Birth Weight In Grams Research Articles

Maternal dioxin-dietary patterns, prenatal exposure to dioxins and dioxin-like compounds, and birth outcomes in a European Mother-Child Study (NewGeneris)

Background Diet is the main source of exposure to dioxins and dioxin-like compounds for the general population. The diet of pregnant women may affect exposure of the foetus to environmental contaminants and influence foetal growth. Aim We investigated the association between maternal diet and biomarker assessed dioxin levels in maternal and cord blood with birth outcomes in a European prospective mother-child study (NewGeneris). Methods Plasma dioxin-like activity was estimated by the Dioxin-Responsive Chemically Activated LUciferase eXpression (DR-CALUX) bioassay in maternal (n=604) and cord (n=198) blood samples collected at delivery in Denmark, England, Greece, Norway and Spain. We used food frequency questionnaires to assess maternal diet and reduced rank regression to identify two dioxin-dietary patterns related to maternal and cord blood dioxin levels (in DR-CALUX TEQ pg/g lipid), respectively. The dioxin-dietary pattern scores described participants’ adherence to each of the two dietary patterns. Results The dioxin-dietary pattern score was positively correlated with dioxin (DR-CALUX) levels in cord blood (rho=0.35, p<0.001) and was characterised by high maternal consumption of red and white meat, low-fat dairy and fast-food and low consumption of fatty fish and high-fat cheese. Dioxin-dietary pattern score in the upper tertile was associated with a reduction of half week in gestational age (95%CI:-1.0 to 0.0) and a non-significant reduction of 73 grams in birth weight (95%CI:-237 to 90) compared to the lower tertile, after adjustment for confounders. Similar negative adjusted associations with birth outcomes were observed for the dioxin-dietary score that was linked to dioxin (DR-CALUX) levels in maternal blood. Conclusions Maternal diet contributes to the exposure of the foetus to dioxins and dioxin-like compounds. We provide evidence that a dioxin-rich diet may be related to reduced gestational age and birth weight, mediated by high prenatal exposure to dioxin and dioxin-like compounds.

Perinatal mortality following assisted reproductive technology treatment in Australia and New Zealand, a public health approach for international reporting of perinatal mortality

BackgroundThere is a need to have uniformed reporting of perinatal mortality for births following assisted reproductive technology (ART) treatment to enable international comparison and benchmarking of ART practice.MethodsThe Australian and New Zealand Assisted Reproduction Database was used in this study. Births of ≥ 20 weeks gestation and/or ≥ 400 grams of birth weight following embryos transfer cycles in Australia and New Zealand during the period 2004 to 2008 were included. Differences in the mortality rates by different perinatal periods from a gestational age cutoff of ≥ 20, ≥ 22, ≥ 24, or ≥ 28 weeks (wks) to a neonatal period cutoff of either < 7 or < 28 days after birth were assessed. Crude and specific (number of embryos transferred and plurality) rates of perinatal mortality were calculated for selected gestational and neonatal periods.ResultsWhen the perinatal period is defined as ≥ 20 wks gestation to < 28 days after birth, the perinatal mortality rate (PMR) was 16.1 per 1000 births (n = 630). A progressive contraction of the gestational age groups resulted in marked reductions in the PMR for deaths at < 28 days (22 wks 11.0; 24 wks 7.7; 28 wks 5.6); and similarly for deaths at < 7 days (20 wks 15.6, 22 wks 10.5; 24 wks 7.3; 28 wks 5.3). In contrast, a contraction of the perinatal period from < 28 to < 7 days after birth only marginally reduced the PMR from 16.2 to 15.6 per 1000 births which was consistent across all gestational ages.The PMR for single embryo transfer (SET) births (≥ 20 weeks gestation to < 7 days post-birth) was significantly lower (12.8 per 1000 SET births) compared to double embryo transfer (DET) births (PMR 18.3 per 1000 DET births; p < 0.001, Fisher’s Exact Test). Similarly, the PMR for SET births (≥ 22 weeks gestation to < 7 days post-birth) was significantly lower (8.8 per 1000 SET births, p < 0.001, Fisher’s Exact Test) when compared to DET births (12.2 per 1000 DET births). The highest PMR (50.5 per 1000 SET births, 95% CI 36.5-64.5) was for twins following SET births (≥ 20 weeks gestation to < 7 days post-birth) compared to twins following DET (23.9 per 1000 DET births, 95% CI 20.8-27.1).ConclusionReporting of perinatal mortality of ART births is an essential component of quality ART practice. This should include measures that monitor the impact on perinatal mortality of multiple embryo transfer. We recommend that reporting of perinatal deaths following ART treatment, should be stratified for three gestation-specific perinatal periods of ≥ 20, ≥ 22 and ≥ 28 completed weeks to < 7 days post-birth; and include plurality specific rates by SET and DET. This would provide a valuable international evidence-base of PMR for use in evaluating ART policy, practice and new research.

