Birth Weight Deficits Research Articles

Is There Still a Role for Peritoneal Drains in Neonatal Pneumoperitoneum? A Single-Center Experience

IntroductionAlthough pneumoperitoneum from necrotizing enterocolitis or spontaneous intestinal perforation is a surgical emergency, risk stratification to determine which neonates benefit from initial peritoneal drainage (PD) is lacking. MethodsUsing a single-center retrospective review of very low birth weight neonates under 1500 g who underwent PD for pneumoperitoneum (January 2015 to December 2023) from necrotizing enterocolitis or spontaneous intestinal perforation, two cohorts were created: drain “responders” (patients managed definitively with PD; includes placement of a second drain) and “nonresponders” (patients who underwent subsequent laparotomy or died after PD). Antenatal/postnatal characteristics, periprocedural clinical data, and hospital outcomes were compared between responders and nonresponders using Student’s t-test, chi-squared test, or Kruskal–Wallis test as appropriate, with P < 0.05 considered significant. ResultsFifty-six neonates were included: 31 (55%) drain responders and 25 (45%) nonresponders. Birth weight, gestational age, sex, ethnicity, use of postnatal steroids, and enteral feeds were similar between the cohorts. Nonresponders had higher base deficits (−3.4 versus −5.0, P = 0.032) and FiO2 (0.25 versus 0.52, P = 0.001) after drain placement. Drain responders had significantly shorter lengths of stay (89 versus 148 days, P = 0.014) and lower mortality (6.4% versus 56%, P < 0.001). A subgroup analysis of the nonresponders showed no differences in birth weight, vasopressor requirement, FiO2, or postdrain base deficit between nonresponders who had a drain alone versus laparotomy following drain placement. ConclusionsPD remains a viable initial therapy for pneumoperitoneum in premature very low birth weight neonates (< 1500 g), demonstrating clinical response in more than half. Ongoing clinical assessment and judgment is imperative after drain placement to ensure continued clinical improvement.

Systematic review and meta-analysis of birth weight and perfluorohexane sulfonate exposures: examination of sample timing and study confidence

We examined the association between mean birth weight (BW) differences and perfluorohexane sulfonate (PFHxS) exposure biomarkers.We fit a random effects model to estimate the overall pooled effect and for different...

BLOOD MINERAL PROFILE IN NEWBORN CALVES WITH INTRAUTERINE GROWTH RETARDATION

Widespread intrauterine growth retardation of embryo and fetal (IUGR) in cattle and its negative effects on postnatal growth and offspring health threaten the economic sustainability of livestock production. IUGR calves often exhibit birth weight deficits, early death, metabolic abnormalities, low growth rate, and poor feed utilization. Effective correction of these disorders is impossible without a detailed study of the causes, mechanisms of development and consequences of IUGR. In the present work, a comparative analysis of the content of macrominerals and trace elements in the blood of newborn Simmental calves with IUGR (Group I, n = 20) and the physiological course of pregnancy in their mothers (Group II, n = 20) was carried out. Blood for studies in calves was obtained at 1 day of age, before the 4th feeding of colostrum. The content of sodium, potassium, calcium and magnesium in blood serum samples and the content of iron, copper, zinc, manganese, cobalt and selenium in whole blood samples were studied by atomic absorption spectrometry (AA6300, Shimadzu, Japan). Group I calves had increased serum potassium (by 6.7%, P = 0.022) and magnesium (by 6.3%, P = 0.004) and decreased sodium (by 4.3%, P = 0. 005), reduced whole blood selenium (by 41.0%, P = 0.0001), copper (by 23.6%, P = 0.0001), and manganese (by 23.4%, P = 0.005) compared with Group II animals. The blood content of the other minerals studied did not differ significantly between the groups. The possible causes and consequences of the identified disorders of the mineral blood profile in newborn calves with IUGR were analyzed.

Reasons for cannabis use during pregnancy and lactation: a qualitative study.

