Newborn Head Circumference Research Articles

Comparison of Growth Parameters, Apgar score, the Blood Zinc, Magnesium, Calcium and Phosphor between Gestational Diabetic and Non-Gestational Diabetic Pregnant Women: a Prospective Cohort Study

Background: Due to little attention to the combined effect of diabetes and pregnancy on mother an infants microelements in literatures. This study aimed to compare newborns growth parameters, Apgar score, the cord blood zinc, magnesium, calcium and phosphor between pregnant women with and without gestational diabetes mellitus. Materials and Methods: This prospective cohort study was conducted in Hamadan city, Iran, during 2013-14. Gestational diabetes considered as exposure and 20 women with gestational diabetes were individually matched with the 20 non-diabetic pregnant women in terms of the variables age, number of pregnancies, and type of delivery were included in this study. The cord blood and mother vein blood samples were taken immediately after delivery. Results: The mean of newborn's head circumference was 34.85±0.9 cm and 33.90±0.97 cm in mothers with gestational diabetes and non- diabetic mothers respectively (P<0.05). The mean of cord blood calcium was 9.81±0.6 mg/dl in the exposed group and 10.23±0.4 mg/dl in the control group (P<0.05) and these figures for zinc were 79.05±13.1 mg/dl in the exposed group and 86.96±11.6 mg/dl in the control group (P<0.05). Conclusion: This prospective cohort study showed the imbalance of some micronutrient in cord blood of mothers with gestational diabetes in comparison to non-diabetic mothers. Therefore in pregnant women with gestational diabetes should be more attention to be paid the concentrations of microelements.

Comparison of infants of adolescent and advanced age mothers in spontaneous vaginal deliveries occured between 2003 and 2013

Introduction: This study aims to compare obstetric results of pregnancies in adolescents and advanced age mothers, which is a significant Mother-Child health problem in developing countries. Methods: This retrospective study included mothers and infants, over a 10-year period, with babies born at full-term by spontaneous vaginal birth to adolescent mothers who were 18 years and younger, and to mothers who were 40 years and older. Both groups were investigated for abnormalities, gender, height, weight, head circumference and birth weight of newborns. Results: Over the 10-year period from 1 March 2003 to 31 March 2013, there were a total of 29981 normal spontaneous vaginal deliveries. 818 pregnant women aged 18 years and younger(2.73%) and 972 pregnant women aged 40 years and older(3.23%) were determined. When the abnormalities and stillbirth rates of newborns are examined, there was no statistically significant difference identified between the two groups. There was statistically significant difference found between height-birth weight-head circumference of infants of advanced age mothers and adolescent mothers. In both groups when the SGA( 4000 g) infants are compared, SGA infants were observed to be significantly higher for adolescent mothers, while LGA infants were found to be significantly higher for advanced age mothers. When the correlation between mothers age and birth weight was investigated, it was observed that infants of advanced age mothers were heavier, while infants born to adolescent mothers had lower birth weights. Conclusion: This study showed that adolescent and advanced age pregnancies form high risk groups. In both groups to improve pregnancy results, social support, education and regular monitoring should be provided.

Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking.

IntroductionThe purpose of this study was to evaluate the associations of the first, second and third trimester serum pregnancy-associated plasma protein A (PAPP-A) concentrations with neonatal anthropometric parameters. The effect of tobacco smoking during pregnancy on PAPP-A level was also studied.Material and methodsOne hundred and fifty healthy pregnant women were divided into smoking and tobacco-abstinent groups. Serum PAPP-A level was measured with the KRYPTOR rapid random-access immunoassay analyzer. The relationship between PAPP-A and newborn related outcome as well as markers of estimated intensity of cigarette smoking was evaluated by univariate and multivariate linear regression.ResultsPregnancy-associated plasma protein A concentration was positively correlated with birth weight in the first (β = 31.6; p < 0.001), second (β = 10.6; p < 0.05), and third (β = 4.6; p < 0.001) trimester of gestation. A significant association between PAPP-A and birth body length and head circumference in the second (β = 0.02; p < 0.05) and third trimester (β = 0.01; p < 0.01) was also found. The serum PAPP-A levels were significantly lower in the smoking than in the tobacco-abstinent group in each trimester of pregnancy (p < 0.001). The largest impact of the number of cigarettes smoked per day on PAPP-A level was found in the second (β = –1.2; p = 0.004) and third trimester (β = –2.6; p = 0.001).ConclusionsMaternal serum PAPP-A levels during gestation might be significant predictors for birth weight. Increased PAPP-A concentrations in the second and third trimester appeared to also be predictive for newborn body length and head circumference. Smoking alters maternal PAPP-A levels in all trimesters, with the greatest impact related to the number of cigarettes smoked per day.

