Increase In Mean Birth Weight Research Articles

Impact of maternal vaccination timing and influenza virus circulation on birth outcomes in rural Nepal.

ObjectiveTo describe the effect of maternal vaccination on birth outcomes in rural Nepal, modified by timing of vaccination in pregnancy and influenza virus activity.MethodsA secondary analysis was conducted using data from two annual cohorts of a randomized controlled trial. A total of 3693 pregnant women from Sarlahi District were enrolled between April 25, 2011, and September 9, 2013. All participants were aged 15–40 years and received a trivalent inactivated influenza vaccine or placebo. The outcome measures included birth weight, pregnancy length, low birth weight (<2500 g), preterm birth, and small‐for‐gestational‐age birth.ResultsData were available on birth weight for 2741 births and on pregnancy length for 3623 births. Maternal vaccination increased mean birthweight by 42 g (95% confidence interval [CI] 8–76). The magnitude of this increase varied by season but was greatest among pregnancies with high influenza virus circulation during the third trimester. Birth weight increased by 111 g (95% CI −51 to 273) when 75%–100% of a pregnancy's third trimester had high influenza virus circulation versus 38 g (95% CI −6 to 81) when 0%–25% of a pregnancy's third trimester had high influenza virus circulation. However, these results were nonsignificant.ConclusionSeasonal maternal influenza vaccination in rural Nepal increased birth weight; the magnitude appeared larger during periods of high influenza virus circulation.ClinicalTrials.gov NCT01034254.

Is consumption of sugar-sweetened soft drinks during pregnancy associated with birth weight?

In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar‐sweetened carbonated soft drinks (SSC) during the period 1990–2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother–infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: −10.3 to −5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW < 2,500 g (OR: 1.05, 95% CI: 0.99 to 1.10). The negative association with SSC consumption was aggravated by smoking, lack of exercise, and obesity. For mothers with gestational diabetes mellitus, we observed an increased risk of BW > 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: −2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus.

Are babies getting heavier? Birth weight trends in England and Wales 1986 to 2012

Introduction Birth weight (BW) is associated with environmental exposures such as air pollution and is a strong predictor of infant mortality, morbidity and development of adult disease. Information on trends is important for environmental epidemiology studies of BW. Work from the 1980s indicated a shift towards heavier births; this study looks at more recent trends. Methods Data on 17.2 million live, single births from 1986-2012 from the Office for National Statistics (ONS) births register were investigated for temporal trends in mean annual BW and changes in the proportions of very low (&lt;1500g), low (&lt;2500g) and high (≥4,000g) BW. Analysis used multiple linear and logistic regression adjusted for maternal age, marital status, area-level deprivation and ethnicity. Data on 4.7 million live, single births from NHS Number for Babies (NN4B), which has information on individual ethnicity and gestational age, was investigated for more recent trends (2006-2012) as well as stratified into pre-term and term births. Results Over the 27 years of the study there was an increase in the BW of live, single births of 1.59g per year (95% CI [1.54-1.63]) for females and 1.63g per year [1.58-1.68] for males. This increase in mean BW was driven by increases between 1986-1991 and 2007-2012, with a 16 year period between showing no increase. Over the study period, there was a decreased risk of being born low BW but an 8% increased risk in males and 10% increased risk in females of being born high BW. In NN4B (2006-2012) the annual increase in BW was 4.41g per year [4.04-4.78] for males and 3.94g per year [3.58-4.30] for females, with the annual increase greater in pre-term compared to term births. Conclusions Since 1986 the BW distribution of live, single births in England and Wales has shifted towards heavier births. The increase in BW from 2007 coincides with introduction of a ban on smoking in public places in the UK, which has been associated with increases in BW in short-term studies.

Continuous subcutaneous insulin infusion versus multiple daily injections of insulin for pregnant women with diabetes.

