Birth Weight In Women Research Articles

Cannabis Use and Fetal Growth in Pregnant Women With Diabetes [18L

INTRODUCTION: Cannabis use during pregnancy is associated with lower birth weight, but little is known about the impact of prenatal cannabis use in women with co-morbidities. Our objective was to examine the association between cannabis use and birthweight in women with pre-existing and gestational diabetes. METHODS: We performed a retrospective cohort study at the Center for Diabetes and Pregnancy at Barnes Jewish Hospital from 2012 to 2016. Women who self-reported cannabis use or had positive maternal or infant drug screens for cannabinoids were compared with those who did not. The primary outcome was large for gestational age (LGA) defined as birthweight >90 percentile. Secondary outcomes were mean birthweight and small for gestational age (SGA, birthweight <10 percentile). Outcomes were compared between women who used cannabis and those who did not. Logistic regression was used to control for potential confounders. RESULTS: Of 298 women who received care during the study period, 12.8% (38) used prenatal cannabis. Women who used cannabis were more likely to have a history of depression and use tobacco. Birthweight was significantly lower in women who used cannabis (2,732 versus 3,170 g; P<.003). Women who used cannabis prenatally were 78% less likely to have babies who were LGA (5.3% versus 19.2%, aOR 0.22, 95% CI 0.05–0.98) after controlling for tobacco use. There was no significant difference in SGA. CONCLUSION: Women with diabetes who use cannabis during pregnancy have lower rates of LGA. Larger prospective studies are needed to determine the impact of prenatal cannabis use on maternal, neonatal, and childhood behavioral outcomes in women with diabetes.

Late Third Trimester Ultrasound Improves Accuracy of Predicted Birthweight in Women with Class III Obesity [32P

INTRODUCTION: Optimal timing of third trimester (3rd tri) ultrasound in the obese population is unclear. Later scans are technically difficult while earlier scans may not reflect clinical changes closer to term. We compared the accuracy of early versus late 3rd tri ultrasounds in predicting actual birthweight (BW) in women with class III obesity. METHODS: A retrospective chart review of women with a pre-pregnancy BMI>40kg/m2 who underwent both an early (28w0d-34w6d) and late 3rd tri scan (35w or greater) was performed. Subjects delivered at two urban tertiary centers. The gestation-adjusted projection method calculated a predicted BW (pBW) using the ultrasound EFW to allow for comparison with actual BW. Paired t-tests compared absolute BW error and percent error. McNemar’s test compared the proportion within 15% of actual BW between scans. RESULTS: 189 women were included. The difference between pBW and actual BW was similar with 75g (SD 367g) for the late scans versus 83g (SD 446g) for the early scans (p=0.765). However, 82.5% of women had a pBW within 15% of actual BW at the late scan compared to only 73% at the early scan (p-value=0.024). There were 22 cases of fetal growth restriction (FGR) (<10th percentile) at delivery. The late scan detected 9 cases of FGR (41%, p<0.003) not detected at the early scan. CONCLUSION: In obese women, the late 3rd tri scan predicted BW more accurately than the early scan and identified additional cases of FGR not previously detected. Consideration should be given to a standard late 3rd tri growth scan in this population.

Is recreational running associated with earlier delivery and lower birth weight in women who continue to run during pregnancy? An international retrospective cohort study of running habits of 1293 female runners during pregnancy

BackgroundIncreasingly, women of reproductive age participate in recreational running, but its impact on pregnancy outcome is unknown. We investigated whether running affects gestational age at delivery and birth weight as...

The Risk of Preterm Births Among Pregnant Women With Adenomyosis.

