Increased maternal serum activin A but not follistatin levels in pregnant women with hypertensive disorders

Activin A levels are elevated in maternal serum of pregnant women with hypertensive disturbances. Because follistatin is a circulating binding protein for activin A, the present study was designed to evaluate whether serum follistatin and activin A levels also change in patients with hypertensive disorders in the last gestational trimester. The study design was a controlled survey performed in the setting of an academic prenatal care unit. Healthy pregnant women (controls, n=38) were compared with patients suffering from pregnancy-induced hypertension (PIH, n=18) or pre-eclampsia (n=16). In addition, the study included a subset of patients with pre-eclampsia associated with intrauterine growth restriction (IUGR, n=5). Maternal blood samples were withdrawn at the time of diagnosis (patients) or in a random prenatal visit (controls), and serum was assayed for follistatin and activin A levels using specific enzyme immunoassays. Hormone concentrations were corrected for gestational age by conversion to multiples of median (MoM) of the healthy controls of the same gestational age. Follistatin levels were not different between controls and patients, while activin A levels were significantly increased in patients with PIH (1.8 MoM), pre-eclampsia (4.6 MoM), and pre-eclampsia+IUGR (3.2 MoM, P<0.01, ANOVA). The ratio between activin A and follistatin was significantly increased in patients with PIH (1.5 MoM) and was further increased in patients with pre-eclampsia (4.5 MoM) and in the group with pre-eclampsia+IUGR (2.6 MoM). Follistatin levels were positively correlated with gestational age in control subjects (r=0. 36, P<0.05) and in patients with PIH (r=0.46, P<0.05) or pre-eclampsia (r=0.61, P<0.01), while activin A correlated with gestational age only in the healthy control group (r=0.69, P<0.0001). The finding of apparently normal follistatin and high activin A levels in patients with PIH and pre-eclampsia suggests that unbound, biologically active, activin A is increased in women with these gestational diseases.

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Maternal Serum Copeptin As a Biomarker For Intrauterine Growth Restriction

Pakistan BioMedical Journal ◽

10.54393/pbmj.v4i2.78 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Amber Hassan ◽

Hisham Nasief

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Intrauterine Growth Restriction ◽

Maternal Serum ◽

Growth Restriction ◽

Cross Sectional ◽

Intrauterine Growth ◽

Gestation Age ◽

Clinical Biomarker ◽

Estimated Fetal Weight

In obstetrical world, Intrauterine Growth Restriction (IUGR) occupies second slot as a cause of small for gestation neonates, first being premature birth, both of which result in potential neonatal morbidities and mortalities. IUGR is defined as an estimated fetal weight at one point in time at or below 10th percentile for gestational age. Annually about thirty million babies suffer from IUGR and out of these about 75% are Asians. IUGR has been found to be associated with increased levels of Copeptin. As copeptin is a marker of endogenous stress, so increased copeptin levels can indicate fetal and maternal stress in IUGR Objectives: The objectives of this study were to the compare maternal serum copeptin levels in pregnancies with IUGR and pregnancies with adequate for gestational age fetuses and to establish the significance of copeptin as a biomarker for IUGR. Methodology: It was a cross-sectional comparative study in which maternal serum copeptin levels were measured and compared in 60 patients divided in two groups, pregnancies with IUGR and normal pregnancies with adequate for gestation age fetuses between 28-35 weeks of gestation Results: Maternal serum copeptin levels were raised in pregnant women with IUGR as compared to that in pregnant women with adequate for gestational age fetuses. Mean ± SD maternal serum copeptin levels were 97.5 ± 6 pg/ml in pregnant women with AGA fetuses and 121 ± 7.8 pg/ml in pregnant women with IUGR. Conclusions: Maternal serum copeptin levels are raised in pregnancies with IUGR as compared to pregnancies with adequate for age fetuses which can represent as a possible clinical biomarker for identification of IUGR.

