Higher Birth Weight Research Articles

Letter to the editor: Association between birth weight, preterm birth, and nonalcoholic fatty liver disease in a community-based cohort.

To the editor, While we commend Amadou et al.1 for their fine study reporting a U-shaped association between birth weight and risk of NAFLD, we have some concerns. NAFLD was defined using the fatty liver index. This index was, however, developed as a risk stratification tool (not as a diagnostic instrument) and has a rather low positive predictive value for the diagnosis of NAFLD (67%).2 Furthermore, the fatty liver index may perform poorly in young individuals with normal body mass index,3 as in the current French study population (mean age 38 y, normal body mass index).1 Given that the fatty liver index formula is largely driven by body mass index and waist circumference, the question arises whether the found associations rather explain a higher risk of obesity and would especially miss individuals with lean NAFLD. While in women, there was a positive association between high birth weight and risk of NAFLD, the mediation analysis revealed that in men high birth weight did neither have a direct nor a total effect on the later risk of NAFLD—in contrast the indirect effect seemed even protective. Against this background, how do the authors explain the contradictive results on high birth weight and NAFLD risk in men andwomen? The authors found a slight negative association between birth weight and the Forns index, which was used as proxy for liver fibrosis. Here, we see two limitations that make the interpretation of these results challenging: first, the Forns index was originally developed to noninvasively rule-out significant fibrosis and has not been validated to be used as a continuous variable. Second, it was derived in high-risk cohorts of patients with chronic hepatitis C infection,4 while the current study applied it in a general population setting. Hence, we are eager to know if the authors could confirm these results using FIB-4 instead, which is recommended by international guidelines.5

Low Birth Weight is Associated with Sperm DNA Fragmentation and Assisted Reproductive Technology Outcomes in Primary Infertile Men: Results of a Cross-Sectional Study.

To assess the relationship between clinical and semen characteristics and assisted reproductive technology (ART) outcomes with different birth weight (BW) categories in a cohort of infertile men. Data from 1,063 infertile men were analyzed. Patients with BW ≤2,500, 2,500-4,000, and ≥4,000 g were considered as having low BW (LBW), normal BW (NBW), and high BW (HBW), respectively. Testicular volume (TV) was assessed with a Prader orchidometer. Serum hormones were measured in all cases. Semen analyses were categorized based on 2021 World Health Organization reference criteria. Sperm DNA fragmentation (SDF) was tested in every patient and considered pathological for SDF >30%. ART outcomes were available for 282 (26.5%) patients. Descriptive statistics and logistic regression analyses detailed the association between semen parameters and clinical characteristics and the defined BW categories. Of all, LBW, NBW, and HBW categories were found in 79 (7.5%), 807 (76.0%), and 177 (16.5%) men, respectively. LBW men had smaller TV, presented higher follicle-stimulating hormone (FSH) but lower total testosterone levels compared to other groups (all p<0.01). Sperm progressive motility (p=0.01) and normal morphology (p<0.01) were lower and SDF values were higher (all p<0.01) in LBW compared to other groups. ART pregnancy outcomes were lower in LBW compared to both NBW and HBW categories (26.1% vs. 34.5% vs. 34.5%, p=0.01). At multivariable logistic regression analysis, LBW was associated with SDF >30% (odd ratio [OR] 3.7; p<0.001), after accounting for age, Charlson Comorbidity Index (CCI), FSH, and TV. Similarly, LBW (OR 2.2; p<0.001), SDF >30% (OR 2.9; p<0.001) and partner's age (OR 1.3; p=0.001) were associated with negative ART outcomes, after accounting for the same predictors. LBW was associated with impaired clinical and semen characteristics in infertile men compared to both NBW and HBW. SDF and ART outcomes were significantly worse in the LBW group.

