Macrosomia Research Articles

Fluctuation trend of inflammatory indexes related to gestational diabetes mellitus from second trimester to third trimester of pregnancy

ObjectiveThis study aims to assess the prognostic and diagnostic value of inflammatory indexes related to gestational diabetes mellitus (GDM) from the second trimester to the third trimester of pregnancy.Materials and methodsIn this study, we randomly selected 65 pregnant women diagnosed with GDM at our hospital from December 2022 to June 2023 to form the GDM group (n = 65). Additionally, 65 pregnant women at the same gestational weeks without GDM were selected as the Normal group (n = 65). We collected gestational information and serum samples at 24 and 36 weeks of gestation from the participants. The levels of NLRP3, IL-1Ra, and TBP-2 were determined using enzyme-linked immunosorbent assay (ELISA) to explore their changes during pregnancy. Further, this study analyzed the changes in the levels of NLRP3, IL-1Ra, and TBP-2 at 24 and 36 weeks of gestation in GDM patients and their correlation with gestational diabetes mellitus.ResultsThe study showed that pre-pregnancy body mass index (BMI), neonatal weight, gestational hypertension, and macrosomia are significantly associated with the occurrence of GDM (P < 0.05). Statistical analysis comparing the normal and GDM groups found no significant changes in the levels of NLRP3, IL-1Ra, and TBP-2 with the progression of gestation in the normal group. In contrast, in the GDM group, the levels of IL-1Ra in serum samples at 24 and 36 weeks were significantly increased (P < 0.05) while the levels of NLRP3 and TBP-2 were significantly reduced (P < 0.05). At 36 weeks, there was a positive correlation between the levels of NLRP3, IL-1Ra, and TBP-2. Compared to the normal group, the overall levels of NLRP3, IL-1Ra, and TBP-2 in the GDM group were lower (P < 0.05) and the weight of the newborns was significantly correlated with these three indicators (P < 0.05), specifically newborn weight increased with the levels of NLRP3 and TBP-2 but decreased with the increase of IL-1Ra (P < 0.05). Multifactorial logistic regression analysis further revealed that NLRP3 is an independent factor influencing GDM (P < 0.05). ROC curve analysis of the NLRP3 level at 24 weeks of gestation found that NLRP3 has a good value in predicting GDM (AUC = 0.720, 95%CI 0.630–0.809, P < 0.001) and the combined prediction of NLRP3, IL-1Ra, and TBP-2 also showed a good predictive value for GDM.ConclusionThe changes in NLRP3, IL-1Ra, and TBP-2 persisted throughout the 24 to 36 weeks of gestation, playing an important role in predicting the occurrence of GDM and the weight of the newborn.

Exploring the Father's Role in Determining Neonatal Birth Weight: A Narrative Review.

Birth weight, which exhibits variability across different populations, is influenced by a mix of genetic, environmental, and dietary factors originating from both the mother and father. Maternal characteristics, including age, socioeconomic status, prior pregnancies, weight, height, and weight increase throughout pregnancy, have a substantial influence on fetal growth and the health of the infant. On the other hand, the influence of paternal characteristics on the weight of newborns is still not fully comprehended in a consistent manner. Birth weight is an important factor that can help predict various maternal complications, such as the probability of having a C-section, experiencing postpartum hemorrhage or infections. It can also indicate future health challenges like asthma, cognitive impairment, and chronic diseases such as hypertension and diabetes. Nineteen publications were found through a thorough search of the Medline, PubMed, and Scopus databases, which provide insights into how paternal variables contribute to variations in birth weight. Significantly, the age of the father was found to be associated with higher chances of preterm birth and having a smaller size for gestational age in premature infants, while full-term children were more likely to have a larger size for gestational age. In addition, there is a constant correlation between the height of the father and the birth weight of the child. Taller dads are more likely to have babies with a higher birth weight and a lower likelihood of being small for gestational age (SGA). Although there were some discrepancies in the data about the weight and BMI of fathers, it was found that the height of fathers played a significant role in determining the size of the fetus and the weight of the newborn. While there may be differences in the conducted studies, these findings provide valuable insights into the complex connection between parental characteristics and fetal development. This data can be utilized to enhance clinical treatment strategies and enhance our comprehension of outcomes for neonates. Further homogeneous investigations are required to conclusively validate and build upon these findings.

