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Abstract: Background: Little is known about the influences of fetal weight and sex on spectral analysis of fetal heart rate (FHR) variability. Aim: The study aims to assess whether there are differences in spectral power of FHR variability according to fetal weight and sex during labor. Study design: Case–control study. A total of 414 singleton term deliveries without fetal acidemia were divided into small-for-gestational-age (SGA) (n=29) and non-SGA (n=385) groups. Analyses were performed separately according to fetal sex. Subjects: FHR recordings obtained with cardiotocography during the last 2h of labor preceding delivery. Outcome measures: Our outcome measures include spectral power of FHR variability. Results: For the male group, SGA fetuses had significantly lower values for low, movement, high, and total frequencies of spectral power compared with non-SGA fetuses (all P <0.005). Normalized low frequency (LFn) was significantly higher, and normalized high frequency (HFn) was significantly lower in SGA fetuses compared with non-SGA fetuses (all P <0.005). In contrast, for the female group, there were no significant differences in any of the indices of spectral power between the SGA and non-SGA fetuses. In addition, SGA males had significantly higher LFn spectral power and lower HFn spectral power compared to SGA females (P =0.016, and 0.041, respectively). Conclusions: SGA males have decreased spectral power of FHR variability compared with non-SGA males during labor. However, there are no differences between SGA and non-SGA female fetuses. It is important in the clinical setting to take fetal weight and sex into account during FHR monitoring using spectral analysis. [Copyright &y& Elsevier]

Objective: Early alterations in glucose homeostasis increase the risk of developing insulin resistance (IR) and obesity later in life. The study aimed to ascertain the peripheral blood levels of hormones that controlling glucose homeostasis and inflammatory factors that are correlated with IR and fetal outcomes in small-for-gestational-age (SGA) infants born to mothers with gestational diabetes mellitus (GDM)., Methods: This cohort study included a total of 90 SGA infants born to mothers with GDM ( n  = 37) and without GDM ( n  = 53). At birth, blood levels of glucose, insulin, C-peptide, growth hormone (GH), IGFBP3, lipid profiles, fibrinogen, and hypersensitive C-reactive protein (Hs-CRP) were measured; homeostatic model assessment-IR (HOMA-IR) and ponderal index were calculated. All newborns were followed up to the first year of life., Results: Compared with SGA infants born to mothers without GDM, the levels of low-density lipoprotein-cholesterol (LDL-C), GH, and fibrinogen were significantly higher in the SGA infants born to mothers with GDM ( p  = .048, .045, and .04, respectively). However, total cholesterol, HDL-C, and apolipoprotein(a) levels were significantly lower in the SGA infants born to mothers with GDM when compared with those in with SGA infants born to mothers without GDM (all p  < .05). Weight gain in the first year was higher in the SGA infants born to mothers with GDM group than SGA infants born to mothers without GDM [6644 g (5991-7572) vs. 6032 g (5529-6932)]., Conclusions: Altered biomarkers of IR were observed among SGA infants born to mothers with GDM, suggesting that these infants were more prone to develop IR after birth.

Objectives: We aimed to identify the weight gain patterns of small-for-gestational age (SGA) infants in early life and to explore the predictive value for later overweight/obesity in childhood., Methods: We obtained data from a prospective cohort including term SGA infants born between January 2006 and November 2015 who received regular health care from birth to 5 years in West China Second University Hospital, Chengdu, China. A latent class growth analysis (LCGA) was applied to group children with similar growth trajectory patterns. Multiple logistic regression was performed to examine the association between weight gain patterns and later overweight/obesity., Results: A total of 296 term SGA infants were finally included. Five weight gain trajectories were identified, including excessive rapid catch-up growth (ERCG) (class 1, 10.9%), rapid catch-up growth (RCG) (class 2, 17.9%), appropriate catch-up growth (ACG) (class 3, 53.0%), slow catch-up growth (SCG) (class 4, 13.4%) and almost no catch growth (NCG) (class 5, 4.8%). SGA infants in class 1 and class 2 had a higher BMI according to age- and sex-specific Z scores from 2-5 years of age. In addition, 25% of SGA infants in class 1 and 13.2% of SGA infants in class 2 were found to be overweight/obese at 2-5 years of age. After adjusting for confounders, we found that extremely rapid weight gain (class 1) in the first 2 years of life increased the risk of overweight/obesity by 2.1 times at 2 to 5 years of age (aOR=2.1, 95% CI: 1.3~4.8; P <0.05). Furthermore, the increment of ΔWAZ between 0 and 4 mo was prominently related to the risk of overweight/obesity at 2 to 5 years for term SGA infants (aOR=3.2, 95% CI: 1.7~8.1; P <0.001). A receiver operating characteristic (ROC) curve showed the area under curve (AUC) was 0.7, with a 95% confidence interval (CI) from 0.6 to 0.8 ( P <0.001)., Conclusions: The extremely rapid weight gain pattern of term SGA infants in the first 2 years of life increased the risk of overweight/obesity at 2 to 5 years of age. It suggests monitoring weight gain across the infant period represents a first step towards primary prevention of childhood obesity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Lu, Qie, Feng, He, Yang and Yang.)