Higher prevalence of pregnancy induced hypertension following assisted reproductive technology treatment

Given the higher proportion of women at older age accessing assisted reproductive technology (ART) and higher rate of multiple pregnancies after ART, it was suggested that ART is related with increased risk of pregnancy induced hypertension (PIH). The objective of this population study is to determine the association between ART and the prevalence of PIH controlling for age and plurality. A population cross-sectional study using National Perinatal Data Collection during 2007 and 2009 from five states in Australia. The study included 400392 mothers (3.6% of ART mothers) who gave births of ≥ 20 weeks of gestation or ≥ 400 grams of birthweight. Logistic regression was used to assess the association between ART and GD. Adjusted odds ratio (AOR) and 95% confidence intervals (CI) were calculated. The overall prevalence of PIH was 4.5%, with ART mothers having significantly higher prevalence of PIH (prevalence 6.9%) than non-ART mothers (4.5%). The prevalence of PIH was higher for mothers who had twins than those who had singletons (13.0% vs 6.1% for ART mothers, and 8.8% vs 4.4% for non-ART mothers). After controlling for age, parity, body mass index and other demographics, ART mothers had 24% increased odds of PIH compared to non-ART mothers (AOR 1.24, 95% CI 1.15-1.33). Of mothers who had singletons, ART mothers had 11% higher odds of PIH than non-ART mothers (AOR 1.11, 95% CI 1.02-1.20). Of mothers who had twins, ART mothers had 1.25 times higher odds of PIH than non-ART mothers (AOR 1.25, 95% CI 1.03-1.53). The 24% increased likelihood of PIH of ART mothers than non-ART mothers after controlling for co-existing risk factors indicates either factors associated with subfertility or the ART procedures may be associated with increased odds of PIH. The lower prevalence of PIH among singleton mothers compared to twins suggests that a policy of single embryo transfer may reduce the excess risk of PIH due to ART.

The Effects of CenteringPregnancy Group Prenatal Care on Gestational Age, Birth Weight, and Fetal Demise

We examined the effects of CenteringPregnancy group prenatal care versus individually delivered prenatal care on gestational age, birth weight, and fetal demise. We conducted a retrospective chart review and used propensity score matching to form a sample of 6,155 women receiving prenatal care delivered in a group or individual format at five sites in Tennessee. Compared to the matched group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had longer weeks of gestation (b = .35, 95 % CI [.29, .41]), higher birth weight in grams (b = 28.6, 95 % CI [4.8, 52.3]), lower odds of very low birth weight (OR = .21, 95 % CI [.06, .70]), and lower odds of fetal demise (OR = .12, 95 % CI [.02, .92]). Results indicated no evidence of differences in the odds of preterm birth or low birth weight for participants in group versus individual prenatal care. CenteringPregnancy group prenatal care had statistically and clinically significant beneficial effects on very low birth weight and fetal demise outcomes relative to traditional individually delivered prenatal care. Group prenatal care had statistically significant beneficial effects on gestational age and birth weight, although the effects were relatively small in clinical magnitude.

