Large For Gestational Age Newborns Research Articles

MTHFR 677 C > T Gene Polymorphism is Associated with Large for Gestational Age Infants

Background The aim of this study was to investigate the methylenetetrahydrofolate reductase (MTHFR) 677 C > T gene polymorphism in term infants born small (SGA), appropriate (AGA), and large for gestational age (LGA). Methods The study comprised 165 newborns with SGA, LGA and AGA. Genomic DNA was isolated from the peripheral blood. Samples were genotyped for MTHFR 677 C > T gene polymorphisms using PCR-RFLP. Results There was a statistically significant difference between the genotype and their allelic distribution of AGA, SGA, and LGA. The newborns carrying the TT genotype had higher birth weight than those carrying the CC and CT genotypes. The frequency of MTHFR 677 TT genotype and T allele was significantly higher and was found to be linked with a higher risk in LGA than in the AGA group. Conclusions The MTHFR 677 C > T gene polymorphism can be used as a genetic marker in Turkish LGA newborns, but not in SGA.

Maternal Dietary Cholesterol and Egg Intake during Pregnancy and Large-for-Gestational-Age Infants: A Prospective Cohort Study

BackgroundCholesterol plays a vital role in fetal growth and development during pregnancy. There remains controversy over whether pregnant females should limit their cholesterol intake. ObjectivesThe objective of this study was to investigate the association between maternal dietary cholesterol intake during pregnancy and infant birth weight in a Chinese prospective cohort study. MethodsA total of 4146 mother-child pairs were included based on the Jiangsu Birth Cohort study. Maternal dietary information was assessed with a semiquantitative food-frequency questionnaire. Birth weight z-scores and large-for-gestational-age (LGA) infants were converted by the INTERGROWTH-21st neonatal weight-for-gestational-age standard. Poisson regression and generalized estimating equations were employed to examine the relationships between LGA and maternal dietary cholesterol across the entire pregnancy and trimester-specific cholesterol intake, respectively. ResultsThe median intake of maternal total dietary cholesterol during the entire pregnancy was 671.06 mg/d, with eggs being the main source. Maternal total dietary cholesterol and egg-sourced cholesterol were associated with an increase in birth weight z-score, with per standard deviation increase in maternal total and egg-sourced dietary cholesterol being associated with an increase of 0.16 [95% confidence interval (CI): 0.07, 0.25] and 0.06 (95% CI: 0.03, 0.09) in birth weight z-score, respectively. Egg-derived cholesterol intake in the first and third trimesters was positively linked to LGA, with an adjusted relative risk of 1.11 (95% CI: 1.04, 1.18) and 1.09 (95% CI: 1.00, 1.18). Compared with mothers consuming ≤7 eggs/wk in the third trimester, the adjusted relative risk for having an LGA newborn was 1.37 (95% CI: 1.09, 1.72) for consuming 8–10 eggs/wk and 1.45 (95% CI: 1.12, 1.86) for consuming >10 eggs/wk (P-trend = 0.015). ConclusionsMaternal total dietary cholesterol intake, as well as consuming over 7 eggs/wk during pregnancy, displayed significant positive relationships with the incidence of LGA, suggesting that mothers should avoid excessive cholesterol intake during pregnancy to prevent adverse birth outcomes.

ERRγ1 and Aromatase Expression in Human Placental Tissues from Term Deliveries of Large for Gestational Age Newborns

Plain Language SummaryEvents during fetal development are associated with susceptibility to chronic disease in adulthood. Extreme birth weight, for newborns of small for gestational age or large for gestational age (LGA), has been associated with an increased risk of developing metabolic syndrome in adulthood. Even though some intrauterine events during fetal development have been described, there is still a long way for identifying all the factors that are involved in fetal programming. The placenta has an important role in intrauterine programming because it controls the intrauterine environment by supplying oxygen, nutrients, and specific hormones involved in fetal development. Estrogens and androgens in maternal and fetal circulations play an important role in determining a physiological placental phenotype. ERRγ1 expression in placental tissues is involved in aromatase activity regulation and hence in intrauterine estrogen-androgen balance. In this study, we propose that the dysregulation of ERRγ1 in placental tissue might modify the estrogen-androgen balance in the intrauterine environment, representing one of the key factors in the regulation of fetal programming in LGA newborns.

