Growth among Twins: Use of Singleton versus Twin-Specific Growth Nomograms

2017 ◽  
Vol 35 (02) ◽  
pp. 184-191 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Van Truong ◽  
Claudia Pedroza ◽  
Suneet Chauhan
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Neonatal Morbidity ◽  
Large For Gestational Age ◽  
Maternal Fetal Medicine ◽  
Logistic Regression Models ◽  
Abnormal Growth ◽  
Birth Weight Percentile ◽  
Appropriate For Gestational Age ◽  
Study Population

Objective We hypothesized that utilization of a twin-specific nomograms, when compared with one based on singleton data, is less likely to classify twins as having abnormal growth and more likely to identify perinatal morbidity and mortality. Materials and Methods Data were culled from seven Maternal-Fetal Medicine Units (MFMU) studies, the included twin gestations in their study population. Each newborn twin's birth weight percentile was categorized using Alexander et al (singleton data) and Ananth et al (twin data) nomogram. Logistic regression models were adjusted for maternal race and body mass index, neonatal sex, study, and twin correlation. Results More twins were categorized as small for gestational age (SGA) when singleton nomogram was used (33%) compared with twin nomogram (4%). The use of singleton nomogram revealed a higher composite neonatal morbidity (CNM) and stillbirth rates among SGA twins but a similar neonatal mortality rate when compared with appropriate for gestational age. Correspondingly, when twin-specific nomogram was utilized, the CNM, odds of stillbirth, and neonatal mortality were higher among SGA twins. The rate of large for gestational age among twins was increased with the use of twin-specific nomograms. Conclusion Utilization of twin-specific nomogram is less likely to categorize twins as SGA and more likely to identify those at risk for stillbirth and neonatal mortality.

scholarly journals Study of foot length as an alternate measurement for assessment of gestational maturity in neonates

2019 ◽  
Vol 6 (2) ◽  
pp. 477 ◽  
Author(s):  
Ananya S. L. Tenali ◽  
Ravi Kumar Tenali
Keyword(s):  
Gestational Age ◽  
Healthcare Personnel ◽  
Large For Gestational Age ◽  
Growth Chart ◽  
Strongly Correlated ◽  
Simple Method ◽  
Medical College ◽  
Foot Length ◽  
Appropriate For Gestational Age ◽  
Study Population

Background: The aim was to study neonatal foot length as a simple method for quick gestational age assessment which can be done by basic healthcare personnel overcoming the technicality required by other assessment methods.Methods: Prospective descriptive study was done. Live born neonates at Saveetha Medical College, Kanchipuram from June 2016 to June2017 were enrolled. Gestational age was assessed by New Ballard’s Scoring and footlength was measured using the paddle blades of automated digital Vernier calipers within 24 hours while birth weight was taken within 72 hours of birth. Based on gestational age, babies were grouped into preterm, term and post term and were subclassified as small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) based on Lubchenco’s intrauterine growth chart. Correlation and regression analysis and Scattergram was done.Results: Out of 300 neonates, term, preterm and post-term were 70.3%,28.3% and1.3% while SGA, AGA, and LGA babies were 9%, 88% and 3%. Mean foot length was 7.728cm±0.59 with a range of 5-8.8cm. Foot length strongly correlated with gestational age in Preterm AGA, SGA and Term AGA babies (<0.001). Correlation coefficient of foot length with gestational age was higher in preterms (r=0.95). Gestational age in 54% of study population could be calculated with the derived regression equation derived.Conclusions: Foot length maybe useful for quick estimation of gestational age in preterm and term neonates for early referral of newborns requiring special care and can even be done by basic healthcare personnel.

