Difference In Mean Birth Weight Research Articles

Perinatal outcomes after in-utero exposure to beta-blockers in women with heart disease: Data from the ESC EORP registry of pregnancy and cardiac disease (ROPAC)

BackgroundBeta-blockers are commonly used drugs during pregnancy, especially in women with heart disease, and are regarded as relatively safe although evidence is sparse. Differences between beta-blockers are not well-studied. MethodsIn the Registry of Pregnancy And Cardiac disease (ROPAC, n = 5739), a prospective global registry of pregnancies in women with structural heart disease, perinatal outcomes (small for gestational age (SGA), birth weight, neonatal congenital heart disease (nCHD) and perinatal mortality) were compared between women with and without beta-blocker exposure, and between different beta-blockers. Multivariable regression analysis was used for the effect of beta-blockers on birth weight, SGA and nCHD (after adjustment for maternal and perinatal confounders). ResultsBeta-blockers were used in 875 (15.2%) ROPAC pregnancies, with metoprolol (n = 323, 37%) and bisoprolol (n = 261, 30%) being the most frequent. Women with beta-blocker exposure had more SGA infants (15.3% vs 9.3%, p < 0.001) and nCHD (4.7% vs 2.7%, p = 0.001). Perinatal mortality rates were not different (1.4% vs 1.9%, p = 0.272). The adjusted mean difference in birth weight was −177 g (−5.8%), the adjusted OR for SGA was 1.7 (95% CI 1.3–2.1) and for nCHD 2.3 (1.6–3.5). With metoprolol as reference, labetalol (0.2, 0.1–0.4) was the least likely to cause SGA, and atenolol (2.3, 1.1–4.9) the most. ConclusionsIn women with heart disease an association was found between maternal beta-blocker use and perinatal outcomes. Labetalol seems to be associated with the lowest risk of developing SGA, while atenolol should be avoided.

Incidence, Risk Factors and Development of Retinopathy of Prematurity in Mid-Preterm and Late-Preterm Infants.

To evaluate the incidence, risk factors, and development of retinopathy of prematurity (ROP) in midpreterm and late-preterm infants born at 32 to 36 6/7 weeks of gestational age. The ophthalmic examination findings and risk factors of 5,477 preterm infants who underwent ophthalmological examination were evaluated retrospectively. The rates of any stage and severe ROP (requiring treatment) development and treatment options were recorded. The risk factors were analyzed by using logistic regression analysis. A total of 5,477 infants were included in the study, of whom 2,715 (49.57%) were mid-preterm and 2,762 (50.43%) were late-preterm. The rates of any stage and severe ROP were 8.2% (n = 223) and 0.6% (n = 15) in mid-preterm infants, respectively. In late-preterm infants, the rate of any stage ROP was 2.1% (n = 59), and no severe ROP was detected. There was no significant difference in mean birth weight in mid-preterm infants between infants with any stage ROP and severe ROP (P = .104). Of the 15 infants (0.3%) who required treatment, 14 (0.2%) infants had laser photocoagulation, 1 (0.01%) had intravitreal bevacizumab, and 2 (0.03%) had additional therapy (laser photocoagulation and intravitreal bevacizumab). In logistic regression analysis, a significant association was found between treatment requirement and transport from an external center (P < .001, ß = 0.04). Although ROP development rates decrease as birth weight and gestational age increase, late-preterm infants should be examined for ROP at least once, especially those born in low-income countries because ROP development can still be observed. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