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Blood Ferritin Levels in Pregnant Women and Prediction of the Development of Fetal Intrauterine Growth Restriction

Journal of Medical Biochemistry ◽

10.2478/v10011-011-0019-1 ◽

2011 ◽

Vol 30 (4) ◽

pp. 317-322

Author(s):

Nemanja Višnjevac ◽

Ljiljana Segedi ◽

Aleksandar Ćurčić ◽

Jovana Višnjevac ◽

Dragan Stajić

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Intrauterine Growth Restriction ◽

Ferritin Level ◽

Newborn Infants ◽

Maternal Blood ◽

Growth Restriction ◽

Intrauterine Growth

Blood Ferritin Levels in Pregnant Women and Prediction of the Development of Fetal Intrauterine Growth RestrictionIntrauterine growth restriction is one of the leading causes of perinatal morbidity and mortality. Prediction of intrauterine growth restriction is one of the priority tasks of perinatal protection. The purpose of this study was to evaluate the levels of serum ferritin in pregnant women, which could point to a group of patients in whom possible development of fetal growth restriction could have been expected. In this investigation, we conducted a prospective study of healthy pregnant women between 30 and 32 gestational weeks, who were estimated for ferritin values. Newborn infants of low birth weight for gestational age were recorded in 8.1%. Anemia was not present in any of the patients who delivered low birth weight babies. Ferritin serum levels in mothers of the babies with low birth weight were on average 6.42 μg/L higher than in the mothers with appropriate for gestational age babies (p<0.005). ROC analysis of newborn infants birth weight and maternal blood ferritin levels showed that blood ferritin level had good predictive value. In case the recorded maternal blood ferritin values are above 13.6 μg/L, we can assume with the sensitivity of 64.7% and specificity of 91.7%, that the pregnant woman will develop a condition of intrauterine growth restriction. The missing decrease of ferritin values, erythrocytes, hemoglobin and hematocrit in the blood of healthy pregnant women between 30 and 32 gestational weeks, can with high probability point to the development of fetal intrauterine growth restriction.

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Association between maternal serum beta human chorionic gonadotropin levels and hypertensive disorders of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203052 ◽

2020 ◽

Vol 9 (8) ◽

pp. 3157

Author(s):

Archana Kumari ◽

Vahini M.

Keyword(s):

Pregnant Women ◽

Late Onset ◽

Maternal Serum ◽

Severe Preeclampsia ◽

Control Group ◽

Study Group ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Significant Difference ◽

Β Hcg

Background: A major challenge in obstetrics is early identification of hypertensive disorders of pregnancy (HDP). This study was performed to determine the association between elevated maternal serum β-hCG levels and HDP, the correlation between serum β-hCG level and severity of preeclampsia and to determine the value of serum β-hCG level as a diagnostic marker for early diagnosis of HDP.Methods: This was a hospital based observational study conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi on 375 pregnant women with period of gestation more than 20 weeks, including 250 pregnant women with HDP as study group and 125 normotensive pregnant women as controls. Serum β-hCG concentration was measured and its level was compared between two groups.Results: The maternal mean serum β-hCG levels (51161.08±30038.21 IU/L) of study group of HDP were higher than the normotensive control group (17603.23±16748.21 IU/L). In non-severe preeclampsia, the mean serum levels were 36417.32±23876.74 IU/L while in severe preeclampsia, 60030.34±28771.31 IU/L. There was statistically significant difference (p<0.001) with higher levels in early onset preeclamptic mothers than late onset preeclampsia. The cut-off point of β-hCG for predicting HDP was 32077 IU/L with sensitivity of 65% and specificity of 86%.Conclusions: Serum β-hCG level is higher in HDP when compared to normotensive women. Higher levels of β-hCG are associated with increasing severity of hypertensive disorders of pregnancy. The utility of serum β-hCG as a diagnostic test is limited because of low sensitivity and difficulty in deciding the cut-off value.

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Study on the Correlation between the Levels of HtrA3 and TGF-β2 in Late Pregnancy and Preeclampsia

Journal of Healthcare Engineering ◽

10.1155/2022/4453646 ◽

2022 ◽

Vol 2022 ◽

pp. 1-5

Author(s):

Wenying Huang ◽

Shuxuan Zhang

Keyword(s):

