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Objective: To develop a core outcome set for pre-eclampsia. Design(s): Consensus development study. Setting(s): International. Population: Two hundred and eight-one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. Method(s): Modified Delphi method and Modified Nominal Group Technique. Result(s): A long-list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre-eclampsia trials with those derived from thematic analysis of 30 in-depth interviews of women with lived experience of pre-eclampsia. Forty-seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small-for-gestational-age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. Conclusion(s): The core outcome set for pre-eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies. Tweetable abstract: 281 healthcare professionals, 41 researchers and 110 women have developed #preeclampsia core outcomes @HOPEoutcomes @jamesmnduffy. [Correction added on 29 June 2020, after first online publication: the order has been corrected.].Copyright © 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetr

Aim: To compare neonatal outcomes of small for gestational age (SGA) infants born to South Asian (SA)-born women and Australian/New Zealand (ANZ)-born women. Method(s): Retrospective cohort study at a hospital network in Australia. Maternal and neonatal data were collected for infants born SGA between 2013 and 2017 to SA- or ANZ-born women. Rates of perinatal mortality and neonatal morbidities were analysed between groups. Result(s): A total of 1018 SA and 959 ANZ SGA infants were included. SA SGA babies were older (median [IQR] 39 [38-40] weeks) and heavier (2590 [2310-2780] grams) compared to ANZ SGA babies (38 [37-40] weeks and 2480 [2059-2740] grams; P <.001 for both). After adjustment for differences in demographics, SA SGA babies were 1.5 times more likely to develop hypothermia (CI: 1.16-1.88, P =.001), but 60% less likely to be born with a major congenital malformation (CI: 0.24-0.67, P =.001) and 36% less likely to need gavage feeding (CI: 0.43-0.93, P =.02) compared to ANZ SGA babies. Conclusion(s): Small for gestational age babies of SA-born women have different neonatal outcomes as compared to those born to ANZ-born women. Further research into influence of maternal region of birth on placental function, organogenesis and body composition of SGA babies is warranted.Copyright © 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd

Objective: It has been suggested that lockdown during the COVID-19 pandemic decreased prematurity rates. We investigated the impact of lockdown on obstetric outcomes. Study Design: We performed a cohort study on women who gave birth at three maternity hospitals in metropolitan Melbourne, Australia, between Jan 1st, 2019 and Sept 16th, 2020. Data were extracted from the common birth registry of the three maternities. The second lockdown started July 8th, 2020 and required people to stay at home, with limited exemptions. We performed interrupted time-series analysis to compare the monthly rates of preterm birth before 34 weeks prior to and after July 2020. We also compared the group of women who delivered between July and September 2020 to the group of women who delivered during the same period in 2019. Result(s): A total 15,394 women gave birth. Interrupted time-series analysis demonstrated a significantly lower monthly rate of deliveries before 34 weeks of gestational age after July 2020 (Figure 1; p = 0.001). There were 2,207 deliveries between July to Sept. 2019 and 1,870 deliveries between July to Sept. 2020. Baseline characteristics were comparable, except for a significantly difference in twins (1.5% in 2020 versus 2.6% in 2019, p = 0.012). After excluding women with pregnancies complicated by major fetal abnormalities or stillbirth, the risk of preterm delivery before 34 weeks was much lower in patients who delivered between July and September 2020 (2.1% versus 3.3%, RR 0.64, 95% CI 0.44 to 0.94, p = 0.022) (Table 1). Similar patterns were observed for iatrogenic and spontaneous preterm birth at different gestational ages. The effect persisted after logistic regression adjustment for multiple pregnancies (adjusted OR 0.65, 95% CI 0.46 to 0.96, p = 0.028). The decrease in prematurity was not at the cost of an increase in stillbirth or undetected small for gestational age neonates. Conclusion(s): Strict lockdown has a strong impact on iatrogenic and spontaneous

Background: Preterm infants undergoing intensive care often experience painful procedures such as heel lance for blood sampling. Knowledge of the cerebral hemodynamic response to painful stimuli contributes to understanding of cortical pain processing and the neurovascular network in the preterm brain. Previous research has demonstrated cerebral hemodynamic responses using near-infrared spectroscopy (NIRS) after noxious stimuli in infants appropriately grown for age (AGA). But this has not been studied in infants born small for gestational age after fetal growth restriction (FGR). FGR infants differ in brain development due to utero-placental insufficiency leading to the intrauterine growth restriction, and cerebral response to pain may be altered. Objective(s): We aimed to compare the cerebral hemodynamic response to painful stimuli (heel lance) in FGR and AGA infants. Method(s): Preterm FGR infants (n = 20) and AGA infants (n = 15) born at 28-32 weeks' gestation were studied at mean +/- SD postnatal age of 11.5 +/- 2.4 and 10.5 +/- 2.4 days, respectively. Infants had baseline echocardiographic assessment of ductus arteriosus and stroke volume. They were monitored with NIRS for changes in tissue oxygenation index (TOI, %), and oxygenated, deoxygenated, and total hemoglobin (DELTAO2Hb, DELTAHHb, and DELTATHb) in contralateral and ipsilateral cerebral hemispheres, during a heel lance. Result(s): At baseline, FGR infants had significantly lower TOI, higher heart rate, and lower stroke volume compared to AGA infants. Most infants in both groups showed increase in each of the NIRS parameters in the contralateral hemisphere following heel lance. However, more AGA infants (6/15) showed decreased DELTATHb compared to FGR infants (1/20) (p = 0.016). The magnitude of cerebral hemodynamic response and time to response did not differ between FGR and AGA infants. FGR infants showed larger DELTAO2Hb in the contralateral compared to ipsilateral cortex (p = 0.05). Conclusion(s): P