Few studies have examined the effect of adenomyosis on pregnancy outcomes. We aimed to evaluate the risk of preterm birth and low birth weight in women with adenomyosis diagnosed during pregnancy. A computerized ultrasonography database was used to identify singleton pregnant women with adenomyosis in the first trimester from January 2010 to December 2011. Only cases with a known pregnancy outcome were included. We reviewed the medical records and analyzed pregnancy outcomes according to the presence of adenomyosis and conception method. Among 11,173 singleton pregnant women, adenomyosis was detected in 88 (0.8%), and 8316 pregnant women (including 72 with adenomyosis) were included. The adenomyosis group was associated with significantly higher rates of preterm birth and low birth weight than the non-adenomyosis group (12.5% versus 4.1%; P < .001; 13.9% versus 3.1%; P < .001, respectively). In a subgroup analysis according to the conception method, incidences of preterm birth and low birth weight were not different in the non-adenomyosis group. However, the risks of preterm birth and low birth weight in the adenomyosis group were significantly higher in pregnant women who conceived by assisted reproductive technologies than in women who conceived naturally (28.0% versus 4.3%; P < .01; 28.0% versus 6.4%; P < .05, respectively). Ultrasonographic findings suggesting adenomyosis in early pregnancy were associated with increased risks of preterm delivery and low birth weight in women who conceived with the use of assisted reproductive technologies but not in women who conceived spontaneously.

Comparison of conventional 2D ultrasound to magnetic resonance imaging for prenatal estimation of birthweight in twin pregnancy

During prenatal follow-up of twin pregnancies, accurate identification of birthweight and birthweight discordance is important to identify the high-risk group and plan perinatal care. Unfortunately, prenatal evaluation of birthweight discordance by 2-dimensional ultrasound has been far from optimal. The objective of the study was to prospectively compare estimates of fetal weight based on 2-dimensional ultrasound (ultrasound-estimated fetal weight) and magnetic resonance imaging (magnetic resonance-estimated fetal weight) with actual birthweight in women carrying twin pregnancies. Written informed consent was obtained for this ethics committee-approved study. Between September 2011 and December 2015 and within 48 hours before delivery, ultrasound-estimated fetal weight and magnetic resonance-estimated fetal weight were conducted in 66 fetuses deriving from twin pregnancies at 34.3-39.0 weeks; gestation. Magnetic resonance-estimated fetal weight derived from manual measurement of fetal body volume. Comparison of magnetic resonance-estimated fetal weight and ultrasound-estimated fetal weight measurements vs birthweight was performed by calculating parameters as described by Bland and Altman. Receiver-operating characteristic curves were constructed for the prediction of small-for-gestational-age neonates using magnetic resonance-estimated fetal weight and ultrasound-estimated fetal weight. For twins 1 and 2 separately, the relative error or percentage error was calculated as follows: (birthweight - ultrasound-estimated fetal weight (or magnetic resonance-estimated fetal weight)/birthweight)× 100 (percentage). Furthermore, ultrasound-estimated fetal weight, magnetic resonance-estimated fetal weight, and birthweight discordance were calculated as 100× (larger estimated fetal weight-smaller estimated fetal weight)/larger estimated fetal weight. The ultrasound-estimated fetal weight discordance and the birthweight discordance were correlated using linear regression analysis and Pearson's correlation coefficient. The same was done between the magnetic resonance-estimated fetal weight and birthweight discordance. To compare data, the χ2, McNemar test, Student t test, and Wilcoxon signed rank test were used as appropriate. We used the Fisher r-to-z transformation to compare correlation coefficients. The bias and the 95% limits of agreement of ultrasound-estimated fetal weight are 2.99 (-19.17% to 25.15%) and magnetic resonance-estimated fetal weight 0.63 (-9.41% to 10.67%). Limits of agreement were better between magnetic resonance-estimated fetal weight and actual birthweight as compared with the ultrasound-estimated fetal weight. Of the 66 newborns, 27 (40.9%) were of weight of the 10th centile or less and 21 (31.8%) of the fifth centile or less. The area under the receiver-operating characteristic curve for prediction of birthweight the 10th centile or less by prenatal ultrasound was 0.895 (P < .001; SE, 0.049), and by magnetic resonance imaging it was 0.946 (P < .001; SE, 0.024). Pairwise comparison of receiver-operating characteristic curves showed a significant difference between the areas under the receiver-operating characteristic curves (difference, 0.087, P= .049; SE, 0.044). The relative error for ultrasound-estimated fetal weight was 6.8% and by magnetic resonance-estimated fetal weight, 3.2% (P < .001). When using ultrasound-estimated fetal weight, 37.9% of fetuses (25 of 66) were estimated outside the range of ±10% of the actual birthweight, whereas this dropped to 6.1% (4 of 66) with magnetic resonance-estimated fetal weight (P < .001). The ultrasound-estimated fetal weight discordance and the birthweight discordance correlated significantly following the linear equation: ultrasound-estimated fetal weight discordance= 0.03+ 0.91× birthweight (r= 0.75; P < .001); however, the correlation was better with magnetic resonance imaging: magnetic resonance-estimated fetal weight discordance= 0.02+ 0.81× birthweight (r= 0.87; P < .001). In twin pregnancies, magnetic resonance-estimated fetal weight performed immediately prior to delivery is more accurate and predicts small-for-gestational-age neonates significantly better than ultrasound-estimated fetal weight. Prediction of birthweight discordance is better with magnetic resonance imaging as compared with ultrasound.