Comparisons of the Rates of Large-for-Gestational-Age Newborns between Women with Diet-Controlled Gestational Diabetes Mellitus and Those with Non-Gestational Diabetes Mellitus.

(1) Objectives: The primary objective is to compare the rate of large-for-gestational-age (LGA) between women with diet-controlled gestational diabetes mellitus (GDM) and those with non-GDM, and to assess whether or not diet-controlled GDM is an independent factor of LGA fetuses. The secondary objectives are to compare the rates of other common adverse pregnancy outcomes, such as preeclampsia, cesarean section rate, preterm birth, and low Apgar score, between pregnancies with diet-controlled GDM and non-GDM pregnancies. (2) Methods: A retrospective cohort study was conducted on singleton pregnancies, diagnosed with GDM and non-GDM between 24 and 28 weeks of gestation, based on a two-step screening test. The prospective database of the obstetric department was accessed to retrieve the records meeting the inclusion criteria, and full medical records were comprehensively reviewed. The patients were categorized into two groups, GDM (study group) and non-GDM (control group). The main outcome was the rate of LGA newborns, and the secondary outcomes included pregnancy-induced hypertension, preterm birth, cesarean rate, low Apgar scores, etc. (3) Results: Of 1364 recruited women, 1342 met the inclusion criteria, including 1177 cases in the non-GDM group and 165 (12.3%) in the GDM group. Maternal age and pre-pregnancy BMI were significantly higher in the GDM group. The rates of LGA newborns, PIH, and cesarean section were significantly higher in the GDM group (15.1% vs. 7.1%, p-value < 0.001; 7.8% vs. 2.6%, p-value = 0.004; and 54.5% vs. 41.5%, p-value = 0.002; respectively). On logistic regression analysis, GDM was not significantly associated with LGA (odds ratio 1.64, 95% CI: 0.97-2.77), while BMI and gender were still significantly associated with LGA. Likewise, GDM was not significantly associated with the rate of PIH (odds ratio: 1.7, 95% CI: 0.825-3.504), while BMI and maternal age were significantly associated with PIH, after controlling confounding factors. (4) Conclusions: The rates of LGA newborns, PIH, and cesarean section are significantly higher in women with diet-controlled GDM than those with non-GDM. Nevertheless, the rates of LGA newborns and PIH are not directly caused by GDM but mainly caused high pre-pregnancy BMI and advanced maternal age, which are more commonly encountered among women with GDM.

Effects of the COVID-19 pandemic on gestational diabetes in Castilla-La Mancha (Spain)

Subject-matterTo assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). Material and methodsIn this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. ResultsDuring the pandemic, the gestational week at diagnosis (24.2 ± 7.4 vs 22.9 ± 7.7, p = 0.0016) and first visit to Endocrinology (26.6 ± 7.2 vs 25.3 ± 7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ± 0.48 vs 5.29 ± 0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. ConclusionsCare for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

Efectos de la pandemia por COVID-19 sobre la diabetes gestacional en Castilla-La Mancha (España)

