Higher Risk Of Low Birth Weight Research Articles

Toxic air pollution and concentrated social deprivation are associated with low birthweight and preterm Birth in Louisiana * *K T and G S provide scientific support to communities engaged in environmental advocacy, including litigation, through their work at the Tulane Environmental Law Clinic. They receive no compensation for this work outside of employment. M W declares that she has nothing

Previous studies indicate that pollution exposure can increase risks of adverse birth outcomes, but Black communities are underrepresented in this research, and the potential moderating role of neighborhood context has not been explored. These issues are especially relevant in Louisiana, which has a high proportion of Black residents, an entrenched history of structural racism, the most pounds of toxic industrial emissions annually, and among the nation’s highest rates of low birthweight (LBW), preterm birth (PTB), and infant mortality. We investigated whether air pollution and social polarization by race and income (measured via the index of concentration at the extremes [ICE]) were associated with LBW and PTB among Louisiana census tracts (n = 1101) using spatial lag models. Data sources included 2011–2020 birth records, U.S. Census Bureau 2017 demographic data, and 2017 respiratory hazard (RH) from the U.S. Environmental Protection Agency. Both RH and ICE were associated with LBW (z = 4.4, P < 0.0001; z = −27.0, P < 0.0001) and PTB (z = 2.3, P = 0.019; z = −16.7, P < 0.0001), with no interaction. Severely polluted tracts had 36% higher and 25% higher risks of LBW and PTB, respectively, versus unpolluted tracts. On average, 2166 low birthweight and 3583 preterm births annually were attributable to pollution exposure. Tracts with concentrated social deprivation (i.e. low ICE scores) had 53% higher and 34% higher risks of LBW and PTB, respectively, versus intermediate or mixed tracts. On average, 1171 low birthweight and 1739 preterm births annually were attributable to concentrated deprivation. Our ecological study found that a majority of adverse birth outcomes in Louisiana (i.e. 67% of LBW and PTB combined) are linked to air pollution exposure or disadvantage resulting from social polarization. These findings can inform research, policy, and advocacy to improve health equity in marginalized communities.

Altered placental immune cell composition and gene expression with isolated fetal spina bifida.

Fetal spina bifida (SB) is more common in pregnant people with folate deficiency or anomalies of folate metabolism. It is also known that fetuses with SB have a higher risk of low birthweight, a condition that is typically placental-mediated. We therefore hypothesized that fetal SB would associate with altered expression of key placental folate transporters and an increase in Hofbauer cells (HBCs), which are folate-dependent placental macrophages. Folate receptor-α (FRα), proton coupled folate receptor (PCFT), and reduced folate carrier (RFC) protein localization and expression (immunohistochemistry) and HBC phenotypes (HBC abundance and folate receptor-β [FRβ] expression; RNA in situ hybridization) were assessed in placentae from fetuses with SB (cases; n=12) and in term (n=10) and gestational age (GA) - and maternal body mass index - matched (n=12) controls without congenital anomalies. Cases had a higher proportion of placental villous cells that were HBCs (6.9%vs. 2.4%, p=.0001) and higher average HBC FRβ expression (3.2 mRNA molecules per HBC vs. 2.3, p=.03) than GA-matched controls. HBCs in cases were largely polarized to a regulatory phenotype (median 92.1% of HBCs). In sex-stratified analyses, only male cases had higher HBC levels and HBC FRβ expression than GA-matched controls. There were no differences between groups in the total percent of syncytium and stromal cells that were positive for FRα, PCFT, or RFC protein immunolabeling. HBC abundance and FRβ expression by HBCs are increased in placentae of fetuses with SB, suggesting immune-mediated dysregulation in placental phenotype, and could contribute to SB-associated comorbidities.

Maternal and Paternal Preconception Serum Concentrations of Per and Polyfluoroalkyl Substances in Relation to Birth Outcomes.