Relaxation therapy for preventing and treating preterm labour

Preterm birth (PTB) is a leading cause of perinatal mortality and morbidity. Although the pathogenesis of preterm labour (PTL) is not well understood, there is evidence about the relationship between maternal psychological stress and adverse pregnancy outcomes. Relaxation or mind-body therapies cover a broad range of techniques, e.g. meditation, massage, etc. There is no systematic review investigating the effect of relaxation techniques on preventing PTL and PTB. This review does not cover hypnosis as this is the subject of a separate Cochrane review. To assess the effectiveness of relaxation therapies for preventing or treating PTL and preventing PTB. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 December 2011),CENTRAL (2011, Issue 4 of 4), CINAHL (1982 to 14 December 2011) and contacted study authors for additional information. Randomized controlled trials, cluster- and quasi-randomized trials comparing relaxation techniques with usual care, no treatment or sham interventions to prevent or treat PTL. Two review authors (B Khianman (BK) and P Pattanittum (PP)) independently assessed all search results for potential inclusion studies. Disagreements were resolved by discussion with a third review author (J Thinkhamrop (JT)). Data were independently extracted onto the standardized data collection form by BK and PP and checked for accuracy. Two review authors independently assessed the risk of bias of all included studies. All differences were resolved by discussion with JT. Mean difference (MD) and its 95% confidence intervals (CI) were calculated for continuous outcomes and risk ratio (RR) and 95% CI for dichotomous data. Eleven randomized controlled trials with a total of 833 women were included in this review. However, the results of this review are based on single studies with small numbers of participants.The majority of included studies reported insufficient information on sequence generation, allocation concealment as well as blinding. There were no included studies that assessed PTL or PTB as the primary outcome. The included studies were different in terms of intervention, practice, and time, and there were no clear coherent hypotheses.For women not in PTL, the benefits of relaxation was found in one study for maternal stress (Anxiety Stress Scale) at 26 to 29 weeks gestational age (mean difference (MD) -7.04; 95% confidence interval (CI) -13.91 to -0.17). In addition, there were some beneficial effects of relaxation including baby birthweight (MD 285.00 g; 95% CI 76.94 to 493.06); type of delivery; (vaginal delivery; risk ratio (RR) 1.52; 95% CI 1.13 to 2.04), (cesarean section; RR 0.38; 95% CI 0.19 to 0.78); maternal anxiety (MD -15.79; 95% CI -18.33 to -13.25); and stress (MD -13.08; 95% CI -15.29 to -10.87) when applying relaxation therapy together with standard treatment. For women in PTL, the results for the main outcome of PTB in the intervention and control groups from a single study were not different (RR 0.95; 95% CI 0.57 to 1.59). The MD of birthweight in grams from the fixed-effect model from two included studies was MD -5.68; (95% CI -174.09 to 162.74). According to the results of this review, there is some evidence that relaxation during pregnancy reduces stress and anxiety. However, there was no effect on PTL/PTB. These results should be interpreted with caution as they were drawn from included studies with limited quality.

Incidence and severity of retinopathy of prematurity in extremely premature infants

ObjectiveTo analyze incidence and severity of retinopathy of prematurity (ROP) among extremely premature infants. DesignRetrospective, longitudinal study. ParticipantsWe studied the data concerning 207 infants whose gestational ages (GAs) were equal to 27 weeks or fewer and who were admitted to a neonatal intensive care unit between July 2006 and July 2010. MethodsData were extracted from the Canadian Neonatal Network, which maintains clinical information about neonates, and were confirmed by reviewing medical charts. Infants were classified into 2 groups: the GAs of the infants in group 1 were ≤ 25 weeks; those in group 2 had GAs between 26 and 27 weeks. The incidence and severity of ROP were assessed in the total screened population and between groups. ResultsThe overall incidence of any ROP was 64.7%; 88% of infants in group 1 had any ROP compared to 48% infants in group 2. The overall incidence of type 1 ROP was 11.6%; in group 1 it was 24.4%, compared to 2.5% in group 2. Type 1 ROP was significantly associated with birth weight in grams (p < 0.001; OR = 8.20) and GA (p < 0.001; OR = 2.46). There was no difference in mean postmenstrual age at first ROP onset between group 1 and group 2 (33.5 vs 33.9 weeks, respectively). PMA at time of ROP diagnosis was not associated with development of type 1 ROP (p = 0.75; OR = 0.94; CI 0.62–1.41). ConclusionsExtremely premature infants with lower GA had a higher incidence of type 1 ROP. Earlier presentation of ROP did not predict development of type 1 ROP. No infant with a GA > 26 weeks at birth or birth weight > 1000 g had type 1 ROP.