Subject-matterTo assess the effect of the 2019 coronavirus (COVID-19) pandemic on gestational diabetes (GDM). Material and methodsIn this retrospective, multicentre, non-interventional study carried out in Castilla-La Mancha, Spain, we compared 663 women with GDM exposed to the pandemic (pandemic group), with 622 women with GDM seen one year earlier (pre-pandemic group). The primary endpoint was a Large for Gestational Age (LGA) newborn as an indicator of poor GDM control. Secondary endpoints included obstetric and neonatal complications. ResultsDuring the pandemic, the gestational week at diagnosis (24.2 ± 7.4 vs 22.9 ± 7.7, p = 0.0016) and first visit to Endocrinology (26.6 ± 7.2 vs 25.3 ± 7.6, p = 0.0014) were earlier. Face-to-face consultations were maintained in most cases (80.3%). The new diagnostic criteria for GDM were used in only 3% of cases. However, in the pandemic group, the final HbA1c was higher (5.2 ± 0.48 vs 5.29 ± 0.44%, p = 0.047) and there were more LGA newborns (8.5% vs 12.8%, p = 0.015). There were no differences in perinatal complications. ConclusionsCare for GDM in our Public Health System did not significantly deteriorate during the COVID-19 pandemic. However, this did not prevent a higher number of LGA newborns.

Functional analysis of daily glycemic profiles and excessive fetal growth in pregnant patients with well-controlled type 1 diabetes: Retrospective cohort

AimsThe study objective was to compare daily glycemic profiles throughout gestation between the mothers of large-for-gestational-age (LGA) and non-LGA newborns in patients with type 1 diabetes (T1D). MethodsWe selected 102 eligible pregnant women who were treated with sensor-augmented pumps in our single-center retrospective cohort study. We used functional data analysis to compare glycemic control across gestation. ResultsMedian HbA1c values in the first, second, and third trimester were 6.23 %, 5.49 %, and 5.75 % respectively. Median time‐in‐range (TIR) exceeded 70 % in each trimester (72.4 %, 72.5 %, and 75.9 %, respectively). From 59 % up to 77 % of women met the criteria for well-controlled T1D defined by the mean HbA1c and TIR in each trimester. Despite that, 27 % (28/102) of pregnancies were complicated by LGA. Mothers of LGA infants had significantly increased HbA1c levels and decreased TIR values in the second and third trimesters. The most significant differences in daily mean glucose values between LGA and non-LGA newborns’ mothers occurred between 26 and 32 weeks of pregnancy. These discrepancies were noted in daytime glucose values rather than nocturnal and fasting glucose levels. ConclusionsMothers of LGA newborns present significantly worse glycemic control. Our findings may emphasize the need for more rigorous daytime glycemic control.

Perinatal outcomes in 6640 singleton pregnancies after donor oocyte IVF across three continents over 7years.

Are trends in singleton donor oocyte IVF perinatal outcomes consistent over time among four international ethnically diverse infertility centers? This retrospective cohort consisted of an infertility network of four international IVF centers across three continents. Singleton live births resulting from fresh and frozen donor oocyte embryo transfers from January 1, 2012 to December 31, 2018 were included. The main outcome measures were birth weight (BW), preterm birth (PTB), large for gestational age (LGA), small for gestational age (SGA) and gestational age (GA) at delivery. The entire cohort (n = 6640) consisted of 4753 fresh and 1887 frozen donor oocyte embryo transfers. Maternal age, parity, body mass index, neonatal sex and GA at delivery were similar for fresh and frozen donor oocyte embryo transfers in the entire cohort and within each infertility center. All four centers had a trend of decreased BW and rates of PTB before 32weeks annually, although significance was not reached. Three of the four centers had annual increased trends of PTB before 37weeks and LGA newborns, although significance was not reached. BWs for the entire cohort for fresh and frozen donor embryo transfers were 3166g ± 601g and 3137g ± 626g, respectively. Similar trends in perinatal outcomes were present across four international infertility centers over 7years. The overall perinatal trends in donor oocyte IVF may be applicable to centers worldwide, but further studies in more geographic regions are needed.

Perinatal outcomes in 13,626 singleton pregnancies after autologous IVF across three continents over 7 years.

