Appropriate Birth Weight For Gestational Age Research Articles

The likelihood of a healthy live birth after frozen embryo transfer with endometrium prepared by natural ovulation regimen vs programmed regimen: a propensity-score matching study

The number of frozen embryo transfer cycles is increasing, but the optimal method of endometrial preparation for frozen embryo transfer remains controversial. Few studies have investigated the healthy live birth outcome after the natural ovulation regimen vs the programmed regimen. This study aimed to explore whether the likelihood of a healthy live birth after frozen embryo transfer differs between the natural ovulation regimen and the programmed regimen. We conducted a retrospective cohort study including 7824 ovulatory women who underwent the first frozen embryo transfer cycle of single-blastocyst transfer with endometrial preparation by natural ovulation regimen vs programmed regimen, between June 2017 and June 2021. Propensity score matching was used to control for confounding variables in a 1:1 ratio. The primary outcome was healthy live birth, defined as birth of a live, singleton infant born at term, with an appropriate birthweight for gestational age. The natural ovulation regimen resulted in a higher probability of achieving healthy live birth compared with the programmed regimen (35.8% vs 30.6%; P<.0001). In addition, a higher rate of singleton live birth was observed after the natural ovulation regimen relative to the programmed regimen (49.6% vs 45.7%; P=.003). Women with the natural ovulation regimen were also less likely to experience clinical pregnancy loss (16.0% vs 19.7%; P=.005) and hypertensive disorders of pregnancy (3.9% vs 6.0%; P=.004) compared with women with the programmed regimen. Singletons born after the programmed regimen had greater mean birthweight (3441.50±539.97 vs 3394.96±503.87; P=.020) and higher risk of being large for gestational age (23.3% vs 18.7%; P=.003) than those conceived after the natural ovulation regimen. The natural ovulation regimen may be superior to the programmed regimen with regard to higher likelihood of healthy live birth and lower risk of pregnancy loss and maternal hypertensive disorders of pregnancy.

Birth Weight, Gestational Age, and Risk of Cardiovascular Disease in Early Adulthood: Influence of Familial Factors.

The association between intrauterine growth restriction and cardiovascular disease (CVD) later in life might be confounded by familial factors. We conducted a binational register-based cohort study to assess associations of birth weight for gestational age (GA), a proxy for intrauterine growth restriction, and GA with CVD risk in early adulthood, before and after addressing familial factors via sibling comparison. We included 3,410,334 live nonmalformed singleton births from Sweden (1973-1996) and Denmark (1978-1998). During a median follow-up period of 10 years from age 18 years onwards, 29,742 individuals developed incident CVD (hypertension, ischemic heart disease, or cerebrovascular disease). Compared with individuals born with appropriate birth weight for GA (AGA; 10th-90th percentiles) or full term (39-40 gestational weeks), individuals born severely small for GA (SGA; ≤3rd percentile) or preterm (22-36 weeks) were at increased risk of CVD (hazard ratio (HR) = 1.38 (95% confidence interval (CI): 1.32, 1.45) and HR = 1.31 (95% CI: 1.25, 1.38), respectively). The association was attenuated when comparing individuals born SGA with their AGA siblings (HR = 1.11, 95% CI: 0.99, 1.25) but remained robust when comparing individuals born preterm with their term siblings (HR = 1.21, 95% CI: 1.07, 1.37). Our findings suggest that both SGA and preterm birth are associated with CVD risk in early adulthood, with greater familial confounding noted for SGA birth.

Amniotic fluid sludge caused by intraamniotic bleeding

A 30-year-old gravida 4, para 1021 woman at 24+5 weeks of gestation presented to the labor and delivery unit because of the onset of vaginal bleeding and abdominal cramps 5 hours before admission. Her antenatal care was complicated by a threatened abortion and subchorionic hemorrhage diagnosed with ultrasound at 5 weeks of gestation. Her previous child was delivered vaginally at term with appropriate birthweight for gestational age. The patient’s ultrasound screening at 23 weeks of gestation revealed a normal female fetus, a sonographic short cervix (cervical length, 24.7 mm), and the presence of amniotic fluid sludge.