Aims/hypothesis: The aim of this systematic review was to develop core outcome sets (COSs) for trials evaluating interventions for the prevention or treatment of gestational diabetes mellitus (GDM). Method(s): We identified previously reported outcomes through a systematic review of the literature. These outcomes were presented to key stakeholders (including patient representatives, researchers and clinicians) for prioritisation using a three-round, e-Delphi study. A priori consensus criteria informed which outcomes were brought forward for discussion at a face-to-face consensus meeting where the COS was finalised. Result(s): Our review identified 74 GDM prevention and 116 GDM treatment outcomes, which were presented to stakeholders in round 1 of the e-Delphi study. Round 1 was completed by 173 stakeholders, 70% (121/173) of whom went on to complete round 2; 84% (102/121) of round 2 responders completed round 3. Twenty-two GDM prevention outcomes and 30 GDM treatment outcomes were discussed at the consensus meeting. Owing to significant overlap between included prevention and treatment outcomes, consensus meeting stakeholders agreed to develop a single prevention/treatment COS. Fourteen outcomes were included in the final COS. These consisted of six maternal outcomes (GDM diagnosis, adherence to the intervention, hypertensive disorders of pregnancy, requirement and type of pharmacological therapy for hyperglycaemia, gestational weight gain and mode of birth) and eight neonatal outcomes (birthweight, large for gestational age, small for gestational age, gestational age at birth, preterm birth, neonatal hypoglycaemia, neonatal death and stillbirth). Conclusions/interpretation: This COS will enable future GDM prevention and treatment trials to measure similar outcomes that matter to stakeholders and facilitate comparison and combination of these studies. Trial registration: This study was registered prospectively with the Core Outcome Measures in Effectiveness Trials (

Background: Small for gestational age (SGA) foetuses have an increased risk of adverse outcomes in the perinatal period and later life. Antenatal detection of these at-risk foetuses allows the opportunity to initiate surveillance and delivery. We aimed to explore the impact of antenatal detection on obstetric and perinatal outcomes. Method(s): This was a retrospective study of all singleton deliveries after 20 weeks' gestation at a large hospital maternity service over an 18-month period. Terminations of pregnancy and major foetal anomalies were excluded. An SGA neonate was defined as birthweight below the 10th percentile according to local birthweight reference ranges. Detected SGA was defined as sonographic estimated foetal weight or abdominal circumference below the 10th percentile at any gestational age after 24 weeks, or small or static symphysio-fundal height. Simple log binomial regression was used to compute the risk of adverse outcomes depending on size at birth and antenatal recognition of foetal smallness. Result(s): 13178 neonates were included. 1303 neonates (10.0%) were small for gestational age at birth. There was a trend towards increased risk of composite adverse perinatal outcome in undetected compared to detected SGA neonates, but the difference was not statistically significant (RR 1.19, 95% CI 0.72-1.95). However, detected SGA neonates were more likely to be delivered preterm (RR 4.55, 95% CI 3.27-6.34), and require admission to neonatal intensive care unit (RR 3.23, 95% CI 1.94-5.37). Conclusion(s): Antenatal detection of SGA neonates may improve perinatal outcomes but is also associated with higher probability of preterm delivery and neonatal admission.

Background: Detection of small for gestational age (SGA) foetuses with risk factor screening and selective growth ultrasonography is the standard of care in Australia, but evidence regarding diagnostic accuracy is limited. We sought to identify pregnancies at risk of poor foetal growth, quantify the use of foetal growth ultrasonography and assess compliance with local screening guidelines for SGA foetuses. Method(s): This was a retrospective clinical audit of all singleton deliveries after 20 weeks' gestation at a large metropolitan maternity care centre, over 18 months. Terminations of pregnancy were excluded. An SGA neonate was defined by birthweight below the 10th percentile according to local reference ranges. Suspected SGA was defined as sonographic estimated foetal weight or abdominal circumference below the 10th percentile at any gestational age after 24 weeks, or small or static symphysis-fundal height. Result(s): 13384 singleton pregnancies were included. 10266 pregnancies (77.0%) had at least one risk factor for an SGA infant. Of these, 6650 (64.8%) underwent at least one foetal growth ultrasound after 24 weeks' gestation. 1330 infants (10.0%) were SGA at birth. Antenatal detection rate of SGA at birth was 39.6%, with a false positive rate of 10.2%. Conclusion(s): Three-quarters of pregnancies had risk factors for delivering an SGA infant, but growth ultrasonography may be underutilised. Overall, antenatal recognition of poor foetal growth is suboptimal using current screening protocols.

OBJECTIVES: To examine how overweight and obesity at specific ages and overall BMI growth patterns throughout childhood predict cardiometabolic phenotypes at 11 to 12 years. METHOD(S): In a population-based sample of 5107 infants, BMI was measured every 2 years between ages 2 to 3 and 10 to 11 years. We identified 5 BMI trajectories using growth curve models. At ages 11 to 12 years, 1811 children completed assessments for metabolic syndrome risk scores, carotid-femoral pulse wave velocity, and carotid intima-media thickness. Multivariable regression models were used to estimate associations, adjusted for potential confounders (eg, age, sex, smoking exposure, and small for gestational age). RESULT(S): Overweight and obesity from early childhood onward were strongly associated with higher cardiometabolic risk at 11 to 12 years of age. At age 6 to 7 years, compared with those with a healthy weight, children with overweight had higher metabolic syndrome risk scores by 0.23 SD units (95% confidence interval 0.05 to 0.41) and with obesity by 0.76 SD units (0.51-1.01), with associations almost doubling by age 10 to 11 years. Obese (but not overweight) children had higher outcome pulse wave velocity (0.64-0.73 SD units) from ages 6 to 7 years and slightly higher outcome carotid intima-media thickness (0.20-0.30 SD units) at all ages. Cumulative exposure to high BMI from 2 to 3 years of age carried the greatest cardiometabolic risk, with a gradient of risk across trajectories. CONCLUSION(S): High early-childhood BMI is already silently associated with the development of cardiometabolic risk by 11 to 12 years, highlighting the urgent need for effective action to reduce overweight and obesity in early childhood.Copyright © 2020 by the American Academy of Pediatrics

