Large For Gestational Age Neonates Research Articles

1155: Customized versus Intergrowth-21st standard for identifying risk of neonatal large for gestational age and complications

Few studies have evaluated the effect of Customized growth charts among LGA (large for gestational age) populations. We sought to compare the Intergrowth-21st Century (IG-21) standard to a Customized standard for predicting pregnancies at risk for neonatal LGA and adverse outcomes. We conducted a secondary analysis of data from a prospective cohort study of women presenting for fetal growth assessment at 26-36 weeks gestation (GA). Fetal growth was assessed using both the IG-21 standard and a Customized USA standard. Prenatal LGA was defined as estimated fetal weight >90th percentile for GA. Neonatal LGA was defined as birth weight >90th percentile for GA by Alexander growth chart. The primary outcome was the prediction of neonatal LGA. Secondary outcomes included cesarean section for macrosomia or arrest of labor and a composite of adverse neonatal outcomes including one or more of the following: neonatal intensive care unit admission; cord pH < 7.1; 5 minute Apgar < 7; hypoglycemia; neonatal seizure; IVH (grade III or IV); or death. The discriminatory ability of the standards were compared using area under receiver operative curves and non-parametric statistics. Relative risks and 95% confidence intervals (CI) were also calculated. Of 1051 women meeting inclusion criteria, neonatal LGA was seen in 123 (11.7%) and a composite adverse neonatal outcome in 139 (13.2%). The overall ability for detecting neonatal LGA was significantly better in the IG-21 growth chart than the Customized growth chart (AUC 0.78, 95%CI 0.75-0.82 vs. AUC 0.73, 95%CI 0.69-0.78; p=0.019) (Figure 1). Both standards performed well, and were comparable, in identifying increased risk of cesarean section for macrosomia or arrest of labor (Table 1). Both standards were poor, but comparable, in predicting adverse neonatal outcomes (Table 1). The IG-21 standard is significantly better at predicting neonatal LGA compared to a Customized growth standard. Both standards identify pregnancies at increased risk of cesarean section but are poor at identifying risk for immediate neonatal adverse outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

844: Identifying neonatal large for gestational age and adverse outcomes using Customized versus NICHD race-specific standards

The predictive efficiency of Customized standard growth charts among LGA (large for gestational age) populations has not been well established. We compare the NICHD race-specific growth standard to a Customized standard for predicting pregnancies at risk for neonatal LGA and adverse outcomes. We conducted a secondary analysis of data from a prospective cohort study of women presenting for fetal growth assessment at 26-36 weeks gestation (GA). Fetal growth was assessed using both the NICHD standard and a Customized USA standard. Prenatal LGA was defined as estimated fetal weight >90th percentile for GA. Neonatal LGA was defined as birth weight >90th percentile for GA by Alexander chart. The primary outcome was prediction of neonatal LGA. Secondary outcomes included cesarean section for macrosomia or arrest of labor and a composite of adverse neonatal outcomes including one or more of the following: neonatal intensive care unit admission; cord pH < 7.1; 5 minute Apgar < 7; hypoglycemia; seizure; IVH (grade III or IV); or death. The discriminatory ability of the growth standards were compared using area under receiver operative curves. Relative risks and 95% confidence intervals (CI) were calculated. Of 1054 women meeting inclusion criteria, neonatal LGA was observed in 123 (11.7%) and a composite adverse neonatal outcome in 139 (13.2%). The NICHD standard was significantly better than the Customized standard in detecting neonatal LGA (AUC 0.79, 95%CI 0.75-0.83 vs. AUC 0.73, 95%CI 0.68-0.78; p=0.004) (Figure 1). Both standards performed well, and were comparable, in identifying increased risk of cesarean section for macrosomia or arrest of labor (Table 1). Both standards were poor, but comparable, in predicting composite adverse neonatal outcomes. Neonatal hypoglycemia, however, was better detected by the NICHD standard (Table 1). The NICHD growth chart is significantly better at predicting neonatal LGA compared to a Customized standard. Both standards identify increased risk of cesarean section but are poor at identifying risk for immediate neonatal adverse outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

