Distinct effects of general psychological distress and COVID-19-specific fear during pregnancy on gestational age and infant birth weight.

P-137: Obstetric and perinatal outcomes in age matched cohorts of ovum donor recipients and in vitro fertilization patients

BackgroundTo examine whether financial stress during pregnancy mediates the association between maternal exposure to adverse childhood experiences (ACEs) and three birth outcomes (i.e., gestational age, birth weight, and admission to the neonatal intensive care unit [NICU]).MethodsData were obtained from a prospective cohort study of pregnant women and their infants in Florida and North Carolina. Mothers (n = 531; Mage at delivery = 29.8 years; 38% Black; 22% Hispanic) self-reported their exposure to childhood adversity and financial stress during pregnancy. Data on infant gestational age at birth, birth weight, and admission to the NICU were obtained from medical records within 7 days of delivery. Mediation analysis was used to test study hypotheses, adjusting for study cohort, maternal race, ethnicity, body mass index, and tobacco use during pregnancy.ResultsThere was evidence of an indirect association between maternal exposure to childhood adversity and infant gestational age at birth (b = -0.03, 95% CI = -0.06 – -0.01) and infant birth weight (b = -8.85, 95% CI = -18.60 – -1.28) such that higher maternal ACE score was associated with earlier gestational age and lower infant birth weight through increases in financial distress during pregnancy. There was no evidence of an indirect association between maternal exposure to childhood adversity and infant NICU admission (b = 0.01, 95% CI = -0.02–0.08).ConclusionsFindings demonstrate one pathway linking maternal childhood adversity to a potentially preterm birth or shorter gestational age, in addition to low birth weight at delivery, and present an opportunity for targeted intervention to support expecting mothers who face financial stress.

Vitamin D deficiency is common in pregnant women. Nevertheless, the association between maternal vitamin D status during pregnancy and the risk of having small for gestational age (SGA) and low birth weight (LBW) infants is uncertain. The objective of this study was to investigate whether there is a correlation between maternal vitamin D deficiency during pregnancy and the risk of having SGA and LBW infants in a Chinese population. This was a population-based birth cohort study that recruited 3658 eligible mother-and-singleton-offspring pairs. Serum 25-hydroxyvitamin D was measured by RIA. The rate and relative risk (RR) for SGA and LBW infants were calculated among subjects with vitamin D deficiency and insufficiency during pregnancy. There was a positive correlation between maternal serum 25-hydroxyvitamin D level and offspring birth weight (r = 0.477; P < .001). Further analysis showed that 4.98% of neonates were LBW infants among the subjects with vitamin D deficiency (RR, 12.00; 95% confidence interval [CI], 4.37, 33.00) and 1.32% among the subjects with vitamin D insufficiency (RR, 3.18; 95% CI, 1.07, 9.48). After adjustment for confounders, the RR for LBW infants was 12.31 (95% CI, 4.47, 33.89) among subjects with vitamin D deficiency and 3.15 (95% CI, 1.06, 9.39) among subjects with vitamin D insufficiency. Moreover, 16.01% of neonates were SGA infants among subjects with vitamin D deficiency (RR, 5.72; 95% CI, 3.80, 8.59) and 5.59% among subjects with vitamin D insufficiency (RR, 1.99; 95% CI, 1.27, 3.13). After adjustment for confounders, the RR for SGA infants was 6.47 (95% CI, 4.30, 9.75) among subjects with vitamin D deficiency and 2.01 (95% CI, 1.28, 3.16) among subjects with vitamin D insufficiency. Maternal vitamin D deficiency during pregnancy elevates the risk of SGA and LBW infants in a Chinese population.