Prenatal per and polyfluoroalkyl substances (PFAS) exposure is associated with adverse birth outcomes. There is an absence of evidence on the relationship between maternal and paternal preconception PFAS exposure and birth outcomes. This study included 312 mothers and 145 fathers with a singleton live birth from a preconception cohort of subfertile couples seeking fertility treatment at a U.S. clinic. PFAS were quantified in serum samples collected before conception. Gestational age (GA) and birthweight (BW) were abstracted from delivery records. We also assessed low birthweight (BW < 2500 g) and preterm birth (GA < 37 completed weeks). We utilized multivariable linear regression, logistic regression, and quantile-based g computation to examine maternal or paternal serum concentrations of individual PFAS and mixture with birth outcomes. Maternal serum concentrations of perfluorooctanesulfonate (PFOS), perfluorohexanesulfonate (PFHxS), and the total PFAS mixture were inversely associated with birthweight. Maternal PFOS concentration was associated with a higher risk of low birthweight. Conversely, paternal PFOS and PFHxS concentrations were imprecisely associated with higher birthweight. No associations were found for gestational age or preterm birth. The findings have important implications for preconception care. Future research with larger sample sizes would assist in validating these findings.

The association between periodontal disease and risk of adverse maternal or neonatal outcomes: A systematic review and meta-analysis of analytical observational studies.

The aim of this meta-analysis was to find the association between periodontal disease (PD) and the risk of adverse pregnancy outcomes, including Pre-eclampsia (PE), premature rupture of the amniotic sac, gestational diabetes (GDM), or low birth weight (LBW) in pregnant women, which should be investigated in a systematic meta-analysis. Studies that reported the association between PD and pregnancy or neonatal outcomes and were published from January 1990 to December 2022, were identified by an extensive search in PubMed (Medline), Scopus, Web of Sciences, and Medline (Elsevier). After retrieving the studies, the screening stage was performed based on their titles, abstracts, and full texts, and after selecting the final articles, their information was extracted and their quality was assessed using the Newcastle Ottawa Scale checklist. Pregnant women with PD had a 1.39 higher chance of developing GDM than those who did not have the infection (risk ratio [RR]: 1.39; 95% confidence interval [CI]: 1.21-1.61; I square: 49.67%; p: 0.03). Additionally, the pooled RRof LBW was 2.19, which indicates that pregnant women with PD had a 2.19-fold higher risk of LBW than pregnant women who do not have the infection (RR: 2.19; 95% CI: 1.82-2.64; I square: 0.00%; p: 0.65). The relationship between the risk of PE and the existence of PD was examined in 33 cohort and case-control studies for this meta-analysis. These results were combined, and the pooled RR was 1.43. This indicates that pregnant women with PD are 1.43 times more likely to experience PE than pregnant women without PD (RR: 1.43; 95% CI: 1.32-1.54; I square: 82.64%; p: 0.00). According to the findings of the current meta-analysis, PD may contribute to a higher risk of poor maternal and newborn outcomes in pregnant women.

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

ObjectiveTo estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.DesignIndividual participant data meta-analysis.SettingProspective pregnancy studies from 24 low and middle...

Exploring associations between residential exposure to pesticides and birth outcomes using the Dutch birth registry

BackgroundMaternal occupational exposure to pesticides has been linked to adverse birth outcomes but associations with residential pesticide exposures are inconclusive. ObjectivesTo explore associations between residential exposure to specific pesticides and birth outcomes using individual level exposure and pregnancy/birth data. MethodsFrom all 2009–2013 singleton births in the Dutch birth registry, we selected mothers > 16 years old living in non-urban areas, who had complete address history and changed addresses at most once during pregnancy (N = 339,947). We estimated amount (kg) of 139 active ingredients (AI) used within buffers of 50, 100, 250 and 500 m around each mother's home during pregnancy. We used generalized linear models to investigate associations between 12 AIs with evidence of reproductive toxicity and gestational age (GA), birth weight (BW), perinatal mortality, child́s sex, prematurity, low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA), adjusting for individual and area-level confounders. For the remainder 127 AIs, we used minimax concave penalty with a stability selection step to identify those that could be related to birth outcomes. ResultsRegression analyses showed that maternal residential exposure to fluroxypyr-meptyl was associated with longer GA, glufosinate-ammonium with higher risk of LBW, linuron with higher BW and higher odds of LGA, thiacloprid with lower odds of perinatal mortality and vinclozolin with longer GA. Variable selection analysis revealed that picoxystrobin was associated with higher odds of LGA. We found no evidence of associations with other AIs. Sensitivity and additional analysis supported these results except for thiacloprid. DiscussionIn this exploratory study, pregnant women residing near crops where fluroxypyr-meptyl, glufosinate-ammonium, linuron, vinclozolin and picoxystrobin were applied had higher risk for certain potentially adverse birth outcomes. Our findings provide leads for confirmatory investigations on these compounds and/or compounds with similar modes of action.