Adulthood blood levels of hsa-miR-29b-3p associate with preterm birth and adult metabolic and cognitive health

Preterm birth (PTB) is associated with increased risk of type 2 diabetes and neurocognitive impairment later in life. We analyzed for the first time the associations of PTB with blood miRNA levels in adulthood. We also investigated the relationship of PTB associated miRNAs and adulthood phenotypes previously linked with premature birth. Blood MicroRNA profiling, genome-wide gene expression analysis, computer-based cognitive testing battery (CANTAB) and serum NMR metabolomics were performed for Young Finns Study subjects (aged 34–49 years, full-term n = 682, preterm n = 84). Preterm birth (vs. full-term) was associated with adulthood levels of hsa-miR-29b-3p in a fully adjusted regression model (p = 1.90 × 10–4, FDR = 0.046). The levels of hsa-miR-29b-3p were down-regulated in subjects with PTB with appropriate birthweight for gestational age (p = 0.002, fold change [FC] = − 1.20) and specifically in PTB subjects with small birthweight for gestational age (p = 0.095, FC = − 1.39) in comparison to individuals born full term. Hsa-miR-29b-3p levels correlated with the expressions of its target-mRNAs BCL11A and CS and the gene set analysis results indicated a target-mRNA driven association between hsa-miR-29b-3p levels and Alzheimer's disease, Parkinson's disease, Insulin signaling and Regulation of Actin Cytoskeleton pathway expression. The level of hsa-miR-29b-3p was directly associated with visual processing and sustained attention in CANTAB test and inversely associated with serum levels of VLDL subclass component and triglyceride levels. In conlcusion, adult blood levels of hsa-miR-29b-3p were lower in subjects born preterm. Hsa-miR-29b-3p associated with cognitive function and may be linked with adulthood morbidities in subjects born preterm, possibly through regulation of gene sets related to neurodegenerative diseases and insulin signaling as well as VLDL and triglyceride metabolism.

Bronchopulmonary dysplasia in neonates born to mothers with preeclampsia: Impact of small for gestational age.

Background and objectivesSmall for gestational age and preeclampsia have both been described as risk factors for bronchopulmonary dysplasia in preterm neonates, but their respective role in the occurrence of bronchopulmonary dysplasia is debated. We evaluated the relation between small for gestational age and bronchopulmonary dysplasia in neonates born to mothers with preeclampsia. We hypothesized that low birth weight is still associated with bronchopulmonary dysplasia in this homogeneous population.MethodsRetrospective single-center cohort study including 141 neonates born between 24 and 30 weeks’ gestation to mothers with preeclampsia. The main outcome measure was moderate to severe bronchopulmonary dysplasia at 36 weeks’ postmenstrual age. Neonates born small for gestational age (birthweight < 10th percentile on the AUDIPOG curves) were compared to those with appropriate birthweight for gestational age by bivariable analyses and logistic regression models, estimating odds ratios (ORs) and 95% confidence intervals (CIs).ResultsBronchopulmonary dysplasia rates were 61.5% (32/52) and 27.4% (20/73) for small for gestational age and appropriate birthweight for gestational age neonates (p < .001). On adjustment for gestational age and other confounding factors, the risk of moderate to severe bronchopulmonary dysplasia was greater for small for gestational age than appropriate birthweight for gestational age neonates (adjusted OR = 5.9, 95% CI [2.2–15.4]), as was the composite outcome death or moderate to severe bronchopulmonary dysplasia (adjusted OR = 4.7, 95% CI [1.9–11.3]).ConclusionsSmall for gestational age was associated with bronchopulmonary dysplasia in very preterm neonates born to mothers with preeclampsia.Registration numberCNIL no. 1747084.

The relationship between birth weight, oxidative stress and bone mineral status in newborn infants

It was shown that oxygen-derived free radicals, and particularly the superoxide anion, are intermediaries in the formation and activation of osteoclasts. Many antioxidant defence systems depend on micronutrients or are micronutrients themselves. Oxidative stress might be related to bone indices in newborn infants. To assess the relationship between oxidative status and bone indices in small-for-gestational-age (SGA), large-for-gestational-age (LGA) and appropriate-for-gestational-age (AGA) babies born to healthy mothers. Umbilical cord venous blood samples were obtained at the delivery from 100 term newborn infants to measure plasma malondialdhyde, superoxide dismutase (SOD) and myeloperoxidase concentrations. Forty of the newborn infants had birth weights AGA, 30 were SGA and 30 LGA. Data were acquired using the whole body dual-energy X-ray absorptiometry scanner in the first 24 h after birth. Plasma malondialdhyde and SOD concentrations of the mothers and their newborn infants were positively correlated; however, plasma myeloperoxidase concentrations were not. SOD concentrations of SGA infants were significantly higher than those of AGA and LGA infants. Whole body bone mineral density and content were lower in SGA but higher in LGA babies than in AGA babies. Oxidative stress status of both infants and their mothers was not related to the bone indices. Our study does not provide support for the hypothesis that oxidative status of the infants and mothers may play a major role in the regulation of bone metabolism in the developing skeleton.

