Birth Weight Research Articles

The association between maternal perfluoroalkylated substances exposure and neonatal birth weight: a system review and meta-analysis.

Some studies have shown that maternal exposure to perfluoroalkyl substances (PFAS) may be related to the neonatal birth weight. The purpose of this study was to explore this relationship between maternal exposure to PFAS and neonatal birth weight. All papers published before March 2024 were retrieved from the Web of Science, PubMed, and Embase databases. A thorough meta-analysis was carried out, involving data extracted from 1,673 samples obtained from a total of 24 articles. Our study found a significantly negative association between maternal PFOS exposure and neonatal birth weight (β=-71.55; 95 %CI=-114.47,-28.62), with high heterogeneity (I 2 =64.15 %, p<0.0001). Similarly, there was a significant negative correlation between maternal PFOA exposure and neonatal birth weight (β=-81.26; 95 %CI=-126.08,-36.43), with high heterogeneity (I 2 =67.23 %, p<0.0001). Subunit analysis showed that there was a significantly negative correlation between PFOS exposure and neonatal birth weight in mid-to-late pregnancy and after delivery (β=-97.87; 95 %CI=-181.83,-13.92, β=-138.06; 95 %CI=-255.91,-20.20), PFOA exposure showed a negative correlation with neonatal birth weight in mid-to-late pregnancy (β=-85.89; 95 %CI=-139.31,-32.47), while PFNA exposure also showed a negative correlation with neonatal birth weight in mid-to-late pregnancy (β=-90.39; 95 %CI=-152.90,-27.88). However, no significant correlation was observed for PFNA exposure (β=3.95; 95% CI=-10.41, 18.31), with medium heterogeneity (I 2 =40.56 %, p=0.0574), or for PFHxS exposure (β=4.61; 95 %CI=-10.60, 19.81), with medium heterogeneity (I 2 =29.27 %, p=0.1368). Further research is needed to better understand the implications of these findings on maternal and neonatal health.

Inbreeding depression for litter size in two mice lines under divergent selection for environmental birth weight variability using genomic data.

Inbreeding depression (ID) is usually observed as reduced survival and fertility and may have a variable impact in different populations. The aim of this study was to estimate ID from genomic and pedigree data in the litter size (LS) of the high variability line (H-Line) and the low variability line (L-Line). Of these, the L-Line performed better on traits related to robustness. A total of 1587 females from 26 selection generations were genotyped with a high-density SNP array. LS data of 732 L-Line and 648 of H-Line animals were used. The following were calculated: pedigree inbreeding coefficient (FPED), genomic inbreeding derived from different genomic matrices (FNEJ, FL&H, FVR1, FVR2 and FYAN), from runs of homozygosity (FROH) and from homozygosity by descent probabilities (FHBD). FROH were calculated in the 19 autosomes (CHR). FROH and FHBD were divided into 9 lengths and age classes, respectively. All the inbreeding coefficients were standardized by the mean inbreeding coefficient of the 1st generation. Regression coefficients (b) obtained from genomic data were between -3.71 with FVR2 and -5.09 with FHBD in the H-Line, and that estimated from FPED was -5.67. In the L-Line the b obtained from genomic data were between -3.52 with FVR2 and -4.55 with FHBD, and that obtained with FPED was -4.08. Significant ID effects were detected in CHR13 in the H-Line and CHR1 and CHR9 in the L-Line. The b negative trended to be lower as the ROH length increased. The age of the homozygosity by descent segment performed differently in each line, for example FHBD raised 128 generations ago produced a significant positive effect only in the L-Line. The effect of global inbreeding coefficients on the LS was negative in both lines with a higher impact in the H-Line than in the L-Line, suggesting the L-Line having higher robustness. CHR 1, 9 and 13 were candidates for future gene search. In general, more recent FROH and FHBD presented negative effects on LS while older FROH and FHBD presented positive effects on LS in both selected lines.

