Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

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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Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data

BMJ Open ◽

10.1136/bmjopen-2019-032763 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032763 ◽

Cited By ~ 1

Author(s):

Carol McInerney ◽

Ibinabo Ibiebele ◽

Jane B Ford ◽

Deborah Randall ◽

Jonathan M Morris ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Lower Risk ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Smoking During Pregnancy ◽

Relative Risks ◽

South Wales ◽

Adverse Perinatal Outcomes

ObjectivesTo provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy.DesignPopulation based retrospective cohort study using linked data.SettingNew South Wales, the most populous Australian state.Population18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm.ExposureNot smoking at any time during pregnancy.Main outcome measuresUnadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks.ResultsCompared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89).ConclusionsBabies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population.

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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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Adverse Outcomes with Maternal Blood Pressure Less than 140/90 in Pregnancy Complicated by Hypertension

American Journal of Perinatology ◽

10.1055/s-0038-1677474 ◽

2019 ◽

Vol 36 (13) ◽

pp. 1394-1400 ◽

Cited By ~ 1

Author(s):

Courtney J. Mitchell ◽

Alan Tita ◽

Sarah B. Anderson ◽

Daniel N. Pasko ◽

Lorie M. Harper

Keyword(s):

Blood Pressure ◽

Preterm Birth ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Gestational Age ◽

Small For Gestational Age ◽

Maternal Blood ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Increased Risk

Objective We assessed the risk of small for gestational age and other outcomes in pregnancies complicated by chronic hypertension with blood pressure <140/90 mm Hg. Study Design Retrospective cohort of singletons with hypertension at a single institution from 2000 to 2014. Mean systolic blood pressure and mean diastolic blood pressure were analyzed as continuous and dichotomous variables (<120/80 and 120–139/80–89 mm Hg). The primary outcome was small for gestational age. Secondary outcomes included birth weight, preeclampsia, preterm birth <35 weeks, and a composite of adverse neonatal outcomes. Results Small for gestational age was not increased with a mean systolic blood pressure <120 mm Hg compared with a mean systolic blood pressure 120 to 129 mm Hg (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI] 0.92–2.79). Mean diastolic blood pressure <80 mm Hg was associated with a decrease in the risk preeclampsia (AOR 0.57; 95% CI 0.35–0.94), preterm birth <35 weeks (AOR 0.35; 95% CI 0.20–0.62), and the composite neonatal outcome (AOR 0.42; 95% CI 0.22–0.81). Conclusion Mean systolic blood pressure <120 mm Hg and mean diastolic blood pressure <80 mm Hg were not associated with increased risk of small for gestational age when compared with higher, normal mean systolic and diastolic blood pressures.

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631Benefits of not smoking during pregnancy for Aboriginal women and their babies

International Journal of Epidemiology ◽

10.1093/ije/dyab168.664 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Siranda Torvaldsen ◽

Ibinabo Ibiebele ◽

Jane Ford ◽

Deborah Randall ◽

Jonathan Morris ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Lower Risk ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Smoking During Pregnancy ◽

Relative Risks ◽

Aboriginal Women ◽

Adverse Perinatal Outcomes

Abstract Background To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with those who reported smoking. Methods This population-based retrospective cohort study used linked data from routinely collected datasets. Not smoking during pregnancy was the exposure of interest among all New South Wales Aboriginal women who became mothers of singleton babies in 2010–2014. Unadjusted and adjusted relative risks (aRR) and 95%CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks. Results Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95%CI 0.44–0.76), preterm birth (aRR=0.58, 95%CI 0.53–0.64) and small-for-gestational age (aRR=0.35, 95%CI 0.32–0.39). PAFs(%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 8,919), those who did not smoke (n = 9,235) had a lower risk of being transferred to another hospital (aRR=0.76, 95%CI 0.66–0.89). Conclusions Babies born to women who did not smoke had much lower risks of all adverse perinatal outcomes. Key messages Between a quarter and a half of adverse perinatal outcomes in this population could potentially be prevented by an effective smoking cessation program.

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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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Impact of Obesity on Perinatal Outcomes among Asthmatic Women

Canadian Respiratory Journal ◽

10.1155/2013/815143 ◽

2013 ◽

Vol 20 (5) ◽

pp. 345-350 ◽

Cited By ~ 3

Author(s):

Meggie Thuot ◽

Marc-André Coursol ◽

Sonia Nguyen ◽

Vanessa Lacasse-Guay ◽

Marie-France Beauchesne ◽

...