710: Trends of change over time in the specific contribution of different risk factors for PPH

Post- partum hemorrhage (PPH) is an obstetrical emergency with rising incidence. The prevalence of some of the risk factors for PPH has changed over the years, however, less is known about the specific contribution of each risk factor throughout the years. The aim of the current study was to identify trends in the specific contribution of different risk factors for PPH, by observing their odds ratios (OR) throughout different time periods. In this population-based retrospective cohort study trends of changes in odds ratios (ORs) of different known risk factors for PPH occurring in three consecutive eight-year intervals from 1988 to 2014 (T1 – 1988-1996; T2 – 1997-2005; T3 – 2006-2014) were compared. Data was retrieved from the medical center's computerized perinatal database. Several multivariable logistic regression models were used in order to identify independent risk factors for PPH in our population. Chi square test for trends was used to compare the trends of the different ORs along the time periods. During the study period 285,992 pregnancies met the inclusion criteria of them 1684 (0.58%) were complicated with PPH. Between 1988 to 2014 the incidence of PPH has gradually increased from 0.5% in 1988 to 0.6% in 2014. Using a logistic regression model for the prediction of PPH, pre-eclampsia, vacuum extraction delivery, manualysis, perineal tear and large for gestational age (LGA) neonate were recognized as independent risk factors for PPH (Table 1). While the ORs of pre-eclampsia and vacuum extraction delivery, as risk factors, have not changed significantly throughout the follow up period, ORs of manualysis, perineal tear and LGA neonate have significantly increased (Table 2). In our study, not only did the rates of different statistically significant risk factors for PPH change during the study period, the specific contribution of each risk factor for the occurrence of PPH has changed as well. Having a better understanding of these trends might be beneficial to our ability to predict this grave obstetrical complication and to improve maternal outcome.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

837: Large-for-gestational-age as a marker for adverse perinatal outcomes in pregnancy complicated by gestational diabetes mellitus

We sought to examine the strength of large-for-gestational-age (LGA) measuring neonates as a marker for adverse perinatal outcomes associated with poor glycemic control in women with gestational diabetes mellitus (GDM). A retrospective cohort study of 141,670 women in California with singleton, vertex, non-anomalous gestations was performed in order to assess prevalence of adverse perinatal outcomes in GDM with LGA neonates. LGA was defined as birth weight greater than or equal to the 90th percentile for a given gestational age. Maternal outcomes examined included preeclampsia, post-partum hemorrhage (PPH) and chorioamnionitis. Neonatal outcomes examined included respiratory distress syndrome (RDS), hypoglycemia, jaundice and intrauterine fetal demise (IUFD). Confounding variables including pre-gestational diabetes mellitus were controlled for and a p-value of less than 0.05 was considered statistically significant. Overall, LGA gestation in women with GDM was a reliable marker for an increased risk of perinatal complications (Table 1). Statistically significant increased complications included neonatal RDS (2.64% vs 1.77% p=0.001), hypoglycemia (1.06% vs 0.05% p< 0.001), jaundice (21.52% vs 19.18% p=0.003), IUFD (0.49% vs 0.14% p< 0.001), PPH (4.07% vs 2.95% p=0.001) and a decreased risk of chorioamnionitis (1.87% vs 2.68% p=0.014). Most notably, the risk of IUFD (Figure 1) and RDS steadily increase as the size of the fetus increases proportional to gestational age. Maternal complications were less statistically significant in the extremes of LGA. Large-for-gestational-age measurements in women with GDM are reliable markers for adverse perinatal outcomes. Of particular concern is the risks of IUFD and RDS, which decidedly increase with LGA centile greater than 90th. Women should be counseled about these risks and providers prepared to give additional respiratory support to neonates at delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal body mass index change as a new optimal gestational weight gain predictor in overweight women