Risk factors and prediction model for low-birth-weight infants born to women with gestational diabetes mellitus.

To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM. The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed. A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 (p = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model. This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes.

Nomograms and Reference Ranges for Intra-Cranial Ventricular Dimensions in Indian Neonates.

To establish normal reference values for commonly used ventricular indices - Anterior Horn Width (AHW), Ventricular Index (VI) and Thalamo-Occipital Distance (TOD)-against common variables including gestational age, birth weight and head circumference in Indian newborns. This was a cross-sectional study. Cranial ultrasound was performed between post-natal days 3 to 7. Anterior fontanelle was taken as the acoustic window. Data were analyzed to determine correlation, coefficient of determination (R2), regression equations and plotted against gestational age (GA). Total 2200 newborns were included in the study.The study observed that there is an increase in VI, AHWand TODwith an increase in gestational age (p-value < 0.001) and birth weight (p-value < 0.001). No significant correlation of gender and singleton or multiple gestation-with the intraventricular dimensions was observed (p-value > 0.05). All the three ventricular parameters were found to have a significantly lower mean value in the normal vaginal delivery group as compared to the LSCS group. There was a good correlation between ventricular indices of the left and right side. Nomograms of AHW, TOD, and VI were prepared with respect to gestational age. Intracranial ventricular size dimensions vary significantly with increasing gestational age and birth weight. The new nomograms for various ventricular indices of Indian neonates can assist in objectively assessing ventricular sizes.

Chronic kidney disease associated with extremely premature birth and extremely low birth weight may progress through the burden of growth.

Chronic kidney disease associated with low birth weight and/or premature birth (L/P-CKD) in infants may result from a decreased number of nephrons at birth. These infants may develop acute kidney injury due to exposure to nephrotoxic substances or other events during nephrogenesis in early infancy. Nonetheless, L/P-CKD progression remains unclear. We present three cases of L/P-CKD diagnosed after neonatal intensive care unit (NICU) discharge. Three patients were born extremely prematurely (gestational age, 24-26weeks) with extremely low birth weight (606-906g). They were admitted to the NICU (117-311days) anad received several nephrotoxic medications during the early postnatal period. They showed elevated serum creatinine levels at 4weeks after birth, which decreased to normal levels at NICU discharge. Proteinuria was first detected during adolescence (10-15years) on annual school urine screening, with a remarkable increase in their height (18 - 50.8cm), without known episodes of urinary tract infection, dehydration, lifestyle-related issues, such as excessive salt/protein intake, and extreme lack of exercise that might have caused kidney damage. Their kidneys were smaller than normal on renal ultrasonography. Open renal biopsy findings indicated glomerulomegaly and perihilar glomerulosclerosis in two of the three patients, suggesting glomerular hypertension. The remarkable differences between the body height before CKD and the timing of diagnosis of CKD could contribute to the progress of CKD. Long-term follow-up of low birth weight and extremely premature infants, from NICU discharge until adulthood, should be established.

Prevalence of Anemia among Adolescent School Girls of Bardoli Taluka, Surat, Gujarat

Introduction: Anemia is a serious public health challenge in India. It affects women, adolescents and children throughout the lifecycle. In boys and girls it limits their development, learning ability, reduce concentration in daily task, increases risk of infections, increases school dropout rates and reduces their physical activity. Anemia in girls can increase risk of pregnancy associated complications like premature births, low birth weight of baby and perinatal and maternal mortality. Aims of the study: The aim of the present study was to identify the prevalence of anemia and its associated factors among adolescent school girls of Bardoli, Surat. Material and methods: A cross sectional survey was carried out to identify the prevalence of anemia among 815 adolescent school girls from both Government and Private schools by using non probability purposive sampling technique and who fulfilled the inclusion criteria Digital hemoglobinometer was used to collect capillary blood for estimation of hemoglobin level. Result: Study results showed that, 694 (85 %) girls were having anemia and 15% of them had normal hemoglobin level. 48% had mild anemia and 37% had moderate level of anemia. 2 (0.24%) girls had severe anemia. It was highly prevalent among 417 (60.15 %) girls of government schools than the private school. Majority 551 of them were under weight (BMI &lt; 18.5). Level of anemia was significant with age, residence, dietary pattern, education and occupation of parents, family income. Menstruation related factors like regularity, amount of blood loss was significant. Conclusion: Anemia is still a major health problem in our country. Anaemia among adolescent girls still continues to be a significant public health problem.

