Light-for-date Research Articles

Preterm birth is strongly affected by the glucocorticoid dose during pregnancy in women complicated by systemic lupus erythematosus

BackgroundThis study aimed to investigate the effect of glucocorticoid doses on adverse pregnancy outcomes (APOs) in women complicated by systemic lupus erythematosus (SLE).MethodsWe investigated 74 pregnancies complicated by SLE or SLE-dominant mixed connective tissue disease. The pregnancies were managed from conception to delivery in our institution. We retrospectively evaluated whether the mean glucocorticoid dose during pregnancy is associated with APOs, including preterm birth (PB), low birth weight (LBW), and light-for-date (LFD). We also calculated the cut-off dose of glucocorticoid that affected APOs.ResultsAll APOs occurred in 35 (50.7%) patients, with 14 cases of PB, 23 cases of LBW, and 10 cases of LFD. Patients with all APOs or PB had a higher dose of glucocorticoid during pregnancy than patients without all APOs or with full-term birth (P = 0.03, P < 0.01, respectively). Logistic regression analysis for all APOs and PB showed that the cut-off values of the mean glucocorticoid dose were 6.5 and 10.0 mg/day, respectively. Patients who delivered LBW or LFD newborns showed no significant difference in the glucocorticoid dose used during pregnancy than patients without LBW or LFD newborns. Patients who delivered LBW newborns were more likely to have used glucocorticoids during pregnancy (P < 0.01).ConclusionsIn pregnancies complicated by SLE, a relatively lower dose of glucocorticoid than previously reported is significantly related to APOs, especially PB. Therefore, the disease activity of patients with SLE should be managed with the appropriate lower dose of glucocorticoid during pregnancy.

Investigation of optimal weight gain during pregnancy for Japanese Women

This study aims to compare the US Institute of Medicine (IOM) and Japanese guidelines proposed by the Ministry and the Japan Society for the Study of Obesity on gestational weight gain (GWG), and to explore the optimal GWG range in Japanese women. We investigated 8,152 Japanese women who had full-term singleton babies between 2010 and 2013 at a single center in Tokyo. Logistic regression models showed that GWG below the recommendation of the IOM and Japanese guidelines was similarly associated with an increased risk of light-for-date (LFD), whereas GWG above these guidelines was similarly associated with an increased risk of heavy-for-date (HFD) in pre-pregnancy body mass index categories of underweight (<18.5 kg/m2, n = 1559), normal-weight (18.5–24.9 kg/m2, n = 4998), overweight (25.0–29.9 kg/m2, n = 270), and obese (30 ≤ kg/m2, n = 60). The receiver-operating characteristic curve demonstrated that the optimal cutoffs for LFD and HFD were 9.7 and 10.4 kg, respectively in normal-weight mothers. The IOM and Japanese guidelines identified the risk of LFD or HFD equally well. The optimal GWG range in normal-weight women observed in this study was more close to Japanese guideline (i.e., 7–12 kg) compared to the IOM guideline (i.e., 11.5–16 kg).

AB0535 Safer Management of Pregnancy and Delivery Complicated with Connective Tissue Disease with Corticosteroid

BackgroundPregnancy and delivery are important life events for women. Recently, many connective tissue disease (CTD) patients have desired to become pregnant because of improved prognosis by early diagnosis and long-term...

AB0669 The risk factor of perinatal complication in the connective tissue disease patients

BackgroundPregnancies and deliveries are the most important life events for women. Many of connective tissue disease (CTD) patients occur in childbearing age. Once, CTD patients tended to give up pregnancy...

Birthweight placental weight ratio of appropriate‐for‐dates and light‐for‐dates infants in preterm delivery

Although birthweight placental weight ratio (BPR) may be a promising indicator which reflects pathophysiology of fetal growth restriction (FGR), the standard of BPR changes throughout gestation in a Japanese population has not been established as far as we know. Therefore, we first examined BPR of appropriate-for-dates (AFD) infants in each gestational week in preterm deliveries. We then compared it with that in a group of light-for-dates (LFD) infants born from mothers with and without pregnancy-induced hypertension (PIH). Placentas of a singleton pregnancy with 373 AFD and 110 LFD infants delivered from 22 to 36weeks of gestation in our hospital during the period between September 2000 and December 2008 were included. We examined the placental weight and BPR of each gestational week in AFD and LFD groups. And the mean BPR and placental weight in the three groups (AFD: LFD with PIH: LFD without PIH) were compared according to gestational periods. The placental weight and BPR were significantly correlated to the gestational week both in AFD and LFD groups. We found that although the mean BPR in LFD-PIH(-) group was significantly lower than those both in AFD group and in LFD-PIH(+) group in 22-29weeks, the mean BPR in 30-36weeks was not statistically different among these three groups. Our result in the AFD group may be useful as one of the standards of BPR changes throughout gestation in a Japanese population for future studies. We believe that BPR may be a clinically useful indicator which reflects pathophysiology of FGR.

