational age (SGA) is a causal factor for malnutrition (undernutrition). The available evidence on this causal relationship is based on observational studies and suffers from confounding and collider biases. This study aimed to construct a theoretical causal model to estimate the effect of SGA on malnutrition in children aged less than 5 years., Methods: For the causal model, we designated term-SGA status as the exposure variable and malnutrition at 6 months to 5 years of age (diagnosed by World Health Organization criteria) as the outcome variable. Causal estimands were formulated for three stakeholders. A "rapid narrative review" methodology was adopted for literature synthesis. Studies (observational and randomized) listing the causal factors of malnutrition in children aged less than 5 years from the Indian subcontinent were eligible. Four databases (PubMed, Scopus, Web of Science, and ProQuest) were searched and restricted to the last 10 years (search date: December 15, 2023). Information about the causal factors (covariates) of malnutrition and study characteristics was extracted from the article abstracts. Next, a causal model in the form of a directed acyclic graph (DAG) (DAGitty software) was constructed by connecting exposure, outcome, and covariate nodes using the sequential causal criteria of temporality, face validity, recourse to theory, and counterfactual thought experiments., Results: The search yielded 4818 records, of which 342 abstracts were included. Most of the studies were conducted in India (39%) and Bangladesh (27%). The literature synthesis identified 81 factors that were grouped into 17 nodes, referring to 5 domains: socioeconomic, parental, child-related, environmental, and political. The DAG identified 12 different minimal sufficient adjustment sets (conditioning sets for regression analysis) to estimate the total effect of SGA on malnutrition., Conclusion: We offer an evidence-based causal diagram that will minimize bias due to improper selection of factors in studies focusing on malnutrition in term-SGA infants. The DAG and adjustment sets will facilitate the design and data analysis of future studies., Competing Interests: Declaration of competing interest The authors declare no conflict of interest related to this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Developmental coordination disorder (DCD) presents motor skill delays in early childhood and has been associated with later maladaptation, necessitating early intervention. However, research on the potential risk factors, particularly in preschool-aged children, remains scarce., Aims: We aimed to explore the association between small for gestational age (SGA) and other factors and motor coordination problems in 5-6-year-olds from the Hokkaido Study on Environment and Children's Health Cohort., Study Design: Prospective., Subjects: We analyzed data from >3500 participants from the Hokkaido Study, a prospective birth cohort, and assessed children aged 5-6 years., Outcome Measures: Participants underwent assessment with the Developmental Coordination Disorder Questionnaire Japanese version (DCDQ-J). We conducted linear regression analyses adjusted for variables such as the child's sex, maternal age, and maternal smoking history during pregnancy, while also examining the independent associations of each risk factor., Results: Among the 3883 children analyzed for SGA, children with SGA exhibited significantly lower DCDQ-J total scores than non-SGA children (mean difference: -2.25, 95 % confidence interval [-4.19, -0.30], p = 0.02). On the subscales, children with SGA demonstrated significantly lower "Control During Movement" scores than non-SGA children (mean difference: -0.96, 95 % confidence interval [-1.78, -0.13], p = 0.02). Furthermore, the child's sex, maternal smoking, maternal age, and preterm birth were independently associated with DCD., Conclusions: SGA was shown to be one of the risk factors for the manifestation of motor coordination difficulties in 5-6-years old children. In combination with other factors, screening for motor coordination difficulties in SGA children will be an important means of initiating appropriate interventions., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have influenced the work reported in this study., (Copyright © 2024. Published by Elsevier B.V.)