A scalable two-stage Bayesian approach accounting for exposure measurement error in environmental epidemiology.

Accounting for exposure measurement errors has been recognized as a crucial problem in environmental epidemiology for over two decades. Bayesian hierarchical models offer a coherent probabilistic framework for evaluating associations between environmental exposures and health effects, which take into account exposure measurement errors introduced by uncertainty in the estimated exposure as well as spatial misalignment between the exposure and health outcome data. While two-stage Bayesian analyses are often regarded as a good alternative to fully Bayesian analyses when joint estimation is not feasible, there has been minimal research on how to properly propagate uncertainty from the first-stage exposure model to the second-stage health model, especially in the case of a large number of participant locations along with spatially correlated exposures. We propose a scalable two-stage Bayesian approach, called a sparse multivariate normal (sparse MVN) prior approach, based on the Vecchia approximation for assessing associations between exposure and health outcomes in environmental epidemiology. We compare its performance with existing approaches through simulation. Our sparse MVN prior approach shows comparable performance with the fully Bayesian approach, which is a gold standard but is impossible to implement in some cases. We investigate the association between source-specific exposures and pollutant (nitrogen dioxide [NO2])-specific exposures and birth weight of full-term infants born in 2012 in Harris County, Texas, using several approaches, including the newly developed method.

Maternal Mediterranean Diet During Lactation and Infant Growth.

Background: Human milk is considered the optimal source of nutrition for infants. Maternal diet is associated with the composition of human milk. The Mediterranean diet (MedDiet) has been studied in pregnancy and during lactation, and it has been associated with changes in milk composition, yet there is a lack of research on MedDiet during lactation and infant outcomes. Methods: Mother-infant dyads (n = 167) from ABC Baby, a prospective observational study, were included in this analysis. Maternal diet was obtained using an adapted version of the National Cancer Institute Diet History Questionnaire II, at 2 weeks or 2 months postpartum. Maternal MedDiet score was calculated using servings of vegetables, fruits, whole grains, nuts and seeds, legumes, fish, monounsaturated-to-saturated fatty acid ratio, red and processed meats, and added sugar. Infants' length, weight, and flank skinfold thickness were measured at 6 months. Using World Health Organization standards, weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) Z-scores were calculated. Multiple linear regression models were adjusted for potential confounders. Results: Higher maternal MedDiet score and intake of fruit and fish were associated with lower flank skinfold thickness (β = -0.33, -0.52, and -1.26, respectively). Intake of nuts and seeds was associated with higher WLZ (β = 0.29). Intake of red and processed meats was associated with lower WAZ (β = -0.18) and LAZ (β = -0.18). Energy-adjusted added sugar intake was associated with lower WLZ (β = -0.02). Conclusions: The maternal MedDiet score was associated with lower skinfold thickness, while its components were associated with differences in anthropometric Z-scores. Further research on the maternal MedDiet and corresponding human milk composition is needed to explore this relationship.

Effect of online infant care training and postpartum counseling based on Meleis' transition theory on mothers' readiness for care and breastfeeding: a randomized controlled trial.

Mothers must acquire the knowledge and skills needed to fulfill their responsibilities and take care of themselves and their babies. This study aimed to examine the effects of online baby care education and postpartum counseling based on Meleis' transition theory on mothers' readiness for baby care and breastfeeding. This randomized controlled trial was conducted between May 2022 and May 2023 at the pregnancy follow-up outpatient clinic of a state hospital. The study sample consisted of 102 pregnant women (52 in the intervention group, 50 in the control group). The mean scores of the intervention group compared to the control group were significantly higher immediately after birth and at 1, 2, and 3 months postpartum. Change over time was significantly higher in repeated measurements of National Institute of Child Health and Human Development scale scores of the intervention and control groups (P=0.001). In the first 24 hours, mothers in the intervention group breastfed more successfully than those in the control group (P<0.001). Mothers in the intervention group exclusively breast fed at a significantly higher rate immediately and at 1, 2, and 3 months postpartum compared to the control group (P<0.001). A statistically significant difference was noted in mean infant height and weight in the intervention group compared to the control group (P<0.05). Theory-based online education initiated during pregnancy and counseling continued up to 3 months postpartum positively affected the mothers' abilities to care for their infants. Mothers who received education and counseling breastfed their babies more successfully on the first day and breast fed exclusively at a higher rate in the first 3 months.