Background: Accurate estimation of fetal weight is essential in guiding management of fetuses with abdominal wall defects (AWDs), as growth restriction is an important predictor of perinatal morbidity and mortality. Several sonographic formulae are available involving multiple biometric parameters, but abdominal circumference measurements may underestimate weight in fetuses with AWDs. No formula has yet shown superior accuracy. Aim(s): The objectives of this study were to evaluate, in fetuses with gastroschisis and omphalocoele, the accuracy of a sonographic estimated fetal weight (EFW) formula proposed by Siemer and colleagues, specifically for use in fetuses with AWDs compared to the commonly used Hadlock IV formula in estimating fetal weight, and detecting small for gestational age (SGA) fetuses. Material(s) and Method(s): A retrospective cohort of 113 fetuses with AWDs was identified from an Australian teaching hospital over 13 years. Pregnancy data and sonographic fetal biometry parameters were obtained. The accuracy of each formula in predicting birthweight was compared using Bland-Altman limits of agreement, and the intraclass correlation coefficient between EFW and actual birthweight. Performance of each formula in detecting SGA fetuses was determined. Result(s): The Siemer and Hadlock formulae have similar accuracies for predicting birthweight in fetuses with AWDs. The Hadlock formula has a higher detection rate for SGA < 10th centile and < 3rd centile compared to the Seimer formula (84% vs 68% and 83% vs 67% respectively), albeit with a higher false-positive rate. Conclusion(s): There is no clear clinical advantage in using the Siemer formula, which is specifically designed for fetuses with AWDs, over the Hadlock formula to estimate weight in fetuses with AWDs.Copyright © 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Objective: The aim of this study was to investigate the relationship between perceived discrimination in perinatal care and birth outcomes of women giving birth to an Aboriginal baby in South Australia using methods designed to respect Aboriginal culture and communities. Design and setting: Population-based study of women giving birth to Aboriginal infants in South Australia, July 2011-June 2013. Women completed a structured questionnaire with an Aboriginal researcher. Study measures include: standardised measure of perceived discrimination in perinatal care; maternal smoking, cannabis use and exposure to stressful events and social health issues; infant birthweight and gestation. Participant(s): 344 women (mean age 25, range 15-43 years) living in urban, regional and remote areas of South Australia. Result(s): Half of women (51%) perceived that they had experienced discrimination or unfair treatment by hospitals or health services providing care during pregnancy and soon after childbirth. Women experiencing three or more stressful events or social health issues were more likely to perceive that care was discriminatory or unfair. Aboriginal women who perceived that they had experienced discrimination in perinatal care were more likely to have a baby with a low birthweight (Adj Odds Ratio 1.9, 95% CI 1.0-3.8) or small for gestational age (Adj Odds Ratio 1.9, 95% CI 1.0-3.5), adjusting for parity, smoking and cannabis use. Conclusion(s): The study provides evidence of the 'inverse care law'. Aboriginal women most at risk of poor infant health outcomes were the least likely to perceive that they received care well matched to their needs. Building stronger evidence about what works to create cultural safety in perinatal health care is an urgent priority.Copyright © 2019 Australian College of Midwives

Intrauterine growth restriction (IUGR) is a complex global healthcare issue. Concerted research and clinical efforts have improved our knowledge of the neurodevelopmental sequelae of IUGR which has raised the profile of this complex problem. Nevertheless, there is still a lack of therapies to prevent the substantial rates of fetal demise or the constellation of permanent neurological deficits that arise from IUGR. The purpose of this article is to highlight the clinical and translational gaps in our knowledge that hamper our collective efforts to improve the neurological sequelae of IUGR. Also, we draw attention to cutting-edge tools and techniques that can provide novel insights into this disorder, and technologies that offer the potential for better drug design and delivery. We cover topics including: how we can improve our use of crib-side monitoring options, what we still need to know about inflammation in IUGR, the necessity for more human post-mortem studies, lessons from improved integrated histology-imaging analyses regarding the cell-specific nature of magnetic resonance imaging (MRI) signals, options to improve risk stratification with genomic analysis, and treatments mediated by nanoparticle delivery which are designed to modify specific cell functions.Copyright © 2019 Fleiss, Wong, Brownfoot, Shearer, Baud, Walker, Gressens and Tolcos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging. Method(s): We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics. Result(s): Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased. Conclusion(s): Consistently with previous findings

Background: Maternal ethnicity has been linked to neonatal outcomes of premature babies. However, the relationship between ethnicity and neonatal outcomes of small for gestational age (SGA) babies is not clear. Method(s): Retrospective cohort study comparing neonatal outcomes of babies born SGA to mothers born in Australia, New Zealand (ANZ) to those born in South Asia (SA) from a large metropolitan hospital network from 2013-17. Univariate and multivariate analysis of neonatal outcomes between groups was conducted. Result(s): 959 ANZ and 1020 SA SGA babies were included. SA babies were significantly older (median (IQR) 39(38-40) weeks) and heavier (2590(2310-2780) grams) compared to ANZ babies (38 (37-40) weeks) and 2480 (2059-2740) grams; p < 0.001 for both). There was no difference in mortality (0.5% vs. 0.9%; p = 0.2). After correction for gestational age and birth weight, SA babies were 20% (95% CI 0.6 to 0.9; p = 0.03) less likely to need resuscitation, and 93% less likely (0.006 to 0.97, p = 0.04) to have chronic lung disease. However there was no difference in rates of admission to NICU/SCN (OR 0.96 (0.7 to 1.1; p = 0.6), length of respiratory support in the NICU/SCN (-1 days (-2.2 to 0.2; p = 0.1) or total length of stay if admitted (21 days (-65 to 107; p = 0.6). Overall, SA babies were 46% (10% to 80%; p < 0.001) more likely to experience hypothermia. Conclusion(s): Babies born to South Asian born mothers have different neonatal outcomes as compared to babies born to Australasian born mothers. The causes of SGA and their consequences are likely different warranting further investigation.