High birth weight and greater gestational age at birth in singletons born after frozen compared to fresh embryo transfer

ObjectiveWhile many studies agree that the fetal birth weight is higher after frozen embryo transfer (FET), few studies have explored the difference in fetal weight change during such pregnancies. This cohort study was to identify the difference in fetal birth weight and gestational age at birth between singletons born following fresh ET and those born following FET. Materials and methodsThis was a hospital-based cohort study using clinical data from the Kaohsiung Chang Gung Memorial Hospital Obstetric and Neonatal Database from January 1, 2007, to December 1, 2018. A sample of 784 eligible women who had singleton pregnancies and live-born deliveries after 428 fresh ET or 356 FET between January 2007 and December 2018. ResultsCompared with those in the fresh ET group, singletons in the FET group had higher birth weight (3137 g [2880–3441 g] vs. 3060 g [2710–3340 g], p < 0.05), were born later (39.0 weeks of gestation [38.0–40.0 weeks] vs. 38.0 weeks of gestation [37.0–39.0 weeks], p < 0.05), and had a lower incidence of preterm birth (10.4% vs. 15.2%, p < 0.05). The difference in birth weight was not associated with maternal body weight (BW) or body mass index, increase in maternal BW in the third trimester, but related to the total increase in maternal BW during pregnancy. ConclusionsThe birthweight of singletons born following FET and fresh ET became significant in the late third trimester. The main reason is that singletons conceived from FET were at a lower relative risk of preterm delivery and had a higher gestational age at birth.

Changes in piglet and litter characteristics across parities in two highly prolific sow hybrids in an outdoor organic herd.

High piglet mortality constitutes a welfare challenge in organic pig production. Litter characteristics were investigated from parities 1-5 of two hyper-prolific hybrids with different selection traits in an organic commercial herd (DanBred vs. Topigs Norsvin [TN70]). TN70 sows had more functional teats than DanBred sows, and their offspring had higher birth weights. Several interactions between hybrid and parity were found. The total born increased with higher parity and was more pronounced for DanBred sows. Litter weight at weaning was higher in parities 1-4 for TN70 compared with DanBred, and within DanBred parities 4 and 5 had higher litter weight at weaning than parity 1. The survival rate was higher for TN70 in parities 1 and 2 compared with DanBred, and for both hybrids, the survival rate was higher in parities 1 and 2 compared with parities 4 and 5. The number of weaned piglets was stable across parities 1-4 but lower in parity 5 for both hybrids. Thus, despite a lower number of total born piglets in TN70, TN70 sows weaned the same number of piglets as DanBred, with a lower mortality rate and a heavier litter at weaning.

Effect of vitamin E and zinc supplementation in pre and post partum period incrossbred cows on anti-oxidant, immunity status and performance of new borncalves

The present study was undertaken to investigate the effect of zinc (Zn) supplementation alone and its combination with vitamin E on growth, anti oxidant status and immunity status of new born calves of crossbred cows. The cows were supplemented with Zn @ 0 ppm (T0), Zn @ 80 ppm (T1) and Zn @80 ppm + 1000 IU α-tocopheryl acetate/d (T2) from 60 days prepartum up to 90 days postpartum. The fat, SNF, total solid, protein, Zn and Cu contents content of colostrum showed no effect of dietary treatments but α-tocopherol content was higher(P&lt;0.01) in group T2 as compared to other groups. Total immunoglobulin in colostrum of T2 group was 25.87% higher than control. There was no effect of dietary treatments on plasma Zn and Cu levels of calves, however α-tocopherol concentration at day 5 was higher (P&lt;0.05) in group T2 as compared to other groups. Status of antioxidant enzymes, lymphocyte proliferation index,total and differential leukocyte count was not affected by the treatments. Higher birth weight (P&lt;0.05) was obtained in groupT2 group as compared to other group. Calves from treatment groups showed lower incidence of morbidity and mortality due to calf scour and other infectious diseases compared to control

Anthelmintic usage on the Reproductive Parameters in Captive reared Agoutis (Dasyprocta leporina) in Trinidad and Tobago, West Indies.