Second- and third-trimester serum levels of placental proteins in preeclampsia and small-for-gestational age pregnancies

Background: Poor placentation may perpetuate preeclampsia, but the presence of a major placental pathology has been questioned in cases of preeclampsia where the newborn has an appropriate birthweight for gestational age. On the other hand, poor placentation is also observed in the absence of preeclampsia, in pregnancies with small-for-gestational-age (SGA) fetuses. In late gestation, maternal serum levels of placental protein hormones are changed in both preeclampsia and SGA, but no longitudinal preonset studies are available for pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific β1-glycoprotein (SP1) or human placental lactogen (HPL). Methods: In a nested case-control study we compared maternal serum levels of PAPP-A, SP1, HPL and placenta growth factor (PLGF) at 17, 25 and 33 weeks in pregnancies developing preeclampsia without fetal growth restriction (n = 28), or characterized by a growth-retarded fetus (n = 25), with gestation-matched controls (n = 65). The proteins were quantified using microplate enzyme immunometric assays and the serum levels at 17, 25 and 33 weeks compared between the three groups by nonparametric statistical tests. Results: In pregnancies with subsequent preeclampsia PAPP-A, SP1, HPL and PLGF were reduced at 17 weeks of gestation whereas at 25 and 33 weeks only PLGF remained below the controls. In growth-restricted pregnancies PAPP-A, SP1 and HPL were reduced at 17 weeks, and only HPL continued to be strongly affected thereafter. Conclusion: The reduced serum levels of the placental proteins PAPP-A, SP1 and HPL in the early second trimester (17 weeks) in pregnancies with subsequent preeclampsia or with fetal growth restriction involve an underlying role for the placenta in either pathology independent from the other.

Second‐ and third‐trimester serum levels of placental proteins in preeclampsia and small‐for‐gestational age pregnancies

Poor placentation may perpetuate preeclampsia, but the presence of a major placental pathology has been questioned in cases of preeclampsia where the newborn has an appropriate birthweight for gestational age. On the other hand, poor placentation is also observed in the absence of preeclampsia, in pregnancies with small-for-gestational-age (SGA) fetuses. In late gestation, maternal serum levels of placental protein hormones are changed in both preeclampsia and SGA, but no longitudinal pre-onset studies are available for pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta1-glycoprotein (SP1) or human placental lactogen (HPL). In a nested case-control study we compared maternal serum levels of PAPP-A, SP1, HPL and placenta growth factor (PLGF) at 17, 25 and 33 weeks in pregnancies developing preeclampsia without fetal growth restriction (n = 28), or characterized by a growth-retarded fetus (n = 25), with gestation-matched controls (n = 65). The proteins were quantified using microplate enzyme immunometric assays and the serum levels at 17, 25 and 33 weeks compared between the three groups by nonparametric statistical tests. In pregnancies with subsequent preeclampsia PAPP-A, SP1, HPL and PLGF were reduced at 17 weeks of gestation whereas at 25 and 33 weeks only PLGF remained below the controls. In growth-restricted pregnancies PAPP-A, SP1 and HPL were reduced at 17 weeks, and only HPL continued to be strongly affected thereafter. The reduced serum levels of the placental proteins PAPP-A, SP1 and HPL in the early second trimester (17 weeks) in pregnancies with subsequent preeclampsia or with fetal growth restriction involve an underlying role for the placenta in either pathology independent from the other.

Fetal growth restriction is not associated with a reduced risk for bilateral spastic cerebral palsy in very-low-birthweight infants.

