Large Babies Research Articles

Blood Glucose Levels and Pregnancy Outcome in a High-risk Population

Objectives: UAE pregnant women have a higher prevalence, of metabolic disorders such as insulin resistance, obesity, diabetes and gestational diabetes. This justifies outcome mapping in relation to blood sugar. Research Design and Methods: A hundred ninety-eight healthy UAE pregnant women enrolled in primary health care centers in 2010-2011 were followed in the hospital for outcome of pregnancy. Methods: Retrospective chart review, Surveyed exposure variables: demographic data, obstetric history, BMI, Blood pressure, Hemoglobin, early trimester glucose levels fasting and 1hr after breakfast, second trimester OGTT. Primary outcomes were: gestational age at delivery, mode of delivery, fetal weight, and baby admission to SCABU or death. Results: A non-significant trend between birth weight and the different glucose levels was found. Surprisingly, small for gestational age babies are seen in mothers with lower 1 hr OGTT. FBS OGTT was associated with the occurrence of pregnancy complications as PET (p<0.012). Only mothers with high BMI and parity appear more likely to have larger babies (p< 0.008, p<0.038). Delivery complications were more common in older women and those with lower parity (p<0.034, p<0.013), GDM was more common in obese women (p<0.033) and 1 hour OGTT with 2 hr OGTT, FBS OGTT and increasing age (p<0.00001, p<0.008, p<0.012). Conclusion: OGTT was not helpful in predicting outcome in this population. Large Birth weight babies were not more common in women with higher glucose levels but obesity was associated with larger babies significantly.

KIR and HLA-C: Immunogenetic regulation of human birth weight

Pregnancies resulting in very small or very large babies are at higher risk of obstetric complications with increased morbidity for both mother and baby. Using data from the Medical Birth Registry of Norway we have shown how human birth weight is still subject to stabilizing selection. Particular combinations of maternal/fetal immune genes have been implicated in pregnancies resulting in a low birth weight baby (&lt;5th birth weight centile). More specifically, an inhibitory maternal KIRAA genotype with a paternally derived fetal HLA-C2 ligand. At the other end of the birth weight spectrum the presence of an activating maternal KIR2DS1 gene is associated with increased birth weight in linear or logistic regression analyses of all pregnancies &gt;5th centile (p=0.005, OR=2.65). Thus, inhibitory maternal KIR combined with fetal HLA-C2 is more frequently associated with low birth weight, whereas activating maternal KIR with fetal HLA-C2 ligand is associated with increasing birth weight. Our findings using the MoBa cohort have replicated the association of KIR and HLA-C seen in poor placentation, and confirm the importance of maternal/fetal immune gene interactions in determining the outcome of pregnancy.

Birth defects and congenital health risks in children conceived through assisted reproduction technology (ART): a meeting report.

Assisted Reproduction Treatment (ART) is here to stay. This review addresses the parental background of birth defects, before, during and after conception and focuses both on the underlying subfertility and on the question whether ART as a treatment is an additional contributing factor. Searches were performed in Medline and other databases. Summaries were discussed in a Delphi panel set-up by the European Society of Human Reproduction and Embryology (ESHRE). Several birth defects and adult diseases arise during the earliest stages of ovarian development and oocyte differentiation: this is the case of cleft palate disorders in offspring from female rat exposed to Dioxin during fetal life or the polycystic ovary diseases in female offspring (primates) exposed to elevated androgen concentration during fetal life. Human oocytes and embryos often fail to stop the propagation of aneuploid cells but maintain their ability to repair DNA damages including those introduced by the fertilizing sperm. There is a 29% increased risk of birth defects in the newborns spontaneously conceived by subfertile couples and the risk is further increased (34%) when conception is achieved by treating infertlity with ART (Danish IVF Registry). Periconceptional conditions are critical for ART babies: their birth weight is in general smaller (Norvegian Registry) but a more prolonged culture time doubled the number of large babies (Finnish Registry). The long-term developmental effects of ART on child and subsequent health as an adult remains a subject worthy of futher monitoring and investigation.

Birthweight and the risk of atopic diseases: the ISAAC Phase III study.