Calcium-Vitamin D Co-supplementation Affects Metabolic Profiles, but not Pregnancy Outcomes, in Healthy Pregnant Women.

Background:Pregnancy is associated with unfavorable metabolic profile, which might in turn result in adverse pregnancy outcomes. The current study was designed to evaluate the effects of calcium plus Vitamin D administration on metabolic status and pregnancy outcomes in healthy pregnant women.Methods:This randomized double-blind placebo-controlled clinical trial was performed among 42 pregnant women aged 18–40 years who were at week 25 of gestation. Subjects were randomly allocated to consume either 500 mg calcium-200 IU cholecalciferol supplements (n = 21) or placebo (n = 21) for 9 weeks. Blood samples were obtained at the onset of the study and after 9-week trial to determine related markers. Post-delivery, the newborn's weight, length, and head circumference were measured during the first 24 h after birth.Results:Consumption of calcium-Vitamin D co-supplements resulted in a significant reduction of serum high-sensitivity C-reactive protein levels compared with placebo (−1856.8 ± 2657.7 vs. 707.1 ± 3139.4 μg/mL, P = 0.006). We also found a significant elevation of plasma total antioxidant capacity (89.3 ± 118.0 vs. −9.4 ± 164.9 mmol/L, P = 0.03), serum 25-hydroxyvitamin D (2.5 ± 3.5 vs. −1.7 ± 1.7 ng/mL, P < 0.0001), and calcium levels (0.6 ± 0.6 vs. −0.1 ± 0.4 mg/dL, P < 0.0001). The supplementation led to a significant decrease in diastolic blood pressure (−1.9 ± 8.3 vs. 3.1 ± 5.2 mmHg, P = 0.02) compared with placebo. No significant effect of calcium-Vitamin D co-supplements was seen on other metabolic profiles. We saw no significant change of the co-supplementation on pregnancy outcomes as well.Conclusions:Although calcium-Vitamin D co-supplementation for 9 weeks in pregnant women resulted in improved metabolic profiles, it did not affect pregnancy outcomes.

ANEMIA IN PREGNANCY: IMPACT ON WEIGHT AND IN THE DEVELOPMENT OF ANEMIA IN NEWBORN.

nutritional deficiencies are still a common problem during pregnancy causing anemia. Gestational anemia is still considered a public health problem in Brazil, because it is hazardous to both mother and fetus, and is associated with increased risk of maternal-fetal morbidity, as well as the nutritional status of child. to evaluate the frequency of maternal gestational anemia in newborns and its relation to the nutritional status of the child at birth. anthropometric data of pregnant women and their newborns were obtained. Blood was collected from pregnant women and the umbilical cord of newborns for analysis of hemoglobin, hematocrit, RDW, iron, ferritin and transferrin saturation index in automatic devices. The results are presented such as the arithmetic mean and the standard deviation. GraphPadinStat Software version 3.0 was used, with a maximum significance level of 5%. the frequency of maternal anemia was 53.7%, and 32.6% in newborns. Half the newborns were anemic children of anemic mothers. 79.3% of the anemic pregnant women had mild anemia and in 20.7% moderate. The average concentration of hemoglobin and hematocrit was lower in anemic pregnant women (9.7 ± 0.9 g/dL and 29.8 ± 3.2%) compared with non-anemic (11.9 ± 0.7 g/ dL and 36.5 ± 2.7%). The maternal iron was positively correlated with ferritin (r = 0.3889, p = 0.01) from umbilical cord blood. The newborns' weight, length and head circumference of anemic mothers were 3 375.9 ± 506,9 g, 51.2 ± 1.7 cm and 34.5 ± 1.5 cm, respectively, while of nonanemic mothers were 3 300.2 ± 458,4 g, 50.3 ± 2.0 cm and 34.2 ± 2.0 cm, respectively. There were no significant correlations between maternal hemoglobin, iron and ferritin with weight, length and head circumference of newborns. the results of this study show that maternal iron deficiency anemia (mild to moderate) can affect the blood profile and iron concentrations in umbilical cord blood of newborns, but without interfering with the child's anthropometric parameters.