The agouti (Dasyprocta leporina) is a rodent that is found in the Neo-tropical region. This animal is hunted for its meat but has recently been reared in captivity as a source of meat protein in rural communities. A 20-month experiment was carried out to evaluate the effect of an anthelmintic on the reproductive performance of the agouti (Dasyprocta leporina) reared in captivity. This experiment was conducted in the humid tropics of Trinidad and Tobago. Sixteen animals (15 females, 1 male) placed in each of the two treatment groups in a completely randomized study design. In treatment 1 (T1) animals were given subcutaneous injections of Endovet Ces® (Ivermectin/Praziquantel) at 0.2 mg/kg every three months. Treatment 2 (T2) was the negative control group where animals were not exposed to an anthelmintic. Reproductive data were collected at parturition which included birth weight, litter weight, litter size and gender of offspring. The results showed that there was no statistical difference (p > 0.05) between the treatment groups with respect to birth weight, litter weight, litter size and gender. However, agoutis that were dewormed had a higher birth weight (220.24 g vs 209.1 g) and litter weight (369.8 g vs 343 g). The same values were obtained for the litter size (1.7 vs 1.7) and animals that were dewormed had a higher female offspring to male offspring (2.41:1 vs 1.11:1). This experiment demonstrated that the use of an anthelmintic strategically in the management of captive reared agoutis had no statistical effect (p > 0.05) on the reproductive parameters. Therefore, these animals can be kept in captive conditions without being dewormed and produce efficiently with proper feeding and housing management.

The effect of source of protein fed during pregnancy and lactation on the development of characteristics of metabolic syndrome in male offspring of obese Wistar rats.

Gestational obesity has major negative impacts on both mothers and their offspring. More than two-thirds of women of reproductive age in the United States are overweight and/or obese. We previously reported that the source of protein in the maternal diet influences the phenotype of offspring born to normal-weight dams. However, whether it has the same effect in obese mothers was unclear. The casein- and soya protein-based diets were fed to obese pregnant Wistar rats and compared for their effects on characteristics of the metabolic syndrome in male offspring. Dams randomized to either a casein (CD) or soya protein (SD) diet (n 12). Pups were weaned to either a CD or SD for 16 weeks. Offspring of SD dams had higher birthweight (P < 0⋅01). Glucose metabolism was not altered at birth but fasting blood glucose (FBG) (P < 0⋅02), insulin (P < 0⋅0002), insulin/glucose ratio (P < 0⋅03), and HOMA-IR index (P < 0⋅0002) were higher in offspring of SD dams at week 17. The pulse rate was higher in dams (P < 0⋅03). Food intake and body weight of offspring were affected by interactive effects of time and dams' diet (P < 0⋅05). Food intake was not influenced by maternal diet, but it was higher in pups weaned to SD dams (P < 0⋅03) The results of this study indicate that although the source of protein in the maternal diet is still an influencing factor in the outcome of the pregnancy in obese mothers, gestational obesity may mask this effect possibly by imposing general detrimental effects on measured parameters regardless of the source of protein in maternal diet.

Neonatal survival after serial amnioinfusions for fetal bilateral renal agenesis: report from the raft trial

Bilateral renal agenesis (BRA) in the fetus leads to anhydramnios and lethal pulmonary hypoplasia. We report obstetric outcomes and neonatal survival/complications for pregnancies undergoing serial amnioinfusions (AIs) in the completed BRA arm of the Renal Anhydramnios Fetal Therapy (RAFT) trial (NCT03101891). RAFT is a nonrandomized prospective clinical trial conducted at 9 North American Fetal Therapy Network sites to assess the safety and efficacy of serial AIs to treat BRA. The primary outcome was postnatal survival ≥ 14 d and dialysis access placement. Inclusion required ultrasound (US) confirmed isolated BRA, normal genetic testing, and first therapeutic AI prior to 26 w gestational age (GA). AIs were done with US guidance to maintain adequate amniotic fluid volume during pregnancy. All delivered at a RAFT center. Enrollment was suspended in July 2022 after Data Safety Monitoring Board review of neonatal morbidity and survival data. Twenty maternal-fetal pairs underwent serial AIs (Figure). There were 18 (90%) livebirths, median GA 32 w [IQR 31.8, 34]. Obstetric complications included preterm prelabor rupture of membranes (60%), chorioamniotic membrane separation (30%) and bleeding (20%). 78% (95% CI, 0.57-0.99) (n=14) of neonates survived to ≥ 14 d and had placement of dialysis access (Table). Factors associated with survival to the primary endpoint included more AIs, GA at birth ≥ 32 w, and higher birthweight (BW). 5/14 infants who met the primary outcome survived to discharge on peritoneal dialysis (PD) at a median age of 25 w [IQR 12, 32]; 2 of the 5 died after discharge. 3 of the 5 infants discharged home and one who remains in the NICU sustained strokes. Serial AIs initiated before 26 w in pregnancies with BRA mitigated lethal pulmonary hypoplasia. Survival to discharge on PD and beyond was considerably lower than survival to ≥ 14 d and strongly associated with GA and BW, highlighting the additional morbidity and mortality independent of lung function for infants lacking kidneys. Recruitment for the non-BRA fetal renal failure arm of the trial continues.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Association of Vitamin D supplementation in pre-eclampsia: Systematic review and meta-analysis

