Increase In Abdominal Circumference Research Articles

Intrauterine growth rate in pregnancies complicated by type 1, type 2 and gestational diabetes.

Fetal macrosomia is a feature of all subtypes of maternal diabetes. The intrauterine time course of development of macrosomia in type 1, type 2 and gestational diabetes (GDM) could identify the times of more rapid growth, which differ as a result of different influences in subtypes of diabetes. Higher maternal weight in type 2 and GDM may be expected to contribute to macrosomia and the blood glucose control will exert an additional influence. Information was collected prospectively on 217 pregnancies in insulin-treated women at a single centre over a six-year period. All women were managed by a single team of obstetricians and diabetologists at a Joint Obstetric Medical Clinic. The rate of increase in abdominal circumference from 28 weeks was identical in each subtype of diabetes and there were no differences between subtypes at the earliest gestation assessed. Use of customized growth centiles showed rates of macrosomia to be similar in type 1, type 2 and GDM (43.0%, 50.0% and 41.8%, respectively). The intrauterine time course to macrosomia is similar in type 1, type 2 and GDM. The relationship of macrosomia to extent of elevation of mean blood glucose control is weak, implying a low threshold for maximal effect on the rate of fetal growth.

Plasma concentrations of fibrinogen and factor VII in adult life and their relation to intra‐uterine growth

To examine the relation between fetal development and plasma concentrations of fibrinogen and factor VII in adult life we followed up 202 men and women, now aged around 50 years, who had been measured in detail at birth. Plasma concentrations of fibrinogen were related to weight and abdominal circumference at birth. In men, after adjustment for cigarette smoking and current obesity, plasma concentrations of fibrinogen fell by 0.12 g/l (95% CI 0.05-0.19) for each pound increase in birthweight and by 0.10 g/l (95% CI 0.03-0.17) for each inch increase in abdominal circumference. In contrast, analysis of the data for women showed no statistically significant relation between plasma fibrinogen concentration and weight or abdominal circumference at birth. No relation was seen between concentrations of factor VII and measurements made at birth in either sex. These findings suggest that, in men, reduced growth of the liver in fetal life has a long-term influence on fibrinogen metabolism.

Growth in utero and serum cholesterol concentrations in adult life.

To see whether reduced rates of fetal growth are related to raised serum cholesterol concentrations in adult life. Follow up study of men and women whose size at birth had been recorded. Jessop and Northern General Hospitals, Sheffield. 219 men and women born in the Jessop Hospital during 1939-40. Serum concentrations of total cholesterol, low density lipoprotein cholesterol, and apolipoprotein B. Men and women who had had a small abdominal circumference at birth had raised serum concentrations of total and low density lipoprotein cholesterol and apolipoprotein B. This was independent of the duration of gestation. Serum concentrations of total cholesterol fell by 0.25 mmol/l (95% confidence interval 0.09 to 0.42) with each 1 in (2.54 cm) increase in abdominal circumference. The corresponding figure for serum low density lipoprotein cholesterol was 0.26 mmol/l (0.11 to 0.42) and for serum apolipoprotein B 0.04 g/l (0.02 to 0.07). Small head and chest circumferences at birth and short length were each associated with raised serum low density lipoprotein cholesterol concentrations but the trends disappeared in a simultaneous regression with abdominal circumference at birth. The association between abdominal circumference at birth and low density lipoprotein cholesterol concentration was independent of social class, current body weight, cigarette smoking, and alcohol consumption. Raised serum cholesterol concentrations in adult life are associated with impaired growth during late gestation, when fetal undernutrition has a disproportionate effect on liver growth. Impaired liver growth may permanently alter low density lipoprotein cholesterol metabolism.

Variability of abdominal circumference of premature infants

Serial measurements of abdominal circumference were made in 27 premature infants 1 hour before feeding, immediately before and after feeding, and 1 and 2 hours after feeding. In some infants these measurements were repeated for 2 (n = 18) or 3 (n = 3) consecutive days. All 258 measurements were performed by the same examiner; 124 were also repeated blindly by another examiner to test interobserver reliability. The coefficient of variation of repeated measurements of any one infant by the same examiner on a single day was 2.7%. Ninety percent of repeated measurements agreed within 1.5 cm. The interobserver reliability was 0.99. Abdominal circumference was positively correlated with birth weight ( P = .0001) and time from last defecation ( P = .0001) and negatively correlated with time from last feeding ( P = .04). Increases in abdominal circumference of less than 1.5 cm occur normally and, in the absence of other clinical signs, should not be considered indicative of disease.

ABDOMINAL DISTENSION IN INFANTS ON PHOTOTHERAPY

We noted that infants undergoing phototherapy (Phx) often develop abdominal distension, and thus undertook a study to evaluate possible mechanisms for this distension. 20 infants on continuous Phx with standard methods of eye occlusion were compared with two control groups - jaundiced infants not on Phx, and healthy non-jaundiced infants. The abdominal circumference was measured prior to feeding. Treated infants exhibited an increase in abdominal circumference ranging from 1-4 cm (mean 2.5) compared with 0-1 cm (mean 0.5) in each of the two control groups; distension was noted within 8-12 hours, reaching a maximum by ca 24 hours.In 4 infants intermittent Phx with intermittent eye occlusion (16 hrs. on, 8 hrs. off) resulted in intermittent abdominal distension during light periods, with a mean increase in circumference of 1.9 cm. In 15 additional infants in whom eye occlusion (and Phx) was discontinued during all feeding periods and re-applied after feeding, abdominal distension still developed (1-3 cm, mean 2.3).Preliminary studies were performed in which infants on Phx did not have their eyes occluded but had their faces shielded by a black screen; abdominal distension did not develop. Subsequent eye occlusion did produce abdominal distension, suggesting that the distension was the result of eye occlusion rather than the direct result of Phx. These findings may be significant in evaluating other sequelae of Phx, e.g. behavioral changes.