Gestational Age Babies Research Articles

OR04-04 Sexually Dimorphic Impact Of Gestational Hyperandrogenism On Offspring Growth Trajectory

Abstract Disclosure: E. Topaktas: None. A.B. Ghnenis: None. J.N. Ciarelli: None. S. Domke: None. V. Padmanabhan: None. A.K. Vyas: None. Gestational hyperandrogenism, as seen in polycystic ovary syndrome, adversely programs birth weight and small for gestational babies. In our established sheep model of PCOS phenotype, gestational testosterone (T) excess from days 30-90 of gestation (sexually dimorphic window where male fetuses naturally are exposed to elevated T) had no effect on fetal weight in early and mid-gestation (day 65 and 90; term 147 days) but manifested in intrauterine growth restriction (IUGR) on day 140 gestation followed by catch up growth in the early postnatal period in female lambs. The impact of T excess on IUGR and postnatal catch up seen in female may not be seen in the male due the elevated T it is naturally exposed to. We hypothesized that gestational T excess will have sexually dimorphic impact on late gestational fetal weights, a period of maximal fetal growth and the postnatal growth trajectory. Pregnant ewes were injected with T propionate (T), or oil-vehicle (CON), 100 mg I.M. twice weekly from gestational day 30 to 90 to obtain CON female (CF), T females (TF), CON males (CM), and T males (TM) fetuses on day 120 of gestation(GD120). In a the follow up study, lambs were delivered and weekly weights from CF, TF, CM, and TM were obtained till early adulthood. GD120 data and neonatal cytokine profile was analyzed by 2-way ANOVA and Cohen D (d) analysis while the postnatal growth data was subjected to mixed model ANOVA. T fetuses at GD120 weighed less then CON (P<0.05); prenatal T excess reduced body weight (BW in kg) in both sexes compared to CON (CM 3.38±0.15 vs.TM 2.68±0.14, p=0.001; CF 3.27±0.21 vs.TF 2.72±0.11, p=0.03). There was a large magnitude increase in IL4 (d=0.92) and moderate in IL6 (d=0.78), IL1α (d=0.74), TNFα (d=0.77) and MIPβ (d=0.74) in TF compared to CF. TF also has large magnitude increase in MIPβ (d=0.97) and moderate magnitude increase in IL36RA (d=0.78), IL6 (d=0.70) compared to TM. TM has large magnitude increase in MIPβ (d=0.99) and IL6 (d=0.80) compared to CM. In contrast, during postnatal life, a significant age x treatment interaction (p =0.029) in average weight gain over time was evident. Growth was significantly higher in CM, TM and TF than CF and did not differ between CM and TM. Presence of IUGR in both sexes in late gestation, as opposed to catchup growth in the postnatal period only in TF not TM could have implication in sex-specific impact on the cardiometabolic function in the lambs. Supported by NIH R01HL139639. Presentation: Thursday, June 15, 2023

Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study

ObjectivesTo explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.DesignPopulation...

Information sharing and communication in management of large for gestational age babies in non‐diabetic mothers

Key content There is no specific UK guideline on how to identify or manage large for gestational age (LGA) fetuses in non‐diabetic mothers. There is conflicting evidence with regard to the optimal mode and timing of delivery in such women and babies in order to minimise the possible risks. Pre‐delivery patient–clinician discussion on management and mode of delivery in LGA babies can be challenging due to the lack of conclusive evidence and guidance for both screening and interventions, but it is crucial in order to facilitate information sharing, counselling and collaborative decision making. Decision‐making tools could help to facilitate these discussions and ensure ‘material risks’ are discussed. Learning objectives To be aware of the limitations of available methods for screening for LGA fetuses, specifically symphyseal fundal height and ultrasound estimation of fetal weight. To understand the lack of robust evidence for obstetric interventions, which makes it difficult to convey clear information in a practical and useful way. To consider the use of decision‐making tools (such as BRAIN and iDECIDE), which can provide a framework for shared decision making, particularly when the evidence is limited or conflicting. These tools offer a structure which empowers patients to weigh up information as well as assist clinicians in determining what is considered ‘material risk’ when counselling in line with the Montgomery ruling. Ethical issues The Montgomery ruling advises that doctors must discuss any ‘material risks’ involved in a proposed treatment and offer other reasonable alternatives. Clinicians, therefore, have a duty to be transparent about the lack of strong evidence to recommend one mode of birth over another but at the same time acknowledge that individual preference and perceptions need to be explored to enable personalised decision making.