DOHaD and Allergic Diseases in Schoolchildren: Does IUGR Affect Risk of Allergic Diseases?

RATIONALE: Developmental Origins of Health and Disease (DOHaD) is the hypothesis that states that the change in fetal programming in response to preterm birth or intrauterine growth restriction (IUGR) is associated with metabolic diseases later in life. It is not clear whether it is also associated with allergic diseases. Our aim was to determine whether the prevalence of allergic diseases in schoolchildren was affected by DOHaD-related prenatal factors, such as being born late preterm (34-36 weeks) or light for dates (LFD). METHODS: A questionnaire-based survey on the prevalence of allergic diseases, such as bronchial asthma (BA), atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis (AC), and food allergy (FA), as well as birth weight and gestational age, was administered to more than 13,000 schoolchildren. Multivariate analysis was performed to test the differences in the prevalence of allergic diseases between those with or without DOHaD-related factors. RESULTS: The prevalence of any allergic disease did not differ significantly between those born late preterm and term. On the other hand, the prevalence of those with any allergic diseases was significantly lower among LFD children than among non-LFD children (p=0.03). Specifically, the prevalence of FA was significantly lower in LFD children than in non-LFD children (1.9% vs. 3.9%, p=0.004). Although not statistically significant, the prevalence of other allergic diseases was also lower in LFD children. CONCLUSIONS: The present data suggest that the change in fetal programming due to IUGR might suppress allergic diseases, especially food allergy, in schoolchildren. Possible mechanisms are discussed.

Association of Women's Birth Weight with Their Blood Pressure during Pregnancy and with the Body Size of Their Babies

The women's own intrauterine environment may influence their own pregnancy and their babies. The aim of our study was to investigate how a woman's birth weight affects the course of her pregnancy later in life as well as the body size of her babies; this study was based on the developmental origins of health and disease (DOHaD) concept. We collected Maternal and Child Health handbooks from 414 women and their biological mothers. They were classified into 3 categories based on the Fetal growth curve of Japan: light-for-date (LFD), which means birth weight is less than the -1.5SD; appropriate-for-date (AFD), which means it lies between the -1.5SD and +1.5SD; and heavy-for-date (HFD), which means it is in the +1.5SD, or higher. In the first trimester, systolic blood pressures (SBPs) were 117.6 (14.4 mmHg), 111.6 (12.4 mmHg), and 105.0 (11.6 mmHg), and diastolic blood pressures (DBP) were 71.0 (8.5 mmHg), 65.7 (9.4 mmHg), and 62.1 (8.7 mmHg) in women born LFD, AFD, and HFD, respectively (SBP: p for trend = 0.018, DBP: p for trend = 0.027). In the second and third trimesters, both SBP and DBP were higher for women born LFD than for those of the other 2 groups. Birth weights of the babies of women born LFD, AFD, and HFD were 2,791.1 (483.0 g), 3,043.4 (361.0 g), and 3,248.0 (431.5 g), respectively (p for trend < 0.01). Our findings support the DOHaD concept and suggest that intrauterine environment in fetal life may be passed down from generation to generation.

Ultrasound diagnosis and management of intra-uterine growth restriction

Intrauterine growth restriction (IUGR) is one of the clinically important conditions to pay full attention to the fetus in womb. However, the process in diagnosing IUGR in daily clinical medicine has not been clarified. In research fields, most studies have been carried out from a retrospective point of view. In other words, the clinical data analysis was done by using the cases delivered as light for date (LFD). As long as the IUGR is not equal to LFD, the prospective point of view for diagnosing IUGR is required in clinical medicine. In this paper, we discussed how to predict and diagnose presumable growth retardation. Usually, ultrasound measurement and fetal weight estimation are used for diagnosis. We introduce one of the promising ways of standardizing fetal growth expressed by the “deviation” from the mean value. Growth velocity was also standardized by means of calculating the index of the deviation trend divided by gestational weeks.