Background: Little is known about the ability of the recently released Brazilian gestational weight gain (GWG) charts to predict the occurrence of adverse birth outcomes., Objectives: We compared the new Brazilian weight gain charts with 3 international charts and determined their ability to predict the occurrence of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births in Brazilian women., Methods: A subsample of 6888 adult women (43,931 weight measurements) with singleton pregnancies from a nationwide, hospital-based cohort study conducted in 2011-2012 was analyzed. Selected percentiles from Brazilian GWG charts were compared with those from American, International Fetal and Newborn Growth Consortium for the 21st Century study, and Lifecycle consortium charts. Sensitivity, specificity, and AUROC values for SGA and LGA births were estimated with 95% CIs using the classification of GWG below or above selected percentiles of each chart., Results: The weight gain corresponding to a given percentile varied among the charts, especially for women with pre-pregnancy overweight and obesity. The proportions of women with GWG classified below or above selected percentiles were closest to the expected values for all pre-pregnancy BMI categories in the Brazilian and Lifecycle charts. At the 10th percentile, the highest sensitivity for SGA births was observed for the American charts at midpregnancy (36.8%) and the highest specificity was observed using the Brazilian charts in the first trimester (93.4%). At the 90th percentile, the highest sensitivity for LGA births occurred in midpregnancy for the Lifecycle charts (26.8%) and the highest specificity occurred in the American charts using total GWG (97.1%). All the AUROCs were under 0.5 for SGA births and ranged from 0.55 (first trimester) to 0.62 (total GWG) for LGA births., Conclusions: The charts differ in GWG trajectories, especially for women with overweight and obesity. The 4 charts had low predictive ability of SGA and LGA births and should not be considered as isolated screening tools for those outcomes., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Despite increased e-cigarette use, limited research has focused on changes in e-cigarette and combustible cigarette use around pregnancy and the subsequent effects on infant health.Objective: This study aimed to characterize changes in e-cigarette and cigarette use from before to during pregnancy and examine their associations with small-for-gestational-age birth.Study Design: This was a secondary data analysis of 2016-2018 data of the US Pregnancy Risk Assessment Monitoring System. We analyzed women aged ≥18 years who had a recent live birth (unweighted: n=105,438; weighted: n=5,446,900). Women were grouped on the basis of their self-reported e-cigarette and/or cigarette use 3 months before pregnancy (exclusive e-cigarette users, exclusive cigarette smokers, dual users, and nonusers) and change in e-cigarette and cigarette use during pregnancy (continuing use, quitting, switching, and initiating use). Small-for-gestational-age was defined as a birthweight below the 10th percentile for infants of the same sex and gestational age. We described the distributions of women's sociodemographic and pregnancy characteristics in both weighted and unweighted samples. We used multivariable log-binomial regression models to estimate the relative risks for the associations between changes in e-cigarette and cigarette use during pregnancy and risk of small-for-gestational-age, adjusting for significant covariates.Results: The rates of cessation during pregnancy were the highest among exclusive e-cigarette users (weighted percentage, 80.7% [49,378/61,173]), followed by exclusive cigarette users (54.4% [421,094/773,586]) and dual users (46.4% [69,136/149,152]). Among exclusive e-cigarette users, continued users of e-cigarettes during pregnancy had a higher risk of small-for-gestational-age than nonusers (16.5% [1849/11,206]) vs 8.8% [384,338/4,371,664]; confounder-adjusted relative risk, 1.52 [95% confidence interval, 1.45-1.60]), whereas quitters of e-cigarettes had a similar risk of small-for-gestational-age with nonusers (7.7% [3730/48,587] vs 8.8% [384,338/4,371,664]; relative risk, 0.84 [95% confidence interval, 0.82-0.87]). Among exclusive cigarette users, those who completely switched to e-cigarettes during pregnancy also had a similar risk of small-for-gestational-age with nonusers (7.6% [259/3412] vs 8.8% [384,338/4,371,664]; relative risk, 0.83 [95% confidence interval, 0.73-0.93]). Among dual users before pregnancy, the risk of small-for-gestational-age decreased from 23.2% (7240/31,208) (relative risk, 2.53 [95% confidence interval, 2.47-2.58]) if continuing use to 16.9% (6617/39,142) (relative risk, 1.88 [95% confidence interval, 1.83-1.92]) if only quitting e-cigarettes or 15.1% (1254/8289) (relative risk, 1.61 [95% confidence interval, 1.52-1.70]) if only quitting cigarettes and further to 11.2% (7589/67,880) (relative risk, 1.23 [95% confidence interval, 1.20-1.25]) if both quitting e-cigarettes and cigarettes during pregnancy, compared with nonusers.Conclusion: Among exclusive e-cigarette users, quitting e-cigarettes during pregnancy normalized the risk of small-for-gestational-age. Among exclusive cigarette users, quitting smoking or completely switching to e-cigarettes normalized small for gestational age risk. Among dual users, smoking cessation has a greater effect than quitting e-cigarettes only, although discontinuing the use of both may lead to the greatest reduction in the risk of small-for-gestational-age. [ABSTRACT FROM AUTHOR]

Background: Serial growth scans are routinely recommended for twin pregnancies to identify fetal growth restriction (defined as an estimated fetal weight of <10th percentile), which can result in increased perinatal morbidity and mortality. However, the clinical significance of early intertwin growth discordance in the absence of fetal growth restriction remains unclear.Objective: This study aimed to compare the rates of small-for-gestational-age infants among twin pregnancies with intertwin growth discordance in the absence of fetal growth restriction with that among twin pregnancies with concordant, normal growth identified by ultrasound between 24 0/7 and 31 6/7 weeks' gestation.Study Design: This was a retrospective cohort study of twin deliveries at a single hospital from 2010 to 2019. Pregnancies without fetal growth restriction were categorized as discordant or concordant using the earliest prenatal growth ultrasound between 24 0/7 and 31 6/7 weeks' gestation. Discordance was defined as an estimated fetal weight difference of ≥18% between twins. Pregnancies with major fetal anomalies, no growth ultrasound between 24 0/7 and 31 6/7 weeks' gestation, or twin-twin transfusion syndrome were excluded. The cohort was stratified by chorionicity. Our primary outcome was small-for-gestational-age defined as <10th percentile per the Fenton growth curve at delivery. Secondary outcomes included gestational age at delivery, mode of delivery, neonatal intensive care unit admission, length of stay, and neonatal complications and placental pathology.Results: Of the 707 twin pregnancies that met the inclusion criteria, 558 (79%) were dichorionic and 149 (21%) were monochorionic. Most pregnancies were concordant on ultrasound between 24 0/7 and 31 6/7 weeks' gestation (dichorionic, 93%; monochorionic, 87%). Regardless of chorionicity, twin pregnancies with discordance at ultrasound, were more likely to have a small-for-gestational-age infant than concordant twin pregnancies (dichorionic: 51% vs 29%; P=.002; monochorionic: 65% vs 24%; P<.001). Furthermore, women with twin pregnancies with discordance were delivered at an earlier gestational age (dichorionic: 36 weeks [interquartile range, 33-36] vs 34 weeks [interquartile range, 34-38]; P<.001; monochorionic: 34 weeks [interquartile range, 32-34] vs 36 weeks [interquartile range, 34-37]; P=.003). Pregnancies with growth discordance were more likely to be delivered by cesarean delivery (dichorionic: 90% vs 72%; P=.01; monochorionic: 65% vs 60%; P=.70), although this was only statistically significant for dichorionic twin pregnancies. Neonates of pregnancies with growth discordance had a higher incidence of respiratory distress syndrome (dichorionic: 54% vs 37%; P=.04; monochorionic: 70% vs 45%; P=.04) and neonatal intensive care unit admission (dichorionic: 71% vs 50%; P=.01; monochorionic: 90% vs 65%; P=.03). Furthermore, dichorionic infants had longer neonatal intensive care unit stays (30 [interquartile range, 18-61] vs 18 [interquartile range, 10-35] days; P=.02).Conclusion: Regardless of chorionicity, twin pregnancies with discordance without fetal growth restriction identified on growth ultrasound between 24 0/7 and 31 6/7 weeks' gestation were nearly twice as likely to develop small-for-gestational-age neonates, deliver earlier in gestation, and experience greater neonatal morbidity than twin pregnancies without discordance. Patients with pregnancies complicated by isolated intertwin discordance between 24 0/7 and 31 6/7 weeks' gestation will need counseling regarding adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective To compare detection rates of small-for-gestational-age fetuses, large-for-gestational-age fetuses, congenital anomalies and adverse perinatal outcomes in pregnancies randomized to third-trimester routine ultrasound or ultrasound on clinical indication. Design Randomized controlled trial. Setting National Center for Fetal Medicine in Norway between 1989 and 1992. Population A total of 6780 pregnancies from a non-selected population. Methods Two routine ultrasound examinations at 18 and 33 weeks were compared with routine ultrasound at 18 weeks and ultrasound on clinical indication. Suspected small-for-gestational-age fetuses were followed with serial scans and cardiotocography. Doppler ultrasound was not used. Main outcome measures Detection rates of small-for-gestational-age and large-for-gestational-age fetuses, congenital anomalies and adverse perinatal outcomes. Results Third trimester routine ultrasound improved detection rates of small-for-gestational-age fetuses from 46 to 80%, but overall perinatal morbidity and mortality remained unchanged. Detection of large-for-gestational-age fetuses increased from 36 to 91%. There was a significant increase of induction of labor and elective cesarean sections due to suspected small-for-gestational-age and a significant decrease of induction of labor and elective cesarean sections due to suspected large-for-gestational-age in the study group; there were no other differences regarding intervention. The detection rate of congenital anomalies was 56%, with no significant difference between the groups. Conclusions Routine use of third-trimester routine ultrasound increased detection rates of small-for-gestational-age and large-for-gestational-age fetuses. This did not alter perinatal outcomes. Third-trimester ultrasound screening should not be rejected before a policy of adding Doppler surveillance to the high-risk group identified has been investigated further. [ABSTRACT FROM AUTHOR]