Are trends in singleton autologous IVF perinatal outcomes consistent over time among five international infertility centers? This was a retrospective cohort study from January 1, 2012, to December 31, 2018. This study was performed through a large infertility network at five international infertility centers in which patients who had a singleton live birth resulting from fresh and frozen autologous IVF cycles were included. The primary outcome was live birth weight (BW) with secondary outcomes of preterm birth (PTB), large for gestational age (LGA), small for gestational age (SGA), and gestational age at delivery. The entire cohort (n = 13,626) consisted of 6941 fresh and 6685 frozen autologous IVF cycles leading to singleton deliveries. Maternal age, parity, body mass index, neonatal sex, and GA at delivery were similar for fresh and frozen IVF cycles in the entire cohort and within each infertility center. Four centers had a trend of decreased BW and three centers had decreased rates of PTB before 32 and 28 weeks and LGA newborns annually, although significance was not reached. Three IVF centers had annual increased trends of PTB before 37 weeks and four centers had increased rates of SGA newborns, although significance was not reached. Similar trends in perinatal outcomes were present across five international infertility centers over 7 years. Additional studies are crucial to further assess and optimize perinatal outcomes at an international level.

The Effect of Maternal Dietary Patterns on Birth Weight for Gestational Age: Findings from the MAMI-MED Cohort.

Limited evidence exists on the effects of maternal dietary patterns on birth weight, and most studies conducted so far did not adjust their findings for gestational age and sex, leading to potentially biased conclusions. In the present study, we applied a novel method, namely the clustering on principal components, to derive dietary patterns among 667 pregnant women from Catania (Italy) and to evaluate the associations with birth weight for gestational age. We identified two clusters reflecting distinct dietary patterns: the first one was mainly characterized by plant-based foods (e.g., potatoes, cooked and raw vegetables, legumes, soup, fruits, nuts, rice, wholemeal bread), fish and white meat, eggs, butter and margarine, coffee and tea; the second one consisted mainly of junk foods (sweets, dips, salty snacks, and fries), pasta, white bread, milk, vegetable and olive oils. Regarding small gestational age births, the main predictors were employment status and primiparity, but not the adherence to dietary patterns. By contrast, women belonging to cluster 2 had higher odds of large for gestational age (LGA) births than those belonging to cluster 1 (OR = 2.213; 95%CI = 1.047-4.679; p = 0.038). Moreover, the odds of LGA increased by nearly 11% for each one-unit increase in pregestational BMI (OR = 1.107; 95%CI = 1.053-1.163; p < 0.001). To our knowledge, the present study is the first to highlight a relationship between adherence to an unhealthy dietary pattern and the likelihood of giving birth to a LGA newborn. This evidence adds to the current knowledge about the effects of diet on birth weight, which, however, remains limited and controversial.

Changes in Large for Gestation and Small for Gestation Births During the COVID-19 Era

Background The COVID-19 pandemic has impacted pregnancy and the fetus. We observed a significant change in the incidence of both large for gestational age (LGA) and small for gestational age (SGA) infants since the beginning of the COVID-19 pandemic. Methods Through chart review, COVID-19 pandemic group (C) was defined as infants born between March 1, 2020, and November 15, 2021. The pre-pandemic period (PC) was from January 1, 2016, to February 29, 2020. Infant birth, treatment, and health outcomes and maternal behaviors and health outcomes were extracted from the charts for review. Results In the PC era, 495/6611 (7.5%) infants were born LGA, and during the C era, 411/3815 (10.8%) infants were born LGA (p &lt; 0.05). In the PC era, 520/6611 (7.9%) infants were born SGA and during the C era, 128/3815 (3.4%) infants were born SGA (p &lt; 0.01). Conclusion We have seen a significant increase in LGA newborns during the C period. Our data also shows a decrease in the proportion of SGA newborns despite an increase in maternal smoking and hypertension. Continued monitoring of issues of pregnancy and fetal well-being during this ongoing pandemic period are warranted.

Speech-Encoding Deficits in Neonates Born Large-for-Gestational Age as Revealed With the Envelope Frequency-Following Response.