The association between birthweight and asthma, eczema and rhinoconjunctivitisis conflicting. To examine the association between birthweight and symptoms of asthma, eczema and rhinoconjunctivitis. Parents or guardians of children aged 6–7 yr completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several risk factors, including birthweight. There were 162,324 children from 60 centres in 26 countries. Low birthweight(<2.5 kg) was associated with an increased risk of symptoms of asthma (current wheeze odds ratio = 1.20; 95% confidence interval = 1.12–1.30). Low birthweight was associated with a lower risk of eczema ever. Low birthweight was not associated with rhinoconjunctivitis. Large babies (birthweight ≥4.5 kg) were not associated with any of these outcomes. This study has confirmed that low birthweight is a risk factor for symptoms of asthma, but not for rhinoconjunctivitis. The findings for eczema are equivocal.

Large baby syndrome in singletons born after frozen embryo transfer (FET): is it due to maternal factors or the cryotechnique?

Are singletons born after frozen embryo transfer (FET) at increased risk of being born large for gestational age (LGA) and if so, is this caused by intrinsic maternal factors or related to the freezing/thawing procedures? Singletons after FET have an increased risk of being born LGA. This cannot solely be explained by intrinsic maternal factors as it was also observed in sibling pairs, where the sibling conceived after FET had an increased risk of LGA compared with the sibling born after Fresh embryo transfer. FET singletons have a higher mean birthweight than singletons born after transfer of fresh embryos, and FET singletons may be at an increased risk of being born LGA. The national register-based controlled cohort study involves two populations of FET singletons. The first population (A: total FET cohort) consisted of all FET singletons (n = 896) compared with singletons born after Fresh embryo transfer (Fresh) (n = 9480) and also with that born after natural conception (NC; n = 4510) in Denmark from 1997 to 2006. The second population (B: Sibling FET cohort) included all sibling pairs, where one singleton was born after FET and the consecutive sibling born after Fresh embryo transfer or vice versa from 1994 to 2008 (n = 666). The sibling cohort included n = 550 children with the sibling combination first child Fresh/second child FET and n = 116 children with the combination first child FET/second child Fresh. Main outcome measures were LGA defined as birthweight of >2 SD from the population mean (z-score >2) according to Marsáls curves. Macrosomia was defined as birthweight of >4500 g. Crude and adjusted odds ratios (AORs) of LGA and macrosomia were calculated for FET versus Fresh and versus NC singletons in the total FET cohort. Similarly, AOR was calculated for FET versus Fresh in the sibling cohort. Adjustments were made for maternal age, parity, child sex, year of birth and birth order in the sibling analyses. Meta-analyses were performed by pooling our data with the previously published cohort studies on LGA and macrosomia. The AORs of LGA (z-score >2) and macrosomia in FET singletons versus singletons conceived after Fresh embryo transfer were 1.34 [95% confidence interval (95% CI) 0.98-1.80] and 1.91 (95% CI 1.40-2.62), respectively. The corresponding risks for FET versus NC singletons were 1.41 (95% CI 1.01-1.98) for LGA and 1.67 (95% CI 1.18-2.37) for macrosomia. The increased risk of LGA and macrosomia in FET singletons was confirmed in the sibling cohort also after adjustment for birth order. Hence, the increased risk of LGA in FET singletons cannot solely be explained by being the second born or by intrinsic maternal factors, but may also partly be related to freezing/thawing procedures per se. In the meta-analysis, the summary effects of LGA and macrosomia in FET versus singletons conceived after Fresh embryo transfer were AOR 1.54 (95% CI 1.31-1.81) and AOR 1.64 (95% CI 1.26-2.12), respectively. The corresponding figures for FET versus NC singletons were for LGA AOR 1.32 (95% CI 1.07-1.61) and macrosomia AOR 1.41 (95% CI 1.11-1.80), respectively. Adjustment for body mass index as a possible confounder was not possible. The size of the FET/Fresh sibling cohort was limited; however, the complete sibling cohort was sufficiently powered to explore the risk of LGA. A bias is very unlikely as data coding was based on national registers. Our findings are consistent with the previous Nordic studies and thus can be generalized to the Nordic countries. The causes for LGA in FET singletons should be further explored. No external funding was used for this project. None of the authors have any conflict of interest to declare.