Background: Maternal nutrition is a key factor influencing birth and offspring health outcomes in later life. Dietary diversity (DD) is a proxy for the macro/micronutrient adequacy of an individual's diet. There is inadequate comprehensive evidence regarding maternal nutrition during pregnancy, measured through DD and birth outcomes. This study aimed to provide extensive evidence on maternal DD during pregnancy and birth outcomes., Methods: A comprehensive search was performed using PubMed, HINARI, and Google Scholar databases up to January 17, 2024. Studies conducted among pregnant mothers and measuring maternal DD with an evaluation of birth outcomes (low birth weight, small for gestational age, preterm birth), in the global context without design restriction were included. The Newcastle Ottawa Scale and the Cochrane Risk of Bias tool were used to assess the risk of bias. The results are summarized in a table, and odds ratios were pooled where possible. Between-study heterogeneity was evaluated using I 2 statistics. Potential publication bias was assessed using a funnel plot and Egger's regression test. To explore the robustness, a leave-one-out sensitivity analysis was conducted., Results: Thirty-three studies were used to synthesize narrative evidence (low birth weight: 31, preterm birth: 9, and small for gestational age: 4). In contrast, 24 records for low birth weight, eight for preterm birth, and four for small for gestational age were used to pool the results quantitatively. Of the 31 studies, 17 reported a positive association between maternal DD and infant birth weight, 13 studies reported a neutral association (not statistically significant), and one study reported a negative association. Overall, inadequate DD increased the risk of low birth weight OR = 1.71, 95% CI; (1.24-2.18), with I 2 of 68.7%. No significant association was observed between maternal DD and preterm birth. Inadequate DD was significantly associated with small for gestational age (OR = 1.32, 95% CI; 1.15-1.49, and I 2  = 0.0%)., Conclusion: Inadequate maternal DD is associated with an increased risk of low birth weight and small for gestational age but not preterm birth, underscoring the importance of promoting adequate DD during pregnancy. To address these issues, it is essential to implement and expand nutritional programs targeted at pregnant women, especially in low-resource settings, to ensure they receive diverse and adequate diets. Further research is needed to address the current limitations and to explore the long-term implications of maternal nutrition on child health. The study was prospectively registered on PROSPERO (registration number CRD42024513197). No funding was received for this study., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Being born small for gestational age (SGA) is a risk factor for motor difficulties. Previous reviews exploring this topic are mostly focused on children born preterm. We aimed to review the literature to determine the association between being born SGA at term and motor outcomes., Methods: PubMed and Embase were searched for relevant articles without any restrictions on publication year or participants' age. Inclusion criteria were SGA exposure at term (≥ 37 weeks of gestation), cohort studies or randomized controlled trials with motor outcome assessed by standardized motor tests with results reported as continuous scores (mean/median) compared with a control group. Exclusion criteria were abstracts, editorials and commentaries, articles in non-English language or no full text available. Reviews were screened for relevant articles. Quality of included studies was assessed by the Newcastle-Ottawa Scale., Results: In total, 674 records were identified by the literature search and screened by two independent authors. Thirteen original articles were eligible and included in a qualitative synthesis, and five (38%) of these were included in a meta-analysis. Nine (69%) studies were from high-income countries. Most studies were carried out in early childhood, and only one study in adulthood. Seven (54%) articles reported that individuals born SGA at term had poorer scores on standardized motor tests compared with controls, while no differences were reported in five (38%) articles. One article did not report p-values, although the differences were comparable to the other studies. Group differences were of small to moderate effect size (0.19 to 0.65 standard deviation units). The pooled effect size was -0.43 (95% confidence interval: -0.60 to -0.25). Adjustment for covariates were reported in seven (54%) articles and did not change the results. Proportions of motor difficulties, reported in five (38%) articles, ranged from 8.9 to 50% in individuals born SGA from infancy to adolescence., Conclusions: This systematic review shows that being born SGA, also at term, may be a risk factor for poorer motor outcomes throughout childhood, confirmed by a meta-analysis in early childhood. Further research is needed to establish the risk of adult motor difficulties in individuals born SGA at term., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The association between serum triglyceride to high density lipoprotein cholesterol ratio (THR) in late pregnancy and adverse birth outcomes (ABO) remains controversial because of inconsistent results. The present study assessed the association between maternal serum THR and incidence of ABO [preterm birth (PTB), small and large for gestational age (SGA/LGA), low birth weight (LBW) and macrosomia] in a Chinese population., Methods: A total of 11,553 consecutive participants from a real-world database with data on lipid profiles and birth outcomes were included. Logistic regression models were applied to assess the association between THR and incident ABO. Mediation analysis was performed to investigate the contribution of pregnancy complications [gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP) and pre-eclampsia (PE)] to this association., Results: Approximately 6.6% (762/11,553), 8.9% (1023/11,553), 15.5% (1792/11,553), 4.3% (494/11,553), and 7.4% (851/11,553) of individuals developed PTB, SGA, LGA, LBW and macrosomia, respectively. Significant trends across the quintiles of THR toward decreasing incidence of SGA and LBW and increasing incidence of LGA and macrosomia were observed. The multivariate-adjusted odds ratios (OR) in the top quintile of serum THR (> 3.16) versus the bottom quintile (< 1.44) were 0.52 for PTB, 0.48 for SGA, 0.64 for LBW, 2.80 for LGA and 3.80 for macrosomia, respectively. A 1-standard deviation (SD) increase in serum THR was associated with decreased risk of PTB [OR = 0.84, 95% confidence interval (CI): 0.76-0.93), SGA (OR = 0.71, 95% CI:0.65-0.78) and LBW (OR = 0.76, 95% CI:0.65-0.90) and increased risk of LGA (OR = 1.40, 95% CI:1.32-1.49) and macrosomia (OR = 1.49, 95% CI:1.38-1.62). In mediation analyses, PE mediated - 19.8%, -10.6% and - 24.6% of THR-associated PTB, SGA and LBW, respectively, GDM accounted for - 3.7%, 6.8% and 4.3% of THR-associated PTB, LGA and macrosomia, respectively, and ICP explained - 1.9% and - 2.1% of THR-associated PTB and LBW, respectively. In addition, incorporating THR to ABO predictive models significantly improved the area under the curve for SGA (0.743 vs. 0.753, P < 0.001), LGA (0.734 vs. 0.745, P < 0.001) and macrosomia (0.786 vs. 0.800, P < 0.001)., Conclusion: Real-world data showed an association between serum THR in late pregnancy and ABO risk, and this association may be partially mediated by prevalent pregnancy complications (PE/GDM/ICP), suggesting a potential role of THR in predicting ABO (SGA/LGA/macrosomia)., (© 2024. The Author(s).)