The present envelope frequency-following response (FFR ENV ) study aimed at characterizing the neural encoding of the fundamental frequency of speech sounds in neonates born at the higher end of the birth weight continuum (>90th percentile), known as large-for-gestational age (LGA). Twenty-five LGA newborns were recruited from the maternity unit of Sant Joan de Déu Barcelona Children's Hospital and paired by age and sex with 25 babies born adequate-for-gestational age (AGA), all from healthy mothers and normal pregnancies. FFR ENV s were elicited to the/da/ syllable and recorded while the baby was sleeping in its cradle after a successful universal hearing screening. Neural encoding of the stimulus' envelope of the fundamental frequency (F 0ENV ) was characterized through the FFR ENV spectral amplitude. Relationships between electrophysiological parameters and maternal/neonatal variables that may condition neonatal neurodevelopment were assessed, including pregestational body mass index (BMI), maternal gestational weight gain and neonatal BMI. LGA newborns showed smaller spectral amplitudes at the F 0ENV compared to the AGA group. Significant negative correlations were found between neonatal BMI and the spectral amplitude at the F 0ENV . Our results indicate that in spite of having a healthy pregnancy, LGA neonates' central auditory system is impaired in encoding a fundamental aspect of the speech sounds, namely their fundamental frequency. The negative correlation between the neonates' BMI and FFR ENV indicates that this impaired encoding is independent of the pregnant woman BMI and weight gain during pregnancy, supporting the role of the neonatal BMI. We suggest that the higher adipose tissue observed in the LGA group may impair, via proinflammatory products, the fine-grained central auditory system microstructure required for the neural encoding of the fundamental frequency of speech sounds.

Does detection of a large for gestational age (LGA) fetus in fetal anomaly scan (FAS) require an early oral glucose screening test (OGTT) and can LGA fetus be detected at birth?

Gestational diabetes mellitus (GDM) complications increase with late diagnosis and late treatment, so early diagnosis and treatment is one of the most important factors in preventing complications. We tried to find an answer to the question of whether the detection of large for gestational age (LGA) fetus in fetal anomaly scan (FAS) requires earlier oral glucose screening test (OGTT) and predicts LGA fetus at birth. Pregnant women who underwent fetal anomaly scan and gestational diabetes screening at the Department of Obstetrics and Gynecology, University of Health Sciences, Tepecik Training and Research Hospital between 2018 and 2020 were included in this large retrospective cohort study. FAS was routinely performed between 18-22 weeks in our hospital. 75 grams of OGTT was used for gestational diabetes screening and it was performed between 24-28 weeks. This large retrospective cohort study was performed on 3,180 fetuses, 2,904 appropriate for gestational age (AGA) and 276 LGA, in the second trimester. The prevalence of GDM was significantly higher in the LGA group (OR 2.44, 95% CI 1.66-3.58; p < 0.001). Insulin requirement for blood glucose regulation was significantly higher in the LGA group (OR 3.6, 95% CI 1.68-7.7; p = 0.001). Fasting and 1st hour OGTT values were similar between the groups, but 2nd hour OGTT values were significantly higher in the second trimester LGA group (p = 0.041). The prevalence of LGA newborns at birth was higher in second trimester LGA fetuses than in fetuses with AGA (21.1% vs. 7.1%, p < 0.001). The fact that the estimated fetal weight (EFW) measured in the second trimester FAS is LGA may be related to GDM in the future and LGA fetus at birth. A more detailed GDM risk questioning should be performed to these mothers and OGTT should be considered when additional risk factors are detected. In addition to all these, glucose regulation may not be possible with diet alone in mothers who have LGA in the second trimester ultrasound and who may have GDM in the future. These mothers should be monitored more closely and more carefully.