Background:Cannabis use among pregnant and lactating people is increasing, despite clinical evidence showing that cannabis use may be associated with low birth weight and childhood developmental deficits. Our objective was to understand why pregnant and lactating people use cannabis and how these motivations change across perinatal stages.Methods:Using qualitative, constructivist grounded theory methodology, we conducted telephone and virtual interviews with 52 individuals from across Canada. We selected participants using maximum variation and theoretical sampling. They were eligible if they had been pregnant or lactating within the past year and had decided to continue, cease or decrease their cannabis use during the perinatal period.Results:We identified 3 categories of reasons that people use cannabis during pregnancy and lactation: sensation-seeking for fun and enjoyment; symptom management of chronic conditions and conditions related to pregnancy; and coping with the unpleasant, but nonpathologized, experiences of life. Before pregnancy, participants endorsed reasons for using cannabis in these 3 categories in similar proportions, with many offering multiple reasons for use. During pregnancy, reasons for use shifted primarily to symptom management. During lactation, reasons returned to resemble those expressed before pregnancy.Interpretation:In this study, we showed that pregnant and lactating people use cannabis for many reasons, particularly for symptom management. Reasons for cannabis use changed across reproductive stages. The dynamic nature of the reasons for use across stages speaks to participant perception of benefits and risks, and perhaps a desire to cast cannabis use during pregnancy as therapeutic because of perceived stigma.

The Impact of Sample Timing and Study Confidence on Mean Birth Weight Differences Detected in a Meta-analysis of PFHxS

BACKGROUND AND AIM: Recent evidence suggests that timing differences in PFOA biomarker sampling may result in reverse causality or confounding due to pregnancy-related hemodynamic changes. In a meta-analysis of epidemiologic data from 16 studies of birth weight identified in a systematic review of the health effects of PFHxS exposure, we examined whether results differed by study quality and by timing of exposure measurement. METHODS: Using a random effects model, we examined studies with maternal blood samples collected during first trimester (T1), second trimester (T2), third trimester (T3), post-partum (PP), or umbilical cord blood (UCB). Three grouping strategies were used: 1) early and mid-pregnancy (T1; T1/T2; T2, n=7) versus later sampling (T3; PP; UCB, n=9); 2) early pregnancy (T1; T1/T2, n=4) versus later sampling (T2; T3; PP; UCB, n=12); 3) early (T1; T1/T2, n=4), mid- and late-pregnancy (T2; T2/T3; T3, n=7), and post-pregnancy (UBC; PP, n=5). RESULTS:The summary mean birthweight deficit was -12 grams (95%CI: -25, 0.1; I2=0%) per ln-unit PFHxS increase with no differences across study confidence level (High/Medium/Low). We saw minimal differences in pooled deficits with the first two dichotomized groups (-11 vs -15 g for early/mid-pregnancy versus late/post-pregnancy; -10 vs -13 g for early pregnancy versus other periods). The third analysis showed comparable pooled estimates for maternal samples collected during pregnancy (early: -10 g, mid-/late-pregnancy: -8 g); but a larger deficit for UCB or PP (-28 g; 95%CI: -69, 13). CONCLUSIONS:Although we saw larger deficits for post-pregnancy samples based on few studies, we consistently saw birth weight deficits for pregnancy-based measures regardless of timing. Additionally, the few PFHxS studies adjusting for hemodynamics did not show evidence of confounding. Thus, more work to determine whether reverse causality is a plausible explanation of these differences and to determine the most relevant grouping strategies based on hemodynamic expectations will be informative. KEYWORDS: PFAS, PFC, PFHxS, Birthweight, Meta-analysis, Pregnancy