Disproportionate body composition and perinatal outcome in large‐for‐gestational‐age infants to mothers with type 1 diabetes

To determine if disproportionate body composition is a risk factor for perinatal complications in large-for-gestational-age infants born to mothers with type 1 diabetes. Population-based cohort study. Data from the Swedish Medical Birth Registry from 1998 to 2007. National cohort of 3517 infants born to mothers with type 1 diabetes. Only singletons with gestational age 32-43 weeks were included. Large for gestational age (LGA) was defined as birthweight > 90th centile and appropriate for gestational age (AGA) as birthweight between 10th and 90th centiles. Disproportionate (D) infants were defined as having a ponderal index [PI: calculated as birthweight in grams/(length in cm)(3) > 90th centile] and proportionate (P) as PI ≤ 90th centile. LGA infants were classified as P-LGA or D-LGA. Odds ratios were calculated for D-LGA and P-LGA infants, with AGA infants as the reference category. Odds ratios were adjusted for mode of delivery, fetal distress and stratified by gestational age. The primary outcome was a composite of neonatal morbidities, i.e. any of the following diagnoses: Apgar score < 7 at 5 minutes, birth trauma (Erb's palsy or clavicle fracture), respiratory disorder, hyperbilirubinaemia or hypoglycaemia requiring treatment. Composite morbidity was significantly more frequent in LGA as opposed to AGA infants, but there was no difference in risk between P-LGA and D-LGA infants. High birthweight, irrespective of body proportionality, is a risk factor for neonatal complications in offspring of women with type 1 diabetes.

355: Gastroschisis: a new fetal weight formula to predict birthweight

formula to predict birthweight Kiran Tam Tam, Laura Bufkin, James Bofill University of Mississippi Medical Center, Maternal Fetal Medicine, Jackson, MS OBJECTIVE: To derive a sonographic fetal weight formula for fetuses with gastroschisis and evaluate it against the Shepards (1982) formula in the prediction of birth weight (BW). STUDY DESIGN: Retrospective review of 115 cases of gastroschisis after 2000. A fetal weight formula was derived by multiple linear regression analysis using BW and sonographic fetal biometry (obtained within 7 days of birth) of 41 infants with gastroschisis. This formula and the Shepard (1982) formula were then used to calculate the estimated fetal weight (EFW) of 25 other infants with gastroschisis that were delivered within 2 weeks of fetal biometry measurements. The accuracy of the two formulas to predict the actual birth weight (ABW) in these 25 infants was evaluated. RESULTS: Head circumference (HC; P 0.001) and abdominal circumference (AC; P 0.001) measured in centimeters were significant predictors of BW in grams (BW 4079.683 (134.430 * HC) (80.717 * AC). The correlation coefficient and the standard error of estimate was 0.8 and 247 grams respectively. The mean difference in EFW and ABW ( / standard error of the mean) for this and Shepards formula was 212 / 56 grams and 392 / 54 grams respectively (P 0.025). CONCLUSION: The sonographic fetal weight formula derived from the biometry of fetuses with gastroschisis is more accurate in the prediction of BW of infants with this anomaly than the Shepards (1982) formula.

The association of maternal age with placental weight: a population‐based study of 536 954 pregnancies

To study the association of maternal age with placental weight, birthweight and placental weight/birthweight ratio. Population-based study. Medical Birth Registry of Norway. All singleton births in Norway in the period 1999-2008 (n = 536,954). Z-scores of placental weight and birthweight were calculated and divided into deciles. The proportions with a small or a large placenta were calculated within each maternal age group. Also, the odds ratios of having a small (lowest decile) and a large (highest decile) placenta, according to maternal age, were estimated, with and without adjustment for birthweight in grams, parity, smoking, pre-eclampsia and diabetes. Placental weight, birthweight and placental weight/birthweight ratio. The mean placental weight increased with maternal age: 647.1 g in women below the age of 20 years and 691.3 g in women aged 45 years or older. Among the oldest group of women (≥45 years) 15.8% of placentas were in the highest decile of placental weight z-score, whereas this was true for just 7.0% of women below the age of 20 years (Wald test, P < 0.001). Using women younger than 20 years of age as a reference, the odds ratio for having a placenta in the highest decile of placental weight z-score was 2.50 (95% CI 1.92-3.26) for women aged 45 years or older, after adjustment for offspring birthweight, parity, maternal smoking, pre-eclampsia and diabetes. We found an association between increased placental weight and maternal age, and this finding may be important in understanding the causes of adverse events associated with high maternal age.