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

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

IMPACT OF TIME INTERVAL FROM CESAREAN DELIVERY TO FROZEN EMBRYO TRANSFER ON REPRODUCTIVE AND NEONATAL OUTCOMES

To evaluate differences in reproductive and neonatal outcomes based on the time interval from cesarean delivery to subsequent frozen embryo transfer (FET) DESIGN: Retrospective cohort SUBJECTS: Women undergoing autologous elective single embryo transfer (eSET) FET following prior cesarean delivery EXPOSURE: Time from prior cesarean delivery to subsequent FET MAIN OUTCOME MEASURES: Live birth RESULTS: A total of 6,556 autologous eSET FET cycles were included. FET cycles were divided into eight groups based on the time interval from prior cesarean delivery to subsequent FET in months. Time was also evaluated as a continuous variable. The proportion of live births did not differ significantly across all time interval groups and over continuous time (range: 40.0% - 45.6%, adjusted (adj) p = 0.572, continuous adj p = 0.599). Mean gestational age at the time of delivery did not significantly differ as the time between prior cesarean delivery and subsequent FET increased (range: 37.3 - 38.4 weeks, adj p = 0.87, continuous adj p = 0.06). When time was evaluated continuously, the proportion of preterm births was higher with a shorter time between cesarean delivery and subsequent FET (p = 0.02). Mean birth weight ranged from 3181 grams to 3470 grams, with a statistically significant increase over time (continuous adj p = 0.01). However, the proportions of extremely low birth weight, very low birth weight, and low birth weight did not significantly differ. There were no significant differences in reproductive outcomes based on the time interval from cesarean delivery to FET, including live birth. The proportion of preterm deliveries decreased with a longer time between cesarean delivery and FET. Differences in mean neonatal birth weight were not clinically significant, as the proportion of low-birth-weight neonates was not significantly different over time. While large, this sample cannot address all outcomes associated with short interpregnancy intervals, particularly rarer outcomes such as uterine rupture. When counseling patients, the timing of FET following cesarean delivery must be balanced against the risks of increasing maternal age on reproductive and neonatal outcomes.

Neonatal Birth Weight With Daily Compared With Every-Other-Day Glucose Monitoring in Gestational Diabetes Mellitus

OBJECTIVE: To assess whether universal use of every-other-day glucose monitoring in patients with gestational diabetes mellitus (GDM) resulted in similar birth weights and medication use and was preferred by the patient compared with traditional daily glucose monitoring. METHODS: This was a noninferiority randomized controlled trial conducted at a single New York City hospital between April 2021 and May 2022. Patients with singleton pregnancies who were diagnosed with GDM after 20 weeks of gestation and had a minimum of 7 days of previous daily blood glucose testing were randomly assigned to test blood glucose values daily or every other day. The primary outcome was neonatal birth weight. We calculated a total sample size of 196 participants needed for noninferiority to be tested, assuming the mean birth weight in the every-other-day group, compared with the daily group, was no higher than the predefined noninferiority margin of 200 g (80% power and one-sided alpha of 0.05). Postrandomization characteristics, including blood glucose values and medication initiation and timing, were recorded. Satisfaction with treatment group was assessed using the validated Oxford Maternity Diabetes Treatment Satisfaction Questionnaire. RESULTS: A total of 197 patients were randomized: 98 in the daily group and 99 in the every-other-day group. Baseline characteristics were similar between groups. The mean neonatal birth weight was similar between groups (mean±SD 3,090±418 g among newborns in the daily group compared with 3,181±482 g among newborns in the every-other-day group). For the primary outcome, the every-other-day group was found to be noninferior to the daily group with an upper confidence limit for the mean difference in mean birth weight of 197 g, which was below the noninferiority margin of 200 g (P=.046). Postrandomization, there were no significant differences in the number of patients who required medication, the gestational age at which medication was started, or the type of medication used. Average fasting and postprandial glucose values were similar between groups. There was an increase in adherence to treatment group in those randomized to every-other-day blood sugars, but no difference in patient satisfaction. CONCLUSION: In patients with GDM, testing blood glucose values every other day was as effective as testing daily, without apparent effects on birth weight, medication initiation, or glucose control. Reduced frequency of blood glucose monitoring might help decrease the emotional, physical, and financial burden experienced by patients with GDM. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04857073.

Retrospective Study on the Large for Gestational Age cases from SSBH, Brunei

Introduction: Large-for-gestational-age babies are at high risk for short-term outcomes such as shoulder dystocia, neonatal hypoglycaemia and birth trauma. Macrosomic babies are defined as those with birth weights of &gt;4,000 g, irrespective of gestational age, sex, or country/region-specific differences in mean birth weight and maternal body weight. In the recent past, the rate of large-for-gestational-age [LGA] babies, has increased all over the world. Purpose This study is aimed to investigate the prevalence of macrosomia/LGA in Suri Seri Begawan Hospital (SSBH) and to determine the maternal and fetal outcomes. Methodology: The selected universe for the study is at Suri Seri Begawan Hospital, for the time duration of 2 consecutive years (2018-19). The secondary data is used to calculate a prevalence. Result: The prevalence of 1.9% was found in this study (all &gt;4 kg) and 75% of male babies were born as macrosomia/LGA. 19% of the participants delivered big babies before, and 27% were diabetic in this current pregnancy. 63.6% were delivered by spontaneous vaginal delivery, and there was 1 shoulder dystocia with a 4.1 kg weighed baby. One LSCS wound infection and one vaginal haematoma occurred in this study, although only 21% of babies were admitted to the neonatal unit. Conclusion: The current study draws its conclusion based on the findings that macrosomia/LGAs in SSBH are not as high as like China. Expectant management was practiced in most of the cases and outcome wise is acceptable ensuring our management protocol was safe. Large-for-gestational-age babies are at high risk for shoulder dystocia with brachial plexus injury, which is of great concern for all obstetricians. The management of macrosomia/LGA pregnancy should be individualized by taking into account all maternal and foetal factors as well as all available diagnostic tools. Obstetricians should be vigilant and careful with proper clinical judgement and early recognition of possible complications.