Gynecological and dermatological aspects of diagnostics of polycystic ovary syndrome from puberty to menopause

The article is devoted to the review of scientific publications on gynecological and dermatological aspects of polycystic ovary syndrome (PCOS) in different age periods of women’s life. Analysis of domestic and foreign publications presents that the prevalence of PCOS depends on the age of women and the state of their reproductive function, and is accounted 17% in women 21 to 30 years old and significantly decreased with age. More than half of all cases of endocrine infertility (50-75%) and about 20-22% of the causes of infertile marriage in general are associated with PCOS. The phenotypic heterogeneity of women with PCOS affects the pregnancy outcomes in different ways, which increases the risk of its pathological course, early pregnancy loss, the development of gestational diabetes mellitus, hypertensive disorders, the birth of small and large for gestational age babies, etc.“The golden standard” for hyperandrogenism diagnosis in PCOS patients is the determination of the index of free testosterone and androstenedione. Other indicators are important for differential diagnosis and definition of syndrome phenotypes. Different PCOS phenotypes are characterized by different ratios of the contribution of sources of excess androgen synthesis. Depending on the cause, hyperandrogenism in PCOS patients is accompanied by various metabolic risks. Usually, an excess of androgens in women is clinically manifested by hirsutism, seborrheic dermatitis, acne, acanthosis nigricans, and androgenetic alopecia.The presence of dermatological manifestations of hyperandrogenism has different diagnostic value in puberty, women of reproductive age and in menopause. Acne can be the first sign of pubertal maturation. Additional examinations should be planned in extremely severe cases, which are accompanied by signs of androgen excess, or do not respond to treatment. In women of reproductive age and in perimenopause, the need to assess androgenic status is extremely important. Hair loss according to the female type is associated with manifestations of metabolic syndrome, and it is an independent risk factor for the development of diabetes, atherosclerosis and mortality from cardiovascular diseases.Therefore it is recommended to use the modified Rotterdam criteria for PCOS diagnosis. Such criteria include clinical or biochemical hyperandrogenism, signs of oligoanovulation, polycystosis (morphology of the ovaries according to ultrasound diagnostics), if other causes of relevant disorders are excluded. At the same time, any two of the specified criteria have diagnostic value, which makes possible to establish not only the diagnosis, but also clinical variant (phenotype) of PCOS, the diagnosis of which is the basis for choosing individual treatment for this contingent of women.

Association Of Maternal Age And Hemoglobin Level With Apgar Score Of Newborns In A Tertiary Care Hospital Of Suburbs Of Islamabad

Objectives: To determine the association of Apgar score with maternal age and hemoglobin.
 Methods
 A cross-sectional study was conducted on mothers (n=306) delivering live, full-term, singleton babies by spontaneous vertex delivery. Women who suffered stillbirths had babies of unknown gestational age or showed co-morbidities were excluded.
 SPSS version 26 was used for data analysis. Mean + standard deviation, and percentages were calculated. Cross-tabulation and logistic regression were done to see the association between dependent and independent variables. A p-value of <0.05 was statistically significant.
 Results
 The ages of women ranged from 20 to 40 years (mean= 25+1.9). The number of patients aged 24 years with Hb <7g/dl was 6 (37.5%). Out of all, 90 (29.4%) patients had Hb >11g/dl, and their ages were 30 years which was significant (p = 0.000). Apgar score for the neonates showed that 258 (84.3%) had an Apgar score >7 while 48 (15.7%) had a score < 7. Babies of mothers whose age was 26 years had Apgar score < 7(25%) (p = 0.001). Neonatal birth weight, of <2kg was observed in infants born to young mothers of 26 years of age (20%) (p = 0.001), and a weight >3.5kg was recorded in 20 infants (6.5%). The younger mothers had lower Hb, and their babies had low Apgar scores <7 at the time of birth (p = 0.001).
 Conclusion
 Women of younger age and lower hemoglobin levels give birth to infants with low Apgar scores and birth weight. Low birth weight in neonates is significantly associated with a low five-minute Apgar score.

