Eye movements and binocular function in low birthweight teenagers

501: Differences in neonatal outcome and placental pathology in relation to the severity of fetal growth restriction

Few data are available on the pubertal development of children born small for gestational age (SGA) who fail to show catch-up growth. A longitudinal analysis compared the pubertal course of persistently short children born SGA compared to children with idiopathic short stature who were appropriate for gestational age (AGA). One hundred and twenty-eight short children (height SDS<-1.7), including 76 (31 boys) born SGA and 52 (22 boys) born AGA, were regularly followed from early childhood to completion of puberty. Puberty was attained at normal age (10.5-14 Years in boys, 9.5-13 Years in girls) for most children in both the SGA and AGA groups (boys, 80% and 77%; girls, 76% and 78% respectively). The duration of puberty was similar in the SGA and AGA groups. Menarche occurred at normal age range but was significantly earlier in the SGA girls (P<0.01 by ANOVA). Despite the similar total pubertal growth, the patterns of growth differed significantly: SGA group - accelerated growth and bone maturation rates from onset of puberty with peak height velocity at Tanner stages 2-3, followed by a decelerated growth rate and earlier fusion of the epiphyses; AGA group - steady progression of bone elongation and maturation throughout puberty (pubertal growth, P<0.05 in both sexes; bone maturation, P<0.001 in both sexes). Final height in the SGA group was compromised compared with their target height (P<0.001). Children born SGA have a normal pubertal course with a distinct pubertal growth pattern. This pattern may represent an altered regulation of their growth modalities.

Objective:Children born small for gestational age (SGA) are at risk of future obesity and associated comorbidities. Therefore the identification of risk factors and novel biomarkers which are associated with this risk are needed for early detection and to improve preventive strategies. Spexin (SPX), a novel neuropeptide that is involved in the regulation of obesity and fat metabolism, is a candidate biomarker for predicting obesity and related comorbidities at an early age. The aim of this study was to investigate serum levels of SPX in term infants born small, appropriate, and large for gestational age (LGA) and its association with newborn anthropometric measurements.Methods:One hundred and twenty term newborn babies classified as SGA, appropriate for gestational age (AGA), or LGA and their mothers were included. SPX, leptin and visfatin were measured in cord blood and maternal serum by enzyme-linked immunosorbent assay.Results:Fifty-six (46.7%) neonates were girls and 64 (53.3%) were boys. The mean birth weight was 3170.70±663 g, birth length was 48.9±2.79 cm, and head circumference was 34.5±1.67 cm. Birth weights, lengths, and head circumferences of the neonates in the SGA, AGA, and LGA groups were significantly different. Cord blood SPX and leptin levels in the SGA groups were significantly lower than those of both the LGA and AGA groups. Cord blood visfatin levels were significantly lower in the AGA group than the LGA and SGA groups. Maternal SPX levels of SGA babies were significantly lower than those of the mothers in both the LGA and AGA groups, but no significant difference was observed between the SGA and LGA groups. Maternal visfatin levels of the AGA babies were significantly higher than the maternal levels of SGA and LGA groups. There was no difference in terms of maternal leptin levels. Cord blood SPX and leptin levels were positively correlated with birth weight, length and head circumference. Birth weight increased significantly in line with maternal pregestational body mass index.Conclusion:The lowest SPX levels were found in the SGA babies and cord SPX level was significantly correlated with newborn length, weight, and head circumference.

PurposeTo assess the delivery complications in neonates with meconium stained amniotic fluid (MSAF) and small for gestational age (SGA) birthweight.MethodsThe medical records of all term, singleton deliveries during 2014–2021 were reviewed. Obstetric characteristics and neonatal outcomes were evaluated among the following groups: SGA neonates with MSAF (SGA-MSAF group), SGA neonates without MSAF (SGA group), appropriate for gestational age (AGA) neonates with MSAF (AGA-MSAF group) and AGA without MSAF (AGA group).ResultsA total of 44,911 deliveries were included in the study, with 673 in the SGA-MSAF group, 2,762 in the SGA group, 6,958 in the AGA-MSAF group, and 34,518 in the AGA group. The SGA-MSAF group exhibited higher rates of nulliparity and hypertensive disorders compared to the SGA, AGA-MSAF, and AGA groups (p ≤ 0.001). Oligohydramnios, labor induction, vacuum extractions (VE), and intrapartum cesarean deliveries (CD) were significantly more frequent in the SGA-MSAF group compared to the SGA, AGA-MSAF, and AGA groups (p ≤ 0.003). The SGA-MSAF group had the highest rates of adverse composite neonatal outcomes compared to the SGA, AGA-MSAF, and AGA groups (p < 0.001). Multivariable logistic regression, adjusted for confounders, revealed increased ORs for the adverse neonatal composite outcome, VE, VE due to NRFHR, intrapartum CD, and CD due to NRFHR, in the presence of MSAF or SGA, and mostly when both risk factors were present (p ≤ 0.002).ConclusionDeliveries complicated with MSAF and SGA were associated with increased obstetric complications compared to each alone. Clinicians should be aware of this and manage labor accordingly.

