Appropriate Size For Gestational Age Research Articles

Serum Adipocytokines Profile in Children Born Small and Appropriate for Gestational Age—A Comparative Study

Adipose tissue is not only a storage place for fat, but also an endocrine organ, secreting bioactive molecules which influence body metabolism. Such molecules are known as adipocytokines. In the past years the coincidence between adipocytokines and fetal growth restriction disorders was found. The aim of the study was to estimate serum levels of adiponectin, leptin and resistin in children born small for gestational age, compared to children born at an appropriate size for gestational age. The study consisted of 35 children aged seven to nine years, born SGA (small for gestational age) on term and 25 healthy children (14 girls, 11 boys), born with proper birthweight (AGA-appropriate for gestational age)-control group. Adiponectin and leptin levels were significantly higher in the SGA group compared to the AGA group (p = 0.023, p = 0.018 respectively). The resistin values were comparable in both groups of patients. There was a positive correlation between serum leptin concentration and current body weight in SGA group (r = 0.28; p = 0.108). In turn, adiponectin levels in this group of patients negatively correlated with actual body weight (r = -0.51; p = 0.002). The negative correlation between body mass index and plasma adiponectin levels was found only in children born SGA. SGA children had significantly higher values of diastolic blood pressure. There was negative correlation between serum adiponectin level and systolic blood pressure in SGA children. In the SGA group the phenomenon of catch-up growth was observed in 32 children. Children born SGA have abnormal adipose tissue biomarkers profiles.

Effect of common pregnancy and perinatal complications on offspring metabolic traits across the life course: a multi-cohort study

BackgroundCommon pregnancy and perinatal complications are associated with offspring cardiometabolic risk factors. These complications may influence multiple metabolic traits in the offspring and these associations might differ with offspring age.MethodsWe used data from eight population-based cohort studies to examine and compare associations of pre-eclampsia (PE), gestational hypertension (GH), gestational diabetes (GD), preterm birth (PTB), small (SGA) and large (LGA) for gestational age (vs. appropriate size for gestational age (AGA)) with up to 167 plasma/serum-based nuclear magnetic resonance-derived metabolic traits encompassing lipids, lipoproteins, fatty acids, amino acids, ketones, glycerides/phospholipids, glycolysis, fluid balance, and inflammation. Confounder-adjusted regression models were used to examine associations (adjusted for maternal education, parity age at pregnancy, ethnicity, pre/early pregnancy body mass index and smoking, and offspring sex and age at metabolic trait assessment), and results were combined using meta-analysis by five age categories representing different periods of the offspring life course: neonates (cord blood), infancy (mean ages: 1.1–1.6 years), childhood (4.2–7.5 years); adolescence (12.0–16.0 years), and adulthood (22.0–67.8 years).ResultsOffspring numbers for each age category/analysis varied from 8925 adults (441 PTB) to 1181 infants (135 GD); 48.4% to 60.0% were females. Pregnancy complications (PE, GH, GD) were each associated with up to three metabolic traits in neonates (P≤0.001) with some evidence of persistence to older ages. PTB and SGA were associated with 32 and 12 metabolic traits in neonates respectively, which included an adjusted standardised mean difference of −0.89 standard deviation (SD) units for albumin with PTB (95% CI: −1.10 to −0.69, P=1.3×10−17) and −0.41 SD for total lipids in medium HDL with SGA (95% CI: −0.56 to −0.25, P=2.6×10−7), with some evidence of persistence to older ages. LGA was inversely associated with 19 metabolic traits including lower levels of cholesterol, lipoproteins, fatty acids, and amino acids, with associations emerging in adolescence, (e.g. −0.11 SD total fatty acids, 95% CI: −0.18 to −0.05, P=0.0009), and attenuating with older age across adulthood.ConclusionsThese reassuring findings suggest little evidence of wide-spread and long-term impact of common pregnancy and perinatal complications on offspring metabolic traits, with most associations only observed for newborns rather than older ages, and for perinatal rather than pregnancy complications.