INTRODUCTION: In the Philippines, hypertensive diseases of pregnancy belong in the top three causes of maternal mortality and complicate up to 10% of pregnancy worldwide. In relation with this, proper interventions must be given during the prenatal check-up to prevent occurrence that may cause feto-maternal mortality and morbidity. During prenatal check-up, pregnant women are given vitamin and mineral supplementations. Vitamin D has an association of having a risk for preeclampsia. Receptors of Vitamin D and 1-a hydroxylase are both expressed in the decidua and trophoblast cells. The active form of Vitamin D affects the transcription and function of genes associated with angiogenesis, invasion of the placenta, and normal implantation. The mechanisms mentioned are all involved in the pathophysiology of preeclampsia.OBJECTIVES: The primary outcome of this study is to determine the association of Vitamin D supplementation in preeclampsia. Specifically, this study aims to compare the following secondary outcomes: Maternal outcomes (complication of gestational diabetes mellitus and underwent cesarean delivery) and fetal outcomes (preterm delivery and birth weight).METHODOLOGY: Meta-analysis and systematic review of eight randomized controlled trials.RESULTS: Vitamin D reduced the risk of preeclampsia (risk ratio [RR] 0.45, 95% confidence interval [CI] 0.30–0.69; P = 0.0002). No significant difference on risk of gestational diabetes mellitus (RR 0.84, 95% CI 0.48–1.48) and risk of preterm delivery (RR 0.71, 95% CI 0.49–1.03). Results showed that newborns of mothers who had no Vitamin D supplementation had a higher birthweight (P = 0.010). No significant difference on cesarean section rate (RR 1.12, 95% CI 0.87–1.45).CONCLUSION: Evidence suggests that Vitamin D supplementation can reduce the risk of preeclampsia. This study encourages obstetricians in our country to add Vitamin D supplementation as prenatal medication to prevent preeclampsia, thereby reducing maternal morbidity and mortality.

ОТКЛОНЕНИЕ МАССЫ ТЕЛА ПРИ РОЖДЕНИИ КАК ФАКТОР РИСКА ДЛЯ ЗДОРОВЬЯ РЕБЕНКА

Significance. The problems of public health deterioration are of great importance for the state socio-economic potential. The most vulnerable group is the child population in the first years of life, especially during the neonatal period. Accordingly, effects of the birth weight deviation on the child health are a focus of high research interest. Purpose. To assess the body weight of born alive newborns, and identify effects of the deviation of body weight at birth on the child health in the Northwestern Federal District. Material and methods. Based on official statistics for 2017-2021, distribution of children by birth weight, neonatal morbidity rates in Russia, the Northwestern Federal District as a whole and its regions in dynamics have been analyzed. A nonparametric Spearman rank-order correlation method was used to assess effects of the baby weight at birth on the newborn health. Statistical data processing was carried out using MS Office-2016 and StatSoft-Statistica 10.0 software packages. Results. The Northwestern Federal District is characterized by a higher, in comparison with the Russian Federation, share of children with a birth weight of more than 4000 g (11.33% vs. 10.12%; p&lt;0.05) and less than 2500 g (6.15% vs. 6.05%; p&lt;0.05). In the Federal district, there is a negative growth dynamic in the share of newborns with high body weight and low birthweight of less than 1500 g. The average District neonatal morbidity rate significantly exceeds the national average (413.8‰ vs. 315.5‰; p&lt;0.05), and tends to increase due to the increased neonatal morbidity in almost all regions of the Federal district. The correlation analysis has identified a direct strong relationship between the number of children born sick and got ill, and the number of babies with low and high weight at birth (rxy=0.83-0.99). Conclusion. The increased number of underweight babies and newborns born with a body weight of 4000 g or more is a regional risk factor for a high incidence rate in the District regions.