Correlation of sonographically measured fetal abdominal wall thickness with birth weight in diabetes

ObjectiveTo determine the association between sonographically measured abdominal wall thickness (AWT) and birth weight of fetuses of pregnant women with diabetes. MethodsThis retrospective study included 185 pregnant women who presented to a level I perinatal centre between January 2021 and December 2022. All mothers had diabetes, and were divided into the following subgroups: diet-controlled gestational diabetes mellitus; insulin-dependent gestational diabetes mellitus; type 1 diabetes mellitus; and type 2 diabetes mellitus. At the time of admission, gestational age varied between 29 + 2 and 41 + 2 weeks (+days) of gestation. Weight estimation was performed routinely using the Hadlock I formula. Fetal AWT was determined retrospectively at the same axial level as used for the measurement of abdominal circumference. Only women with a sonographic fetal weight estimation within 5 days before delivery were included. ResultsFor the whole cohort, a moderate positive correlation was found between fetal AWT and estimated fetal weight (r = 0.411, p < 0.001), a moderate correlation was found between fetal AWT and birth weight (r = 0.493, p < 0.001), a weak correlation was found between fetal AWT and body length (r = 0.365, p < 0.001), and a weak correlation was found between fetal AWT and body length percentile (r = 0.276, p < 0.001). No strong differences in parameters were found between the diabetes subgroups. Receiver operating characteristic (ROC) curve analysis was performed to identify newborns with birth weight > 4000 g (macrosomia) and birth weight > 90th percentile according to Voigt in the group with gestational age > 37 weeks. ROC curve analysis was performed to identify newborns with birth weight > 90th percentile in the whole cohort. AWT and sonographically estimated fetal weight were included in the calculation. The combination of AWT and estimated fetal weight only led to a marginal improvement compared with estimated fetal weight alone for predicting newborns with birth weight > 4000 g in the group with gestational age > 37 weeks [area under the curve (AUC) 0.857 vs 0.871], and for predicting newborns with birth weight > 90th percentile in the group with gestational age > 37 weeks (AUC 0.840 vs 0.846) and in the whole cohort (AUC 0.816 vs 0.826). ConclusionA sonographically measured AWT of 7.1 mm in fetuses of diabetic mothers is predictive of birth weight > 90th percentile with sensitivity of 61 %, specificity of 85 %, and AUC of 0.748. ROC curve analysis showed that estimated fetal weight determined by ultrasound (using Hadlock formula I) seems to be slightly superior for the identification of macrosomic fetuses with birth weight > 90th percentile. A threshold value for estimated fetal weight of 3774 g had sensitivity of 70 %, specificity of 86 %, and AUC of 0.816. The combination of AWT and estimated fetal weight in a single formula only yielded a marginal improvement in accuracy compared with the use of estimated fetal weight alone.

Sustained decline in birth weight and increased rate of preterm infants born small for gestational age in Japan.

Birth weights have continued to decline in Japan in recent years. However, secular trend changes such as the birth weight relative to the week of gestation remain to be explored. This study aimed to determine the trends over time in mean birth weight and small for gestational age (SGA) rate for each gestational week. We used a large dataset of 27,015,792 births obtained from birth certificates between 1997 and 2021. Births from 22 to 41 weeks of gestation were evaluated in six groups (22-24, 25-27, 28-31, 32-33, 34-36, and 37-41 weeks of gestational age). For each group, secular trend changes in the z-scores calculated from standard birth weight values were assessed. Time trends in the proportion of SGA and mean birth weight z-scores were evaluated using the Cochran-Armitage trend test and linear regression analysis. Binomial logistic regression was performed to ascertain the effects of gestational age, sex, primiparity, number of births, and maternal age on the likelihood of SGA. The mean birth weight of preterm infants continued to decrease, and the z-score for mean birth weight decreased linearly, falling to -0.7 at 25-27 weeks of gestation from 1997-2001 (first period) to 2017-2021 (final period). Maternal age continued to increase from the first period to the last period for all weeks of gestation. There was a linear increase in the SGA rate in preterm infants born at <34 weeks. Odds ratios for the likelihood of SGA were 1.3 times higher for maternal age ≥40 years than that for 25-29 years (95% CI: 1.29-1.33, p < 0.001). In Japan, there has been a continuous decline in birth weight and an increase in the rate of preterm SGA infants.