Risk factors for stillbirth at term: an Italian area-based, prospective cohort study

Stillbirth at term has great emotional impact on both parents and professionals. In developed countries, efforts to identify risk factors are mandatory to plan area-specific prevention strategies. The aim of the study was to identify independent risk factors that contribute to stillbirth at 37 weeks' gestation or later. This was an area-based, prospective cohort study on pregnancy at term with enrolled from 2014 to 2021 in Emilia-Romagna, a north Italian region. Data were retrieved from both birth certificates and the Stillbirth Surveillance system database. To identify independent risk factors, a multivariate analysis using logistic regression was performed. A descriptive analysis of the causes of stillbirth is also reported. In the observation period, 246,437 babies born at term (including 260 stillbirths, giving a rate of 1.06/1000) were considered. The risk factors independently associated with stillbirth were small for gestational age babies (odds ratio, 2.58; 95% confidence interval, 1.88-3.53), pregnancy achieved though fertility treatments (odds ratio, 2.01; 95% confidence interval, 1.15-3.51), and delayed access to pregnancy services (odds ratio, 1.56; 95% confidence interval, 1.10-2.22). In multipara, the presence of a previous stillbirth (odds ratio, 3.91; 95% confidence interval, 1.98-7.72) was also associated with an increased risk for recurrence. Early- rather than late-term was an additional risk factor. The most frequent causes of death were placental and cord disorders (61/260 and 56/260, respectively). However, 28.1% of cases remain unexplained. The risks for stillbirth at term are known early in pregnancy or could be identified through tailored antenatal management, allowing effective preventive strategies to reduce preventable cases.

Comparison of umbilical cord blood lipid profiles between appropriate and small for gestational age newborns with their mothers’ lipid profiles: a case-control study from tertiary care centre of Karnataka

Background: Fetal malnutrition and fetal growth restriction results in dysfunctions of neuroendocrine system, pancreas and adipose-tissue; finally increasing the food intake and decreasing energy use. This results in an increase in adipose deposition and insulin-resistance and ultimately increasing chances of adult metabolic-diseases. This study makes an effort to compare and contrast the lipid-profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA)newborns correlating and with their mother’s lipid-profiles. Methods: This was a case-control study, conducted in the Departments of Pediatrics and OBG of Karwar Institute of Medical Sciences,Karwar, Karnataka,India over a period of twelve months(January-2021 to January-2022). With 500neonates, 357appropriate for gestational age (AGA) and 143 small for gestational age(SGA) babies were included for the study as controls and cases for their lipid profiles using their cord-blood. Results: here, we found that SGA-babies had lower gestational age (37.40±1.01 weeks) at birth compared to AGA-babies (39.22±1.05 weeks) which was statistically significant. The mean Total Cholesterol (TC) level (84.47±27.39 mg/dl) was higher in SGA-babies compared to AGA-babies (56.87±32.28 mg/dl) and this difference was statistically highly significant (p value<0.0001). The mean very low density lipoprotein (VLDL) level (14.10±10.67 mg/dl) was higher in SGA-babies than AGA-babies (7.17±3.69 mg/dl) with p value<0.0001 (highly significant). The mean low density lipoprotein (LDL) level (38.74±19.85 mg/dl) was higher in SGA-babies compared to AGA-babies (25.63±14.15 mg/dl) and this difference was statistically significant (p value<0.0001). The mean high density lipoprotein (HDL) levels of AGA and SGA-babies were comparable with low statistical significance (26.70±14.90 mg/dl of SGA; 24.45±9.567 mg/dl of AGA, p value 0.095). Conclusions: Levels of all lipids were observed to be higher in SGA babies than in AGA babies. Mothers who gave birth to SGA babies were found to have statistically significant high VLDL levels.

Time trends in perinatal outcomes among HIV-positive pregnant women in Northern Tanzania: A registry-based study.