Population versus Customized Growth Curves: Prediction of Composite Neonatal Morbidity

2018 ◽  
Vol 36 (08) ◽  
pp. 818-827 ◽  
Author(s):  
Hector Mendez-Figueroa ◽  
Suneet P. Chauhan ◽  
Tyisha Barrett ◽  
Van Thi Thanh Truong ◽  
Claudia Pedroza ◽  
...  
Keyword(s):  
Gestational Age ◽  
Random Effect ◽  
Perinatal Outcomes ◽  
Growth Curves ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Likelihood Ratios ◽  
Maternal Fetal Medicine ◽  
Adverse Perinatal Outcomes

Objective To assess the ability of customized and population growth nomograms in identifying newborns with composite neonatal morbidity (CNM). Study Design This study included women who participated in the 10 Maternal-Fetal Medicine Units (MFMU) trials and delivered a nonanomalous singleton with a known gestational age (GA) of 24 weeks or more and documented birthweight. Population nomograms were based on Alexander's nomogram, whereas customized nomograms used publicly available softwares. Random-effect logistic regression was used to estimate the adjusted odds ratio (aOR). Positive and negative likelihood ratios (LRs) were calculated to assess nomogram performance. Results Of 92,225 women, 85% met the inclusion criteria. Using the population nomogram, 12% were small for gestational age (SGA) and 10% were large for gestational age (LGA), and using customized nomograms, 15% were SGA and 16% LGA. SGA newborns had a higher likelihood of CNM (aOR: 2.62; 95% confidence interval [CI]: 2.48–2.76) for population nomograms and 3.22 (95% CI: 3.07–3.39) for customized nomograms. LGA newborns had a similar CNM with population nomogram but significantly higher with customized nomogram (aOR: 1.42; 95% CI: 1.34–1.50). For the adverse outcomes among SGA and LGA, the positive LRs for the two nomograms were similar with overlapping 95% CI. Conclusion Though both SGA and LGA are associated with adverse perinatal outcomes, the detection using both nomograms was similar.

scholarly journals Factors associated with small- and large-for-gestational-age in socioeconomically vulnerable individuals in the 100 Million Brazilian Cohort

2021 ◽  
Author(s):  
Ila R Falcão ◽  
Rita de Cássia Ribeiro-Silva ◽  
Marcia Furquim de Almeida ◽  
Rosemeire L Fiaccone ◽  
Natanael J Silva ◽  
...  
Keyword(s):  
Gestational Age ◽  
Multinomial Logistic Regression ◽  
Mixed Race ◽  
Sociodemographic Factors ◽  
Reproductive Age ◽  
Large For Gestational Age ◽  
Maternal Characteristics ◽  
Factors Associated ◽  
Study Population ◽  
Brazilian Populations

ABSTRACT Background Evidence points to diverse risk factors associated with small- (SGA) and large-for-gestational-age (LGA) births. A more comprehensive understanding of these factors is imperative, especially in vulnerable populations. Objectives To estimate the occurrence of and sociodemographic factors associated with SGA and LGA births in poor and extremely poor populations of Brazil. Methods The study population consisted of women of reproductive age (14–49 y), whose last child was born between 2012 and 2015. INTERGROWTH 21st consortium criteria were used to classify weight for gestational age according to sex. Multinomial logistic regression modeling was performed to investigate associations of interest. Results Of 5,521,517 live births analyzed, SGA and LGA corresponded to 7.8% and 17.1%, respectively. Multivariate analysis revealed greater odds of SGA in children born to women who self-reported as black (OR: 1.21; 95% CI: 1.19, 1.22), mixed-race (parda) (OR: 1.08; 95% CI: 1.07, 1.09), or indigenous (OR: 1.11; 95% CI: 1.06, 1.15), were unmarried (OR: 1.08; 95% CI: 1.07, 1.08), illiterate (OR: 1.47; 95% CI: 1.42, 1.52), did not receive prenatal care (OR: 1.57; 95% CI: 1.53, 1.60), or were aged 14–20 y (OR: 1.21; 95% CI: 1.20, 1.22) or 35–49 y (OR: 1.12; 95% CI: 1.10, 1.13). Considering LGA children, higher odds were found in infants born to women living in households with ≥3 inadequate housing conditions (OR: 1.11; 95% CI: 1.10, 1.12), in indigenous women (OR: 1.22; 95% CI: 1.19, 1.25), those who had 1–3 y of schooling (OR: 1.18; 95% CI: 1.17, 1.19), 1–3 prenatal visits (OR: 1.16; CI 95%: 1.14, 1.17), or were older (OR: 1.26; 95% CI: 1.25, 1.27). Conclusions In poorer Brazilian populations, socioeconomic, racial, and maternal characteristics are consistently associated with the occurrence of SGA births, but remain less clearly linked to the occurrence of LGA births.