EP18.01: Role of cervical length and birthweight in women with history of previous Caesarean section: prediction of early onset of labour before 39 weeks of gestation

To evaluate whether the serial cervical length measured by transvaginal ultrasound between 26∼30 weeks and 35∼36 weeks of gestation is predictive of spontaneous early onset of labour in women with history of previous Caesarean section (CS). This study was designed as a retrospective observational study on 223 women with history of previous Caesarean section. The cervical length was measured ultrasonographically at 26–30 weeks and 35–36 weeks of gestation. Of the 223 pregnancies enrolled, 80 (35.9%) developed spontaneous onset of labour before 39 weeks of gestation. The cervical length at 35∼36weeks of gestations was significantly shorter in these women when compared with those delivering after 39 weeks of gestation (24 vs. 31 mm P<0.0001). Serial cervical length between 26∼30 weeks and 35∼36weeks of gestations was significantly larger in early spontaneous labour onset groups (0.89 vs. 0.35mm. p=0.004). Also, the birthweight was significantly lower in early spontaneous labour onset groups (3106 vs 3386g p <0.0001) Multivariate logistic regression analysis showed that cervical length (adjusted odds ratio(aOR) 5.85; 95% confidence interval (CI) 2.696-12.695; P≤0.0001) at 35∼36weeks and birthweight (aOR 1.003(95% CI 1.001-1.004, p<0.0001)were predictors for the onset of labour before 39 weeks of gestation. The area under the receiver-operating characteristics curve for the prediction of early onset of labour was 0.847 (95% CI 0.738-0.950) for cervical length and birthweight as test variable. Cervical length at 35-36 weeks of gestation and birthweights provides information about the likelihood of onset of labour before 39 weeks of gestations in women with history of previous CS and may be useful in individualising the gestational age for elective CS.

Increased risk of low birth weight in women with placental malaria associated with P. falciparum VAR2CSA clade