Intergenerational transmission of postpartum hemorrhage risk: analysis of 2 Scottish birth cohorts

The purpose of this study was to determine risk factors for postpartum hemorrhage (PPH) that includes intergenerational transmission of risk of postpartum hemorrhage. We linked birth records of women and their daughters and granddaughters in 2 Scottish birth cohorts: the Walker cohort (collected from 1952-1966) and the Scottish Morbidity Records cohort (collected from 1975-present). We determined clinical risk factors for PPH. We then quantified the risk of PPH in women whose mothers/grandmothers had postpartum hemorrhage before and after adjustment for these risk factors. The risk of PPH in women whose mothers/grandmothers had PPH was no greater than in those whose mothers/grandmothers did not have PPH. Our study had sufficient power (80%) to detect an odds ratio of 1.3, should such an increase in odds that is associated with familial history exist. In contrast, the adjusted odds ratios that were conferred by nulliparity, having a large baby, cesarean delivery, and genital tract trauma were 1.47, 1.84, 8.20, and 9.61, respectively. Women whose mothers/grandmothers had PPH do not appear to be at increased risk themselves. We confirmed an increased risk of PPH that was associated with nulliparity, delivering a large baby, cesarean delivery, and genital tract trauma. We were unable to demonstrate an effect of intergenerational transmission of PPH, although our study was underpowered to detect an odds ratio <1.3. Thus, we confirm that any risk conferred by familial history, should it exist, is less than that conferred by factors in the index pregnancy itself.

Mid-trimester blood glucose levels and pregnancy outcomes in large babies

<p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Introduction: </strong></em></span><span style="color: #231f20;">Large for gestational age at term could be following maternal diabetes and it affects neonatal mortality and morbidity. The aims of this study were to assess, firstly the mid-trimester blood glucose levels and secondly to assess the pregnancy outcomes of the macrosomic babies.</span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Methods: </strong></em></span><span style="color: #231f20;">This was a retrospective descriptive study conducted at labour room C of Castle Street Hospital for Women during 15th May 2012 to 25th October 2012. Pregnancy records, delivery notes and admission notes to the neonatal care units were retrieved in order to find the mid-trimester blood glucose levels, mode of delivery, neonatal morbidity and mortality, stillbirth rate and occurrence of shoulder dystocia.</span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Results: </strong></em></span><span style="color: #231f20;">There were 149 with a BW of </span><span style="color: #231f20;">≥</span><span style="color: #231f20;">3.5kg out of 1363 total deliveries. Rate of macrosomia was 11%. There were 133 women with documented ANBG. Majority (90%) of the women with a BW of </span><span style="color: #231f20;">≥</span><span style="color: #231f20;">3.5Kg were classified as non-diabetes. Out of the mothers who were diagnosed as diabetes (15 cases) in pregnancy, 13 were gestational diabetes (GDM) while two were type 2 diabetes. Majority had a vaginal delivery (n-105, 70.5%). Out of these, six (4%) were instrumental deliveries (4-forcep, 2 vacuum deliveries). There was one stillbirth and zero neonatal deaths reported in this study group. There were three (2%) third degree perineal tears, two following NVD and one following forceps delivery.</span></span></span></span> <p style="margin-bottom: 0in;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><span style="color: #231f20;"><em><strong>Conclusions: </strong></em></span><span style="color: #231f20;">Majority of mothers with babies with birthweight &gt;3.5 kg did not have altered blood glucose levels. Further prospective studies are needed to define the association of adverse perinatal outcomes and macrosomia.</span></span></span></span> <p style="margin-bottom: 0in; font-weight: normal;"><span style="color: #000000;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">DOI: <a href="http://dx.doi.org/10.4038/sljog.v35i3.6336">http://dx.doi.org/10.4038/sljog.v35i3.6336</a></span></span></span> <p style="margin-bottom: 0in; font-weight: normal;"><em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2013; 35: 84-85 <p style="margin-bottom: 0in; font-weight: normal;">

Diagnosis of Gestational Diabetes Mellitus: It Is Time for International Consensus

