Absolute Birth Research Articles

Transfers of Sacredness and the Trifunctional Imagery

Studies on the Indo-European principle of trifunctionality and on the medieval Three Estates imagery provide researchers with precious resources for investigating the ways and means through which social representations become loaded with sacredness, and sacredness progressively transferred from one set of social representations to another. This article focuses on the transformations undergone by the Three Estates religious substratum, first at the time of the birth of Absolutism, and second during and after the French Revolution. In the case of France (and with openings towards other contexts), it shows how trifunctionality has been attributed, alternatively or conjointly, to the bourgeoisie and to the nation. Triune imagery has thus contributed to shape rituals and symbols proper to civil religion in France. Additionally, this contribution draws lessons from our case study for assessing both the resilience and the power of metamorphosis proper to symbolic references once the latter are organized into patterns that nurture a community’s cohesiveness by the putting into motion of images, narratives and ritual practices.

사실혼으로서 동성생활공동체

The Korean family has experienced diversity. Being in appearance, nuclear family has been reduced, single person household is getting absolute majority, and marriage and birth rate are seriously decreased. On the basis of superficial alterations, Koreans' perception about family is newly formed. As a result, people are most receptive to living together without marriage.
 However, Korean legal system does not accept the internal and external transition of family at all. The Korean civil law stands on the principle of legal marriage and does not stipulate de facto marriage relation. Despite all that, de facto marriage relation which has been acknowledged by legal theory and precedents is provided legal protection. But, the definition about de facto marriage is not clear. Basically, when the parties which are able to marry with legally, live together under social recognition without marriage registration, it is protected as de facto marriage. On the other hand the couple who were in same family lineage and thereby could not legally marry with by the previous Korean civil Law were recognized as de facto marriage relation. Furthermore, in the case of social security like pension, the spouse who had been in prohibition of marriage by the Korean civil law, was recognized as de facto marriage partner.
 Legal theory and precedents demand parties' intention of marriage, living together under supporting each other, and obtaining social approval as the conditions of de facto marriage. Parties' internal intention of marriage is presumed when the couple live together under supporting each other and receive social approval. Nevertheless, the Korean court does not admit same sex couple as de facto marriage relation, even if they live together under supporting each other and obtaining social acknowledge. The reason for it is that they can not marry with legally. This paper examines that the position of Korean court is not proper in the stage of getting fact finding and applying provisions of Korean civil law in the lawsuit. It claims also that on the basis of major legal theory and precedents about de facto marriage same sex couple belong to the relation.

Adverse outcomes of nonnuchal umbilical cord entanglement.

To evaluate perinatal effects of umbilical cord entanglement (UCE) of different body parts. The database of a tertiary medical center was retrospectively searched for women who gave birth to a liveborn singleton newborn in 2014-2018. Those diagnosed postpartum with UCE were matched 1:10 with women who were not and compared for adverse obstetric and neonatal outcomes, overall and by site of entanglement. A total of 14 299 women were evaluated, of whom 1243 were diagnosed with UCE: 78.7% neck, 26% trunk, 6.7% limb. UCE was associated with lower birth weight percentile and higher rate of small for gestational age, but findings were significant only for neck and trunk UCE. On multivariate regression analysis adjusted for maternal age, parity, gestational age at birth, and history of cesarean delivery, UCE was an independent risk factor for nonreassuring fetal heart rate, labor induction, operative vaginal delivery, cesarean delivery, and meconium-stained amniotic fluid, but not for lower absolute birth weight/birth weight percentile, small for gestational age, low 1-min Apgar score, or neonatal asphyxia. While fetuses with UCE might be more compromised during labor, they apparently recover shortly after birth. The impact on perinatal outcomes was similar for UCE of the neck and trunk and lower for UCE of the limb.

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

სოციალურ-ეკონომიკური ფაქტორების გავლენა შობადობის თანამედროევე ტენდენციებზე

Correlation of Fetal Anterior Abdominal Wall Thickness and Other Standard Biometric Ultrasound Measurements to Predict Fetal Macrosomia in Gestational Diabetes.