Background: Polycystic ovary syndrome (PCOS) presents with four phenotypes with varying severity. PCOS is associated with increased risk of pregnancy complications. It is unclear if PCOS phenotypes are variably associated with pregnancy complications. We aimed to conduct a meta-analysis of pregnancy complications in women with and without PCOS by PCOS phenotypes. Method(s): A comprehensive search was performed in several electronic databases for pregnancy outcomes in women with and without PCOS. Outcomes of interest included miscarriage, gestational diabetes (GDM), gestational hypertension (GH), preeclampsia (PE), induction of labour (IoL), Caesarean section (CS), intra-uterine growth restriction, preterm birth, birth weight, macrosomia and small for gestational age and large for gestational age (LGA). Twenty six of 4294 identified studies, compromising 1743 women with and 8294 women without PCOS were included. Result(s): The odds ratio (OR) for GDM [3.5; 95% confidence interval (CI) 2.0, 6.0], GH [3.9; 2.1, 7.2], PE [2.7; 1.5, 4.9], IoL [1.8; 1.1, 2.9], CS [1.5; 1.2, 2.0] and LGA [1.4; 1.1, 2.0] were higher in PCOS. Of these, the increased odds were maintained across PCOS phenotypes for GDM and GH however odds were significantly associated with hyperandrogenic phenotypes for PE, IoL, CS and LGA. Women with the hyperandrogenic phenotypes had significantly higher body mass index. Conclusion(s): In pregnancy, glucose profile and blood pressure should be equally screened across PCOS phenotypes with further consideration in women with the hyperandrogenic phenotypes.

Polycystic ovary syndrome (PCOS) is associated with worsened pregnancy and infant outcomes, higher body mass index (BMI), and longitudinal weight gain. Despite most of the clinical features of PCOS being risk factors for worsened infant outcomes in the general population, their impact on infant outcomes in PCOS is unknown. We aimed to investigate the association of PCOS with infant outcomes considering maternal adiposity, other known risk factors, and potential confounders. The meta-analyses included 42 studies in 7041 women with PCOS and 63 722 women without PCOS. PCOS was associated with higher gestational weight gain (GWG) and with higher preterm birth and large for gestational age and with lower birth weight with this association varying by geographic continent, PCOS phenotypes, and study quality. However, PCOS was associated with none of these outcomes on BMI-matched studies. Gestational diabetes was significantly associated with an increased preterm birth on meta-regression. We report for the first time that GWG is higher in PCOS. Infant outcomes vary by geographic continent and study quality but are similar in BMI-matched women with and without PCOS. This suggests that infant outcomes in PCOS may be related to maternal obesity. These novel findings warrant future studies in PCOS investigating screening and management of infant outcomes with consideration of maternal obesity.Copyright © 2019 World Obesity Federation

Thrombocytopenia has been closely associated with small-for-gestational-age neonates (SGA; birthweight less than tenth percentile) admitted to the special care nursery or neonatal ICU. It is unclear if 'well' SGA neonates experience the same incidence of thrombocytopenia in the SGA population as compared to sick neonates. We conducted a retrospective cohort study from a health network in Melbourne, Australia, between 2012 and 2015 to identify SGA neonates (>= 35 weeks' gestation at birth) that were otherwise well. Neonates with at least one platelet count within 7 days of life were matched to appropriate-for-gestational-age (AGA) neonates from the same birth centre, with the same sex, and closest gestational age and birth date, who were also considered otherwise well. 16.7% of matched neonates had thrombocytopenia (303/1814) and of these, a larger proportion of SGA neonates were thrombocytopenic, 21.7% (197/907), than AGA neonates, 11.7% (106/907, P < 0.01). The incidence of thrombocytopenia was greater in the SGA cohort regardless of admission destination (special care nursery/neonatal ICU 26.8 vs. 13.9%, P < 0.01; Postnatal Ward 16.5 vs. 9.4%, P < 0.01). Thrombocytopenia is more prevalent amongst constitutionally well SGA neonates than AGA neonates. SGA alone increases the risk of thrombocytopenia.Copyright © 2019 The Author(s).

Introduction While a number of studies have reported increased risk of adverse pregnancy outcomes in polycystic ovary syndrome (PCOS), these have not been designed considering the impact of body mass index (BMI) as an important contributor to both PCOS severity and pregnancy outcomes. We therefore aimed to explore the impact of BMI on adverse pregnancy outcomes in PCOS. Methods A comprehensive search was conducted in Medline, Medline in-process and other non-indexed citations, EMBASE and all EBM reviews. Prospective studies reporting pregnancy outcomes including miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth, small and large for gestational age birth in women with and without PCOS, until 4th April 2017, were identified as eligible for inclusion. Data were expressed as odds ratio (OR) with 95% confidence interval (CI) and analyzed using the random effect model for meta-analysis. Results Out of a total of 4292 identified articles, 24 prospective studies were included in the meta-analysis. Women with PCOS showed higher risk for miscarriage (OR 2.85, 95% CI 1.74-4.65), gestational diabetes (OR 3.04, 95% CI 2.26-4.10), gestational hypertension (OR 2.24, 95% CI 1.71-2.95), pre-eclampsia (OR 1.90, 95% CI 1.32-2.74), preterm birth (OR 1.51, 95% CI 1.09- 2.08) but similar risk for small for gestational age birth (OR 1.56, 95% CI 0.76-3.21) and large for gestational age birth (OR 1.19, 95% CI 0.90-1.58), compared to women without PCOS. On subgroup analysis by BMI-matched studies, this higher risk was maintained for miscarriage (OR: 4.00, 95% CI 2.59-6.18) and gestational diabetes (OR: 4.94, 95% CI 1.06-23.08), but not for gestational hypertension (OR: 2.50, 95% CI 0.69-9.05), preeclampsia (OR: 2.61, 95% CI 0.55-12.34) and preterm birth (OR: 1.64, 95% CI 0.61-4.41). The risks became significant for small for gestational age birth (OR: 4.52, 95% CI 1.92-10.61) and large for gestational age birth (OR: 1.99, 95% CI 1.05-3.77) in BMI-matc