Serum adiponectin levels and adiponectin +276 G/T gene polymorphism in newborns with large and small birth weights

Purpose Adiponectin may be an important indicator in the regulation of fetal and neonatal growth due to its metabolism, energy balance, and insulin-sensitizing action. The current study’s goal was to determine if there is a link between adiponectin +276 G/T gene polymorphism and serum adiponectin level in newborns classified as appropriate for gestational age (AGA), small for gestational age (SGA), or large for gestational age (LGA). Methods The study included newborns classified as AGA (n = 65), SGA (n = 65), or LGA (n = 65) according to their gestational age or birth weight. To determine the presence of adiponectin +276 G/T gene polymorphism, genotyping was done using polymerase chain reaction-restriction fragment length polymorphism. Enzyme-linked immunosorbent assay was used to determine the level of adiponectin in the blood. Results The SGA newborns had significantly lower levels of serum adiponectin than the AGA and LGA newborns. There were statistically significant differences between the genotype frequencies (GG, GT, TT) of the SGA newborns (29.9%, 45.1%, 13.9%), the AGA newborns (41.6%, 20.7%, 44.4%), and the LGA newborns (28.6%, 34.1%, 41.7%) (chi-square = 15.8; degree of freedom = 4; p = .003). The newborns carrying the GT genotype had an increased risk of being SGA compared to those carrying the GG and TT genotypes (odds ratio [OR] = 3.07; confidence interval [CI] = 95% (1.38–6.64); p = .005 and OR = 6.96; CI = 95% (2.19–22.1); p < .001, respectively). The newborns carrying the GG and TT genotypes had better protection against being SGA than those carrying the GT genotype (OR = 0.33; CI = 95% (0.15–0.72); p = .005 and OR = 0.14; CI = 95% (0.05–0.46); p < .001, respectively). The newborns carrying the GT genotype had lower birth weights, head circumferences, and ponderal indices than those carrying the TT genotype (p < .001). The serum adiponectin levels between adiponectin +276 G/T genotypes did not differ significantly (p = .429). In addition, serum adiponectin level showed a significant positive correlation with birth weight, birth length, head circumference, and ponderal index in all newborns. Conclusion The results of the current study suggest that the adiponectin +276 G/T gene polymorphism was associated with an increased chance of being born SGA or LGA. The effect of this polymorphism on newborn birth size was independently associated with serum adiponectin levels. Adiponectin may play a role in fetal growth.

Neonatal Outcomes and Long-Term Follow-Up of Children Born from Frozen Embryo, a Narrative Review of Latest Research Findings

In recent years, the growing use of ART (assisted reproductive techniques) has led to a progressive improvement of protocols; embryo freezing is certainly one of the most important innovations. This technique is selectively offered as a tailored approach to reduce the incidence of multiple pregnancies and, most importantly, to lower the risk of developing ovarian hyperstimulation syndrome when used in conjunction with an ovulation-triggering GnRH antagonist. The increase in transfer cycles with frozen embryos made it possible to study the effects of the technique in children thus conceived. Particularly noteworthy is the increase in macrosomal and LGA (large for gestational age) newborns, in addition to a decrease in SGA (small for gestational age) and LBW (low birth weight) newborns. The authors aimed to outline a broad-ranging narrative review by summarizing and elaborating on the most important evidence regarding the neonatal outcome of children born from frozen embryos and provide information on the medium and long-term follow- up of these children. However, given the relatively recent large-scale implementation of such techniques, further studies are needed to provide more conclusive evidence on outcomes and implications.

Association of folate and vitamin B12 imbalance with adverse pregnancy outcomes among 11,549 pregnant women: An observational cohort study.