Evidence of changes in the oral language in children born full-term and small for gestational age: a systematic review.

Objective:To perform a systematic review in order to verify the association between full-term birth of small for gestational age (SGA) children and the outcomes in the development of oral language.Data source:Articles from MEDLINE/PubMed, Web of Science, Embase, Lilacs, SciELO and Cochrane Library databases were identified, selected and critically evaluated by two independent reviewers and a judge, blindly, without language restriction and publication period. The PRISMA tool was used, and original studies with a theme involving children born full-term and SGA were included, outcome related to aspects of oral language development, as well as the use of tests, scales and/or specific questionnaires for the investigation, whose methodology was described in full, with children as the target population.Data synthesis:The researchers included nine articles based on the eligibility criteria. Studies have shown that being born SGA can interfere in aspects related to language and reported greater chances of under performance in SGA children when compared to children with appropriate size for gestational age. It was observed that the different studies did not have a uniform design, and the objectives were quite diverse. Furthermore, few of them had as focus issues related to the assessment of language, as well as the variability of instruments used to investigate this domain.Conclusions:The effects of low weight for gestation age in full-term infants continue beyond the neonatal period and may impact on children’s performance, mainly with regard to oral language development.

A better quality of maternal dietary fat reduces the chance of large-for-gestational-age infants: A prospective cohort study

ObjectivesWe sought to investigate the relationship between the usual intake of fatty acids and indices of dietary fat quality in pregnant women and the birth-weight categories of their newborns. MethodsThis prospective cohort study was conducted with 734 mother–infant pairs in Brazil. Dietary intake was estimated through 24-h dietary recalls. Secondary data on birth weight, sex of the newborn, and pregnancy duration were obtained. The relationship of fatty acids and indices with birth-weight categories were investigated using logistic regression models adjusted for confounding factors. We considered P values < 0.05 significant. ResultsThe median (interquartile range) maternal age was 27 (23–31) y; 46.2% of the pregnant women had pregestational body mass index ≥ 25 kg/m2, 18.1% had gestational diabetes mellitus, and 11.2% had hypertension. Regarding the newborns, 68 (9.3%) were classified as small for gestational age, 545 (74.2%) as appropriate size for gestational age, and 121 (16.5%) as large for gestational age. In adjusted logistic regression models, a lower chance of being large for gestational age was observed among the children of women classified in the third tertile (versus the first tertile) for intake of polyunsaturated fatty acids (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.31–0.89; P = 0.02), ω-3 fatty acids (OR, 0.48; 95% CI, 0.28–0.80; P = 0.005), and ω-6 fatty acids (OR, 0.56; 95% CI, 0.33–0.96; P = 0.04) and for ratios of polyunsaturated to saturated fatty acids (OR, 0.54; 95% CI, 0.32–0.92; P = 0.03) and hypocholesterolemic to hypercholesterolemic fatty acids (OR, 0.51; 95% CI, 0.30–0.87; P = 0.01). ConclusionsThe data suggest that better-quality fat in the maternal diet can reduce the chance of a large-for-gestational-age newborn.

Antenatal Markers Related to Fetal Growth Restriction Can Predict Childhood Systolic Blood Pressure