Objective To investigate the relationship between the level of serum adiponectin and insulin resistance(IR) in children aged 1-36 months born small for gestational age (SGA). Methods A total of 71 children born SGA and 31 children born appropriate for gestational age (AGA) with the same age were assigned to SGA group (n= 71) and AGA group(n= 31). The concentration of serum adiponectin, fasting plasma glucose (FPG), and fasting insulin (FINS) were measured in these two groups. Anthropometric indicators were also obtained at the same time. Insulin sensitivity index and IR index both were calculated. Those who had congenital diseases, metabolism diseases, cerebral palsy, hypoxic ischemic encephalopathy, tuberculosis, hepatitis, nephrotic syndrome and some other chronic diseases are excluded from this study. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital, Sichuan University. Informed consent was obtained from all participants. Results ① Among the 71 subjects in SGA group, 25 were eliminated for some kinds of reason. Finally 46 children corresponded the conclusion and exclusion standard. ②There were no difference in gender and age between SGA and AGA groups(χ2=0.377, P>0.05; χ2=0.064,P>0.05). In addition, there were no difference in the feeding after birth and complication (P>0.05). ③The weight, weight Z score, height, height Z score and chest circumference were found significant difference between two groups (P 0.05). ⑤ There was a negative correlation between the level of serum adiponectin and BMI(R=—0.304, P 0.05). ⑥The level of serum adiponectin in SGA group was lower than that in AGA group and statistically significant difference was showed (P < 0.05). ⑦ Multiple linear regression analysis showed a positive correlation between the level of serum adiponectin and BMI (R=-0.304, P<0.05), BMI was the influencing factor of serum adiponectin (R= 0.336, R2= 0.113). Conclusion Children of SGA who aged 1-36 months did not achieve IR yet. There was a negative correlation between serum adiponectin and BMI. The level of serum adiponectin is reduced. Children of SGA had higher risk to develop IR than AGA infants. Key words: small for gestational age; catch-up growth; insulin resistance; adiponectin; insulin

Objectives: Small for gestational age (SGA) children may present an earlier onset of pubertal development, advanced bone maturation and reduced final height. The aim of this study was to compare the clinical parameters such as final adult height (FAH) and menarche with birth weight in girls with idiopathic precocious puberty (PP) treated with gonadotropin releasing hormone agonist (GnRHa). Subjects and methods: We retrospectively reviewed the medical records of 69 girls with PP who have reached FAH in a long-term trial of GnRHa treatment. The subjects were divided into SGA group and appropriated for gestational age (AGA) group. Anthropometric and endocrine parameters were obtained at diagnosis, at 6 months, and at cessation of GnRHa treatment. We investigated chronological age (CA), bone age (BA), BA / CA ratio, height and height SDS, predicted adult height (PAH-calculated with average table of BP method), PAH SDS, PAHa (calculated with advanced table of BP method), basal and stimulated gonadotropin levels, duration of treatment, duration of menarche, and FAH after treatment. The statistical significances of the clinical parameters between the two groups were compared. Results: The BA at the time of diagnosis was higher in SGA than in AGA (p <0.05). In the SGA, PAH SDS and PAHa were lower than those of AGA (p <0.05), but there was no significant difference in FAH between two groups. The FAH after GnRHa treatment was higher than PAH at diagnosis between SGA and AGA groups (p <0.05) . Body mass index was higher at the end of treatment in SGA group than in AGA (p <0.05). In addition, it was confirmed that the menarche was fast after treatment in SGA than in AGA (p <0.05). Target height, height SDS at diagnosis, PAH at diagnosis, and height SDS at end of treatment were found to be factors affecting FAH (p <0.05) . Conclusion: SGA girls with PP have increased bone age and rapid menarche than those of AGA group. But FAH after GnRHa treatment was not difference between the SGA and AGA groups. GnRHa treatment in SGA with PP may be helpful in improving FAH, and further large - scale studies will be needed in the future.

Plasminogen activator inhibitor type-1 is an independent marker of metabolic disorders in young adults born small for gestational age.

Do visual impairments affect risk of motor problems in preterm and term low birth weight adolescents?