Pregnancy associated malaria (PAM) causes adverse pregnancy and birth outcomes owing to Plasmodium falciparum accumulation in the placenta. Placental accumulation is mediated by P. falciparum protein VAR2CSA, a leading PAM-specific vaccine target. The extent of its antigen diversity and impact on clinical outcomes remain poorly understood. Through amplicon deep-sequencing placental malaria samples from women in Malawi and Benin, we assessed sequence diversity of VAR2CSA’s ID1-DBL2x region, containing putative vaccine targets and estimated associations of specific clades with adverse birth outcomes. Overall, var2csa diversity was high and haplotypes subdivided into five clades, the largest two defined by homology to parasites strains, 3D7 or FCR3. Across both cohorts, compared to women infected with only FCR3-like variants, women infected with only 3D7-like variants delivered infants with lower birthweight (difference: −267.99 g; 95% Confidence Interval [CI]: −466.43 g,−69.55 g) and higher odds of low birthweight (<2500 g) (Odds Ratio [OR] 5.41; 95% CI:0.99,29.52) and small-for-gestational-age (OR: 3.65; 95% CI: 1.01,13.38). In two distinct malaria-endemic African settings, parasites harboring 3D7-like variants of VAR2CSA were associated with worse birth outcomes, supporting differential effects of infection with specific parasite strains. The immense diversity coupled with differential clinical effects of this diversity suggest that an effective VAR2CSA-based vaccine may require multivalent activity.

Metabolic markers during pregnancy and their association with maternal and newborn weight status.

Background/AimsObesity during pregnancy increases the risk of adverse clinical outcomes and is associated with low-grade chronic inflammation. We describe maternal metabolic risk and inflammation by maternal weight status, and evaluate the association of metabolic and inflammatory markers with birthweight in a group of pregnant Mexican women.MethodsThis study derived from a prospective cohort of healthy pregnant women <14 weeks of gestation, receiving prenatal care at National Institute of Perinatology (Mexico, 2009–2013). Metabolic and inflammatory markers were measured in maternal serum in all three pregnancy trimesters (1st: 11.42±1.7; 2nd: 21.06±2.4; 3rd: 32.74±2.3 weeks). Pregestational weight was self-reported, and body mass index (BMI) was calculated. Gestational weight gain was evaluated in the third trimester. Newborn´s weight was measured at birth. We carried out correlations, general mixed linear model and regression analyses, based on pregestational weight (self-reported), body mass index (BMI), gestational weight gain (evaluated in the third trimester) and newborn weight (measured at birth).ResultsOf the 177 women included in the study (mean age = 26.93±8.49), thirty-eight percent (n = 67) were overweight or had obesity, and 32.8% (n = 58) showed excessive gestational weight gain. We found insulin, lipids (including total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides-TG), leptin and interleukin 1b (IL-1b) all increased significantly (p<0.05) during pregnancy. Pregestational maternal weight status altered longitudinal concentrations of insulin, leptin, adiponectin, TG and C reactive protein. Excessive gestational weight gain was associated with higher maternal insulin in the third trimester (p<0.05). Early pregnancy leptin and TNFα were determinants of birthweight in women with normal weight, but not in overweight or obese women.ConclusionsMaternal weight status affected the concentrations of insulin, leptin, adiponectin, triglycerides and C reactive protein throughout pregnancy. The role of early leptin and TNFα in fetal growth need further study given the association was only observed in normal weight women. This study presents data distribution of metabolic and inflammatory markers of normal weight and overweight/obese women that did not develop GDM, preeclampsia nor macrosomia.

Ponderal index at birth associates with later risk of gestational diabetes mellitus.

Low birth weight (BW) and low ponderal index (PI) are associated with increased risk of type 2 diabetes mellitus. This study has two purposes: first to investigate the influence of PI on the risk of gestational diabetes mellitus (GDM); second, to study the association between glucose metabolism and BW in women with previous GDM. GDM cohort: 185 women with GDM in 1978-1996, attending a follow-up study in 2000-2002. Control cohort: 1137 women from a population-based diabetes screening study (Inter99) in a neighbouring county in 1999-2001. BW and birth length were collected from the original midwifery records. BW and PI were stratified into tertiles for analysis. PI in the lower tertiles was associated with an increased risk of GDM [odds ratio 1.59 (95% confidence interval 1.07-2.36, p=0.021)]. Among women with previous GDM, the area under the curve (AUC) for plasma levels of glucose and insulin during an OGTT was highest for the lower tertiles of BW (for AUCglucose p=0.048, for AUCinsulin p=0.047 adjusted for age and BMI). Lower PI is associated with increased risk of GDM. In women with previous GDM, lower BW is associated with a more severe impairment of glucose metabolism one to two decades after the pregnancy complicated by GDM.