Background: Being born small for gestational age (SGA) is linked with higher systolic blood pressure (SBP). Fetuses with growth restriction (FGR) may be either SGA or appropriate size for gestational age at birth. However, it is not known which factors contributing to size at birth influence the relationship with SBP. Aim. To determine whether antenatal markers of FGR can predict the upper quartile of childhood SBP. Methods: Brachial SBP was measured for 75 children aged 3-6 years from the Manchester BabyGRO Study, using a Tensiomed®Arteriograph with a child-sized cuff. SBP quartiles were generated. Participants were born to mothers who had attended a specialised clinic, following identification of higher FGR risk based on abnormal maternal serology (pregnancy associated plasma protein-A, β-human chorionic gonadotrophin, α-fetoprotein, Inhibin-A). Antenatal ultrasound data at 23 weeks gestation were obtained. Uterine artery Doppler (UtAD) notching was assigned a rank (0=absent, 1=unilateral, 2=bilateral). Random forest (RF) is a machine learning approach that generates many independent, uncorrelated decision trees based on multiple variables. This was used to determine the relative importance of antenatal variables in prediction of upper quartile of childhood SBP. Variables included in the model were maternal body mass index (BMI), parity, ethnicity (black/white/asian/mixed), maternal SBP and diastolic BP (DBP), maternal serology relating to FGR risk, UtAD pulsatility index, resistance index and notching rank (all measures of uteroplacental blood flow resistance), placental size measurements, 23 week estimated fetal weight (EFW) centile, ∆23w EFW-birthweight centile and birthweight SDS. A receiver operating characteristic (ROC) curve was generated, providing an area under the curve (AUC). A variable of importance (VIP) score was calculated for each marker that was significant in the model. All analyses were conducted in R (version 3.6). Results: RF analysis demonstrated antenatal markers relating to FGR risk predict the upper quartile of childhood SBP with an AUC 0.97. The top five ranked variables were maternal DBP (VIP score 14.0), birthweight SDS (11.5), parity (9.9), notching rank (9.5) and ∆23w EFW-birthweight centile (9.1). Conclusion: Maternal and antenatal markers, as well as birthweight SDS are linked with the upper quartile of SBP at 3-6 years. Antenatal markers were within the top five ranked and could help identify those babies at risk of higher SBP in childhood.

Neonatal Outcomes after Uterus Transplantation: Dallas Uterus Transplant Study.

Limited data are available on the outcome of infants born after uterus transplantation. Our aim was to describe the hospital course and laboratory findings in the first 2 months of life of the 12 infants born in the Dallas UtErus Transplant Study (DUETS). Based on the trial protocol, information about infants was collected in a prospective fashion, including infant demographics, hospital course, and laboratory values. Twelve infants were delivered, all by cesarean section, from 11 mothers who had undergone uterus transplantation (one mother had two pregnancies and delivered two babies). All pregnancies were singleton. The mothers received immunosuppressive therapy, and one had a rejection episode that was detected during pregnancy. The rejection episode resolved after steroid treatment. The infants had a median gestational age of 366/7 weeks (range: 306/7-380/7 weeks) and median birth weight of 2,920 g (range: 1,770-3,470 g). The lowest Apgar's score at 5 minutes was 8. All infants were appropriate size for gestational age. Two infants presented with bandemia but negative blood cultures. At 2 months of age, all infants achieved the developmental and behavioral milestones outlined by the American Academy of Pediatrics. The 12 infants born from mothers with uterus transplants had a neonatal course that reflected the gestational age at delivery. No baby was born with an identified malformation or organ dysfunction. Longer follow-up and a larger number of infants are needed to confirm these observations. · Normal fetal development after uterus transplantation.. · No baby was born with malformations or showed any organ dysfunction.. · At 2 months, all infants achieved appropriate developmental and behavioral milestones..

NEONATAL OUTCOMES AFTER UTERUS TRANSPLANT- DUETS (DALLAS UTERUS TRANSPLANT STUDY)