Pregnant Women ◽

Color Doppler ◽

Late Pregnancy ◽

Maternal Blood ◽

Maternal Plasma ◽

Maternal Serum ◽

Adverse Outcomes ◽

Control Group ◽

Observation Group ◽

Set Up

Preeclampsia (PE) is a common and proprietary complication during pregnancy. The correlation was found between the levels of HtrA3 and TGF-β 2 and preeclampsia (PE). This study aimed to detect the HtrA3 and TGF-β2 in different parts of the third trimester (maternal serum, placenta). The 102 pregnant women who were eligible for enrollment in the obstetric examination at Tengzhou Maternity and Child Health Hospital from June 2020 to December 2020 were selected as the research objects. 28 cases diagnosed with PE were set up as the observation group 1, and 24 cases diagnosed with severe PE were set up as the observation group 2. Select 50 normal pregnant women as the control group and research the expressions of HtrA3 and TGF-β2 in maternal blood and placental tissues of patients with PE. ELISA was used to measure the concentration of HtrA3 and TGF-β2 in maternal blood. The distribution of HtrA3 and TGF-β2 in the placenta was observed by immunohistochemical techniques (IHC) and mean optical density value (MOD). S/D was measured by using color Doppler ultrasonic. The concentration of HtrA3 and TGF-β2 in the maternal blood and placenta tissue was higher in severe PE compared with PE and normotensive pregnancy, respectively ( P < 0.05 ). There is a negative correlation between the level of HtrA3 and TGF-β2 and the birthweight of newborns both in maternal plasma and placenta tissue in preeclampsia and positive correlation between HtrA3 and TGF-β2 levels and S/D. HtrA3 and TGF-β2 may correlate with severity of PE and their neonatal adverse outcomes.

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New Approaches to Treatment of Severe Intrauterine Growth Restriction

Central Asian Journal of Global Health ◽

10.5195/cajgh.2014.166 ◽

2014 ◽

Vol 3 ◽

Author(s):

Zhanar Kurmangali

Keyword(s):

Blood Flow ◽

Pregnant Women ◽

Gestational Age ◽

Intrauterine Growth Restriction ◽

Umbilical Artery ◽

Growth Restriction ◽

Control Group ◽

Intrauterine Growth ◽

New Approaches ◽

Port System

Introduction. Intrauterine growth restriction (IUGR) is a leading cause of perinatal morbidity and mortality due to placental insufficiency. Currently, one of the new approaches to treating this disease is the injection of nutrients to the fetus through intravascular port-systems (catheters).Objective. To assess the impact of nutrient injections as treatment to fetuses with severe growth retardation.Materials and methods. Pregnant women with IUGR (abdominal circumference (AC) < 5th percentile) with the absence of diastolic flow in the umbilical artery and a fetal gestational age of less than 30 weeks were randomly divided into two groups. The treatment group included six pregnant women who had an intravascular port-system for the infusion of nutrients (amino acids and glucose) in the umbilical vein of the fetus for 14 ± 3 days. The control group consisted of eight patients who received only traditional dynamic monitoring and delivery at the optimum time of pregnancy. Fetal status was assessed using ultrasound equipment Accuvix V20 (Medison, South Korea) by examining indicators of biometry and Doppler study of blood flow in utero, umbilical arteries, middle cerebral artery, and ductus venosus with fetal vascular resistance index calculation - pulsatility index (PI). Criteria for blood flow disturbances in the vessels were considered PI values above normal values for their gestational age, which were defined as absence or reverse blood flow in a diastole in the umbilical artery.Results. In a comparative analysis of the two groups, the treatment led to a 44.7% increase in AC of the fetus (121.0 ± 11.5 mm and 219.3 ± 18.3 mm, respectively, p ˂ 0.001). In all cases, the profile of blood flow in the umbilical artery had a positive diastolic component. As a result, there was a 45.3% decrease in PI in the umbilical artery (2.14 ± 0.54 and 1.17 ± 0.15, respectively, p < 0.05). Average fetal weight in the study group was not significantly higher than the control group (1,120.3 ± 213.6 g and 909.6 ± 131.4 g, p > 0.05).Conclusion. Thus, injection of nutrients to the fetuses through intravascular port-system improved placental perfusion and metabolism, which has the potential for improved fetal growth. This, in turn, promoted full-term pregnancy and improved perinatal outcomes in fetal pathology.

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Association between Serum C-reactive Protein and Pre-eclampsia

Faridpur Medical College Journal ◽

10.3329/fmcj.v15i2.53888 ◽

2021 ◽

Vol 15 (2) ◽

pp. 58-61

Author(s):

Sanjoy Kumar Das ◽

Shafeya Khanam ◽

Rajib Kumar Roy ◽

Samiya Alam ◽

Tapan Kumar Roy ◽

...