Maternal HIV infection is associated with increased risk of having a preterm delivery, low birth weight baby, small for gestational age baby and stillbirth. Maternal use of combination antiretroviral treatment is also associated with preterm delivery and low birth weight, although the effects vary by the type of drugs and timing of initiation. To examine time trends in adverse perinatal outcomes among HIV-positive compared with HIV-negative women. Registry-based cohort study. Northern Tanzania, 2000-2018. Mother-baby pairs of singleton deliveries (n = 41 156). Perinatal outcomes of HIV-positive women were compared with HIV-negative women during time periods representing shifts in prevention of mother-to-child transmission guidelines. Monotherapy was used as first-line therapy before 2007 while combination antiretroviral treatment was routinely used from 2007. Log binomial and quantile regression were used to analyze the data. Preterm delivery, low birth weight, perinatal death, stillbirth, low Apgar score, transfer to neonatal care unit and small for gestational age. Overall, maternal HIV infection was associated with a higher risk of low birth weight and small for gestational age. Moreover, this pattern became more pronounced over time for low birth weight, the last time period being an exception. For other outcomes we found none or only a small overall association with maternal HIV infection, although a trend towards higher risk over time in HIV-positive compared with HIV-negative women was observed for preterm delivery and perinatal death. Quantile regression showed an increase in birth weight in babies born to HIV-negative women over time and a corresponding decline in birth weight in babies born to HIV-positive women. Unfavourable trends in some of the selected perinatal outcomes were seen for HIV-positive compared with HIV-negative women. Potential side-effects of combination antiretroviral treatment in pregnancy should be further explored.

The association of maternal pre-pregnancy BodyMassIndex and gestational weight gain with pregnancy and neonatal outcomes.

Overweight and obesity epidemic is still expanding, and it is affecting women of childbearing age. Multiple studies have shown unmatched results concerning the effect of body mass index (BMI) besides gestational weight gain (GWG) on pregnancy and neonatal outcomes. This study aims to determine the effect of each of the two anthropometric indicators: pre-gestational BMI and gestational weight gain on the course of pregnancy, and neonatal outcomes. A retrospective study was conducted at Notre Dame de Secours University Hospital (CHU-NDS) Jbeil-Lebanon. The data was collected from the hospital archive. Out of 804 deliveries during 2020, 583 women were included after randomly choosing their files and eliminating those with exclusion criteria or incomplete data. Underweight/healthy BMI mothers had a higher chance of having low GWG (45.5%), vaginal delivery (51.3%), and a baby of appropriate size (78.6%) or small size for gestational age (10.4%). Obese women had a higher risk of excessive GWG (49.3%), delivery via C-section.(69.3%), and large for gestational age babies (26.7%). Mothers who had low GWG were at a higher risk of having babies of appropriate size (80.1%) or small size for gestational age (13.1%). Mothers who had high GWG had a higher risk of having baby boys (58.9%), large for their gestational age (26.1%), with hypoglycemia at birth (20.6%). Both extremes of BMI and GWG are linked to adverse neonatal outcomes. This highlights the importance of weight monitoring even during pregnancy to prevent its negative impact on neonates.

Neonatal Outcome of Pregnancies with Oligohydramnios and Polyhydramnios

Objective: To asses’ factors associated with neonatal outcome of pregnancies with oligohydramnios and polyhydramnios.
 Study Design: Comparative Cross-sectional Study.
 Place and Duration of Study: Department of Pediatrics and Gynecology, Fauji Foundation Hospital, Lahore Pakistan, from Oct 2020 to Sep 2021
 Methodology: A prospective comparative study was conducted on the babies born to mothers diagnosed witholigohydramnios and polyhydramnios during the course of pregnancy. Neonates were evaluated by neonatologist within first 24 hours of birth. The cases were admitted and well babies were handed over to parents. The neonatal outcome parameters were observed in all these babies for first two weeks of life. Those who lost follow up they were excluded from study. Age of mother, gestational age of baby, maternal hypertension and maternal diabetes were associated with presence of complications among these babies.
 Results: Two thousand One hundred and Twenty-nine deliveries took place in given duration. About 322 had either polyhydramnios or oligohydramnios. About 150 cases could be followed completely. Fifty-five (36.7%) showed presence of one or more complications, of which 29(41.4%) cases had oligohydramnios and 26(32.5%) had polyhydramnios. Maternal age and presence of maternal diabetes and maternal hypertension had statistically significant association with complications in neonates (p-value <0.005).
 Conclusion: Complications rate was high among neonates born to mothers with oligohydramnios or polyhydramnios. Advanced maternal age, presence of diabetes mellitus and hypertension were factors association with presence of complications in neonates included in our study.