Uterus transplantation is restoring fertility in women absolute uterine-factor infertility and allows them to experience gestation and childbirth. Limited data are available on the outcome of infants born after uterus transplantation. Our aim was to describe the hospital course and laboratory findings of the first 6 infants born in the Dallas UtErus Transplant Study (DUETS). Prospective review. Twenty women received a uterus transplant at Baylor University Medical Center in Dallas (a tertiary referral center) from 2016 to 2019 (NCT02656550). Based on the trial protocol, information about the first 6 infants delivered was collected in a prospective fashion, including infant demographics, hospital course, and laboratory values. Six infants were delivered, all by cesarean section, from mothers who had undergone uterus transplantation. All mothers had an immunosuppressive regimen and none experienced an episode of rejection during pregnancy. The infants had a median gestational age of 36.3 weeks (range 30.6–37.2 weeks) and median birthweight of 2890 g (range 1771–3140 g). APGAR scores were at least 7 at 1 minute and at least 8 at 5 minutes. All were appropriate size for gestational age. Two infants had complete blood counts with bandemia but negative blood cultures. Blood urea nitrogen and creatinine levels were within expected range. The 6 infants born from mothers with uterus transplants had a neonatal course that reflected the gestational age at delivery. No baby was born with an identified deformation or malformation attributed to the transplantation or immunosuppression. Despite exposure to a calcineurin inhibitor throughout pregnancy, there were no adverse effects on renal function. Longer follow-up and a larger number of infants are needed to confirm these observations.

Predictors of Transplant-Free Survival After the Norwood Procedure

Birth weight, preterm delivery, and size for gestational age are surrogate markers for development that are commonly used in congenital heart surgery. Understanding the associations of these variables with patient outcomes is of great importance. This study included all patients with hypoplastic left heart syndrome who underwent a Norwood procedure at a single institution from 1995 to 2018. Low birth weight was defined as weight less than 2.5 kg, and preterm delivery occurred at less than 37 weeks' gestation. Overall and conditional analyses were performed to evaluate for association with outcomes after the Norwood procedure. Secondary analyses evaluated the association of development measures with postoperative length of stay and ventilator duration. In total, 303 neonates (60% male) underwent the Norwood procedure and were followed for a median of 3.9 years (interquartile range, 0.5 to 10.4 years). Median birth weight was 3.1 kg (interquartile range, 2.8 to 3.4 kg). Patients with low birth weight had decreased transplant-free survival compared with patients with a normal birth weight (hazard ratio, 1.7; 95% confidence interval, 1.03 to 2.82; P= .039). When conditioning on survival to second-stage palliation, patients born small for gestational age had decreased transplant-free survival compared with patients born at appropriate size for gestational age (hazard ratio, 2.8; 95% confidence interval, 1.31 to 6.09; P= .008). Patients delivered preterm had a longer hospital length of stay (median, 55 days vs 31 days; P= .02) and more ventilator days compared with patients delivered at term (median, 7 days vs 4 days; P= .004). Various developmental markers have differing prognostic importance for patients undergoing the Norwood procedure. Understanding these differences can help guide preoperative decision making and patient selection.

Interrelationships Among Vitamin D Status and Body Composition in Mother-Infant Dyads

Abstract Objectives To explore the associations between postpartum maternal vitamin D status and body composition to neonatal serum 25-hydroxyvitamin D (25(OH)D) and body composition. Methods Healthy mothers and term-born infants of appropriate size for gestational age were recruited from Greater Montreal (March 2016 through March 2019). The present analysis includes data from mothers and infants (n = 144). Maternal characteristics and lifestyle factors were surveyed and newborn capillary blood samples were taken within 36 h of delivery to assess vitamin D status using total serum 25(OH)D (Liaison, Diasorin). Maternal and infant anthropometry and body composition (Dual-energy X-ray absorptiometry) and maternal serum 25(OH)D were measured within 1 mo postpartum. Mothers were classified into 2 groups (group 1: ≥50 nmol/L; group 2: &amp;lt;50 nmol/L). Data were analyzed descriptively (mean ± SD or n (%)) and using a mixed model with Tukey post hoc tests accounting for neonatal sex, gestational age, season, family income, maternal age, education, and race. Correlation tests were used to identify linear relationships between continuous variables. Results Neonates (85 males, 59 females) were 39.7 ± 1.0 wk GA and 3393 ± 363 g at birth. Mothers (32.1 ± 4.5 years) in group 1 had considerably higher serum 25(OH)D concentrations compared to mothers in group 2 (80.3 ± 22.0 n = 96 vs. 38.7 ± 9.0 n = 48, nmol/L, P &amp;lt; 0.0001). Moreover, maternal serum 25(OH)D concentrations were positively associated with their % whole body lean mass (r = 0.28, P = 0.0009) and inversely associated with their % whole body fat mass (r = −0.25, P = 0.003). At birth, infants of mothers in group 1 had higher serum 25(OH)D concentrations compared to infants in group 2 (51.0 ± 18.1 vs. 27.0 ± 12.0 nmol/L, P &amp;lt; 0.0001), and were correlated with maternal 25(OH)D (r = 0.74, P &amp;lt; 0.0001). Maternal lean body mass and lean mass index (LMI) (kg/m2) explained some positive variations in infant lean body mass and LMI (Estimate = 0.01, P = 0.004; Estimate = 27.7, P = 0.04). Conclusions Higher maternal vitamin D status is associated with higher neonatal vitamin D with possible implications to neonatal lean body mass. This study reinforces the importance of ensuring adequate maternal-fetal transfer of vitamin D. Funding Sources Canadian Institutes of Health Research.