Gestational diabetes mellitus (GDM) is one of the most common medical conditions affecting pregnancy and significantly increasing the risk for maternal and perinatal complications. The aim of the present study is to study the correlation of fetal anterior abdominal wall thickness (FAAWT) and other standard fetal biometric parameters measured by ultrasound between 36 and 39 weeks of gestation with neonatal birth weight in pregnancies complicated by GDM. Prospective cohort study in a tertiary care center including 100 singleton pregnancies with GDM were subjected to ultrasound between 36 and 39 weeks of gestation. Standard fetal biometry (Biparietal diameter, Head Circumference, Abdominal circumference [AC], and Femur Length) and estimated fetal weight were calculated. FAAWT was measured at AC section and actual neonatal birth weights were recorded after delivery. Macrosomia was defined as an absolute birth weight more than 4000 g regardless of the gestational age. Statistical analysis was done and 95% confidence level was considered significant. Among 100 neonates, 16 were macrosomic (16%) and third trimester mean FAAWT was significantly higher in macrosomic babies (6.36 ± 0.5 mm) as compared to nonmacrosomic babies (5.54 ± 0.61 mm) (P < 0.0001). FAAWT >6 mm (Receiver operating characteristic curve derived) provided a sensitivity of 87.5%, specificity of 75%, positive predictive value of 40%, and negative predictive value (NPV) of 96.9% for prediction of macrosomia. While other standard fetal biometric parameters did not correlate well with actual birth weight in macrosomic neonates, only FAAWT was found to have statistically significant correlation (correlation coefficient of 0.626, P = 0.009). The FAAWT was the only sonographic parameter to have a significant correlation with neonatal birth weight in macrosomic neonates of GDM mothers. We found a high sensitivity (87.5%), specificity (75%), and NPV (96.9%) suggesting that FAAWT < 6 mm can rule out macrosomia in pregnancies with GDM.

Statistical Analysis of Physiological Childbirth and Obstetric Service in Osh Region from 2016 to 2021 Years

This article is investigating physiological childbirth statistics and obstetric service in Osh, Kyrgyzstan during the 2016 to 2021 years. Statistical analyses revealed several patients’ admissions with their hospital stay days for the period from 2011 to 2020 in all departments. Growth in the population analyzed according to Kyrgyz Republic National Statistical Committee; due to spread of coronavirus infection COVID-19 pandemic and the government declared an emergency in certain territories in the Kyrgyz Republic, from March 31 to May 21, 2020, activities of public service centers and registry office by Government Registration Service were delayed. Conclusions: Quality provision in medical care is vital for both women and newborns and for a minority who experience complications in maternity service. Some statistical analyses revealed that average absolute birth number reduced by 92 births and births number variation analysis in Osh oblast for 2016 to 2021 years showed that in the 2021 year total birth number was 29902 and 31000 in 2020, which can be explained by COVID – 19 infection influence on the population. Number of births registered as 182.971 and the average annual number of births was 30.495. Keywords: physiological childbirth, obstetric service, statistical analysis, Kyrgyz Republic National Statistical Committee, birth analysis, COVID 19

Hypoglycemia during the oral glucose tolerance test in pregnancy-maternal characteristics and neonatal outcomes.

To evaluate maternal and neonatal outcomes in pregnancies complicated by hypoglycemia on 100-g oral glucose tolerance test (OGTT). A retrospective cohort analysis of all live-born deliveries in a single medical center during 2018 and 2019 with available OGTT results and birth outcomes. Preterm deliveries (<34weeks), multiple pregnancies and major anomalies were excluded. Hypoglycemia during OGTT was defined as at least one glucose value below 60mg/dl. Maternal characteristics and perinatal outcomes were compared between three groups: Hypoglycemia on OGTT, Normal OGTT and Abnormal OGTT. Univariate followed by multivariate analyses were used to control for confounders. Overall, 2079 women were entered into the analysis. Of these, 216 (10.4%) had at least one hypoglycemic value, 1072 (51.6%) had normal OGTTs and 791 (38%) abnormal OGTTs. Hypoglycemia in OGTT was more prevalent in multiparous women and was associated with fetal male gender. Absolute birth weight, low birth weight and small for gestational age differed between groups; however, there was no difference between groups in overall birth weight centiles (60.1±26.8 versus 63±26 versus 60.9±27; P>0.05). Following adjustment of confounders, hypoglycemia was not associated with rates of low birth weight or small for gestational age (P<0.05). There were no other differences in perinatal outcomes between groups. Hypoglycemia in OGTT is not associated with maternal or neonatal adverse outcomes.

Cost-effectiveness of ovarian stimulation agents for IUI in couples with unexplained subfertility.