Comparison of Phototherapy Results in Small-for-Gestational-Age and Appropriate-for-Gestational-Age Infants Weighing Less Than 2,000 Grams

PEDIATRICS ◽  
1985 ◽  
Vol 75 (2) ◽  
pp. 413-441
Author(s):  
Joan E. Hodgman ◽  
Paul Y. K. Wu ◽  
Nathaniel B. White ◽  
Dolores A. Bryla
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Congenital Defects ◽  
Intrauterine Growth ◽  
Appropriate For Gestational Age ◽  
Study Population ◽  
Similar Weight ◽  
Gestational Age At Birth ◽  
Evaluation Techniques

The infant who is small for gestational age (SGA) is more mature at birth than similar weight infants who are appropriate for gestational age (AGA). Whether the SGA infant behaves as does the larger gestationally equivalent infant, or whether there are specific changes related to intrauterine growth retardation is a matter of some interest in the understanding of the special needs of these infants. The National Institute of Child Health and Human Development (NICHD) phototherapy study provided a large newborn population for whom birth weight, gestational age at birth, and, thereby, intrauterine growth were carefully assessed. Infants who weighed 2,000 g or more at birth were included in the study only when they became jaundiced, whereas infants who weighed less than 2,000 g at birth were routinely entered into the study. Consequently, this report will be limited to the lowbirth-weight population selected by birth weight. Too few SGA babies were present in the groups with greater birth weight to allow meaningful comparisons. PATIENT SELECTIQN All infants whose birth weight was less than 2,000 g were entered into the study at 24 ± 12 hours. Those excluded from the study were: (1) infants who died before 24 hours, (2) infants with serious congenital defects, and (3) infants whose mothers refused consent for study. The study population consisted of 922 infants surviving at 24 hours. Gestational age was calculated from the first day of the last menstrual period obtained from maternal history and also by the evaluation techniques of Dubowitz.25 Intrauterine growth was determined by plotting birth weight and gestational age on the Denver Intrauterine Growth Curves8; infants below the 10th percentile were considered SGA.

125I-human epidermal growth factor specific binding to placentas and fetal membranes from various pregnancy states

1988 ◽  
Vol 117 (4) ◽  
pp. 485-490 ◽  
Author(s):  
Glen E. Hofmann ◽  
Ch. V. Rao ◽  
Fred R. Carman ◽  
Tariq A. Siddiqi
Keyword(s):  
Gestational Age ◽  
Specific Binding ◽  
Large For Gestational Age ◽  
Fetal Membrane ◽  
Fetal Membranes ◽  
Intrauterine Growth ◽  
Class A ◽  
Appropriate For Gestational Age ◽  
Epidermal Growth ◽  
Twin Pregnancies