Customized versus population birth weight charts for identification of newborns at risk of long-term adverse cardio-metabolic and respiratory outcomes: a population-based prospective cohort study

BackgroundCustomized birth weight charts take into account physiological maternal characteristics that are known to influence fetal growth to differentiate between physiological and pathological abnormal size at birth. It is unknown whether customized birth weight charts better identify newborns at risk of long-term adverse outcomes than population birth weight charts. We aimed to examine whether birth weight classification according to customized charts is superior to population charts at identification of newborns at risk of adverse cardio-metabolic and respiratory health outcomes.MethodsIn a population-based prospective cohort study among 6052 pregnant women and their children, we measured infant catch-up growth, overweight, high blood pressure, hyperlipidemia, liver steatosis, clustering of cardio-metabolic risk factors, and asthma at age 10. Small size and large size for gestational age at birth was defined as birth weight in the lowest or highest decile, respectively, of population or customized charts. Association with birth weight classification was assessed using logistic regression models.ResultsOf the total of 605 newborns classified as small size for gestational age by population charts, 150 (24.8%) were reclassified as appropriate size for gestational age by customized charts, whereas of the total of 605 newborns classified as large size for gestational age by population charts, 129 (21.3%) cases were reclassified as appropriate size for gestational age by customized charts. Compared to newborns born appropriate size for gestational age, newborns born small size for gestational age according to customized charts had increased risks of infant catch-up growth (odds ratio (OR) 5.15 (95% confidence interval (CI) 4.22 to 6.29)), high blood pressure (OR 2.05 (95% CI 1.55 to 2.72)), and clustering of cardio-metabolic risk factors at 10 years (OR 1.66 (95% CI 1.18 to 2.34)). No associations were observed for overweight, hyperlipidemia, liver steatosis, or asthma. Newborns born large-size for gestational age according to customized charts had higher risk of catch-down-growth only (OR 3.84 (95% CI 3.22 to 4.59)). The direction and strength of the observed associations were largely similar when we used classification according to population charts.ConclusionsSmall-size-for-gestational-age newborns seem to be at risk of long-term adverse cardio-metabolic health outcomes, irrespective of the use of customized or population birth weight charts.

A cohort study of maternal cardiometabolic risk factors and primary cesarean delivery in an integrated health system.