Reproductive outcomes in women and men conceived by assisted reproductive technologies in Norway: prospective registry based study

ObjectivesTo determine whether the perinatal outcomes of women or men who were conceived by assisted reproductive technologies are different compared with their peers who were naturally conceived.DesignProspective registry based study.SettingMedical...

The gestational age-specific difference in birthweight between singletons born after fresh and frozen embryo transfer: A cohort study.

Accumulating studies have suggested singletons born after frozen embryo transfer (FET) were higher than those born after fresh embryo transfer (Fre-ET). However, fewer studies had investigated the gestational age-specific between-group difference in birthweight. This study aimed to investigate the gestational week-specific difference in singleton birthweight after FET vs Fre-ET and explore potential factors that impact the difference. In this retrospective cohort study, a total of 25 863 singletons were included. Multivariable linear regression and logistic regression were used to evaluate the between-group differences in mean birthweight and the incidences of large for gestational age (LGA) and small for gestational age (SGA), respectively. Multivariable regression analyses showed a statistically significant interaction between types of embryo transfer (ie FET vs Fre-ET) and the gestational week on mean birthweight (P < 0.001) and on the risks of large for gestational age (P=0.001) and small for gestational age (P < 0.001). When stratified by gestational week, the differences in mean birthweight and the risks of LGA and SGA were only observed in singletons born at 37 gestational weeks or later. After adjusting for confounders, full-term but not preterm singletons born after FET had a higher birthweight (3497.58 ± 439.73 g vs 3445.67 ± 450.24 g; adjusted mean difference 58.35 g; 95% confidence interval [CI] 38.72-77.98 g), a higher risk of LGA (24.3% vs 21.1%; adjusted odds ratio [OR] 1.28, 95% CI 1.15-1.42) and a lower risk of SGA (3.1% vs 4.8%; adjusted OR 0.61, 95% CI 0.53-0.70) compared with those born after Fre-ET. The differences in birthweight between FET and Fre-ET were observed in full-term singletons but not preterm singletons.

Evaluation of Preeclampsia Risk in Gestational Weight Gain

Background: The incidence of obesity worldwide has increased over the last 20 years. The increase in obesity in maternal pregnancy is causing a major challenge to obstetrics practices. The aimed study was to evaluate gestational weight gain as a risk for preeclampsia in pregnant women. Methods: This cross-sectional study was conducted on 2756 pregnant women with gestational age≥37 weeks. The selection of women was categorized into two groups, 1528 normal-weight women with BMI less than 25kg/m2 and 1228 pregnant women with a BMI of 25kg/m2 or more. SPSS software version 26.0 was used to analyze data. Multivariate logistic regression described the relation of weight change to pregnancy course and outcomes. Results: A comparison between study groups shows an increase in antepartum complications in obese women. Besides that, arterial hypertension, pre-eclampsia, and gestational diabetes were more frequent in overweight women compared to normal-weight women. The incidence of cesarean was highest in overweight and obese women with a statistically significant difference from normal weight women (p-value &lt;0.005). In addition, maternal overweight and obese were at twice the risk for delivering infants with macrosomia (OR = 3.1, 95%CI = [1.09-5.8]). The difference in mean birth weight of the babies between normal and overweight women was statistically significant (p&lt;0.05). Conclusion: The results of this study show that obesity during pregnancy is associated with pregnancy complications. To optimize all complications for the mother and fetus, weight gain during the pregnancy must be controlled and appropriate. Furthermore, studies are recommended to explore maternal obesity complications and risk factors for obesity to minimize the adverse effect of this risk.&#x0D; &#x0D;