Objective: Non-Hispanic Black women have increased rates of preterm birth and low infant birth weight. However, we do not know if these disparities replicate in women veterans, a population that may be at further risk for poor perinatal outcomes. This study sought to examine ethnoracial differences in preterm birth and low infant birth weight in veterans. Methods: A national sample of randomly chosen women veterans (i.e., oversampled for residency in high crime neighborhoods) reported information about all pregnancies they have had in their life, demographic characteristics, and history of childhood trauma exposures. The analytic sample was limited to individuals who identified as Hispanic/Latinx, Black, or White (n = 972). Mixed-effects regression models were used to examine ethnoracial differences in gestational age at delivery and infant birth weight, controlling for age at pregnancy, childhood trauma exposure, pregnancy during military service, income, and education. Results: Both Black and Hispanic/Latinx veterans were significantly more likely to have an infant born at lower gestational age (B = -1.04 and B = -1.11, respectively) and lower infant birth weight (B = -195.83 and B = -144.27, respectively) as compared with White veterans in covariate-adjusted models. Black (odds ratio = 3.24, confidence interval = 1.16, 9.09) veterans were more likely to meet the clinical definition of preterm birth as compared with White veterans. Conclusions: Results align with what is seen in the general population regarding ethnoracial disparities in gestational age at delivery and infant birth weight. Findings highlight the critical need for more research on mechanisms and prevention efforts for ethnoracial disparities in perinatal outcomes.

Endostatin is an antiangiogenic growth factor. Together with proangiogenic growth factors it acts to shape the developing vasculature. Dysregulation of angiogenesis is a component in the pathogenesis of bronchopulmonary dysplasia. Our goal was to study whether the concentration of circulating endostatin at birth is associated with the development of bronchopulmonary dysplasia in very low birth weight infants. Endostatin concentration was measured in cord plasma from 92 very low birth weight infants (gestational age < 32 weeks; birth weight < 1500 g) and 48 healthy term infants (gestational age > 37 weeks; birth weight > 2500 g). Endostatin concentration in very low birth weight infants was lower than in healthy term infants. Within the very low birth weight group no correlation existed between endostatin concentration and gestational age or relative birth weight. Very low birth weight infants who subsequently developed bronchopulmonary dysplasia had higher cord endostatin than those who did not. Higher endostatin concentration was associated with higher odds for bronchopulmonary dysplasia. Adjusted for gestational age, the odds for bronchopulmonary dysplasia were higher. Circulating endostatin in term infants was higher than in very low birth weight infants, suggesting a temporal pattern for fetal endostatin concentration. In very low birth weight infants a high concentration of circulating endostatin at birth is associated with the subsequent development of bronchopulmonary dysplasia.

Maternal exposure to polybrominated and polychlorinated biphenyls: Infant birth weight and gestational age

Apnea of prematurity is one of the most common problems in preterm and low birth weight infants, and it is reported to be more likely to occur in infants of lower gestational age and lower birth weight. The present study investigated the efficacy and safety of caffeine according to weight, based on birth weight. We defined preterm infants with birth weights of < 1,000 g, 1,000 g to < 1,500 g, and 1,500 g to < 2,500 g as the extremely low birth weight (ELBW), very low birth weight (VLBW), and low birth weight (LBW) groups, respectively. There was a significant difference among the three groups in the rate of improvement of apnea attacks from days 1 to 10 of administration. The percentage of cases that showed “improvement” on each day tended to be higher in the LBW group. The incidence of adverse events was 100％ in the ELBW group, 90.9％ in the VLBW group, and 64.7％ in the LBW group (P < 0.001). However, regarding adverse events that were suspected to have been caused by caffeine or events that required dose reduction or discontinuation of caffeine due to adverse events, there were no significant differences among the three groups in any of the items that were investigated. These results suggest that the greater the birth weight, the more likely effects of treatment will occur, and that although careful administration is required, the administration of caffeine to infants of lower birth weight may be feasible.