Efficacy of B-Lynch Compression Suture for Control of Primary Post-Partum Hemorrhage

OBJECTIVES This study aimed to evaluate the efficiency of the B-Lynch compression suture for primary post-partum hemorrhage control. METHODOLOGY It is a prospective cross-sectional study performed for two years, i.e., 1 November 2021 to 31 October 2023, at the Department of Obstetrics and Gynaecology in a tertiary care hospital. This study included 65 study cases out of 23,964 with primary post-partum hemorrhage (PPH) due to uterine atony during cesarean delivery not responding to pharmacological treatment and was managed by applying B-Lynch compression sutures. The amount of blood loss, demographic characteristics, birth weight of babies, causative factors, and other related complications were studied in such selected cases. RESULTSB-Lynch compression suture presented a success rate of 97% in the present study. 52% had blood loss of 1000-1500ml, 29% had loss between 1501-2000ml and 18% had 2001-2500ml blood loss. 6% had wound gaping, 10.7% had a fever, and 8% had more than seven days stay in hospital, and wound infections were noted. CONCLUSION Our study concluded that the B-Lynch compression suture had a success rate of 97% in the management of primary post-partum hemorrhage, with few post-operative complications. The current research demonstrates the efficacy of B-Lynch as a lifesaving, easy, effectual technique that avoids hysterectomy and thus avoids heavy blood loss.

Short-Half-Life Chemicals: Maternal Exposure and Offspring Health Consequences-The Case of Synthetic Phenols, Parabens, and Phthalates.

Phenols, parabens, and phthalates (PPPs) are suspected or known endocrine disruptors. They are used in consumer products that pregnant women and their progeny are exposed to daily through the placenta, which could affect offspring health. This review aims to compile data from cohort studies and in vitro and in vivo models to provide a summary regarding placental transfer, fetoplacental development, and the predisposition to adult diseases resulting from maternal exposure to PPPs during the gestational period. In humans, using the concentration of pollutants in maternal urine, and taking the offspring sex into account, positive or negative associations have been observed concerning placental or newborn weight, children's BMI, blood pressure, gonadal function, or age at puberty. In animal models, without taking sex into account, alterations of placental structure and gene expression linked to hormones or DNA methylation were related to phenol exposure. At the postnatal stage, pollutants affect the bodyweight, the carbohydrate metabolism, the cardiovascular system, gonadal development, the age of puberty, sex/thyroid hormones, and gamete quality, but these effects depend on the age and sex. Future challenges will be to explore the effects of pollutants in mixtures using models and to identify the early signatures of in utero exposure capable of predicting the health trajectory of the offspring.

The effect of benzylpenicillin prohylaxis after birth on length and weight of syphilis-exposed infants in eastern China

BackgroundWe conducted this study to assess the impact of an intervention to interrupt mother-to-child transmission on the height and weight of syphilis-exposed infants after receiving penicillin prophylaxis after birth and to provide a scientific basis for further elimination of mother-to-child transmission.MethodsWe recruited 419 infants born to syphilis-infected mothers from 2015 to 2020 in Changzhou, and performed 1:1 matching to infants born to syphilis-free mothers during the same period. All infants were followed up to 18 months of age. We collected height and weight data and compared them.ResultsAt 18 months of age, the height and weight of the syphilis-exposed infants were almost greater than the WHO reference standards. However, when compared with local unexposed infants, there were almost no differences. The boys born to mothers who received two courses of treatment had longer body lengths at 18 months of age than did those born to mothers who did not receive two courses of treatment, and the girls born to mothers who did not receive treatment had lower body weights at 3 months of age than did both treated groups.ConclusionThe growth trajectory of infants without congenital syphilis born to syphilis-infected mothers is virtually indistinguishable from that of the general local population. Syphilis-exposed newborns can receive preventive treatment as a public health intervention.