1191-P: GDM in Twin Pregnancies—Maternal Characteristics and Pregnancy Outcomes

The incidence of both gestational diabetes mellitus (GDM) and twin pregnancies have increased over the past two decades. While the same GDM diagnostic criteria and treatment targets are used for singleton and twin pregnancies, data on outcomes for twin pregnancies with GDM are limited. The aim of this retrospective cohort study is to present comprehensive data on maternal characteristics and pregnancy outcomes for individuals with a twin pregnancy who were diagnosed with GDM and attended our center for prenatal care from 2002-22. In total 185 individuals were identified with a mean age of 32 (± 5) years and a mean prepregnancy body mass index of 31.3 (± 7) kg/m2. The majority were dichorionic diamniotic (n=146, 79%), 32 (17%) had a prior diagnosis of GDM and 63 (34%) had prepregnancy fertility treatment. Women underwent universal screening with a 50g glucose challenge test (normal &amp;lt;140mg/dL) and Carpenter and Coustan Criteria were used to diagnose GDM. Pharmacological therapy was required to treat GDM in 68 (37%) cases. Hypertensive disorders of pregnancy were common (n=55, 30%), as was Cesarean delivery (n= 133, 72%). Assessment of pregnancy outcomes (n=370) revealed 360 (97%) livebirths, 8 (2%) stillbirths and 2 (0.6%) neonatal deaths. Among livebirths and neonatal deaths, premature delivery &amp;lt; 37 weeks was recorded in 225 (62.2%) and &amp;lt;34 weeks in 57 (15.7%). Neonatal macrosomia (birthweight &amp;gt;4.0kg) was rare (n=4, 1%), but low birthweight (&amp;lt;2.5kg) occurred in 168 (46%). Neonatal hypoglycemia was documented in 89 (25%) infants. Maternal attendance at the postpartum glucose tolerance test was low (n=47, 25.5%) individuals, and 38 had a subsequent pregnancy with GDM diagnosed in 18 (47%). In summary, the standard GDM diagnostic criteria applied to twin pregnancies identify a maternal cohort at high risk of pregnancy complications and future GDM. Future work should address the optimal nutritional and glycemic goals for this population, particularly considering the high risk of low birthweight and premature neonates. Disclosure D.M.Das: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None. Funding National Institutes of Health (DK092721, HD065987)

Adverse pregnancy outcomes associated with antiretroviral therapy initiated before pregnancy and during pregnancy: a retrospective study in Hubei province, China.

Antiretroviral therapy (ART) initiation before pregnancy was reported to have an increased risk of adverse pregnancy outcomes (APOs) than ART initiation during pregnancy. However, the risks of APOs associated with different ART regimens initiated before or during pregnancy remain unknown. Pregnant women living with HIV (PWLHIV) from Hubei Province, China, were retrospectively enrolled between January 1, 2004, and December 31, 2021. The trends of ART initiation time and application of different ART regimens were evaluated over time, separately. Using no ART exposure before and during pregnancy as control, the risks of APOs associated with protease inhibitor (PI) based regimens and non-nucleoside reverse transcriptase inhibitors (NNRTIs) based regimens initiated before pregnancy were analyzed; and the risks of APOs associated with PI-based regimens, NNRTIs based regimens and zidovudine (AZT) monotherapy initiated during pregnancy were analyzed. APOs, including low birthweight (LBW), stillbirth, preterm birth (PTB) and early miscarriage, were reviewed. Among 781 PWLHIV including 1,010 pregnancies, 522 pregnancies (51.7%) were exposed to ART before or during pregnancy. Of them, the proportion of ART initiation before pregnancy per year increased from around 20% in the early period to more than 60% after 2019. Efavirenz (EFV)-nucleoside reverse transcriptase inhibitors (NRTIs) (32.2%), LPV/r-NRTIs (31.2%), and nevirapine (NVP)-NRTIs (27.4%) were the most commonly used regimens, and the proportion of LPV/r-NRTIs used per year has increased to around 50.0% in recent years. LPV/r-NRTIs was associated with higher risks of LBW whether initiated before pregnancy [adjusted OR (aOR) = 2.59, 95%CI 1.04-6.45, p = 0.041] or during pregnancy (aOR = 2.19, 95%CI 1.03-4.67, p = 0.041), compared with no exposure to ART before and during pregnancy. However, no matter initiated before or during pregnancy, LPV/r-NRTIs had no significantly increased risks of stillbirth, PTB and early miscarriage, and EFV /NVP-NRTIs and AZT monotherapy had no significantly increased risks of LBW, stillbirth, PTB and early miscarriage when compared with no exposure to ART before and during pregnancy. Our data suggests that LPV/r-NRTIs has been widely used among PWLHIV in recent years. However, the potential risk of LBW should be continuously monitored among PWLHIV whether LPV/r-NRTIs is initiated before or during pregnancy.