Factors influencing the determination of dosing weight in the neonatal intensive care unit (NICU)

The objective of this study is to describe the properties of dosing weight in the neonatal intensive care unit (NICU). Infants were identified from a database of very low birth weight infants. Before regaining birth weight (BW), dosing and birth weight% difference was described. After regaining BW, dosing and measured weight% difference and frequency of dosing weight updates were described. Associations with infant characteristics including comorbid conditions, serum biochemistries, fluid intake, and urine output were evaluated. There were 115 infants over 4,643 infant-days with a median BW of 1060 g (interquartile range [IQR]: 750, 1300) and median time to regain BW of 10 days (IQR: 8, 13). After regaining BW, dosing weight was 4.2% less than measured weight. The gap widened with increasing creatinine and narrowed with increasing urine output. The only factor associated with the frequency of dosing weight updates was day of the week. Dosing weights in the NICU appear to fall into one of three categories: BW prior to regaining BW, practical weight to facilitate medication and nutrition ordering, and “dry” weight, adjusting for fluid overloaded states. We recommend using measured weight to avoid a 4% daily loss in nutrition intake once BW is regained.

The kinetics of maternal and self-developed Streptococcus suis-specific antibodies

BackgroundStreptococcus suis (S. suis) infections are responsible for a large disease burden in piglets during the nursery phase, compromising animal welfare and increasing antibiotic use. The immune gap caused by decreased maternal-derived antibodies (MDA) and insufficient levels or functionality of acquired antibodies in weaned pigs could play a role in the increased susceptibility to S. suis infections. To better understand this, two studies were performed. Study I evaluated the associations between sow antibodies in colostrum and serum, birth parameters (e.g., birth weight, colostrum intake and piglet growth) and the levels of S. suis-specific (serotypes 2 and 9) antibodies in one-day-old piglets from four farms. Subsequently, study II used one of these farms to evaluate S. suis-specific and total antibody kinetics in piglets (10 litters with 6 selected piglets per litter, total n = 60) from birth until 10 weeks of age. Additionally, tonsil swabs from sows and piglets were taken to evaluate the S. suis tonsillar carrier status (serotypes 2 and 9) before and after weaning.ResultsHigh variability in serum and colostrum antibody levels was observed between and within the four farms (study I). In study II, there was a decrease in S. suis-specific MDA after 24 h of age, with the lowest level occurring at approximately 18/19 days of age. Afterwards, there was an increase in specific antibodies, most likely due to acquired immunity. Colostrum intake, birth weight and 24-h weight gain after birth were important parameters that were positively associated with S. suis antibody levels in piglets after birth but also affected these antibody levels at a later age. All the piglet tonsils were colonized with S. suis serotype 9 before weaning, while the prevalence of serotype 2 increased after weaning.ConclusionsTotal Ig against S. suis in serum declined after birth and the lowest level was detected just before weaning. Farmers and veterinarians should focus on piglets with low birth weights and late-born piglets because these parameters reduce both the S. suis-specific MDA preweaning and the specific antibodies acquired postweaning. Colostrum intake and 24 h-weight gain also affect the level of S. suis specific antibodies on day 1.

Causal machine learning models for predicting low birth weight in midwife-led continuity care intervention in North Shoa Zone, Ethiopia

BackgroundLow birth weight (LBW) is a critical global health issue that affects infants disproportionately, particularly in developing countries. This study adopted causal machine learning (CML) algorithms for predicting LBW in newborns, drawing from midwife-led continuity care (MLCC).MethodsA quasi-experimental study was carried out in the North Shoa Zone of Ethiopia from August 2019 to September 2020. A total of 1166 women were allocated into two groups. The first group, the MLCC group, received all their antenatal, labor, birth, and immediate post-natal care from a single midwife. The second group received care from various staff members at different times throughout their pregnancy and childbirth. In this study, CML was implemented to predict LBW. Data preprocessing, including data cleaning, was conducted. CML was then employed to identify the most suitable classifier for predicting LBW. Gradient boosting algorithms were used to estimate the causal effect of MLCC on LBW. Moreover, meta-learner algorithms were utilized to estimate the individual treatment effect (ITE), the average treatment effect (ATE), and performance. Moreover, meta-learner algorithms were utilized to estimate the individual treatment effect (ITE), the average treatment effect (ATE), and performance.ResultsThe study results revealed that Causal K-Nearest Neighbors (CKNN) was the most effective classifier based on accuracy and estimated LBW using a 94.52% accuracy, 90.25% precision, 92.57% recall, and an F1 score of 88.2%. Meconium aspiration, perinatal mortality, pregnancy-induced hypertension, vacuum babies in need of resuscitation, and previous surgeries on their reproductive organs were identified as the top five features affecting LBW. The estimated impact of MLCC versus other professional groups on LBW was analyzed using gradient boosting algorithms and was found to be 0.237. The estimated ATE for the S-learner was 0.284, which is lower than the true ATE of 0.216. Additionally, the estimated ITE for both the T-learner and X-learner was less than -0.5, indicating that mothers would not choose to participate in the MLCC program.ConclusionsBased on these findings, the CKNN classifier demonstrated a higher accuracy and effectiveness. The S-learner and R-learner models, utilizing the XGBoost Regressor and BaseSRegressor, provided accurate estimations of ITE for assessing the impact of the MLCC program. Promoting the MLCC program could help stabilize LBW outcomes.