STUDY QUESTIONWhich agent for ovarian stimulation (OS) is the most cost-effective option in terms of net benefit for couples with unexplained subfertility undergoing IUI?SUMMARY ANSWERIn settings where a live birth is valued at €3000 or less, between €3000 and €55 000 and above €55 000, clomiphene citrate (CC), Letrozole and gonadotrophins were the most cost-effective option in terms of net benefit, respectively.WHAT IS KNOWN ALREADYIUI-OS is a common first-line treatment for couples with unexplained subfertility and its increased uptake over the past decades and related personal or reimbursed costs are pressing concerns to patients and health service providers. However, there is no consensus on a protocol for conducting IUI-OS, with differences between countries, clinics and settings in the number of cycles, success rates, the agent for OS and the maximum number of dominant follicles in order to minimise the risk of a multiple pregnancy. In view of this uncertainty and the association with costs, guidance is needed on the cost-effectiveness of OS agents for IUI-OS.STUDY DESIGN, SIZE, DURATIONWe developed a decision-analytic model based on a decision tree that follows couples with unexplained subfertility from the start of IUI-OS to a protocoled maximum of six cycles, assuming couples receive four cycles on average within one year. We chose the societal perspective, which coincides with other perspectives such as that from health care providers, as the treatments are identical except for the stimulation agent. We based our model on parameters from a network meta-analysis of randomised controlled trials for IUI-OS. We compared the following three agents: CC (oral medication), Letrozole (oral medication) and gonadotrophins (subcutaneous injection).PARTICIPANTS/MATERIALS, SETTING, METHODSThe main health outcomes were cumulative live birth and multiple pregnancy. As the procedures are identical except for the agent used, we only considered direct medical costs of the agent during four cycles. The main cost-effectiveness measures were the differences in costs divided by the differences in cumulative live birth (incremental cost-effectiveness ratio, ICER) and the probability of the highest net monetary benefit in which costs for an agent were deducted from the live births gained. The live birth rate for IUI using CC was taken from trials adhering to strict cancellation criteria included in a network meta-analysis and extrapolated to four cycles. We took the relative risks for the live birth rate after Letrozole and gonadotrophins versus CC from that same network meta-analysis to estimate the remaining absolute live birth rates. The uncertainty around live birth rates, relative effectiveness and costs was assessed by probabilistic sensitivity analysis in which we drew values from distributions and repeated this procedure 20 000 times. In addition, we changed model assumptions to assess their influence on our results.MAIN RESULTS AND THE ROLE OF CHANCEThe agent with the lowest cumulative live birth rate over 4 IUI-OS cycles conducted within one year was CC (29.4%), followed by Letrozole (32.0%) and gonadotrophins (34.5%). The average costs per four cycles were €362, €434 and €1809, respectively. The ICER of Letrozole versus CC was €2809 per additional live birth, whereas the ICER of gonadotrophins versus Letrozole was €53 831 per additional live birth. When we assume a live birth is valued at €3000 or less, CC had the highest probability of maximally 65% to achieve the highest net benefit. Between €3000 and €55 000, Letrozole had the highest probability of maximally 62% to achieve the highest net benefit. Assuming a monetary value of €55 000 or more, gonadotrophins had the highest probability of maximally 56% to achieve the highest net benefit.LIMITATIONS, REASONS FOR CAUTIONOur model focused on population level and was thus based on average costs for the average number of four cycles conducted. We also based the model on a number of key assumptions. We changed model assumptions to assess the influence of these assumptions on our results.WIDER IMPLICATIONS OF THE FINDINGSThe high uncertainty surrounding our results indicate that more research is necessary on the relative effectiveness of using CC, Letrozole or gonadotrophins for IUI-OS in terms of the cumulative live birth rate. We suggest that in the meantime, CC or Letrozole are the preferred choice of agent.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by ZonMw Doelmatigheidsonderzoek, grant 80-85200-98-91072. The funder had no role in the design, conduct or reporting of this work. BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck KGaA and Guerbet and travel and research support from ObsEva, Merck and Guerbet. All other authors have no conflicts of interest to declare.TRIAL REGISTRATION NUMBERN/A.