Distribution and association of interpregnancy weight change with subsequent pregnancy outcomes in Asian women

The extent of interpregnancy weight change and its association with subsequent pregnancy outcomes among Asians remain unclear. We examined changes in maternal body mass index (BMI) between the first two deliveries and outcomes in the second delivery. Medical records of women with their first two consecutive deliveries between 2015 and 2020 at KK Women’s and Children’s Hospital, Singapore were retrieved. Gestational-age-adjusted BMI was determined by standardising to 12 weeks gestation and interpregnancy BMI change was calculated as the difference between both pregnancies. Pregnancy outcomes were analysed using modified Poisson regression models. Of 6264 included women with a median interpregnancy interval of 1.44 years, 40.7% had a stable BMI change within ± 1 kg/m2, 10.3% lost > 1 kg/m2, 34.3% gained 1–3 kg/m2 and 14.8% gained ≥ 3 kg/m2. Compared to women with stable BMI change, those with > 1 kg/m2 loss had higher risk of low birthweight (adjusted risk ratio [RR] 1.36; 95% confidence interval 1.02–1.80), while those with 1–3 kg/m2 gain had higher risks of large-for-gestational-age birth (1.16; 1.03–1.31), gestational diabetes (1.25; 1.06–1.49) and emergency Caesarean delivery (1.16; 1.03–1.31); these risks were higher in those with ≥ 3 kg/m2 gain. Our study strengthens the case for interpregnancy weight management to improve subsequent pregnancy outcomes.

Risk of obstetric and perinatal complications in women presenting with breast cancer during pregnancy and the first year postpartum in Sweden 1973-2017: A population-based matched study.

For women presenting with breast cancer during pregnancy, treatment guidelines were historically restricted to only surgical treatment. Over the past decades, chemotherapy administered during pregnancy has been gradually introduced. Although breast cancer treatments during ongoing pregnancy have been deemed safe, detailed information on potential obstetric risks is lacking. We aimed to assess the risk of adverse obstetric and perinatal outcomes of breast cancer in pregnancy and within 1 year postpartum and in relation to trimester at breast cancer diagnosis, tumor stage, and cancer treatment during pregnancy. Population-based matched study. Women diagnosed with breast cancer during pregnancy in 1973-2017 were identified in the Swedish Cancer Register and the Medical Birth Register, with additional information from the National Quality Register for Breast Cancer. Each birth with maternal breast cancer (n=208 pregnant, n=672 postpartum) was matched by age, calendar year, and birth order to 10 unexposed births from cancer-free women in the population (n=2080 and n=6720). Adjusted conditional logistic and multinomial regression models were used to estimate odds ratios and relative risk ratios, commonly denoted relative risks (RR) with 95% confidence intervals (CI), of adverse obstetric and perinatal outcomes. Breast cancer during pregnancy was associated with higher risks of preterm birth, both planned (RR 67.1, 95% CI 33.2-135.6) and spontaneous preterm birth (RR 3.8, 95% CI 2.0-7.5), and low birthweight (<2500 g: RR 7.5, 95% CI 4.9-11.3). The associated risks were higher if the breast cancer was diagnosed in the second trimester, and of similar magnitude irrespective of stage and treatment groups. There was a higher risk of low birthweight for gestational age (<25th centile) if breast cancer was diagnosed in the first trimester (RR 2.8, 95% CI 1.1-7.3). Risks of other pregnancy complications were similar to those of unexposed women, as were risks of neonatal mortality and malformations. Postpartum breast cancer was only associated with bleeding during pregnancy (RR 1.6, 95% CI 1.0-2.8). Preterm birth and related adverse outcomes were more common in women diagnosed with breast cancer during pregnancy. Reassuringly, breast cancer was not associated with other maternal pregnancy complications or adverse outcomes in children.