Diabetes causes a rise in blood glucose above normal physiological levels causing damage to many systems including the cardiovascular and renal systems. Pregnancy causes a physiological reduction in insulin action; for those women who have pre-gestational diabetes, this results in an increasing insulin requirement. There are several methods of administering insulin. Conventionally, insulin has been administered subcutaneously, formally referred to as intensive conventional treatment, but now more usually referred to as multiple daily injections (MDI). An alternative insulin administration method is the continuous subcutaneous insulin infusion pump (CSII).To compare continuous subcutaneous insulin infusion with MDI of insulin for pregnant women with diabetes.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2006).Randomised controlled trials comparing CSII with MDI for pregnant women with diabetes.Three authors independently assessed studies and extracted data.Two studies (60 women with 61 pregnancies) were included. There was a significant increase in mean birthweight associated with CSII as opposed to MDI (weighted mean difference 220.56, 95% confidence interval (CI) -2.09 to 443.20; two trials, 61 participants). However, taking into consideration the lack of significant difference in rate of macrosomia (birthweight greater than 4000 g) (relative risk (RR) 3.20, 95% CI 0.14 to 72.62; two trials, 61 participants), this is not viewed by the authors as clinically significant. No significant differences were found in any other outcomes measured, which may reflect the small number of trials suitable for meta-analysis and the small number of participants in the included studies. No significant differences were found in perinatal mortality (RR 2.00, 95% CI 0.20 to 19.91), fetal anomaly (RR 1.07, 95% CI 0.07 to 15.54), maternal hypoglycaemia (RR 3.00, 95% CI 0.35 to 25.87) or maternal hyperglycaemia (RR 7.00, 95% CI 0.39 to 125.44).There is a dearth of robust evidence to support the use of one particular form of insulin administration over another for pregnant women with diabetes. The data are limited because of the small number of trials appropriate for meta-analysis, small study sample size and questionable generalisability of the trial population. Conclusions cannot be made from the data available and therefore a robust randomised trial is needed. The trial should be adequately powered to assess the efficacy of continuous subcutaneous insulin infusion versus multiple daily injections in terms of appropriate outcomes for women with diabetes.

Maternal hyperglycemia at different stages of gestation and its effects on male reproductive functions in rats.

The critical period during which maternal hyperglycemia predisposes offspring to develop reproductive disorders in adult life is not known. The relationship between maternal hyperglycemia at different stages and reproductive functions of male offspring was investigated. A single intraperitoneal injection of alloxan (90 mg/kg body weight) was administered at gestation days (GD) 1, 8 and 15. Animals were subsequently given 10% glucose solution daily as drinking water until parturition. All male pups were sacrificed on the 63rd day of postnatal life. Birth weight, anogenital distance index (AGDi), testes descent day, preputial separation day, sperm profile, serum testosterone, luteinizing hormone and follicle-stimulating hormone levels and the histology of the testis were assessed. Data significance test was based on 95% confidence interval. GD1 pups showed a significant increase in mean birth weight, whereas GD8 pups and GD15 pups had significantly reduced birth weight as compared with control. AGDi was significantly increased in GD8 and GD15 pups. Testes descent and preputial separation in all the experimental groups were significantly earlier. There was a significant reduction in sperm count and viability in GD8 offspring. Sperm motility was reduced in all test groups. Testosterone level was reduced in all test groups. Histology of the testis showed varying degrees of pathologies. It was deduced from this study that maternal hyperglycemia caused alterations in reproductive functions in male offspring of Wistar rats irrespective of the period of gestation involved, although GD8 pups were most severely affected.

Effect of maternal weight on fetal outcome

Introduction: Pregnancy in chronically undernourished women with low maternal weight results in delivery of low birth weight babies. Aim of the Study: our aim was to study the correlation between maternal weight during pregnancy with fetal outcome measured in terms of fetal weight and perinatal mortality. Materials and Methods: This was a hospital based prospective study conducted in the department of obstetrics and gynecology in our teaching medical college and hospital over a period of 2 years extending from Jan 2011 - Dec 2012. All the cases delivering in this hospital were taken for this study. Total of about 1449 cases were taken for this study. Results: In this study the average weight of patients was found to be 51.88±7.64 kg. The mean birth weight was found to increase with increasing maternal weight. The difference in the mean birth weight was found to be statistically significant between the different groups (P 0.05).There was found to be a statistically significant increase in birth weight with increase in maternal third trimester weight from less than 45 kg to 55 kg. Differences in perinatal mortality between these groups were found to be statistically insignificant (P>0.05). Conclusion: There was statistically significant increase in mean birth weight with increase in maternal weight upto 60 kg. There was no correlation between perinatal mortality rate and maternal weight.

