Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies

Multiple studies have demonstrated less favourable childhood outcomes in infants born in early term (37-38 weeks gestation) compared to those born at full term (40-41 weeks gestation). While this could be due to lower birthweight and greater perinatal morbidity, gestational age at birth may also have a direct effect on the brain and subsequent neurodevelopment in term-born babies. Here we characterise structural brain correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome. We used T2 and diffusion weighted Magnetic Resonance Images acquired in the neonatal period from a cohort (n=454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor based morphometry (TBM) and tract based spatial statistics (TBSS). Neurodevelopment was subsequently assessed at age 18 months using the Bayley-III Scales of Infant and Toddler Development (n=281), and the effects of gestational age at birth and related neuroimaging findings on outcome were analysed with linear regression. Infants born earlier had areas of higher relative ventricular volume, and lower relative brain volume in the basal ganglia, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Linear regression models predicting outcome from gestational age at birth were significantly improved by adding neuroimaging features associated with gestational age at birth. This work adds to the growing body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies.

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Twin Pregnancies Complicated by a Single Malformed Fetus: Chorionicity, Outcome and Management

Twin Research and Human Genetics ◽

10.1375/twin.13.5.501 ◽

2010 ◽

Vol 13 (5) ◽

pp. 501-507 ◽

Cited By ~ 8

Author(s):

Ali Gedikbasi ◽

Alpaslan Akyol ◽

Gokhan Yildirim ◽

Ali Ekiz ◽

Ahmet Gul ◽

...

Keyword(s):

Gestational Age ◽

Statistical Significance ◽

Expectant Management ◽

Control Group ◽

Study Group ◽

Preliminary Evaluation ◽

Gestational Age At Birth ◽

The Impact ◽

Twin Pregnancies ◽

Age At Birth

The objective of this study was to evaluate the impact of one abnormal fetus in a twin pregnancy, to compare impact of chorionicity and clinical outcome of intervention and expectant management. Thirty-seven dichorionic (DC) twins and 18 monochorionic (MC) twins complicated with one malformed fetus were evaluated for gestational age, birthweight and perinatal outcome. Six hundred and forty-two twin pregnancies were evaluated in the database. The control groups consisted of 429 DC and 86 MC twins without anomalous fetus. Mean birthweight and gestational age at birth for DC control group were (n= 429; 2137g and 34.71 weeks), DC study group,n= 37; 2117g (p= .338) and 33.97 weeks (p= .311), and DC study group with major malformations,n= 30; 2019g (p= .289) and 33.3 weeks (p= .01), and showed only significance for gestational age. There was no statistical significance between MC control group,n= 86; 2097g and 34.93 weeks, and MC study group,n= 18; 2237g (p= .338), and 34.42 weeks (p= .502). Because of limited data, the preliminary evaluation for expectant management and intervention, and survival of at least one normal fetus showed no impact. We conclude that, although, all DC twin pregnancies have a risk for preterm delivery, DC twins complicated with major malformation of one twin, have a lower mean gestational age at birth. Preliminary results for intervention does not improve fetal outcome for DC and MC twins and needs further evaluation with greater studies of impact or review.

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Birth-weight centiles and the risk of serious adverse neonatal outcomes at term

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0176 ◽

2018 ◽

Vol 46 (9) ◽

pp. 1048-1056 ◽

Cited By ~ 9

Author(s):