Documentos médicos de la defunción actualizados: certificado médico de defunción y boletín estadístico de parto

Public health physicians have constantly urged that the Medical Death Certificate (CMD in Spain) and the notification of perinatal deaths be adapted to WHO standards. The new CMD came into effect in January 2009, whilst significant changes were made to the Birth Statistics Bulletin (BEP acronym in Spanish) in 2007. In this article the certifying doctor is informed on their novel and key aspects. The health significance of this medico-legal act is emphasised. At the same time associated issues are mentioned that still need to be resolved in Spain. The CMD unifies the medical cerificate and the death statistics bulletin on one form and complies with WHO recommendations. It asks whether the death has been the result of an already registered traffic or work accident, and if an autopsy (clinical) has been performed. For place of death, it means the place where the cadaver has been recognised and the death certified. The approximate time of the causes of death must also be indicated. The BEP registers the births and deaths in labour. It includes the education level and occupation levels of the mother and father, and still has the number of weeks gestation and the birth weight in grams. Notification of legal deaths and perinatal deaths still need to be improved; the confidential transfer of causes of death to doctors and researchers; and death statistics according to cause with less delay between the events and their availability and publication

Screening and treatment of retinopathy of prematurity in Markusovszky Teaching Hospital, 1989–2009 (20 years of experiences)

The aims of this study was to obtain the frequency and therapy of retinopathy of prematurity (ROP) in Markusovszky Teaching Hospital, Szombathely, Hungary. A population based study on ophthalmological status of preterm infants was performed, between 01.01.1989 and 01.01.2009. During the study period, ophthalmological status was detected in 543 premature infants. Among them, 34 children (6.3%) suffered from retinopathy of prematurity, and all of them were bilateral. ROP occurred in the highest rate (23/78 cases, 29.5%) at the birth weight of lower than 1000 grams, but frequency was only l.2% (2/169 cases) between weight 1250-1500 grams. Spontaneous recovery was observed in 19 eyes of 10 cases. The frequency of spontaneous resolution was 40% and 50% in the group of larger birth weight: between 1251-1500 grams and weight > or = 1500 grams, but on the other hand, complete recovery was only 26% (6/23 cases) below 1000 grams of birth weight. "Threshold retinopathy" (stage 3 plus), that needed therapy was detected in 25 children's 49 eyes. Cryotherapy was performed in both eyes of 16 children (32 eyes), laser photocoagulation was performed in 9 patients (16 eyes). ROP regressed after cryotherapy in 26 eyes, but in 6 eyes symptoms progressed to stage 5. After laser photocoagulation, recovery was observed in 16 eyes; this therapy was not successful in only one case. According to our experiences, stage 5 ROP developed only in two patients' both eyes, and in 1-1 eye of three children, during the 20 years of study. Our ophthalmological screening program proved that providing cryopexia or laser photocoagulation in time, severe visual impairment of retinopathy can be prevented. In spite of the few number of patients, this population based investigation with a long duration (20 years) offers new data in Hungarian ROP epidemiology.

Evidence for an Effect of Fetal Growth on the Risk of Tuberculosis

We examined the risk of tuberculosis in relation to birth weight and ponderal index among 21,596 Swedish twins born from 1926 through 1958. Using a cohort design, tuberculosis risk was 11% lower for every 500 g of birth weight (P = .05) and 8% lower for every 0.2 of ponderal index, calculated as birth weight in grams multiplied by 100 and divided by the cube of birth length in centimeters (P = .08). The association between birth weight and tuberculosis was stronger in male individuals than in female individuals. In co-twin control analyses among disease-discordant monozygotic twins, tuberculosis risk was 46% lower for every 500 g of birth weight (P = .05). The association was stronger in male individuals (87% risk reduction; P = .02) than it was in female individuals (16% reduction; P = .62). A similarly stronger relation with male sex, compared with female sex, was found for ponderal index. Because associations among monozygotic twins are largely independent of shared genetic or environmental factors, we postulate that fetal growth may play a causal role in susceptibility to tuberculosis, possibly through early programming of immunity.