The association between maternal malaria infection and poor birth outcomes in a remote community in Papua, Indonesia

Background Sikari is a remote district in Papua, Indonesia, which is malaria-endemic. Malaria infection during pregnancy has been linked to poor birth outcomes.&#x0D; Objective To evaluate for an association between malaria infection in pregnancy and birth outcome.&#x0D; Methods This cohort study compared the outcomes of newborns from mothers infected with malaria during pregnancy vs. uninfected controls. We included clinical data of 82 pregnant women from January to December 2020 at the Batavia Public Health Center, Sikari District, Mamberamo Raya, Papua. Malaria diagnosis was established based on the World Health Organization (WHO) criteria and positive rapid diagnostic tests. The maternal and infant characteristics analyzed were years of formal education, antenatal care (ANC) visits, gestational age, obstetric history, diagnosis of malaria, birth weight, APGAR score, and newborn mortality.&#x0D; Results Forty-six mothers (56.1%) were diagnosed with malaria during pregnancy, of whom 33 (71.7%) had tropical malaria, 7 (15.2%) had tertian malaria, and 6 (13.0%) had mixed malaria. Malaria infections of any type were associated with an increased risk of preterm birth (OR 5.34; 95%CI 1.10 to 25.91; P=0.04), low birth weight (LBW) (OR 49.00; 95%CI 28.62 to 838.89; P=0.00), newborn mortality (OR 13.86; 95%CI 0.76 to 251.37; P=0.04), and low 5-minute APGAR score (OR 23.65; 95%CI 1.34 to 416.61; P=0.03). Tropical malaria was associated with a higher risk of preterm birth (OR 5.44; 95%CI 1.06 to 27.86; P=0.04), LBW (OR 15.22; 95%CI 1.82 to 127.02; P=0.01), newborn mortality (OR 14.09; 95%CI 0.75 to 265.48; P=0.04), and low APGAR (OR 24.33; 95%CI 1.34 to 440.77; P=0.03). Mixed malaria was associated with a higher risk of LBW (OR 35.00; 95%CI 2.73 to 449.10; P=0.01) and low APGAR score (OR 40.56; 95%CI 1.67 to 985.39; P=0.02).&#x0D; Conclusion Malaria infections are associated with an increased risk of preterm birth, low birth weight, newborn mortality, and low 5-minute APGAR scores.

Air pollution and pregnancy outcomes in Dhaka, Bangladesh

• Air quality in Dhaka city remains in ‘unhealthy’ to ‘extremely unhealthy’ state for two third of the year • There is an alarming increase in the number of ‘unhealthy’ to ‘extremely unhealthy’ air days • Low birth weight (LBW) increases from 20.6% to 36.0% for the lowest and highest category air pollution exposure. • Percent preterm births (PTB) shows a linear increase from 9% to 15.2% between lowest and highest category of air pollution exposure • Female fetuses are at higher risk of LBW and male fetuses are more prone to PTB • For every 10,000 Air Quality Index (AQI) value increase in cumulative exposure, the rate of increase in LBW and PTB is 4% and 2% respectively • Second trimester could be potentially the most vulnerable period of pregnancy due to ambient air pollution Air pollution, one of the biggest environmental risks to health, is a severe problem in Bangladesh. The Lancet ‘Commission on Pollution and Health’ emphasized on the importance of research on health effects of ambient air pollution. This study explored the negative health impact of air pollution on pregnancy outcomes - preterm births (PTB) and low birth weight (LBW). The study assessed air quality in terms Air Quality Index (AQI) and, quantified the association with LBW and PTB. Pregnancy outcome data was collected from the Maternal and Child Health Training Institute in Dhaka, and the AQI data from the Clean Air and Sustainable Environment project of Department of Environment. A total 3,206 birth outcome records were assessed within the period from 2014 to 2017. Air pollution situation is quite alarming in Dhaka city, at ‘Unhealthy’ to ‘Extremely Unhealthy’ levels for two thirds of the year. An increase in the prevalence of LBW and PTB was found with increasing cumulative air pollution exposure. LBW increased from 20.6% to 36.0% and PTB increased from 9% to 15.2% respectively between the lowest and highest category AQI value exposure. For every 10,000 AQI value increase in cumulative exposure, LBW and PTB increased by 4% and 2%, respectively. There is significant gender differentiated impact on LBW and PTB due to air pollution where female fetuses are at higher risk of LBW and males are more prone to PTB. Air pollution exposure during the second trimester increased LBW and PTB more compared to first and third trimesters; suggesting it potentially the most vulnerable period of pregnancy. Proper interventions to reduce air pollution levels need to be urgently implemented.