The Hidden Cost of Bananas: Pesticide Effects on Newborns’ Health

We study the effects of aerial fumigation of banana plantations on newborns’ birth weight during the period 2015-2017 in Ecuador. We use mothers’ addresses and information on the perimeter of the plantations to create an individual measure of newborns’ exposure to pesticides. We use this measure to implement three independent identification strategies to address the endogeneity of exposure to aerial fumigations. First, we consider a difference-indifferences strategy that exploits seasonal variations in the use of pesticides across provinces. Second, we estimate a difference-in-differences model that considers geographical variations in the use of pesticides across comparable crops. Third, and finally, we estimate a maternal fixed effects model to examine the effect of pesticides on siblings who had a different residence during gestation and who were exposed to different levels of fumigations. Our first empirical model shows that newborns exposed to pesticides, when their first gestational trimester coincides with the periods of intensive fumigations of the plantations, have a birth weight reduction of between 38 and 89 grams. Moreover, exposure to pesticides increases the likelihood of low birth weight and low Apgar score at the first minute by around 0.35 and 0.33, respectively. The second model finds that newborns exposed to fumigated banana plantations have a birth weight deficit of between 29 and 76 grams, when compared to those exposed to other fumigated crops. Finally, the maternal fixed effect model shows that girl newborns exposed to pesticides have a birth weight deficit of 346 grams when compared to non-exposed siblings.

Perinatal protein restriction with postnatal catch-up growth leads to elevated p66Shc and mitochondrial dysfunction in the adult rat liver.

Epidemiological data suggest an inverse relationship between birth weight and long-term metabolic deficits, which is exacerbated by postnatal catch-up growth. We have previously demonstrated that rat offspring subject to maternal protein restriction (MPR) followed by catch-up growth exhibit impaired hepatic function and ER stress. Given that mitochondrial dysfunction is associated with various metabolic pathologies, we hypothesized that altered expression of p66Shc, a gatekeeper of oxidative stress and mitochondrial function, contributes to the hepatic defects observed in MPR offspring. To test this hypothesis, pregnant Wistar rats were fed a control (20% protein) diet or an isocaloric low protein (8%; LP) diet throughout gestation. Offspring born to control dams received a control diet in postnatal life, while MPR offspring remained on a LP diet (LP1) or received a control diet post weaning (LP2) or at birth (LP3). At four months, LP2 offspring exhibited increased protein abundance of both p66Shc and the cis-trans isomerase PIN1. This was further associated with aberrant markers of oxidative stress (i.e. elevated 4-HNE, SOD1 and SOD2, decreased catalase) and aerobic metabolism (i.e., increased phospho-PDH and LDHa, decreased complex II, citrate synthase and TFAM). We further demonstrated that tunicamycin-induced ER stress in HepG2 cells led to increased p66Shc protein abundance, suggesting that ER stress may underlie the programmed effects observed in vivo. In summary, because these defects are exclusive to adult LP2 offspring, it is possible that a low protein diet during perinatal life, a period of liver plasticity, followed by catch-up growth is detrimental to long-term mitochondrial function.

Low birth weight and its association with attention deficit hyperactivity disorder (ADHD) in young children

This study was conducted to understand the association between low birth weight and attention deficit hyperactivity disorder (ADHD) in young children aged 36 – 59 months in Sedayu Subdistrict, Bantul District, Daerah Istimewa Yogyakarta. This study used cross-sectional design with a total of 185 children aged 36 – 59 months were selected by probability proportional to size (PPS) sampling technique. This study was located in Sedayu Subdistrict, Bantul District, Daerah Istimewa Yogyakarta. The study was conducted January 2017. Main variables in this study were low birth weight, prematurity, and attention deficit hyperactivity disorder (ADHD). Maternal and child book was used to confirm the birth weight and gestational age data. Abbreviated Conners Rating Scale form was used to detect ADHD symptoms in young children, followed by a psychologist confirmation. Data were analyzed by using descriptive statistics, chi-square test, and multiple logistic regression at 0.05 level of significance. The proportion of attention deficit hyperactivity disorder (ADHD) was 29.2% in this study. Meanwhile, the prevalence of low birth weight (&lt;2500 g) was 8.11% and prematurity (&lt;37 weeks gestational age) was 2.16%. Children with birth weight less than 2500 g were more likely to develop ADHD symptoms (OR: 3.2; 95%CI: 1.09-9.48) compared to children with normal birth weight. On the other hand, prematurity was not associated with ADHD (OR: 0.64; 95%CI: 0.06-6.89). This study concluded that low birth weight was associated with attention deficit hyperactivity disorder (ADHD). However, prematurity was not related significantly with ADHD. Efforts are needed in improving nutrition adequacy for infants and young children, also development stimulation, especially for those born with low birth weight.