Association Between Low Birthweight and Air Pollution in an Industrial Brazilian City

ISEE-0777 Introduction and Background: Vitória is a Brazilian industrial city by the seashore, which has faced an increase in the automotive fleet in the last decade and, consequently, air pollution levels. The exposure of pregnant women and children to environmental toxic agents has been a more frequent concern. Some studies have been carried out to both identifying and preventing the effects of these agents in the human being. Among these studies, a considerable part has focused on alterations that these exposures can cause on fetal development and growth. This study aims to investigate the association between birth weight and atmospheric pollution from January 2001 to December 2004, in the city of Vitória. Methods: This is a historical cohort study of pregnant women. Birth weight and information on mother and pregnancy were obtained at the Brazilian “Born Alive National Information System” (SINASC, in Portuguese). Daily records of air pollutants (PM10, NO2, SO2 and O3), temperature and relative humidity of air for the study period were obtained from the São Paulo State Environmental Agency (CETESB). Associations between birth weight and air pollutants mean levels at each gestational trimester were investigated using both linear and logistic regression models. Results: 16,316 births were registered in the period and in 91% of them newborns presented weight above 2,500 grams. An increase of 10 μg/m3in the mean level of PM10 in the third trimester of pregnancy was associated with a decrease of 50.7 grams in birth weight. The effect of PM10 was robust, remaining significant in a logistic regression model, OR=1.32 (CI95%: 1.01; 1.71), showing a dose-dependent behavior (PM10 quartiles). Conclusion: Our findings suggest that even at concentrations below the standards of air quality, there is an association between variations of PM10 and low birth weight.

The impact of Mexico’s conditional cash transfer programme, Oportunidades, on birthweight

To evaluate the impact of Oportunidades, a large-scale, conditional cash transfer programme in Mexico, on birthweight. The programme provides cash transfers to low-income, rural households in Mexico, conditional on accepting nutritional supplements health education, and health care. The primary analyses used retrospective reports from 840 women in poor rural communities participating in an effectiveness study and randomly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states. Pregnant women in participating households received nutrition supplements and health care, and accepted cash transfers. Using multivariate and instrumental variable analyses, we estimated the impact of the programme on birthweight in grams and low birthweight (<2500 g), receipt of any pre-natal care, and number of pre-natal visits. Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight. The Oportunidades conditional cash transfer programme improved birthweight outcomes. This finding is relevant to countries implementing conditional cash transfer programmes.

Risk factors for necrotizing enterocolitis in preterm infants: how race, gender, and health status contribute.

To examine 5 infant characteristics and health factors that might be risk factors for necrotizing enterocolitis (NEC) in preterm infants. One hundred thirty-four preterm infants at high risk for NEC because of either having a birth weight of <1500 g or requiring mechanical ventilation at birth. Descriptive secondary analysis using data from a larger longitudinal study. Weekly review of infants' medical record until discharge; demographic questionnaire completed by mothers at the time of enrollment; and data analysis done with logistic regression, Fischer's exact tests, and correlations. Total number of days the infant required mechanical ventilation, birth weight in grams, number of infections prior to NEC diagnosis, maternal race (black, white, or Asian), and infant gender were used to predict the development of NEC. Maximum likelihood estimates indicated that mechanical ventilation had a positive relationship with developing NEC, such that as the number of days of mechanical ventilation increased so did the risk of developing NEC. There was also a very strong positive relationship between the number of nosocomial infections and NEC, indicating that as the number of infections increased, the likelihood of developing NEC increased. Although the relationship between race and NEC was not significant in the logistic regression, the Fisher exact test showed that black preterm infants had increased incidence of NEC as compared with other races. This relationship was not due to correlations between race and mechanical ventilation or infections. No relationship between gender and NEC was noted. Birth weight was not significantly associated with NEC in the logistic regression but was correlated with NEC, probably because of its correlation with mechanical ventilation and number of infections. In this sample, number of infections and length of mechanical ventilation were the primary predictors of NEC in preterm infants. In addition, the frequency that black infants are diagnosed with NEC is significantly higher than that of other races. Knowledge of risk factors for NEC can allow healthcare providers to evaluate and adjust care practices for preterm infants who present with higher risk for NEC on the basis of empirical data.

Moderate Alcohol Consumption During Pregnancy and the Risk of Low Birth Weight and Preterm Birth. The Generation R Study

To examine the associations of alcohol consumption in different periods of pregnancy with the risks of low birth weight and preterm birth. This study was based on 7141 subjects participating in a population-based prospective cohort study from early pregnancy. Alcohol consumption was assessed in early, mid, and late pregnancy. Birth outcomes were birth weight in grams, low birth weight (<2500 g), small size for gestational age at birth (< -2 standard deviation scores) and preterm birth (gestational age <37 weeks). Overall, alcohol consumption during pregnancy was not associated with adverse birth outcomes. However, dose-response analyses showed tendencies toward adverse effects of average consumption of 1 or more alcoholic drinks per day in early pregnancy on birth weight (difference -129 g [95% confidence interval (CI): -271, 12]), low birth weight (adjusted odds ratio [aOR] 4.81 [95% CI: 1.10, 21.08]), small size for gestational age at birth (aOR 1.45 [95% CI: 0.33, 6.44]) and preterm birth (aOR 2.51 [95% CI: 0.92, 6.81]). Similar effects were found in late pregnancy. Average consumption of one or more but not less than one alcoholic drink per day in early or late pregnancy seems to be associated with adverse birth outcomes in the offspring.