Zinc Supplementation and the Effects on Pregnancy Outcomes in Gestational Diabetes: a Randomized, Double-blind, Placebo-controlled Trial.

The current study was designed to determine the beneficial effects of zinc intake on biomarkers of inflammation, oxidative stress, and pregnancy outcomes among pregnant women with gestational diabetes (GDM). This randomized, double-blind, placebo-controlled clinical trial was conducted among 50 women with GDM. Patients were randomly allocated to intake either 233 mg zinc gluconate (containing 30 mg zinc) (n=25) or a placebo (n=25) for 6 weeks. Fasting blood samples were taken at the fist of the study and after 6 weeks of intervention to quantify related variables. Newborn's weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined. The change in serum zinc levels after 6 weeks of supplementation was greater in women consuming zinc than in the placebo group (+8.5±13.5 vs. -3.6±16.2 mg/dL, P=0.006). Changes in serum high sensitivity C-reactive protein (hs-CRP) (-110.1±1 475.5 vs. +1 137.8±2 429.2 ng/mL, P=0.03) and plasma total antioxidant capacity (TAC) concentrations (+60.0±129.0 vs. -28.4±81.4 mmol/L, P=0.006) were significantly different between the supplemented women and placebo group. We did not find any significant effect of zinc administration on pregnancy outcomes. Taken together, zinc administration among patients with GDM was associated with decreased hs-CRP and increased TAC concentrations; however, it did not influence maternal plasma nitric oxide (NO), glutathione (GSH), malondialdehyde (MDA) levels, or pregnancy outcomes.

Newborn birth weight, length, and head circumference for gestational age in Guangzhou based on the INTERGROWTH-21st standard: a multiyear hospital liveborn cohort study

BackgroundWHO's INTERGROWTH-21st Project published an international standard for newborn size using a rigorous method. We aimed to examine the frequency of small and large birth weight, length, and head circumference for gestational age for live births in Guangzhou, China. MethodsData for all singleton live births in 2009–12 were obtained from the Guangzhou Maternal-Fetal Medical Database. The database, maintained by the Key Laboratory for Major Obstetric Diseases of Guangdong, contains information on sex, gestational age (ultrasound-based estimate), birth weight, length, head circumference, diagnoses, and interventions. We classified the newborn infants between 33 and 42 weeks gestation into centile categories according to the international standard. Our study protocol was approved by the medical ethics committee of the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. FindingsOf 16 965 singleton live births, 308 (1·8%, 95% CI 1·6–2·0) were below the third centile for their birth weight for gestational age, 808 (4·8%, 4·4–5·1) were below the tenth centile, 1140 (6·7%, 6·3–7·1) were in the 90–97th centile, and 455 (2·7%, 2·4–2·9) were above the 97th centile. For length for gestational age, 422 (2·5%, 95% CI 2·1–2·8) were below the third centile, 696 (4·1%, 3·8–4·5) were in the third to tenth centile, 1603 (9·4%, 8·9–9·9) were in the 90–97th centile, and 628 (3·7%, 3·3–4·1) were above the 97th centile. For head circumference for gestational age, 1940 (11·4%, 95% CI 10·8–12·1) were below the third centile, 2046 (12·1%, 11·5–12·6) were in the third to tenth centile, 849 (5·0%, 4·5–5·4) were in the 90–97th centile, and 510 (3·0%, 2·6–3·4) were above the 97th centile. InterpretationThe birth weight and length for gestational age patterns for newborns in Guangzhou are as expected. The surprisingly high rates of live births below the tenth centile and low rates of live births above the 90th centile of head circumference imply the need to re-assess fetal head growth in the population and to ensure adequate care during pregnancy. FundingMinister of Science and Technology of Guangdong Province.