BackgroundMaternal cardiometabolic risk factors (i.e., hyperglycemia, pre-existing hypertension and high body mass index) impact fetal growth and risk of having a cesarean delivery. However, the independent and joint contribution of maternal cardiometabolic risk factors to primary cesarean section is unclear. We aimed to elucidate the degree to which maternal cardiometabolic risk factors contribute to primary cesarean deliveries and whether associations vary by infant size at birth in an integrated health system.MethodsA cohort study of 185,045 singleton livebirths from 2001 to 2010. Poisson regression with robust standard errors provided crude and adjusted relative risks (RR) and 95% confidence intervals (CIs) for cesarean delivery risk associated with risk factors. We then estimated the proportion of cesarean sections that could be prevented if the cardiometabolic risk factor in pregnant women were eliminated (the population-attributable risk [PAR]).ResultsIn a single multivariable model, maternal cardiometabolic risk factors were independently associated with cesarean delivery: RR (95% CI) abnormal glucose screening 1.04 (1.01–1.08); gestational diabetes 1.18 (1.11–1.18) and pre-existing diabetes 1.60 (1.49–1.71); pre-existing hypertension 1.16 (1.10–1.23); overweight 1.27 (1.24–1.30); obese class I 1.46 (1.42–1.51); obese class II 1.73 (1.67–1.80); and obese class III 1.97 (1.88–2.07); adjusting for established risk factors, medical facility and year. The associations between maternal cardiometabolic risk factors and primary cesarean delivery remained among infants with appropriate weights for gestational age. The PARs were 17.4% for overweight/obesity, 7.0% for maternal hyperglycemia, 2.0% for pre-existing hypertension and 20.5% for any cardiometabolic risk factor.ConclusionsMaternal cardiometabolic risk factors were independently associated with risk of primary cesarean delivery, even among women delivering infants born at an appropriate size for gestational age. Effective strategies to increase the proportion of women entering pregnancy at an optimal weight with normal blood pressure and glucose before pregnancy could potentially eliminate up to 20% of cesarean deliveries.

Long-term outcomes for large for gestational age infants born at term.

Large for gestational age (LGA) babies have increased risks for short-term outcomes such as shoulder dystocia, neonatal hypoglycaemia and longer hospital stay. Little is known of long-term health, development and educational outcomes of LGA babies. The aim of this study was to determine the long-term health, mortality, development and educational outcomes for infants born LGA at term. A population-based record linkage study of live singletons born at term (37-41 weeks of gestation) in New South Wales, Australia, from 2001 to 2006. This study compared 49 439 LGA (>90th percentile for birthweight, gestational age and sex) and 400 418 appropriate size for gestational age (AGA; 10th-90th percentile) infants. LGA infants had increased risk of birth and neonatal outcomes and hospitalisations, for brachial plexus injury after the neonatal period, and for all causes from 1 to 5 years of age. There were no differences in mortality up to 5 years of age or hospitalisations for type 1 diabetes in childhood. LGA infants had lower rates of developmental vulnerability (in kindergarten) and showed a significant trend (χ2 for trend <0.0001) to fewer low scores and more high scores in reading and numeracy (in Year 3) compared with AGA. After adjusting for potential confounders, only the relative risk for higher reading scores was statistically significant. LGA infants show positive long-term health, development and educational outcomes. Concerns for LGA infants still remain in the perinatal period as a result of birth trauma; however, these complications usually do not persist in postnatal and early childhood.

Birth weight, intrauterine growth restriction and nutritional status in childhood in relation to grip strength in adults: from the 1982 Pelotas (Brazil) birth cohort

ObjectiveThe aim of this study was to evaluate the association among birth weight, intrauterine growth, and nutritional status in childhood with grip strength in young adults from the 1982 Pelotas (Brazil) birth cohort. MethodsIn 1982, the hospital live births of Pelotas were followed. In 2012, grip strength was evaluated using a hand dynamometer and the best of the six measurements was used. Birth weight was analyzed as z-score for gestational age according to Williams (1982) curve. Weight-for-age, weight-for-length/height, and length/height-for-age at 2 and 4 y were analyzed in z-scores according to 2006 World Health Organization Child Growth Standards. Lean mass at 30 y was included as possible mediator using the g-computation formula. ResultsIn 2012, 3701 (68.1%) individuals were interviewed and 3470 were included in the present analyses. An increase of 1 z-score in birth weight was associated with an increase of 1.5 kg in grip strength in males (95% confidence interval, 1.1–1.9). Positive effect of birth weight on grip strength was found in females. Grip strength was greater in individuals who were born with appropriate size for gestational age and positively associated with weight- and length/height-for-age z-score at 2 and 4 y of age. A positive association between birth weight and grip strength was only partially mediated by adult lean mass (50% and 33% of total effect in males and females), whereas direct effect of weight at 2 y was found only in males. ConclusionsIt is suggested that good nutrition in prenatal and early postnatal life has a positive influence on adult muscle strength. The results from birth weight were suggestive of fetal programming on grip strength measurement.