Background: The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. Method(s): Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. Result(s): Overall, 5874 studies were identified and 23 were included (n=1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]

Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method(s): Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Result(s): VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and >=32 weeks, AUC 0.50-0.65; >=1500 g and <32 weeks, AUC 0.60-0.62). Conclusion(s): There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking.Copyright © 2017 The Author(s).

Controversy remains surrounding International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria for gestational diabetes mellitus (GDM), including perceived improvement in perinatal outcomes and health service implications. We compared perinatal outcomes for untreated women meeting IADPSG-only criteria and women without GDM in Victoria. Women meeting IADPSG-only criteria were characterised according to fasting and one hour glucose thresholds and by region of birth. IADPSG criteria identified women with increased risk of adverse perinatal outcomes, particularly women born in Australia compared to Asian regions.Copyright © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Background: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. Objective(s): We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. Method(s): We monitored regional cerebral oxygen saturation (rScO2) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). Result(s): In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO2 [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. Conclusion(s): Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.Copyright © 2016 S. Karger AG, Basel.

Objective: To compare contemporary pregnancy outcomes in women with and without type 1 diabetes, and to examine the effects of obesity and glycaemic control on these outcomes. Design and setting: Historical cohort study in a specialist diabetes and maternity network in Victoria. Participant(s): All singleton births (at least 20 weeks' gestation), 2010e2013, were analysed: 107 pregnancies to women with type 1 diabetes and 27 075 pregnancies to women without diabetes. Women with type 2 diabetes or gestational diabetes were excluded. Method(s): Data were extracted from the Birthing Outcomes System database; associations between type 1 diabetes and pregnancy outcomes were analysed by multivariable regression. Main Outcome Measure(s): Mode of birth; maternal and neonatal outcomes. Result(s): The mean body mass index was higher for women with type 1 diabetes than for women without diabetes (mean, 27.3 kg/m2 [SD, 5.0] v 25.7 kg/m2 [SD, 5.9]; P = 0.01); the median gestation period for their babies was shorter (median, 37.3 weeks [IQR, 34.6e38.1] v 39.4 weeks [IQR, 38.4e40.4]; P<0.001)and they were more likely to be large for gestational age (LGA) (adjusted odds ratio [aOR], 7.9; 95% CI, 5.3e11.8). Women with type 1 diabetes were more likely to have had labour induced (aOR, 3.0; 95% CI, 2.0e4.5), a caesarean delivery (aOR, 4.6; 95% CI, 3.1e7.0), or a pre-term birth (aOR, 6.7; 95% CI, 4.5e10.0); their babies were more likely to have shoulder dystocia (aOR, 8.2; 95% CI, 3.6e18.7), hypoglycaemia (aOR, 10.3; 95% CI, 6.8e15.6), jaundice (aOR, 5.1; 95% CI, 3.3e7.7), respiratory distress (aOR, 2.5; 95% CI, 1.4e4.4) or to suffer perinatal death (aOR, 4.3; 95% CI, 1.9e9.9). In women with type 1 diabetes, greater obesity was associated with increased odds for an LGA baby or congenital malformation, and increased HbA1c levels were associated with pre-term birth and perinatal death. Conclusion(s): Women with type 1 diabetes, even when managed in a specialist setting, still experience ad

Background: We aimed to determine whether the association between obesity and a range of adverse maternal and perinatal outcomes differed in South Asian and Australian and New Zealand born women. Method(s): A retrospective cohort study of singleton births in South Asian (SA) and Australian/New Zealand (AUS/NZ) born women at an Australian hospital between 2009 and 2013. The interaction between maternal region of birth and obesity on a range of maternal and perinatal outcomes was assessed using multivariate logistic regression. Result(s): Obesity was more strongly associated with gestational hypertension/Preeclampsia/HELLP and Gestational Diabetes Mellitus in AUS/NZ born women (p = 0.001 and p < 0.001, respectively for interaction) and was only associated with shoulder dystocia in SA born women (p = 0.006 for interaction). There was some evidence that obesity was more strongly related with admission to NICU/Special care nursery (SCN) (p = 0.06 for interaction) and any perinatal morbidity (p = 0.05 for interaction) in SA born women. Conclusion(s): Interventions targeted at reducing maternal obesity will have different impacts in SA compared to AUS/NZ born women.Copyright © 2016 The Author(s).