Active case detection of malaria in pregnancy using loop-mediated amplification (LAMP): a pilot outcomes study in South West Ethiopia

Background125 million women are pregnant each year in malaria endemic areas and are, therefore, at risk of Malaria in Pregnancy (MiP). MiP is the direct consequence of Plasmodium infection during pregnancy. The sequestration of Plasmodium falciparum parasites in the placenta adversely affects fetal development and impacts newborn birth weight. Importantly, women presenting with MiP commonly develop anaemia. In Ethiopia, the Ministry of Health recommends screening symptomatic women only at antenatal care visits with no formal intermittent preventive therapy. Since MiP can display low-level parasitaemia, current tests which include microscopy and RDT are challenged to detect these cases. Loop mediated isothermal Amplification (LAMP) technology is a highly sensitive technique for DNA detection and is field compatible. This study aims to evaluate the impact of active malaria case detection during pregnancy using LAMP technology in terms of birth outcomes.MethodsA longitudinal study was conducted in two health centres of the Kafa zone, South West Ethiopia. Both symptomatic and asymptomatic pregnant women were enrolled in the first or second trimester and allocated to either Standard of Care (SOC—microscopy and RDT) or LAMP (LAMP, microscopy and RDT). Women completed at least three visits prior to delivery, and the patient was referred for treatment if Plasmodium infection was detected by any of the testing methods. The primary outcome was to measure absolute birth weight, proportion of low birth weight, and maternal/neonatal haemoglobin in each arm. Secondary outcomes were to assess the performance of microscopy and RDT versus LAMP conducted in the field.ResultsOne hundred and ninety-nine women were included and assigned to either LAMP or SOC. Six were lost to follow up. In this cohort, 66.8% of women did not display any clinical symptoms and 70.9% were multi-parous. A reduced proportion of low birth weight newborns was observed in the LAMP group (0%) compared to standard of care (14%) (p <0.001). Improved neonatal haemoglobin was observed in the LAMP (13.1 g/dL) versus the SOC (12.8 g/dL) (p = 0.024) arm. RDT and microscopy had an analytical sensitivity of 66.7% and 55.6% compared to LAMP as a reference standard.ConclusionsThese results support the use of highly sensitive tools for rapid on-site active case detection of MiP which may improve birth outcomes in the absence of IPT. However, further large-scale studies are required to confirm this finding.

Intrauterine growth restriction, preterm birth and risk of end-stage renal disease during the first 50 years of life

BackgroundLow birth weight (LBW) is associated with a higher risk of end-stage renal disease (ESRD). The relative impacts of absolute birth weight, birth weight in relation to gestational age and preterm birth are, however, uncertain.MethodsThe Medical Birth Registry of Norway has since 1967 recorded data on all births. All patients with ESRD since 1980 have been registered in the Norwegian Renal Registry. Data from these registries were linked. All individuals registered in the Medical Birth Registry were included and the development of ESRD was used as endpoint in Cox regression statistics. LBW and LBW for gestational age [small for gestational age (SGA)] according to the 10th percentiles were used as the main predictor variables.ResultsOf the 2 679 967 included subjects, 1181 developed ESRD. Compared with subjects without LBW, subjects with LBW had an adjusted hazard ratio (aHR) for ESRD of 1.61 (1.38–1.98). SGA had an aHR of 1.44 (1.22– 1.70). Further analyses showed that as compared with subjects who had none of the risk factors LBW, SGA and preterm birth, subjects with one risk factor had an aHR of 1.05 (0.84–1.31), subjects with two risk factors had an aHR of 1.67 (1.40–1.98) and subjects with three risk factors had an aHR of 2.96 (1.84–4.76).ConclusionsWe conclude that LBW was associated with increased risk for ESRD during the first 50 years. Our analyses add to previous knowledge showing that only subjects with at least two of the risk factors LBW, SGA or preterm birth have increased risk.

Secondary sex ratio and trends in the associated gender-specific births near nuclear facilities in France and Germany: Update of birth counts