Electronic Poster Presentations, Maternal Fetal Medicine

Electronic Poster Presentations, Maternal Fetal Medicine

The effect of parity on maternal body mass index, plasma mineral element status and new-born anthropometrics.

Adverse pregnancy outcome is an important public health problem that has been partly associated with increasing maternal parity. To determine the effect of parity on maternal body mass index (BMI), mineral element status and newborn anthropometrics. Data for 349 pregnant women previously studied for the impacts of maternal plasma mineral element status on pregnancy and its outcomes was analysed. Obstetric and demographic data and 5mls of blood samples were obtained from each subject. Blood lead, plasma copper, iron and zinc were determined using atomic absorption spectrophotometer. Maternal BMI increases with parity. Women with parity two had significantly higher plasma zinc but lower plasma copper with comparable levels of the elements in nulliparous and higher parity groups. Although plasma iron was comparable among the groups, blood lead was significantly higher in parity > three. Newborn birth length increases with parity with a positive correlation between parity and maternal BMI (r = 0.221; p = 0.001) and newborn birth length (r = 0.170; p = 0.002) while plasma copper was negatively correlated with newborn's head circumference (r = -0.115; p = 0.040). It is plausible that parity affects maternal BMI and newborn anthropometrics through alterations in maternal plasma mineral element levels. While further studies are desired to confirm the present findings, there is need for pregnant and would-be pregnant women to diversify their diet to optimize their mineral element status.

Placental Anthropometric Features: Maternal and Neonate Characteristics in North Central Nigeria

The objectives of the study were to determine placental weight as well as factors associated with low placental weight and to determine its impact on some anthropometrical parameters in the newborn. A total of 300 freshly delivered placentas were examined in this longitudinal-prospective study. Sobi Specialist Hospital, Alagbado, Ilorin, and Surulere Medical Centre, Eruda, Ilorin, were used for sample collections. Informed consent was obtained from patients and institutional ethical clearance was obtained from Kwara State Ministry of Health (MOH/KS/ECI/777/82). Semistructured questionnaire was used to gather data on the patients and newborns demographic indices. Analysis of variance, Student’st-test, regression analysis, and Pearson moment correlation statistical analysis were employed to analyze the data. The mean wet placental weight for normal pregnancies was 529 g (SD = 84.01). Placental weight to birth weight ratio of 1 : 5.83 was generated, 529 g impact on newborn head circumference (mean: male = 35.30 cm, female = 34.90 cm) having a linear correlation. Regression analysis showed negative association between female babies (2.99 kg) placental weight (r=0.369;P≤0.05), birth weight, and cord length (mean = 58.4 cm). Placental weight correlation with male newborn weight (3.14 kg) had placental birth weight ratio of 0.679 between 90th and 10th percentileP&lt;0.05with head circumference (r=0.473,P&lt;0.05), lower limit placental diameter 22.80 ± 1.76 cm (SD = 4.8), BMI ≤ 19.50, and Apgar score of 7/10. It is concluded that blood holding capacity of the placenta (relative to weight) and the maternal-dietary have influence on placental weight. Differences in hormonal environment in utero and pathologic adaptation of placenta, due to racial factors, significantly contributed to the size of newborn baby.

Changes in weight, length, head circumference, and ponderal index at birth of healthy term newborns in nine cities in China during the period of rapid social development 1985–2005

The changes in the anthropometric parameters at birth of healthy singleton term newborns in nine cities in China were analyzed by means of the data collected in three large-scale cross-sectional physical growth surveys in 1985, 1995, and 2005 (n=6660, 7109 and 6144). Between 1985 and 2005, average increases in body weight (BW), body length (BL), ponderal index (PI), and head circumference (HC) of newborns were statistically significant: 107g, 0.2cm, 0.6kg/m3 and 0.4cm, respectively. The relative increase in BW was more than that in BL (3.4% vs 0.4%) in the last two decades, leading to an increase in PI. The distribution of birth size shifted slightly to the right, and the proportion of macrosomia increased from 3.2% in 1985 to 3.4% in 1995 and to 4.3% in 2005. The increases in BW and PI and the increase in rate of macrosomia are concerns from public health perspectives.