Introduction: Recent studies indicate that treatment with low-dose aspirin may reduce the risk of preeclampsia. Thus, early prediction of preeclampsia is needed. Low serum concentrations of hyperglycosylated human chorionic gonadotrophin (hCG-h) are associated with early pregnancy loss. We therefore studied whether it may serve as an early marker of preeclampsia.Methods: A nested case-control study included 158 women with subsequent preeclampsia, 41 with gestational hypertension, 81 normotensive women giving birth to small-for-gestational-age (SGA) infants and 427 controls participating in first trimester screening for Down's syndrome between 8 and 13 weeks of gestation. Gestational-age-adjusted multiples of medians (MoMs) were calculated for serum concentrations of hCG-h, the free beta subunit of hCG (hCGβ) and pregnancy-associated plasma placental protein A (PAPP-A) and the proportion of hCG-h to hCG (%hCG-h). Clinical risk factors including mean arterial pressure (MAP) and parity were also included in the risk calculation.Results: In women with subsequent preeclampsia %hCG-h was lower than in controls (median MoM 0.92, P < 0.001), especially in 29 cases with early-onset preeclampsia (0.86, P < 0.001), in which PAPP-A also was reduced (0.95, P = 0.001). At 90% specificity for prediction of early-onset preeclampsia, sensitivity was 56% (95% confidence interval, 52-61%) for %hCG-h, 33% (28-37%) for PAPP-A, and 69% (51-83%) for the combination of these with first trimester MAP and parity. The area under the receiver-operating characteristic (ROC) curve for the combination of all these was 0.863 (0.791-0.935).Conclusions: hCG-h is a promising first trimester marker for early-onset preeclampsia. Addition of PAPP-A and maternal risk factors may improve the results. [ABSTRACT FROM AUTHOR]

Background. The current cross-sectional study examined the associations between low birth weight (LBW), preterm birth, and small-for-gestational-age (SGA) and the prevalence of wheeze, asthma, and eczema in Japanese children aged 3 years. Methods. Study subjects were 2004 children. All data were obtained using a questionnaire. Outcomes were defined according to the criteria of the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, number of siblings, breastfeeding duration, paternal and maternal educational level, paternal and maternal history of allergic disorders, maternal smoking during pregnancy, secondhand smoke exposure at home, and gestational age at birth. Results. The prevalence of wheeze, asthma, and eczema in the previous 12 months were 22.1%, 9.0%, and 17.5%, respectively, and 8.4% were classified as LBW (<2500 g), 4.7% as preterm birth (<37 weeks), and 7.1% as SGA (<10th percentile). There were no significant associations between LBW, preterm birth, or SGA and the prevalence of wheeze, asthma, or eczema. A positive relationship between preterm birth and asthma was of borderline significance in children whose mothers had smoked during pregnancy (adjusted OR: 4.71 [95% CI: 0.97−21.39]), but not in those whose mothers had never smoked during pregnancy; the multiplicative interaction between preterm birth and maternal smoking during pregnancy with respect to asthma was significant ( p = .04). Conclusions. The current study failed to detect significant associations between birth conditions and allergic disorders. Nevertheless, we did find evidence for an interaction between preterm birth and maternal smoking during pregnancy affecting asthma. [ABSTRACT FROM AUTHOR]

Objective To present a new gestational-age-specific percentile curve for symphysis-fundus ( SF) height and to determine the effects of maternal and fetal covariates. Design A population-based register study. Setting Antenatal clinics in Västra Götaland County, Sweden, between 2005 and 2010. Population A total of 42 018 women with ultrasound-dated singleton pregnancies who delivered at Sahlgrenska University Hospital. Main outcome measures Measurement of SF height. Methods A non-linear regression of SF height on day of pregnancy was used to construct a reference chart for the median and other percentiles of SF height. Results The new reference curve for SF height showed almost linear growth until term. The median value was considerably larger at each gestational age compared with the curves for SF height used in Norway and Denmark. Compared with the curve currently used in Sweden, higher median values were observed only at gestational ages >34 weeks, accompanied by an upward shift in all percentiles. The only notably influential covariates were maternal pre-pregnancy weight and height. Conclusions The new reference curve for SF height shows a pattern that is different from the Scandinavian reference curves of older origin, reflecting changes in the pregnant population, as well as methodological differences. The new curve can be adjusted for maternal and fetal covariates to suit individual pregnancies. [ABSTRACT FROM AUTHOR]

Abstract: Natural selection conserves mechanisms allowing women to spontaneously abort gestations least likely to yield fit offspring. Small gestational size has been proposed as an indicator of fitness observable by maternal biology. Previous research suggests that exposure to ambient stress in utero results in more “culling” of small fetuses and therefore lower rates of small-for-gestational-age (SGA). However, African American women persistently have higher rates of SGA than non-Hispanic white women, despite experiencing more ambient stress. This paper tests whether attenuation of the stress response among highly stressed African American women, as suggested by the weathering hypothesis, may help to explain this apparent inconsistency. We apply time-series modeling to over 2 million African American and non-Hispanic white male term births in California over the period of January 1989 through December 2010. We test for the parabolic (i.e., “U” shaped) relationship, implied by an attenuated stress response, between unusually strong labor market contraction and the rate of SGA among African American term male infants, and a linear relationship among non-Hispanic whites. We find the hypothesized parabolic relationship among term male African American infants. As expected, we find a linear relationship between unexpected layoffs and the rate of SGA among term male non-Hispanic whites. These results are robust to sensitivity analyses. These results may help to explain the high rates of SGA among term male African American infants, despite greater maternal exposure to ambient stress during pregnancy. [Copyright &y& Elsevier]