Increases in childhood cancer near nuclear facilities in France and in Germany as well as elevated human birth sex ratios after the atmospheric atomic bomb tests and after Chernobyl motivated the inspection of the secondary sex ratio and the corresponding gender-specific birth counts in the vicinity of nuclear facilities. Focus is on which changes in the birth counts go along with significant changes in the sex ratios. Official municipality-specific annual birth counts by sex for all of France and for whole Germany are updated until 2016 and 2017, respectively. Using logistic regression, we determine significant change-points (jumps) after distinct radiological events in sex ratio time-trends in circular areas around pertinent nuclear facilities. With Poisson regression, we quantify the corresponding change-points in the trends of absolute annual birth counts for boys and girls. In the 35-km vicinity of the ‘Centre de l’Aube Nuclear Disposal Facility (CSA)’ in France in the year 2000, we observe a jump in the sex odds (SO) with sex odds ratio (SOR) 1.101; 95% CI: (1.033, 1.175), p-value 0.0033. This jump in the sex odds can be associated with a drop in boys of 3.44% (−4.02, 10.37), p-value 0.3561, and a drop in girls of 8.44% (1.33, 15.04), p-value 0.0208. In the highly populated area around the nuclear power plant Philippsburg in Germany from 2001 onward, we see a similar effect: SOR 1.027 (1.008, 1.046), p-value 0.0045; drop in boys 5.56% (2.24, 8.76), p-value 0.0012; drop in girls 6.92% (3.62, 10.10), p-value <0.0001. The presented findings corroborate and specify earlier observations and call for intensifying bio-physical research in exposure mechanisms and exposure pathways of natural or artificial ionizing radiation including neutron radiation and neutron activation. Reinforced biological and epidemiological research should aim at clarifying the associated genetic and carcinogenic consequences at the population level.

Day 6 blastocyst is associated with increased birth weight in full-term singleton newborns after frozen-thawed transfer.

The purpose of the study is to compare the newborns weight in singleton term birth following transfer of thawed blastocysts-frozen on either day 5 or day 6 after in vitro fertilization. The retrospective study included 1444 frozen-thawed blastocyst transfer (FBT) cycles resulting in live singleton births between Jan 2013 and Dec 2016. The main outcomes measured were absolute birth weight, z-score adjusted for gestational age and gender, and incidence of large-for-gestational-age (LGA) newborns. Generalized linear model (GLM) and logistic regression were used in multivariate analyses. Both the absolute birth weight (3416.49 ± 404.74 vs 3349.22 ± 416.17) and the z-score (0.6 ± 0.93 vs 0.41 ± 0.93) were significantly higher on day 6 FBT in comparison with day 5 FBT. The incidence of LGA newborns was also increased on day 6 FBT (22.8 vs 14.7%, P = 0.006). Adjusted for maternal age, BMI, PCOS diagnosis, present of vanishing twin, and embryo quality, the odds ratio (95% confidence interval) for LGA on day 6 FBT comparing with day 5 FBT was 1.76 (1.18-2.64). Day 6 FBT is associated with increased birth weight and contributes to the incidence of LGA newborns in FBT.

Effect of early use of low-dose aspirin therapy on late-onset preeclampsia

Objective: Low-dose aspirin (LDA) therapy has been found to be effective in preventing the development of early-onset preeclampsia. However, its effect on late-onset preeclampsia has not been described. Our study was aimed at determining if LDA therapy prescribed from early in pregnancy modified the severity of late-onset preeclampsia. Materials and methods: A retrospective analysis of all women who were screened for early-onset preeclampsia at 11–13+6 weeks’ gestation between April 2012 and October 2014 at our institution, and who subsequently developed late-onset preeclampsia. The treatment group consisted of women who were prescribed LDA therapy from early in pregnancy as a result of the screening. The control group consisted of women who did not receive LDA therapy. Results: The aspirin group was associated with earlier delivery at 38.0 (37.5–38.5) weeks’ gestation versus 39.0 (38.7–39.4) weeks’ gestation for the nonaspirin group (p < .01). The aspirin group was also associated with lower absolute birth weight 2851 (2646–3055) versus 3215 (3068–3362) grams in the nonaspirin group (p < .01). However, when normalised for gestational age at delivery, the proportion of foetuses that were small for gestation age (< 10th centile) were not significantly different between the two groups [28% in aspirin group versus 23% in nonaspirin group; p = .62]. No other significant difference was noted. Conclusions: There was no difference in the clinical severity of late-onset preeclampsia between women screened as high risk for early-onset preeclampsia and subsequently prescribed LDA during their pregnancy, compared to women found to be at low risk and not prescribed LDA.

Assisted Reproductive Techniques and Risk of Beckwith-Wiedemann Syndrome.