Elevated serum uric acid level is associated with adverse reproductive outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization or intracytoplasmic sperm injection embryo transfer cycles: a retrospective cohort study

Serum uric acid levels are elevated in polycystic ovary syndrome, however, the relationship between serum uric acid level and reproductive outcomes in women with polycystic ovary syndrome remains unclear. This study aimed to investigate the association between serum uric acid level and the reproductive outcomes in women with polycystic ovary syndrome undergoing invitro fertilization or intracytoplasmic sperm injection embryo transfer cycles. This was a retrospective cohort study performed at a university-affiliated reproductive medicine center. A total of 1903 women with polycystic ovary syndrome undergoing their first invitro fertilization or intracytoplasmic sperm injection embryo transfer cycles between January 2010 and January 2021 were initially included. The trends for reproductive outcomes in polycystic ovary syndrome across quartiles of serum uric acid levels were assessed. A logistic regression analysis was performed to obtain the odds ratios for invitro fertilization outcomes based on the quartiles of serum uric acid with or without adjusting for potential confounding variables. Using generalized additive models, serum uric acid was further treated as its original continuous property to visualize its nonlinear relationship with invitro fertilization outcomes. The live birth rate was the main outcome. After exclusions, a total of 883 women with polycystic ovary syndrome with their first fresh-embryo transfer cycles were included. In quartiles of serum uric acid levels, there was a significant decreasing trend in the live birth rate from the lowest quartile (Q1: 61.8%) to the highest (Q4:45.9%) (Ptrend=.002). The percentage of low birthweight increased from Q1 (22.3%) to Q4 (31.7%) (Ptrend=.049). Compared with those in Q1, women in Q4 showed a significant lower probability of live birth and clinical pregnancy and a higher risk for low birthweight (all P<.05). Both the unadjusted and adjusted generalized additive models indicated that as the serum uric acid level increased, the probability of clinical pregnancy and the live birth rate exhibited an overall decreasing profile, and the risk for low birthweight showed an increasing profile. An elevated serum uric acid level is associated with decreased probabilities of live birth and clinical pregnancy and an increased risk for low birthweight in women with polycystic ovary syndrome. However, these associations may be confounded by other factors and more well-designed studies are needed to confirm these findings in the future.

Antenatal Care Services and Incidence of Low Birth Weight: A Comparison of Demographic and Health Surveys in 4 ASEAN Countries.

This study aimed to assess the effect of complete coverage and content of available antenatal care (ANC) on the incidence of low birth weight (LBW) in 4 countries belonging to the Association of Southeast Asian Nations (ASEAN). Measures of complete coverage and content of ANC services included the frequency of ANC visits and the seven service components (blood pressure measurement, iron supplementation, tetanus toxoid immunization, explanations of pregnancy complications, urine sample test, blood sample test, and weight measurement). The complete coverage and content of ANC services were assessed as high if more than 4 ANC visits and all seven components were delivered. Multivariable logistic regression with complex survey designs was conducted using Demographic Health Survey data from the 4 ASEAN countries in question from 2014 to 2017. The proportion of LBW infants was higher in the Philippines (13.8%) than in Indonesia (6.7%), Cambodia (6.7%), or Myanmar (7.5%). Poor ANC services were associated with a 1.30 times higher incidence of LBW than a high level of complete coverage and content of ANC services (adjusted odds ratio [aOR], 1.30; 95% confidence interval [CI], 1.11 to 1.52). In addition, the risk of LBW was higher in the Philippines than in other countries (aOR, 2.25; 95% CI, 2.01 to 2.51) after adjusting for mothers' demographic/socioeconomic factors, health behaviors, and other factors. In sum, complete coverage and content of ANC services were significantly associated with the incidence of LBW in Indonesia, Cambodia, and Myanmar. The Philippines did not show statistically significant results for this relationship, but had a higher risk of LBW with poor ANC.