AimTo investigate the relationship between maternal pre-pregnancy body-mass index (BMI) and neonatal birth weight.MethodsThe observational study included 2906 mothers and their neonates born from 2005 to 2011 at the Department of Gynecology and Obstetrics, Split University Hospital Center. Mothers with singleton term pregnancies who were overweight before pregnancy (BMI 25-29.9 kg/m2) were compared with those with normal pre-pregnancy weight (BMI 18.5-24.9 kg/m2). BMI change was assessed as a predictor of birth weight, categorized as small (SGA), appropriate (AGA), or large for gestational age (LGA).ResultsThe rate of SGA infants was significantly lower (n = 199; 6.8% vs n = 1548; 9.2%) and the rate of LGA infants significantly greater among pre-pregnancy overweight mothers compared with normal-weight mothers (n = 371; 12.8% vs n = 1302; 7.8%; P < 0.001 both). Overweight mothers had a significant probability of delivering an SGA neonate when they gained less than 6 kg, as compared with 8 kg among normal-weight mothers. They had a significant probability of delivering an LGA neonate when they gained more than 14 kg, compared with more than 20 kg among normal-weight mothers. BMI change was a more consistent indicator, suggesting that the ranges of 3.0-7.9 kg/m2 in normal-weight and 2-5.9 kg/m2 in overweight women were not associated with a significant increase in the rate of SGA or LGA.ConclusionMaternal height seems to be an important factor in optimal weight gain definition, suggesting that BMI change should be a preferred measure of pregnancy-related weight.

Impact of placenta previa with placenta accreta spectrum disorder on fetal growth.

To evaluate fetal growth in pregnancies complicated by placenta previa with or without placenta accreta spectrum (PAS) disorder, compared with in pregnancies with a low-lying placenta. This was a multicenter retrospective cohort study of singleton pregnancies complicated by placenta previa with or without PAS disorder, for which maternal characteristics, ultrasound-estimated fetal weight and birth weight were available. Four maternal-fetal medicine units participated in data collection of diagnosis, treatment and outcome. The control group comprised singleton pregnancies with a low-lying placenta (0.5-2 cm from the internal os). The diagnosis of PAS and depth of invasion were confirmed at delivery using both a predefined clinical grading score and histopathological examination. For comparison of pregnancy characteristics and fetal growth parameters, the study groups were matched for smoking status, ethnic origin, fetal sex and gestational age at delivery. The study included 82 women with placenta previa with PAS disorder, subdivided into adherent (n = 35) and invasive (n = 47) PAS subgroups, and 146 women with placenta previa without PAS disorder. There were 64 controls with a low-lying placenta. There was no significant difference in the incidence of small-for-gestational age (SGA) (birth weight ≤ 10th percentile) and large-for-gestational age (LGA) (birth weight ≥ 90th percentile) between the study groups. Median gestational age at diagnosis was significantly lower in pregnancies with placenta previa without PAS disorder than in the low-lying placenta group (P = 0.002). No significant difference was found between pregnancies complicated by placenta previa with PAS disorder and those without for any of the variables. Median estimated fetal weight percentile was significantly lower in the adherent compared with the invasive previa-PAS subgroup (P = 0.047). Actual birth weight percentile at delivery did not differ significantly between the subgroups (P = 0.804). No difference was seen in fetal growth in pregnancies complicated by placenta previa with PAS disorder compared with those without and compared with those with a low-lying placenta. There was also no increased incidence of either SGA or LGA neonates in pregnancies with placenta previa and PAS disorder compared with those with placenta previa with spontaneous separation of the placenta at birth. Adverse neonatal outcome in pregnancies complicated by placenta previa and PAS disorder is linked to premature delivery and not to impaired fetal growth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Third Trimester Umbilical Artery Doppler in Low-Risk Pregnancies and its Correlation to Estimated Fetal Weight and Birthweight.