The emerging association of assisted reproductive techniques (ART) with imprinting disorders represents a major issue in the scientific debate on infertility treatment and human procreation. We studied the prevalence of Beckwith-Wiedemann syndrome (BWS) in children conceived through ART to define the specific associated relative risk. Patients with BWS born in Piemonte, Italy, were identified and matched with the general demographic data and corresponding regional ART registry. Between 2005 and 2014, live births in Piemonte were 379 872, including 7884 from ART. Thirty-eight patients with BWS were born, 7 from ART and 31 naturally conceived. BWS birth prevalence in the ART group was significantly higher than that of the naturally conceived group (1:1126 vs 1:12 254, P < .001). The absolute live birth risk in the ART group was 887.9 per 1 000 000 vs 83.3 per 1 000 000 in the naturally conceived group, providing a relative risk of 10.7 (95% confidence interval 4.7-24.2). During the 1997-2014 period, 67 patients were diagnosed with BWS out of 663 834 newborns (1:9908 live births). Nine out of the 67 BWS patients were conceived through ART (13.4%), and 8 were molecularly tested, with 4 having an imprinting center 2 loss of methylation, 2 with 11p15.5 paternal uniparental disomy, and 2 negative results. ART entails a 10-fold increased risk of BWS and could be implicated in the pathogenesis of genomic events besides methylation anomalies. These data highlight the need for awareness of ART-associated health risk.

Relationship between birth weight or fetal growth rate and postnatal allergy: a systematic review protocol.

The objective of this systematic review is to synthesize the best available evidence on the relationship between size at birth or fetal growth and postnatal allergy. Specifically, this review aims to assess evidence regarding relationships between absolute birth weight at term, birth weight corrected for gestational age, expressed as relative to population or customized growth data, or fetal growth measures and physician-diagnosed or parent- and self-reported postnatal clinical allergic disease (eczema/atopic dermatitis, hay fever/rhinitis, allergic asthma or anaphylaxis).The specific review question is: what is the association between the absolute birth weight at full-term or birth weight relative to population or customized data and corrected for gestational age or direct measures of fetal growth, and physician-diagnosed or parent- and self-reported clinical allergic disease (eczema/atopic dermatitis, hay fever/rhinitis, allergic asthma or anaphylaxis)?

Contested modernity: divided rule and the birth of sectarianism, nationalism, and absolutism in Bahrain

This study argues that political mobilization based on ethnosectarian identities in Bahrain is a modernist product of the contestations that occurred in the period of increasing British colonial involvement in the early twentieth century. Two concepts are utilized. The first is the colonial ‘ethnosectarian gaze’, marked primarily by its underlying epistemology that saw ethnosectarian cleavages as the main analytic units for approaching local political power, practice, and discourse. The second is ‘contested and divided rule’. With the advent of Curzon’s ‘forward policy’ in the Gulf, Britain actively divided sovereignty between itself and the local ruler, with actors on the island faced with two conflicting sources of jurisdiction. The British viewed issues of jurisdiction primarily through an ethnosectarian lens, and increasingly so did other actors, creating an inter-feeding dynamic between ethnosectarianism, nationalism, and divided rule. Two emergent forms of political mobilization are emphasized. The first mobilized based on ethnosectarian identity-specific demands and grievances. The other took an overtly nationalist, trans-sectarian, anti-colonial tone, having its roots in the al-Nahda renaissance that swept the Arab world in the nineteenth century. Thus, colonialism, absolutism, ethnosectarianism, and nationalism went hand in hand, products of a similar period of divided rule, their lingering effects still felt today.

Birth characteristics and all-cause mortality: a sibling analysis using the Uppsala birth cohort multigenerational study

This paper investigates the association between perinatal health and all-cause mortality for specific age intervals, assessing the contribution of maternal socioeconomic characteristics and the presence of maternal-level confounding. Our study is based on a cohort of 12,564 singletons born between 1915 and 1929 at the Uppsala University Hospital. We fitted Cox regression models to estimate age-varying hazard ratios of all-cause mortality for absolute and relative birth weight and for gestational age. We found that associations with mortality vary by age and according to the measure under scrutiny, with effects being concentrated in infancy, childhood or early adult life. For example, the effect of low birth weight was greatest in the first year of life and then continued up to 44 years of age (HR between 2.82 and 1.51). These associations were confirmed in within-family analyses, which provided no evidence of residual confounding by maternal characteristics. Our findings support the interpretation that policies oriented towards improving population health should invest in birth outcomes and hence in maternal health.