In the United States, offspring outcomes of preterm birth and low birth weight contribute to numerous infant health complications and healthcare costs. Food insecurity during the prenatal period may negatively impact maternal and child health, though limited research exists investigating this unique independent relationship. Especially amidst the COVID-19 pandemic, which elevated rates of food insecurity, it is necessary to understand food insecurity as a unique stressor with a potential relationship to adverse pregnancy outcomes. Using a large diverse prospective cohort of pregnant people in South Dakota, this study investigated the independent relationship between FI and infant outcomes, early gestational age and low birth weight. Data from 1,478 pregnant people were obtained from the Environmental Influences on Child Health Outcomes in the Northern Plains PASS-ECHO study in South Dakota from 2020-2023. Maternal and infant outcomes were obtained through a hierarchy of medical record abstraction and self-reported data. Self-reported food insecurity was measured using a modified United States Department of Agriculture food security questionnaire. Descriptive statistics and logistic regression were conducted using SAS software to identify significant relationships between food insecurity and adverse offspring outcomes. In the sample, 20.7% (n=306) of pregnant people experienced food insecurity. Unadjusted data in the univariate model showed a statistically significant relationship between earlier gestational age and maternal food insecurity, with food insecure infants born on average around 3 days before food secure infants (p=0.0009), which made the average food insecure infant preterm, less than 37 weeks gestational age. Similarly, there was a statistically significant relationship between low infant birth weight and maternal food insecurity, with food insecure infants weighing 3.3% less than their food-secure counterparts on average (p=0.0203). However, in the multiple linear regression, adjusted for covariates accounting for socioeconomic status, these associations did not remain significant. Elevated pre-pregnancy BMI continued to have a statistically significant association with low birth weight and preterm birth even after adjusting for covariates. Study findings showed there was no statistically significant association between food insecurity and low birth weight or earlier gestational age in adjusted models despite a statistically significant association existing in unadjusted models. However, elevated pre-pregnancy BMI was independently associated with low birth weight and earlier gestational age and should be investigated further regarding maternal food insecurity during pregnancy. Understanding food insecurity as a social determinant of health has critical consequences for both maternal and child health. Future research should investigate interventions to decrease food insecurity during pregnancy.

Both fetal growth restriction and prematurity have been associated with elevated blood pressure (BP). However, their combined effects on adult BP are unclear. Our analyses were based on 1756 participants in the population-based Cardiovascular Risk in Young Finns Study who had information on birth weight and gestational age, together with longitudinal data on cardiovascular risk markers from age 3-18 years in 1980 to age 34-49 years in 2011. Three groups were defined by birth data: those born at term (term); those born preterm (<37 weeks) with an appropriate birth weight (>-1 SD z score according to national sex and gestational week-stratified data) for gestational age (preterm appropriate birth weight for gestational age); and those born preterm with low birth weight (≤-1 SD z score) for gestational age [preterm small birth weight for gestational age (SGA)]. There were no differences between the three groups in BP at baseline, but at the 31-year follow-up (mean age 41 years), mean SBP in the preterm SGA group was 7.2 mmHg (95% confidence interval = 2.3-12.1 mmHg, P = 0.004) higher than the preterm appropriate birth weight for gestational age group and 7.3 mmHg (95% confidence interval = 5.2-9.4 mmHg, P < 0.0001) higher than the term group, adjusted for age and sex. In addition, preterm SGA individuals had a higher prevalence of adult hypertension compared with those born at term (36.9 vs. 25.4%; age, sex, and risk factors adjusted P = 0.006). These longitudinal data suggest that elevated BP levels associated with prematurity are more likely to be present in those with fetal growth restriction.

To evaluate the effects of dietary Ca intake and Ca supplementation during pregnancy on low birth weight (LBW) and small for gestational age (SGA) infants. A birth cohort study was conducted in 2010-2012 at the Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. A birth cohort study. Totally, 9595 pregnant women who came to the hospital for delivery at 20 weeks of gestation or more, and who were 18 years of age or older. Compared with non-users, Ca supplement users had a reduced risk of LBW infants (OR = 0·77, 95 % CI: 0·63, 0·95) and a reduced risk of nulliparous women giving birth to LBW infants (OR = 0·75, 95 % CI: 0·58, 0·98) (P < 0·05). More specifically, both the use of Ca supplement before conception and during pregnancy (OR = 0·44, 95 % CI: 0·19, 0·99) and during pregnancy only (OR = 0·80, 95 % CI: 0·65, 0·99) had the main effect of reducing risk of nulliparous women giving birth to LBW infants (P < 0·05). There was no association between Ca supplementation and SGA (OR = 0·87, 95 % CI: 0·75, 1·01) (P > 0·05). However, higher dietary Ca intake during pregnancy decreases the risk of both LBW (quartile 2: OR = 0·72, 95 % CI: 0·55, 0·94; quartile 3: OR = 0·68, 95 % CI: 0·50, 0·62) and SGA infants (quartile 2: OR = 0·77, 95 % CI: 0·63, 0·95; quartile 3: OR = 0·71, 95 % CI: 0·57, 0·88, quartile 4: OR = 0·71, 95 % CI: 0·57, 0·88) (P < 0·05). Ca supplementation and adequate dietary intake of Ca during pregnancy are associated with a decreased risk of LBW infants born to nulliparous women.