Impact of ambient air pollution on birth weight in Sydney, Australia

Background: Studies in Asia, Europe, and the Americas have provided evidence that ambient air pollution may have an adverse effect on birth weight, although results are not consistent. Methods: Average...

Fetal ponderal index is more sensitive than birthweight-to-gestational age to predict fetal and neonatal mortality

ObjectiveTo establish whether the fetal ponderal index (PI) is more effective than neonatal birthweight-for- gestational age (BGA) to predict fetal and neonatal outcome.Study designA retrospective analysis of our perinatal database was performed from January 1, 1992 to December 31, 1999. The ponderal index (PI) was defined as birthweight in grams ×100/ Crown- heel length3. SGA-infant was defined as less than 10th percentile of BGA and LGA-infant, as more than 90th percentile of BGA according to Fetal Peruvian Growth Charts (Hernandez et al, Annals UNMSM 1976).ResultsDuring the study period, the rate of fetal death was 70,3 × 1000 (3617/51439) and neonatal death was 11.6 × 1000 (555/47673). Among 47773 neonates, PI was 2.75 ± 0.50 g/cm3 (mean ± SD). Normal PI was considered between 2.41 and 3.07 (10th and 90th percentiles). Fetal undernourishment (FU) was defined as PI less than 241 and Fetal Obesity (FO) as PI greater than 3.07.ConclusionTabled 1PI and BGA as predictors of perinatal outcomeOutcomeSensitivSpecificPPVNPVFetal death FU/SGA0.46/0.360.90/0.920.03/0.030.99/0.99Fetal death FO/LGA0.17/0.030.89/0.930.14/0.210.99/0.99Neonatal death FU/SGA0.47/0.320.90/0.930.05/0.050.99/0.99Neonatal death FO/LGA0.11/0.020.89/0.930.01/0.0040.98/0.98Morbidity FU/SGA0.19/0.200.91/0.940.27/0.410.86/0.87Morbidity FO/LGA0.10/0.100.93/0.890.14/0.210.85/0.85 Open table in a new tab ObjectiveTo establish whether the fetal ponderal index (PI) is more effective than neonatal birthweight-for- gestational age (BGA) to predict fetal and neonatal outcome. To establish whether the fetal ponderal index (PI) is more effective than neonatal birthweight-for- gestational age (BGA) to predict fetal and neonatal outcome. Study designA retrospective analysis of our perinatal database was performed from January 1, 1992 to December 31, 1999. The ponderal index (PI) was defined as birthweight in grams ×100/ Crown- heel length3. SGA-infant was defined as less than 10th percentile of BGA and LGA-infant, as more than 90th percentile of BGA according to Fetal Peruvian Growth Charts (Hernandez et al, Annals UNMSM 1976). A retrospective analysis of our perinatal database was performed from January 1, 1992 to December 31, 1999. The ponderal index (PI) was defined as birthweight in grams ×100/ Crown- heel length3. SGA-infant was defined as less than 10th percentile of BGA and LGA-infant, as more than 90th percentile of BGA according to Fetal Peruvian Growth Charts (Hernandez et al, Annals UNMSM 1976). ResultsDuring the study period, the rate of fetal death was 70,3 × 1000 (3617/51439) and neonatal death was 11.6 × 1000 (555/47673). Among 47773 neonates, PI was 2.75 ± 0.50 g/cm3 (mean ± SD). Normal PI was considered between 2.41 and 3.07 (10th and 90th percentiles). Fetal undernourishment (FU) was defined as PI less than 241 and Fetal Obesity (FO) as PI greater than 3.07. During the study period, the rate of fetal death was 70,3 × 1000 (3617/51439) and neonatal death was 11.6 × 1000 (555/47673). Among 47773 neonates, PI was 2.75 ± 0.50 g/cm3 (mean ± SD). Normal PI was considered between 2.41 and 3.07 (10th and 90th percentiles). Fetal undernourishment (FU) was defined as PI less than 241 and Fetal Obesity (FO) as PI greater than 3.07. ConclusionTabled 1PI and BGA as predictors of perinatal outcomeOutcomeSensitivSpecificPPVNPVFetal death FU/SGA0.46/0.360.90/0.920.03/0.030.99/0.99Fetal death FO/LGA0.17/0.030.89/0.930.14/0.210.99/0.99Neonatal death FU/SGA0.47/0.320.90/0.930.05/0.050.99/0.99Neonatal death FO/LGA0.11/0.020.89/0.930.01/0.0040.98/0.98Morbidity FU/SGA0.19/0.200.91/0.940.27/0.410.86/0.87Morbidity FO/LGA0.10/0.100.93/0.890.14/0.210.85/0.85 Open table in a new tab