Iron supplements in pregnant women with normal iron status: A systematic review and meta-analysis.

Effects of daily iron supplementation in iron replete pregnancy are unclear. This systematic review aimed to assess benefits and harms of oral iron supplements in pregnant women without anemia and iron deficiency. We predefined and registered a protocol in PROSPERO (CRD42020186210) and performed the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched for randomized clinical trials (RCTs) and observational studies comparing daily oral iron supplementation with no iron supplements in non-anemic iron replete pregnant women. Searches were conducted in MEDLINE (by PubMed), EMBASE (by OVID), Cochrane Library, and ClinicalTrials.gov from inception to September 2022 without language restrictions. Two authors independently screened records, extracted data, and assessed risk of bias using the revised Cochrane risk of bias tool (RoB2). One author read full-texts, assessed certainty of evidence by GRADE and conducted meta-analyses using a random-effects model. Primary outcomes included iron deficiency anemia, iron deficiency, hemoglobin >130 g/L, elevated iron status, small for gestational age newborns, low birthweight newborns, preterm birth, and congenital anomalies. Eight RCTs (2822 women) but no observational studies were eligible for inclusion. Daily oral iron supplementation in pregnancy probably reduces iron deficiency anemia at term (risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.38-0.70; 4 RCTs, 1670 women; I2 = 13%; moderate-certainty evidence) and the incidence of low birthweight babies (RR: 0.30, 95% CI: 0.13-0.68; 2 RCTs, 361 infants; I2 = 0%; moderate-certainty evidence). In addition, it may reduce iron deficiency at term (RR: 0.74, 95% CI: 0.60-0.92; 4 RCTs, 1663 women; I2 = 58%; low-certainty evidence) and the incidence of small for gestational age babies (RR: 0.39, 95% CI: 0.17-0.86; 1 RCT, 213 infants; I2 not estimable; low-certainty evidence). Daily iron supplementation in iron replete non-anemic pregnant women probably reduces the risk of maternal iron deficiency anemia at term and low birthweight.

Impact of timing and severity of COVID-19 infection in pregnancy on intrauterine fetal growth- a registry-based study from Qatar.

The novel coronavirus disease (COVID-19) pandemic has impacted pregnant women, increasing maternal and neonatal morbidity. The placenta is a potential target for the pathophysiological processes due to the increased thrombotic inflammatory activation and inadequate uteroplacental perfusion and oxygenation, potentially causing intrauterine growth restriction. This study investigates the impact of gestational age at diagnosis of COVID-19 and the presence of symptoms on intrauterine fetal growth in pregnant women. A retrospective review of COVID-19 positive pregnant women in Qatar from March 2020 to March 2021 was conducted. They were divided based on trimester of pregnancy in which they were infected. The outcomes included birthweight, customised fetal birthweight centiles, small for gestational age (SGA) baby and daily growth increments, compared between the trimesters and between symptomatic and asymptomatic women. In our cohort, 218 women (20.5%) were infected in the first trimester, 399 (37.5%) in the second and 446 (42%) in the third. Women in the second trimester were significantly younger and symptomatic. Women infected in the first trimester were least likely to have diabetes. The mean birthweight, risk of SGA (11.5% vs 10% vs 14.6%, p = 0.302), and median customized growth centiles (47.6% vs 45.9% vs 46.1%)were similar between the groups. Symptomatic women had significantly lower mean birthweight (3147 gms vs 3222 gms) and median birthweight centiles (43.9% vs 54.0%)compared to the asymptomatic (p<0.05 for both). In women infected within 20 weeks of gestation, a delay in daily fetal growth increments was noted with symptomatic disease, although not statistically significant. This study shows that women with symptomatic disease had lower birth centiles and birth weights. This was regardless of the gestational age at which they were infected. Early symptomatic disease seems to have an impact on fetal growth velocity; however, larger studies are needed to corroborate these findings.