Childhood occasional hypertension and its association with size at birth and early growth: a population-based retrospective cohort study from China

BackgroundHypertension has recently shown a rapid rise in prevalence among children and adolescents. It can track into adulthood and tend to manifest at an earlier age. It should be prevented urgently and efficiently.MethodsThis study assesses the prevalence of occasional hypertension (OHTN) at 5 ~ 6 years old and evaluates its association with size at birth and BMI at 2 and 5 ~ 6 years old in full-term children. We conducted a population-based cohort study of 12,564 children from 66 kindergartens in Tianjin, China. Information on birth weight, body mass index (BMI) at 2 and 5 ~ 6 years old, and blood pressure at 5 ~ 6 years old was retrospectively collected.ResultsThe prevalence of childhood OHTN (SBP or DBP ≥ P95 percentile for sex, age, and height) was 17.0%. At birth, SGA has a high risk of OHTN (AOR 1.36, 95%CI 1.10–1.68). In the SGA subgroup, although children are of normal weight at 5 ~ 6 years old, excessive catch-up growth (BMI ≥75th at 2 years old) was still attributed to OHTN (OR 1.51, 95%CI 1.03–2.24). Obesity (BMI ≥2SD at 5 ~ 6 years old) was a vital risk factor for OHTN (AOR 2.93, 95%CI 2.56–3.36) unregarding with birthweight (OR 95%CI: SGA 3.23(1.66 ~ 6.27), AGA 2.83 (2.42–3.31), LGA 3.52 (2.65–4.68)). The co-presence of moderate or excessive catch-up growth before 2 years old and obesity at 5 ~ 6 years old significantly increased the risk of childhood OHTN (OR from 2.74 (1.65–4.54) to 6.53 (2.68–15.90)).ConclusionsPreschool obesity, low birth weight, and excessive catch-up growth increased the risk of OHTN in childhood.

The Effect of Parental Weight and Genetics on the Body Mass Index of Very Low Birth Weight Infants as They Reach School Age.

Prematurely born individuals are usually of low or normal weight in childhood; in adulthood, however, their probability of being overweight is twice that of persons born at full term. There is not yet any way to predict the weight development of premature babies. A polygenic BMI score (BMI = body-mass index), calculated from the often very small individual effects of more than 2 million genetic variants, was recently described for adults. We studied the possible association of this score with the course of BMI in premature babies over time, from infancy up to the age of 10-14 years. 508 individuals were included in the study. At the age of 5-7 years, their mean body weight was 18.8 ± 3.3 kg. The difference between the highest and lowest deciles of the polygenic score was 3.3 kg. At age 10-14, the average body weight was 41.3 ± 11.3 kg, and the difference between the highest and lowest deciles had increased to 9.2 kg. In persons with birth weight under the 10th percentile (n = 68), the difference was 19.2 kg (30.9 kg vs. 50.1 kg). The polygenic BMI score was significantly associated with the BMI z-scores of the overall group and the subgroup of growth-retarded children. Extreme values of a polygenic BMI score are strongly associated with the weight development of preterm infants as they develop into children aged 10-14. The large effect size implies that this score may aid in the counseling of prematurely born children and their parents.