Validity and Reliability of the Neonatal Skin Condition Score

To demonstrate the validity and reliability of the Neonatal Skin Condition Scale (NSCS) used in the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN) neonatal skin care evidence-based practice project. NICU and well-baby units in 27 hospitals located throughout the United States. Site coordinators (N = 27) and neonates (N = 1,006) observed during both the pre and postimplementation phases of the original neonatal skin care project. To assess reliability, two consecutive NSCS assessments on a single infant were analyzed. Site coordinators were contacted after the original project was concluded. Sites indicating that a single nurse scored all infant skin observations provided data that were used to evaluate intrarater reliability. Sites using more than one nurse to score skin observations provided data that were used to assess interrater reliability. To assess validity, the following variables were used from the original data set: the Neonatal Skin Condition Scale (NSCS), with three subscales for dryness, erythema, and breakdown; birth weight in grams; number of skin score observations for each infant; and the prevalence of infection, defined as a positive blood culture. For intrarater reliability, 16 sites used a single nurse for all NSCS assessments; total NSCS assessments 475. For interrater reliability, 11 sites used multiple raters; total assessments 531. The NSCS demonstrated adequate reliability for each of the three subscales and for the total score, with the percent agreement between scores ranging from 68.7% to 85.4% (intrarater) and 65.9% to 89% (interrater); all Kappas were significant at p < .001 and were in the moderate range for reliability. The validity of the NSCS was demonstrated by the findings that smaller infants were 6 times more likely to have erythema (chi2(6) = 109.55, p < .0001), and approximately twice as likely to have the most severe breakdown (chi2(6) = 108.01, p < .0001). Infants with more observations (longer length of stay) had higher skin scores (odds ratio = 1.21, p < .0001), and an increased probability of infection was noted for infants with higher skin scores (odds ratio = 2.25, p < .0001). The Neonatal Skin Condition Score (NSCS) is reliable when used by single and multiple raters to assess neonatal skin condition, even across weight groups and racial groups. Validity of the NSCS was demonstrated by confirmation of the relationship of the skin condition scores with birth weight, number of observations, and prevalence of infection.

Assessing the net effect of young maternal age on birthweight.

Pregnancy during adolescence presents an increased risk for low birthweight, which is attributed not only to physiologic immaturity but also to socioeconomic and behavioral risk factors associated with adolescence. The independent effect of maternal age on birthweight is difficult to ascertain because age is closely entangled with these risks. We first examined the effect of being an adolescent mother on these risk pathways and then estimated the net effect of maternal age on birthweight (weight in grams or low birthweight (<2500 g)) after controlling for these risks. We used data on 214 adolescent and 415 adult primiparae and their infants from the Cebu Longitudinal Health and Nutrition Survey, a community-based survey in Metro Cebu, Philippines. Consistent with findings from other studies, adolescents in this sample were more socioeconomically disadvantaged, had poorer nutritional status during pregnancy, and received less prenatal care than adults. Bivariate analyses showed that infants of adolescents had a lower mean birthweight and were more at risk of low birthweight compared to those born to older mothers. When socioeconomic, biological, and behavioral risk factors were controlled for, young maternal age ceased to have an effect on birthweight in grams but remained a significant predictor of low birthweight. The common pathways through which maternal age influenced both birthweight variables were through its effects on maternal height and weight-for-height during pregnancy. In the model predicting birthweight in grams the maternal age effect was further manifested through prenatal care utilization.