Examining maternal depression, birthweight and linear growth: Findings from the South African National Income Dynamics Study

Background. Literature is inconclusive regarding an association between maternal depression, low birthweight (LBW) and stunting in early childhood. While some studies have found an association, others have not. Maternal food insecurity is a risk factor for both maternal depression and reduced linear growth in early childhood. &#x0D; Objective. This study examined the relationship between maternal depression, food insecurity, LBW and stunting in the first five years of life. The study employed longitudinal data of South African women and children from the National Income Dynamics Study (NIDS). &#x0D; Methods. Mothers were classified into four groups: food insecure and depressed; food insecure only; depressed only; and neither food insecure nor depressed. During data collection, 22% of women were pregnant and the remaining 78% were pre-conception. The primary outcomes were low birthweight and height-for-age (HAZ) scores. Generalised Linear Mixed Effects (GLME) models were used to account for women having more than one child. GLME models with a Gaussian link function were used to compare mean differences in birthweight and HAZ scores. Multivariable regression models were used to examine factors associated with depression. &#x0D; Results. Food insecurity was significantly associated with depression among pre-conceptional and pregnant women. There was no statistically significant difference in birthweight or linear growth across groups, but this may be influenced by proximity of depression measurement in relation to outcomes. &#x0D; Conclusion. Food insecurity is a potentially modifiable risk factor for depression and may be a confounding factor in studies that have found associations between depression and child health outcomes.

Evaluation of Preeclampsia Risk in Gestational Weight Gain

Background: The incidence of obesity worldwide has increased over the last 20 years. The increase in obesity in maternal pregnancy is causing a major challenge to obstetrics practices. The aimed study was to evaluate gestational weight gain as a risk for preeclampsia in pregnant women. Methods: This cross-sectional study was conducted on 2756 pregnant women with gestational age≥37 weeks. The selection of women was categorized into two groups, 1528 normal-weight women with BMI less than 25kg/m2 and 1228 pregnant women with BMI over 25kg/m2. SPSS software version 26.0 was used to analyze data. Multivariate logistic regression described the relation of weight change to pregnancy course and outcomes. Results: A comparison between study groups appears an increase in antepartum complications in obese weight women. Besides that, arterial hypertension, pre-eclampsia, and gestational diabetes were more frequent in obese weight women compared to normal-weight women obese women. The incidence of cesarean was highest in obese women statistically significant difference from normal women with a p-value &lt;0.005. In addition, maternal obese pregnancies were at twice the risk for delivery of infants who were macrosomia with higher odds (OR = 3.1, 95%CI = [1.09-5.8]). In perinatal outcomes, the difference in mean birth weight of the babies among normal and obese women was statistically significant (p&lt;0.05). Conclusion: As we saw from the results of this study obesity during pregnancy was associated with pregnancy complications. To optimize all complications to maternal and fetus, weight gains during the pregnancy must be controlled and appropriate. Furthermore, studies are recommended to explore the maternal obesity complication and risk factors that influence obesity to minimize the adverse negative effect of this risk.

Comparing neonatal outcome of late preterm: Intrauterine growth restricted (IUGR) average for gestational age infants

Comparing Neonatal outcome of late preterm -Intrauterine growth restricted (IUGR) vs Average for Gestational age (AGA) infants.Background: Individuals who had IUGR experience a range of poorer developmental outcomes, encompassing cognitive, socioemotional, and behavioral domains, compared with individuals who were born appropriate for gestational age (AGA).The primary aim was to evaluate neonatal outcome in late preterm IUGR and SGA infants and comparing them.Methods: Out of 3256 total live births, late preterm births are 341(10.4%). Incidence of IUGR in late preterm infants is 71/341(2.15%) and AGA is 170/341(8.25%). We analysed 100 singleton pregnancies, 50 infants with birth weight less than 10th percentile, control group with 50 infants with birth weight between 11-89 percentile at 34-36+6 weeks gestational age. The control group consisted of spontaneous preterm delivery at the same gestational age.Birth weight percentiles were based on the standard growth curve of Alexander et al. Results: There was a significant difference in mean birth weight between the two groups (IUGR: 1720g and AGA: 2495g). The frequency of cesarean sections was 64% in the IUGR group and 26% in the AGA group. 3 neonates of the IUGR group and one of the AGA infants presented Apgar scores <7 at 5 minutes. The length of stay of the newborn in the nursery, as well as the need for and duration of hospitalization in the NICU, differed significantly between the two groups. TTN, Neonatal sepsis and hyperbilirubinemia didnot differ between groups but phototherapy required for IUGR group is more.Conclusion: Late-preterm IUGR infants present a significantly higher risk of neonatal complications and a significantly longer NICU and hospital stay when compared to late-preterm AGA infants.

