Customised Birthweight Centiles Research Articles

Inverse relationship between gestational weight gain and glucose uptake in human placenta from female foetuses

Maternal obesity and gestational weight gain (GWG) have a significant impact on the in utero environment, and thus on foetal development and the health of the offspring later in life. The aim of this study was to determine the effect of maternal pre-existing obesity and maternal GWG on glucose uptake from placentas from male and female offspring. Total glucose uptake was measured in placental explants using radio-labelled glucose. In the female placentas (n = 36), GWG and glucose uptake were significantly negatively correlated (r = -0.7, P < 0.0001; n = 36), and customized birthweight centile correlated with placental glucose uptake (r = 0.36, P = 0.03) but not GWG. In the male placentas (n = 45), GWG and glucose uptake were not related, and customized birthweight centile correlated with GWG (r = 0.34, P = 0.02; n = 45), but not placental glucose uptake. The female placenta can adapt glucose uptake in the face of excessive GWG. The male placenta showed no evidence of changing glucose uptake in response to maternal GWG.

Maternal alcohol intake up to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort

BackgroundHigh maternal alcohol consumption has been linked to adverse birth outcomes such as small for gestational age and preterm birth, which in turn have been linked to increased risk of development of cardiovascular diseases and type 2 diabetes in adulthood. The UK Department of Health (DH) recommends that pregnant women and those trying to conceive should avoid alcohol and never drink more than 1–2 units once or twice a week. This study aimed to investigate the association between alcohol intake before and during different stages of pregnancy with both birthweight and gestational age. MethodsData were used from the Caffeine and Reproductive Health Study (CARE), a prospective birth cohort that included 1303 low-risk pregnant women aged 18–45 years, recruited from September, 2003, to June, 2006. Questionnaires administered in the first and second trimester and postpartum assessed alcohol consumption before pregnancy and for the three trimesters. Frequency of weekly alcohol consumption was analysed by categories of intake to accord with DH guidelines (≤2 units per week, >2 units per week, and a non-drinking category as the referent) and was related to preterm birth and size at birth, measured as grams and as customised birthweight centile, which takes into account maternal prepregnancy weight, height, parity, ethnicity, gestation, and baby's sex in multivariable linear and logistic regression models. We also adjusted for maternal age, caffeine intake, education, energy intake, and salivary cotinine as a biomarker of smoking status. Only participants with complete data for all variables were included in the analyses, which excluded just under 10% of the sample. All women provided informed consent and the study was approved by the Leeds West Local Research Ethics Committee (ref 03/054). Findings1153, 1135, 793, and 377 women, respectively, had data available for birth outcomes and alcohol consumption before pregnancy and during the three trimesters. 74% of women before pregnancy and 53% in the first trimester reported alcohol intakes above the DH recommendation. For intakes above 2 units per week compared with non-drinkers, the adjusted differences in birth centile were −7·7 (95% CI −12·8 to −2·6; ptrend=0·009), −8·2 (−12·6 to −3·7; ptrend=0·002), and −6·4 (−11·8 to −1·1, ptrend=0·06) before pregnancy and during trimesters 1 and 2, respectively. The association with small for gestational age and preterm birth was strongest in trimester 1, with adjusted odds ratios of 2·0 (95% CI 1·2–3·4; ptrend=0·03) and 3·5 (1·1–11·2, ptrend=0·04), respectively. Women who adhered to the recommendations in the first trimester of 2 units or fewer per week were also at a significantly higher risk of having babies born with lower birthweight (adjusted difference −98·5, 95% CI −170·9 to −26·1; ptrend=0·007), birth centile (−5·8, −10·8 to −0·7; ptrend=0·002), and preterm birth (adjusted odds ratio 4·6, 95% CI 1·4–14·7; ptrend=0·04) compared with non-drinkers. InterpretationThe first trimester was the most sensitive period for the association of alcohol with restricted fetal growth. However, this finding could be explained by under-reporting of alcohol intake. Our small sample size in the third trimester did not allow us to detect a change in birthweight, and larger prospective studies that take into account timing of exposure to alcohol are needed. We showed no evident safe level of alcohol consumption in pregnancy, and the safe advice should be to abstain from alcohol when planning to conceive and during pregnancy, particularly during its early stages. FundingThe CARE study was supported by a grant from the Food Standards Agency, UK (T01033).