Associations of maternal organophosphate pesticide exposure and PON1 activity with birth outcomes in SAWASDEE birth cohort, Thailand

Prenatal organophosphate (OP) pesticide exposure has been reported to be associated with adverse birth outcomes and neurodevelopment. However, the mechanisms of toxicity of OP pesticides on human fetal development have not yet been elucidated. Our pilot study birth cohort, the Study of Asian Women and Offspring's Development and Environmental Exposures (SAWASDEE cohort) aimed to evaluate environmental chemical exposures and their relation to birth outcomes and infant neurodevelopment in 52 pregnant farmworkers in Fang district, Chiang Mai province, Thailand. A large array of data was collected multiple times during pregnancy including approximately monthly urine samples for evaluation of pesticide exposure, three blood samples for pesticide-related enzyme measurements and questionnaire data. This study investigated the changes in maternal acetylcholinesterase (AChE) and paraoxonase 1 (PON1) activities and their relation to urinary diakylphosphates (DAPs), class-related metabolites of OP pesticides, during pregnancy. Maternal AChE, butyrylcholinesterase (BChE) and PON1 activities were measured three times during pregnancy and urinary DAP concentrations were measured, on average, 8 times from enrollment during pregnancy until delivery. Among the individuals in the group with low maternal PON1 activity (n=23), newborn head circumference was negatively correlated with log10 maternal ∑DEAP and ∑DAP at enrollment (gestational age=12±3 weeks; β=−1.0cm, p=0.03 and β=−1.8cm, p<0.01, respectively) and at 32 weeks pregnancy (β=−1.1cm, p=0.04 and β=−2.6cm, p=0.01, respectively). Furthermore, among these mothers, newborn birthweight was also negatively associated with log10 maternal ∑DEAP and ∑DAP at enrollment (β=−219.7g, p=0.05 and β=−371.3g, p=0.02, respectively). Associations between maternal DAP levels and newborn outcomes were not observed in the group of participants with high maternal PON1 activity. Our results support previous findings from US birth cohort studies. This is the first study to report the associations between prenatal OP pesticide exposure and birth outcomes in Thailand.

El perímetro cefálico del feto varón sano después de la semana 40 es mayor que antes de la semana 40

OBJETIVO: Establecer los valores del perímetro cefálico (PC) de un grupo de recién nacidos sanos hijos de mujeres limeñas que tuvieron embarazos simples sanos. DISEÑO: Estudio retrospectivo , analítico y transversal. MATERIALES Y MÉTODOS: Se revisó la base de datos materna y perinatales del Departamento de Obstetricia y Pediatría del Hospital Nacional Docente Madre-Niño "San Bartolomé" entre el 1 de enero 1991 y el 31 de diciembre de 1999 (SIP). Se seleccionó los embarazos simples de mujeres entre 20 y 30 años, con IMC entre 20 y 25 km/m2 sanas, sin complicaciones obstétricas, con diferencia­ ± 2 semanas entre FUR y EG al examen físico del neonato vivo y sano. RESULTADOS: El perímetro cefálico de 5443 recién nacidos (RN) sanos en Lima (percentil 50 (percentil 10-percentil 90)) en las semanas 36,36,37,38,39,40,41 y 42 fueron 33 (31-35), 33(31-35), 34(32-35,5), 34(32-36), 34(32-36), 34(32,5-36), 34,5(33-36) y 35(33-36,5) cm, respectivamente. El perímetro cefálico de los fetos sanos entre 48 y 41 semanas fue mayor en los fetos varones que los fetos femeninos (p&lt;0,001). Los RN de gestantes multíparas en las semenas 37 a 41 tuvieron mayor perímetro cefálico que los de nulíparas (p&lt;0,001). CONCLUSIONES: El perímetro cefálico aumenta con la edad gestacional y es influenciado por el sexo fetal y la paridad materna. El perímetro cefálica de los fetos masculinos a partir de la semana 40 es mayor que antes de la semana 40. Esta característica favorecería la desproporción cefalopélvica en el feto varón.

Dyspareunia and sexual dysfunction after vaginal delivery in Thai primiparous women with episiotomy.