Amplitude-integrated electroencephalography shows mild delays in electrocortical activity in preterm infants born small for gestational age.

Being born small for gestational age (SGA) seems to be a relevant risk factor for long-term neurologic deficits. We compared the differences between amplitude-integrated electroencephalography (aEEG) signals in very preterm infants born small for gestational age (SGA) and those in age-matched infants born appropriate size for gestational age (AGA). We performed serial aEEG recording on 305 infants: 255 (83.6%) were AGA, and 50 (16.3%) were SGA. The number of bursts per hour decreased over time in both groups, but was higher in the SGA group at every time point. On day one, it was significantly higher in the SGA group (17.4) than in the AGA group (10.1) (p = 0.016). The total Burdjalov score increased with post-natal age and tended to be lower in SGA infants, but did not reach statistical significance at any time point. The percentage of continuous background patterns increased with post-natal age in both groups, with no significant difference between the groups. Very preterm infants born SGA showed normal maturation of aEEG signals during post-natal life, but they also showed mild delays in electrocortical activity compared to age-matched AGA infants. The predictive value of these findings on neurodevelopmental outcome needs to be further evaluated.

Macrosomia in Discordant Twin: An Out of the Box Presentation of Abnormal Growth in Dizygotic Twin

Background: Weight discordance of ≥ 20 percent is present in 15 percent of twin pairs and mostly the smaller twin’s birth weight <10th percentile and the larger twin is nearer appropriate size for gestational age. We report twin pairs where the larger twin is macrosomic with smaller twin having normal birth weight. We could not find a similar report in the literature. Case presentation: The twins were born to 29 years old gravida 3 para 2 lady at 38 weeks and 3 days of gestation. The first of twins was male and macrosomic (4500 gm) and his twin sister was of normal birth weight (3500 gm), with 22 percent birth weight discordance. Conclusion: We report this case as there is no similar report in the literature on abnormal growth of twins with macrosomia and discordance: an out of the box presentation. Both of our cases are large for gestational age an adjustable fetal weight standard for twins.

Birth Status, Child Growth, and Adult Outcomes in Low- and Middle-Income Countries

ObjectiveTo assess the impact of being born preterm or small for gestational age (SGA) on several adult outcomes.Study designWe analyzed data for 4518 adult participants in 5 birth cohorts from Brazil, Guatemala, India, the Philippines, and South Africa.ResultsIn the study population, 12.8% of males and 11.9% of females were born preterm, and 26.8% of males and 22.4% of females were born term but SGA. Adults born preterm were 1.11 cm shorter (95% CI, 0.57-1.65 cm), and those born term but SGA were 2.35 cm shorter (95% CI, 1.93-2.77 cm) compared with those born at term and appropriate size for gestational age. Blood pressure and blood glucose level did not differ by birth category. Compared with those born term and at appropriate size for gestational age, schooling attainment was 0.44 years lower (95% CI, 0.17-0.71 years) in those born preterm and 0.41 years lower (95% CI, 0.20-0.62 years) in those born term but SGA.ConclusionBeing born preterm or term but SGA is associated with persistent deficits in adult height and schooling, but is not related to blood pressure or blood glucose level in low- and middle-income settings. Increased postnatal growth is associated with gains in height and schooling regardless of birth status, but not with increases in blood pressure or blood glucose level.