Clinical Prediction in Early Pregnancy of Infants Small for Gestational Age by Customised Birthweight Centiles: Findings from a Healthy Nulliparous Cohort

ObjectiveSmall for gestational age (SGA) infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants.Methods5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15±1 weeks’ gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20±1 weeks’. The cohort was divided into training (n = 3735) and validation datasets (n = 1871). All-SGA (birthweight <10th customised centile), Normotensive-SGA (SGA with normotensive mother) and Hypertensive-SGA (SGA with mother who developed hypertension) were the primary outcomes. Multivariable analysis was performed using stepwise logistic regression firstly using clinical variables and then with clinical and ultrasound variables. Receiver operator curves were constructed and areas under the curve (AUC) calculated.Results633 infants (11.3%) in the whole cohort were SGA; 465 (8.3%) Normotensive-SGA and 165 (3.0%) Hypertensive-SGA. In the training dataset risk factors for All-SGA at 15±1 weeks’ included: family history of coronary heart disease, maternal birthweight <3000 g and 3000 g to 3499 g compared with ≥3500 g, >12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥80. Recreational walking ≥4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10th centile and increasing uterine artery Doppler resistance at 20±1 weeks’ were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively.ConclusionPredictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.

The association of maternal ACE A11860G with small for gestational age babies is modulated by the environment and by fetal sex: a multicentre prospective case-control study

We aimed to determine whether the ACE A11860G genotype is associated with small for gestational age babies (SGA) and to determine whether the association is affected by environmental factors and fetal sex. Overall, 3234 healthy nulliparous women with singleton pregnancies, their partners and babies were prospectively recruited in Adelaide, Australia and Auckland, New Zealand. Data analyses were confined to 2121 Caucasian parent–infant trios, among which 216 were pregnancies with SGA infants and 1185 were uncomplicated pregnancies. Women with the ACE A11860G GG genotype in the combined and Adelaide cohorts had increased risk for SGA [odds ratios (OR) 1.5, 95% confidence interval (CI) 1.1–2.1 and OR 2.0, 95% CI 1.3–3.3, respectively) and delivered lighter babies (P = 0.02; P = 0.007, respectively) compared with those with AA/AG genotypes. The maternal ACE A11860G GG genotype was associated with higher maternal plasma ACE concentration at 15 weeks' gestation than AA/AG genotypes (P < 0.001). When the Adelaide cohort was stratified by maternal socio-economic index (SEI) and pre-pregnancy green leafy vegetable intake, the ACE A11860G GG genotype was only associated with an increased risk for SGA (OR 4.9, 95% CI 1.8–13.4 and OR 3.3, 95% CI 1.6–7.0, respectively) and a reduction in customized birthweight centile (P = 0.006 and P = 0.03) if superimposed on maternal SEI <34 or pre-pregnancy green leafy vegetable intake <1 serve/day. Furthermore, the associations of maternal ACE A11860G with customized birthweight centile observed among Adelaide women with SEI <34 or pre-pregnancy green leafy vegetable intake <1 serve/day were female specific. The current study identified a novel association of maternal ACE A11860G with SGA. More interestingly, this association was modified by environmental factors and fetal sex, suggesting ACE A11860G–environment–fetal sex interactions.Trial Registry Name: Screening nulliparous women to identify the combinations of clinical risk factors and/or biomarkers required to predict pre-eclampsia, SGA babies and spontaneous preterm birth.URL: http://www.anzctr.org.au.Registration number: ACTRN12607000551493.

PM.41 Can Pulse Wave Analysis Predict Adverse Obstetric Outcome in Pregnant Women with Chronic Hypertension?

IntroductionComplications of pregnancy including super imposed pre-eclampsia (PE), fetal growth restriction (FGR) and preterm delivery are common in women with chronic hypertension. Outside of pregnancy measurement of arterial stiffness using...

Maternal and fetal risk factors for stillbirth: population based study

Objective To assess the main risk factors associated with stillbirth in a multiethnic English maternity population.Design Cohort study. Setting National Health Service region in England.Population 92 218 normally formed singletons...

Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort

Excessive gestational weight gain (GWG) is an important contributing factor to the obesity epidemic in women and is associated with pregnancy complications. We investigated the relationship between GWG and caesarean delivery in labour, large for gestational age (LGA), small for gestational age (SGA) infants and pregnancy-induced hypertension by maternal pre-pregnancy body mass index (BMI) in a contemporary nulliparous cohort. Using 2009 Institute of Medicine guidelines, participants in the SCOPE study (from Cork, Ireland, Auckland, New Zealand and Adelaide, Australia) were classified into GWG categories (low, normal and high) according to pre-pregnancy BMI. Maternal characteristics and pregnancy outcomes were compared between weight gain categories. SGA and LGA were defined as <10th and >90th customised birthweight centile. Multivariable analysis adjusted for confounding factors that impact on GWG including BMI. Of 1950 participants, 17.2% (n=335) achieved the recommended GWG, 8.6% (n=167) had low and 74.3% (n=1448) had high GWG. Women with high GWG had increased rates of LGA infants [adjusted OR 4.45 (95% CI 2.49-7.99)] and caesarean delivery in labour [aOR 1.46 (1.03-2.07)]. SGA was increased in women with low GWG [aOR 1.79 (1.06-3.00)]. Three quarters of participants had high GWG, which was associated with an independent risk of LGA infants and caesarean in labour. Low GWG was associated with SGA infants. These adverse outcomes are potentially modifiable by achievement of normal GWG, which should be an important focus of antenatal care.

Independent risk factors for infants who are small for gestational age by customised birthweight centiles in a multi‐ethnic New Zealand population

Infants born small for gestational age (SGA) by customised birthweight centiles are at increased risk of adverse outcomes compared with those SGA by population centiles. Risk factors for customised SGA have not previously been described in a general obstetric population. To determine independent risk factors for customised SGA in a multi-ethnic New Zealand population. We performed a retrospective cohort analysis of prospectively recorded maternity data from 2006 to 2009 at National Women's Health, Auckland, New Zealand. After exclusion of infants with congenital anomalies and missing data, our final study population was 26,254 singleton pregnancies. Multivariable logistic regression analysis adjusted for ethnicity, body mass index, maternal age, parity, smoking status, social deprivation, hypertensive disease, antepartum haemorrhage (APH), diabetes and relevant pre-existing medical conditions. Independent risk factors for SGA included obesity (adjusted odds ratio 1.24 [95% CI 1.11-1.39] relative to normal weight), maternal age≥35years (1.16 [1.05-1.30] relative to 20-29years), nulliparity (1.13 [1.04-1.24] relative to parity 1), cigarette smoking (2.01 [1.79-2.27]), gestational hypertension (1.46 [1.21-1.75]), pre-eclampsia (2.94 [2.49-3.48]), chronic hypertension (1.68 [1.34-2.09]), placental abruption (2.57 [1.74-3.78]) and APH of unknown origin (1.71 [1.45-2.00]). Gestational diabetes (0.80 [0.67-0.96]) and type 1 diabetes (0.26 [0.11-0.64]) were associated with reduced risk. We report independent pregnancy risk factors for customised SGA in a general obstetric population. In contrast to population SGA, obesity is associated with increased risk. Our findings may help identify pregnancies that require increased fetal growth surveillance.

Perinatal Outcomes in Large Infants Using Customised Birthweight Centiles and Conventional Measures of High Birthweight