Factors associated with underweight, overweight, and obesity in Chinese children aged 3-14 years using ensemble learning algorithms.

Factors underlying the development of childhood underweight, overweight, and obesity are not fully understood. Traditional models have drawbacks in handling large-scale, high-dimensional, and nonlinear data. In this study, we aimed to identify factors responsible for underweight, overweight, and obesity using machine learning methods among Chinese children. Our study participants were children aged 3-14 from 30 kindergartens and 26 schools in Beijing and Tangshan. Weight status was defined per the World Health Organization criteria. We implemented three ensemble learning algorithms and compared their performance and ranked the contributing factors by importance and identified an optimal set. A user-friendly web application was developed to calculate the predicted probability of childhood underweight, overweight, and obesity. We analysed data from 18 503 children aged 3-14, including 1798 underweight, 10 579 of normal weight, 3257 overweight, and 2869 with obesity. Of all algorithms, random forest performed the best, with the area under the receiver operating characteristic reaching 0.759 for underweight, 0.806 for overweight, and 0.849 for obesity, with other metrics also reinforcing this algorithm. Further cumulative analyses showed that, for underweight, the optimal set of six factors included maternal body mass index (BMI), age, paternal BMI, maternal reproductive age, paternal reproductive age, and birth weight. The optimal set for overweight comprised of five factors: age, fast food intake, maternal BMI, paternal BMI, and sedentary time. For obesity, the optimal set included six factors: age, fast food intake, maternal BMI, paternal BMI, sedentary time, and maternal reproductive age. Further logistic regression analyses confirmed the predictive capability of individual top factors. Our findings indicate that random forest is the best ensemble learning algorithm for predicting underweight, overweight, and obesity in children aged 3-14 years. We identified the optimal set of significant factors for each malnutrition status and incorporated them into a web application to support the application of this study's findings.

Nasal mask ventilator-delivered versus face maskT-piece resuscitator positive pressure ventilation during resuscitation of preterm neonates: a cohort study

ObjectiveTo evaluate the clinical impact of nasal mask ventilator-delivered positive pressure ventilation (PPV) versus face mask manual T-piece resuscitator PPV during resuscitation of preterm neonates.DesignWe conducted a pre-post cohort study...

Prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia: a large retrospective cohort study

BackgroundPreeclampsia (PE) is the primary cause of maternal and neonatal morbidity and mortality. However, comprehensive studies on the related risk factors with PE and its effects on adverse perinatal outcomes are limited. This study aimed to evaluate the prevalence, risk factors, and adverse perinatal outcomes in Chinese women with preeclampsia.MethodsWe conducted a retrospective cohort study from January 1, 2018, to December 31, 2019, which enrolled 38,496 women without preeclampsia (non-PE) and 1130 women with PE. Univariate and multivariate logistic regression models were used to determine the risk factors and adverse perinatal outcomes of PE.ResultsMultivariate logistic regression models showed that maternal age > 35 years, pp-BMI overweight/obesity, excessive gestational weight gain, multiparity, twin pregnancy, IVF, cesarean section history, times of abortion history ≥ 2, GDM, and ICP were significantly associated with the risk of PE (all P < 0.05). Women with PE in singleton pregnancies were associated with an increased risk of maternal outcomes of cesarean section, and preterm birth, and a higher risk of neonatal outcomes of stillbirth, low birth weight, fetal distress, neonatal asphyxia, and neonatal unit admission, which were also observed in women with PE in twin pregnancies, except for stillbirth and neonatal asphyxia.ConclusionThis study identified the risk factors and associated adverse perinatal outcomes of PE, which providing comprehensive evidence for clinicians to manage women at risk of PE.

Does Maternal Location of Residence Affect Low Birth Weight Outcomes in Hunter New England Local Health District?

