Risk Factors and Short Term Morbidities Associated With Term-Small for Gestational Age Babies Delivered at Nepalgunj Medical College

Introduction: Small for gestational age (SGA) refers to birth weight of neonates less than 10th percentile for gestational age or 2nd standard deviation below the population norms on the growth charts. Aims: To identify common risk factors and common morbidities for small for gestational age babies. Methods: This is a cross sectional descriptive study and it has been conducted at Department of pediatrics, Nepalgunj Medical college which is a tertiary level teaching hospital located in western part of Nepal. All term small for gestational age neonates born during study period from January 2020 to December 2020 were included. Detailed baseline demographic and clinical profile has been collected and recorded in the predesigned Proforma. Results: The most common risk factors associated with small for gestational age babies in our study were maternal hypertension (14.6%) , maternal GDM(9.6%), Urinary Tract Infection (UTI) in 1st or 2nd trimester of pregnancy, maternal anemia, smoking, alcohol consumption, hypothyroidism and congenital heart disease. The most common short term complications associated with Small for gestational age babies were hypoglycemia and Meconium aspiration syndrome. Conclusion: The most common risk factors associated with Small for gestational age babies in our study were maternal hypertension, maternal Gestational diabetes Mellitus (GDM), Urinary Tract Infection in 1st or 2nd trimester of pregnancy, maternal anemia, smoking, alcohol consumption, hypothyroidism and congenital heart disease. The most common short term complications associated with Small for gestational age babies were hypoglycemia and Meconium aspiration syndrome (MAS).

A longitudinal study of exposure to fine particulate matter during pregnancy, small-for-gestational age births, and birthweight percentile for gestational age in a statewide birth cohort

Background Previous studies observed associations between prenatal exposure to fine particulate matter (≤ 2.5 μm; PM2.5) and small-for-gestational-age (SGA) birth and lower birthweight percentile for gestational age. Few, if any, studies examine prenatal air pollution exposure and these pregnancy outcomes in neonates born to the same women. Here, we assess whether prenatal exposure to ambient fine particulate matter (PM2.5) is associated with small-for-gestational-age (SGA) birth or birthweight percentile for gestational age in a longitudinal setting. Methods Detailed birth record data were used to identify women who had singleton live births at least twice in North Carolina during 2002–2006 (n = 53,414 women, n = 109,929 births). Prenatal PM2.5 exposures were calculated using daily concentration estimates obtained from the US EPA Fused Air Quality Surface using Downscaling data archive. Associations between PM2.5 exposure and birthweight percentile and odds of SGA birth were calculated using linear and generalized mixed models, comparing successive pregnancies to the same woman. Odds ratios and associations were also estimated in models that did not account for siblings born to the same mother. Results Among NHW women, pregnancy-long PM2.5 exposure was associated with SGA (OR: 1.11 [1.06, 1.18]) and lower birthweight percentile (− 0.46 [− 0.74, − 0.17]). Trimester-specific PM2.5 was also associated with SGA and lower birthweight percentile. Among NHB women, statistically significant within-woman associations between PM2.5, SGA, and birthweight percentile were not observed. However, in models that did not account for births to the same mother, statistically significant associations were observed between some PM2.5 exposure windows and higher odds of SGA and lower birthweight percentile among NHB women. Conclusions Findings suggest that a woman is at greater risk of delivering an SGA or low birthweight percentile neonate when she has been exposed to higher PM2.5 levels. The within-woman comparison implemented here better controls for factors that may differ between women and potentially confound the relationship between PM2.5 exposure and pregnancy outcomes. This adds to the evidence that PM2.5 exposure may be causally related to SGA and birthweight percentile, even at concentrations close to or below National Ambient Air Quality Standards.

Preconception Hemoglobin Concentration and Risk of Low Birth Weight and Small-for-Gestational-Age: A Large Prospective Cohort Study in China

Less is known about the impact of maternal preconception anemia on birth outcomes. We aimed to examine associations between preconception hemoglobin (Hb) concentrations with risk of low birth weight (LBW) and small-for-gestational-age (SGA). This study was from a large population-based prospective cohort in China and included 124,725 women with singleton live births delivered at gestational ages of 28–45 weeks who were registered before pregnancy. Maternal Hb concentrations were measured during registration, and other health-related information was recorded prospectively. Logistic regression was used to evaluate the associations between preconception Hb concentrations with risk of LBW and SGA, adjusting for potential confounders. The results showed women with preconception anemia accounted for 22.28%. The incidences of LBW/SGA were 2.37%/6.30% among anemic women, and 2.01%/5.48% among non-anemic women, respectively. Preconception mild anemia increased by 17% (95% confidence interval (CI): 1.06, 1.28) and 14% (95% CI: 1.07, 1.21) the risk for LBW and SGA, while moderate-to-severe anemia had no significant association with LBW and SGA. Compared with the 120–129 g/L group, a U-shaped association was observed between preconception Hb concentrations with LBW and SGA. In conclusion, not only maternal anemia but also elevated Hb concentrations before pregnancy contribute to an increased risk of LBW and SGA.

G-ROP Criteria for Predicting Retinopathy of Prematurity Among Neonates with Different Birth Weight Percentiles

Purpose: To determine whether being small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) affected the sensitivity and specificity of Postnatal Growth and Retinopathy of Prematurity (G-ROP) model. Methods: We applied the G-ROP criteria, except hydrocephalus, for prematures retrospectively. The infants were divided into three subgroups according to birth weight percentiles (SGA, AGA, LGA), and the performance of the G-ROP criteria was tested for each group by calculating sensitivity and specificity for any stage retinopathy of prematurity (ROP) and severe ROP. Severe ROP was defined as ROP needing treatment. Results: Three hundred and ninety neonates screened for ROP were included. The gestational age and birth weight of the neonates were 29.3±2.9 weeks and 1302.9±416 g, respectively. There were 41 (10.5%) SGA, 312 (80%) AGA and 37 (9.5%) LGA neonates. The sensitivity of the model for any ROP was 67.8%, 66.7%, 73.2%, 55.6% for all of the patients in the study, SGA, AGA, and LGA neonates, respectively. The sensitivity of the model for severe ROP in all group and for each subgroup was 100%. The specificity of the model for any ROP was 65.9%, 70.6%, 87.7%, 90% for all of the patients, SGA, AGA, and LGA neonates, respectively. The specificity for severe ROP was 46.4%, 50%, 44%, 63.6% for all of the patients, SGA, AGA, and LGA neonates, respectively.Conclusion: The sensitivity and specificity of the G-ROP model in SGA infants were similar with the whole group, but was different between SGA, AGA and LGA neonates. Although the model did not miss any severe ROP, the specificity of the model for severe ROP was found low.

Excessive Subchorionic Fibrinoid Deposition as a Component of Massive Perivillous Fibrin Deposition: A Case With Maternal Immune Thrombocytopenia

Maternal floor infarction (MFI) and massive perivillous fibrin deposition (MPFD) are overlapping placental disorders of unknown etiology, associated with adverse obstetric outcome, and a significant risk of recurrence. We describe a 31-year-old mother with asymptomatic thrombocytopenia throughout pregnancy and a positive lupus anticoagulant. She delivered a normal female neonate at term, whose weight was small for gestational age, with a placenta weighing less than the 10th percentile. Placental examination showed MPFD together with excessive subchorionic fibrinoid deposition. The placenta showed diffuse C4d deposition and an immune-mediated reaction was postulated for the pathogenesis of the placental changes. We suggest that excessive subchorionic fibrinoid deposition may be part of the morphologic spectrum of MFI/MPFD.