Large-for-gestational-age (LGA) or macrosomic infants are associated with adverse maternal and neonatal outcomes. It is unclear if these associations are stronger using customised birthweight centiles. We compared outcomes between term infants defined macrosomic by birthweight >4000 g (Macro(4000) ) or LGA by population centiles (LGA(pop) ) with those defined LGA by customised centiles (LGA(cust) ). This is a prospective cohort study of 2668 term nulliparous women recruited into the Screening for Pregnancy Endpoints (SCOPE) study centres in Auckland, New Zealand and Adelaide, Australia. Maternal (caesarean delivery, postpartum haemorrhage) and infant (severe neonatal morbidity/mortality and admission to neonatal intensive care) outcomes in Macro(4000) and LGA groups were compared with appropriate-for-gestational-age infants by customised centiles using logistic regression. Customised centiles defined fewer infants as LGA (10.3% LGA(cust) , 14.8% Macro(4000) , 11.2% LGA(pop) ). However customised centiles showed stronger association with adverse outcomes. Pre-labour and intrapartum caesarean section were increased twofold in LGA(cust) pregnancies, including those that were not Macro(4000) or LGA(pop) . Postpartum haemorrhage was increased twofold in mothers of LGA(cust) infants only when infants were also LGA(pop) . Severe neonatal morbidity/mortality or admission to neonatal intensive care was increased twofold in LGA(cust) who were also either Macro(4000) or LGA(pop) . Importantly 52.3% of Macro(4000) and 25.5% of LGA(pop) infants were AGA(cust) and not at increased risk of most adverse maternal or neonatal outcomes. The use of customised centiles are more strongly associated with adverse birth outcomes and its use should be considered in the definition of LGA.

P16.07: Use of customised birthweight centiles in fetuses with congenital heart disease

P16.07: Use of customised birthweight centiles in fetuses with congenital heart disease

Measurement of spiral artery jets: general principles and differences observed in small‐for‐gestational‐age pregnancies

To investigate whether the jets of blood from the mouths of the spiral arteries could be measured reliably, as well as their relationship with the uterine artery (UtA) and any differences in small-for-gestational-age (SGA) pregnancies. Participants underwent serial ultrasound scans, from 11 weeks' gestation. Pulsatility index (PI) and resistance index (RI) of jets into the intervillous space (IVS) and UtA were recorded at every visit. Intra- and interobserver variability studies were performed. Customized birth weight centiles were calculated and SGA was defined as < 10(th) centile. Linear mixed model analysis was used to allow for the longitudinal nature of the data. Sixty-six women were recruited; 58 remained normotensive and delivered at term. Of these, six women delivered SGA newborns and 52 delivered appropriate-for-gestational-age newborns. All had pulsatile jets until 20 weeks' gestation. The PI and RI of the jets decreased with advancing gestation, following a trend similar to that of the UtAs. There was no correlation between the jets and UtA waveforms when gestational age was controlled for. For intraobserver variability the intraclass correlation coefficient was 0.9. The interobserver study showed no significant difference between the observers. Mixed model analysis demonstrated that PI and RI of jets were different in SGA pregnancies (P < 0.06). This difference was not seen for the UtAs (P = 0.8). This technique enables examination of characteristics of the jets of blood flowing from spiral arteries into the IVS. It is both precise and reproducible, with biologically plausible results. Further work is required to assess differences in pregnancies with adverse outcomes.

Maternal and pathological pregnancy characteristics in customised birthweight centiles and identification of at‐risk small‐for‐gestational‐age infants: a retrospective cohort study

To regenerate coefficients for the New Zealand customised birthweight centile calculator using an updated birth cohort, and compare the identification of at-risk small-for-gestational-age (SGA) infants between full customisation (including maternal characteristics) and an ultrasound-based fetal weight and infant gender partial customisation. Retrospective cohort study of prospectively collected maternity data. National Women's Health Auckland, New Zealand. Singleton pregnancies in the period 2006-2009; n = 24,176. Multiple linear regression analysis was performed for full customisation (adjusted for gestation, infant gender, maternal characteristics and pathological variables) and ultrasound-and-gender customisation (adjusted for gestation and infant gender). Risks of SGA-related perinatal death were compared between models. Changes occurred in some ethnicity coefficients, including Chinese (-135 g), Tongan (-101 g) and Samoan (-89 g), and ten ethnicities were added. Overall, full customisation identified SGA infants with higher odds of perinatal death (OR 5.6, 95% CI 3.6-8.7) than infants classed as SGA by ultrasound-and-gender customisation (OR 2.1, 95% CI 1.4-3.3) (P = 0.02). In subgroup analyses, infants classed as SGA by full but not ultrasound-and-gender customisation (n = 888, 3.4%) had an increased risk of perinatal death (RR 4.7, 95% CI 2.7-7.9); however, those identified as SGA by ultrasound-and-gender customisation alone were not at an increased risk (n = 676, 2.6%, RR 1.1, 95% CI 0.4-3.6). The population attributable risk (PAR) of SGA-related perinatal death was higher for full (49.8%) than for ultrasound-and-gender (43.0%) customisation. Updating the New Zealand customised birthweight centile calculator resulted in revised coefficients that better reflect a contemporary birth cohort. Inclusion of maternal characteristics in a birthweight customisation model increases the detection of SGA infants at risk of perinatal death.