Low birth weight (LBW) is associated with adverse short-term and long-term health outcomes for neonates. The impact of maternal geographical location on rates of LBW in Australia is conflicted in existing literature. The aim was to identify if a difference in rates of LBW exist between neonates born to rural versus metropolitan maternal residence. Secondary aim was to identify any associated factors influencing LBW. A secondary data analysis of retrospective health surveillance data from all births from 2018 to 2022 in the Hunter New England Local Health District (New South Wales, Australia) was performed. Logistic regression was used to determine odds ratio and adjusted odds ratio of LBW for rural versus metropolitan residence. A total of 39,579 neonates were included in this analysis, with 50.9% of the maternal cohort residing rurally. Median maternal was age 29.2 years. Rates of LBW were higher in rural maternal residence (5.7%) compared to metropolitan residence (5.2%). Odds of neonatal LBW did not differ between rural and maternal metropolitan residence after adjusting for confounders (adjusted Odds Ratio (aOR) = 0.90, 95% CI 0.79-1.01, p = 0.07). Socioeconomic disadvantage was significantly identified as an issue associated with LBW. LBW neonates were more likely to be born to rural maternal residence and LBW risk factors disproportionately affected those living in rural locations. To reduce LBW in neonates, it is imperative that access to safe and affordable healthcare is available, and resources addressing LBW risk factors are specific to geographical locations.

Prenatal and Postnatal Nutritional Mismatch, Reflected by Birth Weight and Adult BMI, and Cardiometabolic Disease Risk.

This study aimed to investigate how nutritional exposures in early life, represented by birth weight (BW), and in later life, indicated by adult body mass index (BMI), interact to influence cardiometabolic disease (CMD) risk and to examine the underlying causal relationships. Included were 254,224 participants of White European ancestry from the UK Biobank. To evaluate the joint associations of BW and adult BMI with CMD risk, BW was categorized as low (LBW, <2.5 kg) or high (HBW, ≥2.5 kg), and BMI as low (LBMI, <30 kg/m²) or high (HBMI, ≥30 kg/m²). Multivariable Cox proportional hazards models and 2x2 factorial Mendelian randomization (MR) analyses were employed to assess these associations and the underlying causality. Compared to the participants with HBW-LBMI, the hazard ratio (HR) for atherosclerotic cardiovascular disease (ASCVD) was 1.19 (95% CI: 1.12 to 1.26) in the LBW-LBMI group, 1.33 (1.28 to 1.38) in the HBW-HBMI group, and 1.62 (1.50 to 1.75) in the LBW-HBMI group. The LBW-HBMI group also exhibited higher risks for hypertension (HR: 2.42 [2.26-2.59]), diabetes (HR: 5.16 [4.73-5.63]), and hyperlipidemia (HR: 1.95 [1.81-2.10]). Additive interactions between LBW and HBMI were identified for metabolic diseases but not for ASCVD. The causality of these associations was confirmed by MR analysis. Combined exposure to LBW and HBMI was most strongly associated with an elevated risk of CMD, underscoring the critical role of the mismatch between early-life and adult nutritional status in shaping long-term cardiometabolic health.

Early plasma ferritin concentrations are not associated with time to red cell transfusions in extremely and very preterm neonates: a prospective single-site observational study

ObjectiveTo assess the relationship between plasma ferritin concentrations and (1) antenatal factors and (2) requirement for red cell transfusion.Study designThis single-site prospective study recruited infants in the first week of...

Nutritional Status of Children and its Relation to Maternal Factors: An Endeavor Toward Better-Nourished Western Rural India

Abstract Introduction: Malnutrition has a direct impact on infant mortality rate and under-five mortality rates, which are prime indicators of the health status of a country. COVID-19 has also substantially affected the nutritional status of children. Hence, the objective is to highlight the magnitude of malnutrition and associated maternal factors in rural areas of Rajkot district. Methods: A community-based cross-sectional study was conducted from March 2021 to May 2022 among children up to six years of age registered in the Anganwadi centers (AWCs) of Rajkot district. To achieve the desired sample size of 504, a multi-stage sampling method was used. Statistical significance for all comparisons was based on the Chi-square test and factors with P value &lt;0.05 were considered for binary logistic regression. For nutritional status assessment, a Z-score was obtained using WHO Anthro 2011 software. Results: Out of the total 504 participants, 50.2% were female and 49.8% were male. The mean age of the participants was 32.43 ± 18.7 months Prevalence of underweight, stunting, and wasting was found to be 39.1%, 36.7%, and 30.5%, respectively. After adjustment by binary logistic regression, a significant correlation was found between different forms of malnutrition and the age of participants, education of the mother, type of family, socio-economic class, mother’s age at the birth of participants, and birth weight. (P &lt; 0.05). Conclusions: The prevalence of acute malnutrition (wasting) is higher than the national, state, and regional average in this study. Thus, more emphasis should be given to better utilization of services such as nutritional supplementation, nutritional rehabilitation, and growth monitoring along with treatment of morbidities.