Role of melatonin receptor 1B gene polymorphism and its effect on the regulation of glucose transport in gestational diabetes mellitus.

Melatonin receptor 1B (MT2, encoded by the MTNR1B gene), a high-affinity receptor for melatonin, is associated with glucose homeostasis including glucose uptake and transport. The rs10830963 variant in the MTNR1B gene is linked to glucose metabolism disorders including gestational diabetes mellitus (GDM); however, the relationship between MT2-mediated melatonin signaling and a high birth weight of GDM infants from maternal glucose abnormality remains poorly understood. This article aims to investigate the relationship between rs10830963 variants and GDM development, as well as the effects of MT2 receptor on glucose uptake and transport in trophoblasts. TaqMan-MGB (minor groove binder) probe quantitative real-time polymerase chain reaction (qPCR) assays were used for rs10930963 genotyping. MT2 expression in the placenta of GDM and normal pregnant women was detected by immunofluorescence, western blot, and qPCR. The relationship between MT2 and glucose transporters (GLUTs) or peroxisome proliferator-activated receptor γ (PPARγ) was established by western blot, and glucose consumption of trophoblasts was measured by a glucose assay kit. The results showed that the genotype and allele frequencies of rs10830963 were significantly different between GDM and normal pregnant women (P<0.05). The fasting, 1-h and 2-h plasma glucose levels of G-allele carriers were significantly higher than those of C-allele carriers (P<0.05). Besides, the protein and messenger RNA (mRNA) expression of MT2 in the placenta of GDM was significantly higher than that of normal pregnant women (P<0.05). Melatonin could stimulate glucose uptake and GLUT4 and PPARγ protein expression in trophoblasts, which could be attenuated by MT2 receptor knockdown. In conclusion, the rs10830963 variant was associated with an increased risk of GDM. The MT2 receptor is essential for melatonin to raise glucose uptake and transport, which may be mediated by PPARγ.

Comparison of the Clinical Characteristics of Infants with Punctate White Matter Lesions and/or Cystic Lesions

We aimed to investigate the differences in the clinical characteristics of preterm infants with punctate white matter lesions (PWMLs) and those with cystic periventricular leukomalacia (cPVL) using term-equivalent age magnetic resonance imaging. We conducted a retrospective case-control study to explore the clinical characteristics of infants (< 35 weeks gestation, born between 2007 and 2017 in a single Level III perinatal center) with PWML, cPVL or with PWML plus cPVL and compared them with those of gestational-age-matched controls. Among 602 infants, 29, 5, and 4 were assigned to the PWML group, cPVL group, and PWML plus cPVL group (PWML-cPVL group), respectively. Compared to the control group (n = 87), the PWML group had higher birth weights (p = 0.04), rates of histological chorioamnionitis (p = 0.04), vaginal delivery (p = 0.008), and early heart contraction failure (within 72 hours after birth) (p = 0.003). The cPVL group had lower umbilical blood gas base excess (p = 0.01), higher rate of late-onset circulatory collapse (p = 0.008), and higher hydrocortisone requirements (p = 0.03) than the control group (n = 15). The PWML-cPVL group had a higher rate of intraventricular hemorrhage (p = 0.03) than the control group (n = 12). In the multivariate logistic regression analysis, vaginal delivery (odds ratio [OR] = 3.5; 95% confidence interval [CI] = 1.37-9.40; p = 0.009), higher birth weight (per 1 g) (OR = 1.001; 95% CI = 1.0001-1.002; p = 0.03), and early heart contraction failure (OR = 5.4; 95% CI = 1.84-16.8; p = 0.002), were independent risk factors for PWML. Clinical characteristics of infants with PWML compared with gestational-age-matched controls differed from those with cPVL or PWML plus cPVL, as PWML were not related to severe disruption of hemodynamics.