Abstract: This study assessed the temporal stability of spatial patterns in the incidence of preterm and small-for-gestational-age (SGA) in regional Western Australia, from 1987 to 2006. Using a time-stratified design, we characterised spatial variation in the probability of preterm and SGA among 109 contiguous areas within each year, and compared spatial patterns between years. We also analysed spatial patterns based on all 20 years combined. In each instance, spatial variation was modelled by fitting a spatially-correlated random effect plus a spatially-uncorrelated random effect. We observed that spatial patterns were consistent over time. We demonstrated weak temporal autocorrelation and little evidence of anomalous years in the spatial patterns of preterm and SGA. Whereas the mean 20-year probability of preterm was 0.057 and the mean probability of SGA was 0.051, areas in the north of Western Australia had probabilities of 0.090 or more for both outcomes. Four areas in the far north of Western Australia were above the 90th centile of preterm for at least 14 of the 20 years, and above the 90th centile of SGA for at least 15 years. The consistency of spatial patterns over time and between birth outcomes strengthens the case for targeting high risk areas for improved outcomes. This study demonstrates how, even in the absence of a spatio-temporal interaction, incorporating the temporal dimension adds value to the spatial analysis of health data. [Copyright &y& Elsevier]

Although vaccines against influenza can reduce maternal morbidity and mortality, large-scale data on adverse effects in the offspring are scarce. Historical cohort study in Stockholm County, Sweden. We linked H1N1 vaccination data (Pandemrix, a mono-valent AS03 adjuvanted H1N1 vaccine) with pregnancy and birth data from 21,087 women with singleton offspring conceived between February 2009 and January 2010 (vaccinated during pregnancy: n = 13,297 vs. unvaccinated: n = 7,790). Data were analysed by conceptualizing the observational cohort as a series of nested cohorts defined at each week of gestation. Logistic regression estimated odds ratios (ORs) for low birth weight (LBW, <2,500 g), preterm birth (<37 completed weeks), small-for-gestational age (SGA, <10th percentile of the gestational age-specific birth weight within the cohort), low 5-min Apgar score (<7), and caesarean section. Data were adjusted for potential confounders, including maternal age, body mass index, smoking, parity, civil status and comorbidities. Compared with infants of non-vaccinated women, infants of vaccinated women had similar adjusted ORs (95 % CI) for LBW (0.91; 0.79-1.04), preterm birth (0.99; 0.89-1.10), SGA (0.97; 0.90-1.05), low Apgar score (1.05, 0.84-1.31), and a marginal risk reduction for caesarean section (0.94, 0.89-0.99). H1N1 vaccination during pregnancy, using an AS03-adjuvanted vaccine, does not appear to adversely influence offspring risks of LBW, preterm birth, SGA, or low Apgar score. Our results suggest that this vaccine is safe for the offspring when used in different stages of pregnancy. [ABSTRACT FROM AUTHOR]

This study was designed to examine differences in serum 25(OH)D levels between small-for-gestational-age (SGA) and appropriate- for-gestational-age (AGA) prepubertal children in correlation with birth weight and indices of insulin resistance and β-cell function. Sixtyfive nonobese children were examined at age 5-7.5 years; 27 born SGA and 38 matched AGA. Body weight, height, BMI, and waist circumference were recorded and fasting serum levels of glucose, insulin, 25(OH)D, and parathyroid hormone (PTH) were measured. The homeostasis model assessment for insulin resistance (HOMAIR) and the β-cell function index (HOMA-β %) were estimated. The mean level of 25(OH)D was higher in the SGA group (26.2 ± 10 vs. 17.2 ± 7 ng/ ml, p < 0.01) but that of PTH was no different. The insulin resistance and β-cell function indices were higher in the SGA group: HOMA-IR 1.34 ± 0.67 vs. 0.99 ± 0.53, and HOMA-β % 135 ± 56 vs. 97 ± 60 in the SGA and AGA groups, respectively. In the SGA group, 25(OH)D was correlated with HOMA-β % but not with HOMA-IR or insulin. In multiple regression, in the total cohort 25(OH)D and HOMA-IR were independently negatively correlated with birth weight (β = - 0.31, β = - 0.36, p < 0.05) respectively. In conclusion, at prepuberty severely in utero growth restricted children have increased birth weight dependent levels of 25(OH)D, which might exert a regulatory role on β-cell function. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed firstly to investigate the contribution of maternal 25(OH) vitamin D to the association of maternal education and small-for-gestational-age birth weight (SGA) and secondly to examine whether the contribution of 25(OH) vitamin D differs by overweight, season, and maternal smoking. Methods: Logistic regression analysis was carried out in this study, using data of 2,274 pregnant women of Dutch ethnicity from the ABCD study, a population-based cohort study in the Netherlands. Maternal 25(OH) vitamin D was measured in early pregnancy. Stratified analyses were conducted for overweight, season of blood sampling, and smoking. Results: Low-educated women had lower 25(OH) vitamin D levels compared to high-educated women, and women in the lowest 25(OH) vitamin D quartile had a higher risk of SGA offspring. In addition, low-educated women had a higher risk of SGA offspring (OR 1.95 [95% CI: 1.20-3.14]). This association decreased with 7% after adjustment for 25(OH) vitamin D (OR 1.88 [95% CI 1.16-3.04]). In stratified analyses, adjustment for 25(OH) vitamin D resulted in a decrease in OR of about 17% in overweight women and about 15% in women who conceived in wintertime. Conclusions: 25(OH) vitamin D appears to be a modifiable contributor to the association between low maternal education and SGA offspring, particularly in overweight women and women who conceived in the winter period. In those women, increasing the intake of vitamin D, either through dietary adaptation or through supplementation in order to achieve the recommendation, could be beneficial. [ABSTRACT FROM AUTHOR]

