Maternal and Neonatal Morbidity Associated With Early Term Delivery of Large-for-Gestational-Age But Nonmacrosomic Neonates

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

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Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension–Associated Risks for Newborns and Mothers

Circulation Research ◽

10.1161/circresaha.119.314682 ◽

2019 ◽

Vol 125 (2) ◽

pp. 184-194 ◽

Cited By ~ 16

Author(s):

Jie Hu ◽

Yuanyuan Li ◽

Bin Zhang ◽

Tongzhang Zheng ◽

Jun Li ◽

...

Keyword(s):

Blood Pressure ◽

Preterm Delivery ◽

High Blood Pressure ◽

Gestational Age ◽

Small For Gestational Age ◽

Gestational Hypertension ◽

Blood Pressure Elevation ◽

Early Term ◽

Term Delivery ◽

The Impact

Rationale: In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new hypertension guideline for nonpregnant adults, using lower blood pressure values to identify hypertension. However, the impact of this new guideline on the diagnosis of gestational hypertension and the associated maternal and neonatal risks are unknown. Objective: To estimate the impact of adopting the 2017 ACC/AHA guideline on detecting gestational blood pressure elevations and the relationship with maternal and neonatal risk in the perinatal period using a retrospective cohort design. Methods and Results: This study included 16 345 women from China. Systolic and diastolic blood pressures of each woman were measured at up to 22 prenatal care visits across different stages of pregnancy. Logistic and linear regressions were used to estimate associations of blood pressure categories with the risk of preterm delivery, early-term delivery, and small for gestational age, and indicators of maternal liver, renal, and coagulation functions during pregnancy. We identified 4100 (25.1%) women with gestational hypertension using the 2017 ACC/AHA guideline, compared with 4.2% using the former definition. Gestational hypertension, but not elevated blood pressure (subclinical blood pressure elevation), was significantly associated with altered indicators of liver, renal, and coagulation functions during pregnancy for mothers and increased risk of adverse birth outcomes for newborns; adjusted odds ratios (95% CIs) for gestational hypertension stage 2 were 2.23 (1.18–4.24) for preterm delivery, 2.05 (1.67–2.53) for early-term delivery, and 1.43 (1.13–1.81) for small for gestational age. Conclusions: Adopting the 2017 ACC/AHA guideline would result in a substantial increase in the prevalence of gestational hypertension; subclinical blood pressure elevations during late pregnancy were not associated with increased maternal and neonatal risk in this cohort. Therefore, the 2017 ACC/AHA guideline may improve the detection of high blood pressure during pregnancy and the efforts to reduce maternal and neonatal risk. Replications in other populations are required.

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376: Impact of prior cesarean delivery on early term delivery and neonatal morbidity

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.392 ◽

2020 ◽

Vol 222 (1) ◽

pp. S249-S250

Author(s):

Braxton Forde ◽

Emily DeFranco

Keyword(s):

Cesarean Delivery ◽

Neonatal Morbidity ◽

Early Term ◽

Term Delivery

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Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth

International Journal of Epidemiology ◽

10.1093/ije/dyt251 ◽

2013 ◽

Vol 43 (3) ◽

pp. 802-814 ◽

Cited By ~ 58

Author(s):

H. K. Brown ◽

K. N. Speechley ◽

J. Macnab ◽

R. Natale ◽

M. K. Campbell

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Neonatal Morbidity ◽

Late Preterm ◽

Term Birth ◽

Early Term ◽

Biological Determinants

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PREDICTION OF FETAL BIRTH WEIGHT BY JOHNSON'S FORMULA & ULTRASONOGRAPHY COMPARED WITH ACTUAL BIRTH WEIGHT

10.36106/ijar/9506779 ◽

2020 ◽

pp. 1-2

Author(s):

K. Thamara Veni ◽

Gadam Swathi

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Neonatal Morbidity ◽

Birth Trauma ◽

Fetal Weight ◽

Large For Gestational Age ◽

Accurate Estimation ◽

Future Health ◽

Fetal Birth Weight ◽

Neonatal Problems

INTRODUCTION Birth weight is the greatest single factor which determines the survival of the fetus and future health of neonate. It is an important factor for prediction of neonatal problems. Accurate estimation of fetal weight is of paramount importance in the management of labor and delivery. Fetal weight is also important in assessing whether the fetus is small for gestational age or large for gestational age in order to have a good obstetrical decision making and also to avoid the intra partum distress, birth trauma and thereby to reduce the neonatal morbidity and mortality1.

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Performance of different fetal growth charts in prediction of large‐for‐gestational age and associated neonatal morbidity in multiethnic obese population

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.20413 ◽

2020 ◽

Vol 56 (1) ◽

pp. 73-77 ◽

Cited By ~ 2

Author(s):

C. Verger ◽

A. A. Moraitis ◽

L. Barnfield ◽

U. Sovio ◽

J. E. A. K. Bamfo

Keyword(s):

Fetal Growth ◽

Gestational Age ◽

Neonatal Morbidity ◽

Large For Gestational Age ◽

Growth Charts ◽

Obese Population

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

American Journal of Perinatology ◽

10.1055/s-0037-1606381 ◽

2017 ◽

Vol 35 (02) ◽

pp. 184-191 ◽

Cited By ~ 4

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.

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Weight gain in pregnancy: is less truly more for mother and infant?

Obstetric Medicine ◽

10.1258/om.2012.120004 ◽

2012 ◽

Vol 5 (2) ◽

pp. 58-64 ◽

Cited By ~ 10

Author(s):

Linda A Barbour

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Neonatal Morbidity ◽

Current Data ◽

Large For Gestational Age ◽

Institute Of Medicine ◽

Gestational Weight ◽

The Relationship ◽

In Pregnancy

SUMMARY Although more than 50% of women gain weight above the Institute of Medicine (IOM) guidelines for weight gain in pregnancy and excessive weight gain is an independent risk factor for significant maternal and neonatal morbidity and offspring obesity, there is little consensus over the ideal weight gain during pregnancy. Surprisingly, the 2009 IOM guidelines varied minimally from the 1990 IOM guidelines, and many critics advocate lower weight gain recommendations. This review explores the energy costs of pregnancy, the relationship between gestational weight gain and birth weight, and considers what gestational weight gain minimizes both large-for-gestational age as well as small-for-gestational age infants. An extensive examination of the current data leads this author to question whether the current weight gain recommendations are too liberal, especially for obese pregnant women.

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