This study investigated the correlation between the umbilical artery (UA) pulsatility index (PI) and the estimated fetal weight percentile and birthweight (BW) percentile, respectively. We included low-risk pregnancies, in which UA Doppler investigations after 28 weeks were performed. Cases were allocated according to BW percentiles: small for gestational age (SGA) with BW < 10th percentile; appropriate for gestational age (AGA) and large for gestational age (LGA) with BW > 90th percentile. We analyzed differences in the mean UA-PI and UA-PI z-score for gestational age according to the three groups. Linear regression was performed to evaluate any relationship between Doppler indices and BW percentiles. Multiple logistic regression analysis was performed to determine the independent association of UA-PI with LGA babies. In a second step, we considered data on estimated fetal weight (EFW) percentiles and performed the same analysis. We analyzed 14 554 pregnancies from 2004 to 2015. The mean UA-PI and mean UA-PI z-scores in the LGA group were lower than in the AGA and SGA groups (p < 0.001). UA-PI and UA-PI z-scores were linearly related to birthweight percentiles (p < 0.001) and to EFW percentiles (p < 0.001). Logistic regression analysis showed that low UA-PI was independently associated with neonatal LGA (p < 0.001). The higher the EFW and BW percentiles, the lower the UA-PI. However, reference ranges for UA Doppler are only based on gestation weeks. Further studies are needed to clarify whether customized reference ranges based on EFW percentiles are more appropriate for the evaluation of fetal wellbeing in the third trimester.

Maternal clinical profile and immediate neonatal outcome in term large for gestational age neonates

Background: The objective of the study was to know the maternal clinical profile and short term outcome of term large-for-gestational-age (LGA) neonates.Methods: The study was a prospective observational study conducted in the tertiary neonatal unit, Odisha, during the study period February to November 2018. All inborn term neonates with birth weight above 90th percentile for gestational age excluding neonates with major congenital anomalies were included. Maternal clinical profile data from the antenatal records, neonatal demographic profile and co-morbidities over time were recorded using a checklist. The analysis of data was done using SPSS 21.0. Univariate summary statistics and bivariate Fischer’s exact test were used to analyse the data.Results: The prevalence of delivery of LGA and macrosomic neonate in our institution was 2.5%, and 1.1% respectively. Ninety one percent of LGA neonates were born before 39weeks and 80% babies delivered by cesarean section. Majority 39 (86.7%) of LGA babies were born to non-diabetic mother, four (8.9%) neonates born to GDM mother, two (4.4%) were born to mother with pre pregnancy diabetes mellitus. Sixteen (35.5%) neonates were admitted to NICU for different comorbidities like neonatal jaundice (37.8%), polycythemia (24.4%), transient tachypnea of new-born (20%), hypoglycemia (15.6%), hypocalcaemia (15.6%), and seizure (4.4%). The comorbidities like hypoglycaemia, hypocalcemia, respiratory distress were more in LGA babies with diabetic mother compared to non-diabetic mother.Conclusions: About nine in ten LGA neonates were born to non-diabetic mothers, however, LGA infants of diabetic mothers are at higher risk of metabolic complications like hypoglycemia, hypocalcemia compared to non-diabetic mother.

Identifying fetal growth disorders using ultrasound in obese nulliparous women

Objective We evaluated the ability of third trimester ultrasound to diagnose fetal growth disorders among obese women. Methods This is a retrospective cohort study of obese nulliparous women who delivered term singleton neonates who had an ultrasound within 5 weeks of delivery. We characterized the sensitivity, specificity, positive predictive value and negative predictive value of ultrasound to detect large-for-gestational age (LGA) and small-for-gestational age (SGA) infants. Antenatally, LGA and SGA were defined as an ultrasound estimated fetal weight >90% or <10% based on the Hadlock formula. Postnatally, LGA or SGA designation was based on gestational age-based birthweight percentiles. Test characteristics were analyzed for the total cohort and by class of obesity (class II, body mass index [BMI] = 35.0–39.9 kg/m2 versus class III, BMI ≥ 40 kg/m2). We compared the area under the curve for receiver-operating characteristic (ROC) curves for different classes of obesity. Results Of 690 women, 13 (1.9%) screened positive for SGA and 19 (2.8%) delivered an SGA neonate. In contrast, 158 (22.9%) screened positive for LGA and 97 (14.1%) delivered an LGA neonate. The sensitivity of ultrasound for SGA was 26.3% and the specificity was 98.8%. The sensitivity for LGA was 75.3% and the specificity was 85.7%. The ROC curves did not differ significantly for different classes of obesity (p = .69 for SGA, p = .75 for LGA). Conclusion Ultrasound in obese women who delivered term pregnancies has a high specificity but poor sensitivity for SGA and a low positive predictive value for LGA.