Ultrasound diagnosis and management of intra-uterine growth restriction

AbstractIntrauterine growth restriction (IUGR) is one of the clinically important conditions to pay full attention to the fetus in womb. However, the process in diagnosing IUGR in daily clinical medicine has not been clarified. In research fields, most studies have been carried out from a retrospective point of view. In other words, the clinical data analysis was done by using the cases delivered as light for date (LFD). As long as the IUGR is not equal to LFD, the prospective point of view for diagnosing IUGR is required in clinical medicine. In this paper, we discussed how to predict and diagnose presumable growth retardation. Usually, ultrasound measurement and fetal weight estimation are used for diagnosis. We introduce one of the promising ways of standardizing fetal growth expressed by the “deviation” from the mean value. Growth velocity was also standardized by means of calculating the index of the deviation trend divided by gestational weeks.

Recent decelerated decline in perinatal mortality rate of unlike-sexed twins in Japan.

The effect of assisted reproductive technology is more pronounced in unlike-sexed twins than in like-sexed. Trends in perinatal mortality of twins were compared between the two types of sex combination. Certificates for births (478,276 cases), stillbirths (50,542 cases), and early neonatal deaths (8747 cases) were the subjects of this analysis. Since 1984, the decline in the perinatal mortality of unlike-sexed twins has been slower than that of like-sexed twins. In both light-for-dates (LFD) and non-LFD, the decline in the gestational age standardised mortality ratio has been slower in unlike-sexed twins. We suggest this is due to the introduction of assisted reproductive technologies.

Historical Perspectives

This month’s contribution by Dr. Battaglia draws attention to the importance of both birthweight and gestational age in determining neonatal morbidity and mortality. It is hard to imagine the language of neonatology without the terms SGA, AGA, and LGA (small, appropriate, and large for gestational age), but prior to 1967 it was unusual to combine birthweight with gestational age. As Dr. Battaglia points out, small babies were considered to have been born prematurely. It is also interesting to note the mortality statistics in that era. The figures in the original article from Colorado subsequently were revised in a chart that detailed birthweight/gestational age categories by 250 g/1 week groups. (1) 1. ↵ Lubchenco LO, Searle DJ, Brazie JF. Neonatal mortality rate: relationship to birth weight and gestational age. J Pediatr. 1972;81:814–822 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] # Classification by Birthweight and Gestational Age {#article-title-2} Small for gestational age (SGA), a term that has become widely used and occasionally misused, originated in the 1960s. At that time, neonatal intensive care units (ICUs) were called “premature nurseries” because it was assumed that all babies admitted to those units were preterm infants. Consideration of the small baby born at term or even postterm had led to the use of the term “placental insufficiency syndrome,” but scant attention had been paid to the heterogeneous population that was cared for in “premature nurseries” at that time. Some years earlier, my colleagues and I at Johns Hopkins, Dr Hellegers and Dr Frazier, had published an article examining the outcome of teenage pregnancies. (1) That study alerted us to the fact that clinical problems could be missed with specific study restrictions. For example, if teenage pregnancies included 16- to 19-year-old women, the perinatal mortality rate was not increased compared with women ages 20 to 29 years. Pregnancies in the 16- to 19-year-old group were far more frequent than in girls younger than 15 years of age and masked the high perinatal mortality rate of the latter group. This prompted us … [1]: {openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2Bpediatrics%26rft.stitle%253DJ%2BPediatr%26rft.aulast%253DLubchenco%26rft.auinit1%253DL.%2BO.%26rft.volume%253D81%26rft.issue%253D4%26rft.spage%253D814%26rft.epage%253D822%26rft.atitle%253DNeonatal%2Bmortality%2Brate%253A%2Brelationship%2Bto%2Bbirth%2Bweight%2Band%2Bgestational%2Bage.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0022-3476%252872%252980114-8%26rft_id%253Dinfo%253Apmid%252F5074362%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0022-3476(72)80114-8&link_type=DOI [3]: /lookup/external-ref?access_num=5074362&link_type=MED&atom=%2Fneoreviews%2F4%2F4%2Fe91.atom [4]: /lookup/external-ref?access_num=A1972N589700027&link_type=ISI

Prothrombin levels in newborn infants by the carinactivase-1 method.