Simultaneous accelerated solvent extraction and hydrolysis of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid glucuronide in meconium samples for gas chromatography–mass spectrometry analysis

Cannabis misuse during pregnancy is associated with severe impacts on the mother and baby health, such as newborn low birth weight, growth restriction, pre-term birth, neurobehavioral and developmental deficits. In most of the cases, drug abuse is omitted or denied by the mothers. Thus, toxicological analyzes using maternal-fetal matrices takes place as a suitable tool to assess drug use. Herein, meconium was the chosen matrix to evaluate cannabis exposure through identification and quantification of 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic (THCCOOH). Accelerated solvent extraction (ASE) was applied for sample preparation technique to simultaneously extract and hydrolyze conjugated THCCOOH from meconium, followed by a solid-phase extraction (SPE) procedure. The method was developed and validated for gas chromatography–mass spectrometry (GC–MS), reaching hydrolysis efficiency of 98%. Limits of detection (LOD) and quantification (LOQ) were, respectively, 5 and 10 ng/g. The range of linearity was LOQ to 500 ng/g. Inter and intra-batch coefficients of variation were <8.4% for all concentration levels. Accuracy was in 101.7–108.9% range. Recovery was on average 60.3%. Carryover effect was not observed. The procedure was applied in six meconium samples from babies whose mothers were drug users and showed satisfactory performance to confirm fetal cannabis exposure.

A Meta-Analysis of the Association Between Birth Weight and Attention Deficit Hyperactivity Disorder.

A large body of work has investigated the association between birth weight and ADHD and has resulted in mixed findings with regard to the direction and magnitude of this association. Despite the vast amount of research on this topic, a comprehensive and systematic quantification of the association between birth weight and ADHD has yet to be undertaken. A meta-analysis of 88 unique studies (N = 4,645,482) was conducted to quantify the overall effect size of birth weight on ADHD symptoms. Several variables were examined as moderators that may contribute to systematic variation in effect sizes. Overall, birth weight was found to have a small, but significant, association with ADHD symptoms such that individuals born at lower birth weights manifested greater symptoms of ADHD (r = -0.15). Sample type, mean birth weight of the sample, geographic region, the informant of ADHD symptoms, ADHD symptom measurement method, and race were all found to contribute significantly to heterogeneity in effect sizes. Notably, several early life risk factors previously found to be associated with both ADHD and birth weight, gestational age and prenatal smoking exposure, were not found to contribute to heterogeneity in effect sizes. The findings of the current analyses align with the growing recognition that early life adversity contributes to neurodevelopmental difficulties, and the findings highlight the importance of a better understanding of the mechanisms underlying the association between early life risk factors and adverse neurodevelopmental sequela, such as that observed in ADHD.

Subclinical Hypothyroidism and Isolated Hypothyroxinemia during Pregnancy and Their Association with Pregnancy Outcome: A 2-Year Study