Background Preterm births ( PTB) and small-for-gestational-age ( SGA) births are distinct but related pregnancy outcomes, with differing aetiologies and short and long-term morbidities. Few studies have compared a broad array of predictors among these two outcomes. The purpose of this study was to compare risk factors for PTB and SGA births using a national sample of Canadian women. Methods We analysed data from the Canadian Maternity Experiences Survey ( n = 6421). Mothers were ≥15 years of age, gave birth to a singleton infant and were living with their infant at the time of the interview (between 5 and 14 months post-partum). Backward stepwise multivariable logistic regression models were constructed for each outcome. Results Risk profiles for the two outcomes had both differences and similarities. Risk factors specific to PTB were education less than high school, having a previous medical condition, developing a new medical condition or health problem during pregnancy, being a primigravida, or being a multigravida with a previous PTB or a previous miscarriage or abortion. Risk factors unique to SGA were low pre-pregnancy body mass index (<18 kg/m2), smoking during pregnancy and being a recent immigrant. Risk factors for both outcomes included low weight gain during pregnancy (<9.1 kg), short stature (<155 cm) and reporting life as 'very stressful' in the year prior to birth of the baby. Conclusion A greater understanding of the risk factors related to PTB and SGA may help to reduce the prevalence of these conditions and the associated risk of infant mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objectives: A screening model for prediction of small-for-gestational-age (SGA) neonates (SGAp) was established by logistic regression using ultrasound data and maternal factors (MF). We aimed to evaluate the ability of SGAp as well as abdominal circumference (AC) and estimated fetal weight (EFW) measurements to predict SGA neonates at 33-39 weeks' gestation., Methods: This retrospective study evaluated 5298 singleton pregnancies that had involved three ultrasound examinations at 21 +0 -27 +6 , 28 +0 -32 +6 , and 33 +0 -39 +6  weeks. All ultrasound data were transformed to MoM values (multiple of the median). Multivariate logistic regression was used to analyze the correlation between SGA status and various variables (ultrasound data and MF) during pregnancy to build the SGAp model. EFW was calculated according to the Hadlock formula at 33-39 weeks of gestation. The predictive performance of SGAp, AC MoM value at 33 +0 -39 +6  weeks (AC-M), EFW MoM value (EFW-M), EFW-M plus MF, AC value at 33 +0 -39 +6  weeks (AC), AC growth velocity, EFW, and EFW plus MF was evaluated using ROC curves. The detection rate (DR) of SGA neonate with SGAp, AC-M, EFW-M, and EFW-M plus MF at false positive rate (FPR) of 5% and 10%, and the FPR at DR of 85%, 90%, and 95% were observed., Results: The AUCs of SGAp, AC-M, EFW-M, EFW-M plus MF, AC, AC growth velocity, EFW, and EFW plus MF for SGA neonates screening were 0.933 (95%CI: 0.916-0.950), 0.906 (95%CI: 0.887-0.925), 0.920 (95%CI: 0.903-0.936), 0.925 (95%CI: 0.909-0.941), 0.818 (95%CI: 0.791-0.845), 0.786 (95%CI: 0.752-0.821), 0.810 (95%CI: 0.782-0.838), and 0.834 (95%CI: 0.807-0.860), respectively. The screening efficiency of SGAp, AC-M, EFW-M, and EFW-M plus MF are significantly higher than AC, AC growth velocity, EFW, and EFW plus MF. The DR of SGAp, AC-M, EFW-M, and EFW-M plus MF for SGA neonates were 80.4%, 69.6%, 73.8% and 74.3% at 10% FPR. The AUCs of SGAp, AC-M, EFW-M, and EFW-M plus MF 0.950 (95%CI: 0.932-0.967), 0.929 (95%CI: 0.909-0.948), 0.938 (95%CI: 0.921-0.956) and 0.941 (95%CI: 0.924-0.957), respectively for screening SGA neonates delivered within 2 weeks after the assessment. The DR for these births increased to 85.8%, 75.8%, 80.0%, and 82.5%, respectively., Conclusion: The rational use of ultrasound data can significantly improve the prediction of SGA statuses., (© 2022. The Author(s).)

Background: Small-for-gestational-age neonates (SGA) are at increased risk of neonatal morbidity. Nulliparity represents a risk factor for SGA; birthweight charts may perform differently for the detection of SGA among nulliparas. This study aimed at describing the prevalence of SGA in nulliparas according to different birthweight charts and evaluating the diagnostic performance of these charts to maternal and perinatal outcomes., Methods: This is a secondary analysis of a Brazilian cohort of nulliparas named Preterm SAMBA study. Birthweight centiles were calculated using the Intergrowth-21st, WHO-Fetal Growth Charts, Birth in Brazil population chart and GROW-customised chart. The risks of outcomes among SGA neonates and their mothers in comparison to neonates with birthweights between the 40 th -60 th centiles were calculated, according to each chart. ROC curves were used to detect neonatal morbidity in neonates with birth weights below different cutoff centiles for each chart., Results: A sample of 997 nulliparas was assessed. The rate of SGA infants varied between 7.0-11.6%. All charts showed a significantly lower risk of caesarean sections in women delivering SGA neonates compared to those delivering adequate-for-gestational-age neonates (OR 0.55-0.64, p < .05). The charts had poor performance (AUC 0.492 - 0.522) for the detection of neonatal morbidity related to SGA born at term., Conclusion: The populational and customised birthweight charts detected different prevalence of small-for-gestational-age neonates and showed similar and poor performance to identify related neonatal adverse outcomes in this population., (© 2022. The Author(s).)

Maternal gestational weight gain (GWG) is an important determinant of infant birth weight, and having adequate total GWG has been widely recommended. However, the association of timing of GWG with birth weight remains controversial. We aimed to evaluate this association, especially among women with adequate total GWG. In a prospective cohort study, pregnant women's weight was routinely measured during pregnancy, and their GWG was calculated for the ten intervals: the first 13, 14-18, 19-23, 24-28, 29-30, 31-32, 33-34, 35-36, 37-38 and 39-40 weeks. Birth weight was measured, and small-for-gestational-age (SGA) and large-for-gestational-age were assessed. Generalized linear and Poisson models were used to evaluate the associations of GWG with birth weight and its outcomes after multivariate adjustment, respectively. Of the 5049 women, increased GWG in the first 30 weeks was associated with increased birth weight for male infants, and increased GWG in the first 28 weeks was associated with increased birth weight for females. Among 1713 women with adequate total GWG, increased GWG percent between 14 and 23 weeks was associated with increased birth weight. Moreover, inadequate GWG between 14 and 23 weeks, compared with the adequate GWG, was associated with an increased risk of SGA (43 (13·7 %) v . 42 (7·2 %); relative risk 1·83, 95 % CI 1·21, 2·76). Timing of GWG may influence infant birth weight differentially, and women with inadequate GWG between 14 and 23 weeks may be at higher risk of delivering SGA infants, despite having adequate total GWG.