Relationship between Gestational Hypertension and High Birth Weight, in the State of Guanajuato, Mexico

Hypertensive disease is one of the main concerns during pregnancy. It is classified as gestational hypertension, preeclampsia, and eclampsia. The objective of this study was to analyze whether there is a relationship between gestational hypertension and high birth weight (≥3500 g) in newborns. It was designed a retrospective quantitative study, considering women admitted for obstetric resolution and their products treated in hospitals from Guanajuato State, Mexico, with hypertension developing after 20 weeks of pregnancy. The Chi-squared test was performed to show a relationship between gestational hypertension and preeclampsia-eclampsia with the newborn's birth weight. Then calculated the effect of gestational hypertension on birthweight by computing the corresponding Odds Ratios (OR). We also fitted a multivariate logistic regression model that included age group, marital status, number of previous pregnancies, and gestational age as covariates. It was computed the Pearson correlation and adjusted a linear regression model to identify the relationship between systolic and diastolic pressure with birthweight. The alpha value was fixed at .05 as a threshold for statistical significance. The number of reviewed registries was 1,675. For the variables age, gestational age at hospital admission, systolic and diastolic blood pressure, and birth weight of the products, there are differences between the groups of mothers (P&lt;.05). For the logistic regression model just including gestational hypertension as covariable, the OR was 1.28 (95% CI=1.0 to 1.63). The gestational age plays a confounding role -other variables did not improve the model-. Systolic and diastolic blood pressure showed a statistically significant (P=0.2, P=0.048) low negative correlation (r=-0.07, r=-0.06) with birth weight for women with gestational hypertension. There is an effect between gestational hypertension and high birth weight, although the effect is confounded by gestational age at birth time. Linear regression between systolic-diastolic pressure and birthweight supports this association. The evidence is low and further studies are advisable.

Study of factors affecting the duration of spontaneous regression of retinopathy of prematurity

The aim of this study was to identify the factors influencing the duration of spontaneous regression of Retinopathy of Prematurity. A prospective observational study was conducted over a duration of 1.5 years from December, 2019 to May, 2021. All the infants presenting with ROP or developed any stage later were considered for the study and were followed up as per International Classification of Retinopathy Guidelines (ICROP), 2005 guidelines till compete vascularisation. Data regarding the birth history and maternal factors were noted. In those neonates in whom the Retinopathy of Prematurity presented or progressed to type 1 ROP were treated and the rest were followed up till complete vascularisation and duration noted. Risk factors were compared in neonates undergoing spontaneous regression within 45 weeks PMA and those taking longer than 45 weeks. The Statistical analysis was performed by SPSS 23.0 version. Mean gestational age in neonates undergoing earlier spontaneous regression (&amp;#60;45 weeks) was 31.86±2.02 months, and that of delayed spontaneous regression group was 33±2.24 months. Mean birth weight in earlier spontaneous regression group was 1537.14±202.02 grams, and that delayed spontaneous regression group was 1406.19±229.88 grams. Mean duration of complete regression of ROP is 44.9 weeks postmenstrual age. Higher birth weight and Hyperbilirubinemia was found to significantly cause the regression of ROP within 45 weeks (P=0.021). Higher birth weight and Hyperbilirubinemia was found to cause earlier regression of ROP and hence could be a possible protective factor in the pathogenesis of ROP.

Birthweight, genetic risk, and gastrointestinal cancer incidence: a prospective cohort study

Background The epidemiologic studies investigating the association of birthweight and genetic factors with gastrointestinal cancer remain scarce. The study aimed to prospectively assess the interactions and joint effects of birthweight and genetic risk levels on gastrointestinal cancer incidence in adulthood. Methods A total of 254,997 participants were included in the UK Biobank study. We used multivariate restricted cubic splines and Cox regression models to estimate the hazard ratios (HRs) and 95% confidential intervals (CI) for the association between birthweight and gastrointestinal cancer risk, then constructed a polygenic risk score (PRS) to assess its interaction and joint effect with birthweight on the development of gastrointestinal cancer. Results We documented 2512 incident cases during a median follow-up of 8.88 years. Compare with participants reporting a normal birthweight (2.5–4.5 kg), multivariable-adjusted HR of gastrointestinal cancer incidence for participants with high birthweight (≥4.5 kg) was 1.17 (95%CI: 1.01–1.36). Such association was remarkably observed in pancreatic cancer, with an HR of 1.82 (95%CI: 1.26–2.64). No statistically significant association was observed between low birth weight and gastrointestinal cancers. Participants with high birthweight and high PRS had the highest risk of gastrointestinal cancer (HR: 2.95, 95%CI: 2.19–3.96). Conclusion Our findings highlight that high birthweight is associated with a higher incidence of gastrointestinal cancer, especially for pancreatic cancer. Benefits would be obtained from birthweight control, particularly for individuals with a high genetic risk. KEY MESSAGES The epidemiologic studies investigating the association of birthweight and genetic factors with gastrointestinal cancer remain scarce. This cohort study of 254,997 adults in the United Kingdom found an association of high birthweight with the incidence of gastrointestinal cancer, especially for pancreatic cancer, and also found that participants with high birthweight and high polygenic risk score had the highest risk of gastrointestinal cancer. Our data suggests a possible effect of in utero or early life exposures on adulthood gastrointestinal cancer, especially for those with a high genetic risk.