Prediction of large-for-gestational-age neonate by routine third-trimester ultrasound.

ABSTRACTObjectivesFirst, to evaluate and compare the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference (AC) at 31 + 0 to 33 + 6 and 35 + 0 to 36 + 6 weeks' gestation in the prediction of a large‐for‐gestational‐age (LGA) neonate born at ≥ 37 weeks' gestation. Second, to assess the additive value of fetal growth velocity between 32 and 36 weeks' gestation to the performance of EFW at 35 + 0 to 36 + 6 weeks' gestation for prediction of a LGA neonate. Third, to define the predictive performance for a LGA neonate of different EFW cut‐offs on routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Fourth, to propose a two‐stage strategy for identifying pregnancies with a LGA fetus that may benefit from iatrogenic delivery during the 38th gestational week.MethodsThis was a retrospective study. First, data from 21 989 singleton pregnancies that had undergone routine ultrasound examination at 31 + 0 to 33 + 6 weeks' gestation and 45 847 that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks were used to compare the predictive performance of EFW and AC for a LGA neonate with birth weight &gt; 90th and &gt; 97th percentiles born at ≥ 37 weeks' gestation. Second, data from 14 497 singleton pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation and had a previous scan at 30 + 0 to 34 + 6 weeks were used to determine, through multivariable logistic regression analysis, whether addition of growth velocity, defined as the difference in EFW Z‐score or AC Z‐score between the early and late third‐trimester scans divided by the time interval between the scans, improved the performance of EFW at 35 + 0 to 36 + 6 weeks in the prediction of delivery of a LGA neonate at ≥ 37 weeks' gestation. Third, in the database of the 45 847 pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation, the screen‐positive and detection rates for a LGA neonate born at ≥ 37 weeks' gestation and ≤ 10 days after the initial scan were calculated for different EFW percentile cut‐offs between the 50th and 90th percentiles.ResultsFirst, the areas under the receiver–operating characteristics curves (AUC) of screening for a LGA neonate were significantly higher using EFW Z‐score than AC Z‐score and at 35 + 0 to 36 + 6 than at 31 + 0 to 33 + 6 weeks' gestation (P &lt; 0.001 for all). Second, the performance of screening for a LGA neonate achieved by EFW Z‐score at 35 + 0 to 36 + 6 weeks was not significantly improved by addition of EFW growth velocity or AC growth velocity. Third, in screening by EFW &gt; 90th percentile at 35 + 0 to 36 + 6 weeks' gestation, the predictive performance for a LGA neonate born at ≥ 37 weeks' gestation was modest (65% and 46% for neonates with birth weight &gt; 97th and &gt; 90th percentiles, respectively, at a screen‐positive rate of 10%), but the performance was better for prediction of a LGA neonate born ≤ 10 days after the scan (84% and 71% for neonates with birth weight &gt; 97th and &gt; 90th percentiles, respectively, at a screen‐positive rate of 11%). Fourth, screening by EFW &gt; 70th percentile at 35 + 0 to 36 + 6 weeks' gestation predicted 91% and 82% of LGA neonates with birth weight &gt; 97th and &gt; 90th percentiles, respectively, born at ≥ 37 weeks' gestation, at a screen‐positive rate of 32%, and the respective values of screening by EFW &gt; 85th percentile for prediction of a LGA neonate born ≤ 10 days after the scan were 88%, 81% and 15%. On the basis of these results, it was proposed that routine fetal biometry at 36 weeks' gestation is a screening rather than diagnostic test for fetal macrosomia and that EFW &gt; 70th percentile should be used to identify pregnancies in need of another scan at 38 weeks, at which those with EFW &gt; 85th percentile should be considered for iatrogenic delivery during the 38th week.ConclusionsFirst, the predictive performance for a LGA neonate by routine ultrasonographic examination during the third trimester is higher if the scan is carried out at 36 than at 32 weeks, the method of screening is EFW than fetal AC, the outcome measure is birth weight &gt; 97th than &gt; 90th percentile and if delivery occurs within 10 days than at any stage after assessment. Second, prediction of a LGA neonate by EFW &gt; 90th percentile is modest and this study presents a two‐stage strategy for maximizing the prenatal prediction of a LGA neonate. Copyright © 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.