Study on the relationship between frequencies of prenatal care and neonatal low birth weight in women of childbearing age from rural areas of Shaanxi province

Objective: To investigate the relationship between frequencies of prenatal care and neonatal low birth weight (LBW) among women of childbearing age from the rural areas of Shaanxi province. Methods: A questionnaire survey was conducted among the childbearing-aged women from the rural areas. Samples were selected through multi stage stratified random sampling method. The childbearing aged women were in pregnancy or having had definite outcomes of pregnancy. Measurement of data was described by median±standard deviation, and chi square test was used to compare the rates. Neonatal low birth weight and frequencies of prenatal care were dependent variables and independent variables grouped into the generalized Poisson regression model. Confounding factors were under control. Results: The overall incidence rate of LBW was 3.75% among 18 911 rural women of childbearing age during 2010-2013. Frequencies on pregnancy care were up to 15 times (0.70%), with a minimum of 0 (0.70%), an average of 5.65±2.74 times (including ≥10 times accounted for 12.37%; ≥7 times accounted for 28.52%; ≥5 times accounted for 62.80% and <4 times accounted for 21.49%). After controlling confounding factors, results from the generalized Poisson regression analysis revealed that the difference was statistically significant when compared to the reference group. The incidence of neonatal LBW in the <4 group was 1.61 times of the one in the >7 group (OR=1.61, 95%CI:1.31-2.00) while in the <4 group it was 1.23 times of the 4-7 group (OR=1.23, 95% CI:1.04-1.45). Conclusion: In the rural areas of Shaanxi province, the incidence of neonatal LBW was gradually reduced through the increasing number of frequencies on prenatal care, among women of childbearing age.

Increased risk of low birth weight in women with placental malaria associated with P. falciparum VAR2CSA clade

Increased risk of low birth weight in women with placental malaria associated with P. falciparum VAR2CSA clade

Effect of Maternal Retroplacental Leiomyomas on Fetal Growth.

To evaluate the association between retroplacental leiomyoma identified on second trimester ultrasound and fetal growth. We performed a retrospective study comparing the presence or absence of one or more retroplacental leiomyomas on birth weight in a cohort of women with singleton pregnancies undergoing second trimester fetal anatomic ultrasound at our institution between 2007 and 2012. The incidence of small for gestational age (SGA) infants was recorded. Secondary analysis evaluated the effect of number and size of retroplacental leiomyomas. Birth weight in women with at least one retroplacental leiomyoma was 177 grams less than in women without leiomyomas (95% CI-295 to-95, P= 0.003). There was a non-significant trend towards a higher incidence of SGA in infants born to women with retroplacental leiomyoma compared with women without leiomyoma (OR 2.84; 95% CI 0.97 to 6.84, P= 0.057). Women with a retroplacental leiomyoma > 4 cm in mean diameter were more likely to deliver an SGA infant than women without leiomyomas (OR 2.84, 95% CI 1.01 to 8.01; P= 0.048). Multiple retroplacental leiomyomas did not have a greater effect on pregnancy outcomes than single leiomyomas. Infants born to women with one or more retroplacental leiomyomas had a lower mean birth weight than infants born to women without leiomyomas. In addition, retroplacental leiomyomas > 4 cm in mean diameter were associated with an increased risk of delivering an SGA infant.

Fetal Hemodynamics and Fetal Growth Indices by Ultrasound in Late Pregnancy and Birth Weight in Gestational Diabetes Mellitus.