Spatio-temporal modelling of extreme low birth rates in U.S. counties

The continuous declining rate of birth may cause severe worldwide problems, including population ageing and demographic imbalance. This paper aims to identify the geographic disparities and potential influential factors of the extreme downward excess of birth rates in the U.S. at the county level from 2003 to 2020. The innovative Bayesian generalized Pareto (GP) quantile regression model is employed for analysing the spatiotemporal pattern of stressful low birth rate and its association with socioeconomic, demographic, and meteorological factors. The optimal stochastic partial differential equation and autoregressive model of order one (SPDE-AR(1)) spatiotemporal structured model is selected based on common Bayesian criteria and scaled threshold weighted continuous ranked probability score, indicating apparent spatial unbalance and deteriorating tendency of falling birth rate. The findings show that elderly, highly educated population structure, city-developed situation, average birth weight, and average age of mother have a significant impact on the stressful downward excess of birth rate, particularly in examples of Charlotte, Sarasota, Collier counties in Florida, and Marin, Santa, Cruuz, San Mateo in California. Conversely, the increasing female proportion and GDP per capita can alleviate the declining birth rate pressure. Our methodology is productive for analysing extreme population stress including but not limited to birth weight and cognitive impairment.

A rare case of Sjögren’s syndrome in pregnancy and its perinatal outcome- Fetal congenital heart block

Sjögren’s syndrome is an autoimmune disease that commonly affects women after the fourth decade of life. Management of pregnancy in women with Sjögren’s syndrome poses unique challenges due to potential maternal and fetal complications. Children born to women with Sjögren’s syndrome can have a higher incidence of prematurity, low birth weight, hypoxic-ischemic encephalopathy, and congenital heart block. We describe the case of 24-year-old primi at 36 weeks of gestation with Sjögren’s syndrome and hypothyroidism, resulting in congenital heart block in the fetus. In this case report, we will discuss the management and perinatal outcome of pregnancy in the case of Sjögren’s syndrome.

'I Did Not Know We Could Exercise This Small Premature Baby': Challenges Experienced by Parents While Implementing Early Intervention for Their Preterm Infants-A Qualitative Perspective.

Preterm birth is a highly stressful experience for both parents and infants. Parental participation in care enhances developmental outcomes, fosters parent-infant interactions and builds parental confidence. However, low parental adherence has always been a challenge in the successful implementation of intervention programs both in the NICU and at home. It is imperative to understand parents' perspectives and view the challenges that they experience through their lens while providing early intervention to their infants born preterm. This study is aimed at identifying new parents' challenges when implementing early intervention programs for their infants during the transition from hospital to home. Ten parents of preterm infants trained to administer early intervention programs in the NICU and at home were recruited during their infants' 3-month follow-up. Semistructured in-depth interviews were conducted until data saturation. The audio recordings of the interviews were transcribed and translated into English. Thematic analysis, using ATLAS.ti Version 8.0 software, identified overarching challenges through deductive and inductive coding. Data analysis identified five recurring themes: (1) navigating early days of parenthood, (2) nurturing resilience in infant care, (3) supporting infants through informed caregiving, (4) maximizing efficiency in infant care through time mastery and (5) balancing equity and flexibility in caregiving. Parents expressed fear of handling their infants born preterm because of their low birth weight and small size. Time constraints, changing sleep patterns and daily routines make it difficult for mothers to adhere to exercise programs. Parents also face challenges when infants exhibit stressful behaviour. Furthermore, gender differences were observed, with fathers often not continuing the program at home. The study highlights parents' main challenges when providing early intervention for infants born preterm at home. It emphasizes issues related to maternal roles, family support and difficulties in infant handling, exercise and time management. ClinicalTrials.gov identifier: CTRI/2020/09/027994.