To evaluate the influence of confounding and sampling bias on the relationship between fetal growth restriction in a very-low-birthweight-defined cohort (VLBW, < or =1500 g) and bilateral spastic cerebral palsy (BSCP) at early school-age. Three hundred twenty-four of 407 long-term survivors of a regional cohort of VLBW newborns were followed until age 6 years. We categorized as small for gestational age (SGA) all infants whose birthweight Z-score was below -2 relative to published reference values. Uni- and multivariable logistic regression models were fit to estimate the risk of BSCP associated with SGA in the total sample, in subsamples defined by gestational age, and in a gestational age-matched case-control sample. In the total sample, no child below 28 weeks was SGA, and no child above 32 weeks had an appropriate birthweight for gestational age (AGA). The prevalence of BSCP was 14% in AGA and 2% in SGA infants. In both uni- and multivariable logistic regression analyses of the total sample, SGA was associated with a prominently reduced risk of BSCP (odds ratios range from 0.1 to 0.2, all 95% confidence limits exclude 1.0). However, analyses performed in samples defined by different gestational age cutoffs (24--31 weeks, 28--31 weeks) and in a sample using three gestational age-matched controls per BSCP-case did not show a protection by growth restriction (odds ratios range from 0.8 to 2.2, all 95% confidence limits include 1.0). In VLBW-defined samples, the apparent protective effect of SGA for BSCP can be explained, at least in part, by the highly skewed distribution of SGA over the available gestational age range. From this follows that study cohorts should be defined by gestational age and not by birthweight. In distorted samples like this one, even controlling for gestational age does not reduce the illusion of a reduced cerebral palsy risk for growth restricted infants. Only restriction of the sample by gestational age and/or matching for gestational age reveals the absence of this apparent protective effect.

INSULIN IS NOT THE MAJOR GLUCOREGULATORY HORMONE IN THE NEONATAL PERIOD

The glucoregulatory role of insulin for adult subjects is undisputed. However, less is known about its secretion and actions in the neonatal period, either in healthy subjects, or in those at risk of disordered blood glucose homeostasis. We studied the relationships between blood glucose and plasma insulin concentrations in 52 healthy children, 67 appropriate birthweight for gestational age (AGA) term infants, 39 AGA preterm infants, and 59 infants who were hypoglycaemic or hyperglycaemic. In addition, 26 babies from the latter group underwent glucose turnover studies. In children and AGA infants, plasma insulin concentration was positively related to blood glucose concentration (Spearman rho, P: Children, 0.58, <0.001; AGA term, 0.31 <0.01; AGA preterm, 0.44, <0.01). However, at equivalent glucose concentrations, there was greater variation in insulin concentration and the median insulin concentration was higher in AGA infants than for children. In hypoglycaemic and hyperglycaemic infants, there was no relationship between blood glucose and plasma insulin levels, and, in turn, glucose production rates were not related to plasma insulin levels. These data suggest that, compared to older subjects, neonatal pancreatic insulin secretion is less closely linked to circulating blood glucose concentrations, and that insulin does not control glucose production rates in infants with disorders of blood glucose homeostasis.

Postnatal Dependence of Plasma Copper and Zinc Levels on Gestational Age and Maturity Observed in Infants Fed a High Zinc Content Formula

Summary:We studied the effect of gestational age and maturity on plasma zinc and copper levels at 10 and 120 days of age. The association of plasma zinc changes and body growth was also investigated. Infants were receiving a controlled intake of zinc and copper solely through a zinc‐supplemented formula (4.7 mg/L of zinc and 0.16 mg/L of copper). Twenty‐eight low‐birthweight infants (&lt;2,500 g) having gestational ages ranging from 33 to 40 weeks [17 with an appropriate birthweight for gestational age (AGA) and 11 small for gestational age (SGA)] were enrolled in the present study. Measurements of plasma zinc and copper concentration, weight, length, head circumference, and tricipital and subscapular skinfolds were carried out at 10 and 120 days of age. Proton‐induced x‐ray fluorescence technique (PIXE) was used to assess copper and zinc concentrations. At 10 days of age a significant correlation between copper concentration and gestational age was found. At 120 days of age the copper concentration was higher than at 10 days and independent of gestational age and maturity (mean ± SEM = 116 ± 5 μg/dl). At 10 days of age no significant correlation between zinc content and gestational age was found (86 ± 4 μg/dl). The plasma zinc percent change over the period from 10 to 120 days of age was positively correlated with gestational age in the whole sample as well as in AGA and SGA infants separately. The value of gestational age at which the zinc percent change turns from negative to positive was 35.6 ± 0.7 weeks for AGA, 37.4 ± 0.5 weeks for SGA, and 36.2 ± 0.5 weeks for the whole sample. No significant correlation between the increments of the measured body features and the plasma zinc change was found. Length and weight velocities were similar in AGA and SGA infants. These observations indicate that the possibility of increasing plasma zinc level by zinc supplementation depends on gestational age and maturity.