Maternal Characteristics and Socio-Economic Factors as Determinants of Low Birth Weight in Indonesia: Analysis of 2017 Indonesian Demographic and Health Survey (IDHS).

Although low birth weight (LBW) is still a major health problem in Indonesia, studies about determinants of LBW with large sample sizes are still limited. This study aimed to examine the association between LBW and maternal characteristics, as well as socio-economic backgrounds in Indonesia. A secondary analysis of 2017 Indonesian Demographic and Health Survey (IDHS) was conducted, specifically using the questionnaires for women of childbearing age. A bivariate chi-square analysis and a multivariate logistic regression analysis were performed. As many as 6.7% of infants were born with LBW. In terms of maternal characteristics, women who gave birth to twins were 20.30 times more likely to have infants with LBW (p &lt; 0.001). Women with birth intervals of &lt;24 and ≥24 months were likely to have LBW infants (p &lt; 0.05). Complications during pregnancy were also associated with LBW (1.99 times higher than women with no complications) (p &lt; 0.001). In terms of socio-economic factors, women with higher education and higher wealth index were less likely to give birth to infants with LBW. Additionally, marital status and type of residence were also significantly associated with a higher risk of LBW. In conclusion, LBW was associated with maternal characteristics and socio-economic backgrounds among women of childbearing age in Indonesia, including twin births, birth interval, and pregnancy complications as well as educational attainment, wealth index, marital status, and type of residence.

Predictors of Poor Neonatal Outcomes among Pregnant Women in Indonesia: A Systematic Review and Meta-Analysis.

Objectives: This study aimed to examine the association between maternal health behaviors and neonatal outcomes among the Indonesian population. Methods: Articles were collected from PubMed, EBSCO, ProQuest, DOAJ, and GARUDA. Funnel plots and Egger’s tests analyzed indications of publication bias. A Mantel–Haenszel random-effects model was used to see the overall effect size of exposures on outcomes. Heterogeneity was seen based on I2. Data collected from articles included the author, year of publication, location of the study, study design, number of samples, risk factors, and effect sizes. Results: We identified 24 relevant studies, including eight from the primary databases and 16 from an additional database. A total of 12 studies were included in the meta-analysis, examining the association between maternal health behaviors and neonatal outcomes. The pooled odds ratio (OR) for passive smoking and low-birth-weight (LBW) was 3.41 (95% CI: 1.75–6.63, I2 = 40%, four studies). The pooled OR for incomplete antenatal care (ANC) and LBW was 6.29 (95% CI: 2.11–18.82, I2 = 70%, four studies). The pooled OR for incomplete ANC and neonatal mortality was 2.59 (95% CI: 1.01–6.66, I2 = 93%, four studies). Conclusions: The results indicated that pregnant women with incomplete ANC had a higher risk of LBW and neonatal mortality, and those who were passively exposed to smoking had a higher risk of LBW. Further investigations are needed, considering the high heterogeneity found, and additional meta-analyses should be based on the variations of socio-demographic conditions.

Long-term exposure to air pollution and risk of preterm birth and low birth weight in Tehran, Iran

Introduction: Adverse effects of air pollution on human health has been identified as a major concern worldwide. We conducted this study to investigate the association between prenatal exposure to ambient air pollution and Low Birth Weight (LBW) and preterm among newborns in the megacity of Tehran. Materials and methods: This cross-sectional study was carried out on 1605 newborns. Data on the residential locations of mothers were collected from birth certificates. To estimate the prenatal exposure to air pollutants, data of 21 air quality monitoring stations in Tehran were used. The Man-Whitney test was used to estimate the association between exposure to ambient air pollution and LBW and preterm. Results: The mean birth weight in our analyses was 3117 g. A significant association was found between maternal exposure to particulate matter less than 2.5 µm (PM2.5) in the first trimester and incidence of preterm (p=0.011) and LBW (p=0.003) in newborns. Also, a close association was observed between exposure to Carbon Monoxide (CO) in the first and second trimesters and LBW (p=0.002, p=0.015). There were no statistically significant associations in LBW in the case of Particulate Matter less than 10 µm (PM10), Sulfur Dioxide (SO2), and Ozone (O3). Conclusion: The results revealed that the higher risk for LBW was related to ambient PM2.5 and CO. Since many factors may affect LBW, and the pathogenic mechanisms of the effect of air pollution on LBW have not been completely elucidated, the findings should be interpreted with caution and further studies need to be conducted on this issue considering the large sample size.