Oenothera biennis improves pregnancy outcomes by suppressing inflammation and fibrosis in an intra-uterine adhesion rat model

Intrauterine adhesion (IUA), also referred to as Asherman’s syndrome, is characterized by fibrosis, inflammation, and can cause amenorrhea and infertility due to abnormal endometrial healing. Histological and Molecular methods were used to evaluate the efficacy of EPO, which is traditionally known for its anti-inflammatory and fibrinolytic properties, in preventing the formation of IUA. Oral administration of EPO reduced the formation of adhesion bands and promoted endometrial regeneration. EPO administration decreased extracellular matrix accumulation, evidenced by the down-regulation of tissue COL1A1 and COL3A1 expression. The anti-inflammatory effect of EPO was confirmed by a reduction in oxidants and down-regulation of pro-inflammatory cytokines including TNF-α, IL-6, IFN-γ, and IL-1β. Furthermore, EPO improved embryonic development parameters, including size and weight of embryo, as well as increased embryo count and live embryo percentage in the rat IUA model. EPO also positively enhanced implantation markers, particularly enlargement and mass gain in the placenta of the treated group, consequently improving pregnancy outcomes such as the number of babies, percent of live babies, baby weight and gestation time. Histopathological investigation provides evidence that oral administration of EPO showed no toxicity on the main three organs including liver, kidney and heart. These results showed that EPO can be considered as a safe and natural product with potent anti-inflammatory and fibrinolytic properties without any observed side effects for the treatment of IUA.

Application en routine des résultats d’un essai randomisé : performance de l’échographie en pratique courante pour le dépistage de la macrosomie fœtale

ObjectiveTo evaluate the performance of ultrasound at 36 weeks of gestation for screening fetal macrosomia according to the criteria of the randomized “DAME” trial. MethodRetrospective observational study over 2 years in a type 3 maternity hospital. The primary outcome was birth weight above the 97th percentile on Audipog birth weight curves. The sensitivity, specificity, positive and negative predictive value of ultrasound at 36 SA for predicting macrosomia were calculated. For each patient, the absolute value of the difference between actual and estimated weight [EPF difference=(Birth weight − Estimated weight)/Birth weight] was calculated. Among undetected macrosomic newborns (≥97th Audipog percentile), risk factors associated with misdiagnosis were investigated (false negatives versus true positives). ResultsUltrasound estimation of fetal weight at 36 SA to detect fetal macrosomia had a sensitivity of 43.7% and a specificity of 82.1%. With a positive predictive value for ultrasound of 36,9% and a negative predictive value of 85.8%. The mean absolute value of the difference between estimated and actual birth weight was 287g (95% CI [115–409]), with a mean relative difference of 6.8% (95% CI [3.0–11.3]). A relative difference of less than 10% between the estimated weight and the birth weight was found in 68.5% of the patients. Among macrosomic newborns (≥97th percentile), a third-trimester estimated fetal weight at or above the 90th percentile, along with a history of fetal macrosomia in a previous pregnancy, reduced the risk of false negatives in the screening ultrasound at 36 weeks of gestation. ConclusionUltrasound performed at 36 weeks’ gestation in a population targeted for suspected fetal macrosomia in routine practice has moderate sensitivity and positive predictive value. It would be timely for teams also applying this protocol to share their results, in order to verify whether or not our findings can be generalized to a larger scale.

Vitamin D Deficiency and Maternal Diseases as Risk Factors for the Development of Macrosomia in Newborns.

Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination of vitamin D were performed. Results: Newborns with macrosomia were statistically significantly more likely to have severe vitamin D deficiency compared with control (13.5 ± 6.7 ng/mL vs. 21.3 ± 12.1 ng/mL; p < 0.05). In the main group, severe deficiency was found in 40.7% of newborns, in the control group this rate was 5.8% (χ2 = 71,788, df = 3, p < 0.001). Multiple regression analysis shows that statistically significant risk factors for the development of macrosomia were vitamin D deficiency in the cord blood (OR = 2.29), maternal age over 36 years old (OR = 19.54), and hypothyroidism (OR = 9.35). Conclusion: the results of our study demonstrate relationship between macrosomia in newborns and vitamin D deficiency in the cord blood, maternal overweight and obesity, maternal age and thyroid disease.