Abstract. Specific binding of 125I-human epidermal growth factor (hEGF) to homogenates of term human placentas and fetal membranes from normal and appropriate for gestational age (N = 20), intrauterine growth retarded (N = 9), twin (N = 11), White class A/B diabetic (N = 12), and large for gestational age (N = 13) pregnancies was measured. In all pregnancy states, placentas bound approximately four times more 125I-hEGF than did fetal membranes (P < 0.001). There was no significant difference in 125I-hEGF binding to fetal membranes from the various pregnancy states (P > 0.05). 125I-hEGF specific binding to placentas from intrauterine growth retarded or twin pregnancies was significantly greater compared with placentas from normal and appropriate for gestational age pregnancies (P < 0.05). The binding to placentas from pregnancies complicated by White class A/B diabetes or large for gestational age infants, on the other hand, was not significantly different from that to placentas from normal and appropriate for gestational age pregnancies. 125I-hEGF specific binding did not differ between placentas from intrauterine growth retarded or twin pregnancies (P > 0.05). Placental and fetal membrane 125I-hEGF binding did not vary with fetal sex, maternal race, placental weight, or gestational age between 37 to 42 weeks (P > 0.05). Placental but not fetal membrane 125I-hEGF binding increased with increasing infant weight when appropriate for gestational age and large for gestational age infants were included (P < 0.05, r = 0.38, N = 32) but not for intrauterine growth retarded, appropriate for gestational age, or large for gestational age infants alone.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

2021 ◽  
pp. 1-10
Author(s):  
Peña Dieste Pérez ◽  
Luis M. Esteban ◽  
Ricardo Savirón-Cornudella ◽  
Faustino R. Pérez-López ◽  
Sergio Castán-Mateo ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Outcomes ◽  
Entire Study ◽  
Birth Weight Percentile ◽  
Gestational Age At Delivery ◽  
Study Population ◽  
The Difference ◽  
Relationship Of ◽  
The Relationship

<b><i>Objective:</i></b> This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). <b><i>Material and Method:</i></b> It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score &#x3c;7, arterial cord blood pH &#x3c;7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and &#x3e;50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. <b><i>Results:</i></b> The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), <i>p</i> &#x3c; 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (<i>p</i> &#x3c; 0.001). The RR was 1.63 (95% CI: 1.365–1.944, <i>p</i> &#x3c; 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were &#x3e;40 points (RR: 2.036, 95% CI: 1.581–2.623, <i>p</i> &#x3c; 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of &#x3e;40 percentile points.

scholarly journals Large-for-gestational-age phenotypes and obesity risk in adulthood: a study of 195,936 women

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
José G. B. Derraik ◽  
Sarah E. Maessen ◽  
John D. Gibbins ◽  
Wayne S. Cutfield ◽  
Maria Lundgren ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Reference Group ◽  
Ponderal Index ◽  
Large For Gestational Age ◽  
Adjusted Relative Risk ◽  
Obesity Risk ◽  
Increased Risk ◽  
Appropriate For Gestational Age ◽  
Using Data

AbstractWhile there is evidence that being born large-for-gestational-age (LGA) is associated with an increased risk of obesity later in life, the data are conflicting. Thus, we aimed to examine the associations between proportionality at birth and later obesity risk in adulthood. This was a retrospective study using data recorded in the Swedish Birth Register. Anthropometry in adulthood was assessed in 195,936 pregnant women at 10–12 weeks of gestation. All women were born at term (37–41 weeks of gestation). LGA was defined as birth weight and/or length ≥2.0 SDS. Women were separated into four groups: appropriate-for-gestational-age according to both weight and length (AGA – reference group; n = 183,662), LGA by weight only (n = 4,026), LGA by length only (n = 5,465), and LGA by both weight and length (n = 2,783). Women born LGA based on length, weight, or both had BMI 0.12, 1.16, and 1.08 kg/m2 greater than women born AGA, respectively. The adjusted relative risk (aRR) of obesity was 1.50 times higher for those born LGA by weight and 1.51 times for LGA by both weight and height. Length at birth was not associated with obesity risk. Similarly, women born LGA by ponderal index had BMI 1.0 kg/m2 greater and an aRR of obesity 1.39 times higher than those born AGA. Swedish women born LGA by weight or ponderal index had an increased risk of obesity in adulthood, irrespective of their birth length. Thus, increased risk of adult obesity seems to be identifiable from birth weight and ignoring proportionality.