P-270 The timing of intracytoplasmic sperm injection does not impact live birth rate and neonatal outcomes

Abstract Study question Does the timing of intracytoplasmic sperm injection (ICSI) relative to ovulation trigger impact live birth rates and neonatal outcomes? Summary answer ICSI timing relative to ovulation trigger impacts neither live birth rates nor neonatal outcomes. What is known already When conducting ICSI, the timing of the insemination relative to ovulation trigger is difficult to standardise in clinical practice, especially in busy ART laboratories. Flexibility when scheduling ICSI procedures would therefore be beneficial from a laboratory management perspective. However, the impact of this timing on live birth rates and neonatal outcomes remains inconclusive in the literature. Study design, size, duration This retrospective study included a total of 1547 consecutive single autologous embryo transfer cycles (maternal age 35.2 ± 4.8 years) performed at Fertility North between January 2017 and August 2021. ICSI was performed immediately after denudation without timing restrictions relative to ovulation trigger. A total of 422 (27.3%) transfers resulted in a live birth, including 415 singletons, 5 twin deliveries, and 2 lost to follow-up. Only singleton babies were included for neonatal outcome analysis. Participants/materials, setting, methods ICSI timings relative to ovulation induction trigger (mean ± SD 42.5 ± 1.4 hours, range 37.0-46.5 hours) were extracted from the electronic witnessing database. Cycles were grouped according to ICSI timing quartiles (groups Q1-4: &amp;lt;41.7, 41.7-42.7, 42.8-43.4 and 43.5+ hours). Logistic/linear regressions were used to assess impacts of ICSI timing on the subsequent live birth and birthweight outcomes in the singleton babies. Mixed effect model was used to account for clustering effect from repeat cycles by same patients. Main results and the role of chance Q1 group had significantly lower live birth rate (22.7%) but higher maternal age (37.3 ± 5.2 years) in comparison to Q2 (28.5% and 34.5 ± 4.6, P &amp;lt; 0.05 respectively), Q3 (30.2% and 34.8 ± 4.5, P &amp;lt; 0.05 respectively) and Q4 groups (27.7% and 34.4 ± 4.4, P &amp;lt; 0.05 respectively). However, following multivariate logistic regression adjusting for potential confounders including maternal age, body mass index, aetiology, sperm origin (ejaculated or surgical), sperm type (donor/partner), embryo stage at transfer (cleavage or blastocyst), and fresh/frozen transfer; observed differences in live birth rates became no longer significant (Q2 vs Q1, aOR = 0.982, 0.692-1.394, P = 0.919; Q3 vs Q1, aOR = 1.058, 0.884-1.266, P = 0.538; Q4 vs Q1, aOR = 0.969, 0.859-1.094, P = 0.615; Q3 vs Q2, aOR = 1.153, 0.830-1.600, P = 0.396; Q4 vs Q2, aOR = 0.963, 0.818-1.134, P = 0.649; Q4 vs Q3, aOR = 0.836, 0.601-1.164, P = 0.289). Gestational age and birthweight of singletons arising from 4 groups were also comparable (Q1 38.1 ± 2.2 weeks and 3209.1 ± 581.4 grams, Q2 38.2 ± 1.6 weeks and 3159.9 ± 508.2 grams, Q3 38.7 ± 1.8 weeks and 3304.7 ± 546.9 grams, and Q4 38.4 ± 2.0 weeks and 3297.5 ± 526.9 grams; P &amp;gt; 0.05 respectively). Multivariate linear regression further confirmed the absence of significant impacts (standardised coefficient = 0.001, P = 0.980) by ICSI timing on the birthweight of resulting newborns, taking into account gestational age and baby sex plus all above mentioned 7 potential confounders. Limitations, reasons for caution Our study is limited by its retrospective nature, where it is impossible to control all known and unknown confounding factors. The varied denudation duration as a result of different egg numbers was unable to be analysed, although ICSI was aimed to be performed immediately after completion of denudation. Wider implications of the findings Our findings indicate a wide time window in human oocytes to initiate fertilization via ICSI. This data offers reassurance in applying flexible ICSI timing without impacting live birth rates and neonatal outcomes. This is clinically valuable by providing evidence-based guidance to daily practice and patient counselling. Trial registration number not applicable

Macrosomia and Large for Gestational Age Babies

Macrosomia and Large for Gestational Age Babies

Fetal Growth Restriction and Small for Gestational Age Babies

Fetal Growth Restriction and Small for Gestational Age Babies

Body Mass Index Categories Among Pregnant Women Attending Primary Health Care Centers / Baghdad 2022