The Effectiveness of Chain Pumpkin on Improving Breast Milk Production and Increasing Baby's Weight

The Effectiveness of Chain Pumpkin on Improving Breast Milk Production and Increasing Baby's Weight

Effects of dexamethasone on short-term and long-term outcomes in late preterm infants with twin pregnancy: an observational study

Objective: To investigate the effect of prenatal dexamethasone on short-term outcomes and long-term neurological development in late preterm infants with twin pregnancy. Methods: A total of 315 pregnant women with twin pregnancy and their preterm infants who delivered in Peking University Third Hospital from January 2019 to December 2022 were retrospectively analyzed. The clinical data of pregnant women and preterm infants were collected. They were divided into non-medication group (93 pregnant women and 186 preterm infants), medication after 34 weeks group (123 pregnant women and 246 preterm infants), and medication before 34 weeks group (99 pregnant women and 198 preterm infants). Short-term outcomes of preterm infants were analyzed, including the incidence of neonatal respiratory distress syndrome (NRDS), wet lung, hypoglycemia, neonatal septicemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and neonatal necrotizing enterocolitis (NEC). "Ages and Stages Questionnaire-Third Edition (ASQ-3) scale" was used to follow up the late neurological development of preterm infants at the corrected age of 6-54 months, and the level of neurological development was compared. Results: (1) General conditions: the gestational age at delivery in the non-medication group [36.1 weeks (35.6, 36.6 weeks)] was later than that in the medication after 34 weeks group [36.1 weeks (35.2, 36.4 weeks)] and medication before 34 weeks group [35.2 weeks (34.2, 36.2 weeks)] groups, and the differences were statistically significant (all P<0.05). After correcting for gestational age, there was no significant difference in birth weight among the three groups (H=3.808, P=0.149). There were no significant differences in gender and the proportion of small for gestational age among the three groups (all P>0.05). (2) Short-term outcome: the incidence of wet lung was 7.0% (13/186), 11.0% (27/246) and 16.2% (32/198) in the non-medication group, medication after 34 weeks group and medication before 34 weeks group, respectively, and the difference was statistically significant (P=0.018). There were no significant differences in the incidence rates of NRDS, hypoglycemia, sepsis, IVH, BPD, and NEC among the three groups (all P>0.05). Logistic regression analysis with gestational age and newborn birth weight as confounding factors showed that early gestational age (OR=0.884, 95%CI: 0.837-0.933, P<0.001) and increased incidence of selective intrauterine growth restriction type I (OR=2.967, 95%CI: 1.153-7.639, P=0.024) could both lead to an increased incidence of wet lung. (3) Long-term outcomes: a total of 109 pregnant women completed the follow-up, and 218 preterm infants with a corrected age of 6-54 months at the end of follow-up were enrolled, including 86 cases in the non-medication group, 66 cases in the medication after 34 weeks group, and 66 cases in the medication before 34 weeks group. There were no significant differences in the scores of communication, gross motor, fine motor, problem solving and personal-social among the three groups (all P>0.05). Conclusion: Prenatal administration of a single course of dexamethasone does not affect the neonatal birth weight and short-term outcomes of twin late preterm infants, and has no adverse effect on the neurological development of twin late preterm infants with a corrected age of 6-54 months.

An Internet-Based Developmental Home Care Support Program Improved Maternal Psychological Symptoms and Infant Growth: A Randomized Controlled Trial.

To examine the effects of an internet-based Developmental Home Care Support program (DHCSP) to reduce maternal psychological symptoms and improve preterm infants' physical growth outcomes. A randomized controlled trial was conducted. The mother-infant dyads (nm=34, np=40) were randomly assigned to either the DHCSP intervention group or the control group. Data were collected at discharge (T0), 1-month corrected age (T1), and 2-month follow-up (T2), including mothers' postpartum depressive and posttraumatic stress disorder (PTSD) symptoms and mother-proxy infants' body length, weight, and head circumference. There were no significant differences in sociodemographic characteristics between the 2 groups at T0, except for mothers' age and monthly household income (both P =.01). Mothers in the DHCSP group reported significantly higher decreases in depression symptoms (β=-2.24; 95% confidence interval [CI], -4.31 to -0.16, P =.03), and their preterm infants showed significantly more increases in body length (β=2.09; 95% CI, 0.30-3.87, P =.02) than the control participants at T2. The 2 groups did not show significant differences in mothers' PTSD symptoms or infants' body weight and head circumference. The internet-based DHCSP intervention was effective in improving mothers' depressive symptoms and infants' body length.