Background: Structural racism and pandemic-related stress from the COVID-19 pandemic may increase the risk of adverse birth outcomes., Objective: Our objective was to examine associations between neighborhood measures of structural racism and pandemic stress with 3 outcomes: SARS-CoV-2 infection, preterm birth, and delivering small-for-gestational-age newborns. Our secondary objective was to investigate the joint association of SARS-CoV-2 infection during pregnancy and neighborhood measures with preterm birth and delivering small-for-gestational-age newborns., Study Design: We analyzed data of 967 patients from a prospective cohort of pregnant persons in New York City, comprising 367 White (38%), 169 Black (17%), 293 Latina (30%), and 87 Asian persons (9%), 41 persons of other race or ethnicity (4%), and 10 of unknown race or ethnicity (1%). We evaluated structural racism (social/built structural disadvantage, racial-economic segregation) and pandemic-related stress (community COVID-19 mortality, community unemployment rate increase) in quartiles by zone improvement plan code. SARS-CoV-2 serologic enzyme-linked immunosorbent assay was performed on blood samples from pregnant persons. We obtained data on preterm birth and small-for-gestational-age newborns from an electronic medical record database. We used log-binomial regression with robust standard error for clustering by zone improvement plan code to estimate associations of each neighborhood measure separately with 3 outcomes: SARS-CoV-2 infection, preterm birth, and small-for-gestational-age newborns. Covariates included maternal age, parity, insurance status, and body mass index. Models with preterm birth and small-for-gestational-age newborns as the dependent variables additionally adjusted for SARS-CoV-2 infection., Results: A total of 193 (20%) persons were SARS-CoV-2-seropositive, and the overall risks of preterm birth and small-for-gestational-age newborns were 8.4% and 9.8%, respectively. Among birthing persons in neighborhoods in the highest quartile of structural disadvantage (n=190), 94% were non-White, 50% had public insurance, 41% were obese, 32% were seropositive, 11% delivered preterm, and 12% delivered a small-for-gestational-age infant. Among birthing persons in neighborhoods in the lowest quartile of structural disadvantage (n=360), 39% were non-White, 17% had public insurance, 15% were obese, 9% were seropositive, 6% delivered preterm, and 10% delivered a small-for-gestational-age infant. In adjusted analyses, structural racism measures and community unemployment were associated with both SARS-CoV-2 infection and preterm birth, but not small-for-gestational-age infants. High vs low structural disadvantage was associated with an adjusted relative risk of 2.6 for infection (95% confidence interval, 1.7-3.9) and 1.7 for preterm birth (95% confidence interval, 1.0-2.9); high vs low racial-economic segregation was associated with adjusted relative risk of 1.9 (95% confidence interval, 1.3-2.8) for infection and 2.0 (95% confidence interval, 1.3-3.2) for preterm birth; high vs low community unemployment increase was associated with adjusted relative risk of 1.7 (95% confidence interval, 1.2-1.5) for infection and 1.6 (95% confidence interval, 1.0-2.8) for preterm birth. COVID-19 mortality rate was associated with SARS-CoV-2 infection but not preterm birth or small-for-gestational-age infants. SARS-CoV-2 infection was not independently associated with birth outcomes. We found no interaction between SARS-CoV-2 infection and neighborhood measures on preterm birth or small-for-gestational-age infants., Conclusion: Neighborhood measures of structural racism were associated with both SARS-CoV-2 infection and preterm birth, but these associations were independent and did not have a synergistic effect. Community unemployment rate increases were also associated with an increased risk of preterm birth independently of SARS-CoV-2 infection. Mitigating these factors might reduce the impact of the pandemic on pregnant people., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Beta-blockers are prescribed for many pregnant women with heart disease, but whether there is a dose-dependent effect on fetal growth remains to be examined. We aimed to investigate if antenatal beta-blocker use and dose were associated with delivering a small-for-gestational-age infant among women with heart disease., Material and Methods: Our cohort included women with heart disease who delivered at Oslo University Hospital between 2006 and 2015. Maternal heart disease was classified into modified WHO risk scores. Women with beta-blocker treatment were dichotomized into whether they had been treated with a low or high dose based on clinical factors. We compared the risk of delivering a small-for-gestational-age infant in women exposed to high doses, low doses, or with no exposure to antenatal beta-blockers while adjusting for severity of maternal heart disease in logistic regression models., Results: Of a total of 540 pregnancies among women with heart disease, 163 (30.2%) were exposed to beta-blocker treatment. The majority were treated with metoprolol (86.5%). Almost twice as many babies in the beta-blocker group were small-for-gestational-age, compared with the non-exposed group (19.8 vs 9.5%, P < 0.001). Women using a high-dose beta-blocker had a five-fold increased risk of delivering a small-for-gestational-age infant compared with non-exposure (adjusted odds ratio [aOR] 4.89, 95% confidence interval [CI] 2.22-10.78, P < 0.001). Women using a low dose of beta-blocker had a two-fold increased risk of delivering a small-for-gestational-age infant; however, the confidence interval included the null (aOR 1.75, 95% CI 0.83-3.72, P = 0.143). Results when restricting the analyses to metoprolol showed the same pattern, but with attenuation of risks., Conclusions: We found a five-fold increased risk of delivering a small-for-gestational-age infant in women with heart disease treated with a high dose of beta-blocker, and a two-fold increased risk among those treated with a low dose, showing an apparent dose-response relation. Close monitoring of fetal growth is warranted among women with heart disease treated with beta-blockers. As drug therapy in pregnancy concerns both mother and fetus, an optimum balance for both should be the goal., (© 2022 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Abstract: Objectives: To evaluate the estimation of fetal weight by external abdominal measurements, alone or associated with fundal height measurement and/or ultrasonographic exams near 32 weeks, to detect intra-uterine growth retardation (IUGR) near term. Patients and methods: A retrospective cohort study included all women who delivered a small-for-gestational-age infant less than 37 weeks gestation during 2008–2009. We analyzed the sensitivity of estimation of fetal weight by external abdominal measurements and the others different routine exams during third trimester, and compared them to detect IUGR near term. Results: The estimation of fetal weight by external abdominal measurements was used in 263 pregnant patients. External abdominal measurements and fundal height measurement were not statistically different and were better tests than ultrasonographic exams at 32 weeks to detect IUGR near term (sensitivity: 41.4%, 42.2% and 22.8%, respectively; P <0.05). External abdominal measurements associated with regular ultrasonographic examination at 32 weeks of gestation significantly increased the sensitivity to detect IUGR near term (42.9% vs 22.8%; P <0.05). But, the association of external abdominal measurements and fundal height measurement did not increase the rate of detection (47.9% vs 42.2%; P =0.22). Discussion and conclusion: The present findings confirm that the use of the estimation of fetal weight by external abdominal measurements to detect intra-uterine growth retardation is effective. Measures to improve the learning of this technique and its reproducibility are recommended. [Copyright &y& Elsevier]

Abstract: Background: In preterm-born infants, low birth weight and diminished bone accretion deteriorate peak bone mass. Whether low birth weight is already associated with decreased bone mass during infancy is unknown. Objective: To study the effect of birth weight on bone accretion between term age (40weeks postmenstrual age) and six months post-term in preterm-born infants. Design: In 139 preterm-born infants (51% male, gestational age 30.3±1.5weeks, birth weight 1341±288g) weight and whole-body bone mineral content (BMC, gram) were measured at term age and six months post-term. At birth, infants were small-for-gestational-age (SGA, n=33, weight and/or length<−2 SDS) or appropriate-for-gestational-age (AGA, n=98, weight and length≥−2 SDS). Results: At term age and six months post-term, BMC adjusted for gender and gestational age was lower in SGA than AGA infants (term age: 38.1±9.5 versus 48.6±10.1g, β=−0.26, 95% CI −0.37; −0.16, p<0.001; six months: 130.1±25.7 versus 145.4±22.9g, β=−0.16, 95% CI −0.25; −0.08, p<0.001). At six months post-term, BMC remained lower in SGA infants after adjustment for actual weight and length. Between term age and six months post-term, BMC gain adjusted for gender and gestational age was lower in SGA than AGA infants (91.7±22.8 versus 98.2±20.7g; β=−0.12, 95% CI −0.24; −0.003, p=0.044). BMC gain remained lower in SGA infants after adjustment for weight and length gain. Conclusion: The first six months post-term, SGA preterms have lower bone accretion, independent of body size, suggesting that prenatal conditions for bone accretion cannot be replicated postnatally. [Copyright &y& Elsevier]

Abstract: Objectives: Teenagers are susceptible to delivering small-for-gestational-age infants. Previous studies implicate continued skeletal growth as a contributory factor, and impaired placental development was the primary cause of fetal growth restriction in growing adolescent sheep. The aims of this study were to examine the impact of young maternal age and growth on placental development. Study design: Placentas were collected from 31 teenagers, of which 12 were growing and 17 non-growing based on knee height measurements. An adult control group (n = 12) was included. Main outcome measures: Placental weight and morphometric measurements of villous, syncytiotrophoblast, fibrin and vessel areas, as well as indices of proliferation and apoptosis, were analysed in relation to maternal growth and age. Results: Growing teenagers had a higher birthweight:placental weight ratio than non-growing teenagers (p < 0.05). Villous area, syncytial area, fibrin content, vascularisation and cell turnover did not differ between growing and non-growing teenagers. There were no differences in placental weight or morphometry between adult and teenage pregnancies. Maternal smoking, a potential confounding factor, did not exert a major influence on the placental parameters examined, except for a stimulatory effect on placental proliferation (p < 0.05) and syncytial knot formation (p < 0.05). Conclusions: We were unable to detect any major differences in placental size or composition between growing and non-growing teenagers. Birthweight:placental weight ratio was higher in growing compared to non-growing teenagers. This suggests that maternal growth may affect placental function rather than development, and is consistent with our recent observations that maternal growth was not detrimental to fetal growth. [Copyright &y& Elsevier]