Background: Recommended weight gain to support a healthy pregnancy vary by prepregnant body mass index. Insufficient weight gain especially associated with prepregnant underweight is associated with increased risk of spontaneous preterm delivery, small for gestational age. Extensive weight gain often results in large for gestational age babies also may increase risk during delivery. Good nutrition and a healthy diet during pregnancy are critical for a mother’s health, as well as that of her child. A healthy diet contains adequate energy, protein, vitamins and mineral obtained from a variety of foods including green and orange vegetables, meat, fish, beans, nuts, whole grains, and fruit. Many studies have suggested that weight gain during pregnancy is affected by prepregnancy BMI. This study is conducted to determine maternal weight gain, pattern and associated of some selected socio-demographic factors. Method: A cross-sectional analytic study wholly done from July 4th to December 20th; the sample size was 114 pregnant antenatal care files archived selected from primary health care centers. It searched for the full previous pregnancy files and with frequent visits from the beginning of pregnancy to birth. The data and information were collected from antenatal care files from six primary health care centers of As-Salam, AL-A’dil, AL-Mansour, AL-A’dhamiya 3rd, AL-Baladiyaat, AL-Mustansiriya. The exclusion criteria exclude all incomplete files, pregnant women less than 18 years, and pregnant with chronic disease multiple pregnancy. Frequencies and percentage were calculated; Chi square test were used; and the statistical probability were consider significant if P value &lt; 0.05. Results: The current study was conducted through 114 pregnant care files or antenatal care in 6 primary health care centers. 73% of them gained excessive weight during pregnancy; 11% of them gained insufficient weight gain during pregnancy; and 17% of pregnant women had adequate weight gain during pregnancy. There was a statistically significant association between weight gain during pregnancy and primary health care centers, as representing social factor, and also significant association between pre pregnancy BMI and gestational weight gain. Conclusion: Gestational weight gain was significantly affected by pre pregnancy body mass index. Prevalence of excessive weight gain increases with the increase of the pre-pregnancy body mass index and with the increase of age in pregnant women. Weight gain during pregnancy should be monitored and intervention should be developed.

Evaluation of Pregnancy Outcome in Women with Rheumatic Mitral Valve Stenosis

Background and Aims: Rheumatic heart disease is still one of the most common heart lesion in developing countries. The maternal and fetal hazards increase with the severity of Mitral stenosis. This study was aimed to determine the fetomaternal outcome in women with mitral stenosis during pregnancy. Methods: This was descriptive cross-sectional study which included all pregnant patients with isolated rheumatic mitral valve stenosis. Major adverse outcomes studied were cardiac failure, thromboembolic event, admission in cardiac care or intensive care unit, atrial fibrillation, endocarditis, pulmonary hypertension and cardiac death. Results: Out of 3194 pregnant women, 31 had mitral stenosis. Their mean age was 27 years, mean mitral valve area 1.43cm2 and majority were primigravida (61.29%). Among them, symptomatic cardiac failure was present in 6.66%, 30% and 66.66% of mild, moderate and severe mitral stenosis respectively. The chances of cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies was high in all patients without having percutaneous trans-luminal mitral commissurotomy than those who underwent the procedure for moderate to severe mitral stenosis during pregnancy. Conclusion: There were high chances of adverse fetomaternal outcome in pregnant women with mitral stenosis. Cardiac failure was found to be increased with the severity of mitral stenosis. PTMC during pregnancy resulted in decreased cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies.