INTRODUCTION: Overt hypothyroidism in pregnancy is associated with adverse outcomes, but the effects of subclinical hypothyroidism and isolated hypothyroxinemia on pregnancy outcomes are still controversial. Subclinical hypothyroidism might be associated with preterm delivery, low Apgar score, fetal death and miscarriages and isolated hypothyroxinemia with preterm labor, high birth weight and neurocognitive deficits in children. Other studies show no association with any complications at all. In the present study we tried to estimate whether maternal subclinical hypothyroidism and isolated hypothyroxinemia are associated with complications during pregnancy in our population which represents the pregnant population of Western Greece. METHODS: In a total of 469 pregnant women, third trimester serum was assayed for thyroid-stimulating hormone (TSH) and free thyroxine (free T4). Thyroid hypofunction was defined as 1) subclinical hypothyroidism with TSH levels above 3 mIU/L for the 3rd trimester and normal free T4 and 2) isolated hypothyroxinemia with TSH levels below 3 mIU/L for the 3rd trimester and free T4 below the 5th percentile. The results were associated with birth weight, week of labor, history of miscarriages and demographic characteristics. Patients with thyroid hypofunction were compared with euthyroid patients (TSH and free T4 between normal limits). The results were analyzed with one-way ANOVA and χ2 test. RESULTS: Subclinical hypothyroidism was documented in 10.9% and isolated hypothyroxinemia in 21.7% of pregnant women. Subclinical hypothyroidism was not associated with birth weight, week of labor, or history of miscarriages. On the contrary, hypothyroxinemia was associated with high birth weight (P < 0.05). CONCLUSION: In our study, we did not find a link between subclinical hypothyroidism and adverse pregnancy outcomes. Similarly, hypothyroxinemia was not associated with pregnancy complications. However, it was associated with higher birth weight. Our studies contribute to our understanding, whether or not subclinical hypothyroidism and isolated hypothyroxinemia are associated with pregnancy adverse outcomes and whether treatment and test for hypothyroidism should become routine during pregnancy.

The relationship between birth weight and congenital heart disease at Ahmed Gasim Cardiac Centre, Bahri, Sudan

Low birth weight is a known comorbidity of congenital heart disease (CHD). This study examines the relationship between CHD and birth weight of singletons, while attempting to remove factors that influence birth weight, and assesses the impact of CHD on growth in later life. The main objective is to study the relationship between birthweight and CHD. This is a cross-sectional study of 141 samples, covering all patients who were referred to the Paediatric Echocardiography Lab at Ahmed Gasim Cardiac Centre between September and October 2016. Infants with genetic syndromes or other major extracardiac abnormalities were excluded. The findings of this study clearly demonstrate that infants with CHD are more likely to be of low birth weight than the general Sudanese population, by a factor of 2.6. Of the sample, 31.9% were born with low or very low birthweight. The mean birth weight of the cases was 2.59 kg, which is 17.3% and 542.4 g less than the national average. CHD that cause a decrement in birth weight in a descending order of severity were atrial septal defect (-721 g/23%), patent ductus arteriosus (-669 g/21%), ventricular septal defect (-610 g/19%), pulmonary stenosis (-548 g/13%) and tetralogy of Fallot (248 g/8%). Pre/postnatal growth impairment is a common feature among children with CHD. No statistically significant relationship was found between the degree of birth weight/weight to age decrement and the specific type of hemodynamic disturbance. Our results are comparable to other studies that have been undertaken. However, Sudanese patients display larger birthweight deficits than other populations.

An Adolescent Parents' Programme to Reduce Child Abuse

Teen pregnancy is a significant social, political and economic issue, and potential adverse outcomes for children of adolescent mothers include a higher incidence of low birth weight, prematurity, developmental delays, cognitive and behavioural deficits, and school failure. These children are also at a greater risk for abuse and neglect as well as intentional injury by their adolescent mothers. We evaluated child abuse reporting and the health outcomes for infants and their adolescent parents in Bellevue Hospital's Adolescent Parenting Program to assess whether better outcomes were achieved for mother‐baby dyads in our adolescent mothers' groups compared to the general clinic and New York City populations. We found that those who completed a full year of the programme during 2011–12 had some significantly improved measures compared to those who did not, with fewer child abuse reports and more well‐baby visits, more immunisations and earlier referral for developmental delays. There were additional health benefits for the adolescent mothers noted as well. We concluded that a specialised programme for high‐risk adolescent mothers and their babies offers a number of benefits compared to standard separate care, but more research and funding are needed to tailor programmes to the unique needs of adolescent mothers in diverse social and educational contexts. Copyright © 2015 John Wiley &amp; Sons, Ltd.Key Practitioner Messages Adolescent parents have increased risk for several adverse child health and development outcomes for their children, including child abuse and neglect. An adolescent parenting programme focusing on simultaneous medical care for teen parents and their infants with multidisciplinary staff can provide important support and guidance to help teen parents improve their parenting skills. Additional benefits of simultaneous care include improved child immunisation rates and developmental outcomes and decreased reported abuse and neglect. ‘Adolescent parents have increased risk for several adverse child health and development outcomes for their children’‘We evaluated child abuse reporting and the health outcomes for infants and their adolescent parents in Bellevue Hospital's Adolescent Parenting Program’