Association between weight at birth and body composition in childhood: A Brazilian cohort study

Background and aimPrevious studies have shown that the association between birth weight and obesity later in life apparently follows a U-shaped curve. However, due to the continuous increase of mean birth weight in several countries worldwide, it is expected that higher birth weight will play a more important role as a risk factor for further obesity than low birth weight. This study investigated the association between birth weight and body composition of children in order to establish their relationship in an earlier period of life. Study design and subjectsProspective cohort study carried out from 1997 to 2006 in Jundiai city, Brazil, involving 486 children at birth and from 5 to 8years of age. The following anthropometric measurements were determined: birth weight, weight, height, waist circumference and triceps skinfold thickness. Fat mass percentage, fat mass and fat-free mass were measured by electrical bioimpedance analysis by the 310 Body Composition Analyzer, Biodynamics®. Five multiple linear regression models were developed considering waist circumference, triceps skinfold thickness, fat mass percentage, fat mass and fat-free mass as markers of body composition, and outcomes. ResultsSignificant positive associations were observed between birth weight and waist circumference (p<0.001), triceps skinfold thickness (p=0.006), fat mass (p=0.007) and fat-free mass (p<0.001). Approximately 10% of the children presented excess body fat assessed by bioimpedance, and 27.6% of them had central adiposity (waist circumference ≥95th percentile). ConclusionsIntrauterine growth, assessed by weight at birth, was positively associated with body composition of children aged 5–8years, indicating that those with the highest birth weight are more at risk for obesity, and probably to chronic diseases in adulthood.

The impact of smoke-free legislation on educational differences in birth outcomes

BackgroundSmoke-free legislation may have positive effects on birth outcomes. Given that smoking and secondhand smoke during pregnancy vary with socioeconomic position, legislation may have greater effects in some socioeconomic groups....

Sulphadoxine-pyrimethamine plus azithromycin for the prevention of low birthweight in Papua New Guinea: a randomised controlled trial.

BackgroundIntermittent preventive treatment in pregnancy has not been evaluated outside of Africa. Low birthweight (LBW, <2,500 g) is common in Papua New Guinea (PNG) and contributing factors include malaria and reproductive tract infections.MethodsFrom November 2009 to February 2013, we conducted a parallel group, randomised controlled trial in pregnant women (≤26 gestational weeks) in PNG. Sulphadoxine-pyrimethamine (1,500/75 mg) plus azithromycin (1 g twice daily for 2 days) (SPAZ) monthly from second trimester (intervention) was compared against sulphadoxine-pyrimethamine and chloroquine (450 to 600 mg, daily for three days) (SPCQ) given once, followed by SPCQ placebo (control). Women were assigned to treatment (1:1) using a randomisation sequence with block sizes of 32. Participants were blinded to assignments. The primary outcome was LBW. Analysis was by intention-to-treat.ResultsOf 2,793 women randomised, 2,021 (72.4%) were included in the primary outcome analysis (SPCQ: 1,008; SPAZ: 1,013). The prevalence of LBW was 15.1% (305/2,021). SPAZ reduced LBW (risk ratio [RR]: 0.74, 95% CI: 0.60–0.91, P = 0.005; absolute risk reduction (ARR): 4.5%, 95% CI: 1.4–7.6; number needed to treat: 22), and preterm delivery (0.62, 95% CI: 0.43–0.89, P = 0.010), and increased mean birthweight (41.9 g, 95% CI: 0.2–83.6, P = 0.049). SPAZ reduced maternal parasitaemia (RR: 0.57, 95% CI: 0.35–0.95, P = 0.029) and active placental malaria (0.68, 95% CI: 0.47–0.98, P = 0.037), and reduced carriage of gonorrhoea (0.66, 95% CI: 0.44–0.99, P = 0.041) at second visit. There were no treatment-related serious adverse events (SAEs), and the number of SAEs (intervention 13.1% [181/1,378], control 12.7% [174/1,374], P = 0.712) and AEs (intervention 10.5% [144/1,378], control 10.8% [149/1,374], P = 0.737) was similar. A major limitation of the study was the high loss to follow-up for birthweight.ConclusionsSPAZ was efficacious and safe in reducing LBW, possibly acting through multiple mechanisms including the effect on malaria and on sexually transmitted infections. The efficacy of SPAZ in the presence of resistant parasites and the contribution of AZ to bacterial antibiotic resistance require further study. The ability of SPAZ to improve pregnancy outcomes warrants further evaluation.Trial registrationClinicalTrials.gov NCT01136850 (06 April 2010).Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0258-3) contains supplementary material, which is available to authorized users.