Can customised sfh charts predict SGA in unexplained stillbirth?

Small for gestational age (SGA) fetuses are at greater risk of stillbirth. Standard antenatal care utilises symphyseal fundal height (SFH) for the identification of SGA. We explored how useful SFH...

6: Can differences in obstetric outcomes be explained by differences in the care provided?

6 Can differences in obstetric outcomes be explained by differences in the care provided? William Grobman For the Eunice Kennedy Shriver National Institute of Health and Human Development, Maternal-Fetal Units Network, Bethesda, MD OBJECTIVE: Although many obstetric outcomes have been suggested as quality indicators, there is little direct evidence that institutional differences in these indicators are related to differences in the care provided. The objective of this study was to determine whether variation in the frequency of potential quality indicators could be related to differences in care. STUDY DESIGN: Data were obtained by trained abstractors, with ongoing data edits and audits, from all deliveries on 365 randomly selected days at 25 hospitals over a three-year period. Four outcome measures, selected a priori and rigorously defined, were chosen as potential quality indicators: severe postpartum hemorrhage (PPH), maternal peripartum infection (INF), perineal trauma (3rd or 4th degree laceration) at SVD (LAC), and a composite adverse neonatal outcome (NEO). Because the frequency of outcomes may be related to other patient, physician (e.g. years of experience), and institutional (e.g. in-house obstetrician 24 hours daily) factors, these characteristics were assessed for their associations with the above outcomes of interest through the use of hierarchical logistic regression, which was used to account for potential confounding and clustering of observations. Selected care processes were then placed into the model to assess whether these were independently associated with the outcomes. RESULTS: Data were collected on 115,502 women. After adjustment for patient, physician, and institutional characteristics, differential use of labor induction, cesarean delivery, and episiotomy, were associated with the outcomes of interest (Table). CONCLUSION: After controlling for differences in patients, physicians, and institutional factors, several care processes were found to be associated with variation in predefined adverse outcomes. These associations support the use of these outcomes as quality indicators, and also may suggest process measures that also are reasonable to use as quality indicators. 7 ROLO study: a randomized control trial of low glycemic index diet to prevent macrosomia in euglycemic women Jennifer Walsh, Rhona Mahony, Michael Foley, Fionnuala McAuliffe UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: The macrosomic fetus is predisposed to a variety of adverse obstetric and neonatal outcomes, and significantly increases the risk of birth complications for the mother. In the long term, infants that are at the highest end of the distribution for weight are more likely to be obese in childhood. Eating primarily a high glycaemic carbohydrate diet can result in feto-placental overgrowth, excessive maternal weight gain and fetal macrosomia. Our hypothesis was that altering the source of maternal dietary carbohydrate could prevent macrosomia in euglycemic women. STUDY DESIGN: This is a randomised control intervention trial of 720 secundigravid women whose first baby was macrosomic (birth weight 4.0 Kg). Women were randomized to receive either no dietary intervention or a low glycemic index (GI) diet from early pregnancy. Those with pre-existing or previous gestational diabetes were excluded. The low GI group attended a small group dietetic session at 14-18 weeks’ gestation and continued the diet until term with written information and regular re-enforcement. The primary endpoint of the study was the difference in birth weight. Secondary outcomes included gestational weight gain and the development of glucose intolerance. RESULTS: There was no difference between the control and intervention groups in birthweight, customized birthweight centile or birthweight z-score. Fetal macrosomia recurred in 51% (n 184) of the intervention group and in 52 % (n 187) of controls. Women in the low GI group had significantly less gestational weight gain than those without any dietary intervention. (12.2kg vs 13.6kg p 0.01). The incidence of glucose intolerance was also significantly less in the low GI arm with 16.7% having a glucose challenge test result of 7.8 mmol/L compared with 23.4% of controls (p 0.04). CONCLUSION: Infant birthweight is a complex interplay of environmental and genetic factors. Despite a significant reduction in maternal gestational weight gain and glucose intolerance, a low GI diet in pregnancy has no effect on infant birthweight.