Keyword(s):

Blood Pressure ◽

Pregnant Women ◽

Gestational Age ◽

Maternal Serum ◽

Control Group ◽

Case Group ◽

C Reactive Protein ◽

Reactive Protein ◽

Blood Pressures ◽

Serum Crp

Among the common disorders of pregnancy, Pre-eclampsia is important one which causes significant maternal and perinatal morbidity and mortality. Its incidence is still high in the developing countries. The triad of high blood pressure, edema and albuminuria is neither specific nor sensitive enough; therefore, a reliable biochemical marker is needed to solve the problem. C-reactive protein(CRP), a marker of tissue damage and inflammation, is elevated in serum in overt preeclampsia. The present study is aimed to explore the association of high maternal serum C-reactive protein (CRP) level with preeclampsia and correlation with the severity of pre-eclamptic process. A total of 60 pregnant women constituting 30 pre-eclamptic (case) and 30 normal (control) pregnant women in the third trimester were enrolled in this study. Both the groups were matched for their age, parity and other baseline characteristics. More than three quarters (76.70%) of the case group exhibited raised serum CRP, which was 20% in control group (p=0.001). CRP was elevated about 13 fold higher than that in the normal pregnant women. The mean systolic and diastolic blood pressure were significantly higher in case group (154±12 mm of Hg) vs (107±7 mm of Hg) in control group (p<_0.001) and serum level of CRP bears linear relationship with both systolic and diastolic blood pressures. Preeclamptic women with higher serum CRP level were at a significantly (p<0.001) lower gestational age than control. Twenty two (73.30%) cases had gestational age <37 weeks (p=0.302) and 66.70% control group had gestational age > 37 weeks. The hypothesis of the study was supported by the study findings that maternal CRP concentration was higher in women with preeclampsia and was correlated with disease progression as evidenced by the investigative analysis. Faridpur Med. Coll. J. Jan 2020;15(2): 58-61

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Pathological features of the sequence in pregnant women with delayed fetal growth

HEALTH OF WOMAN ◽

10.15574/hw.2019.140.50 ◽

2019 ◽

pp. 50-54

Author(s):

V.O. Golyanovskiy ◽

◽

Ye.O. Didyk ◽

Keyword(s):

Pregnant Women ◽

Intrauterine Growth Restriction ◽

Normal Development ◽

Intrauterine Infection ◽

Normal Pregnancy ◽

Growth Restriction ◽

Control Group ◽

Intrauterine Growth ◽

Increased Risk ◽

Infection And Inflammation

Pregnant women with intrauterine growth restriction (IUGR) have an increased risk of adverse perinatal and long-term complications compared with the birth of children with normal body weight. Thus, IUGR is one of the main challenges for the global health system, especially in poor and developing countries. Morpho-functional studies of the placentas help in determining the causes of IUGR, and therefore, timely prevent complications in pregnant women with IUGR. The objective: The purpose of this study is to investigate various morphometric and pathomorphological changes in the placenta, including inflammatory, in cases of IUGR, and to establish a correlation of these results with the etiology and complications for the fetus. Materials and methods. In the current study, 54 placentas of the fetuses with IUGR (the main group) were compared with 50 placentas of the fetuses with normal development (control group). The criteria for the inclusion of IUGR were gestational age more than 30 weeks and all fetuses with a weight less than 10th percentile for this period of pregnancy. The placenta material was studied pathomorphologically with laboratory screening for infection and inflammation. Similarly, the results were determined for placentas of the fetuses with normal development compared to placentas with IUGR. Results. The placenta study showed the presence of calcification in the case of IUGR, as well as in the case of prolonged pregnancy. However, calcification of the placenta in the case of IUGR was more progressive compared with placenta in the normal pregnancy. In addition, the presence of intrauterine infection and inflammation was observed, which could also lead to an adverse outcome for the further progression of pregnancy with IUGR. Conclusion. A comparative macro- and microscopic pathomorphological study of the placentas in the two groups has shown a significant increase in the pathological changes in all the anatomical structures of the fetuses with IUGR. Key words: Intrauterine growth restriction (IUGR), fetal weight, pathomorphological changes of the placenta.