Long-term metabolic effects of high birth weight: a critical review of the literature.

Recent studies in USA, Europe, and across the world have revealed a continuous increase of mean birth weight in the last 2 decades. Strong evidence exists from several studies indicating that individuals born with a low birth weight are more likely to present cardiometabolic complications in later life. So far, the long-term consequences of high birth weight have not been clearly defined. This review examines the role of high birth weight on the development of cardiometabolic consequences (obesity, body composition, type 2 diabetes mellitus, and cardiovascular disease) in childhood and adulthood. The majority of the studies show that high BW is associated with an increased risk for obesity. To a certain extent high birth weight affects diseases of the heart and circulatory, but does not constitutes a risk for the development of type 2 diabetes mellitus in the general population. Maternal glycemia and the subsequent fetus hyperinsulinemia appear to be the key component for increased fetal growth. With the increase in incidence of diabetes mellitus and obesity over the years, the number of high birth weight infants is likely to increase. The elucidation of the relationship between high birth weight and the cardiometabolic disorders will be particularly important.

Is the growth of the child of a smoking mother influenced by the father's prenatal exposure to tobacco? A hypothesis generating longitudinal study

ObjectivesTransgenerational effects of different environmental exposures are of major interest, with rodent experiments focusing on epigenetic mechanisms. Previously, we have shown that if the study mother is a non-smoker, there...

English

INTRODUCTION: When maternal anemia is diagnosed before mid-pregnancy, it has been associated with an increased risk of preterm delivery. High maternal hemoglobin is associated with fetal growth restriction. Several epidemiologic studies have shown that high fetal hemoglobin is associated with lower birth weight and increased incidence of IUGR and intrauterine death. MATERIAL AND METHODS: It was a prospective observational study. All pregnant women attending antenatal clinic with first visit before 18 weeks of gestation were included in the study. Hemoglobin levels were done on women at the first visit to antenatal clinic and also in the third trimester between 34-36 weeks. Outcome criteria were birth weight of neonate, gestational age at delivery, maternal weight gain in pregnancy, development of PIH, IUGR, IUD and preterm labor. RESULTS: Increased weight gain in pregnancy was associated with increase in mean birth weight r=0.23 (P value 0.672). Increase in the hemoglobin concentration was associated with increase in birth weight r=0.36 (P value 0.49). It was observed that high hemoglobin concentration in pregnancy was associated with more length of gestation but it was not significant r=0.31 (P value 0.50). CONCLUSION: During early pregnancy normal hemoglobin concentrations were associated with higher birth weights. Weight gain in pregnancy was associated with lower hemoglobin concentrations at term and higher birth weights. The best outcomes of pregnancy were observed in women who had normal hemoglobin concentrations at the onset of pregnancy and who became anemic at term, presumably due to physiologic hemodilution.

Visceral Adiposity in the First Half of Pregnancy Predicts Newborn Weight Among Adolescent Mothers

ObjectiveMaternal obesity is a strong risk factor for gestational diabetes mellitus and fetal macrosomia. We assessed the association between maternal visceral adiposity tissue (VAT) depth in the first half of pregnancy and both glucose tolerance in late pregnancy and newborn weight in pregnant adolescents. MethodsWe completed a prospective cohort study of 73 pregnant adolescents aged 10 to 19 years, without pre-pregnancy diabetes. VAT depth was measured by ultrasound at 12 to 20 weeks’ gestation, followed by a two-hour 75-g oral glucose tolerance test at 36 to 39 weeks’ gestation, to determine the glucose area under the curve (AUC glucose0–120). The association between VAT depth and newborn weight was evaluated by multiple linear regression analysis, controlling for maternal age, parity, smoking, gestational age at delivery, infant sex, pre-pregnancy BMI, weight gain in pregnancy, and fasting serum glucose at 36 to 39 weeks’ gestation. The relation between VAT depth and AUC glucose0–120 was assessed by linear regression analysis, adjusting for maternal age, parity, smoking, pre-pregnancy BMI, and weight gain in pregnancy. ResultsA 1 cm increase in VAT depth was associated with a 206 g (95% CI 101 to 311) adjusted increase in mean birth weight. VAT depth and the other model covariates together explained more of the variance in birth weight (r2 = 0.282; P < 0.001) than pre-pregnancy BMI with the other covariates in the same model (r2 = 0.081; P = 0.076). All three glucose tolerance test measures were performed at 36 to 39 weeks’ gestation in 51 of the 73 participants. The relationship between VAT depth and AUC glucose0–120 was not significant (P = 0.43). ConclusionVAT depth in the first half of pregnancy predicts newborn weight better than BMI, but is not associated with glucose tolerance in late pregnancy.