Aim Intrauterine growth restriction (IUGR) is an important cause for prematurity and adversely influences prematurity-related morbidities. This study evaluates the impact of IUGR on respiratory outcomes in infants <32 weeks with IUGR and birthweight <10th centile (SGA) compared to matched appropriate for gestation (AGA) controls. Methods The primary outcomes of this retrospective study are short-term pulmonary outcomes of chronic lung disease (CLD), CLD or death, and need for home oxygen at discharge. Subgroup analysis by gestation-based stratification (<28 and >=28 <32 weeks) was decided a priori. Results Total of 153 IUGR and 306 non-IUGR infants were enrolled. The rate of CLD (45% vs. 17%, p = 0.0001), death (16% vs. 4.6%, p = 0.0001), CLD or death (46% vs. 21.5%, p = 0.0001), home oxygen rates (13.7% vs. 6.5%, p = 0.01) and duration of respiratory support was significantly higher in the IUGR group. IUGR emerged as the strongest predictor of CLD (adjusted OR, 95%CI: (8.4 [2, 35]) and CLD or death (12.7 [3, 54]) across all gestation. Conclusion IUGR is a major risk factor for adverse short-term pulmonary outcomes as reflected by higher rates of CLD, CLD or death, and oxygen dependency at discharge in preterm infants.Copyright ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Background: Maternal ethnicity is an emerging risk factor for stillbirth. In this study we aimed to explore associations between maternal country of birth and the risk of stillbirth among women giving birth in Victoria. Method(s): A retrospective cohort study of routinely collected perinatal data for Victoria from 2000 to 2011. The rates of stillbirth >24 weeks (excluding TOPs and known congenital abnormalities) were determined by gestational week and maternal country of birth. Result(s): The rate of stillbirth was higher in South Asian (SA) and lower in South-East-East Asian (SE-EA) women compared to Australian (Aus) born women. Compared to Aus women, the relative risk of stillbirth among SA women increased with increasing gestation. After adjustment with known risk factors for stillbirth, SA women were 50% (95%CI 1.2-1.9) more likely to have a stillbirth and SE-EA women were almost 40% (95%CI 0.5-0.8) less likely to have a stillbirth compared to Aus women. The increased rate of stillbirth in SA women was entirely explained by undetected small for gestational age (SGA) babies. In those SA pregnancies there was an 11 fold increased risk of stillbirth (95%CI 9.6-12.9). In SA pregnancies where SGA was detected or there was not SGA the risk of stillbirth was similar to Aus women (OR 1.15 [95%CI 0.91-1.46]). Conclusion(s): Our findings suggests that improvements in the detection of small for gestational babies will likely have a large impact in the reduction of stillbirth in SA women.

Introduction: Hypoparathyroidism in pregnancy is rare, but important, as it is associated with maternal morbidity and foetal loss. There are limited case reports and no established management guidelines. Optimal maintenance of calcium levels during pregnancy is required to minimise the risk of related complications. This study aims to identify causes and examine outcomes of hypoparathyroidism in pregnancy in a cohort of women delivering at a large referral centre. Design and method: The Monash Health maternity service database captures pregnancy and birthing outcomes in over 9000 women each year. We audited this database between 2000 and 2014 to examine the clinical course, treatment and outcomes of pregnant women with hypoparathyroidism. Result(s): We identified 10 pregnancies from 6 women with pre-existing hypoparathyroidism secondary to idiopathic hypoparathyroidism (n. =. 3), autosomal dominant branchial arch disorder with hypoparathyroidism (n. =. 3) and autosomal dominant hypocalcaemia (n. =. 1), surgery for thyroid cancer (n. =. 2) and Graves' disease (n. =. 1). Maternal calcium levels were monitored through pregnancy and management adjusted to maintain normocalcaemia. One woman was delivered by caesarean section at 34. weeks' gestation because of intrauterine growth restriction, and oligohydramnios complicated two other pregnancies. The postpartum period was complicated by severe hypercalcaemia in one woman and by symptomatic, labile serum calcium levels during lactation in another woman, requiring close monitoring over a 6. month period. Conclusion(s): Although rare, hypoparathyroidism in pregnancy poses a management challenge for clinicians, and co-ordinated care is required by obstetricians and endocrinologists to ensure optimal outcomes for both mother and baby. Continued monitoring of maternal calcium levels during lactation and weaning is essential to avoid the potential complications of either hypercalcaemia or hypocalcaemia.Copyright © 2015 .

Worldwide, approximately 10% of neonates are born preterm. The majority of preterm neonates are born when the kidneys are still developing; therefore, during the early postnatal period renal function is likely reflective of renal immaturity and/or injury. This study evaluated glomerular and tubular function and urinary neutrophil gelatinase-associated lipocalin (NGAL; a marker of renal injury) in preterm neonates during the first month of life. Preterm and term infants were recruited from Monash Newborn (neonatal intensive care unit at Monash Medical Centre) and Jesse McPherson Private Hospital, respectively. Infants were grouped according to gestational age at birth: <=28 wk (n = 33), 29-31 wk (n = 44), 32-36 wk (n = 32), and term (>=37 wk (n = 22)). Measures of glomerular and tubular function were assessed on postnatal days 3-7, 14, 21, and 28. Glomerular and tubular function was significantly affected by gestational age at birth, as well as by postnatal age. By postnatal day 28, creatinine clearance remained significantly lower among preterm neonates compared with term infants; however, sodium excretion was not significantly different. Pathological proteinuria and high urinary NGAL levels were observed in a number of neonates, which may be indicative of renal injury; however, there was no correlation between the two markers. Findings suggest that neonatal renal function is predominantly influenced by renal maturity, and there was high capacity for postnatal tubular maturation among preterm neonates. There is insufficient evidence to suggest that urinary NGAL is a useful marker of renal injury in the preterm neonate. © 2014 the American Physiological Society.