Background: Adolescents with a chronological age of less than 15 years or a gynecological age of less than 2 years may have a higher probability of complications because they are more likely to conceive within 1 to 2 years of menarche and, therefore, are still growing and maturing. This could impair their ability to adapt to the physiological demands of pregnancy. Objective: To evaluate the relationship between chronological age and gynecological age with low birth weight and small for gestational age among adolescent mothers in Mexico City. Methods: A retrospective cohort design of adolescent mother-child dyads was conducted. The study followed 1242 adolescents under 19 years of age and their children, collecting data on physical, socioeconomic, and clinical characteristics, including hemoglobin levels. Low birth weight was assessed using the Intergrowth-21st project standards and categorized as above or below 2500 g. The mothers were grouped by chronological age (<15 years and ≥15 years) and gynecological age (<3 years and ≥3 years). Adjusted odds ratios were calculated using binary logistic regression models. The outcome variables were low birth weight and small for gestational age. The independent variables included gynecological age, chronological age, age at menarche, hemoglobin concentration, and gestational weight gain, among others. All independent variables were converted to dummy variables for analysis. Calculations were adjusted for the following variables: marital status, maternal education, occupation, educational lag, family structure, socioeconomic level, pre-pregnancy body mass index, and initiation of prenatal care. Results: The average age of the participants was 15.7 ± 1 years. The frequency of small for gestational age and low birth weight was 20% and 15.3%, respectively. Factors associated with small for gestational age included gynecological age < 3 years [aOR = 2.462, CI 95%; 1.081-5.605 (p = 0.032)], hemoglobin < 11.5 g/dL [aOR = 2.164, CI 95%; 1.08-605 (p = 0.019)], insufficient gestational weight gain [aOR = 1.858, CI 95%; 1.059-3.260 (p = 0.031)], preterm birth [aOR = 1.689, CI 95%; 1.133-2.519 p = 0.01], and living more than 50 km from the care center [aOR = 2.256, CI 95%; 1.263-4.031 (p = 0.006)]. An early age of menarche [aOR = 0.367, CI 95%; 0.182-0.744 (p = 0.005)] showed a protective effect against small for gestational age. Factors associated with low birth weight included gynecological age < 3 years [aOR = 3.799, CI 95%; 1.458-9.725 (p = 0.006)], maternal age < 15 years [aOR = 5.740, CI 95%; 1.343-26.369 (p = 0.019)], preterm birth [aOR = 54.401, CI 95%; 33.887-87.335, p = 0.001], living more than 50 km from the care center [aOR = 1.930, CI 95%; 1.053-3.536 (p = 0.033)], and early age of menarche [aOR = 0.382, CI 95%; 0.173-0.841 (p = 0.017), which demonstrated a protective effect, respectively. Conclusions: The study concludes that biological immaturity, particularly early gynecological age, significantly contributes to adverse birth outcomes during adolescent pregnancies. Interestingly, early menarche appeared to have a protective effect, whereas chronological age was not a significant predictor of small for gestational age. Chronological age has an even greater impact: women younger than 15 years are 5.7 times more likely to have low birth weight infants. However, chronological age did not increase the likelihood of having an SGA newborn.