Exploration of the shared pathophysiological mechanisms of gestational diabetes and large for gestational age offspring.

Gestational diabetes mellitus (GDM) and large for gestational age (LGA) offspring are two common pregnancy complications. Connections also exist between the two conditions, including mutual maternal risk factors for the conditions and an increased prevalence of LGA offspring amongst pregnancies affected by GDM. Thus, it is important to elucidate potential shared underlying mechanisms of both LGA and GDM. One potential mechanistic link relates to macronutrient metabolism. Indeed, derangement of carbohydrate and lipid metabolism is present in GDM, and maternal biomarkers of glucose and lipid control are associated with LGA neonates in such pregnancies. The aim of this paper is therefore to reflect on the existing nutritional guidelines for GDM in light of our understanding of the pathophysiological mechanisms of GDM and LGA offspring. Lifestyle modification is first line treatment for GDM, and while there is some promise that nutritional interventions may favourably impact outcomes, there is a lack of definitive evidence that changing the macronutrient composition of the diet reduces the incidence of either GDM or LGA offspring. The quality of the available evidence is a major issue, and rigorous trials are needed to inform evidence-based treatment guidelines.

Maternal and Neonatal Morbidity Associated With Early Term Delivery of Large-for-Gestational-Age But Nonmacrosomic Neonates

To evaluate whether, at 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity. This retrospective cohort study used U.S. Vital Statistics datasets for the years 2011-2013. Inclusion criteria were singleton pregnancies delivered at 37-39 weeks of gestation after labor in which the neonates were nonanomalous, and either appropriate for gestational age or large for gestational age (LGA) neonates with birth weights of less than 4,000 g (our threshold for macrosomia). The coprimary outcomes were composite maternal morbidity (any of the following: maternal transfusion, ruptured uterus, unplanned hysterectomy, admission to intensive care unit, or unplanned procedure) and composite neonatal morbidity (any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure or serious neurologic dysfunction, significant birth injury or neonatal mortality). Multivariable Poisson regression models were used to calculate adjusted relative risk (aRR) and 95% CI. Among the 3.9 million women who met inclusion criteria, 1.3% delivered neonates who were LGA but nonmacrosomic. The rate of composite maternal morbidity was 53% higher women who delivered nonmacrosomic LGA neonate (6.27 vs 4.09/1,000 live births; aRR 1.40, 95% CI 1.25-1.56). This increased risk of composite maternal morbidity persisted in analyses stratified by diabetes. The rate of composite neonatal morbidity was 83% higher for nonmacrosomic LGA neonates (11.09 vs 6.07/1,000 live births; aRR 1.47, 95% CI 1.35-1.60) and persisted in analyses stratified by diabetes. At 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity.

Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden

BackgroundDiabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses.MethodsRetrospective population-based records review 2009–2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses.ResultsAmong 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p = 0.0001), pregnancy weight gain lower (11.1 ± 6.7 kg vs 13.1 ± 7.1 kg, p = 0.005), more delivered preterm (p = 0.0001), by CS (p = 0.05), and had more LGA neonates (p = 0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9 kg vs 13.5 kg) (p = 0.006), and rates of CS (p = 0.03), preterm deliveries (p = 0.001) and LGA (p = 0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother’s type of diabetes and gestational week were associated with higher rates of CS.ConclusionWeight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes.