Background: Fetal growth monitoring is important for twin pregnancies. However, there has been no clinically validated tool for monitoring fetal growth of twin pregnancies in China. This study aims to develop and validate a chorionicity-specific growth chart of ultrasound estimated fetal weight (EFW) for Chinese twin pregnancies., Methods: This retrospective cohort study included all twin pregnancies who delivered two live fetuses with gestational age ≥ 34 weeks without severe obstetric complications at a tertiary hospital from January 2007 to March 2021. The participants were divided into a development set (delivered in or before December 2017) and a validation set (delivered in or after January 2018). Chorionicity-specific growth charts were created using the generalized additive models for location, scale, and shape (GAMLSS) based on the development set. The fetuses from the validation set were classified into three groups based on the last EFW: small-for-gestational-age (SGA) indicated by both the newly established twin charts and the Hadlock singleton chart currently used for twin pregnancies in China, suspected SGA indicated by only the singleton chart, and no SGA indicated by either chart. The incidence of neonatal outcomes among the three groups was then compared accordingly, including intensive care unit (NICU) stay length, respiratory diseases, and neurological disorders., Results: The development set included 883 twin pregnancies and a total of 6374 EFW measurements between 16 and 38 weeks of gestation, and the validation set included 801 twin pregnancies and 7630 EFW measurements. In the development set, monochorionic diamniotic (MCDA) twins had a significantly lower EFW compared to dichorionic diamniotic (DCDA) twins beginning at 26 weeks, with the difference gradually increasing thereafter, supporting the establishment of chorionicity-specific growth charts. Of the 1,602 twin neonates in the validation set, 103 (6.4%) were classified into the SGA group, 164 (10.2%) into the suspected SGA group, and 1335 (83.3%) into the no SGA group. The incidence of respiratory diseases and neurological disorders was comparable between the suspected SGA group and the no SGA group, but apparently higher in the SGA group. Meanwhile, NICU stay lengths were consistently longer for twins in the SGA group compared to the no SGA group (difference: 0.57, 95% CI: 0.31-0.83), with no significant differences observed between the suspected SGA and no SGA groups., Conclusions: The fetal growth trajectories differed by chorionicity, with a lower EFW for MCDA twins beginning at 26 weeks. The establishment of chorionicity-specific growth chart could reduce overdiagnosis of SGA and improve fetal growth monitoring of twin pregnancies., (© 2024. The Author(s).)