Chorionic bump on first-trimester sonography: not necessarily a poor prognostic indicator for pregnancy.

The purpose of this study was to determine the live birth rate of pregnancies with a diagnosis of a chorionic bump, a convex bulge from the choriodecidual surface into the first-trimester gestational sac. Pregnant patients at least 18 years old with the finding of a chorionic bump on first-trimester sonography were included in this prospective observational study. The independent variables were chorionic bump size and number and presence or absence of a history of infertility or coagulation disorder. The primary end point was pregnancy outcome. During the 4-year study period, 52 pregnancies had a diagnosis of a chorionic bump. Overall, 34 resulted in live births, corresponding to an absolute live birth rate of 65%, and 18 were nonviable. Forty-one chorionic bump pregnancies were otherwise normal (ie, pregnancies in which a gestational sac, yolk sac, and embryo with heartbeat were seen at some point), and in this subset, the live birth rate was 83% (34 of 41). All pregnancies with more than 1 chorionic bump (4) ended in demise (100%). The average maximum dimension of the chorionic bump was 1.3 cm (range, 0.5-3.8 cm); however there was not a statistically significant correlation between chorionic bump size and pregnancy outcome (P = .5866; odds ratio, 0.54; 95% confidence interval, 0.06-5.01). Nine patients (17%) had a history of infertility treatment, and 4 (8%) had a history of coagulation disorder. Only 1 chorionic bump pregnancy was associated with a birth defect. The live birth rate in our chorionic bump cohort was 65% overall and even higher (83%) if the pregnancy was otherwise normal. The clinical implication is that a chorionic bump on first-trimester sonography is not necessarily associated with a guarded prognosis.

Can a single preterm ultrasound accurately predict birth weight in gestational diabetes?

Objective: To evaluate the accuracy of the gestation-adjusted projection method of birth weight prediction, as compared to near delivery ultrasound estimated fetal weight, in a gestational diabetic population.Methods: A retrospective cohort was conducted including all women with gestational diabetes who had an ultrasound estimated fetal weight (EFW) between 340/7 and 366/7 weeks and an additional ultrasound EFW within 7 d of delivery at term. The gestation-adjusted projection (GAP) method was applied to the earlier sonogram, resulting in the GAP predicted birth weight. The GAP predicted weight and the term ultrasound EFW were compared to the actual birth weight. Absolute and percent birth weight errors were compared using paired t-tests.Results: The mean absolute percent errors and mean absolute errors for the GAP method and term ultrasound were 7.7 ± 5.6% versus 7.1 ± 5.1% and 256 ± 184 g versus 236 ± 169 g respectively (p = 0.22 and p = 0.29). The sensitivity of predicting birth weight ≥4000 g was 22% for the GAP method and 28% for term ultrasound, with specificity reaching 97% for both the methods.Conclusion: The GAP method is as accurate as term ultrasound in predicting birth weight in gestational diabetes.

Are there any relationships between umbilical artery Pulsatility Index and macrosomia in fetuses of type I diabetic mothers?

Objective: To establish whether there are relationships between umbilical artery Pulsatility Index (PI) and fetal macrosomia in pregnancies complicated by type I diabetes.Methods: In a retrospective observational study, 102 singleton pregnant women with type I diabetes were considered. Umbilical artery PI was measured by Doppler ultrasonography within one week from delivery and related to neonatal weight. Pregnancies were grouped according to birtweight in macrosomic group (≥4000 g) and normal growth group (<4000 g). Relationships between umbilical artery PI and birth weight and birth weight centile were tested by Pearson’s correlation analysis. Further umbilical artery PI values were compared between macrosomic and normally grown fetuses.Results: Birth weight was ≥4000 g in 24 pregnancies (23.5%). A significant relationship was found between umbilical artery PI and neonatal weight (r = 0.512; p < 0.01) and neonatal weight centile (r = 0.400; p < 0.01). Umbilical artery PI were significantly lower (t = −6.013; p < 0.001) in the macrosomic group (0.78; 95% confidence interval (CI) 0.73–0.84) than in the normal growth group (1.00; 95% CI 0.97–1.04).Conclusions: In pregnancies complicated by type I diabetes there is a significant relationship between umbilical artery PI value before delivery and absolute birth weight and birth weight centile. Macrosomic fetuses show a significant reduction in umbilical artery PI when compared with diabetic pregnancies without fetal overgrowth.