ObjectiveThis study aimed to evaluate maternal serum levels of folate, vitamin B12, and their ratio on admission for labor and determine whether an imbalance between folate and vitamin B12, represented by a higher or lower serum folate to vitamin B12 ratio (SFVB12R), was associated with adverse pregnancy outcomes.MethodsA retrospective cohort study of 11,549 pregnant women attending a district specialized hospital and who had serum folate (SF) and serum vitamin B12 (SVB12) levels measured at delivery was performed. The levels of SF, SVB12, and SFVB12R were defined as high (>95th percentile), normal (5–95th percentile), and low (<5th percentile). Information on pregnancy outcomes was retrieved from medical records. Linear regression was performed to examine the association of abnormal SF, SVB12, and SFVB12R levels with fetal growth indicators. Logistic regression was applied to estimate the association between abnormal SF, SVB12, and SFVB12R levels and pregnancy outcomes.ResultsLower SF levels were associated with higher risks of intrahepatic cholestasis of pregnancy (ICP, OR 1.58; 95% CI 1.15–2.17), pre-eclampsia (PE, OR 1.89; 95% CI 1.28–2.81), and a lower risk of gestational diabetes mellitus (GDM, OR 0.40; 95% CI 0.23–0.70), whereas higher SVB12 levels were associated with a higher risk of ICP (OR 2.22; 95% CI 1.67–2.96), PE (OR 1.69; 95% CI 1.04-2.74), and GDM (OR 1.62; 95% CI 1.24–2.11). A higher SFVB12R increased birthweight (β 60.99; 95% CI 29.52–92.45) and was associated with a higher risk of large-for-gestational-age (LGA) newborns (OR 3.08; 95% CI 1.63–5.83); a lower SFVB12R decreased birthweight (β −43.81; 95% CI −75.62, −12.00) and was associated with a lower risk of LGA newborns (OR 0.75; 95% CI 0.56–1.00), and with higher risks of ICP (OR 2.03; 95% CI 1.54–2.67) and pregnancy-induced hypertension (PIH, OR 1.81; 95% CI 1.09–3.00).ConclusionAn imbalance between folate and vitamin B12, represented by a higher or lower SFVB12R before delivery, was significantly associated with adverse pregnancy outcomes (ICP/PIH/LGA).

High level of γH2AX phosphorylation in the cord-blood cells of large-for-gestational-age (LGA) newborns

Newborns can experience adverse effects as a consequence of maternal or in utero exposure, altered growth of the fetus, or placental dysfunctions. Accurate characterization of gestational age allows monitoring of fetal growth, identification of deviations from the normal growth trajectory, and classification of babies as adapted, small, or large for gestational age (AGA, SGA, or LGA). The aim of this work was to evaluate nuclear and oxidative damage in umbilical cord-blood cells of newborns (sampled at birth), by applying the γH2AX assay and the fluorescent probe BODIPY581/591 C11, to detect DNA DSB and cell membrane oxidation, respectively. No statistically significant differences were observed in the proportion of oxidized cord-blood cells among the groups of newborns, although the LGA group showed the highest value. With regard to genome damage, elevated levels of γH2AX foci were detected in the cell nuclei from LGA newborns as compared to AGA or SGA babies, whose values did not differ from each other. Considering that the observed DNA damage, although still repairable, can represent a risk factor for obesity, metabolic diseases, or other pathologies, monitoring genome and cell integrity at birth can provide useful information for prevention of diseases later in life.

Association of maternal socio-demographic factors, maternal anthropometric measurements, and foetal sex with LGA newborns in Sri Lanka