Background: Limited English proficiency is associated with worse health outcomes regardless of health literacy. Prior research suggests that using interpreter services for low English proficiency helps mitigate the language barrier, is associated with improved health outcomes, and patient satisfaction; however, obstetric and neonatal outcomes and pregnancy risks in this population are not well studied., Objectives: The primary purpose of this study was to determine if low English proficiency is an independent risk factor for small for gestational age infants by utilizing interpreter use as a proxy for low English proficiency. Due to the known challenges in communication with a language barrier and discrimination against people whose first language is not English, we hypothesized that this could result in an increase in high risk conditions in pregnancy such as SGA. Our hypothesis was that the need for an interpreter would be associated with having small for gestational age infants., Study Design: We performed a retrospective cohort study at a single center using data between 1/1/2016 and 12/31/2021; we included singleton, live births ≥ 21 weeks gestation. We excluded multiple gestations, intrauterine fetal demise, and delivery < 21 weeks. The primary outcome was rate of small for gestational age. Small for gestational age was defined as birthweight < 10th percentile for gestational age using the 2018 Fenton newborn growth curve. Multivariable logistic regression was performed to control for confounding variables., Results: Of the 26,260 patients included in the study, 71.3% were non-Hispanic White, 9.5% were Hispanic/Latino, and 7.9% were non-Hispanic Black. Overall, 1,662 (6.3%) patients utilized an interpreter. Over half (58.0%) of patients requesting interpreter services were Hispanic. In unadjusted analyses, the rate of small for gestational age was not different between patients who used interpreter services (n=106, 6.4%) and those who did not (n=1612, 6.6 %), P=.779. After adjusting for race/ethnicity, gravidity, gestational age, private insurance, diabetes, hypertension, and prepregnancy body mass index, the use of interpreter services was associated with decreased odds of small for gestational age (aOR 0.67, 95% CI 0.53-0.84)., Conclusions: Our findings suggest that use of an interpreter is associated with a lower incidence of small for gestational age when controlling for patient characteristics and social determinants of health. Additional research is required to explore this association, but our results indicate that recognizing demographic risk factors and providing patients with social resources such as access to interpreter services may positively impact obstetric and neonatal outcomes., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Up to a quarter of pregnant individuals with SLE have small for gestational age (SGA) infants. We aimed to characterize placental pathology associated with SGA infants in SLE., Methods: We retrospectively analysed SLE deliveries with placental analysis at UCSD from November 2018 to October 2023, comparing SLE pregnancies resulting in SGA to those that did not, and additionally, to matched pregnancies with SGA but without SLE., Results: Placental analysis was available only for 28/70 (40%) SLE deliveries, which had high rates of adverse outcomes (75%). All exhibited at least one histopathologic abnormality. Key findings distinguishing 12 SLE placentas resulting in SGA infants (vs.16 without) included small placental disc for gestational age (100% vs 56%, P = 0.01), placental disc infarct (50% vs 6%, P = 0.02) and increased perivillous fibrin deposition (PVFD, 58% vs 0%, P = 0.001). All seven SLE placentas with increased PVFD resulted in SGA infants. Compared with matched non-SLE pregnancies with SGA (n = 36), the only distinguishing placental lesion was a higher prevalence of increased PVFD in SLE-associated SGA (58% vs 22%, P = 0.03)., Conclusion: The higher prevalence of increased PVFD in placentas of SLE-associated SGA may indicate a specific mechanism of placental injury leading to SGA in this context. Thus, its presence, particularly in context of SGA, should prompt providers to screen for an underlying autoimmune disease, including SLE. Systematic placental examination in context of SLE and associated autoimmune diseases could help evaluate responses to existing therapies, comparative studies of novel therapies and correlation to adverse outcomes., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Background: Adverse intrauterine environment was believed to have deleterious effects on the gonadal function. However, the association between impaired intrauterine growth and fertility in adult males has not been established., Objectives: To compare the reproductive rates of males born small for gestational age (SGA), with low birth weight (LBW) or very low birth weight (VLBW) with control groups., Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed to search PubMed, Web of Science, Cochrane Library, and Embase databases from inception to June 16, 2023. Cohort studies investigating the reproductive rates of males born SGA, with LBW or VLBW were included. A random or fixed effects model was used for different exposures., Results: A total of 10 studies out of 3,801 records were included. Males born SGA showed a higher risk of infertility than the control group (odds ratio, OR = 0.91, 95% confidence interval, 95% CI 0.89-0.93, p = 0.000). The reproductive rates of individuals born with LBW or VLBW were lower than the control group (OR = 0.86, 95% CI 0.78-0.94, p = 0.001; OR = 0.57, 95% CI 0.40-0.81, p = 0.002, respectively). Participants were further divided into two age groups of 18-35 and 35-45 years. In both subgroups, the reproductive rates were lower in males born SGA, with LBW or VLBW compared with controls. Sensitivity analysis showed the robustness of the pooled estimates among LBW and VLBW., Conclusion: In summary, SGA, LBW, and VLBW were associated with a higher risk of male infertility in both early and middle adulthood. Achieving optimal intrauterine growth would be helpful to prevent male infertility., (© 2024 The Author(s). Andrology published by Wiley Periodicals LLC on behalf of American Society of Andrology and European Academy of Andrology.)