Food subsidy programs and the health and nutritional status of disadvantaged families in high income countries: a systematic review

BackgroundLess healthy diets are common in high income countries, although proportionally higher in those of low socio-economic status. Food subsidy programs are one strategy to promote healthy nutrition and to reduce socio-economic inequalities in health. This review summarises the evidence for the health and nutritional impacts of food subsidy programs among disadvantaged families from high income countries.MethodsRelevant studies reporting dietary intake or health outcomes were identified through systematic searching of electronic databases. Cochrane Public Health Group guidelines informed study selection and interpretation. A narrative synthesis was undertaken due to the limited number of studies and heterogeneity of study design and outcomes.ResultsFourteen studies were included, with most reporting on the Special Supplemental Nutrition Program for Women, Infants and Children in the USA. Food subsidy program participants, mostly pregnant or postnatal women, were shown to have 10–20% increased intake of targeted foods or nutrients. Evidence for the effectiveness of these programs for men or children was lacking. The main health outcome observed was a small but clinically relevant increase in mean birthweight (23–29g) in the two higher quality WIC studies.ConclusionsLimited high quality evidence of the impacts of food subsidy programs on the health and nutrition of adults and children in high income countries was identified. The improved intake of targeted nutrients and foods, such as fruit and vegetables, could potentially reduce the rate of non-communicable diseases in adults, if the changes in diet are sustained. Associated improvements in perinatal outcomes were limited and most evident in women who smoked during pregnancy. Thus, food subsidy programs for pregnant women and children should aim to focus on improving nutritional status in the longer term. Further prospective studies and economic analyses are needed to confirm the health benefits and justify the investment in food subsidy programs.

Influenza Pandemics—Pregnancy, Pathogenesis, and Perinatal Outcomes

SINCE THE 1918 INFLUENZA PANDEMIC, IT HAS BEEN clear that pandemic influenza is associated with increased morbidity and mortality in pregnancy, and more recent studies have shown that nonpandemic seasonal influenza strains also lead to morbidity for pregnant women and their infants. In the 2009 worldwide pandemic of influenza A(H1N1)pdm09, pregnant women were at high risk for severe complications, including death and intensive care unit admission. The adverse effects of antenatal influenza infection on pregnant women and their infants suggest a biological effect of influenza infection in the mother that compromises the fetus. These effects are rarely associated with direct infection of the fetus with influenza virus, although fetal infection has been reported infrequently during epidemics, pandemics, and with the H5N1 influenza strain. Instead, it appears that the normal pregnancy-associated immunologic changes may inhibit the inflammatory response to influenza virus infection in pregnancy, leading to increased risks to mother and infant. Because of these observations, pregnant women have been listed among high-risk groups for seasonal influenza vaccine in the United States since 1997, and safety data suggest these vaccines are safe in pregnancy. Pregnant women were prioritized for immunization during the 2009 influenza A(H1N1)pdm09 pandemic, despite limited data on the safety of pandemic influenza vaccines in pregnancy. In this issue of JAMA, Pasternak and colleagues report the results of an observational cohort study on the safety in pregnancy of the monovalent inactivated ASO3adjuvanted split virion influenza A(H1N1)pdm09 vaccine. The authors linked several Danish national registries to examine outcomes in infants born during the 2009 influenza A(H1N1)pdm09 pandemic. From a cohort of 53 432 infants, 6989 received the influenza vaccine during pregnancy. The authors included 330 infants whose mothers received the influenza A(H1N1)pdm09 vaccine in the first trimester and 6642 infants whose mothers received the vaccine in the second or third trimesters in propensity score analyses matched 1:1 with infants whose mothers were unvaccinated. No statistically significant relationships were found between receipt of vaccine and several perinatal outcomes, including major birth defects, preterm birth, and fetal growth restriction. The authors had sufficient sample size to exclude these adverse outcomes after vaccination in the second or third trimesters, but could only exclude moderate to large risks after vaccination in the first trimester. In addition, these authors recently reported on the risk of fetal death (spontaneous abortion and stillbirth) in the same cohort and found no increased risk after vaccination in pregnancy. These results suggest that this monovalent adjuvanted pandemic vaccine is safe when given during pregnancy. The authors did not address the question of vaccine effectiveness and did not discuss the issue of narcolepsy, which was observed with use of this adjuvanted vaccine in Scandinavian countries. However, the researchers have the opportunity to follow up this cohort of children to determine long-term vaccine safety, ie, assessment of early infant development. Recently, Fell et al reported a similar analysis of the use of H1N1 pdm09 adjuvanted vaccine in a cohort in Ontario, Canada, of 55 570 pregnant women, of whom 23 340 received the vaccine. This study demonstrated that mothers who were immunized were less likely than mothers who were not to have an infant with small for gestational age (relative risk [RR], 0.90; 95% CI, 0.85-0.96), preterm birth at less than 32 weeks gestation (RR, 0.73; 95% CI, 0.530.91), and fetal death (RR, 0.66; 95% CI, 0.47-0.91). Reports of maternal vaccination during seasonal influenza have also shown a reduction in the proportion of small for gestational age births and an increase in mean birth weight associated with immunization of the pregnant woman, or a decrease in birth weight related to influenza infection. The pandemic vaccine used in Denmark was an adjuvanted vaccine. In the United States, a nonadjuvanted vaccine was used during the 2009 pandemic with identical H1N1 viral antigens, which were also included in the seasonal trivalent vaccines for 2009-2012. Data from the United States

