444: Severity of small For gestational age birth weight at term: increased risk for neonatal morbidity

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil

BMJ Open ◽

10.1136/bmjopen-2018-023529 ◽

2019 ◽

Vol 9 (7) ◽

pp. e023529 ◽

Cited By ~ 2

Author(s):

Enny S Paixão ◽

Oona M Campbell ◽

Maria Gloria Teixeira ◽

Maria CN Costa ◽

Katie Harron ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Birth Outcomes ◽

Live Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Severe Dengue ◽

Maternal Risk ◽

Increased Risk

ObjectivesDengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.Design and settingWe conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.ParticipatingWe linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks’ gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.ResultsWe included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.ConclusionThis study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.

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Pregnancy outcome among HIV-infected women on different antiretroviral therapies in Ethiopia: a cohort study

BMJ Open ◽

10.1136/bmjopen-2018-027344 ◽

2019 ◽

Vol 9 (8) ◽

pp. e027344

Author(s):

Yohannes Ejigu ◽

Jeanette H Magnus ◽

Johanne Sundby ◽

Maria C Magnus

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Highly Active Antiretroviral Therapy ◽

Addis Ababa ◽

Zidovudine Monotherapy ◽

Increased Risk

ObjectiveThe objective of the study was to compare pregnancy outcomes according to maternal antiretroviral treatment (ART) regimens.DesignA retrospective cohort study.Participants and settingsClinical data was extracted from ART exposed pregnancies of HIV-infected Ethiopian women attending antenatal care follow-up in public health facilities in Addis Ababa between February 2010 and October 2016.OutcomesThe primary outcomes evaluated were preterm birth, low birth weight and small-for-gestational-age.ResultsA total 1663 of pregnancies exposed to ART were included in the analyses. Of these pregnancies, 17% resulted in a preterm birth, 19% in low birth weight and 32% in a small-for-gestational-age baby. Compared with highly active antiretroviral therapy (HAART) initiated during pregnancy, zidovudine monotherapy was less likely to result in preterm birth (adjusted OR 0.35, 95% CI 0.19 to 0.64) and low birth weight (adjusted OR 0.48, 95% CI 0.24 to 0.94). We observed no differential risk of preterm birth, low birth weight and small-for-gestational-age, when comparing women who initiated HAART during pregnancy to women who initiated HAART before conception. The risk for preterm birth was higher in pregnancies exposed to nevirapine-based HAART (adjusted OR 1.44, 95% CI 1.06 to 1.96) compared with pregnancies exposed to efavirenz-based HAART. Comparing nevirapine-based HAART with efavirenz-based HAART indicated no strong evidence of increased risk of low birth weight or small-for-gestational-age.ConclusionsWe observed a higher risk of preterm birth among women who initiated HAART during pregnancy compared with zidovudine monotherapy. Pregnancies exposed to nevirapine-based HAART also had a greater risk of preterm births compared with efavirenz-based HAART.

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Marcadores Bioquímicos do Primeiro Trimestre e Recém-Nascidos Leves para Idade Gestacional

Acta Médica Portuguesa ◽

10.20344/amp.3985 ◽

2014 ◽

Vol 27 (2) ◽

pp. 191

Author(s):

Cláudia Andrade ◽

Joana Santos ◽

Ana Rita Pinto ◽

Pedro Manso ◽

Susana Pereira

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Odds Ratio ◽

Biochemical Markers ◽

First Trimester ◽

Control Group ◽

Maternal Weight ◽

Increased Risk ◽

Β Hcg

Introduction: Several studies suggested an association between first trimester biochemical markers (PAPP-A and β- HCG) and infants below 10th percentile. Our goal was to describe this relationship of biochemical markers with small-for- gestational-age fetuses in our population. Material and Methods: Retrospective analytic study of 2 035 pregnant women that underwent first-trimester screening in the period between March 2009 and September 2011. Small-for-gestational-age infants below 10th percentile were compared with control group (term newborn with birth weight above 10th percentile). Infants below 3rd percentile and control group were also compared. Multiple and logistic regression analysis were done with PAPP-A, β-HCG (multiples of the expected normal median) and demographic maternal characteristics (ethnicity, weight and smoker status). Results: This study demonstrated an independent contribution of PAPP-A, maternal weight and smoker status in predicting small-for-gestational-age infants. For PAPP-A, the odds ratio for small-for-gestational age below 10th and 3rd percentile was 2.41 and 3.41, respectively (p < 0.01). For β-HCG, odds ratio below 10th percentile was 1.70 (p = 0.03) and for birth weight below the 3rd percentile, the odds ratio was 3.22 (p < 0.01). Conclusions: Low levels of PAPP-A and β-HCG (values below 5th percentile of the study population) were associated with an increased risk of small-for-gestational-age infants in the pregnant population included in this study.