Introduction: There is an increased trend of delivering large for gestational age (LGA) newborns globally, which has already caused significant impact on health, nutrition, economics, and social aspects. LGA newborns are more vulnerable for complications developed from intrauterine life to adulthood and it is becoming additional burden to the health care and economic state of the country. However, we lack published data on incidence, trend and factors affecting LGA newborns in Sri Lanka. Determination of risk factors associated with LGA newborns would help to formulate and implement effective preventive measures. Method: A case control study was carried out at obstetrics and gynaecology unit, Teaching Hospital Kandy from 01.01.2016 to 31.12.2016. Systematic sample technique was used, and study sample was consisted of 44 cases and 132 controls. Pretested interviewer administered questionnaire was used for data collection. Significance of associations between dependent and independent variables was estimated using probit regression model. Probit coefficient was estimated to assess the significance and respective marginal effects were estimated to assess the magnitude of significance. STATA software was used for analysis. Ethical clearance was obtained from ethical review committee, Teaching Hospital Kandy. Results: According to probit regression estimates of socio-demographic factors, maternal parity of two (Coefficient 1.89: 95% CI 0.75-3.03: P &lt;0.05) or more (Coefficient 2.37: 95% CI 0.92-3.82: P &lt;0.05), Monthly family income of more than 30,000/= rupees (Coefficient 2.28: 95% CI 0.92-3.63: P&lt;0.05) and Tamil ethnicity (Coefficient 2.10: 95% CI 0.69-3.52: P&lt;0.05) were statistically significant risk factor. In the analysis, maternal age (Coefficient 0.09: 95% CI -0.05-0.23: P&gt;0.05), mother’s occupation (Coefficient 0.08: 95% CI -1.01-1.17: P&gt;0.05) and maternal educational level (Coefficient 1.68: 95% CI -0.30-3.66: P&gt;0.05) were not significant risk factors at 5% significance level. Considering the maternal anthropometric measurements, maternal weight gain during pregnancy (Coefficient 0.77: 95% CI 0.50-1.03: P&lt;0.05) was a significant risk factor. Maternal BMI at booking visit (Coefficient 1.76: 95% CI -0.34-3.85: P&gt;0.05), maternal weight at booking visit (Coefficient -0.63: 95% CI -1.5-0.26: P&gt;0.05) and maternal height (Coefficient 0.56: 95% CI -0.08-1.2: P&gt;0.05) were not significant risk factors in the analysis at 5% significance level. Foetal sex (Coefficient -0.69: 95% CI -1.5-0.13: P&gt;0.05) was not a significant causative factor at 5% significance level. Conclusions: Among maternal socio-demographic factors, high monthly family income, parity of 2 or more and Tamil ethnicity were determined as statistically significant risk factors for LGA newborns. Among maternal anthropometric measurements, increased weight gain during pregnancy was determined as significant modifiable risk factor for LGA newborns. Maternal weight gain during pregnancy should be monitored throughout the antenatal period from the booking visit to identify mothers at risk. Effective interventions should be designed to minimize the negative impact on mothers at risk.

Comparative assessment of the health status of large for gestational age newborns

Our aim was to conduct a comparative assessment of the health status of large for gestational age (LGA) newborns. 348 full-term neonates who were born at the Republican Scientific and Practical Center “Mother and Child” were examined. The main group 1 (Gr1) consisted of 58 LGA newborns from mothers with diabetes mellitus (DM) type 1, the main group 2 (Gr2) consisted of 66 LGA babies from mothers without carbohydrate and lipid metabolism disorders, the main group 3 (Gr3) included 65 LGA babies from mothers with pregravid overweight or obesity, the control group (Gr4) had 159 newborns with the anthropometric parameters corresponding to the gestational age (AGA) from mothers without carbohydrate and lipid metabolism disorders. The negative impact of the mothers’ metabolic disorders on the newborns’ health status, functional state, and neuropsychological development was established. Babies born with macrosomia from mothers with DM were diagnosed with hypoglycemia, congenital pneumonia, hyperbilirubinemia, and neonatal encephalopathy much more often (p &lt; 0.001). LGA babies from obese women were characterized by polycythemia, hyperbilirubinemia, and neonatal encephalopathy. Polycythemia, hyperbilirubinemia, and toxic erythema were often noted in Gr2 patients. The cases of brachial plexus injuries and limb fractures were not registered. A slower rate of neuropsychological development was noted in large neonates in the analyzed groups, and was more pronounced in infants from mothers with diabetes mellitus and obesity. LGA newborns from mothers with DM had a high hospitalization rate at the intensive care unit, followed by the separation of mother and child and a lower breastfeeding rate in the neonatal period. Large newborns from mothers with DM and from women with obesity had a higher probability of adverse neonatal outcomes and a reduced health status in the neonatal period.

Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study.

BackgroundThe implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare.MethodsWe conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA1c) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA1c ≥ 5.7%). Others with HbA1c < 5.7% but without GDM were selected as the control group (HbA1c < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population.ResultsA total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, P < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, P < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, P = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA1c, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692–3.739) risk of delivering LGA newborns compared to the control group.ConclusionThe glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.