Background:The offspring of women with gestational diabetes mellitus (GDM) are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed to investigate the correlations between fetal hemodynamics, fetal growth indices in late pregnancy, and birth weight in GDM.Methods:A total of 147 women with GDM and 124 normal controls (NC) were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA), and renal artery (RA), were collected. Fetal growth indices, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length, were also measured by ultrasound. Birth weight, newborn gender, and maternal clinical data were collected.Results:The independent samples t-test showed that BPD, HC, and AC were larger in GDM than in NC (P < 0.05). Fetal hemodynamic indices of the UA and MCA were lower (P < 0.05), but those of the RA were higher (P < 0.001) in GDM than in NC. Birth weight was higher in GDM than in NC (P < 0.001). Pearson's correlation analysis showed that hemodynamic indices of the UA were negatively correlated with birth weight, BPD, HC, and AC in both groups (P < 0.05). MCA (S/D, PI, and RI) was negatively correlated with birth weight, HC, and AC in GDM (r = −0.164, −0.206, −0.200, −0.226, −0.189, −0.179, −0.196, −0.177, and − 0.172, respectively, P < 0.05), but there were no correlations in NC (P > 0.05). RA (S/D, PI, and RI) was positively correlated with birth weight in GDM (r = 0.168, 0.207, and 0.184, respectively, P < 0.05), but there were no correlations in NC (P > 0.05).Conclusion:Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM.

Maternal Cardiac and Obstetric Performance in Consecutive Pregnancies in Women With Heart Disease

(BJOG. 2015;122(11):1552–1559) Pregnant women with preexisting cardiac disease often experience cardiac decompensation due to the physiological stresses of pregnancy. Some studies have suggested that these adverse effects on cardiac function might not be reversible once the pregnancy is completed. Therefore, women with cardiac disease might be expected to experience increased complications and poorer outcomes with subsequent pregnancies. This current study was undertaken to determine the effect of a second pregnancy on cardiac, obstetric, and perinatal complications in women with heart disease, compared with the first pregnancy in the same women. It secondarily estimated the effect of a second pregnancy on birth weight in women with heart disease.

Comparison of umbilical cord ghrelin concentrations in full-term pregnant women with or without gestational diabetes

ABSTRACTPurpose: Ghrelin is a potent orexigenic peptide hormone secreted from the gastrointestinal tract that plays a crucial role in the regulation of lipids and glucose metabolism. Ghrelin also has links with fetal development and growth. Gestational diabetes mellitus (GDM) causes fetal macrosomia, but there is no available evidence of a relationship between ghrelin levels and birth weight in women with GDM. The purpose of this study is to investigate whether umbilical cord ghrelin concentrations are altered in full-term pregnant women with GDM compared to women without GDM and whether birth weight is correlated with ghrelin levels. Materials and methods: Sixty pregnant women with GDM and 64 healthy pregnant women without GDM were included in this cross-sectional study. Blood samples were drawn from the umbilical vein following birth. Ghrelin concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Results: Umbilical vein ghrelin levels were decreased in women with GDM (879.6 ± 256.1 vs. 972.2 ± 233.6 pg/ml in women without GDM, p=0.033), whereas birth weights were higher for babies in the GDM than in the non-GDM group (3448 ± 410 vs. 3308 ± 365 gr, respectively, p=0.046). Umbilical ghrelin levels were inversely correlated with birth weight (r=–0.765, p<0.001). Multiple regression analysis revealed that birth weight was independently and negatively associated with umbilical ghrelin levels (β= –2.077, 95% CI=–2.652 to –1.492, p=0.002). Conclusions: Umbilical ghrelin levels were lower in GDM women. Birth weight was inversely associated with umbilical ghrelin levels. This association may be explained by a negative feedback mechanism between ghrelin and birth weight.