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Perinatal Factors Associated with Infant Maltreatment

Clinical medicine Pediatrics ◽

10.4137/cmped.s980 ◽

2008 ◽

Vol 1 ◽

pp. CMPed.S980 ◽

Cited By ~ 2

Author(s):

Takeo Fujiwara ◽

Makiko Okuyama ◽

Haley Tsui ◽

Karestan C. Koenen

Keyword(s):

At Risk ◽

Chronic Disease ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Z Score ◽

Increased Risk

Background The association between birth outcomes and child maltreatment remains controversial. The purpose of this study is to test whether infants without congenital or chronic disease who are low birth weight (LBW), preterm, or small for gestational age (SGA) are at an increased risk of being maltreated. Methods A hospital-based case-control study of infants without congenital or chronic diseases who visited the National Center for Child Health and Development, Tokyo, between April 1, 2002 and March 31, 2005 was conducted. Cases (N = 35) and controls (N = 29) were compared on mean birth weight, gestational age, and z-score of birth weight. Results SGA was significantly associated with infant maltreatment after adjusting for other risk factors (adjusted odds ratio: 4.45, 95% CI: 1.29–15.3). LBW and preterm births were not associated with infant maltreatment. Conclusion Infants born as SGA are 4.5 times more at risk of maltreatment, even if they do not have a congenital or chronic disease. This may be because SGA infants tend to have poorer neurological development which leads them to be hard-to-soothe and places them at risk for maltreatment. Abbreviations SCAN, Suspected Child Abuse and Neglect; LBW, low birth weight; ZBW, z-score of birth weight adjusted for gestational age, sex, and parity; SGA, small for gestational age; SD, standard deviation; OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; IPV, intimate partner violence.

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Association of Low Maternal Plasma Glucose after Oral Glucose Challenge Test with Small for Gestational Age Neonate

International Journal of Infertility & Fetal Medicine ◽

10.5005/jp-journals-10016-1035 ◽

2012 ◽

Vol 3 (1) ◽

pp. 22-25 ◽

Cited By ~ 6

Author(s):

Pratap Kumar ◽

Rajeshwari G Bhat ◽

KV Bhagya

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Plasma Glucose ◽

Small For Gestational Age ◽

Challenge Test ◽

Neonatal Morbidity ◽

Maternal Plasma ◽

Oral Glucose ◽

Glucose Challenge Test ◽

Glucose Challenge

ABSTRACT Aims and objectives To study the association of low maternal plasma sugar with birth weight and neonatal morbidity. Materials and methods Glucose challenge test was performed in low risk women, the birth weight and neonatal morbidities were compared between women with low GCT (<88 mg/dl) and normal GCT (88-139 mg/dl). Results Incidence of small for gestational age (<2500 gm) was significantly more in women with low GCT (17.3% vs 7.3%), but difference in NICU admission between the two groups was not significant statistically. Conclusion Prevalence of small for gestational age neonate was significantly higher in women with low GCT compared to women with normal GCT. How to cite this article Bhat RG, Bhagya KV, Kumar P. Association of Low Maternal Plasma Glucose after Oral Glucose Challenge Test with Small for Gestational Age Neonate. Int J Infertility Fetal Med 2012;3(1):22-25.

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Small for gestational age and poor fluid intelligence in childhood predict externalizing behaviors among young adults born at extremely low birth weight

Development and Psychopathology ◽

10.1017/s0954579414000662 ◽

2014 ◽

Vol 27 (1) ◽

pp. 181-188 ◽

Cited By ~ 3

Author(s):

Ayelet Lahat ◽

Ryan J. Van Lieshout ◽

Saroj Saigal ◽

Michael H. Boyle ◽

Louis A. Schmidt

Keyword(s):

Young Adults ◽

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Fluid Intelligence ◽

Risk Model ◽

Externalizing Behaviors ◽

Extremely Low Birth Weight ◽

Increased Risk

AbstractAlthough infants born at extremely low birth weight (ELBW; birth weight < 1000 g) are at increased risk for developing later psychopathology, the mechanisms contributing to this association are largely unknown. In the present study, we examined a putative cognitive link to psychopathology in a cohort of ELBW survivors. These individuals were followed up prospectively at age 8 and again at ages 22–26. At 8 years, participants completed measures of fluid and general intelligence. As young adults, a subset of ELBW survivors free of major neurosensory impairments provided self-reports of personality characteristics related to psychopathology. Data from 66 participants indicated that, as predicted, the association between ELBW and externalizing behaviors was moderated by fluid intelligence. Specifically, ELBW individuals with poor fluid intelligence who were born small for gestational age (birth weight < 10th percentile for gestational age) showed the highest level of externalizing behaviors. These findings provide support for a cumulative risk model and suggest that fluid intelligence might be a cognitive mechanism contributing to the development of psychopathology among nonimpaired individuals who were born at ELBW and small for gestational age.