Gestational diabetes mellitus (GDM)2 has been defined as any degree of glucose intolerance with an onset or first recognition during pregnancy (1–3). Fetal complications of GDM include macrosomia (large baby, which leads to birth injuries), shoulder dystocia, and neonatal hypoglycemia, and adverse outcomes for the mother are an increased risk of cesarean delivery, preeclampsia, and hypertension during pregnancy, as well as a significantly higher risk of subsequent type 2 diabetes. Treating women with GDM reduces at least some of the adverse outcomes (4). Estimates of the prevalence of GDM range from <1% to 28%, reflecting the different diagnostic criteria and populations studied. The increasing prevalence of GDM in the US is congruent with the marked increase in obesity and type 2 diabetes. Pregnant women have been evaluated for diabetes for more than 50 years. Notwithstanding the 5 international workshops devoted to GDM that have been held between 1979 and 2005, there is lack of agreement concerning the optimal method to identify “any degree of glucose intolerance.” The criteria for both screening and diagnosing GDM vary considerably among countries and often between diabetes and obstetric organizations in a single country (5). Screening recommendations range from none (do not screen) to selective (screen only those at high risk) to universal. Approaches for screening tests include fasting glucose, random glucose, or, more commonly, a glucose challenge in which the patient ingests 50 g glucose (regardless of the time of the last meal). If the 1-h postload plasma glucose concentration exceeds the threshold, a full diagnostic oral glucose tolerance test (OGTT) is performed; however, 2 thresholds [140 mg/dL (7.8 mmol/L) or 130 mg/dL (7.2 mmol/L)] are generally used. Approximately 15% of women have concentrations that exceed the higher cutoff, which identifies approximately 80% of women with GDM, whereas the use of …

Population ageing trends in Serbia from the beginning of the 21st century and prospects until 2061: Regional aspect

The results of the 2011 Census confirm that Serbia is still among countries with the oldest population in Europe. Persons aged 65+ out?numbered those under the age of 15 by 20% (17.4% versus 14.4%), and the median age was 42.7 years. Population ageing has continued, but it was slower in the intercensal period of 2002-2011 than during the 1980s and 1990s. Population ageing in Serbia has not only continued but is also widespread at all territorial levels. According to the 2011 Census, in all four statistical regions (NUTS 2), people aged 65 or older outnumbered those under the age of 15 and, in comparison to 2002, regional differences in the key indicators of population ageing increased. Heterogeneity is more present at lower territorial levels (cities/municipalities) with the least favourable age structure which will be pointed out. This paper also explores trends of components of population dynamics in the intercensal period 2002-2011, as well as causal relationship with the change of the age structure. Current demographic trends (low fertility, negative natural increase, net emigration) and very old age structure severely limit the spectrum of future demographic changes both in the medium and especially in the short term. The situation is particularly influenced by the entrance of the large baby boom generation in the elderly ages. Explorations of future population trends are conducted based on the author?s own demographic projections for Serbia until 2061 (revision 2014).

Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study

Background: During the past two decades there has been a sustained decline in child mortality; however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services. Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan. Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths with birth asphyxia diagnosed through verbal autopsy accreditation during 2005 and 2006 were taken as cases. Controls were the live births during the same period, matched on area of residence, gender and age. Result: The factors found to be associated with birth asphyxia mortality in Matiari District of Sindh Province, Pakistan are maternal education, history of stillbirths, pregnancy complications (including smelly or excessive vaginal discharge and anemia), intrapartum complications (including fever, prolong or difficult labour, breech delivery, cord around child’s neck, premature delivery, large baby size) and failure to establish spontaneous respiration after birth. Conclusion and Recommendation: There is an immediate need to develop strategies for early identification and management of factors associated with birth asphyxia by involving women, families, communities, community health workers, health professionals and policy makers. Community health workers should be trained for emergency obstetric care, basic newborn care including preliminary resuscitation measures to provide skilled birth attendance and encourage early recognition and referral.

The Family Living Room: A Child's Playpen?

ABSTRACTFor a long time, the Dutch family living room has been the most prestigious domestic space, reflecting in its furnishing and decoration the status and class of the male breadwinner without any material indication of the presence of children in the household. In the latter part of the twentieth century, children were increasingly acknowledged as family members in their own right and allowed to extend their play into the living room. More recently, the situation has developed into the extreme opposite of the pristine family living rooms of yore. Nowadays, with baby equipment visibly predominant, the living room of a young family looks more like a day-care center, the playpen taking a focal position, surrounded by large toys and baby furniture. This article presents a sociological explanation of the material transformation of the living room in its relation to the rise in labor participation of young Dutch mothers over the last two decades, as well as a cultural interpretation of the material living room as a reflection of Dutch family life in the twentieth century.