Episiotomy remains commonly practiced in Thailand. There are limited data on its impacts on sexuality among Asian women during the first postdelivery year. The aim was to study dyspareunia and sexual function at 3-12 months after vaginal delivery in Thai primiparous women with episiotomy. A total of 190 participants were approached on Day 2 postpartum. Of these, 93 sexually active women were evaluated for dyspareunia and sexual function at 3 months by using 10-cm visual analog scale and the validated Thai version of Female Sexual Function Index (TFSFI). TFSFI < 26.5 was defined as having potential sexual dysfunction. At 6 and 12 months, sexual function was evaluated by telephone interview. The prevalence of dyspareunia at 3 months and the changes of TFSFI scores during the first postdelivery year were the main outcome measures. The average age of the participants, over 90% of whom were high school finishers, was 24. Their partners were around 3 years older, and the median partnership duration was 3 years. At 3 months, 30.1% of participants reported dyspareunia. There was no association between dyspareunia and the following characteristics: pre-pregnancy dyspareunia, newborn's head circumference and birthweight and breast-feeding (P > 0.05 for all). Sexual dysfunction was demonstrated in 66.7% at 3 months, 31.0% at 6 months, and 14.9% at 12 months. From 3 to 12 months, the median TFSFI scores in all domains increased significantly. There was no difference of the scores in all domains at 3 and 12 months between women with and without dyspareunia at 3 months. However, at 6 months, those without dyspareunia had better scores in pain, orgasm, satisfaction, and total scores (P < 0.05 for all). Dyspareunia at 3 months is common in Thai primiparous women with episiotomy. Those with dyspareunia have a slower resumption of normal sexual function.

The impact of lipid-based nutrient supplement provision to pregnant women on newborn size in rural Malawi: a randomized controlled trial

Small birth size, often associated with insufficient maternal nutrition, contributes to a large share of global child undernutrition, morbidity, and mortality. We developed a small-quantity lipid-based nutrient supplement (SQ-LNS) to enrich the diets of pregnant women. The objective was to test a hypothesis that home fortification of pregnant women's diets with SQ-LNS would increase birth size in an African community. We enrolled 1391 women with uncomplicated pregnancies (<20 gestational weeks) in a randomized controlled trial in Malawi. The women were provided with one daily iron-folic acid (IFA) capsule, one capsule containing multiple micronutrients (MMNs), or one 20-g sachet of SQ-LNS (LNS, containing 118 kcal, protein, carbohydrates, essential fatty acids, and 21 micronutrients). Primary outcomes were birth weight and newborn length. Secondary outcomes included newborn weight, head and arm circumference, and pregnancy duration. Analysis was by intention to treat. The mean ± SD birth weight and newborn length were 2948 ± 432, 2964 ± 460, and 3000 ± 447 g (P = 0.258) and 49.5 ± 2.4, 49.7 ± 2.2, and 49.9 ± 2.1 cm (P = 0.104) in the IFA, MMN, and LNS groups, respectively. For newborn weight-for-age, head circumference, and arm circumference, the point estimate for the mean was also highest in the LNS group, intermediate in the MMN group, and lowest in the IFA group, but except for midupper arm circumference (P = 0.024), the differences were not statistically significant. The prevalence of low birth weight (<2500 g) was 12.7%, 13.5%, and 12.1% (P = 0.856), respectively; newborn stunting (length-for-age z score < -2) was 19.2%, 14.0%, and 14.9% (P = 0.130), respectively; and newborn small head circumference (head circumference-for-age z score < -2) was 5.8%, 3.0%, and 3.1% (P = 0.099), respectively. The associations between the intervention and the outcomes were not modified by maternal parity, age, or nutritional status (P > 0.100). The study findings do not support a hypothesis that provision of SQ-LNS to all pregnant women would increase the mean birth size in rural Malawi. The trial was registered at clinicaltrials.gov as NCT01239693.

The Effect of Multi mineral-Vitamin D Supplementation on Pregnancy Outcomes in Pregnant Women at Risk for Pre-eclampsia.