Joanna Yu ◽

Christopher Flatley ◽

Ristan M. Greer ◽

Sailesh Kumar

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Neonatal Outcomes ◽

Predicted Probability ◽

Exposure Variable ◽

Adverse Neonatal Outcomes ◽

Gestational Age At Birth ◽

The Impact ◽

Age At Birth

Abstract Background: Birth-weight is an important determinant of perinatal outcome with low birth-weight being a particular risk factor for adverse consequences. Aim: To investigate the impact of neonatal sex, mode of birth and gestational age at birth according to birth-weight centile on serious adverse neonatal outcomes in singleton term pregnancies. Materials and methods: This was a retrospective cohort study of singleton term births at the Mater Mother’s Hospital, Brisbane, Australia. Serious adverse neonatal outcome was defined as a composite of severe acidosis at birth (pH ≤7.0 and/or lactate ≥6 mmol/L and/or base excess ≤−12 mmol/L), Apgar <3 at 5 min, neonatal intensive-care unit admission and antepartum or neonatal death. The main exposure variable was birth-weight centile. Results: Of the 69,210 babies in our study, the overall proportion of serious adverse neonatal outcomes was 9.1% (6327/69,210). Overall, neonates in the <3rd birth-weight centile category had the highest adjusted odds ratio (OR) for serious adverse neonatal outcomes [OR 3.53, 95% confidence interval (CI) 3.06–4.07], whilst those in the ≥97th centile group also had elevated odds (OR 1.51, 95% CI 1.30–1.75). Regardless of birth modality, smaller babies in the <3rd centile group had the highest adjusted OR and predicted probability for serious adverse neonatal outcomes. When stratified by sex, male babies consistently demonstrated a higher predicted probability of serious adverse neonatal outcomes across all birth-weight centiles. The adjusted odds, when stratified by gestational age at birth, were the highest from 37+0 to 38+6 weeks in the <3rd centile group (OR 5.97, 95% CI 4.60–7.75). Conclusions: Low and high birth-weights are risk factors for serious adverse neonatal outcomes. The adjusted OR appears to be greatest for babies in the <3rd birth-weight centile group, although an elevated risk was also found in babies within the ≥97th centile category.

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Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study

BMJ ◽

10.1136/bmj.l1346 ◽

2019 ◽

pp. l1346 ◽

Cited By ~ 48

Author(s):

Casey Crump ◽

Jan Sundquist ◽

Marilyn A Winkleby ◽

Kristina Sundquist

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Environmental Factors ◽

Gestational Age ◽

Early Term ◽

Extremely Preterm ◽

National Cohort ◽

Gestational Age At Birth ◽

Age At Birth

Abstract Objective To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. Design National cohort study. Setting Sweden. Participants 4 186 615 singleton live births in Sweden during 1973-2014. Exposures Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. Main outcome measures CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. Results 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.

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Effects of gestational age at birth on perinatal structural brain development in healthy term‐born babies

Human Brain Mapping ◽

10.1002/hbm.25743 ◽

2021 ◽

Author(s):

Oliver Gale‐Grant ◽

Sunniva Fenn‐Moltu ◽

Lucas G. S. França ◽

Ralica Dimitrova ◽

Daan Christiaens ◽

...

Keyword(s):

Brain Development ◽

Gestational Age ◽

Gestational Age At Birth ◽

Age At Birth ◽

Structural Brain

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9 The Burden of Bronchopulmonary Dysplasia and Pulmonary Vascular Disease in Premature Infants

Paediatrics & Child Health ◽

10.1093/pch/pxab061.005 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e7-e7

Author(s):

Gabriela de Carvalho Nunes ◽

Punnanee Wutthigate ◽

Jessica Simoneau ◽

Claudia Renaud ◽

Adrian Dancea ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Gestational Age ◽

Ductus Arteriosus ◽

Positive Pressure ◽

Pulmonary Vascular Disease ◽

Intervention Policy ◽

Gestational Age At Birth ◽

The Impact ◽

Age At Birth

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Extremely premature infants are at a high risk of bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension (PH). Prolonged patency of the ductus arteriosus (PDA) may worsen PH; however, due to the lack of evidence supporting improvement in outcomes after strategies to promote ductal closure, our center has adopted a strict non-intervention policy since 2013. Objectives Assess PH prevalence and severity, as well as the impact of BPD on echocardiographic parameters of cardiac performance. Design/Methods Retrospective cohort of infants <29 weeks gestational age at birth, admitted between 2015 and 2019, and without genetic/congenital anomalies. Measurements from the echocardiography acquired closest to 36 weeks were done by masked experts. Severe BPD was defined as positive pressure support at 36 weeks. PH was defined as an estimated systolic pulmonary pressure (SPAP) ≥40 mmHg or an abnormal septal curvature by eccentricity index (EI) (>1.3). Results Out of 387 infants, 222 were included, of which 27 (12%) were categorized as severe BPD and 78 (35%) had PH. Severe BPD was associated with lower birth weight (704±214 vs 842±229g, p<0.01), longer hospitalization (median 138 [IQR 108-167] vs 103 [IQR 86-125] days, p<0.01) and longer mechanical ventilation duration (median 82 [IQR 33-107] vs 17 [IQR 2-32] days, p<0.01), with no difference in gestational age at birth. Severe BPD was associated with PH (70% vs 43%, p<0.01). The combined outcome of death (after the 36 weeks echocardiography) or severe BPD was associated with PH (68% vs 30%, p<0.01), smaller left ventricle length in diastole (2.8±0.5 vs 3.0±0.5 cm, p=0.03), decrease in the tricuspid annular plane systolic excursion (0.7±0.2 vs 0.9±0.2 cm, p<0.01), abnormal EI (1.31±0.25 vs 1.17±0.18, p<0.01) and smaller right ventricle fraction area change (41.3±5.8 vs 47.8±7.6%, p<0.01), without a significant increase on SPAP (35±21 vs 35±14, p=0.15). Other echocardiographic markers were similar. Conclusion In the context of a PDA non-intervention policy, a third of our population was affected by PH at 36 weeks. Furthermore, those with severe BPD or death had signs of RV dysfunction (despite similar SPAP estimate), indicating that the effect of BPD on pulmonary vascular remodelling and cardiac function may be underestimated.