Boys born small for gestational age may be at an increased risk of symptoms of depression and anxiety during adolescence if exposed to chronic stress

QUESTION Question: Are adolescents who were born small or large for gestational age more likely to suffer symptoms of depression in response to stressful life events than adolescents born the...

Autism risk in small- and large-for-gestational-age infants

We sought to determine whether small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights increase autism risk. This was a retrospective cohort analysis comparing children with autism (n = 20,206) within a birth cohort (n = 5,979,605). Stratification by sex and birthweight percentile (SGA, <5th or 5-10th percentile; appropriate size for gestational age [GA], >10th to <90th percentile; LGA, either 90-95th or >95th percentile) preceded Cochran-Mantel-Haenszel analysis for GA effect, and multivariate analysis. Autism risk was increased in preterm SGA (<5th percentile) infants 23-31 weeks (adjusted odds ratio [aOR], 1.60; 95% confidence interval [CI], 1.09-2.35) and 32-33 weeks (aOR, 1.83; 95% CI, 1.16-2.87), and term LGA (>95th percentile) infants 39-41 weeks (aOR, 1.16; 95% CI, 1.08-1.26), but was decreased in preterm LGA infants 23-31 weeks (aOR, 0.45; 95% CI, 0.21-0.95). SGA was associated with autism in preterm infants, while LGA demonstrated dichotomous risk by GA, with increased risk at term, and decreased risk in the premature infants. These findings likely reflect disparate pathophysiologies, and should influence prenatal counseling, pediatric autism screening, and further autism research.

Reassuring follow up of girls with precocious adrenarche

The growth pattern, pubertal course, and adult height are reported for 85 girls born with appropriate size for gestational age who were referred to Schneider Children's Medical Center of Israel between 5 and 8.8 years of age for precocious adrenarche (PA). The clinical course of these girls provides reassurance that although PA had impact on the pre-pubertal growth pattern, it was not associated with early/rapid progression of puberty or reduced adult height. This cohort and outcomes are in contrast to those of girls with PA who were born small for gestational age. Article page 308▶ Interrelationship of Extent of Precocious Adrenarche in Appropriate for Gestational Age Girls with Clinical OutcomeThe Journal of PediatricsVol. 160Issue 2PreviewTo assess the interrelationship between extent of adrenarche at presentation in girls with precocious adrenarche (PA) born appropriate for gestational age and their growth pattern, pubertal course and adult height. Full-Text PDF

The catechol‐O‐methyltransferase (COMT) Val158Met polymorphism moderates the effect of antenatal stress on childhood behavioural problems: longitudinal evidence across multiple ages

The functional polymorphism Val158Met in the catechol-O-methyltransferase (COMT) gene was analysed to determine its association with maternal stress and childhood total difficulties. Data were collected at birth from a group of infants who were born small for gestational age and a group who were born at an appropriate size for gestational age and had been enrolled in the Auckland Birthweight Collaborative Study. Children were followed up at the ages of 1 year, 3 years 6 months, 7 years, and 11 years. At the age of 11 years, DNA samples were collected from 546 children (270 females, 276 males): 227 children born small for gestational age and 319 children born at an appropriate size for gestational age. The main independent variable was perceived maternal stress at birth and at 7 and 11 years of age, assessed using the total difficulties scale of the Strength and Difficulties Questionnaire. IQ was assessed at the age of 7 years. Met/Met homozygotes were at a significantly increased risk of behavioural and emotional problems at the ages of 7 (p=0.002) and 11 years (p=0.003), relative to either heterozygous or homozygous carriers of the Val158Met polymorphism, but only when they were exposed to maternal stress in utero. Met/Met homozygotes had, on average, IQ scores that were four points higher than those of Val/Val homozygotes (p=0.010). These findings emphasize the potential long-term consequences of prenatal stress for genetically susceptible individuals during neurodevelopment in utero. Our findings add to the general understanding of the aetiology and developmental nature of childhood emotional and behavioural problems.