Associations between Gestational Weight Gain Adequacy and Neonatal Outcomes in Tanzania

Introduction: Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited. Methods: We used data from a prenatal micronutrient supplementation trial among a cohort of human immunodeficiency virus-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and neonatal outcomes. GWG adequacy was defined as the ratio of the total observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index-specific guidelines. Neonatal outcomes assessed were stillbirth, perinatal death, preterm birth, low birthweight, macrosomia, small-for-gestational age (SGA), large-for-gestational age (LGA), stunting at birth, and microcephaly. Modified Poisson regressions with robust standard error were used to estimate the relative risk of newborn outcomes as a function of GWG adequacy. Results: Of 7,561 women included in this study, 51% had severely inadequate (<70%) or inadequate GWG (70 to <90%), 31% had adequate GWG (90 to <125%), and 18% had excessive GWG (≥125%). Compared to adequate GWG, severely inadequate GWG was associated with a higher risk of low birthweight, SGA, stunting at birth, and microcephaly, whereas excessive GWG was associated with a higher risk of LGA and macrosomia. Conclusion: Interventions to support optimal GWG are needed and may contribute to preventing adverse neonatal outcomes.

The impact of different cycle regimens on birthweight of singletons in frozen-thawed embryo transfer cycles of ovulatory women

To investigate whether different endometrial preparation regimens affect neonatal outcomes after frozen-thawed embryo transfer (FET). Retrospective cohort study. Tertiary care academic medical center. A total of 3,639 patients with live-born singletons were categorized into three groups on the basis of the type of endometrial preparation regimens. Of these, 1,225, 2,136, and 278 live-born singletons were conceived through natural cycle FET, artificial cycle FET, and stimulated cycle FET, respectively. None. The main outcomes were the measures of birthweight including the absolute mean birthweight, Z-score, low birthweight, high birthweight (HBW), small for gestational age, and large for gestational age (LGA). After controlling for a variety of covariates, singletons from the artificial cycle FET group had a higher mean birthweight and Z-score than those from the natural cycle FET group and stimulated cycle FET group. The risk of LGA infants significantly increased in the artificial cycle group (14.0%) than that in the natural cycle group (10.3%) and stimulated cycle group (7.6%). The risk of hypertensive disorders of pregnancy in the artificial cycle group (4.4%) was significantly higher than that in the natural cycle group (2.5%). The stimulated cycle FET singletons had a higher risk of low birthweight than the natural cycle FET singletons. The other perinatal outcomes, including the incidence of preterm birth, small for gestational age, and gestational diabetes mellitus, were comparable between the groups before or after adjustment for confounders. Singletons from artificial cycle FET were associated with a higher risk of LGA infants, and natural cycle FET may be a better regimen for ovulatory women. Our results indicate a link between the absence of the corpus luteum and adverse perinatal outcomes, and further studies are needed to detect the underlying mechanism.

Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020.

Maternal smoking during pregnancy may be associated with low birth weight (LBW) in offspring and global risk estimates have not been summarized previously. We aimed to systematically explore evidence regarding maternal smoking and the LBW risk in offspring globally and examine possible causes of heterogeneity across relevant studies. Comprehensive search of PubMed, Ovid Embase, Ovid Medline (R), and Web of science from inception until October 2021 was carried out. A random-effects meta-analysis was used to estimate the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). Restricted cubic spline analysis with three knots was used to further examine the dose-response relationship. Literature searches yielded 4940 articles, of which 53 met inclusion criteria (comprising 55 independent studies). Maternal smoking during pregnancy was significantly associated with the risk of LBW in offspring (OR = 1.89, 95% CI = 1.80-1.98). Furthermore, an obvious dose-response relationship between the amount of cigarettes daily smoked in pregnancy and the risk of LBW in offspring was observed. The results of subgroup analyses indicated that the risk of maternal smoking on LBW was larger in more recently conducted studies (P = 0.020) and longer period of active smoking during pregnancy (P = 0.002). No evidence of publication bias was found. In summary, maternal smoking in pregnancy was significantly associated with a higher risk of LBW in offspring on a global scale. The risk of maternal smoking on infant LBW seems to be increasing over time, and was higher with longer smoking duration throughout pregnancy and more cigarettes smoked daily.