To determine the relationship between ultrasound findings during the first trimester and obstetrical outcomes. A retrospective cohort study was carried out on 516 women who underwent ultrasound examination between 12 and 14 gestational weeks. The reduced crown-rump length, biparietal diameter, femur length (Z-score < -1 and -1.5) and increased umbilical artery pulsatility index (>90th and 95th percentile) were not associated with poor obstetrical outcomes. A ductus venosus pulsatility index greater than the 90th percentile was associated with aneuploidy, small for gestational age and low birth weight infants. Increased pulsatility in the ductus venosus is associated with increased risk for chromosomal abnormality in early pregnancy. Here we show that increased pulsatility is also linked to fetal growth restriction.

Abstracts from The Academy of Breastfeeding Medicine 20th Annual International Meeting Los Angeles, California October 16–18, 2015

To investigate the risk factors for low Apgar score (≤7) at 1 minute after birth in very low/extremely low birth weight infants. Clinical data of very low/extremely low birth weight infants were retrospectively collected from January 2018 to December 2019 in the multicenter clinical database of the Jiangsu Multicenter Study Collaborative Group for Breastmilk Feeding in Neonatal Intensive Care Units. The infants were divided into two groups: low Apgar score group (Apgar score ≤7) and normal Apgar score group (Apgar score >7) based on the Apgar score at 1 minute after birth. Multivariable logistic regression analysis was used to identify factors associated with low Apgar score at 1 minute after birth. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of relevant indicators for low Apgar score at 1 minute after birth. A total of 1 809 very low/extremely low birth weight infants were included. The incidence of low Apgar score at 1 minute was 52.90% (957/1 809). Multivariable logistic regression analysis showed that older gestational age (OR=0.853, P<0.05) and higher birth weight (OR=0.999, P<0.05) were associated with a lower risk of low Apgar score at 1 minute, while the presence of abnormal amniotic fluid (OR=1.646, P<0.05) and antenatal use of glucocorticoids (OR=0.502, P<0.05) were associated with a higher and lower risk, respectively. ROC curve analysis showed that the combination of gestational age, birth weight, abnormal amniotic fluid, and antenatal use of glucocorticoids had a sensitivity of 0.554 and specificity of 0.680 in predicting low Apgar score at 1 minute. Younger gestational age, lower birth weight, and abnormal amniotic fluid increase the risk of low Apgar score at 1 minute after birth in very low/extremely low birth weight infants, while antenatal use of glucocorticoids can reduce this risk.

Background:Weight gain during pregnancy is related to optimizing health for both mother and baby. In addition, the increase in pregnancy weight is also an important indicator of maternal nutri-tion fulfillment during pregnancy and is a good measure to monitor fetal growth. This study aims to estimate the average effect of inadequate gestational weight gain on the risk of low birth weight and small for gestational age. Subjects and Method: This was a systematic review and meta-analysis with PRISMA guideline and PICO model. Population: pregnant women.Intervention: inadequate gestational weight gain. Comparison: normal gestational weight gain. Outcome: low birth weight and small for gestational age. Online databases used are PubMed, SpringerLink, Scopus, and ProQuest with the keywords "Gestational Weight Gain" OR “Inadequate Weight Gain" AND "Low Birth Weight" OR "Birth Weight Infant” OR “Pregnancy Outcomes" AND "Small Gestational Age" AND"Multivariate" AND "Cohort". There were 19 cohort studies published in 2013-2022 that met the inclusion criteria. The analysis was conducted using the Review Manager 5.3 application. Results:Meta-analysis using 19 cohort studies showed that pregnant women with inadequate weight gain had a risk of giving birth to infants with low birth weight 1.94 times compared to those with normal gestational weight (aOR= 1.94; CI 95%=1.74 to 2.16; p&lt;0.001) and pregnant women with inadequate gestational weight gain had 1.69 times higherrisk of giving birth to infants with small for gestational age than those with normal gestational weight (aOR= 1.69;95%CI= 1.55 to 1.85; p&lt;0.001). Conclusion: Inadequate gestational weight gain increases the risk of low birth weight and small for gestational age. Keywords:Pregnant women, gestational weight gain, low birth weight, small for gestational age