Time-specific placental growth factor (PlGF) across pregnancy and infant birth weight in women with preexisting diabetes

Objective: Determine the independent association between time-specific placental growth factor (PIGF)—a marker of placental vasculature—and infant birth weight in offspring of mothers with preexisting type 1 and 2 diabetes. Methods: A total of 150 women were recruited from Joslin Diabetes Center’s/Beth Israel Deaconess Medical Center’s Diabetes in Pregnancy Program. PlGF was measured up to four times during pregnancy. Infant birth weight and covariate data were collected from medical records. Hemoglobin A1c was assessed from drawn blood samples. We used generalized linear and log-binomial models to calculate the change in continuous birth weight, as well as macrosomia for every unit change in time-specific ln-transformed PlGF, respectively. Models were adjusted for potential confounders. Results: Approximately 75% of women had type 1 diabetes. Third trimester PlGF levels were significantly associated with infant birth weight (r = 0.24, p = 0.02 at 27–34 weeks; r = 0.26, p < 0.009 for 36–40 weeks). After full adjustment, there was a 6.1% and 6.6% increase in birth weight for gestational age percentile for each unit increase in ln-transformed PlGF level at 27–34 weeks and 35–40 weeks, respectively (95% CI for 27–34 weeks gestation: 1.1, 11.0, and 95% CI for 35–40 weeks gestation: 0.7%, 12.5%). We found a statistically significant increased risk of macrosomia among women with higher ln-transformed PlGF levels (RR: 1.72; 95% CI: 1.09, 2.70). Associations were not mediated by hemoglobin A1c. Conclusions: Third trimester PlGF levels were associated with higher birth weight in women with preexisting diabetes. These findings may provide insight to the pathophysiology of fetal overgrowth in women with diabetes.

Developmental origins of polycystic ovary syndrome (PCOS), a case control study comparing birth weight in women with PCOS and control group

Evidence from various epidemiological studies and experimental animal studies has linked adverse intrauterine circumstances with health problems in adult life. This field of investigation is known as Developmental Origins of Health and Disease (DOHaD). Studies investigating the relation between developing polycystic ovary syndrome (PCOS) in adulthood and birth weight have yielded inconsistent results: PCOS is described more often in women with low birth weight and high birth weight, while other studies have failed to establish any relation. In this retrospective case–control study, we evaluated whether women diagnosed with PCOS had lower birth weight compared to women with a regular menstrual cycle (controls). Binary logistic regression models were used to analyze the data and correct for known confounders. About 65 women with PCOS and 96 controls were recruited for this purpose. The average birth weight of PCOS women (3357 g) did not differ from the average birth weight of controls (3409 g). Mean age at menarche differed significantly between groups, 13.7 years and 12.8 years (p = 0.006), respectively, for PCOS women and controls. In conclusion, we could not confirm the effect of adverse intrauterine conditions, reflected in birth weight, on developing PCOS.

Abstract 201: Maternal HDL-Cholesterol Levels in Women From the Gambia are Directly Related to Infant Birthweight

Babies born with low birthweight are often at a health disadvantage. Previous studies have shown direct relationships between maternal plasma cholesterol and infant birthweight in resource-rich countries. As plasma cholesterol levels are often decreased in resource-poor countries, the purpose of these studies was to evaluate the relationship between plasma cholesterol and birthweight in women enrolled in the ENID trial (ISRCTN49285450) in rural Gambia, West Africa. Plasma was obtained at enrolment (13.6±3.3 wk) and at 20 and 30 weeks of gestation; samples were obtained from women with term infants that weighed &lt;2.75 kg or &gt;3.25 kg at birth. Women with lower HDL-cholesterol (HDL-C) concentrations in mid-pregnancy had lower birthweight infants compared to women with higher HDL-C concentrations. There was no significant association between LDL-C or total cholesterol concentrations and birthweight. The relationship with HDL-C and birthweight was maintained when maternal BMI was included in the model. To begin to elucidate the processes involved in the regulation of fetal growth, placental function was examined in mice with increasing maternal HDL-C concentrations based on apoA-I levels; mice were lacking apoA-I (apoA-I -/- ), were wildtype (apoA-I +/+ ), or had excess apoA-I (apoA-I tg/tg ). HDL decreased in size as plasma apoA-I levels increased, and there were no statistical differences in the proteins carried by HDL, except for apoA-I, in pregnant mice of different genotypes. However, pregnancy alone led to changes in the HDL proteome. Importantly, fetuses of mice with lower concentrations of maternal HDL-C had reduced growth rates, not due to a lack of fetal apoA-I. The murine fetal growth rates were directly related to nutrient uptake by and transport across the placenta. This work suggests that maternal HDL affects placental function leading to enhanced nutrient supply and improved growth in utero, making HDL a potential biomarker for fetal growth and putative target for intervention.