A recently developed method to quantitate prothrombin in plasma uses the carinactivase-1 (CA-1) method. The present study was designed to establish the reference value by the CA-1 method in the neonatal period and to explore the effect of gestational age, birth weight, concurrent diseases, and vitamin K administration on the prothrombin levels. We enrolled 78 consecutive neonates. The gestational ages ranged from 28 to 41 weeks, and the birth weight ranged from 850 to 3750 g. Twenty-nine infants had concurrent diseases, and the others (n = 49) were healthy. A 300 microL blood sample was drawn into a plastic syringe containing 60 U freeze-dried buffered heparin. Prothrombin levels did not differ between appropriate-for-date (AFD) and light-for-date (LFD) babies (p = 0.090) or between groups with and without concurrent diseases (p = 0.210). In healthy AFD babies, prothrombin levels correlated with gestational age (r = 0.465, p = 0.003) and birth weight (r = 0.458, p = 0.003). In healthy low-birth-weight infants (n = 14) and those with concurrent diseases (n = 17), the changes after vitamin K administration were not significant. The CA-1 method is of clinical use in monitoring coagulation during the early neonatal period.

Neonatal 24-hour urinary C-peptide and birth weight in infants of diabetic mothers.

Our purpose was to investigate the relationship between the birth weights and 24-h urinary C-peptide in infants of diabetic mothers. Sixty pregnancies with gestational diabetes mellitus (DM) were enrolled. Neonatal urine was collected for the first and second 24 h for measuring C-peptide. Birth weights were classified into 3 categories according to the Japanese standard curves; heavy-for-date (HFD), appropriate-for-date (AFD), and light-for-date (LFD). Unpaired t-test was used for comparison of 24-h urinary C-peptide in the 3 birth weight categories, with P-value <0.05. There were 7 HFD, 47 AFD, and 6 LFD infants. Birth weight averaged 3.9+/-0.7, 3.0+/-0.4, and 2.3+/-0.3 kg, respectively. Insulin concentrations of the umbilical artery were significantly higher in HFD than in AFD, and significantly higher in AFD than in LFD (49.5+/-45.1, 16.8+/-15.2, and 6.3+/-6.1 microU/ml). During the first 24 h, urinary C-peptide was significantly higher in HFD than in AFD (2.73+/-1.52 vs. 0.76+/-0.81 microg/day), and significantly higher in AFD than in LFD (0.27+/-0.27). On the second day, there was no longer statistical significance. Measurement of 24-h urinary C-peptide revealed that, among infants of diabetic mothers, HFD infants continue to secrete more insulin than AFD and LFD infants for the first 24 h.

The possibility of clinical application of the thromboxane A2 synthase inhibitor, ozagrel, for the treatment and prevention of preeclampsia: a preliminary report.

This study was performed to investigate whether the TXA2 synthase inhibitor, ozagrel, was effective in the treatment and prevention of pre-eclampsia. Ozagrel was administrated therapeutically to 4 severely pre-eclamptic women, and prophylactically to 5 pregnant women with histories of severe preeclampsia and complications. The therapeutic administration (TA) of ozagrel improved hypertension and proteinuria. Two patients delivered appropriate-for-date (AFD) infants, whereas the other 2 patients delivered light-for-date (LFD) infants. Mean plasma concentrations of TXB2 (plasma TXB2) decreased, whereas plasma 6-keto PGF1 alpha were almost unchanged. The prophylactic administration (PA) of ozagrel prevented the occurrence of preeclampsia in 3 of the 5 patients. All delivered AFD infants. The duration of pregnancy was prolonged more than that of previous pregnancies in all patients. Plasma TXB2 decreased, whereas plasma 6-keto PGF1 alpha increased. PA prevented preeclampsia and intrauterine growth retardation, whereas TA improved only maternal symptoms. These results might justify a large prospective study to determine whether ozagrel is an effective prophylactic.

Morphometric evaluation of neonatal brainstem development by means of the ultrasonographic method

Development of the midbrain in 260 newborn infants was studied by means of the ultrasonographic method. The 260 infants were divided into four groups; 211 appropriate-for-date (AFD) infants without intracranial abnormalities or chromosomal disorders, 41 light-for-date (LFD) infants without intracranial abnormalities or chromosomal disorders, 5 cases of Down syndrome and 3 cases of trisomy 18. The midbrain area (MBA) was measured in transverse sections using a Sonos 1000 (YHP) within 24 h of birth. MBA of the 211 AFD infants was correlated with gestational age (GA), the standard curve being −0.0029(GA) 2 + 0.2611(GA) − 3.335 ( r = 0.87, P < 0.0001). MBA of the other three groups were compared with this standard curve. Thirty-seven of the 41 LFD cases and all the Down syndrome infants showed MBA within 1.5 S.D. of the standard curve. However, all the infants with trisomy 18 had smaller MBA than −1.5 S.D. of the standard curve. The standard curve should be useful for assessing the gestational age of newborn infants and for detecting abnormal development of the brainstem in developmental disorders.