There is some evidence for elevated thyrotropin (TSH) levels in children born preterm, but follow-up studies into adulthood are lacking. We tested whether thyroid function in young adults born at a gestational age <32 weeks, with either an appropriate (appropriate for gestational age, AGA) or low birth weight for gestational age (small for gestational age, SGA), differed from that in age-matched controls. We made our measurements when the study participants reached 21 years of age. Serum concentrations of TSH and free T4 (fT4) and body composition were measured in subjects born preterm and AGA (n = 29) or SGA (n = 28), and in non-preterm controls (n = 30). The TSH and fT4 concentrations of participants were within normal limits. Free T4 levels in subjects born preterm were slightly higher than those in controls: 17.0 ± 2.4 (AGA) and 17.2 ± 1.7 (SGA) vs. 16.1 ± 1.9 pmol/L (p = 0.04). TSH concentrations did not differ between groups. From these preliminary data, we conclude that young adults born preterm have a normal thyroid function. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Bakker R, Steegers E, Biharie A, Mackenbach J, Hofman A, Jaddoe V. Explaining differences in birth outcomes in relation to maternal age: the Generation R Study. BJOG 2011;118:500-509. To examine the association between maternal age and birth outcomes, and to investigate the role of sociodemographic and lifestyle-related determinants. Population-based prospective cohort study from early pregnancy onwards. Rotterdam, the Netherlands. A cohort of 8568 mothers and their children. Maternal age was assessed at enrolment. Information about sociodemographic (height, weight, educational level, ethnicity, parity) and lifestyle-related determinants (alcohol consumption, smoking habits, folic acid supplement use, caffeine intake, daily energy intake) and birth outcomes was obtained from questionnaires and hospital records. Multivariate linear and logistic regression analyses were used. Birthweight, preterm delivery, small-for-gestational-age, and large-for-gestational-age. As compared with mothers aged 30-34.9 years, no differences in risk of preterm delivery were found. Mothers younger than 20 years had the highest risk of delivering small-for-gestational-age babies(OR 1.6, 95% CI: 1.1-2.5); however, this increased risk disappeared after adjustment for sociodemographic and lifestyle-related determinants. Mothers older than 40 years had the highest risk of delivering large-for-gestational-age babies (OR 1.3, 95% CI: 0.8-2.4). The associations of maternal age with the risks of delivering large-for-gestational-age babies could not be explained by sociodemographic and lifestyle-related determinants. As compared with mothers aged 30-34.9 years, younger mothers have an increased risk of small-for-gestational-age babies, whereas older mothers have an increased risk of large-for-gestational-age babies. Sociodemographic and lifestyle-related determinants cannot fully explain these differences. [ABSTRACT FROM AUTHOR]

Objectives To determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) andmiddle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late-onset small-for-gestational-age (SGA) fetuses. Methods UtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late-onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis. Results A total of 616 scans were performed on 171 SGA fetuses. Mean gestational age at inclusion and at delivery was 34.1 (SD 1.6) and 38.7 (SD 1.7) weeks, respectively. The proportions of abnormal UtA (2.3 vs. 4.1%) and UA (2.3 vs. 2.9%) pulsatility index (PI) were not significantly different between 37 weeks and before delivery. On the other hand, the proportions of abnormal MCA-PI (4.1 vs. 13.5%) and cerebroplacental ratio (CPR) (7 vs. 22.8%) were significantly different between these two examinations. The remaining proportion of cases with normal UtA-, UA- and MCA-PIs and CPR at 40 weeks were 98.6, 94.5, 85 and 49.6%, respectively. Whereas a slight increasing trend was observed for the UtA-PI (β = 0.002) and UA-PI (β = 0.01), MCA-PI (β = 0.044) and CPR (β = 0.124) showed a progressive decrease until delivery. Conclusions Late-onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks' gestation with worsening CPR followed by a decrease in MCA-PI. [ABSTRACT FROM AUTHOR]

Objective. To assess the effect of storage time on the stability of placental growth factor (PlGF) and fms-like tyrosine kinase 1 (sFlt-1) levels in frozen serum samples from pregnant women. Methods. This is a matched case-control study using fresh and stored serum samples collected at 6, 12, 18, 24, 30 and 36 months prior to the collection of the fresh samples and frozen at -80°C. Forty-eight samples from each of the seven time-groups were matched for non-smoking Chinese, maternal weight, singleton-term pregnancy without major obstetric complications and extracted for PlGF and sFlt-1 assays. Multivariate analysis was performed to assess residual effects of the case-matching procedure. ANOVA was used to assess the effects of storage time. Results. Multivariate analysis of the 336 samples indicated that log10PlGF was positively correlated with parity ( p = 0.014) and gestational age ( p = 0.029), while log10sFlt-1 was inversely correlated with parity ( p = 0.018). After correcting for the residual effect of gestation and parity, ANOVA showed no significant difference in PlGF and sFlt-1 levels between the fresh samples and all stored samples ( p = 0.410 and p = 0.158, respectively). Conclusions. Serum PlGF and sFlt-1 levels are stable for at least 3 years when stored at -80°C. Parity is an independent factor of PlGF and sFlt-1 levels. PlGF levels are lower and sFlt-1 levels are higher in nulliparous women compared to multiparous. [ABSTRACT FROM AUTHOR]

Aim: To determine the independent effect of prenatal tobacco smoke exposure on fetal growth using customized birthweight norms. Methods: Demographic characteristics and data on exposure to tobacco smoke during pregnancy were obtained from singleton neonates ≥34 weeks' gestation. Centile Calculator software v62.2 (www.gestation.net) was used for calculating customized birthweight percentiles. Results: Of the 3227 neonates studied, 30.9% were exposed to maternal smoking during pregnancy, whereas involuntary maternal exposure was reported in 20.1%. Growth restriction was noted in 350 (10.8%). The odds ratio (OR) for fetal growth restriction was 1.49 (1.10-1.91) in passive smokers, and 2.34 (1.81-2.96) in smokers. A decrease in birthweight and an increase in the prevalence of growth restriction with the increasing number of cigarette consumption was observed. This effect was evident even in cases of a 'minimal' consumption of 1-5 cigarettes per day. Conclusion: An essential adverse effect of tobacco smoke exposure on fetal growth in pregnancies exposed to passive smoking, as well as in those with 'minimal' maternal cigarette consumption, was found. Since approximately 30% of growth restricted neonates could be independently attributed to active or passive maternal exposure, these findings reinforce the need for smoking preventive strategies in pregnant women and their environment. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the brain metabolic and microstructural variation between appropriate-for-gestational (AGA) fetuses and small-for-gestational age (SGA) at 37 weeks' gestation. The study uses magnetic resonance imaging (MRI) spectroscopy and diffusion weighted imaging to match five AGA singleton fetuses and eight SGA. Results show that SGA fetuses show an increase in inositol/choline ratio and higher ADC values in the pyramidal tract.