Tandem mass spectrometry determined maternal cortisone to cortisol ratio and psychiatric morbidity during pregnancy−interaction with birth weight

Maternal serum cortisol has been suggested to be influenced by psychiatric morbidity, and may also influence fetal growth. However, several studies found equal cortisol levels in depressed and healthy pregnant women. Placental 11-β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) shields the fetus from maternal cortisol by conversion to cortisone, a function that may be compromised by maternal stress. We aimed to compare the serum ratio of cortisone to cortisol, in women with and without psychiatric morbidity during pregnancy. A secondary aim was to investigate whether fetal growth, approximated by infant birth weight, was associated with the cortisone to cortisol ratio.We performed tandem mass spectrometry analysis of serum cortisol and cortisone in late pregnancy in 94 women with antenatal psychiatric morbidity and 122 controls (cohort 1). We also compared the placental gene expression of HSD11B1 and 2 in another group of 69 women with psychiatric morbidity and 47 controls (cohort 2).There were no group differences in cortisol to cortisone ratio, absolute levels of cortisone and cortisol (cohort 1), or expression of HSD11B1 or 2 (cohort 2). However, cortisone to cortisol ratio was positively associated with birth weight in women with psychiatric morbidity, also after adjustment for gestational length, fetal sex, maternal height, smoking, SSRI use, and time of blood sampling (standardized β=0.35, p<0.001), with no association in the healthy controlsThus, the maternal serum cortisone to cortisol ratio does not seem to be affected by psychiatric morbidity, but psychiatric morbidity may increase fetal exposure to cortisol or other metabolic factors influencing fetal growth.

Maternal lipids associated with large-for-gestational-age birth weight in women with type 1 diabetes: results from a prospective single-center study.

IntroductionDespite improvement in diabetes care over the years, the incidence of macrosomia in type 1 diabetic mothers is still very high and even shows an increasing tendency. It is suggested that other factors that maternal hyperglycemia might be associated with excessive fetal growth in diabetic mothers. The aim of this study was to determine whether maternal lipids might contribute to high rates of large-for-gestational-age (LGA) newborns in women with type 1 diabetes (T1DM).Material and methodsThis prospective, single-center study was performed in a population of women with T1DM admitted to the perinatal center for women with diabetes. Data were collected in the first trimester (< 12th week), in mid-pregnancy (20th–24th weeks), and before delivery (34th–39th weeks).ResultsAmong 114 women included in the analysis, 30 (26.3%) delivered LGA newborns. The remaining 84 (73.7%) newborns were appropriate for gestational age (AGA). Lower high-density lipoprotein (HDL) HDL concentration in the first trimester was significantly associated with LGA (p = 0.01). Similar associations were observed for the HDL concentrations in mid-pregnancy (p = 0.04) and before delivery (p = 0.03). Higher triglyceride concentrations in the first trimester (p = 0.02) and before delivery (p = 0.008) were associated with LGA. Higher glycated haemoglobin (HbA1c) levels in mid-pregnancy and before delivery were associated with LGA. The associations between maternal lipids and LGA were independent of maternal body mass index at onset of the study, gestational weight gain and HbA1c concentrations.ConclusionsDecreased HDL and increased triglycerides during pregnancy might contribute to the development of LGA in women with type 1 diabetes.