Continence Care Literature Review 2012

Continence Care Literature Review 2012

The changing demographics of Australia over the last 30 years

The changing demographics of <scp>A</scp>ustralia over the last 30 years

Huerto escolar: estrategia educativa para la vida.

Hace aproximadamente cinco años, y preocupados por la erosión del conocimiento vinculado a los procesos productivos de los alimentos, el acceso a ellos y la calidad nutrimental e inocuidad, se estableció el huerto agroecológico “un pasito en grande”, donde el uso de los agroquímicos (fertilizantes, insecticidas, herbicidas, etc.) están prohibidos. Todo ello con la colaboración y participación de niños, niñas, padres y madres de familia y personal docente del Colegio Ateneo prescolar de Tezoyuca, Estado de México. La participación de los infantes ha permitido la difusión de la experiencia, y poco a poco la estrategia se ha ampliado a otros espacios educativos. El huerto escolar se ha convertido en un espacio para fomentar una conciencia ecológica y ambiental que se fortalece a partir de las actividades cotidianas y acciones específicas implementadas. El huerto escolar se fundamenta en una serie de principios filosóficos que ayuda a la reflexión de nuestro aprender-hacer; en términos metodológicos su implementación se sustenta en la ética y principios de la permacultura.

Sacrohysteropexy with synthetic mesh in Aba, South-Eastern Nigeria: A report of three cases and review of the literature

The surgical treatment of uterovaginal prolapse in women who wish to preserve their uteri for fertility presents a challenge to a gynecologist. This is particularly more challenging in Nigeria and the rest of Africa where there is not only a strong cultural aversion to hysterectomy but women also prefer large family size and male babies. This underscores the need for fertility friendly, uterus-preserving procedures. Three young women under the age of 40 presented with uterovaginal prolapse. They were of low parity and wanted to preserve their uteri for future reproductive function. They had open abdominal suspension of their uteri to the sacrum using a synthetic polypropylene mesh. A pus-string suture was also used to obliterate their pouch of Douglas to prevent future enterocele. Pelvic anatomy was restored and normal vaginal axis was achieved. They had uneventful post-operative period. In resource-limited settings, open abdominal (rather than laparoscopic) sacrohysteropexy with synthetic mesh is an effective and safe alternative to Manchester operation and other vaginal procedures in women who desire to preserve the uterus for future reproductive function.

Oleic acid stimulates system A amino acid transport in primary human trophoblast cells mediated by toll-like receptor 4

Obese women have an increased risk to deliver large babies. However, the mechanisms underlying fetal overgrowth in these pregnancies are not well understood. Obese pregnant women typically have elevated circulating lipid levels. We tested the hypothesis that fatty acids stimulate placental amino acid transport, mediated via toll-like receptor 4 (TLR4) and mammalian target of rapamycin (mTOR) signaling pathways. Circulating NEFA levels and placental TLR4 expression were assessed in women with varying prepregnancy body mass index (BMI). The effects of oleic acid on system A and system L amino acid transport, and on the activation of the mTOR (4EBP1, S6K1, rpS6), TLR4 (IĸB, JNK, p38 MAPK), and STAT3 signaling pathways were determined in cultured primary human trophoblast cells. Maternal circulating NEFAs (n = 33), but not placental TLR4 mRNA expression (n = 16), correlated positively with BMI (P < 0.05). Oleic acid increased trophoblast JNK and STAT3 phosphorylation (P < 0.05), whereas mTOR activity was unaffected. Furthermore, oleic acid doubled trophoblast system A activity (P < 0.05), without affecting system L activity. siRNA-mediated silencing of TLR4 expression prevented the stimulatory effect of oleic acid on system A activity. Our data suggest that maternal fatty acids can increase placental nutrient transport via TLR4, thereby potentially affecting fetal growth.