Effect of Multiple Micronutrient Supplementation on Pregnancy and Infant Outcomes: A Systematic Review

Supplementation with multiple micronutrients (MM) during pregnancy may result in improved pregnancy and infant outcomes. We conducted meta-analyses of randomised controlled trials that evaluated the effects of prenatal supplementation with MM (defined as containing at least five micronutrients and typically included iron or iron and folic acid). The outcomes of interest were low birthweight (<2500 g), birthweight, small-for-gestational age (SGA), gestational age, preterm birth (<37 weeks' gestation), stillbirth and neonatal death, maternal morbidity and mortality. We identified eligible studies through PubMed and EMBASE database searches. Meta-analyses were performed by pooling results for outcomes that were reported from more than one trial and sub-analyses were conducted to evaluate the effect of timing of intervention and amount of iron. We included published results from 16 trials in this review. Compared with control supplementation that was usually iron plus folic acid in most studies, MM supplementation resulted in a significant reduction in the incidence of low birthweight [pooled risk ratio (RR) 0.86; 95% confidence interval (CI) 0.81, 0.91] and SGA (pooled RR 0.83 [95% CI 0.73, 0.95]) and an increase in mean birthweight (weighted mean difference (WMD) 52.6 g [95% CI 43.2 g, 62.0 g]). There was no significant difference in the overall risk of preterm birth, stillbirth, and maternal or neonatal mortality, but we found an increased risk of neonatal death for the MM group compared with iron-folate in the subgroup of five trials that began the intervention after the first trimester (RR 1.38 [95% CI 1.05, 1.81]). None of the studies evaluated maternal morbidity. Compared with iron plus folic acid supplementation alone, prenatal maternal supplementation with MM resulted in a reduction in the incidence of low birthweight and SGA but increased risk of neonatal death in the subgroup of studies that began the intervention after the first trimester.

Third and fourth degree perineal tear audit, NHS Lothian

Perineal injuries are a recognised complication of vaginal deliveries, with an overall risk of 1%. Although there are many recognised risk factors, it can still be difficult to predict their...

Neonatal outcomes after influenza immunization during pregnancy: a randomized controlled trial