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The Impact of Symptoms of Depression and Walking on Gestational Age at Birth in African American Women

Women s Health Issues ◽

10.1016/j.whi.2016.12.010 ◽

2017 ◽

Vol 27 (2) ◽

pp. 181-187 ◽

Cited By ~ 1

Author(s):

Carmen Giurgescu ◽

Jaime C. Slaughter-Acey ◽

Thomas N. Templin ◽

Dawn P. Misra

Keyword(s):

African American ◽

African American Women ◽

Gestational Age ◽

American Women ◽

Symptoms Of Depression ◽

Gestational Age At Birth ◽

The Impact ◽

Age At Birth

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Gestational age at birth and child special educational needs: a UK representative birth cohort study

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320213 ◽

2021 ◽

pp. archdischild-2020-320213

Author(s):

Neora Alterman ◽

Samantha Johnson ◽

Claire Carson ◽

Stavros Petrou ◽

Oliver Rivero-Arias ◽

...

Keyword(s):

Cohort Study ◽

Gestational Age ◽

Sociodemographic Factors ◽

Educational Needs ◽

Birth Cohort Study ◽

Special Educational Needs ◽

Early Term ◽

Increased Risk ◽

Gestational Age At Birth ◽

Age At Birth

ObjectiveTo examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.MethodsThe Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.ResultsThe sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37–38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.ConclusionChildren born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.

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Does Fetal Gender Really Affects Neonatal Birth Weight and Gestational Age at Birth? A Prospective Cohort Study

International Journal of Childbirth ◽

10.1891/ijcbirth-d-19-00013 ◽

2019 ◽

Vol 9 (4) ◽

pp. 203-210

Author(s):

Naina Kumar ◽

Ashu Yadav

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Apgar Scores ◽

Fetal Gender ◽

Neonatal Birth Weight ◽

Tertiary Center ◽

Significant Difference ◽

Gestational Age At Birth ◽

The Impact ◽

Age At Birth

OBJECTIVEThe objective of this study was to understand the impact of fetal gender on neonatal birth weight for the gestational age at the time of birth. Only neonates with a gestational age of 28 weeks or more than 28 weeks were included in the study.METHODSThis prospective study was conducted within the Obstetrics and Gynecology Department of a rural tertiary center in Northern India. The study was conducted after ethical clearance and informed consent from participants who fulfilled the inclusion criteria. Data collection included neonatal gender, birth weight, Apgar scores, and gestational age. Neonates were delivered vaginally or by cesarean section at 28 or more weeks of gestation. Statistical analysis was done using version SPSS-22 software.RESULTSOf 2,997 live fetuses, 1,574 (52.5%) were male, 1,421 (47.4%) were female, and 2 (0.07%) had ambiguous genitalia. Mean ± standard deviation (SD) for male neonate's birth weight was 2.79 ± 0.503 kg (95% confidence interval [CI]: 2.76–2.81), for females 2.67 ± 0.485 kg (95% CI: 2.64–2.69) respectively (p = .000). Males had lower Apgar scores at 1 and 5 minutes of age compared to females (7.06 ± 0.859, 8.83 ± 0.838 vs. 7.12 ± 0.645, 8.88 ± 0.612). There were no significant difference between fetal gender and gestational age at birth (18% females were preterm vs. 15.4% males, 81.8% females were term vs. 84.2% males, 0.1% females post-term vs. 0.4% males; p = .079).CONCLUSIONFetal gender was related to birth weight. Male neonates had a higher birth weight, but lower Apgar scores than female neonates. Fetal gender was not correlated with gestational age at the time of birth.

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