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High Maternal Serum Estradiol Environment in the First Trimester Is Associated With the Increased Risk of Small-for-Gestational-Age Birth

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2013-3362 ◽

2014 ◽

Vol 99 (6) ◽

pp. 2217-2224 ◽

Cited By ~ 59

Author(s):

Xiao-Ling Hu ◽

Chun Feng ◽

Xian-Hua Lin ◽

Zi-Xing Zhong ◽

Yi-Min Zhu ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

First Trimester ◽

Maternal Serum ◽

Serum Estradiol ◽

Ideal Model ◽

Fresh Embryo Transfer ◽

Increased Risk ◽

The Mean

Context: There are increasing concerns that a disrupted endocrine environment may disturb the growth of the fetus. Assisted reproductive technology (ART) situates gamete/embryo in a supraphysiological estradiol (E2) environment and, thus, provides an ideal model to investigate this problem. Objective: Our objective was to investigate whether the maternal high-E2 environment in the first trimester increases the risks of low birth weight (LBW) and small-for-gestational-age (SGA) birth. Methods: In total, 8869 singletons born after fresh embryo transfer (ET) (n = 2610), frozen ET (n = 1039), and natural conception (NC) (n = 5220) and their mothers were included. Birth weight, LBW, SGA, and maternal serum E2 levels were investigated. Results: The mean serum E2 levels of women undergoing fresh ET at 4 and 8 weeks of gestation were significantly higher than those of the women undergoing frozen ET and the women with NC (P < .01). Serum E2 levels of women undergoing fresh ET at 4 and 8 weeks of gestation were positively correlated to those on the day of human chorionic gonadotropin (hCG) administration (r = 0.5 and r = 0.4, respectively; P < 0.01). The birth weight after fresh ET was significantly lower than that after frozen ET and NC (P < 0.01), with increased incidence of LBW and SGA (P < .05). Furthermore, in the fresh ET group, singletons of mothers with high E2 levels (≥10460 pmol/L on the day of hCG administration) had higher risks of LBW (P < .01) and SGA (P < .01) than those with low E2 levels, and maternal serum E2 level on the day of hCG administration negatively correlated with the birth weight (P < .01). Conclusions: The maternal high-E2 environment in the first trimester is correlated with increased risks of LBW and SGA. Evaluation of serum E2 before ET should be adopted to reduce the possibility of high E2 exposure to gamete/embryo.

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IGF-II expression and methylation in small for gestational age infants

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2014-0269 ◽

2015 ◽

Vol 28 (5-6) ◽

Cited By ~ 5

Author(s):

Shulian Zhang ◽

Guanpeng Zhai ◽

Jin Wang ◽

Wenjing Shi ◽

Rong Zhang ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Newborn Infants ◽

Adult Life ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Increased Risk ◽

The Status ◽

Appropriate For Gestational Age

AbstractLow birth weight is associated with an increased risk of adverse outcomes in many diseases in adult life. We investigated the expression of IGF-II and the status of differentially methylated regions (DMR) in small for gestational age (SGA) infants after birth.Plasma IGF-II, IGF-II receptor (IGF2R), IGF-I, and IGF-binding protein 3 (IGFBP3) levels were measured after birth in 150 newborn infants. These included 30 term appropriate for gestational age (AGA), 30 term SGA, 30 term large for gestational age (LGA), 30 preterm AGA, and 30 preterm SGA infants.Plasma IGF-II levels after birth were lower in both term SGA (435.1±33.82 vs. 620.4±44.79, p=0.002) and LGA infants (483.7±33.8 vs. 620.42±44.79, p=0.018) than in term AGA infants. The expression ofIGF-II was associated with birth weight and expressed at high levels, which suggests that IGF-II may continue to play an important role after birth.

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Occupational exposure to organic particles and combustion products during pregnancy and birth outcome in a nationwide cohort study in Sweden

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105672 ◽

2019 ◽

Vol 76 (8) ◽

pp. 537-544 ◽

Cited By ~ 2

Author(s):

Filip Norlén ◽

Per Gustavsson ◽

Pernilla Wiebert ◽

Lars Rylander ◽

Magnus Westgren ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Birth Outcome ◽

Combustion Products ◽

Increased Risk ◽

Organic Particles ◽

Absence From Work

ObjectiveTo study if children of women exposed to organic particles and combustion products at work during pregnancy, have an increased risk of low birth weight, preterm birth or small for gestational age.MethodsA nationwide cohort of all occupationally active mothers and their children from single births during 1994 to the end of 2012 (1 182 138 observations) was formed. Information on birth outcome was obtained from the medical birth register. Information on absence from work, education, occupation, age, nationality and smoking habits was obtained from national registers. A job exposure matrix (FINJEM) was used to assess the exposure.ResultsPregnant women with low absence from work and high (>50th percentile) exposure to organic particles had an increased risk of giving birth to children with low birth weight (OR=1.19; 95% CI: 1.07 to 1.32), small for gestational age (OR=1.22; 95% CI: 1.07 to 1.38) or preterm birth (OR=1.17; 95% CI: 1.08 to 1.27). Subgroup analyses showed an increased risk of small for gestational age in association with exposure to oil mist. Exposure to oil mist and cooking fumes was associated with low birth weight. Paper and other organic dust was associated with preterm birth. Exposure to combustion products showed an increased risk of small for gestational age (OR=1.40; 95% CI: 1.15 to 1.71).ConclusionsThe results indicate that occupational exposure to organic particles or combustion products during pregnancy is associated with restriction of fetal growth and preterm birth. More studies are needed to confirm a casual association.

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