Maternal serum concentrations of one-carbon metabolism factors modify the association between biomarkers of arsenic methylation efficiency and birth weight

BackgroundInorganic arsenic (iAs) is a ubiquitous metalloid and drinking water contaminant. Prenatal exposure is associated with birth outcomes across multiple studies. During metabolism, iAs is sequentially methylated to mono- and di-methylated arsenical species (MMAs and DMAs) to facilitate whole body clearance. Inefficient methylation (e.g., higher urinary % MMAs) is associated with increased risk of certain iAs-associated diseases. One-carbon metabolism factors influence iAs methylation, modifying toxicity in adults, and warrant further study during the prenatal period. The objective of this study was to evaluate folate, vitamin B12, and homocysteine as modifiers of the relationship between biomarkers of iAs methylation efficiency and birth outcomes.MethodsData from the Biomarkers of Exposure to ARsenic (BEAR) pregnancy cohort (2011–2012) with maternal urine and cord serum arsenic biomarkers and maternal serum folate, vitamin B12, and homocysteine concentrations were utilized. One-carbon metabolism factors were dichotomized using clinical cutoffs and median splits. Multivariable linear regression models were fit to evaluate associations between each biomarker and birth outcome overall and within levels of one-carbon metabolism factors. Likelihood ratio tests of full and reduced models were used to test the significance of statistical interactions on the additive scale (α = 0.10).ResultsAmong urinary biomarkers, % U-MMAs was most strongly associated with birth weight (β = − 23.09, 95% CI: − 44.54, − 1.64). Larger, more negative mean differences in birth weight were observed among infants born to women who were B12 deficient (β = − 28.69, 95% CI: − 53.97, − 3.42) or experiencing hyperhomocysteinemia (β = − 63.29, 95% CI: − 154.77, 28.19). Generally, mean differences in birth weight were attenuated among infants born to mothers with higher serum concentrations of folate and vitamin B12 (or lower serum concentrations of homocysteine). Effect modification by vitamin B12 and homocysteine was significant on the additive scale for some associations. Results for gestational age were less compelling, with an approximate one-week mean difference associated with C-tAs (β = 0.87, 95% CI: 0, 1.74), but not meaningful otherwise.ConclusionsTissue distributions of iAs and its metabolites (e.g., % MMAs) may vary according to serum concentrations of folate, vitamin B12 and homocysteine during pregnancy. This represents a potential mechanism through which maternal diet may modify the harms of prenatal exposure to iAs.

Using Mendelian Randomisation to Prioritise Candidate Maternal Metabolic Traits Influencing Offspring Birthweight.

Marked physiological changes in pregnancy are essential to support foetal growth; however, evidence on the role of specific maternal metabolic traits from human studies is limited. We integrated Mendelian randomisation (MR) and metabolomics data to probe the effect of 46 maternal metabolic traits on offspring birthweight (N = 210,267). We implemented univariable two-sample MR (UVMR) to identify candidate metabolic traits affecting offspring birthweight. We then applied two-sample multivariable MR (MVMR) to jointly estimate the potential direct causal effect for each candidate maternal metabolic trait. In the main analyses, UVMR indicated that higher maternal glucose was related to higher offspring birthweight (0.328 SD difference in mean birthweight per 1 SD difference in glucose (95% CI: 0.104, 0.414)), as were maternal glutamine (0.089 (95% CI: 0.033, 0.144)) and alanine (0.137 (95% CI: 0.036, 0.239)). In additional analyses, UVMR estimates were broadly consistent when selecting instruments from an independent data source, albeit imprecise for glutamine and alanine, and were attenuated for alanine when using other UVMR methods. MVMR results supported independent effects of these metabolites, with effect estimates consistent with those seen with the UVMR results. Among the remaining 43 metabolic traits, UVMR estimates indicated a null effect for most lipid-related traits and a high degree of uncertainty for other amino acids and ketone bodies. Our findings suggest that maternal gestational glucose and glutamine are causally related to offspring birthweight.