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Is ProBNP a New Marker for Predicting Intrauterine Growth Restriction?

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1382-8787 ◽

2021 ◽

Vol 225 (02) ◽

pp. 125-128

Author(s):

Hasan Eroğlu ◽

Nazan Vanlı Tonyalı ◽

Gokcen Orgul ◽

Derya Biriken ◽

Aykan Yucel ◽

...

Keyword(s):

Intrauterine Growth Restriction ◽

Final Analysis ◽

First Trimester ◽

Maternal Serum ◽

Growth Restriction ◽

Control Group ◽

Aneuploidy Screening ◽

Intrauterine Growth ◽

Potential Marker ◽

The Mean

Abstract Purpose To evaluate the usability of first-trimester maternal serum ProBNP levels in the prediction of intrauterine growth restriction (IUGR). Methods In this prospective study, blood samples taken from 500 women who applied to our polyclinic for routine serum aneuploidy screening between the 11–14th gestational weeks were centrifuged. The obtained plasma samples were placed in Eppendorf tubes and stored at −80+°C. For the final analysis, first-trimester maternal serum ProBNP levels of 32 women diagnosed with postpartum IUGR and 32 healthy women randomly selected as the control group were compared. FGR was defined as estimated fetal weight below the 10th percentile for the gestational age. Results The mean ProBNP levels were statistically and significantly higher in the women with intrauterine growth restriction (113.73±94.69 vs. 58.33±47.70 pg/mL, p<0.01). At a cut-off level of 50.93, ProBNP accurately predicted occurrence of IUGR (AUC+= 0.794 (95% confidence interval 0.679–0.910), p+= 0.001) with sensitivity and specificity rates of 78.1 and 69.0%, respectively. Conclusion First-trimester serum ProBNP level was significantly higher in women who developed IUGR compared to healthy controls. First-trimester ProBNP level can be used as a potential marker to predict the development of IUGR in pregnant women.

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Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00256-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Dong Wang ◽

Caixia Liu ◽

Xinyu Liu ◽

Ying Zhang ◽

Yu Wang

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Pregnant Women ◽

Gestational Age ◽

Speckle Tracking ◽

Control Group ◽

Second Trimester ◽

Cardiac Morphology ◽

Sphericity Index ◽

And Function

Abstract Background Due to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW). Methods Fifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable. Results The GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup. Conclusions Fetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

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Serum Concentrations of Selected Organochlorines in Pregnant Women and Associations with Pregnancy Outcomes. A Cross-Sectional Study from Two Rural Settings in Cambodia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207652 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7652

Author(s):

Margit Steinholt ◽

Shanshan Xu ◽

Sam Ol Ha ◽

Duong Trong Phi ◽

Maria Lisa Odland ◽

...

Keyword(s):

Polychlorinated Biphenyls ◽

Pregnant Women ◽

Gestational Age ◽

Low Income ◽

Cross Sectional Study ◽

Maternal Serum ◽

Sectional Study ◽

Serum Samples ◽

Cross Sectional ◽

Rural Settings

We conducted a cross-sectional study among 194 pregnant women from two low-income settings in Cambodia. The inclusion period lasted from October 2015 through December 2017. Maternal serum samples were analyzed for persistent organic pollutants (POPs). The aim was to study potential effects on birth outcomes. We found low levels of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCP), except for heptachlors, β-hexachlorocyclohexane (HCH), heptachlor epoxide, and p,p’-DDE. There were few differences between the two study locations. However, the women from the poorest areas had significantly higher concentrations of p,p’-DDE (p < 0.001) and hexachlorobenzene (HCB) (p = 0.002). The maternal factors associated with exposure were parity, age, residential area, and educational level. Despite low maternal levels of polychlorinated biphenyls, we found significant negative associations between the PCB congeners 99 (95% CI: −2.51 to −0.07), 138 (95% CI: −1.28 to −0.32), and 153 (95% CI: −1.06 to −0.05) and gestational age. Further, there were significant negative associations between gestational age, birth length, and maternal levels of o,p’-DDE. Moreover, o,p’-DDD had positive associations with birth weight, and both p,p’-DDD and o,p’-DDE were positively associated with the baby’s ponderal index. The poorest population had higher exposure and less favorable outcomes.

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