The Fetal Effect of Maternal Caffeine Consumption During Pregnancy—A Review

Caffeine is commonly used to excess by the general public, and most pregnant women drink caffeine on a daily basis, which can become a habit. Maternal caffeine intake during pregnancy is associated with severe gestational outcomes. Due to its lipophilic nature, caffeine can cross the blood–brain barrier, placental barrier, and even amniotic fluid. It can be found in substantive amounts in breast milk and semen. There has been a reported drop in neonatal anthropometric measurements with increased caffeine consumption in some cohort studies. This narrative review using literature titles and abstracts from the electronic databases of PubMed, Embase, and Scopus investigates the data linking maternal caffeine use to unfavorable pregnancy outcomes. It also evaluates the validity of the recommendations made by health professionals on caffeine consumption by mothers from the available literature. The results of our comprehensive literature search of case–control studies, cohort studies, randomized control trials, and meta-analyses, imply that caffeine use during pregnancy is linked to miscarriage, stillbirth, low birth weight, and babies that are small for gestational age. It was also found that there may be effects on the neurodevelopment of the child and links to obesity and acute leukemia. These effects can even be seen at doses well below the daily advised limit of 200 mg. The genetic variations in caffeine metabolism and epigenetic changes may play a role in the differential response to caffeine doses. It is crucial that women obtain solid, evidence-based guidance regarding the possible risks associated with caffeine.

Risk and causes of early mortality among extremely preterm infants born small for gestational age.

Extreme preterm (EPT) delivery, occurring before 28 weeks of gestation, carries high morbidity and mortality risks. Small for Gestational Age (SGA) infants, about 8-20% of EPT neonates, face increased risks. Mortality risk varies with gestational age and birth weight, with mixed reports on specific morbidities. This study aims to determine mortality rates and common causes of death among EPT SGA infants. The study used data from the CDC National Vital Statistics System, covering births and deaths from 2016-2021, with follow-up through 2022. It included infants born between 22 and 27 weeks gestation who were admitted to the neonatal intensive care unit. The outcome was all-cause in-hospital mortality within 30 days of birth, with causes of mortality classified based on ICD-10 codes. Small for Gestational Age (SGA) was the primary independent variable. Based on a sample of N=96134 infants, we estimated 13% were born SGA and 30-day mortality rates were higher among SGA compared to non-SGA infants (31% vs. 13%). On multivariable analysis SGA infants had higher 30-day mortality than non-SGA (odds ratio: 3.82; 95% CI: 3.64, 4.01; p<0.001), and were more likely to have death ascribed to complications of short gestation rather than other causes of death (Relative Risk Ratio: 1.42; 95% CI: 1.27, 1.59; p<0.001). SGA infants receiving intensive care have high mortality risk, especially due to complications of short gestation and low birthweight complications.

The effect of surgical treatment of tubal pregnancy on concurrent intrauterine pregnancy after in vitro fertilization

Whether surgical treatment of tubal pregnancy affects the outcomes of concomitant live normally sited (eutopic) pregnancies is unknown. The purpose of this study was to investigate the outcomes of live eutopic singleton pregnancies following surgical treatment for concomitant fallopian pregnancies. A total of 446 patients who conceived tubal heterotopic pregnancies (HPs) via in vitro fertilization–embryo transfer and underwent surgical treatment to remove ectopic pregnancies (EPs) were included. For each study patient, one matched patient who conceived a live eutopic singleton pregnancy was selected randomly as a control. The rates of early miscarriage, late miscarriage, live birth, preterm birth, low birth weight and perinatal mortality were not significantly different between the study and control groups. The birth weight were also similar between these two groups. However, the caesarean section rate was significantly higher in the study group than that in the control group(P < 0.001). Additionally, laparotomy and laparoscopy for tubal HPs yielded similar pregnancy outcomes. Compared with controls, patients who conceived tubal pregnancies and concomitant live eutopic singleton pregnancies had similar pregnancy outcomes after proper surgical treatment of EPs. These findings can be used for counselling women who have conceived tubal HPs regarding the risks associated with surgical treatment.