A NEW METHOD FOR EVALUATION OF FETAL GROWTH FROM SIZE AT BIRTH

A new method for evaluation of weight(BW) in relation to length (BL) (leanness/fatness) in the newborn infant is presented using standard deviation score for BW (BWSDS) and for BL (BLSDS) normalized for sex, gestational age (GA) in a linear regression model, based on all Swedish “healthy” singletons 1986 (n=79,976). Result: A continuous variable called LEANSDS was found with intercepts, regr. coeff. =0 .715, SD=0.699 and r=0.72 irrespective of sex and GA (34-43 weeks). It was tested on the 1985 years cohort with good fit. A chart is constructed which simplify visual evaluation. Using -2SD as cut off lines about 1/3 of the infants light for date (LFD) are also lean but 2/3 of the lean infants are not LFD. In stillborn infants the proportion of lean not LFD infants is increased 13 times, in early neonatal deaths 2.6 times. Other methods based on GA dependent regression of BW on BL or ponderal indices are more complex. Conclusion: A continous LEANSDS variable which can be added for further processing unlike percentiles will together with BWSDS and BLSDS improve evaluation of for example intrauterine growth retardation from size at birth in proportionally small (extreme stunting) and in lean (extreme wastage).

Intralobular variations in villous membrane thickness

In 38 twin pregnancies human placental lactogen (HPL) and oxytocinase were measured in serum and estriol in urine. Eleven women carried light-for-dates (LFD) twins (birth weight less than P5), and 27 had appropriate-for-dates twins (birth weight greater than p5). We investigated if intrauterine growth retardation in these patients could be detected either by the biochemical measurements or by clinical examination. The values of oxytocinase and estriol were not related to fetal weight. A serum level of HPL of 12 mg/l after 34 wk of gestation proved to be helpful in the detection of LFD twins. The predictive value of a positive test was 64% (711) and of a negative test 84% (2125). Eight LFD twins were suspected clinically. If clinical examination and HPL measurements were used in conjunction all LFD twins could have been suspected before birth.

The use of human placental lactogen, oxytocinase and estriol in twin pregnancies with intrauterine growth retardation

In 38 twin pregnancies human placental lactogen (HPL) and oxytocinase were measured in serum and estriol in urine. Eleven women carried light-for-dates (LFD) twins (birth weight less than P 5), and 27 had appropriate-for-dates twins (birth weight greater than p 5). We investigated if intrauterine growth retardation in these patients could be detected either by the biochemical measurements or by clinical examination. The values of oxytocinase and estriol were not related to fetal weight. A serum level of HPL of 12 mg/l after 34 wk of gestation proved to be helpful in the detection of LFD twins. The predictive value of a positive test was 64% ( 7 11 ) and of a negative test 84% ( 21 25 ). Eight LFD twins were suspected clinically. If clinical examination and HPL measurements were used in conjunction all LFD twins could have been suspected before birth.

Nutritional status of light-for-date infants at birth and its influence on early postnatal growth.

The ponderal index (PI) (g/cm3 X 100) was used to define the state of nutrition at birth of 47 light-for-date (LFD) term infants and to determine how intrauterine undernutrition influences growth during the first 6 months of postnatal life, at four age intervals: birth--4, 5--8, 9--12, 13--26 weeks. With the exception of one baby, each PI was less than 50th centile on the Miller and Hassanein standards: in 24 (51%) babies the PI was less than 3rd centile. This suggests that, generally, LFD infants are underweight for length, and by inference, are likely to have experienced intrauterine undernutrition. In the first month the 24 'wasted' infants (PI less than 3rd centile) gained more rapidly in weight, and grew more quickly in head circumference and length than the 16 'nonwasted' infants (PI greater than 10th centile). Thereafter growth rates were similar. With the exception of weight in the 'nonwasted' infants during the first month, rates of growth (weight, length, and head circumference) in both groups of babies in each of the 3 months after birth were greater than in normal infants. The first 3 months after birth can therefore be defined as the period of 'catch-up' growth in LFD term infants.

Changes in body proportions over the first year of life: comparisons between ‘light-for-dates’ and ‘appropriate-for-dates’ term infants

The ponderal index (PI) has been used to compare changes in body proportions over the first year of life in light-for-dates (LFD) and appropriate-for-dates (AFD) term infants. At birth the mean PI of the LFD infants was significantly lower than that of the AFD infants, but at 1 year there was no significant difference between the two groups. These findings indicate that LFD infants increase their weight relatively more than their length over the first year of postnatal life, to become similarly proportioned to AFD infants.