Activation of Placental mTOR Signaling and Amino Acid Transporters in Obese Women Giving Birth to Large Babies

Babies of obese women are often large at birth, which is associated with perinatal complications and metabolic syndrome later in life. The mechanisms linking maternal obesity to fetal overgrowth are largely unknown. We tested the hypothesis that placental insulin/IGF-I and mammalian target of rapamycin (mTOR) signaling is activated and amino acid transporter activity is increased in large babies of obese women. Pregnant women were recruited prospectively for collection of placental tissue at a university hospital and academic biomedical center. Twenty-three Swedish pregnant women with first trimester body mass index ranging from 18.5 to 44.9 kg/m(2) and with uncomplicated pregnancies participated in the study. There were no interventions. We determined the phosphorylation of key signaling molecules (including Akt, IRS-1, S6K1, 4EBP-1, RPS6, and AMPK) in the placental insulin/IGF-I, AMPK, and mTOR signaling pathways. The activity and protein expression of the amino acid transporter systems A and L were measured in syncytiotrophoblast microvillous plasma membranes. Birth weights (range, 3025-4235 g) were positively correlated to maternal body mass index (P < 0.05). The activity of placental insulin/IGF-I and mTOR signaling was positively correlated (P < 0.001), whereas AMPK phosphorylation was inversely (P < 0.05) correlated to birth weight. Microvillous plasma membrane system A, but not system L, activity and protein expression of the system A isoform SNAT2 were positively correlated to birth weight (P < 0.001). Up-regulation of specific placental amino acid transporter isoforms may contribute to fetal overgrowth in maternal obesity. This effect may be mediated by activation of insulin/IGF-I and mTOR signaling pathways, which are positive regulators of placental amino acid transporters.

Possible relation between maternal consumption of added sugar and sugar-sweetened beverages and birth weight – time trends in a population

BackgroundHigh birth weight (BW) is a risk factor for later obesity. In Norway, mean BW and proportion of large newborns increased from 1989 to 2000 and subsequently decreased to the 1989 level by 2010. The purpose of the study was to explore causes of this temporary increase.MethodsFrom a regional prospective database pregnancy and newborn data were extracted for all 33088 singleton pregnancies resulting in live infants born at term without malformations during 1989–2010. Trends in BW, ponderal index and proportion of large newborns were related to individual prenatal exposures, including pre-pregnancy body mass index (PP-BMI) and gestational weight gain (GWG) for the years 2001–2010, and thereafter related ecologically to national population data on consumption of nutrients and physical activity.ResultsFor the regional cohort mean (standard deviation) BW increased from 3580 (453) grams in 1989/90 to 3633 (493) grams in 2001/02 (p<0.001), and decreased to 3583 (481) grams in 2009/10 (p<0.001). The proportion with BW>4500 grams increased from 2.6% to 4.8% (p<0.001) and subsequently decreased to 3.3% (p=0.002). The trends remained after adjustment for relevant exposures. For the years 2001/02 to 2009/10 (n= 15240) mean (SD) PP-BMI increased from 24.36 (4.44) to 24.85 (5.02) kg/m2 (p<0.001) while GWG decreased from 14.79 (5.85) to 13.86 (5.79) kg (p<0.001). The estimated net effect of changes in PP-BMI, GWG and other known exposures was a 6 grams reduction in BW from 2001/02 to 2009/10, leaving 44 grams reduction unexplained. National consumption of major nutrients did not change, but consumption of sucrose, in large part as sugar-sweetened beverages (SSB) changed in parallel to the BW trends.ConclusionThe temporary increase in BW and large babies in the regional cohort was identical to that reported for Norway. Individual level data on known pregnancy related predictors for BW could not explain these changes, but the parallel time trend in national consumption of sucrose, in particular as SSB, may lend support to a hypothesis that intake of sugar may have a direct effect on BW and infant body proportions independent of effects through PP-BMI and GWG.