Aims: Speckle derived strain echocardiography is an emerging technique for assessing cardiac function. Small for gestational age infants are characterised by perinatal mortality and morbidity. The objective was to compare strain and conventional Doppler indices between small for gestational age (SGA) and appropriate for gestational age (AGA) infants and to ascertain correlations with arterial biophysical parameters. Our hypothesis was that fetal programming and adaptation to growth restriction induces changes in cardiac and arterial indices. Method(s): A prospective observational echocardiographic study of cardiac and arterial indices was done. Demographic and echocardiographic data for 20 inborn term SGA infants weighing < 3rd centile for gestational age were compared with 20 AGA infants. Arterial indices measured included stiffness, impedance and strain elastic modulus. Result(s): The gestational age of both groups was comparable (39.1 +/- 1.3 vs 38.9 +/- 1.4 weeks). Ponderal index was significantly lower in SGA infants than the term AGA infants. Left ventricular global longitudinal strain (GLS) was significantly impaired in the SGA infants (-15.9 % +/- 2.1 vs -21.3 % +/- 2.8, p <0.001). A basal to apical gradient was noted in segmental strain. Left ventricular output was lower in SGA infants (170 +/- 31 vs 197 +/- 39 ml/kg/min, p=0.017). Diastolic dysfunction (reduced E and A wave velocities, higher E/A ratio [1.08 +/- 0.16 vs 0.85 +/- 0.07]) and prolonged isovolumic relaxation time [73 +/- 6.2 vs 62.6 +/- 3.6 ms]) were noted in the SGA infants. Aortic intima media thickness (aIMT) was noted to be significantly greater in SGA infants (822 +/- 105 vs 694 +/- 52 mum). Arterial wall stiffness index and input impedance were significantly greater in the SGA infants. Significant correlations were noted between GLS and arterial stiffness (r = -0.4, p = 0.03), weight indexed stiffness (r = -0.45, p=0.02) and pressure - strain elastic modulus (r = - 0.49, p = 0.01). Concl

Objective: To describe the distribution of magnetic resonance imaging (MRI) patterns in a large population sample of children with cerebral palsy (CP), and to examine associations between MRI patterns and selected antenatal, perinatal, and clinical variables. Design(s): Retrospective cohort study. Method(s): Data were retrieved from the Victorian CP Register for 884 children born in Victoria between 1999 and 2006, excluding those with postneonatally-acquired CP. MRI was assessed for 594 children (67% of eligible cohort) by one of two radiologists blinded to clinical information and previously- generated reports. The classification system was adapted from those used in previous studies and systematic reviews. It included white matter injury, grey matter injury, focal vascular insults, malformations, as well as miscellaneous and normal findings. Demographic, birth, and clinical data were retrieved from the register for all eligible children. For 563 children classified to a single MRI pattern (329 males, 234 females; mean age at imaging 2y 9mo [SD 2yr 4m]), the frequencies of variables previously reported to be associated with CP were compared with population or control frequencies. Result(s): Normal imaging and miscellaneous findings were seen in 13% and 7% of children, respectively. White matter injury, the most common MRI pattern (45%), was strongly associated with preterm delivery and poor condition at birth, but was also seen in 32% of children with CP born at term. Grey matter injury (14%), primarily seen in term-born children, was strongly associated with variables suggestive of unforeseen, severe perinatal compromise and intrapartum timing. Small for gestational age was a strong risk factor for focal vascular insults (9%). Only approximately one third of focal vascular insults were associated with neonatal seizures and early diagnosis. Children with malformations (10%) had relatively few perinatal problems. Male gender was a risk factor for MRI patterns indica

Background: Improvements in vitrification now make frozen embryo transfers (FETs) a viable alternative to fresh embryo transfer, with reports fromobservational studies and randomized controlled trials suggesting that: (i) the endometrium in stimulated cycles is not optimally prepared for implantation; (ii) pregnancy rates are increased following FET and (iii) perinatal outcomes are less affected after FET. methods: This review integrates and discusses the available clinical and scientific evidence supporting embryo transfer in a natural cycle. Result(s): Laboratory-based studies demonstrate morphological and molecular changes to the endometrium and reduced responsiveness of the endometriumtohCG, resulting fromcontrolledovarian stimulation.Theliteraturedemonstrates reducedendometrial receptivity incontrolledovarian stimulation cycles and supports the clinical observations that FET reduces the risk of ovarian hyperstimulation syndrome and improves outcomes for both the mother and baby. Conclusion(s): This review provides the basis for an evidence-based approach towards changes in routine IVF, which may ultimately result in higher delivery rates of healthier term babies.Copyright © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

Aim: The aim of this study was to describe the distribution of magnetic resonance imaging (MRI) patterns in a large population sample of children with cerebral palsy (CP) and to examine associations between MRI patterns, and antenatal and perinatal variables. Method(s): Data were retrieved from the Victorian CP Register for 884 children (527 males, 357 females) born between 1999 and 2006. Postneonatal MRI was classified for 594 children. For 563 children (329 males, 234 females) for whom classification was to a single MRI pattern, the frequency of each variable was compared between patterns and with the population frequency. Result(s): White matter injury was the most common MRI pattern (45%), followed by grey matter injury (14%), normal imaging (13%), malformations (10%), focal vascular insults (9%), and miscellaneous patterns (7%). Parity, birth gestation, level of neonatal care, Apgar score, and time to established respiration varied between MRI patterns (p<0.01). Nulliparity was most strongly associated with focal vascular insults, whereas multiparity was associated only with malformations. Grey matter injury was not associated with birth in a tertiary unit, but was strongly associated with severe perinatal compromise. The frequency of neonatal seizures and of nursery admissions was lowest among children with malformations. Interpretation(s): As known risk factors for CP are differentially associated with specific MRI patterns, future exploration of causal pathways might be facilitated when performed in pathogenically defined groups. © 2013 Mac Keith Press.