Association of Vascular Endothelial Growth Factor &lt;emph type="ital"&gt;+936 C/T&lt;/emph&gt; Single-Nucleotide Polymorphism With Pregnancies Complicated by Small-for-Gestational-Age Babies

To examine whether single-nucleotide polymorphisms (SNPs) in VEGFA (-2578 C/A and +936 C/T) associate with small-for-gestational-age (SGA) pregnancies and to identify their effects on first-trimester placental VEGFA expression. Multicenter prospective cohort study. Adelaide, Australia, and Auckland, New Zealand. A total of 3234 nulliparous pregnant women, their partners, and their infants. The SNPs in the parent-infant trios and first-trimester placentae (n = 74) were genotyped. Placental VEGFA messenger RNA expression was determined by quantitative reverse transcription-polymerase chain reaction. Small for gestational age was defined as a birth weight less than the 10th customized birth weight percentile adjusted for maternal height, weight, parity, and ethnicity and for gestational age at delivery and infant sex. Uterine and umbilical artery Doppler was performed at 20 weeks' gestation, and resistance indices greater than the 90th percentile were considered abnormal. Of 2123 pregnancies, 1176 (55.4%) were uncomplicated and 216 (10.2%) had SGA infants. Neonatal VEGFA +936 C/T SNP associates with SGA (adjusted odds ratio [aOR], 1.6; 95% CI, 1.0-2.3), SGA with abnormal Doppler findings (aOR, 3.5; 95% CI, 1.8-7.1), lower birth weight (P = .006), customized birth weight percentile (P = .049), and abnormal uterine artery Doppler findings (OR, 2.5; 95% CI, 1.2-5.4). Maternal VEGFA +936 C/T associates with abnormal umbilical artery Doppler findings (OR, 1.5; 95% CI, 1.1-2.2). VEGFA +936 CT+TT first-trimester placentae have 36% lower VEGFA messenger RNA expression compared with CC (P = .045). Neonatal VEGFA +936 C/T associates with SGA, and the association is stronger for SGA with abnormal uterine or umbilical artery Doppler findings. The SNP also associates with reduced first-trimester placental VEGFA expression, suggesting that it may have a role in the pathogenesis of SGA. Trial Registration clinicaltrials.gov Identifier: ACTRN12607000551493.

The Fetal Growth Restricted Baby: Definition and Outcome

Introduction: There is growing evidence that the intrauterine environment has far-reaching consequences on life-long health. Almost all studies examining this effect have relied on birth weight centile alone. The aim of this study is to describe measured body composition at birth in growth restricted infants. Methods: In a prospective birth cohort study (BASELINE study) infants were recruited antenatally. Weight, length, fat mass, fat free mass and percentage body fat (%BF) were measured at birth using air displacement body plethysmography (PEAPOD). Fetal growth restriction (FGR) was defined as customised birthweight centile < 10th. Results: Of the 1335 recruited neonates, 886 had %BF measured between day 1-4. 11.09% (n=148/1335) were categorised as having FGR. The overall mean (SD) %BF was 10.84 (4.21), range = (1.30, 30.10). Significant differences between FGR babies and normal controls were noted for ponderal index [mean (SD) 25.26 (2.99); 27.82 (3.22); p< .001]; gestational age [mean 38+5 (3.40); vs 39+6 (1.95); p=.000] and rate of neonatal unit admission [12.8% (19/148); 7.4% (88/1187), p=.033]. In the infants with FGR the mean (SD) %BF was 7.9 (3.6), compared to 11.1 (4.2) %BF in the non-FGR group. In the total sample, %BF increased linearly ((r=.455, p< .001) across the customised birthweight quartiles (p< .001)). There were significant differences in mean %BF across the quartiles of customised birthweight centiles (Mean (SD) 0-25= 8.39 (3.77)%; 26-50=10.13 (3.40)%; 51-75=11.35 (3.77)%; 76-100=13.59 (4.17)% at p< .001. Conclusion: Low birth weight and reduced customized birth weight centile are associated with an altered body composition and lower mean %BF.