Arsenic and Its Methylated Metabolites Inhibit the Differentiation of Neural Plate Border Specifier Cells.

Exposure to arsenic in food and drinking water has been correlated with adverse developmental outcomes, such as reductions in birth weight and neurological deficits. Additionally, studies have shown that arsenic suppresses sensory neuron formation and skeletal muscle myogenesis, although the reason why arsenic targets both of these cell types in unclear. Thus, P19 mouse embryonic stem cells were used to investigate the mechanisms by which arsenic could inhibit cellular differentiation. P19 cells were exposed to 0, 0.1, or 0.5 μM sodium arsenite and induced to form embryoid bodies over a period of 5 days. The expression of transcription factors necessary to form neural plate border specifier (NPBS) cells, neural crest cells and their progenitors, and myocytes and their progenitors were examined. Early during differentiation, arsenic significantly reduced the transcript and protein expression of Msx1 and Pax3, both needed for NPBS cell formation. Arsenic also significantly reduced the protein expression of Sox 10, needed for neural crest progenitor cell production, by 31-50%, and downregulated the protein and mRNA levels of NeuroD1, needed for neural crest cell differentiation, in a time- and dose-dependent manner. While the overall protein expression of transcription factors in the skeletal muscle lineage was not changed, arsenic did alter their nuclear localization. MyoD nuclear translocation was significantly reduced on days 2-5 between 15 and 70%. At a 10-fold lower concentration, monomethylarsonous acid (MMA III) appeared to be just as potent as inorganic arsenic at reducing the mRNA levels Pax3 (79% vs84%), Sox10 (49% vs 65%), and Msx1 (56% vs 56%). Dimethylarsinous acid (DMA III) also reduced protein and transcript expression, but the changes were less dramatic than those with MMA or arsenite. All three arsenic species reduced the nuclear localization of MyoD and NeuroD1 in a similar manner. The early changes in the differentiation of neural plate border specifier cells may provide a mechanism for arsenic to suppress both neurogenesis and myogenesis.

Evaluation of contaminated drinking water and preterm birth, small for gestational age, and birth weight at Marine Corps Base Camp Lejeune, North Carolina: a cross-sectional study.