Background:The objective of this study was to determine the favorable effects of multi mineral-Vitamin D supplementation on pregnancy outcomes among women at risk for pre-eclampsia.Methods:This randomized double-blind controlled clinical trial was conducted among 46 women at risk for pre-eclampsia at 27 weeks’ gestation with positive roll-over test. Pregnant women were randomly assigned to receive either the multi mineral-Vitamin D supplements (n = 23) or the placebo (n = 23) for 9-week. Multi mineral-Vitamin D supplements were containing 800 mg calcium, 200 mg magnesium, 8 mg zinc, and 400 IU Vitamin D3. Fasting blood samples were taken at baseline and after 9-week intervention to measure related factors. Newborn's outcomes were determined.Results:Although no significant difference was seen in newborn's weight and head circumference between the two groups, mean newborns’ length (51.3 ± 1.7 vs. 50.3 ± 1.2 cm, P = 0.03) was significantly higher in multi mineral-Vitamin D group than that in the placebo group. Compared to the placebo, consumption of multi mineral-Vitamin D supplements resulted in increased levels of serum calcium (+0.19 vs. −0.08 mg/dL, P = 0.03), magnesium (+0.15 vs. −0.08 mg/dL, P = 0.03), zinc (+8.25 vs. −21.38 mg/dL, P = 0.001) and Vitamin D (+3.79 vs. −1.37 ng/ml, P = 0.01). In addition, taking multi mineral-Vitamin D supplements favorably influenced systolic blood pressure (SBP) (−1.08 vs. 6.08 mmHg, P = 0.001) and diastolic blood pressure (DBP) (−0.44 vs. 3.05 mmHg, P = 0.02).Conclusions:Multi mineral-Vitamin D supplementation for 9-week in pregnant women at risk for pre-eclampsia resulted in increased newborn's length, increased circulating levels of maternal serum calcium, magnesium, zinc and Vitamin D, and led to decreased maternal SBP and DBP.

LESIONS PERINEALES AU COURS DE L’ACCOUCHEMENT

Objectives: Specify the epidemiological profile; identify associated factors and assessing the prognosis of perineal tears during childbirth. Materials and methods: This is a comprehensive prospective study of casecontrol study maternity IHS Dakar between 4 May 2009 and 3 May 2010. Following repair of perineal injury, each patient was then the 'monitored post-natal (the 8th day, 15th day, at the end of the first month and the third month). Results: 1399 perineal lesions were identified among 3853 vaginal deliveries, a prevalence of 36.3%. It was 1087 episiotomies and perineal tears 312. The epidemiological profile was that of a young woman (24 years), primiparous (66.9%), with a history of genital mutilation (19.2%) and carrying a pregnancy to term (96.8%). The modes of delivery were: natural vaginal (94.3%), cup (5%) and forceps (0.7%). Four types of perineal lesions were observed: mediolateral episiotomy (77.7%), incomplete tears (21.4%), complete tear (0.6%) and complete and complex tears (0.3%). During post-natal monitoring, we noted a some complications like of dehiscence (3.6%) or infection of the perineum (3.7%). Morbidity in 3 months was essentially represented by dyspareunia (4.4%). childbirth. Multivariate analysis showed that the risk of perineal lesions was significantly correlated with the following parameters: maternal age, parity, existence of female genital mutilation, nature of the presentation, mode of delivery, duration of the expulsive stage, qualification of the obstetrician and head circumference of newborns. Conclusion: The perineal tears during childbirth affect a large and growing number of women during chilbirth. Their morbidity is not negligible and recommends better training for midwives to ask good indications for episiotomy and prevent perineal tears. keywords: episiotomy - perineal tear - vaginal delivery

Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery

ObjectiveThis study was conducted to investigate the risk factors of third- and fourth-degree lacerations following vaginal deliveries in Taiwanese women, and to offer clinical guidance for the reduction of severe perineal lacerations. Materials and methodsA total of 1879 women who underwent vaginal deliveries assisted by midline episiotomy at a tertiary hospital were included. Obstetric risk factors were analyzed for women with and without third- and fourth-degree lacerations. ResultsTwo hundred and five deliveries (10.9%) resulted in third- or fourth-degree lacerations. Parity, duration of first and second stages of labor, rate of instrument-assisted vaginal deliveries, the newborn's birth weight and head circumference, and the ratio of the newborn's birth weight to maternal body mass index were significantly different between women with and without severe perineal lacerations. Logistic regression demonstrated that nulliparity (odds ratio = 3.626, p < 0.001), duration of second stage of labor (odds ratio = 1.102, p = 0.044), instrument-assisted vaginal delivery (odds ratio = 4.102, p < 0.001), and newborn's head circumference (odds ratio = 1.323, p < 0.001) were independent risk factors of severe perineal lacerations. Instrument-assisted vaginal delivery was a common independent risk factor for severe lacerations shared between primiparous and multiparous women. ConclusionsWith regard to severe perineal lacerations during vaginal delivery, there are multiple obstetric contributory factors despite routine episiotomy, among them, nulliparity, longer labor duration, greater newborn head circumference, and instrument-assisted vaginal delivery. The latter should only be performed after careful evaluation.