Background: Children of mothers with chronic-hypertension in pregnancy have high rates of preterm-birth (<37 weeks of gestation) and small-for-gestational-age (SGA), both of which are risk factors of cerebral palsy (CP). This study investigated the cumulative risks of CP in children exposed to maternal chronic-hypertension vs. other types of hypertensive-disorders-of-pregnancy (HDP), and whether preterm-birth and SGA potentiate the antenatal impact of chronic-hypertension to increase CP hazards., Methods: This population-based cohort study enrolled 1,417,373 mother-child pairs with singleton live births between 2004 and 2011 from the Taiwan Maternal and Child Health Database. A total of 19,457 pairs with HDP were identified and propensity-score-matched with 97,285 normotensive controls. Children were followed up for CP outcome until age 6-13 years. HDP were classified into chronic-hypertension, gestational-hypertension, preeclampsia, and preeclampsia-with-chronic-hypertension. Using the normotensive group as the reference, the associations between chronic-hypertension and CP hazard were assessed with adjusted hazard ratios (HR) and 95% confidence intervals (CI) in Cox proportional hazards regression models, and the effects of preterm-birth and SGA on the associations were examined., Results: The HDP group had higher rates of CP (0.8%) than the normotensive group (0.5%), particularly the subgroup of preeclampsia-with-chronic-hypertension (1.0%), followed by preeclampsia (0.9%), chronic-hypertension (0.7%) and gestational-hypertension (0.6%). Preterm-birth, but not SGA, exerted moderating effects to increase CP risks in children exposed to maternal chronic-hypertension. Before adjustments, chronic-hypertension alone had no substantial contribution to CP hazard (HR 1.35, 95% CI 1.00-1.83), while preeclampsia alone (1.64, 1.28-2.11) or with superimposed-chronic-hypertension (1.83, 1.16-2.89) had significant effects. After including preterm-birth in the multivariable model, the CP hazard for chronic-hypertension alone rather than other types of HDP was raised and became significant (1.56, 1.15-2.12), and the significance remained after stepwise adjustments in the final model (1.74, 1.16-2.60)., Conclusions: Preterm-birth might potentiate CP hazards in children of mothers with chronic-hypertension in pregnancy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

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., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies., Design: Cross-sectional survey., Setting: International., Population: Clinicians involved in the management of MCDA twin pregnancies with sFGR., Methods: A structured, self-administered survey., Main Outcome Measures: Clinical practices and attitudes to diagnostic criteria and management strategies., Results: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter-twin EFW discordance of >25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide., Conclusions: There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background and Aims: This study aimed to quantify adverse perinatal outcomes (APO), including small/large for gestational age (SGA/LGA) and preterm birth (PTB), in pregnant women with abnormal red cell distribution width (RDW) and explore the related mechanisms., Methods: This study included 11,659 pregnant women who delivered in a specialized hospital. At the time of admission, the lipid profiles and whole blood cell counts were assessed, and APO was analyzed., Results: Women with high RDW (>18.5% [the 97.5 th percentile]) in late pregnancy had a higher risk of LGA compared with those with low RDW (<12.3% [the 2.5 th percentile]), whereas women with low RDW had a higher risk of SGA and PTB, compared with those with high RDW. A 1% increase in RDW was associated with an increased risk of LGA and a decreased risk of SGA and PTB. Consistent associations were observed in sensitivity analysis among pregnant women of non-advanced age, non-obesity, non-pregnancy complications, and non-PTB (for SGA/LGA only). Increased RDW was significantly associated with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C). Triglycerides and HDL-C significantly mediated 10.63 and 15.8% of RDW-associated LGA, 9.51% and 9.40 of RDW-associated SGA, and 8.44 and -8.25% of RDW-associated PTB, respectively., Conclusion: Abnormal RDW was associated with an increased risk of APO, and the RDW-associated APO risk could be partially mediated by triglycerides and HDL-C, suggesting that RDW may be a promising APO predictor., (Copyright © 2024 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.)

Aim: This study was based on the need to predict neurodevelopmental outcomes of children with foetal growth restriction. The aim was to systematically review the correlation between biomarkers of neural injury in children with foetal growth restriction and their neurodevelopment., Method: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included studies on growth-restricted foetuses that measured biomarkers of postpartum brain injury and assessed neurodevelopment in childhood. Studies published between 1 January 2014 and 31 March 2024 were identified through PubMed and Embase, with the study protocol registered in PROSPERO (CRD42024520254)., Results: Only five met the inclusion criteria. Results showed that urinary S100B levels were significantly elevated in foetal growth restriction, negatively correlating with neurological development at 7 days of life. Neuron-specific enolase negatively correlated with cognitive, motor and socio-emotional development. Urinary nerve growth factor levels were significantly lower in neonates with foetal growth restriction, correlating with poor neurodevelopment. No alterations in BDNF levels were observed. Tau protein levels were lower in children with foetal growth restriction and adverse outcomes., Conclusion: The study emphasised the need for further research on biomarkers and predictive models of neurodevelopment in children with foetal growth restriction., (© 2024 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)