Objective To investigate the afamin concentration in the serum of pregnant women diagnosed with late fetal growth restriction (FGR) or small for gestational age (SGA) in the third trimester. Methods This prospective case-control study was conducted on 126 pregnant women, 42 of whom were diagnosed with late FGR in the third trimester, 43 were SGA, and 41 were healthy controls. The groups were compared in terms of maternal serum afamin concentrations. Results Three groups were similar in terms of demographic characteristics and gestational age at blood sampling for afamin (p < .05). The median afamin concentration was determined as 199 ng/mL in the late FGR group, 153 ng/mL in the SGA group, and 108 ng/mL in the control group (p = .000). In the post-hoc analysis, while maternal serum afamin concentrations were found to be significantly higher in the late FGR group and SGA group compared to the control group but, this significance could not be shown between the FGR group and the SGA group (p = .00001, p = .005, p = .137, respectively). In the ROC analysis, the optimal cutoff value of serum afamin concentration to predict late FGR was determined as 141 ng/mL, with a sensitivity of 66.6% and a specificity of 85.3%. Conclusions The serum afamin concentration in the third trimester was found to be higher in pregnant women with late FGR compared to the SGA and control groups. Although afamin is seen as a promising molecule in the clinical prediction of late FGR, this needs to be supported by large series of studies.

To investigate the factors influencing the occurrence of small for gestational age (SGA) at different degrees and provide a basis for early identification of severe SGA cases. Neonatal and maternal prenatal information were retrospectively collected from January 2018 to December 2022 at Peking University People's Hospital. The neonates were divided into three groups: severe SGA group (birth weight below the 3rd percentile for gestational age and sex), mild SGA group (birth weight ≥3rd percentile and <10th percentile), and non-SGA group (birth weight ≥10th percentile). An ordered multinomial logistic regression model was used to analyze the factors influencing the occurrence of SGA at different degrees. A total of 14 821 neonates were included, including 258 cases (1.74%) in the severe SGA group, 902 cases (6.09%) in the mild SGA group, and 13 661 cases (92.17%) in the non-SGA group. The proportions of preterm births and stillbirths were higher in the severe SGA group compared to the mild SGA and non-SGA groups (P<0.0125). The proportion of neonatal asphyxia was higher in both the severe SGA and mild SGA groups compared to the non-SGA group (P<0.0125). Ordered multinomial logistic regression analysis showed that maternal pre-pregnancy underweight (OR=1.838), maternal pre-pregnancy obesity (OR=3.024), in vitro fertilization-embryo transfer (OR=2.649), preeclampsia (OR=1.743), connective tissue disease during pregnancy (OR=1.795), nuchal cord (OR=1.213), oligohydramnios (OR=1.848), and intrauterine growth restriction (OR=27.691) were all associated with a higher risk of severe SGA (P<0.05). Maternal parity as a multipara (OR=0.457) was associated with a lower likelihood of severe SGA (P<0.05). Maternal pre-pregnancy underweight, maternal pre-pregnancy obesity, in vitro fertilization-embryo transfer, preeclampsia, connective tissue disease during pregnancy, oligohydramnios, nuchal cord, and intrauterine growth restriction are closely related to the occurrence of more severe SGA. Maternal parity as a multipara acts as a protective factor against the occurrence of severe SGA.

Increased sympathetic nervous system activity has been proposed as a potential mechanism for the blood pressure (BP) elevation seen in individuals born small for gestational age (SGA). This study was carried out to detect the changes in BP and heart rate (HR) in children born SGA during exposure to stress and to assess for changes in urinary catecholamine excretion. Nineteen children aged 6-14years born SGA and 17 age- and gender-matched healthy controls were included in the study. The stress test included a mathematical test and venipuncture. BP and HR were monitored during the test. Spot urine samples were collected at baseline and after the stress test to determine dopamine, epinephrine and norepinephrine levels. At baseline, there was no difference in BP and HR between the SGA and control groups, but mean urinary norepinephrine levels were slightly higher in the SGA group (55.7 ± 16.1 vs. 43.4 ± 3.8 mcg/gCr; P = 0.10). Compared to the control group, mean maximal HR increase was higher in the SGA group (31.3 ± 3.1 vs. 19.2 ± 3.8%; P = 0.008), and mean duration of maximal HR to baseline HR was longer (186 ± 23 vs. 97 ± 13s, respectively; P = 0.003). There was a significant negative correlation between birth weight and maximal HR increase (r = -0.497, P = 0.003). Children born SGA showed significantly greater increases in HR and significantly longer periods of tachycardia during exposure to stress than did healthy controls. The rise in HR was inversely correlated with birth weight. These findings suggest that children born SGA have a greater increase in sympathetic response when exposed to stress than do healthy individuals.