Keyword(s):

Body Mass Index ◽

Birth Weight ◽

Preterm Birth ◽

Body Mass ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Normal Weight ◽

Large For Gestational Age ◽

Obese Women

BACKGROUND: Only one study has investigated the combined effect of maternal asthma and obesity on perinatal outcomes; however, it did not consider small-for-gestational age and large-for-gestational age infants.OBJECTIVES: To examine the impact of obesity on perinatal outcomes among asthmatic women.METHODS: A cohort of 1386 pregnancies from asthmatic women was reconstructed using three of Quebec’s administrative databases and a questionnaire. Women were categorized using their prepregnancy body mass index. Underweight, overweight and obese women were compared with normal weight women. The primary outcome was the birth of a small-for-gestational-age infant, defined as a birth weight below the 10th percentile for gestational age and sex. Secondary outcomes were large-for-gestational-age infants (birth weight >90th percentile for gestational age) and preterm birth (<37 weeks’ gestation). Logistic regression models were used to obtain the ORs of having small-for-gestational-age infants, large-for-gestational-age infants and preterm birth as a function of body mass index.RESULTS: The proportions of underweight, normal weight, overweight and obese women were 10.8%, 53.3%, 19.7% and 16.2%, respectively. Obese asthmatic women were not found to be significantly more at risk for giving birth to small-for-gestational-age infants (OR 0.6 [95% CI 0.4 to 1.1]), large-for-gestational-age infants (OR 1.2 [95% CI 0.7 to 2.2]) or having a preterm delivery (OR 0.7 [95% CI 0.4 to 1.3]) than normal-weight asthmatic women.CONCLUSIONS: No significant negative interaction between maternal asthma and obesity on adverse perinatal outcomes was observed.

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Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population

Journal of International Medical Research ◽

10.1177/0300060519861463 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4397-4412 ◽

Cited By ~ 2

Author(s):

Ping Guan ◽

Fei Tang ◽

Guoqiang Sun ◽

Wei Ren

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Maternal Weight ◽

Increased Risk

Objective This study aimed to analyze the effects of maternal weight on adverse pregnancy outcomes. Methods Data were retrospectively collected from a hospital in Wuhan, China. A total of 1593 pregnant women with singletons were included. Adverse outcomes during pregnancy, such as small for gestational age (SGA), large for gestational age (LGA), and hypertensive disorders in pregnancy (HDP) were analyzed. Results The risks of low birth weight, SGA, and preterm birth were significantly higher in the inadequate gestational weight gain (GWG) group compared with the adequate GWG group. GWG over the guidelines was related to a higher risk of macrosomia, LGA, cesarean section, and HDP than GWG within the guidelines. The risks of low birth weight (OR = 5.082), SGA (OR = 3.959), preterm birth (OR = 3.422), and gestational diabetes mellitus (OR = 1.784) were significantly higher in women with a normal pre-pregnancy body mass index (BMI) and inadequate GWG compared with women with a normal pre-pregnancy BMI and adequate GWG. The risks of macrosomia (OR = 3.654) and HDP (OR = 1.992) were increased in women with normal pre-pregnancy BMI and excessive GWG. Conclusion Women with an abnormal BMI and inappropriate GWG have an increased risk of adverse maternal and infant outcomes. Weight management during the perinatal period is required.

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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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Intergenerational Cohort Study of Preterm and Small-for-Gestational-Age Birth in Twins and Singletons

Twin Research and Human Genetics ◽

10.1017/thg.2015.60 ◽

2015 ◽

Vol 18 (5) ◽

pp. 581-590 ◽

Cited By ~ 3

Author(s):

Marie Bladh ◽

Ann Josefsson ◽

John Carstensen ◽

Orvar Finnström ◽

Gunilla Sydsjö

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Statistical Significance ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Preterm Child ◽

Increased Risk ◽

Intergenerational Effect

To date, several studies have investigated the intergenerational effect of preterm and small-for-gestational-age (SGA) births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and SGA births among twins and singletons. A prospective population-based register study of mother–firstborn offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4,073 twins and 264,794 singletons born from 1973–1983 and their firstborns born from 1986–2009. Preterm birth was defined as birth at <37 weeks of gestation, and SGA as birth weight <2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers’ and mothers’ socio-demographic factors, in addition to maternal birth characteristics. Among mothers born as singletons, being born preterm was associated with an increased risk of delivering a preterm child (adjusted odds ratio (OR) 1.39, 95% Confidence Interval (CI) = 1.29–1.50), while being born SGA increased the likelihood of having an SGA child (adjusted OR 3.04, 95% CI = 2.80–3.30) as well as a preterm child (adjusted OR 1.30, 95% CI = 1.20–1.40). In twin mothers, the corresponding ORs tended to be lower, and the only statistically significant association was between an SGA mother and an SGA child (adjusted OR 2.15, 95% CI = 1.40–3.31). A statistically significant interaction between twinning and mother's size for gestational age was identified in a multivariate linear regression analysis, indicating that singleton mothers born SGA were associated with a lower birth weight compared with mothers not born SGA. Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

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