Circulating renin–angiotensin system and catecholamines in childhood: is there a role for birthweight?

2008 ◽  
Vol 114 (5) ◽  
pp. 375-380 ◽  
Author(s):  
Maria C. P. Franco ◽  
Dulce E. Casarini ◽  
Marcela S. Carneiro-Ramos ◽  
Ana L. Sawaya ◽  
Maria L. M. Barreto-Chaves ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Gestational Age ◽  
Low Birthweight ◽  
Renin Angiotensin System ◽  
Age Group ◽  
Renin Angiotensin ◽  
Appropriate For Gestational Age ◽  
Study Population ◽  
Ace Activity ◽  
Underlying Mechanisms

There have been only a few reports on the sympathoadrenal and renin–angiotensin systems in children of small gestational age. The purpose of the present study was to investigate plasma levels of ACE (angiotensin-converting enzyme) activity, angiotensin and catecholamines in 8- to 13-year-old children and to determine whether there are correlations between the components of these systems with both birthweight and BP (blood pressure) levels. This clinical study included 66 children (35 boys and 31 girls) in two groups: those born at term with an appropriate birthweight [AGA (appropriate-for-gestational age) group, n=31] and those born at term but with a small birthweight for gestational age [SGA (small-for-gestational age) group, n=35]. Concentrations of angiotensin, catecholamines and ACE activity were determined in plasma. Circulating noradrenaline levels were significantly elevated in SGA girls compared with AGA girls (P=0.036). In addition, angiotensin II and ACE activity were higher in SGA boys (P=0.024 and P=0.050 respectively). There was a significant association of the circulating levels of both angiotensin II and ACE activity with BP levels in our study population. Although the underlying mechanisms that link restricted fetal growth with later cardiovascular events are not fully understood, the findings in the present study support the link between low birthweight and overactivity of both sympathoadrenal and renin–angiotensin systems into later childhood.

scholarly journals Serum Microelements in Early Pregnancy and their Risk of Large-for-Gestational Age Birth Weight

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 866 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Jan Lubiński
Keyword(s):  
Birth Weight ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Preliminary Evidence ◽  
Large For Gestational Age ◽  
Female Fetus ◽  
Appropriate For Gestational Age ◽  
Nested Case Control ◽  
Relationship Of

Excessive birth weight has serious perinatal consequences, and it “programs” long-term health. Mother’s nutritional status can be an important element in fetal “programming”; microelements such as selenium (Se), zinc (Zn), copper (Cu), and iron (Fe) are involved in many metabolic processes. However, there are no studies assessing the relationship of the microelements in the peri-conceptual period with the risk of excessive birth weight. We performed a nested case control study of serum microelements’ levels in the 10–14th week of pregnancy and assessed the risk of large-for-gestational age (LGA) newborns using the data from a prospective cohort of pregnant women recruited in 2015–2016 in Poznań, Poland. Mothers delivering LGA newborns (n = 66) were examined with matched mothers delivering appropriate-for-gestational age (AGA) newborns (n = 264). Microelements’ levels were quantified using mass spectrometry. The odds ratios of LGA (and 95% confidence intervals) were calculated by multivariate logistic regression. In the whole group, women with the lowest quartile of Se had a 3 times higher LGA risk compared with women in the highest Se quartile (AOR = 3.00; p = 0.013). Importantly, the result was sustained in the subgroup of women with the normal pre-pregnancy BMI (AOR = 4.79; p = 0.033) and in women with a male fetus (AOR = 6.28; p = 0.004), but it was not sustained in women with a female fetus. There were no statistical associations between Zn, Cu, and Fe levels and LGA. Our study provides some preliminary evidence for the relationships between lower serum Se levels in early pregnancy and a higher risk of large-for-gestational age birth weight. Appropriate Se intake in the periconceptual period may be important for optimal fetal growth.

Sign in / Sign up

Export Citation Format

Share Document