There are limited data about the effect of maternal influenza infection on fetuses and newborns. We performed a secondary analysis of data from the Mother's Gift project, a randomized study designed to test the effectiveness of inactivated influenza and pneumococcal vaccines during pregnancy. In the Mother's Gift project, 340 pregnant women in Bangladesh received either inactivated influenza vaccine or 23-valent pneumococcal polysaccharide vaccine (control). This study was performed from August 2004 through December 2005. We performed a secondary analysis of outcomes following maternal influenza immunization during two periods: when influenza virus was not circulating (September 2004 through January 2005) and when influenza virus was circulating (February through October 2005). We assessed gestational age, mean birth weight and the proportion of infants who were small for gestational age. During the period with no circulating influenza virus, there were no differences in the incidence of respiratory illness with fever per 100 person-months among mothers and infants in the two groups (influenza vaccine: 3.9; control: 4.0; p > 0.9). The proportion of infants who were small for gestational age and the mean birth weight were similar between groups (small for gestational age: influenza vaccine 29.1%, control 34.3%; mean birth weight: influenza vaccine 3083 g, control 3053 g). During the period with circulating influenza virus, there was a substantial reduction in the incidence per 100 person-months of respiratory illness with fever among the mothers and infants who had received the influenza vaccine (influenza vaccine: 3.7; control: 7.2; p = 0.0003). During this period, the proportion of infants who were small for gestational age was lower in the influenza vaccine group than in the control group (25.9% v. 44.8%; p = 0.03). The mean birth weight was higher among infants whose mothers received the influenza vaccine than among those who received the control vaccine during this period (3178 g v. 2978 g; p = 0.02). During the period with circulating influenza virus, maternal immunization during pregnancy was associated with a lower proportion of infants who were small for gestational age and an increase in mean birth weight. These data need confirmation but suggest that prevention of influenza infection in pregnancy can influence intrauterine growth. ClinicalTrials.gov: NCT 00142389.

The Effect of Swimming During Pregnancy on Fetal Growth

Some epidemiological studies have shown a protective effect of exercise on risk of adverse reproductive and developmental outcomes, but few studies have examined the potential benefit of specific recreational activities such as swimming during pregnancy. Using 1,854 births enrolled from 2000–2004 in a prospective cohort study across three study sites in the United States, we examined swimming reported during pregnancy in relation to birth weight. We used linear regression to examine the relationship between swimming and mean birth weight. Based on self-reported data collected at 20–24 weeks of gestation, 12% reported swimming during this time period. Although we saw a large unadjusted increase in mean birth weight (108 grams; 95% confidence interval [CI]: 10, 205) among those swimming more than 1 hour/week relative to nonswimmers, the results (26 grams; 95% CI: −68,120) were attenuated following adjustment for confounding, principally due to maternal race/ethnicity, maternal education and mean household income. Consistent with previous prospective cohort studies from the United Kingdom and Denmark, our data suggest that swimming during pregnancy is at most associated with a small increase in mean birth weight.

Consequences of malnutrition in early life and strategies to improve maternal and child diets through targeted fortified products

This supplement brings together papers focusing onthe critical 1000 days of human development frompregnancy until 2 years of age. It is the third in anannual series first published as a Special SupplementoftheFoodandNutritionBulletininJune2009.Dietsof poor nutritional quality during pregnancy, infancyandearlychildhoodleadtonutrientintakes,whichdonot meet requirements.This, combined with frequentinfections during early childhood,results in deficits ingrowth (stunting),limited psychosocial development,increased risk of mortality, and reduced learningcapacity and productivity later in life among thosethat survive. Programmes need to prevent these defi-cits by improving maternal and child nutrient intakein addition to preventing and treating infections.Over the past 3 years, the community of nutritionscientists and researchers, activists and developmentpractitioners committed to an integrated approach tonutrition programming has grown. This communityadvocates for a greater focus on maternal, infant andyoung child nutrition (MIYCN), the application of alifecycle approach to programming and the breakingdown of the barriers between expertise and sectorsthat limit the scale-up of cost-effective programmesthat meet the needs of vulnerable populations on asustainedbasis.ThisMIYCNsupplementcontinuestoreflect and contribute to this movement by providingthe results of leading-edge research to inform techni-cal consensus, programme design, policy and furtherresearch. It discusses the consequences of malnutri-tion in early life and focuses on programme-relatedresearch to improve nutrient intake through breast-feeding, promoting consumption of special formu-lated fortified foods that fill nutrient gaps or enhancethe diets of women and children. It also presentsresearch assessing feeding practices and preferencesof caregivers in relation to child feeding and formu-lated products. An operations research project inChina is described that illustrates how these activitieswerebroughttogetherinanintegratedprogrammetoimprove nutrient intake in young children.Dewey and Begum (2011) set the stage by summa-rizing the prevalence, causes and consequences ofstunting.One-third of children under 5 years of age indeveloping countries are stunted,with many childrenin several regions already stunted at birth. Stuntingrates increase during the first 24 months of life withlittle change thereafter until adolescence, whendelayed maturation and an extended growth periodresult in some compensatory growth (Bosch