BackgroundBirths during 1968-1985 at Camp Lejeune were exposed to drinking water contaminated with trichloroethylene (TCE), tetrachloroethylene (PCE), and benzene.MethodsWe conducted a cross-sectional study to evaluate associations between residential prenatal exposure to contaminated drinking water at Camp Lejeune during 1968–1985 and preterm birth, small for gestational age (SGA), term low birth weight (TLBW), and mean birth weight (MBW) deficit. Birth certificates identified mothers residing at Camp Lejeune at delivery. We analyzed exposure data for the entire pregnancy and individual trimesters. For each period examined, births were categorized as unexposed if mothers did not reside at Camp Lejeune or if their residence on base received uncontaminated drinking water. Ground water contaminant fate/transport and distribution system models provided monthly estimated contaminant levels at residences. For PCE and TCE, the exposed group was divided into four levels: < median value, ≥ median value, ≥75th percentile, and ≥90th percentile. For benzene, the exposed group was categorized as <1 part per billion (ppb) versus ≥1 ppb because of sparse data. Magnitude of effect estimates and exposure response relationships were used to assess associations. Confidence intervals (CIs) indicated precision of estimates.ResultsFor the highest TCE exposure category during the entire pregnancy, odds ratios (ORs) were 1.5 (95% CI: 1.2, 1.9) and 1.3 (95% CI: 0.8, 2.2) for SGA and TLBW, respectively, and reduced MBW β = −78.3 g (95% CI: −115.0, −41.7). The OR =1.3 (95% CI: 1.0, 1.6) for preterm birth and the highest PCE exposure category during the entire pregnancy. Monotonic exposure-response relationships were observed for benzene exposure during the entire pregnancy and TLBW (highest category OR =1.5, 85% CI: 0.9, 2.3). Although a monotonic association between benzene and adjusted MBW difference was also observed (highest category β = −36.2 g, 95% CI: −72.3, −0.1), the association disappeared when TCE was also added to the model. We found no evidence suggesting any other associations between outcomes and exposures.ConclusionFindings suggested associations between in utero exposures to TCE and SGA, TLBW and reduced MBW; benzene and TLBW; and PCE and preterm birth.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-13-99) contains supplementary material, which is available to authorized users.

Low birth weight is a risk factor for severe retinopathy of prematurity depending on gestational age.

ObjectiveTo evaluate the impact of low birth weight as a risk factor for retinopathy of prematurity (ROP) that will require treatment in correlation with gestational age at birth (GA).Study designIn total, 2941 infants born <32 weeks GA were eligible from five cohorts of preterm infants previously collected for analysis in WINROP (Weight IGF-I Neonatal ROP) from the following locations: Sweden (EXPRESS) (n = 426), North America (n = 1772), Boston (n = 338), Lund (n = 52), and Gothenburg (n = 353). Data regarding GA at birth, birth weight (BW), gender, and need for ROP treatment were retrieved. Birth weight standard deviation scores (BWSDS) were calculated with Swedish as well as Canadian reference models. Small for gestational age (SGA) was defined as BWSDS less than −2.0 SDS using the Swedish reference and as BW below the 10th percentile using the Canadian reference charts.ResultsUnivariate analysis showed that low GA (p<0.001), low BW (p<0.001), male gender (p<0.05), low BWSDSCanada (p<0.001), and SGACanada (p<0.01) were risk factors for ROP that will require treatment. In multivariable logistic regression analysis, low GA (p<0.0001), male gender (p<0.01 and p<0.05), and an interaction term of BWSDS*GA group (p<0.001), regardless of reference chart, were risk factors. Low BWSDS was less important as a risk factor in infants born at GA <26 weeks compared with infants born at GA ≥26 weeks calculated with both reference charts (BWSDSSweden, OR = 0.80 vs 0.56; and BWSDSCanada, OR = 0.72 vs 0.41).ConclusionsLow BWSDS as a risk factor for vision-threatening ROP is dependent on the infant's degree of immaturity. In more mature infants (GA ≥26 weeks), low BWSDS becomes a major risk factor for developing ROP that will require treatment. These results persist even when calculating BW deficit with different well-established approaches.

Relationship of birth weight with congenital cardiovascular malformations in a population-based study.

A known comorbidity of congenital cardiovascular malformations is low birth weight, but the reasons for this association remain obscure. This retrospective study examines the relationship between congenital cardiovascular malformations and the birth weight of singletons, taking into account differences in gestational age and other factors. Using data from the retrospective, population-based Baltimore-Washington Infant Study, six types of congenital cardiovascular malformations were investigated in comparison with controls (n=3519) through linear regression: d-transposition of the great arteries (n=187), other conotruncal heart defects (n=361), endocardial cushion defects (n=281), left heart obstructive lesions (n=507), atrial septal defects (n=281), and membranous ventricular septal defects (n=622). Infants with conotruncal heart defects (-218 g), endocardial cushion defects with Down syndrome (-265 g), endocardial cushion defects without Down syndrome (-194 g), left heart obstructive lesions (-143 g), atrial septal defects (-150 g), and membranous ventricular septal defects (-127 g) showed significant birth weight deficits, adjusting for gestational age, and other covariates. Infants with d-transposition of the great arteries (-67 g) did not show significant birth weight deficits compared with the control group. The degree of birth weight decrement appears to be highly related to the specific type of congenital cardiovascular malformation. As a whole, these infants do not exhibit low birth weights solely because of being premature, and thus other mechanisms must underlie these associations.

