Intermittent maternofetal oxygenation during late gestation improved birthweight, neonatal growth, body symmetry, and muscle metabolism in intrauterine growth-restricted lambs

In humans and animals, intrauterine growth restriction (IUGR) results from fetal programming responses to poor intrauterine conditions. Chronic fetal hypoxemia elevates circulating catecholamines, which reduces skeletal muscle β2 adrenoceptor content and contributes to growth and metabolic pathologies in IUGR-born offspring. Our objective was to determine whether intermittent maternofetal oxygenation during late gestation would improve neonatal growth and glucose metabolism in IUGR-born lambs. Pregnant ewes were housed at 40°C from the 40 th to 95 th d of gestational age (dGA) to produce IUGR-born lambs (n = 9). A 2 nd group of IUGR-born lambs received prenatal O2 supplementation via maternal O2 insufflation (100% humidified O2, 10 L/min) for 8 h/d from dGA 130 to parturition (IUGR+O2, n = 10). Control lambs (n = 15) were from pair-fed thermoneutral ewes. All lambs were weaned at birth, hand-reared, and fitted with hindlimb catheters at d 25. Glucose-stimulated insulin secretion (GSIS) and hindlimb hyperinsulinemic-euglycemic clamp (HEC) studies were performed at d 28 and 29, respectively. At d 30, lambs were euthanized and ex vivo HEC studies were performed on isolated muscle. Without maternofetal oxygenation, IUGR lambs were 40% lighter (P < 0.05) at birth and maintained slower (P < 0.05) growth rates throughout the neonatal period compared to controls. At 30 d of age, IUGR lambs had lighter (P < 0.05) hindlimbs and flexor digitorum superficialis (FDS) muscles. IUGR+O2 lambs exhibited improved (P < 0.05) birthweight, neonatal growth, hindlimb mass, and FDS mass compared to IUGR lambs. Hindlimb insulin-stimulated glucose utilization and oxidation rates were reduced (P < 0.05) in IUGR but not IUGR+O2 lambs. Ex vivo glucose oxidation rates were less (P < 0.05) in muscle from IUGR but not IUGR+O2 lambs. Surprisingly, β2 adrenoceptor content and insulin responsiveness were reduced (P < 0.05) in muscle from IUGR and IUGR+O2 lambs compared to controls. In addition, glucose-stimulated insulin secretion was reduced (P < 0.05) in IUGR lambs and only modestly improved (P < 0.05) in IUGR+O2. Insufflation of O2 also increased (P < 0.05) acidosis and hypercapnia in dams, perhaps due to the use of 100% O2 rather than a gas mixture with a lesser O2 percentage. Nevertheless, these findings show that intermittent maternofetal oxygenation during late gestation improved postnatal growth and metabolic outcomes in IUGR lambs without improving muscle β2 adrenoceptor content.

Neuropsychological Development and New Criteria for Extrauterine Growth Restriction in Very Low-Birth-Weight Children

Background: Controversy between short-term neonatal growth of very low birth-weight preterm (VLBW) and neurodevelopment may be affected by criteria changes of extrauterine growth restriction (EUGR). Objective: to determine if new EUGR criteria imply modifications in the relationship between old criteria and results of neuropsychological tests in preterm children. Patients and methods: 87 VLBW at 5–7 years of age were studied. Neuropsychological assessment included RIST test (Reynolds Intellectual Sctreening Test) and NEPSY-II (NE neuro, PSY psycolgy assessment) tests. The relationships between these tests and the different growth parameters were analyzed. Results: RIST index was correlated with z-score Fenton’s weight (p = 0.004) and length (p = 0.003) and with z-score IGW-21’s (INTERGRWTH-21 Project) weight (p = 0.004) and length (p = 0.003) at neonatal discharge, but not with z-score difference between birth and neonatal discharge in weight, length, and HC for both. We did not find a statistically significant correlation between Fenton or IGW-21 z-scores and scalar data of NEPSY-II subtasks. Conclusion: In our series, neonatal growth influence on neuropsychological tests at the beginning of primary school does not seem robust, except for RIST test. New EUGR criteria do not improve the predictive ability of the old ones.

Maternal Anxiety, Depression, and Stress during Pregnancy and Neonatal Growth Indices at Birth

Background: Anxiety, depression, and stress during the pregnancy period are usually overlooked in women despite their detrimental effects on the mother and infant. Studies have shown an increase in the risk of behavioral and psychological problems in an infant's life because of the mother's exposure to negative excitement and stress before childbirth. In the present study, we aimed to assess the effect of maternal anxiety, depression, and stress during pregnancy on neonatal growth indices at birth. Methods: This longitudinal survey was done on 102 pregnant women referred to the obstetrics clinic of Shahid Sadoughi Hospital of Yazd for prenatal care from September 2019 to March 2020. They were asked to fulfill two questionnaires related to the study. After delivery, the further information and growth indices of neonates were extracted by telephone. Results: Regardless of the severity of depression, anxiety, and stress, a significant relationship was found between maternal age and stress (P= 0.033), so in mothers with younger age, pregnancy stress was more. Moreover, the study showed a significant relationship between height and maternal anxiety (P = 0.018). Conclusion: Based on the findings of this study and due to the possible association of neonatal indices with maternal anxiety, depression, and stress during pregnancy, more attention to maternal emotional health seems necessary.

Construction of China national newborn growth standards based on a large low-risk sample

Most published newborn growth references are based on conventional monitoring data that usually included both low- and high-risk pregnancies. We sought to develop a set of neonatal growth standards constructed from only a large sample of low-risk pregnancies. A total of 24,375 naturally conceived singleton live births with gestational ages of 24–42 weeks were collected in 69 hospitals in thirteen Chinese cities between 2015 and 2018. Unhealthy infants or those with high-risk mother were excluded. Smoothed percentile curves of six anthropometric indicators were established using the Generalized Additive Model for Location, Scale and Shape. The 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile references for birth weight, length, head circumference, weight/length, body mass index, and ponderal index were calculated for neonates with gestational ages of 24–42 weeks. This set of neonatal growth standards with six anthropometric indicators can provide more tools for growth and nutrition assessment and body proportionality in neonatal clinical practice. These standards might also help to show the differences between growth curves based on low-risk and mixed low- and high-risk pregnancies.