Effects of early maternal cancer and fertility treatment on the risk of adverse birth outcomes

SummaryBackgroundEarly maternal cancer and fertility treatment each increase the risk for adverse birth outcomes, but the joint effect of these outcomes has not yet been reported. Thus, the aim was to assess the individual and joint effect of maternal cancer and fertility treatment on the risk for adverse birth outcomes.MethodsThis population-based cohort study included 5487 live-born singletons identified in the Danish Medical Birth Register (1994–2016) of mothers with previous cancer (<40 years) recorded in the Danish Cancer Registry (1955–2014). We randomly selected 80,262 live-born singletons of mothers with no cancer <40 years matched to mothers with cancer by birth year and month. We calculated odds ratios (ORs) for preterm birth, low birth weight (LBW) (<2500 g) and small for gestational age (SGA), mean differences in birth weight in grams, and additional cases of preterm birth (gestational age<259 days) per 100,000 person-years. Multiplicative and additive interaction of maternal cancer and fertility treatment was compared with outcomes of children conceived naturally to mothers with no maternal cancer (reference group).FindingsAmong 84,332 live-born singletons, increased ORs for preterm birth were observed among children born to mothers with previous cancer (1·48, 95% confidence interval [CI] 1·33–1.65) or after fertility treatment (1·43, 95% 1·28–1–61), with 22 additional cases of preterm birth among both group of children (95% CI 15–29; 95% CI 14–30). In the joint analyses, the OR for SGA for children born after fertility treatment to mothers with previous cancer was similar to that of the reference group (OR 1·02, 95% CI 0·72–1·44, P for interaction=0·52). Children with both exposures had increased ORs for LBW (1·86, 95% CI 1·17–2·96, P for interaction=0·06) and preterm birth (2·31, 955 CI 1·66–3·20, P for interaction = 0·56), with 61 additional cases of preterm birth (95% CI 27–95, P for interaction=0.26) over that of children in the reference group. The mean birth weight was also lower in children born to mothers with both exposures (-140 g, 95% CI -215; -65) (P for interaction=0.06) but decreased to -22 g (95% CI -76; 31) after adjustment for GA.InterpretationAlthough we did not find any statistically significant additive interaction between maternal cancer and fertility treatment, children born after fertility treatment of mothers with previous cancer were at increased risk for adverse birth outcomes. Thus, pregnant women with both exposures need close follow-up during pregnancy.FundingThe Danish Cancer Society and the Danish Childhood Cancer Foundation.

Weight gain in pregnancy: can metformin steady the scales?

Objective Metformin has been associated with modest weight reduction in the non-pregnant population. Our hypothesis is that metformin exposure will lead to a higher incidence of appropriate weight gain during pregnancy. Study Design This was a retrospective cohort study in a single center between 2009 and 2019. We included all pregnant women with type 2 diabetes or prediabetes. We compared women exposed to metformin in any trimester. The primary outcome was appropriate weight gain defined by the Institute of Medicine guidelines. Secondary outcomes included excessive weight gain, weight loss, suspected fetal growth restriction (FGR), and mean birth weight. Adjusted odds ratios or group differences were calculated using logistic or linear regression, controlling for confounders. Results Of 41,472 deliveries during the study period, 511 pregnancies met inclusion criteria. 284 pregnancies had no metformin exposure; 227 did have metformin exposure, of which 169 (72.2%) were initiated on metformin in the first trimester. Women exposed to metformin in any trimester were statistically not more likely to have appropriate weight gain (aOR 1.53 (95% CI 1.00–2.34, p = .048), but did have less excess weight gain (aOR 0.45, 95% CI 0.30–0.66, p < .001), and more maternal weight loss (aOR 2.17, 95% CI 1.18–3.98, p = .012) than the unexposed group. Women exposed to metformin in the first trimester of pregnancy were less likely to have excess weight gain (aOR 0.39, 95% CI 0.25–0.61, p < .001) and more likely to have maternal weight loss (aOR 2.56, 95% CI 1.30–5.07, p = .007) than the unexposed cohort. There was no difference in FGR (5.3% vs 2.5% p = .094) or mean birth weight (3235.6 vs 3352.4 gm p = .122) in the metformin exposed group vs non-exposed groups, respectively. Conclusions Metformin exposure in pregnancy was associated with less excess weight gain and a higher rate of weight loss. There was no difference in FGR or mean birth weight in metformin exposed neonates. This suggests that metformin may help avoid excess weight gain and its associated comorbidities.