Predictors of the Need to Use Medications in the Management of Neonatal Hypoglycemia.

Background and objective Neonatal hypoglycemia (NH) is one of the most common causes of admission to the neonatal intensive care unit (NICU). Persistent NH despite adequate feeding and intravenous dextrosemay often require medications to maintain normal blood glucose levels (BGL). Several medications are used in the management of persistent NH, such as glucagon, diazoxide, and octreotide. In this study, we aimed to determine the factors that predict the need for medications to treat persistent NH. Methods This was a retrospective cohort studyconducted at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Infants admitted to the NICU between 2015 and 2019 with hypoglycemia (capillary blood glucose <2.6 mmol/l) were eligible to be included in the study. A prespecified dataset was collected from electronic patientrecords, including birth weight (BW), APGAR scores, gestational age, BGL, maternal risk factors such as diabetes mellitus (DM), hypertension, or antenatal use of medications, and the NICU management during admission. Data analysis was performed usingSPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, NY). Results A total of 89 neonates were admitted due to NH during the study period. Of them, 10 (11.2%) patients had received medication (diazoxide). Use of medication for persistent NH was significantly associated with maternal gestational diabetes/diabetes mellitus (GDM/DM) status (p=0.041), higher BW (p=0.001), and large for gestational age [LGA (defined as BW >90th percentile)] (p=0.014), severe hypoglycemia (mean glucose level of 1-1.5 mmol/l) at two hours of life and at admission, and elevated maximum glucose infusion rate (GIR). GIR for the medication-requiring cohort was 12.95 mg/kg/min and that for the non-medication-requiring cohort was 6.77 mg/kg/min (p<0.001). Conclusion Based on our findings, the need for using certain medications to treat persistent NH, such as diazoxide in neonates admitted with NH, can be predicted byfactors such as maternal GDM/DM status, BW >90th percentile, very low BGL at two hours of age and on admission, and elevated GIR. Elevated maximum GIR was a leading indicator for using medications in the treatment of NH.

Clinical Overview in Pregnancy with COVID-19 at prof. Dr. I.G.N.G. Ngoerah Hospital Period of April 2020-March 2021

BACKGROUND: Pregnant women are one of the populations that are susceptible to coronavirus disease 2019 (COVID-19) infection due to physiological changes during pregnancy that is an adaptive response to pregnancy such as diaphragmatic elevation, increased oxygen consumption, and airway mucosal edema which can also make pregnant women more intolerant of hypoxia. In addition to being vulnerable, COVID-19 in pregnant women may have a different clinical course from the general population. AIM: This study aims to determine the demographic and clinical characteristics in pregnancy with COVID-19 at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia. METHODS: This study was a cross-sectional descriptive study using secondary data derived from patient medical records and carried out in the delivery room and medical record installation at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia, for the period of April 1, 2020–March 31, 2021. RESULTS: Of the 275 patients, most were in the age range of 26–30 years (46.55%), in the third trimester (81.45%), and patients came alone (54.18%). Most of the patients came without symptoms with reactive rapid antibody results (60.97%). Of the 197 patients who delivered, 84.77% had CS and 66.55% without oxygen therapy. About 69.69% of patients experienced complications and the mortality rate was 1.09%. The highest birth weight was &gt;2500 g by 76.8%, with the good neonatal outcome (82.92%) and negative swab results (89.45%). Inflammatory markers tend to increase as symptoms increase. Neutrophil-to-lymphocyte ratio, procalcitonin, and ferritin were markedly increased from moderate symptoms to severe-critical symptoms. The same was true for ferritin levels, where there was a sharp rise in significant symptoms. Meanwhile, procalcitonin levels have started to increase quite strikingly from moderate symptoms to the highest in severe symptoms. CONCLUSION: It is hoped that this demographic and clinical picture would further our understanding of COVID-19 and help us develop methods to lessen the disease’s severity and spread to enhance maternal and newborn outcomes.