Association between HbA1c Levels and Fetal Macrosomia and Large for Gestational Age Babies in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 17,711 Women.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. GDM is associated with serious maternal and fetal complications, in particular, fetal macrosomia and large for gestational age (LGA), which predisposes to a higher risk of childhood obesity and type 2 diabetes mellitus later in life. Early prediction and diagnosis of GDM leads to early interventions such as diet and lifestyle, which could mitigate the maternal and fetal complications associated with GDM. Glycated haemoglobin A1c (HbA1c) has been widely used for monitoring, screening for and diagnosing diabetes and prediabetes. Increasing evidence has also showed that HbA1c could indicate fetal glucose supply. Thus, we hypothesise that the HbA1c level at around 24 to 28 weeks may predict the development of fetal macrosomia or an LGA baby in women with GDM, which could be useful for better prevention of fetal macrosomia and LGA. We searched MEDLINE, EMBASE, Cochrane and Google Scholar databases from inception to November 2022 for relevant studies that reported at least one HbA1c level during 24-28 weeks of pregnancy and fetal macrosomia or an LGA baby. We excluded studies that were not published in the English language. No other search filters were applied during the search. Two independent reviewers selected eligible studies for meta-analysis. Two independent reviewers performed data collection and analyses. The PROSPERO registration number is CRD42018086175. A total of 23 studies were included in this systematic review. Of these, 8 papers reported data of 17,711 women with GDM that allowed for inclusion in a meta-analysis. The obtained results demonstrated the prevalence of fetal macrosomia was 7.4% and of LGA, 13.36%. Meta-analyses showed that the estimated pooled risk ratio (RR) for LGA in women with high HbA1c values compared to normal or low values was 1.70 (95% CI: 1.23-2.35), p = 0.001; and the pooled RR for fetal macrosomia was 1.45 (95% CI: 0.80 to 2.63), p = 0.215. Further research is needed to evaluate the utility of HbA1c levels in predicting the delivery of a baby with fetal macrosomia or LGA in pregnant women.

Maternal periodontitis: A risk factor for preterm labour and low birth weight

Purpose: Preterm delivery and low birth weight is becoming the foremost crunch in India and is the most prevailing public health issue in developed and developing countries. To prove the confederacy between preterm labour (PTL) or low birth weight (LBW) and maternal periodontitis, a case control study was conducted among 30 puerpera women in rural population. Methods: The study sample was grouped into cases and controls based on the pregnancy outcomes, cases include 15 mothers with preterm birth and low birth weight babies and controls includes 15 mothers with normal term (greater than or equal to 37 weeks) gestation and normal birth weight babies (more than or equal to 2500 grams), in accordance with postnatal records regarding the gestation weeks and baby weight. Within 48 hours of parturition, periodontal status of the puerperal was examined by Community Periodontal Index. Statistical analysis used: Epi Info 7 Software. Results: Pregnant women with periodontal disease are 56 times risk of preterm labour and low birth weight babies and Chi-square value = 16.425 (p =0.000). Conclusions: This study shows that there is a strong statistical association between the preterm labour and birth type of babies with maternal periodontitis. Maternal periodontitis are 56 times risk of preterm labour and low birth weight. Hence, pregnant mothers should be educated about the risk of periodontal disease and motivated to maintain the oral hygiene by proper oral hygiene instruction measures with periodic dental visits.

Pyroptosis: A Promising Mechanism Linking SARS-CoV-2 Infection to Adverse Pregnancy Outcomes.

Pregnancy is characterized by a delicate immune balance; therefore, infectious diseases might increase the risk of adverse pregnancy outcomes (APOs). Here, we hypothesize that pyroptosis, a unique cell death pathway mediated by the NLRP3 inflammasome, could link SARS-CoV-2 infection, inflammation, and APOs. Two blood samples were collected from 231 pregnant women at 11-13 weeks of gestation and in the perinatal period. At each time point, SARS-CoV-2 antibodies and neutralizing antibody titers were measured by ELISA and microneutralization (MN) assays, respectively. Plasmatic NLRP3 was determined by ELISA. Fourteen miRNAs selected for their role in inflammation and/or pregnancy were quantified by qPCR and further investigated by miRNA-gene target analysis. NLRP3 levels were positively associated with nine circulating miRNAs, of which miR-195-5p was increased only in MN+ women (p-value = 0.017). Pre-eclampsia was associated with a decrease in miR-106a-5p (p-value = 0.050). miR-106a-5p (p-value = 0.026) and miR-210-3p (p-value = 0.035) were increased in women with gestational diabetes. Women giving birth to small for gestational age babies had lower miR-106a-5p and miR-21-5p (p-values = 0.001 and 0.036, respectively), and higher miR-155-5p levels (p-value = 0.008). We also observed that neutralizing antibodies and NLRP3 concentrations could affect the association between APOs and miRNAs. Our findings suggest for the first time a possible link between COVID-19, NLRP3-mediated pyroptosis, inflammation, and APOs. Circulating miRNAs might be suitable candidates to gain a comprehensive view of this complex interplay.