Does multiple gestation impact birthweight deficit from smoking?

To test the hypothesis that the combined birthweight deficit from smoking in twin gestation is significantly greater than previously described for singletons. Retrospective cohort study of White/Black live-born twins, 32 to 40 weeks of gestation, 1990 to 2005, Kansas City, MO. Data were analyzed by t-test, χ(2), linear and linear regression analyses. The cohort comprised 1190 twin pairs, 58% Whites and 55% ≥37 weeks. Smoking rate was 14.5% and similar by race (14.2% White vs 14.8%, P=0.772). The aggregate birthweight of twins of nonsmokers was greater, 5116 g ± 25 g vs 4870 g ± 59 g, P<0.001 (mean±s.d.) and the difference was 264 g (95% confidence interval, 156 to 372 g) after adjusting for other variables in linear regression analyses. Smoking-associated growth restriction in twins is quantitatively similar to that of singletons. This finding is suggestive of dissipation or a ceiling effect to the growth-restricting effect of cigarette smoking.

Short‐ and long‐term effects of exposure to natural and synthetic glucocorticoids during development

1.Glucocorticoids (GCs) are necessary for fetal development, but clinical and experimental studies suggest that excess exposure may be detrimental to health in both the short and longer term. 2.Exposure of the fetus to synthetic GCs can occur if the mother has a medical condition requiring GC therapy (e.g. asthma) or if she threatens to deliver her baby prematurely. Synthetic GCs can readily cross the placenta and treatment is beneficial, at least in the short term, for maternal health and fetal survival. 3.Maternal stress during pregnancy can raise endogenous levels of the natural GC cortisol. A significant proportion of the cortisol is inactivated by the placental 'GC barrier'. However, exposure to severe stress during pregnancy can result in increased risk of miscarriage, low birth weight and behavioural deficits in children. 4.Animal studies have shown that excess exposure to both synthetic and natural GCs can alter normal organ development, including that of the heart, brain and kidney. The nature and severity of the organ impairment is dependent upon the timing of exposure and, in some cases, the type of GC used and the sex of the fetus. 5.In animal models, exposure to elevated GCs during pregnancy has been associated with adult-onset diseases, including elevated blood pressure, impaired cardiac and vascular function and altered metabolic function.

Prenatal Secondhand Smoke Exposure and Infant Birth Weight in China

Epidemiologic evidence provides some support for a causal association between maternal secondhand smoke (SHS) exposure during pregnancy and reduction in infant birth weight. The purpose of this cross-sectional study is to examine the magnitude of this association in China, where both prevalence and dose of SHS exposure are thought to be higher than in U.S. populations. Women who gave birth in Beijing and Changchun September 2000–November 2001 were interviewed to quantify self-reported prenatal SHS exposure. Their medical records were reviewed for data on pregnancy complications and birth outcomes. Non-smoking women who delivered term babies (≥37 weeks gestation) were included in the study (N = 2,770). Nearly a quarter of the women (24%) reported daily SHS exposure, 47% reported no prenatal exposure, and 75% denied any SHS exposure from the husband smoking at home. Overall, no deficit in mean birth weight was observed with exposure from all sources of SHS combined (+11 grams, 95% CI: +2, +21). Infants had higher mean birth weights among the exposed than the unexposed for all measures of SHS exposure. Future studies on SHS exposure and infant birth weight in China should emphasize more objective measures of exposure to quantify and account for any exposure misclassification.