Objective. To investigate the outcome of small-for-gestational-age (SGA) fetuses in relation to the features of umbilical artery (UA) Doppler and to explore the prognosticator of middle cerebral artery (MCA) Doppler in SGA fetuses with normal UA impedance. Methods. Two hundred ninety-seven patients were classified into Group 1 with normal UA and MCA pulsatility index (PI), Group 2 with normal UA but abnormal MCA PI and Group 3 with abnormal UA PI/absent or reversed end diastolic flow. Neonatal outcomes were compared between each group. Results. Neonatal intensive care unit (NICU) admission, duration of hospital stay and perinatal mortality were higher in Group 3 as compared to the others. Group 2 had a lower birth weight and more fetuses with 5-min Apgar score <7 than Group 1; NICU admission and need for ventilators were also significantly higher than Group 1. Conclusions. SGA fetuses with abnormal UA Doppler suffered more morbidity and mortality compared to those with normal UA Doppler. SGA fetuses with normal UA PI but abnormal MCA PI had worse outcomes compared to those with normal UA and MCA PI. [ABSTRACT FROM AUTHOR]

Objective: To analyze avoidable perinatal mortality in small-for-gestational-age (SGA) children. Methods: All SGA-children (≤10th percentile) among 22,189 newborns delivered after 24 weeks' gestation (175 days), from three regions of the Netherlands during 2003–2004 were evaluated. Cases of perinatal mortality were identified and assessed in a consensus model by perinatal audit groups for cause of death and the presence of substandard care factors (SSF). We analyzed all singleton SGA-cases with and without SSF for avoidable perinatal mortality. Results: Out of 20,927 singletons, 2396 newborns were SGA. Of those, 59 died perinatally (2.46%), and 55 of which were assessed by perinatal audit groups. SSF by caregivers were found in 22 cases (40%). In 16 of these cases (29%) the relation to the perinatal death was considered possible or (very) probable. Of the cases without SSF by caregivers, 15 cases (25%) could possibly have been avoided: in 13 cases an avoidable condition and in 2 cases avoidable death were identified. Failure in the correct and timely diagnosis of fetal growth restriction appears to be an important issue in all cases of perinatal mortality in SGA-children. Before referral growth restriction was suspected only in 22% of all SGA cases during the third trimester of pregnancy. Conclusions: More adequate action by caregivers could decrease perinatal mortality in nearly 1/3 among SGA-children. Adjustments in pregnancy monitoring, especially in low-risk pregnancies, such as routine ultrasound biometry examination, may improve the accuracy in detecting growth deviations and decreasing the number of possibly avoidable cases of perinatal mortality in this category. [ABSTRACT FROM AUTHOR]

First-trimester serum markers in 110 in-vitro fertilization (IVF) and 331 intracytoplasmatic sperm injection (ICSI) pregnancies were compared with 1431 pregnancies with spontaneous conception. Alterations of serum markers were evaluated with respect to small-for-gestational-age (SGA) growth and number of embryos transferred. For pregnancy-associated plasma protein A (PAPP-A), significantly lower concentrations were observed in IVF and ICSI pregnancies compared with controls (0.86 and 0.9 versus 1.06; P < 0.001). Free β-human chorionic gonadotrophin (βHCG) values were significantly higher in the IVF/ICSI groups than in controls (1.1 and 1.1 versus 0.94; P < 0.005). IVF and ICSI pregnancies showed higher rates of SGA (10.0% and 8.2%) compared with natural conception (4.6%), but differences in PAPP-A concentrations remained significant (P < 0.005) after the exclusion of SGA pregnancies. No relationship between serum values and the transfer of one, two or three embryos was observed. Centre-specific corrections may be needed to adjust screening parameters for assisted reproductive technology. [ABSTRACT FROM AUTHOR]

Aims: It remains questionable what birth weight for gestational age percentile cut-offs should be used in defining clinically important poor or excessive foetal growth. We aimed to evaluate the optimal birth weight percentile cut-offs for defining small- or large-for-gestational-age (SGA or LGA). Methods: In a birth cohort-based analysis of 17 979 120 non-malformation singleton live births, U.S. 1995–2001, we assessed the optimal birth weight percentile cut-offs for defining SGA and LGA. The 25th–75th percentile group served as the reference. Primary outcomes are the risk ratios (RR) of neonatal death and low 5-min Apgar score (<4) comparing SGA or LGA versus the reference group. More than 2-fold risk elevations were considered clinically significant. Results: The 15th birth weight cut-off already identified SGA infants at more than 2-fold risk of neonatal death at pre-term, term or post-term, except for extremely pre-term births <28 weeks (continuous risk reductions over increasing birth weight percentiles). LGA was associated with a reduced risk of low 5-min Apgar score at pre-term, but an elevated risk at term and post-term. The 97th cut-off identified LGA infants at 2-fold risk of low 5-min Apgar at term. Conclusion: The commonly used 10th and 90th birth weight percentile cut-offs for defining SGA and LGA respectively seem largely arbitrary. The 15th and 97th percentiles may be the optimal cut-offs to define SGA and LGA respectively. [ABSTRACT FROM AUTHOR]

Aim: To determine the fluid requirement of small-for-gestational-age (SGA) newborns and to compare them with that of appropriate for gestational age (AGA) newborns in the first 5 days of life. Materials and methods: The present study was conducted from January 2007 to August 2007, including newborns with a gestation age of 32-40 weeks, with respiratory problems, feeding problems, and prematurity, and required intravenous fluid for at least 3 days. Two study groups were established: SGA (group 1) and AGA (group 2) according to the Lubchenco scale. All newborns were cared at an ambient humidity of 40% in an incubator and received intravenous fluid therapy. Daily fluid intake was adjusted with urine output, hydration, and weight gain/loss. Results: During the study period, 124 newborns were admitted to neonatal wards, and only 48 newborns met the inclusion criteria. Two study groups were formed: group 1, SGA (n = 24) and group 2, AGA (n = 24). The comparison of percentage weight loss differences on day 5 with birth weight was 1.39 ± 3.7% in group 1, and 4.29 ± 4.02% in group 2. The mean percentage of weight loss in group 1 was lower than group 2 (P = 0.014). During 5 days, the mean daily fluid requirements in groups 1 and 2 were measured as 103.18 ± 28.68 cc/kg per day and 129.09 ± 25.8 cc/kg per day. The daily fluid requirement in group 1 was lower compared to group 2 (P = 0.003). Conclusion: SGA newborns need lower fluid requirements, and experience lower weight loss during the first 5 days of life as compared with AGA counterparts, which suggests that fluid requirement of SGA newborns are different from AGA newborns and the fluid therapy of SGA newborns should be special. [ABSTRACT FROM AUTHOR]