The positive effect of malaria IPTp-SP on birthweight is mediated by gestational weight gain but modifiable by maternal carriage of enteric pathogens.

SummaryBackgroundPoor pregnancy and birth outcomes are common in sub-Saharan Africa and have complex aetiologies. Sulfadoxine-pyrimethamine (SP), given for intermittent preventive therapy of malaria in pregnancy (IPTp), is one of few existing interventions that improves outcomes of both mother and baby despite widespread SP-resistant malaria. Compelling evidence exists that malaria-independent pathways contribute to this protective effect, but the exact sources of non anti-malarial protection remained unknown. We hypothesized that the beneficial effect of SP on birthweight is mediated by SP activity on maternal factors, including increased gestational weight gain and antibiotic activity on pathogens in the maternal gut.MethodsExpectant mothers from a larger randomized control trial comparing the efficacy of IPTp-SP to IPTp with dihydroartemisinin-piperaquine (DP) were also enrolled in this sub-study study at their first antenatal care visit before commencement of IPTp (n = 105). Participants were followed monthly until delivery. Weights and mid-to-upper-arm circumferences (MUAC) were recorded. Monthly stool samples were collected and screened for five Escherichia coli pathotypes, Shigella spp., Vibrio cholerae, Salmonella, Campylobacter coli/jejuni, and three protozoa (Giardia spp., Entameba histolytica, and Cryptosporidium spp.) using previously validated molecular assays.FindingsIPTp-SP vs. IPTP-DP was associated with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). GWG was found to be a mediator of the birthweight and IPTp-SP relationship, as the birthweight of SP infants, but not DP infants, varied according to maternal GWG. The burden of maternal enteric infections was high. The three most commonly observed pathogens were enteroaggregative E. coli (EAEC), atypical enteropathogenic E.coli/enterohaemorrhagic E. coli (aEPEC/EHEC), and typical enteropathogenic E.coli (tEPEC). We found that SP reduced the prevalence of EAEC in a dose-dependent manner. After 3 or more doses, SP-recipients were 90% less likely to be infected with EAEC compared to DP-recipients (ORadj = 0.07, CI95 = 0.12, 0.39, p = 0.002). Compared to DP, this coincided with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). The beneficial effect of SP on maternal GWG, MUAC and BMI, was lower if SP mothers had detectable EAEC, aEPEC/EHEC, tEPEC, and LT-ETEC at baseline. Maternal EAEC and tEPEC at baseline associated with lower birthweight for babies of both SP mothers and DP mothers. When comparing IPTp regimens, the positive effect of SP on birthweight compared to DP was only observed for infants of women who did not test positive for EAEC at baseline (adjusted mean birthweight difference SP vs. DP = 156.0 g, CI95 = -18.0 g, 336.9 g, p = 0.087), though confidence intervals crossed the null.InterpretationOur findings indicate that in pregnant Malawian women, IPTp-SP vs. IPTp-DP is consistently associated with higher MUAC, BMI, and GWG following the WHO-recommended regimen of at least 3 doses, but carriage of maternal gut pathogens before initiation of IPTp lessens this effect. Because GWG was a mediator of the association between birthweight and SP, we show that SP's previously proven positive effect on birthweight is by promoting maternal weight gain. Overall, our results present one plausible pathway SP exerts malaria-independent protection against poor birth outcomes in the context of its waning antimalarial activity and warrants further investigation.FundingA full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

Clinical and Laboratory Findings of Nosocomial Sepsis in Extremely Low Birth Weight Infants According to Causative Organisms.