Favorable effects of vitamin D supplementation on pregnancy outcomes in gestational diabetes: a double blind randomized controlled clinical trial.

Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for unfavorable pregnancy outcomes. Prevalence of vitamin D deficiency is highly prevalent among women with GDM. This study was designed to assess the effect of vitamin D supplementation on pregnancy outcomes of pregnant women with GDM who were not on oral hypoglycemic agents. This randomized controlled clinical trial was performed among 45 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either vitamin D supplements (cholecalciferol) or placebo. Individuals in the vitamin D group (n=22) received 50 000 IU vitamin D3 pearl 2 times during the study: at study baseline and day 21 of intervention and those in placebo group (n=23) received 2 placebos at the mentioned times. Fasting blood samples were taken at baseline to measure fasting plasma glucose. Participants underwent a 3-h oral glucose tolerance tests (OGTT) and the blood samples were collected at time 60, 120, and 180 min to measure plasma glucose levels. Newborn's weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined. Taking vitamin D supplements, compared with placebo, resulted in improved pregnancy outcomes; such that those in the vitamin D group had no case of polyhydramnios, while 17.4% of subjects in placebo group had this condition (p=0.04). In addition, newborn's hyperbilirubinemia was significantly lower in vitamin D group than that in placebo group (27.3% vs. 60.9%, p=0.02). In conclusion, vitamin D supplementation for 6 weeks among pregnant women with GDM resulted in decreased maternal polyhydramnios and infant hyperbilirubinemia compared with placebo. Clinical trial registration number www.irct.ir:IRCT201305115623N7.

International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project

In 2006, WHO published international growth standards for children younger than 5 years, which are now accepted worldwide. In the INTERGROWTH-21(st) Project, our aim was to complement them by developing international standards for fetuses, newborn infants, and the postnatal growth period of preterm infants. INTERGROWTH-21(st) is a population-based project that assessed fetal growth and newborn size in eight geographically defined urban populations. These groups were selected because most of the health and nutrition needs of mothers were met, adequate antenatal care was provided, and there were no major environmental constraints on growth. As part of the Newborn Cross-Sectional Study (NCSS), a component of INTERGROWTH-21(st) Project, we measured weight, length, and head circumference in all newborn infants, in addition to collecting data prospectively for pregnancy and the perinatal period. To construct the newborn standards, we selected all pregnancies in women meeting (in addition to the underlying population characteristics) strict individual eligibility criteria for a population at low risk of impaired fetal growth (labelled the NCSS prescriptive subpopulation). Women had a reliable ultrasound estimate of gestational age using crown-rump length before 14 weeks of gestation or biparietal diameter if antenatal care started between 14 weeks and 24 weeks or less of gestation. Newborn anthropometric measures were obtained within 12 h of birth by identically trained anthropometric teams using the same equipment at all sites. Fractional polynomials assuming a skewed t distribution were used to estimate the fitted centiles. We identified 20,486 (35%) eligible women from the 59,137 pregnant women enrolled in NCSS between May 14, 2009, and Aug 2, 2013. We calculated sex-specific observed and smoothed centiles for weight, length, and head circumference for gestational age at birth. The observed and smoothed centiles were almost identical. We present the 3rd, 10th, 50th, 90th, and 97th centile curves according to gestational age and sex. We have developed, for routine clinical practice, international anthropometric standards to assess newborn size that are intended to complement the WHO Child Growth Standards and allow comparisons across multiethnic populations. Bill & Melinda Gates Foundation.