Increased Incidence of Small for Gestational Age Neonates Among Hispanic English Only Speaking Women [20C

INTRODUCTION: The association of limited English proficiency and adverse perinatal outcomes is unclear. This study looked at the relationship between maternal language proficiency and birth weight. METHODS: Data from all Hispanic/Latino women in the database Peribank were included. The GROW-Centile calculator from the Perinatal Institute categorized neonates into 3 groups: small for gestational age (SGA), normal for gestational age, and large for gestational age (LGA). Logistic regression analysis was used to control for confounding factors (type I/II diabetes, gestational diabetes, maternal smoking, hypertension/preeclampsia, BMI, parity, country of birth, total years living in the US). RESULTS: Spanish only speaking patients (n=6248) had a lower incidence of SGA neonates than those with some English proficiency (n=3955) (OR .822; 95% CI .707-.954; P=.012). In contrast, English only speaking patients (n=295) had a higher incidence of SGA neonates than those with some Spanish proficiency (n=9908) (OR 1.452; 95% CI 1.045-2.019, P=.026). Of note, Spanish only speaking patients (n=6248) had a higher incidence of LGA neonates than those with some English proficiency (n=3955) (OR 1.266; 95% CI 1.052-1.523, P=.012). No association was found between English only speaking patients and LGA neonates (P=.937). CONCLUSION: Spanish only speaking patients were associated with larger neonates than those who have some English proficiency. One hypothesis is that higher English proficiency may be an indicator of greater assimilation into American culture, and therefore increased adoption of the American diet. As Hispanic/Latino patients become further assimilated into the American culture and diet, they may be at a higher risk of SGA neonates.

Protocol for the prospective observational clinical study: estimation of fetal weight by MRI to PREdict neonatal MACROsomia (PREMACRO study) and small-for-gestational age neonates

IntroductionMacrosomia refers to growth beyond a specific threshold, regardless of gestational age. These fetuses are also frequently referred to as large for gestational age (LGA). Various cut-offs have been used...

Risk Factor Assessment and the Incidence of Neonatal Hypoglycemia in the Postnatal Period.

Objectives:The aim of this study was to evaluate risk factors used for the assessment of neonatal hypoglycemia and to examine the follow-up outcomes observed in the first 48 hours of postnatal life.Methods:The records of infants born between 2015 and 2017 (3 years) at Şişli Hamidiye Etfal Training and Research Hospital who had a blood glucose level test performed within the first 24 hours after birth and who had follow-up results for 48 hours were included in the study. Data of gestational age; birth weight; gender; antenatal, natal and postnatal characteristics; blood glucose measurement method and time during the first 48 hours postpartum; glucose values and follow-up; nutritional status; and the need for hospitalization due to a low blood glucose value were recorded. Groups were created based on data of a diabetic mother, small for gestational age (SGA), large for gestational age (LGA), late preterm birth (34-36+6/7 gestational weeks), fetal distress, and feeding intolerance. Blood glucose measurement values and reasons for hypoglycemia and assessment were compared in subgroups.Results:The data of 9480 infants were reviewed and included in the study. It was determined that blood levels were checked in 28.7% (n=2720). The mean birth weight and gestational age of the infants was 3143±804 g and 37.7±2.5 weeks, respectively. In the study group, 54.7% were male, and 57.5% were delivered via cesarean section. The most frequent factors prompting blood glucose measurement were LGA status (25.9%), prematurity (18%), transient tachypnea (17.3%), and SGA status (11.6%). Results revealed that the blood glucose values of 2009 (73.9%) infants were within normal limits, and there was no further monitoring of blood glucose level during the first 48 hours. In 711 (26.1%), a low blood glucose level finding led to follow-up assessment. The incidence of hospitalization with a preliminary diagnosis of hypoglycemia was 2.5% (n=67). Subgroup analysis indicated that at the first hour, the mean blood glucose value of the patients with multiple factors that were risks for hypoglycemia suggesting further evaluation was lower than those with transient tachypnea and fetal distress (p<0.001), and the mean blood glucose value of premature and LGA neonates were significantly lower than the infants of diabetic mothers at the sixth hour (p<0.001).Conclusion:In the postnatal period, the rate of monitoring blood glucose levels in newborn babies was found to be 28.7% and the most commonly predicted risk factor was LGA babies. The frequency of postpartum hospitalization due to hypoglycemia was found to be 2.5%, and blood sugar levels were lower in the first hour in groups with multiple causes.

Nerve Growth Factor Levels in Term Human Infants: Relationship to Prenatal Growth and Early Postnatal Feeding.