PurposeThe clinical significance of birth weight relative to gestational age in girls with central precocious puberty is unclear. This study sought to compare clinical parameters such as final adult height (FAH) and menarche onset after treatment with gonadotropin-releasing hormone agonist (GnRHa) on birth weight in girls with central precocious puberty treated.MethodsThis retrospective study reviewed data of 69 girls with precocious puberty who had reached their FAH in a long-term trial of GnRHa treatment between January 2007 and December 2017. The subjects were divided into small for gestational age (SGA) (n=19) and appropriate for gestational age (AGA) (n=50) groups.ResultsWhen starting GnRHa treatment, bone age was 10.9±0.9 and 10.3±0.8 years in the SGA and AGA groups, respectively (P<0.05). The predicted adult height (PAH) (established according to the Bayley-Pinneau average table) and advanced PAH (established according to the Bayley-Pinneau advanced table) were 151.5±4.8 cm and 155.8±4.9 cm in the SGA group, respectively, and 153.4±5.3 cm and 159.0±6.0 cm in the AGA group. After treatment, no significant difference in bone age was found between the groups. The time to menarche after treatment was 12.5±7.6 and 21.1±12.3 months in the SGA and AGA groups, respectively (P<0.05). FAH in the SGA and AGA groups was 161.0±4.7 cm and 161.6±5.0 cm, respectively, without a significant difference.ConclusionsSGA girls with precocious puberty have increased bone age and earlier menarche relative to AGA girls. However, no difference in FAH after treatment was found between these groups.

Changes in white matter diffusion anisotropy in adolescents born prematurely

Small for Gestational Age and Intrauterine Growth Restriction Decreases Cognitive Function in Young Adults

Study question Do small for gestational age (SGA) female newborns have lower AMH levels compared to appropriate for gestational age (AGA) female newborns? Summary answer No differences were found between neonatal AMH levels of the SGA and AGA group. A correlation was found between maternal and neonatal AMH levels. What is known already The Barker hypothesis suggests a fetal origin for diseases diagnosed later in life, shedding light on the influence of the uterine environment on the developing fetus. There is limited data regarding whether fetal growth restriction impacts ovarian reserve, and only few studies reporting on AMH levels in female newborns. We aimed to compare umbilical cord anti-mullerian hormone (AMH) levels between small for gestation age (SGA) and appropriate for gestational age (AGA) female newborns and study the correlation between maternal and neonatal AMH levels. Additionally, we aimed to report on normal AMH levels of female newborns. Study design, size, duration A prospective observational single center cohort study, conducted at our delivery room from March 2022 up to December 2024. 201 patients and their female newborns were recruited and had an umbilical and maternal blood AMH level obtained. SGA was defined as birthweight up to the 10th percentile according to the HADLOCK equations. Included were pregnant women at term with a female-sex singleton gestation expected to give birth within three days. Participants/materials, setting, methods Pregnant women at term of their female-sex singleton gestation expected to give birth within three days were enrolled and recruited consecutively upon admission to the delivery room. Excluded were women above the age of 40 years old, women with a diagnosis of polycystic ovary syndrome, women carrying a multi-gestational pregnancy or a male-sex fetus. A maternal blood sample was obtained following recruitment, and an umbilical blood sample was obtained within 30 minutes following delivery. Main results and the role of chance In the SGA group 42 women and their female newborns were included with a mean ±SD birth weight of 2708 gr (218 gr), while the AGA group included 159 women and their female newborns, with a mean ±SD birth weight of 3362 gr (322 gr). Median (IQR) newborn AMH levels were found to be 0.18 (0.07-0.57) in the SGA group, and 0.15 (0.06-0.68) in the AGA group. Neonatal AMH levels presented a right-skewed distribution, with 70% of the neonates having AMH levels up to 0.5. No differences were found between neonatal AMH levels of the SGA and AGA group (p = 0.78). A correlation was found between maternal and neonatal AMH levels (B = 0.35, p = 0.001), that remained significant in an adjusted multivariate model that included adjustment to age, gravidity, parity, maternal BMI, paternal BMI, smoking status and comorbidities. When divided into two groups according to the neonatal birth weight the correlation between maternal and neonatal AMH levels remained significant. Limitations, reasons for caution This is a single center study, suggesting a rather homogeneous population therefore selection bias cannot be excluded. The strength of the study is in the prospective nature and the enrolment of a large cohort of women and newborns with the simultaneous collection of both maternal and umbilical cord AMH. Wider implications of the findings Female newborns born SGA were not found to have a lower level of AMH compared with female AGA newborns. However, a correlation between maternal and neonatal AMH levels was observed, implying AMH genetic predisposition of ovarian reserve, yet more research is needed on this important topic. Trial registration number No