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women

About a third of women have urinary incontinence and up to a 10th have faecal incontinence after childbirth. Pelvic floor muscle training is commonly recommended during pregnancy and after birth both for prevention and the treatment of incontinence. To determine the effect of pelvic floor muscle training compared to usual antenatal and postnatal care on incontinence. We searched the Cochrane Incontinence Group Specialised Register, which includes searches of CENTRAL, MEDLINE, MEDLINE in Process and handsearching (searched 7 February 2012) and the references of relevant articles. Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial needed to include pelvic floor muscle training (PFMT). Another arm was either no PFMT or usual antenatal or postnatal care. Trials were independently assessed for eligibility and methodological quality. Data were extracted then cross checked. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook for Systematic Reviews of Interventions. Three different populations of women were considered separately, women dry at randomisation (prevention); women wet at randomisation (treatment); and a mixed population of women who might be one or the other (prevention or treatment). Trials were further divided into those which started during pregnancy (antenatal); and those started after delivery (postnatal). Twenty-two trials involving 8485 women (4231 PFMT, 4254 controls) met the inclusion criteria and contributed to the analysis.Pregnant women without prior urinary incontinence (prevention) who were randomised to intensive antenatal PFMT were less likely than women randomised to no PFMT or usual antenatal care to report urinary incontinence up to six months after delivery (about 30% less; risk ratio (RR) 0.71, 95% CI 0.54 to 0.95, combined result of 5 trials).Postnatal women with persistent urinary incontinence (treatment) three months after delivery and who received PFMT were less likely than women who did not receive treatment or received usual postnatal care to report urinary incontinence 12 months after delivery (about 40% less; RR 0.60, 95% CI 0.35 to 1.03, combined result of 3 trials). It seemed that the more intensive the programme the greater the treatment effect.The results of seven studies showed a statistically significant result favouring PFMT in a mixed population (women with and without incontinence symptoms) in late pregnancy (RR 0.74, 95% CI 0.58 to 0.94, random-effects model). Based on the trial data to date, the extent to which mixed prevention and treatment approaches to PFMT in the postnatal period are effective is less clear (that is, offering advice on PFMT to all pregnant or postpartum women whether they have incontinence symptoms or not). It is possible that mixed prevention and treatment approaches might be effective when the intervention is intensive enough.There was little evidence about long-term effects for either urinary or faecal incontinence. There is some evidence that for women having their first baby, PFMT can prevent urinary incontinence up to six months after delivery. There is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence. It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women (for example primiparous women; women who had bladder neck hypermobility in early pregnancy, a large baby, or a forceps delivery). These and other uncertainties, particularly long-term effectiveness, require further testing.

Vacuum‐assisted deliveries and the risk of obstetric anal sphincter injuries—a retrospective register‐based study in Finland

Please cite this paper as: Räisänen S, Vehviläinen‐Julkunen K, Cartwright R, Gissler M, Heinonen S. Vacuum‐assisted deliveries and the risk of obstetric anal sphincter injuries—a retrospective register‐based study in Finland. BJOG 2012;119:1370–1378.Objectives To identify and quantify the risks of obstetric anal sphincter injury (OASIS) separately in nulliparae, including women admitted for a first vaginal delivery after a previous caesarean section for their first birth, and multiparae delivered by vacuum extraction in Finland where the type of episiotomy is exclusively lateral.Design A retrospective population‐based register study.Methods Nulliparous and multiparous women with OASIS were compared separately with women without OASIS using stepwise logistic regression analysis.Main outcome measures Risk of OASIS.Results Among a sample of 16 802 women whose infants were delivered by vacuum extraction between 2004 and 2007, the incidence of OASIS was significantly higher among nulliparous women (475 of 13 981, 3.4%) than multiparous women (40 of 2821, 1.4%), with adjusted odds ratio 2.44 (95% CI 1.77–3.39). Lateral episiotomy was associated with 46% decreased incidence of OASIS (adjusted odds ratio 0.54, 95% CI 0.42–0.70) in nulliparae delivered by vacuum extraction. There was no statistically significant association for multiparous women. An increase of 1000 g in birthweight increased the OASIS incidence 2.10‐fold for nulliparae and 2.83‐fold for multiparae.Conclusions Nulliparous women with infants delivered by vacuum extraction had an increased risk of OASIS compared with multiparous women. Lateral episiotomy was associated with a decreased incidence of OASIS, especially in women with large babies and long second stage. These results support liberal use of lateral episiotomy at vacuum extraction for nulliparous women at high risk of OASIS, but the role of episiotomy should be re‐investigated in interventional randomised trials.