Background: IBD is common in the fertile years. With anti- TNF-alpha therapy it has become possible to rapidly induce and maintain remission. This improved therapy makes it possible for women with IBD to consider pregnancy, but concerns regarding the use of drugs during pregnancy are often raised by IBD patients. We examined outcomes of pregnancy among women with IBD exposed to anti-TNF-alpha during pregnancy. Further, medical treatment, disease activity, and counselling were investigated in an international multicentre study. Method(s): 115 women exposed to Infliximab (IFX) or Adalimumab (ADA) during pregnancy who had given birth during a 3 year period were identified at 14 hospitals in Denmark, Australia and New Zealand. Electronic questionnaires were used to investigate diagnosis, medical treatment, disease activity, counselling, and birth outcome. Recruitment is ongoing. Result(s): 86 (74.8%) of the women filled in the questionnaire of whom 3 had a miscarriage prior to gestational week (GW) 10, leaving a study population of 83 women. The pregnancy was planned in 60 (72.3%) of the cases. 54 (65.1%) and 29 (34.9%) received treatment with IFX and ADA, respectively. Co-medication with thiopurines were used in 25 (30.1%) of the pregnancies. 7 (8.4%) gave birth preterm (GW 32 36). None of the babies were small for gestational age or had congenital malformations. Median Apgar score at 5 minutes was 9.3 (range 7 10). Caesarean section was performed in 52 (60.5%) of the deliveries and in 36 (69.2%) of these cases the women stated IBD as the reason. 19 (22.3%) women experienced a relapse during pregnancy of whom 8 (42.1%) had disease activity at delivery. Anti-TNF-alpha therapy was discontinued during the 1st., 2nd. and 3rd. trimester in 3.9%, 38.2% and 57.9% of the cases, respectively. Counselling on medical treatment with anti-TNF-alpha therapy was given to 72 (83.7%) of the women most frequently by a gastroenterologist (88.9%). The vast majority (98.4%) of women were s

Aim To compare strain indices between small for gestational age (SGA) infants and asymptomatic appropriate for gestational age (AGA) infants and to ascertain correlations with arterial biophysical properties. Methods In this prospective observational echocardiographic study, 20 inborn term SGA infants weighing <3rd centile for gestational age were compared with 20 AGA infants. Demographic and echocardiographic data were analysed regarding cardiac strain and strain rate and arterial indices (stiffness, impedance and strain elastic modulus). Correlations between variables were assessed using Pearson's coefficient of correlation. Results Ponderal index was significantly lower in SGA infants (24.6 +/- 2.9 vs. 29.5 +/- 2.5). Left ventricular global longitudinal strain (GLS) was noted to be significantly impaired in the SGA infants (-15.9% +/- 2.1 vs. -21.3% +/- 2.8, p < 0.001). A basal to apical gradient was noted in segmental strain. Arterial biophysical measurements were significantly altered in the SGA infants. Significant correlations were noted between GLS and arterial stiffness (r = -0.4, p = 0.03), weight-indexed stiffness (r = -0.45, p = 0.02) and pressure-strain elastic modulus (r = -0.49, p = 0.01). Conclusion Impairment in myocardial deformation was noted in the presence of altered arterial biophysical properties in the SGA infants. © 2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Objective: Approximately 24% of children with hemiplegia and 10% of those with cerebral palsy (CP) have imaging evidence of perinatal arterial ischaemic stroke (PAIS). The aim of this study was to investigate potential risk factors for PAIS in children with CP, with particular emphasis on maternal and child blood groups. The secondary aim was to examine differences in the frequency of selected antenatal and perinatal variables between children with neonatally symptomatic and neonatally asymptomatic PAIS. Design(s): Retrospective cohort and nested case-control study. Method(s): Reports of magnetic resonance imaging (MRI) and computerised tomography (CT) scans were searched for evidence of PAIS in 1-18 year old children who were registered with the Victorian CP Register. PAIS was defined as infarction conforming to a major arterial territory. Sixty-two mother-child pairs participated and provided information on blood groups (mean age of children 8y 0m [SD 4y 9mo]; 40 male, 22 female). Additional antenatal, perinatal, and clinical variables were extracted from the Victorian CP Register and medical records. The frequency of variables previously reported to be associated with CP was compared with the reported population frequency, as well as between the symptomatic and asymptomatic groups. Result(s): Sixteen mothers (26%) in the PAIS group were rhesus negative (Rh(D) ); this was higher than the 17% reported in the population for Caucasians (p=0.065). There were no statistically significant differences for maternal or child Rh(D) and ABO blood groups, nor for Rh(D) or ABO incompatibility. The proportions of male sex, primiparity and primigravidity, small for gestational age, and unplanned caesarean delivery in the PAIS group were statistically different from the frequencies in the Victorian population (p<0.05). Neonatal seizures and nursery admission were also more common in the PAIS group. Compared to the asymptomatic PAIS group (n=45), mothers of children in the early s

Brief Introduction: Bartter syndrome (BS) is a rare inherited tubulopathy defined (Bartter et al. 1962) as the association of hypokalemia with metabolic alkalosis, hyperaldosteronism with normal blood pressure and hyperplasia of the juxtaglomerular apparatus (figure 1). There is marked variation in age of onset, clinical presentation and severity of symptoms in accordance with different genetic abnormalities identified and the different transporter channels that they affect (table 1). The incidence of antenatal variant of BS varies between 1 to 2 cases per 100,000 live births per year. Early recognition and management of the antenatal form of BS is critical to patient survival. However, the low incidence and the presence of other morbidities, especially in premature infants, may impede timely diagnosis. Material(s) and Method(s): The aim of this study was to describe the presenting features, management and short-term outcomes of infants diagnosed with antenatal Bartter syndrome (aBS). The study was a retrospective case series of all infants who were admitted to a tertiary neonatal intensive care unit, and who were diagnosed with antenatal onset of Bartter syndrome between January 2007 and December 2013. Clinical Cases or Summary Results: Six cases of antenatal onset of Bartter syndrome were identified (table 2). All infants had an antenatal history of unexplained polyhydramnios and premature labour and delivery. Amnioreduction was performed in four cases. Fluid chloride analysis was performed in only one of these cases and the level was significantly elevated. The median gestation of delivery was 32 weeks (range 25 to 34 weeks). There was a male predominance of 5:1 and all had weights appropriate for gestational age. All infants had>10% weight loss within the first 48 hours of life due to polyuria, and required fluid replacement therapy with saline infusion as high as 40 millilitres/kilogram/hour in the first few weeks of life. All except one exhibited significant e