The role of thromboxane A 2 in the pathogenesis of intrauterine growth restriction associated with maternal smoking in pregnancy

Background To examine the effect of maternal smoking in pregnancy on the production of two eicosanoids, thromboxane A 2 and prostacyclin I2, and their role in the pathogenesis of intrauterine growth restriction. Methods Prospective case control study enrolled smoking and non-smoking women at ≤14 weeks gestation. Maternal urine samples were obtained at ≤14, 28 and 36 weeks. High performance liquid chromatography tandem mass spectrometry (LC–MS–MS) was used to quantify 11-dehydrothromboxane B 2 (TX-M) and 2,3 dinor-6-ketoprostaglandin F1α (PG-M), stable urinary metabolites of thromboxane A 2 and prostacyclin I2. Confirmation of the smoking status was performed by quantitation of urinary nicotine metabolites. Data was analysed using SPSS and Stata ®. Results Thirty five were enrolled in the smoking group and 32 in the non-smoking group. Smoking resulted higher levels of TX-M at ≤14, 28 and 36 weeks gestation. There was no difference in PG-M at any gestational time point between the two groups. The median customised birthweight centile in the smoking group was 17.0 (0–78) compared to 55.5 (4–100) in the non-smoking group ( P < 0.001). A causal relationship between elevated TX-M and IUGR could not be established. Conclusions Maternal smoking in pregnancy is associated with altered eicosanoid production in favour of the vasoconstrictor thromboxane A 2 which occurs early in the first trimester.

Chronic renal disease in pregnancy: obstetric outcomes and effect of pregnancy on renal function

IntroductionChronic renal impairment is associated with adverse obstetric outcomes including pre-eclampsia, prematurity and intra-uterine growth restriction. Pregnancy can accelerate decline in renal function: degree of deterioration is dependent on pre-pregnancy...

Effect of Maternal Heart Disease on Fetal Growth

To estimate the effect of maternal heart disease on fetal growth and neonatal outcomes. A retrospective cohort study of all women with congenital and acquired heart disease admitted at Chelsea and Westminster Hospital between 1994 and 2010 was performed. The women who delivered immediately before and immediately after each index pregnancy were used as controls. Data were obtained from medical and obstetric notes. Birth weight percentiles were calculated using a customized birth weight percentile program, and neonatal complications (preterm birth, perinatal mortality, and recurrence of congenital heart disease) were noted. Median birth weight percentile was significantly lower in the heart disease group (31) compared with the control group (49;P.001 Mann-Whitney U test [corrected].The rate of neonatal complications was significantly higher in the heart disease group (34% compared with 15%). Preterm birth occurred in 42 (13%) pregnancies, of which 67% were iatrogenic. Eighty-one (25%) newborns in the heart disease group were small for gestational age, and there were four stillbirths and four neonatal deaths (perinatal mortality rate 20 per 1,000). This cohort study suggests a significant reduction in fetal growth rates associated with maternal heart disease, which is also associated with preterm delivery and reduced birth weight. The presence of maternal cyanosis and a reduced cardiac output are the most significant predictors. II.

Being too large for gestational age precedes childhood obesity in African Americans

The purpose of this study was to investigate the association between large-for-gestational-age (LGA) infants and the development of childhood obesity in an inner-city primarily African American population. Maternal, neonatal, socioeconomic, and nutritional histories were collected for mothers with children who were 2-5 years old. Associations between Alexander and customized birthweight percentiles and body mass index for the age of the child were examined. One hundred ninety-five mother-child pairs were enrolled; the childhood obesity rate was 18%. Increasing Alexander and customized birthweight percentiles were related to increasing obesity. LGA newborn infants were 2.5 times more likely to be obese in childhood than average size newborn infants. Maternal smoking was also associated with childhood obesity. LGA infants have the highest likelihood of childhood obesity in this inner-city predominantly African American population. Customized growth percentiles perform best in the identification of the highest risk population.