Background Nerve growth factor (NGF) plays a key role in neuroprotection and developmental maturity. We assessed longitudinally the circulating concentrations of NGF in term healthy human newborns and infants as well as their association with prenatal growth and early postnatal feeding patterns. Methods Circulating NGF and anthropometric measures (weight, length, body mass index, and ponderal index) were assessed longitudinally—at birth and at age 4 months—in 86 term infants born appropriate (AGA), small (SGA), or large for gestational age (LGA). Results Cord blood NGF levels in SGA newborns were higher than those in AGA newborns (1.41 ± 0.2 pg/mL vs. 0.66 ± 0.1 pg/mL; p = 0.02) and not different from those in LGA neonates (0.79 ± 0.2 pg/mL). At age 4 months, SGA-breastfed infants showed the highest NGF concentrations (p = 0.02 and p = 0.01 vs. AGA and SGA-formula-fed infants, respectively), while LGA infants depicted a marginal increase. NGF levels in cord blood correlated negatively with the ponderal index at birth (r = −0.36; p = 0.0008). Conclusions Circulating NGF is related to both prenatal growth and early postnatal nutrition. The maintenance of increased NGF concentrations in SGA-breastfed infants at age 4 months might be a potential mechanism to counterbalance potential risks for developing cognitive and psychomotor disadvantages.

Large-for-Gestational-Age Neonates in Type 1 Diabetes and Pregnancy: Contribution of Factors Beyond Hyperglycemia.

Despite significant reductions in serious adverse perinatal outcomes for women with type 1 diabetes in pregnancy, the opposite effect has been observed for fetal overgrowth and associated complications, such as neonatal hypoglycemia, shoulder dystocia, and admission to the neonatal intensive care unit. In addition, infants born large for gestational age (LGA) have an increased lifetime risk of obesity, diabetes, and chronic disease. Although exposure to hyperglycemia plays an important role, women who seemingly achieve adequate glycemic control in pregnancy continue to experience a greater risk of excess fetal growth, leading to LGA neonates and macrosomia. We review potential contributors to excess fetal growth in pregnancies complicated by type 1 diabetes. In addition to hyperglycemia, we explore the role of glycemic variability, prepregnancy overweight and obesity, gestational weight gain, and maternal lipid levels. Greater understanding of the stimuli that drive excess fetal growth could lead to targeted management strategies in pregnant women with type 1 diabetes, potentially reducing the incidence of LGA neonates and the inherent risk of acute and long-term complications.

The association between birth weight at term and long-term endocrine morbidity of the offspring

Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity.Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders.Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n = 11,062), 91% were AGA (n = 214,249), and 4.3% were LGA neonates (n = 10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR = 1.4; 95%CI = 1.1–1.8; p = .015 and aOR = 1.4; 95%CI = 1.1–1.8; p = .005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR = 1.7; 95%CI = 1.2–2.5; p = .001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR = 3.2; 95%CI = 1.8–5.8; p = .001).Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.

Clinical significance of low result of 1-h 50-g glucose-challenge test in pregnant women

Objective: The objective of this study is to examine the effect of low-glucose value on the 1-h 50-g glucose challenge test (GCT) on neonatal body weight in low-risk Asian singleton pregnant women. Method: We retrospectively analyzed women who delivered a singleton neonate at term at a tertiary center and underwent GCT at 24–28 weeks of gestation between June 2001 and June 2015. The low GCT group was defined as <75 mg/dL and 75–139 mg/dL were control. We compared these two groups of maternal characteristics, small for gestational age neonate (SGA), large for gestational age neonate (LGA), low-birth weight, and macrosomia. The χ 2 test, Fisher’s exact test, and Student’s t test were used. Results: There were 313 low GCT groups and 4611 control. The low GCT group were younger, had lower prepregnancy body weight, higher stature, and lower prepregnancy body mass index (BMI). After adjusting these variables, the low GCT group had a lower rate of LGA and a higher rate of SGA. Neonatal body weight is more influenced by maternal physique than by low GCT result (standardized coefficient (β); GCT 0.071, height 0.188, prepregnancy BMI 0.143). Conclusions: Neonatal body weight was only slightly influenced by low GCT result, but markedly influenced by maternal physique, such as height and prepregnancy BMI.