Background: nosocomial sepsis remains a significant source of morbidity and mortality in extremely low birth weight (ELBW) infants. Early and accurate diagnosis is very important, but it is difficult due to the similarities in clinical manifestation between the causative microorganisms. We tried to identify the differences between causative microorganisms in clinical and laboratory findings and to help choose antibiotics, when sepsis was suspected in ELBW infants. Methods: a retrospective study was conducted on preterm infants, born at less than 28 weeks of gestation, with a birth weight of less than 1000 g between January 2009 and December 2019. Clinical and laboratory findings of suspected sepsis, after the first 72 h of life, were assessed. We classified them into four groups according to blood culture results (gram positive, gram negative, fungal, and negative culture groups) and compared them. Results: a total of 158 patients were included after using the exclusion criteria, with 45 (29%) in the gram positive group, 35 (22%) in the gram negative group, 27 (17%) in the fungal group, and 51 (32%) in the negative culture group. There were no significant differences in mean gestational age, birth weight, and neonatal morbidities, except for the age of onset, which was earlier in the fungal group than other groups. White blood cell (WBC) counts were the highest in the gram negative group and the lowest in the fungal group. The mean platelet counts were the lowest in the fungal group. C-reactive protein (CRP) levels were the highest in the gram negative group, while glucose was the highest in the fungal group. Conclusions: in conclusion, we showed that there are some differences in laboratory findings, according to causative microorganisms in the nosocomial sepsis of ELBW infants. Increased WBC and CRP were associated with gram negative infection, while decreased platelet and glucose level were associated with fungal infection. These data may be helpful for choosing empirical antibiotics when sepsis is suspected.

Association between maternal anemia and poor pregnancy outcome in selected hospitals of Ujjain districts of the central part of India

Background: Anaemia is one of the most important factors influencing maternal morbidity and mortality and also the health of the newborn. It is a global health issue affecting nearly half of pregnant women. This study aimed to assess the association of maternal anemia with poor pregnancy outcomes.Methods: It was a cross-sectional study that included 2 study centers. As per inclusion/exclusion criteria, this study included 650 post-partum mothers. Using Stratified random sampling study participants were enrolled. Data were collected and analyzed in SPSS 23. Using statistical tests i.e., Chi-square, t-test, etc data was analyzed.Results: Anaemic mothers had a statistically significant association with low birth weight (χ2-9.099, p -0.003) and babies born dead (χ2-8.045, p -0.005). Using the student t-test, there was a significant mean birth weight difference of 114 gms of newborns among anemic and non-anemic mothers (p-0.003).Conclusions: Improving anemic status during pregnancy can reduce the burden of poor pregnancy outcomes.

DAY 6 BLASTOCYST TRANSFER FOR ALL WHEN ICSI IS PLANNED ON TUESDAY : IS IT A SAFE APPROACH?

Improved embryo culture conditions have made extended culture to blastocyst stage increasingly popular. The choice between day 5 and day 6 is usually made on the blastocyst expansion. There is currently no data showing the impact of the day 6 transfer on ICSI outcomes when the choice of transfer day is made out according to the laboratory schedule. Indeed, some IVF centers minimize biological activity on weekends. In addition, work on weekends is the subject of recovery days that reduce the staff available on other week days. Is it possible not to schedule embryo transfers on Sundays without compromising ICSI outcomes? Retrospective cohort follow up study of ICSI cycles with blastocysts transfers on either day 5 or day 6, between January and December 2019 in a single center. The day 5 group comprised 416 cycles, and the day 6 group comprised 91 cycles. ICSI planned on Tuesday, with biological decision of an extended culture (EC) were programmed straight away for a day 6 transfer to avoid Sunday, without taking into account blastocyst expansion on day 5. ICSI planned on other days of the week with EC decision were scheduled for a transfer on day 5. The day 5 group comprised 416 cycles, and the day 6 group comprised 91 cycles. Our results indicate that the two groups were comparable respectively in terms of the mean age of patients (35.05 ± 5.01 VS 34.49 ± 4.46; p>0.05), the mean number of collected oocytes (11.11 VS 10.66; p>0.05); the oocyte maturity rate (63.35% VS 63.48%; p>0.05) and the mean number of blastocysts transferred (1.9 VS 1.78;p>0.05).Sperm parameters were also comparable between the two groups. The clinical pregnancy rate was higher in Day 5 group compared to Day 6 group, but this difference wasn't statistically significant (36,5 % VS 35,1 % ; p=0,91). Miscarriage rate wasn't statistically significant between the two groups (p> 0.05). There was also no difference in live birth rate (26,9 % VS 28,57% , p=0,8). When only singletons births were analysed, there was no difference in mean birthweight (2860g ± 540g VS 2690g ± 480g; p> 0,05). Furthermore, statistical significance was achieved when comparing male sex rate ( 40,2% VS 73,7%; p=0,03). The results did not change after controlling for possible confounding factors. Avoiding embryo transfers on Sundays may be possible without affecting ICSI outcomes