Analysing outlier communities to child birth weight outcomes in Malawi: application of multinomial logistic regression model diagnostics

Studies have reported significant effect of geographically shared variables on new-born baby weight. Although there is growing use of community-based child health interventions in public health research, such as through provinces, schools, or health facilities, there has been less interest by researchers to study outlying communities to child birth weight outcomes. We apply multinomial logistic regression model diagnostics to identify outlier communities to child birth weight in Malawi. We use a random sample of 850 clusters, each with at least 7 households based on 2015-16 Malawi demographic and health survey data. There were a total of 11,680 children with measured birth weight, that was categorised as either low (< 2,500 grams), normal (2,500 - 4,000 grams) or high (> 4,000 grams). The analyses were done in STATA version 15 and R version 3.6.3. Based on a multinomial logit model with various socio-demographic factors associated with child birth weight, the results showed that two clusters from rural parts of Southern region of Malawi had overly influence on estimated effects of the factors on birth weight. Both clusters had normal to high birth weight babies, with no child having low birth weight. There could be some desired motherhood practices applied by mothers in the two rural clusters worth learning from by policy makers in the child healthcare sector.

Recurrence of Postpartum Hemorrhage in Relatives: A Population-based Cohort Study

(Acta Obstet Gynecol Scand. 2021;100:2278–2284. doi: 10.1111/aogs.14262) While postpartum hemorrhage (PPH) continues to be a serious cause of maternal mortality and morbidity worldwide, there are very few studies on the family aggregation of PPH, and existing studies give inconsistent results. Impact of current birthweight on PPH recurrence between relatives has also not been studied. The aim of this study was to determine PPH recurrence in relatives, the impact of birthweight on PPH recurrence, and the rate at which family history of high birthweight and PPH contributes to current PPH cases.

Secular trends of birth weight and its associations with obesity and hypertension among Southern Chinese children and adolescents.

The association of low or high birth weight (L/HBW) with obesity and hypertension in childhood remains unclear. We aimed to identify the secular trend ofbirth weight distribution and its relationship to obesity and hypertension in Southern Chinese children and adolescents. 6,561 individuals (6-17-year-old) were enrolled by multistage cluster sampling to observed the trend of birth weight distribution and its associated factors. 1,218 were further selected by group matching to investigate thecorrelation between birth weight and obesity or hypertension. Between 1997 and 2008, a significant decline inthe LBW rate and no significant change in the HBW ratewas found. LBW was associated with maternal BMI<18kg/m2 (OR1.79, 95% CI 1.08-2.97) during pregnancy, while maternal BMI between 25.0 and 27.9kg/m2 (OR1.62, 95% CI 1.04-2.52) and paternal BMI>28kg/m2 (OR1.64, 95% CI 1.02-2.63) during pregnancy were associated with HBW. The prevalence of obesity was significantly higher with HBW than normal birth weight (NBW) or LBW (16.73, 6.25 and 5.50%, respectively). The prevalence rates ofsuspected hypertension were 1.62, 1.25 and 1.49% amongLBW, NBW and HBW, respectively (p>0.05). LBW decreased the risks of childhood overweight (OR0.31, 95% CI 0.18-0.54), but had no effect on suspected hypertension. HBW increased the risks of childhood obesity (OR2.19, 95% CI 1.50-3.20), but decreased the risks of suspected hypertension (OR0.22, 95% CI 0.09-0.58). HBW was positively associated with childhood obesity, and parental BMIs management might be one of the measurements to control birth weight to lessen childhood obesity.